Pharmacology 2017 Hesi PN Specialty V2
Pharmacology 2017 Hesi PN Specialty V2
1) A client is being treated for hyperthyridism with propylthiouracil
... [Show More] (PTU). The LPN/LVN 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. PTU is an adjunct therapy used to control hyperthyroidism by inhibiting production of thyroid hormones. It is often prescribed in prep for thyroidectomy or radioactive iodine therapy
2) A female client with RA takes ibuprofen (motrin) 600mg PO 4xday. To preven GI bleeding, misoprostol (cytotec) 100mcg 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 30min prior to motrin
A. Use contraception during intercourse.
Cytotec, a synthetic form of prostaglandin, is classified as pregnancy category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of early pregnancy
3) Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which condition? A) Shock. B) Asthma. C) Hypotension.D) Heart failure
D. Heart Failure
Dobutamine is a beta-1 adrenergic agonist that is indicated for short term
use in cardiac decompensation or heart failure (D) related to reduced
cardiac contractility due to organic heart disease or cardiac surgical
procedures. Alpha and beta adrenergic agonists, such as epinephrine and
dopamine, are sympathomimetics used in the treatment of shock (A).
Other selective beta-2 adrenergic agonists, such as terbutaline and
isoproterenol, are indicated in the treatment of asthma (B). Although
dobutamine improves cardiac output, it is not used to treat hypotension
(C).
4) Which medications should the nurse caution the client about taking
while receiving an opioid analgesic?
A. Antacids.
B. Benzodiasepines
C. Antihypertensives
D. Oral antidiabetics
B. B. Benzodiasepines
Respiratory depression increases with the concurrent use of opioid
analgesics and other cns depressant agents, such as alcohol, barbiturates,
and benzodiasepines
5) Which client should the LPN/LVN identify as being at the highest
risk for complications during the use of an opioid analgesic?
A. an older client with type 2 diabetes
B. A client with chronic rheumatoid arthritis
C. A client with a open compound fracture
D. A young adult with inflammatory bowel disease
D. A young adult with inflammatory bowel disease
6) Which change in data indicates to the nurse the desired effect of the
angiotensin II receptor antagonist valsartan (Diovan) has been achieved
A. Dependent edema reduced form +3 to +1
B. Serum HDL increased from 35 to 55mg/dl
C. PUlse rate reduced from 150 to 90 beats/minD. Blood pressure reduced from 160/90 to 130.80
D. D. Blood pressure reduced from 160/90 to 130.80
angiotensin II receptor antagonist (blocker), prescribed from treatment of
HTN. The desired effect is a decrease in blood pressure.
7) A client with heart failure is prescribed spironolactone (Aldactone).
Which information is most important for the LPN/LVN 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.
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.
8) 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.
9) The healthcare provider prescribes naproxen (Naproxen) twice dailyfor 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).
10) An older client with a decreased percentage of lean body mass is
likely to receive a prescription that is adjusted based on which
pharmacokinetic process?
A) Absorption.
B) Metabolism.
C) Elimination.
D) Distribution.
D.
A decreased lean body mass in an older adult affects the distribution of
drugs (D), which affects the pharmacokinetics of drugs. Decreased gastric
pH, delayed gastric emptying, decreased splanchnic blood flow,
decreased gastrointestinal absorption surface areas and motility affect (A)
in the older adult population. Decreased hepatic blood flow, decreased
hepatic mass, and decreased activity of hepatic enzymes affect (B) in
older adults. Decreased renal blood flow, decreased glomerular filtration
rate, decreased tubular secretion, and decreased number of nephrons
affects (C) in an older adult.
11) A peak and trough level must be drawn for a client receiving
antibiotic therapy. What is the optimum time for the LPN/LVN to obtain
the trough level?
A) Sixty minutes after the antibiotic dose is administered.
B) Immediately before the next antibiotic dose is given.C) When the next blood glucose level is to be checked.
D) Thirty minutes before the next antibiotic dose is given.
B. Immediately before the next antibiotic dose is given.
Trough levels are drawn when the blood level is at its lowest, which is
typically just before the next dose is given (B). (A, C, and D) do not
describe the optimum time for obtaining a trough level of an antibiotic.
12) A client with Parkinson's disease is taking carbidopa-levodopa
(Sinemet). Which observation by the nurse should indicate that the
desired outcome of the medication is being achieved?
A) Decreased blood pressure.
B) Lessening of tremors.
C) Increased salivation.
D) Increased attention span.
