Page 1 of 39
HESI Pharmacology Exam 2 2025Review Questions PRACTICE GRADED A+ QUESTIONS
WITH CORRECT ANSWERS GRADED A+ 2025-2026 VERIFIED
HESI: Pharmacology
For which clients should the nurse withhold the initial dose of a
cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider?
(Select all that apply.)
A. A middle-aged adult with a history of tinnitus while taking aspirin
B. A middle-aged adult with a history of polycystic ovarian disease
C. An older adult with a history of a skin rash while taking glyburide (DiaBeta)
D. An adolescent with a history of an anaphylactic reaction to penicillin
E. An older adult with a history of gastrointestinal upset while taking naproxen
sodium (Naprosyn)
F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema
Correct Answer: C, D, F
Rationale: COX-2 inhibitors are contraindicated for those who are allergic to sulfa
drugs (C), aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety
for adolescents (D and F) is not yet established, and COX-2 inhibitors, as well as
NSAIDs, are contraindicated during the third trimester of pregnancy (F) because they
can cause a premature closure of the patent ductus arteriosus. Tinnitus, an adverse
reaction of aspirin (A), and ovarian disease (B) are not contraindications for the use
of COX-2 inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs
(E) but is not a contraindication for the use of a COX-2 inhibitor.
An older client is receiving a water-soluble drug that is more than the average
dose for a young adult. Which action should the nurse implement first?
A. Obtain a prescription for lower medication dosages.
B. Determine the drug's serum levels for toxicity.
C. Start IV fluids to decrease the serum drug levels.
D. Hold the next dosage and notify the health care provider.
Correct Answer: B
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Rationale: Older clients usually have a decline in lean body mass and total body
water that causes water-soluble drugs to become distributed in fluid compartments,
resulting in an increased concentration, so determining the drug's serum level for
toxicity should be implemented first. Although options A, C, and D may be indicated,
an increased plasma drug level should be the determining factor to consider when
water-soluble drugs warrant a reduced dosage in the older client.
A client is receiving acyclovir sodium IV for a severe herpes simplex infection.
Which intervention should the nurse implement during this drug therapy?
A. Maintain respiratory isolation precautions.
B. Increase daily fluids to 2000 to 4000 mL/day.
C. Administer with meals to decrease gastric irritation.
D. Assess for signs of severe liver dysfunction.
Correct Answer: B
Rationale: Increasing fluid intake during treatment prevents precipitation of the drug
in the renal tubules, which could lead to obstructive problems that impair kidney
function. Acute glomerulonephritis is a possible complication of acyclovir sodium
therapy. Options A, C, and D are unrelated interventions for treatment with acyclovir
sodium.
The nurse is evaluating a client's understanding of the prescribed antilipemic
drug lovastatin. Which client statement indicates that further teaching is
needed?
A. "My bowel habits should not be affected by this drug."
B. "This medication should be taken once a day only."
C. "I will still need to follow a low-cholesterol diet."
D. "I will take the medication every day before breakfast."
Correct Answer: D
Rationale: The enzyme that helps metabolize cholesterol is activated at night, so this
medication should be taken with the evening meal. Options A, B, and C reflect
correct information about lovastatin
A female client is receiving tamoxifen following surgery for breast cancer. She
reports the onset of hot flashes to the nurse. Which intervention should the
nurse implement?
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A. Instruct the client that hot flashes are a side effect that often occurs with the
use of this medication
B. Encourage the client to verbalize her feelings and fears about the
recurrence of her breast cancer
C. Help the client schedule an appointment for evaluation of the need to
increase the dose of medication
D. Notify the HCP that the client needs immediate evaluation for medication
toxicity
Correct Answer: A
Rationale: Tamoxifen is an estrogen receptor blocker used to treat breast carcinoma.
Hot flashes are a common side effect. If the hot flashes become bothersome, the
client can be instructed in measures to reduce the discomfort. Hot flashes are not an
indication of option B, C, or D.
The charge nurse is reviewing the admission history and physical data for four
clients newly admitted to the unit. Which client is at greater risk for adverse
reactions to medications?
