HESI pharm practice test 1

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

A 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.

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

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).

Use an additional form of contraception until your menstrual cycle Cephlasporins such as cefadroxil can decrease the efficacy of oral contraceptives, so the client should be instructed to use an additional form of contraception.

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.

Stimulates fetal surfactant production Antenatal glucocorticoids, such as betamethasone (Celestone), are given IM to the mother to stimulate surfactant production in the fetus and accelerate fetal lung maturity, in the event the fetus is delivered prematurely to minimize respiratory distress syndrome associated with premature infants.

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.

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

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.

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

A client 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.

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

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.

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

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.

Take the medication at least 30 minutes before eating meals The nurse should instruct the client to take the medication 30 minutes before meals with an empty stomach, which allows for the onset of action and therapeutic effects to be present during the meal to help improve swallowing and chewing. The doses should also be spaced evenly apart to optimize the effects of the medication.

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.

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

A client 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.

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

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

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

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

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

A 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.

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

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.

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

The 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.

Clarithromycin (Biaxin) Omeprazole (Prilosec) Metronidazole (Flagyl) Recommended medical treatment for Helicobacter pylori includes the use of at least 2 different antibiotics and a proton pump inhibitor to decrease the incidence of antibiotic resistance.

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) Clarithromycin (Biaxin) Sulfisoxazole (Gantrisin) Misoprostol (Cytotec) Omeprazole (Prilosec) Metronidazole (Flagyl) Sucralfate (Carafate)

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

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

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

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

Inhibiting aqueous humor production Beta-blockers are used to inhibit aqueous humor production, with the goal is to reduce intraocular pressure.

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

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. Sildenafil (Viagra) enhances the natural response to sexual stimuli, so a client should be instructed to take Viagra within 30 to 60 minutes before sexual intercourse to provide adequate time to enhance penile erection. Sildenafil does not cause erection directly, but priapism can occur and should be reported to the healthcare provider if it persists. Common side effects include headaches, facial flushing, and diarrhea. Viagra can potentiate vasodilators, such as alpha-adrenergic blockers, nitroglycerin, and other nitrates used for angina pectoris, and may cause hypotension, which decreases perfusion to vital organs.

What teaching should the nurse provide a client who has received a new prescription for sildenafil (Viagra)? (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.

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

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.

Amiodarone Based on the Tachycardia Algorithm, amiodarone is the drug of choice for acute ventricular dysrhythmias associated with myocardial infarction (C). (B) is not indicated. (A and D) are used for supraventricular tachyarrhythmias.

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

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

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

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

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

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

Which side effects should the nurse monitor for a client who is receiving dexamethasone (Decadron) following neurosurgery? (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.