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NGN HESI PHARMACOLOGY EXAM 2023/2024 COMPLETE SOLUTION PACKAGE
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Pharmacology HESI Exit Exam with NGN Latest Update 2023-2024 Actual Exam Questions Verified Q&A
1. 1.ID: 310953449 A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effe... [Show More] ct of the medication has been achieved? A. Client denies recent episodes of angina. Incorrect B. Change in peripheral edema from +3 to +1. C. Client denies recent nausea or vomiting. D. Blood pressure has changed from 180/120 to 140/70. Correct Catapres acts as a centrally-acting analgesic and antihypertensive agent. (D) indicates a reduction in hypertension. Catapres does not affect (A, B, or C), so these findings do not indicate desired outcomes of Catapres. Awarded 0.0 points out of 1.0 possible points. 2. 2.ID: 310972761 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. Correct 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. 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). Awarded 1.0 points out of 1.0 possible points. 3. 3.ID: 310989365 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. Incorrect B. Headache. C. Constipation. D. Vomiting. Correct Vomiting, anorexia and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse (D). (A, B and C) are expected side effects of Lipitor. Awarded 0.0 points out of 1.0 possible points. 4. 4.ID: 310974953 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. Correct C. Restrict fluid intake to 1000 ml per day. D. Increase intake of milk and milk products. 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. Awarded 1.0 points out of 1.0 possible points. 5. 5.ID: 310950706 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. Correct B. QID. C. AC and bedtime. D. PC and bedtime. 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. Awarded 1.0 points out of 1.0 possible points. 6. 6.ID: 310949440 A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? A. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. B. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Correct D. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug. Myopathy, suggested by the leg pain and weakness, is a serious, and potentially life-threatening, complication of Lipitor, and should be evaluated immediately by the healthcare provider (C). Although electrolyte imbalances such as (A or B) can cause muscle spasms in some cases, this is not the likely cause of leg pain in the client receiving Lipitor, and evaluation by the healthcare provider should not be delayed for any reason. A low-cholesterol diet is recommended for those taking Lipitor since the drug is used to lower total cholesterol (D), but diet is not related to the leg pain symptom. Awarded 1.0 points out of 1.0 possible points. 7. 7.ID: 310962739 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. Correct B. Avoid exposure to ultra violet light. C. Refuse this medication if planning pregnancy. D. Abstain from intercourse while on this drug. 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. Awarded 1.0 points out of 1.0 possible points. 8. 8.ID: 310953453 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. Correct 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. Awarded 1.0 points out of 1.0 possible points. 9. 9.ID: 310993901 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. Correct B. Check the client's apical pulse. C. Notify the healthcare provider. D. Repeat the serum potassium level. 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. Awarded 1.0 points out of 1.0 possible points. 10. 10.ID: 310962715 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. Incorrect C. Pulse rate reduced from 150 to 90 beats/minute. D. Blood pressure reduced from 160/90 to 130/80. Correct 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. [Show Less]
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2023 HESI Pharmacology Exit Exam Latest Exam Verified Questions with Answers
HESI Pharmacology Exit Exam What is the indication for metoclopramide/reglan? - ✅✅✅Prevention of chemotherapy-induced emesis and diabetic gastropa... [Show More] resis Side effects of metoclopramide/reglan - ✅✅✅Drowsiness, EPS such as tremors Notify MD if what occurs when using metoclopramide/reglan - ✅✅✅Tremors What is the indication xenical (orlistat, Alli) - ✅✅✅For PTs with BMI of 30+; LT weight control SE of xenical (orlistat or alli) - ✅✅✅Oily stool and flatulence Nursing implications for a pt on xenical (orlistat or alli) - ✅✅✅Ask pt to describe dietary intake since SE are increased if greater than 30% of fat is in diet. What can decrease side effects of xenical (orlistat or alli) - ✅✅✅Fiber laxatives like Metamucil help decrease SE by binding to the fat. Which type