Pharmacology Evolve HESI Exam.
A 19-year-old male client who has sustained a severe head injury is intubated and
placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent
the client from "fighting" the ventilator, the health care provider administers
pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be
immediately accessible for a potential complication with this drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine - ANSWER-B. Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the
respiratory muscle paralysis caused by pancuronium bromide. Options A, C, and D are
not antagonists to pancuronium bromide and would not be helpful in reversing the
effects of the drug compared with the use of anticholinergics.
A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and
acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care
provider to report that the client has developed diarrhea. Which change in prescriptions
should the nurse anticipate?
A. Change the acetaminophen to ibuprofen.
B. Change the elixir to an injectable route.
C. Decrease the dose of vitamin C.
D. Begin treatment with an antibiotic. - ANSWER-C. Decrease the dose of vitamin C.
When providing nursing care for a client receiving pyridostigmine bromide for
myasthenia gravis, which nursing intervention has the highest priority?
A. Monitor the client frequently for urinary retention.
B. Assess respiratory status and breath sounds often.
C. Monitor blood pressure each shift to screen for hypertension.
D. Administer most medications after meals to decrease gastrointestinal irritation. -
ANSWER-B. Assess respiratory status and breath sounds often.
A client with a dislocated shoulder is being prepared for a closed manual reduction
using conscious sedation. Which medication should the nurse explain as a sedative
used during the procedure?
A.Inhaled nitrous oxide
B.Midazolam IV
C.Ketamine IM
D.Fentanyl and droperidol IM - ANSWER-B. Midazolam IV
,A client is being discharged with a prescription for sulfasalazine to treat ulcerative
colitis. Which instruction should the nurse provide to this client prior to discharge?
A. Maintain good oral hygiene.
B. Take the medication 30 minutes before a meal.
C. Discontinue use of the drug gradually.
D. Drink at least eight glasses of fluid a day. - ANSWER-D. Drink at least eight glasses
of fluid a day.
The health care provider prescribes carbamazepine for a child whose tonic-clonic
seizures have been poorly controlled. The nurse informs the mother that the child must
have blood tests every week. The mother asks why so many blood tests are necessary.
Which complication is assessed through frequent laboratory testing that the nurse
should explain to this mother?
A. Nephrotoxicity
B. Ototoxicity
C. Myelosuppression
D.Hepatotoxicity - ANSWER-C. Myelosuppression
Myelosuppression is the highest priority complication that can potentially affect clients
managed with carbamazepine therapy. The client requires close monitoring for this
condition by weekly laboratory testing. Hepatic function may be altered, but this
complication does not have as great a potential for occurrence as option C. Options A
and B are not typical complications of carbamazepine therapy.
When developing a written nursing care plan for a client receiving chemotherapy for
treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The
administration of which type of chemotherapeutic agent would prompt the nurse to add
this intervention?
A. Vincristine
B. Bleomycin sulfate
C. Chlorambucil
D. Cyclophosphamide - ANSWER-D. Cyclophosphamide
Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide.
Administration of options A, B, and C does not typically cause hemorrhagic cystitis.
A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which
response by the client indicates an accurate understanding of the drug teaching
conducted by the nurse?
A. "I'll wear sunscreen whenever I mow the lawn."
B. "This is the worse bacterial infection I've ever had."
,C. "I will need to take the medication for 7 days."
D. "My urine will probably turn brown due to this drug." - ANSWER-A. "I'll wear
sunscreen whenever I mow the lawn."
Photosensitivity is a side effect of griseofulvin, so clients should be cautioned to wear
protective sunscreen during sun exposure. Options B, C, and D are not accurate
statements about side effects of this medication.
A 6-year-old child is admitted to the emergency department with status epilepticus. His
parents report that his seizure disorder has been managed with phenytoin, 50 mg PO
bid, for the past year. Which drug should the nurse plan to administer in the emergency
department?
A. Phenytoin
B. Diazepam
C. Phenobarbital
D. Carbamazepine - ANSWER-B. Diazepam
Diazepam is the drug of choice for treatment of status epilepticus. Options A, C, and D
are used for the long-term management of seizure disorders but are not as useful in the
emergency management of status epilepticus.
A client who has trouble swallowing pills intermittently has been prescribed venlafaxine
(XR) for depression. The medication comes in capsule form. What should the nurse
include in the discharge teaching plan for this client?
A. Capsule contents can be sprinkled on pudding or applesauce.
B. Chew the medication thoroughly to enhance absorption.
C. Take the medication with a large glass of water or juice.
D. Contact the health care provider for another form of medication. - ANSWER-D.
Contact the health care provider for another form of medication.
Venlafaxine is administered PO in capsule form. Capsules that are extended-release
(XR) or continuous-release (CR) contain delayed-release, enteric-coated granules to
prevent decomposition of the drug in the acidic pH of the stomach. The client should
notify the health care provider about the inability to swallow the capsule. This
medication should not be chewed or opened so that the delayed-release, enteric-coated
granules can remain intact. Water or juice will not affect the medication.
