Hesi Rn 301 pharmacology Exam
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Free Hesi Rn 301 pharmacology Exam Questions
A nurse is teaching about metformin. Which statement by the client requires further teaching
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I will stop taking this before a CT scan with contrast.
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This medicine helps my body use insulin better.
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I can skip meals if I’m not hungry.
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I should monitor my blood sugar regularly.
Explanation
Correct Answer C. I can skip meals if I’m not hungry.
Explanation:
Metformin should be taken with meals to reduce gastrointestinal side effects such as nausea, diarrhea, and abdominal discomfort. Skipping meals while taking metformin increases the risk of hypoglycemia if used with other glucose-lowering medications, and it can also worsen gastrointestinal upset. Clients should be instructed to maintain regular meal schedules to support stable blood glucose levels and medication tolerance.
Why Other Options Are Incorrect:
A. I will stop taking this before a CT scan with contrast.
This is correct and indicates understanding. Metformin should be withheld before and for 48 hours after contrast dye to prevent lactic acidosis, especially in clients with impaired renal function.
B. This medicine helps my body use insulin better.
This is accurate. Metformin improves insulin sensitivity and reduces hepatic glucose production, which helps control blood sugar in type 2 diabetes.
D. I should monitor my blood sugar regularly.
This is correct. Even though metformin does not usually cause hypoglycemia alone, regular glucose monitoring is important to track the effectiveness of therapy and detect abnormal levels early.
Prior to administration of the initial dose of the gastrointestinal (GI) agent misoprostol, which information should the nurse obtain from the patient
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Taking an antiemetic medication.
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Allergy to aspirin.
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Currently pregnant.
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History of glaucoma.
Explanation
Correct Answer C. Currently pregnant.
Explanation:
Misoprostol is contraindicated during pregnancy because it stimulates uterine contractions and can induce miscarriage or premature labor. Before initiating therapy, it is critical for the nurse to determine if the patient is pregnant. This precaution prevents serious fetal harm and potential pregnancy loss. If the patient is of childbearing age, a pregnancy test is often required before starting treatment with misoprostol for gastrointestinal indications, such as NSAID-induced ulcer prevention.
Why Other Options Are Wrong:
A. Taking an antiemetic medication.
There is no significant contraindication between misoprostol and common antiemetic drugs. Although medication history is generally important, concurrent antiemetic use does not pose a specific risk or require special precautions when administering misoprostol.
B. Allergy to aspirin.
While aspirin allergy is relevant for other medications, misoprostol is not chemically related to aspirin and does not pose cross-reactivity risks. This information is not a primary concern before misoprostol administration, though overall allergy history is still important in general assessment.
D. History of glaucoma.
Misoprostol has no known adverse effect on intraocular pressure or glaucoma progression. Therefore, a history of glaucoma does not influence the safety or appropriateness of misoprostol use for gastrointestinal purposes. This is not a priority assessment before starting therapy.
A client receiving IV gentamicin for a severe bacterial infection reports a new onset of ringing in the ears. The nurse must determine the appropriate action to prevent potential complications. Which action should the nurse take?
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Continue therapy and reassess in one week
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Hold the dose and notify the provider
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Increase IV fluids to protect kidneys
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Switch to oral gentamicin
Explanation
Correct Answer:
Hold the dose and notify the provider
Explanation:
Tinnitus during gentamicin therapy is an early sign of ototoxicity, which can progress to irreversible hearing loss and balance problems if not addressed promptly. Gentamicin, an aminoglycoside, can also cause nephrotoxicity, so both hearing and kidney function must be monitored. The nurse should withhold the medication and notify the healthcare provider immediately so the drug can be discontinued or the dose adjusted.
Why Other Options Are Incorrect:
Continue therapy and reassess in one week
This could allow permanent hearing damage to occur before intervention.
Increase IV fluids to protect kidneys
While hydration helps reduce nephrotoxicity risk, it does not address ototoxicity, which is unrelated to fluid status.
Switch to oral gentamicin
Gentamicin is rarely given orally for systemic infections due to poor absorption, and the route change does not eliminate ototoxicity risk.
A pregnant client asks which medication should be taken with folic acid to help reduce the risk of neural tube defects in the baby.
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None – folic acid alone is recommended
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Methotrexate
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Warfarin
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Isotretinoin
Explanation
Correct Answer:
None – folic acid alone is recommended
Explanation:
Folic acid alone is the recommended supplement to reduce the risk of neural tube defects such as spina bifida and anencephaly. Pregnant women are advised to take 400–800 mcg daily before conception and during early pregnancy. No additional drug should be combined for this purpose.
Why Other Options Are Incorrect:
Methotrexate
This is teratogenic and can cause severe birth defects, including neural tube defects, and should be avoided in pregnancy.
Warfarin
An anticoagulant that crosses the placenta and can cause fetal bleeding and malformations; it is unsafe in pregnancy.
Isotretinoin
A potent teratogen associated with severe birth defects, including craniofacial, cardiac, and central nervous system abnormalities; absolutely contraindicated in pregnancy.
