Pharmacology Hesi Practice 1
Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic? An older client with Type 2 diabetes mellitus. A client with chronic rheumatoid arthritis. A client with a open compound fracture. A young adult with inflammatory bowel disease.
A young adult with inflammatory bowel disease.
When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? Flank. Abdomen. Chest. Head.
Abdomen.
An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h. Which action should the nurse implement? Administer both medications according to the prescription. Hold the ketorolac to prevent an antagonistic effect. Hold the morphine to prevent an additive drug interaction. Contact the healthcare provider to clarify the prescription.
Administer both medications according to the prescription.
A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00 p.m. dose. What action can the nurse take to alleviate this side effect? Change the time of the dose. Hold the 9 p.m. dose. Administer the dose with a snack. Administer an antiemetic with the dose.
Administer the dose with a snack.
Which medications should the nurse caution the client about taking while receiving an opioid analgesic? Antacids. Benzodiazepines. Antihypertensives. Oral antidiabetics.
Benzodiazepines.
Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis? Loperamide (Imodium). Probanthine (Propantheline). Bismuth subsalicylate (Pepto Bismol). Diphenoxylate hydrochloride with atropine (Lomotil).
Bismuth subsalicylate (Pepto Bismol).
A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved? Client denies recent episodes of angina. Change in peripheral edema from +3 to +1. Client denies recent nausea or vomiting. Blood pressure has changed from 180/120 to 140/70 mmHg.
Blood pressure has changed from 180/120 to 140/70 mmHg.
Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? Dependent edema reduced from +3 to +1. Serum HDL increased from 35 to 55 mg/dl. Pulse rate reduced from 150 to 90 beats/minute. Blood pressure reduced from 160/90 to 130/80.
Blood pressure reduced from 160/90 to 130/80.
A client is receiving metoprolol (Lopressor SR, Nu-Metop). What assessment is most important for the nurse to obtain? Temperature. Lung sounds. Blood pressure. Urinary output.
Blood pressure.
While taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? Aminoglycosides. Cephalosporins. Sulfonamides. Tetracyclines.
Cephalosporins.
Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? Client states chest pain is relieved. Client's pulse decreases from 120 to 90. Client's systolic blood pressure decreases from 180 to 90. Client's SaO2 level increases from 92% to 96%.
Client states chest pain is relieved.
The nurse is teaching a client with cancer about opioid management for intractable pain and tolerance related side effects. The nurse should prepare the client for which side effect that is most likely to persist during long-term use of opioids? Sedation. Constipation. Urinary retention. Respiratory depression.
Constipation.
A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? Administer a PRN dose of the PO meperidine (Demerol). Administer naloxone (Narcan) IV per PRN protocol. Decrease the IV infusion rate of the meperidine (Demerol) per protocol. Notify the healthcare provider of the client's confusion and hallucinations.
Decrease the IV infusion rate of the meperidine (Demerol) per protocol.
A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent? Progressive difficulty with swallowing. Decreased respiratory effort. Improvement in generalized fatigue. Decreased muscle weakness.
Decreased muscle weakness.
A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? Glaucoma. Hypertension. Heart failure. Asthma.
Heart failure.
A client is receiving digoxin for the onset of supraventricular tachycardia (SVT). Which laboratory finding should the nurse identify that places this client at risk? Hypokalemia. Hyponatremia. Hypercalcemia. Low uric acid levels.
Hypokalemia.
A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? Sixty minutes after the antibiotic dose is administered. Immediately before the next antibiotic dose is given. When the next blood glucose level is to be checked. Thirty minutes before the next antibiotic dose is given.
Immediately before the next antibiotic dose is given.
Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)? Fluid volume deficit. Risk for infection. Risk for injury. Impaired sleep patterns.
Risk for injury.
A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." "No, it is not an oral insulin and can be used only when some beta cell function is present." "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."
"No, it is not an oral insulin and can be used only when some beta cell function is present."
A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? "Take the first dose of Sinemet today, as soon as your prescription is filled." "Since you already took your levodopa, wait until tomorrow to take the Sinemet." "Take both drugs for the first week, then switch to taking only the Sinemet." "You can begin taking the Sinemet this evening, but do not take any more levodopa."
"You can begin taking the Sinemet this evening, but do not take any more levodopa."
Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.) 1. Prednisone (Deltasone) orally. 2. Gentamicin (Garamycin) IM. 3. Albuterol (Proventil) puffs. 4. Salmeterol (Serevent Diskus).
1. Albuterol (Proventil) puffs. 2. Salmeterol (Serevent Diskus). 3. Prednisone (Deltasone) orally. 4. Gentamicin (Garamycin) IM.
