HESI PHARMACOLOGY A+
QUESTIONS WITH DETAILED
VERIFIED ANSWERS /A+ GRADE
ASSURED
1. A healthcare provider prescribes cephalexin monohydrate (Keflex) for a patient
with a postoperative infection. It is most important for the nurse to assess for what
additional drug allergy before administering this prescription?
A) Penicillins.
B) Aminoglycosides.
C) Erythromycins.
D) Sulfonamides.
A) Penicillins.
Cross-allergies exist between penicillins (A) and cephalosporins, such as cephalexin
monohydrate (Keflex), so checking for penicillin allergy is a wise precaution before
administering this drug.
2. Which nursing intervention is most important when caring for a patient receiving
the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy?
A) Hydrate the patient with IV fluids before and after infusion.
B) Assess the patient for numbness and tingling of extremities.
C) Inspect the patient's oral mucosa for ulcerations.
D) Monitor the patient's urine pH for increased acidity.
C) Inspect the patient's oral mucosa for ulcerations.
Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore
stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity (C). (A, B, and D)
are not typical interventions associated with the administration of antimetabolites.
,3. When assessing an adolescent who recently overdosed on acetaminophen
(Tylenol), it is most important for the nurse to assess for pain in which area of the
body?
A) Flank.
B) Abdomen.
C) Chest.
D) Head.
B) Abdomen.
Acetaminophen toxicity can result in liver damage; therefore, it is especially important for
the nurse to assess for pain in the right upper quadrant of the abdomen (B), which might
indicate liver damage. (A, C, and D) are not areas where pain would be anticipated.
4. An adult patient is given a prescription for a scopolamine patch (Transderm Scop)
to prevent motion sickness while on a cruise. Which information should the nurse
provide to the patient?
A) Apply the patch at least 4 hours prior to departure.
B) Change the patch every other day while on the cruise.
C) Place the patch on a hairless area at the base of the skull.
D) Drink no more than 2 alcoholic drinks during the cruise.
A) Apply the patch at least 4 hours prior to departure.
Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak
onset in 6 hours, so the patient should be instructed to apply the patch at least 4 hours
before departure (A) on the cruise ship. The duration of the transdermal patch is 72 hours,
so (B) is not needed. Scolopamine blocks muscarinic receptors in the inner ear and to the
vomiting center, so the best application site of the patch is behind the ear, not at the base of
the skull (C). Anticholinergic medications are CNS depressants, so the patient should be
instructed to avoid alcohol (D) while using the patch.
5. The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump
with a patient in the immediate postoperative period. The patient will receive
morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total
5 mg IV maximally per hour. What assessment has the highest priority before
initiating the PCA pump?
A) The expiration date on the morphine syringe in the pump.
,B) The rate and depth of the patient's respirations.
C) The type of anesthesia used during the surgical procedure.
D) The patient's subjective and objective signs of pain.
B) The rate and depth of the patient's respirations.
A life-threatening side effect of intravenous administration of morphine sulfate, an opiate
narcotic, is respiratory depression (B). The PCA pump should be stopped and the
healthcare provider notified if the patient's respiratory rate falls below 12 breaths per
minute, and the nurse should anticipate adjustments in the patient's dosage before the PCA
pump is restarted. (A, C, and D) provide helpful information, but are not as high a priority
as the assessment described in (B).
6. A medication that is classified as a beta-1 agonist is most commonly prescribed
for a patient with which condition?
A) Glaucoma.
B) Hypertension.
C) Heart failure.
D) Asthma.
C) Heart failure.
Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure
and are indicated in heart failure (C), shock, atrioventricular block dysrhythmias, and
cardiac arrest. Glaucoma (A) is managed using adrenergic agents and beta-adrenergic
blocking agents. Beta-1 blocking agents are used in the management of hypertension (B).
Medications that stimulate beta-2 receptors in the bronchi are effective for
bronchoconstriction in respiratory disorders, such as asthma (D).
7. A female patient with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4
times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO
is prescribed. Which information is most important for the nurse to include in
patient teaching?
A) Use contraception during intercourse.
B) Ensure the Cytotec is taken on an empty stomach.
C) Encourage oral fluid intake to prevent constipation.
D) Take Cytotec 30 minutes prior to Motrin.
, A) Use contraception during intercourse.
Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can
act as an abortifacient, so the patient should be instructed to use contraception during
intercourse (A) to prevent loss of an early pregnancy. (B) is not necessary. A common side
effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed
(C). Cytotec and Motrin should be taken together (D) to provide protective properties
against gastrointestinal bleeding.
8. A patient with heart failure is prescribed spironolactone (Aldactone). Which
information is most important for the nurse to provide to the patient about diet
modifications?
A) Do not add salt to foods during preparation.
B) Refrain for eating foods high in potassium.
C) Restrict fluid intake to 1000 ml per day.
D) Increase intake of milk and milk products.
B) Refrain for eating foods high in potassium.
Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a
diet high in potassium should be avoided (B), including potassium salt substitutes, which
can lead to hyperkalemia. Although (A) is a common diet modification in heart failure, the
risk of hyperkalemia is more important with Aldactone. Restriction of fluids (C) or
increasing milk and milk products (D) are not indicated with this prescription.
9. In evaluating the effects of lactulose (Cephulac), which outcome should indicate
that the drug is performing as intended?
A) An increase in urine output.
B) Two or three soft stools per day.
C) Watery, diarrhea stools.
D) Increased serum bilirubin.
B) Two or three soft stools per day.
Lactulose is administered to reduce blood ammonia by excretion of ammonia through the
stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A)
would be expected if the patient received a diuretic. (C) would indicate an overdose of
lactulose and is not expected. Lactulose does not affect (D).
