HESI Pharmacology Exam | Questions and Verified Answers with Rationales | Latest 2020 / 2021

1.      A client with acute lymphocytic leukemia is to begin chemotherapy today. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the rationale for administering Zofran prior to the chemotherapy induction?

Reduction or elimination of nausea and vomiting

Rationale:
Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy. 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s).

2.      A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome?

Uric acid level

Rationale:
The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so uric acid level should be reported to the health care provider.

3.      The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide?

Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.

Rationale:
Oral doses of medication are usually larger than parenteral doses to compensate for the first-pass effect in the liver after oral administration, which metabolizes more of the drug's dose before affecting its therapeutic response. Although recommended dose ranges for adults should be individualized, a client's pain should be controlled at discharge.

4.      The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is louder than previously assessed. Which action should the nurse implement?

Administer the prescribed dose as scheduled.

Rationale:
A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result of atherosclerosis. Aspirin is prescribed to reduce platelet aggregation and should be administered to this client, who is at high risk for thrombus occlusion.

5.      A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication?

Diarrhea

Rationale:
The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea.

6.      A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent?

A cough that is new and persistent

Rationale:
A cough that is new and persistent  is an adverse effect that is immediately life threatening. Severe fluid retention can cause pleural effusion (requiring urgent drainage), dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (caused by ascites). Persistent nausea and vomiting, Fingernail and toenail changes and Increasing weakness and neuropathy are all adverse effects from chemotherapy and need to be monitored consistently.

7.      The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement?

Administer the drug if the solution's reconstitution time is <24 hours.

Rationale:
The color of the dobutamine solution is normal, and the solution should be administered within 24 hours after reconstitution, so the time of reconstitution should be verified before administering the solution of medication.

8.      Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control?

Brush and floss teeth daily.

Rationale:
Brushing and flossing the teeth daily prevents gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy.

9.      When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan?

Offer the child the medication with breakfast and after the child eats lunch.

Rationale:
Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals.  A dose given mid-afternoon is likely to increase insomnia.  Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely