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HESI RN pharmacology exam

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Total Questions : 56

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Question 1:

When administering zolpidem to an older adult client, which computer documentation indicates that the desired outcome has been achieved?

A. Exhibits fewer emotional outbursts. B. Decreased episodes of incontinence. C. Improved ability to concentrate. D. Sleeps soundly through the night.

Answer and Explanation

Choice A:

Exhibits fewer emotional outbursts: Zolpidem is a sedative-hypnotic medication primarily used to treat insomnia. A reduction in emotional outbursts is not a direct expected outcome of this medication. While improved sleep might indirectly influence mood, it is not the primary therapeutic goal.

Choice B:

Decreased episodes of incontinence: Zolpidem's primary action is on the central nervous system to promote sleep. A decrease in episodes of incontinence is not a direct pharmacological effect of zolpidem.

Choice C:

Improved ability to concentrate: Zolpidem is a sedative and can potentially cause daytime drowsiness or cognitive impairment rather than improving concentration. Its intended effect is to induce sleep, which could indirectly benefit concentration if the client's difficulty concentrating was due to sleep deprivation, but it's not a direct outcome of the medication itself.

Choice D:

Sleeps soundly through the night: The intended therapeutic effect of zolpidem is to help the client initiate and maintain sleep. Documentation stating that the client sleeps soundly through the night indicates that the medication has achieved its desired outcome.

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Question 2:

A male client is admitted for observation because he is reporting progressively increasing fatigue over the past month and a brief episode of dizziness that occurred today. He has a history of heartburn and indigestion that the self treats with ibuprofen and antacids. Which assessment finding should the nurse report immediately to the healthcare provider (HCP)?Reference Ranges:
Hemoglobin [14 to 18 g/dL (140 to 180 g/L)]
Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]
Gastric pH (1.5 to 3.5]

A. Positive guaiac of stool. B. Hemoglobin 13 g/dL (130 g/L). C. Hematocrit 42% (0.42 volume fraction). D. Gastric pH 2.

Answer and Explanation

Choice A:

Positive guaiac of stool: A positive guaiac test indicates the presence of blood in the stool, suggesting gastrointestinal bleeding. Given the client’s history of frequent ibuprofen use, which can cause gastric ulcers and GI bleeding, this is a critical finding that must be reported immediately to the healthcare provider.

Choice B:

Hemoglobin 13 g/dL (130 g/L): Although slightly below the normal reference range for males, a hemoglobin of 13 g/dL is not critically low. It suggests mild anemia but is not an urgent finding compared to evidence of active gastrointestinal bleeding.

Choice C:

Hematocrit 42% (0.42 volume fraction): A hematocrit of 42% falls within the normal reference range for a male client. Therefore, this finding is stable and does not require immediate reporting in the context of the client's current symptoms.

Choice D:

Gastric pH 2: A gastric pH of 2 is within the normal range for stomach acid levels (1.5 to 3.5). The current gastric pH suggests that their acid production is within expected limits and is not the immediate concern. This value does not indicate any acute problem by itself and would not require immediate notification of the healthcare provider.

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Question 3:

The client is a 36-year-old female with moderate persistent asthma. She takes fluticasone/salmeterol 250 mcg/50 mcg 1 inhalation twice daily and albuterol 90 mcg/inhalation 2 inhalations every 4 to 6 hours PRN. The client reports that she has had more severe asthma symptoms than usual in the past week. Her forced expiratory volume has been 60 to 65% even with multiple doses of albuterol for several days in a row. She came to the hospital feeling dizzy, lightheaded, and reporting "heart palpitations". Upon assessment found no wheezes. Her oxygen saturation is 99% on room air.

