HESI-Pharmacological Therapies

A client is to receive an intravenous (IV) antibiotic in 50 mL of 0.9% sodium chloride to be administered over 20 minutes. At what rate should the nurse set the infusion pump? Record your answer using a whole number. mL/hr

150 mL/hr

A client has primary open-angle glaucoma. The nurse expects that the client will receive a prescription for which eye drops? 1. Tetracaine (Pontocaine) 2. Cyclopentolate (Cyclogyl) 3. Timolol maleate (Timoptic) 4. Atropine sulfate (Atropisol Ophthalmic)

3. Timolol maleate Rationale Timolol maleate is a beta-adrenergic antagonist that decreases aqueous humor production and increases outflow, thereby reducing intraocular pressure. Tetracaine is a topical; it will not reduce the increased intraocular pressure associated with glaucoma. Cyclopentolate is contraindicated because it dilates the pupil and paralyzes ciliary muscles. Atropine sulfate, a mydriatic, is contraindicated because it dilates the pupil, obstructing drainage, which increases intraocular pressure

A client with urge incontinence is receiving oxybutynin (Ditropan XL) 30 mg orally. Each tablet contains 5 mg. How many tablets should the nurse administer? Record your answer using a whole number. tablets

6

A nurse is teaching a client how to self-administer a medicated douche. In which direction should the nurse instruct the client to direct the douche nozzle? 1. To the left 2. To the right 3. Toward the sacrum 4. Toward the umbilicus.

3. Toward the sacrum Rationale Toward the sacrum is the anatomic direction of the vaginal tract in the back-lying position. The vaginal tract may be injured if the douche nozzle is directed without consideration of the pelvic anatomy

A nurse assesses a client's intravenous site. What clinical finding leads the nurse to conclude that the intravenous (IV) site has been infiltrated? 0. Redness along the vein 1. Coolness of skin near the insertion site 2. Swelling around the insertion site 3. Cessation in flow of solution 4. Vein feels hard and cordlike

1, 3 Rationale When an IV infiltrates, the IV solution entering the interstitial space is at room temperature (approximately 75° F), whereas body temperature is approximately 98.6° F; therefore, the client's skin will feel cool to the touch at the site of an IV infiltration. In addition, the fluid in the interstitial space causes swelling around the insertion site, and the solution stops flowing. Redness along the vein, with the vein feeling hard and cordlike, is present with phlebitis.

A client comes to the mental health clinic for a monthly intramuscular 37.5 mg fluphenazine decanoate injection. Fluphenazine decanoate is available 25 mg/mL. How many milliliters of solution should the nurse administer? Record your answer using one decimal place.

1.5 mL

A nurse is caring for a client who is scheduled to have an abdominal perineal resection for colorectal cancer. A type and cross match is done because of a concern about blood loss. The client has type B-negative blood. The blood type that can be used for this client is 1. A positive 2. B negative 3. O negative 4. AB positive

2. B negative Rational: B negative is the same as the client's blood type and is preferred; only in an emergency will type O-negative blood be given. Irrespective of blood type, Rh-positive blood is incompatible with the client's blood and will cause hemolysis if it is transfused. Although O-negative blood can be used in an emergency, it is not the preferred blood type in an elective situation.

A nurse is teaching the parents of a school-aged child with attention deficit-hyperactivity disorder (ADHD) about the prescribed medication methylphenidate (Ritalin). When should the daily dose be administered? 1. When the child arrives at school 2. Just after breakfast 3. Immediately before lunch 4. When the child arrives home from school

2. Just after breakfast Rationale Methylphenidate (Ritalin) should be given just after breakfast to avoid appetite suppression. Giving the medication when the child arrives at school or immediately before lunch would not allow enough time for the medication to be effective during school hours. Giving the medication when the child arrives home from school would not allow the medication to be effective during school hours, and would likely interfere with the child's sleep times.

After surgery for cancer, a client is to receive chemotherapy. When teaching the client about the side effects of chemotherapy, the nurse emphasizes that the occurrence of alopecia is: 1. Usually rare 2. Not permanent 3. Frequently prolonged 4. Sometimes preventable

2. Not permanent Rational: Once the drugs that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the drugs are being received; once the drugs are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.

