HESI Pharmacology
A chemotherapeutic regimen with doxorubicin HCl 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 receives a prescription for theophylline PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse take first?
Hold the theophylline dose and notify the health care provider.
A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery?
Hypoglycemia
The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider?
Hypokalemia
In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen?
Hypotension
A client is receiving acyclovir sodium IV for a severe herpes simplex infection. Which nursing action will the nurse include in the client's plan of care?
Increase daily fluids to 2000 to 4000 mL/day.
Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response?
Increase in urine output
A female client is receiving tamoxifen following surgery for breast cancer. She reports to the nurse the onset of hot flashes. Which is the best nursing action?
Instruct the client that hot flashes are a side effect that often occurs with the use of this medication.
The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level?
Instruct the laboratory to draw the trough immediately before the next scheduled dose.
A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client?
Isoniazid
During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely?
Liver enzyme levels
When caring for a client on digoxin therapy which laboratory finding alerts the nurse to the potential for digoxin toxicity?
Low serum potassium level
A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure?
Midazolam IV
A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide?
Multiple drugs prevent the development of resistant organisms.
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
The nurse is reviewing prescribed medications with a client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose received during hospitalization. Which response is best for the nurse to provide?
Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.
A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse?
Parkinson-like symptoms
The nurse is providing care to a client on heparin. Which laboratory test indicates to the nurse that the medication is effective?
Partial thromboplastin time (PTT)
A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. Which adverse effect should the nurse report promptly to the health care provider?
Petechiae
The nurse is teaching a student about the dynamics of medication administration. Which physiologic mechanism will the nurse include in the teaching which explains a drug's increased metabolism triggered by a disease process?
Pharmacokinetics
In administering the antiinfective agent chloramphenicol IV to a client with bacterial meningitis, 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
A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging?
Protamine sulfate
Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect?
Psychological response to inert medication
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?
Take one tablet at the onset of angina and stop activity.
A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing action should the nurse take first?
Take the child's vital signs.
The nurse is assessing a client receiving an antipsychotic medication. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration?
Tardive dyskinesia
The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone. Which assessment finding reflects a problem related to this medication that should be included in the care plan?
Temperature of 101.3°F/38.5°C.
A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client?
The benztropine is used to control extrapyramidal symptoms.
A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client?
Use sunglasses and sunscreen when outdoors.
A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization?
Vastus lateralis
The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions?
Avoid ingesting any alcohol or acetaminophen.
A client with mild parkinsonism is started on oral amantadine. Which information will the nurse include in the client's teaching plan?
Dopamine in the central nervous system is increased.
Methylphenidate is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents?
Administer the medication in the morning before the child goes to school.
A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent?
A cough that is new and persistent
Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate?
"Are you having difficulty hearing?"
The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included?
"Contact your health care provider if your daily pulse rate exceeds 100 beats/minute."
A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which client statement indicates to the nurse an understanding of the medication regimen?
"I might feel some tingling in my fingers."
A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug?
"I seem to be having difficulty thinking clearly."
The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed?
"I will take the medication every day before breakfast."
A client is receiving antiinfective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection?
"My mouth feels sore."
Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.)
"Notify the health care provider immediately if you think you are pregnant." "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." "Before, during, and after therapy, two effective forms of birth control must be used at the same time."
A client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond?
"Tolerance to medication requires increased drug levels to achieve the same effect."
The nurse has completed diabetic teaching for a client who was newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed?
"When I exercise, I should plan to increase my insulin dosage."
A lidocaine IV infusion at 4 mg/min via infusion pump is prescribed for a client having premature ventricular contractions (PVCs). The available premixed infusion contains 2 mg/mL of D5W. How many milliliters per hour should the nurse program the IV pump?
120
A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL. How many milliliters should be administered? _____ mL
2.2
Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? _______ mL
20
The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given?
5 minutes after subcutaneous administration
A client has started long-term corticosteroid therapy tells the nurse that the daily dose will be taken at bedtime with a snack of crackers and milk. Which is the best response by the nurse?
Advise the client to take the medication in the morning, rather than at bedtime
For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.)
An older adult with a history of a skin rash while taking glyburide (DiaBeta) An adolescent with a history of an anaphylactic reaction to penicillin An adolescent at 34 weeks of gestation experiencing 1+ pitting edema
Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin?
Activated partial thromboplastin time (aPTT)
Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication?
Antimetabolites
A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my child a half-ounce." The nurse sees that the bottle contains loperamide. What is the next nursing action?
Ask the mother when the child last voided
When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing action has the highest priority?
Assess respiratory status and breath sounds often.
A client with Tourette syndrome takes haloperidol. The client has become increasingly drowsy over the past 2 days, and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take?
Assess skin tone and urine.
The health care provider prescribes ipratropium for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for ipratropium?
Atropine sulfate
The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse take first to reduce the risk of systemic absorption?
Avoid abraded skin areas when applying the anesthetic.
A client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole. Which instruction is most important for the nurse to include in this client's teaching plan?
Avoid alcohol consumption.
Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control?
Brush and floss teeth daily.
The nurse is preparing a teaching plan for a client's new medication. Which factor will the nurse consider is most important to ensure compliance when developing the plan?
Client education
A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client?
Contact the health care provider for another form of medication.
The health care provider has prescribed a low-molecular-weight heparin, enoxaparin prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, what is the priority nursing action?
Contact the health care provider to clarify the prescription.
When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to
Cyclophosphamide
Following the administration of sublingual nitroglycerin, which assessment finding indicates to the nurse that the medication was effective?
Decrease in level of chest pain
he nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time?
Decrease the oral secretions.
An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first?
Determine the drug's serum levels for toxicity.
The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs?
Develops a sore throat
A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication?
Diarrhea
A 6-year-old child is admitted to the emergency department with status epilepticus. The parents report that the seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer?
Diazepam
The nurse is providing care for a client with digoxin toxicity. Which medication will the nurse look for in the client's prescriptions?
Digoxin immune Fab
A client who is HIV-positive is receiving epoetin alfa for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider?
Hematocrit (HCT) of 58%
A child is being treated with mebendazole for pinworms. What dietary information will the nurse relay to the client's mother?
High-fat diet
A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report?
Fatigue and muscle weakness
In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, because the nurse is concerned about adequate nutrition, which intervention would best meet this child's needs?
Give pancrelipase capsule mixed with applesauce before each meal.
Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse take first?
Give the dose of digoxin if the client's heart rate is within a safe range.
The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which action is most important prior to administering this medication?
Have another nurse check the prescription.
A 19-year-old has 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 health care provider administers pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be immediately accessible for a potential complication with this drug?
Neostigmine bromide
A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection?
Neutrophil count
A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide?
Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV.
The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which is the best nursing action for this client?
Notify the health care provider of the change in the client's laboratory values.
A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which action should the nurse initiate?
Notify the health care provider of the need to increase the dose.
The apical heart rate of an infant receiving digoxin for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first?
Obtain a serum digoxin level.
A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication?
Obtain the client's blood pressure.
When providing client teaching about the administration of methylphenidate to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan?
Offer the child the medication with breakfast and after the child eats lunch.
A 21-year-old female client is receiving tetracycline for acne. Which client teaching should the nurse include?
Oral contraceptives may not be effective.
The nurse is preparing to administer amphotericin B IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication?
Serum potassium level
The nurse is providing care to a client recently diagnosed with acute lymphocytic leukemia. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the most important information for the nurse to include in the client's teaching plan?
Reduction or elimination of nausea and vomiting
A client receives pancuronium, a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication?
Renal insufficiency
A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client?
Report any vomiting to the clinic.
Minocycline, 50 mg PO 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.
An 80-year-old client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which finding requires immediate nursing action?
Respirations decrease to 10 breaths/min.
During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity?
Restlessness
A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan?
Return to the clinic every 2 weeks for blood counts.
A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse take first?
Review the medication administration record (MAR).
Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective?
The frequency of urinary tract infections decreases.
A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective?
The staff observes the client sitting in the day room reading a book.
The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level?
Thirty minutes after the dose is administered
A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase. The nurse would be correct in providing which explanation to the client regarding the purpose of this drug?
This drug is a clot buster that dissolves clots within a coronary artery.
A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia?
Transdermal
A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome?
Uric acid level
The health care provider prescribes cisplatin to be administered in 5% dextrose and 0.45% normal saline with mannitol added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the therapy?
Urine output