The nurse is preparing to apply a surface anesthetic agent for a client. Which action
should the nurse implement to reduce the risk of systemic absorption?
A. Apply the anesthetic to mucous membranes.
B. Limit the area of application to inflamed areas.
C. Avoid abraded skin areas when applying the anesthetic.
, D. Spread the topical agent over a large surface area. - ANSWER-C. Avoid abraded
skin areas when applying the anesthetic.
To minimize systemic absorption of topical anesthetics, the anesthetic agent should be
applied to the smallest surface area of intact skin. Application to the mucous
membranes poses the greatest risk of systemic absorption because absorption occurs
more readily through mucous membranes than through the skin. Inflamed areas
generally have an increased blood supply, which increases the risk of systemic
absorption, so option B should be avoided. A large surface area increases the amount
of topical drug that is available for transdermal absorption, so the smallest area should
be covered, not option D.
A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The
nurse plans to observe this client for which common side effect associated with the use
of this medication?
A. Diarrhea
B. Hypothermia
C. Seizures
D. Dysphagia - ANSWER-A. Diarrhea
The most common side effects associated with quinidine therapy are gastrointestinal
complaints, such as diarrhea. Options B, C, and D are not usually associated with
quinidine therapy.
The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the
morning and at bedtime. Which statement regarding the action of H2 antagonists offers
the correct rationale for administering the medication at bedtime?
A. Gastric acid secreted at night is buffered, preventing pepsin formation.
B. Hydrochloric acid secreted during the night is blocked.
C. The drug relaxes stomach muscles at night to reduce acid.
D. Ingestion of the medication at night offers a sedative effect, promoting sleep. -
ANSWER-B. Hydrochloric acid secreted during the night is blocked.
H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric
secretion occurs all the time, even when the stomach is empty, unless medications are
taken to inhibit this action. Options C and D are not actions of famotidine. Option A is
the action of antacids. Antacids do not affect healing or prevent the recurrence of ulcers;
they merely provide symptomatic relief. Knowing the difference between H2 antagonists
and antacids is important when teaching clients.
The nurse is preparing to administer the disease-modifying antirheumatic drug
(DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which
intervention is most important to implement prior to administering this medication?
A 19-year-old male client who has sustained a severe head injury is intubated and
placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent
the client from "fighting" the ventilator, the health care provider administers
pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be
immediately accessible for a potential complication with this drug?
A. Dantrolene sodium
B. Neostigmine bromide
C. Succinylcholine bromide
D. Epinephrine - ANSWER-B. Neostigmine bromide
Neostigmine bromide and atropine sulfate, both anticholinergic drugs, reverse the
respiratory muscle paralysis caused by pancuronium bromide. Options A, C, and D are
not antagonists to pancuronium bromide and would not be helpful in reversing the
effects of the drug compared with the use of anticholinergics.
A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and
acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care
provider to report that the client has developed diarrhea. Which change in prescriptions
should the nurse anticipate?
A. Change the acetaminophen to ibuprofen.
B. Change the elixir to an injectable route.
C. Decrease the dose of vitamin C.
D. Begin treatment with an antibiotic. - ANSWER-C. Decrease the dose of vitamin C.
When providing nursing care for a client receiving pyridostigmine bromide for
myasthenia gravis, which nursing intervention has the highest priority?
A. Monitor the client frequently for urinary retention.
B. Assess respiratory status and breath sounds often.
C. Monitor blood pressure each shift to screen for hypertension.
D. Administer most medications after meals to decrease gastrointestinal irritation. -
ANSWER-B. Assess respiratory status and breath sounds often.
A client with a dislocated shoulder is being prepared for a closed manual reduction
using conscious sedation. Which medication should the nurse explain as a sedative
used during the procedure?
A.Inhaled nitrous oxide
B.Midazolam IV
C.Ketamine IM
D.Fentanyl and droperidol IM - ANSWER-B. Midazolam IV
,A client is being discharged with a prescription for sulfasalazine to treat ulcerative
colitis. Which instruction should the nurse provide to this client prior to discharge?
A. Maintain good oral hygiene.
B. Take the medication 30 minutes before a meal.
C. Discontinue use of the drug gradually.
D. Drink at least eight glasses of fluid a day. - ANSWER-D. Drink at least eight glasses
of fluid a day.
The health care provider prescribes carbamazepine for a child whose tonic-clonic
seizures have been poorly controlled. The nurse informs the mother that the child must
have blood tests every week. The mother asks why so many blood tests are necessary.
Which complication is assessed through frequent laboratory testing that the nurse
should explain to this mother?
