Pharm Hesi - Notes 2
The health care provider prescribes morphine sulfate grain 1/8 IM stat. Morphine is available in 8 mg/mL. How many milliliters should the practical nurse (PN) administer?
Rationale:1 mL, because 1 gr = 60 to 64 mg. 1 gr:60 mg::1/8:x mg = x = 60 × 1/8 = 7.5 = 8 mg, or 1 gr:64 mg::1/8:x mg = x = 64 × 1/8 = 8 mg.Formula:D/H × Q = (8 mg/8 mg) × 1 mL = 1 mLDimensional analysis formula:mL/8 mg × 64 mg/gr × 1/8 gr/x mL = 1 mL. A
A client diagnosed with a herniated disc is prescribed hydrocodone/acetaminophen 10 mg/300 mg PRN every 4 to 6 hours. As the practical nurse (PN) enters the client's room to administer their requested medication, the client is seen talking and laughing with his visiting family. Which action should the PN implement?
Rationale:The medication should be administered as per client's request. The client's self-report of pain is the single most reliable indication of the existence, character, and intensity of pain. Analgesics should be administered as soon as pain occurs and before it increases in intensity. The PN should consult with the charge nurse after she administers the medication about the situation.
A client is prescribed an antacid for the treatment of peptic ulcer disease. What is the action of this medication that is effective in treating the client's ulcer?
Rationale:The objective of antacids is to neutralize gastric acids and keep a pH of 3.5 or above which is necessary for pepsinogen inactivity.
A client receiving the antibiotic vancomycin is prescribed to have a peak and trough level done with the next dose. What time should the practical nurse obtain the blood specimen for the trough level?
Rationale:Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given. The PN needs to wait for the lab results of the trough level from the lab before administering the scheduled antibiotic. If the trough level is above the recommended levels, the medication needs to be held and the health care provider needs to be notified.
The practical nurse (PN) is obtaining the medical history of a client starting a new prescription for conjugated estrogens PO daily. Which medical condition is not treated by this medication?
The practical nurse (PN) is obtaining the medical history of a client starting a new prescription for conjugated estrogens PO daily. Which medical condition is not treated by this medication?
The health care provider (HCP) recommends the over-the-counter (OTC) expectorant guaifenesin for a client who has a dry, nonproductive cough and congested nasal passages. The client reports that they usually have a glass of wine with dinner nightly. Which information should the practical nurse provide to this client?
Rationale:A cough that lasts more than 1 week or is accompanied by a fever, rash, or headache may be an indication of more serious medical condition such as a bacterial infection and should be followed up by the health care provider. Alcohol and CNS depressants, such as guaifenesin, have a cumulative effect when consumed concurrently which can be lethal such as respiratory depression. The client needs to be aware of this and advise that alcohol consumption should not be consumed while taking this medication.
A client diagnosed with bacterial pneumonia is being admitted to the unit from the emergency room. Which intervention should the practical nurse ensure that it has been done prior to the administration of antibiotics?
Rationale:A culture and sensitivity of a sputum specimen should be done prior to the initiation of the administration of antibiotics.
A 6-month-old infant is prescribed digoxin for the treatment of congestive heart failure. Which observation by the practical nurse (PN) warrants immediate intervention?
Rationale:A heart rate of 60 beats/min for a 6-month-old warrants immediate intervention. The normal heart rate for a 6-month-old is 80 to 150 beats/min when awake, and a rate of 70 beats/min while sleeping is considered to be within normal limits.
A client in the immediate postoperative period is prescribed morphine via a patient-controlled analgesia (PCA) pump. Which finding should the PN consider the highest priority in this client?
Rationale:A life-threatening side effect of intravenous administration of morphine sulfate, an opiate narcotic, is respiratory depression. If the client is going in to respiratory depression, the PCA pump should be stopped and the registered nurse (RN) or health care provider should be notified if the client's respiratory rate falls below 10 breaths/min.
The health care provider (HCP) has prescribed a 74-year-old client to be vaccinated with the influenza vaccine prior to discharge. Which client condition will make the practical nurse not to vaccinate the client and consult with the charge nurse?
Rationale:According to the CDC website, the flu vaccination is contraindicated if a client has a severe allergy to any part of the vaccine. "Most, but not all, types of flu vaccine contain a small amount of egg protein." The practical nurse needs not to administer the flu vaccination and consult with the charge nurse for further guidance.
Which assessment finding indicates that the expected outcome of administering donepezil to a client with Alzheimer disease has been accomplished?
