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NR 509 Pharmacology HESI Practice Exam 3 Answers : RATED A

HESI PRACTICE EXAM 3 PHARMACOLOGY A client with mild parkinsonism is started on oral amantadine (Symmetrel). What statement accurately describes the... [Show More] action of this medication? dopamine in central nervous system is increased A 52-year-old client is admitted to the hospital for possible duodenal ulcers. The healthcare provider prescribes ranitidine hydrochloride (Zantac) 150 mg BID PO. Which data would indicate that this medication is effective? Within 4 hours after meals, the client denies having pain. A 78-year-old client with congestive heart failure receives the cardiac glycoside digoxin (Lanoxin) 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective? Clear breath sounds anteriorly and posteriorly Minocycline (Minocin) 50 mg every 8 hours is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) Report vaginal itching or discharge. Protect skin from natural and artificial ultraviolet light. Avoid driving until response to medication is known. Use a nonhormonal method of contraception if sexually active. The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? Naloxone hydrochloride (Narcan) The healthcare provider prescribes captopril (Capoten) 37.5 mg. The medication is available in 25 mg tablets. What should the nurse administer? 1½ tablets A client who is HIV positive is receiving epoetin (Epogen) for management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the healthcare provider? Hematocrit (HCT) of 58% A 75-year-old male client taking hydrochlorothiazide (HCTZ) is admitted to the hospital having "palpitations" and "skipped heart beats." What is the most likely cause of these symptoms given the client's medication history? Hypokalemia Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR) C. Activated partial thromboplastin time, commonly referred to as aPTT Rationale: The laboratory value that measures heparin's therapeutic anticoagulation time is the aPTT (C). (A) should be checked before the administration of digoxin. (B) is valuable information but not a parameter measured for heparin therapy. (D) is evaluated during anticoagulation therapy using sodium warfarin (Coumadin). A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug? Improves nerve impulse transmission In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of Alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? Give pancrelipase (Cotazym-S) capsule mixed with applesauce before each meal. When providing client teaching about the administration of methylphenidate (Ritalin) to the mother of a child diagnosed with attention-deficit/hyperactive disorder (ADHD), what instruction should the nurse include in the teaching plan? Offer the child the medication before eating breakfast and after eating lunch. Alteration of which laboratory finding represents achievement of a therapeutic goal for heparin administration? Partial thromboplastin time The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection A. 75-year-old woman with liver disease Rationale: Impaired hepatic metabolic pathways for drug and chemical degradation place (C) at greatest risk for adverse reactions to medications based on advancing age and liver disease. (A and D) have no predisposing factors, such as genetics, pathophysiologic dysfunction, or drug allergies, that would increase the risk for cumulative toxicity or adverse drug reactions. (B) is at risk for dose-related adverse reactions but is at less risk than (C). The healthcare provider prescribes ipratropium (Atrovent) for a client. An allergic reaction to what other medication would cause the nurse to question the prescription for Atrovent? Atropine sulfate (Atropine) 68-year-old client has been diagnosed with open-angle glaucoma. The healthcare provider prescribes pilocarpine (Isopto Carpine) eye drops. What action of this drug makes it a useful treatment for the client's condition? The outflow of aqueous humor in the eyes is increased. The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption? A. Apply the anesthetic to mucous membranes. B. Limit the area of application to inflamed areas. C. Avoid abraded skin areas when applying the anesthetic. D. Spread the topical agent over a large surface area. C. Avoid abraded skin areas when applying the anesthetic Rationale: To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin (C). Application to the mucous membranes poses the greatest risk (A) of systemic absorption because absorption occurs more readily through mucous membranes than through the skin. Inflamed areas generally have an increased blood supply, which increases the risk of systemic absorption, so (B) should be avoided. A large surface area increases the amount of topical drug that is available for transdermal absorption, so the smallest area should be covered, not (D). The healthcare provider prescribes the anticonvulsant carbamazepine (Tegretol) for a client with a seizure disorder. The nurse should instruct the client to notify the healthcare provider if which condition occurs? Experiences a sore throat chemotherapeutic regimen with doxorubicin HCl (Adriamycin) is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment? Electrocardiogram (ECG) A client who is HIV positive is receiving combination therapy with the antiviral medication zidovudine (Retrovir). What instruction should the nurse include in this client's teaching plan? Return to the clinic every 2 weeks for blood counts A 67-year-old client is discharged from the hospital with a prescription for digoxin (Lanoxin) 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? Take and record radial pulse rate daily. Benztropine mesylate (Cogentin) and levodopa (Dopar) are prescribed for a client with Parkinson's disease. After a few days of therapy, the client complains of a "dry mouth" and "dizziness." What response by the nurse would be most appropriate? "Chew gum to relieve the dry mouth and move slowly when assuming a standing position to reduce the dizziness Vancomycin (Vancocin) is prescribed for a client who has a history of endocarditis and is to undergo minor dental surgery. The nurse knows that this drug may be administered PO. Which assessment finding could indicate to the nurse that a client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl (Reglan)? Demonstrates