of fluids need plenty of water? - ✅✅✅Bulk forming laxatives Why do you need plenty of fluids when taking bulk forming laxatives - ✅✅✅Because they can produce esophageal and or intestinal obstruction Laxative use assessment - ✅✅✅Last BM and characteristics, abdominal pain, fever and obstruction. Assess dietary and fluid intake. With laxative use the nurse should - ✅✅✅Encourage fluids, fiber and exercise as tolerated/indicated Laxative use and result in - ✅✅✅Lack of bowel tone which can lead to dependency what is ondansetron (zofran) - ✅✅✅antiemetic What is ondansetron (zofran)used for? - ✅✅✅Prevention of N/V associated with chemotherapy and radiation therapy. Who should you use caution with when giving ondansetron/zofran? - ✅✅✅PTs with liver failure Drugs for ulcerative colitis and crohns - ✅✅✅5 aminosalicylates; mesalamie, sulfasalazine. How do 5 aminosalicylates; (mesalamie, sulfasalazine) work? - ✅✅✅They decrease GI inflammation Side effects of 5 aminosalicylates; (mesalamie, sulfasalazine) - ✅✅✅Nausea, rash, arthralgia, hematological disorders Which drug can cause colitis/c.diff - ✅✅✅Linezolid/zyvox What kind of infection is c.diff - ✅✅✅Suprainfection What is azithromycin/zithromax? - ✅✅✅An antibiotic What does azithromycin/zithromax treat? - ✅✅✅STDs such as: gonorrhea and chlamydia How much azithromycin/zithromax is usually required? - ✅✅✅One dose of 1g or 2g. If a female pt has trichomonas (any STI) and is asymptomatic does the male need to be tested? - ✅✅✅Yes! azithromycin/zithromax can cause what? - ✅✅✅Hepatotoxicity- elevated liver enzymes What is nitrofurantoin/cipro used for? - ✅✅✅An antibiotic for UTI nitrofurantoin/cipro side effect - ✅✅✅Hepatotoxicity, skin reactions, neuropathy nitrofurantoin/cipro nursing considerations - ✅✅✅Give with milk or meals check LFTs. Watch for numbness or tingling of extremities this can be an irreversible peripheral neuropathy Drug of choice for treating c.diff? - ✅✅✅Metronidazole/flagyl When is metronidazole/flagyl to be taken? - ✅✅✅With food and around the clock What should be avoided when taking metronidazole/flagyl and why? - ✅✅✅Alcohol; can cause a disulfiram-like reaction aminoglycosides examples - ✅✅✅gentamicin(garamycin), neomycin, tobramycin(nebcin) how are aminoglycosides ,(-mycin, -micin), administered? - ✅✅✅given IV for several days what is an adverse effect of aminoglycosides (-mycin, -micin) - ✅✅✅decreased hearing/ototoxicity and nephrotoxicity what labs need to be evaluated when given aminoglycosides (-mycin, -micin)? - ✅✅✅BUN and creatinine DOC for MRSA - ✅✅✅vancomycin what is MRSA - ✅✅✅severe staph infections that have become resistant to most antibiotics implications for giving vancomycin - ✅✅✅acute care requires frequent monitoring og serum drug level for dose adjustment. peak and trough schedule. trough is drawn just prior to next dose. risks when using vancomycin - ✅✅✅nephrotoxicity and ototoxicity SE of vancomycin - ✅✅✅thrombophlebitis, red man syndrome if infused too rapidly: flushing or rash of upper body, dyspnea, itching, hypotension- can be lethal how long should IV vancomycin infuse? - ✅✅✅greater than 60 minutes what is trimethoprim/sulfamethoxazole? - ✅✅✅it is a sulfonamide for treatment of UTI. combination increases efficacy and inhibits metabolism of folic acid at two different points what is trimethoprim/sulfamethoxazole known for? - ✅✅✅sulfa allergy nursing implications for trimethoprim/sulfamethoxazole - ✅✅✅assess for rash due to potential for stevens johnson syndrome penicillins have a ____ to ____ - ✅✅✅cross-sensitivity; cephalosporins. they are structurally similar. nursing considerations for penicillins - ✅✅✅observe respiratory status for first 30 minutes when administering for the first time. watch for anaphylaxis if allergic to one or the other may have cross sensitivity what can a nurse treat penicillin anaphylaxis with? - ✅✅✅epinephrine nursing considerations for antibiotics - ✅✅✅do not take for viral illnesses. take entire prescription as ordered. don't take if not needed as it can produce resistance. what is ribavirin(copegus) indicated for? - ✅✅✅antiviral for treatment of hepatitis C that has failed other treatment ribavirin(copegus) SE - ✅✅✅hemolytic anemia what is ticarcillin/clavulanic acid (timentin)? - ✅✅✅broad spectrum/extended spectrum penicillins nursing considerations for ticarcillin/clavulanic acid (timentin) - ✅✅✅do not administer in same infusion with aminoglycosides what is the indicated use for rifampin? - ✅✅✅antitubercular for treatment of TB rifampin SE - ✅✅✅turns: body fluids; tears, saliva, urine, soft contacts red/orange/brown. (ADVISE PT THIS IS NORMAL). Teratogenic- may decrease effectiveness of oral contraceptives; advise to use nonhormonal form of conception throughout therapy. Hepatotoxicity what labs need