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HESI PHARMACOLOGY 2022-2023 Complete Solution Package
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2022 HESI Pharmacology Version 1 (v1) exit exam – REAL EXAM 2022. Questions & Answer
2022 HESI Pharmacology Version 1 (v1) exit exam – REAL EXAM 2022. Questions & Answers HESI Pharmacology Version 1 (v1) exit exam – REAL EXAM 20... [Show More] 22. Questions & Answers [Show Less]
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HESI Pharmacology Version 2 (V2) Practice Exam (2022/2023)
HESI Pharmacology Version 2 (V2) Practice Exam (2022/2023)
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HESI PHARMACOLOGY ACTUAL EXAM QUESTIONS 2022
HESI PHARMACOLOGY ACTUAL EXAM QUESTIONS 2022
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HESI Pharmacology Version 2 (V2) Questions and Answers (2022/2023)
HESI Pharmacology Version 2 (V2) Questions and Answers (2022/2023)
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HESI Pharmacology Version 1 (V1) Test Bank 2022
HESI Pharmacology Version 1 (V1) Test Bank 2022
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HESI Pharmacology (ACTUAL) Questions & Answers with Elaborations (2022/2023)
HESI Pharmacology (ACTUAL) Questions & Answers with Elaborations (2022/2023)
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Hesi Pharmacology 2022-2023 LATEST SOLUTION 100- CORRECT GUARANTEED GRADE A+++
Hesi Pharmacology 2022/2023 LATEST SOLUTION 100% CORRECT GUARANTEED GRADE A+++ 1 . A healthcare provider prescribes cephalexin monohydrate (Keflex) for a ... [Show More] client with a postoperative infection. It is most important for the nurse to assess for what additional drug allergy before administering this prescription? A) Penicillins. B) Aminoglycosides. C) Erythromycins. D) Sulfonamides. A) Penicillins. Cross-allergies exist between penicillins (A) and cephalosporins, such as cephalexin monohydrate (Keflex), so checking for penicillin allergy is a wise precaution before administering this drug. 2. Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? A) Hydrate the client with IV fluids before and after infusion. B) Assess the client for numbness and tingling of extremities. C) Inspect the client's oral mucosa for ulcerations. D) Monitor the client's urine pH for increased acidity. C) Inspect the client's oral mucosa for ulcerations. Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity (C). (A, B, and D) are not typical interventions associated with the administration of antimetabolites. 3. When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? A) Flank. B) Abdomen. C) Chest. D) Head. B) Abdomen. Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen (B), which might indicate liver damage. (A, C, and D) are not areas where pain would be anticipated. 4. An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? A) Apply the patch at least 4 hours prior to departure. B) Change the patch every other day while on the cruise. C) Place the patch on a hairless area at the base of the skull. D) Drink no more than 2 alcoholic drinks during the cruise. A) Apply the patch at least 4 hours prior to departure. Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure (A) on the cruise ship. The duration of the transdermal patch is 72 hours, so (B) is not needed. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear, not at the base of the skull (C). Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol (D) while using the patch. 5. The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? A) The expiration date on the morphine syringe in the pump. B) The rate and depth of the client's respirations. C) The type of anesthesia used during the surgical procedure. D) The client's subjective and objective signs of pain. B) The rate and depth of the client's respirations. A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression (B). The PCA pump should be stopped and the healthcare provider notified if the client's respiratory rate falls below 12 breaths per minute, and the nurse should anticipate adjustments in the client's dosage before the PCA pump is restarted. (A, C, and D) provide helpful information, but are not as high a priority as the assessment described in (B). 6. A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? A) Glaucoma. B) Hypertension. C) Heart failure. D) Asthma. C) Heart failure. Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure (C), shock, atrioventricular block dysrhythmias, and cardiac arrest. Glaucoma (A) is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension (B). Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma (D). 7. A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? A) Use contraception during intercourse. B) Ensure the Cytotec is taken on an empty stomach. C) Encourage oral fluid intake to prevent constipation. D) Take Cytotec 30 minutes prior to Motrin. A) Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse (A) to prevent loss of an early pregnancy. (B) is not necessary. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed (C). Cytotec and Motrin should be taken together (D) to provide protective properties against gastrointestinal bleeding. 8. A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A) Do not add salt to foods during preparation. B) Refrain for eating foods high in potassium. C) Restrict fluid intake to 1000 ml per day. D) Increase intake of milk and milk products. B) Refrain for eating foods high in potassium. Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided (B), including potassium salt substitutes, which can lead to hyperkalemia. Although (A) is a common diet modification in heart failure, the risk of hyperkalemia is more important with Aldactone. Restriction of fluids (C) or increasing milk and milk products (D) are not indicated with this prescription. 9. In evaluating the effects of lactulose (Cephulac), which outcome should indicate that the drug is performing as intended? A) An increase in urine output. B) Two or three soft stools per day. C) Watery, diarrhea stools. D) Increased serum bilirubin. B) Two or three soft stools per day. Lactulose is administered to reduce blood ammonia by excretion of ammonia through the stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A) would be expected if the patient received a diuretic. (C) would indicate an overdose of lactulose and is not expected. Lactulose does not affect (D). 10. The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A) The frequency of the dosing is necessary to increase the effectiveness. B) Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C) Another type of nonsteroidal antiinflammatory drug may be indicated. D) Systemic corticosteroids are the next drugs of choice for pain relief. C) Another type of nonsteroidal antiinflammatory drug may be indicated. Individual responses to nonsteroidal antiinflammatory drugs are variable, so (C) is the best response. Naproxen is usually prescribed every 8 hours, so (A) is not indicated. The peak for naproxen is one to two hours, not (B). Corticosteroids are not indicated for osteoarthritis (D). 11. Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) A) Increase fluid intake, especially cranberry juice. B) Do not abruptly discontinue the medication; taper use. C) Check blood pressure daily to detect hypertension. D) Avoid drinking alcohol while taking this medication. E) Use condoms until treatment is completed. F) Ensure that all sexual partners are treated at the same time. A) Increase fluid intake, especially cranberry juice. D) Avoid drinking alcohol while taking this medication. E) Use condoms until treatment is completed. F) Ensure that all sexual partners are treated at the same time. Correct selections are (A, D, E, and F). Increased fluid intake and cranberry juice (A) are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug (B) or to check the blood pressure daily (C), as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol (D). All sexual partners should be treated at the same time (E) and condoms should be used until after treatment is completed to avoid reinfection (F). 