Pharm HESI II - Mod III
Serum blood glucose.
A client is hospitalized with an asthma exacerbation and is being treated with methylprednisolone (Solu-Medrol) 125 mg q6 hours. Which laboratory value should the practical nurse (PN) to monitor?
Seizure free during the last 24 hours.
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?
Uses a salt substitute that has potassium.
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?
Glasgow Coma Scale (GCS) score of 15.
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?
Calcium gluconate.
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?
0700 and 1900.
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?
Hold the administration of the drug dose and notify the charge nurse.
The healthcare provider calls in a telephone prescription for digoxin (Lanoxin) of 2.5 mg PO now. The practical nurse (PN) questions the dosage, and the provider confirms that the dose is correct. Which action should the PN take?
Blood pressure.
The practical nurse (PN) is caring for a client who is receiving secondary infusion of procainamide (Pronestyl) IV. Which assessment should the PN obtain during the administration of the medication?
Give neostigmine bromide (Prostigmin) before meals.
Which action should the practical nurse (PN) implement for a client who is recently diagnosed with myasthenia gravis?
Obtain the client's heart rate and blood pressure.
Which action should the practical nurse implement prior to administering furosemide (Lasix) 60 mg and hydrochlorothiazide (HydroDIURIL) 25 mg to a client?
Blood pressure 90/60 mmHg.
A client is receiving a nitroglycerin transdermal patch daily. Which assessment finding indicates that the practical nurse (PN) should withhold the next dose?
Administer morphine 5 mg IM now.
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?
Chronic constipation and diverticulosis.
A client who is admitted for bradycardia receives a prescription for atropine. Which client information should the practical nurse report to the healthcare provider?
Regular insulin (Humulin R).
A client who is admitted with diabetic ketoacidosis (DKA) and an initial serum glucose level of 300 mg/dl has a prescription of IV insulin per sliding scale. The nurse asks the practical nurse (PN) to retrieve the insulin from the automated medication dispensing system. Which insulin vial should the PN obtain?
Remove the patch at 1930.
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?
Serum potassium level.
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?
Administer Humalog 15 minutes before each meal.
A client with type 2 diabetes mellitus receives glargine (Lantus) insulin 10 units every evening and lispro (Humalog) insulin 5 units TID. Which information should the practical nurse (PN) reinforce in a teaching session?
"Have you felt sad or depressed lately?"
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?
Inform the charge nurse about the client's status.
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?
Administer diphenhydramine (Benadryl) PRN.
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?
Peak flow reading is raised to 80% of personal best.
After an albuterol (Ventolin) nebulizer treatment is given to a client with asthma, what finding by the practical nurse indicates that the treatment was effective?
"I wonder if I will have to stop taking my diuretic for my kidney problem."
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?
Withhold the dose of digoxin.
An older client who is receiving digoxin (Lanoxin) 0.25 mg PO at 0800 has an apical pulse of 68 beats/minute and respirations of 16 breaths/minute. The practical nurse (PN) identifies that the client's serum digoxin level is 3.2 ng/ml. What action should the practical nurse implement?
A side-effect.
An older client with a broken humerus received an IV dose of morphine in the emergent care center. Thirty minutes later, the client complained of feeling lightheaded and vomits once. The practical nurse (PN) understands which process is most likely the cause for these symptoms?
Administer the Ativan as prescribed.
An older male has a PRN prescription for lorazepam (Ativan) for intermittent agitation and confusion. After observing that the client is becoming increasingly restless and making inappropriate comments, what action should the practical nurse take?
Do not abruptly stop the medication.
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?
Check the urinary drainage system for kinks.
Forty minutes after a client with pulmonary edema receives furosemide (Lasix) 40 mg, 50 ml of concentrated dark amber urine is in the indwellling uri catheter's bedside drainage bag.What action should the practical nurse (PN) implement first?
Administer 30 minutes before a meal BID if capillary glucose is greater than 70 mg/dl.
