ESTUDYR
HESI PHARMACOLOGY (NCLEX PN) 2 VERSIONS ACTUAL EXAM COMPLETE 300
QUESTIONS WITH DETAILED VERIFIED ANSWERS ANRATIONALES (100%
CORRECT ANSWERS WITH DETAILED RATIONALES)
1. A client with hyperparathyroidism has a serum calcium of 13 mg/dL. Which medication
should the nurse prepare to administer as prescribed?
A. Calcium chloride
B. Calcium gluconate
C. ✅Calcitonin (Miacalcin)
D. Large doses of vitamin D
Rationale: Serum Ca 13 mg/dL indicates hypercalcemia. Calcitonin lowers serum calcium
by inhibiting bone resorption. Calcium salts would worsen hypercalcemia; vitamin D
increases Ca absorption.
2. A 6-year-old with iron-deficiency anemia is prescribed oral iron. The nurse instructs the
parent to give the iron with which food/drink to increase absorption?
A. Milk
B. Water
C. Apple juice
D. ✅Orange juice
Rationale: Vitamin C (ascorbic acid) enhances nonheme iron absorption. Orange juice
contains more vitamin C than apple juice. Milk can inhibit iron absorption.
3. A client using topical salicylic acid for psoriasis develops systemic toxicity (salicylism).
Which sign would indicate salicylism?
A. Diarrhea
B. Constipation
C. Decreased respirations
D. ✅Tinnitus
Rationale: Tinnitus, dizziness, hyperpnea, and CNS changes are classic signs of salicylate
toxicity. GI symptoms like constipation/diarrhea are not specific to salicylism;
respirations typically increase (hyperventilation) with toxicity.
,ESTUDYR
4. Chemical sunscreens are most effective when applied:
A. Immediately before swimming
B. 15 minutes before exposure to the sun
C. Immediately before exposure to the sun
D. ✅At least 30 minutes before exposure to the sun
Rationale: Chemical sunscreens need time (~20–30 min) to absorb into stratum
corneum and become effective; reapply after swimming/sweating.
5. A client applying mafenide acetate (Sulfamylon) to burns complains of
burning/discomfort. The best nursing response is:
A. Notify the RN
B. Discontinue the medication
C. ✅Inform the client that some local burning is normal
D. Apply a thinner film than prescribed
Rationale: Mafenide commonly causes local burning and stinging; the client should be
reassured. Discontinuing or altering dose requires provider input only for severe
reactions.
6. While receiving topical mafenide acetate, which finding indicates a systemic effect?
A. Local pain at burn site
B. Local rash at burn site
C. Elevated blood pressure
D. ✅Hyperventilation
Rationale: Mafenide can inhibit carbonic anhydrase and cause metabolic acidosis;
hyperventilation (respiratory compensation) indicates systemic acid–base disturbance.
Local pain/rash are local effects.
7. Before starting isotretinoin for severe acne, which baseline lab should the nurse expect
to be prescribed?
A. Platelet count
B. ✅Triglyceride level
C. Complete blood count
D. White blood cell count
Rationale: Isotretinoin commonly elevates triglycerides and can cause hepatotoxicity;
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baseline and periodic lipid levels are required. CBC/WBC not primary monitoring tests
for isotretinoin.
8. A client is prescribed isotretinoin. Which concurrent medication should prompt
contacting the prescriber?
A. ✅Vitamin A supplement
B. Digoxin (Lanoxin)
C. Furosemide (Lasix)
D. Phenytoin (Dilantin)
Rationale: Isotretinoin is a vitamin A derivative; supplemental vitamin A increases risk of
hypervitaminosis A/toxicity. The other drugs are not direct contraindications (though all
meds require review).
9. When applying topical corticosteroid for eczema, absorption (and systemic risk) is
greatest at which site?
A. Back
B. ✅Axilla
C. Soles of the feet
D. Palms of the hands
Rationale: Skin sites with thin, highly permeable epidermis (face, axilla, perineum,
genitalia) permit greater systemic absorption. Thick skin (palms/soles, back) absorbs
less.
