Review HESI RN Pharmacology 106a Proctored Exam

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HESI RN Pharmacology 106a Proctored Exam

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Total Questions : 36

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Question 1:

A client reports confusion and blurred vision after receiving a dose of glipizide. Which action should the nurse implement?

A. Perform a neurological exam. B. Administer glucagon intramuscularly. C. Measure the client's vital signs. D. Obtain a fingerstick blood glucose.

Answer and Explanation

Choice A:

Performing a neurological exam is important in assessing the overall neurological status of a client, but it does not immediately address the symptoms of confusion and blurred vision caused by hypoglycemia, which is a common side effect of glipizide. This action would be more appropriate if there were indications of neurological impairment due to other causes.

Choice B:

Administering glucagon intramuscularly is an effective treatment for severe hypoglycemia when the client is unconscious or unable to take oral glucose. However, it may not be the first step if the client is still conscious and able to cooperate. The priority is to confirm the client's blood glucose level first.

Choice C:

Measuring the client's vital signs is a necessary step in assessing their overall condition, but it does not specifically address the issue of hypoglycemia. Vital signs may help identify other potential complications, but they do not provide information about the blood glucose level, which is crucial in this scenario.

Choice D:

Obtaining a fingerstick blood glucose is the immediate action to determine if the client is experiencing hypoglycemia. Glipizide is a sulfonylurea that can cause low blood sugar levels, leading to confusion and blurred vision. Confirming the blood glucose level will guide the subsequent actions to correct hypoglycemia if it is present.

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Question 2:

The nurse is administering SUBQ enoxaparin to a client following knee replacement surgery to prevent a deep vein thrombosis. Which laboratory result requires immediate action by the nurse?
Reference Range:
Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]
Platelets [150,000 to 400,000/mm³ (150 to 400 x 10⁹/L)]
Creatinine [0.5 to 1.1 mg/dL (44 to 97 umol/L)]
Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]

A. Platelet count of 100,000/mm³ (100 x 10⁹/L). B. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L). C. Serum creatinine 1.0 mg/dL (88.4 umol/L). D. Hematocrit 45% (0.45 volume fraction). H. Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]

Answer and Explanation

Choice A:

A platelet count of 100,000/mm³ is significantly below the normal range and indicates thrombocytopenia, which increases the risk of bleeding. Enoxaparin, an anticoagulant, further elevates this risk, making immediate intervention necessary. The nurse must notify the healthcare provider and take appropriate measures to prevent potential bleeding complications.

Choice B:

A blood urea nitrogen (BUN) level of 20 mg/dL is at the upper limit of the normal range and does not require immediate action. This value does not indicate a critical change in the client's condition and does not have the same urgency as a low platelet count.

Choice C:

A serum creatinine level of 1.0 mg/dL is within the normal range and does not require urgent action. This result does not suggest any immediate threat to the client's health and is not influenced by the administration of enoxaparin.

Choice D:

A hematocrit level of 45% is within the normal range and does not require immediate intervention. This value does not indicate any abnormality that would necessitate urgent action by the nurse.

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Question 3:

What are the signs and symptoms of hypothyroidism?

A. Decreased appetite. B. Restlessness. C. Intolerance to cold. D. Constipation.

Answer and Explanation

Choice A:

Decreased appetite is a common symptom of hypothyroidism. The reduced metabolic rate associated with low thyroid hormone levels can lead to a lack of hunger and reduced food intake, contributing to weight gain despite a lower calorie intake.

Choice B:

Restlessness is not a typical symptom of hypothyroidism. In fact, hypothyroidism often causes fatigue, lethargy, and a general slowing down of mental and physical processes rather than restlessness or hyperactivity.

Choice C:

Intolerance to cold is a hallmark symptom of hypothyroidism. The decreased metabolic rate results in reduced heat production, making individuals more sensitive to cold temperatures and often leading them to feel cold even in warm environments.

Choice D:

Constipation is a common symptom of hypothyroidism. The slowed metabolism affects the gastrointestinal system, reducing the movement of the intestines and leading to infrequent and difficult bowel movements.

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Question 4:

Levothyroxine sodium is prescribed for a client with hypothyroidism. The nurse should instruct the client to report which symptom because it indicates that the client is taking too much levothyroxine sodium?

A. Bradycardia B. Somnolence C. Insomnia D. Constipation

Answer and Explanation

Choice A:

This is a classic symptom of hypothyroidism (underactive thyroid). Levothyroxine is meant to increase the heart rate; therefore, a slow heart rate suggests the dose may actually be too low, not too high.

Choice B:

Excessive fatigue and sleeping are signs that the metabolic rate is still too slow. If a patient is taking too much medication, they would experience the opposite—heightened energy or restlessness.

Choice C:

Because Levothyroxine mimics the body’s "metabolic gas pedal," an excessive dose leads to symptoms of hyperthyroidism. This includes insomnia, palpitations, tremors, heat intolerance, and tachycardia. The body is effectively in "overdrive," making it difficult to rest.

Choice D:

This is another hallmark of an underactive metabolism. An overdose of Levothyroxine would more likely cause frequent bowel movements or diarrhea due to increased gastrointestinal motility.

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Question 5:

A client with narcolepsy receives a new prescription for methylphenidate. Prior to administration of the medication, the nurse should review the medical record for which condition?

A. Bronchitis. B. Hypertension. C. Diabetes mellitus. D. Hypercholesterolemia.

Answer and Explanation

Choice A:

Bronchitis is not typically a contraindication for the use of methylphenidate. This medication primarily affects the central nervous system and has no direct impact on bronchitis.

