Pharm HESI
The nurse is providing postoperative care for a client who has received a prescription for nalbuphine for pain. What side effects or adverse reactions does the nurse anticipate after administering this medication? Select all that apply. Nausea Oliguria Sedation Dry mouth Flushed skin Orthostatic hypotension
Nausea Sedation Dry Mouth Orthostatic Hypotension Dry mouth, sedation, nausea, and hypotension are the most common side effects of nalbuphine HCl. The client may lose bladder control, but oliguria is not seen. Cold and clammy skin, not flushed skin, may occur.
A nurse is caring for a client who is receiving a unit of packed red blood cells. Which findings lead the nurse to suspect a transfusion reaction caused by incompatible blood? Select all that apply. Cyanosis Backache Shivering Bradycardia Hypertension
Backache Shivering Mismatched blood cells are attacked by antibodies, and the hemoglobin released from ruptured erythrocytes plugs the kidney tubules; this kidney involvement results in backache. Shivering occurs as part of the inflammatory response associated with a transfusion reaction. Cyanosis is not commonly associated with a transfusion reaction. Tachycardia, not bradycardia, is associated with a transfusion reaction. Hypotension, not hypertension, is associated with a transfusion reaction.
A client with a diagnosis of acquired immunodeficiency syndrome (AIDS) has a protozoal infection and is receiving pentamidine. The nurse should monitor the client for which common side effects? Select all that apply. Leukocytosis Hypokalemia Hypoglycemia Increased serum calcium Decreased blood pressure
Hypoglycemia Decreased blood pressure Hypoglycemia is a side effect of pentamidine. Hypotension and dysrhythmias are common side effects of this medication. Neutropenia, not leukocytosis, is associated with this drug. Hyperkalemia, not hypokalemia, may occur. Hypocalcemia, not hypercalcemia, may occur.
A client with metastatic breast cancer is started on a multiple drug regimen that includes docetaxel. The nurse assesses the client for which nontherapeutic effects of docetaxel? Select all that apply. Alopecia Constipation Febrile neutropenia Increased blood pressure Hypersensitivity reaction
Alopecia Febrile neutropenia Hypersensitivity reaction Alopecia is a nontherapeutic response to docetaxel. Docetaxel affects interphase and mitosis of the cell cycle. Febrile neutropenia is a common nontherapeutic effect. Clients should concurrently receive a growth factor support agent such as pegfilgrastim when given a regimen of docetaxel. Hypersensitivity reactions (e.g., flushing, rash, local eruption) are common nontherapeutic reactions, particularly within the first few minutes of the infusion. Minor reactions do not require discontinuation of the therapy. Nausea, vomiting, and diarrhea, not constipation, are nontherapeutic effects of docetaxel. Hypotension, not hypertension, is a nontherapeutic effect of docetaxel.
A client with systemic lupus erythematosus is taking prednisone. The nurse anticipates that the steroid may cause hypokalemia. What food will the nurse encourage the client to eat? Broccoli Oatmeal Fried rice Cooked carrots
Broccoli Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.
A client is diagnosed with pulmonary tuberculosis, and the healthcare provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the drug is effective when the client reports which action as most important? Report any changes in vision Take the medicine with meals Call my doctor if my urine or tears turn red-orange Continue taking the medicine even after I feel better
Continue taking the medicine even after I feel better The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.
A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, what essential test results should the nurse review? Liver function studies Pulmonary function studies Electrocardiogram and echocardiogram White blood cell counts and sedimentation rate
Liver function studies Antitubercular drugs, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacologic therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular drugs. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.
A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? Select all that apply. Polyuria Polydipsia Paralytic ileus Respiratory rate of 24 breaths/min Serum glucose of 105 mg/dL (5.8mmol/L)
Polyuria Polydipsia Respiratory rate of 24 breaths/min Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia (excessive thirst) and fluid intake are the responses to excess fluid loss related to osmotic diuresis. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced; 24 breaths/min is characteristic of hyperventilation. Paralytic ileus is not associated with hyperglycemia. Serum glucose of 105 mg/dL (5.8 mmol/L), by most standards, is within the expected range of 60 to 110 mg/dL (3.3 to 6.1 mmol/L).