In conjunction with which classification of medication are trihexyphenidyl, biperiden (Akineton), and benztropine (Cogentin) often prescribed? 1.Anxiolytics 2. Barbiturates 3. Antipsychotics 4. Antidepressants

3. Antipsychotics Rationale Antipsychotics are used to control the extrapyramidal (parkinsonian) symptoms that often develop as a side effect of antipsychotic therapy. There is no documented use of anxiolytics with antianxiety agents because they do not have extrapyramidal side effects. Barbiturates do not have extrapyramidal side effects that respond to these drugs. Antiparkinsonian drugs usually are not prescribed in conjunction with antidepressants because antidepressants do not cause parkinsonian symptom

A nurse is caring for a client who is receiving IV magnesium sulfate for preeclampsia. At 37 weeks' gestation she gives birth to an infant weighing 4 lb. What clinical finding in the newborn may indicate magnesium sulfate toxicity? 1. Pallor 2. Tremor 3. Hypotonia 4. Tachycardia Rationale Hypotonia occurs with magnesium sulfate toxicity because of skeletal and smooth muscle relaxation. Pallor, tremor, and tachycardia are not signs of magnesium sulfate toxicity.

3. Hypotonia Rationale Hypotonia occurs with magnesium sulfate toxicity because of skeletal and smooth muscle relaxation. Pallor, tremor, and tachycardia are not signs of magnesium sulfate toxicity.

A client had an abdominal cholecystectomy. Postoperatively, the client refuses to deep breathe and cough, saying, "It's too painful." The nurse should: 1. Give pain medication regularly as soon as possible 2. Obtain a prescription to increase the client's pain medication 3. Medicate the client for pain before coughing and deep breathing 4. Substitute incentive spirometry for coughing and deep breathing

3. Medicate the client for pain before coughing and deep breathing Rationale Analgesics limit pain, facilitating effective coughing and deep breathing. Although giving pain medication regularly may be necessary, it must be coordinated with the deep breathing and coughing exercises. Opioids depress the central nervous system (CNS), particularly respirations, and increasing the dose should be an option only after other interventions have been unsuccessful. Incentive spirometry will cause pain because it increases intraabdominal pressure, and the client may not cooperate if pain is not relieved.

A nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication should the nurse expect to be prescribed for this client on the day of surgery and in the immediate postoperative period? 1. Methimazole (Tapazole) 2. Pituitary extract (Pituitrin) 3. Regular insulin (Novolin R) 4. Hydrocortisone succinate (Solu-Cortef)

4. Hydrocortisone succinate (Solu-Cortef) Rationale Hydrocortisone succinate is a glucocorticoid. A client undergoing bilateral adrenalectomy must be given adrenocortical hormones so that adjustment to the sudden lack of these hormones that occurs with this surgery can take place Methimazole is used to treat a client with hyperthyroidism, not a client with a bilateral adrenalectomy. Because the surgery involves the adrenal glands, not the pituitary gland, secretion of pituitary hormones will not be affected. Regular insulin is not necessary. Insulin is produced by the pancreas, and its function is not altered by this surgery.

The nurse is caring for a client who has just received epidural anesthesia. Which finding would be of most concern? <p>The nurse is caring for a client who has just received epidural anesthesia. Which finding would be of most concern?</p> Tachycardia Hypotension Decreased urine production Precipitous second stage of labor

BP Rationale lowers the blood pressure, which puts both mother and fetus in jeopardy. Blood pressure, not the heart rate, is affected first. The client may not have the sensation to void, but the amount of urine in the bladder does not decrease, because a regional block does not affect the kidneys. Epidural anesthesia does not shorten the second stage of labor.

A nurse attempts to give a client with chronic arterial insufficiency of the legs the prescribed dose of aspirin (ASA). The client refuses it, stating, "My legs are not painful." The nurse should: 1. Explain the reason for the medication and encourage the client to take it 2. Withhold the medication and tell the client to ask for it if the legs become uncomfortable 3. Withhold the medication at this time and return to check with the client again in 30 minutes 4. Request that the client take the medication and explain that it prevents the client from being uncomfortable in the next few hours

1. Explain the reason for the medication and encourage the client to take it Rationale Aspirin is given to the client to prevent platelet aggregation and possible deep vein thrombosis. The client needs information to make an educated decision. Aspirin is not prescribed to relieve pain. The client should receive information and support before making the decision to refuse the medication. Clients should never be pressured to take medication, especially when they do not have an understanding of the risks and benefits of the medication.

