HESI Pharmacology Practice Exam

Correct Answer A: I need to obtain a yearly influenza vaccine.

Explanation of Correct Answer:

Cyclosporine (Sandimmune) is an immunosuppressive medication used to prevent organ rejection following kidney transplants. One of the main concerns with immunosuppressants like cyclosporine is that they make the body more vulnerable to infections, including respiratory infections like the flu. Therefore, it is highly recommended that individuals taking immunosuppressants get an annual flu vaccine to reduce the risk of contracting the virus and suffering from complications.

A yearly influenza vaccine is a standard precaution for transplant recipients to help prevent flu-related complications, which can be serious for individuals with compromised immune systems.

Why the Other Options Are Incorrect:

B. I need to have dental checkups every 3 months.

This is incorrect because while it is important for patients taking cyclosporine to receive regular dental checkups due to the risk of gingival hyperplasia, the frequency of checkups every 3 months is not necessarily required. Typically, dental checkups every 6 months are sufficient unless the client has specific oral health issues. The recommendation for more frequent visits might be due to personalized needs or the severity of side effects.

C. I need to self-monitor my blood pressure at home.

This is correct but not the best answer in this case. While self-monitoring of blood pressure is important for clients on cyclosporine (as it can cause hypertension), the key instruction that stands out in this context is obtaining a yearly flu vaccine. Monitoring blood pressure is certainly important, but it is a more routine measure rather than one that directly relates to preventing infection or complications from immunosuppressive therapy.

D. I need to call the health care provider (HCP) if my urine volume decreases or my urine becomes cloudy.

This is correct and very important as cyclosporine can cause nephrotoxicity (kidney damage). However, the priority action for this scenario is the yearly flu vaccine as part of routine preventive care for immunocompromised individuals.

Summary:

The most important instruction for the client taking cyclosporine is obtaining an annual influenza vaccine to reduce the risk of infection due to the immunosuppressive effects of the medication. Other important actions like self-monitoring blood pressure and reporting changes in urine output are also critical but relate to other aspects of managing cyclosporine therapy.

Correct Answer C: Early morning

Why this answer is correct:

Prednisone is a corticosteroid that mimics the natural secretion of cortisol, which is produced by the adrenal glands in a diurnal pattern. The highest levels of cortisol are typically produced in the early morning (around 6 to 8 a.m.) to help the body cope with the stresses of the day. To align with the body's natural rhythms and reduce the risk of side effects such as insomnia and adrenal suppression, it is recommended that prednisone be taken in the early morning, preferably with food to minimize gastric irritation.

Why the other options are incorrect:

A. At noon

Taking prednisone at noon could interfere with the body's natural cortisol rhythm. This could increase the risk of side effects such as insomnia or mood changes later in the day due to the way the body metabolizes the medication. The ideal timing is in the morning when cortisol levels are naturally highest.

B. At bedtime

Taking prednisone at bedtime is generally not recommended, as it could interfere with sleep due to its stimulant-like effects. Prednisone can increase energy and cause insomnia, making it harder for the client to fall asleep if taken too late in the day.

D. Anytime, at the same time, each day

While it is important to take prednisone at the same time each day to maintain a consistent level of the drug in the body, early morning is the optimal time for administration. Taking it at any time may not align with the body's natural cortisol production cycle and may increase the risk of side effects.

Summary:

The best time to take prednisone is in the early morning, ideally with food, to align with the body's natural cortisol secretion patterns and reduce the risk of side effects such as insomnia or mood disturbances.

Correct Answer A: Protamine sulfate

Why this answer is correct:

Protamine sulfate is the antidote for heparin overdose or excessive anticoagulation. Heparin is a blood thinner that inhibits the formation of blood clots, and in cases where there is excessive bleeding or overanticoagulation, protamine sulfate can be administered to reverse the effects of heparin. The nurse must ensure that protamine sulfate is available on the unit in case of emergency situations where heparin reversal is needed.

Why the other options are incorrect:

B. Potassium chloride

Potassium chloride is used to correct potassium deficiencies. While hypokalemia (low potassium) can be a concern in various clinical settings, it is not related to heparin therapy. The administration of potassium chloride is not necessary for managing heparin therapy or overdose.

C. Phytonadione (vitamin K)

Phytonadione (vitamin K) is used as an antidote for warfarin (Coumadin) overdose, not for heparin overdose. Warfarin and heparin are both anticoagulants, but they work via different mechanisms. Vitamin K would not be effective in reversing the effects of heparin.

D. Aminocaproic acid (Amicar)

Aminocaproic acid is an antifibrinolytic agent used to prevent excessive bleeding in situations where fibrinolysis (the breakdown of clots) is occurring excessively, such as in bleeding disorders or post-surgical bleeding. It is not used to reverse the effects of heparin therapy.

