HESI PHARMACOLOGY

A client prescribed chemotherapy asked the practical nurse (PN), "Why is so much of my hair falling out each day?" Which response by the PN best explains the reason for alopecia?

"Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant." Rationale: The common adverse effects of chemotherapy (nausea, vomiting, alopecia, bone marrow depression) are results of chemotherapy's effect on the rapidly reproducing cells, both normal and malignant.

A client prescribed glipizide asked why they had to take their insulin orally. How should the practical nurse respond?

"Glipizide is not an oral form of insulin and can be used only when some beta cell function is present." Glipizide is an oral hypoglycemic agent that enhances pancreatic production of insulin when some beta cell function is present.

Dietary trays usually arrive on the hospital unit at 7:30 AM. When should the practical nurse (PN) plan to administer NPH insulin 40 units subcutaneously to a client with diabetes mellitus?

6:30 and 7:00 AM.

A child is admitted to the emergency department for accidental ingestion of a poison. The practical nurse (PN) should know that inducing vomiting is recommended for which child?

A 16-month-old who drank 2 ounces of acetaminophen elixir

A hospitalized patient is taking amantadine. What action by the nurse is best?

Assist the patient when getting up. Amantadine is given for influenza. One of its side effects is orthostatic hypotension, so the nurse would provide assistance to the patient when getting up. There is no need to keep the door shut, remove produce from the meal trays, or wear gloves and mask during administration.

The practical nurse (PN) gives written discharge instructions to an older adult client who has undergone cataract surgery on the right eye. Which discharge instruction should the PN reinforce?

Avoid sleeping on your right side.

A first-day postoperative client vomits 30 minutes after receiving a dose of hydromorphone. What initial intervention is best for the practical nurse (PN) to implement?

Administer a prn dose of ondansetron. 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.

Which drug increases sun sensitivity?

Antibiotics, NSAIDs, and thiazide diuretics are some common causes of sun sensitivity. Methotrexate, isotretinoin, and sulfonylureas can also cause this side effect

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 for signs of digoxin toxicity?

Apical heart rate of 60 beats/min

Which information should the practical nurse (PN) reinforce with a client who is self-administering insulin injections?

Aspirate regular insulin in the syringe first when mixing insulins.

A client has vancomycin intravenous piggybacks (IVPB) prescribed. Which is the crucial aspect of care for this client?

Besides noting the urine output is less than the intake, report increased creatinine levels.

The practical nurse (PN) observes a thick white-coating on the tongue of a client who takes fluphenazine (Prolixin). What instructions should the PN reinforce with the client about this medication?

Brush your teeth and tongue, floss, gargle, and notify the healthcare provider.

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.

Where do you assess a pedal pulse?

The dorsalis pedis pulse and the posterior tibial pulse, which are behind and below the medial malleolus, should be checked.

The practical nurse (PN) discusses antihypertensive drug therapy with several clients diagnosed with high blood pressure. To improve client understanding, the PN should emphasize that which medication preserves renal function in a client with diabetes?

Captopril (Capoten).

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?

Clarify the prescription with the RN and healthcare provider. 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 healthcare provider to clarify the route of administration.

An older client diagnosed with congestive heart failure is taking furosemide 40 mg twice daily. The practical nurse (PN) plans to monitor this client for the development of which complication?

Hyponatremia

A 35-week gestation primigravida who takes lithium (Eskalith) tells the practical nurse (PN) that she would like to breastfeed her infant. What information should the PN provide to the client?

The drug is excreted in breast milk so use formula to feed the infant.

The LPN is preparing to give ribavirin. Which statement is incorrect

I only need to wear a mask and gloves." Ribavirin is very toxic and requires careful handling with the nurse wearing gloves, mask, and a gown during administration. The nurse would not give it if she were pregnant. It can be given via aerosol and the door to the room is closed during treatment to prevent anyone else from coming into contact with it.

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 Metoclopramide HCL blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson's disease. It is not associated with an inability to see well, dizziness, or an unpleasant metallic taste.

