HESI Practice Questions
The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine) IM STAT What is the primary purpose for administering this drug to the child at this time?
Decrease the oral secretions
Which assessment finding could indicate to the nurse that a client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl (Reglan)?
Demonstrates Parkinson-like symptoms, such as cogwheel rigidity
What intervention is most important for a nurse to implement prior to administering atropine PO?
Determine the presence of 5 to 35 bowel sounds per minute.
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.
What medication is useful in treating digoxin (Lanoxin) toxicity?
Digoxin immune Fab (Digibind)
A client with mild parkinsonism is started on oral amantadine (Symmetrel). What statement accurately describes the action of this medication?
Dopamine in the central nervous system is increased
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)
The healthcare provider prescribes the anticonvulsant carbamazepine (Tegretol) for a client with a seizure disorder. The nurse should instruct the client to notify the healthcare provider if which condition occurs?
Experiences a sore throat
55-year-old male client was diagnosed with schizophrenia 5 years earlier. He has had numerous hospitalizations since diagnosis because of noncompliance with the prescribed medication regime. 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 client's digoxin level of 1.3 ng/dl is not above the upper range of its therapeutic index (toxic level is greater than 2.0 ng/dl), so the dose should be administered after evaluating the client's heart rate
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. Double-checking the prescription (C) is an important intervention since death can occur from an overdose. This medication is administered weekly and in low doses for rheumatoid arthritis and should not be confused with administration of the drug as a chemotherapeutic agent.
Clients receiving disulfiram (Antabuse) for treatment of alcoholism should be cautioned about the importance of avoiding alcohol, particularly during concurrent treatment with cephalosporin antibiotics, because an Antabuse reaction may be initiated. Which symptom would indicate that the client is experiencing a reaction to disulfiram (Antabuse)?
Headache
A child is being treated with mebendazole (Vermox) for pinworms. What type of diet should the mother be instructed to feed the child while receiving this medication?
High-fat diet A high-fat diet increases the absorption of mebendazole (Vermox), which boosts the effectiveness of the medication in eliminating the pinworms
A male client who resides in a long-term care facility has a seizure disorder that has been managed with phenobarbital (Nembutal) for several years. Lately, he has become more difficult to arouse, and frequently tells the nurse that he wants to take a nap. What intervention should the nurse implement?
Hold the medication and notify the healthcare provider.
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. What complication should the nurse monitor for in this infant during the first few hours after delivery?
Hypoglycemia
A 75-year-old male client taking hydrochlorothiazide (HCTZ) is admitted to the hospital having "palpitations" and "skipped heart beats." What is the most likely cause of these symptoms given the client's medication history?
Hypokalemia
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 healthcare provider?
Hypokalemia
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
Before administering an antiinfective agent to a client with a urinary tract infection, which nursing intervention is most important?
Obtain a clean catch urine specimen.
The apical heart rate of an infant receiving digoxin (Lanoxin) for congestive heart failure slows to 80 beats/min. What intervention should the nurse implement first?
Obtain a serum digoxin level Sinus bradycardia (rate of less than 90 to 110 in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level is the highest priority
When providing client teaching about the administration of methylphenidate (Ritalin) to the mother of a child diagnosed with attention-deficit/hyperactive disorder (ADHD), what instruction should the nurse include in the teaching plan?
Offer the child the medication before eating breakfast and after eating lunch.
Alteration of which laboratory finding represents achievement of a therapeutic goal for heparin administration?
Partial thromboplastin time
A client who is receiving phenytoin (Dilantin) begins to exhibit nystagmus and diplopia. Which physiologic manifestation is consistent with these findings?
Phenytoin toxicity
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)?
Physostigmine (Antilirium)
In administering the antiinfective agent chloramphenicol (Chloromycetin) IV to a client, 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
A client with acute lymphocytic leukemia is to begin chemotherapy today. The healthcare provider's prescription specifies that ondansetron (Zofran) is to be administered IV 30 minutes prior to the infusion of cisplatin (Platinol). What is the rationale for administering Zofran prior to the chemotherapy induction?
Reduction or elimination of nausea and vomiting
A client who is experiencing an acute attack of gouty arthritis is prescribed Colchicine USP 1 mg PO daily. Which information is most important for the nurse to provide the client?
Report any vomiting to the clinic.
Minocycline (Minocin) 50 mg 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.)
Report vaginal itching or discharge. Protect skin from natural and artificial ultraviolet light. Avoid driving until response to medication is known. Use a nonhormonal method of contraception if sexually active.
During administration of theophylline (Theo-Dur), the nurse should monitor for signs of toxicity. What symptom would cause the nurse to suspect Theo-Dur toxicity?