12. A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9 p.m. dose. What action should the nurse take to alleviate this side effect? A) Change the time of the dose. B) Hold the 9 p.m. dose. C) Administer the dose with a snack. D) Administer an antiemetic with the dose. C) Administer the dose with a snack. Administering oral doses with food (C) helps minimize GI discomfort. (A) would be appropriate only if changing the time of the dose corresponds to meal times while at the same time maintaining an appropriate time interval between doses. (B) would disrupt the dosing schedule, and could result in a nontherapeutic serum level of the medication. (D) should not be attempted before other interventions, such as (C), have been proven ineffective in relieving the nausea. 13. A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A) Assess for erythema. B) Administer the antidote. C) Apply warm compresses. D) Discontinue the IV fluids. D) Discontinue the IV fluids. Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site (D) to prevent further tissue damage by the vesicant. Erythema is one sign of infiltration and should be noted, but edema and pain at the infusion site require stopping the IV fluids (A). Although an antidote may be available (B), additional fluids contribute to the trauma of the subcutaneous tissues. Depending on the type of vesicant, warm or cold compresses (C) may be prescribed after the infusion is discontinued. 14. A client with congestive heart failure (CHF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? A) Weight loss. B) Dizziness. C) Muscle cramps. D) Dry mucous membranes. B) Dizziness. Angiotensin-converting enzyme (ACE) inhibitors are used in CHF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness (B). (A) is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. (C) often indicates hypokalemia in the client receiving diuretics. Excessive diuretic administration may result in fluid volume deficit, manifested by symptoms such as (D). 15. The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? A) Withhold the scheduled dose. B) Check the client's apical pulse. C) Notify the healthcare provider. D) Repeat the serum potassium level. A) Withhold the scheduled dose. The nurse should first withhold the scheduled dose of Cozaar (A) because the client is hyperkalemic (normal range 3.5 to 5 mEq/L). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm (B), and the blood pressure. Before repeating the serum study (D), the nurse should notify the healthcare provider (C) of the findings. 16. The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? A) Refer the client to an audiologist for evaluation of her hearing. B) Advise the client that this is a common side effect of aspirin therapy. C) Notify the healthcare provider of this finding immediately. D) Ask the client to turn off her hearing aid during the exam. C) Notify the healthcare provider of this finding immediately. Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately (C), and the medication discontinued. (A and D) are not needed, and (B) is inaccurate. 17. The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with congestive heart failure. Which intervention should the nurse implement prior to administering the digoxin? A) Observe respiratory rate and depth. B) Assess the serum potassium level. C) Obtain the client's blood pressure. D) Monitor the serum glucose level. B) Assess the serum potassium level. Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin (B). (A and C) will not affect the administration of digoxin. (D) should be monitored if he/she is a diabetic and is perhaps receiving insulin. 18. A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? A) Take the first dose of Sinemet today, as soon as your prescription is filled. B) Since you already took your levodopa, wait until tomorrow to take the Sinemet. C) Take both drugs for the first week, then switch to taking only the Sinemet. D) You can begin taking the Sinemet this evening, but do not take any more levodopa. D) You can begin taking the Sinemet this evening, but do not take any more levodopa. Carbidopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa (D), but can be started the same day (B). (A and C) may result in toxicity. 19. A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? A) q6h. B) QID. C) AC and bedtime. D) PC and bedtime. A) q6h. Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock (A) so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. (B, C, and D) do not provide an around-the-clock dosing schedule. Pronestyl may be given with food if GI distress is a problem, but an around-the-clock schedule should still be maintained. 20. A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A) Rash. B) Nausea. C) Headache. D) Dizziness. A) Rash. Rash (A) is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency. (B, C, and D) are common side effects of penicillins that should subside after the body adjusts to the medication. These would not require immediate medical care unless the symptoms persist beyond the first few days or become extremely severe. 21. A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to A) decrease the amount of thyroid-stimulating hormone circulating in the blood. B) increase the amount of thyroid-stimulating hormone circulating in the blood. C) increase the amount of T4 and decrease the amount of T3 produced by the thyroid. D) inhibit synthesis of T3 and T4 by the thyroid gland. D) inhibit synthesis of T3 and T4 by the thyroid gland. PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones (D). It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy. Thyroid- stimulating hormone (TSH) is produced by the pituitary gland, and PTU does not affect the pituitary (A and B). PTU inhibits the synthesis of all thyroid hormones--both T3 and T4(C). 22. A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication should be contraindicated for this client? A) Liothyronine (Cytomel) to replace iodine. B) Furosemide (Lasix) for relief of fluid retention. C) Pentobarbital sodium (Nembutal Sodium) for sleep. D) Nitroglycerin (Nitrostat) for angina pain. C) Pentobarbital sodium (Nembutal Sodium) for sleep. Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates (C), and anesthetics. They do tolerate liothyronine (Cytomel) (A) and usually receive iodine replacement therapy. These clients are also susceptible to heart problems such as angina for which nitroglycerin (Nitrostat) (D) would be indicated, and congestive heart failure for which furosemide (Lasix) (B) would be indicated. 23. Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? A) Dependent edema reduced from +3 to +1. B) Serum HDL increased from 35 to 55 mg/dl. C) Pulse rate reduced from 150 to 90 beats/minute. D) Blood pressure reduced from 160/90 to 130/80. D) Blood pressure reduced from 160/90 to 130/80. Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure (D). (A, B, and C) do not describe effects of Diovan. 24. A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory findings should the nurse identify that places this client at risk? A) Hypokalemia. B) Hyponatremia. C) Hypercalcemia. D) Low uric acid levels. A) Hypokalemia. Hypokalemia affects myocardial contractility, so (A) places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum electrolytes, (B and C), can effect cardiac rhythm, the greatest risk for the client receiving digoxin is (A). (D) does not cause any interactions related to digoxin therapy for supraventricular tachycardia (SVT). 25. Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription? A) As needed. B) Every 12 hours. C) Every 24 hours. D) Every 4 to 6 hours. B) Every 12 hours. [Show Less]
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2022-2023 HESI Pharmacology Question Bank 100- Verified Questions with Rationale