Summary:

Protamine sulfate is the appropriate medication to reverse the anticoagulant effects of heparin, making A the correct answer.

Correct Answer C: Treat hypocalcemic tetany

Explanation:

Calcium gluconate is prescribed after a thyroidectomy to treat or prevent hypocalcemic tetany, a condition caused by accidental removal or damage to the parathyroid glands during surgery. The parathyroid glands regulate calcium levels, and their impairment leads to decreased serum calcium. Symptoms include muscle cramps, tingling around the mouth or in the extremities, carpopedal spasms, and in severe cases, laryngospasm. Calcium gluconate is administered intravenously to rapidly correct serum calcium levels and alleviate symptoms.

Why the Other Options Are Incorrect:

A. Treat thyroid storm

Thyroid storm is a life-threatening complication of hyperthyroidism characterized by fever, tachycardia, and altered mental status. Treatment includes antithyroid medications (e.g., propylthiouracil), beta blockers, corticosteroids, and supportive care—not calcium gluconate. Calcium plays no direct role in treating thyroid storm.

B. Prevent cardiac irritability

While hypocalcemia can cause cardiac irritability, the specific indication here is hypocalcemic tetany, which presents with more urgent neuromuscular symptoms. Calcium gluconate might incidentally stabilize cardiac rhythm in hypocalcemia, but the primary purpose post-thyroidectomy is to address tetany from low calcium due to parathyroid dysfunction.

D. Stimulate the release of parathyroid hormone

Calcium gluconate does not stimulate the release of parathyroid hormone (PTH). In fact, increased calcium levels in the blood inhibit PTH release through negative feedback. This choice is incorrect because calcium gluconate addresses the effects of low PTH (hypocalcemia), rather than stimulating its production.

Summary:

The nurse correctly identifies that calcium gluconate is prescribed after thyroidectomy to treat hypocalcemic tetany (C), which can result from accidental damage or removal of the parathyroid glands. It is not used for thyroid storm (A), general cardiac irritability (B), or to stimulate PTH release (D). Prompt recognition and treatment of hypocalcemia are crucial to prevent complications such as laryngospasm and seizures.

Correct Answer D: Vomiting following cancer chemotherapy

Why this answer is correct:

Metoclopramide (Reglan) is a prokinetic agent that increases gastrointestinal motility and is commonly used to treat conditions such as nausea and vomiting, particularly those related to chemotherapy. It is highly effective in controlling chemotherapy-induced nausea and vomiting (CINV) by blocking dopamine receptors in the brain's chemoreceptor trigger zone, which reduces the sensation of nausea. Therefore, it can be safely used in clients experiencing vomiting following cancer chemotherapy.

Why the other options are incorrect:

A. Intestinal obstruction

Metoclopramide increases gastrointestinal motility, which can worsen an existing intestinal obstruction. It is contraindicated in cases of bowel obstruction because enhancing motility could lead to more severe complications, such as perforation or ischemia.

B. Peptic ulcer with melena

In cases of peptic ulcer disease with melena (indicating active gastrointestinal bleeding), metoclopramide is not recommended. Although metoclopramide helps with nausea and vomiting, it does not address the underlying issues related to active bleeding in the gastrointestinal tract and could potentially exacerbate bleeding due to its effects on motility.

C. Diverticulitis with perforation

Metoclopramide should not be used in diverticulitis with perforation because it could increase the risk of worsening gastrointestinal injury or perforation. In such cases, treating the infection and stabilizing the client is the priority, not stimulating motility with a prokinetic agent like metoclopramide.

Summary:

Metoclopramide (Reglan) can be safely administered for vomiting following cancer chemotherapy, as it is effective in controlling chemotherapy-induced nausea and vomiting. It should be avoided in conditions that could be worsened by increased motility, such as intestinal obstruction, peptic ulcers with active bleeding, and diverticulitis with perforation.

Correct Answer D: Orthostatic hypotension

Explanation:

Etoposide (VePesid), a chemotherapy agent used in the treatment of small cell lung cancer, is known to cause various side effects. One specific side effect associated with etoposide is orthostatic hypotension. This condition occurs when there is a significant drop in blood pressure when a person moves from a lying or sitting position to a standing position. It can be caused by the vasodilatory effects of chemotherapy agents like etoposide. The exact mechanism is not fully understood, but it is thought that chemotherapy can affect the autonomic nervous system or lead to dehydration, both of which can contribute to orthostatic hypotension. This side effect can cause dizziness, lightheadedness, or fainting upon standing, which the nurse should monitor closely.

Explanation of Incorrect Options:

A. Alopecia – While alopecia (hair loss) is a common side effect of many chemotherapy agents, including etoposide, it is not the most specifically associated with it in this case. Alopecia occurs due to the chemotherapy's effect on rapidly dividing cells, but the most direct association here is with orthostatic hypotension.

