Review Hesi 212/235 2nd level

Random 2

1. One patient has cancer of the bone; another has cancer in the connective tissues of the thigh muscles; a third patient has cancer in the vascular tissues. These patients have a type of tumor referred to as a- sarcoma 2. A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem? "Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations." 3. When administering chemotherapy for treatment of cancer, the nurse implements which intervention that treats or even prevents chemotherapy-induced nausea and vomiting? Giving an antiemetic 30 to 60 minutes before the chemotherapy is started. 4. The nurse is administering a combination of three different antineoplastic drugs to a patient who has metastatic breast cancer. Which statement best describes the rationale for combination therapy? Increased cancer-cell killing will occur. 5. The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered the principal early sign of infection? Fever 6. When giving chemotherapy as cancer treatment, the nurse recognizes that toxicity to rapidly growing normal cells also occurs. Which rapidly growing normal cells are also harmed by chemotherapy? (Select all that apply.) Hair follicle cells, Gastrointestinal (GI) mucous membrane cells, Bone marrow cells 7. What is the nurse's priority action if extravasation of an antineoplastic drug occurs during intravenous (IV) administration? Stop the infusion immediately, but leave the IV catheter in place 8. A patient is receiving a third session of chemotherapy with daunorubicin (Cerubidine). The nurse will assess the patient for which signs of a potential severe toxic effect of this drug? "A weight gain of 2 pounds or more in 24 hours" 9. The nurse is providing education regarding chemotherapy to a patient who is about to receive the first course of treatment. Which statement by the nurse is appropriate? "Report black, tarry stools if they occur." 10. The nurse is teaching a class about the various chemotherapy drugs and explains that alkylating drugs are also called "cell cycle-nonspecific drugs" because they are- cytotoxic in any phase of the cell cycle 11. When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? The penicillin will cause an enhanced anticoagulant effect of the warfarin. 12. The nurse is preparing to administer morning meds to a pt who has been newly diagnosed with tuberculosis. The patient ask, "Why do I have to take so many different drugs?" Which response by the nurse is correct? "Taking multiple drugs reduces the chance that tuberculosis will become drug resistant." 13. First question is putting the nursing process in order- ADPIE 14. What will decrease the absorption of tetracycline? I put "milk" 15. Something about transdermal patches and I put "they are usually via adhesive patches" 16. A patient is admitted with a fever of 102.8 F (39.3 ° C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain urine and blood cultures and to administer an antibiotic intravenously stat (now). The nurse will complete these orders in which sequence? Blood and urine cultures, ampicillin dose ß I found this question online but I know for a fact that you have to get cultures FIRST and then administer medications. The answers choices included all meds first and then cultures except for one that said something with cultures FIRST and then administer medications. 17. Tetracycline, 8 year old boy, mother says something like "I was fine I took it why can't my son?" or whatever- something with tooth decay/discoloration 18. Avoid drug that interacts with tetracyclines- "antacids" 19. Something else with what to avoid while on tetracycline- "avoid sunlight exposure" something like that 20. Main adverse effect of clindamycin- "diarrhea" 21. Nonspecific cell cycle- something with "cytoxic cells...at any phase" 22. Doxorubicin- "cardiomyopathy" 23. How to make sure you're giving the medication to the right patient- I put something with "2 identifiers (that included) last name, MRN, and room #) or something like that 24. What is the nurse's main priority when a medication error has occurred? Patient safety 25. Doctor prescribed to give a certain med STAT but pharmacy sent it an hour late, what should the nurse do? "hold the medication and call doctor" 26. Something about giving chemotherapy, it included "500 neutrophils"- "administer the prescription as ordered" 27. Immunosuppressant- "should not be stopped abruptly" 28. Oral vs sublingual- "sublingual absorbs faster" 29. Which OTC form or something would be absorbed the fastest- "powders" 30. Something with patient taking some kind med and has been getting watery diarrhea for the past 10- I chose the answer with something that said "may be developing superinfection" 31. Gentamicin, patient asks to repeat questions, imbalanced- "Patient is experiencing ototoxicity from the gentamicin." 32. Patient has painful mouth sores, what should the patient do? "avoid acidic juices" 33. What is right about cephalosporins? "Cannot administer if patient has a past history of penicillin allergy" 34. Nurse is about start on patient's first chemotherapy session, patient says something where she needs further teaching on- "I plan on getting pregnant soon" 35. Patient asks why she's getting meds through IV, what should nurse respond? "IV meds are faster"