A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? Serum glucose. Serum calcium. Red blood cells. Serum potassium.
Serum glucose.
A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What intervention should the nurse implement? Alternate the two medications q4h PRN for pain. Alternate the two medications q2h PRN for pain. Administer only the Dilaudid q4h PRN for pain. Administer only the Stadol q4h PRN for pain.
Administer only the Dilaudid q4h PRN for pain.
A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). Administer the 40 mg of Imdur and then contact the healthcare provider. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.
Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol).
The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? The frequency of the dosing is necessary to increase the effectiveness. Therapeutic blood levels of this drug are reached in 4 to 6 weeks. Another type of nonsteroidal antiinflammatory drug may be indicated. Systemic corticosteroids are the next drugs of choice for pain relief.
Another type of nonsteroidal antiinflammatory drug may be indicated.
Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)? Assess pupillary response to light. Instruct the client that facial flushing may occur. Apply continuous cardiac monitoring. Request that family members leave the room.
Apply continuous cardiac monitoring.
An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client? Apply the patch at least 4 hours prior to departure. Change the patch every other day while on the cruise. Place the patch on a hairless area at the base of the skull. Drink no more than 2 alcoholic drinks during the cruise.
Apply the patch at least 4 hours prior to departure.
The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin? Observe respiratory rate and depth. Assess the serum potassium level. Obtain the client's blood pressure. Monitor the serum glucose level.
Assess the serum potassium level.
Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) Select all that apply Increase fluid intake, especially cranberry juice. Do not abruptly discontinue the medication; taper use. Check blood pressure daily to detect hypertension. Avoid drinking alcohol while taking this medication. Use condoms until treatment is completed. Ensure that all sexual partners are treated at the same time.
Avoid drinking alcohol while taking this medication. Use condoms until treatment is completed. Ensure that all sexual partners are treated at the same time. Increase fluid intake, especially cranberry juice.
Which drug is used as a palliative treatment for a client with tumor-induced spinal cord compression? Morphine Sulfate (Duromorph). Ibuprofen (Advil). Amitriptyline (Amitril). Dexamethasone (Decadron).
Dexamethasone (Decadron).
A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? Assess for erythema. Administer the antidote. Apply warm compresses. Discontinue the IV fluids.
Discontinue the IV fluids.
An older client with a d ecreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process? Absorption. Metabolism. Elimination. Distribution.
Distribution
A client with heart failure (HF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? Weight loss. Dizziness. Muscle cramps. Dry mucous membranes.
Dizziness.
The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan? Quit taking the medication if dizziness occurs. Do not get up quickly. Always rise slowly. Take the medication with food only. Increase your intake of potassium-rich foods.
Do not get up quickly. Always rise slowly.
The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which prescription should the nurse prepare to administer this client? Dopamine. Ephedrine. Epinephrine. Diphenhydramine.
Epinephrine.
Which dosing schedule should the nurse teach the client to observe for a controlled-release oxycodone prescription? As needed. Every 12 hours. Every 24 hours. Every 4 to 6 hours.
Every 12 hours.
A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? Expected duration of flushing. Symptoms of hyperglycemia. Diets that minimize GI irritation. Comfort measures for pruritis.
Expected duration of flushing.
Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which condition? Shock. Asthma. Hypotension. Heart failure.
Heart failure.
Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? Hydrate the client with IV fluids before and after infusion. Assess the client for numbness and tingling of extremities. Inspect the client's oral mucosa for ulcerations. Monitor the client's urine pH for increased acidity.
Inspect the client's oral mucosa for ulcerations.
A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved? Decreased blood pressure. Lessening of tremors. Increased salivation. Increased attention span.
Lessening of tremors.
A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.
Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect.
A client is admitted to the coronary care unit with a medical diagnosis of acute myocardial infarction. Which medication prescription decreases both preload and afterload? Nitroglycerin. Propranolol (Inderal). Morphine. Captopril (Capoten).
Nitroglycerin.
A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 ml/hour. The nurse notes that the client's urinary output has been 20 ml/hour for the last two hours. Which intervention should the nurse initiate? Stop the infusion of dopamine. Change the normal saline to a keep open rate. Replace the urinary catheter. Notify the healthcare provider of the urinary output.
Notify the healthcare provider of the urinary output.
The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? Refer the client to an audiologist for evaluation of her hearing. Advise the client that this is a common side effect of aspirin therapy. Notify the healthcare provider of this finding immediately. Ask the client to turn off her hearing aid during the exam.
Notify the healthcare provider of this finding immediately.
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose? Review the client's hemoglobin results. Notify the healthcare provider. Inquire about the reaction to sulfa. Record the client's vital signs.
