HESI practice

The nurse is teaching a new nurse about medication administration for patients with attention deficit/hyperactivity disorder (ADHD) . Which statement by the new nurse indicates understanding of the teaching? A. 'Patients taking stimulant drugs for ADHD may lose weight B. 'I may dispense these medications to nursing staff if needed. C. 'It is permissible to crush extended-release medications for patients who have difficulty swallowing pills D. 'If i notice side effects of these medications, I should stop giving the drug immediately and notify the provider.'

A. 'Patients taking stimulant drugs for ADHD may lose weight Anorexia is a common side effect of stimulant drugs, so weight loss often occurs. Extended-release preparations should not be crushed or chewed. Patients taking these medications should be weaned off of them when necessary and not stopped abruptly. These are controlled substances and can never be dispensed without a prescription.

A bleeding patient receiving warfarin has an international normalized ratio (INR) of 6. What is the nurse's best course of action? A. Administer phytonadione. B. Stop the intravenous drip. C. Wait for the INR to decrease. D. Administer protamine sulfate.

A. Administer phytonadione. The nurse should administer phytonadione to the bleeding patient who is on warfarin and has an extremely elevated INR. This medication will block the vitamin K-dependent clotting factors. Increasing vitamin K can hasten the return to normal coagulation. Warfarin is given orally, not intravenously. Protamine sulfate is an antidote to heparin therapy, not

How do H 2 receptor antagonists reduce the secretion of acids? A. By blocking the H 2 receptors B. By stimulating gastrin receptors C. By blocking acetylcholine receptors D. By stimulating acetylcholine receptors

A. By blocking the H 2 receptors

A patient who recently returned from South America is admitted with suspected vivax malaria. Which symptoms does the nurse expect to find upon assessing the patient? Select all that apply A. Chills B. Fever C. Vomiting D. Diaphoresis E. Abdominal pain F. Dark-colored urine

A. Chills B. Fever D. Diaphoresis Symptoms of vivax malaria include chills, fever, and sweating as infected erythrocytes rupture releasing pyrogens and other substances in the blood. Vomiting and abdominal pain are not typical symptoms of vivax malaria. Dark-colored urine is a symptom of falciparum malaria, not vivax malaria. With this type, up to 60% of circulating red blood cells can be destroyed and the hemoglobin released by these cells darken the urine.

The healthcare provider indicates that the patient will be ordered an opioid antitussive. Which medication would the nurse anticipate the provider will order? A. Codeine B. Benzonatate C. Levocetirizine D. Promethazine with dextromethorphan

A. Codeine Codeine is classified as an opioid antitussive. Promethazine with dextromethorphan and benzonatate are both nonopioid antitussives. Levocetirizine is an antihistamine.

The nurse is monitoring a patient on vancomycin for indications of major toxicity. Which test should be monitored closely ? A. Creatinine level B. Alkaline phosphatase C. Electroencephalogram D. Creatine phosphokinase ( CPK)

A. Creatinine level

The nurse working with elderly patients is concerned about the number of medications each patient is taking . Which should the nurse assess as the highest priority for the patients related to polypharmacy? A. Drug interactions B. Cost of medications C. Schedule of medications D. Nonadherence to drug regimen

A. Drug interactions

The nurse would recognize that the patient with which condition is at risk of developing an adverse reaction to mefloquine? A. Epilepsy B. Pancreatitis C. Type 2 diabetes D. Chronic bronchitis

A. Epilepsy Central nervous system toxicity is a concern with mefloquine . Higher doses should be avoided in patients who have epilepsy or psychiatric disorders . Chronic bronchitis , pancreatitis , and type 2 diabetes do not pose a threat in patients taking mefloquine .

