Hesi pharmacolgy

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?

0700 and 1900 Rationale Twice a day in 24 hours is best spaced q12 hours (D), which is the best time frame for the administration of low-molecular weight heparin dosing. (A) is a common time schedule for BID or twice a day medication administration that does not need to be evenly spaced within the 24 hour clock. (B) is 8 hours apart. (C) is 14 hours apart.

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

A side-effect. A common side effect (C) of opiate narcotic agents is nausea and vomiting. Although the PN should consider (A, B, and D), the recently administer morphine is likely causing side effects.

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?

Administer 30 minutes before a meal BID if capillary glucose is greater than 70 mg/dl. Glipizide, an oral hypoglycemic agent that stimulates the pancreas to secrete more insulin, should be administered 30 minutes prior to a meal if the blood glucose is within a normal range (70 to 110 mg/dl) (A). Capillary glucose is evaluated just prior to the administration of glipizide, not 2 hours after meals (B). This hypoglycemic agent should be administered before a meal so the drug can be effective when the client eats, not (C). The client's preprandial blood glucose level is used to determine if glipizide should be withheld (D).

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?

Administer Humalog 15 minutes before each meal.

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?

Administer diphenhydramine (Benadryl) PRN.

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?

Administer the Ativan as prescribed. Because the client is currently exhibiting agitation and confusion, Ativan should be administered as prescribed (B). A client who is agitated and inappropriate should not be given the choice regarding the need for the medication (A). There is no need to wait for worsening symptoms when the current symptoms, which most likely will escalate, indicate the need for the drug (C). The client has significant signs beyond behavioral interventions (D) that indicates the need for "chemical restraint" 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?

Administer the medication as prescribed. Neurontin is effective for painful neuropathies, so the PN should administer the medication (A). (B and C) are unnecessary. (D) is not indicated.

Administer Humalog 15 minutes before each meal.

Blood pressure Pronestyl is an antiarrhythmic that decreases myocardial excitability by slowing down conductivity of cardiac tissue. The client's telemetry and blood pressure (C) should be monitored continuously during IV administration. Pronestyl does not cause effects related to pupillary response (A). Pronestyl's side effects do not significantly affect (B and D).

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?

Blood pressure of 96/52. Rationale Procardia is a potent vasodilator and lowers blood pressure. Although daily calcium channel blockers should be given regularly, the PN should withhold the next dose for a low blood pressure (A) and report the finding to the healthcare provider. Procardia does not have a significant effect on (B, C, and D

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

Blood urea nitrogen (BUN) is 30 mg/dL and creatinine is 1.5 mg/dL The BUN and creatinine levels (A) (norm BUN 10-20 mg/dL and serum creatinine 0.5-1.1 mg/dL) are higher than normal, which indicate the need for hydration that requires further treatment. The client is likely to have an elevated WBC and elevated neutrophils due to the IBD exacerbation (B). Anemia (C) and low potassium (norm 3.5-5.0 mEq/L) (D) can occur due to the IBD exacerbation, but these findings do not affect the drug administration.

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?

Blood urea nitrogen and serum creatinine. Vancomycin and gentamicin are nephrotoxic, which should be evaluated by reviewing the client's current serum values for blood urea nitrogen and creatinine (D). (A, B and C) do not provide the best evaluation of renal function.

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?

Calcium gluconate

A client who is admitted for bradycardia receives a prescription for atropine. Which client information should the practical nurse report to the healthcare provider?

Chronic constipation and diverticulosis Anticholinergics agents increase the heart rate but also slow peristalsis. The client's history of chronic constipation and diverticulosis (C) should be reported to the healthcare provider so additional treatment can be implemented to manage potential side effects, such as constipation. (A, B, and D) do not impact the use of atropine.

Which action should the practical nurse (PN) implement for a client who is recently diagnosed with myasthenia gravis

Give neostigmine bromide (Prostigmin) before meals. Myasthenia gravis affects upper body muscles and muscles used for swallowing. Prostigmin, which intensifies transmission in the neuromuscular junction, should be given before meals (A) to provide a therapeutic response that reduces the risk of dysphagia and aspiration during meals. Prednisone, which has been used in autoimmune diseases such as myasthenia gravis, should be administered with food, not (B). Distal extremities are least likely to be affected, so (C) is not required. Although the client's eye movement can be affected, (D) is not indicated at this time.

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?

Glasgow Coma Scale (GCS) score of 15. Mannitol is an osmotic diuretic that is administered to reduce intracranial swelling, so a GCS of 15 (B) is a sensitive indicator of neurologic status that changes as cerebral edema resolves. (A) is an expected response of mannitol but is not indicative of a therapeutic decrease in cerebral edema. Although headache is a symptom of ICP, (C) does not imply a reduction in ICP. Mannitol does not affect body temperature (D).

