2020 HESI Pharmacology Version 1 With Answers (100 Solved Questions)

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2020 HESI Pharmacology Version 1–Questions 1through 1001) A nurse is caring for a client with hyperparathyroidism and notes that the client'sserum calcium level is 13 mg/dL. Which medication should the nurse prepare toadminister as prescribed to the client?1.Calcium chloride2.Calcium gluconate3.Calcitonin (Miacalcin)4.Large doses of vitamin D3. Calcitonin (Miacalcin)Rationale:The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencinghypercalcemia. Calcium gluconate and calcium chloride are medications used forthe treatment of tetany, which occurs as a result of acute hypocalcemia. Inhypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroidhormone, decreases the plasma calcium level by inhibiting bone resorption andlowering the serum calcium concentration.2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiencyanemia. The nurse instructs the mother to administer the iron with which best fooditem?1.Milk2.Water3.Apple juice4.Orange juice4. Orange juiceRationale:Vitamin C increases the absorption of iron by the body. The mother should beinstructed to administer the medication with a citrus fruit or a juice that is high invitamin 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.3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nursemonitors the client, knowing that which of the following would indicate the presenceof systemic toxicity from this medication?1.Tinnitus2.Diarrhea3.Constipation4.Decreased respirations1. TinnitusRationale:

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Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism)can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychologicaldisturbances. Constipation and diarrhea are not associated with salicylism.4.) The camp nurse asks the children preparing to swim in the lake if they haveapplied sunscreen. The nurse reminds the children that chemical sunscreens aremost effective when applied:1.Immediately before swimming2.15 minutes before exposure to the sun3.Immediately before exposure to the sun4.At least 30 minutes before exposure to the sun4. At least 30 minutes beforeexposure to the sunRationale:Sunscreens are most effective when applied at least 30 minutes before exposure tothe sun so that they can penetrate the skin. All sunscreens should be reapplied afterswimming or sweating.5.) 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 nurse2.Discontinuing the medication3.Informing the client that this is normal4.Applying a thinner film than prescribed to the burn site 3. Informing the clientthat this is normalRationale:Mafenide acetate is bacteriostatic for gram-negative and gram-positive organismsand is used to treat burns to reduce bacteria present in avascular tissues. The clientshould be informed that the medication will cause local discomfort and burning andthat this is a normal reaction; therefore options 1, 2, and 4 are incorrect6.) 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 thefollowing indicates that a systemic effect has occurred?1.Hyperventilation2.Elevated blood pressure3.Local pain at the burn site4.Local rash at the burn site1.Hyperventilation

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Rationale:Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretionof acid, thereby causing acidosis. Clients receiving this treatment should bemonitored for signs of an acid-base imbalance (hyperventilation). If this occurs, themedication should be discontinued for 1 to 2 days. Options 3 and 4 describe localrather than systemic effects. An elevated blood pressure may be expected from thepain that occurs with a burn injury.7.) Isotretinoin is prescribed for a client with severe acne. Before the administrationof this medication, the nurse anticipates that which laboratory test will beprescribed?1.Platelet count2.Triglyceride level3.Complete blood count4.White blood cell count 2. Triglyceride levelRationale:Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should bemeasured before treatment and periodically thereafter until the effect on thetriglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitoredspecifically during this treatment.8.) 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 wouldcontact the (HCP) if the client is taking which medication?1.Vitamin A2.Digoxin (Lanoxin)3.Furosemide (Lasix)4.Phenytoin (Dilantin)1. Vitamin ARationale:Isotretinoin is a metabolite of vitamin A and can produce generalized intensificationof isotretinoin toxicity. Because of the potential for increased toxicity, vitamin Asupplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4are not contraindicated with the use of isotretinoin.9.) The nurse is applying a topical corticosteroid to a client with eczema. The nursewould monitor for the potential for increased systemic absorption of the medicationif the medication were being applied to which of the following body areas?1.Back2.Axilla