The nurse is administering several different diuretics . Which drug will produce the most diuresis in a patient ? A. Furosemide B. Triamterene C. Spironolactone D. Hydrochlorothiazide

A. Furosemide

Which increases the concentration of gastric acids? A. Hypersecretion of parietal cells B. Inhibition of proton pump activity C. Inhibition of acetylcholine receptors D. Hypersecretion of proteolytic enzymes

A. Hypersecretion of parietal cells

A patient with cystic fibrosis presents to the emergency department with epistaxis. Upon taking the history of the patient, which drug would the nurse attribute to the epistaxis? A. Ibuprofen B. Salmeterol C. Tobramycin D. Dornase alfa

A. Ibuprofen Side effects attributable to ibuprofen include epistaxis (nosebleedand conjunctivitis . Salmeterol is used for bronchodilation . Common adverse effects of tobramycin include cough , wheezing , and hoarseness . Adverse effects of dornase alfa include hoarseness , pharyngitis , laryngitis , rash, chest pain, and conjunctivitis.

In which part of the ear are cochlea and semicircular canals located? A. Inner B. Outer C. Middle D. External

A. Inner The cochlea and semicircular canals are located in the inner part of the ear. The external auditory canal is in the outer part of the ear. The tympanic cavity is in the middle part of the ear. The pinna is part of the external ear.

Which is accurate regarding the benefits of misoprostol compared to dinoprostone ? Select all that apply. A. It is more effective. B. It is much less expensive. C. It is approved for cervical ripening. D. It causes a lower incidence of uterine tachysystole. E. It can be used in women with a history of major uterine surgery or cesarean section.

A. It is more effective. B. It is much less expensive. It is true that misoprostol is both more effective and much less expensive than dinoprostone. Misoprostol use is not approved for cervical ripening. Misoprostol causes a higher incidence of uterine tachysystole. Misoprostol is contraindicated in women with a history of major uterine surgery or cesarean section.

The nurse is teaching the parents of a premature infant about respiratory distress syndrome (RDS ). Which is the underlying cause of RDS of prematurity ? A. Low level of lung surfactant B. Buildup of uric acid in the blood C. Inherited disorder that affects lungs D. Mutation in the gene that makes hemoglobin

A. Low level of lung surfactant

Which acid-base imbalance is caused by chronic renal failure loss of bicarbonate during severe diarrhea, or metabolic disorders that result in overproduction of lactic acid? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis Principal causes of metabolic acidosis are chronic renal failure, loss of bicarbonate during severe diarrhea , and metabolic disorders that result in overproduction of lactic acid (lactic acidosis ) or ketoacids (ketoacidosis ). Metabolic acidosis also may result from poisoning by methanol and certain medications (eg, aspirin and other salicylates ).

The nurse caring for a patient with cystic fibrosis is preparing to administer a transmembrane regulator modifier . For which adverse effects will the nurse monitor the patient ? Select all that apply . A. Nausea B. Dyspnea C. Diarrhea D. Hypotension E. Nasal congestion

A. Nausea B. Dyspnea C. Diarrhea E. Nasal congestion The most common adverse effects of a transmembrane regulator modifier include nausea, dyspnea, diarrhea, and nasal congestion. Hypertension, not hypotension, is also an adverse effect of a transmembrane regulator modifier .

A nurse is assessing a child with an inadequate intake of vitamin D. Which condition will the nurse monitor for in this child? A. Rickets B. Anemia C. Pellagra D. Osteomalacia

A. Rickets The classic effects of deficiency are rickets (in children) and osteomalacia (in adults). Anemia can occur with vitamin B 12 and folic acid deficiencies. Pellagra is a deficiency of niacin (nicotinic acid).

The patient is receiving tobramycin . The nurse asks the patient to choose daily meal selections , to which the patient responds, 'Oh, dear , I don't want another IV. The nurse makes which assessment about the patient's response? A. Some hearing loss may have occurred. B. A nutrition consult most likely is needed. C. The confusion is due to the hospital stay. D. The patient has a family history of dementia.

A. Some hearing loss may have occurred.

The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's first action? A. Stop the infusion. B. Apply cold pack to the site. C. Elevate the patient's extremity. D. Remove the intravenous (IV) line immediately.

A. Stop the infusion. The nurse's first action is to stop the infusion. The IV line should remain in place to allow for infusion of the appropriate antidote, phentolamine .

Which resource would the nurse use to determine if adverse effects had been identified after a drug was on the market ? A. The black box warning. B. Ethnopharmacologic studies C. The phase II trials of the drug D. The phase trials of the drug

A. The black box warning.

When preparing a teaching session for residents at an assisted living facility, what should the nurse include?

