HESI Pharmacology Practice Exam
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Free HESI Pharmacology Practice Exam Questions
A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following indicates toxicity associated with the medication
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Sodium of 140 mEq/L
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Prothrombin time of 12 seconds
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Platelet count of 400,000 cells/mm3
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A direct bilirubin level of 2 mg/dL
Explanation
Correct Answer D: A direct bilirubin level of 2 mg/dL
Why this answer is correct:
Acetaminophen (Tylenol) in high doses or with chronic use can cause hepatotoxicity, especially when taken above recommended limits. The liver metabolizes acetaminophen, and excessive doses overwhelm the liver’s capacity, leading to accumulation of toxic metabolites and liver cell damage. One of the key markers of liver injury is elevated bilirubin, especially direct (conjugated) bilirubin, which reflects impaired hepatic excretion. A normal direct bilirubin level is generally less than 0.3 mg/dL. A value of 2 mg/dL is significantly elevated and strongly suggests liver dysfunction, which may be a consequence of acetaminophen toxicity.
Why the other options are incorrect:
A. Sodium of 140 mEq/L
This is a normal sodium level (normal range: 135–145 mEq/L) and does not indicate any toxicity or imbalance. It is unrelated to acetaminophen metabolism or toxicity.
B. Prothrombin time of 12 seconds
This value is within the normal range (usually 11–13.5 seconds). Although liver dysfunction can prolong prothrombin time due to impaired synthesis of clotting factors, this value does not indicate coagulopathy or toxicity. A prolonged PT might appear later with significant liver damage, but this value is currently normal.
C. Platelet count of 400,000 cells/mm³
This is also a normal platelet count (normal range: 150,000–450,000 cells/mm³). Platelet levels are not a primary indicator of acetaminophen toxicity, and this number does not indicate any hematologic abnormality.
Summary:
The most indicative lab result of acetaminophen toxicity in this scenario is an elevated direct bilirubin level, which points to liver dysfunction. The other lab values are within normal limits and do not suggest toxicity. Therefore, the correct answer is D because it reflects the most relevant laboratory abnormality associated with acetaminophen-induced hepatotoxicity.
A client with Mycobacterium avium complex (MAC) is receiving an infusion of 5 % dextrose in water with amikacin (Amikin) 0.572 grams/100 ml every 12 hours. The nurse prepares the dose of amikacin using a vial labeled, 250 mg/ml. How many ml should the nurse add to the infusion
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2.0 ml
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2.3 ml
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2.5 ml
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2.7 ml
Explanation
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.
A health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which of the following times
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At bedtime
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After lunch
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With supper
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Before breakfast
Explanation
Correct Answer A: At bedtime
Why this answer is correct:
Ranitidine (Zantac) is a histamine-2 (H2) blocker that reduces stomach acid production. It is commonly prescribed to treat conditions like peptic ulcers or gastroesophageal reflux disease (GERD). The most effective time to administer ranitidine is at bedtime, as this helps to reduce nocturnal acid secretion and prevents acid reflux during sleep. This is especially helpful for clients who experience symptoms of acid reflux or ulcers at night.
Why the other options are incorrect:
B. After lunch
This is not the ideal time for administering ranitidine because it may not be as effective in controlling nighttime acid production, which is often when reflux or ulcers cause significant symptoms.
C. With supper
While taking ranitidine with a meal might help control symptoms after eating, the optimal time is at bedtime to address acid secretion during the night. Administering it with supper may not provide the same level of benefit for nocturnal symptoms.
D. Before breakfast
Taking ranitidine before breakfast is not as effective as taking it at bedtime for managing nocturnal acid secretion. While it could provide some benefit during the day, it would not address nighttime symptoms as effectively.
Summary:
Ranitidine (Zantac) should be taken at bedtime to maximize its effectiveness in controlling nocturnal acid secretion, which is especially important for conditions like GERD and peptic ulcers.
A nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs), by metered- dose inhaler. The nurse administers the medication by giving the
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Albuterol first and then the beclomethasone dipropionate
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Beclomethasone dipropionate first and then the albuterol
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Alternating a single puff of each, beginning with the albuterol
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Alternating a single puff of each, beginning with the beclomethasone dipropionate
Explanation
Correct Answer A: Albuterol first and then the beclomethasone dipropionate
Why this answer is correct:
When administering bronchodilators and anti-inflammatory corticosteroids via a metered-dose inhaler (MDI), the bronchodilator (in this case, albuterol) should be administered first. The reason for this is that albuterol helps open the airways by relaxing the smooth muscle, which allows the corticosteroid (beclomethasone dipropionate) to reach deeper into the lungs more effectively. Administering the bronchodilator first helps the client better absorb the anti-inflammatory medication.
Why the other options are incorrect:
B. Beclomethasone dipropionate first and then the albuterol
This option is incorrect because beclomethasone dipropionate is an anti-inflammatory medication and should not be administered before albuterol. Administering the corticosteroid first may prevent the airways from being open enough for the medication to be effectively distributed.
