2023-2024 HESI Pharmacology V1
42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for
the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin
(Amoxil). Which statement by the client indicates the best understanding of the medication regimen?
1. "My ulcer will heal because these medications will kill the bacteria."
2. "These medications are only taken when I have pain from my ulcer."
3. "The medications will kill the bacteria and stop the acid production."
4. "These medications will coat the ulcer and decrease the acid production in my stomach." - Correct Answer 3. "The
medications will kill the bacteria and stop the acid production."
Rationale:
Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor.
Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill
the bacteria and decrease acid production.
57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate
a potential serious complication associated with propranolol?
1. The development of complaints of insomnia
2. The development of audible expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the
medication
4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the
medication - Correct Answer 2. The development of audible expiratory wheezes
Rationale:
Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β- Blockers may induce this
reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood
pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.
A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the
client understands the most effective use of this medication if the client states that he or she will:
1. Watch for irritability as a side effect.
2. Take the tablet with a full glass of water.
3. Take an extra dose if the cough is accompanied by fever.
4. Crush the sustained-release tablet if immediate relief is needed. - Correct Answer 2. Take the tablet with a full
glass of water.
Rationale:
Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions.
Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally
cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the
cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.
A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is forgotten
3. Causes orange discoloration of sweat, tears, urine, and feces
4. May be discontinued independently if symptoms are gone in 3 months - Correct Answer 3. Causes orange
discoloration of sweat, tears, urine, and feces
Rationale:
Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The
client should not stop therapy until directed to do so by a health care provider. The medication should be
administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food.
Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red
discoloration of body secretions and will permanently stain soft contact lenses.
,A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias,
and tingling in the extremities. The nurse interprets that the client is experiencing:
1. Hypercalcemia
2. Peripheral neuritis
3. Small blood vessel spasm
4. Impaired peripheral circulation - Correct Answer 2. Peripheral neuritis
Rationale:A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling,
and paresthesia in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3,
and 4 are incorrect.
A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase
(Activase, tPA). Which action is a priority nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
3. Monitor for signs of bleeding.
4. Have heparin sodium available. - Correct Answer 3. Monitor for signs of bleeding.
Rationale:
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication.
The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are
important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is
not asking about follow-up medications.
A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the
medication. Which statement by the client would indicate an understanding of the instructions?
1. "It is not necessary to avoid the use of alcohol."
2. "The medication should be taken with meals to decrease flushing."
3. "Clay-colored stools are a common side effect and should not be of concern."
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." - Correct Answer 4.
"Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
Rationale:
Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes
before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance
this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the
medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should
be immediately reported to the health care provider (HCP).
A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse
should have which item available for possible use after giving this medication?
1. Ambu bag
2. Intubation tray
3. Nasogastric tube
4. Suction equipment - Correct Answer 4. Suction equipment
Rationale:
Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by
inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction
equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.
A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this
medication. Select all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory rate - Correct Answer 2. Tremors
3. Drowsiness
4. Hypotension
, Rationale:Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness,
hypotension, constipation, urinary retention, nausea, vomiting, and tremors.
A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells
the client that the most likely time for a hypoglycemic reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours after administration
3. 16 to 18 hours after administration
4. 18 to 24 hours after administration - Correct Answer 2. 4 to 12 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its
duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.
A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the
following indicates a therapeutic serum drug range?
1.) 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL - Correct Answer 2. 10 to 20 mcg/mL
Rationale:
The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL.* A helpful hint may be to
remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same
as the phenytoin (Dilantin) therapeutic range.*
A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to:
1. Drink alcohol in small amounts only.
2. Report yellow eyes or skin immediately.
3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy. - Correct Answer 2.
Report yellow eyes or skin immediately.
Rationale:
INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which
include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should
avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction
characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The
client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of
INH therapy for TB.
A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which
information should the nurse teach when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage. - Correct Answer 2. Rotate the insulin injection
sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may
possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the
insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to
another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has
been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.
A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of
anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results,
knowing that which of the following is the therapeutic serum level (range) for digoxin?
1. 3 to 5 ng/mL
2. 0.5 to 2 ng/mL
3. 1.2 to 2.8 ng/mL
42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for
the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin
(Amoxil). Which statement by the client indicates the best understanding of the medication regimen?