Choice B:

Hypertension is a critical condition to review before administering methylphenidate because this medication can increase blood pressure. Clients with pre-existing hypertension may be at risk for exacerbation of their condition, requiring careful monitoring and dosage adjustments.

Choice C:

Diabetes mellitus does not present a direct contraindication for the use of methylphenidate. However, clients with diabetes should be monitored for any changes in blood glucose levels, as the stress response and changes in appetite can indirectly impact diabetes management.

Choice D:

Hypercholesterolemia is not a primary concern when prescribing methylphenidate. While general health and cardiovascular risk factors should always be considered, hypercholesterolemia does not directly contraindicate the use of this medication.

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Question 6:

A client is receiving tamsulosin for the management of urinary retention due to benign prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide?

A. Hard candy can be used for a dry mouth. B. Insomnia may occur while taking the medication.

Answer and Explanation

Choice A:

Hard candy is often recommended for dry mouth, a common side effect of tamsulosin. Dry mouth can occur due to the anticholinergic properties of the medication, and sucking on hard candy or using saliva substitutes can help alleviate this discomfort.

Choice B:

Insomnia is another side effect that may occur while taking tamsulosin. This medication can affect the central nervous system, leading to difficulty sleeping. Clients should be advised of this potential side effect and monitor their sleep patterns.

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Question 7:

A female client with mild depression reports to the nurse recently starting St. John's wort. Which information provided by the client requires further instruction?

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

Answer and Explanation

Choice A:

Using hard candy to alleviate dry mouth is a common suggestion for clients experiencing dry mouth as a side effect of medications, including herbal supplements like St. John's wort. This information does not require further instruction as it is a helpful and safe practice.

Choice B:

Insomnia can occur while taking St. John's wort due to its stimulating effects. Clients should be informed about this potential side effect and how to manage it, but this information does not require further instruction as it is accurate and relevant.

Choice C:

Sensitivity to the sun is a known side effect of St. John's wort. Clients should be advised to use sun protection and avoid excessive sun exposure. This information is correct and does not require further instruction.

Choice D:

The statement that another form of contraception is not needed requires further instruction because St. John's wort can interact with hormonal contraceptives, potentially reducing their effectiveness. Clients should be advised to use an additional form of contraception to prevent unintended pregnancy.

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Question 8:

When the nurse discontinues a 24-hour postoperative client's patient-controlled analgesia (PCA) pump, the client asks to go to the hospital's smoking area to smoke a cigarette. Which response should the nurse provide?

A. "Your PCA pump has just been discontinued, and you need to wait at least one hour before leaving the unit." B. "You may smoke in your room if you keep the door closed and open a window." C. "Smoking is hazardous to your health, and since you just had surgery, it would be best for you to avoid smoking." D. "As long as you go to the smoking area in a wheelchair, it will be all right for you to go smoke."

Answer and Explanation

Choice A:

Advising the client to wait at least one hour before leaving the unit may not address the underlying health risks associated with smoking, especially after surgery. It does not provide sufficient health education about the dangers of smoking.

Choice B:

Allowing the client to smoke in their room is inappropriate and unsafe. Smoking indoors poses fire hazards and exposes others to secondhand smoke, which is harmful. This response is not acceptable in a healthcare setting.

Choice C:

This response addresses the health risks of smoking and provides sound advice for postoperative care. Educating the client about the dangers of smoking, especially after surgery, is crucial for their recovery and overall health.

Choice D:

Allowing the client to go to the smoking area in a wheelchair does not address the health risks associated with smoking, especially after surgery. This response is not appropriate for promoting the client's health and recovery.

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Question 9:

The nurse discontinues the client's patient-controlled analgesia (PCA) pump. Which response should the nurse provide to the client's request to go to the smoking area?

A. The drops increase the fluid in the eyes and cloud the visual field. B. The eye drops slow pupil response to accommodate for darkness.

Answer and Explanation

Choice A:

Increased fluid in the eyes and clouding of the visual field is a concern for clients using certain types of eye drops. This information is relevant and important for the client to understand potential side effects and how to manage them.

Choice B:

Slowing of pupil response to accommodate for darkness may be a side effect of some eye drops, but it is not as immediately concerning as clouding of the visual field. Clients should be aware of changes in vision, but this information may not require as urgent instruction as other potential side effects.

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Question 10:

A client is receiving pilocarpine hydrochloride ophthalmic drops for glaucoma. The client calls the clinic nurse and reports difficulty seeing at night. Which explanation should the nurse provide?

A. The drops increase the fluid in the eyes and cloud the visual field. B. The eye drops slow pupil response to accommodate for darkness. C. The medication can cause the lens to become more opaque. D. The medication causes pupils to dilate, which reduces night vision.

Answer and Explanation

Choice A:

While pilocarpine ophthalmic drops can cause increased fluid in the eyes to help manage glaucoma, they do not typically cloud the visual field. The main purpose of pilocarpine is to reduce intraocular pressure by increasing the outflow of aqueous humor.

Choice B:

Pilocarpine is a cholinergic agent that stimulates the sphincter muscles of the iris, leading to miosis (constriction of the pupil). This reduces the pupil's ability to dilate in low-light conditions, making it more difficult for clients to see in the dark. This explanation accurately addresses the client's concern about night vision.

Choice C:

Pilocarpine does not cause the lens to become more opaque. Opaque lenses are more commonly associated with cataracts, which are not related to the use of pilocarpine.

Choice D:

Pilocarpine causes the pupils to constrict (miosis) rather than dilate. This constriction affects the pupil's ability to adapt to darkness but does not cause dilation that reduces night vision.

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Total Questions : 36

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HESI RN Pharmacology 106a Proctored Exam

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