Pharmacology HESI Comprehensive Review

A client receives a prescription for theophylline (Theo-Dur) PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse implement?

Hold the theophylline dose and notify the health care provider.

The health care provider prescribes the H2 antagonist famotidine (Pepcid), 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime?

Hydrochloric acid secreted during the night is blocked.

A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate (Brethine) continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery?

Hypoglycemia

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is a standing order. Which finding should the nurse report to the health care provider?

Hypokalemia

In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen?

Hypotension

A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug?

Improves nerve impulse transmission

A client is receiving acyclovir sodium (Zovirax) IV for a severe herpes simplex infection. Which intervention should the nurse implement during this drug therapy?

Increase daily fluids to 2000 to 4000 mL/day.

Dopamine (Intropin) is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response?

Increase in urine output

A client taking linezolid (Zyvox) at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. Which intervention should the nurse implement?

Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis.

The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level?

Instruct the laboratory to draw the trough immediately before the next scheduled dose.

A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client?

Isoniazid (INH)

During therapy with isoniazid (INH), it is most important for the nurse to monitor which laboratory value closely?

Liver enzyme levels

When caring for a client on digoxin (Lanoxin) therapy, the nurse knows to be alert for digoxin (Lanoxin) toxicity. Which finding would predispose this client to developing digoxin toxicity?

Low serum potassium level

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens?

Maintain a drug administration record.

A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure?

Midazolam (Versed) IV

A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide?

Multiple drugs prevent the development of resistant organisms.

The health care provider prescribes carbamazepine (Tegretol) for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother?

Myelosuppression

The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose?

Naloxone hydrochloride (Narcan)

The nurse is reviewing prescribed medications with a female client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose that she received during hospitalization. Which response is best for the nurse to provide?

Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.

Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration?

Partial thromboplastin time (PTT)

A male client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond?

Pharmacodynamic tolerance requires increased drug levels to achieve the same effect.

Which physiologic mechanism explains a drug's increased metabolism that is triggered by a disease process?

Pharmacokinetics

In administering the antiinfective agent chloramphenicol (Chloromycetin) IV to a client with bacterial meningitis, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor?

Platelet count

Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect?

Psychological response to inert medication

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. These findings are consistent with which client response that requires immediate action?

Severe acute anaphylactic response

A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline (Elavil) in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline (Elavil)?

Sodium bicarbonate

During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride (Sumycin) for urethritis. Which medication taken concurrently with Sumycin could interfere with its absorption?

Sucralfate (Carafate)

The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client?

Take one pill at the same time every day until all the pills are gone.

A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan?

Take one tablet at the onset of angina and stop activity.

The nurse knows that certain antipsychotic drugs cause extrapyramidal symptoms. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration?

Tardive dyskinesia

A client who is receiving chlorpromazine HCl (Thorazine) to control his psychotic behavior also has a prescription for benztropine (Cogentin). When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine (Cogentin) in the treatment plan for this client?

The benztropine (Cogentin) is used to control extrapyramidal symptoms.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization?

Vastus lateralis

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement?

Compare the client's blood pressure before and after the client takes the medication.

A client with mild parkinsonism is started on oral amantadine (Symmetrel). Which statement accurately describes the action of this medication?

Dopamine in the central nervous system is increased.

A female client is receiving tetracycline (Vibramycin) for acne. Which client teaching should the nurse include?

Oral contraceptives may not be effective.

A client is being discharged with a prescription for sulfasalazine (Azulfidine) to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge?

Drink eight glasses of fluid a day.

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications?

75-year-old woman with liver disease

Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate (Garamycin)?

"Are you having difficulty hearing?"

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin (Mevacor). Which client statement indicates that further teaching is needed?

"I will take the medication every day before breakfast."

The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium (Synthroid). Which instruction should be included?

"Take your pulse daily, and if it exceeds 100 beats/min, contact the health care provider."

A lidocaine IV infusion at 4 mg/min via infusion pump is prescribed for a client having premature ventricular contractions (PVCs). The available premixed infusion contains 2 mg/mL of D5W. How many milliliters per hour should the nurse program the pump to deliver to this client?

120

A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL. How many mL should be administered?

2.2 mL

Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose?

20

Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin (Accutane) for acne vulgaris? (Select all that apply.)

A. "Notify the health care provider immediately if you think you are pregnant." E. "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." F. "Before, during, and after therapy, two effective forms of birth control must be used at the same time."

Minocycline (Minocin), 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.)

A. Report vaginal itching or discharge. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. F. Use a nonhormonal method of contraception if sexually active.

The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin (Aggrenox) PO. The nurse notes that the client's carotid bruit is louder than previously assessed. Which action should the nurse implement?

Administer the prescribed dose of Aggrenox as scheduled.

A female client who has started long-term corticosteroid therapy tells the nurse that she is careful to take her daily dose at bedtime with a snack of crackers and milk. Which is the best response by the nurse?

Advise the client to take the medication in the morning, rather than at bedtime.

Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin?

Activated partial thromboplastin time (aPTT)

The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse implement?

Administer the drug if the solution's reconstitution time is less than 24 hours.

Methylphenidate HCl (Concerta) is prescribed for daily administration to a 10-year-old child with attention deficit-hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents?

Administer the medication in the morning before the child goes to school.

A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my daughter a half-ounce." The nurse sees that the bottle contains loperamide (Imodium AD). Which intervention is most important for the nurse to implement initially?