QUESTIONS WITH DETAILED
VERIFIED ANSWERS /A+ GRADE
ASSURED
1. A healthcare provider prescribes cephalexin monohydrate (Keflex) for a patient
with a postoperative infection. It is most important for the nurse to assess for what
additional drug allergy before administering this prescription?
A) Penicillins.
B) Aminoglycosides.
C) Erythromycins.
D) Sulfonamides.
A) Penicillins.
Cross-allergies exist between penicillins (A) and cephalosporins, such as cephalexin
monohydrate (Keflex), so checking for penicillin allergy is a wise precaution before
administering this drug.
2. Which nursing intervention is most important when caring for a patient receiving
the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy?
A) Hydrate the patient with IV fluids before and after infusion.
B) Assess the patient for numbness and tingling of extremities.
C) Inspect the patient's oral mucosa for ulcerations.
D) Monitor the patient's urine pH for increased acidity.
C) Inspect the patient's oral mucosa for ulcerations.
Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore
stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity (C). (A, B, and D)
are not typical interventions associated with the administration of antimetabolites.
,3. When assessing an adolescent who recently overdosed on acetaminophen
(Tylenol), it is most important for the nurse to assess for pain in which area of the
body?
A) Flank.
B) Abdomen.
C) Chest.
D) Head.
B) Abdomen.
Acetaminophen toxicity can result in liver damage; therefore, it is especially important for
the nurse to assess for pain in the right upper quadrant of the abdomen (B), which might
indicate liver damage. (A, C, and D) are not areas where pain would be anticipated.
4. An adult patient is given a prescription for a scopolamine patch (Transderm Scop)
to prevent motion sickness while on a cruise. Which information should the nurse
provide to the patient?
A) Apply the patch at least 4 hours prior to departure.
B) Change the patch every other day while on the cruise.
C) Place the patch on a hairless area at the base of the skull.
D) Drink no more than 2 alcoholic drinks during the cruise.
A) Apply the patch at least 4 hours prior to departure.
Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak
onset in 6 hours, so the patient should be instructed to apply the patch at least 4 hours
before departure (A) on the cruise ship. The duration of the transdermal patch is 72 hours,
so (B) is not needed. Scolopamine blocks muscarinic receptors in the inner ear and to the
vomiting center, so the best application site of the patch is behind the ear, not at the base of
the skull (C). Anticholinergic medications are CNS depressants, so the patient should be
instructed to avoid alcohol (D) while using the patch.
5. The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump
with a patient in the immediate postoperative period. The patient will receive
morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total
5 mg IV maximally per hour. What assessment has the highest priority before
initiating the PCA pump?
A) The expiration date on the morphine syringe in the pump.
,B) The rate and depth of the patient's respirations.
C) The type of anesthesia used during the surgical procedure.
D) The patient's subjective and objective signs of pain.
B) The rate and depth of the patient's respirations.
A life-threatening side effect of intravenous administration of morphine sulfate, an opiate
narcotic, is respiratory depression (B). The PCA pump should be stopped and the
healthcare provider notified if the patient's respiratory rate falls below 12 breaths per
minute, and the nurse should anticipate adjustments in the patient's dosage before the PCA
pump is restarted. (A, C, and D) provide helpful information, but are not as high a priority
as the assessment described in (B).
6. A medication that is classified as a beta-1 agonist is most commonly prescribed
for a patient with which condition?
A) Glaucoma.
B) Hypertension.
C) Heart failure.
D) Asthma.
C) Heart failure.
Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure
and are indicated in heart failure (C), shock, atrioventricular block dysrhythmias, and
cardiac arrest. Glaucoma (A) is managed using adrenergic agents and beta-adrenergic
blocking agents. Beta-1 blocking agents are used in the management of hypertension (B).
Medications that stimulate beta-2 receptors in the bronchi are effective for
bronchoconstriction in respiratory disorders, such as asthma (D).
7. A female patient with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4
times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO
is prescribed. Which information is most important for the nurse to include in
patient teaching?
A) Use contraception during intercourse.
B) Ensure the Cytotec is taken on an empty stomach.
C) Encourage oral fluid intake to prevent constipation.
D) Take Cytotec 30 minutes prior to Motrin.
, A) Use contraception during intercourse.
Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can
act as an abortifacient, so the patient should be instructed to use contraception during
intercourse (A) to prevent loss of an early pregnancy. (B) is not necessary. A common side
effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed
(C). Cytotec and Motrin should be taken together (D) to provide protective properties
against gastrointestinal bleeding.
8. A patient with heart failure is prescribed spironolactone (Aldactone). Which
information is most important for the nurse to provide to the patient about diet
modifications?
A) Do not add salt to foods during preparation.
B) Refrain for eating foods high in potassium.
C) Restrict fluid intake to 1000 ml per day.
D) Increase intake of milk and milk products.
B) Refrain for eating foods high in potassium.
Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a
diet high in potassium should be avoided (B), including potassium salt substitutes, which
can lead to hyperkalemia. Although (A) is a common diet modification in heart failure, the
risk of hyperkalemia is more important with Aldactone. Restriction of fluids (C) or
increasing milk and milk products (D) are not indicated with this prescription.
9. In evaluating the effects of lactulose (Cephulac), which outcome should indicate
that the drug is performing as intended?
A) An increase in urine output.
B) Two or three soft stools per day.
C) Watery, diarrhea stools.
D) Increased serum bilirubin.
B) Two or three soft stools per day.
Lactulose is administered to reduce blood ammonia by excretion of ammonia through the
stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A)
would be expected if the patient received a diuretic. (C) would indicate an overdose of
lactulose and is not expected. Lactulose does not affect (D).
