HESI Pharmacology Exam 2 Study Guides

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Sample questions from HESI Pharmacology Exam 2 Study Guides

This material has 18 questions with answers and rationales. Here are the first 5.

1. 1.A client receiving IV vancomycin for a bloodstream infection has a serum creatinine increase from 0.8 to 1.9 mg/dL over 48 hours. Urine output has decreased to 20 mL/hr for the past 6 hours. The next dose is due now. Which action should the nurse take first?

   • A.Administer the dose over a longer infusion period.
   • B.Withhold the dose and contact the prescriber about the renal changes.
   • C.Administer the dose and obtain a drug level afterward.
   • D.Encourage oral fluids and reassess after the dose.

   Rationale: Vancomycin is eliminated primarily by the kidneys. Rising creatinine and oliguria suggest acute kidney injury, increasing the risk of drug accumulation and toxicity. The nurse should withhold the pending dose and promptly obtain guidance about drug levels and dosing. Slower infusion reduces infusion-related reactions but does not correct impaired clearance. Giving the dose before evaluating renal changes may worsen toxicity. Oral fluids alone do not adequately address possible kidney injury and may be inappropriate if fluid retention develops.

2. 2.A client with diabetic ketoacidosis has a prescription for regular insulin IV at 0.1 unit/kg/hr. The client weighs 70 kg, and the infusion contains 100 units in 100 mL of 0.9% sodium chloride. Before starting the infusion, the nurse reviews a potassium level of 2.9 mEq/L. Which action is appropriate?

   • A.Start the infusion at 7 mL/hr and recheck potassium in 4 hours.
   • B.Start the infusion at 0.7 mL/hr to reduce the potassium shift.
   • C.Delay insulin and contact the prescriber for potassium replacement.
   • D.Administer the calculated hourly dose subcutaneously instead.

   Rationale: Insulin moves potassium into cells and can worsen hypokalemia, causing life-threatening dysrhythmias. A potassium level of 2.9 mEq/L requires replacement and reassessment before insulin begins. The calculated rate is 7 units/hr, or 7 mL/hr, but starting that rate is unsafe until potassium is corrected. A rate of 0.7 mL/hr is a calculation error and does not resolve the contraindication. Changing to subcutaneous administration without a prescription is inappropriate and still causes an intracellular potassium shift.

3. 3.A client taking lithium for bipolar disorder started hydrochlorothiazide 1 week ago. The client now reports vomiting and difficulty walking. The nurse observes a coarse hand tremor and slurred speech. Which action is the priority?

   • A.Administer the scheduled lithium with food.
   • B.Restrict sodium intake and encourage additional water.
   • C.Reassure the client that these effects resolve with continued therapy.
   • D.Withhold lithium and obtain urgent evaluation for toxicity.

   Rationale: Vomiting, ataxia, coarse tremor, and slurred speech suggest lithium toxicity. Thiazide diuretics can reduce lithium clearance and increase serum concentrations. Withholding lithium and arranging urgent evaluation, including lithium concentration, renal function, and electrolytes, addresses the immediate safety risk. Giving lithium with food may reduce mild gastrointestinal irritation but worsens exposure during suspected toxicity. Sodium restriction can further increase lithium retention. These neurologic findings are not expected effects that should be managed with reassurance alone.

4. 4.A postoperative client who received IV morphine is difficult to arouse, has a respiratory rate of 6 breaths/min, and has an oxygen saturation of 84%. The nurse activates emergency assistance and begins assisted ventilation. Which medication should the nurse anticipate administering?

   • A.Naloxone IV, titrated to restore adequate ventilation.
   • B.Flumazenil IV, titrated to restore full alertness.
   • C.Acetylcysteine IV, administered as a loading infusion.
   • D.Diphenhydramine IV, administered slowly.

   Answer and rationale are in the full material.

5. 5.A client receiving an unfractionated heparin infusion for pulmonary embolism develops coffee-ground emesis. Blood pressure decreases from 128/76 to 86/50 mm Hg, and the activated partial thromboplastin time is markedly above the prescribed therapeutic range. After stopping the infusion and activating emergency assistance, which medication should the nurse prepare?

   • A.Vitamin K.
   • B.Protamine sulfate.
   • C.Idarucizumab.
   • D.Tranexamic acid.

   Answer and rationale are in the full material.