Pharm Hesi

The nurse retrieves hydromorphone (Dilaudid) 4mg/ ml from the Pyxis Medstation, an automated dispensing system, for a client who is receiving Dilaudid 3 mg IM q6 hours PRN severe pain. How many ml should the nurse administer to the client. (Enter the numerical value only. If rounding is required round to the nearest tenth.

*not multiple choice 0.8 d/h x v = 3mg/ 4mg x 1 ml = 0.75 = 0.8 ml

A client receives a prescription for penicillin G 1,000,000 units IM daily. The medication is available in 1,200,000 until/ 2 ml syringe. How many ml should the nurse administer?

.83 ??

The HCP prescribed 2 L of 5% dextrose in water (d5w) to infuse in 24 hours. The IV administration set delivers 15 gtt/ ml. How many ml/ hour should the nurse program the infusion pump. (enter the numeric value only. if rounding is required, round to the nearest whole number)

83 ml/hr

A client with asthma is receiving long term glucorcoticoid therapy. The nurse includes a risk for impaired skin integrity to the problem list in the client's plan of care. Which rations is the reason for including this problem?

Thinned skin bruises and tears more easily

A female client has a hgb of 9 g/dL (90 g/L) and iron supplements are prescribed. When teaching this client about the administration of iron supplements, how should the nurse instruct her to take the iron tablets?

Two hours after breakfast, with a small sn

A female client is being treated for TB with rifampin (Rifadin). Which statement indicates that further teaching is needed? a. I'll take my usual oral contraceptives for birth control b. even when not menstruation, my urine may be red-tinged c. my nausea will disappear as I adjust to the medication d. I might be having an allergic reaction if a rash occurs

a. I'll take my usual oral contraceptives for birth control ??

A client diagnosed with myasthenia gravis receives a prescription for the anticholinesterase medication, pyridostigmine (Mestinon). Which intervention should the nurse implement when preparing to administer this medication? a. administer the medication thirty minutes prior to meals b. schedule the medication to be given just before bedtime c. instruct the client to avoid dairy products for 30 minutes d. break the medication into small pieces and sprinkle onto food

a. administer the med 30 minutes prior to meals this medication should be administered before meals because it increases muscle strength to help enhance chewing and swallowing b. this would not help improve strength during the day c. it can be taken with dairy to minimize side effects d. do not sprinkle on food

Hormone replacement therapy with levothyroxine sodium (Synthroid) is prescribed for a client with hypothyroidism. The nurse should instruct the client to report which symptom because it indicates that the client is taking too much of the hormonal agent, Synthroid? a. decreased appetite b. restlessness c. intolerance to cold d. constipation

a. decreased appetite ??

A client has been taking ibuprofen, an NSAID, PO, 2q daily for chronic lower back pain for several months. Which assessment is most important for the nurse to complete? a. determine presence of abdominal pain b. evaluate ongoing sleeping patterns c. evaluate volume of pedal pulses d. assess back pain using numeric scale

a. determine presence of abdominal pain ??

Which instruction should the nurse include when teaching a client about self-administration of a bulk-forming laxatives a. follow medication administration with an additional glass of water b. avoid the intake of dairy products while using the medication c. remain upright for 30 minutes following drug administration d. take the medication one hour after meals and other medications

a. follow medication administration with an additional glass of water ??

A client asks the nurse about using zinc as a complementary therapy for treatment of cold symptoms. What should the nurse explain to the client regarding the use of zinc? a. it is relatively safe when taken at recommended dosages b. interference may occur if taken with almost any other drugs c. there is very limited evidence it reduces cold symptoms d. take with caffeine or dairy products to enhance absorption

a. it is relatively safe when taken at recommended dosages

The nurse is preparing a discharge teaching plan for a client who is taking ciprofloxacin hydrochloride (Cipro) tablets, which were prescribed because of a suspected anthrax exposure. Which instructions should be included in the teaching plan? (SATA) a. limit exposure to sunlight and avoid tanning beds b. crush and mix tabs with pudding if you have trouble swallowing c. increase fluid intake while taking the medication d. use NSAIDs to relieve mild joint aches caused by medication e. report and tendon pain or swelling to the HCP immediately

a. limit exposure to sunlight and avoid tanning beds c. increase fluid intake while taking the medication e. report and tendon pain or swelling to the HCP immediately ??

A client with chronic kidney disease is receiving calcium acetate (PhosLo) 667 mg PO. a decrease in which blood values indicates to the nurse that the medication is having the desired effect. a. phosphate b. potassium c. calcium d. ph

a. phosphate ??

