HESI-P HESI Pharmacology - Set 4 - Part 1

Correct Answer: Lower conjunctival sac of eye

The drop is placed in the lower conjunctival sac, never directly on the cornea. The dropper should not touch the eye, and gentle eyelid closure preserves the medication for absorption. Option a is incorrect because the cornea is sensitive and a drop placed there causes pain and reflex blinking that ejects the medication. The chapter specifically warns against corneal contact during instillation of any ophthalmic preparation. Option b is incorrect because the inner canthus is where pressure is applied to block systemic absorption, not where the drop itself is deposited. Placing medication on skin around the canthus would not deliver it into the eye chamber. Option d is incorrect because the upper eyelid is not the deposition site for eye drops; medication placed there cannot reach the conjunctival sac properly. The chapter directs instillation into the lower sac after retracting the lower lid downward.

Correct Answer: Monitoring the blood pressure

Betaxolol is a beta-adrenergic blocker that can cause systemic bradycardia and hypotension after ocular absorption. The nurse monitors blood pressure and pulse and withholds the drug if pulse drops below sixty. Option b is incorrect because ankle edema is not a recognized adverse effect of ophthalmic betaxolol in the chapter and does not guide dose timing. The priority parameter ties to cardiovascular suppression from systemic beta-blockade after absorption through nasolacrimal ducts. Option c is incorrect because oral temperature monitoring is not relevant to ophthalmic beta-blocker therapy. The chapter directs cardiovascular surveillance because systemic absorption can cause bradycardia and hypotension rather than febrile reactions. Option d is incorrect because blood glucose monitoring becomes important only if the client is diabetic, since beta-blockade can mask hypoglycemia. The universal priority for all clients on ophthalmic betaxolol is cardiovascular monitoring of pressure.

Correct Answer: Pull the pinna upward and back

For adults the pinna is pulled up and back to straighten the external auditory canal so drops can travel inward. After instilling, the head stays tilted while the head is gently moved back and forth. Option a is incorrect because downward and back is the technique for infants and children younger than three years, whose ear canal anatomy is shorter and angled differently. Using this pediatric technique on an adult misdirects the drops. Option b is incorrect because pushing the tragus inward does not straighten the canal and may push cerumen deeper rather than open the canal for medication entry. The chapter specifies pinna manipulation, not tragus pressure, for canal alignment. Option c is incorrect because stretching the lobe downward does not align the adult ear canal and accomplishes nothing for drop delivery. The correct technique lifts the pinna upward and posteriorly to open the canal path.

Correct Answer: Atropine sulfate eye drops

Atropine sulfate is a mydriatic and anticholinergic that dilates the pupil and increases intraocular pressure. The drug is contraindicated in glaucoma, and the chapter warns clients to avoid atropine-like over-the-counter medications. Option a is incorrect because pilocarpine is a miotic that constricts the pupil and lowers intraocular pressure, which is the desired glaucoma treatment. It is an appropriate prescription rather than one to question with the prescriber. Option c is incorrect because erythromycin is an antibacterial ophthalmic ointment with no effect on intraocular pressure. It treats bacterial conjunctivitis safely in a client with glaucoma and does not warrant prescriber clarification. Option d is incorrect because betaxolol is a beta-adrenergic blocker used to reduce intraocular pressure by decreasing aqueous humor production. It is a standard glaucoma therapy rather than a contraindicated medication for this client population.

Correct Answer: It constricts pupils to lower eye pressure

Miotics cause pupillary constriction and contract the ciliary muscle, widening the trabecular meshwork. This action lowers intraocular pressure, improves retinal blood flow, and reduces retinal damage and vision loss in glaucoma. Option b is incorrect because dilation describes mydriatics, which raise intraocular pressure and are contraindicated in glaucoma. Telling a glaucoma client the drug dilates the eye misrepresents miotic action and the chapter's pupillary constriction explanation. Option c is incorrect because muscle relaxation describes cycloplegic action used for eye examinations, not the targeted constriction effect of miotics on the pupil. The mechanism described in this option does not match miotic glaucoma therapy. Option d is incorrect because muscle paralysis describes anticholinergic blockade used to produce mydriasis and cycloplegia, again contraindicated in glaucoma. The chapter defines miotic action as constriction, not blockade of muscle response.