The healthcare provider prescribes celecoxib (Celebrex), a nonsteroidal antiinflammatory drug (NSAID), for a client with osteoarthritis. Which finding in the client's history should the practical nurse (PN) report

Peptic-ulcer disease.

The LPN is instructing the patient concerning antiretroviral drugs. Which statement indicates a need for further instruction?

I can eat all the fresh fruits and vegetables I want." Patients taking antiretroviral drugs must avoid eating raw meats and fish, fruits, and vegetables that cannot be peeled or scrubbed due to decreased immunity. Alcohol and recreational drugs must be avoided because of the increased risk for liver damage associated with these drugs. The drugs must be taken at the same time every day and use a cell phone reminder for time alerts. This way drug levels remain steady and viral suppression is ideal. Safer sexual practice and standard precautions must be taken to prevent disease transmission.

client who returns from surgery for bowel resection complains of severe pain around the incision. Which assessment is most important for the practical nurse obtain prior to the administration of morphine sulfate?

Rate of respirations

Which drugs are contraindicated in patient allergic to sulfonamides or sulfa? (Select all that apply.)

Darunavir Before giving cidofovir, ask about allergies to sulfonamides or probenecid because cross-reactivity can result in a similar cidofovir allergic reaction. Do not give darunavir or fosamprenavir to patients who have a known sulfa allergy because these two drugs contain sulfa. Atazanavir and foscarnet are of no concern regarding sulfa or sulfonamide allergies. Cidofovir Before giving cidofovir, ask about allergies to sulfonamides or probenecid because cross-reactivity can result in a similar cidofovir allergic reaction. Do not give darunavir or fosamprenavir to patients who have a known sulfa allergy because these two drugs contain sulfa. Atazanavir and foscarnet are of no concern regarding sulfa or sulfonamide allergies. Fosamprenavir Before giving cidofovir, ask about allergies to sulfonamides or probenecid because cross-reactivity can result in a similar cidofovir allergic reaction. Do not give darunavir or fosamprenavir to patients who have a known sulfa allergy because these two drugs contain sulfa. Atazanavir and foscarnet are of no concern regarding sulfa or sulfonamide allergies.

Which assessment finding indicates that the expected outcome of administering donepezil to a client with Alzheimer disease has been accomplished?

Decreased confusion and improved mood

Many antiretroviral drugs can cause peripheral neuropathy. Which symptoms indicate peripheral neuropathy?

Decreased coordination Report signs of neuropathy: numbness, tingling in feet or hands, which spread to legs and arms. Sharp, jabbing, throbbing, or burning pain in arms and legs and decreased coordination and falling.

The practical nurse (PN) is reinforcing teaching for a client who is receiving diltiazem (Cardizem), a calcium channel blocker. Which drug action should the practical nurse explain?

Decreased rate of contraction.

An adolescent client with a seizure disorder is prescribed the anticonvulsant medication carbamazepine. The nurse should notify the healthcare provider if the client develops which condition?

Develops a sore throat 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.

A client whose seizure disorder has been managed with phenytoin is admitted to the emergency department with status epilepticus. Which drug should the practical nurse (PN) anticipate being prescribed for administration to treat these seizures?

Diazepam is the drug of choice for the treatment of status epilepticus and is given during a seizure.

client receives a prescription for c lotrimazole 1% (Gyne-Lotrimin ) vaginal cream for Candidiasis. Which information should the practical nurse provide the client?

Do not have vaginal intercourse or use other vaginal products

What side effect should the practical nurse (PN) report to the healthcare provider for a client who is taking prednisone (Deltasone)?

Gastric bleeding

A client who has been taking phenazopyridine (Pyridium) for symptoms of urethritis and cystitis comes to the clinic because her urine is reddish-orange. Which question should the practical nurse ask to determine if the medication has been effective?

Have you had any relief from urinary pain, burning, or urgency?

Which adverse effect should the practical nurse monitor for in a client who is taking amikacin (Amikin)?