A. 30-year-old man with a fracture
B. 7-year-old child with an ear infection
C. 75-year-old woman with liver disease
D. 50-year-old man with an URI
Correct Answer: C
Rationale: Impaired hepatic metabolic pathways for drug and chemical degradation
place option C at greatest risk for adverse reactions to medications based on
advancing age and liver disease. Options A and D have no predisposing factors,
such as genetics, pathophysiologic dysfunction, or drug allergies, that would
increase the risk for cumulative toxicity or ADRs. Option B is at risk for dose-related
adverse reactions but is at less risk than option C.
A client is ordered 22 mg of gentamicin by IM injection. The drug is available in
20 mg/2 mL. How many milliliters should be administered?
A. 1.8
B. 2.0
, Page 4 of 39
C. 2.4
D. 2.2
Correct Answer: D
Rationale:
(22 mg/20 mg) × (x mL/2 mL) = 22x = 40x = 2.2 mL
A client with metastatic cancer reports severe continuous pain. Which route of
administration should the nurse use to provide the most effective continuous
analgesia?
A. Oral
B. Intravenous (IV)
D. Transdermal
D. Intramuscular (IM)
Correct Answer: C
Rationale: Continuous pain is best managed by maintaining a constant serum drug
level. Transdermal drug administration of an analgesic provides around-the-clock,
controlled release of the medication that is absorbed through intact skin into the
bloodstream to provide continuous pain relief. Option A is convenient, but
gastrointestinal variables affect the absorption rate of the drug, its onset and
intensity, and duration of response and requires repeated doses around the clock.
Option B provides immediate action because the drug is infused directly into the
bloodstream and is quickly metabolized, and repeated IV doses are required to
maintain a continuous blood level. Option D requires repeated injections at regular
intervals, which are uncomfortable, and absorption rates vary between muscle sites.
Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl
diagnosed with acne. The nurse discusses self-care with the client while she is
taking the medication. Which teaching points should be included in the
discussion? (Select all that apply.)
A. Report vaginal itching or discharge
B. Take the medication at 0800, 1500, and 2200 hours
C. Protect skin from natural and artificial UV light
D. Avoid drinking until response to medication is known
HESI Pharmacology Exam 2 2025Review Questions PRACTICE GRADED A+ QUESTIONS
WITH CORRECT ANSWERS GRADED A+ 2025-2026 VERIFIED
HESI: Pharmacology
For which clients should the nurse withhold the initial dose of a
cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider?
(Select all that apply.)
A. A middle-aged adult with a history of tinnitus while taking aspirin
B. A middle-aged adult with a history of polycystic ovarian disease
C. An older adult with a history of a skin rash while taking glyburide (DiaBeta)
D. An adolescent with a history of an anaphylactic reaction to penicillin
E. An older adult with a history of gastrointestinal upset while taking naproxen
sodium (Naprosyn)
F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema
Correct Answer: C, D, F
Rationale: COX-2 inhibitors are contraindicated for those who are allergic to sulfa
drugs (C), aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety
for adolescents (D and F) is not yet established, and COX-2 inhibitors, as well as
NSAIDs, are contraindicated during the third trimester of pregnancy (F) because they
can cause a premature closure of the patent ductus arteriosus. Tinnitus, an adverse
reaction of aspirin (A), and ovarian disease (B) are not contraindications for the use
of COX-2 inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs
(E) but is not a contraindication for the use of a COX-2 inhibitor.
An older client is receiving a water-soluble drug that is more than the average
dose for a young adult. Which action should the nurse implement first?
A. Obtain a prescription for lower medication dosages.
B. Determine the drug's serum levels for toxicity.
C. Start IV fluids to decrease the serum drug levels.
D. Hold the next dosage and notify the health care provider.
Correct Answer: B
, Page 2 of 39
Rationale: Older clients usually have a decline in lean body mass and total body
water that causes water-soluble drugs to become distributed in fluid compartments,
resulting in an increased concentration, so determining the drug's serum level for
toxicity should be implemented first. Although options A, C, and D may be indicated,
an increased plasma drug level should be the determining factor to consider when
water-soluble drugs warrant a reduced dosage in the older client.
A client is receiving acyclovir sodium IV for a severe herpes simplex infection.
Which intervention should the nurse implement during this drug therapy?
A. Maintain respiratory isolation precautions.
B. Increase daily fluids to 2000 to 4000 mL/day.
C. Administer with meals to decrease gastric irritation.
D. Assess for signs of severe liver dysfunction.
Correct Answer: B
Rationale: Increasing fluid intake during treatment prevents precipitation of the drug
in the renal tubules, which could lead to obstructive problems that impair kidney
function. Acute glomerulonephritis is a possible complication of acyclovir sodium
therapy. Options A, C, and D are unrelated interventions for treatment with acyclovir
sodium.
The nurse is evaluating a client's understanding of the prescribed antilipemic
drug lovastatin. Which client statement indicates that further teaching is
needed?
A. "My bowel habits should not be affected by this drug."
B. "This medication should be taken once a day only."
C. "I will still need to follow a low-cholesterol diet."
D. "I will take the medication every day before breakfast."
Correct Answer: D
Rationale: The enzyme that helps metabolize cholesterol is activated at night, so this
medication should be taken with the evening meal. Options A, B, and C reflect
correct information about lovastatin
A female client is receiving tamoxifen following surgery for breast cancer. She
reports the onset of hot flashes to the nurse. Which intervention should the
nurse implement?
, Page 3 of 39
A. Instruct the client that hot flashes are a side effect that often occurs with the
use of this medication
B. Encourage the client to verbalize her feelings and fears about the
recurrence of her breast cancer
C. Help the client schedule an appointment for evaluation of the need to
increase the dose of medication
D. Notify the HCP that the client needs immediate evaluation for medication
toxicity
Correct Answer: A
Rationale: Tamoxifen is an estrogen receptor blocker used to treat breast carcinoma.
Hot flashes are a common side effect. If the hot flashes become bothersome, the
client can be instructed in measures to reduce the discomfort. Hot flashes are not an
indication of option B, C, or D.
The charge nurse is reviewing the admission history and physical data for four
clients newly admitted to the unit. Which client is at greater risk for adverse
reactions to medications?
A. 30-year-old man with a fracture
B. 7-year-old child with an ear infection
C. 75-year-old woman with liver disease
D. 50-year-old man with an URI
Correct Answer: C
Rationale: Impaired hepatic metabolic pathways for drug and chemical degradation
place option C at greatest risk for adverse reactions to medications based on
advancing age and liver disease. Options A and D have no predisposing factors,
such as genetics, pathophysiologic dysfunction, or drug allergies, that would
increase the risk for cumulative toxicity or ADRs. Option B is at risk for dose-related
adverse reactions but is at less risk than option C.
A client is ordered 22 mg of gentamicin by IM injection. The drug is available in
20 mg/2 mL. How many milliliters should be administered?
A. 1.8
B. 2.0
, Page 4 of 39
C. 2.4
D. 2.2
Correct Answer: D
Rationale:
(22 mg/20 mg) × (x mL/2 mL) = 22x = 40x = 2.2 mL
A client with metastatic cancer reports severe continuous pain. Which route of
administration should the nurse use to provide the most effective continuous
analgesia?
A. Oral
B. Intravenous (IV)
D. Transdermal
D. Intramuscular (IM)
Correct Answer: C
Rationale: Continuous pain is best managed by maintaining a constant serum drug
level. Transdermal drug administration of an analgesic provides around-the-clock,
controlled release of the medication that is absorbed through intact skin into the
bloodstream to provide continuous pain relief. Option A is convenient, but
gastrointestinal variables affect the absorption rate of the drug, its onset and
intensity, and duration of response and requires repeated doses around the clock.
Option B provides immediate action because the drug is infused directly into the
bloodstream and is quickly metabolized, and repeated IV doses are required to
maintain a continuous blood level. Option D requires repeated injections at regular
intervals, which are uncomfortable, and absorption rates vary between muscle sites.
Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl
diagnosed with acne. The nurse discusses self-care with the client while she is
taking the medication. Which teaching points should be included in the
discussion? (Select all that apply.)
A. Report vaginal itching or discharge
B. Take the medication at 0800, 1500, and 2200 hours
C. Protect skin from natural and artificial UV light
D. Avoid drinking until response to medication is known
