HESI Pharmacology Practice Quiz

Which findings should the nurse identify in an adult client with possible chronic salicylate intoxication? A. Tinnitus and hearing loss. B. Photosensitivity and nervousness. C. Acute gastrointestinal bleeding and anorexia. D. Hyperventilation and central nervous system effects.

A. Tinnitus and hearing loss. Rationale: The most frequent manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss.

A male client who is in the terminal stage of cancer is cared for at home by his family and receives a prescription for morphine at a rate to control intractable pain. When the hospice nurse visits, the client awakens, moans in severe pain, and asks for an increase in the morphine dosage. After determining the client's respirations are 10 per minute, what is the best action for the nurse to implement? A. Titrate the morphine dose upward until the client has adequate pain relief. B. Suggest to the family that they can also give the client ibuprofen, a non-narcotic analgesic. C. Hold additional morphine until the client's respirations are at least 16 per minute. D. Inform the client that an increased dose of morphine increases side effects without additional pain control.

A. Titrate the morphine dose upward until the client has adequate pain relief. Rationale: Tolerance can occur in a client who requires large doses of opioids for intractable pain management, and an increased titration of the analgesic or an additional drug in the same or a different classification may provide more effective pain management. The client's basic need for comfort during the last stages of a terminal malignancy is the main priority for this hospice client.

A client who is diagnosed with methicillin-resistant Staphylococcus aureus receives a prescription for vancomycin. Which assessment should the nurse perform to identify a potential adverse effect? A. Whisper test. B. Romberg test. C. Tactile discrimination. D. Skin turgor.

A. Whisper test. Rationale: The most serious adverse effect of vancomycin is ototoxicity, which often causes irreversible, permanent impairment. So, a whisper test determines the presence of early hearing impairment.

A client who uses Ipratropium reports having nausea, blurred vision, headaches, and insomnia after using the inhaler. Which action should the nurse implement first? A. Withhold medication and report symptoms and vital signs to the healthcare provider. B. Give PRN medication for nausea and vomiting and evaluate client in 30 minutes. C. Reassure client that the Ipratropium given will alleviate the symptoms. D. Delay administration of Ipratropium until next maintenance medication is scheduled.

A. Withhold medication and report symptoms and vital signs to the healthcare provider. Rationale: Headache, nausea, blurred vision and insomnia are symptoms of excessive use of ipratropium, so withholding the medication until the healthcare provider is notified should be initiated to maintain client safety.

A client who uses ipratropium reports having nausea, blurred vision, headaches, and insomnia after using the inhaler. Which action should the nurse implement first? A. Withhold medication and report symptoms and vital signs to the healthcare provider. B. Give PRN medication for nausea and vomiting and evaluate client in 30 minutes. C. Reassure client that the ipratropium given will alleviate the symptoms. D. Delay administration of ipratropium until next maintenance medication is scheduled.

A. Withhold medication and report symptoms and vital signs to the healthcare provider. Rationale: Headache, nausea, blurred vision and insomnia are symptoms of excessive use of ipratropium, so withholding the medication until the healthcare provider is notified should be initiated to maintain client safety.

The mother of a newborn asks the nurse why her infant needs the vitamin K injection. Which information should the nurse provide? A. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. B. Oral vitamin K impedes the synthesis of clotting factors in the liver. C. The maternal diet is often deficient in vitamin K, so the infant is also deficient in the vitamin. D. The synthesis of vitamin K is inadequate for 3 to 4 months in the newborn.

A. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. Rationale: Vitamin K is provided due to the fact the newborn does not have the intestinal flora to synthesize adequate vitamin K in the intestines at birth and vitamin K levels in breast milk are considered inadequate for the first 2 to 3 days of life.

The nurse should withhold which medication if a client reports nausea, vomiting, and diarrhea? A. Colchicine. B. Erythromycin. C. Naproxen. D. Labetolol.

A. Colchicine. Rationale: Nausea, vomiting, and diarrhea are indicators of the toxic effects of colchicine which can be life-threatening, and if present, this drug should be withheld and the healthcare provider notified.

The nurse reviews the new prescription, phenelzine, a monoamine oxidase inhibitor (MAOI), for a client on the psychiatric unit with depression. Which information is most important for the nurse to assess? A. Consumption of any alcohol or tyramine-rich foods. B. Complaints of nausea or vomiting. C. Therapeutic serum drug levels. D. Blood pressure and pulse prior to taking each dose.

A. Consumption of any alcohol or tyramine-rich foods. Rationale: The consumption of any type of tyramine-containing foods such as aged cheeses, fermented fruits and vegetables, smoked or cured meats, dark wines, and other alcoholic products should be avoided when a client is prescribed an MAOI due to the food-drug interaction causing a hypertensive crisis which can lead to a hemorrhagic stroke.

A pediatric client who has been diagnosed with partial seizures receives a prescription for topiramate. Which information should the nurse provide to the child's parents? A. Do not crush the tablet prior to administration. B. Give the medication with 8 oz of orange juice. C. Avoid prolonged exposure to direct sunlight. D. Administer the tablet an hour before meals.

