Hesi Rn 301 pharmacology Exam
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Free Hesi Rn 301 pharmacology Exam Questions
A client in the intensive care unit is prescribed a dopamine infusion at 5 mcg/kg/min to support blood pressure and cardiac output. The nurse must calculate the correct dose in micrograms per minute based on the client’s weight. The provider orders a dopamine infusion at 5 mcg/kg/min. The client weighs 70 kg. What is the dose per minute?
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250 mcg/min
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350 mcg/min
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400 mcg/min
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500 mcg/min
Explanation
Step-by-Step Calculation:
Weight in kg: Already given as 70 kg
Dose per minute: 5 mcg × 70 kg = 350 mcg/min
Correct Answer:
350 mcg/min
Explanation:
Accurate weight-based calculations are essential for vasoactive drug infusions like dopamine to prevent underdosing (ineffective treatment) or overdosing (risk of tachyarrhythmias, hypertension, or vasoconstriction). The correct infusion rate is 350 mcg per minute based on the prescribed 5 mcg/kg/min and the client’s 70 kg body weight.
Why Other Options Are Incorrect:
250 mcg/min
Results from using an incorrect weight or dose multiplier—underdoses the client.
400 mcg/min
Overestimates the dose, risking excessive cardiovascular stimulation.
500 mcg/min
Significantly overdoses the client, potentially causing severe hypertension and arrhythmias.
A nurse is reviewing a medication information sheet about ciprofloxacin with a client. Which of the following adverse reactions should this nurse include? (Select all that apply.)
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Observe for pain and swelling of the Achilles tendon
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Watch for a vaginal yeast infection.
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Expect excessive nighttime perspiration.
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Inspect the mouth for cottage cheese-like lesions.
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Take the medication with a dairy product.
Explanation
Correct Answers:
A. Observe for pain and swelling of the Achilles tendon
B. Watch for a vaginal yeast infection.
D. Inspect the mouth for cottage cheese-like lesions.
Explanation:
Ciprofloxacin, a fluoroquinolone, can cause tendinitis or tendon rupture, especially in the Achilles tendon. It may also disrupt normal flora, leading to fungal overgrowth such as vaginal yeast infections or oral thrush (white, cottage cheese-like patches in the mouth). These are important adverse effects for the nurse to teach the patient to monitor and report promptly.
Why Other Options Are Incorrect:
C. Expect excessive nighttime perspiration
Night sweats are not a common or expected adverse reaction of ciprofloxacin. If present, they may indicate another underlying condition such as infection progression or hormonal imbalance rather than the drug itself.
E. Take the medication with a dairy product
Ciprofloxacin should not be taken with dairy products alone or calcium-fortified juices because these can bind the drug and reduce its absorption. It may be taken with food, but dairy should be avoided close to dosing unless part of a larger meal.
A pediatric client weighs 22 lb and has been prescribed amoxicillin 25 mg/kg/day in two equally divided doses for the treatment of otitis media. The nurse must calculate the correct milligram dose to be given per administration. How many milligrams should the nurse administer per dose?
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100 mg
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125 mg
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250 mg
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275 mg
Explanation
Step-by-Step Calculation:
Convert pounds to kilograms:
22 lb ÷ 2.2 = 10 kg
Calculate the total daily dose:
25 mg × 10 kg = 250 mg/day
Divide into two doses:
250 mg/day ÷ 2 = 125 mg per dose
Correct Answer:
125 mg
Explanation:
The nurse must ensure accurate pediatric dosing to avoid underdosing (risking treatment failure) or overdosing (risking toxicity). Converting weight to kilograms and carefully dividing the total daily dose according to the prescribed frequency ensures safe medication administration.
Why Other Options Are Incorrect:
100 mg
Underdoses the child, which may lead to ineffective therapy.
250 mg
This is the total daily dose, not the dose per administration.
275 mg
Exceeds the calculated safe dose, risking adverse effects.
A 68-year-old client is prescribed an oral antibiotic for a complicated urinary tract infection. The nurse educates the client on potential adverse effects and stresses the importance of reporting sudden tendon pain or swelling, as the medication may increase the risk of tendon rupture in older adults. Which drug is associated with this risk?