A nurse is caring for a client whose laboratory values indicate the presence of hyponatremia. Which factors does the nurse determine were the most likely cause of the hyponatremia? Select all that apply. Diabetes Insipidus Profuse diaphoresis Excess sodium intake Removal of the parathyroid glands Rapid IV infusion of 5% dextrose in water
Profuse diaphoresis Rapid IV infusion of D5W Common causes of hyponatremia from loss of sodium-rich body fluids include draining wounds, diarrhea, vomiting, and primary adrenal insufficiency. Inappropriate use of sodium-free or hypotonic IV fluids (like D5W) causes hyponatremia from water excess. Since perspiration contains high levels of sodium, this is a cause of hyponatremia. Diabetes insipidus results in inadequate antidiuretic hormone (ADH), causing water loss and hypernatremia. Excess sodium intake can lead to hypernatremia. Removal of the parathyroid glands can lead to hypocalcemia.
A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? Blocks the effects of acetylcholine Increases production of dopamine Restores dopamine levels in the brain Promotes production of acetylcholine
Restores dopamine levels in the brain Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic drugs. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production.
After surgery a client develops a deep vein thrombosis and a pulmonary embolus. Heparin via a continuous drip is prescribed. Several hours later, vancomycin intravenously every 12 hours is prescribed. The client has one intravenous (IV) site: a peripheral line in the left forearm. What action should the nurse take? Stop the heparin, flush the line, and administer vancomycin Use a piggyback set up to administer the vancomycin into the heparin Start another IV line for the vancomycin and continue the heparin as prescribed Hold the vancomycin and tell the healthcare provider that the drug is incompatible with the heparin
Start another IV line for the vancomycin and continue the heparin as prescribed The vancomycin and heparin are incompatible in the same IV and therefore must be administered separately. By instituting a second line for the antibiotic, heparin can continue to infuse. Twice a day both drugs must run concurrently. Also, flushing the line may not eliminate remnants of the heparin, which is incompatible with vancomycin. Using a piggyback setup to administer the vancomycin into the heparin is unsafe because heparin and vancomycin are incompatible and should not be administered via the same intravenous line. The client has two medications prescribed, and it is a nurse's responsibility, not the healthcare provider's, to administer them safely
A health care provider prescribes bisacodyl for a client with cardiac disease. The nurse explains to the client that this drug acts by what mechanism? Producing bulk Softening feces Lubricating feces Stimulating peristalsis
Stimulating peristalsis Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. Bisacodyl is not a bulk cathartic. Bulk-forming laxatives, such as psyllium hydrophilic mucilloid, form soft, pliant bulk that promotes physiologic peristalsis. Bisacodyl is not a stool softener. Stool softeners, such as docusate sodium, permit fat and water to penetrate feces, which softens and delays the drying of the feces. Bisacodyl is not an emollient. Emollient laxatives, such as mineral oil, lubricate the feces and decrease absorption of water from the intestinal tract.
A nurse is caring for a client with pulmonary tuberculosis who is to receive several antitubercular medications. Which of the first-line antitubercular medications is associated with damage to the eighth cranial nerve? Isoniazid Rifampin Streptomycin Ethambutol
Streptomycin Streptomycin is ototoxic and can cause damage to the eighth cranial nerve, resulting in deafness. Assessment for ringing or roaring in the ears, vertigo, and hearing acuity should be made before, during, and after treatment. Isoniazid does not affect the ear; however, blurred vision and optic neuritis, as well as peripheral neuropathy, may occur. Rifampin does not affect hearing; however, visual disturbances may occur. Ethambutol does not affect hearing; however, visual disturbances may occur.
During administration of a whole blood transfusion, the client begins to complain of shortness of breath. The nurse notes the presence of jugular venous distension, bibasilar crackles, and tachycardia. Prioritize the following nursing actions. 1- Elevate the head of the bed to 45 degrees 2- Apply oxygen via nasal cannula 3- Reduce the flow rate of the transfusion 4- Administer furosemide (Lasix) per provider instruction 5- Document findings in the client record
These symptoms represent circulatory overload. First, the nurse's priority is to facilitate gas exchange by elevating the head of the bed, then applying oxygen. Next, the transfusion rate should be slowed to reduce further circulatory overload and client compromise, followed by the administration of a diuretic to reduce circulating volume. Lastly, the findings and interventions should be documented accordingly.