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3.Soles of the feet4.Palms of the hands2. AxillaRationale:Topical corticosteroids can be absorbed into the systemic circulation. Absorption ishigher from regions where the skin is especially permeable (scalp, axilla, face,eyelids, neck, perineum, genitalia), and lower from regions in which permeability ispoor (back, palms, soles).10.) The clinic nurse is performing an admission assessment on a client. The nursenotes that the client is taking azelaic acid (Azelex). Because of the medicationprescription, the nurse would suspect that the client is being treated for:1.Acne2.Eczema3.Hair loss4.Herpes simplex 1. AcneRationale:Azelaic acid is a topical medication used to treat mild to moderate acne. The acidappears to work by suppressing the growth of Propionibacterium acnes anddecreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for theclient with a partial-thickness burn, which has cultured positive for gram-negativebacteria. The nurse is reinforcing information to the client about the medication.Which statement made by the client indicates a lack of understanding about thetreatments?1."The medication is an antibacterial."2."The medication will help heal theburn."3."The medication will permanently stain myskin."4."The medication should be applied directly to the wound."3. "The medicationwill permanently stain my skin."Rationale:Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum ofactivity against gram-negative bacteria, gram-positive bacteria, and yeast. It isapplied directly to the wound to assist in healing. It does not stain the skin.12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of anantineoplastic medication. During the infusion, the client complains of pain at theinsertion site. During an inspection of the site, the nurse notes redness and swelling

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and that the rate of infusion of the medication has slowed. The nurse should takewhich appropriate action?1.Notify the registered nurse.2.Administer pain medication to reduce thediscomfort.3.Apply ice and maintain the infusion rate, as prescribed.4.Elevate the extremity of the IV site, and slow the infusion.1. Notify theregistered nurse.Rationale:When antineoplastic medications (Chemotheraputic Agents) are administered via IV,great care must be taken to prevent the medication from escaping into the tissuessurrounding the injection site, because pain, tissue damage, and necrosis can result.The nurse monitors for signs of extravasation, such as redness or swelling at theinsertion site and a decreased infusion rate. If extravasation occurs, the registerednurse needs to be notified; he or she will then contact the health care provider.13.) The client with squamous cell carcinoma of the larynx is receiving bleomycinintravenously. The nurse caring for the client anticipates that which diagnostic studywill be prescribed?1.Echocardiography2.Electrocardiography3.Cervical radiography4.Pulmonary function studies4. Pulmonary function studiesRationale:Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can causeinterstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonaryfunction studies along with hematological, hepatic, and renal function tests need tobe monitored. The nurse needs to monitor lung sounds for dyspnea and crackles,which indicate pulmonary toxicity. The medication needs to be discontinuedimmediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to thespecific use of this medication.14.) The client with acute myelocytic leukemia is being treated with busulfan(Myleran). Which laboratory value would the nurse specifically monitor duringtreatment with this medication?1.Clotting time2.Uric acid level3.Potassium level4.Blood glucose level2. Uric acid level

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Rationale:Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia canproduce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3,and 4 are not specifically related to this medication.15.) The client with small cell lung cancer is being treated with etoposide (VePesid).The nurse who is assisting in caring for the client during its administrationunderstands that which side effect is specifically associated with this medication?1.Alopecia2.Chest pain3.Pulmonary fibrosis4.Orthostatic hypotension4. Orthostatic hypotensionRationale:A side effect specific to etoposide is orthostatic hypotension. The client's bloodpressure is monitored during the infusion. Hair loss occurs with nearly all theantineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to thismedication.16.) The clinic nurse is reviewing a teaching plan for the client receiving anantineoplastic medication. When implementing the plan, the nurse tells the client:1.To take aspirin (acetylsalicylic acid) as needed forheadache2.Drink beverages containing alcohol in moderate amounts each evening3.Consult with health care providers (HCPs) before receiving immunizations4.That it is not necessary to consult HCPs before receiving a flu vaccine at the localhealth fair3. Consult with health care providers (HCPs) before receivingimmunizationsRationale:Because antineoplastic medications lower the resistance of the body, clients mustbe informed not to receive immunizations without a HCP's approval. Clients alsoneed to avoid contact with individuals who have recently received a live virusvaccine. Clients need to avoid aspirin and aspirin-containing products to minimizethe risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicityand side effects.17.) The client with ovarian cancer is being treated with vincristine (Oncovin). Thenurse monitors the client, knowing that which of the following indicates a side effectspecific to this medication?1.Diarrhea2.Hair loss