to be monitored with rifampin? - ✅✅✅LFTs what is the indicated use for isoniazid (INH) - ✅✅✅TB what does isoniazid (INH) interact with? - ✅✅✅foods containing tyramine; can produce life-threatening hypertensive crisis. what should be used with isoniazid (INH)? - ✅✅✅2nd form of birth control flu vaccine SE - ✅✅✅for anyone 6 months and older every season; soreness, redness and swelling at site of injections, low grade fever, aches. what is the indicated use for fluconazole (diflucan)? - ✅✅✅antifungal for vaginal candidiasis what labs should be monitored with fluconazole (diflucan)? - ✅✅✅many antifungals can cause liver injury monitor LFTs what is antifunal terbinafine (lamisil) used to treat? - ✅✅✅superficial dermatologic infections (athlete's foot) and onychomycosis (nail fungus). nursing considerations for terbinafine (lamisil) - ✅✅✅avoid alcohol, monitor LFTs, report: nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools and jaundice how do you know if an antibiotic is effective? - ✅✅✅decrease in WBC, decrease in fever, better cultures, pt feels better nursing considerations for antidepressants. - ✅✅✅can cause addiction, pts experience withdrawal symptoms. ALWAYS GET MEDICATION HISTORY SINCE MANY DRUGS CAN INTERACT WITH ANTIDEPRESSANTS what is the indicated use for benztropine/cogentin? - ✅✅✅parkinson's disease and treatment of extrapyramidal symptoms (EPS) AKA parkinsonism what is benztropine/cogentin? - ✅✅✅anticholinergic SE of benztropine/cogentin - ✅✅✅blurry vision, urinary retention how does levodopa-carbidopa (sinemet) work? - ✅✅✅stimulates dopamine production or increases sensitivity of dopamine receptors what does levodopa-carbidopa (sinemet) treat? - ✅✅✅parkinson's S/S of levodopa-carbidopa (sinemet) toxicity - ✅✅✅involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of the tongue. NOTIFY PRESCRIBER. what foods should a pt on levodopa-carbidopa (sinemet) avoid? - ✅✅✅high protein meals! can impair effects! what is lithium (lithobid, lithotabs) indicated for? - ✅✅✅to treat pts with bipolar disorder. what kind of therapeutic index does lithium have? - ✅✅✅low/narrow; toxicity can occur at blood levels only slightly greater than therapeutic levels monitoring lithium is mandatory lithium (lithobid, lithotabs) levels - ✅✅✅below 1.5 mEq/L; anything greater causes toxicity initial lithium therapy levels - ✅✅✅0.8-1.4 mEq/L maintenance lithium levels - ✅✅✅0.5-1.5 mEq/L when should lithium levels be drawn? - ✅✅✅in the morning 12 hours after evening dose how often during maintenance therapy should lithium levels be checked? - ✅✅✅every 3-6 months normal sodium level - ✅✅✅136-145 mEq/L how does an increased sodium level effect serum lithium levels? - ✅✅✅increase in sodium causes increase in renal excretion which will lower serum lithium levels early S/S of lithium toxicity - ✅✅✅D/N/V, drowsiness, muscle weakness. what happens with lithium toxicity? - ✅✅✅life-threatening dysrhythmia, coma, convulsions, and death nursing considerations for lithium - ✅✅✅keep salt consistent in diet; no diuretic haloperidol/haldol produces what? - ✅✅✅severe extrapyramidal symptoms (EPS) or reactions including tardive dyskinesia what are EPS - ✅✅✅movement disorders resulting from effects of anypsychotic drugs on the extrapyramidal motor system. what is the extrapyramidal system? - ✅✅✅same neuronal network whose malfunction is responsible for movement disorders of parkinson's disease. 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HESI Pharmacology Exam Practice Test with NGN Item Type (Latest Update 2023/2024) Guaranteed (A+)
HESI Pharmacology Exam Practice Test with NGN Item Type A healthcare provider prescribes cephalexin monohydrate (Keflex) for a client with a postoperativ... [Show More] e 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. Correct ans - 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. 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. Correct ans - 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. 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. Correct ans - 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. 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. Correct ans - 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. 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. Correct ans - 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). 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. Correct ans - 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). 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. Correct ans - 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. 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. Correct ans - 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. 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. Correct ans - 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). 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. Correct ans - 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). 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. Correct ans - 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). 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. Correct ans - 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. 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. Correct ans - 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. 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. Correct ans - 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). [Show Less]