A client with a history of asthma is experiencing an acute episode of wheezing and SOB four hours after returning from surgery. Which prescription should the nurse administer at this time? a. pirbuterol (maxair) b. theophylline c. cromolyn d. montelukast (singulair)

a. pirbuterol (maxair) ??

A client with a respiratory infection has been receiving an antibiotic and antipyretic for five days. What current datum is the best indication that the antibiotic is effective? a. the sputum specimen culture report shows no growth b. the client has been afebrile for 48 hrs c. the client's WBC has remained stable at 12,000 mm3 d. the peak antibiotic level is within the therapeutic range

a. the sputum specimen culture report shows no growth the lack of growth of organisms indicates that the ab has been effective b- this may be the result of the antipyretic, rather than the ab c- is elevated (normal is 5,000 mm3 to 10,000 mm3) and a likely indication that infection is still present d- indicates that the desired amount of antibiotic is present, but does not evaluate the effect of the ab on the infection

A client with TB, whose anti tubercular drugs include rifampin (Rifadin), reports to the nurse that his urine in reddish-orange. What response should the nurse provide to this client? a. this is an expected side effect and is harmless b. drink 8 oz of cranberry juice a day c. a UA should be done ASAP d. discontinue the medication, and call your HCP

a. this is an expected side effect and is harmless ??

A nitroglycerin infusion is prescribed for a client whose BP is 210/112. Ten minutes after initiating the infusion at 10 mcg/ minute, the client complains of a severe headache and numbness of the left arm. Which intervention should the nurse implement? a. turn off the nitroglycerin infusion b. reevaluate the BP c. increase the infusion to 20 mcg/ minute d. administer a dose acetaminophen

a. turn off the nitroglycerin infusion ??

A client with multiple sclerosis starts a new prescription, baclofen, to control muscle spasticity. Three days later, the client calls the clinic nurse and reports feeling fatigue and dizzy. What instruction should the nurse provide? a. stop taking the medication immediately b. avoid hazardous activities until symptoms subside c. increase intake of fluids and high protein foods d. obtain transportation to the ED

b. avoid hazardous activities until symptoms subside fatigue and dizziness are common side effects of baclofen, so the client should be instructed to avoid hazardous activities until symptoms subside a- abrupt withdrawal of baclofen may precipitate withdrawal symtoms c/d- not necessary

thirty minutes after administer trimethobenzamide (Tigan) to a client with nausea, the nurse observes that the client is sedated, but arouses easily, and denies further nausea. Which action should the nurse implement? a. administer a PRN protocol dose of naloxone b. encourage the client to rest until feeling more alert c. remain in the room until the client is fully awake d. notify the HCP of the client's lethargy

b. encourage the client to rest until feeling more alert ??

After receiving the first dose of penicillin, the client begins wheezing and has trouble breathing. The nurse notifies the HCP immediately and receives several prescriptions. Which medication prescription should the nurse administer first? a. albuterol inhaler b. epinephrine injection, USP IV c. diphenhydramine (Benadryl) IV d. methylprednisolone (medrol) OV

b. epinephrine injection, USP IV ??

A client with amyotrophic lateral sclerosis (ALS) has been taking riluzole for two weeks. The nurse notes that the client remains weak with observable muscle atrophy. What action should the nurse take? a. advise the client to schedule an appointment for liver function test b. explain that medication takes several weeks to reverse symptoms c. document the assessment finding in the EHR d. withheld the medication until the HCP is notified

b. explain that medication take several weeks to reverse symptoms ??

During a home visit, the nurse assesses a client with Alzheimer's disease who recently started a prescription for rivastigmine (Exelon). the caregiver reports that the client seems to be thinking more clearly but is not sleeping well at night. Which action should the nurse take? a. advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed b. explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started c. notify the HCP that the dosage of the medication may need to be increased to manage the client's insomnia d. instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's safety

b. explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started ??

A client with anemia secondary to chronic kidney disease started a prescription for epoetin alfa (Epogen) two months ago. Which client finding best indicates that the medication is effective a. reports of increased energy levels and decreased fatigue b. hemoglobin level increase to 12 grams/ dL (120 mmol/L) c. food diary shows increased consumption of iron-rich foods d. takes concurrent iron therapy, without adverse effects

b. hemoglobin level increased to 12 grams/ dL ??