Restlessness
A client who is HIV positive is receiving combination therapy with the antiviral medication zidovudine (Retrovir). What instruction should the nurse include in this client's teaching plan?
Return to the clinic every 2 weeks for blood counts
The nurse is preparing to administer amphotericin B (Fungizone) IV to a client. What laboratory data are most important for the nurse to assess before initiating an IV infusion of this medication?
Serum potassium
A 46-year-old female client is instructed to take Lugol's solution (strong iodine solution) in preparation for thyroidectomy surgery. Which food should the nurse instruct this client to remove from her diet?
Shrimp
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 1 tablet at the onset of angina and stop activity. Rationale: Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest (B). One tablet can by taken every 5 minutes, up to three doses (A). Nitroglycerin should be replaced every 3 to 6 months, not every 12 months (C). Nitroglycerin should provide relief in 5 minutes, not 30 minutes (D).
A 67-year-old client is discharged from the hospital with a prescription for digoxin (Lanoxin) 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan?
Take and record radial pulse rate daily.
Phenazopyridine (Pyridium) is commonly prescribed for clients with urinary tract infections. What statement should be included by the nurse when teaching clients about the administration of phenazopyridine (Pyridium)?
Take this medication with food to decrease gastric irritation.
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 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.
Which question should the nurse ask an older client prior to the initiation of treatment with intravenous infusions of gentamicin sulfate (Garamycin)?
"Are you hard of hearing?" Complications of gentamicin sulfate (Garamycin) therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining if the client is hard of hearing
Benztropine mesylate (Cogentin) and levodopa (Dopar) are prescribed for a client with Parkinson's disease. After a few days of therapy, the client complains of a "dry mouth" and "dizziness." What response by the nurse would be most appropriate?
"Chew gum to relieve the dry mouth and move slowly when assuming a standing position to reduce the dizziness
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."
client is receiving oral griseofulvin (Grisactin) for a persistent tinea corporis infection. What response by the client indicates an accurate understanding of the drug teaching conducted by the nurse?
"I'll wear sunscreen whenever I mow the lawn."
A male client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief 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."
The nurse gives a client NPH insulin 15 units subcutaneously before breakfast (7:30 AM). At what time should the nurse be particularly alert for signs or symptoms of a potential hypoglycemic reaction?
1:30 to 3:30 PM NPH, an intermediate-acting insulin, peaks within 4 and 12 hours after subcutaneous injection, so the most likely time for this client to experience a hypoglycemic reaction is between 1:30 PM and 3:30 PM
The healthcare provider prescribes captopril (Capoten) 37.5 mg. The medication is available in 25 mg tablets. What should the nurse administer?
1½ tablets
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
The nurse is administering the early morning dose insulin aspart (NovoLog) 5 units subcutaneously to a client with diabetes mellitus type 1. The client's fingerstick serum glucose is 140 mg/dl. Considering the onset of NovoLog, when should the nurse ensure that the client's breakfast is available?
5 minutes after subcutaneous administration Insulin aspart is a very rapidly acting insulin with an onset of 5 to 15 minutes. NovoLog should be administered when the client's tray is available (A). NovoLog peaks in 45 minutes to 1.5 hours (B and C) and has a duration of 3 to 4 hours.
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?
A 75-year-old woman with liver disease
An older client who had a colon resection yesterday is receiving a constant dose of meperidine (Demerol) via PCA pump. Which assessment finding is most significant and requires that the nurse intervene?
A new hand tremor is noted.
Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin?
Activated partial thromboplastin time, commonly referred to as aPTT
Methylphenidate HCl (Concerta) 18 mg PO is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactive disorder (ADHD). In preparing a teaching plan for the parents of this newly diagnosed ADHD child, which instruction is most important for the nurse to provide the parents?
Administer the medication in the morning before the child goes to school.
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. What action should the nurse implement?
Administer the prescribed dose of Aggrenox as scheduled.
A female client who has started taking 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. What is the best response by the nurse?
Advise the client to take the medication in the morning, rather than at bedtime.
A client with 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 healthcare provider of the need to increase the dose
Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication?
Antimetabolites
What nursing intervention has the highest priority during IV administration of mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin-D)?
Assess for extravasation at the IV site during infusion.
What nursing intervention has the highest priority during IV administration of mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin-D)?
Assess for extravasation at the IV site during infusion. Mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin-D) are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion
An older male client with Tourette syndrome takes haloperidol (Haldol) to control tics and vocalizations. He has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. What action should the nurse take?
Assess for poor skin turgor, sunken eyeballs, and concentrated urine output.
When providing nursing care for a client receiving pyridostigmine bromide (Mestinon) for myasthenia gravis, which nursing intervention has the highest priority?