Patient Data

Exhibits

Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

Explanation

Methemoglobinemia: Methemoglobinemia is characterized by hypoxia symptoms despite normal oxygen saturation readings. However, this condition is very rare in asthma patients and is typically associated with certain medications or chemical exposures, not beta-agonist overuse like albuterol.
Anemia: Anemia could cause dizziness and lightheadedness, but it would not explain palpitations triggered by excessive albuterol use. The acute worsening of symptoms with a background of asthma and heavy beta-agonist use points away from anemia as the primary concern.
Anaphylaxis: Anaphylaxis presents with airway swelling, hypotension, wheezing, and respiratory compromise. Since the client’s oxygen saturation is excellent (99%) and no wheezing or airway edema is noted, anaphylaxis is unlikely in this scenario.
Tachydysrhythmia: Tachydysrhythmia is the most likely diagnosis because overuse of albuterol stimulates beta receptors, leading to increased heart rate, palpitations, dizziness, and lightheadedness. This aligns precisely with the client's reported symptoms and assessment findings.
Administer diphenhydramine: Diphenhydramine is an antihistamine used primarily for allergic reactions and anaphylaxis. There is no evidence of an allergic process in this client; thus, administering diphenhydramine would not address the cardiac symptoms from probable tachydysrhythmia.
Give a dose of albuterol: Administering more albuterol would likely worsen the tachydysrhythmia, as beta-agonists increase heart rate and myocardial oxygen demand. Since the problem stems from albuterol overuse, giving another dose would be inappropriate and harmful.
Take a set of baseline vital signs: Taking a set of baseline vital signs is essential because it provides a foundation for assessing current cardiovascular stability. It would help establish the severity of the tachycardia and guide further intervention strategies.
Place the client on a cardiorespiratory monitor: Placing the client on a cardiorespiratory monitor is critical to continuously assess heart rate, rhythm, and potential arrhythmias. This allows immediate detection of life-threatening patterns such as supraventricular tachycardia or ventricular ectopy.
Draw blood for a complete blood count: Drawing a CBC would help if there was suspicion of anemia or infection, but the clinical picture points primarily toward a cardiac rhythm problem. This diagnostic step would not be immediately necessary based on the current situation.
Methemoglobin level: Monitoring methemoglobin levels would be appropriate if the client had cyanosis or unexplained hypoxia without respiratory distress. Since the oxygen saturation is excellent, checking methemoglobin is not relevant to her current condition.
Iron level: Monitoring iron levels is important in diagnosing chronic anemia, but anemia is not the primary issue here. The focus should remain on cardiovascular monitoring because the immediate symptoms suggest arrhythmia rather than a hematologic cause.
Breath sounds: Although the client currently has no wheezing, regular assessment of breath sounds is necessary to detect any developing bronchospasm or respiratory deterioration, especially given her underlying asthma diagnosis and recent respiratory strain.
Airway edema: Monitoring for airway edema would be essential if anaphylaxis were suspected. Since there are no signs of respiratory distress, stridor, or swelling, airway edema monitoring is less relevant compared to cardiac monitoring in this situation.
Heart rate and rhythm: Heart rate and rhythm must be continuously monitored because the client is exhibiting signs of tachydysrhythmia. Detecting arrhythmias early enables prompt treatment and reduces the risk of serious cardiac complications like syncope or cardiac arrest.

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Question 4:

A client who is a vegetarian has a new prescription for warfarin. The client reports eating green leafy vegetables every day. How should the nurse respond?

A. Advise the client that the healthcare provider (HCP) needs to be made aware of the current diet. B. Suggest that the client replace the leafy vegetables with a protein source such as nuts or beans. C. Confirm that the clients diet choices will help the medication be more effective in preventing blood clots. D. Commend the client for a healthy lifestyle and encourage the client to continue current diet habits.

Answer and Explanation

Choice A:

Advise the client that the healthcare provider (HCP) needs to be made aware of the current diet: Green leafy vegetables are high in vitamin K, which can interfere with the effectiveness of warfarin by promoting clotting. The healthcare provider must be informed to adjust the medication dose if necessary or provide specific dietary guidance.

Choice B:

Suggest that the client replace the leafy vegetables with a protein source such as nuts or beans: Advising the client to eliminate green vegetables is not appropriate because sudden changes in vitamin K intake can destabilize warfarin therapy. Consistency in vitamin K consumption is key rather than abrupt dietary changes.

Choice C:

Confirm that the client's diet choices will help the medication be more effective in preventing blood clots: Regular consumption of vitamin K-rich foods without dose adjustment can decrease warfarin's anticoagulant effect, increasing the risk of clot formation. The current diet does not inherently support the intended action of the medication.