2022/2023 HESI Pharmacology Question Bank 100% Verified Questions with Rationale 1) A nurse is caring for a client with hyperparathyroidism and notes that... [Show More] the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D 3. Calcitonin (Miacalcin) Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration. 2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item? 1. Milk 2. Water 3. Apple juice 4. Orange juice 4. Orange juice Rationale: Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice. 3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations 1. Tinnitus Rationale: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism. 4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied: 1. Immediately before swimming 2. 15 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun 4. At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating. 5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action? 1. Notifying the registered nurse 2. Discontinuing the medication 3. Informing the client that this is normal 4. Applying a thinner film than prescribed to the burn site 3. Informing the client that this is normal Rationale: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect 6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred? 1.Hyperventilation 2.Elevated blood pressure 3.Local pain at the burn site 4.Local rash at the burn site 1.Hyperventilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury. 7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Platelet count 2. Triglyceride level 3. Complete blood count 4. White blood cell count 2. Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment. 8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin) 1. Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin. 9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands 2. Axilla Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles). 10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for: 1. Acne 2. Eczema Hair loss 4. Herpes simplex 1. Acne Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect. 11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial- thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication will permanently stain my skin." 4. "The medication should be applied directly to the wound." 3. "The medication will permanently stain my skin." Rationale: Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram- negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin. 12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action? 1. Notify the registered nurse. 2. Administer pain medication to reduce the discomfort. 3. Apply ice and maintain the infusion rate, as prescribed. 4. Elevate the extremity of the IV site, and slow the infusion. 1. Notify the registered nurse. Rationale: When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider. 13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography Cervical radiography 4. Pulmonary function studies 4. Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication. 14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level 2. Uric acid level Rationale: Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication. 15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension 4. Orthostatic hypotension Rationale: A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication. 16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client: 1. To take aspirin (acetylsalicylic acid) as needed for headache 2. Drink beverages containing alcohol in moderate amounts each evening 3. Consult with health care providers (HCPs) before receiving immunizations 4. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair Consult with health care providers (HCPs) before receiving immunizations Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects. 17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Numbness and tingling in the fingers and toes 4. Numbness and tingling in the fingers and toes Rationale: A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication. 18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history? 1. Pancreatitis 2. Diabetes mellitus 3. Myocardial infarction 4. Chronic obstructive pulmonary disease 1. Pancreatitis Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication. 19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to: 1. Increase DNA and RNA synthesis. 2. Promote the biosynthesis of nucleic acids. Increase estrogen concentration and estrogen response. 4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. 4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response. 20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time 2. Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain. 21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply. 1. Tinnitus 2. Ototoxicity 3. Hyperkalemia 4. Hypercalcemia 5. Nephrotoxicity 6. Hypomagnesemia 1. Tinnitus 2. Ototoxicity 5. Nephrotoxicity 6. Hypomagnesemia Rationale: Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity. 22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to: 1. Treat thyroid storm. 2. Prevent cardiac irritability. 3. Treat hypocalcemic tetany. 4. Stimulate the release of parathyroid hormone. 3. Treat hypocalcemic tetany. Rationale: Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside. 23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge? 1. Keep insulin vials refrigerated at all times. 2. Rotate the insulin injection sites systematically. 3. Increase the amount of insulin before unusual exercise. 4. Monitor the urine acetone level to determine the insulin dosage. 2. Rotate the insulin injection sites systematically. Rationale: Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption. [Show Less]
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2022-2023 HESI PHARMACOLOGY EXAM 100- VERIFIED Q&A BRAND NEW QUESTIONS INCLUDED GRADED A+++
HESI PHARMACOLOGY QUESTIONS WITH ANSWERS 1. A healthcare provider prescribes cephalexin monohydrate (Keflex) for a client with a postoperative infection... [Show More] . It is most important for the nurse to assess for what additional drug allergy before administering this prescription? A) Penicillin’s. B) Aminoglycosides. C) Erythromycins. D) Sulfonamides. A) Penicillin’s. Cross-allergies exist between penicillin’s (A) and cephalosporins, such as cephalexin monohydrate (Keflex), so checking for penicillin allergy is a wise precaution before administering this drug. 2. Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? A) Hydrate the client with IV fluids before and after infusion. B) Assess the client for numbness and tingling of extremities. C) Inspect the client's oral mucosa for ulcerations. D) Monitor the client's urine pH for increased acidity. C) Inspect the client's oral mucosa for ulcerations. Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity (C). (A, B, and D) are not typical interventions associated with the administration of antimetabolites. 3. When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? A) Flank. B) Abdomen. C) Chest. D) Head. B) Abdomen. Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen (B), which might indicate liver damage. (A, C, and D) are not areas where pain would be anticipated. 4. An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? A) Apply the patch at least 4 hours prior to departure. B) Change the patch every other day while on the cruise. C) Place the patch on a hairless area at the base of the skull. D) Drink no more than 2 alcoholic drinks during the cruise. A) Apply the patch at least 4 hours prior to departure. Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure (A) on the cruise ship. The duration of the transdermal patch is 72 hours, so (B) is not needed. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear, not at the base of the skull (C). Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol (D) while using the patch. 5. The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? A) The expiration date on the morphine syringe in the pump. B) The rate and depth of the client's respirations. C) The type of anesthesia used during the surgical procedure. D) The client's subjective and objective signs of pain. B) The rate and depth of the client's respirations. A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression (B). The PCA pump should be stopped and the healthcare provider notified if the client's respiratory rate falls below 12 breaths per minute, and the nurse should anticipate adjustments in the client's dosage before the PCA pump is restarted. (A, C, and D) provide helpful information, but are not as high a priority as the assessment described in (B). 