Pharmacology Practice HESI
The healthcare provider prescribes a medication for an oder adult client who is complaining of insomnia, and instructs the client to return in two weeks. The nurse should question which prescription?
B. Eszopiclone (Lunesta) 10 milligrams orally at bedtime. Rationale: The dosage range for eszopiclone (Lunesta) is 1 to 3 milligrams daily at bedtime, so the dosage for (B) is too high.
A client is beginning therapy with montelukast (Singulair) PO 10 mg once a day in the evening. The client asks the nurse, "When should I begin to feel better?" How should the nurse respond?
B. within 24 hours Rationale: Maximal effects of montelukast (Singulair) develop within 24 hours of the first dose.
The mother of a newborn asks the nurse why her infant needs the vitamin K (AquaMEPHYTON) injection. What information should the nurse provide?
A. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. Rationale: Vitamin K is provided because the newborn does not have the intestinal flora to synthesize adequate vitamin K in the intestines. Vitamin K promotes the formation of clotting factors in the liver.
The nurse should expect the healthcare provider to prescribe what treatment regimen for a client with peptic ulcer caused by Helicobacter pylori? (Select all that apply.)
A. Clarithromycin (Biaxin) D. Omeprazole (Prilosec) E. Metronidazole (Flagyl) Rationale: Recommended medical treatment for Helicobacter pylori includes the use of at lease 2 different antibiotics and a proton pump inhibitor to decrease the incidence of antibiotic resistance, so (A, D, and E) are consistent with this protocol.
The nurse should withhold which medication if a client reports nausea, vomiting, and diarrhea?
A. Colchicine Rationale: Nausea, vomiting, and diarrhea are indicators of toxic effects of colchicine which can be life-threatening and if present, this drug should be withheld and the healthcare provider notified
Which side effects should the nurse monitor for a client who is receiving dexamethasone (decadron) following neurosurgery? (Select all that apply.)
A. Mood swings C. increased weight gain E. delayed incisional would healing F. Serum hemoglobin level of 9 mg/dl Rationale: Correct selections are (A, C, E, and F). Dexamethasone (Decadron) is a long-acting glucocorticoid prescribe for neurosurgical procedures because it suppresses inflammation and has a low sodium-retaining ability, which is important in averting cerebral edema. Other side effects related to fluid and electrolyte imbalances, such as mood swings, an increase in appetite, and weight gain are common. Hyperglycemia is related to the gluconeogenesis properties of corticosteroids. Delayed wound healing related to immune suppression properties and complete blood count results for a decreased in WBC and hemoglobin (less than 12 mg/dl) should be monitored.
Which route should the nurse clarify with the healthcare provider prior to administering a drug with a high first-pass effect?
A. Oral Rationale: The first-pass effect occurs when hepatic metabolism decreases the bioavailability of a drug. Oral forms of medications are processed through the GI tract, absorbed through the small intestines, and undergo the first-pass effect in the liver before the drug reaches the intended site of action.
What is the expected outcome of esomeprazole (Nexium) when prescribed for a client with gastroesophageal reflux disease (GERD)?
A. Promotion of rapid tissue healing Rationale: Proton pump inhibitors, such as esomeprazole (Nexium), act to inhibit gastric acid secretion and promote rapid healing of esophageal tissue.
A client who has Trichomonas vaginalis receives a prescription for metronidazole (Flagyl). Which instruction should the nurse provide during client education?
D. Avoid over-the-counter antitussives Rationale: Flagyl can produce a disulfiram (Antabuse)-like reaction when combined with products containing alcohol, such as over-the-counter cough remedies, so the client should be informed to avoid ingesting any alcohol product during the use of Flagyl.
Which statement by a client warrants further instruction by the nurse about the changing insulin needs of a diabetic client during pregnancy?
B. "I will increase my insulin dosage by 5 units each month during the first trimester." Rationale: Insulin needs during pregnancy are determined individually according to the client's glucose levels. Insulin needs in the first trimester may actually decrease, so "B" indicates the need for reteaching.
Which heparin concentration should the nurse use to convert an intravenous site to a heparin lock?