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Ciprofloxacin
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Azithromycin
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Amoxicillin
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Doxycycline
Explanation
Correct Answer:
Ciprofloxacin
Explanation:
Ciprofloxacin is a fluoroquinolone antibiotic linked to tendinitis and tendon rupture, particularly of the Achilles tendon. The risk is higher in adults over 60, those on corticosteroids, and individuals with kidney disease. The drug interferes with collagen synthesis and tendon repair, making tendons more vulnerable to injury. Symptoms such as tendon pain, swelling, or movement difficulty should prompt immediate discontinuation and medical evaluation to prevent permanent damage.
Why Other Options Are Incorrect:
Azithromycin
A macrolide antibiotic primarily used for respiratory and skin infections. It is not associated with tendon injury; its main risks include gastrointestinal upset, QT prolongation, and rare hepatotoxicity.
Amoxicillin
A penicillin-class antibiotic with no known link to tendon damage. Side effects are generally limited to allergic reactions, gastrointestinal upset, and possible C. difficile–associated diarrhea.
Doxycycline
A tetracycline antibiotic used for acne, respiratory infections, and tick-borne diseases. It does not cause tendon injury. Common side effects include photosensitivity, gastrointestinal upset, and tooth discoloration in children if given during tooth development.
A 55-year-old client with type 2 diabetes receives a subcutaneous injection of regular insulin at 7:00 AM before breakfast. The nurse plans to monitor for hypoglycemia during the drug’s peak action. At what time is the client most at risk?
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8:00 AM
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10:00 AM
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12:00 PM
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2:00 PM
Explanation
Correct Answer:
10:00 AM
Explanation:
Regular insulin is a short-acting insulin with an onset of 30–60 minutes, a peak of 2–5 hours, and a duration of 5–8 hours. Hypoglycemia risk is highest during the peak action. When given at 7:00 AM, the peak occurs between 9:00 AM and 12:00 PM, making 10:00 AM the time of greatest concern.
Why Other Options Are Incorrect:
8:00 AM
Too early—insulin is just beginning to work; peak hypoglycemia risk has not yet occurred.
12:00 PM
Still within the peak window but not as immediate a concern as mid-peak at 10:00 AM.
2:00 PM
Regular insulin action is tapering off; risk of hypoglycemia is lower compared to peak times.
A 64-year-old client with erectile dysfunction is prescribed sildenafil. The nurse reviews the client’s medication list and must identify which drug, if taken with sildenafil, could cause severe hypotension. Which drug should be avoided?
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Nitroglycerin
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Furosemide
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Warfarin
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Atorvastatin
Explanation
Correct Answer:
Nitroglycerin
Explanation:
Sildenafil is a phosphodiesterase type 5 (PDE-5) inhibitor that increases nitric oxide effects, causing vasodilation. When combined with nitrates like nitroglycerin, the vasodilatory effect is amplified, leading to profound and potentially life-threatening hypotension. This combination is absolutely contraindicated. Clients should avoid nitrates for at least 24 hours after taking sildenafil (longer for some PDE-5 inhibitors).
Why Other Options Are Incorrect:
Furosemide
A loop diuretic; does not cause dangerous interactions with sildenafil, though both can lower blood pressure mildly.
Warfarin
An anticoagulant; no direct interaction with sildenafil affecting blood pressure.
Atorvastatin
A statin; safe to use with sildenafil without significant blood pressure effects.
A 70-year-old client with chronic stable angina is prescribed a transdermal nitroglycerin patch for chest pain prevention. During a follow-up visit, the nurse reviews the client’s understanding of correct patch use and application. Which statement shows correct understanding about nitroglycerin patch use?
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"I can keep it on 24 hours a day for continuous relief."
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"I should rotate the patch site daily."
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"I can cut the patch in half if I need a lower dose."
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"I should store the patches in the refrigerator."
Explanation
Correct Answer:
"I should rotate the patch site daily."
