hesi pharm

The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime?

Hydrochloric acid secreted during the night is blocked.

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

n 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

Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective?

I expect my urine to be red for the next few days."

client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug?

Improves nerve impulse transmission

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.

A client taking linezolid at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. What is the best nursing action for this client?

Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis.

he 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

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 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 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.

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

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 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan?

Take and record radial pulse rate daily.

The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client?

Take one pill at the same time every day for the entire pack of pills.

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

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 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."

he 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.

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?

B. Pharmacokinetics

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?

B. Take the child's vital signs.

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.

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response?

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response?

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications?

75-year-old woman with liver disease

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."

he nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is louder than previously assessed. What is the best nursing action related to this finding?

Administer the prescribed dose as scheduled.

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 with viral influenza is receiving vitamin C, 3000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate?

. Decrease the dose of vitamin C.

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

During the initial nursing assessment history, the client reports taking tetracycline hydrochloride for urethritis. Which concurrent medication will the nurse report to the health care provider?

. Sucralfate

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

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

Dopamine, 5 mcg/kg/min, is prescribed for a client who weighs 105 kg. The nurse mixes 400 mg of dopamine in 250 mL D5W for IV administration via an infusion pump. What is the hourly rate that the nurse should set on the pump?

20 mL/hr

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

client is receiving oral griseofulvin for a persistent tinea corporis infection. Which client statement indicates to the nurse an understanding of the medication regimen? Rationale:Common side effects include tingling of hands and feet, nausea, vomiting, dizziness, stomach upset, tiredness, and flushing. Options B, C, and D are not accurate statements about side effects of this medication.

A. "I might feel some tingling in my fingers."

Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.)

A. "Notify the health care provider immediately if you think you are pregnant." E. "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." F. "Before, during, and after therapy, two effective forms of birth control must be used at the same time."

Which nursing action has the highest priority during IV administration of mechlorethamine HCl and actinomycin? Rationale:Mechlorethamine HCl and actinomycin are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion. Options B, C, and D do not have the priority of option A during the administration of vesicants. A.

A. Assess for extravasation at the IV site during infusion.

Following the administration of sublingual nitroglycerin, which assessment finding indicates to the nurse that the medication was effective?

A. Decrease in level of chest pain

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?

A. Hold the theophylline dose and notify the health care provider.

he 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?

A. Hypokalemia

During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely? Rationale:The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy. Options B, C, and D are not specific indicators of liver function, so they are not monitored closely during isoniazid therapy.

A. Liver enzyme levels

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens?

A. Maintain a drug administration record.

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.)

A. Report vaginal itching or discharge. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. F. Use a nonhormonal method of contraception if sexually active.

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. The nurse will develop an immediate plan of care based on which finding?

A. Severe acute anaphylactic response

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.

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

Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin?

Activated partial thromboplastin time (aPTT)

The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse take first?

Administer the drug if the solution's reconstitution time is <24 hours.

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?"

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.

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

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.

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.)

C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema

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?

C. Avoid abraded skin areas when applying the anesthetic.

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother?

C. Myelosuppression

This drug is a clot buster that dissolves clots within a coronary artery.

C. Renal insufficiency

During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity?

C. Restlessness

Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect?

Client denies nausea

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, what is the best nursing action?

Compare the client's blood pressure before and after the client takes the 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.

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."

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 add this assessment?

Cyclophosphamide

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?

D. 120

The nurse is providing care to a client on heparin. Which laboratory test indicates to the nurse that the medication is effective?

D. Partial thromboplastin time (PTT)

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)

The 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.

Which intervention is most important for a nurse to implement prior to administering atropine PO?

Determine the presence of 5 to 35 bowel sounds/min.

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse take first?

Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.

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

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

The nurse is providing care to a 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. The nurse anticipates a prescription for which medication?

Fluphenazine decanoate

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.

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.

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.

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

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering?

Rationale:Butorphanol is a mixed agonist-antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics. A. Butorphanol

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?

Rationale:During chemotherapy, granulocytes are significantly suppressed. Because neutrophils comprise 60% to 70% of the granulocyte count, these levels are the most useful laboratory results of the options presented to determine the child's risk for infection. Options B, C, and D are not as useful as option A in determining risk of infection. A. Neutrophil count

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).

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.

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 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."

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

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.

The nurse is providing care for a client with digoxin toxicity. Which medication will the nurse look for in the client's prescriptions?

digoxin

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 hydrochloriden

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.