B. Lessening of tremors.
Sinemet increases the amount of levodopa to the CNS (dopamine to the
brain). Increased amounts of dopamine improve the symptoms of
Parkinson's, such as involuntary movements, resting tremors (B),
shuffling gait, etc. (A) is a side effect of Sinemet. Decreased drooling
would be a desired effect, not (C). Sinemet does not affect (D).
13) A client with congestive heart failure (CHF) is being discharged
with a new prescription for the angiotensin-converting enzyme (ACE)
inhibitor captopril (Capoten). The LPN/LVN 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
The client should be prepared to implement measures for constipation (B)
which is the most likely persistent side effect related to opioid use.
Tolerance to opiate narcotics is common, and the client may experience
less sedation (A) and respiratory depression (D) as analgesic use
continues. Opioids increase the tone in the urinary bladder sphincter,
which causes retention (C) but may subside.14) A client is receiving metroprolol (Lopressor SR). What assessment
is most important for the LPN/LVN to obtain?
A) Temperature.
B) Lung sounds.
C) Blood pressure.
D) Urinary output.
C. Blood pressure
It is most important to monitor the blood pressure (C) of clients taking
this medication because Lopressor is an antianginal, antiarrhythmic,
antihypertensive agent. While (A and B) are important data to obtain on
any client, they are not as important for a client receiving Lopressor as
(C). Intake and output ratios and daily weights should be monitored while
taking Lopressor to assess for signs and symptoms of congestive heart
failure, but (D) alone does not have the importance of (C).
15) A client with coronary artery disease who is taking digoxin
(Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two
weeks after initiation of the Lipitor prescription, the nurse assesses the
client. Which finding requires the most immediate intervention?
A) Heartburn.
B) Headache.
C) Constipation.
D) Vomiting.
D. Vomiting.
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.
16) Upon admission to the emergency center, an adult client with acute
status asthmaticus is prescribed this series of medications. In which
order should the nurse administer the prescribed medications? (Arrange
from first to last.)
A) Prednisone (Deltasone) orally.
B) Gentamicin (Garamycin) IM.
C) Albuterol (Proventil) puffs.
D) Salmeterol (Serevent Diskus).C, D, A, B
17) An antacid (maalox) is prescribed for a client with PUD. The LPN/
LVN knows that the purpose of this medication is to
A. Decrease production of gastric secretions
B. produce an adherent barrier over the ulcer
C. Maintain a gastric pH of 3.5 or above
D. decrease gastric motor activity
C. Maintain a gastric pH of 3.5 or above
18) 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
19) In teaching a client who had a liver transplant about cyclosporine
(Sandimmune), the nurse should encourage the client to report which
adverse response to the healthcare provider?
A) Changes in urine color.
B) Presence of hand tremors.
C) Increasing body hirsutism.
D) Nausea and vomiting.
B. Presence of hand tremors.
Neurological complications, such as hand tremors (B), occur in about
50% of clients taking cyclosporine and should be reported. Although this
drug can be nephrotoxic, (A) typically does not occur. (C and D) are
common side effects, but are not usually severe.
20) Which antidiarrheal agent should be used with caution in clients
taking high dosages of aspirin for arthritis?
A) Loperamide (Imodium).B) Probanthine (Propantheline).
C) Bismuth subsalicylate (Pepto Bismol).
D) Diphenoxylate hydrochloride with atropine (Lomotil).
C. Bismuth subsalicylate (Pepto Bismol).
Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that
increases the potential for salicylate toxicity when used concurrently with
aspirin (acetylsalicylic acid, another salicylate preparation). (A, B, and D)
do not pose the degree of risk of drug interaction with aspirin as Pepto
Bismol would.
21) A client receiving albuterol (Proventil) tablets complains of nausea
every evening with her 9 p.m. dose. What action should the LPN/LVN
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.
22) A client is receiving digoxin for the onset of supraventricular
tachycardia (SVT). Which laboratory findings should the LPN/LVN
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 effectcardiac 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).
23) Following heparin treatment for a PE, a client is being discharged with a prescription for warfarin. In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly? A. Perfusion scan B. Prothrombin time (PT/INR) C. Activated Partial thromboplastin (APTT) D. Serum Coumadin Level (SCL)
B. Prothrombin time (PT/INR)
When used for a client with PE, the therapeutic goal for wafarin therapy is a PT 1/5 to 2/5 times greater than the control or an INR of 2-3. A perfusion might be preformed to monitor lung function but not monthly. APTT is monitored for Heparin.
24) A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider? A) Tinnitus and dizziness. B) Tachycardia and chest pain. C) Dry skin and intolerance to cold. D) Weight gain and increased appetite. B. Tachycardia and chest pain. Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and symptoms of toxicity include tachycardia and chest pain (B). (A, C, and D) do not indicate a t [Show Less]