A. Do not crush the tablet prior to administration. Rationale: The tablet form of topiramate should be taken with adequate fluids and without breaking it because of its extremely bitter taste, so crushing the tablet should be avoided.

Miotic drug therapy for the treatment of glaucoma is based chiefly upon which physiologic action? A. Enhancing aqueous humor outflow. B. Inhibiting aqueous humor production. C. Maintaining intraocular pressure. D. Preventing extraocular infection.

A. Enhancing aqueous humor outflow. Rationale: Miotic drugs act to enhance aqueous outflow through papillary constriction with the goal to reduce intraocular pressure.

The therapeutic effect of insulin in treating type 1 diabetes mellitus is based on which physiologic action? A. Facilitates transport of glucose into the cells. B. Stimulates function of beta cells in the pancreas. C. Increases intracellular receptor site sensitivity. D. Delays carbohydrate digestion and absorption.

A. Facilitates transport of glucose into the cells. Rationale: Glucose moves across the cell membrane by using an active transport mechanism. Insulin acts as the carrier of glucose and is the only hormone that decreases blood glucose levels by facilitating the transport of glucose into the cells.

A client who is receiving chemotherapy is prescribed ondansetron. Which side effect should the nurse include in the teaching plan? A. Headache. B. Dry mouth. C. Impaired taste. D. Blurred vision.

A. Headache. Rationale: Ondansetron, a serotonin antagonist, is the most effective antiemetic in suppressing nausea and vomiting caused by cancer chemotherapy-induced emesis or emetogenic anticancer drugs. Common side effects include headache, diarrhea, dizziness, and fatigue.

A client diagnosed with multiple sclerosis is experiencing profound weakness, blurry vision, and shooting pains in both legs. Which medication is considered the best course of treatment for the nurse to administer? A. High dose methylprednisolone intravenously. B. Baclofen three times a day. C. Broad spectrum antibiotic coverage orally. D. Immunomodulatory drug therapy periodically.

A. High dose methylprednisolone intravenously. Rationale: Multiple sclerosis (MS) relapses are caused by inflammation in the central nervous system that damages the myelin coating around nerve fibers. The client is experiencing an acute exacerbation of MS, which is best managed with high-dose steroids, such as methylprednisolone.

An older client is taking warfarin sodium PO 2.5 mg twice a day. Which laboratory value should the nurse identify as a therapeutic response of the medication? A. INR of 2 to 3. B. PT of 4 seconds. C. PTT of 20 seconds. D. aPTT of 3 times normal.

A. INR of 2 to 3. Rationale: Recommended INR ranges for clients on warfarin therapy is 2 to 3. Therapeutic anticoagulation using warfarin should prolong the prothrombin time (PT) by 1.5 to 2 times the control value (a normal value is 10-20 seconds, or 20% to 30% of the normal value if percentages are used).

Which is the effect of beta-blocking agents when used for the treatment of glaucoma? A. Inhibiting aqueous humor production. B. Enhancing aqueous humor outflow. C. Increasing intraocular pressure. D. Preventing extraocular infection.

A. Inhibiting aqueous humor production. Rationale: Beta-blockers are used to inhibit aqueous humor production, and the goal is to reduce intraocular pressure.

A client with rheumatoid arthritis is receiving a prescription for minocycline. Which side effect is most important for the nurse to instruct the client to report? A. Loss of balance and dizziness. B. Nausea and vomiting. C. Headache and mouth sores. D. Abdominal pain and diarrhea.

A. Loss of balance and dizziness. Rationale: Minocycline, a tetracycline antibiotic, is used to treat mild cases of rheumatoid arthritis and can cause damage to the vestibular part of the inner ear, so the client should report dizziness or difficulty maintaining balance.

When prescribed for a client with hepatic encephalopathy, which is the therapeutic action of lactulose? A. Lowers the pH of the colon. B. Softens the stool. C. Increases glucose absorption. D. Stimulates peristalsis.

A. Lowers the pH of the colon. Rationale: Colonic bacteria digest lactulose to create a drug-induced acidic and hyperosmotic environment that draws water and blood ammonia into the colon. The physiologic action of lactulose for the client with hepatic encephalopathy is to lower the pH of the colon which inhibits the diffusion of ammonia into the bloodstream.

Which side effects should the nurse monitor for a client who is receiving dexamethasone following neurosurgery? (Select all that apply.) A. Mood swings. B. Decreased appetite. C. Increased weight gain. D. Serum glucose level of 65 mg/dl. E. Delayed incisional wound healing. F. Serum hemoglobin level of 9 mg/dl.

A. Mood swings. C. Increased weight gain. E. Delayed incisional wound healing. F. Serum hemoglobin level of 9 mg/dl. Rationale: Dexamethasone is a long-acting glucocorticoid prescribed for neurosurgical procedures because it suppresses inflammation and has a low sodium-retaining ability, which is important in averting cerebral edema. However, the medication does produce the following side effects such as: mood swings, an increase in appetite, resulting in weight gain, hyperglycemia (serum glucose level above 120 mg/dl) which is related to the gluconeogenesis properties of corticosteroids, delayed in wound healing related to immune suppression properties, and complete blood count resulting in a decreased in WBC and hemoglobin (less than 12mg/dl). When a client is receiving dexamethasone, they should be monitored for these side effects.

