PHARMACOLOGY HESI PRACTICE

The nurse is developing a plan of care for a client who takes hydroxychloroquine for the treatment of systemic lupus erythematosus (SLE). Which recommendation should the nurse provide the client to monitor side effects from this drug?

Schedule an ophthalmic exam every 6 to 12 months.

The nurse is assessing the eyes of a client who just received mydriatic eye drops. Which physiological function of the eye will not respond during the therapeutic period after administration of eye drops?

Accommodation

A client with dehydration is prescribed potassium chloride infusion at 10 mEq/hr. Potassium chloride 80 mEq is mixed with 1 liter of normal saline. The nurse should regulate the infusion pump to deliver how many mL/hour? (Enter numeric value only. Round to nearest whole number).

125 ml/hr

The nurse is instructing a client how to use a metered dose inhaler. What instruction should the nurse direct the client to use?

Activate the canister at the beginning of a slow deep breath.

A client is using the nasal spray hormone calcitonin (miacalan) to reduce bone loss from osteoporosis. To reduce rhinitis associated with administration of the nasal spray, the nurse should provide the client with which instruction?

Alternate the use of each nostril when administering the nasal spray each day.

An adolescent with major depressive disorder has been taking duloxetine for the past 12 days. Which assessment finding requires immediate follow-up?

Describes life without a purpose.

A client has a prescription for clopidogrel bisufulate 75 mg by mouth daily at 0900. In which situation should the nurse hold this medication?

Elective surgery is scheduled in two hours.

A female client with history of peptic ulcer disease receive a prescription of misoprostol. Which information provided by the client indicates to the nurse a need for further teaching?

Ensure a negative negative pregnancy test result 2 weeks before therapy.

The nurse is caring for a client receiving regular insulin prescribed per sliding scale. If a regular insulin is administered at 0730, which additional nursing action is indicated for this client?

Ensure that the client eats breakfast.

During a home visit, the nurse assesses a client with Alzheimer's Disease who recently started a new prescription for rivastigmine. 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?

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

During a home visit, the nurse assesses a client with Alzheimer's disease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is not sleeping at night. Which action should the nurse take?

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

During a home visit, the nurse assesses a client with Alzheimer's Disease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is r _______ to sleeping well at night. Which action should the nurse take?

Explain to the caregivers that insomnia is a common and temporary side effect when the medication is first started.

When conducting drug education about an oral preparation for cyclosporine. Which juice should the nurse instruct the client?

Grapefruit

The nurse is caring for an older client with multiple comorbidities. Which medication should the nurse recognize an increasing the client's risk for fractures.

Lansoprazole

A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and blood pressure is 138/96 mmHg. A transdermal nitroglycerin patch that was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

Leave the patch in place and administer a PRN dose of a sublingual nitroglycerin.

A client, who has a myocardial infarction last year, has a daily prescription for aspirin 325 mg by mouth. Which assessment finding should alert the nurse to withhold the medication?

Low platelet count.

When caring for a client with diabetes insipidus who is receiving an antidiuretic hormone intranasally, which serum lab test is most important for the nurse to monitor?

Osmolarity

A postoperative client has a prescription for ketorolac 30 mg IV every 6 hours. Which intervention should the nurse implement to determine if the expected outcome of the medication has been achieved?

Perform pain assessment using numeric scale.

A client with chronic kidney disease (CKD) is receiving calcium acetate 667 mg by mouth. A decrease in which blood value indicates to the nurse that the medication is having the desired effect?

Phosphate

The nurse is providing discharge instructions to a client who has been prescribed gabapentin 300 mg by mouth three times a day for post-herpetic neuralgia. Which symptom should the nurse tell the client to report to healthcare provider?

Photosensitivity

A client with a history of asthma is experiencing an acute episode of wheezing and shortness of breath four hours after returning from surgery. Which prescription should the nurse administer at this time?

Pirbuterol

A client with cystitis receives a prescription for phenazopyridine. which information should the nurse explain to the client about it's therapeutic effect?

Provides an analgesic effect for irritated bladder mucosa.

The nurse is interviewing a client who takes a daily antihypertensive medication. Current blood pressure reading is 124/80 mmHg. Which client statement supports the nursing problem of, "knowledge deficit of medication regimen"?

"I will save my blood pressure medicine for tomorrow since my blood pressure is good today."