Choice D:

Commend the client for a healthy lifestyle and encourage the client to continue current diet habits: Although a diet rich in vegetables is generally healthy, with warfarin therapy, any vitamin K intake must be consistent and properly managed. Simply encouraging the client without notifying the provider could lead to therapeutic failure.

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Question 5:

The nurse is reviewing the laboratory results of a client who reports taking five times the recommended daily allowance of vitamins and minerals in a multivitamin form. Which finding indicates a possible vitamin D overdose?Reference Range:
Bilirubin (0.3 to 1 mg/dL (5.1 to 17 μmol/L)]
Calcium [9 to 10.5 mg/dL (2.3 to 2.6 mmol/L)]
Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]
Blood Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)]

A. Total bilirubin 4 mg/dL (68.4 μmol/L). B. Total calcium level 12 mEq/L (3 mmol/L). C. Sodium level 140 mEq/L (140 mmol/L). D. Serum glucose 170 mg/dL (9.4 mmol/L).

Answer and Explanation

Choice A:

Total bilirubin 4 mg/dL (68.4 μmol/L): Elevated bilirubin suggests possible liver dysfunction or hemolysis but is not directly associated with vitamin D toxicity. Vitamin D overdose primarily leads to disturbances in calcium metabolism rather than bilirubin elevations.

Choice B:

Total calcium level 12 mEq/L (3 mmol/L): Hypercalcemia is a hallmark of vitamin D overdose because vitamin D increases calcium absorption from the gastrointestinal tract. A calcium level above the normal range signals potential toxicity that needs immediate attention.

Choice C:

Sodium level 140 mEq/L (140 mmol/L): A sodium level of 140 mEq/L falls squarely within the normal reference range. This value does not suggest any connection to vitamin D toxicity or indicate any immediate concern regarding electrolyte imbalance.

Choice D:

Serum glucose 170 mg/dL (9.4 mmol/L): Elevated blood glucose may point to uncontrolled diabetes or stress response but is not linked to excessive vitamin D intake. Vitamin D toxicity primarily affects calcium regulation, not glucose metabolism.

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Question 6:

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

Answer and Explanation

Choice A:

"I should take this medication only when I am having an asthma attack.": Montelukast is not intended for acute asthma attacks. It is a maintenance medication taken daily to reduce airway inflammation and prevent symptoms, not to treat attacks in progress.

Choice B:

"This medication will stop an asthma attack immediately.": Montelukast does not act quickly enough to treat acute bronchospasm. Short-acting beta-agonists like albuterol are used for immediate relief during an asthma attack, not leukotriene modifiers.

Choice C:

"I will take the tablet every evening to control my asthma.": Montelukast is prescribed as a daily maintenance therapy, typically taken in the evening to help control chronic asthma symptoms and to reduce the frequency and severity of exacerbations over time.

Choice D:

"I will not need to use my inhalers twice a day when I start this medicine.": Even after starting montelukast, clients often still need to use inhaled corticosteroids or other maintenance inhalers. Montelukast is an adjunct therapy, not a replacement for inhaled medications.

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Question 7:

A client with generalized anxiety disorder (GAD) receives a new prescription for lorazepam. Which statement provided by the client requires additional instruction by the nurse?

A. Use relaxation techniques to reduce excessive anxiety. B. Avoid alcohol and other sedatives while taking the medication. C. Move slowly from a sitting position to a standing position. D. Stop taking the medication if intended effect is not immediate.

Answer and Explanation

Choice A:

Use relaxation techniques to reduce excessive anxiety: Incorporating non-pharmacological strategies such as relaxation exercises complements lorazepam therapy and can improve anxiety management. This statement reflects appropriate understanding and safe self-care practices.

Choice B:

Avoid alcohol and other sedatives while taking the medication: Lorazepam is a central nervous system depressant, and combining it with alcohol or other sedatives can lead to respiratory depression, increased sedation, and potentially life-threatening effects. This is an important and accurate precaution.

Choice C:

Move slowly from a sitting position to a standing position: Orthostatic hypotension and dizziness are common side effects of benzodiazepines like lorazepam. Changing positions slowly helps minimize the risk of falls, especially in older adults or those sensitive to the medication.