Which route should the nurse clarify with the healthcare provider prior to administering a drug with a high first-pass effect? A. Oral. B. Buccal. C. Sublingual. D. Intravenous.

A. Oral. Rationale: The first-pass effect occurs when hepatic metabolism decreases the bioavailability of a drug. Oral forms of medications are processed through the GI tract, absorbed through the small intestines, and undergo the first-pass effect in the liver in which some of the active ingredients are removed from the drug before it reaches the intended site of action.

A healthcare provider prescribes cefadroxil for a client with a postoperative infection. It is most important for the nurse to assess for which additional drug allergy before administering this prescription? A. Penicillins. B. Aminoglycosides. C. Erythromycins. D. Sulfonamides.

A. Penicillins. Rationale: Cross-allergies exist between penicillins and cephalosporins, such as cefadroxil, so checking for penicillin allergy is a wise precaution before administering this drug.

Which is the expected outcome of esomeprazole when prescribed for a client with gastroesophageal reflux disease (GERD)? A. Promotion of rapid tissue healing. B. Increased gastric emptying. C. Improved esophageal peristalsis. D. Neutralization of gastric secretions.

A. Promotion of rapid tissue healing. Rationale: Proton pump inhibitors, such as esomeprazole, act to inhibit gastric acid secretion and promote rapid healing of esophageal tissue.

A client is taking sulfisoxazole for a urinary tract infection (UTI) and complains of nausea and gastric upset since starting the medication. Which additional adverse reaction should the nurse instruct the client to report? A. Rash. B. Diarrhea. C. Hematuria. D. Muscle cramping.

A. Rash. Rationale: Side effects of sulfisoxazole, a sulfonamide antibiotic, include possible allergic response, manifested by skin rash and itching, which can progress to Stevens-Johnson syndrome - erythema multiforme, a severe hypersensitivity reaction. Other gastrointestinal disturbances, such as diarrhea, crystalluria, and photosensitivity are other side effects that commonly occur with "sulfa" agents but do not indicate a discontinuation of the prescription.

The nurse receives a unit of blood from the blood bank for a postoperative client who is currently in the X-ray department. Which action should the nurse implement? A. Return the blood to the blood bank for refrigeration within 30 minutes. B. Hang the blood transfusion as soon as the client returns to the unit. C. Store the blood bag in the nursing unit's refrigerator until the client returns. D. Take the unit of blood to the X-ray department to initiate the transfusion.

A. Return the blood to the blood bank for refrigeration within 30 minutes. Rationale: A blood transfusion should be hung for administration within 30 minutes of its arrival from the blood bank. If it is not going to be used within that time frame, it must be returned to the blood bank for refrigeration. Waiting until the client returns to the unit is unpredictable, and the delay to hang the blood within 30 minutes can contribute to contamination and infection.

A client who takes a statin and gemfibrozil for hyperlipidemia reports the onset of muscle pain and weakness. Which additional assessment is most important for the nurse to obtain? A. Serum liver enzymes. B. T3 and T4 blood levels. C. Bowel function. D. Peripheral sensation.

A. Serum liver enzymes. Rationale: Concomitant use of gemfibrozil and statins that can cause muscle weakness and wasting is known as myopathy, which is reflected in serum liver function enzymes, such as elevated serum aspartate aminotransferase (AST or SGOT) that is also found in skeletal muscle.

A client calls the clinic and states that she forgot to take her oral contraceptives for the past two days. Which instruction is best for the nurse to provide to this client? A. Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days. B. Quit the pills for this cycle, use an alternate method of contraception, and resume pills on the fifth day of menstruation. C. Take one extra pill per day for the rest of this cycle, then resume taking pills as usual next cycle. D. Take 4 pills now and use an alternate method of contraception for the rest of this cycle.

A. Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days. Rationale: If two pills are missed in a row, the client should take 2 pills a day for two days and use an alternative form of birth control for seven days.

Which statement by a client warrants further instruction by the nurse about the changing insulin needs of a diabetic client during pregnancy? A. "Episodes of hypoglycemia are more likely to occur during the first 3 months." B. "I will increase my insulin dosage by 5 units each month during the first trimester." C. "Insulin dosage will likely need to be increased during the second and third trimesters." D. "Breastfeeding will decrease my insulin needs to lower than my pre-pregnancy levels."

B. "I will increase my insulin dosage by 5 units each month during the first trimester." Rationale: Insulin needs during pregnancy are determined individually according to the client's glucose levels. Insulin needs in the first trimester may actually decrease, so the client's statement about increasing her insulin dose, indicates the need for reteaching.

A client asks the nurse to explain the meaning of a narrow therapeutic index of a medication. Which information should the nurse use to answer the question? A. The onset of action for the medication occurs very quickly. B. A small margin exists between safe and toxic plasma levels. C. Bioavailability is significantly reduced by the first-pass effect. D. Minimum dosage is needed for the medication to be effective

B. A small margin exists between safe and toxic plasma levels. Rationale: A narrow therapeutic index means that there is a narrow difference between safe and toxic drug levels, so clients receiving these medications should be closely monitored.

