HESI PHARM REVIEW

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." B. "If your acne gets worse, stop the medication and call the health care provider." C. "Take a daily multiple vitamin to prevent deficiencies and promote dermal healing." D. "Dermabrasion for deep acne scars should be postponed for 1 month after therapy is stopped." 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."

Rationale: (A, E, and F) are correct. Isotretinoin (Accutane) has been found to cause pregnancy category D drug-related birth defects, premature births, and fetal death (A), which necessitates the use of effective birth control methods before, during, and after therapy (F). Accutane is associated with sadness (E), depression, suicidal ideations, and other serious mental health problems. An initial exacerbation of acne (B) is common when starting drug therapy. Accutane is a retinoid related to vitamin A, and taking additional multivitamin supplements (C) can predispose the client to vitamin A toxicity. The client should stop taking Accutane at least 6 months before cosmetic procedures, such as dermabrasion (D), because the drug can increase the chances of scarring.

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? A. Maintain a drug administration record. B. Fill all prescriptions at one pharmacy. C. Allow one person to give the medications. D. Give all medications in small volumes.

A written drug administration record (A) provides a consistent plan to ensure safe adherence to multiple medication dosages and times. Although (B) is an important safeguard to monitor for drug interactions, the parents should be given a tool to enhance their confidence and provide a mechanism to ensure accurate and timely medication administration without duplicating or omitting a dose. Using a written record to record medication administration allows more than one person (C) to share the responsibility of giving medications to the child. Although smaller volumes (D) ensure that all the medication is taken, it is more important to maintain an accurate administration schedule.

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? A. Administer the medication in the morning before the child goes to school. B. Plan to implement periodic interruptions in the administration of the drug. C. Attempt to be consistent when setting limits on inappropriate behavior. D. Seek professional counseling if the child's behavior continues to be disruptive.

Concerta, a central nervous system (CNS) stimulant, is an extended-release tablet. To be most effective in affecting the child's behavior, the drug should be administered in the morning before the child goes to school (A). Drug holidays (B) are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time. (C and D) are worthwhile instructions but do not have the priority of (A).

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? A.20 B.24 C.60 D.120

D is the correct calculation; 120 mL/hr = 1 mL/2 mg × 4 mg/min × 60 min/hr.

Alteration of which laboratory finding represents the achievement of a therapeutic goal for heparin administration? A.Prothrombin time (PT) B.Fibrin split products C.Platelet count D.Partial thromboplastin time (PTT)

Heparin therapy is guided by changes in the partial thromboplastin time (PTT) (D). (A, B, and C) are not used to track the therapeutic effect of heparin administration.

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? A. Naloxone hydrochloride (Narcan) B. Atropine sulfate (Atropair) C. Vitamin K (AquaMEPHYTON) D. Flumazenil (Romazicon)

Naloxone is an opioid antidote used in opioid overdose (A) to reverse CNS and respiratory depression. Atropine (B) is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K (C) is used to manage warfarin overdose and vitamin K deficiency in newborns. Flumazenil (D) reduces the sedative effects of benzodiazepines following general anesthesia or overdose.

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? A. Take the drug as prescribed to cure HIV infections. B. Use the drug to reduce the risk of transmitting HIV to sexual contacts. C. Return to the clinic every 2 weeks for blood counts. D. Report to the health care provider immediately if dizziness is experienced.

Rationale: Bone marrow depression with granulocytopenia is a severe but common adverse effect of zidovudine (Retrovir). Careful monitoring of CBCs is indicated (C). (A and B) are not correct instructions related to use of this medication. (D) is an expected side effect. The client should be instructed to avoid driving until this reaction improves.

A client is receiving pyridostigmine bromide (Mestinon) to control the symptoms of myasthenia gravis. Which client behavior would indicate that the drug therapy is effective? A. Decreased oral secretions B. Clear speech C. Diminished hand tremors D. Increased ptosis

Rationale: Clear speech (B) is the result of increased muscle strength. Muscle weakness characteristic of myasthenia gravis often first appears in the muscles of the neck and face. (A and D) are symptoms of multiple sclerosis that would persist if the medication was ineffective. Hand tremors (C) are not typical symptoms of the disease.

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? A. Albuterol (Proventil) B. Theophylline (Theo-24) C. Metaproterenol (Alupent) D. Atropine sulfate (Atropine)

Rationale: Clients who have experienced allergic reactions to atropine sulfate (Atropine) (D) and belladonna alkaloids may also be allergic to ipratropium (Atrovent), so the prescription for Atrovent should be questioned. Allergies to (A, B, and C) would not cause the nurse to question a prescription for ipratropium (Atrovent).