Choice D:

Stop taking the medication if intended effect is not immediate: Lorazepam has a relatively quick onset, but stopping it abruptly without consulting a healthcare provider is unsafe and may lead to withdrawal symptoms including increased anxiety, insomnia, tremors, and even seizures. Clients must understand that medication adjustments require medical guidance.

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Question 8:

A client who had a kidney transplant last week is receiving cyclosporine. This morning the client reports experiencing a headache and blurred vision. Based on which assessment finding should the nurse withhold the medication until the healthcare provider (HCP) is notified?

A. Temperature of 100.8° F (38.2° C). B. Elevated blood urea nitrogen (BUN). C. Renal output of 120 mL/hour. D. Blood pressure 180/98 mm Hg.

Answer and Explanation

Choice A:

Temperature of 100.8° F (38.2° C): A mildly elevated temperature in a post-transplant client may suggest infection or early rejection, both of which warrant monitoring. However, this is not a direct reason to withhold cyclosporine, which is essential for preventing organ rejection.

Choice B:

Elevated blood urea nitrogen (BUN): Elevated BUN could indicate impaired renal function, which should be monitored during cyclosporine therapy. However, this alone is not an urgent reason to withhold the medication without further evaluation of kidney function trends and symptoms.

Choice C:

Renal output of 120 mL/hour: This is a healthy urine output and suggests good renal perfusion and function. It does not present any contraindication to continuing cyclosporine and supports that the transplanted kidney is functioning well.

Choice D:

Blood pressure 180/98 mm Hg: Hypertension is a known side effect of cyclosporine and can become severe. A blood pressure this high, especially when accompanied by headache and blurred vision, suggests possible cyclosporine-induced hypertensive crisis or toxicity, and warrants immediate withholding of the medication and notification of the HCP.

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Question 9:

The nurse is administering sucralfate to a client with stomatitis secondary to chemotherapy. The client wants to take the medication after breakfast. How should the nurse respond?

A. Document the client's refusal of the medication at this time. B. Explain the need to take the medication at least 1 hour before meals. C. Allow the client to take the medication up to 1 hour after breakfast. D. Instruct the client to take it when the meal tray is delivered.

Answer and Explanation

Choice A:

Document the client's refusal of the medication at this time: While documentation is necessary if a medication is refused, the priority is to educate the client first. The nurse should explain the proper timing of sucralfate to promote understanding and adherence rather than simply accepting refusal.

Choice B:

Explain the need to take the medication at least 1 hour before meals: Sucralfate acts by forming a protective barrier over ulcerated mucosa and must be taken on an empty stomach for maximum effectiveness. Administering it one hour before meals ensures the stomach lining is properly coated before food intake.

Choice C:

Allow the client to take the medication up to 1 hour after breakfast: Taking sucralfate after a meal diminishes its ability to bind effectively to the mucosa. Food interferes with its action, so post-meal dosing is inappropriate for achieving therapeutic benefit.

Choice D:

Instruct the client to take it when the meal tray is delivered: Taking sucralfate at mealtime is too late for optimal therapeutic effect. At that point, gastric contents may interfere with its binding to ulcerated areas, reducing its protective action.

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Question 10:

A client with a cold is taking an antitussive medication. Which assessment information indicates to the nurse that the medication is effective?

A. Expectorating bronchial secretions. B. Reports reduced nasal discharge. C. Able to sleep through the night. D. Denies having coughing spells.

Answer and Explanation

Choice A:

Expectorating bronchial secretions: This outcome is more closely associated with expectorants, which loosen mucus in the airways. Antitussives, by contrast, suppress the cough reflex and are not intended to increase mucus clearance or productive coughing.

Choice B:

Reports reduced nasal discharge: Reduced nasal discharge is typically an effect of decongestants or antihistamines, not antitussive medications. Antitussives target the cough reflex, not nasal secretions.

Choice C:

Able to sleep through the night: While improved sleep may result from reduced coughing, it is a secondary and nonspecific outcome. The ability to sleep could be influenced by other factors such as overall symptom relief, not necessarily the effectiveness of the antitussive alone.

Choice D:

Denies having coughing spells: Antitussives are designed to suppress the cough reflex, particularly in cases of dry, nonproductive cough. A report of no more coughing spells directly reflects the intended therapeutic effect of the medication.

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HESI RN pharmacology exam

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