Based on the blood culture and sensitivity results, the healthcare provider prescribes an IV aminoglycoside antibiotic and discontinues the current prescription for another broad-spectrum antibiotic. The medication administration record indicates that the client received the broad-spectrum antibiotic two hours ago. Which action should the nurse implement? A. Obtain peak and trough serum levels so the aminoglycoside antibiotic can be initiated. B. Administer the initial dose of the aminoglycoside antibiotic as soon as possible. C. Withhold antibiotic administration until the healthcare provider clarifies the prescriptions. D. Schedule the initial dose of the aminoglycoside antibiotic for the following day.

B. Administer the initial dose of the aminoglycoside antibiotic as soon as possible. Rationale: Based on the blood culture and sensitivity results, the prescribed aminoglycoside antibiotic is the most effective in treating the client's infection, so it should be administered as soon as possible.

A client with depression receives a prescription for amitriptyline. Which instruction should the nurse include in the client's teaching? A. Do not ingest foods with tyramine. B. Avoid the consumption of alcohol. C. Obtain daily blood pressure readings. D. Take with a glass of orange juice.

B. Avoid the consumption of alcohol. Rationale: Tricyclic antidepressants (TCAs) such as amitriptyline can cause sedation and should not be mixed with agents that depress the central nervous system, so the client should be instructed to avoid alcohol. The consumption of alcohol and TCAs interaction could worsen the client's depression, increase drunkenness, and potentially cause death.

While reviewing the client's electronic medical record (EMR), the nurse assesses a client who is at risk for a possible interaction with an over-the-counter (OTC) decongestant. Which client health history should the nurse report to the healthcare provider concerning the OTC medication? (Select all that apply). A. Type I diabetes mellitus (DM). B. Closed angle glaucoma. C. Chronic hypertension. D. Rheumatoid arthritis. E. Crohn's disease.

B. Closed angle glaucoma. C. Chronic hypertension. Rationale: OTC decongestants can increase intra-ocular pressure and should be avoided in clients with closed-angle glaucoma. Decongestants can also increase the heart rate and elevate blood pressure which can impact the client's management of chronic hypertension.

A client receives a prescription for sulfamethoxazole-trimethoprim for a urinary tract infection (UTI). Which instruction should the nurse provide the client? A. Ingest food prior to taking the antibiotic. B. Drink at least 8 glasses of water a day. C. Take the medication with grapefruit juice. D. Avoid prolonged exposure to sunlight.

B. Drink at least 8 glasses of water a day. Rationale: To decrease the risk of renal damage due to crystalluria associated with sulfamethoxazole, the client should be instructed to consume at least 8 glasses of water a day. To increase absorption, sulfamethoxazole should be given on an empty stomach.

The nurse is administering haloperidol 0.5 mg IM PRN to a client for the first time. What side effects should the nurse assess the client for during the initial dose? A. Bradykinesia. B. Dystonia. C. Somatization. D. Akathisia.

B. Dystonia. Rationale: Dystonia can be a sudden adverse reaction to this psychotropic medication which should be discontinued to resolve dystonia, and the healthcare provider notified immediately.

The healthcare provider prescribes medication for an older adult client who is complaining of insomnia and instructs the client to return in two weeks. The nurse should question which prescription? A. Zolpidem 10 milligrams orally at bedtime. B. Eszopiclone 10 milligrams orally at bedtime. C. Temazepam 7.5 milligrams orally at bedtime. D. Ramelteon 8 milligrams orally at bedtime.

B. Eszopiclone 10 milligrams orally at bedtime. Rationale: The prescription for eszopiclone 10mg at bedtime is too high for this client. The dosing of this medication is usually started off at 1 mg at bedtime and may advance up to 3 mg maximum if needed.

A client receives a prescription for esomeprazole for heartburn. Which finding in the client's history should the nurse report to the healthcare provider before administering the prescription? A. Eats spicy food three times a week. B. History of deep vein thrombosis. C. Drinks 2 alcoholic beverages on weekends. D. Family history of diabetes mellitus.

B. History of deep vein thrombosis. Rationale: Esomeprazole, a proton pump inhibitor (PPI), may increase the chance of bleeding in a client who is taking both PPI and warfarin, which is used in the treatment of deep vein thrombosis (DVT). The healthcare provider should be informed of the client's recent history and treatment for DVT prior to giving the medication.

A client is beginning therapy with montelukast PO 10 mg once a day in the evening. The client asks the nurse, "When should I begin to feel better?" How should the nurse respond? A. Immediately. B. Peak is 3-4 hours with duration of 24 hours. C. In about 12 hours. D. 30 minutes to 1 hour.

B. Peak is 3-4 hours with duration of 24 hours. Rationale: Maximal effects of montelukast develop within 24 hours after initiating the first dose.

The nurse is providing medication teaching for a client who has recently received a prescription for clozapine. Which instruction should be included in this client's teaching plan? A. Avoid prolonged sun exposure. B. Rise slowly from a lying position. C. Do not eat any aged cheese. D. Take as needed for anxiety.

B. Rise slowly from a lying position. Rationale: Orthostatic hypotension is a side effect of clozapine, so the client should be instructed to rise slowly from a lying down or sitting position.