Correct Answer: Acetylsalicylic acid tablets

Acetylsalicylic acid is ototoxic, and tinnitus is the most frequent early sign of salicylism. The chapter lists aspirin among medications affecting hearing and links it directly to roaring or ringing complaints. Option a is incorrect because doxycycline is a tetracycline antibiotic and is not on the chapter's list of ototoxic agents responsible for tinnitus. The roaring sound reflects salicylate accumulation rather than tetracycline activity in the inner ear. Option b is incorrect because atropine sulfate causes anticholinergic effects such as dry mouth, blurred vision, and tachycardia, not tinnitus. The chapter does not link atropine with hearing changes, so it is not the responsible agent here. Option c is incorrect because diltiazem is a calcium channel blocker that can cause hypotension and edema, not roaring in the ears. The chapter does not categorize this cardiac medication as ototoxic, so it is not the likely source.

Correct Answer: Warm solution to ninety-eight point six

The irrigating solution is warmed to ninety-eight point six degrees Fahrenheit to prevent ear injury, nausea, vertigo, and nystagmus. The stream is directed toward the canal wall above or below the cerumen, never the eardrum. Option a is incorrect because directing fluid at the eardrum risks perforation and pain and is explicitly prohibited by the chapter. The stream must be aimed at the canal wall so back pressure can dislodge cerumen without striking the membrane. Option b is incorrect because chilled or room-temperature solution can trigger nausea, vertigo, and nystagmus by stimulating vestibular function. The chapter specifies body-temperature solution to avoid these vestibular reactions during ear irrigation procedures. Option d is incorrect because the affected ear is positioned facing upward during irrigation so solution can flow into the canal. After completion the affected ear is turned downward for drainage, but not during active instillation of solution.

Correct Answer: Apply the drop first, then ointment

When a drop and ointment are scheduled together, the drop is administered first followed by the ointment. The drop would not penetrate an oily ointment layer, so the aqueous medication must be deposited initially. Option a is incorrect because ointment first leaves an oily film that blocks drop absorption into the conjunctival tissue. The chapter reverses this sequence, requiring the drop to be instilled before the ointment is applied to ensure proper penetration. Option c is incorrect because waiting fifteen minutes between the two does not correct the wrong order, which still impairs drop absorption. The chapter specifies separating two of the same form by three to five minutes. Option d is incorrect because simultaneous administration is not feasible since each preparation requires separate technique and timing. The chapter assigns a specific order to ensure both forms are absorbed without one blocking the other's contact.

Correct Answer: Occlude nasolacrimal duct with finger

Applying gentle pressure over the inner canthus next to the nose for thirty to sixty seconds occludes the nasolacrimal duct, prevents drainage into the nasal pharynx, and minimizes systemic absorption of the medication. Option a is incorrect because eating before instillation has no relationship to nasolacrimal drainage of an eye drop. The drop reaches systemic circulation through the duct regardless of meal timing, so this measure does not reduce absorption. Option b is incorrect because swallowing after instillation actually moves any drained medication further along the gastrointestinal tract for absorption. The chapter directs occlusion at the duct rather than encouraging downstream transit of escaped medication. Option c is incorrect because blinking vigorously and tearing flush the medication out of the eye and may push fluid into the nasolacrimal duct. Both actions reduce intended ocular contact and may increase rather than decrease systemic absorption.

Correct Answer: Monitor for abdominal distention

Atropine eye drops in infants may contribute to abdominal distention from anticholinergic slowing of the gut. The nurse keeps a record of bowel movements and auscultates bowel sounds during therapy with this medication. Option b is incorrect because projectile vomiting is associated with pyloric stenosis rather than atropine eye drop systemic effects. The chapter links atropine specifically to bowel slowing rather than to gastric outflow obstruction in this age group. Option c is incorrect because fontanelle bulging signals increased intracranial pressure, which is not an effect of ophthalmic atropine. The chapter directs gastrointestinal surveillance rather than neurological pressure assessment after this medication is given. Option d is incorrect because jaundice and rash are not described as systemic effects of ophthalmic atropine in infants. The chapter highlights bowel distention as the priority monitoring parameter rather than hepatic or dermatologic adverse responses.