Hearing loss

An older client who has a history of a hip fracture was admitted to the hospital for congestive heart failure. The client is taking codeine-acetaminophen as needed for pain. Which risk factor puts this client at greatest risk for a fall?

History of falls

A client diagnosed with essential hypertension is prescribed phenylephrine for nasal congestion as needed every 4 hours. The client is complaining about nasal congestion. Which nursing action should the practical nurse (PN) do next?

Hold the medication and consult with the charge nurse. Phenylephrine can cause transient hypertension and should not be taken by a client with hypertension. The PN should hold the medication and consult with the charge nurse about the client's diagnosed hypertension and prescribed medication.

A client with angina pectoris has been prescribed nitroglycerin tablets prn for chest pain. Which statement by the client causes the practical nurse (PN) to clarify instructions for this client?

I should ensure that I chew the pill completely before swallowing it. Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet should be placed under the tongue (sublingually), not chewed or swallowed. One tablet can be taken every 5 minutes, up to three doses. If pain relief not achieved after taking three pills, seek medical attention immediately. Nitroglycerin should be replaced every 3-6 months. Nitroglycerin pain relief should occur in 5 minutes and duration should last 30 minutes.

Which statement indicates that a patient has an accurate understanding of antiviral drugs?

I should not expect the drug to kill the virus causing my illness.

How do eye drops treat glaucoma?

Identify client name and date of birth. Compare medication with the MAR. Explain reason for eye drops. Place gentle downward pressure on lower lid. Ask client to look at ceiling. Place one drop in the conjunctival sac. Instruct client to close eyes and apply pressure on lacrimal gland.

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?

Immediately before the next antibiotic dose is given 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 healthcare provider needs to be notified.

The practical nurse (PN) is caring for a client who is receiving dexamethasone (Decadron) after abdominal surgery. Which finding should the PN report to the charge nurse?

Impaired healing.

The practical nurse administered cyclobenzaprine to a client. Which outcome would indicate a therapeutic response?

Improved range of motion during physical therapy exercises 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 with type 1 diabetes mellitus received an early AM dose of regular insulin per sliding scale. At 1000, the practical nurse (PN) should report which signs indicative of hypoglycemia?

Irritability and confusion.

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?

Isoniazid is highly specific for Mycobacterium tuberculosis and is the primary drug of choice for clients with positive PPD skin tests.

The practical nurse (PN) should emphasize the importance of monitoring for which side effect(s) in a client who takes a daily antilipemic agent?

Liver dysfunction.

Which prescription should the practical nurse (PN) administer for a client who is experiencing an anaphylactic reaction to an antibiotic?

Medications used for a patient at risk or under anaphylactic shock are: Epinephrine. Epinephrine is given for its vasoconstrictive reaction; for emergency situations, an immediate injection of 1:1, 000 aqueous solution, 0.1 to 0.5 ml, repeated every 5 to 20 minutes is given

A client who is comatose is admitted after an overdose of baclofen (Lioresal). What nursing action should the practical nurse (PN) implement?

Monitor for signs of respiratory arrest.

Which prescription should the practical nurse administer for a client who is experiencing an acute episode of bronchial asthma?

Nedocromil (Tilade). Corticosteroids

An older adult client is seen in the clinic for problems with urinary frequency, urgency, and nocturia. The symptoms are an example of which condition?

Normal aging changes

The healthcare 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?

Notify the HCP if the cough persists longer than 7 days. 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 healthcare provider. Alcohol and CNS depressants, such as guaifenesin, have a cumulative effect when consumed concurrently which can be lethal such as respiratory depression. The combination would not likely cause vomiting. The client needs to be aware of this and advise that alcohol consumption should not be consumed while taking this medication.

Which antiviral drugs can be used to treat or prevent influenza in children?

Only two antivirals are used in treating or preventing influenza in children: oseltamivir phosphate and zanamivir.

The practical nurse (PN) is caring for an older client diagnosed with Alzheimer dementia. Which behavior by the client should the PN be the most concerned about?

PN be the most concerned about? Climbing out of bed

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 8-12 hours after subcutaneous injection. The most likely time for this client to experience a hypoglycemic reaction is between 3:30 and 7:30 PM.