The healthcare provider prescribes pyridostigmine bromide tablets for a client with Myasthenia Gravis (MG). Which instruction should the nurse provide this client? A. Increase activity in the afternoon when the medication is most effective. B. That the medication is not a cure, but it does relieve symptoms. C. Use a PRN dose for increasing muscular weakness or fasciculations. D. Give the client a dietary guide that describes low-protein foods.

B. That the medication is not a cure, but it does relieve symptoms. Rationale: Pyridostigmine bromide, an acetylcholinesterase inhibitor, increases the amount of neuromuscular transmitters to promote muscular strength and swallowing. Clients should be aware that the medication is not a cure for MG, but it does relieve symptoms.

The healthcare provider prescribes oral antifungal therapy for a client with onychomycosis. Which information should the nurse tell the client? A. A single dose of the oral antifungal agent is usually sufficient to treat the infection. B. The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months. C. Complete eradication is important because of the risk of a systemic infection. D. Prolonged therapy provides no benefit and increases the risk of adverse effects.

B. The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months. Rationale: Treatment of onychomycosis, a fungal infection of the fingernails and toenails, is difficult to treat and requires prolonged therapy of 3 to 6 months for oral antifungal therapy.

The nurse should instruct a client to avoid which product while taking carisoprodol for muscle spasms? A. Aspirin products. B. Antacids. C. Alcoholic beverages. D. Dairy products.

C. Alcoholic beverages. Rationale: Carisoprodol is a centrally-acting muscle relaxant that can cause CNS depression and can have an additive effect when taken with other CNS depressants, such as alcohol.

Which drug of choice is indicated for acute ventricular dysrhythmias associated with myocardial infarction? A. Diltiazem. B. Bretylium. C. Amiodarone. D. Adenosine.

C. Amiodarone. Rationale: Based on the Tachycardia Algorithm, amiodarone is the drug of choice for acute ventricular dysrhythmias associated with myocardial infarction.

A client with pneumonia receives a prescription for tetracycline. Which precaution should the nurse include in this client's teaching? A. Take the medication with a glass of orange juice. B. Avoid over-the-counter medications containing alcohol. C. Avoid dairy products for 2 hours after taking the medication. D. Do not use teeth whitening agents during the treatment regimen.

C. Avoid dairy products for 2 hours after taking the medication. Rationale: Dairy products should not be ingested until at least 2 hours after taking tetracycline because the calcium from the dairy binds with tetracycline and decreases the medication's absorption.

A client is taking cyclosporine for renal allograft rejection prevention. After 9 months of drug therapy, the nurse reviews laboratory data and notes that the blood urea nitrogen level is 36 mg/dl. What additional finding should the nurse identify? A. Hypotension. B. White blood cell count 10,000. C. Creatinine 2.8 mg/dl (0.25 mmol/L). D. Anaphylactic reaction.

C. Creatinine 2.8 mg/dl (0.25 mmol/L). Rationale: Acute organ rejection usually occurs in the first 3 months after transplantation or at any time if an infection develops. Cyclosporine is a cytokine inhibitor used to prevent and treat organ rejection, which is manifested by elevated blood urea nitrogen(normal ranges are 10 to 20 mg/dl or 3.6-7.1 mmol/L) and creatinine (normal ranges are 0.6 to 1.2 mg/dl or 53-106 μmol/L).

A client is admitted for atrial fibrillation, and the healthcare provider prescribes disopyramide. After explaining the action of this antidysrhythmic agent, which complaint should the nurse instruct the client to report? A. Joint pain. B. Dizziness or muscle weakness. C. Daily weight gain of 2 pounds. D. Dry mouth.

C. Daily weight gain of 2 pounds. Rationale: Disopyramide is a Class IA antiarrhythmic (with similar actions as procainamide) used to suppress and prevent premature ventricular contractions, episodes of ventricular tachycardia, atrial flutter, and atrial fibrillation. The nurse should instruct the client to report any sudden weight gain that may indicate fluid retention related to poor cardiac output, which may be the result of ineffective management of the dysrhythmia.

What pathophysiological action supports the expected outcome for a client with chronic cancer pain who is treated with imipramine, a tricyclic antidepressant? A. Increases pain threshold by stimulating opiate receptors in the CNS to release of endogenous enkephalins. B. Decreases perception of pain by blocking opiate receptors in the brain and descending inhibitory nerves. C. Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses. D. Increases pain tolerance through relief of depression by increasing the amounts of norepinephrine in the brain.

C. Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses. Rationale: Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking the reuptake of serotonin and norepinephrine in the CNS, thereby inhibiting pain transmission in the spinal cord dorsal horn, which is part of the descending pain-modulating system.

When assessing a client prior to the administration of digoxin, which data is most important for the nurse to consider? A. Presence of a grade 2 murmur. B. Nailbed capillary refill of 5 seconds. C. Irregular apical pulse with a rate of 87. D. Bilateral lower extremity dependent rubor.

C. Irregular apical pulse with a rate of 87. Rationale: The action of digoxin is to slow the heart rate and strengthen the force of contraction, so it is essential for the nurse to auscultate the apical pulse for a full minute and that the apical pulse is greater than 60 beats per minute for an adult or greater than 90 beats per minute for an infant prior to administration. If the apical pulse is below the desired parameters, hold the dose and recheck the rate in one hour.