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3.Chest pain4.Numbness and tingling in the fingersand toes4. Numbness and tingling inthefingers and toesRationale:A side effect specific to vincristine is peripheral neuropathy, which occurs in almostevery client. Peripheral neuropathy can be manifested as numbness and tingling inthe fingers and toes. Depression of the Achilles tendon reflex may be the firstclinical sign indicating peripheral neuropathy. Constipation rather than diarrhea ismost likely to occur with this medication, although diarrhea may occur occasionally.Hair loss occurs with nearly all the antineoplastic medications. Chest pain isunrelated to this medication.18.) The nurse is reviewing the history and physical examination of a client who willbe receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults withthe registered nurse regarding the administration of the medication if which of thefollowing is documented in the client'shistory?1.Pancreatitis2.Diabetes mellitus3.Myocardial infarction4.Chronic obstructive pulmonary disease1. PancreatitisRationale:Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, orif the client has a history of pancreatitis. The medication impairs pancreatic functionand pancreatic function tests should be performed before therapy begins and whena week or more has elapsed between administration of the doses. The client needsto be monitored for signs of pancreatitis, which include nausea, vomiting, andabdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicatedwith this medication.19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. Thenurse understands that the primary action of this medication is to:1.Increase DNA and RNA synthesis.2.Promote the biosynthesis of nucleic acids.3.Increase estrogen concentration and estrogen response.4.Compete with estradiol for binding to estrogen in tissues containing highconcentrations of receptors.4. Compete with estradiol for binding to estrogen intissues containing high concentrations of receptors.Rationale:

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Tamoxifen is an antineoplastic medication that competes with estradiol for bindingto estrogen in tissues containing high concentrations of receptors. Tamoxifen is usedto treat metastatic breast carcinoma in women and men. Tamoxifen is also effectivein delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNAsynthesis and estrogen response.20.) The client with metastatic breast cancer is receiving tamoxifen. The nursespecifically monitors which laboratory value while the client is taking thismedication?1.Glucoselevel2.Calcium level3.Potassium level4.Prothrombin time2. Calcium levelRationale:Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before theinitiation of therapy, a complete blood count, platelet count, and serum calciumlevels should be assessed. These blood levels, along with cholesterol andtriglyceride levels, should be monitored periodically during therapy. The nurseshould assess for hypercalcemia while the client is taking this medication. Signs ofhypercalcemia include increased urine volume, excessive thirst, nausea, vomiting,constipation, hypotonicity of muscles, and deep bone and flank pain.21.) A nurse is assisting with caring for a client with cancer who is receivingcisplatin. Select the adverse effects that the nurse monitors for that are associatedwith this medication. Select all that apply.1.Tinnitus2.Ototoxicity3.Hyperkalemia4.Hypercalcemia5.Nephrotoxicity6.Hypomagnesemia1. Tinnitus2. Ototoxicity5.Nephrotoxicity6.HypomagnesemiaRationale:Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus,

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hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine(Ethyol) may be administered before cisplatin to reduce the potential for renaltoxicity.22.) A nurse is caring for a client after thyroidectomy and notes that calciumgluconate is prescribed for the client. The nurse determines that this medication hasbeen prescribed to:1.Treat thyroid storm.2.Prevent cardiac irritability.3.Treat hypocalcemic tetany.4.Stimulate the release of parathyroid hormone.3. Treat hypocalcemic tetany.Rationale:Hypocalcemia can develop after thyroidectomy if the parathyroid glands areaccidentally removed or injured during surgery. Manifestations develop 1 to 7 daysafter surgery. If the client develops numbness and tingling around the mouth,fingertips, or toes or muscle spasms or twitching, the health care provider is notifiedimmediately. Calcium gluconate should be kept at the bedside.23.) A client who has been newly diagnosed with diabetes mellitus has beenstabilized with daily insulin injections. Which information should the nurse teachwhen 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.2. Rotate theinsulin injection sites systematically.Rationale:Insulin dosages should not be adjusted or increased before unusual exercise. Ifacetone is found in the urine, it may possibly indicate the need for additionalinsulin. To minimize the discomfort associated with insulin injections, the insulinshould be administered at room temperature. Injection sites should besystematically rotated from one area to another. The client should be instructed togive injections in one area, about 1 inch apart, until the whole area has been usedand then to change to another site. This prevents dramatic changes in daily insulinabsorption.24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulinand NPH insulin in the same syringe. Which of the following actions, if performed bythe client, indicates the need for further teaching?1.Withdraws the NPH insulin first