Correct Answer: Impaired voluntary movements from dyskinesia

Dyskinesia and impaired voluntary movements may occur with high doses of carbidopa-levodopa. The nurse reports new involuntary movement to the prescriber because dose adjustment may be required to manage this adverse effect. Option a is incorrect because pruritus is not associated with carbidopa-levodopa as a dyskinetic effect and would represent allergy rather than involuntary movement. The clinical finding described matches drug-induced movement disorder not a skin reaction. Option b is incorrect because tachycardia can occur but does not produce visible involuntary movement of the face and trunk. The chapter ties new involuntary movements specifically to dyskinesia from cumulative dopaminergic exposure rather than heart rate. Option d is incorrect because hypertension is a possible effect, especially combined with monoamine oxidase inhibitors, but does not explain visible involuntary movement. The dyskinesia label captures the involuntary movement pattern observed in this client.

Correct Answer: Birth control effectiveness may decrease while taking

Phenytoin enhances estrogen metabolism and can decrease the effectiveness of some birth control pills. The client should consult the prescriber about an alternative contraceptive method to prevent unintended pregnancy while on therapy. Option a is incorrect because phenytoin is pregnancy category D with documented teratogenic effects, not a safe medication during pregnancy. Telling the client the drug is safe contradicts the chapter's teratogenicity warning for this hydantoin. Option b is incorrect because stopping antiseizure medication abruptly risks recurrent seizures and is never an appropriate teaching point. The chapter directs gradual taper under prescriber supervision rather than self-discontinuation for side effects. Option c is incorrect because thrombophlebitis from phenytoin and birth control pills together is not a chapter-identified interaction. The real concern is decreased contraceptive effectiveness from accelerated estrogen metabolism in the liver.

Correct Answer: Acetylcysteine for oral administration

Acetylcysteine is the chapter-listed antidote for acetaminophen overdose. Therapeutic acetaminophen level is ten to twenty micrograms per milliliter, with hepatic toxicity risk rising sharply when serum levels exceed two hundred after ingestion. Option b is incorrect because pentostatin is an antineoplastic agent used for hematologic malignancies, not an antidote for acetaminophen overdose. The chapter does not list this drug among reversal agents for analgesic toxicity in any setting. Option c is incorrect because auranofin is a gold preparation used in rheumatoid arthritis, not an antidote for acetaminophen poisoning. The chapter assigns this drug to musculoskeletal disease and lists acetylcysteine as the analgesic reversal agent. Option d is incorrect because fludarabine is an antineoplastic drug used for chronic lymphocytic leukemia and other malignancies. Selecting it for analgesic toxicity would deliver cytotoxic therapy instead of glutathione precursor replacement that the liver

Correct Answer: Temporary worsening of the condition

In cholinergic crisis from overmedication, edrophonium temporarily worsens the condition rather than improving it. Atropine sulfate must be readily available as the antidote, along with emergency airway and resuscitation equipment. Option a is incorrect because improvement of weakness after edrophonium indicates myasthenic crisis from undermedication, not cholinergic crisis. The client improves because additional cholinesterase inhibition restores function at the neuromuscular junction transiently. Option c is incorrect because muscle spasms are not the chapter-described response to edrophonium in either crisis type. The test distinguishes the two by whether weakness improves or worsens, not by spasm onset after the injection. Option d is incorrect because no measurable change is not the chapter-described pattern in either crisis state. Cholinergic crisis produces transient worsening while myasthenic crisis produces transient improvement after the diagnostic injection.

Correct Answer: Slurred speech with ataxia

Therapeutic phenytoin range is ten to twenty micrograms per milliliter, with nystagmus appearing above twenty and ataxia plus slurred speech emerging above thirty. A level of thirty-five places this client into the slurred speech range. Option a is incorrect because hypotension can occur with rapid intravenous administration but is not the expected oral toxicity finding at thirty-five micrograms per milliliter. The chapter ties this level specifically to ataxia and slurred speech presentations. Option b is incorrect because tachycardia is not the chapter-described toxicity finding for phenytoin at this serum concentration. Cardiac dysrhythmias relate to rapid intravenous infusion rather than oral level above thirty in chronic therapy contexts. Option d is incorrect because this level is well above therapeutic range, so an abnormal finding is expected rather than a normal examination. The chapter assigns specific cerebellar findings to levels above thirty micrograms per milliliter consi

