HESI PHARMACOLOGY
"I wonder if I will have to stop taking my diuretic for my kidney problem."
An elderly female client who is starting a pain management program using opioid analgesia receives a prescription for codeine 10 mg PO q4 hours PRN for pain, or codeine 15 mg PO q4 hours PRN for pain, or codeine 30 mg PO q4 hours PRN for pain. Which statement by the client is most important to consider when deciding on the dose to administer at this time?
Withhold the dose of digoxin. Rationale Since digoxin has a narrow therapeutic index (serum ranges between 0.5 and 0.8 ng/ml), toxicity can occur at levels greater than 2.0 ng/ml, and the dose should be withheld (B), even if no other symptoms are present. Giving the medication (A) contributes to worsening the condition. Obtaining a blood pressure (C) and determining the client's mental status (D) provide useful information, but the digoxin should be withheld.
An older client who is receiving digoxin (Lanoxin) 0.25 mg PO at 0800 has an apical pulse of 68 beats/minute and respirations of 16 breaths/minute. The practical nurse (PN) identifies that the client's serum digoxin level is 3.2 ng/ml. What action should the practical nurse implement?
Serum blood glucose. Rationale: A side effect of large doses of steroids can cause in elevation in the serum glucose levels, so the PN should monitor the client's serum glucose (A). (B, C, and D) are not affected by the administration of corticosteroids.
A client is hospitalized with an asthma exacerbation and is being treated with methylprednisolone (Solu-Medrol) 125 mg q6 hours. Which laboratory value should the practical nurse (PN) to monitor?
Remove the patch at 1930. Rationale A transdermal nitroglycerin patch is replaced daily and should be removed after 12 to 14 hours to prevent tolerance to the drug (A). The PN should note that the patch is in place during nursing assessments until it is time for removal in 12 hours, not (B). Transdermal patches provide sustained release of the drug and are applied once per day, not (C). (D) is not indicated.
A client with chronic stable angina receives a prescription for nitroglycerin (Nitro-Dur) 0.4 mg topical patch. The practical nurse (PN) applies the first patch at 0730. Which intervention should the PN take next?
Uses a salt substitute that has potassium Rationale: Avapro, angiotensin II receptor blocking (ARB) agent, causes vasodilation to reduce blood pressure. Since ARBs can raise the concentration of potassium in the blood, the client should be reinstructed to avoid the use of salt substitutes containing potassium (A). Avapro, an antihypertensive, is also used to treat diabetic nephropathy, so having type 2 diabetes (B) is not a contraindication for taking this drug. Dizziness (C) is a common side effect. The drug can be taken with or without food (D).
A client with hypertension receives a prescription for irbesartan (Avapro). Which finding by the practical nurse indicates that the client needs additional instruction regarding the medication?
Glasgow Coma Scale (GCS) score of 15. Rationale Mannitol is an osmotic diuretic that is administered to reduce intracranial swelling, so a GCS of 15 (B) is a sensitive indicator of neurologic status that changes as cerebral edema resolves. (A) is an expected response of mannitol but is not indicative of a therapeutic decrease in cerebral edema. Although headache is a symptom of ICP, (C) does not imply a reduction in ICP. Mannitol does not affect body temperature (D).
A client with increased intracranial pressure (ICP) is receiving an infusion of mannitol 25% (Osmitrol). Which finding indicates to the practical nurse (PN) that the medication is effective?
Administer Humalog 15 minutes before each meal. Rationale Humalog is a rapid acting insulin with a short duration and should be administered within 15 minutes of meals (C). Lantus is a basal insulin which does not have a peak action, so (A) is unlikely. Serum glucose levels are controlled by ongoing insulin administration and is given even if the current glucose is within the normal range, not just at levels above 140 mg/dl (B). Lantus insulin should not be mixed with any other insulin in the same syringe (D).
A client with type 2 diabetes mellitus receives glargine (Lantus) insulin 10 units every evening and lispro (Humalog) insulin 5 units TID. Which information should the practical nurse (PN) reinforce in a teaching session?
"Have you felt sad or depressed lately?" Rationale: St. John's Wort is an herbal supplement that is often used for depression. The nurse should further explore why the client felt the need for taking this over-the-counter (OTC) herb and determine if the client is at risk for suicide (B). Gingko, not St. John's Wort, is often used to improve memory (A). Although all OTC medications should be included in the client's medication list, (C) is not indicated at this time. The vitamin niacin causes facial flushing (D).