A client who takes lithium is admitted to the mental health unit for suicidal ideations. The nurse shares the client's serum lithium level results of 1.5 mEq/L with the client who becomes very anxious, asking the nurse what to do. Which action should the nurse implement?

Ask the healthcare provider if hemodialysis is needed.

A client who is newly diagnosed with erosive esophagitis secondary to GERD reports to the home health nurse that there has been only a minimal reduction in symptoms after taking lansoprazole PO for one full week. Which action should the nurse take?

Confirm that the client is taking the medication one hour after meals.

Before administering the initial dose of sumatriptan succinate to a client with migraine headache. It is most important to determine if the client's history includes which protein?

Coronary artery disease

Before administering the initial dose of sumatriptan succinate (imitrex) to a client with a migraine headache, it is most important to determine if the client's history includes which problem?

Coronary artery disease.

Prior to administration of the initial dose of the GI agent misoprostol, which information should the nurse obtain from the client?

Currently pregnant.

A client with symptoms of influenza that started the previous day asks the clinic nurse about taking oseltamivir to treat the infection. Which response should the nurse provide?

Refer the client to the healthcare provider at the clinic to obtain a medication prescription.

A male client with a newly diagnosed seizure disorder starts a prescription for clonazepam. One week later, the nurse observes that his speech is slurred and he has an ataxic gait. Which action should the nurse implement?

Report these side effect to healthcare provider.

A client with open-angle glaucoma is using pilocarpine ophthalmic solution, a miotic agent. Which action should the nurse at the eye clinic include in evaluating the effectiveness of the medication?

Review eye pressure measurements.

A client is receiving pilocarpine hydrochloride ophthalmic drops for glaucoma. The client calls the clinic nurse and reports difficulty seeing at night. Which explanation should the nurse provide?

The eye drops slow pupil response to accommodate darkness.

The nurse is planning teaching for a client with diabetes mellitus who has prescription of insulin. Which action should the nurse should the nurse plan to indicate in the discharge teaching?

To teach self injection skills for daily subcutaneous administration.

A client who is taking an oral dose of tetracycline reports gastrointestinal upset. Which snack should the nurse instruct the client to take with the tetracycline?

Toasted wheat bread and jelly.

A client received succinylcholine, a depolarizing neuromuscular blocking agent during surgery. Which assessment finding is most important for the nurse to report to the surgeon?

Ventricular tachycardia

Which assessment data indicates to the nurse that a client is having anaphylaxtic reaction to a medication?

Wheezing and dyspnea.

The healthcare provider prescribes vancomycin 500 mg IV every 12 hours for a client with methicillin-resistant staphylococcus aureus (MRSA). Review of the client's laboratory values shows that serum peak and trough levels are within the desired therapeutic range and the serum creatinine level is 4.5 mg/dL. Which action should the nurse implement?

Withhold the next scheduled dose and contact the healthcare provider.

A client receiving the urinary antispasmodic oxybutynin reports having extremely dry mouth. How should the nurse respond?

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

A client who is receiving pregabalin for fibromyalgia complains of tremors in the hands. Which action should the nurse implement?

Notify the healthcare provider.

A client receives a prescription for haloperidol 2 mg intramuscular STAT. The medication is available in 5 mg/ml vial. How many mL should the nurse administer? (Enter numerical value ONLY, round to nearest tenth).

0.4

The healthcare provider prescribes ceftazidime 1,500 intravenously (IV) every 12 hours. The available vial is labeled. "Ceftazdime 1 gram." and the instructions for reconstitution state, "For IV use add 10 mL sterile water for injection. Concentration after reconstitution after reconstitution = 100 mg/mL. "How many mL should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

15

A female client with multiple sclerosis reports having less fatigue and improved memory since she began using the herbal supplement, gingko biloba. Which information is most important for the nurse to include in the teaching plan for this client?

Aspirin and non-steroidal inflammatory drugs interact with ginkgo.

A nurse administered a second dose of an opioid containing codeine and acetaminophen to a client fifteen minutes 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?

Evaluate the client's vital signs.

Two months after taking nitrofurantoin for a bacterial infection, a client reports the onset of severe, watery diarrhea to the home health nurse. How should the nurse respond?

Explain that the diarrhea maybe an adverse effect that requires further evaluation.

A client with heart failure, who is taking furosemide, complains of muscle cramps and weakness in the lower extremities. Which action should the nurse implement?

Collect blood for serum electrolytes

A client is receiving rifampin and antitubercular medication. Which statement by this client should prompt the nurse to notify the healthcare provider of potential problem?

Complains of persistent tinnitus.

Two months after taking nitrofurantoin for bacterial infection, a client reports the onset of severe, watery diarrhea to the home health nurse. How should the nurse respond?

Explain that the diarrhea maybe an adverse effect that requires further evaluation.

A male client with Laennec's cirrhosis refuses to take the daily dose of lactulose because he had three soft stools yesterday. Which action should the nurse implement?

Explain that this effect reduces serum ammonia levels.

A client scheduled to receive an IM dose of corticotropin tells the nurse about feeling swollen and gaining weight. The client no longer wants to take the medication. What action should the nurse take?

Explain the need to reduce salt intake while the medication dose is tapered off.

To evaluate the effectiveness of a client's prescription of rosuvastatin, which action should the nurse implement?

Evaluate the client's serum cholesterol level results.

An older adult client with restless legs syndrome begins taking melatonin at bedtime. When evaluating effectiveness of the herb, which client assessment should the nurse to complete?

Determine sleep patterns

An older adult client with restless legs syndrome begins taking melatonin at bedtime. When evaluating the effectiveness of the herb, which client assessment should the nurse complete?

Determine sleep patterns.

Before administering a laxative to a bedfast client, it is most important for the nurse to perform which assessment?

Determine the frequency and consistently of bowel movements.

A young adult female client who is planning to become pregnant asks the nurse if she can continue taking isotretinoin for cystic acne . Which information is most important for the nurse to provide this client?

Discontinue this medication one month before attempting to conceive.

When assessing a female client who has been taking an antipsychotic medication for the past year, the nurse observes that the client demonstrates involuntary foot tapping while both feet are flat on the floor. The nurse plans to report the observation to the healthcare provider. Which additional action should the nurse take?

Document the finding on the abnormal involuntary movements scale.

The nurse is administering sucralfate to a client with stomatitis secondary to chemotherapy. The client wants to take the medication after breakfast. How should the nurse respond? a. Document the client's refusal of the medication at this time.

Explain the need to take the medication at least 1 hour before meals.

Azithromycin is prescribed to a client with Chlamydia trachomatis. In providing client teaching about the medication, the nurse should emphasize the importance of reporting the onset of which symptom to the healthcare provider?

Flatulence and nausea.

The nurse is caring for a client who is taking diclofenac, a non-steroidal anti-inflammatory drug (NSAID) for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client's serum laboratory values is most important for the nurse to review?

Hemoglobin.

The nurse is preparing a discharge teaching plan for a client who is taking ciprofloxacin hydrochloride tablets, which were prescribed because of suspected anthrax exposure. Which instructions should be included in the teaching plan? (Select all that apply.)

Increase fluid intake while taking the medication. Limit exposure to sunlight and avoid tanning beds. Report any tendon pain or swelling to the healthcare provider immediately.

A client with schizophrenia receives a prescription for fluphenazine. Which instruction is most important for the nurse to include when teaching the client about this drug?

Notify your healthcare provider immediately if involuntary movements develop.

A client with schizophrenia receives a prescription for fluphenazine. which instruction is most important for the nurse to include when teaching the client about this drug?

Notify your healthcare provider immediately if involuntary movements develop.

The nurse is teaching a client with coronary artery disease about a newly prescribed medication, atorvastatin. The client plans to take the medication in the morning with breakfast. Which food choices are best for the nurse to recommend that the client should include with the meal? (select all that apply)

Oatmeal Whole banana

Which action should the nurse take to assess for analgesic tolerance in a client who is unable to communicate?

Observe the client for presence of pain behaviors before the next analgesic dose is due.

An older adult is receiving vancomycin for a hospital-acquired infection. which intervention is most important for the nurse to implement?

Obtain a white blood cell count daily to determine response of infection.

One hour after receiving the initial dose of doxazosin, a male client with benign prostatic hypertrophy (BPH) complains of a rapid heartbeat and dizziness. He is sitting at the side of the bed finishing his bedtime snack. His radial pulse is 144 beats/minute. What action should the nurse take first?

Obtain his blood pressure and apical pulse rate.