B. Chest pain – Chest pain is not typically associated with etoposide therapy. It can occur in some cases due to underlying conditions or other causes, but it is not a known or common side effect of etoposide.

C. Pulmonary fibrosis – Pulmonary fibrosis is more commonly associated with other chemotherapy agents, such as bleomycin, and is less of a concern with etoposide. While some lung toxicity can occur, pulmonary fibrosis is not a primary side effect of etoposide.

Summary:

Orthostatic hypotension is a side effect specifically associated with etoposide (VePesid) due to its vasodilatory effects and impact on the autonomic nervous system. Correct answer: D. Orthostatic hypotension.

Correct Answer C: 11.3 ml/hour

Explanation:

We are given the following information:

Prescribed dose: 5 mcg/kg/min

Client weight: 75 kg

Dobutamine concentration: 0.5 grams in 250 ml

Step 1: Convert dobutamine from grams to micrograms.

1 gram = 1,000,000 mcg, so 0.5 grams = 500,000 mcg.

Step 2: Determine the concentration in mcg/ml.

The concentration is 500,000 mcg in 250 ml.

Concentration (mcg/ml) = 500,000 mcg ÷ 250 ml = 2,000 mcg/ml.

Step 3: Calculate the required dose in mcg/min.

The ordered rate is 5 mcg/kg/min.

Dose (mcg/min) = 5 mcg/kg/min × 75 kg = 375 mcg/min.

Step 4: Calculate the volume required to deliver 375 mcg per minute.

Volume (ml/min) = 375 mcg ÷ 2,000 mcg/ml = 0.1875 ml/min.

Step 5: Convert the rate to ml/hour.

0.1875 ml/min × 60 minutes = 11.25 ml/hour, which rounds to 11.3 ml/hour.

Explanation of Incorrect Options:

A. 10 ml/hour – This would result in a lower dose than prescribed.

B. 11 ml/hour – This would result in a slightly lower dose than required.

D. 12 ml/hour – This would result in a higher dose than prescribed.

Summary:

The nurse should program the infusion pump to deliver 11.3 ml/hour to administer the correct dose. Correct answer: C. 11.3 ml/hour.

Correct Answer B: 2.3 ml

Explanation:

We are given:

Prescribed dose of amikacin = 0.572 grams

Available concentration = 250 mg/ml

Step 1: Convert the prescribed dose to milligrams.

0.572 grams × 1000 = 572 mg

Step 2: Use the concentration to calculate the volume to administer.

572 mg ÷ 250 mg/ml = 2.288 ml

Step 3: Round to the nearest tenth.

2.288 rounds to 2.3 ml

Explanation of Incorrect Options:

A. 2.0 ml – This would provide only 500 mg, which is less than the prescribed 572 mg.

C. 2.5 ml – This would provide 625 mg, which is more than prescribed.

D. 2.7 ml – This would provide 675 mg, which is much higher than the prescribed dose.

Summary:

The nurse should add 2.3 ml of amikacin to the infusion to deliver the correct dose. Correct answer: B. 2.3 ml.

Correct Answer A: Hyperventilation

Explanation:

Mafenide acetate (Sulfamylon) is a topical antimicrobial commonly used for burn injuries to prevent infection. While it is generally well-tolerated, it can cause systemic effects, especially when used in large amounts or for extended periods. One of the potential systemic effects of Mafenide acetate is metabolic acidosis, which can lead to symptoms such as hyperventilation. Hyperventilation is the body’s attempt to compensate for the acidosis by exhaling more carbon dioxide, which helps to raise blood pH.

When monitoring a client receiving Mafenide acetate, hyperventilation can indicate that the client is experiencing a systemic effect, likely metabolic acidosis due to the medication's ability to inhibit carbonic anhydrase and affect acid-base balance. This side effect warrants prompt attention, as it can signal that the medication is having an adverse systemic impact.

Explanation of Incorrect Options:

B. Elevated blood pressure:

While elevated blood pressure may occur for various reasons, it is not a typical sign of systemic toxicity from Mafenide acetate. The more common issue is acidosis, not hypertension.

C. Local pain at the burn site:

Local pain is a common expected effect of both the burn injury itself and the topical application of Mafenide acetate. This is not indicative of a systemic effect, but rather a local reaction.

D. Local rash at the burn site:

A local rash is also a possible reaction at the application site, but it does not indicate a systemic effect. A rash may indicate a local allergic reaction or irritation, but it is not typically associated with systemic toxicity.

Summary:

Hyperventilation (A) is a sign of systemic toxicity from Mafenide acetate (Sulfamylon), potentially indicating metabolic acidosis. This warrants closer monitoring and possible intervention. Other symptoms like local pain or rash (C and D) are expected side effects of the medication and do not indicate a systemic effect. Elevated blood pressure (B) is not a typical systemic effect of Mafenide acetate.