6. A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? A) Glaucoma. B) Hypertension. C) Heart failure. D) Asthma. C) Heart failure. Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure (C), shock, atrioventricular block dysrhythmias, and cardiac arrest. Glaucoma (A) is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension (B). Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma (D). 7. A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? A) Use contraception during intercourse. B) Ensure the Cytotec is taken on an empty stomach. C) Encourage oral fluid intake to prevent constipation. D) Take Cytotec 30 minutes prior to Motrin. A) Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse (A) to prevent loss of an early pregnancy. (B) is not necessary. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed (C). Cytotec and Motrin should be taken together (D) to provide protective properties against gastrointestinal bleeding. 8. A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A) Do not add salt to foods during preparation. B) Refrain for eating foods high in potassium. C) Restrict fluid intake to 1000 ml per day. D) Increase intake of milk and milk products. B) Refrain for eating foods high in potassium. Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided (B), including potassium salt substitutes, which can lead to hyperkalemia. Although (A) is a common diet modification in heart failure, the risk of hyperkalemia is more important with Aldactone. Restriction of fluids (C) or increasing milk and milk products (D) are not indicated with this prescription. 9. In evaluating the effects of lactulose (Cephulac), which outcome should indicate that the drug is performing as intended? A) An increase in urine output. B) Two or three soft stools per day. C) Watery, diarrhea stools. D) Increased serum bilirubin. B) Two or three soft stools per day. Lactulose is administered to reduce blood ammonia by excretion of ammonia through the stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A) would be expected if the patient received a diuretic. (C) would indicate an overdose of lactulose and is not expected. Lactulose does not affect (D). 10. The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A) The frequency of the dosing is necessary to increase the effectiveness. B) Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C) Another type of nonsteroidal antiinflammatory drug may be indicated. D) Systemic corticosteroids are the next drugs of choice for pain relief. C) Another type of nonsteroidal antiinflammatory drug may be indicated. Individual responses to nonsteroidal antiinflammatory drugs are variable, so (C) is the best response. Naproxen is usually prescribed every 8 hours, so (A) is not indicated. The peak for naproxen is one to two hours, not (B). Corticosteroids are not indicated for osteoarthritis (D). 11. Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) A) Increase fluid intake, especially cranberry juice. B) Do not abruptly discontinue the medication; taper use. C) Check blood pressure daily to detect hypertension. D) Avoid drinking alcohol while taking this medication. E) Use condoms until treatment is completed. F) Ensure that all sexual partners are treated at the same time. A) Increase fluid intake, especially cranberry juice. D) Avoid drinking alcohol while taking this medication. E) Use condoms until treatment is completed. F) Ensure that all sexual partners are treated at the same time. Correct selections are (A, D, E, and F). Increased fluid intake and cranberry juice (A) are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug (B) or to check the blood pressure daily (C), as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol (D). All sexual partners should be treated at the same time (E) and condoms should be used until after treatment is completed to avoid reinfection (F). 12. A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9 p.m. dose. What action should the nurse take to alleviate this side effect? A) Change the time of the dose. B) Hold the 9 p.m. dose. C) Administer the dose with a snack. D) Administer an antiemetic with the dose. C) Administer the dose with a snack. Administering oral doses with food (C) helps minimize GI discomfort. (A) would be appropriate only if changing the time of the dose corresponds to meal times while at the same time maintaining an appropriate time interval between doses. (B) would disrupt the dosing schedule, and could result in a nontherapeutic serum level of the medication. (D) should not be attempted before other interventions, such as (C), have been proven ineffective in relieving the nausea. 13. A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A) Assess for erythema. B) Administer the antidote. C) Apply warm compresses. D) Discontinue the IV fluids. D) Discontinue the IV fluids. Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site (D) to prevent further tissue damage by the vesicant. Erythema is one sign of infiltration and should be noted, but edema and pain at the infusion site require stopping the IV fluids (A). Although an antidote may be available (B), additional fluids contribute to the trauma of the subcutaneous tissues. Depending on the type of vesicant, warm or cold compresses (C) may be prescribed after the infusion is discontinued. 14. A client with congestive heart failure (CHF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? A) Weight loss. B) Dizziness. C) Muscle cramps. D) Dry mucous membranes. B) Dizziness. Angiotensin-converting enzyme (ACE) inhibitors are used in CHF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness (B). (A) is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. (C) often indicates hypokalemia in the client receiving diuretics. Excessive diuretic administration may result in fluid volume deficit, manifested by symptoms such as (D). 15. The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? A) Withhold the scheduled dose. B) Check the client's apical pulse. C) Notify the healthcare provider. D) Repeat the serum potassium level. A) Withhold the scheduled dose. The nurse should first withhold the scheduled dose of Cozaar (A) because the client is hyperkalemic (normal range 3.5 to 5 mEq/L). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm (B), and the blood pressure. Before repeating the serum study (D), the nurse should notify the healthcare provider (C) of the findings. 16. The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? A) Refer the client to an audiologist for evaluation of her hearing. B) Advise the client that this is a common side effect of aspirin therapy. C) Notify the healthcare provider of this finding immediately. D) Ask the client to turn off her hearing aid during the exam. C) Notify the healthcare provider of this finding immediately. Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately (C), and the medication discontinued. (A and D) are not needed, and (B) is inaccurate. 17. The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with congestive heart failure. Which intervention should the nurse implement prior to administering the digoxin? A) Observe respiratory rate and depth. B) Assess the serum potassium level. C) Obtain the client's blood pressure. D) Monitor the serum glucose level. B) Assess the serum potassium level. Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin (B). (A and C) will not affect the administration of digoxin. (D) should be monitored if he/she is a diabetic and is perhaps receiving insulin. 18. A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? A) Take the first dose of Sinemet today, as soon as your prescription is filled. B) Since you already took your levodopa, wait until tomorrow to take the Sinemet. C) Take both drugs for the first week, then switch to taking only the Sinemet. D) You can begin taking the Sinemet this evening, but do not take any more levodopa. D) You can begin taking the Sinemet this evening, but do not take any more levodopa. Carbidopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa (D), but can be started the same day (B). (A and C) may result in toxicity. 