Glipizide (Glucotrol) 10 mg BID is prescribed for a client with type 2 diabetes mellitus. Breakfast is served at 0800, and dinner is served at 1700. Which action should the practical nurse (PN) implement?
The amount and time of the previous dose.
The healthcare provider prescribes hydromorphone (Dilaudid) 2 mg PO every 4 hours as needed for pain for a client with a kidney stone. When the client asks for pain medication, the practical nurse (PN) reviews a drug reference and finds the usual adult dosage, Dilaudid 1 to 4 mg every 4 to 6 hours. What information is most important for the PN to know prior to administering the analgesic?
A 40-year-old client is encouraged to receive yearly influenza and pneumonia vaccinations.
The practical nuise (PN) is orienting a new nurse at the immunization clinic. What information provided by the new nurse indicates a need for further orientation?
Blood pressure of 96/52.
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?
While on fluorouracil (5-FU) chemotherapy, the client reports tarry, loose stools.
The practical nurse (PN) is administering medications to several clients. Which client statement indicates that additional action should be taken by the PN?
Blood urea nitrogen and serum creatinine.
The practical nurse (PN) is administering secondary infusions of vancomycin (Vancocin) and gentamicin (Garamycin) to a client with kidney infection and colitis due to Clostridium difficile. Which laboratory results should the PN review before administering the medications?
Pain rating of 9 on a 0 to 10 pain scale.
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?
Pad side rails for seizure precaution.
The practical nurse (PN) is caring for a client who overdosed with 10 tablets of buproprion (Wellbutrin) 150 mg tablets and a pint of vodka. Which priority action should the PN implement?
Bowel sounds auscultated at 20 gurgles/minute.
The practical nurse (PN) is caring for a client with hypokalemia who is receiving IV potassium chloride (KCI). Which finding should the PN identify as a therapeutic response?
Administer the medication as prescribed.
The practical nurse (PN) is giving gabapentin (Neurontin) to a male client and asks him if he has a history of seizures. The client states he does not have seizures but has a history of chronic burning and numbing pain in both legs. What action should the PN take?
Take before meals and apart from other drugs.
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?
Withhold the dose and report findings to the charge nurse.
The practical nurse (PN) is preparing the next secondary infusion of gentamicin IV ql8 hours for an older client. The PN reviews the client's serum values for gentamicin, which is 14 ug/ml (therapeutic range is 4-10 ug/ml.) Which action should the practical nurse take?
Prescribed morphine; dispensed Roxanol.
The practical nurse (PN) is preparing to administer medications and identifies that the pharmacy has delivered a substituted drug for one of the prescribed drugs. Which drug should the PN identify as the trade name equivalent for administration?
Muscle aching.
The practical nurse (PN) is reinforcing medication teaching to a client who receives a prescription for lovastatin (Mevacor). Which symptom should the PN tell the client to report immediately?
Blood urea nitrogen (BUN) is 30 mg/dL and creatinine is 1.5 mg/dL.
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?
Clopidogrel (Plavix).
The practical nurse (PN) reinforces preoperative instructions to a client scheduled for abdominal surgery. Which medication should the PN tell the client to stop taking 7 days prior to the surgery?
No wheezing is audible or auscultated.
What criterion provides the best indication to the practical nurse that albuterol (Ventolin) nebulizing treatment is effective for a client with asthma?
Recommend the use of a soft toothbrush.
When caring for a client receiving warfarin (Coumadin), what action should the practical nurse implement?
The pulse is greater than 100 beats/minute.
When should the practical nurse (PN) withhold administration of oral levothyroxine (Levothroid)?
A client who takes metformin (Glucophage) is scheduled for a test using iodine dye.
Which client situation requires a response from the practical nurse?
History of dysrhythmias.
Which co-morbidity of a client who is starting thyroid replacement should the practical nurse report to the healthcare provider?
Bilateral breath sounds are clear.
Which finding by the practical nurse indicates that the client's use of ipratropium bromide (Atrovent) inhaler was effective?
Albuterol (Proventil).
Which medication prescription should the practical nurse administer for a client who is having an asthmatic episode?
