HESI Pharm Practice Test - Assignment

An elderly female client who is starting a pain management program using opioid analgesia receives a prescription for codeine 10 mg PO q4 hours PRN for pain, or codeine 15 mg PO q4 hours PRN for pain, or codeine 30 mg PO q4 hours PRN for pain. Which statement by the client is most important to consider when deciding on the dose to administer at this time?

"I wonder if I will have to stop taking my diuretic for my kidney problem." Rationale Decreased kidney function in an elderly client can cause life-threatening complications, such as respiratory depression, when opioid analgesics, such as codeine, are introduced (C). The correct action is to start with the lowest dose when the client is known to have decreased kidney function. Addiction is not as common of an occurrence when the medication is used for a legitimate need (A). Sedation is an expected side effect of the narcotic, but is not life-threatening (B). Constipation is a treatable side effect (D).

Which client situation requires a response from the practical nurse?

A client who takes metformin (Glucophage) is scheduled for a test using iodine dye. Rationale Glucophage, which is used to treat type 2 diabetes, should be temporarily discontinued before a client has a diagnostic test that requires the use of iodine-based dye, which places the client at risk for renal complications (C). (A) is a harmless, common side effect of Niacin. (B) is a common side effect of albuterol (Ventolin). Ampicillin can alter the normal bowel flora and cause (D), a common side effect.

A client is receiving a nitroglycerin transdermal patch daily. Which assessment finding indicates that the practical nurse (PN) should withhold the next dose?

Blood pressure 90/60 mmHg. Rationale Nitroglycerin causes vasodilation and can result in hypotension (A), which is an indication to withhold the dose and notify the healthcare provider. (B) is not an indication to withhold the drug. Crackles (C) are an abnormal finding but do not necessitate withholding the transdermal patch. (D) indicates the need to rotate the application site, not withhold the medication.

The practical nurse (PN) is administering a daily dose of nifedipine (Procardia) 60 mg extended release to a client with angina pectoris. Which finding should the PN consider withholding the medication?

Blood pressure of 96/52. Rationale Procardia is a potent vasodilator and lowers blood pressure. Although daily calcium channel blockers should be given regularly, the PN should withhold the next dose for a low blood pressure (A) and report the finding to the healthcare provider. Procardia does not have a significant effect on (B, C, and D).

The practical nurse (PN) is reviewing the laboratory results for a client who is taking sulfasalazine (Azulfidine) for an exacerbation of inflammatory bowel disease (IBD). Before administering the next dose, which laboratory results warrant further action by the PN?

Blood urea nitrogen (BUN) is 30 mg/dL and creatinine is 1.5 mg/dL. Rationale The BUN and creatinine levels (A) (norm BUN 10-20 mg/dL and serum creatinine 0.5-1.1 mg/dL) are higher than normal, which indicate the need for hydration that requires further treatment. The client is likely to have an elevated WBC and elevated neutrophils due to the IBD exacerbation (B). Anemia (C) and low potassium (norm 3.5-5.0 mEq/L) (D) can occur due to the IBD exacerbation, but these findings do not affect the drug administration.

When caring for a client receiving warfarin (Coumadin), what action should the practical nurse implement?

Recommend the use of a soft toothbrush. Rationale To reduce the risk of bleeding, soft toothbrushes (A) and electric razors are recommended for a client who is taking Coumadin, an anticoagulant. Platelet production (B) is not affected by the use of Coumadin. Dairy foods (C) do not interfere with the effectiveness of Coumadin. A low serum potassium level (D) is not directly related to the administration of Coumadin.

A client with chronic stable angina receives a prescription for nitroglycerin (Nitro-Dur) 0.4 mg topical patch. The practical nurse (PN) applies the first patch at 0730. Which intervention should the PN take next?

Remove the patch at 1930. Rationale A transdermal nitroglycerin patch is replaced daily and should be removed after 12 to 14 hours to prevent tolerance to the drug (A). The PN should note that the patch is in place during nursing assessments until it is time for removal in 12 hours, not (B). Transdermal patches provide sustained release of the drug and are applied once per day, not (C). (D) is not indicated.

The practical nurse (PN) is giving medications to a client with hyperlipidemia who receives a new prescription for cholestyramine (Questran). Which information should the PN reinforce with the client?

Take before meals and apart from other drugs. Rationale Cholestyramine is used to treat hyperlipidemia of primary hypercholesterolemia and binds with bile in the intestines to reduce fat and cholesterol absorption from foods. The systemic absorption of oral medications, such as digoxin and warfarin, can also be reduced, so the medication should be taken before meals and apart from other drugs (C). (A and B) are not necessary when taking Questran. Although constipation is a side effect, a diet high in fiber, not (D), should be recommended.

