Review HESI RN 311 Pharmacology

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HESI RN 311 Pharmacology

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Total Questions : 41

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Question 1:

A patient with peptic ulcer disease is scheduled to receive doses of pantoprazole IV and sucralfate PO before breakfast at 0800. The patient reports experiencing heartburn. The nurse brings the scheduled medications. Which action should the nurse take?

A. Provide a PRN dose of antacid along with the scheduled medications. B. Instruct the client to take the dose of sucralfate PO while eating breakfast. C. Hold the dose of IV pantoprazole until the client has finished eating breakfast. D. Administer both of the medications before breakfast as scheduled.

Answer and Explanation

Choice A:

: Providing a PRN dose of antacid along with the scheduled medications is not the best option. Antacids can interfere with the absorption of other medications, including sucralfate and pantoprazole. Sucralfate works by forming a protective barrier on the ulcer site, and pantoprazole is a proton pump inhibitor that reduces stomach acid production. Adding an antacid could alter the effectiveness of these medications.

Choice B:

: Instructing the client to take the dose of sucralfate PO while eating breakfast is incorrect. Sucralfate should be taken on an empty stomach, typically one hour before meals, to ensure it can effectively coat the ulcer site and provide protection. Taking it with food can reduce its efficacy.

Choice C:

: Holding the dose of IV pantoprazole until the client has finished eating breakfast is not advisable. Pantoprazole is most effective when taken before meals, as it helps to reduce stomach acid production in anticipation of food intake. Delaying the dose could result in less effective acid suppression and increased discomfort for the patient.

Choice D:

: Administering both of the medications before breakfast as scheduled is the correct action. Sucralfate should be taken on an empty stomach to form a protective barrier on the ulcer site, and pantoprazole should be administered before meals to reduce stomach acid production. This timing ensures both medications work optimally to manage the patient’s peptic ulcer disease and alleviate symptoms like heartburn.

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Question 2:

A client with a history of anaphylactic reaction to penicillin receives a prescription for cephalexin 500 mg PO twice daily. Which action should the nurse take?

A. Contact the healthcare provider. B. Give with prescribed antihistamine. C. Administer the medication as prescribed. D. Monitor the client for a rash or hives.

Answer and Explanation

Choice A:

: Contact the healthcare provider: Given the client’s history of anaphylactic reaction to penicillin, there is a potential risk of cross-reactivity with cephalexin, a cephalosporin. Although the risk of cross-reactivity is relatively low, it is still significant enough to warrant caution. Studies indicate that 1-4% of people with a true penicillin allergy may also react to cephalosporins. Therefore, the nurse should contact the healthcare provider to discuss alternative antibiotics or additional precautions.

Choice B:

: Give with prescribed antihistamine: While antihistamines can help manage mild allergic reactions, they are not sufficient to prevent or treat anaphylaxis. Anaphylactic reactions require immediate medical intervention, including epinephrine administration. Therefore, relying solely on antihistamines is not an appropriate or safe action in this scenario.

Choice C:

: Administer the medication as prescribed: Administering cephalexin without consulting the healthcare provider could put the client at risk of a severe allergic reaction. Given the client’s history of anaphylaxis to penicillin, it is crucial to verify the safety of cephalexin with the healthcare provider before administration.

Choice D:

: Monitor the client for a rash or hives: While monitoring for allergic reactions is essential, it should not be the primary action in this case. The priority is to prevent a potential severe allergic reaction by consulting the healthcare provider before administering the medication. Monitoring alone does not address the underlying risk of cross-reactivity.

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Question 3:

Ferrous sulfate elixir is prescribed for a client with iron deficiency anemia. Which instruction should the nurse provide this client about taking the liquid medication?

A. Use a straw to ingest. B. Swallow undiluted. C. Mix with an antacid. D. Take with a glass of milk.

Answer and Explanation

Choice A:

: Use a straw to ingest: Ferrous sulfate elixir can cause staining of the teeth. Using a straw helps to minimize contact with the teeth, thereby reducing the risk of staining. This method ensures that the medication is ingested directly into the throat, bypassing the teeth.

Choice B:

: Swallow undiluted: Swallowing ferrous sulfate elixir undiluted is not recommended because it can cause gastrointestinal irritation. Diluting the elixir in water or juice can help to minimize this irritation and improve absorption.

Choice C:

: Mix with an antacid: Mixing ferrous sulfate with an antacid is not advisable because antacids can interfere with the absorption of iron. Iron is best absorbed in an acidic environment, and antacids neutralize stomach acid, thereby reducing iron absorption.

Choice D:

: Take with a glass of milk: Taking ferrous sulfate with milk is not recommended because calcium in milk can inhibit the absorption of iron. It is best to take iron supplements on an empty stomach or with a source of vitamin C, such as orange juice, to enhance absorption

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Question 4:

A client with chronic asthma receives a prescription for montelukast, a leukotriene modifier. Which statement by the client indicates to the nurse that medication teaching was effective?

A. I should take this medication only when I am having an asthma attack. B. I will not need to use my inhalers twice a day when I start this medicine. C. I will take the tablet every evening to control my asthma. D. This medication will stop an asthma attack immediately.

Answer and Explanation

Choice A:

: I should take this medication only when I am having an asthma attack: This statement is incorrect because montelukast is not a rescue medication. It is a maintenance medication designed to be taken regularly to prevent asthma symptoms and attacks. Using it only during an asthma attack would not provide the intended preventive benefits.

Choice B:

: I will not need to use my inhalers twice a day when I start this medicine: This statement is also incorrect. Montelukast is often used as an adjunct therapy and does not replace the need for inhalers, especially for those with moderate to severe asthma. Inhalers, particularly corticosteroids, remain a critical part of asthma management.

Choice C:

: I will take the tablet every evening to control my asthma: This statement is correct. Montelukast is typically prescribed to be taken once daily in the evening. This helps to control asthma symptoms and prevent attacks by reducing inflammation and constriction in the airways.

Choice D:

: This medication will stop an asthma attack immediately: This statement is incorrect. Montelukast is not a fast-acting medication and will not provide immediate relief during an asthma attack. Fast-acting bronchodilators, such as albuterol, are used for immediate relief.

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Question 5:

The nurse is providing discharge instructions for a client with metastatic cancer who is prescribed morphine for bone pain. Which information from the client indicates to the nurse an understanding of the medication?

A. Observe bowel movement pattern and take a stool softener. B. Do not drink grapefruit juice after taking morphine. C. Take the benzodiazepine at the same time as taking the morphine. D. Watch for signs of agitation and record any insomnia.

Answer and Explanation

Choice A:

Morphine, an opioid analgesic, is commonly prescribed for severe pain management, such as in cases of metastatic cancer. One of the well-known side effects of morphine is constipation. This occurs because opioids slow down gastrointestinal motility, leading to harder and less frequent stools. Therefore, it is crucial for patients taking morphine to monitor their bowel movements and use stool softeners or laxatives as needed to prevent constipation. This choice indicates that the client understands the importance of managing this common side effect, which can significantly impact their comfort and quality of life.

Choice B:

Grapefruit juice is known to interact with various medications by inhibiting the cytochrome P450 3A4 (CYP3A4) enzyme in the liver, which can lead to increased blood levels of certain drugs. However, morphine is primarily metabolized by the liver enzyme UGT2B7, not CYP3A4. Therefore, grapefruit juice does not significantly affect morphine metabolism. This choice reflects a misunderstanding of the specific interactions relevant to morphine.

Choice C:

Taking a benzodiazepine at the same time as morphine can be dangerous due to the risk of additive central nervous system (CNS) depression. Both morphine and benzodiazepines can cause sedation, respiratory depression, and impaired cognitive and motor functions. Concurrent use increases the risk of severe side effects, including potentially life-threatening respiratory depression. This choice indicates a lack of understanding of the risks associated with combining these medications.

Choice D:

While it is important to monitor for signs of agitation and insomnia, these are not the primary concerns associated with morphine use. Morphine is more likely to cause sedation rather than agitation, and insomnia is not a common side effect. This choice does not reflect a comprehensive understanding of the primary side effects and necessary precautions related to morphine use.

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Question 6:

A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for pulmonary embolism. Which information in the client’s history requires follow-up by the nurse?

A. A CT scan that was performed six months earlier. B. Takes metformin hydrochloride for type 2 diabetes mellitus. C. Report of client’s sobriety for the last five years. D. Metal hip prosthesis was placed twenty years ago.

Answer and Explanation

Choice A:

A CT scan performed six months earlier does not typically require follow-up unless there were specific findings or complications from the previous scan. The timing of the previous scan is not a contraindication for a new CT scan with contrast. However, it is always good practice to review previous imaging results to compare and assess any changes.

Choice B:

Metformin hydrochloride is a medication used to manage type 2 diabetes mellitus. It is important to follow up on this information because metformin can interact with the contrast dye used in CT scans. The combination can increase the risk of lactic acidosis, a rare but serious complication. Therefore, it is crucial to assess kidney function and possibly withhold metformin before and after the procedure to reduce this risk.

Choice C:

A report of the client’s sobriety for the last five years is generally a positive aspect of their medical history and does not require follow-up in the context of a CT scan with contrast. Sobriety does not impact the safety or efficacy of the contrast dye used in the scan.

Choice D:

A metal hip prosthesis placed twenty years ago is relevant information but does not typically require follow-up before a CT scan. Unlike MRI, where metal implants can cause issues, CT scans are generally safe for patients with metal prostheses. However, the presence of metal can sometimes affect the quality of the images, so it is important for the radiologist to be aware of it.

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Question 7:

A female client with mild depression reports to the nurse that she recently started taking St. John’s wort. Which information provided by the client requires further instruction?

A. Insomnia may occur while taking the medication. B. Another form of contraception is not needed. C. Sensitivity to the sun can develop. D. Hard candy can be used for a dry mouth.

Answer and Explanation

Choice A:

Insomnia is a known side effect of St. John’s wort. While it can be bothersome, it does not typically require further instruction beyond standard advice on managing insomnia. Patients should be advised to take the medication earlier in the day to minimize sleep disturbances.