B. 100 units/ml Rationale: The concentration of heparin 100 unit/ml is used for flushing and maintaining a heparin lock.
A client asks the nurse to explain the meaning of a narrow therapeutic index of a medication. What information should the nurse to answer the question?
B. A small margin exists between safe toxic plasma levels. Rationale: A narrow therapeutic index means that there is a narrow difference between safe and toxic drug levels, so clients receiving these medications should be closely monitored.
Which drug of choice is indicated for acute ventricular dysrhythmias associated with myocardial infarction?
C. Amiodarone Rationale: Based on the Tachycardia Algorithm, amiodarone is the drug of choice for acute ventricular dysrhythmias associated with myocardial infarction.
A pediatric client who has been diagnosed with partial seizures receives a prescription for topiramate (Topamax). What information should the nurse provide to the child's parents?
A. Do not crush the tablet prior to administration Rationale: The tablet form of topiramate should be taken with adequate fluids and without breaking it because of its extremely bitter taste, so crushing the tablet should be avoided.
Miotic drug therapy for the treatment of glaucoma is based chiefly upon which physiologic action?
A. Enhancing aqueous humor outflow Rationale: Miotic drugs act to enhance aqueous outflow through papillary constriction.
The therapeutic effect of insulin in treating Type 1 diabetes mellitus is based on which physiologic action?
A. Facilitates transport of glucose into cells. Rationale: Glucose moves across the cell membrane by using an active transport mechanism. Insulin acts as the carrier of glucose and is the only hormone that decreases blood glucose levels by facilitating transport of glucose into the cells.
A client who is receiving chemotherapy is prescribed ondansetron (Zofran). What side effect should the nurse include in the teaching plan?
A. Headache Rationale: Ondansetron (Zofran), a serotonin antagonist is the most effective antiemetic in suppressing nausea and vomiting caused by cancer chemotherapy - induced emesis or emetogenic anticancer drugs. Common side effects include headache, diarrhea, dizziness, and fatigue.
An older client is taking warfarin sodium (Coumadin) PO 2.5 mg twice a day. Which laboratory value should the nurse identify as therapeutic response of the medication?
A. INR of 2 to 3 Rationale: Recommended INR ranges for clients on warfarin therapy is 2 to 3. Therapeutic anticoagulation using Coumadin should prolong the prothrombin time (PT) by 1.5 to 2 times the control value. PTT and aPTT are laboratory monitoring tests used for clients on heparin therapy.
What is the effect of beta-blocking agents when used for treatment of glaucoma?
A. Inhibiting aqueous humor production Rationale: Beta blockers are used to inhibit aqueous humor production
A client with rheumatoid arthritis is receiving a prescription for minocycline (Minocin). Which side effect is most important for the nurse to instruct the client to report?
A. Loss of balance and dizziness. Rationale: Minocycline (Minocin), a tetracycline antibiotic, is used to treat mild cases of rheumatoid arthritis and can cause damage to the vestibular part of the inner ear, so the client should report dizziness or difficulty maintaining balance.
When prescribed for a client with hepatic encephalopathy, what is the therapeutic action of lactulose (Portalac)?
A. Lowers the pH of the colon Rationale: colonic bacteria diget lactulose to create a drug-induced acidic and hyperosmotic environment that draws water and blood ammonia into the colon. The physiologic action of lactulose for the client with hepatic encephalopathy is to lower the pH of the colon., which inhibits diffusion of ammonia into the bloodstream.
A client is taking sulfisoxazole (Gantrisin) for a urinary tract infection (UTI) and complains of nausea and gastric upset since starting the medication. Which additional adverse reaction should the nurse instruct the client to report?
A. Rash Rationale: Side effects of sulfisoxazole (Gantrisin), a sulfonamide antibiotic, include possible allergic response, manifested by skin rash and itching, which can progress to Stevens - Johnson syndrome - erythema multiforme, a severe hypersensitivity reaction.
The nurse receives a unit of blood from the blood bank for a postoperative client who is currently in the X-ray department. What action should the nurse implement?