A. The importance of taking the full prescribed dose

Which action indicates the nurse is following The Joint Commission's pain management standards? A. The nurse assesses the fifth vital sign. B. The nurse monitors some high-risk patients for pain. C. The nurse administers adjuvants as primary pain control. D. The nurse focuses on the family's satisfaction with pain management.

A. The nurse assesses the fifth vital sign. Pain must be regarded as a fifth vital sign, and pain intensity must be quantified and recorded along with blood pressure, heart rate, respiration , and temperature . All patients must be assessed for pain, not just some . Adjuvants are not primary pain control measures; they are not intended to substitute for these drugs. The institution must monitor patient satisfaction with pain management , not the family .

A primary health care provider has prescribed isoniazid and pyridoxine (vitamin B 6 for a patient who has tuberculosis. What is the purpose of administering pyridoxine? A. To prevent peripheral neuropathy B. To prevent cardiovascular complication C. To prevent the metabolic rate from raising D. To prevent gastrointestinal (Gl) disturbances

A. To prevent peripheral neuropathy

A patient is experiencing sickle cell crisis . Which goals are priority ? Select all that apply . A. To provide fluids B. To provide calories diuresis C. To provide pain relief D. To provide education for crisis prevention

A. To provide fluids C. To provide pain relief For patients undergoing an acute crisis, hydration and analgesics are the cornerstone of treatment. Calories are not a priority. Diuresis would make the situation worse. Although the patient should receive education for prevention of sickle cell crisis, that can wait until the crisis has subsided.

A patient is prescribed rifampin for the treatment of tuberculosis . While checking the patient's history , the nurse finds that the patient is taking oral contraceptive therapy. What should the nurse advise the patient concerning the safe use of rifampin ?

A. Use other forms of birth control.

To normalize a low serum calcium level, the body releases parathyroid hormone (PTH). This results in which therapeutic effect ? A. An increase in renal calcium excretion B. An increase in bone resorption of calcium C. An increase in plasma levels of phosphate D. A decrease in the intestinal absorption of calcium

B. An increase in bone resorption of calcium PTH restores normal calcium levels by promoting calcium resorption from bone and transferring it to the blood.

A nurse is administering clonidine to a patient in opioid withdrawal. Which assessment finding indicates a therapeutic effect of the drug? A. Fever is decreased B. Diarrhea is decreased C. Opioid craving is decreased D. Cross -tolerance is decreased

B. Diarrhea is decreased Clonidine is most effective against symptoms related to autonomic hyperactivity (nausea, vomiting, and diarrhea)

While completing preoperative patient teaching , the nurse provides which explanation of general anesthesia? A. Typically is achieved using only one type of medication B. Produces deep muscle relaxation and loss of consciousness C. Provides anesthesia to a specific region of the body and generalized sedation D. Results in moderate sedation in which the patient can follow commands but will not remember anything following the PROCEDURE

B. Produces deep muscle relaxation and loss of consciousness

A patient is scheduled for surgery. After an assessment , the nurse finds that the patient regularly takes codeine in large amounts to improve sleep. What will the nurse interpret from the information?

B. The patient may require a higher dose of anesthetics

A nurse is administering leuprolide to a patient with prostate cancer. Which goal does the nurse document in the care plan for this treatment? A. To provide a cure B. To provide palliation C. To prevent metastases D. To prevent osteoporosis andor fractures

B. To provide palliation Leuprolide is indicated for advanced carcinoma of the prostate. Palliation is the primary benefit. It does not provide a cure or prevent metastases. Leuprolide may increase the risk of osteoporosis and related fractures, so denosumab or bisphosphonates are added. . 1254

Which instruction should the nurse include in the discharge teaching for a patient receiving tetracycline? A. Take the medication until you feel better. B. Use sunscreen and protective clothing when outdoors.' C. Keep the remainder of the medication in case of recurrence. D. Take the medication with food or milk to minimize gastrointestinal upset.

B. Use sunscreen and protective clothing when outdoors.' Photosensitivity is a common side effect of tetracycline . Exposure to the sun can cause severe burns. Milk can inhibit absorption of the medication . It is best taken without food. The medication should be taken until the prescription is finished.