C. Alternating a single puff of each, beginning with the albuterol
This option is incorrect because, while albuterol should be given first, it is not recommended to alternate single puffs of each medication. The sequence is important for proper absorption and effectiveness, and alternating puffs may not ensure the full benefit of either medication.
D. Alternating a single puff of each, beginning with the beclomethasone dipropionate
This option is also incorrect because the bronchodilator should be given first, not the corticosteroid. Giving beclomethasone before albuterol could hinder the medication's effectiveness.
Summary:
The nurse should administer albuterol (a bronchodilator) first to open the airways, followed by beclomethasone dipropionate (a corticosteroid) to maximize the absorption of the anti-inflammatory medication.
A client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include a β-blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis
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Dyspnea, edema, and palpitations
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Chest pain, hypotension, and paresthesia
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Double vision, loss of appetite, and nausea
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Constipation, dry mouth, and sleep
Explanation
Correct Answer C: Double vision, loss of appetite, and nausea
Why this answer is correct:
Digoxin toxicity is a well-known side effect of digoxin (Lanoxin), especially when serum levels exceed the therapeutic range. The most common symptoms of digoxin toxicity include visual disturbances (e.g., double vision or yellow-green halos), gastrointestinal symptoms (e.g., loss of appetite, nausea, vomiting), and neurological symptoms (e.g., fatigue and confusion). These symptoms occur due to the direct effect of digoxin on the cardiac and gastrointestinal systems. Therefore, double vision, loss of appetite, and nausea are classic signs supporting the diagnosis of digoxin toxicity.
Why the other options are incorrect:
A. Dyspnea, edema, and palpitations
While dyspnea, edema, and palpitations could be signs of heart failure or worsening cardiovascular conditions, these symptoms are not specific to digoxin toxicity. They may indicate other issues, such as fluid retention due to heart failure, rather than direct toxicity from digoxin.
B. Chest pain, hypotension, and paresthesia
These symptoms are more likely to be associated with cardiovascular events such as angina or myocardial infarction. Paresthesia (abnormal sensation) is not a typical symptom of digoxin toxicity. In contrast, digoxin toxicity is more closely associated with gastrointestinal and visual disturbances, rather than chest pain or paresthesia.
D. Constipation, dry mouth, and sleep
While constipation and dry mouth are potential side effects of many medications, including diuretics and β-blockers, they are not characteristic of digoxin toxicity. Additionally, sleep disturbances are not a typical feature of digoxin toxicity. This combination of symptoms is more general and not specifically related to digoxin overdose.
Summary:
Double vision, loss of appetite, and nausea are classic signs of digoxin toxicity, which can occur when serum levels of the drug become too high. These symptoms are directly linked to the effects of digoxin on the visual system and gastrointestinal system, making them the most supportive of a diagnosis of digoxin toxicity.
A nurse is providing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which of the following statements indicates that the client understands the instructions
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I will never be able to drive a car.
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My anticonvulsant medication will clear up my skin
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I can't drink alcohol while I am taking my medication
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If I forget my morning medication, I can take two pills at bedtime
Explanation
Correct Answer C: I can't drink alcohol while I am taking my medication.
Explanation of the Correct Answer:
Adolescents taking anticonvulsant medication must be educated about the potential interactions between their medication and alcohol. Alcohol can increase the sedative effects of anticonvulsant drugs, potentially lowering the seizure threshold, which can increase the risk of a seizure. It may also interfere with the effectiveness of the medication. The statement about not drinking alcohol is a correct understanding of the instructions and indicates the client is aware of this significant precaution.
Why the Other Options Are Incorrect:
A. I will never be able to drive a car.
This statement is incorrect because, in many cases, individuals with epilepsy or seizure disorders can eventually drive safely once they are seizure-free for a specific period of time as determined by local laws and their healthcare provider. There is no absolute prohibition on driving, but clients should follow the guidance of their healthcare provider and adhere to local regulations regarding driving with a history of seizures.
B. My anticonvulsant medication will clear up my skin.
This statement is incorrect because anticonvulsant medications are not prescribed for skin issues. Although some anticonvulsants, such as phenytoin, may cause skin rashes as a side effect, these medications are primarily used to control seizures. This statement indicates a misunderstanding of the medication’s intended use.
D. If I forget my morning medication, I can take two pills at bedtime.
This statement is incorrect because double dosing after a missed dose is generally not recommended with anticonvulsant medications. Taking extra medication can lead to adverse effects such as toxicity or sedation. The proper action is to follow the healthcare provider's specific instructions on what to do in case of a missed dose, which typically involves taking the medication as soon as the missed dose is remembered, unless it is near the time for the next dose.
Summary:
The correct answer is C, as it reflects the need to avoid alcohol while taking anticonvulsant medications. The other responses either misunderstand the medication’s effect on lifestyle or incorrectly advise on medication dosing or its effects. It is crucial for adolescents with seizure disorders to follow these instructions to manage their condition safely and effectively.