Notify the healthcare provider.
Which method of medication administration provides the client with the greatest first-pass effect? Oral. Sublingual. Intravenous. Subcutaneous.
Oral.
A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication would be contraindicated for this client? Liothyronine (Cytomel) to replace iodine. Furosemide (Lasix) for relief of fluid retention. Pentobarbital sodium (Nembutal Sodium) for sleep. Nitroglycerin (Nitrostat) for angina pain.
Pentobarbital sodium (Nembutal Sodium) for sleep.
In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider? Changes in urine color. Presence of hand tremors. Increasing body hirsutism. Nausea and vomiting.
Presence of hand tremors.
Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? Perfusion scan. Prothrombin Time (PT/INR). Activated partial thromboplastin (APTT). Serum Coumadin level (SCL).
Prothrombin Time (PT/INR).
A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? Rash. Nausea. Headache. Dizziness.
Rash.
A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? Do not add salt to foods during preparation. Refrain for eating foods high in potassium. Restrict fluid intake to 1000 ml per day. Increase intake of milk and milk products.
Refrain for eating foods high in potassium.
A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider? Tinnitus and dizziness. Tachycardia and chest pain. Dry skin and intolerance to cold. Weight gain and increased appetite.
Tachycardia and chest pain.
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? Take medication, go for a 30 minute morning walk, then eat breakfast. Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. Take medication with breakfast, then take a 30 minute morning walk. Go for a 30 minute morning walk, eat breakfast, then take medication.
Take medication, go for a 30 minute morning walk, then eat breakfast.
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction? Notify the clinic of any changes in the color of urine. Avoid overexposure to the sun. Stop the medication after the diarrhea resolves. Take the medication with food.
Take the medication with food.
After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse why he is receiving this medication. Which is the best response for the nurse to provide? This medication is a blood thinner given to prevent blood clot formation. This medication enhances antibiotics to prevent infection. This medication dissolves any clots that develop in the legs. This abdominal injection assists in the healing of the abdominal wound.
This medication is a blood thinner given to prevent blood clot formation.
The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? The expiration date on the morphine syringe in the pump. The rate and depth of the client's respirations. The type of anesthesia used during the surgical procedure. The client's subjective and objective signs of pain.
The rate and depth of the client's respirations.
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? An increase in urine output. Two or three soft stools per day. Watery, diarrhea stools. Increased serum bilirubin.
Two or three soft stools per day.
A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? Use a reliable form of birth control. Avoid exposure to ultra violet light. Refuse this medication if planning pregnancy. Abstain from intercourse while on this drug.
Use a reliable form of birth control.
A female client with rheumatoid arthritis take ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? Use contraception during intercourse. Ensure the Cytotec is taken on an empty stomach. Encourage oral fluid intake to prevent constipation. Take Cytotec 30 minutes prior to Motrin.
Use contraception during intercourse.
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement? Verify both prescriptions with the healthcare provider. Report the medication interactions to the nurse manager. Hold the ACE inhibitor and give the new prescription. Transcribe and send the prescription to the pharmacy.
Verify both prescriptions with the healthcare provider.
A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? Heartburn. Headache. Constipation. Vomiting.
Vomiting.
Which symptoms are serious adverse effects of beta-adrenergic blockers such as propranolol (Inderal)? Headache, hypertension, and blurred vision. Wheezing, hypotension, and AV block. Vomiting, dilated pupils, and papilledema. Tinnitus, muscle weakness, and tachypnea.
Wheezing, hypotension, and AV block.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. What action should the nurse take first? Withhold the scheduled dose. Check the client's apical pulse. Notify the healthcare provider. Repeat the serum potassium level.
Withhold the scheduled dose.
A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to decrease the amount of thyroid-stimulating hormone circulating in the blood. increase the amount of thyroid-stimulating hormone circulating in the blood. increase the amount of T4 and decrease the amount of T3 produced by the thyroid. inhibit synthesis of T3 and T4 by the thyroid gland.
inhibit synthesis of T3 and T4 by the thyroid gland.
An antacid (Maalox) is prescribed for a client with peptic ulcer disease. The nurse knows that the purpose of this medication is to decrease production of gastric secretions. produce an adherent barrier over the ulcer. maintain a gastric pH of 3.5 or above. decrease gastric motor activity.
maintain a gastric pH of 3.5 or above.
A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? q6h. QID. AC and bedtime. PC and bedtime.
q6h
The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? The client's statement that the chest pain is better. respiratory rate is 16 breaths/minute. seizure activity has stopped temporarily. pupils are constricted bilaterally.
respiratory rate is 16 breaths/minute.