A client has metoprolol prescribed. The nurse should reinforce instructions that this medication has which potential adverse effect?

Rationale: The nurse should reinforce education that metoprolol (a beta-blocker) can cause sexual dysfunction as an adverse effect. It can cause depression, rather than anxiety. Bradycardia is another potential adverse reaction. Acute renal failure is not associated with a beta blocking agent.

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 practical nurse (PN) is reviewing the plan of care for client who is prescribed glucocorticoid methylprednisolone to treat an exacerbation of chronic obstructive pulmonary disease (COPD). The nurse expects to see which intervention is emphasized in the plan of care?

Remind staff to wash hands before patient care. Corticosteroids suppress the immune system, placing the client at risk for infection. The hand hygiene is emphasized due to the fact that glucocorticoids may affect the body's ability to fight infections and is directly related to the administration of glucocorticoid methylprednisolone.

A male client who is hypertensive is starting a new prescription for clonidine (Catapress) 0.4 mg PO daily. In reviewing common side effects, what information should the practical nurse (PN) provide the client?

Report problems with sexual function.

What are the side effects of rivastigmine tartrate?

Rivastigmine may cause nausea, vomiting, diarrhea, stomach pain, loss of appetite, or weight loss. is used to treat confusion (dementia) related to Alzheimer's disease and to Parkinson's disease. Rivastigmine does not cure either of these diseases, but it may improve memory, awareness, and the ability to perform daily functions.

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?

Serum glucose Methylprednisolone is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can increase a client's glucose levels, which can lead to hyperglycemia

A client with a productive cough and fever has been diagnosed with bacterial pneumonia and 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?

Sputum specimen

A client receives a prescription for nystatin (Mycostatin) oral suspension for the treatment of oral thrush. Which information should the practical nurse (PN) provide?

Swish then swallow the medication.

A 43-year-old female client who has had a thyroidectomy due to Grave's disease is prescribed a thyroid replacement hormone. Which signs and symptoms are associated with thyroid hormone toxicity and should be reported promptly to the healthcare provider?

Tachycardia and chest pain The signs and symptoms of thyroid replacement hormone toxicity include tachycardia and chest pain.

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?

Take medication 30 minutes before breakfast and remain in an upright position for 30 minutes after taking the medication.

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?

The benztropine is used to control the side effects of olanzapine. 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.

A client has been diagnosed with open-angle glaucoma. The healthcare provider prescribes pilocarpine 1% eye drops. The nurse explains that which action of this drug makes it a useful treatment for the client's condition?

The ciliary muscle contracts increasing the outflow of aqueous humor in the eye.

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?

The immunization is recommended for children younger than 2 years old and all adults 65 years or older.

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?

The rate and depth of the client's respirations 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 healthcare provider should be notified if the client's respiratory rate falls below 10 breaths/min.

An adult male arrives in the clinic requesting a prescription for sildenafil (Viagra). Which client history should the practical nurse (PN) report to the healthcare provider?

The use of nitrates.

A client undergoing hemodialysis for chronic kidney disease is taking the medication erythropoietin. The nurse should reinforce instructions to explain which is the reason for this medication to be prescribed?

This drug helps to stimulate production of red blood cells.

What assessment is most important for the practical nurse (PN) to obtain prior to initiating medication therapy with phenelzine (Nardil) for a client with depression?

Understanding of diet modification

Which drugs are contraindicated for a patient with a true milk allergy?

Zanamivir Before giving acyclovir or zanamivir to a patient, check whether there is a true milk allergy because this is a contraindication to therapy as there is cross-reactivity of the antibodies. Milk allergies are not concerning for prescribing famciclovir, oseltamivir, or valacyclovir. Acyclovir Before giving acyclovir or zanamivir to a patient, check whether there is a true milk allergy because this is a contraindication to therapy as there is cross-reactivity of the antibodies. Milk allergies are not concerning for prescribing famciclovir, oseltamivir, or valacyclovir.