Rationale:Aricept is used for those suffering from Alzheimer disease. Its action elevates acetylcholine concentrations by slowing down degradation of acetylcholine released in cholinergic neurons. It does not reverse or cure Alzheimer disease but slows down the deterioration.
A first-day post-operative client vomits 30 minutes after receiving a dose of hydromorphone. What initial intervention is best for the practical nurse (PN) to implement?
Rationale:Because the emesis appears to be directly related to the administration of the opiate analgesic, the first action should be to reduce the client's nausea with the administration of the ondansetron, which is an antiemetic.
A client diagnosed with seizures is prescribed phenytoin. Which medication instruction should the practical nurse (PN) reinforce to this client?
Rationale:Brushing and flossing the teeth daily prevents gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy.
A 78-year-old client with congestive heart failure (CHF) receives digoxin 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective?
Rationale:Digoxin is a cardiac glycoside, which increases force of the heart contractions and decreases heart rate, which in turn increases cardiac output. Clear breath sounds bilaterally indicates that the medication was effective in increasing the cardiac output thus preventing pulmonary edema.
A client has developed oral thrush. Which pharmacological agent should the practical nurse (PN) expect to be prescribe
Rationale:Nystatin is an antifungal drug that is effective in treating thrush, an oral fungal infection.
A client diagnosed with a sinus infection is prescribed ampicillin sodium. The practical nurse (PN) should instruct the client to notify the health care provider immediately if which symptom occurs?
Rationale:Rash is the most common adverse side effect of all generations of penicillin, indicating an allergy to the medication, which could result in anaphylactic shock, a medical emergency.
A female client who started taking an oral sulfonamide for a urinary tract infection the previous day reports to the nurse that the medication is causing slight anorexia. She also states that she continues to experience urinary frequency, so she takes the medication with a glass of cranberry juice and with a snack. What information should the practical nurse provide?
Rationale:The PN should emphasize the need to take sulfonamides with a full glass of water to help prevent crystalluria and to take the medicine on an empty stomach, ideally 1 hour before anything is eaten or 2 hours after eating something.
The practical nurse (PN) administers two newly prescribed medications, isosorbide dinitrate (a nitrate) and hydrochlorothiazide (a diuretic), to a client. What instructions should the PN reinforce with the client in regard to these medications?
Rationale:The additive effects of the concomitant use of nitrates, such as isosorbide dinitrate, which produce vasodilation, and diuretics, such as hydrochlorothiazide, which reduce blood volume, can cause hypotension, so it is important to instruct the client to slowly change positions when rising from a sitting or lying position. Both of these medications can cause orthostatic hypotension.
A client with diagnoses of diabetes mellitus and gastroesophageal reflux disease is newly prescribed propranolol for hypertension. Which information should the nurse provide to this client?
Rationale:The client needs to be instructed to monitor blood glucose because propranolol may mask symptoms of hypoglycemia. The propranolol should be taken with 8 ounces (240 mL) of water and food because food enhances bioavailability.
A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication?
Rationale:The client should be instructed to discontinue the use of the medication and notify the health care provider immediately if the client is experiencing vision and/or hearing loss or an erection lasting more than 4 hours.
While taking a client's history, the practical nurse (PN) discovers that the client, who takes warfarin daily for atrial fibrillation, has added a St. John's wort to their daily regime. What recommendation should the PN provide to this client?
Rationale:Use of natural products should be shared with the health care provider, so possible interactions can be addressed. The St. John's wort may interfere with the effectiveness of the warfarin.
A client is prescribed clonidine 0.1 mg/24 hour via transdermal patch. Which client outcome would indicate the medication is effective?
Rationale:Clonidine acts as a centrally acting analgesic and antihypertensive agent. The decrease in the blood pressure indicates a reduction in hypertension.
The practical nurse interprets the client's PPD as a positive skin test. Which drug is considered the primary prophylaxis for a client exposed to active tuberculosis?
Rationale:Isoniazid is highly specific for Mycobacterium tuberculosis and is the primary drug of choice for clients with positive PPD skin tests.
A practical nurse (PN) is reviewing teaching with the client and/or significant others about the concurrent use of benztropine and olanzapine to manage psychotic behavior. What information should the PN reinforce?
Rationale:Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with olanzapine use. Caution is required in the dosage of benztropine used in conjunction with olanzapine.
An adolescent client with a seizure disorder is prescribed the anticonvulsant medication carbamazepine. The nurse should notify the health care provider if the client develops which condition?
Rationale:Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flu-like symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias.
The practical nurse administered carbidopa levodopa to a client diagnosed with Parkinson disease. Which outcome by the client would indicate a therapeutic response?