Explanation:
Nitroglycerin patches should be applied to a clean, dry, hairless area of the upper body or upper arm and rotated daily to prevent skin irritation. They are usually worn for 12–14 hours, followed by a nitrate-free period to reduce the risk of tolerance. Patches should not be cut, as this alters the delivery system, and they should be stored at room temperature in their original packaging.
Why Other Options Are Incorrect:
"I can keep it on 24 hours a day for continuous relief."
Continuous wear increases the risk of tolerance; a daily nitrate-free interval is necessary.
"I can cut the patch in half if I need a lower dose."
Cutting the patch can compromise the drug delivery system and result in unpredictable dosing.
"I should store the patches in the refrigerator."
Nitroglycerin patches should be stored at room temperature, away from moisture and heat.
A 52-year-old client with newly diagnosed type 2 diabetes is prescribed metformin. During medication teaching, the nurse emphasizes lifestyle and dietary precautions to prevent complications. A nurse should instruct a client taking metformin to avoid:
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Alcohol
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High-protein diet
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Low-fat foods
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Green leafy vegetables
Explanation
Correct Answer:
Alcohol
Explanation:
Alcohol should be avoided while taking metformin because it increases the risk of lactic acidosis, a rare but potentially fatal complication. Alcohol can also cause unpredictable changes in blood glucose levels, increasing the risk of hypoglycemia, especially in clients on additional glucose-lowering drugs.
Why Other Options Are Incorrect:
High-protein diet
A high-protein diet does not specifically interact with metformin, though balanced nutrition is encouraged for diabetes management.
Low-fat foods
Low-fat foods are not contraindicated and can be part of a healthy diabetic diet.
Green leafy vegetables
Green leafy vegetables are encouraged for their fiber, vitamins, and minerals, and do not cause adverse effects with metformin.
A 68-year-old client with atrial fibrillation is prescribed warfarin for stroke prevention. During a follow-up visit, the nurse reviews the client’s medication list and herbal supplement use. Which herbal supplement should the nurse advise the client to avoid due to increased risk of bleeding ?
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Ginkgo biloba
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Echinacea
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Peppermint
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Ginger
Explanation
Correct Answer:
Ginkgo biloba
Explanation:
Ginkgo biloba can increase the risk of bleeding by inhibiting platelet aggregation. When combined with warfarin, the anticoagulant effect can be potentiated, increasing the risk of serious bleeding events such as intracranial hemorrhage or gastrointestinal bleeding. Clients on warfarin should avoid ginkgo and other herbs that have anticoagulant effects (e.g., garlic, dong quai).
Why Other Options Are Incorrect:
Echinacea
May affect immune function and interact with certain drugs metabolized by the liver, but it is not a major bleeding risk with warfarin.
Peppermint
No significant interaction with warfarin regarding bleeding risk.
Ginger
Can have mild antiplatelet effects, but ginkgo biloba has a stronger documented interaction and is the more critical to avoid in this context.
Which adverse effect requires the nurse to hold metoprolol and notify the provider?
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Blood pressure 152/88 mm Hg
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Apical heart rate 48/min
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Blood glucose 130 mg/dL
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Mild fatigue
Explanation
Correct Answer:
Apical heart rate 48/min
Explanation:
Metoprolol is a beta-1 adrenergic blocker that slows the heart rate and decreases myocardial contractility. Before administering, the nurse should assess the apical pulse for a full minute. If the heart rate is below 50–60 beats/min (per provider or facility protocol), the medication should be held and the provider notified due to the risk of symptomatic bradycardia, hypotension, and possible heart block. This is a priority safety measure.
Why Other Options Are Incorrect:
Blood pressure 152/88 mm Hg
This is elevated and may actually be an indication for metoprolol use; it is not a reason to hold the drug.
Blood glucose 130 mg/dL
This is slightly above normal fasting range but not critical. While beta-blockers can mask hypoglycemia symptoms, this reading does not warrant holding the medication.
Mild fatigue
Fatigue is a common side effect of beta-blockers but is not an immediate reason to withhold the dose unless it is severe or associated with other concerning signs.
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