Hesi Milestone Exam Practice (Latest 2023/ 2024) | Questions and Verified Answers with Rationales| 100% Correct (160 Q&A)
QUESTION
The postoperative
... [Show More] client has been receiving a continuous IV infusion of Meperidine (Demerol), 35 mg/hr for four days. The client has a PRN prescrip- tion for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable, and confused, stating that there are bugs all over the walls. What action should the nurse take first?
a. Administer a PRN dose of the PO Meperidine (Demerol)
b. Administer Naloxone (Narcan) IV per PRN protocol
c. Decrease the IV infusion rate of the Meperidine (Demerol) per protocol Notify the HCP of the client's confusion and hallucinations
Answer:
c. Decrease the IV infusion rate of the Meperidine (Demerol) per protocol
The client is exhibiting symptoms of Demerol toxicity, which is consistent with the large dose of Demerol received over four days. C is the most effective action to immediately decrease the amount of Serum Demerol. A will increase the toxic level of medication in the bloodstream. Naloxone is an opioid antagonist that is used during an opioid overdose but is not beneficial during Demerol toxicity and can precipitate seizures. The HCP should be notified, but that is not the initial action the nurse should take; first, the amount of drug infusing should be decreased
QUESTION
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication admin- istration. Which morning schedule would indicate to the nurse that the client's teaching has been effective?
a. Take medication, go for a 30-minute morning walk, then eat breakfast b. Take medication, rest in bed for 30 minutes, eat breakfast, and go for a morning walk
c. Take medication with breakfast, then go for a 30-minute morning walk
Answer:
Take medication, go for a 30-minute morning walk, then eat breakfast
Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least 30 minutes after taking the medication to reduce the risk of esophageal reflux and irritation. A is the best schedule to meet these needs. B, C, and D do not meet these criteria.
QUESTION
In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider.
a. Changes in urine color
b. Presence of hand tremors c. Increasing body hirsutism
d. Nausea and Vomiting
Answer:
b. Presence of hand tremors
Neurological complications, such as hand tremors, occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine color typically do not occur. C and D are common side effects but usually are not severe
QUESTION
Taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of anti-infective agent should the nurse ask the client about when taking the nursing history?
a. Aminoglycosides b. Cephalosporins c. Sulfonamides
d. Tetracyclines
Answer:
b. Cephalosporins
i. Cross allergies exist between penicillins and cephalosporins. Penicillin allergies are unrelated to allergies associated with A, C, or D.
QUESTION
A client with hyperlipidemia receives a prescription for Niacin (Niaspan). Which client teaching is most important for the nurse to provide?
a. Expected duration of flushing b. Symptoms of hyperglycemia
c. Diets that minimize GI irritation
d. Comfort measures for pruritis
Answer:
Expected duration of flushing
i. Flushing of the face and neck, lasting up to an hour, is a frequent reason for discon- tinuing Niacin. Inclusion of this effect in client teaching A may promote compliance in taking the medication. While B, C, and D are all worthwhile instructions to help clients minimize or cope with normal side effects associated with Niacin (Niaspan), flushing is intense and causes the most concern for the client/
QUESTION
A client is receiving Methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication.
a. Serum glucose b. Serum calcium c. Red blood cells
d. Serum Potassium
Answer:
a. Serum glucose
i. Solu-Medrol is a corticosteroid with glucocorticoid and mineralocorticoid actions.
These effects can lead to hyperglycemia, which is reflected as an increase in the serum glucose value. The client taking Solu-Medrol is at risk for hypocalcemia and hypokalemia, which results in a decrease, not an increase, in the serum calcium and serum potassium levels. This medication does not adversely affect RBC count.
QUESTION
A client's dose of Isosorbide Dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When does the client report the onset of a headache before the next scheduled dose, which action should the nurse implement?
a. Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of Acetaminophen (Tylenol)
b. Administer the 40 mg of Imdur and then contact the HCP
c. Administer the 60 mg dose of Imdur and a PRN dose of Acetaminophen d. Do not administer the next dose of Imdur or any acetaminophen until notifying the HCP
Answer:
c. Administer the 60 mg dose of Imdur and a PRN dose of Acetaminophen
i. Imdur is a nitrate that will cause vasodilation. This vasodilation can result in headaches, which can generally be controlled with Acetaminophen until the client develops a tolerance to this adverse effect. A and B may result in the onset of angina if a therapeutic level of Imdur is not maintained. Lying down is less likely to reduce the headache than a mild analgesic.
QUESTION
A client has a continuous IV infusion of Dopamine (Intropin) and an IV of normal saline at 50 mL/hr. The nurse notes that the client's urinary output has been 20 mL/hr for the last two hours. Which intervention should the nurse initiate?
a. Stop the infusion of dopamine
b. Change the normal saline to a keep open rate c. Replace the urinary catheter
d. Notify the healthcare provider of the urinary output
Answer:
d. Notify the healthcare provider of the urinary output [Show Less]