Ask the mother when the child last voided.

A client with Tourette's syndrome takes haloperidol (Haldol) to control tics and vocalizations. The client has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take?

Assess for poor skin turgor, sunken eyeballs, and concentrated urine output.

The health care provider prescribes ipratropium (Atrovent) for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for Atrovent?

Atropine sulfate (Atropine)

The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption?

Avoid abraded skin areas when applying the anesthetic.

A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole (Flagyl). Which instruction is most important for the nurse to include this client's teaching plan?

Avoid alcohol consumption.

The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions?

Avoid ingesting any alcohol or acetaminophen (Tylenol).

Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin (Dilantin) for seizure control?

Brush and floss teeth daily.

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering?

Butorphanol (Stadol)

Which assessment datum indicates to the nurse that a dose of granisetron (Kytril) administered IV prior to chemotherapy has had the desired effect?

Client denies nausea

Which factor is most important to ensure compliance when planning to teach a client about a drug regimen?

Client education

A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (Effexor XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client?

Contact the health care provider for another form of medication.

The health care provider has prescribed a low-molecular-weight heparin, enoxaparin (Lovenox) prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement?

Contact the health care provider to clarify the prescription.

When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this intervention?

Cyclophosphamide (Cytoxan)

A chemotherapeutic regimen with doxorubicin HCl (Adriamycin) is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment?

Electrocardiogram (ECG)

Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective?

Decrease in level of chest pain

A client with viral influenza is receiving vitamin C, 1000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate?

Decrease the dose of vitamin C.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl (Reglan). Which assessment finding would require immediate intervention by the nurse?

Demonstrates Parkinson's-like symptoms, such as cogwheel rigidity

An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first?

Determine the drug's serum levels for toxicity.

Which intervention is most important for a nurse to implement prior to administering atropine PO?

Determine the presence of 5 to 35 bowel sounds/min.

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse implement?

Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.

The health care provider prescribes the anticonvulsant carbamazepine (Tegretol) for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs?

Develops a sore throat

A client experiencing dysrhythmias is given quinidine (Quinidex), 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication?

Diarrhea

Which medication is useful in treating digoxin (Lanoxin) toxicity?

Digoxin immune Fab (Digibind)

A client who is HIV-positive is receiving epoetin alfa (Epogen) for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider?

Hematocrit (HCT) of 58%

A child is being treated with mebendazole (Vermox) for pinworms. Which type of diet should the mother be instructed to feed the child while the child is receiving this medication?

High-fat diet

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan?

Risk for infection

A client who is hypertensive receives a prescription for hydrochlorothiazide (HCTZ). When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report?

Fatigue and muscle weakness

A 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. Which drug might work best for this particular client?

Fluphenazine decanoate (Prolixin decanoate)

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of Alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs?

Give pancrelipase (Cotazym-S) capsule mixed with applesauce before each meal.

Prior to administering a scheduled dose of digoxin (Lanoxin), the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse implement?

Give the dose of digoxin if the client's heart rate is within a safe range.

The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate (Rheumatrex) to a client diagnosed with rheumatoid arthritis. Which intervention is most important to implement prior to administering this medication?

Have another nurse check the prescription.

A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection?

Neutrophil count

A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide?

Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV.

A client with metastatic cancer who has been receiving fentanyl (Duragesic) for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which intervention should the nurse initiate?

Notify the health care provider of the need to increase the dose.

The apical heart rate of an infant receiving digoxin (Lanoxin) for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first?

Obtain a serum digoxin level.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication?

Obtain the client's blood pressure.

When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan?

Offer the child the medication before the child eats breakfast and after the child eats lunch.

The nurse is preparing to administer amphotericin B (Fungizone) IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication?

Serum potassium level

A client receives pancuronium (Pavulon), a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication?

Renal insufficiency

A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine (Colcrys) USP, 1 mg PO daily. Which information is most important for the nurse to provide the client?

Report any vomiting to the clinic.

An older client who had a colon resection yesterday is receiving a constant dose of hydromorphone (Dilaudid) via a patient-controlled analgesia (PCA) pump. Which assessment finding is most significant and requires that the nurse intervene?

Respirations decrease to 14 breaths/min.

A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine (Retrovir). Which instruction should the nurse include in this client's teaching plan?

Return to the clinic every 2 weeks for blood counts.

A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse implement first?

Review the medication administration record (MAR).

Methenamine mandelate (Mandelamine) is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective?

The frequency of urinary tract infections decreases.

A 45-year-old female client is receiving alprazolam (Xanax) for anxiety. Which client behaviors would indicate that the drug is effective?

The staff observes the client sitting in the day room reading a book.

A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase (Activase). The nurse would be correct in providing which explanation to the client regarding the purpose of this drug?

This drug is a clot buster that dissolves clots within a coronary artery.

A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia?

Transdermal

A client with chronic gouty arthritis is talking allopurinol (Zyloprim), 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome?

Uric acid level

The health care provider prescribes cisplatin (Platinol) to be administered in 5% dextrose and 0.45% normal saline with mannitol (Osmitrol) added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the Osmitrol therapy?

Urine output

A psychiatric client is discharged from the hospital with a prescription for haloperidol (Haldol). Which instruction should the nurse include in the discharge teaching plan for this client?

Use sunglasses and sunscreen when outdoors.