1. "My ulcer will heal because these medications will kill the bacteria."
2. "These medications are only taken when I have pain from my ulcer."
3. "The medications will kill the bacteria and stop the acid production."
4. "These medications will coat the ulcer and decrease the acid production in my stomach." - Correct Answer 3. "The
medications will kill the bacteria and stop the acid production."
Rationale:
Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor.
Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill
the bacteria and decrease acid production.
57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate
a potential serious complication associated with propranolol?
1. The development of complaints of insomnia
2. The development of audible expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the
medication
4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the
medication - Correct Answer 2. The development of audible expiratory wheezes
Rationale:
Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β- Blockers may induce this
reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood
pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.
A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the
client understands the most effective use of this medication if the client states that he or she will:
1. Watch for irritability as a side effect.
2. Take the tablet with a full glass of water.
3. Take an extra dose if the cough is accompanied by fever.
4. Crush the sustained-release tablet if immediate relief is needed. - Correct Answer 2. Take the tablet with a full
glass of water.
Rationale:
Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions.
Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally
cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the
cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.
A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is forgotten
3. Causes orange discoloration of sweat, tears, urine, and feces
4. May be discontinued independently if symptoms are gone in 3 months - Correct Answer 3. Causes orange
discoloration of sweat, tears, urine, and feces
Rationale:
Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The
client should not stop therapy until directed to do so by a health care provider. The medication should be
administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food.
Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red
discoloration of body secretions and will permanently stain soft contact lenses.
,A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias,
and tingling in the extremities. The nurse interprets that the client is experiencing:
1. Hypercalcemia
2. Peripheral neuritis
3. Small blood vessel spasm
4. Impaired peripheral circulation - Correct Answer 2. Peripheral neuritis
Rationale:A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling,
and paresthesia in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3,
and 4 are incorrect.
A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase
(Activase, tPA). Which action is a priority nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
3. Monitor for signs of bleeding.
4. Have heparin sodium available. - Correct Answer 3. Monitor for signs of bleeding.
Rationale:
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication.
The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are
important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is
not asking about follow-up medications.
A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the
medication. Which statement by the client would indicate an understanding of the instructions?
1. "It is not necessary to avoid the use of alcohol."
2. "The medication should be taken with meals to decrease flushing."
3. "Clay-colored stools are a common side effect and should not be of concern."
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." - Correct Answer 4.
"Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
Rationale:
Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes
before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance
this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the
medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should
be immediately reported to the health care provider (HCP).
A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse
should have which item available for possible use after giving this medication?
1. Ambu bag
2. Intubation tray
3. Nasogastric tube
4. Suction equipment - Correct Answer 4. Suction equipment
Rationale:
Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by
inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction
equipment available in case the client cannot manage to clear the increased volume of liquefied secretions.
A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this
medication. Select all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory rate - Correct Answer 2. Tremors
3. Drowsiness
4. Hypotension
, Rationale:Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness,
hypotension, constipation, urinary retention, nausea, vomiting, and tremors.
A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells
the client that the most likely time for a hypoglycemic reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours after administration
3. 16 to 18 hours after administration
4. 18 to 24 hours after administration - Correct Answer 2. 4 to 12 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its
duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.
A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the
following indicates a therapeutic serum drug range?
1.) 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL - Correct Answer 2. 10 to 20 mcg/mL
Rationale:
The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL.* A helpful hint may be to
remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same
as the phenytoin (Dilantin) therapeutic range.*
A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to:
1. Drink alcohol in small amounts only.
2. Report yellow eyes or skin immediately.
3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy. - Correct Answer 2.
Report yellow eyes or skin immediately.
Rationale:
INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which
include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should
avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction
characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The
client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of
INH therapy for TB.
A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which
information should the nurse teach when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage. - Correct Answer 2. Rotate the insulin injection
sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may
possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the
insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to
another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has
been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.
A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of
anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results,
knowing that which of the following is the therapeutic serum level (range) for digoxin?
1. 3 to 5 ng/mL
2. 0.5 to 2 ng/mL
3. 1.2 to 2.8 ng/mL
