Pharmacology Hesi Practice 2

Which heparin concentration should the nurse use to convert an intravenous site to a heparin lock? 10 units/ml. 100 units/ml. 1000 units/ml. 10,000 units/ml.

100 units/ml.

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

Mood swings. Increased weight gain. Delayed incisional wound healing. Serum hemoglobin level of 9 mg/dl.

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? Titrate the morphine dose upward until the client has adequate pain relief. Suggest to the family that they can also give the client ibuprofen, a non-narcotic analgesic. Hold additional morphine until the client's respirations are at least 16 per minute. Inform the client that an increased dose of morphine increases side effects without additional pain control.

Titrate the morphine dose upward until the client has adequate pain relief.

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

Avoid the consumption of alcohol.

The nurse should instruct a client to avoid which product while taking carisoprodol (Soma) for muscle spasms? Aspirin products. Antacids. Alcoholic beverages. Dairy products.

Alcoholic beverages.

The nurse should expect the healthcare provider to prescribed what treatment regimen for a client with peptic ulcer caused by Helicobacter pylori ? (Select all that apply.) Select all that apply Clarithromycin (Biaxin). Sulfisoxazole (Gantrisin). Misoprostol (Cytotec). Omeprazole (Prilosec). Metronidazole (Flagyl). Sucralfate (Carafate).

Clarithromycin (Biaxin). Omeprazole (Prilosec). Metronidazole (Flagyl).

The nurse administers the initial dose of a fentanyl (Duragesic) 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? Level of consciousness. Moistness of mucosa. Bowel sound activity. Numeric pain scale.

Numeric pain scale.

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

A small margin exists between safe and toxic plasma levels.

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

Do not crush the tablet prior to administration.

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

Drink at least 8 glasses of water a day.

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

Enhancing aqueous humor outflow.

A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast media. What pharmacologic agent is of greatest use in this situation? Dopamine (Intropin). Loratadine (Claritin). Nitroprusside (Nipride). Epinephrine (Adrenalin).

Epinephrine (Adrenalin).

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

Report symptoms of hypothyroidism such as fatigue and constipation.

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

Serum liver enzymes.

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

She ran out of her medication 4 days ago.

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

Tinnitus and hearing loss.

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

Urinary retention.

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

Works twenty hours a week as a lifeguard at the local pool.

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

Whisper test.

Which drug of choice is indicated for acute ventricular dysrhythmias associated with myocardial infarction? Diltiazem.VT dys Bretylium. Amiodarone. Adenosine.

Amiodarone.

The nurse should withhold which medication if a client reports nausea, vomiting, and diarrhea? Colchicine (Colchicine). Erythromycin (E-Mycin). Naproxen (Aleve, Naprosyn). Labetolol (Normodyne).

Colchicine (Colchicine).

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

Method of infant feeding.

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

Avoid diary products for 2 hours after taking the medication.

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

Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract.

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

Determine the optimal analgesic dosage required that causes the least side effects.

The healthcare provider prescribes a 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? Zolpidem (Ambien) 10 milligrams orally at bedtime. Eszopiclone (Lunesta) 10 milligrams orally at bedtime. Temazepam (Restoril) 7.5 milligrams orally at bedtime. Ramelteon (Rozerem) 8 milligrams orally at bedtime.

Eszopiclone (Lunesta) 10 milligrams orally at bedtime.

A client who is receiving chemotherapy is prescribed ondansetron (Zofran). What side effect should the nurse include in the teaching plan? Headache. Dry mouth. Impaired taste. Blurred vision.

Headache.

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

INR of 2 to 3.

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

Inhibiting aqueous humor production.

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

Loss of balance and dizziness.

When prescribed for a client with hepatic encephalopathy, what is the therapeutic action of lactulose (Portalac)? Lowers the pH of the colon. Softens the stool. Increases glucose absorption. Stimulates peristalsis.

Lowers the pH of the colon.

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

Proceed to the closest emergency room.

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

Promotion of rapid tissue healing.

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

Reduces inflammation at the affected site.

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

Renal artery stenosis.

A client receives a new prescription for pentazocine (Talwin), a mixed opioid agonist-antagonist, after an opioid agonist is discontinued. What is the advantage for the client when the new prescription is implemented? Tolerance does not occur. Less agitation is experienced. The analgesic ceiling is higher. Respiratory depression is less.

Respiratory depression is less.

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

The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months.

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

Tremors and muscle twitching.

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

"I will increase my insulin dosage by 5 units each month during the first trimester."

A school-aged child is taking methylphenidate hydrochloride (Ritalin, Biphentin) 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. What modification to the administration plan should the nurse recommend to this mother? Continue administering the medication dose at bedtime. Give the medication when the child arrives at school. Take the medication with meals. Administer at least six hours before bedtime.

Administer at least six hours before bedtime.

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? Obtain peak and trough serum levels so the aminoglycoside antibiotic can be initiated. Administer the initial dose of the aminoglycoside antibiotic as soon as possible. Withhold antibiotic administration until the healthcare provider clarifies the prescriptions. Schedule the initial dose of the aminoglycoside antibiotic for the following day.

Administer the initial dose of the aminoglycoside antibiotic as soon as possible.

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

Cefotaxime (Claforan) provides therapeutic CNS concentrations.

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

Oral.

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

Avoid over-the-counter antitussives.

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

Vaginal bleeding after discontinuing the medication.

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

Observe the client for signs of hypersensitivity.

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

Use an additional form of contraception until your menstrual cycle.

A client is beginning therapy with montelukast (Singulair) 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? Immediately. Within 24 hours. In about 12 hours. 30 minutes to 1 hour.

Within 24 hours.

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

Potassium.

A client is taking sulfisoxazole (Gantrisin) 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? Rash. Diarrhea. Hematuria. Muscle cramping.

Rash.

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? Hypotension. White blood cell count 10,000. Creatinine 28 mg/dl. Anaphylactic reaction.

Creatinine 28 mg/dl.

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? Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days. Quit the pills for this cycle, use an alternate method of contraception, and resume pills on the fifth day of menstruation. Take one extra pill per day for the rest of this cycle, then resume taking pills as usual next cycle. Take 4 pills now and use an alternate method of contraception for the rest of this cycle.

Take 2 pills a day for 2 days and use an alternate method of contraception for 7 days.

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

Take at same time each day one hour before eating a meal.

The healthcare provider prescribes pyridostigmine bromide (Mestinon) tablets for a client with myasthenia gravis (MG). What instruction should the nurse provide this client? Increase activity in the afternoon when the medication is most effective. Take the medication 30 to 45 minutes before eating. Use a PRN dose for increasing muscular weakness or fasciculations. Give the client a dietary guide that describes low-protein foods.

Take the medication 30 to 45 minutes before eating.

A client who is recently diagnosised with myasthenia gravis receives a prescription for pyridostigmine (Mestinon), a cholinergic agent. Which information should the nurse instruct the client to implement when taking this medication? Always take with meals to avoid gastrointestinal distress. Plan the doses close together for maximal therapeutic effect. Take the medication at least 30 minutes before eating meals. Avoid dairy products two hours before and after taking medications.

Take the medication at least 30 minutes before eating meals.

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

Take the medication when consuming food.

What teaching should the nurse provide a client who has received a new prescription for sildenafil (Viagra)? (Select all that apply.) Select all that apply Frequent use can lead to the development of hypertension. Most effective if taken after at least 6 hours of REM sleep. Take within 30 to 60 minutes of sexual stimulation. Report rebound priapism that occurs for 4 hours or more. Can cause facial flushing and headache.

Take within 30 to 60 minutes of sexual stimulation. Report rebound priapism that occurs for 4 hours or more. Can cause facial flushing and headache.

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

Place under the tongue as needed every 5 minutes up to 3 times.

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

Daily weight gain of 2 pounds.

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

Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses.

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

History of deep vein thrombosis.

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

Irregular apical pulse with a rate of 87.

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

Return the blood to the blood bank for refrigeration within 30 minutes.

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

Rise slowly from a lying position.

A client at 30-weeks gestation is in preterm labor. The healthcare provider prescribes two 12-mg doses of betamethasone (Celestone) intramuscularly every 12 hours. The client asks the nurse why she is receiving the Celestone. What information should the nurse use to explain the action of the medication? Suppresses uterine contractions. Stimulates fetal surfactant production. Reduces maternal and fetal tachycardia associated with terbutaline (Brethine) administration. Maintains adequate maternal respiratory effort and ventilation with magnesium administration.

Stimulates fetal surfactant production.

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

The dose must be tapered over the course of 7 to 10 days.

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

Facilitates transport of glucose into the cells.