A client with hypertension receives a prescription for irbesartan (Avapro). Which finding by the practical nurse indicates that the client needs additional instruction regarding the medication?

Uses a salt substitute that has potassium. Rationale Avapro, angiotensin II receptor blocking (ARB) agent, causes vasodilation to reduce blood pressure. Since ARBs can raise the concentration of potassium in the blood, the client should be reinstructed to avoid the use of salt substitutes containing potassium (A). Avapro, an antihypertensive, is also used to treat diabetic nephropathy, so having type 2 diabetes (B) is not a contraindication for taking this drug. Dizziness (C) is a common side effect. The drug can be taken with or without food (D).

A female client tells the practical nurse (PN) that she started taking an over-the-counter herbal supplement, St. John's Wort (Hypericum perforatum), last week. Which question should the PN ask the client?

"Have you felt sad or depressed lately?" Rationale St. John's Wort is an herbal supplement that is often used for depression. The nurse should further explore why the client felt the need for taking this over-the-counter (OTC) herb and determine if the client is at risk for suicide (B). Gingko, not St. John's Wort, is often used to improve memory (A). Although all OTC medications should be included in the client's medication list, (C) is not indicated at this time. The vitamin niacin causes facial flushing (D).

Enoxaparin (Lovenox) 40 mg subcutaneous is prescribed to be administered twice within 24 hours. Which times of administration are best for the practical nurse (PN) to give the injections?

0700 and 1900. Rationale Twice a day in 24 hours is best spaced q12 hours (D), which is the best time frame for the administration of low-molecular weight heparin dosing. (A) is a common time schedule for BID or twice a day medication administration that does not need to be evenly spaced within the 24 hour clock. (B) is 8 hours apart. (C) is 14 hours apart.

A postoperative client is receiving hydromorphone (Dilaudid) via an epidural administration. The practical nurse (PN) notes the client is constantly scratching his arms. Which action should the PN take?

Administer diphenhydramine (Benadryl) PRN. Rationale Pruritis (itching) is a common side effect of opioids that are administered via intraspinal (i.e., epidural, intrathecal) routes. An antihistamine, such as diphenhydramine (Benadryl) (B), should be given to relieve the client's itching. Pruritis is a known side effect, not an allergic response, so (A) is not indicated. The client is not experiencing an overdose response, so (C) is not indicated. Although lotion applied to the client's dry skin (D) can provide some relief, the use of Benadryl is most effective in relieving the client's response to epidural administration of an opioid.

A client returns to the postoperative unit with prescriptions for morphine 5 mg IM q4 hours PRN pain and morphine 10 mg IM q4 hours PRN pain. At 1300, the practical nurse (PN) administers morphine 5 mg IM for the client's rated pain of "8" on a 0 to 10 scale. At 1500, the client rates the pain at "7." Which intervention should the PN implement?

Administer morphine 5 mg IM now. Rationale Additional analgesia within the prescribed range may be administered (A) 20 to 30 minutes after the first administration. The client should receive additional pain medication within the prescription range and time frame, not (B). The client continues to experience significant pain, and the total amount of prescribed analgesia should be given prior to contacting the healthcare provider (C). (D) is not a prescribed dose.

Which finding by the practical nurse indicates that the client's use of ipratropium bromide (Atrovent) inhaler was effective?

Bilateral breath sounds are clear. Rationale Atrovent, an anticholinergic, antimuscarinic bronchodilator, decreases excessive bronchiole secretions and clears wheezing. Clear bilateral breath sounds (D) provide the best evaluation of the drug's effectiveness. It is not used as an anti-infective treatment (A and C). Although the respiration rate (B) is within normal limits, the client may continue to manifest wheezing.

The practical nurse (PN) is caring for a client with hypokalemia who is receiving IV potassium chloride (KCl). Which finding should the PN identify as a therapeutic response?

Bowel sounds auscultated at 20 gurgles/minute. Rationale Potassium replacement for a client with hypokalemia should improve smooth and skeletal muscle strength, so normal peristalsis findings are indicative of a therapeutic response (A). (B) is not a therapeutic response of KCl replacement. (C) is indicative of hyperkalemia, not a return to a normal serum level. Muscle strength of 2+ indicates significant weakness (D), which is not a therapeutic response.

After a thyroidectomy, a client's facial muscles twitch when the practical nurse (PN) taps the skin surface in front of the ear. Which prescription should the PN administer?

Calcium gluconate. Rationale A potential complication for a client after thyroidectomy is damage to the parathyroid glands that can cause hypocalcemia, which is manifested by a positive Chvostek's sign. Supplemental calcium gluconate (D) should be administered immediately. (A, B, and C) are not indicated by the client's findings.

A client who is admitted for bradycardia receives a prescription for atropine. Which client information should the practical nurse report to the healthcare provider?