A client is admitted for observation because he is reporting progressively increasing fatigue over the past month and brief episodes of dizziness that occurred today. He has a history of heartburn and indigestion that he self-treats with ibuprofen and antacids. Which assessment finding should the nurse report immediately to the healthcare provider?

Positive guaiac stool.

Hormone replacement therapy with levothyroxine sodium 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, levothyroxine sodium?

Restlessness

A client receiving a heparin sodium infusion develops hemoptysis. The nurse reviews the client's laboratory values to include hemoglobin 8 g/dL and platelet count of 50,000/mm3. Vital signs are: oxygen saturation 92% on 50% venturi mask, heart rate 130 beats/minute, respiration 32 breaths/minute, and blood pressure 76/50mmHg. Which intervention should the nurse implement first?

Stop the heparin sodium infusion.

A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for a pulmonary embolism. Which information in the client's history requires follow-up by the nurse?

Takes metformin hydrochloride for type 2 diabetes mellitus.

A client diagnosed with chronic hepatitis c is receiving ribavirin in combination with alpha-interferon reports the onset of extreme fatigue and dyspnea on exertion. i tis most important for the nurse to monitor which serum laboratory value?

Glucose

The nurse is preparing a client with obstructive pulmonary disease (COPD) and chronic productive cough for discharged. Which prescribed medication should the nurse review with the client to manage this symptom?

Guaifenesin

A client is taking clonazepam, benztropine, haloperidol, and divalproex. The nurse suspects that the client is experiencing akathisia because the client is rocking back and forth in the chair and having difficulty still. Which medication is most likely to be the cause of this condition?

Haloperidol.

A male client has been receiving the antibiotic gentamicin sulfate, IV piggyback every 12 hours for several days. Which observation by the nurse indicates that the client may be experiencing an adverse effect of gentamicin?

Hearing has decreased.

A client recently diagnosed with multiple sclerosis who self administers beta-1a interferon reports feeling depressed. Which action should the nurse implement?

Notify the healthcare provider of findings immediately.

Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address?

Reported history of alcoholism.

The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first?

Respiratory rate

The nurse initiates an infusion of piperacillin-tazobactam for a client with a urinary tract infection. Five minutes into the infusion, the client reports not feeling well. Which client manifestation should the nurse identify as a reason to stop the infusion?

Scratchy throat.

The nurse is administering the sixth intravenous dose of gentamycin to a client with extensive full thickness burns. Which assessment finding warrants further investigation?

Serum creatinine level of 1.6 mg/L, a blood urea nitrogen (BUN) of 20 mg/dL.

A client recently diagnosed with Parkinson's Disease receives a new prescription for carbidopa levodopa, a dopaminergic drug. To reduce the client's risk for injury, which instruction should the nurse provide?

Ambulate using a four-point cane or a walker with wheels.

When preparing to apply a schedule fentanyl transdermal patch, the nurse note that the previously applied patch is intact on the client's upper back and the client denies pain. Which action should the nurse take?

Apply the new patch in a different location and after removing the original patch.

A client who uses transdermal contraceptive, calls to the clinic because she forgot to apply a new patch three days ago. Which instruction should the nurse provide to the client?

Apply the new patch today and use backup method for 7 days.

A client with peptic ulcer disease is scheduled to receive doses of pantoprazole IV and sucralfate PO Before breakfast at 0730. The client reports experiencing heartburn when the nurse brings to schedule medications. What action should the nurse take?

Administer both of the medications before breakfast as scheduled

A client diagnosed with myasthenia gravis receives a prescription for the anticholinesterase medication, pyridostigmine. Which intervention should the nurse implement when preparing to administer this medication?

Administer the medication thirty minutes prior to meals.

A male client reports to the nurse that he is experiencing gastrointestinal distress from high dose of corticosteroid and planning to stop taking the medication. In response the client's statement, which nursing action is most important for the nurse to implement?

Advise the client that the medication should be stopped gradually rather than abruptly.

After taking orlistat for one week, a female client tells the home health nurse that she is experiencing increasingly frequent oily stools and flatus. Which action should the nurse take?

Ask the client to describe her dietary intake history for the last several days..

A postoperative male client asks the nurse to bring the largest possible dose of a prescribed narcotic. Which action should the nurse implement first?

Ask the client to describe his current pain using a pain scale.

The nurse notes that a client has been receiving hydromorphone every six hours for four days. Which assessment is most important for the nurse to complete? Measure the client's capillary glucose level.

Auscultate the client's bowel sounds.

The nurse is caring for a client who takes methotrexate to rheumatoid arthritis and is now prescribed adalimumab. Which instructions should the nurse provide the client?

Avoid crowds and people who are sick.

Based on the client's serum digoxin level, the client is diagnosed with digoxin toxicity. Which action should the nurse expect to implement?

Begin cardioversion to stabilize heart rhythm.

A client who has a kidney transplant last week is receiving cyclosporine, an immunosuppressant. This morning the client is complaining of a headache and blured vision. Based on which assessment finding should the nurse withhold the medication until the healthcare provider is notified?

Blood pressure 180/98 mm HG

Prior to administering a scheduled dose of verapamil HCl to a client with a history of angina, which finding should the nurse review?

Blood pressure.

A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication?

Body mass index.

The home health observes a client self-administering an epinephrine injection using an auto-injector pen. Which client action requires intervention by the nurse?

Cleanses the injection pen for re-use.

client who is scheduled for surgery has a heparin solution infusing at 500 units/hour. When monitoring the client, the nurse observes the onset of hematuria. Which client data is most important for the nurse to review before contacting the healthcare provider?

Coagulation tests.

A client with muscle spasticity receive a prescription for baclofen. Which information provided by the client requires additional instruction by the nurse?

Discontinue when spasms cease.

Prior to administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL. Which action should the nurse implement?

Hold both medications until contacting the healthcare provider.

The nurse is administering IV fluconazole to a client's diagnostic studies, the nurse identifies a rising trend in the liver enzyme levels for aspartate aminotransferase (AST, also called SGOT). Which action should the nurse implement?

Hold the dose and notify the healthcare provider of the changes in the laboratory studies.

A client with pneumonia who has an emergent episode of respiratory distress is intubated and transferred to the intensive care unit. The client's chest x-ray shows consolidation in the left lobe, and physical assessment reveals diminished lung sounds. The nurse administers acetylcysteine as prescribed per nebulization via endotracheal tube. Which therapeutic response of this medication should the nurse expect?

Increased sputum, requiring suctioning.

The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

Initiate cardiopulmonary resuscitation (CPR).

A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report?

Involuntary movements.

A client with emphysema is complaining of difficulty breathing and is exhibiting audible wheezing. The nurse administers abulterol as prescribed for third time within the last 12 hours. Which assessment warrants immediate intervention by the nurse?

Irregular rapid heart beat.

Which action should the nurse implement to assess the effectiveness of the calcium channel blocker amlodipine?

Measure the client's blood pressure.

The nurse assesses a client with intermittent claudication who is receiving pentoxifyline. Which assessment should the nurse perform to determine the effectiveness of the medication?

Monitor numeric pain scale.

A client has is receiving tamsulosin, an alpha adrenergic blocking agent for management of urinary retention due to benign hyperplasia (BPH). Which instruction is most important for this nurse to provide?

Stand and sit up slowly.

A older male client is being discharged after a myocardial infarction (MI) and receives a new prescription for atenolol. Which instruction is most important for the nurse to include in her clients teaching plan?

Standing slowly when getting up from bed.

A client receives a new prescription for zafirlukast. Prior to administering the medication, the nurse should review the electronic medical record for which condition?

Status Asthmaticus

A client receives a prescription for itraconazole. Which information by the client requires additional instructions by the nurse.

Take the medication with antacids.

A client is scheduled for a spiral computed tomography (CT) with contrast to evaluate for pulmonary embolism. Which information in the client's history requires follow-up by the nurse?

Takes metformin hydrochloride for type 2 diabetes mellitus

The nurse prepares to administer a scheduled dose of labetaol by mouth to a client with hypertension. The client's vital signs are temperature 99 F (37.2 C) heart rate 48 beats/minute respirations 16 breaths/minute, and blood pressure 150/90 mmHg. Which action should the nurse take?

Withhold the scheduled dose and notify the healthcare provider

A client who received a renal transplant three months ago is readmitted to the acute unit with signs of graft rejection. While taking the client's history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation, on the advice of a friend. Which information is most significant about this finding?

Wort can decrease plasma concentrations of cylosporine.