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NGN- HESI Pharmacology Exit Exam Quiz Bank 2023/2024 281 questions with complete solutions
Assess AP for a full minute; if its below 60 or above 100 then hold the drug. correct answer: What do you do before administering Digoxin? Postive & ne... [Show More] gative correct answer: Digoxin has a _______ inotrope &_________ chronotrope. Positive inotrope correct answer: increases force of contraction Negative chronotrope correct answer: decreases HR Digoxin toxicity correct answer: Lasix can cause hypokalemia, which can lead to what toxicity? dig toxicity correct answer: A client with longterm hx use of digoxin and lasix can create a high risk of what? 0.5 - 2 ng/mL correct answer: What is the normal range for digoxin? 3.5 - 5.0 mEq/L correct answer: What is the normal level for potassium? potassium and magnesium correct answer: What 2 electrolyte deficiency would cause a increase risk for digoxin toxicity? Anorexia, bradycardia, HA, dizziness, confusion, nausea, and visual disturbances (blurred vision, yellow vision, and/or halo vision). correct answer: What are the S/S of digoxin toxicity? HTN correct answer: Labetalol is a beta blocker used to tx what condition? Notify the prescriber for the low pulse (bradycardia) and do not give the med. correct answer: Patient is about to be administered Labetalol for HTN. The nurse checks the patient's pulse and it is below 60. What step does the nurse take next? Weight gain (fluid retention); Monitor patient's weight daily. 1 kg = 2.2 lb = 1,000 mL fluid gain or loss in 24 hours. correct answer: Major SE of labetalol? How do you assess for this? Chest Pain correct answer: Nitroglycerin transdermal patch is for tx of..... at bedtime to allow 8 hours without patch ( can produce tolerance in 24 hours) correct answer: When do you remove the nitroglycerin patch? patient may use SL nitro when wearing patch if patient having chest pain. correct answer: A patient who is prescribed the nitroglycerin patch for angina is still continuing to have chest pain. What is a nursing consideration for this? B/c it can cause severe vasodilation, decrease in BP, & intense HA. correct answer: Why wear gloves when applying a nitroglycerin patch? They can take APAP for the HA. correct answer: What can a patient take if experiencing a HA while taking nitroglycerin? decrease rate of nitro drip correct answer: Pt. in CCU/ICU on nitro drip; becomes hypotensive, what does the nurse do? Yes b/c nitrates cause hypotension. correct answer: is it OK to give nitroglycerin to a patient who is hypertensive?) blood vessels; blood vessels & heart correct answer: CCB "dipines" affect the ______ only. While CCBs Verapamil & diltiazem affects the _________ & ________. vasodilation correct answer: CCBs "dipines" causes ? vasoconstriction correct answer: CCBs Verapamil & diltiazem causes? dizziness, facial flushing, hypotension, edema, constipation correct answer: SE of CCBs Monitor HR, BP. Avoid grapefruit juice. correct answer: Nursing considerations CCBs HTN correct answer: Aliskiren (Tekturna) is a direct renin inhibitor that tx for? 1. Don't take if pregnant (Stop drug is become pregnant). 2. Don't take with high fat meal. 3. May increase potassium so don't take with other drugs that increase potassium. correct answer: Teaching for Aliskiren (Tekturna)? pulmonary edema correct answer: Lasix is a loop diuretic that used for rapid diuresis in emergencies. It tx for.... Asses for muscle cramps, and muscle weakness. correct answer: Lasix may produce hypokalemia. How do you assess for this? Hypokalemia, hypotension, F/E abnormalities, and dehydration, dizziness, HA, tinnitus, N/V/D, hypokalemia, ototoxicity with aminoglycosides (-mycin). correct answer: SE of lasix 1. Avoid taking lasix with aminoglycosides due to potential risk of ototoxicity. 2. Pt may need to be potassium supplements. correct answer: Lasix nursing considerations. Dried fruits, fish, leafy veggies, squash, beans, meats, nuts, bananas, potatoes, dairy products. correct answer: Foods containing potassium.... 