A client experiencing cardiogenic shock receives a prescription for an IV infusion of 0.9% normal saline with milrinone (Primacor) 10 mg in 100 ml at a rate of 46 mcg/minute. The nurse should program the infusion pump to deliver how many ml/hour
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28 ml/hour
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30 ml/hour
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26 ml/hour
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32 ml/hour
Explanation
Correct Answer A: 28 ml/hour
Explanation:
We are given the following information:
The medication concentration is 10 mg in 100 ml.
The ordered infusion rate is 46 mcg/minute.
Step 1: Convert the dose from milligrams to micrograms to match the infusion rate's units.
10 mg = 10,000 mcg.
Step 2: Determine the concentration in mcg/ml.
10,000 mcg ÷ 100 ml = 100 mcg/ml.
Step 3: Calculate how many milliliters need to be infused to deliver 46 mcg per minute.
The ordered rate is 46 mcg/minute.
Since the concentration is 100 mcg/ml, the required volume per minute is:
Volume (ml/min) = 46 mcg ÷ 100 mcg/ml = 0.46 ml/min.
Step 4: Convert the rate to ml/hour.
0.46 ml/min × 60 minutes = 27.6 ml/hour, which rounds to 28 ml/hour.
Explanation of Incorrect Options:
B. 30 ml/hour – This would result in an infusion rate of 48 mcg/min, which is higher than the ordered 46 mcg/min.
C. 26 ml/hour – This would result in an infusion rate of 43.3 mcg/min, which is less than the ordered 46 mcg/min.
D. 32 ml/hour – This would result in an infusion rate of 53.3 mcg/min, which is higher than the ordered 46 mcg/min.
Summary:
The nurse should program the infusion pump to deliver 28 ml/hour, which is A. 28 ml/hour.
A client receives a prescription for an intravenous infusion 0.45% sodium chloride 500 ml to be infused over 6 hours. The nurse should program the infusion pump to deliver how many ml/hour
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75 ml/hour
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83 ml/hour
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90 ml/hour
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100 ml/hour
Explanation
Correct Answer B: 83 ml/hour
Explanation:
To calculate the flow rate in ml/hour for the intravenous infusion, use the formula:
Flow rate (ml/hour) = Total volume (ml) ÷ Time (hours)
Given:
Total volume = 500 ml
Time = 6 hours
Step 1: Calculate the flow rate:
500 ml ÷ 6 hours = 83.33 ml/hour
Step 2: Round to the nearest whole number:
The flow rate should be 83 ml/hour.
Explanation of Incorrect Options:
A. 75 ml/hour – This would deliver 450 ml in 6 hours, which is less than the prescribed 500 ml.
C. 90 ml/hour – This would deliver 540 ml in 6 hours, which exceeds the prescribed volume.
D. 100 ml/hour – This would deliver 600 ml in 6 hours, which also exceeds the prescribed volume.
Summary:
The nurse should set the infusion pump to 83 ml/hour, which is B. 83 ml/hour.
The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition
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Intestinal obstruction
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Peptic ulcer with melena
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Diverticulitis with perforation
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Vomiting following cancer chemotherapy
Explanation
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.
The healthcare provider prescribes oxytocin (Pitocin) 0.5 milliunits/minute for a client in labor. One liter Ringer's Lactate with 10 units of oxytocin (Pitocin) is infusing. The nurse should program the infusion pump at how many ml/hour
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3
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5
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10
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15
Explanation
Correct answer A: 3
Detailed explanation of the correct answer:
To determine the infusion rate in milliliters per hour (mL/hour) for oxytocin, we need to break the problem down step-by-step.Step 1: Calculate the concentration of oxytocin in the solution.
The solution contains 10 units of oxytocin in 1 liter (1,000 mL) of Ringer's Lactate.
Therefore, the concentration of oxytocin is:
10 units ÷ 1,000 mL = 0.01 units/mL.
Step 2: Convert the prescribed oxytocin dose from milliunits to units.
The prescribed dose is 0.5 milliunits/minute. Since 1 unit = 1,000 milliunits, we can convert this to units:
0.5 milliunits = 0.0005 units/minute.
Step 3: Calculate the required infusion rate in mL/hour.
We need to deliver 0.0005 units/minute.
With the concentration of 0.01 units/mL, the infusion rate required to deliver 0.0005 units/minute is:
0.0005 units/minute ÷ 0.01 units/mL = 0.05 mL/minute.
Step 4: Convert mL/minute to mL/hour.
To convert the infusion rate from mL/minute to mL/hour, multiply by 60 (since 1 hour = 60 minutes):
0.05 mL/minute × 60 minutes = 3 mL/hour.
Explanation of why the other options are incorrect:
B. 5 mL/hour is incorrect because it overestimates the required infusion rate based on the concentration and prescribed dose.
C. 10 mL/hour is incorrect because it is too high for the prescribed dose of oxytocin.
D. 15 mL/hour is incorrect because it does not match the required infusion rate for the prescribed dose.
Summary:
The nurse should program the infusion pump to deliver 3 mL/hour to administer the prescribed dose of 0.5 milliunits/minute of oxytocin.
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