Chronic constipation and diverticulosis. Rationale Anticholinergics agents increase the heart rate but also slow peristalsis. The client's history of chronic constipation and diverticulosis (C) should be reported to the healthcare provider so additional treatment can be implemented to manage potential side effects, such as constipation. (A, B, and D) do not impact the use of atropine.

For the past 3 months, a client has taken prednisone (Deltasone) 40 mg PO daily. What information is most important for the practical nurse (PN) to reinforce with the client about this medication?

Do not abruptly stop the medication. Rationale The PN should reinforce the information that glucocorticosteroids, such as prednisone, should not be abruptly stopped because abrupt withdrawal can precipitate Addison's crisis (A). Instructions regarding the possible side effects, such as fluid retention (B), cataracts (C), and gastric irritation (D) do not have the priority of (A).

Which action should the practical nurse (PN) implement for a client who is recently diagnosed with myasthenia gravis?

Give neostigmine bromide (Prostigmin) before meals. Rationale Myasthenia gravis affects upper body muscles and muscles used for swallowing. Prostigmin, which intensifies transmission in the neuromuscular junction, should be given before meals (A) to provide a therapeutic response that reduces the risk of dysphagia and aspiration during meals. Prednisone, which has been used in autoimmune diseases such as myasthenia gravis, should be administered with food, not (B). Distal extremities are least likely to be affected, so (C) is not required. Although the client's eye movement can be affected, (D) is not indicated at this time.

A client with increased intracranial pressure (ICP) is receiving an infusion of mannitol 25% (Osmitrol). Which finding indicates to the practical nurse (PN) that the medication is effective?

Glasgow Coma Scale (GCS) score of 15. Rationale Mannitol is an osmotic diuretic that is administered to reduce intracranial swelling, so a GCS of 15 (B) is a sensitive indicator of neurologic status that changes as cerebral edema resolves. (A) is an expected response of mannitol but is not indicative of a therapeutic decrease in cerebral edema. Although headache is a symptom of ICP, (C) does not imply a reduction in ICP. Mannitol does not affect body temperature (D).

Which co-morbidity of a client who is starting thyroid replacement should the practical nurse report to the healthcare provider?

History of dysrhythmias. Rationale Thyroid supplement can increase the heart rate and precipitate angina in a client who has a history of cardiac disease and dysrhythmia (C). (A, B, and D) do not impact the client's use of thyroid replacement therapy.

A male client whose postoperative patient-controlled analgesia (PCA) pump is discontinued receives a prescription for hydrocordone bitartrate with acetaminophen (Vicodin) 2 tablets PO every 4 hours for pain. One hour after receiving the prescribed dose of Vicodin, the client states he is having pain rated as "11" on a 0 to 10 pain scale. Which action should the practical nurse (PN) implement?

Inform the charge nurse about the client's status. Rationale The client's rating should be evaluated because the client is indicating that the pain is unbearable. The PN should inform the charge nurse (A) so that a new prescription can be obtained from the healthcare provider. (B, C, and D) are not indicated at this time.

The practical nurse (PN) is caring for a client who is receiving hydromorphone (Dilaudid) per patient-controlled analgesia (PCA) pump at 1 mg/hour basal rate for postoperative pain. The PCA pump is programmed for a 0.1 mg bolus dose and the lock out time is 6 minutes. Which finding should the PN report to the charge nurse?

Pain rating of 9 on a 0 to 10 pain scale. Rationale Although analgesic medication is provided via the PCA pump, the client's pain level of 9 on a 0 to 10 pain scale indicates the infusion, current PCA dosage, or type of medication is ineffective, and the charge nurse should be notified of the client's persistent pain (A). (B, C, and D) are expected findings postoperatively and are not significantly variant.

A client who sustains a severe blunt head trauma during a motor vehicle collision receives a prescription for phenytoin (Dilantin). Which therapeutic response should the practical nurse (PN) observe in the client?

Seizure free during the last 24 hours. Rationale Phenytoin (Dilantin) is administered to prevent seizures, which exacerbate increased intracranial pressure after a head injury. Absence of seizures is the therapeutic response of anticonvulsants (D). (A, B, and C) are not indicators of therapeutic effects for Dilantin.

A client with hyperkalemia receives a prescription for sodium polystyrene sulfonate (Kayexalate). Which finding should the practical nurse (PN) monitor to evaluate the effectiveness of the prescription?

Serum potassium level. Rationale Hyperkalemia (serum potassium level greater than 5.0 mEq/L) increases the client risk for fatal cardiac dysrhythmias. Kayexalate is used to decrease the serum potassium level, so the PN should monitor the client's serum potassium level (C) to determine if the prescription is effective. (A, B, and D) do not evaluate the effectiveness of Kayexalate on serum potassium levels.