A female client tells the practical nurse (PN) that she started taking an over-the-counter herbal supplement, St. John's Wort (Hypericum perforatum), last week. Which question should the PN ask the client?
Administer diphenhydramine (Benadryl) PRN. Rationale Pruritis (itching) is a common side effect of opioids that are administered via intraspinal (i.e., epidural, intrathecal) routes. An antihistamine, such as diphenhydramine (Benadryl) (B), should be given to relieve the client's itching. Pruritis is a known side effect, not an allergic response, so (A) is not indicated. The client is not experiencing an overdose response, so (C) is not indicated. Although lotion applied to the client's dry skin (D) can provide some relief, the use of Benadryl is most effective in relieving the client's response to epidural administration of an opioid.
A postoperative client is receiving hydromorphone (Dilaudid) via an epidural administration. The practical nurse (PN) notes the client is constantly scratching his arms. Which action should the PN take?
Calcium gluconate. Rationale A potential complication for a client after thyroidectomy is damage to the parathyroid glands that can cause hypocalcemia, which is manifested by a positive Chvostek's sign. Supplemental calcium gluconate (D) should be administered immediately. (A, B, and C) are not indicated by the client's findings.
After a thyroidectomy, a client's facial muscles twitch when the practical nurse (PN) taps the skin surface in front of the ear. Which prescription should the PN administer?
Peak flow reading is raised to 80% of personal best. Rationale Albuterol (Ventolin) is a bronchodilator that relaxes constricted bronchiole muscles to increase air flow to the lungs, which is determined by an increased peak flow meter (C) that indicates the client has an improved ability to move air as a result of bronchodilation. (B) is normal tidal volume, which is the air volume with a normal inspiratory effort and exhalation but does not reveal a change related to albuterol. (A and D) are not indicative of the effectiveness of albuterol.
After an albuterol (Ventolin) nebulizer treatment is given to a client with asthma, what finding by the practical nurse indicates that the treatment was effective?
Administer 30 minutes before a meal BID if capillary glucose is greater than 70 mg/dl. Rationale Glipizide, an oral hypoglycemic agent that stimulates the pancreas to secrete more insulin, should be administered 30 minutes prior to a meal if the blood glucose is within a normal range (70 to 110 mg/dl) (A). Capillary glucose is evaluated just prior to the administration of glipizide, not 2 hours after meals (B). This hypoglycemic agent should be administered before a meal so the drug can be effective when the client eats, not (C). The client's preprandial blood glucose level is used to determine if glipizide should be withheld (D).
Glipizide (Glucotrol) 10 mg BID is prescribed for a client with type 2 diabetes mellitus. Breakfast is served at 0800, and dinner is served at 1700. Which action should the practical nurse (PN) implement?
Hold the administration of the drug dose and notify the charge nurse. Rationale The drug dosage is outside the therapeutic dosing range and should not be administered (C) and the charge nurse should be notified for additional support with this decision. Although (B) may be indicated for a client receiving digoxin, the dose should be corrected before administering. Regardless of the client's current digoxin level (A) or apical heart rate (D), a dose higher than a safe range should not be administered (A).
The healthcare provider calls in a telephone prescription for digoxin (Lanoxin) of 2.5 mg PO now. The practical nurse (PN) questions the dosage, and the provider confirms that the dose is correct. Which action should the PN take?
Blood pressure of 96/52. Rationale Procardia is a potent vasodilator and lowers blood pressure. Although daily calcium channel blockers should be given regularly, the PN should withhold the next dose for a low blood pressure (A) and report the finding to the healthcare provider. Procardia does not have a significant effect on (B, C, and D).
The practical nurse (PN) is administering a daily dose of nifedipine (Procardia) 60 mg extended release to a client with angina pectoris. Which finding should the PN consider withholding the medication?
While on fluorouracil (5-FU) chemotherapy, the client reports tarry, loose stools. Rationale Fluorouracil is an antineoplastic drug, and signs of toxicity include black, tarry-colored stools (D) that indicate GI bleeding, which requires further investigation into the source of the bleeding and discontinuation of the medication to reduce the risk of hemorrhage. Mucomyst normally smells like "rotten eggs", so this is an expected finding that does not indicate any need to alter the medication administration routines (A). Expected side effects of anticholinergics, such as pseudoephedrine, include dried mucous membranes and and dry mouth (B). Statins, such as lovastatin, can cause constipation, which is a manageable side effect (C).