Parkinson-like symptoms, such as cogwheel rigidity Methylphenidate HCl (Concerta) 18 mg PO is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactive disorder (ADHD). In preparing a teaching plan for the parents of this newly diagnosed ADHD child, which instruction is most important for the nurse to provide the parents? Administer the medication in the morning before the child goes to school. The nurse is preparing to administer amphotericin B (Fungizone) IV to a client. What laboratory data are most important for the nurse to assess before initiating an IV infusion of this medication? Serum potassium A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan? A. Take one tablet every 3 minutes, up to five tablets. B. Take one tablet at the onset of angina and stop activity. C. Replace nitroglycerin tablets yearly to maintain freshness. D. Allow 30 minutes for a tablet to provide relief from angina. Take 1 tablet at the onset of angina and stop activity. Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest (B). One tablet can by taken every 5 minutes, up to three doses (A). Nitroglycerin should be replaced every 3 to 6 months, not every 12 months (C). Nitroglycerin should provide relief in 5 minutes, not 30 minutes (D). A client with cancer who has been receiving fentanyl (Duragesic) for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate? Notify the healthcare provider of the need to increase the dose A 55-year-old male client was diagnosed with schizophrenia 5 years earlier. He has had numerous hospitalizations since diagnosis because of noncompliance with the prescribed medication regime. Which drug might work best for this particular client? Fluphenazine decanoate (Prolixin decanoate) Prolixin, an antipsychotic drug that can be given IM, has a delayed onset (24 to 96 hours) and a long duration of action (up to 3 or 4 weeks), so would be the drug of choice for a noncompliant psychotic client. In administering the antiinfective agent chloramphenicol (Chloromycetin) IV to a client, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor? Platelet count The healthcare provider has prescribed a low-molecular-weight heparin, enoxaparin (Lovenox), 30 mg IVP BID for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement? Contact the healthcare provider to clarify the prescription. The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A. "Regular insulin can be stored at room temperature for 30 days." B. "My legs, arms, and abdomen are all good sites to inject my insulin." C. "I will always carry hard candies to treat hypoglycemic reactions." D. "When I exercise, I should plan to increase my insulin dosage." D. When I exercise, I should plan to increase my insulin dosage." Rationale: Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction (D). (A, B, and C) reflect accurate statements about the use of insulin and management of hypoglycemic reactions. A client with schizophrenia has been taking the antipsychotic agent clozapine (Clozaril) for the past 3 weeks. Which nursing assessment finding would have the greatest implications for this client's care? Low-grade fever The apical heart rate of an infant receiving digoxin (Lanoxin) for congestive heart failure slows to 80 beats/min. What intervention should the nurse implement first? Obtain a serum digoxin level Sinus bradycardia (rate of less than 90 to 110 in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority A client with viral influenza is receiving vitamin C 1000 mg PO daily and acetaminophen elixir 650 mg PO every 4 hours PRN. The nurse calls the healthcare provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? Decrease the dose of vitamin C. What nursing intervention has the highest priority during IV administration of mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin-D)? Assess for extravasation at the IV site during infusion. client is receiving oral griseofulvin (Grisactin) for a persistent tinea corporis infection. What response by the client indicates an accurate understanding of the drug teaching conducted by the nurse? "I'll wear sunscreen whenever I mow the lawn." A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline (Elavil) in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline (Elavil)? Physostigmine (Antilirium) The healthcare provider prescribes the H2 antagonist famotidine (Pepcid) 20 mg in the morning and at bedtime. What statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime? Gastric acid secreted at night is buffered, preventing pepsin formation female client is receiving sulfisoxazole (Gantrisin) for a urinary tract infection. What client teaching should the nurse include? Oral contraceptives may not be effective. Prior to administering a scheduled dose of digoxin (Lanoxin), the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dl. Which action should the nurse implement? A. Administer Digibind to counteract the toxicity. B. Withhold the drug and notify the health care provider immediately. C. Withhold the dose and notify the health care provider during rounds that the dose was held. D. Give the dose of digoxin if the client's heart rate is within a safe range. Give the dose of digoxin if the client's heart rate is within a safe range The client's digoxin level of 1.3 ng/dl is not above the upper range of its therapeutic index (toxic level is greater than 2.0 ng/dl), so the dose should be administered after evaluating the client's heart rate A 19-year-old male client who sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the healthcare provider administers pancuronium bromide (Pavulon) IV with adjunctive narcotic analgesia. What medication should the nurse maintain at the client's bedside? Neostigmine bromide (Prostigmin) The nurse is administering the early morning dose insulin aspart (NovoLog) 5 units subcutaneously to a client with diabetes mellitus type 1. The client's fingerstick serum glucose is 140 mg/dl. Considering the onset of NovoLog, when should the nurse ensure that the client's breakfast is available? 5 minutes after subcutaneous administration Insulin aspart is a very rapidly acting insulin with an onset of 5 to 15 minutes. NovoLog should be administered when the client's tray is available (A). NovoLog peaks in 45 minutes to 1.5 hours (B and C) and has a duration of 3 to 4 hours. [Show Less]

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