A. Nephrotoxicity
B. Ototoxicity
C. Myelosuppression
D.Hepatotoxicity - ANSWER-C. Myelosuppression
Myelosuppression is the highest priority complication that can potentially affect clients
managed with carbamazepine therapy. The client requires close monitoring for this
condition by weekly laboratory testing. Hepatic function may be altered, but this
complication does not have as great a potential for occurrence as option C. Options A
and B are not typical complications of carbamazepine therapy.
When developing a written nursing care plan for a client receiving chemotherapy for
treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The
administration of which type of chemotherapeutic agent would prompt the nurse to add
this intervention?
A. Vincristine
B. Bleomycin sulfate
C. Chlorambucil
D. Cyclophosphamide - ANSWER-D. Cyclophosphamide
Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide.
Administration of options A, B, and C does not typically cause hemorrhagic cystitis.
A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which
response by the client indicates an accurate understanding of the drug teaching
conducted by the nurse?
A. "I'll wear sunscreen whenever I mow the lawn."
B. "This is the worse bacterial infection I've ever had."
,C. "I will need to take the medication for 7 days."
D. "My urine will probably turn brown due to this drug." - ANSWER-A. "I'll wear
sunscreen whenever I mow the lawn."
Photosensitivity is a side effect of griseofulvin, so clients should be cautioned to wear
protective sunscreen during sun exposure. Options B, C, and D are not accurate
statements about side effects of this medication.
A 6-year-old child is admitted to the emergency department with status epilepticus. His
parents report that his seizure disorder has been managed with phenytoin, 50 mg PO
bid, for the past year. Which drug should the nurse plan to administer in the emergency
department?
A. Phenytoin
B. Diazepam
C. Phenobarbital
D. Carbamazepine - ANSWER-B. Diazepam
Diazepam is the drug of choice for treatment of status epilepticus. Options A, C, and D
are used for the long-term management of seizure disorders but are not as useful in the
emergency management of status epilepticus.
A client who has trouble swallowing pills intermittently has been prescribed venlafaxine
(XR) for depression. The medication comes in capsule form. What should the nurse
include in the discharge teaching plan for this client?
A. Capsule contents can be sprinkled on pudding or applesauce.
B. Chew the medication thoroughly to enhance absorption.
C. Take the medication with a large glass of water or juice.
D. Contact the health care provider for another form of medication. - ANSWER-D.
Contact the health care provider for another form of medication.
Venlafaxine is administered PO in capsule form. Capsules that are extended-release
(XR) or continuous-release (CR) contain delayed-release, enteric-coated granules to
prevent decomposition of the drug in the acidic pH of the stomach. The client should
notify the health care provider about the inability to swallow the capsule. This
medication should not be chewed or opened so that the delayed-release, enteric-coated
granules can remain intact. Water or juice will not affect the medication.
The nurse is preparing to apply a surface anesthetic agent for a client. Which action
should the nurse implement to reduce the risk of systemic absorption?
A. Apply the anesthetic to mucous membranes.
B. Limit the area of application to inflamed areas.
C. Avoid abraded skin areas when applying the anesthetic.
, D. Spread the topical agent over a large surface area. - ANSWER-C. Avoid abraded
skin areas when applying the anesthetic.
To minimize systemic absorption of topical anesthetics, the anesthetic agent should be
applied to the smallest surface area of intact skin. Application to the mucous
membranes poses the greatest risk of systemic absorption because absorption occurs
more readily through mucous membranes than through the skin. Inflamed areas
generally have an increased blood supply, which increases the risk of systemic
absorption, so option B should be avoided. A large surface area increases the amount
of topical drug that is available for transdermal absorption, so the smallest area should
be covered, not option D.
A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The
nurse plans to observe this client for which common side effect associated with the use
of this medication?
A. Diarrhea
B. Hypothermia
C. Seizures
D. Dysphagia - ANSWER-A. Diarrhea
The most common side effects associated with quinidine therapy are gastrointestinal
complaints, such as diarrhea. Options B, C, and D are not usually associated with
quinidine therapy.
The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the
morning and at bedtime. Which statement regarding the action of H2 antagonists offers
the correct rationale for administering the medication at bedtime?
A. Gastric acid secreted at night is buffered, preventing pepsin formation.
B. Hydrochloric acid secreted during the night is blocked.
C. The drug relaxes stomach muscles at night to reduce acid.
D. Ingestion of the medication at night offers a sedative effect, promoting sleep. -
ANSWER-B. Hydrochloric acid secreted during the night is blocked.
H2 antagonists act on the parietal cells to inhibit gastric secretion. Some gastric
secretion occurs all the time, even when the stomach is empty, unless medications are
taken to inhibit this action. Options C and D are not actions of famotidine. Option A is
the action of antacids. Antacids do not affect healing or prevent the recurrence of ulcers;
they merely provide symptomatic relief. Knowing the difference between H2 antagonists
and antacids is important when teaching clients.
The nurse is preparing to administer the disease-modifying antirheumatic drug
(DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which
intervention is most important to implement prior to administering this medication?