A 42-year-old client is diagnosed with latent tuberculosis and started on a daily dose of an antitubercular medication. To prevent peripheral neuropathy, the nurse educates the client about the need for concurrent vitamin B6 (pyridoxine) supplementation. Which drug requires this co-administration
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Isoniazid
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Rifampin
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Ethambutol
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Pyrazinamide
Explanation
Correct Answer A. Isoniazid
Explanation:
Isoniazid interferes with pyridoxine (vitamin B6) metabolism, which can lead to a deficiency and subsequent peripheral neuropathy. Supplementation with vitamin B6 during isoniazid therapy prevents nerve damage, especially in individuals with risk factors such as diabetes, malnutrition, HIV infection, alcoholism, or pregnancy. This preventive measure allows continued TB treatment without compromising nerve function, and it is standard practice in TB protocols worldwide.
Why Other Options Are Incorrect:
A. Rifampin
Does not interfere with vitamin B6 metabolism; its major adverse effects include hepatotoxicity, gastrointestinal upset, and orange discoloration of body fluids.
C. Ethambutol
Primarily associated with optic neuritis and requires baseline and periodic vision testing, not vitamin B6 supplementation.
D. Pyrazinamide
Can cause hepatotoxicity and hyperuricemia leading to gout but does not affect vitamin B6 metabolism or cause neuropathy.
The healthcare provider prescribes the anticoagulant heparin for a client with a pulmonary embolism. Before initiating the medication, the nurse should ensure that which drug is readily available in case of heparin overdose
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Warfarin.
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Vitamin K.
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Protamine sulfate.
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Diphenhydramine HCl.
Explanation
Correct Answer C. Protamine sulfate.
Explanation:
Protamine sulfate is the specific antidote for heparin overdose. It binds with heparin to form a stable complex that neutralizes its anticoagulant effect, reducing the risk of life-threatening bleeding. It is administered intravenously and should always be available when patients are receiving heparin therapy.
Why Other Options Are Wrong:
A. Warfarin.
Warfarin is an oral anticoagulant used for long-term prevention of clot formation, not for reversing heparin's effects.
B. Vitamin K.
Vitamin K is used as an antidote for warfarin overdose, not heparin.
D. Diphenhydramine HCl.
Diphenhydramine is an antihistamine used to treat allergic reactions, not anticoagulant overdoses.
A client receives a prescription for methotrexate. Which information provided by the client requires additional instruction by the nurse
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Obtain a platelet count weekly.
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Take the medication during pregnancy.
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Use folic acid to protect the liver.
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Store the medication at room temperature.
Explanation
Correct Answer B. Take the medication during pregnancy.
Explanation:
Methotrexate is a folate antagonist that is highly teratogenic and contraindicated during pregnancy because it can cause severe fetal harm, including miscarriage and congenital malformations. Clients must be instructed to avoid pregnancy during therapy and for a period after discontinuation. If a client states they will take methotrexate while pregnant, this indicates a serious knowledge gap and requires urgent correction to prevent harm to the fetus.
Why Other Options Are Wrong:
A. Obtain a platelet count weekly.
Monitoring blood counts, including platelets, is appropriate because methotrexate can cause bone marrow suppression. This practice helps detect thrombocytopenia early, making it an important and correct safety measure for patients taking the medication.
C. Use folic acid to protect the liver.
Folic acid supplementation is recommended to reduce methotrexate toxicity, especially effects on the gastrointestinal tract and bone marrow. While it does not specifically “protect the liver,” it is still a correct supportive measure in therapy.
D. Store the medication at room temperature.
Methotrexate tablets are stable at room temperature, making this storage method correct. Proper storage prevents loss of drug potency and maintains safety. This does not require correction by the nurse.
A 42-year-old client with bipolar disorder has been taking lithium for mood stabilization. During a clinic visit, the client reports recent symptoms that started after an episode of dehydration from gastroenteritis. Which symptom suggests lithium toxicity?
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Fine hand tremor
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Nausea
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Ataxia
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Increased urination
Explanation
Correct Answer:
Ataxia
Explanation:
Ataxia (loss of coordination or unsteady gait) is a sign of moderate to severe lithium toxicity, often accompanied by confusion, coarse tremors, and slurred speech. This requires immediate lithium level measurement and possible discontinuation to prevent progression to seizures, coma, or death. Therapeutic range is typically 0.6–1.2 mEq/L; toxicity can occur at levels above 1.5 mEq/L.
Why Other Options Are Incorrect:
Fine hand tremor
A common, mild side effect of lithium at therapeutic levels; not necessarily toxic unless it becomes coarse.
Nausea
Often occurs when starting lithium or with mild toxicity, but it’s less specific than neurologic symptoms like ataxia.
Increased urination
May occur due to lithium’s effect on renal concentrating ability (nephrogenic diabetes insipidus) but is not an acute toxicity indicator.
A 62-year-old client with a history of atrial fibrillation is prescribed warfarin. The nurse reinforces the importance of regular blood tests to monitor therapeutic effect and safety. Which laboratory test is most appropriate?