A. Return the blood to the blood bank for refrigeration within 30 minutes. Rationale: A blood transfusion should be hung for administration within 30 minutes of its arrival from the blood bank. If it is not used within this time frame, it must be returned to the blood bank for refrigeration.
A client who takes a statin and gemfibrozil (Lopid) for hyperlipidemia reports onset of muscle pain and weakness. What additional assessment is most important for the nurse to obtain?
A. Serum liver enzymes Rationale: concomitant use of gemfibrozil and statins can cause muscle weakness and wasting known as myopathy, which is reflected in serum liver function enzymes, such as elevated serum aspartate aminotransferase (AST or SGOT) that is also found in skeletal muscle.
A male client who is in the terminal stage of cancer is cared for at home by his family and receives a prescription for morphine at a rate to control intractable pain. When the hospice nurse visits, the client awakens, moans in severe pain, and asks for an increase in the morphine dosage. After determining the client's respirations are 10 per minute, what is the best action for the nurse to implement?
A. Titrate the morphine dose upward until the client has adequate pain relief Rationale: Tolerance can occur in a client who requires large doses of opioids or intractable pain management, and an increased titration of the analgesic or an additional drug in the same or a different classification may provide more effective pain management.
A client calls the clinic and states that she forgot to take her oral contraceptives for the past two days. Which instruction is best or the nurse to provide to t his client?
A. take 2 pills a day for 2 days and use an alternate method of contraception for 7 days Rationale: if two pills are missed the client should implement (A).
The nurse is providing medication teaching for a client who has recently received a prescription for clozapine (Clozaril). Which instruction should be included in this client's teaching plan?
B. Rise Slowly from a lying position Rationale: Orthostatic hypotension is a side effect of Clozaril, so the client should be instructed to rise slowly from a lying position.
Based on the blood culture ans sensitivity results, the healthcare provider prescribes an IV aminoglycoside antibiotic and discontinues the current prescription for another broad spectrum antibiotic. The medication administration record indicates that the client received the broad spectrum antibiotic two hours ago. Which action should the nurse implement.?
B. Administer the initial dose of the aminoglycoside antibiotic as soon as possible Rationale: The blood culture and sensitivity results identify the specific antibiotic that is most effective in treating the client's infection, so the aminoglycoside antibiotic should be administered as soon as possible.
A client with depression receives a prescription for amitriptyline (Elavil). Which instruction should the nurse include in the client's teaching?
B. Avoid the consumption of alcohol. Rationale: Tricyclic antidepressants (TCAs) such as amitriptyline can cause sedation and should not be mixed with agents that depress the central nervous system, so the client should be instructed to avoid alcohol.
A client receives a prescription for sulfamethoxazole-trimethoprim (Septra) for a urinary tract infection (UTI). What instruction should the nurse provide the client?
B. Drink at least 8 glasses of water a day Rationale: to decrease the risk of renal damage due to crystalluria associated with sulfamethoxazole, the client should be instructed to consume at least 8 glass of water a day.
A client receives a prescription for esomeprazole (Nexium) for heartburn. Which finding in the client's history should the nurse report tot he healthcare provider before administering the prescription?
B. History of deep vein thrombosisOF THE CLIENTS RECENT' Rationale: Esomeprazole (Nexium), a proton pump inhibitor (PPI) and warfarin (Coumadin), which is used in the treatment of deep vein thrombosis (DVT). The healthcare provider should be informed of the client's recent history and treatment for DVT prior to giving Nexium.
A client at 30-weeks gestation is in preterm labor. The healthcare provider prescribes two 12-mg doses of betamethasone (Celestone) intramuscularly every 12 hours. The client asks the nurse why she is receiving he Celestone. What information should the nurse use to explain the action of the medication?
B. Stimulates fetal surfactant production Rationale: Antenatal glucocorticoids, such as betamethasone (Celestone), are given IM to the mother to stimulate surfactant production in the fetus and accelerate fetal lung maturity.
The healthcare provider prescribes pyridostigmine bromide (Mestinon) tablets for a client with myasthenia gravis (MG). What instruction should the nurse provide this client?