Rationale:Carbidopa-levodopa increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson, such as involuntary movements, resting tremors, and shuffling gait.
An older client is prescribed gentamicin sulfate. Which question should the practical nurse (PN) ask an older client before beginning treatment?
Rationale:Complications of gentamicin sulfate therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining and monitoring the client's hearing before initiation of this medication and as the treatment progresses is important. Peak and trough levels are usually prescribed around the second and third dose.
A practical nurse (PN) is reviewing the plan of care for client who is prescribed glucocorticoid methylprednisolone. Which nursing diagnosis is related to this medication?
Rationale:Corticosteroids depress the immune system, placing the client at risk for infection. The nursing diagnosis for "risk for infection" is directly related to the administration of glucocorticoid methylprednisolone
The practical nurse administered cyclobenzaprine to a client. Which outcome would indicate a therapeutic response
Rationale:Cyclobenzaprine is a central skeletal muscle relaxant used to relieve muscle spasms, so an improved range of motion would indicate a therapeutic response and expected outcome of therapy.
A client who received a prescription for cyclosporine ophthalmic emulsion for dry eyes asks the practical nurse (PN) if it is safe to continue using artificial tears. What information should the PN provide?
Rationale:Cyclosporine, an ophthalmic emulsion which increases tear production, may be used in conjunction with artificial tears as long as the products are administered 15 minutes apart. Transient blurring after administration is a side effect of cyclosporine and does not necessitate discontinuation of the medication. After tear production is increased, artificial tears may be stopped, but discontinuing cyclosporine will result in a decrease in tear production.
An immobile client is prescribed dalteparin subcutaneously and has been receiving the medication for 5 days. Which finding indicates that the PN should hold the prescribed dose?
Rationale:Dalteparin is a low-molecular-weight heparin (LMWH) anticoagulant used to prevent DVT in the at-risk client. If the client develops overt signs of bleeding such as guaiac-positive stool while receiving an anticoagulant, the medication should be held and coagulation studies completed.
A client status post hip replacement 24 hours ago has been prescribed enoxaparin 30 mg IVP bid × 4 doses. Which intervention is most important for the practical nurse (PN) to implement?
Rationale:Enoxaparin is a low-molecular-weight heparin that can only be administered subcutaneously, so the PN should contact and ask the registered nurse (RN) to call the health care provider to clarify the route of administration.
The H2 receptor blocker famotidine is prescribed for a client for gastroesophageal reflux disease (GERD). Which client statement indicates to the practical nurse (PN) that teaching was effective regarding concurrent use of these medications?
Rationale:Famotidine inhibits histamine at the histamine H2-receptor site, thus decreasing gastric secretions. In the treatment of GERD, it should be taken twice a day.
The health care provider orders 1000 mL of 0.45% lactated ringers to run over 8 hours. The drop factor is 15 gtt/mL. The nurse plans to adjust the flow rate to how many gtt/min? (Round to the nearest whole number.)
Rationale:First convert the 8 hours to minutes (8 hours × 60 minutes/hour = 480 minutes).Then use the formula below to determine the gtt/min. Finally, round to the nearest whole number.Total volume in mL × gtt factor = flow rate in gtt/minTime in minutes:(1000 mL × 15 gtt/mL)/480 minutes = 15,000/480 = 31.2 or 31 gtt/min
Rationale:Phenazopyridine, a urinary analgesic, is used to relieve pain associated with urinary tract infections such as burning, pain, urgency, and frequent voiding. The administration of phenazopyridine will turn the urine to a bright red orange color. This medication should be taken with food to decrease gastric irritation. Phenazopyridine should only be used for 2 days when taken together with an antibacterial agent, which is typically prescribed for approximately 2 weeks.
Rationale:Furosemide is a loop diuretic. The action of this medication inhibits the reabsorption of sodium and chloride at the proximal and distal tubule and in the loop of Henle. This medication potentiates the excretion of potassium, causing hypokalemia. Hypokalemia can cause cardiac irregularities. A
A 78-year-old client prescribed furosemide 40 mg PO twice daily is demonstrating EKG changes. Which condition should the practical nurse suspect is causing these changes?
Rationale:Furosemide potentiates the excretion of potassium causing hypokalemia. Hyperchloremia, hypernatremia, and hypophosphatemia are not related to furosemide administration.
A client prescribed glipizide asked why they had to take their insulin orally. How should the practical nurse respond?
Rationale:Glipizide is an oral hypoglycemic agent that enhances pancreatic production of insulin when some beta cell function is present.