19. A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? A) q6h. B) QID. C) AC and bedtime. D) PC and bedtime. A) q6h. Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock (A) so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. (B, C, and D) do not provide an around-the-clock dosing schedule. Pronestyl may be given with food if GI distress is a problem, but an around-the-clock schedule should still be maintained. 20. A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A) Rash. B) Nausea. C) Headache. D) Dizziness. A) Rash. Rash (A) is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency. (B, C, and D) are common side effects of penicillins that should subside after the body adjusts to the medication. These would not require immediate medical care unless the symptoms persist beyond the first few days or become extremely severe. 21. A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to A) decrease the amount of thyroid-stimulating hormone circulating in the blood. B) increase the amount of thyroid-stimulating hormone circulating in the blood. C) increase the amount of T4 and decrease the amount of T3 produced by the thyroid. D) inhibit synthesis of T3 and T4 by the thyroid gland. D) inhibit synthesis of T3 and T4 by the thyroid gland. PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones (D). It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy. Thyroid-stimulating hormone (TSH) is produced by the pituitary gland, and PTU does not affect the pituitary (A and B). PTU inhibits the synthesis of all thyroid hormones--both T3 and T4(C). 22. A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication should be contraindicated for this client? A) Liothyronine (Cytomel) to replace iodine. B) Furosemide (Lasix) for relief of fluid retention. C) Pentobarbital sodium (Nembutal Sodium) for sleep. D) Nitroglycerin (Nitrostat) for angina pain. C) Pentobarbital sodium (Nembutal Sodium) for sleep. Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates (C), and anesthetics. They do tolerate liothyronine (Cytomel) (A) and usually receive iodine replacement therapy. These clients are also susceptible to heart problems such as angina for which nitroglycerin (Nitrostat) (D) would be indicated, and congestive heart failure for which furosemide (Lasix) (B) would be indicated. 23. Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? A) Dependent edema reduced from +3 to +1. B) Serum HDL increased from 35 to 55 mg/dl. C) Pulse rate reduced from 150 to 90 beats/minute. D) Blood pressure reduced from 160/90 to 130/80. D) Blood pressure reduced from 160/90 to 130/80. Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure (D). (A, B, and C) do not describe effects of Diovan. 24. A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory findings should the nurse identify that places this client at risk? A) Hypokalemia. B) Hyponatremia. C) Hypercalcemia. D) Low uric acid levels. A) Hypokalemia. Hypokalemia affects myocardial contractility, so (A) places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum electrolytes, (B and C), can effect cardiac rhythm, the greatest risk for the client receiving digoxin is (A). (D) does not cause any interactions related to digoxin therapy for supraventricular tachycardia (SVT). 25. Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription? A) As needed. B) Every 12 hours. C) Every 24 hours. D) Every 4 to 6 hours. B) Every 12 hours. A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours (B) provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule (A). (C) is inadequate for continuous pain management. Using a schedule of every 4 to 6 hours (D) may jeopardize patient safety due to cumulative effects. 26. postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? A) Administer a PRN dose of the PO meperidine (Demerol). B) Administer naloxone (Narcan) IV per PRN protocol. C) Decrease the IV infusion rate of the meperidine (Demerol) per protocol. D) Notify the healthcare provider of the client's confusion and hallucinations. C) Decrease the IV infusion rate of the meperidine (Demerol) per protocol. The client is exhibiting symptoms of Demerol toxicity, which is consistent with the large dose of Demerol received over four days. (C) is the most effective action to immediately decrease the amount of serum Demerol. (A) will increase the toxic level of medication in the bloodstream. Naloxone (B) is an opioid antagonist that is used during an opioid overdose, but it is not beneficial during Demerol toxicity and can precipitate seizures. The healthcare provider should be notified (D), but that is not the initial action the nurse should take; first the amount of drug infusing should be decreased. 27. A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? A) Take medication, go for a 30 minute morning walk, then eat breakfast. B) Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. C) Take medication with breakfast, then take a 30 minute morning walk. D) Go for a 30 minute morning walk, eat breakfast, then take medication. A) Take medication, go for a 30 minute morning walk, then eat breakfast. Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation. (A) is the best schedule to meet these needs. (B, C, and D) do not meet these criteria. 28. In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider? A) Changes in urine color. B) Presence of hand tremors. C) Increasing body hirsutism. D) Nausea and vomiting. B) Presence of hand tremors. Neurological complications, such as hand tremors (B), occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, (A) typically does not occur. (C and D) are common side effects, but are not usually severe. 29. taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? A) Aminoglycosides. B) Cephalosporins. C) Sulfonamides. D) Tetracyclines. B) Cephalosporins. Cross allergies exist between penicillins and cephalosporins (B). Penicillin allergies are unrelated to allergies associated with (A, C, or D). 30. A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? A) Expected duration of flushing. B) Symptoms of hyperglycemia. C) Diets that minimize GI irritation. D) Comfort measures for pruritis. A) Expected duration of flushing. Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching (A) may promote compliance in taking the medication. While (B, C, and D) are all worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client. 31. A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? A) Serum glucose. B) Serum calcium. C) Red blood cells. D) Serum potassium. A) Serum glucose. Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia (A), which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is at risk for hypocalcemia (B) and hypokalemia (D), which result in a decrease, not an increase, in the serum calcium and serum potassium levels. This medication does not adversely affect the RBC count (C). 32. A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? A) Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). B) Administer the 40 mg of Imdur and then contact the healthcare provider. C) Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). D) Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider. C) Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen (C) until the client develops a tolerance to this adverse effect. (A and B) may result in the onset of angina if a therapeutic level of Imdur is not maintained. Lying down (D) is less likely to reduce the headache than is a mild analgesic. 33. A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 ml/hour. The nurse notes that the client's urinary output has been 20 ml/hour for the last two hours. Which intervention should the nurse initiate? A) Stop the infusion of dopamine. B) Change the normal saline to a keep open rate. C) Replace the urinary catheter. D) Notify the healthcare provider of the urinary output. D) Notify the healthcare provider of the urinary output. The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 ml/hour is oliguria and should be reported to the healthcare provider (D) so that the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased. If the dose is decreased, it should be titrated down, rather than abruptly discontinued (A). Fluid intake may need to be increased, rather than (B). The urinary catheter is draining and does not need to be replaced (C). 34. Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.) A) Prednisone (Deltasone) orally. B) Gentamicin (Garamycin) IM. C) Albuterol (Proventil) puffs. D) Salmeterol (Serevent Diskus). The best sequence of administration is (C, D, A and B). Status asthmaticus is potentially a life-threatening respiratory event, so albuterol (C), a beta2 adrenergic agonist and bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus) (D) with a 12-hour duration of action should be given next. Prednisone (A), an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin (B), an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence. 35. A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? A) Sixty minutes after the antibiotic dose is administered. B) Immediately before the next antibiotic dose is given. C) When the next blood glucose level is to be checked. D) Thirty minutes before the next antibiotic dose is given. B) Immediately before the next antibiotic dose is given. Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given (B). (A, C, and D) do not describe the optimum time for obtaining a trough level of an antibiotic. 36. The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which prescription should the nurse prepare to administer this client? A) Dopamine. B) Ephedrine. C) Epinephrine. D) Diphenhydramine. C) Epinephrine. Epinephrine (C) is an adrenergic agent that stimulate beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. Dopamine (A) is a vasopressor used to treat clients with shock. Ephedrine (B) causes peripheral vasoconstriction and is used in the treatment of nasal congestion. Diphenhydramine (D) is an antihistamine decongestant used in the treatment of mild allergic reactions and motion sickness. 37. Which medications should the nurse caution the client about taking while receiving an opioid analgesic? A) Antacids. B) Benzodiazepines. C) Antihypertensives. D) Oral antidiabetics. B) Benzodiazepines. Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines (B). (A and D) do not interact with opiates to produce adverse effects. Antihypertensives (C) may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider. 38. After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse why he is receiving this medication. Which is the best response for the nurse to provide? A) This medication is a blood thinner given to prevent blood clot formation. B) This medication enhances antibiotics to prevent infection. C) This medication dissolves any clots that develop in the legs. D) This abdominal injection assists in the healing of the abdominal wound. A) This medication is a blood thinner given to prevent blood clot formation. Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that inhibits thrombin- mediated conversion of fibrinogen to fibrin and is given prophylactically to prevent postoperative venous thrombosis (A) or to treat pulmonary embolism or deep vein thrombosis following knee and abdominal surgeries. Heparin does not dissolve clots but prevents clot extension or further clot formation (C). The anticoagulant heparin does not prevent infection (B) or influence operative wound healing (D). 39. An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse knows that the purpose of this medication is to A) decrease production of gastric secretions. B) produce an adherent barrier over the ulcer. C) maintain a gastric pH of 3.5 or above. D) decrease gastric motor activity. C) maintain a gastric pH of 3.5 or above. The objective of antacids is to neutralize gastric acids and keep pH of 3.5 or above (C) which is necessary for pepsinogen inactivity. (A) is the purpose of H2 receptor antagonists (cimetidine, ranitidine). (B) is the purpose of sucralfate (Carafate). (D) is the purpose of anticholinergic drugs which are often used in conjunction with antacids to allow the antacid to remain in the stomach longer. 40. A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? A) Use a reliable form of birth control. B) Avoid exposure to ultra violet light. C) Refuse this medication if planning pregnancy. D) Abstain from intercourse while on this drug. A) Use a reliable form of birth control. Drugs classified in the category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control (A) during drug therapy. (B) is not a specific precaution with Category X drugs. The client should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription (C) can be provided if pregnancy occurs. Although the risk of birth defects during pregnancy explains the restriction of these drugs during pregnancy, (D) is not indicated. 41. A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What intervention should the nurse implement? A) Alternate the two medications q4h PRN for pain. B) Alternate the two medications q2h PRN for pain. C) Administer only the Dilaudid q4h PRN for pain. D) Administer only the Stadol q4h PRN for pain. C) Administer only the Dilaudid q4h PRN for pain. Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided (C). (A, B, and D) do not reflect good nursing practice. 42. Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? A) Client states chest pain is relieved. B) Client's pulse decreases from 120 to 90. C) Client's systolic blood pressure decreases from 180 to 90. D) Client's SaO2 level increases from 92% to 96%. A) Client states chest pain is relieved. Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain (A). (B and D) would also occur if the angina was relieved, but are not as significant as the client's subjective report of decreased pain. (C) may indicate a reduction in pain, or a potentially serious side effect of the medication. 43. A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? A) Heartburn. B) Headache. C) Constipation. D) Vomiting. D) Vomiting. [Show Less]
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HESI PHARMACOLOGY (QUESTIONS AND ANSWERS) (2022-2023).
HESI PHARMACOLOGY (QUESTIONS AND ANSWERS) (2022/2023) 1. A healthcare provider prescribes cephalexin monohydrate (Keflex) for a client with a postoperat... [Show More] ive infection. It is most important for the nurse to assess for what additional drug allergy before administering this prescription? A) Penicillins. B) Aminoglycosides. C) Erythromycins. D) Sulfonamides. A) Penicillins. Cross-allergies exist between penicillins (A) and cephalosporins, such as cephalexin monohydrate (Keflex), so checking for penicillin allergy is a wise precaution before administering this drug. 2. Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? A) Hydrate the client with IV fluids before and after infusion. B) Assess the client for numbness and tingling of extremities. C) Inspect the client's oral mucosa for ulcerations. D) Monitor the client's urine pH for increased acidity. C) Inspect the client's oral mucosa for ulcerations. Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity (C). (A, B, and D) are not typical interventions associated with the administration of antimetabolites. 3. When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? A) Flank. B) Abdomen. C) Chest. D) Head. B) Abdomen. Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen (B), which might indicate liver damage. (A, C, and D) are not areas where pain would be anticipated. 4. An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? A) Apply the patch at least 4 hours prior to departure. B) Change the patch every other day while on the cruise. C) Place the patch on a hairless area at the base of the skull. D) Drink no more than 2 alcoholic drinks during the cruise. A) Apply the patch at least 4 hours prior to departure. Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure (A) on the cruise ship. The duration of the transdermal patch is 72 hours, so (B) is not needed. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear, not at the base of the skull (C). Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol (D) while using the patch. 