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HESI NCLEX RN: Pharmacology
- In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, because the nurse is concerned about adequate nutrition, which intervention would best meet this child's needs?
A. Give aluminum hydroxide and magnesium hydroxide after meals. B. Give pancrelipase capsule mixed with applesauce before each meal. C. Administer cholestyramine resin before each meal and at bedtime. D. Administer omeprazole for gastroesophageal reflux. B. Give pancrelipase capsule mixed with applesauce before each meal.
- An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first?
A. Obtain a prescription for lower medication dosages. B. Determine the drug's serum levels for toxicity. C. Start IV fluids to decrease the serum drug levels. D. Hold the next dosage and notify the health care provider. B. Determine the drug's serum levels for toxicity.
- When providing client teaching about the administration of methylphenidate to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan?
A. The doses should be given exactly 12 hours apart to sustain a therapeutic serum level. B. Doses should be scheduled at midmorning and midafternoon to achieve optimal benefit. C. Give the medication only on school days and when the child appears to be anxious. D. Offer the child the medication with breakfast and after the child eats lunch. D. Offer the child the medication with breakfast and after the child eats lunch.
- The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time?
A. Decrease the oral secretions. B. Reduce the child's anxiety. C. Potentiate the opioid effects. D. Prevent possible peritonitis. A. Decrease the oral secretions.
- 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?
A. Take the medication with meals. B. Limit fluid intake until the attack subsides. C. Stop the medication when the pain resolves. D. Report any vomiting to the clinic. D. Report any vomiting to the clinic. Rationale:The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting, and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently. Limited fluid intake decreases the excretion of the uric acid crystals, which contributes to painful attacks. Typically, a client should remain on a daily dose of colchicine to decrease the number and severity of acute attacks, so stopping the medication after the pain resolves is not indicated.
- A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge?
A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink at least eight glasses of fluid a day. D. Drink at least eight glasses of fluid a day.
Adequate hydration is important for all sulfa drugs because they can crystallize in the urine. If possible, the drug should be taken after eating to provide longer intestinal transit time. Option A is important for other medications, such as phenytoin, because of the incidence of gingival hyperplasia, and option C is important for steroid administration, but option D is most important to stress with this client.
- Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control?
A. Maintain consistent sodium intake. B. Use sunscreen when outdoors. C. Return for monthly urinalysis. D. Brush and floss teeth daily. D. Brush and floss teeth daily. Rationale: Brushing and flossing the teeth daily prevent gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy. Options A, B, and C are not indicated for client instruction regarding phenytoin.
- 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?
A. Promotes excretion of neurotoxins B. Slows nerve cell degeneration C. Improves nerve impulse transmission D. Stimulates nerve cell regeneration C. Improves nerve impulse transmission Rationale:Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation. Basing an explanation on this concept, option C should provide an accurate explanation that the family can understand. Options A, B, and D are incorrect.
- The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose?
A. Naloxone hydrochloride B. Atropine sulfate C. Vitamin K D. Flumazenil A. Naloxone hydrochloride Rationale:Naloxone is an opioid antidote used in opioid overdose to reverse CNS and respiratory depression. Atropine is used for bradycardia, intestinal hypertonicity and hypermotility, muscarinic agonist poisoning, peptic ulcer disease, and biliary colic. Vitamin K is used to manage warfarin overdose and vitamin K deficiency in
newborns. Flumazenil reduces the sedative effects of benzodiazepines following general anesthesia or overdose.
- Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. The nurse will develop an immediate plan of care based on which finding?
A. Severe acute anaphylactic response B. Side reaction that should resolve C. Idiosyncratic reaction D. Cumulative drug response A. Severe acute anaphylactic response Rationale:Anaphylaxis related to penicillin can cause a life- threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client’s ingestion of penicillin and presenting clinical picture indicate the client is having an acute reaction with respiratory difficulty. Options B, C, and D are other physiologic responses to medications, but immediate action is required for a potential loss of airway, breathing, and circulation.
- The nurse is providing care to a 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. The nurse anticipates a prescription for which medication?
A. Chlorpromazine HCl B. Lithium carbonate C. Fluphenazine decanoate D. Diazepam C. Fluphenazine decanoate Rationale:Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client. Option A is an antipsychotic drug used to treat schizophrenia and is usually administered PO (IM doses are short- acting). The client must be compliant in taking this drug for it to be effective. Option B is most effective with manic and depressive bipolar affective disorders. Option D is an antianxiety drug and would not be effective for a psychotic disorder.
