HESI PHARMACOLOGY V1 ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
/. A nurse is caring for a client with hyperparathyroidism and notes that the client's
serum calcium level is 13 mg/dL. Which medication should the nurse prepare to
administer as prescribed to the client?1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D - Answer-3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing
hypercalcemia. Calcium gluconate and calcium chloride are medications used for the
treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia,
large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases
the plasma calcium level by inhibiting bone resorption and lowering the serum calcium
concentration.
/.Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia.
The nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice - Answer-4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed
to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk
may affect absorption of the iron. Water will not assist in absorption. Orange juice
contains a greater amount of vitamin C than apple juice.
/.Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse
monitors the client, knowing that which of the following would indicate the presence of
systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased Respirations - Answer-1. Tinnitus
Rationale:
,Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can
result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological
disturbances. Constipation and diarrhea are not associated with salicylism.
/.The camp nurse asks the children preparing to swim in the lake if they have applied
sunscreen. The nurse reminds the children that chemical sunscreens are most effective
when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun - Answer-4. At least 30 minutes
before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the
sun so that they can penetrate the skin. All sunscreens should be reapplied after
swimming or sweating
/.Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When
applying the medication, the client complains of local discomfort and burning. Which of
the following is the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site - Answer-3. Informing the
client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and
is used to treat burns to reduce bacteria present in avascular tissues. The client should
be informed that the medication will cause local discomfort and burning and that this is a
normal reaction; therefore options 1, 2, and 4 are incorrect
/.The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the
site of injury. The nurse monitors the client, knowing that which of the following indicates
that a systemic effect has occurred?1.Hyperventilation
2.Elevated blood pressure
3.Local pain at the burn site
4.Local rash at the burn site - Answer-1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of
acid, thereby causing acidosis. Clients receiving this treatment should be monitored for
signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should
be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than syeffects. An
elevated blood pressure may be expected from the pain that occurs with a burn injury.
,/.Isotretinoin is prescribed for a client with severe acne. Before the administration of this
medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count - Answer-2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured
before treatment and periodically thereafter until the effect on the triglycerides has been
evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this
treatment.
/.A client with severe acne is seen in the clinic and the health care provider (HCP)
prescribes isotretinoin. The nurse reviews the client's medication record and would
contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin) - Answer-1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of
isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A
supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are
not contraindicated with the use of isotretinoin
/.The nurse is applying a topical corticosteroid to a client with eczema. The nurse would
monitor for the potential for increased systemic absorption of the medication if the
medication were being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands - Answer-2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circulation. Absorption is
higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids,
neck, perineum, genitalia), and lower from regions in which permeability is poor (back,
palms, soles).
/.The clinic nurse is performing an admission assessment on a client. The nurse notes
that the client is taking azelaic acid (Azelex). Because of the medication prescription,
the nurse would suspect that the client is being treated for:
1. Acne
, 2. Eczema
3. Hair loss
4. Herpes simplex - Answer-1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid
appears to work by suppressing the growth of Propionibacterium acnes and decreasing
the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.
/.The health care provider has prescribed silver sulfadiazine (Silvadene) for the client
with a partial-thickness burn, which has cultured positive for gram-negative bacteria.
The nurse is reinforcing information to the client about the medication. Which statement
made by the client indicates a lack of understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound." - Answer-3. "The
medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity
against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly
to the wound to assist in healing. It does not stain the skin.
/.A nurse is caring for a client who is receiving an intravenous (IV) infusion of an
antineoplastic medication. During the infusion, the client complains of pain at the
insertion site. During an inspection of the site, the nurse notes redness and swelling and
that the rate of infusion of the medication has slowed. The nurse should take which
appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion - Answer-1. Notify the
registered nurse.
Rationale:
When antineoplastic medications (Chemotherapeutic Agents) are administered via IV,
great care must be taken to prevent the medication from escaping into the tissues
surrounding the injection site, because pain, tissue damage, and necrosis can result.
The nurse monitors for signs of extravasation, such as redness or swelling at the
insertion site and a decreased infusion rate. If extravasation occurs, the registered
nurse needs to be notified; he or she will then contact the health care provider.
/.The client with squamous cell carcinoma of the larynx is receiving bleomycin
intravenously. The nurse caring for the client anticipates that which diagnostic study will
be prescribed?