10. The client takes azelaic acid (Azelex). The nurse would suspect azelaic acid is being used
to treat:
A. ✅Acne
B. Eczema
C. Hair loss
D. Herpes simplex
Rationale: Azelaic acid is used topically for mild–moderate acne (antibacterial and
comedolytic). It is not a treatment for eczema, hair loss, or HSV.
, ESTUDYR
11. A client states, “Silver sulfadiazine (Silvadene) will permanently stain my skin.” This
indicates:
A. Understanding that it’s antibacterial
B. Understanding that it will help heal the burn
C. ✅Lack of understanding — it does NOT permanently stain skin
D. Understanding that it’s applied directly to the wound
Rationale: Silvadene is a topical antibacterial applied directly to burns and helps healing;
it does not permanently stain skin (may temporarily discolor).
12. During an IV antineoplastic infusion the client reports pain at the site; inspection shows
redness, swelling, and slowed infusion rate. The nurse should:
A. ✅Notify the registered nurse immediately
B. Administer pain medication to reduce discomfort
C. Apply ice and maintain the infusion rate
D. Elevate the extremity and slow the infusion
Rationale: These are signs of extravasation with vesicant/antineoplastic agents. Notify
RN/physician immediately for protocol (stop infusion, aspirate, antidote), rather than
continuing or just treating pain.
13. A client receiving IV bleomycin (for squamous cell carcinoma) will require monitoring
with which diagnostic study?
A. Echocardiography
B. Electrocardiography
C. Cervical radiography
D. ✅Pulmonary function studies
Rationale: Bleomycin has notable pulmonary toxicity (interstitial pneumonitis →
fibrosis). Baseline and periodic PFTs and pulmonary assessment are indicated.
14. A client on busulfan (Myleran) for AML should have monitoring of which lab value
particularly?
A. Clotting time
B. ✅Uric acid level
C. Potassium level
D. Blood glucose level
HESI PHARMACOLOGY (NCLEX PN) 2 VERSIONS ACTUAL EXAM COMPLETE 300
QUESTIONS WITH DETAILED VERIFIED ANSWERS ANRATIONALES (100%
CORRECT ANSWERS WITH DETAILED RATIONALES)
1. A client with hyperparathyroidism has a serum calcium of 13 mg/dL. Which medication
should the nurse prepare to administer as prescribed?
A. Calcium chloride
B. Calcium gluconate
C. ✅Calcitonin (Miacalcin)
D. Large doses of vitamin D
Rationale: Serum Ca 13 mg/dL indicates hypercalcemia. Calcitonin lowers serum calcium
by inhibiting bone resorption. Calcium salts would worsen hypercalcemia; vitamin D
increases Ca absorption.
2. A 6-year-old with iron-deficiency anemia is prescribed oral iron. The nurse instructs the
parent to give the iron with which food/drink to increase absorption?
A. Milk
B. Water
C. Apple juice
D. ✅Orange juice
Rationale: Vitamin C (ascorbic acid) enhances nonheme iron absorption. Orange juice
contains more vitamin C than apple juice. Milk can inhibit iron absorption.
3. A client using topical salicylic acid for psoriasis develops systemic toxicity (salicylism).
Which sign would indicate salicylism?
A. Diarrhea
B. Constipation
C. Decreased respirations
D. ✅Tinnitus
Rationale: Tinnitus, dizziness, hyperpnea, and CNS changes are classic signs of salicylate
toxicity. GI symptoms like constipation/diarrhea are not specific to salicylism;
respirations typically increase (hyperventilation) with toxicity.
,ESTUDYR
4. Chemical sunscreens are most effective when applied:
A. Immediately before swimming
B. 15 minutes before exposure to the sun
C. Immediately before exposure to the sun
D. ✅At least 30 minutes before exposure to the sun
Rationale: Chemical sunscreens need time (~20–30 min) to absorb into stratum
corneum and become effective; reapply after swimming/sweating.