Rationale:Nitroglycerin reduces myocardial oxygen consumption, which decreases ischemia and reduces chest pain. Options B, C, and D are not expected outcomes of sublingual nitroglycerin.
- A client who is HIV-positive is receiving epoetin alfa for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider?
A. Hematocrit (HCT) of 58% B. Hemoglobin of 10.8 g/dL C. White blood cell count of 5000 mm D. Serum potassium level of 5 mEq/L A. Hematocrit (HCT) of 58% Rationale:Option A should be reported to the health care provider immediately because of the likelihood of a hypertensive crisis and because seizure activity increases with an increase in HCT of more than 4 points, or an HCT above 36%. Epoetin alfa stimulates erythropoiesis (production of red blood cells), thereby decreasing the need for blood transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high. Option B is the reason why the client is receiving epoetin alpha. Options C and D are within normal limits.
- Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR) C. Activated partial thromboplastin time (aPTT) Rationale:The laboratory value that measures heparin’s therapeutic anticoagulation time is the aPTT. Option A should be checked before the administration of digoxin. Option B is valuable information but not a parameter measured for heparin therapy. Option D is evaluated during anticoagulation therapy using sodium warfarin.
- In administering the antiinfective agent chloramphenicol IV to a client with bacterial meningitis, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor?
A. Platelet count
B. Blood urea nitrogen level C. Culture and sensitivity D. Serum calcium level A. Platelet count Rationale:Chloramphenicol can cause irreversible, fatal bone marrow depression, so the nurse should monitor the client’s platelet count. Options B, C, and D do not provide data related to bone marrow depression when monitoring a client who has been prescribed this medication.
- Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse take first?
A. Administer Digibind to counteract the toxicity. B. Withhold the drug and notify the health care provider immediately. C. Withhold the dose and notify the health care provider during rounds that the dose was held. D. Give the dose of digoxin if the client's heart rate is within a safe range. D. Give the dose of digoxin if the client’s heart rate is within a safe range. Rationale:The client’s digoxin level of 1.3 ng/dL is not above the upper range of its therapeutic index (toxic level is >2.0 ng/dL), so the dose should be administered after the client’s heart rate is evaluated. Digibind is administered for toxic levels of digoxin, so option A is not indicated. Options B and C are not necessary.
- A 21-year-old female client is receiving tetracycline for acne. Which client teaching should the nurse include?
A. Oral contraceptives may not be effective. B. Drinking cranberry juice will promote healing. C. Breast tenderness may occur as a side effect. D. The urine will turn a red-orange color. A. Oral contraceptives may not be effective. Rationale:Certain antibiotics, such as tetracycline, decrease the effectiveness of oral contraceptives. Options B, C, and D do not convey accurate information related to client teaching about this medication.
C. Draw a blood specimen for a phenobarbital level. D. Teach the mother safe medication storage practices. B. Take the child’s vital signs. Rationale:Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs. Options A, C, and D are actions that may all be used in the treatment of this child, but they do not have the priority of option B.
- A client with Tourette syndrome takes haloperidol. The client has become increasingly drowsy over the past 2 days, and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take? A. Assess skin tone and urine. B. Document the expected findings. C. Have the caregiver hold the next two doses of the medication. D. Determine whether the client's urine is pink or reddish brown. A. Assess skin tone and urine. Rationale:Because haloperidol causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration. Although sedation may occur with haloperidol administration, this side effect may signal an adverse CNS reaction; therefore, option B is not a sufficient intervention when client safety is threatened. Option C could precipitate withdrawal-emergent dyskinesia, which is potentially life threatening. Option D is expected.
- During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely?
A. Liver enzyme levels B. Blood urea nitrogen (BUN) level C. Serum electrolyte levels D. Complete blood count (CBC) A. Liver enzyme levels Rationale:The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy. Options B, C, and D are not specific indicators of liver function, so they are not monitored closely during isoniazid therapy.
- 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?
A. Butorphanol B. Hydromorphone C. Morphine sulfate D. Codeine sulfate A. Butorphanol Rationale:Butorphanol is a mixed agonist–antagonist analgesic resulting in good analgesia but with less respiratory depression, nausea, and vomiting compared with opioid agonist analgesics.