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
/. A nurse is caring for a client with hyperparathyroidism and notes that the client's
serum calcium level is 13 mg/dL. Which medication should the nurse prepare to
administer as prescribed to the client?1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D - Answer-3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing
hypercalcemia. Calcium gluconate and calcium chloride are medications used for the
treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia,
large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases
the plasma calcium level by inhibiting bone resorption and lowering the serum calcium
concentration.
/.Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia.
The nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice - Answer-4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed
to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk
may affect absorption of the iron. Water will not assist in absorption. Orange juice
contains a greater amount of vitamin C than apple juice.
/.Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse
monitors the client, knowing that which of the following would indicate the presence of
systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased Respirations - Answer-1. Tinnitus
Rationale:
,Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can
result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological
disturbances. Constipation and diarrhea are not associated with salicylism.
/.The camp nurse asks the children preparing to swim in the lake if they have applied
sunscreen. The nurse reminds the children that chemical sunscreens are most effective
when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun - Answer-4. At least 30 minutes
before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the
sun so that they can penetrate the skin. All sunscreens should be reapplied after
swimming or sweating
/.Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When
applying the medication, the client complains of local discomfort and burning. Which of
the following is the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site - Answer-3. Informing the
client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and
is used to treat burns to reduce bacteria present in avascular tissues. The client should
be informed that the medication will cause local discomfort and burning and that this is a
normal reaction; therefore options 1, 2, and 4 are incorrect
/.The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the
site of injury. The nurse monitors the client, knowing that which of the following indicates
that a systemic effect has occurred?1.Hyperventilation
2.Elevated blood pressure
3.Local pain at the burn site
4.Local rash at the burn site - Answer-1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of
acid, thereby causing acidosis. Clients receiving this treatment should be monitored for
signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should
be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than syeffects. An
elevated blood pressure may be expected from the pain that occurs with a burn injury.
,/.Isotretinoin is prescribed for a client with severe acne. Before the administration of this
medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count - Answer-2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured
before treatment and periodically thereafter until the effect on the triglycerides has been
evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this
treatment.
/.A client with severe acne is seen in the clinic and the health care provider (HCP)
prescribes isotretinoin. The nurse reviews the client's medication record and would
contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin) - Answer-1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of
isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A
supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are
not contraindicated with the use of isotretinoin
/.The nurse is applying a topical corticosteroid to a client with eczema. The nurse would
monitor for the potential for increased systemic absorption of the medication if the
medication were being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands - Answer-2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circulation. Absorption is
higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids,
neck, perineum, genitalia), and lower from regions in which permeability is poor (back,
palms, soles).
/.The clinic nurse is performing an admission assessment on a client. The nurse notes
that the client is taking azelaic acid (Azelex). Because of the medication prescription,
the nurse would suspect that the client is being treated for:
1. Acne
, 2. Eczema
3. Hair loss
4. Herpes simplex - Answer-1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid
appears to work by suppressing the growth of Propionibacterium acnes and decreasing
the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.
/.The health care provider has prescribed silver sulfadiazine (Silvadene) for the client
with a partial-thickness burn, which has cultured positive for gram-negative bacteria.
The nurse is reinforcing information to the client about the medication. Which statement
made by the client indicates a lack of understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound." - Answer-3. "The
medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity
against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly
to the wound to assist in healing. It does not stain the skin.
/.A nurse is caring for a client who is receiving an intravenous (IV) infusion of an
antineoplastic medication. During the infusion, the client complains of pain at the
insertion site. During an inspection of the site, the nurse notes redness and swelling and
that the rate of infusion of the medication has slowed. The nurse should take which
appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion - Answer-1. Notify the
registered nurse.
Rationale:
When antineoplastic medications (Chemotherapeutic Agents) are administered via IV,
great care must be taken to prevent the medication from escaping into the tissues
surrounding the injection site, because pain, tissue damage, and necrosis can result.
The nurse monitors for signs of extravasation, such as redness or swelling at the
insertion site and a decreased infusion rate. If extravasation occurs, the registered
nurse needs to be notified; he or she will then contact the health care provider.
/.The client with squamous cell carcinoma of the larynx is receiving bleomycin
intravenously. The nurse caring for the client anticipates that which diagnostic study will
be prescribed?