1. assess overall condition of the veins. Use large vein, like antecubital (AC) vein when administering potassium. 2. Venous access is important because IV potassium can irritate the vein. 3. Have patient notify nurse immediately if burning at site. IV K+ extravasation can cause necrosis of tissues. 4. Calculate and set the rate as ordered, know anticipated duration of therapy. 5. Know restrictions imposed by patient's history. 6. Don't give IV push; use at a rate no greater than 10 mEq/hr for peripheral IV and 20 mEq/hr for central line. Always use infusion pump. 7. Assess IV site every hour. 8. Treatment of hypokalemia adults IV: 10-20 mEq/dose (maximum 40 mEq/dose) to infuse over 2-3 hr (maximum infusion rate: 40mEq/hr) correct answer: IV potassium KCL nursing considerations Elderly correct answer: Antihypertensive effects are more pronounced in the ACE inhibitors (-pril), aldosterone antagonists (-one), direct renin inhibitor Aliskiren (Tekturna) correct answer: Which antihypertensives will raise potassium? Osmitrol (Mannitol) correct answer: This Osmotic diuretic effectiveness is determined by ↓ ICP. NOT used for peripheral edema; used to treat pt. with closed head injury; effective response is decreased ICP. Potassium Sparing Diuretics correct answer: Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) are all in what class of drugs? potassium-sparing diuretic correct answer: this class of diuretics can cause ↑K+. Blocks receptors for aldosterone. Inhibits sodium and water reabsorption. Teach: Take in a.m. (diuretics in the morning if possible); avoid salt substitutes, ACE inhibitors, ARBs. Often taken with other (thiazide) diuretics to treat edema, hypertension, heart failure. Can be taken with other meds that lower K+. atorvastatin (lipitor), rosuvastatin (Crestor), fluvastatin, lovastatin, simvastatin, pravastatin. correct answer: Statin drugs include.... HDL should increase; LDL and total cholesterol decrease. correct answer: How do you evaluate effectiveness of statin drugs? Check LFTs due to risk of hepatotoxicity risk & CK for any c/o of muscle pain. correct answer: What labs should be routinely checked during Statin therapy? 1.) Take lovastatin with evening meals. 2.) All other statins can be taken without regards to meals. 3.) Dosing in the evenings is preferred for all satins. 4.) Take with at least 6 oz. of water. 5.) Take with food to decrease GI distress. 6.) Avoid alcohol 7.) Avoid foods that are high in fats 8.) Increase fiber in diet due to constipation SE. correct answer: Statin Teaching diet. Vasoconstriction correct answer: Alpha 1 stimulation causes heart ("1 heart") correct answer: Beta 1 causes stimulation of the lungs ("2 lungs") correct answer: Beta 2 causes stimulation of the Mydriatics correct answer: agents used to produce dilation of pupils for eye exams and ocular surgery Tamsulosin (Flomax) correct answer: alpha1 adrenergic blocker; ↓ smooth muscle contraction of prostate capsule and bladder neck. Used for treating sx of BPH. Antihypertensives correct answer: Alpha 1 blockers -zosin have what kind of indication? 1) dopaminergic activation; 2) Shock; 3) renal correct answer: The effects of ___(1)___ activation causes dilation of the renal vasculature; this effect is exploited in the treatment of ___(2)___; by dilating ___(3)___ blood vessels, we can improve renal perfusion and can thereby reduce the risk of renal failure. Dopamine correct answer: Which drug is the only drug available that can activate dopamine receptors? Cardiac performance (because it actives beta1 receptors in the heart.) correct answer: When dopamine is given to treat shock, the drug also enhances? why? epinephrine, norepinephrine, dopamine, dobutamine, etc.) correct answer: What are some names Catecholamines drugs? Extravasation correct answer: Catecholamines must be watched carefully for what? 1) sloughing 2) necrosis 3) infiltrated 4) saline 5) hypodermic 6) hyperemic 7) 12 hours correct answer: The FDA has this to say about treating dopamine extravasation: To prevent ___(1)___ and ___(2)___ in ischemic areas, the area should be ___(3)___ as soon as possible with 10 to 15 mL of ___(4)___ solution containing 5 to 10 mg of Regitine (brand of phentolamine), an adrenergic blocking agent. A syringe with a fine ___(5)___ needle should be used, and the solution liberally infiltrated throughout the ischemic area. Sympathetic blockade with phentolamine causes immediate and conspicuous local ___(6)___ changes if the area is infiltrated within ___(7)___ hours. Therefore, phentolamine should be given as soon as possible after the extravastation is noted. Epi-Pen correct answer: This Epinephrine Auto Injector is a single dose of epinephrine that can be injected (IM) into the middle of the outer thigh (even through clothes). Seek emergency medical treatment immediately. increase in heart rate, stronger or irregular heartbeat, sweating, nausea or vomiting, difficulty breathing, paleness, dizziness, weakness, shakiness, headache, apprehension, nervousness or anxiety. correct answer: SE of Epi-Pen (Epinephrine Auto Injector): *These side effects may go away if patient rests.