Which co-morbidity of a client who is starting thyroid replacement should the practical nurse report to the healthcare provider?

History of dysrhythmias Thyroid supplement can increase the heart rate and precipitate angina in a client who has a history of cardiac disease and dysrhythmia (C). (A, B, and D) do not impact the client's use of thyroid replacement therapy.

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?

Hold the administration of the drug dose and notify the charge nurse. The drug dosage is outside the therapeutic dosing range and should not be administered (C) and the charge nurse should be notified for additional support with this decision. Although (B) may be indicated for a client receiving digoxin, the dose should be corrected before administering. Regardless of the client's current digoxin level (A) or apical heart rate (D), a dose higher than a safe range should not be administered (A

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?

I wonder if I will have to stop taking my diuretic for my kidney problem." Decreased kidney function in an elderly client can cause life-threatening complications, such as respiratory depression, when opioid analgesics, such as codeine, are introduced (C). The correct action is to start with the lowest dose when the client is known to have decreased kidney function. Addiction is not as common of an occurrence when the medication is used for a legitimate need (A). Sedation is an expected side effect of the narcotic, but is not life-threatening (B). Constipation is a treatable side effect (D

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?

Muscle aching Severe muscle aching (B) can be a sign of rhabdomyolysis, a potential serious complication of statins. Although constipation and diarrhea are side effects of statins, (A) does not need to be reported immediately. (C) is unrelated to the use of statins. A hacking cough (D) is most commonly associated with ACE inhibitors, not statins.

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?

Pain rating of 9 on a 0 to 10 pain scale. Although analgesic medication is provided via the PCA pump, the client's pain level of 9 on a 0 to 10 pain scale indicates the infusion, current PCA dosage, or type of medication is ineffective, and the charge nurse should be notified of the client's persistent pain (A). (B, C, and D) are expected findings postoperatively and are not significantly variant.

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?

Regular insulin (Humulin R). The only preparation of insulin that should be administered IV is regular insulin (B). (A, B, and C) are for subcutaneous administration only.

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?

Remove the patch at 1930.

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?

Seizure free during the last 24 hours. Rationale Phenytoin (Dilantin) is administered to prevent seizures, which exacerbate increased intracranial pressure after a head injury. Absence of seizures is the therapeutic response of anticonvulsants (D). (A, B, and C) are not indicators of therapeutic effects for Dilantin.

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?

Serum blood glucose. A side effect of large doses of steroids can cause in elevation in the serum glucose levels, so the PN should monitor the client's serum glucose (A). (B, C, and D) are not affected by the administration of corticosteroids.

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?

Take before meals and apart from other drugs. Cholestyramine is used to treat hyperlipidemia of primary hypercholesterolemia and binds with bile in the intestines to reduce fat and cholesterol absorption from foods. The systemic absorption of oral medications, such as digoxin and warfarin, can also be reduced, so the medication should be taken before meals and apart from other drugs (C). (A and B) are not necessary when taking Questran. Although constipation is a side effect, a diet high in fiber, not (D), should be recommended.

When should the practical nurse (PN) withhold administration of oral levothyroxine (Levothroid)?

The pulse is greater than 100 beats/minute.

The practical nurse (PN) is administering medications to several clients. Which client statement indicates that additional action should be taken by the PN?

While on fluorouracil (5-FU) chemotherapy, the client reports tarry, loose stools. Fluorouracil is an antineoplastic drug, and signs of toxicity include black, tarry-colored stools (D) that indicate GI bleeding, which requires further investigation into the source of the bleeding and discontinuation of the medication to reduce the risk of hemorrhage. Mucomyst normally smells like "rotten eggs", so this is an expected finding that does not indicate any need to alter the medication administration routines (A). Expected side effects of anticholinergics, such as pseudoephedrine, include dried mucous membranes and and dry mouth (B). Statins, such as lovastatin, can cause constipation, which is a manageable side effect (C).

The practical nurse (PN) is preparing the next secondary infusion of gentamicin IV q18 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?

Withhold the dose and report findings to the charge nurse. Rationale The medication doses should be spaced out to allow the body to adequately clear the drug, so the PN should withhold the dose and contact the healthcare provider (B). Administering the drug at a slower rate (A) or in a more dilute solution (C) does not change the drug's serum level, which is above its narrow therapeutic range. Since urine output (D) is influenced by many factors, its value alone does not indicate any further action at this time.

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?

Withhold the dose of digoxin. Since digoxin has a narrow therapeutic index (serum ranges between 0.5 and 0.8 ng/ml), toxicity can occur at levels greater than 2.0 ng/ml, and the dose should be withheld (B), even if no other symptoms are present. Giving the medication (A) contributes to worsening the condition. Obtaining a blood pressure (C) and determining the client's mental status (D) provide useful information, but the digoxin should be withheld.

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

take before meals and apart from other drugs.