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin (Coumadin). Which clinical adverse effect should the nurse identify as a reason for the client to seek medical consultation? 1. Presence of blood in urine 2. Increased swelling of the ankles 3. Diminished ability to concentrate 4. Occurrence of transient ischemic attacks

1. Presence of blood in urine Rationale Warfarin causes an increase in the prothrombin time and international normalized ratio (INR) level, leading to an increased risk for bleeding. Any abnormal or prolonged bleeding must be reported, because it may indicate an excessive level of the drug. Increased swelling of the ankles, diminished ability to concentrate, and occurrence of transient ischemic attacks are not signs of bleeding, the primary concern with warfarin

The nurse administers the prescribed vitamin K intramuscularly to a newborn immediately after birth to: 1. Promote the synthesis of prothrombin 2. Facilitate the growth of intestinal flora 3. Limit an increase in the serum bilirubin level 4. Decrease the level of calciferol until the kidneys have matured

1. Promote the synthesis of prothrombin Rational: Vitamin K stores are almost absent in the newborn because the intestinal flora that produce this vitamin are not present; vitamin K is an essential precursor of prothrombin, which is part of the clotting mechanism. The intestinal flora develop as the newborn is exposed to extrauterine living conditions. An increased serum bilirubin level may occur in the newborn because of the rapid breakdown of red blood cells and the immature liver's inability to conjugate such large amounts; it is not related to vitamin K. A newborn's kidneys operate at a functional level appropriate to the needs of a healthy newborn, and kidney maturity and calciferol are not related to vitamin K

A young adult client with schizophrenia is prescribed haloperidol (Haldol). When the nurse administers the medication, the client asks, "What's this for?" The nurse responds that the medication: 1. Will help him relax and think more clearly 2. Fights "the blues" and helps keeps thoughts together 3. Maintains an even mood and will control his temper 4. Will raise his seizure threshold by letting him think more clearly Rationale Stating that the medication will help the client to relax and think more clearly is an accurate and concise explanation of the effects of haloperidol (Haldol); it blocks postsynaptic dopamine receptors in the brain. Haloperidol lowers, not increases, the seizure threshold. Haloperidol is a neuroleptic; it does not alter mood.

1. Will help him relax and think more clearly Rationale Stating that the medication will help the client to relax and think more clearly is an accurate and concise explanation of the effects of haloperidol (Haldol); it blocks postsynaptic dopamine receptors in the brain. Haloperidol lowers, not increases, the seizure threshold. Haloperidol is a neuroleptic; it does not alter mood.

A client receiving the medication buspirone hydrochloride (Buspar) is admitted to the hospital with the diagnosis of possible hepatitis. The nurse identifies that the client's sclerae look yellow. What should be the nurse's initial action? 1.Withhold the medication 2. Give the Buspar with milk 3. Reduce the dosage of the medication 4. Ensure that the medication can be given parenterally

1. Withhold the medication Rationale The medication should be stopped immediately because jaundice indicates possible liver damage, which prolongs elimination of the drug and may result in toxic accumulation. Milk does not change the effect of the drug. The drug must be stopped, not reduced. The drug is available only in an oral form; in addition, the route of administration will not influence the occurrence of toxic accumulation.

A client has been in an acute care psychiatric unit for 3 days and is receiving haloperidol (Haldol) tablets orally to reduce agitation and preoccupation with auditory hallucinations. There has been no decrease in the client's agitation or preoccupation with auditory hallucinations since the medication was started. What should the nurse's priority intervention be? 1. Asking the health care provider to change the medication 2. Making certain that the client is swallowing the medication 3. Concluding that a therapeutic level of the drug has not been achieved 4. Securing a prescription for as-needed sedation until the client calms down

2. Making certain that the client is swallowing the medication Rationale Because the medication is being taken orally, the client may be pocketing the tablet in the buccal cavity and discarding it later; the nurse must check to ensure that the administered medication is swallowed. Asking the health care provider to change the medication, may not be a response failure. If the client is swallowing the medication, this may be necessary; the nurse first should ensure that the medication is swallowed. This medication reaches a peak of action in 3 to 5 hours.