Which statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? A. I will change my position slowly to prevent feeling dizzy B. 'I will not mow my lawn until see how this medication makes me feel C. 'I will check my blood pressure daily and take my medication when it is over 140/90 . D. 'I will include rest periods during the day to help me tolerate the fatigue my medicine may cause.

C. 'I will check my blood pressure daily and take my medication when it is over 140/90 .

In the case of an inhalational anthrax attack, the nurse would prepare for how many days of antibiotic treatment, including intravenous and by mouth, for affected adults? A. 14 B. 30 C. 60 D. 96

C. 60 Treatment of inhalational anthrax includes initial intravenous therapy followed by oral therapy for 60 days total. Time frames of 14 and 30 days are not long enough, and 96 days is longer than necessary.

When does gastric emptying time reach adult values in infants? A. At birth B. At 3-4 months C. At 6-8 months D. 18-24 months

C. At 6-8 months

The patient has been started on stavudine (d4T). After taking the drug for 3 days, the patient reports experiencing muscle pain and weakness. What is the nurse's highest priority action? A. Instruct the patient to self- medicate with a nonsteroidal anti inflammatory drug. B. Reassure the patient that this is an expected side effect of the medication. C. Contact the health care provider regarding the patient's symptoms. D. Reassure the patient that the symptom is short-lived and will resolve.

C. Contact the health care provider regarding the patient's symptoms.

When assessing a patient for side effects of morphine sulfate which finding would a nurse expect? A. Diarrhea B. Insomnia C. Drowsiness D. Increased bowel sounds

C. Drowsiness Morphine sulfate depresses the central nervous system, resulting in drowsiness, constipation

A nurse is describing mediator molecules released by any immune system cell. Which specific term does the nurse use to identify a mediator molecule released by a phagocyte? A. Antibody B. Cytokine C. Monokine D. Lymphokine

C. Monokine

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect? A. Delayed healing B. Bone and joint pain C. Nausea and diarrhea D. Loosening of the teeth

C. Nausea and diarrhea Large doses of vitamin can cause nausea and vomiting, headache, abdominal cramps, and the development of renal stones. Delayed healing, bone and joint pain , and loosening of the teeth are unrelated to the side effects of vitamin C ; they actually are symptoms of scurvy , a deficiency of vitamin C.

Which clinical condition can be managed with estrogen therapy? A. Pregnancy B. Amenorrhea C. Symptomatic vaginal atrophy D. Undiagnosed vaginal bleeding

C. Symptomatic vaginal atrophy Estrogen is used to treat symptomatic vaginal atrophy. Symptomatic vulvar and vaginal atrophy are menopause-related, causing dryness, irritation, itching, and uncomfortable intercourse due to a decrease in estrogen levels. Estrogen is not used to treat amenorrhea, pregnancy, or undiagnosed vaginal bleeding .

The patient asks what it means when a medication order says to administer a drug 'with food.' How will the nurse reply? A. Take the medication 2 hours after a meal. B. Take the medication 1 hour before the meal C. Take the medication before the morning meal. D. 'Take the medication when you eat your meal or shortly after a meal '

D. 'Take the medication when you eat your meal or shortly after a meal '

Which prescription will the nurse administer to provide the most safe and effective care to patients with hypertension? A. An adrenergic neuron blocker to a 16- year-old with hypertension B. A beta blocker to an African American patient with hypertension C. A centrally acting alpha agonist to a 16-year-old with hypertension D. A calcium channel blocker (CCB) to an African American patient with hypertension

D. A calcium channel blocker (CCB) to an African American patient with hypertension CCBs and alpha and beta blockers are also effective in African American patients. In contrast, monotherapy with beta blockers or angiotensin converting me( ACE) inhibitors is less effective in blacks than in whites. Drugs recommended for treatment of hypertension in children 1 to 18 years old include ACE inhibitors, xiuretics, beta blockers, and calcium channel blockers (not centrally acting alpha 2 agonist or adrenergic neuron blockers).