Assess respiratory status and breath sounds often.
The healthcare provider prescribes ipratropium (Atrovent) for a client. An allergic reaction to what 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
female client is receiving sulfisoxazole (Gantrisin) for a urinary tract infection. What instruction should the nurse include in the teaching plan for this client?
Avoid cranberry juice while taking this drug.
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)
A client with dysphagia has been diagnosed with duodenal ulcers and is being discharged from the hospital with a prescription for the gastric acid pump inhibitor lansoprazole (Prevacid) 15 mg PO daily. The medication comes in capsule form. What instruction should the nurse include in the discharge teaching plan for this client?
Capsule contents can be sprinkled on pudding or applesauce.
A 78-year-old client with congestive heart failure receives the cardiac glycoside digoxin (Lanoxin) 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective?
Clear breath sounds anteriorly and posteriorly
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?
Clear speech 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.
To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, what action should the nurse implement?
Compare the client's blood pressure before and after taking the medication.
The healthcare provider has prescribed a low-molecular-weight heparin, enoxaparin (Lovenox), 30 mg IVP BID for a client following hip replacement. Prior to administering the first dose, which intervention is most important for the nurse to implement?
Contact the healthcare provider to clarify the prescription.
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 healthcare provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate?
Decrease the dose of vitamin C.
A 55-year-old male client was diagnosed with schizophrenia 5 years earlier. He has had numerous hospitalizations since diagnosis because of noncompliance with the prescribed medication regime. Which drug might work best for this particular client?
Fluphenazine decanoate (Prolixin decanoate) Prolixin, an antipsychotic drug that can be given IM, has a delayed onset (24 to 96 hours) and a long duration of action (up to 3 or 4 weeks), so would be the drug of choice for a noncompliant psychotic client.
The healthcare provider prescribes the H2 antagonist famotidine (Pepcid) 20 mg in the morning and at bedtime. What statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime?
Gastric acid secreted at night is buffered, preventing pepsin formation
A client who is HIV positive is receiving epoetin (Epogen) for management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the healthcare provider?
Hematocrit (HCT) of 58%
A client has a positive skin test for tuberculosis. What 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 lab value closely?
Liver enzymes The client receiving isoniazid (INH) is at risk for developing hepatitis; therefore, liver function tests should be monitored carefully during drug therapy
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
A client with schizophrenia has been taking the antipsychotic agent clozapine (Clozaril) for the past 3 weeks. Which nursing assessment finding would have the greatest implications for this client's care?
Low-grade fever
The nurse notes that a client receiving phenytoin (Dilantin) 300 mg PO daily has a serum phenytoin level of 14 mcg/ml. What intervention should the nurse implement?
Make sure that the client is performing thorough oral care. therapeutic range for phenytoin is 10 to 20 mcg/ml
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
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)
A 19-year-old male client who sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the healthcare provider administers pancuronium bromide (Pavulon) IV with adjunctive narcotic analgesia. What medication should the nurse maintain at the client's bedside?
Neostigmine bromide (Prostigmin)
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
female client is receiving sulfisoxazole (Gantrisin) for a urinary tract infection. What client teaching should the nurse include?
Oral contraceptives may not be effective.
68-year-old client has been diagnosed with open-angle glaucoma. The healthcare provider prescribes pilocarpine (Isopto Carpine) eye drops. What action of this drug makes it a useful treatment for the client's condition?
The outflow of aqueous humor in the eyes is increased.
A 45-year-old female client is receiving alprazolam (Xanax) for anxiety. Which client behaviors would indicate that the drug is effective?
The staff observe the client sitting in the day room reading a book.
A client receives a prescription for theophylline (Theo-Dur) PO to be initiated in the morning. The nurse determines that a theophylline level drawn yesterday was 15 mcg/ml. Based on this information, what should the nurse tell the nurse on the next shift about initiating the new prescription?
The theophylline dose can be initiated as planned. The therapeutic range for theophylline is 10 to 20 mcg/ml!
The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate (Garamycin) in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level?
Thirty minutes after the dose is administered
The healthcare 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
The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed?
When I exercise, I should plan to increase my insulin dosage."
A 52-year-old client is admitted to the hospital for possible duodenal ulcers. The healthcare provider prescribes ranitidine hydrochloride (Zantac) 150 mg BID PO. Which data would indicate that this medication is effective?
Within 4 hours after meals, the client denies having pain.
A client with mild parkinsonism is started on oral amantadine (Symmetrel). What statement accurately describes the action of this medication?
dopamine in central nervous system is increased
Vancomycin (Vancocin) is prescribed for a client who has a history of endocarditis and is to undergo minor dental surgery. The nurse knows that this drug
may be administered PO.