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PT/INR
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aPTT
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Platelet count
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Serum creatinine
Explanation
Correct Answer:
PT/INR
Explanation:
Warfarin's anticoagulant effect is monitored by PT/INR. The INR standardizes prothrombin time results, allowing for consistent interpretation across labs. The therapeutic INR range is typically 2.0–3.0 for most conditions and slightly higher for mechanical heart valves. Monitoring ensures adequate clot prevention without increasing bleeding risk. Dose adjustments are based on INR values, dietary vitamin K intake, and interacting medications. Nurses should instruct clients to have INR testing at recommended intervals and report signs of bleeding or unusual bruising promptly.
Why Other Options Are Incorrect:
aPTT
Used to monitor unfractionated heparin therapy, not warfarin.
Platelet count
Monitors for thrombocytopenia but does not reflect warfarin's anticoagulant effect.
Serum creatinine
Evaluates kidney function but is unrelated to warfarin's mechanism of action or safety monitoring.
A client who has dysphagia after a cerebral vascular accident (CVA) receives a new prescription for lansoprazole capsules via nasogastric tube (NGT). Which action should the nurse implement prior to administering the medication
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Open the capsule to crush the granules.
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Sprinkle the granules in applesauce.
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Request the pharmacist to provide tablets.
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Contact the pharmacist for a liquid formulation of lansoprazole that is safe for administration via nasogastric tube.
Explanation
Correct Answer D. Contact the pharmacist for a liquid formulation of lansoprazole that is safe for administration via nasogastric tube.
Explanation:
Lansoprazole capsules contain enteric-coated granules that must remain intact to ensure the medication reaches the small intestine for absorption. Crushing them destroys the coating and reduces efficacy. For a client with an NGT, the safest approach is to request a liquid or suspension specifically designed for tube administration. This ensures proper drug delivery, maintains therapeutic effect, and prevents tube obstruction.
Why Other Options Are Wrong:
A. Open the capsule to crush the granules.
Crushing the granules destroys the enteric coating, causing premature drug release in the stomach and reducing therapeutic benefit.
B. Sprinkle the granules in applesauce.
This is an option for patients who can swallow, not for those requiring NG administration. Applesauce can clog the tube and is unsuitable for this route.
C. Request the pharmacist to provide tablets.
Tablets may not be available in an NG-compatible form and crushing enteric-coated or extended-release tablets has the same risks as crushing granules. Liquid formulations are the recommended option.
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HESI RN 301 Pharmacology: Comprehensive Study Guide
1. Your Basic Pharmacy Learning
Definition: The body responds to medication use.
Key Processes:
- Drug-receptor interactions
- Mechanism of action
- A drug's treatment value and negative side effects relate to one another
ADME Principles:
- Absorption: How drugs cross from outside the body into bloodstream
- Distribution: Drugs travel from one body part to another
- Metabolism: Body enzymes in the liver break down drugs
- Excretion: How drugs exit the human body system
2. Medical Drug Giving Basics
- Oral
- Intravenous (IV)
- Intramuscular (IM)
- Subcutaneous
- Topical
- Rectal
- Inhaled
Six Rights of Medication Administration:
- Right Patient
- Right Drug
- Right Dose
- Right Route
- Right Time
- Right Documentation
3. Major Drug Classifications
Antihypertensives
- ACE Inhibitors
- Beta-Blockers
- Calcium Channel Blockers
Anticoagulants
- Warfarin
- Heparin
- Patients require Direct Oral Anticoagulant medicines.
Antiarrhythmics
Respiratory Medications
- Bronchodilators
- Corticosteroids
- Antihistamines
- Decongestants
Medicines That Act On The Nervous System
Antidepressants
- SSRIs
- SNRIs
- Antipsychotics
- Anxiolytics
- Analgesics
Diabetes Medications
Insulin
- Oral Hypoglycemics
- Thyroid Medications
Classification by Spectrum
- Narrow-spectrum
- Broad-spectrum
Major Classes
- Penicillins
- Cephalosporins
- Aminoglycosides
- Macrolides
4. How Medicines Interact with Each Other
Types of Interactions:
- Synergistic
- Antagonistic
- Additive
Potential Interaction Risks
- Food interactions
- Drug-drug interactions
- Genetic variations
Our Medication Guide Includes Specific Details About Different Patient Populations
- Pediatric Dosing
- Medical Team Must Care for Older Patients Who Take Medicines
- Pregnancy and Lactation
- Renal and Hepatic Impairment
5. Medication Effects and Harmful Responses
- Gastrointestinal
- Neurological
- Dermatological
- Cardiovascular
Severe Adverse Reactions
- Anaphylaxis
- Stevens-Johnson Syndrome
- Hepatotoxicity
- Nephrotoxicity
6. Medication Calculations
-
Weight-based Dosing
- Body Surface Area to Properly Administer Medications
- IV Drip Rates
- Pediatric Dosing
Conversion Calculations
- Metric Conversions
- Unit Conversions
- Medication Concentration
7. Our Medical Team Teaches Patients About Their Treatment While Watching Their Response
- Medication Teaching
- Side Effect Monitoring
- Therapeutic Drug Levels
- Patient Adherence Strategies
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