A 38-year-old gravida 2 para 2 is diagnosed with bacterial vaginosis 9-months postpartum. A prescription is written for metronidazole. Which information is most important for the nurse to obtain from the client before initiating treatment? A. Sexual history. B. Use of oral contraceptives. C. Method of infant feeding. D. Possibility of pregnancy.

C. Method of infant feeding. Rationale: Metronidazole is contraindicated if the woman is breastfeeding because high concentrations have been found in breast milk fed to infants. If metronidazole must be prescribed, the woman should be instructed to pump and discard the milk during treatment and for 48 to 72 hours after the last dose.

A client receives a new prescription for nitroglycerin tablets. Which instruction should the nurse include in this client's teaching? A. Take the medication at least an hour before every meal. B. Monitor your pulse for 60 seconds before administration. C. Place under the tongue as needed every 5 minutes up to 3 times. D. Resume normal activities after chest pain relief is obtained.

C. Place under the tongue as needed every 5 minutes up to 3 times. Rationale: The client should be instructed to place a tablet under the tongue every 5 minutes up to 3 times, and call 911 if the anginal pain is not relieved after the third tablet. Nitroglycerin tablets should be taken sublingually (SL), under the tongue, to avoid the first-pass effect, and be taken at the onset of chest pain without delay to expedite oxygen flow to myocardial tissues.

The healthcare provider has prescribed digoxin for a client who has been taking furosemide for six months. What laboratory serum levels should the nurse review before administering the digoxin? A. Calcium. B. Magnesium. C. Potassium. D. Furosemide.

C. Potassium. Rationale: The client's serum potassium levels should be evaluated before giving the first dose of digoxin because furosemide can cause hypokalemia which increases the risk of digoxin toxicity and cardiac arrhythmias.

A client is taking danazol for endometriosis and calls the clinic nurse to complain of a dark, swollen, and painful leg. Which instructions should the nurse provide the client? A. Wear support stockings. B. Elevate both legs and apply heat. C. Proceed to the closest emergency room. D. Walk for 20 to 30 minutes to reduce muscle cramps.

C. Proceed to the closest emergency room. Rationale: A dark, swollen, and painful leg is consistent with deep vein thrombosis (DVT), an adverse effect of danazol, so the client should be instructed to seek immediate emergency care.

A client with chronic gouty arthritis takes allopurinol and experiences an acute attack of gouty arthritis. The healthcare provider prescribes concurrent low-dose colchicine. Which information should the nurse provide the client that best explains the action of the colchicine? A. Acts like aspirin to relieve pain. B. Facilitates the excretion of uric acid. C. Reduces inflammation at the affected site. D. Prevents formation of uric acid crystals.

C. Reduces inflammation at the affected site. Rationale: Allopurinol improves joint function in chronic gouty arthritis by reducing blood uric acid levels to prevent and promote regression of tophi. Low-dose colchicine, an antiinflammatory agent specific for gout, is used concurrently with allopurinol, which can precipitate an incident of acute gouty arthritis.

A client receives a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. Which client history contraindicates its use? A. Asthma. B. Heart failure. C. Renal artery stenosis. D. Coronary artery disease.

C. Renal artery stenosis. Rationale: Angiotensin-converting enzyme (ACE) inhibitors can cause severe renal insufficiency in clients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney.

An emergency department triage nurse is interviewing a female client who has a history of epilepsy with tonic-clonic seizures controlled by phenytoin. Which information is most significant in planning this client's care? A. She has missed 2 menstrual periods. B. She has had no dental care for several years. C. She ran out of her medication 4 days ago. D. She has smoked 3 packs of cigarettes a day for 10 years.

C. She ran out of her medication 4 days ago. Rationale: Abruptly stopping anticonvulsant medications can precipitate seizures or the development of status epilepticus. Immediate seizure precautions and medication administration are necessary.

The healthcare provider discontinues prednisone, a glucocorticoid, for a client with chronic obstructive pulmonary disease. Which instructions should the nurse give the client about the regimen to follow? A. Life-long treatment is common for chronic disease. B. The drug should be stopped immediately if no longer needed. C. The dose must be tapered over the course of 7 to 10 days. D. Another glucocorticoid should be used to prevent cross-tolerance.

C. The dose must be tapered over the course of 7 to 10 days. Rationale: To minimize the impact of adrenal insufficiency, withdrawal of exogenous glucocorticoids should be done by gradually decreasing the dosage over several days because it can cause life-threatening adrenal insufficiency if abruptly terminated.

A client who was recently diagnosed with myasthenia gravis receives a prescription for pyridostigmine, a cholinergic agent. Which information should the nurse instruct the client to implement when taking this medication? A. Always take with meals to avoid gastrointestinal distress. B. Plan the doses close together for maximal therapeutic effect. C. To report muscle weakness or bradycardia. D. Avoid dairy products two hours before and after taking medications.

C. To report muscle weakness or bradycardia. Rationale: The nurse should instruct the client to report muscle weakness or bradycardia which can indicate a cholinergic crisis, or underdosing. The doses should also be spaced evenly apart to optimize the effects of the medication.