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. B.Take the medication at 0800, 1500, and 2200 hours. C.Protect skin from natural and artificial ultraviolet light. D.Avoid driving until response to medication is known. E.Take with an antacid tablet to prevent nausea. F.Use a nonhormonal method of contraception if sexually active.

Rationale: Correct selections are (A, C, D, and F). Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge (A), protect the skin from ultraviolet light (C), and use a nonhormonal method of contraception (F) while on the medication. Minocycline (Minocin) is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving (D) should be avoided. Tetracyclines should be taken around the clock (B) but exhibit decreased absorption when taken with antacids, so (E) is contraindicated.

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? A. Vincristine (Oncovin) B. Bleomycin sulfate (Blenoxane) C. Chlorambucil (Leukeran) D. Cyclophosphamide (Cytoxan)

Rationale: Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide (Cytoxan) (D). Administration of (A, B, and C) does not typically cause hemorrhagic cystitis.

Dopamine (Intropin) is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure

Rationale: Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output (B) indicates an increase in glomerular filtration caused by increased arterial blood pressure. (A) is related to fluid retention but is not an indicator of a therapeutic response to dopamine therapy. (C) is not related to the vasopressor effect of dopamine therapy. Dopamine increases cardiac output, which increases a client's blood pressure, not (D).

Which assessment datum indicates to the nurse that a dose of granisetron (Kytril) administered IV prior to chemotherapy has had the desired effect? A. Oral mucosa pink and intact B. Scalp intact without alopecia C. Client denies nausea D. Client denies pain

Rationale: Kytril is an antiemetic administered before chemotherapy to prevent chemotherapy-induced nausea and vomiting (C). Chemotherapy can cause oral sores (A), but Kytril does not prevent this problem. Kytril does not affect (B or D).

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? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.

Rationale: Maintaining optimal dosage for cholinesterase inhibitors can be challenging for clients with myasthenia gravis. Clients should be taught to recognize signs of overmedication and undermedication so that they can modify the dosage themselves (D) based on a prescribed sliding scale. (A, B, and C) do not adequately address the client's concerns.

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? A. Assess for deep tendon reflexes. B. Observe urinary output. C. Review the medication administration record (MAR). D. Administer naloxone (Narcan).

Rationale: Most general anesthetics produce cardiovascular and respiratory depression, so a review of the client's MAR identifies all the medications (C) received during surgery and helps the nurse anticipate the client's response and emergence from anesthesia. (A and B) are ongoing postoperative assessments. Based on the medications that the client has received, (D) may need to be administered if indicated by the client's vital signs and delayed spontaneous reactivity.

A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital (Luminal) elixir prescribed for his brother's seizure disorder. Which nursing intervention should the nurse implement first? A. Administer syrup of ipecac. B. Take the child's vital signs. C. Draw a blood specimen for a phenobarbital level. D. Teach the mother safe medication storage practices.

Rationale: Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs (B). (A, C, and D) are actions that may all be used in the treatment of this child, but they do not have the priority of (B).

A client is receiving oral griseofulvin (Grisactin) for a persistent tinea corporis infection. Which response by the client indicates an accurate understanding of the drug teaching conducted by the nurse? A. "I'll wear sunscreen whenever I mow the lawn." B. "This is the worse bacterial infection I've ever had." C. "I will need to take the medication for 7 days." D. "My urine will probably turn brown due to this drug."

Rationale: Photosensitivity is a side effect of griseofulvin (Grisactin), so clients should be cautioned to wear protective sunscreen during sun exposure (A). (B, C, and D) are not accurate statements about side effects of this medication.

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin (Mevacor). Which client statement indicates that further teaching is needed? A. "My bowel habits should not be affected by this drug." B. "This medication should be taken once a day only." C. "I will still need to follow a low-cholesterol diet." D. "I will take the medication every day before breakfast."

Rationale: The enzyme that helps metabolize cholesterol is activated at night, so this medication should be taken with the evening meal (D). (A, B, and C) reflect correct information about lovastatin.

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? A.Hold the theophylline dose and notify the health care provider. B.Start the client on a half-dose of theophylline PO. C.The theophylline dose can be initiated as planned. D.The client is not ready to be weaned from the IV to the PO route.

Rationale: The therapeutic range for theophylline is 10 to 20 mcg/mL, so the theophylline dose should be held for fear of causing toxicity (A). (B, C, and D) are not indicated actions based on the reported theophylline level.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A.Verify the expiration date. B.Obtain the client's blood pressure. C.Determine the client's history of adverse reactions. D.Review the client's medical record for a change in drug route.

Rationale: To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring (B). Although (A, C, and D) are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered.