HESI-P HESI Pharmacology - Set 2 - Part 1

Correct Answer: Use the bronchodilator first, then steroid

The bronchodilator is administered first to open airways so the corticosteroid can reach deeper into the lungs. Five minutes is allowed between different inhaled medications, and one to two minutes between two doses of the same drug. Option a is incorrect because any-order use loses the airway-opening benefit the bronchodilator provides for steroid deposition. The chapter assigns a specific sequence so that the second drug actually reaches the smaller airways rather than depositing in the upper passages. Option b is incorrect because using the corticosteroid first defeats the goal of opening airways before the steroid is delivered. The sequence is reversed from this option, since the bronchodilator's rapid action sets up the lungs for better steroid penetration. Option d is incorrect because inhalers cannot be combined into a single device; each delivery system is engineered for one product. Mixing would not be possible mechanically and would bypass the sequencing rule that gives

Correct Answer: Ten to twenty micrograms per milliliter

Therapeutic theophylline level is ten to twenty micrograms per milliliter. Toxicity occurs when the level exceeds twenty, with early signs of restlessness, nervousness, tremors, and palpitations that warrant dose reduction and prescriber notification immediately. Option b is incorrect because twenty to thirty enters the toxic range, not the therapeutic one. A level in this band would prompt holding the drug, evaluating symptoms, and notifying the prescriber rather than confirming safe ongoing dosing. Option c is incorrect because thirty to forty represents severe toxicity and may require dose discontinuation and supportive care. The chapter pegs the therapeutic ceiling at twenty, and any level above this warrants intervention not continuation of the same regimen. Option d is incorrect because less than five is a subtherapeutic level and predicts inadequate bronchodilation rather than safety. A subtherapeutic level would prompt dose adjustment upward, but it does not represent the thera

Correct Answer: Hold the dose and notify prescriber

Ipratropium contains soy lecithin and is contraindicated in clients with peanut allergy due to cross-reactivity. The nurse holds the dose and notifies the prescriber so a different bronchodilator without the allergenic excipient can be ordered instead. Option a is incorrect because halving the dose does not address the underlying allergenic excipient in the formulation. Any amount of soy lecithin can trigger a serious cross-reaction in a peanut-allergic client, so dose reduction is not a safe workaround. Option b is incorrect because premedicating with an antihistamine does not eliminate the cross-reactivity risk of soy lecithin in a peanut-allergic client. Diphenhydramine may mask early reaction signs without preventing anaphylaxis, and the chapter says to avoid the drug entirely. Option c is incorrect because altering nebulizer flow rate changes droplet size but does nothing about the allergenic content. The excipient remains in every droplet, and a flow change cannot make the formul

Correct Answer: Wait one to two minutes between puffs

The chapter directs a one to two minute wait between two doses of the same inhaled medication, and a five-minute wait between two different inhaled medications. The pause lets the prior puff deposit before the next is delivered. Option a is incorrect because five minutes is the interval between two different inhaled medications, not between two doses of the same drug. Waiting that long between puffs of the same drug delays bronchodilation and does not improve deposition further. Option c is incorrect because thirty seconds is too brief to let the first puff distribute across the airways before the second arrives. A rushed second puff can largely coat the upper airway not reach the deeper smaller airways targeted. Option d is incorrect because delivering two puffs back-to-back deposits much of the second puff in the mouth and throat rather than the lungs. The chapter specifies a pause so deposition is maximized, and skipping it reduces therapeutic effect substantially.

Correct Answer: Tachycardia, tremors, nervousness, hyperglycemia

Beta-adrenergic bronchodilators cause tachycardia, tachypnea, dysrhythmias, tremors, nervousness, hyperglycemia, and mouth dryness. These reflect the sympathomimetic activity of the drug class and are anticipated rather than unexpected adverse effects of normal therapy. Option b is incorrect because bradycardia, sedation, hypoglycemia, and miosis describe a parasympathetic or sedative profile that contradicts the sympathomimetic mechanism of beta-agonists. Bronchodilators stimulate sympathetic activity, producing the opposite cluster of findings in cardiac and metabolic systems. Option c is incorrect because hypotension and drowsiness do not match a bronchodilator's stimulant action; the drug raises heart rate and produces nervousness not sedation. The combination listed points toward central depressants not airway-opening sympathomimetic agents used in asthma. Option d is incorrect because apnea and lethargy are not bronchodilator effects; the drug class stimulates rather than de

Correct Answer: Use preventively, not for acute attacks

Cromolyn is a preventive medication and can cause bronchospasm rather than relieve it acutely. The chapter directs the client to use it on a scheduled basis to prevent attacks and never to substitute it for a true rescue inhaler. Option a is incorrect because using cromolyn at the first wheeze can worsen bronchospasm not open the airways. The drug is preventive only, so using it during an acute attack is contraindicated and risks turning a mild episode severe. Option b is incorrect because using cromolyn as a rescue inhaler misclassifies the drug and can endanger the client during an attack. Rescue therapy belongs to short-acting beta-agonists, and substituting cromolyn removes the fast bronchodilator the client needs. Option c is incorrect because limiting use to nighttime attacks treats cromolyn like a rescue inhaler, which it is not. The drug is given on a regular schedule for prevention and is not appropriate for acute symptom relief.

Correct Answer: Baseline liver function tests

Leukotriene modifiers require baseline liver function tests with close hepatic monitoring during therapy. Hepatic injury is a known adverse effect, and trending liver enzymes from a baseline lets the team detect drug-induced changes promptly before significant damage occurs. Option a is incorrect because thyroid panel monitoring is not the baseline requirement for leukotriene modifiers. The class affects hepatic function not thyroid axis, so a thyroid baseline would not detect the relevant drug-induced toxicity the chapter is concerned about. Option b is incorrect because coagulation panel monitoring is not the focus for leukotriene modifiers, which do not exert toxicity on the clotting system. Baseline labs for this class target the liver because hepatic injury is the documented adverse effect. Option d is incorrect because serum digoxin level is unrelated to leukotriene modifier safety monitoring. Digoxin levels are tracked in clients receiving that specific drug, not as a baseline b

Correct Answer: Epinephrine and resuscitation equipment ready

Omalizumab carries an anaphylaxis risk during initial administration, so epinephrine and treatment medications for severe hypersensitivity reactions must be immediately available. The nurse monitors for lip and tongue swelling and stops the infusion at the first sign of reaction. Option a is incorrect because insulin and glucose are not the bedside readiness items for an omalizumab infusion. Hypoglycemia is not the expected adverse event; anaphylaxis is, so reversal supplies for an allergic emergency are what the chapter requires nearby. Option c is incorrect because naloxone reverses opioid-induced respiratory depression and has no role in managing a monoclonal antibody hypersensitivity reaction. The relevant emergency drug for omalizumab anaphylaxis is epinephrine, not an opioid antagonist held in reserve. Option d is incorrect because activated charcoal is used for some oral overdoses and is irrelevant to a subcutaneous biologic agent. The risk during omalizumab administration is an

Correct Answer: Rebound congestion from overuse

Topical nasal decongestants cause tolerance and rebound congestion when used longer than forty-eight hours. The client should wean off one nostril at a time and use the spray only for short courses to avoid this pattern. Option a is incorrect because an infection would typically produce fever, purulent drainage, and facial pain, not progressive worsening tied to spray use. The pattern of worsening as use continues is characteristic of rebound congestion not a sinus infection. Option b is incorrect because allergic rhinitis usually involves clear drainage, sneezing, and itching, and would not be caused by the decongestant. The chapter ties this worsening pattern to overuse of the topical drug not to a new allergic process. Option c is incorrect because spray potency is a manufacturing concept that does not explain progressive worsening with daily use. The chapter attributes this pattern to rebound effects after the body adapts to prolonged decongestant exposure of the mucosa.

Correct Answer: Take with a full glass of water

Guaifenesin must be taken with a full glass of water so secretions can be loosened effectively and cleared from the airways. Adequate hydration is part of how the drug helps mobilize mucus that is otherwise hard to clear. Option b is incorrect because avoiding fluids defeats the expectorant mechanism, which depends on hydration to thin secretions. Restricting fluid would leave mucus thick and harder to clear, the opposite of what the medication is meant to accomplish. Option c is incorrect because bedtime-only dosing concentrates the effect into one period and may worsen daytime cough when clearance is most needed. The chapter does not restrict guaifenesin to nighttime use and emphasizes hydration regardless of dose timing. Option d is incorrect because mixing with milk is not the recommended technique; the teaching point is volume and timing of fluid intake. Water taken with the dose supports the drug's mechanism, but a specific vehicle like milk does not.

Correct Answer: Pyridoxine, also known as vitamin B6

Isoniazid causes peripheral neuritis, and pyridoxine is administered to prevent this neurologic adverse effect. The chapter routinely pairs the two so that clients on long-term tuberculosis therapy avoid the numbness and tingling associated with vitamin B6 depletion. Option a is incorrect because folic acid supplementation does not address the peripheral neuritis caused by isoniazid. The chapter pairs isoniazid specifically with pyridoxine because B6 depletion is the mechanism behind the nerve symptoms, not folate insufficiency from this drug. Option b is incorrect because vitamin C is unrelated to the peripheral nervous system effects of isoniazid therapy. The relevant supplement is pyridoxine, which directly counters the B6 depletion responsible for the numbness and tingling clients can develop. Option d is incorrect because vitamin K relates to coagulation not peripheral nerve function, and would not prevent isoniazid neuritis. The chapter is specific about pyridoxine as the protect

Correct Answer: This is harmless and expected with rifampin

Rifampin causes harmless orange-red discoloration of body secretions including urine, tears, and sweat. The nurse reassures the client that the color change is an expected pharmacologic effect and does not indicate toxicity or organ injury at all. Option a is incorrect because stopping rifampin for this color change would interrupt a critical tuberculosis regimen without cause. The discoloration is expected and harmless, and discontinuing the drug would undermine the long course of treatment the client needs. Option b is incorrect because kidney failure presents with changes in urine output and lab values, not a color change tied to a drug. The reddish-orange tint is a direct dye effect of rifampin, not a marker of renal failure. Option c is incorrect because internal bleeding would produce findings such as hematuria with frank blood or coffee-ground emesis, not a uniform tint in tears and urine. The chapter attributes this color pattern to rifampin's known and harmless secretion

Correct Answer: Ophthalmologic exam for visual changes

Ethambutol causes optic neuritis with loss of red-green color discrimination, so baseline and periodic eye examinations are required. The nurse arranges ophthalmologic follow-up and teaches the client to report any visual changes immediately during therapy. Option b is incorrect because dental monitoring is not the focus for ethambutol therapy and does not capture the drug's primary toxicity. The chapter ties surveillance to vision because the optic nerve is the at-risk structure, not the oral cavity. Option c is incorrect because hearing exams address ototoxicity from other drug classes such as aminoglycosides and loop diuretics. Ethambutol does not have a recognized auditory toxicity that requires periodic monitoring, so the chapter does not direct hearing assessments here. Option d is incorrect because cardiac monitoring is not specific to ethambutol surveillance during tuberculosis therapy. The drug's signature adverse effect is optic neuritis, so the chapter focuses peri

Correct Answer: Six to nine months of therapy

Tuberculosis treatment regimens require a minimum of six to nine months of therapy to achieve cure and prevent resistance. The nurse teaches the client about adherence over this long course because intermittent dosing risks both relapse and resistance development. Option a is incorrect because two to three weeks is the duration of simple antibacterial courses and is inadequate for tuberculosis. Stopping the regimen at that point would leave viable organisms behind and almost trigger relapse with possible resistance. Option c is incorrect because ten to fourteen days is a typical short antibiotic course for unrelated infections such as routine pneumonia. Tuberculosis treatment is measured in months because the slow-growing organism requires sustained drug pressure to be eradicated reliably. Option d is incorrect because twelve to eighteen weeks falls between short antibiotic courses and full tuberculosis therapy and does not match the recommended range. The minimum standard is six to ni

Correct Answer: Head injury or postoperative cranial surgery

Centrally acting antitussives are contraindicated in clients with head injury or postoperative cranial surgery because they can mask important neurologic assessments and depress the cough reflex needed for airway protection. The nurse questions the order before administration. Option a is incorrect because sinusitis with congestion is not a categorical contraindication to antitussive therapy. The chapter lists head injury and recent cranial surgery as the specific safety concern, not routine upper-respiratory inflammation in an otherwise stable client. Option b is incorrect because mild seasonal allergic rhinitis does not warrant withholding an antitussive on safety grounds. The chapter directs the nurse's attention to neurosurgical and head-injury contexts where suppressing the cough reflex carries genuine risk of airway compromise. Option d is incorrect because stable controlled hypertension is not the contraindication driving the chapter's caution about antitussive use. Th