* Sympathomimetic correct answer: Remember that many decongestants and bronchodilators have _________ effects (adrenergic effects). SE include ↑ HR, nervousness, insomnia, etc. β1 correct answer: Bronchodilators that stimulate β2 receptors can also stimulate _______ if dose is high enough (loses selectivity). 1) Teach how to avoid bleeding: soft toothbrush, electric razor, don't go without shoes, etc.; 2) Teaching maintain vitamin K foods (greens- spinach, mustard greens, swiss chard, etc.) in diet (don't increase or decrease); 3) PT/INR monitored routinely 4) avoid activities that may cause bleeding. correct answer: Patient is discharged on warfarin (Coumadin), what are some teaching instructions for the patient? [Show Less]
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Ngn HESI Pharmacology Exam Test Bank 2023/2024 Questions, Answers, terms and definitions
1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse p... [Show More] repare 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. [Show Less]
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2023 HESI Pharmacology Exam 100- Verified Questions and Answers
1. A healthcare provider prescribes cephalexin monohydrate (Keflex) for a client with a postoperative infection. It is most important for the nurse to asse... [Show More] ss 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). [Show Less]
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2023/2024 Pharmacology HESI Exit Exam Test Questions With Answers 100- Correct
2 Correct ans - Which nursing action is the priority when administering chelation therapy for a toddler-age client? 1 Assessing vital signs 2 ... [Show More] Monitoring urine output 3 Conducting a behavioral assessment 4 Providing education to reduce lead exposure 2 Correct ans - A 67-year-old client has tested positive for influenza A. The client also has asthma. Which drug would the nurse recommend be avoided in this client? 1 Ribavirin 2 Zanamivir 3 Oseltamivir 4 Amantadine 1 Correct ans - Which first line medication would the nurse state is used to treat anaphylactic reactions? 1 Epinephrine 2 Norepinephrine 3 Dexamethasone 4 Diphenhydramine 1 Correct ans - A mother complains that her child's teeth have become yellow in color. With prolonged use, which medication may be responsible for the child's condition? 1 Tetracycline 2 Promethazine 3 Chloramphenicol 4 Fluoroquinolones 2,3,6 Correct ans - What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? Select all that apply 1 Diuresis 2 Pain relief 3 Antipyresis 4 Bronchodilation 5 Anticoagulation 6 Reduced inflammation 2 Correct ans - A client with tuberculosis is started on a chemotherapy protocol that includes rifampin. The nurse evaluates that the teaching about rifampin is effective when the client makes which statement? 1 "I need to drink a lot of fluid while I take this medication." 2 "I can expect my urine to turn orange from this medication." 3 "I should have my hearing tested while I take this medication." 4 "I might get a skin rash because it is an expected side effect of this medication. 1 Correct ans - Which statement regarding treatment with interferon indicates that the client understands the nurse's teaching? 1 "I will drink 2 to 3 quarts (2 to 3 liters) of fluid a day." 2 "Any reconstituted solution must be discarded in 1 week." 3 "I can continue driving my car as long as I have the stamina." 4 "While taking this medicine I should be able to continue my usual activity." 2 Correct ans - A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug? 1 Arterial blood pH 2 Intake and output 3 Fasting serum glucose 4 Pulse and respiratory rates 1 Correct ans - A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? 1 Increase the intake of fluids. 2 Strain the urine for crystals and stones. 3 Stop the drug if urinary output increases. 4 Maintain the exact time schedule for taking the drug 3 Correct ans - A client admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease has received a prescription for a medication that is delivered via a nebulizer. When teaching about use of the nebulizer, the nurse should teach the client to do what? 1 Hold the breath while spraying the medication into the mouth. 2 Position the lips loosely around the mouthpiece and take rapid, shallow breaths. 3 Seal the lips around the mouthpiece and breathe in and out, taking slow, deep breaths. 4 Inhale the medication from the nebulizer, remove the mouthpiece from the mouth, and then exhale. 