Review Hesi Practice Problems

3. The home health nurse observes that a female patient is using a topical preparation that contains echinacea to tx a canker sore. Her husband expresses concern regarding the effectiveness and safety of using herbs. How should the nurse respond? ANS: Echinacea seems to be useful in the tx of some infections, such as canker sores 6. When preparing to administer the next schedule dose of fentanyl (Sublimaze) transdermal patch to a client with metastatic cancer and renal insufficiency, the nurse notes that the client has shallow resps @ 8 breaths/min. What actions should the nurse take? ANS: Notify the health care provider 7. A client diagnosed with myasthenia gravis receives a prescription for the anticholinesterase medication, pyridostigmine (Mestinon). Which intervention should the nurse implement when preparing to admin this med? ANS: Admin med 30 min prior to meals 9. A nurse administered a second dose of an opioid containing codeine and acetaminophen to a client 15 minutes after a first dose was not documented in the medication record. Which intervention is most important for the nurse to implement? ANS: Evaluate the client's vital signs 28. 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 with in the last 12 hours. Which assessment finding warrants immediate intervention by the nurse? ANS: Irregular rapid heart beat 33. After taking lactulose (Chlolac) for several days, which therapeutic response should the nurse expect for a client with hepatic encephalopathy? ANS: Improved mental status 34. What action should the nurse take prior to administering digoxin (Lanoxin) PO? ANS: Listen to the heart at the 5th intercostal space 36. the nurse is instructing a client with allergic rhinitis about the correct technique for using an intranasal inhaler. What instructions is most important for the nurse to provide the client? ANS: Hold one nostril closed while spraying the other nostril 38. 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 instructions should the nurse provide? ANS: Avoid hazardous activities until the symptoms subside 40. The nurse notes that a client has a new prescription for 20mEq 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 actions should the nurse take? ANS: Contact the healthcare provider to clarify the prescription 42. A client with a respiratory infection has been receiving an antibiotic and an antipyretic for 5 days. What current datum is the best indication that the antibiotic is effective? ANS: The sputum specimen culture report shows no growth 43. A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00 PM dose. What actions can the nurse take to alleviate this side effect? ANS: Administer the dose with a snack 17. A client is receiving tamsulosin (Flomax), an alpha adrenergic blocking agent, for the management of urinary retention due to benign prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide? ANS: Stand and sit up slowly 19. Thirty minutes after administering 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? ANS: Encourage the client to rest until feeling more alert. 20. 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 "hearburn." How should the nurse respond? ANS: Advise the client to go to the nearest emergency department. 21. 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 also be discontinued? ANS: Lithium 22. An adolescent receives a new prescription for isotretinoin (claravis) for cystic acne. Which information is most important for the nurse to provide? ANS: Consider an alternative summer job, other than life-guarding. 23. 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. The the insulin is self-administered at 0800, when is the client most likely to experience hypoglycemia? ANS: No peak occurs 24. Which nursing action has the highest priority when administering a dose of codeine with acetaminophen to a client? ANS: Instruct the client to request assistance when ambulating to the bathroom. 25. 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? ANS: Explain that the medication is not given to prevent pain. 26. The nurse is administering the muscle relaxant baclofen (lioresal) PO to a client diagnosed with multiple sclerosis. Which intervention should then nurse implement? ANS: Advise the client to move slowly and cautiously when rising and walking. 27. During a home visit, the nurse assesses a client with Alzheimer's Disease who recently started a new 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? ANS: Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started. 28. The nurse is administering IV fluconazole (Diflucan) to a client who has systemic candidiasis. After reviewing the client's diagnostic studies, then nurse identifies a rising trend in the liver enzyme levels for aspartate aminotransferase (AST, also called SGOT). What action should the nurse implement? ANS: Hold the dose and notify the healthcare provider of the changes in the laboratory studies. 29. 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? ANS: Pirbuterol (Maxair). 30. A client with hear failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client's plan of care? ANS: Limit intake of high-potassium foods. 