After taking lactulose (cholac) for several days. What therapeutic response for a patient with hepatic encephalopathy? a) reduce liquid stools b) improve mental status c) increase urine output d) ability to ambulate independently

b. improved mental status Lactulose, a hyperosmotic laxative, draws water into the gut, reduces the formation of ammonia in the gut, and lowers serum ammonia levels, which are elevated in hepatic encephalopathy and cause confusion that can lead to pre-coma and coma. The client's mental status should improve after taking lactulose. a/c/d- not expected outcomes

What action should the nurse take prior to administering digoxin (Lanoxin) PO? a. Obtain a left radial pulse for 30 seconds b. listen to the heart at the left 5th intercostal space c. check the client for signs of orthostatic hypotension d. verify that the urine output exceeds 30 ml/ hour

b. listen to the heart at the left 5th intercostal space Bradycardia, a late sign of digtox, should be assessed for by counting the client's apical heart rate (with the stethoscope positioned at the 4th or 5th intercostal space at the midclavicular line) for a full minute. a. is often irregular and can vary significantly from apical rate c/d. can provide information but not priority assessments

A female client who has trichomonas vaginalis receives a prescription for metronidazole (flagyl). which instruction should the nurse provide this client? a. take the medication only when symptomatic b. male partners must also be treated c. report any difficulty with hearing d. urine may turn an orange color

b. male partners must also be treated

A client with a history of angina is taking diltiazem, a calcium channel blocker. The client reports increasing fatigue with periods of feeling "faint". Which client assessment should the nurse complete first? a. auscultate lungs for adventitious breath sounds b. measure pulse and BP for changes c. review fluid intake and outage for imbalances d. observe gait and posture for muscle weakness

b. measure pulse and blood pressure for changes ??

The nurse is teaching a male client with Type 1 diabetes mellitus about the onset, peak, and duration of a new prescription for glargine (Lantus) insulin. If the insulin is self-administered at 0800, when is the client most likely to experience hypoglycemia a. midmorning b. mid-afternoon c. no peak occurs d. shortly after midnight

b. midafternoon ??

A client who is receiving pregabalin (Lyrica) for fibromyalgia complains of tremors in the hands. What action should the nurse implement? a. obtain orthostatic BP readings b. notify the HCP c. collect a capillary glucose level d. administer PRN of an anti anxiety drug

b. notify the HCP

A male client who has been taking a high-dose of an NSAID comes to the clinic complaining of gastric pain and blood in his stool. The HCP discontinues the NSAIDs and prescribes esomeprazole (Nexium). Which information should the nurse include in this client's teaching plan? a. once pain subsides, NSAID therapy can be resumed b. notify the HCP of the passage of black stools c. resume a diet that consists of milk, cream, and bland foods. d. call the clinic if diarrhea or headache occur when taking Nexium.

b. notify the HCP of the passage of black stools ??

When preparing to administer the next scheduled dose of fentanyl (Sublimaze) transdermal patch to a client with metastatic cancer and renal insufficiency. The nurse notes that the client has shallow respiration at 8 breath/ minute. What action should the nurse take first? a. apply the transdermal patch b. notify the healthcare provider c. give a breakthrough pain medication d. assess deep tendon reflexes

b. notify the healthcare provider respiratory depression is a side effect of opioid analgesics in a client with renal failure. the HCP should be notified so Rx changes can be made

A client who is obtunded arrives in the ED with a suspected drug overdose. The client becomes responsive after the administration of IV naloxone, but within a short period, the client's LOC decreases again and the respiratory rate decreases to 6 breaths per minute. Which action should the nurse take first? a. administer an additional dose of naloxone b. prepare to initiate CPR c. determine if results of the drug toxicity screen are available d. initiate a second intravenous access site

b. prepare to initiate CPR ??

A client is receiving tamsulosin (Flomax), an alpha adrenergic blocking agent, for the management of urinary retention due to BPH. Which instruction is most important for the nurse to provide. a. take the medication early in the day b. stand and sit up slowly c. use a twice-a-week dosing schedule d. reduce daily fluid intake

b. stand and sit up slowly Perpheral vasodilation is the therapeutic outcome of alpha adrenergic blocking agents such as tamsulosin, which relay veins, arteries, and in the client with BPH also relaxes the muscle in the prostate and bladder neck to ease initiating a urinary stream. Orthostatic hypotension due to rapid mobilization is a common side effect. a/c/d- Flomax is prescribed once daily and should be taken half an hour following the same meal each day

Ferrous sulfate elixir is prescribed for a client with iron deficiency anemia. Which instruction should the nurse provide this client about taking the liquid medication? a. mix with an antacid b. use a straw to ingest c. take with a glass of milk d. swallow undiluted

b. use a straw to ingest ??