A school-aged child with a seizure disorder is to start taking divalproex (Depakote). What should the nurse teach the parents about caring for their child in regard to this medication? 1. Crush the tablets and mix them with applesauce 2. Take the child for regularly scheduled blood tests 3. Stop the medication immediately if a rash develops 4. Provide oral hygiene, especially gum massage and flossing

2. Take the child for regularly scheduled blood tests Rationale Adverse reactions to divalproex include thrombocytopenia, leukopenia, and lymphocytosis; blood studies must be performed on a regular basis. Tablets must be swallowed whole; they should not be broken, crushed, or chewed. If the medication is stopped suddenly a seizure may result; a rash should be reported to the practitioner. Meticulous oral hygiene is more important for a child who is taking phenytoin (Dilantin).

A client in her 30th week of gestation is in preterm labor, and the practitioner prescribes betamethasone (Celestone). The client asks the nurse why she is being given this drug. As a basis for the response the nurse takes into consideration that it: 1. Prevents chorioamnionitis 2. Increases uteroplacental exchange 3. Promotes neonatal pulmonary maturity 4. Is used to treat fetal respiratory distress syndrome

3. Promotes neonatal pulmonary maturity Rationale (Celestone), a corticosteroid, accelerates lung maturity and reduces intravascular hemorrhage and necrotizing enterocolitis in the preterm neonate if given 24 hours before birth. Chorioamnionitis is treated with antibiotic therapy; this problem may occur if the membranes rupture prematurely and birth does not occur within 24 hours. Corticosteroids do not have an effect on uteroplacental exchange. Respiratory distress syndrome (RDS) develops in the neonate, not the fetus; if betamethasone is given to the mother 24 hours before a preterm birth, the severity and incidence of RDS in the neonate should decrease

What should the nurse explain to a newly pregnant client with cardiac disease? 1. Palpitations are expected as pregnancy progresses. 2. Other cardiac medications will be substituted for digoxin. 3. It is not safe to administer prophylactic penicillin during pregnancy. 4. Maintenance dosages of cardiac medications will probably be increased.

4. Maintain everything dosages of cardiac medications will probably be increased Rationale During the second and third trimesters blood volume and cardiac output increase, placing a greater workload on the heart. Women with preexisting heart disease may require larger doses of cardiac medication to prevent cardiac decompensation. Palpitations may occur when the heart rate reaches 120 beats/min. A heart rate of more than 100 beats/min may be an indicator of cardiac decompensation; further assessment and treatment are required. Digoxin (Lanoxin) is a category C medication and is prescribed during pregnancy. Penicillin is a category B medication and is relatively safe to take during pregnancy.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy: 1. Is the easiest method for administering needed nutrition 2. Is the safest method for meeting the client's nutritional requirements 3. Will satisfy the client's hunger without the discomfort associated with eating 4. Will meet the client's nutritional needs without causing the discomfort precipitated by eating

4. Will meet the clients nutritional needs without causing the discomfort precipitated by eating Rational: Providing nutrients by the intravenous route eliminates pancreatic stimulation, therefore reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.

The nurse prepares to give a prescribed capsule of hydroxyzine (Vistaril) to a client. The client begins to vomit so the nurse holds the oral medication. The nurse has not opened the medication package. Proper and safe disposal of the capsule of hydroxyzine requires the nurse to: 1. Drop the capsule into the sharps container 2. Crush the capsule and flush it into the sewer system 3. Place the capsule into a red biohazard bag and tie it shut 4. Return the capsule to the pharmacy

Rationale Medication taken from a stock supply cannot be returned; it should be returned to the pharmacy for safe disposal. The purpose of a sharps container is for safe disposal of sharp objects; a tablet dropped into a sharps container can be retrieved. Wasted medications should not be disposed of through the sewer system because this can contaminate underground water sources. Placing the tablet into a biohazard bag does not render it unusable.

Pyridostigmine (Mestinon) is prescribed for a client with myasthenia gravis. The primary reason that the nurse instructs the client to take pyridostigmine about one hour before meals is to: 1. Limit the appetite 2. Promote absorption 3. Prevent gastric irritation 4. Increase chewing strength

Rationale Peak action of the medication will occur during meals to promote chewing and swallowing and prevent aspiration. It should be given with a small amount of food to prevent gastric irritation. Pyridostigmine improves muscle strength; it does not affect appetite. Absorption is not affected significantly by the presence of food in the stomach. Gastric irritation is reduced best by the administration of drugs with food, not on an empty stomach.