Choice B:

St. John’s wort can interact with hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. This interaction occurs because St. John’s wort induces the enzymes that metabolize contraceptive hormones, leading to lower levels of these hormones in the body. Therefore, it is crucial to instruct the client to use an additional form of contraception to prevent pregnancy.

Choice C:

Sensitivity to the sun, or photosensitivity, is a documented side effect of St. John’s wort. Patients should be advised to use sunscreen and wear protective clothing when exposed to sunlight. While this side effect requires caution, it does not necessitate further instruction beyond these preventive measures.

Choice D:

Using hard candy to alleviate dry mouth is a common and effective strategy. St. John’s wort can cause dry mouth, and sucking on sugar-free hard candy can help stimulate saliva production. This advice is appropriate and does not require further instruction.

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Question 8:

A client who is receiving pregabalin for fibromyalgia complains of tremors in the hands. Which action should the nurse implement?

A. Administer a PRN dose of an antianxiety drug. B. Obtain orthostatic blood pressure readings. C. Notify the healthcare provider. D. Collect a capillary glucose level.

Answer and Explanation

Choice A:

Administering a PRN dose of an antianxiety drug might seem like a reasonable action if the tremors are related to anxiety. However, without a clear indication that anxiety is the cause of the tremors, this action could mask the underlying issue and delay appropriate treatment. It is essential to identify the root cause of the tremors before administering any medication.

Choice B:

Obtaining orthostatic blood pressure readings is a useful assessment for determining if the client has orthostatic hypotension, which can cause dizziness and fainting. However, this action is not directly related to the complaint of hand tremors. While it is a good practice to monitor vital signs, it does not address the immediate concern of tremors caused by pregabalin.

Choice C:

Notifying the healthcare provider is the most appropriate action. Tremors can be a side effect of pregabalin12. The healthcare provider needs to be informed to evaluate the severity of the side effect and decide whether to adjust the medication dosage or switch to an alternative treatment. This ensures that the client receives the most appropriate care and avoids potential complications.

Choice D:

Collecting a capillary glucose level is important for clients with diabetes or those at risk of hypoglycemia or hyperglycemia. However, there is no indication in the scenario that the client has diabetes or that blood glucose levels are related to the tremors. Therefore, this action is not directly relevant to the client’s current complaint.

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Question 9:

A client with a history of smoking cigarettes for many years arrives at the clinic and expresses a desire to stop smoking. The client receives a prescription for bupropion to reduce nicotine cravings. Which information should the nurse include in the discharge teaching?

A. Be aware that difficulty sleeping and weight loss may occur. B. Notify the healthcare provider if experiencing changes in taste. C. Administer each dose with at least 8 ounces of water. D. Consume tyramine-free foods while taking the medicine.

Answer and Explanation

Choice A:

Bupropion is known to cause side effects such as insomnia and weight loss. These side effects are due to its stimulant properties, which can interfere with sleep patterns and suppress appetite1. Patients should be informed about these potential side effects so they can monitor their symptoms and seek medical advice if necessary.

Choice B:

While changes in taste can occur with some medications, it is not a common side effect of bupropion. Therefore, it is not necessary to specifically instruct patients to notify their healthcare provider about changes in taste when taking bupropion.

Choice C:

There is no specific requirement to administer bupropion with 8 ounces of water. Bupropion can be taken with or without food, and the amount of water consumed with the medication does not impact its effectiveness.

Choice D:

Consuming tyramine-free foods is crucial for patients taking monoamine oxidase inhibitors (MAOIs) due to the risk of hypertensive crisis. However, bupropion is not an MAOI, so this dietary restriction is not applicable.

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Question 10:

A client with cystitis receives a prescription for phenazopyridine. Which information should the nurse explain to the client about its therapeutic effect?

A. Eliminates urinary bacteria. B. Use the medication after voiding after sexual intercourse. C. Calms spasms in the urinary tract. D. Provides an analgesic effect for irritated bladder mucosa.

Answer and Explanation

Choice A:

Phenazopyridine does not eliminate urinary bacteria. It is not an antibiotic and does not have antibacterial properties. Instead, it is used to relieve symptoms such as pain, burning, and discomfort caused by irritation of the urinary tract. Therefore, this choice is incorrect.

Choice B:

Using phenazopyridine after voiding or after sexual intercourse is not a standard recommendation. This medication is typically taken after meals to reduce stomach upset. It is not specifically indicated for use after sexual intercourse, and this choice does not align with the typical usage instructions for phenazopyridine.

Choice C:

Phenazopyridine does not calm spasms in the urinary tract. Its primary function is to provide symptomatic relief from pain, burning, and discomfort in the urinary tract. It does not have antispasmodic properties, so this choice is also incorrect.

Choice D:

Phenazopyridine provides an analgesic effect for irritated bladder mucosa. It works by numbing the lining of the urinary tract, which helps to alleviate pain and discomfort associated with conditions like cystitis. This is the correct therapeutic effect of the medication.

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Total Questions : 41

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HESI RN 311 Pharmacology

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