A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 2100 dose. What action can the nurse take to alleviate this side effect? a. change the time of the dose b. hold the 2100 dose c. administer the dose with a snack d. administer and antiemetic with the dose

c. administer the dose with a snack administering oral doses with food helps minimize GI discomfort a- would be appropriate only if changing the time of the dose corresponds to meal times while also maintaining an appropriate interval b/w doses b- would disrupt dousing schedule which could result in a non therapeutic serum level of the medication d- should not be attempted before other interventions

A female client with osteoporosis has been taking a weekly dose of oral risedronate for several weeks. The client calls the clinic nurse to report increasing "heartburn." How should the nurse respond? a. advise the client to go to the nearest ED b. suggest use of an antacid 2 hours after the medication c. ask the client to describe how she takes the medication d. remind the client to take the medication with plenty of water

c. ask the client to describe how she takes the medication ??

The wife of a client diagnosed with Parkinson's disease calls the client and tells the nurse her husband d is having involuntary jerky movements of the legs and arms and is confused. What action should the nurse implement? a. determine how long he has been diagnosed with Parkinson's b. request that the client's wife bring him to the clinic ASAP c. ask the client's wife to list all medications her husband is currently taking d. advise client's wife to call an ambulance to take him to the ER

c. ask the client's wife to list all medications her husband is currently taking ??

The nurse suspects that a client has experienced an adverse reaction to a prescribed medication. Which action should the nurse take first? a. determine how long the client has been taking the drug b. review the half life of the medication in a drug guide c. complete a focused systems assessment of the client d. notify the HCP who prescribed the medication

c. complete a focused systems assessment of the client ??

An adolescent receives a new prescription for isotretinoin (Claravis) for cystic acne. Which information is most important for the nurse to provide? a. discontinue all multi-vitamins during acne medication therapy b. store the medicine in a plastic, tight, light-resistant container c. consider an alternative summer job, other than lifeguarding d. start the second course of therapy after an 8 week delay

c. consider an alternative summer job, other than life guarding ??

A nurse administered a second dose of an opioid containing codeine and acetaminophen to a client fifteen after a first dose was administered by another nurse, because the first dose was not documented in the medication record. Which intervention is most important for the nurse to implement? a. obtain a serum liver panel b. complete a medication error form c. evaluate vital signs d. assess the client's pain on a 10 point scale

c. evaluate the client's vital signs an opioid containing codeine and acetaminophen can cause CNS depression and the nurse's highest priority is to assess the client's vital signs and LOC a. high doses of acetaminophen can cause liver toxicity, but it is not the highest priority b/d. also important but not as important

A male client receives a scopolamine transdermal patch 2 hours prior to surgery. Four hours after surgery, the client tells the nurse that he is experiencing pain and asks why the patch is not working. What action should the nurse take? a. offer to apply a new transdermal patch to relieve the pain b. check for correct placement of the patch behind the client's ear c. explain that the medication is not given to precent pain d. advise the client that the effects of the medication have worn off

c. explain that the medication is not given to prevent pain ??

Prior to administering oral doses of calcitriol (Rocaltrol) and calcium carbonate (os-cal) to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL or 3.5 mmol/ L (SI). Which action should the nurse implement? a. hold the rocaltrol, but administer the os-cal as scheduled b. administer both prescribed medications as scheduled c. hold both medication until contacting the HCP d. hold the oas-cal, but administer the rocaltrol as scheduled

c. hold both medications until contacting the HCP ??

The nurse is instructing a client with allergic rhinitis about the correct technique for using an intranasal inhaler. What instruction is most important for the nurse to provide to this client? a. use the inhaler when first awakening in the morning b. avoid shaking the inhaler immediately before using c. hold one nostril closed while spraying the other nostril d. angle the tip of the inhaler upward while spraying

c. hold one nostril closed while spraying the other nostril to receive the medication as prescribed, one nostril should be held closed while the other is sprayed. a. inhaler use is not limited to morning b. the inhaler should be shaken before use d. this is not necessary

A client with emphysema is complaining of difficulty breathing and is exhibiting audible wheezing. The nurse administers albuterol (Proventil) as prescribed for the third time within the last 12 hours. Which assessment finding warrants immediate intervention by the nurse? a. throat irritation b. increased anxiety c. irregular rapid heart beat d. uncontrollable shaking

c. irregular rapid heart beat A critical side effect of Proventil is an irregular rapid heart beat that requires immediate intervention for a potential life-threatening dysrhythmia a/b/d. these are common side effects that should resolve without intervention

A client with heart failure develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client's plan of care? a. cover your skin before going outside b. monitor skin for excessive bruising c. limit intake of high-potassium foods d. replace salt with a salt substitute

c. limit intake of high- potassium foods ??