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2.Withdraws the regular insulin first3.Injects air into NPH insulin vialfirst4.Injects an amount of air equal to the desired dose of insulin into the vial1.Withdraws the NPH insulin firstRationale:When preparing a mixture of regular insulin with another insulin preparation, theregular insulin is drawn into the syringe first. This sequence will avoidcontaminating the vial of regular insulin with insulin of another type. Options 2, 3,and 4 identify the correct actions for preparing NPH and regular insulin.25.) A home care nurse visits a client recently diagnosed with diabetes mellitus whois taking Humulin NPH insulin daily. The client asks the nurse how to store theunopened vials of insulin. The nurse tells the client to:1.Freeze the insulin.2.Refrigerate the insulin.3.Store the insulin in a dark, dry place.4.Keep the insulin at room temperature.2. Refrigerate the insulin.Rationale:Insulin in unopened vials should be stored under refrigeration until needed. Vialsshould not be frozen. When stored unopened under refrigeration, insulin can beused up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nursereinforces instructions for the client and tells the client to avoid which of thefollowing while taking this medication?1.Alcohol2.Organ meats3.Whole-grain cereals4.Carbonated beverages1. AlcoholRationale:When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction mayoccur. This syndrome includes flushing, palpitations, and nausea. Alcohol can alsopotentiate the hypoglycemic effects of the medication. Clients need to be instructedto avoid alcohol consumption while taking this medication. The items in options 2,3, and 4 do not need to be avoided.27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. Anurse reviews the client's medical record and would question the prescription ifwhich of the following is noted in the client's history?

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1.Neuralgia2.Insomnia3.Use of nitroglycerin4.Use of multivitamins3. Use of nitroglycerinRationale:Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpuscavernosum of the penis, thus sustaining an erection. Because of the effect of themedication, it is contraindicated with concurrent use of organic nitrates andnitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgiaand insomnia are side effects of the medication.28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client withtype 1 diabetes mellitus who takes insulin. The nurse knows that which of thefollowing is the appropriate intervention?1.The medication is administered within 60 minutes before the morning andevening meal.2.The medication is withheld and the HCP is called to question the prescription forthe client.3.The client is monitored for gastrointestinal side effects after administration of themedication.4.The insulin is withdrawn from the Penlet into an insulin syringe to prepare foradministration.2. The medication is withheld and the HCP is called to questionthe prescription for the client.Rationale:Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It isnot recommended for clients taking insulin. Hence, the nurse should hold themedication and question the HCP regarding this prescription. Although options 1and 3 are correct statements about the medication, in this situation the medicationshould not be administered. The medication is packaged in prefilled pens ready forinjection without the need for drawing it up into another syringe.29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforcesinstructions for the client and tells the client that the most likely time for ahypoglycemic reaction to occur is:1.2 to 4 hours after administration2.4 to 12 hours after administration3.16 to 18 hours after administration4.18 to 24 hours after administration 2. 4 to 12 hours after administration

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Rationale:Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, itpeaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemicreactions most likely occur during peaktime.30.) A client with diabetes mellitus visits a health care clinic. The client's diabetesmellitus previously had been well controlled with glyburide (DiaBeta) daily, butrecently the fasting blood glucose level has been 180 to 200 mg/dL. Whichmedication, if added to the client's regimen, may have contributed to thehyperglycemia?1.Prednisone2.Phenelzine (Nardil)3.Atenolol (Tenormin)4.Allopurinol (Zyloprim) 1. PrednisoneRationale:Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, andpotassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, aβ-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreasesurinary excretion of sulfonylurea agents, causing increased levels of the oral agents,which can lead to hypoglycemia.31.) A community health nurse visits a client at home. Prednisone 10 mg orally dailyhas been prescribed for the client and the nurse reinforces teaching for the clientabout the medication. Which statement, if made by the client, indicates that furtherteaching is necessary?1."I can take aspirin or my antihistamine if I need it."2."I need to take the medication every day at the same time."3."I need to avoid coffee, tea, cola, and chocolate in my diet."4."If I gain more than 5 pounds a week, I will call my doctor."1. "I can takeaspirin or my antihistamine if I need it."Rationale:Aspirin and other over-the-counter medications should not be taken unless theclient consults with the health care provider (HCP). The client needs to take themedication at the same time every day and should be instructed not to stop themedication. A slight weight gain as a result of an improved appetite is expected, butafter the dosage is stabilized, a weight gain of 5 lb or more weekly should bereported to the HCP. Caffeine-containing foods and fluids need to be avoidedbecause they may contribute to steroid-ulcerdevelopment.

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