4 Correct ans - A client is diagnosed with pulmonary tuberculosis, and the healthcare provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the drug is effective when the client reports which action as most important? 1 "Report any changes in vision." 2 "Take the medicine with my meals." 3 "Call my doctor if my urine or tears turn red-orange." 4 "Continue taking the medicine even after I feel better. 2 Correct ans - A nurse administers beclomethasone by inhalation to a client with asthma, and the client asks why this medication is necessary. What should the nurse explain is the purpose of this pharmacologic therapy? 1 Promotes comfort 2 Decreases inflammation 3 Stimulates smooth muscle relaxation 4 Reduces bacteria in the respiratory tract 1,2,4 Correct ans - A nurse is caring for a female client who is receiving rifampin for tuberculosis. Which statements indicate that the client understands the teaching about rifampin? Select all that apply 1 "This drug may be hard on my liver so I must avoid alcoholic drinks while taking it." 2 "This drug may reduce the effectiveness of the oral contraceptive I am taking." 3 "I cannot take an antacid within 2 hours before taking my medicine." 4 "My healthcare provider must be called immediately if my eyes and skin become yellow. 4 Correct ans - The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure does the nurse reinforce as the highest priority? 1 Getting sufficient rest 2 Getting plenty of fresh air 3 Changing the current lifestyle 4 Consistently taking prescribed medication 1 Correct ans - A client is diagnosed with tuberculosis associated with human immunodeficiency virus infection. What crucial laboratory test results should the nurse review before antitubercular pharmacotherapy is started? 1 Liver function studies 2 Pulmonary function studies 3 Electrocardiogram and echocardiogram 4 White blood cell (WBC) count and sedimentation rate 3 Correct ans - Pyridoxine (vitamin B6) and isoniazid (INH) are prescribed as part of the chemotherapy protocol for a client with tuberculosis. Which response indicates to the nurse that vitamin B6 is effective? 1 Weight gain 2 Absence of stomatitis 3 Absence of numbness and tingling in extremities 4 Acceleration of dormant tubercular bacilli destruction 1,3,2,4 Correct ans - A healthcare provider prescribes a medication to be administered via a metered-dose inhaler (MDI) for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using the inhaler. 1. Shake the inhaler for 30 seconds. 2. Hold the inhaler upright in the mouth. 3. Exhale slowly and deeply to empty the air from the lungs. 4. Start breathing in and press down on the inhaler once 1 Correct ans - A client with tuberculosis is to begin combination therapy with isoniazid, rifampin, pyrazinamide, and streptomycin. The client says, "I've never had to take so much medication for an infection before." How will the nurse respond? 1 "This type of organism is difficult to destroy." 2 "Streptomycin prevents side effects of the other drugs." 3 "You'll only need to take the medications for a couple of weeks." 4 "Aggressive therapy is needed because the infection is well advanced." 2 Correct ans - A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client? 1 Determine the client's emotional state. 2 Give prescribed drugs to promote bronchiolar dilation. 3 Provide education about the impact of a family history. 4 Encourage the client to use an incentive spirometer routinely 4 Correct ans - The nurse is preparing to administer an intravenous piggyback antibiotic that has been newly prescribed. Shortly after initiation, the client becomes restless and flushed and begins to wheeze. The nurse determines the that appropriate priority action will be to stop the antibiotic infusion and then do what? 1 Notify the physician immediately about the client's condition. 2 Take the client's blood pressure. 3 Obtain the client's pulse oximetry. 4 Assess the client's respiratory status 3 Correct ans - A client has an anaphylactic reaction after receiving intravenous penicillin. What does the nurse conclude is the cause of this reaction? 1 An acquired atopic sensitization occurred. 2 There was passive immunity to the penicillin allergen. 3 Antibodies to penicillin developed after a previous exposure. 4 Potent antibodies were produced when the infusion was instituted 3 Correct ans - During the administration of total parenteral nutrition (TPN), an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention? 1 Restart the client's infusion at another site. 2 Slow the rate of the client's infusion of the TPN. 3 Interrupt the client's infusion and notify the healthcare provider. 