A client with type 1 diabetes receives regular insulin every morning at 8:00 AM. During what period of time does the nurse recognize the risk of hypoglycemia is greatest? 8:30 to 9:30am 8:00pm to midnight 1:00pm to 8:00pm 10am to 1pm
10am to 1pm Regular insulin peaks in 2 to 5 hours; therefore the greatest risk is between 10:00 AM and 1:00 PM. Although the onset of action occurs earlier, during the period from 8:30 to 9:30 AM, the level is not yet at its highest, so the risk of hypoglycemia is not at its greatest. NPH insulin's peak action is 4 to 12 hours; if hypoglycemia occurs, it will happen most likely between midnight and 8 PM.
A client in a hospice home care program is experiencing severe pain. Morphine has been prescribed for pain management. Which information should the nurse plan to explain to the client in preparation for this pain management regimen? Drug addiction is a concern with this drug Request the medication before the pain becomes severe Dosages of this drug will be given automatically at regular intervals around the clock Intermittent administration of the drug is possible after an intermittent lock is inserted
Dosages of this drug will be given automatically at regular intervals around the clock The drug will be given routinely to maintain a continuous therapeutic blood level to keep the terminally ill client comfortable. Addiction is not a major concern for the terminally ill client. The client should not have to request this medication; it should be given regularly. Morphine is not administered intermittently; usually, it is prescribed in liquid form and is taken orally when administered in the home.
A client is admitted for dehydration, and an intravenous (IV) infusion of normal saline is started at 125 mL/hour. One hour later, the client begins screaming, "I can't breathe!" How should the nurse respond? Discontinue the IV and notify the healthcare provider Elevate the head of the client's bed and obtain vital signs Assess the client for allergies and change the IV to an intermittent lock Contact the healthcare provider to request a prescription for a sedative
Elevate the head of the client's bed and obtain vital signs Verbalization indicates that the client is breathing; elevating the head of the bed facilitates breathing by decreasing pressure against the diaphragm. Vital signs reflect the current status of the client. Auscultation of breath sounds should be done also. Discontinuing the IV access line is unsafe and may cause unnecessary discomfort if it must be restarted; more information is needed before calling the healthcare provider. No information is available to support changing the IV to an intermittent lock; assessment for allergies should be done on admission. Not enough information is available to support requesting a prescription for a sedative; further assessment is required.
A client with a gastric hemorrhage is scheduled to receive two units of whole blood. List the nurse's activities in the order that they should be performed when administering a blood transfusion. 1- Verify that a type and cross match blood sample has been sent to the lab 2- Obtain venous access, preferably with a 19 gauge needle or larger 3- Prime the blood infusion set tubing with normal saline at the bedside 4- Ask another nurse to check the blood identification at the client's bedside 5- Run the blood at a slower rate during the first 10 minutes of the transfusion
First, the nurse should ensure that a type and crossmatch blood sample (called a clot) has been sent to the lab to identify the client's blood type. This should be done first because it could take some time to be completed. Also, if a clot has not yet been sent, it can be collected and sent immediately to save waiting time to receive the blood. Secondly, the nurse must ensure there is peripheral intravenous (PIV) access with a large enough gauge needle (19-gauge or larger) to prevent destruction to the blood cells. After the PIV has been established, the blood tubing should be hung at the bedside and the lines primed with normal saline. Once the blood is brought to the unit, it must be verified by two nurses who check the blood and the client's identification before blood administration can begin. Starting the transfusion at a slow rate for the first 10 to 15 minutes provides time to monitor the client for a developing transfusion reaction before too much blood has been administered.