- The nurse is providing care to a client recently diagnosed with acute lymphocytic leukemia. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the most important information for the nurse to include in the client's teaching plan? A. Promotion of diuresis to prevent nephrotoxicity B. Reduction or elimination of nausea and vomiting C. Prevention of a secondary hyperuricemia D. Reduction in the risk of an allergic reaction B. Reduction or elimination of nausea and vomiting Rationale:Ondansetron is a type 3 receptor (5-HT3) antagonist that is recognized for improved control of acute nausea and vomiting associated with chemotherapy. 5-HT3 antagonists are most effective when administered IV prior to the induction of the chemotherapeutic agent(s). Options A, C, and D are not therapeutic actions of ondansetron.
- A client with viral influenza is receiving vitamin C, 3000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate?
A. Change the acetaminophen to ibuprofen. B. Change the elixir to an injectable route. C. Decrease the dose of vitamin C. D. Begin treatment with an antibiotic.
C. Low serum potassium level Rationale:Hypokalemia predisposes the client on digoxin to digoxin toxicity, which usually presents as abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and atrioventricular (AV) dissociation. Assessment of serum potassium levels with prompt correction of hypokalemia is an important intervention for the client taking digoxin. Options A, B, and D are not relevant.
- The nurse is preparing a teaching plan for a client's new medication. Which factor will the nurse consider is most important to ensure compliance when developing the plan?
A. Genetics B. Client age C. Client education D. Absorption rate C. Client education Rationale:The client’s educational level is the most important factor when planning teaching to ensure a client’s compliance with taking a prescribed drug. Options A and D are physiologic responses that do not relate to a client’s compliance. Although maturity level and age contribute to compliance, the client’s basic understanding of instructions, which is best indicated by educational level, is more significant.
- The nurse is providing care to a client on heparin. Which laboratory test indicates to the nurse that the medication is effective?
A. Prothrombin time (PT) B. Fibrin split products C. Platelet count D. Partial thromboplastin time (PTT) D. Partial thromboplastin time (PTT) Rationale:Heparin therapy is guided by changes in the partial thromboplastin time (PTT). Options A, B, and C are not used to track the therapeutic effect of heparin administration.
- A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which action should the nurse initiate?
A. Instruct the client about the indications of opioid dependence.
B. Monitor the client for symptoms of opioid withdrawal. C. Notify the health care provider of the need to increase the dose. D. Administer naloxone per PRN protocol for reversal. C. Notify the health care provider of the need to increase the dose. Rationale:Clients can develop a tolerance to the analgesic effect of opioids and may require an increased dose for effective long-term pain relief. The client is not exhibiting indications of dependence, withdrawal, or toxicity.
- A client has started long-term corticosteroid therapy tells the nurse that the daily dose will be taken at bedtime with a snack of crackers and milk. Which is the best response by the nurse?
A. Advise the client to take the medication in the morning, rather than at bedtime. B. Teach the client that dairy products should not be taken with her medication. C. Tell the client that absorption is improved when taken on an empty stomach. D. Affirm that the client has a safe and effective routine for taking the medication. A. Advise the client to take the medication in the morning, rather than at bedtime. Rationale:Daily doses of long-term corticosteroid therapy should be administered in the morning to coincide with the body’s normal secretion of cortisol. Clients receiving long-term corticosteroids need to increase their intake of calcium, which generally means an increase in dairy products. Corticosteroids can often cause gastrointestinal distress and should be administered with meals. The client has established a safe routine by taking the medication with a snack, but the routine will be more effective if done in the morning.
- A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome? A. Prothrombin time B. Uric acid level C. White blood cell count D. Creatinine level B. Uric acid level Rationale:The primary therapeutic outcome associated with allopurinol therapy is reduced serum uric acid levels with a lower frequency of acute gouty attacks, so option B should be reported to
C. Serum creatinine level D. Hemoglobin level A. Serum potassium level Rationale:The nurse should obtain baseline potassium levels prior to beginning drug therapy because amphotericin B changes cellular permeability, allowing potassium to escape from the cell, which could lead to a decrease in the serum potassium level and severe hypokalemia. Options B, C, and D are helpful laboratory values, but they do not have the importance of option A in determining if amphotericin B can be administered safely via IV infusion.
- The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client? A. Take one pill at the same time every day for the entire pack of pills. B. Use condoms and foam instead of the pill while on any antibiotics. C. Limit sexual intercourse for at least one cycle after starting the pill. D. Use another contraceptive if two or more pills are missed in one cycle. A. Take one pill at the same time every day for the entire pack of pills. Rationale:To maintain adequate hormonal levels for contraception and enhance compliance, oral contraceptives should be taken at the same time each day. There is no strong pharmacokinetic evidence that shows a relationship between the category of broad-spectrum antibiotic use and altered hormone levels in oral contraceptive users, so option B is not indicated at this time. Abstinence is the best method to prevent pregnancy during the first cycle. If a client misses two pills during the first week, the client should take two pills a day for 2 days and finish the package while using a backup method of birth control until her next menstrual cycle.
- A client with mild parkinsonism is started on oral amantadine. Which information will the nurse include in the client's teaching plan? A. Viral organisms that provide the underlying pathophysiology for parkinsonism are eliminated. B. Acetylcholine in the myoneural junction is enhanced. C. Dopamine in the central nervous system is increased. D. Norepinephrine release is reduced within the peripheral system as the final step in dopamine uptake. C. Dopamine in the central nervous system is increased. Rationale:Amantadine is a dopamine-releasing agent; therefore, this medication increases the amount of dopamine present in the central
nervous system. Although this medication is also an antiviral agent, the antiviral effect is not significant in the treatment of parkinsonism. Options B and D are not affected by amantadine.
- An 80-year-old client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which finding requires immediate nursing action? A. The client is drowsy and complains of pruritus. B. Pupils are 3 mm; PERRLA. C. The area around the sutures is reddened and swollen. D. Respirations decrease to 10 breaths/min. D. Respirations decrease to 10 breaths/min Rationale:Hydromorphone is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the “start low and go slow” approach should be taken. Option A lists common side effects of opioids, particularly the opiates, which are usually harmless and often transient. Option B is within the normal range ( to 6 cm). The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature.
- The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. When the client's temperature is 98.6°F/37°C. A. Thirty minutes after the dose is administered Rationale:Peak drug serum levels are achieved 30 minutes after the IV administration of aminoglycosides, so option A is the optimum time to get a peak level. Options B, C, and D are not appropriate times associated with peak levels for gentamicin.
- The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included? A. "Take this medication with a high-protein snack at bedtime." B. "You may change at any time to a less expensive generic brand." C. "Contact your health care provider if your daily pulse rate exceeds
- A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. Which adverse effect should the nurse report promptly to the health care provider? A. Petechiae B. Tinnitus C. Oliguria D. Hypertension A. Petechiae Rationale:Adverse effects of ticarcillin disodium include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae. Options B, C, and D are not adverse effects primarily associated with the administration of ticarcillin disodium.
- When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this assessment? A. Vincristine B. Bleomycin sulfate C. Chlorambucil D. Cyclophosphamide D. Cyclophosphamide Rationale:Hemorrhagic cystitis is the characteristic adverse reaction of cyclophosphamide. Administration of options A, B, and C does not typically cause hemorrhagic cystitis.
- A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia? A. Oral B. Intravenous C. Transdermal D. Intramuscular C. Transdermal Rationale:Continuous pain is best managed by maintaining a constant serum drug level. Transdermal drug administration of an analgesic provides around-the-clock, controlled release of the medication that is absorbed through intact skin into the bloodstream to provide continuous pain relief. Option A is convenient, but gastrointestinal variables affect the absorption rate of the drug, its onset and intensity, and duration of response and requires repeated doses around the clock.
Option B provides immediate action because the drug is infused directly into the bloodstream and is quickly metabolized, and repeated IV doses are required to maintain a continuous blood level. Option D requires repeated injections at regular intervals, which are uncomfortable, and absorption rates vary between muscle sites.
- Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective? A. The frequency of urinary tract infections decreases. B. The urine changes color and pain is diminished. C. The dipstick test changes from +1 to trace. D. The daily urinary output increases by 10%. A. The frequency of urinary tract infections decreases. Rationale:Mandelamine is prescribed to acidify the urine, decreasing the incidence of calcium phosphate calculi and urinary tract infections. Option B is related to the administration of pyridine. Mandelamine has no effect on option C or D.
- 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? A. Inhaled nitrous oxide B. Midazolam IV C. Ketamine IM D. Fentanyl and droperidol IM B. Midazolam IV Rationale:Conscious sedation uses sedative-hypnotics that do not compromise the airway, so IV midazolam, a short-duration benzodiazepine sedative, provides conscious sedation with local and regional anesthesia and has an amnestic effect. Option A is a weak anesthetic and is rarely used alone. Option C causes profound analgesia that causes a client to appear catatonic and amnestic. Fentanyl is an opioid more commonly used as an analgesic during anesthesia, whereas droperidol is a skeletal muscle anesthetic agent used to reduce spasticity to ensure a smooth induction under general anesthesia and requires intubation and ventilation during its onset and duration.