4 Obtain the vital signs and continue monitoring the client's status 4 Correct ans - A client develops a fever after surgery. Ceftriaxone is prescribed. For which potential adverse effect should the nurse monitor the client? 1 Dehydration 2 Heart failure 3 Constipation 4 Allergic response 4 Correct ans - A healthcare provider prescribes famotidine and magnesium hydroxide/aluminum hydroxide antacid for a client with a peptic ulcer. The nurse should teach the client to take the antacid at what time? 1 Only at bedtime, when famotidine is not taken 2 Only if famotidine is ineffective 3 At the same time as famotidine, with a full glass of water 4 One hour before or 2 hours after famotidine 1 Correct ans - A healthcare provider prescribes an antibiotic intravenous piggyback twice a day for a client with an infection. The healthcare provider prescribes peak and trough levels 48 and 72 hours after initiation of the therapy. The client asks the nurse why there is a need for so many blood tests. What reason does the nurse provide? 1 "They determine adequate dosage levels of the drug." 2 "They detect if you are having an allergic reaction to the drug." 3 "The tests permit blood culture specimens to be obtained when the drug is at its lowest level." 4 "These allow comparison of your fever to when the blood level of the antibiotic is at its highest." 3 Correct ans - A nurse is administering a histamine H2 antagonist to a client who has extensive burns. The nurse explains to the client that this drug is given prophylactically during the first few weeks after extensive burns. What complication of burns will it prevent? 1 Colitis 2 Gastritis 3 Stress ulcer 4 Metabolic acidosis 3 Correct ans - A client is receiving penicillin G and probenecid for syphilis. What rationale should the nurse give for the need to take these two drugs? 1 Each drug attacks the organism during different stages of cell multiplication. 2 The penicillin treats the syphilis, whereas the probenecid relieves the severe urethritis. 3 Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods. 4 Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis 4 Correct ans - Ampicillin 250 mg by mouth every 6 hours is prescribed for a client who is to be discharged. Which statement indicates to the nurse that the client understands the teaching about ampicillin? 1 "I should drink a glass of milk with each pill." 2 "I should drink at least six glasses of water every day." 3 "The medicine should be taken with meals and at bedtime." 4 "The medicine should be taken one hour before or two hours after meals 3 Correct ans - A healthcare provider prescribes ampicillin for a client with an infection. What information should the nurse include in the teaching plan about this medication? 1 Take the ampicillin with meals. 2 Store the ampicillin in a light-resistant container. 3 Notify the healthcare provider if diarrhea develops. 4 Continue the drug until a negative culture is obtained 4 Correct ans - A nurse is caring for a client who has been taking several antibiotic medications for a prolonged time. Because long-term use of antibiotics interferes with the absorption of fat, what prescription does the nurse anticipate? 1 High-fat diet 2 Supplemental cod liver oil 3 Total parenteral nutrition (TPN) 4 Water-soluble forms of vitamins A and E 2 Correct ans - A health care provider prescribes vancomycin peak and trough levels for a client who is receiving vancomycin intravenous piggyback (IVPB). When should the nurse have the laboratory obtain a blood sample to determine a peak level of the antibiotic? 1 Halfway between two doses of the drug 2 Between 30 and 60 minutes after a dose 3 Immediately before the medication is administered 4 Anytime it is convenient for the client and the laboratory 3 Correct ans - A client is started on tetracycline antibiotic therapy. What should the nurse do when administering this drug? 1 Administer the medication with meals or a snack. 2 Provide orange or other citrus fruit juice with the medication. 3 Give the medication an hour before milk products are ingested. 4 Offer antacids 30 minutes after administration if gastrointestinal side effects occur 1,2,3 Correct ans - A client with gastroesophageal reflux disease (GERD) receives a prescription for an H2 receptor antagonist. Which medications are within the classification of an H2 receptor antagonist? Select all that apply 1 Nizatidine 2 Ranitidine 3 Famotidine 4 Lansoprazole 5 Metoclopramide [Show Less]
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HESI Pharmacology Exit Exam with NGN Questions 2023/2024 71 Q&A
1 . A healthcare provider prescribes cephalexin monohydrate (Keflex) for a client with a postoperative infection. It is most important for the nurse to ass... [Show More] ess 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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