A client with chronic schizophrenia illness is admitted after taking risperidone 10 mg/day for three months. The nurse implements a daily assessment using the "Abnormal Involuntary Movement Scale" (AIMS). Which findings should the nurse report to the healthcare provider? A. Cogwheel rigidity. B. Drowsiness and dizziness. C. Tremors and muscle twitching. D. Dry mouth, constipation, and blurred vision.

C. Tremors and muscle twitching. Rationale: For a client with chronic mental illness, evidence-based pharmacological guidelines recommend first-line treatment using an atypical antipsychotic, such as risperidone, which can cause extrapyramidal symptoms (EPS) at dosages above 10 mg/day. The AIMS criteria measures tardive dyskinesia movements, such as facial, oral, tongue, teeth, and other akinesias of the trunk and extremity, such as tremors and muscle twitching, which should be reported.

A client is receiving fentanyl via an epidural infusion. Which side effect should the nurse anticipate in the first 24 hours of epidural analgesia? A. Headache. B. Agitation. C. Urinary retention. D. Abdominal cramping and diarrhea.

C. Urinary retention. Rationale: Anticipated common side effects of epidural opioids include nausea, itching, and urinary retention which may require urinary catheterization.

Which common side effect should the nurse alert a female client about when medroxyprogesterone is prescribed? A. Leg or calf pain. Headaches or visual changes. C. Vaginal bleeding after discontinuing the medication. D. Jaundice during the first 3 weeks of administration.

C. Vaginal bleeding after discontinuing the medication. Rationale: Approximately 3 to 7 days after the last cyclic dose of medroxyprogesterone, a female client may experience withdrawal vaginal bleeding.

A school-aged child is taking methylphenidate hydrochloride for the treatment of attention-deficit hyperactivity disorder (ADHD). The mother tells the nurse that she gives the medication at bedtime so it is "working" during school the next morning. Which modification to the administration plan should the nurse recommend to this mother? A. Continue administering the medication dose at bedtime. B. Give the medication when the child arrives at school. C. Take the medication with meals. D. Administer at least six hours before bedtime.

D. Administer at least six hours before bedtime. Rationale: Central nervous system stimulants, such as methylphenidate, should be taken at least six hours before bedtime to decrease insomnia.

A client who has Trichomonas vaginalis receives a prescription for metronidazole. Which instruction should the nurse provide during client education? A. Do not ingest with dairy products. B. Notify the clinic if the urine changes color. C. Obtain liver function tests every 3 months. D. Avoid over-the-counter antitussives.

D. Avoid over-the-counter antitussives. Rationale: Metronidazole can produce a disulfiram-like reaction when combined with products containing alcohol, such as over-the-counter cough remedies, so the client should be informed to avoid ingesting any alcohol product during the use of metronidazole.

A male client with meningitis is prescribed cefotaxime IV and asks the nurse why he cannot receive an oral drug, such as cefaclor or cefadroxil, that he has taken before for infections. How should the nurse respond when considering the actions of cephalosporins? A. Cefazolin is another IV antibiotic that can be prescribed. B. Cefaclor is a good alternative to suggest to the healthcare provider. C. Cefadroxil is usually prescribed when the IV is discontinued. D. Cefotaxime provides therapeutic CNS concentrations.

D. Cefotaxime provides therapeutic CNS concentrations. Rationale: According to research studies, only third-generation cephalosporins such as cefotaxime and ceftazidime have been shown effective in treating bacterial meningitis with the exception of cefuroxime, the only second-generation cephalosporin shown to be effective. First-generation cephalosporins have not been successful in the treatment of bacterial meningitis. IV administration of these antibiotics is the preferred route of administration due to oral administration medication levels tend to be too low to be effective in comparison to parental administration.

Which action should the nurse implement to provide analgesic titration for a client in pain? A. Teach the client to increase the time range between doses of pain medication. B. Monitor the effects of continuous intravenous infusion of narcotic analgesics. C. Plan with the client how to use a specific total dose of analgesic over a 24-hour period. D. Determine the optimal analgesic dosage required that causes the least side effects.

D. Determine the optimal analgesic dosage required that causes the least side effects. Rationale: No given dosage of an analgesic provides the same level of pain relief for every patient, and so titration upward or downward is determined based on the client's response, so that the optimal dosage achieves adequate pain relief with minimal side effects for the client. An individual's response to the medication dosage is the assessment for titration, and the titration dose should be implemented as long as analgesia is needed.

A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast media. Which pharmacologic agent is of greatest use in this situation? A. Dopamine. B. Loratadine. C. Nitroprusside. D. Epinephrine.

D. Epinephrine. Rationale: Epinephrine is the drug of choice in treating hypotension and circulatory failure associated with anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an acute systemic hypersensitivity reaction that occurs within minutes of antigen exposure (such as with contrast material containing iodine) that can result in peripheral vascular collapse.

The nurse administers the initial dose of a fentanyl transdermal patch to a client with chronic pain. When monitoring the client an hour later, which assessment is most important for the nurse to obtain? A. Level of consciousness. B. Moistness of mucosa. C. Bowel sound activity. D. Numeric pain scale.