B. Take the medication 30 to 45 minutes before eating. Rationale: Mestinon, an acetylcholinesterase inhibitor, increases the amount of neuromuscular transmitters to promote muscular strength and swallowing, so the client should take the medication at least 30 minutes before meals.
The healthcare provider prescribes oral antifungal therapy for a client with onychomycosis. What information should the nurse tell the client?
B. The infection is difficult to eradicate and requires prolonged therapy for 3 to 6 months. Rationale: Treatment of onychomycosis, a fungal infection of the fingernails and toenails, is difficult to treat and requires prolonged therapy of 3 to 6 months.
A client with pneumonia receives a prescription for tetracycline (Sumycin). What precaution should the nurse include in this client's teaching?
C. Avoid dairy products for 2 hours after taking the medication Rationale: Dairy products should be ingested at least 2 hours after taking Sumycin because calcium binds with tetracycline and decreases its absorption.
A client is taking cyclosporine for renal allograft rejection prevention. After 9 months of drug therapy, the nurse reviews laboratory data and notes that the blood urea nitrogen level is 36 mg/dl. What additional finding should the nurse identify?
C. Creatinine 28 mg/dl Rationale: Acute organ rejection usually occurs in the first 3 months affter transplantation or at any time if an infection develops. Cyclosporine (Sandimmune, Neoral, Gengraf), is a cytokine inhibitor used to prevent and treat organ rejection, which is manifested by elevated blood urea nitrogen (norm 10-20 mg/dl) and creatinine (norm 0.6 to 1.2 mg/dl).
A client is admitted for atrial fibrillation, and the healthcare provider prescribes disopyramide (Norpace). After explaining the action of this antidysrhythmic agent, which complaint should the nurse instruct the client to report?
C. Daily weight gain of 2 pounds Rationale: Disopyramide (Norpace) is a class IA antiarrhythmic (with similar actions such as procainamide) used to suppress and prevent premature ventricular contractions, episodes of ventricular tachycardia, atrial flutters and atrial fibrillation. The nurse should instruct the client to report any sudden weight gain that may indicate fluid retention related to poor cardiac output, which may e the result of ineffective management of the dysrhythmia.
An emergency department triage nurse is interviewing a female client who has a history of epilepsy with tonic-clonic seizures controlled by penguin (Dilantin). Which information is most significant in planning this client's care?
C. she ran out of her medication 4 days ago Rationale: abruptly stopping anticonvulsant medications can precipitate seizures or the development of status epilepticus
What pathophysiological action supports the expected outcome for a client with chronic cancer pain who is treated with imipramine (Tofranil), a tricyclic antidepressant?
C. Decreases transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses. Rationale: Tricyclic antidepressants reduce neuropathic pain due to cancer invasion by blocking the reuptake of serotonin and norepinephrine in the CNS, and thereby inhibit pain transmission in the spinal cord dorsal horn, which are part of the deciding pain-modulating system.
When assessing a client prior to the administration of digoxin (Lanoxin), which data is most important for the nurse to consider?
C. Irregular apical pulse with a rate of 87. Rationale: The action of digoxin is to slow the heart rate and strengthen the force of contraction, so it is essential for the nurse to ensure that the apical pulse is within determined parameters prior to administration.
A 38-year-old gravid 2 para 2 is diagnosed with bacterial vaginosis 9-months postpartum. A prescription is written for metronidazole (Flagyl). Which information is most important for the nurse to obtain from the client before initiating treatment?
C. Method of infant feeding Rationale: Flagyl is contraindicated if the woman is breastfeeding because high concentrations have been found in infants. If flatly must be prescribed, the woman should be instructed to pump and discard the milk during treatment and for 48 to 72 hours after the last dose.
A client receives a new prescription for nitroglycerin (Nitrostat) tablets. Which instruction should the nurse include in this client's teaching?
C. Place under the tongue as needed every 5 minutes up to 3 times. Rationale: The client should be instructed to place a tablet under the tongue every 5 minutes up to 3 times, ad call 911 if the anginal pain is not relieved.
The healthcare provider has prescribed digoxin for a client who has been taking furosemide (Lasix) for six months. What laboratory serum levels should the nurse review before administering the digoxin?
C. Potassium Rationale: The client's serum potassium levels should be evaluated before giving the first dose of digoxin because Lasix can cause hypokalemia and increase the risk of digoxin toxicity and cardiac arrhythmia.
A client is taking danazol (Danocrine) for endometriosis and calls the clinic nurse to complain of a dark, swollen, and painful leg. What instructions should the nurse provide the client?
C. Proceed to the closest emergency room. Rationale: A dark, swollen, and painful leg is consistent with deep vein thrombosis (DVT), an adverse effect of danazol, so the client should be instructed to seek immediate emergency care.
A client with chronic gouty arthritis takes allopurinol (Zyloprim) and experiences an acute attack of gouty arthritis. The healthcare provider prescribes concurrent low-dose colchicine. What information should the nurse provide the client that best explains the action of the colchicine?
C. Reduces inflammation at the affected site Rationale: allopurinol (Zyloprim) improves joint function in chronic gouty arthritis by reducing blood uric acid levels to prevent and promote regression of top. Low dose colchicine, an antiinflammatory agent specific for gout, is used concurrently with allopurinol which can precipitate an incident of acute gouty arthritis
A client receives a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. What client history contraindicates its use?
C. Renal artery stenosis Rationale: Angiotensin-converting enzyme (ACE) inhibitors can cause severe renal insufficiency in clients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney. ACE inhibitors should not be used during the second and third trimesters of pregnancy and should be used with caution in clients who are taking potassium sparing diuretics or who have hyperkalemia.
A client who is recently diagnosed with myasthenia gravis receives a prescription for pyridostigmine (Mestinon), a cholinergic agent. Which information should the nurse instruct the client to implement when taking this medication
C. Take the medication at least 30 minutes before eating meals. Rationale: The nurse should instruct the client to take the medication 30 minutes before meals, which allows for the onset of action and therapeutic effects during the meal to improve swallowing and chewing.
The healthcare provider discontinues prednisone, a glucocorticoid, for a client with chronic obstructive pulmonary disease. What instructions shold the nurse give the client about the regimen to follow?
C. The dose must be tapered over the course of 7 to 10 days Rationale: To minimize the impact of adrenal insufficiency, withdrawal of exogenous glucocorticoids should be done by gradually decreasing the dosage over several days.
A client with chronic schizophrenia illness is admitted after taking risperidone (Risperdal) 10mg/day for three months. The nurse implements a daily assessment using the Abnormal Involuntary Movement Scale (AIMS). What findings should the nurse report to the healthcare provider?
C. Tremors and muscle twitching Rationale: For a client with chronic mental illness, evidence-based pharmacological guidelines recommend first-line treatment using an atypical antipsychotic, such as risperidone (Risperdal), which can cause extrapyramidal symptoms (EPS) at dosages above 10 mg/day. The IMS crietria measures tardive dyskinesia movements, such as facial, oral, tongue, teeth, and other akinesias of the trunk and extremity, such as tremors and muscle twitching, which should be reported.
A client is receiving fentanyl via an epidural infusion. Which side effect should the nurse anticipate in the first 24 hours of epidural analgesia?
C. Urinary retention Rationale: Common side effects of epidural opioids include nausea, itching, and urinary retention, which may require urinary catheterization.
Which common side effect should the nurse alert a female client about when medroxyprogesterone (Depo-Provera) is prescribed?
C. Vaginal bleeding after discontinuing the medication. Rationale: Approximately 3 to 7 days after the last cyclic dose of medroxyprogesterone, a female client may experience withdrawal vaginal bleeding.
The nurse should instruct a client to avoid which product while taking carisoprodol (Soma) for muscle spasms?
C. alcoholic beverages Rationale: Soma is a centrally-acting muscle relaxant that can cause CNS depression, and can have an additive effect when taken with other CNS depressants, such as alcohol.