Correct Answer: Tinnitus in both ears

Tinnitus is the most frequent early sign of salicylism and typically appears when daily dose exceeds four grams. Other findings include hyperventilation from respiratory center stimulation and fever from metabolic uncoupling at this dose. Option b is incorrect because watery diarrhea is not a chapter-listed manifestation of salicylism, which centers on auditory and respiratory findings. The mild intoxication picture features ringing in the ears rather than gastrointestinal hypermotility as the first clue. Option c is incorrect because constipation and abdominal pain are not features of salicylism in the chapter. The most frequent early symptom is auditory rather than gastrointestinal and reflects salicylate effect on the inner ear chemistry. Option d is incorrect because photosensitivity is associated with other medications such as muscle relaxants and tetracyclines, not salicylism. The chapter's most frequent early finding for salicylate intoxication is ringing in the ears at mod

Correct Answer: Adverse effect of agranulocytosis

Carbamazepine can cause blood dyscrasias including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. A white blood cell count of three thousand is consistent with agranulocytosis and warrants prompt prescriber notification for further evaluation. Option a is incorrect because therapeutic response is judged by seizure or neuralgia control, not a low white blood cell count. The reported value reflects bone marrow suppression rather than a sign of effective therapy. Option b is incorrect because fluid intake adequacy is judged by intake, output, and electrolytes, not by white blood cell count alone. The low value reflects hematologic suppression rather than hydration status during carbamazepine therapy in any patient. Option c is incorrect because electrolyte balance is judged through sodium, potassium, and related laboratory results, not the white blood cell count. A different laboratory panel would be needed to evaluate this parameter, since leukocyte trends track immu

Correct Answer: Monitor bowel activity and stool pattern

Codeine commonly causes constipation, so the nurse increases fluid intake, palpates the bladder, auscultates bowel sounds, and monitors stool pattern. Respiratory status is also assessed because of opioid-related ventilatory depression risk. Option a is incorrect because radial pulse monitoring is part of general assessment but not the specific concern with codeine. The chapter identifies constipation as the codeine-specific intervention focus rather than peripheral cardiovascular surveillance in this scenario. Option c is incorrect because apical heart rate is part of routine vital signs and not the codeine-specific monitoring focus. The chapter ties bowel monitoring specifically to codeine therapy because constipation is a predictable adverse effect of this opioid. Option d is incorrect because peripheral pulse assessment is unrelated to codeine adverse effects and not part of the specific monitoring plan. The chapter identifies bowel monitoring as the codeine-specific nursing interv

Correct Answer: Good oral hygiene with brushing and flossing

Phenytoin commonly causes gingival hyperplasia, so good oral hygiene with brushing, flossing, and regular dental visits is essential. The client should also wear a medical alert bracelet identifying the seizure medication therapy. Option a is incorrect because alcohol consumption is contraindicated with phenytoin because of additive central nervous system depression. Telling the client alcohol is permitted contradicts the chapter's clear directive to avoid alcohol during anticonvulsant therapy in any patient. Option b is incorrect because self-adjustment of antiseizure medication is never appropriate, since dose changes risk seizure recurrence or toxicity. Only the prescriber adjusts dosing based on serum levels and clinical response over time during treatment course. Option d is incorrect because taking the morning dose before serum level draws falsely elevates the measured concentration and misguides dose adjustment. The level should be drawn before the morning dose to reflect t

Correct Answer: White blood cell and platelet counts

Etanercept is a disease-modifying antirheumatic drug associated with infection and pancytopenia. Baseline and ongoing white blood cell, platelet, and neutrophil counts detect potentially life-threatening hematologic suppression that warrants discontinuation and reporting. Option b is incorrect because serum sodium and chloride are not the chapter-listed monitoring focus for etanercept and would not detect the infection or pancytopenia risk. The chapter directs hematologic surveillance for this disease-modifying antirheumatic drug therapy. Option c is incorrect because cholesterol and triglyceride monitoring is unrelated to etanercept adverse effects. The chapter ties safety monitoring to the hematologic profile because infection and pancytopenia are the recognized life-threatening complications of this agent. Option d is incorrect because hemoglobin A1C and glucose are not adverse-effect monitoring parameters for etanercept. The chapter identifies infection and pancytopenia as the prio