D. Numeric pain scale. Rationale: Transdermal fentanyl, an opioid analgesic, has an onset and peak of 6 to 12 hours after the initial dose, so it is most important to determine the client's level of pain, which can persist as breakthrough pain throughout the 72-hour duration of the patch.

A client with Paget's disease is started on calcitonin 500 mcg subcutaneously daily. During the initial treatment, which is the priority nursing action? A. Assess the injection site for inflammation. B. Evaluate the client's level of pain. C. Monitor the client's alkaline phosphatase levels. D. Observe the client for signs of hypersensitivity.

D. Observe the client for signs of hypersensitivity. Rationale: Calcitonin is given to a client with Paget's disease to lower serum calcium levels. The nurse's highest priority is to observe for signs of hypersensitivity, such as skin rash, hives, or anaphylaxis. Upon initiation of treatment, emergency equipment should be readily available.

The nurse should expect the healthcare provider to prescribe which treatment regimen for a client with a peptic ulcer caused by Helicobacter pylori ? (Select all that apply.) Select all that apply- A. Clarithromycin. B. Sulfisoxazole. C. Misoprostol. D. Omeprazole. E. Metronidazole. F. Sucralfate.

D. Omeprazole. E. Metronidazole. Rationale: Recommended medical treatment for Helicobacter pylori includes the use of at least 2 different antibiotics and a proton pump inhibitor to decrease the incidence of antibiotic resistance.

A resident of a long-term care facility is taking lithium carbonate to treat bipolar disorder. Which instruction should the nurse provide to this client's caregivers? A. Offer the morning dose of the medicine before breakfast. B. Have the client chew the pill if it is difficult to swallow. C. Encourage high energy fluid intake by providing sports drinks or sodas. D. Report symptoms of hypothyroidism such as fatigue and constipation.

D. Report symptoms of hypothyroidism such as fatigue and constipation. Rationale: Lithium carbonate causes hypothyroidism in 1 to 4% of those clients receiving the medication, so caregivers should assess for signs of hypothyroidism, including fatigue and constipation (early signs) and myxedema or goiter (late symptoms).

A client is diagnosed with peptic ulcer disease and receives a prescription for esomeprazole 20 mg capsule daily. When providing this client with discharge teaching, the nurse should include which instruction? A. Drink fluids between meals to relieve gastric distress. B. Monitor for an increase in blood pressure during therapy. C. Dissolve capsule contents in fruit juice for easier ingestion. D. Take at same time each day one hour before eating a meal.

D. Take at same time each day one hour before eating a meal. Rationale: Esomeprazole, a proton pump inhibitor (PPI), is a first-line agent for symptomatic GERD that poorly responds to other acid-reducing drugs, such as H2 antagonists. Nexium is most effective when taken 30 to 60 minutes before a meal.

A client with chronic pancreatitis receives a new prescription for pancrelipase. Which instruction is most important for the nurse to include in this client's teaching? A. Avoid prolonged exposure to direct sunlight. B. Stay away from products containing alcohol. C. Ingest 8 oz of grapefruit juice with the medication. D. Take the medication when consuming food.

D. Take the medication when consuming food. Rationale: With the loss of exocrine function for a client with chronic pancreatitis, the replacement of pancreatic enzymes using pancrelipase becomes necessary. Diarrhea and steatorrhea (fatty stools) indicate insufficient pancreatic enzymes are present to digest dietary fats and other nutrients, so pancrelipase, a fat-digesting enzyme, should be consumed with any type of food.

A female client receives a prescription for cefadroxil for a urinary tract infection. The client informs the nurse that she is currently taking oral contraceptives (OCP). Which information is important for the nurse to share with the client? A. The antibiotic may be less effective while taking OCP. B. The medication combination potentiates the risk of adverse reactions. C. Avoid prolonged sun exposure while taking the antibiotic. D. Use an additional form of contraception until your menstrual cycle.

D. Use an additional form of contraception until your menstrual cycle. Rationale: Cephalosporins such as cefadroxil can potentially decrease the efficacy of oral contraceptives, so the client should be instructed to use an additional form of contraception. Further study is needed to determine if a correlation exists.

A client receives a new prescription for pentazocine, a mixed opioid agonist-antagonist after an opioid agonist is discontinued. Which is the advantage for the client when the new prescription is implemented? A. Tolerance does not occur. B. Less agitation is experienced. C. The analgesic ceiling is higher. D. Used to decrease substance use disorder.

D. Used to decrease substance use disorder. Rationale: Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as antagonists or partial agonists on the mu receptor, which decreases the likelihood of substance use disorder more than opioid agonists that are pure mu agonists.

A client receives a new prescription for ciprofloxacin, a synthetic quinolone. When teaching about this drug, which information in the client's history requires special emphasis by the nurse? A. Snacks on dairy products such as yogurt or ice cream. B. Previously had a mild allergic reaction to a cephalosporin. C. Consumes alcoholic drinks occasionally on the weekends. D. Works twenty hours a week as a lifeguard at the local pool.

D. Works twenty hours a week as a lifeguard at the local pool. Rationale: Ciprofloxacin can cause both dizziness and photosensitivity. Since the client works as a lifeguard outdoors, measures related to these adverse effects should be addressed.