31. A client receiving the urinary antispasmodic oxybutynin CL (Ditropan XL) reports having an extremely dry mouth. How should the nurse respond? ANS: You can suck on hard candy to help relieve the mouth dryness, which is a common side effect. 32. A female client is being treated for tuberculosis with rifampin (rifadin). Which statement indicates that further teaching is needed? ANS: "I'll take my usual oral contraceptives for birth control." 33. The nurse suspects that a client has experienced an adverse reaction to a prescribed medication. Which action should the nurse take first? ANS: Complete a focuses system assessment of the client. 34. Calculation: convert 2 Liters to 2,000ml. Then take 2,000mL and divide by 24 hours. We should have 83.33 or rounded to the nearest whole number is 83. We set the pump running at 83 ml/ hour. DOUBLE CHECK YOUR MATH CALCULATION AND ASK ANOTHER TO SOLVE THIS PROBLEM IF IN DOUBT. 35. 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? ANS: There is very limited evidence it reduces cold symptoms. 36. 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? ANS: Hold both medications until contacting the healthcare provider 37. A male client who has been taking a high-dose of a nonsteroidal anti-inflammatory drug (NSAID) comes to the clinic complaining of gastric pain and blood in his stool. The healthcare provider discontinues the NSAIDs and prescribes esomepraxole (Nexium). Which information should the nurse in this client's teaching plan? ANS: Notify the healthcare provider of the passage of black stools. 38. 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? ANS: Advise the client to schedule an appointment for liver function tests. 39. A female client who has trichomonas vaginalis receives a prescription for metronidazole (Flagyl). Which instruction should the nurse provide this client? ANS: Male partners must also be treated. 40. 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? ANS: Measure pulse and blood pressure for changes. 41. A peak and trough level was obtained from a client receiving an aminoglycoside IV piggyback every 8 hours. Which finding presents the highest risk for the client and should be reported immediately to the healthcare provider? ANS: Decreased peak, decreased trough. 42. Which instruction should the nurse include when teaching a client about self-administration of a bulk-forming laxative? ANS: Follow medication administration with an additional glass of water. 43. 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? ANS: Use a straw to ingest. 44. To assess for effectiveness of amlodipine (Norvasc), a calcium channel blocker, what action should the nurse implement? ANS: Measure the client's blood pressure. 45. A client has been taking ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), by mouth, twice a day for chronic lower back pain for several months. Which assessment is most important for the nurse to complete. ANS: Determine presence of abdominal pain. 46. The wife of a client diagnosed with Parkinson's disease calls the clinic and tells the nurse her husband is having involuntary jerky movements of the legs and arms and is confused. Which action should the clinic nurse implement first? ANS: Ask the client's wife to list all medications her husband is currently taking. 47. 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? ANS: Restlessness. 48. A client with tuberculosis, whose antitubercular drugs include rifampin (Rifadin), reports to the nurse that his urine is reddish-orange. What response should the nurse provide this client? ANS: This is an expected side effect and is harmless. 49. A client who is receiving pregabalin (Lyrica) for fibromyalgia complains of tremors in the hands. What action should the nurse implement? ANS: Administer a prn dose of an antianxiety drug. 50. A client with chronic kidney disease (CKD) is receiving calcium acetate (PhosLo) 667 mg PO. A decrease in which blood value indicates to the nurse that the medication is having the desired effects? ANS: Phosphate 51. A client is discharged with a prescription for warfarin (Coumadin). Which discharge instruction should the nurse emphasize to the client? ANS: Avoid going barefoot, especially outside. 52. 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? (Select all that apply). ANS: A: Limit exposure to sunlight and avoid tanning beds ANS: C: Increase fluid intake while taking the medication ANS: E: Report any tendon pain or swelling to the healthcare provider immediately. 53. A client receives a prescription for penicillin G 1,000,000 units IM daily. The medication is available in 1,200,000 units/2 ml syringe. How many ml should the nurse administer? ANS: 0.8 mL ~ after calculation, you must round to the nearest tenth! 54. A nitroglycerin infusion is prescribed for a client whose blood pressure 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? ANS: Turn off the nitroglycerin infusion. 55. A client who is obtunded arrives in the Emergency Center with a suspected drug overdose. The client becomes responsive after the administration of intravenous naloxone, but within a short period, the client's level of consciousness decreases again and the respiratory rate decreases to 6 breaths per minute. Which action should the nurse take first? ANS: Administer an additional dose of naloxone.

review 2

Before administering a laxative to a bedfast client, it is most important for the nurse to perform what assessment? ans: determine the frequency and consistency of bowel movements A female client with multiple sclerosis reports having less fatigue and improved memory since she began using the herbal supplement, ginkgo biloba. Which information is most important for the nurse to include in the teaching plans for this client? ans: Aspirin and nonsteroidal anti-inflammatory drugs interact with ginkgo In explaining the benefits of the combination anti-infective drug code tri-moxazole/TMP-SMZ (bactrium) to a client receiving the medication for a urinary tract infection, more rationale to the nurse provide? ans: the two drugs work together to reduce resistance of the bacterial infection of symptoms Client being treated with Haldol for schizophrenia is complaining of jaw tightness & a stiff neck. Which interventions should the nurse impliment? ans: give PRN those of diphenhydramine Benadryl Which intervention is most important for the nurse implement for a client is receiving lispro Humalog insulin? ans: provide meals at the same time that insulin is given Client takes nonsteroidal anti-inflammatory drugs every day for rheumatoid arthritis is being treated for anemia which intervention is most important for the nurse to include any plan of care ans: observe for gastrointestinal bleeding A client who is taking an oral dose of tetracycline complains of GI upset. What snack should the nurse instruct the client to take with this medication? ans: Toasted wheat bread and jelly A patient was given a dose of Trimethobenzamide is sedated but easily aroused. What should the nurse do? ans: Allow the patient to rest A client is having an acute asthma attack. What medication to administer? ans: Pirbuterol The nurse is assessing the clinet's INR which is 20. What is the nurse's priority? ans: give vitamin K A client is being educated on benedryl. What is the most important teaching? ans: avoid driving A client complaints about upset stomach when taking Resedronate. What will the nurse ask the client? ans: how does she take the medication How does the nurse know that Kayexalate is effective? ans: K+ 3.8 The nurse assesses a client with intermittent claudication who is receiving pentoxifyline (Trental). Which assessment should the nurse perform to determine the effectiveness of the medication? ans: Monitor numeric pain scale. A female client is receiving rifampin (Rifadin), an antitubercular medication. Which assessment by this client should prompt the nurse to notify the prescriber of a potential problem? ans: Reports sclera are yellow. 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/min, SpaO2 of 75%, and is unable to be aroused. What action should the nurse implement? ans: Administer a second dose of naloxone A client is receiving orlistat (Xenlcal) 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? ans: BMI 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? ans: Explain that this effect reduces serum ammonia levels. Prior to administering morning medications, the nurse assesses a client who is receiving digoxin (Lanoxin) 0.25mg PO, levothyroxine (Synthroid) 0.5mcg PO, and olmesartan hydrochlorothiazide (Benicar HCT) 40/12.5 PO. Which assessment finding indicates that the nurse should withhold one of the morning medication doses? ans: Apical pulse of 52bpm A client receiving filgrastim (Neupogen) reports increasing bone pain. What action should the nurse implement? ans: Administer a prescribed PRN analgesic A Schiz patient on Risperadone making funny body movements...? ans: Give Benzotropine A client is giving himself a self-injection with Epi-pen. The nurse should intervene if ans: Client cleans the Epi-pen for reuse A male client who is currently receiving methadone (Dolophine) 10mg q8hrs reports that his pain is an 8 on a scale of 1 to 10. Which action should the nurse implement? ans: Give the PRN dose of Morphine for break-through pain A client has a prescription for Tamsulosin, what is the priority teaching before administering this medication? ans: Call for assistance when needing to go to the bathroom A patient is scheduled for a CT Scan with contrast. What in the patient's history would cause the nurse to notify the HCP?. ans: The patient takes Metformin A patient in the hospital tells the nurse that she does not want to take her Carafate until after she eats. What should the nurse instruct the patient to do? ans: Explain the importance of taking the medication 1 hour before meals A patient had Succinycholine during surgery. What should the nurse report post op? ans: Ventricular Tachycardia A client has been taking insulin for years. The HCP has prescribed Gargline so what should the nurse teach? ans: Self injections What should the nurse report for a patient taking Cefoxitin? ans: Rash The nurse is evaluating the prescribed medication Prednisolone. The patient reports that she has not seen any improvement by using this medication. What should the nurse anticipate? ans: The HCP to adjust the dosage of the medication A patient is on IV Nitroglycerin suddenly develops a severe headache. What is the nursing first priority? ans: Reevaluate the blood pressure Whats the purpose of Phenazopyridine? ans: Stop the burning... txs symptoms not the infection A patient prescibed Pregamblin presents with Tremors. What should the nurse do? ans: notify the HCP The nurse is monitor labs for a patient who is taking statins. Which lab should the nurse observe? ans: liver enzymes Which data indicate the Epoetin is effective? ans: Hemoglobin is 12 What should the nurse monitor for a patient taking Propythiouracil? ans: Monitor white blood cells What does the nurse need to report after a patient has taken Albuterol? ans: Rapid, irregular heartbeat What's the purpose of Probenicid? ans: Promote excretion of uric acid through the urine A patient has been taking Feverfew which is a herbal. What should the nurse teach the patient about taking herbal medications? ans: May interact with Aspirin and NSAIDs What is a priority when caring for a patient with an Epidural infusion? ans: Monitor O2 with oximeter probe How should a patient use the meterdose inhaler? ans: Activate with a slow deep breath

insulin

Lispro (HumaLog)- rapid acting, onset <15m, peak 30-1hr, duration 3-4hr Regular (Humalin R)- short acting, onset 30-1hr, peak 2-3hr, duration 5-7hr NPH (Novolin N)- intermediate, onset 1-2hr, peak 4-12hr, duration 18-24hr (cloudy appearance) Insulin Glargine (Lantus)- long lasting, onset 2 hr, no peak, duration 24hr SE: tachyca, diupherisis, headache, shaky, weakness, lipohypertrophy

Drip rate

gtts/min, round to nearest whole number

Random Facts

1. antidepressants have anticholinergic SE 2. Miotics....decrease night vision 3. Bactrium...Both of these medications provide a synergistic effect to reduce bacteria 4. vancomycin...can cause acute kidney injury 5. Scopclamine... for n/v 6. verapamil SE...constipation 7. common SE of rivastigmine... Nausea, vomiting, loss of appetite/weight loss, diarrhea, weakness, dizziness, drowsiness, and shakiness (tremor) 8. Glucosamine...decreases pain 9. acetomeniphen poisoning antidote-mucolytic-acetylcysteine 10. codeine- for cough SE:sedation resp depr, constipation, gi upset, dependency

BP, Cardiac

BP meds: ACE inhibitors- end in pril -dry cough high K angioedema ARBs inhibitors- end in sartan -gi upset Calcium Channel Blockers- dilti vera and "pines" -peripheral edema, gingival hyperplasia, constipation, no grapefruit juice alpha 1 blockers- end in zosin beta blockers- ema lol is 1 -selective-ED, cold hands and feet, pst is 2- non selective-not for asthmatics For hypertensive crisis-nitroprusside Cardiac meds: cardiac glycoside - digoxin - toxicity=n/v, vision changes, weakness, fatigue, gi upset hold- <60adults, <70children <90infants

antibiotics

TB- RIPE (Rifampin- hepatoxicity, orange tears/urine normal, gi upset, decrease effect of birth control. Isoniazid- hepatoxicity, risk of neuropathy. Pyrazinamide-hepatoxicity. Ethambutol- changes in vision.) - no alcohol, sputum samples needed 2-4 wks Penicillin SE: less effective birth control Vancomycin SE: Red man syndrome (stop infusion assess airway), very nephrotoxic, hypotension - used when there is a penicillin allergy, check p&t Gentamycin SE: nephrotoxic and ototoxic-tinnitus Ceftriaxone SE: cholecystisis (gallstones), radiating shoulder pain, no alcohol!