The practical nurse (PN) is administering medications to several clients. Which client statement indicates that additional action should be taken by the PN?
Blood pressure Rationale Pronestyl is an antiarrhythmic that decreases myocardial excitability by slowing down conductivity of cardiac tissue. The client's telemetry and blood pressure (C) should be monitored continuously during IV administration. Pronestyl does not cause effects related to pupillary response (A). Pronestyl's side effects do not significantly affect (B and D).
The practical nurse (PN) is caring for a client who is receiving a secondary infusion of procainamide (Pronestyl) IV. Which assessment should the PN obtain during the administration of the medication?
Bowel sounds auscultated at 20 gurgles/minute. Rationale Potassium replacement for a client with hypokalemia should improve smooth and skeletal muscle strength, so normal peristalsis findings are indicative of a therapeutic response (A). (B) is not a therapeutic response of KCl replacement. (C) is indicative of hyperkalemia, not a return to a normal serum level. Muscle strength of 2+ indicates significant weakness (D), which is not a therapeutic response.
The practical nurse (PN) is caring for a client with hypokalemia who is receiving IV potassium chloride (KCl). Which finding should the PN identify as a therapeutic response?
Take before meals and apart from other drugs. Rationale Cholestyramine is used to treat hyperlipidemia of primary hypercholesterolemia and binds with bile in the intestines to reduce fat and cholesterol absorption from foods. The systemic absorption of oral medications, such as digoxin and warfarin, can also be reduced, so the medication should be taken before meals and apart from other drugs (C). (A and B) are not necessary when taking Questran. Although constipation is a side effect, a diet high in fiber, not (D), should be recommended.
The practical nurse (PN) is giving medications to a client with hyperlipidemia who receives a new prescription for cholestyramine (Questran). Which information should the PN reinforce with the client?
Muscle aching. Rationale Severe muscle aching (B) can be a sign of rhabdomyolysis, a potential serious complication of statins. Although constipation and diarrhea are side effects of statins, (A) does not need to be reported immediately. (C) is unrelated to the use of statins. A hacking cough (D) is most commonly associated with ACE inhibitors, not statins.
The practical nurse (PN) is reinforcing medication teaching to a client who receives a prescription for lovastatin (Mevacor). Which symptom should the PN tell the client to report immediately?
Clopidogrel (Plavix)
The practical nurse (PN) reinforces preoperative instructions to a client scheduled for abdominal surgery. Which medication should the PN tell the client to stop taking 7 days prior to the surgery?
Recommend the use of a soft toothbrush. Rationale To reduce the risk of bleeding, soft toothbrushes (A) and electric razors are recommended for a client who is taking Coumadin, an anticoagulant. Platelet production (B) is not affected by the use of Coumadin. Dairy foods (C) do not interfere with the effectiveness of Coumadin. A low serum potassium level (D) is not directly related to the administration of Coumadin.
When caring for a client receiving warfarin (Coumadin), what action should the practical nurse implement?
The pulse is greater than 100 beats/minute. Rationale Thyroid supplemental medication, such as Levothroid, increase basal metabolic rate and should be withheld if the client's pulse is greater than 100 beats/minute (B), which is an indication of excessive dosage. (A) is not an indication to withhold Levothroid. Finger and toe paresthesia (C) is not related to thyroid supplements. Although excess thyroid hormone can cause diarrhea (D), other symptoms of toxicity should be manifested before withholding the medication.
When should the practical nurse (PN) withhold administration of oral levothyroxine (Levothroid)?
A client who takes metformin (Glucophage) is scheduled for a test using iodine dye. Rationale: Glucophage, which is used to treat type 2 diabetes, should be temporarily discontinued before a client has a diagnostic test that requires the use of iodine-based dye, which places the client at risk for renal complications (C). (A) is a harmless, common side effect of Niacin. (B) is a common side effect of albuterol (Ventolin). Ampicillin can alter the normal bowel flora and cause (D), a common side effect.
Which client situation requires a response from the practical nurse?
History of dysrhythmias. Rationale Thyroid supplement can increase the heart rate and precipitate angina in a client who has a history of cardiac disease and dysrhythmia (C). (A, B, and D) do not impact the client's use of thyroid replacement therapy.
Which co-morbidity of a client who is starting thyroid replacement should the practical nurse report to the healthcare provider?
Albuterol (Proventil).
Which medication prescription should the practical nurse administer for a client who is having an asthmatic episode?