5. A client applying mafenide acetate (Sulfamylon) to burns complains of
burning/discomfort. The best nursing response is:
A. Notify the RN
B. Discontinue the medication
C. ✅Inform the client that some local burning is normal
D. Apply a thinner film than prescribed
Rationale: Mafenide commonly causes local burning and stinging; the client should be
reassured. Discontinuing or altering dose requires provider input only for severe
reactions.
6. While receiving topical mafenide acetate, which finding indicates a systemic effect?
A. Local pain at burn site
B. Local rash at burn site
C. Elevated blood pressure
D. ✅Hyperventilation
Rationale: Mafenide can inhibit carbonic anhydrase and cause metabolic acidosis;
hyperventilation (respiratory compensation) indicates systemic acid–base disturbance.
Local pain/rash are local effects.
7. Before starting isotretinoin for severe acne, which baseline lab should the nurse expect
to be prescribed?
A. Platelet count
B. ✅Triglyceride level
C. Complete blood count
D. White blood cell count
Rationale: Isotretinoin commonly elevates triglycerides and can cause hepatotoxicity;
,ESTUDYR
baseline and periodic lipid levels are required. CBC/WBC not primary monitoring tests
for isotretinoin.
8. A client is prescribed isotretinoin. Which concurrent medication should prompt
contacting the prescriber?
A. ✅Vitamin A supplement
B. Digoxin (Lanoxin)
C. Furosemide (Lasix)
D. Phenytoin (Dilantin)
Rationale: Isotretinoin is a vitamin A derivative; supplemental vitamin A increases risk of
hypervitaminosis A/toxicity. The other drugs are not direct contraindications (though all
meds require review).
9. When applying topical corticosteroid for eczema, absorption (and systemic risk) is
greatest at which site?
A. Back
B. ✅Axilla
C. Soles of the feet
D. Palms of the hands
Rationale: Skin sites with thin, highly permeable epidermis (face, axilla, perineum,
genitalia) permit greater systemic absorption. Thick skin (palms/soles, back) absorbs
less.
10. The client takes azelaic acid (Azelex). The nurse would suspect azelaic acid is being used
to treat:
A. ✅Acne
B. Eczema
C. Hair loss
D. Herpes simplex
Rationale: Azelaic acid is used topically for mild–moderate acne (antibacterial and
comedolytic). It is not a treatment for eczema, hair loss, or HSV.
, ESTUDYR
11. A client states, “Silver sulfadiazine (Silvadene) will permanently stain my skin.” This
indicates:
A. Understanding that it’s antibacterial
B. Understanding that it will help heal the burn
C. ✅Lack of understanding — it does NOT permanently stain skin
D. Understanding that it’s applied directly to the wound
Rationale: Silvadene is a topical antibacterial applied directly to burns and helps healing;
it does not permanently stain skin (may temporarily discolor).
12. During an IV antineoplastic infusion the client reports pain at the site; inspection shows
redness, swelling, and slowed infusion rate. The nurse should:
A. ✅Notify the registered nurse immediately
B. Administer pain medication to reduce discomfort
C. Apply ice and maintain the infusion rate
D. Elevate the extremity and slow the infusion
Rationale: These are signs of extravasation with vesicant/antineoplastic agents. Notify
RN/physician immediately for protocol (stop infusion, aspirate, antidote), rather than
continuing or just treating pain.
13. A client receiving IV bleomycin (for squamous cell carcinoma) will require monitoring
with which diagnostic study?
A. Echocardiography
B. Electrocardiography
C. Cervical radiography
D. ✅Pulmonary function studies
Rationale: Bleomycin has notable pulmonary toxicity (interstitial pneumonitis →
fibrosis). Baseline and periodic PFTs and pulmonary assessment are indicated.
14. A client on busulfan (Myleran) for AML should have monitoring of which lab value
particularly?
A. Clotting time
B. ✅Uric acid level
C. Potassium level
D. Blood glucose level