5. The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? A) The expiration date on the morphine syringe in the pump. B) The rate and depth of the client's respirations. C) The type of anesthesia used during the surgical procedure. D) The client's subjective and objective signs of pain. B) The rate and depth of the client's respirations. A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression (B). The PCA pump should be stopped and the healthcare provider notified if the client's respiratory rate falls below 12 breaths per minute, and the nurse should anticipate adjustments in the client's dosage before the PCA pump is restarted. (A, C, and D) provide helpful information, but are not as high a priority as the assessment described in (B). 6. A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? A) Glaucoma. B) Hypertension. C) Heart failure. D) Asthma. C) Heart failure. Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure and are indicated in heart failure (C), shock, atrioventricular block dysrhythmias, and cardiac arrest. Glaucoma (A) is managed using adrenergic agents and beta-adrenergic blocking agents. Beta-1 blocking agents are used in the management of hypertension (B). Medications that stimulate beta-2 receptors in the bronchi are effective for bronchoconstriction in respiratory disorders, such as asthma (D). 7. A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? A) Use contraception during intercourse. B) Ensure the Cytotec is taken on an empty stomach. C) Encourage oral fluid intake to prevent constipation. D) Take Cytotec 30 minutes prior to Motrin. A) Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse (A) to prevent loss of an early pregnancy. (B) is not necessary. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed (C). Cytotec and Motrin should be taken together (D) to provide protective properties against gastrointestinal bleeding. 8. A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A) Do not add salt to foods during preparation. B) Refrain for eating foods high in potassium. C) Restrict fluid intake to 1000 ml per day. D) Increase intake of milk and milk products. B) Refrain for eating foods high in potassium. Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided (B), including potassium salt substitutes, which can lead to hyperkalemia. Although (A) is a common diet modification in heart failure, the risk of hyperkalemia is more important with Aldactone. Restriction of fluids (C) or increasing milk and milk products (D) are not indicated with this prescription. 9. In evaluating the effects of lactulose (Cephulac), which outcome should indicate that the drug is performing as intended? A) An increase in urine output. B) Two or three soft stools per day. C) Watery, diarrhea stools. D) Increased serum bilirubin. B) Two or three soft stools per day. Lactulose is administered to reduce blood ammonia by excretion of ammonia through the stool. Two to three stools a day indicate that lactulose is performing as intended (B). (A) would be expected if the patient received a diuretic. (C) would indicate an overdose of lactulose and is not expected. Lactulose does not affect (D). 10. The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A) The frequency of the dosing is necessary to increase the effectiveness. B) Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C) Another type of nonsteroidal anti-inflammatory drug may be indicated. D) Systemic corticosteroids are the next drugs of choice for pain relief. C) Another type of nonsteroidal anti-inflammatory drug may be indicated. Individual responses to nonsteroidal anti-inflammatory drugs are variable, so (C) is the best response. Naproxen is usually prescribed every 8 hours, so (A) is not indicated. The peak for naproxen is one to two hours, not (B). Corticosteroids are not indicated for osteoarthritis (D). 11. Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) A) Increase fluid intake, especially cranberry juice. B) Do not abruptly discontinue the medication; taper use. C) Check blood pressure daily to detect hypertension. D) Avoid drinking alcohol while taking this medication. E) Use condoms until treatment is completed. F) Ensure that all sexual partners are treated at the same time. A) Increase fluid intake, especially cranberry juice. D) Avoid drinking alcohol while taking this medication. E) Use condoms until treatment is completed. F) Ensure that all sexual partners are treated at the same time. Correct selections are (A, D, E, and F). Increased fluid intake and cranberry juice (A) are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug (B) or to check the blood pressure daily (C), as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol (D). All sexual partners should be treated at the same time (E) and condoms should be used until after treatment is completed to avoid reinfection (F). 12. A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9 p.m. dose. What action should the nurse take to alleviate this side effect? A) Change the time of the dose. B) Hold the 9 p.m. dose. C) Administer the dose with a snack. D) Administer an antiemetic with the dose. C) Administer the dose with a snack. Administering oral doses with food (C) helps minimize GI discomfort. (A) would be appropriate only if changing the time of the dose corresponds to meal times while at the same time maintaining an appropriate time interval between doses. (B) would disrupt the dosing schedule, and could result in a nontherapeutic serum level of the medication. (D) should not be attempted before other interventions, such as (C), have been proven ineffective in relieving the nausea. 13. A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A) Assess for erythema. B) Administer the antidote. C) Apply warm compresses. D) Discontinue the IV fluids. D) Discontinue the IV fluids. Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site (D) to prevent further tissue damage by the vesicant. Erythema is one sign of infiltration and should be noted, but edema and pain at the infusion site require stopping the IV fluids (A). Although an antidote may be available (B), additional fluids contribute to the trauma of the subcutaneous tissues. Depending on the type of vesicant, warm or cold compresses (C) may be prescribed after the infusion is discontinued. 14. A client with congestive heart failure (CHF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? A) Weight loss. B) Dizziness. C) Muscle cramps. D) Dry mucous membranes. B) Dizziness. Angiotensin-converting enzyme (ACE) inhibitors are used in CHF to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness (B). (A) is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. (C) often indicates hypokalemia in the client receiving diuretics. Excessive diuretic administration may result in fluid volume deficit, manifested by symptoms such as (D). 15. The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? A) Withhold the scheduled dose. B) Check the client's apical pulse. C) Notify the healthcare provider. D) Repeat the serum potassium level. A) Withhold the scheduled dose. The nurse should first withhold the scheduled dose of Cozaar (A) because the client is hyperkalemic (normal range 3.5 to 5 mEq/L). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm (B), and the blood pressure. Before repeating the serum study (D), the nurse should notify the healthcare provider (C) of the findings. 16. The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? A) Refer the client to an audiologist for evaluation of her hearing. B) Advise the client that this is a common side effect of aspirin therapy. C) Notify the healthcare provider of this finding immediately. D) Ask the client to turn off her hearing aid during the exam. C) Notify the healthcare provider of this finding immediately. Tinnitus is an early sign of salicylate toxicity. The healthcare provider should be notified immediately (C), and the medication discontinued. (A and D) are not needed, and (B) is inaccurate. 