To assess for the effectiveness of amlodipine (Norvasc), a calcium channel blocker, what action should the nurse implement? a. review the client's intake and output b. note the client's serum calcium levels c. measure the client's BP d. monitor the client's serum electrolytes

c. measure the client's BP ??

Which nursing action has the highest priority when administering a dose of codeine with acetaminophen to a client? a. administer a stool softener/ laxative at the same time as the analgesic b. instruct the client to request assistance when ambulating to the bathroom c. tell the client to notify the nurse if the pain is not relieved d. advise the client that the medication should start to work in about 30 minutes

c. tell the client to notify the nurse if the pain is not relieved ??

A client is discharged with a prescription for warfarin (Coumadin). Which discharge instruction should the nurse emphasize to the client? a. add large amounts of spinach to the diet b. use an astringent for superficial bleeding c. take a multi-vitamin supplement daily d. avoid going barefoot, especially outside

d. avoid going barefoot, especially outside

The nurse is preparing medications for a client with bipolar disorder and notices that the antipsychotic medication was discontinued several days ago. Which medication should be discontinued? a. magnesium (milk of magnesia) b. alprazolam (xanax) c. lithium (lithotabs) d. benztropine (cogentin)

d. benztropine (congentin) ??

The nurse notes that a client has a new prescription for 20 mEq of potassium chloride (KCl) to be administered IV push STAT. The client's IV site is slightly inflamed but is not tender and has a blood flashback. What action should the nurse take? a. fax the prescription to the pharmacy for immediate delivery of the medication b. obtain a liter of normal saline with 20 mEq of KCl from the supply cart c. withheld the prescribed medication until a new IV is inserted d. Contact the healthcare provider to clarify the prescription

d. contact the healthcare provider to clarify the prescription IV administration of undiluted KCl can cause life-threatening dysrhythmias, so the nurse must contact the HCP to clarify the prescription a/c- may result in the administration of a fatal dose of medication. b- Although 20 mEq of KCl diluted in a liter of normal saline solution is a safe dilution for administration, the nurse cannot prescribe medications and must contact the HCP to change the Rx

The home health nurse observes that a female client is using a topical preparation that contains echinacea to treat a canker sore. Her husband expresses concern regarding the effectiveness and safety of using herbs. How should the nurse respond? a. many of the herbal preparations are helpful primarily because of their placebo effect b. this product is essentially harmless, but also is not very beneficial in treating skin infections c. topical echinacea is usually used to soothe burns and can cause damage to the skin d. echinacea seems to be useful in the treatment of some infections such as canker sores

d. echinacea seems to be useful in the treatment of some infections such as canker sores echinacea stimulates the immune system and seems to be useful in the prevention and treatment of some infections including its topical use to treat canker sores. A- while a placebo can play a role in disease management, herbal remedies have evidence of effectiveness b- if used improperly it can be harmful c- aloe vera is used to soothe burns

The nurse is administering the muscle relaxant baclfen (Lioresal) PO to a client diagnosed with multiple sclerosis. Which intervention should the nurse implement? a. advise the client to move slowly and cautiously when rising and walking b. monitor intake and output q 8 hrs c. ensure the client knows to stop baclofen before using other antispasmodics d. evaluate muscle strength q 4 hours

d. evaluate muscle strength q 4 hours ??

The nurse is administering IV fluconzale (Diflucan) to a client who has systemic candidiasis. After reviewing the client's diagnostic studies, the nurse identifies a rising trend in the liver enzyme levels for aspartate aminotransferase (AST, also called SGOT). What action should the nurse implement? a. hold the dose and notify the pharmacy to stop dispensing the next premixed doses b. begin the infusion and submit a drug reaction report to the nursing supervisor c. begin the infusion and monitor the client's BUN, serum creatinine, and liver function tests d. hold the dose and notify the HCP of the changes in the lab studies

d. hold the dose and notify the HCP of the changes in the lab studies ??

A peak and trough level was obtained from a client receiving an amino glycoside IV piggyback q 8 hours. Which finding presents highest risk for the client and should be reported immediately to the HCP? a. decreased peak only b. decreased peak, decreased trough c. decreased trough only d. increased peak, increased trough

d. increased peak, increased trough ??

A client receiving the urinary antispasmodic oxybutynin Cl (Ditropan XL) reports having an extremely dry mouth. How should the nurse respond? a. stop taking the medication immediately and schedule an appointment to see the HCP b. it sounds as if you are losing too much fluid, so increase your fluid intake to 3 L a day c. secondary infections, which must be treated with a different medication, sometimes occur during treatment. d. you can such on hard candy to help relieve the mouth dryness, which is a common side effect

d. you can suck on a hard candy to help relieve the mouth dryness, which is a common side effect ??