A client who is taking hydrochlorothiazide is admitted to the hospital and is experiencing muscle weakness and cramps. Which condition should the practical nurse suspect is causing these changes?
Rationale:Hydrochlorothiazide acts on the distal tubule and ascending limb of loop of Henle by increasing excretion of water, sodium, chloride, and potassium. The signs and symptoms of hyponatremia include muscle weakness and cramps.
A client who is being discharged to home asks the practical nurse (PN) for a dose of hydrocodone before leaving the hospital. How should the PN respond to this client's request?
Rationale:Hydrocodone is a narcotic analgesic, and the practical nurse should gather more data from the client about the pain he is experiencing before giving the medication. It is possible for the client to take one of the prescriptions provided, but first the nurse should assess the client's level of pain. The client's need for pain medication should be addressed, and pain medication should not be withheld because he is going home.
The practical nurse is assigned a client on digoxin therapy. Which finding is likely to predispose this client to developing digoxin toxicity?
Rationale:Hypokalemia predisposes the client on digoxin to digoxin toxicity and is usually presented as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels and prompt correction of hypokalemia are important interventions for the client taking digoxin.
A healthy 68-year-old client asks the practical nurse (PN) should they take the pneumococcal vaccine. Which statement should the PN offer to the client that provides the most accurate information about this vaccine?
Rationale:It is usually recommended that persons younger than 2 years old and 65 years and older get vaccinated. Those with a history of certain medical conditions may also be recommended to receive the immunization.
A client has been prescribed an angiotensin II receptor antagonist losartan. Which change in data indicates to the practical nurse (PN) that the desired effect of this medication has been achieved?
Rationale:Losartan is prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.
A client diagnosed with asthma is prescribed methylprednisolone 40 mg IV daily. Which laboratory test results should the practical nurse closely monitor for increased values?
Rationale:Methylprednisolone is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can increase a client's glucose levels, which can lead to hyperglycemia.
The practical nurse (PN) administered 15 units of NPH insulin subcutaneously to a client before they consumed their breakfast at 7:30 am. At what time is the client at an increased risk for a hypoglycemic reaction?
Rationale:NPH, an intermediate acting insulin, peaks approximately 8 to 12 hours after subcutaneous injection. The most likely time for this client to experience a hypoglycemic reaction is between 3:30 and 7:30 pm.
Benztropine is prescribed for a client with Parkinson disease. After a few days of therapy, the client complains of a constipation and abdominal distention. What response by the practical nurse would be most appropriate?
Rationale:One of the side effects of benztropine is a paralytic ileus. It is important to first assess the client's abdomen, listen for bowel sounds, and determine when they last had a bowel movement. The practical nurse should then consult with the charge nurse and report findings.
Phenazopyridine is commonly prescribed for clients with urinary tract infections (UTI). Which statement by the practical nurse describes the purpose for the administration of phenazopyridine?
Rationale:Phenazopyridine, a urinary analgesic, is used to relieve pain associated with urinary tract infections such as burning, pain, urgency, and frequent voiding. The administration of phenazopyridine will turn the urine to a bright red orange color. This medication should be taken with food to decrease gastric irritation. Phenazopyridine should only be used for 2 days when taken together with an antibacterial agent, which is typically prescribed for approximately 2 weeks.
A client has been diagnosed with open-angle glaucoma. The health care provider prescribes pilocarpine 1% eye drops. What action of this drug makes it a useful treatment for the client's condition?
Rationale:Pilocarpine, a cholinergic agent, causes pupillary constriction (miosis), which facilitates outflow of aqueous humor, causing a decrease in intraocular pressure.
The nurse is caring for a client who was newly prescribed insulin aspart 7 units subcutaneously prior to each meal. Which nursing intervention has the highest priority when planning this client's care?
Rationale:Rapid-acting synthetic insulin analogs like insulin aspart have an onset of action of approximately 15 minutes and should be injected 0 to 15 minutes before the meal to prevent or decrease the risk of hypoglycemia.
A client who takes metformin for diabetes mellitus type 2 is NPO for surgery. The practical nurse (PN) anticipates which pre-op prescription for this client's glucose management.
Rationale:Regular insulin dosing based on the client's blood glucose levels (sliding scale) is the best method to achieve control of the client's blood glucose while the client is NPO.
Daily dose of alendronate is prescribed for a 54-year-old postmenopausal client. Which instruction should the practical nurse provide to this client regarding taking the prescribed medications?
Rationale:Studies have shown a significant reduction in fractures when clients take the alendronate. It is important to instruct the client to remain in an upright position for at least 30 minutes after administration to prevent esophageal irritation.