A school-aged child is taking methylphenidate hydrochloride (Ritalin) for the treatment of attention-deficit hyperactivity disorder (ADHD). The mother tells the nurse that she gives the medication at bedtime so its "working" during school the next morning. What modification to the administration plan should the nurse recommend to this mother?
D. Administer at least six hours before bedtime. Rationale: Central nervous system stimulants, such as Ritalin, should be taken at least six hours before bedtime to decrease insomnia.
What action should the nurse implement to provide analgesic titration for a client in pain?
D. Determine the optimal analgesic dosage required that causes the least side effects Rationale: No given dosage of an analgesic provides the same level of pain relief for every patient, and so titration upward or downward is determined based on the client's response, so that the optimal dosage achieves adequate pain relief with minimal side effects for the client.
A 48-year-old client is experiencing a severe anaphylactic reaction to an injection of contrast media. What pharmacologic agent is of greatest use in this situation?
D. Epinephrine (Adrenalin) Rationale: Epinephrine is the drug of choice in treating hypotension and circulatory failure associated with anaphylaxis because it is a potent vasoconstrictor. An anaphylactic reaction is an acute systemic hypersensitivity reaction that occurs within minutes of antigen exposure (such as with contrast material containing iodine) that can result in peripheral vascular collapse.
The nurse administers the initial dose of fentanyl (Duragesic) transdermal patch to a client with chronic pain. When monitoring the client an hour later, which assessment is most important for the nurse to obtain?
D. Numeric pain scale Rationale: Transdermal fentanyl, an opioid analgesic, has an onset and peak of 6 to 12 hours after the initial dose, so its most important to determine the client's level of pain, which can persist as breakthrough pain throughout the 72-hour duration of the patch.
A resident of a long-term care facility is taking lithium carbonate (Eskalith) to treat bipolar disorder. Which instruction should the nurse provide to this client's caregivers?
D. Report symptoms of hypothyroidism such as fatigue and constipation Rationale: Lithium carbonate (Eskalith) causes hypothyroidism in 1 to 4% of those clients receiving the medication, so caregivers should assess for signs of hypothyroidism including fatigue and constipation (early signs) and myxedema or goiter (late symptoms)
A client receives a new prescription for pentazocine (Talwin), a mixed opioid agonist-antagonist, after an opioid agonist is discontinued. What is the advantage for the client when the are prescription is implemented?
D. Respiratory depression is less Rationale: Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as antagonists or partial agonists on the mu receptor, which produces less respiratory depression than opioid agonists that are pure mu agonists.
A client with chronic pancreatitis receives a new prescription for pancrelipase (Pancrease). Which instruction is most important for the nurse to include in this client's teaching?
D. Take the medication when consuming food. Rationale: With the loss of exocrine function for a client with chronic pancreatitis, replacement of pancreatic enzymes using pancrelipase (Pancrease) becomes necessary. Diarrhea and steatorrhea (fatty stools) indicate insufficient pancreatic enzymes are present to digest dietary fats and other nutrients, so pancrelipase, a fat-digesting enzyme should be consumed with any type of food.
A client with Paget's disease is started on calcitonin (Calcimar) 500 mpg subcutaneously daily. During the initial treatment, what is the priority nursing action?
D. The nurse's highest priority is to observe for signs of hypersensitivity, such as skin rash, hives, or anaphylaxis.
A female client receives a prescription for cefadroxil (Duricef) for a urinary tract infection. The client informs the nurse that she is currently taking oral contraceptives (OCP). What information is important for the nurse to share with the client?
D. Use an additional form of contraception until your menstrual cycle. Rationale: Cephalosporins such as cefadroxil can decrease the efficacy of oral contraceptives, so the client should be instructed to use an additional form of contraception.
A client receives a new prescription for ciprofloxacin (Cipro), a synthetic quinolone. When teaching about this drug, which information in the client's history requires special emphasis by the nurse?
D. Works twenty hours a week as a lifeguard at the local pool. Rationale: Cipro can cause both dizziness and photosensitivity. since the client works as a lifeguard outdoors, measures related to these adverse effects should be addressed.