Which drug is a class III antidysrhythmic ? A. Atenolol B. Lidocaine C. Verapamil D. Amiodarone

D. Amiodarone

A patient with hyperlipidemia is prescribed atorvastatin; however, the patient does not want to take a pill and prefers powder form. What alternative medication available in powder form would be most beneficial for the patient? A. Ezetimibe B. Fluvastatin C. Simvastatin D. Colesevelam

D. Colesevelam Colesevelam is a bile acid sequestrant and is also available in a powder form. Fluvastatin , ezetimibe , and simvastatin are only available in tablet form and cannot be prescribed for the patient who has a fear of taking pills.

The nurse is assessing a patient with Huntington's disease for chorea. Which finding will the nurse observe that confirms the chorea? A. Profound fatigue B. Paranoid psychosis C. Decline of intellectual functioning D. Continuous movements of the whole body

D. Continuous movements of the whole body In late stages of Huntington's disease, patients develop chorea, manifesting as involuntary, irregular, flowing movements that may shift from one area of the body to another. Severe chorea manifests as pronounced continuous movements of the whole body. Profound fatigue occurs with fibromyalgia. While paranoid psychosis does occur in Huntington's disease, it is a psychiatric symptom. While decline of cognitive/intellectual functioning does occur with Huntington's, it is not classified as chorea.

Which is an environmental factor that affects the patient's response to a medication? A. Age B. Culture C. Gender D. Diet

D. Diet The factors that affect drug polymorphism are divided into environmental factors, cultural factors, and genetic factors . Environmental factors include diet and nutritional status . Age and gender are not environmental factors.

A patient questions the use of epinephrine for repair of laceration, stating, 'I thought that was the drug they use in the emergency room when patients have cardiac arrest. Select the nurse's best response. A. 'Epinephrine allows anesthetic effects to occur more quickly. B. ' Epinephrine is commonly used with lidocaine to prevent adverse effects ' C. Epinephrine causes the anesthetic effect to wear off quickly once the laceration is sutured D. Epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site.

D. Epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site. Epinephrine causes localized vasoconstriction, which not only allows for a bloodless field to suture but also delays absorption of the lidocaine, thus enhancing its numbing effect . Epinephrine is used to prevent adverse effects, but more specifically , it helps to minimize toxicity caused by local anesthetics. Epinephrine is often coadministered with the local anesthetic to maintain localized drug activity. It does not help the anesthetic effect wear off more quickly.

Which antiprotozoal drug is effective for the treatment of trichomoniasis? A. lodoquinol B. Atovaquone C. Pentamidine D. Metronidazole

D. Metronidazole Metronidazole is the antiprotozoal drug that is effective for the treatment of trichomoniasis. lodoquinol is effective for the treatment of amebiasis. Atovaquone is effective for the treatment of pneumocystosis . Pentamidine is effective for the treatment of pneumocystosis .

For which type of pain is fentanyl transdermal patch best suited? A. pain after abdominal surgery B. acute treatment of a migraine headache C. Lower back pain related to lumbar strain D. Severe pain resulting from cancer metastasis

D. Severe pain resulting from cancer metastasis

The nurse is planning a teaching session for coworkers about laws that require a company to report adverse effects of nonprescription drugs and dietary supplements. Which act would the nurse review in preparation for the teaching? A. Pure Food and Drug Act B. Federal FoodDrug, and Cosmetics Act C. Dietary Supplement Health and Education Act of 1994 D. The Dietary Supplement and Nonprescription Drug Consumer Protection Act

D. The Dietary Supplement and Nonprescription Drug Consumer Protection Act The Dietary Supplement and Nonprescription Drug Consumer Protection Act, passed in 2006, mandates reporting of serious adverse events for nonprescription drugs and dietary supplements. The following events should be reported deaths, hospitalizations, life-threatening experiences, persistent or significant disabilities, and birth defects. The Pure Food and Drug Act of 1906 was an initial act that eventually led to the creation of the Food and Drug Administration (FDA). The Food, Drug, and Cosmetics Act, passed in 1938, gave authority to the FDA to oversee safety of food, drugs, and cosmetics. The Dietary Supplement and Health Education Act of 1994 states that no proof of efficacy is required for dietary supplements because they are considered safe.

For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? A. age B. weight C. height/length D. body surface area

D. body surface area