The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin-induced hypoglycemia should the nurse particularly be observant? Select all that apply. Excessive hunger Headache Diaphoresis Excessive thirst Deep respirations
Headache Diaphoresis Hypoglycemia affects the central nervous system, causing headache. Hypoglycemia affects the sympathetic nervous system, causing diaphoresis. Excessive hunger is associated with hyperglycemia because glucose is not being used for cellular metabolism. Excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria. Deep respirations (Kussmaul respirations) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.
A client receiving chemotherapy for cancer develops sores in the mouth and asks the nurse why this happened. What is the nurse's best response? The sores occur because of the direct irritating effects of the drug These tissues are poorly nourished because you have a decreased appetite The frequently dividing cells of the gastrointestinal tract are damaged by the drug This side effect occurs because it targets the cells of the gastrointestinal system
The frequently dividing cells of the gastrointestinal tract are damaged by the drug Many chemotherapeutic agents function by interfering with DNA replication associated with cellular reproduction (mitosis). Frequent cellular mitosis of the stratified squamous epithelium of the mouth and anus results in these areas being powerfully affected by the drugs. The response "The sores occur because of the direct irritating effects of the drug" is not accurate; most agents are administered parenterally. A decreased appetite (anorexia) does not cause stomatitis. Chemotherapeutic agents affect most rapidly proliferating cells, which include not only the cells of the gastrointestinal epithelium but also those of the bone marrow and hair follicles.
A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. Urine output Deep tendon reflexes Last bowel movement Arterial blood gas results Last serum potassium level Patency of the intravenous access
Urine output Last serum potassium level Patency of the intravenous access Before administering IV potassium, the urinary output must be normal. If the urine output is low, a potassium infusion may damage renal cells. The last serum potassium level should also be checked to ensure potassium replacement is appropriate. A patent IV access is essential because potassium is very irritating and painful to subcutaneous tissue. The infusion of KCL 40 mEq in 100 mL of 5% dextrose and water has no direct effect on deep tendon reflexes, bowel movement patterns, or arterial blood gases. Therefore these items are not required to be assessed before administration of this medication.
A nurse mixes a short-acting and an intermediate-acting insulin in the same syringe to administer to a client with diabetes. List the actions in the order the nurse should perform them. 1 - Put air into the intermediate-acting insulin vial 2- Put air into the short-acting insulin vial 3- Withdraw the prescribed amount of short-acting insulin 4- Withdraw the prescribed amount of intermediate-acting insulin
Air should be injected into the air space of the intermediate-acting insulin vial before short-acting insulin is drawn into the syringe; the needle should not touch the insulin. The nurse should inject the amount of air into the short-acting insulin vial equivalent to the volume to be withdrawn to prevent negative pressure that can make withdrawal difficult. The short-acting insulin should be withdrawn first to prevent possible contamination of the vial with the intermediate-acting insulin, which would cause a delay in onset time of the short-acting insulin. The intermediate-acting insulin should be drawn up after the short-acting insulin to prevent contamination of the short-acting insulin.
The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. What does the nurse explain to the client regarding the purpose of the albumin? It provides nutrients It increases protein stores Albumin elevates the circulating blood volume Albumin temporarily diverts blood flow away from the liver
Albumin elevates the circulating blood volume Increasing oncotic pressure increases the client's circulating blood volume; salt-poor albumin pulls interstitial fluid into the blood vessels, restoring blood volume and limiting ascites. Nutrients are provided by total parenteral nutrition, not salt-poor albumin. Salt-poor albumin is not given to increase protein stores. Salt-poor albumin has no effect on diverting blood flow away from the liver.
A healthcare provider prescribes selegiline 5 mg twice a day for a client with a diagnosis of Parkinson disease. What is most important for the nurse to teach the client? Eat food high in tyramine Ensure than an opioid is not taken currently Take the medication in the morning and the evening Monitor for signs of hypoglycemia and hyperglycemia
Ensure that an opioid is not taken currently Selegiline concurrently used with an opioid analgesic can result in a fatal reaction (e.g., excitation, rigidity, hypertension, hypotension, coma). Foods high in tyramine (e.g., cheese, wine, beer, pickled products) should be avoided, not encouraged. When foods high in tyramine are broken down, they release specific biogenic amines. When the breakdown of these biogenic amines is inhibited by monoamine oxidase inhibitors, such as selegiline, pressor substances accumulate in the body, causing a quick increase in blood pressure to excessively high levels, precipitating intracranial bleeding and death. It is recommended that this medication be taken at breakfast and lunch, so its effects are more apparent while the client is awake; it should not be taken in the evening or at bedtime. Selegiline does not influence serum glucose levels. It can produce false-positive or false-negative results for glycosuria.
A client with Hodgkin disease is placed on an ABVD combination chemotherapy regimen. Because doxorubicin is part of this therapy, what education will the nurse provide about this drug? Cease taking any medications that contain vitamin D Keep the doxorubicin in a dark place protected from light Expect urine to turn red for a few days after taking this drug Take the doxorubicin on an empty stomach with large amounts of fluid
Expect urine to turn red for a few days after taking this drug Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the drugs in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.
Warfarin is prescribed for a client who has been receiving intravenous (IV) heparin for a partial occlusion of the left common carotid artery. The client expresses concern about why both drugs are needed at the same time. What rationale does the nurse include to address the client's concern? This permits the administration of smaller doses of each medication Giving both drugs allows clot dissolution while preventing new clot formation Heparin provides anticoagulant effects until warfarin reaches therapeutic levels Administration of heparin with warfarin provides immediate and maximum protection against clot formation
Heparin provides anticoagulant effects until warfarin reaches therapeutic levels Warfarin is administered orally for 2 to 3 days to achieve the desired effect on the international normalized ratio (INR) level before heparin is discontinued. These drugs do not dissolve clots already present. Because each drug affects a different part of the coagulation mechanism, dosages must be adjusted separately. That this approach immediately provides maximum protection against clot formation does not account for the reason for the administration of both drugs; warfarin will not exert an immediate therapeutic effect.
A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client? Iodide solutions must be diluted in water and taken on an empty stomach Monitoring for signs of infection or bleeding is necessary Postoperative hemorrhage is a common complication if these drugs are used before a thyroidectomy These drugs will be discontinued as soon as temperature and pulse rate return to the expected range
Postoperative hemorrhage is a common complication if these drugs are used before a thyroidectomy Propylthiouracil can cause depression of leukocytes and platelets. Propylthiouracil and potassium iodide should be given with milk, juice, or food to prevent gastric irritation. Drug therapy decreases the risk of postoperative hemorrhage because this drug regimen decreases the size and vascularity of the thyroid gland. Drug therapy is continued for at least 6 to 8 weeks, even if the client's temperature and pulse return to the expected range.
After a basal cell carcinoma is removed by fulguration, a client is given a topical steroid to apply to the surgical site. The nurse evaluates that the teaching regarding steroids and skin lesions is effective when the client identifies which action as the primary purpose of the medication? Prevent infection of the wound Increase fluid loss from the skin Reduce inflammation at the surgical site Limit itching around the area of the lesion
Reduce inflammation at the surgical site Steroids are used for their antiinflammatory, vasoconstrictive, and antipruritic effects. Steroids increase the incidence of infections because they are antiinflammatory agents and mask symptoms of infection. Steroids increase fluid retention because they promote the reabsorption of sodium from the tubular fluid into the plasma. Although steroid ointments have an antipruritic effect, their major purpose after surgery is their systemic antiinflammatory effect.
What will the nurse do to assess a client's response to ongoing serum albumin therapy for cirrhosis of the liver? Monitor the client's vital signs Measure the client's urine output every half hour Obtain the client's weight at least once every day Determine the client's urine albumin level each shift
Obtain the client's weight at least once every day The increased osmotic effect after the administration of albumin increases intravascular volume and urinary output; weight loss reflects fluid loss. Vital signs do not change drastically; however, they should be checked routinely. Urinary output is measured hourly, every 8 hours, and every 24 hours; half-hour outputs are insignificant in this instance. Serum albumin levels are significant; however, albumin in the urine indicates kidney dysfunction, not liver dysfunction.
A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. What purpose does the nurse provide? To augment the immune response To potentiate the effects of antacids To treat Helicobacter Pylori infection To reduce hydrochloric acid secretion
To treat H pylori Approximately two thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.