17. The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with congestive heart failure. Which intervention should the nurse implement prior to administering the digoxin? A) Observe respiratory rate and depth. B) Assess the serum potassium level. C) Obtain the client's blood pressure. D) Monitor the serum glucose level. B) Assess the serum potassium level. Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin (B). (A and C) will not affect the administration of digoxin. (D) should be monitored if he/she is a diabetic and is perhaps receiving insulin. 18. A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? A) Take the first dose of Sinemet today, as soon as your prescription is filled. B) Since you already took your levodopa, wait until tomorrow to take the Sinemet. C) Take both drugs for the first week, then switch to taking only the Sinemet. D) You can begin taking the Sinemet this evening, but do not take any more levodopa. D) You can begin taking the Sinemet this evening, but do not take any more levodopa. Carbidopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa (D), but can be started the same day (B). (A and C) may result in toxicity. 19. A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? A) q6h. B) QID. C) AC and bedtime. D) PC and bedtime. A) q6h. Pronestyl is a class 1A antidysrhythmic. It should be taken around-the-clock (A) so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. (B, C, and D) do not provide an around-the-clock dosing schedule. Pronestyl may be given with food if GI distress is a problem, but an around-the-clock schedule should still be maintained. 20. A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A) Rash. B) Nausea. C) Headache. D) Dizziness. A) Rash. Rash (A) is the most common adverse effect of all penicillins, indicating an allergy to the medication which could result in anaphylactic shock, a medical emergency. (B, C, and D) are common side effects of penicillins that should subside after the body adjusts to the medication. These would not require immediate medical care unless the symptoms persist beyond the first few days or become extremely severe. 21. A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to A) decrease the amount of thyroid-stimulating hormone circulating in the blood. B) increase the amount of thyroid-stimulating hormone circulating in the blood. C) increase the amount of T4 and decrease the amount of T3 produced by the thyroid. D) inhibit synthesis of T3 and T4 by the thyroid gland. D) inhibit synthesis of T3 and T4 by the thyroid gland. PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones (D). It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy. Thyroid-stimulating hormone (TSH) is produced by the pituitary gland, and PTU does not affect the pituitary (A and B). PTU inhibits the synthesis of all thyroid hormones--both T3 and T4(C). 22. A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication should be contraindicated for this client? A) Liothyronine (Cytomel) to replace iodine. B) Furosemide (Lasix) for relief of fluid retention. C) Pentobarbital sodium (Nembutal Sodium) for sleep. D) Nitroglycerin (Nitrostat) for angina pain. C) Pentobarbital sodium (Nembutal Sodium) for sleep. Persons with myxedema are dangerously hypersensitive to narcotics, barbiturates (C), and anesthetics. They do tolerate liothyronine (Cytomel) (A) and usually receive iodine replacement therapy. These clients are also susceptible to heart problems such as angina for which nitroglycerin (Nitrostat) (D) would be indicated, and congestive heart failure for which furosemide (Lasix) (B) would be indicated. 23. Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? A) Dependent edema reduced from +3 to +1. B) Serum HDL increased from 35 to 55 mg/dl. C) Pulse rate reduced from 150 to 90 beats/minute. D) Blood pressure reduced from 160/90 to 130/80. D) Blood pressure reduced from 160/90 to 130/80. Diovan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure (D). (A, B, and C) do not describe effects of Diovan. 24. A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory findings should the nurse identify that places this client at risk? A) Hypokalemia. B) Hyponatremia. C) Hypercalcemia. D) Low uric acid levels. A) Hypokalemia. Hypokalemia affects myocardial contractility, so (A) places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum electrolytes, (B and C), can effect cardiac rhythm, the greatest risk for the client receiving digoxin is (A). (D) does not cause any interactions related to digoxin therapy for supraventricular tachycardia (SVT). 25. Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription? A) As needed. B) Every 12 hours. C) Every 24 hours. D) Every 4 to 6 hours. B) Every 12 hours. A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours (B) provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule (A). (C) is inadequate for continuous pain management. Using a schedule of every 4 to 6 hours (D) may jeopardize patient safety due to cumulative effects. 26. postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? A) Administer a PRN dose of the PO meperidine (Demerol). B) Administer naloxone (Narcan) IV per PRN protocol. C) Decrease the IV infusion rate of the meperidine (Demerol) per protocol. D) Notify the healthcare provider of the client's confusion and hallucinations. C) Decrease the IV infusion rate of the meperidine (Demerol) per protocol. The client is exhibiting symptoms of Demerol toxicity, which is consistent with the large dose of Demerol received over four days. (C) is the most effective action to immediately decrease the amount of serum Demerol. (A) will increase the toxic level of medication in the bloodstream. Naloxone (B) is an opioid antagonist that is used during an opioid overdose, but it is not beneficial during Demerol toxicity and can precipitate seizures. The healthcare provider should be notified (D), but that is not the initial action the nurse should take; first the amount of drug infusing should be decreased. 27. A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? A) Take medication, go for a 30 minute morning walk, then eat breakfast. B) Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. C) Take medication with breakfast, then take a 30 minute morning walk. D) Go for a 30 minute morning walk, eat breakfast, then take medication. A) Take medication, go for a 30 minute morning walk, then eat breakfast. Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation. (A) is the best schedule to meet these needs. (B, C, and D) do not meet these criteria. 28. In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider? A) Changes in urine color. B) Presence of hand tremors. C) Increasing body hirsutism. D) Nausea and vomiting. B) Presence of hand tremors. Neurological complications, such as hand tremors (B), occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, (A) typically does not occur. (C and D) are common side effects, but are not usually severe. 29. taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? A) Aminoglycosides. B) Cephalosporins. C) Sulfonamides. D) Tetracyclines. B) Cephalosporins. Cross allergies exist between penicillins and cephalosporins (B). Penicillin allergies are unrelated to allergies associated with (A, C, or D). 30. A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? A) Expected duration of flushing. B) Symptoms of hyperglycemia. C) Diets that minimize GI irritation. D) Comfort measures for pruritis. A) Expected duration of flushing. Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching (A) may promote compliance in taking the medication. While (B, C, and D) are all worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client. 31. A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? A) Serum glucose. B) Serum calcium. C) Red blood cells. D) Serum potassium. A) Serum glucose. Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia (A), which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is at risk for hypocalcemia (B) and hypokalemia (D), which result in a decrease, not an increase, in the serum calcium and serum potassium levels. This medication does not adversely affect the RBC count (C). [Show Less]
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