Correct Answer: Protamine sulfate

Protamine sulfate is the antidote for unfractionated heparin overdose and binds heparin to neutralize its anticoagulant effect. The nurse holds the infusion and prepares to administer protamine while monitoring closely for further bleeding and circulatory compromise. Option b is incorrect because phytonadione is vitamin K and reverses warfarin, not heparin. The mechanisms differ; warfarin blocks vitamin K-dependent clotting factors, so vitamin K corrects it, while heparin requires a binding agent such as protamine. Option c is incorrect because aminocaproic acid reverses thrombolytic medications and is not the agent for heparin overdose. The chapter assigns specific antidotes to each anticoagulant class, and heparin specifically pairs with protamine sulfate as its reversal agent. Option d is incorrect because vitamin C ascorbate has no role as a heparin antidote and does not affect coagulation reversal at all. The chapter is explicit about protamine sulfate as the antidote for unfracti

Correct Answer: Phytonadione, vitamin K

Phytonadione, vitamin K, is the antidote for warfarin overdose. Warfarin blocks vitamin K-dependent clotting factor synthesis, so administering vitamin K restores the body's ability to make the factors and normalizes the international normalized ratio over hours. Option a is incorrect because protamine sulfate reverses heparin, not warfarin. The two anticoagulants have different mechanisms and different reversal agents, so substituting protamine here would not correct the elevated international normalized ratio or the bruising the client is showing. Option b is incorrect because aminocaproic acid is the reversal for thrombolytic medications, not for warfarin overdose. The chapter assigns specific antidotes to each agent, and warfarin reversal uses the vitamin whose synthesis pathway the drug blocks. Option c is incorrect because acetylcysteine reverses acetaminophen toxicity and has no role in warfarin reversal. The chapter is explicit that vitamin K is the antidote because warfar

Correct Answer: Bleeding from any site

Bleeding is the primary concern for any client on an anticoagulant, antiplatelet, or thrombolytic. The nurse monitors for bleeding gums, petechiae, hematuria, hematemesis, and epistaxis at every shift and teaches the client to report any new bleeding. Option a is incorrect because hyperglycemia is not the overarching concern with anticoagulant or antiplatelet therapy. The chapter assigns hyperglycemia to other drug classes such as glucocorticoids, while the priority risk for blood thinners is bleeding from any site. Option c is incorrect because hypotensive episodes are not the central concern of anticoagulant therapy itself. While significant bleeding can lead to hypotension, the chapter frames the priority assessment around bleeding as the underlying cause rather than the downstream effect. Option d is incorrect because photosensitivity belongs to drug classes such as sulfonamides and amiodarone, not to anticoagulants. The chapter does not list sun protection as a priority for blood

Correct Answer: Above normal by twofold

Therapeutic activated partial thromboplastin time on heparin is one and a half to two and a half times normal, often expressed as sixty to eighty seconds. The nurse adjusts the infusion based on these results per the prescribed nomogram. Option a is incorrect because half the normal value indicates a hypercoagulable state, not therapeutic anticoagulation. A result that low would mean the heparin infusion is grossly subtherapeutic, and dose escalation rather than maintenance would be required by the team. Option b is incorrect because an activated partial thromboplastin time equal to baseline normal means the heparin is having no anticoagulant effect. The client would still be at risk for new clot formation, so a higher therapeutic range is required. Option d is incorrect because four to five times normal is well above the therapeutic ceiling and indicates elevated bleeding risk. The infusion would need to be slowed or paused and the level rechecked, since this exceeds the target range.

Correct Answer: Maintain consistent intake of leafy greens

The client is taught to maintain a consistent intake of green leafy vegetables, since vitamin K content interacts with warfarin's mechanism. Sudden increases or decreases swing the international normalized ratio and can produce either bleeding or clotting risk. Option b is incorrect because increasing leafy greens daily would add vitamin K and reduce warfarin's effect, putting the client at clotting risk. The chapter teaches consistency not escalation, so the international normalized ratio remains predictable on a stable dose. Option c is incorrect because eliminating all leafy greens removes important nutrients and is not the chapter's recommendation. Consistency of intake is what matters; both sudden increase and sudden elimination destabilize the international normalized ratio in opposite directions. Option d is incorrect because dairy products are not the dietary concern with warfarin therapy. The relevant interaction is vitamin K from green leafy vegetables, so the