HESI Pharmacology IV Exam

Correct answer B: The white blood cell counts and platelet counts

Explanation of the correct answer:

B. The white blood cell counts and platelet counts

Etanercept (Enbrel) is a tumor necrosis factor (TNF) inhibitor used in the treatment of rheumatoid arthritis and other autoimmune disorders. While effective in reducing inflammation and slowing disease progression, etanercept suppresses the immune system, making the client more susceptible to infections and hematologic abnormalities, including leukopenia (low white blood cells) and thrombocytopenia (low platelets).

It is critical for the nurse to monitor complete blood counts (CBC) regularly during therapy. A decrease in white blood cells can increase the risk of serious infections, while a drop in platelets can increase the risk of bleeding. These lab values provide an early warning for potentially severe adverse effects and guide decisions about continuing or adjusting the medication.

Why the other options are incorrect:

A. The injection site for itching and edema

While mild injection site reactions such as redness, itching, or swelling are common and expected with subcutaneous administration of etanercept, they are not the most critical concern. These reactions are usually self-limiting and manageable with symptomatic care.

C. Whether the client is experiencing fatigue and joint pain

Fatigue and joint pain are symptoms of rheumatoid arthritis, not necessarily side effects of etanercept. While it's useful to monitor the client’s clinical response to treatment, these symptoms are not as urgent or serious as hematologic complications.

D. A metallic taste in the mouth, with a loss of appetite

These symptoms are not typical or significant side effects of etanercept. They are more commonly associated with medications like metronidazole or chemotherapy drugs, not TNF inhibitors.

Summary:

Monitoring white blood cell and platelet counts is most important when administering etanercept, due to the risk of immunosuppression and hematologic abnormalities. While local injection reactions and joint symptoms may occur, they are less critical than potentially life-threatening changes in blood counts.

Correct Answer D: Suction equipment

Explanation of the Correct Answer:

D. Suction equipment

Acetylcysteine (Mucomyst) is commonly used to break down mucus in the airways, making it easier to clear. This medication is often administered through a nebulizer, especially in clients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, or other respiratory conditions where thick mucus is present. One of the side effects of acetylcysteine is that it can cause excessive mucus production. The client may have difficulty clearing the mucus from the airways, leading to increased secretions. Therefore, it is essential to have suction equipment available in case the client has difficulty clearing the mucus and needs assistance to maintain a clear airway. Suctioning can help remove excess secretions, preventing aspiration or respiratory distress.

Why the Other Options Are Incorrect:

A. Ambu bag

An Ambu bag is a device used for manual resuscitation, often in cases of respiratory failure. While it is important to have emergency resuscitation equipment available in some clinical settings, it is not specifically needed for a client receiving acetylcysteine via nebulizer unless there is a significant respiratory emergency. In this scenario, the main concern is the increased mucus production that might require suctioning, not immediate ventilation or resuscitation.

B. Intubation tray

An intubation tray contains the necessary equipment to insert a breathing tube (endotracheal tube) in a client who has lost the ability to maintain their airway. While intubation may be necessary in some cases of respiratory failure, it is not a routine requirement when administering acetylcysteine, unless the client fails to clear secretions or develops significant respiratory distress. The primary concern with acetylcysteine administration is the need for suctioning to clear excess mucus, not intubation.

C. Nasogastric tube

A nasogastric tube is used for feeding or drainage in the stomach. While it may be used in some patients with certain conditions (such as gastrointestinal issues), it is not directly relevant to the administration of acetylcysteine, especially when given by nebulizer for respiratory purposes. A nasogastric tube would not help with clearing mucus from the airway, which is the primary concern after giving acetylcysteine.

Summary:

When administering acetylcysteine (Mucomyst) via nebulizer, the nurse should have suction equipment readily available. This medication helps break down mucus, which can lead to increased mucus production that may need to be suctioned to prevent airway obstruction. Ambu bags, intubation trays, and nasogastric tubes are not necessary in this scenario unless there is a significant emergency.

Correct Answer B: 4 to 12 hours after administration

Explanation of the Correct Answer:

B. 4 to 12 hours after administration is correct because Humulin NPH insulin is an intermediate-acting insulin that typically reaches its peak effect 4 to 12 hours after administration. During this time, the insulin is working to reduce blood glucose levels, and the client is most likely to experience a hypoglycemic reaction. This peak period is when the insulin is at its most active and could cause a drop in blood sugar, especially if the client has not eaten appropriately or has increased physical activity.

Why the other options are incorrect:

A. 2 to 4 hours after administration is incorrect because this is typically the peak action time for short-acting insulin or regular insulin, not for Humulin NPH. Short-acting insulin typically peaks within 2 to 4 hours, while NPH insulin has a slower, longer action.

C. 16 to 18 hours after administration is incorrect because this is typically outside the peak action window for Humulin NPH insulin. While the insulin will still be working beyond 12 hours, the risk for hypoglycemia is lower compared to the peak time frame of 4 to 12 hours.

D. 18 to 24 hours after administration is incorrect because this time frame is too late for Humulin NPH insulin's peak action. The insulin’s effect usually wanes before this time, making it less likely for a hypoglycemic event to occur.

Summary:

The most likely time for a hypoglycemic reaction to occur when taking Humulin NPH insulin is 4 to 12 hours after administration, which coincides with the insulin’s peak action. Understanding this timing helps the client be more aware of when to monitor blood glucose levels closely.

Correct answer C: Proceed to the closest emergency room.

Explanation of the correct answer:

Danazol (Danocrine) is a synthetic steroid used to treat conditions like endometriosis. One of the serious side effects of danazol is an increased risk of deep vein thrombosis (DVT), which can present with symptoms such as dark, swollen, and painful legs. These symptoms are indicative of a potential blood clot in the leg, which is a medical emergency because a clot can travel to the lungs (pulmonary embolism) or other organs, which could be life-threatening. Therefore, the client should immediately seek medical care by going to the emergency room for further evaluation and treatment.

Why the other options are incorrect:

A. Wear support stockings:

While support stockings can help with circulation, they are not appropriate or effective for managing a possible DVT. In fact, using them without addressing the underlying problem of a clot could delay the proper treatment and diagnosis.

B. Elevate both legs and apply heat:

Elevating the legs and applying heat may provide temporary relief for minor swelling or discomfort, but they do not address the potential DVT. Applying heat to a clot could actually increase the risk of the clot dislodging, which could lead to a serious complication like a pulmonary embolism.

D. Walk for 20 to 30 minutes to reduce the pain and edema:

Walking could potentially worsen the situation if there is a clot present. Exercise or movement could cause the clot to dislodge, increasing the risk of it traveling to the lungs or other vital organs. Therefore, walking is not recommended in this scenario.

Summary:

The client’s symptoms of dark, swollen, and painful leg could indicate a deep vein thrombosis (DVT), a potentially serious side effect of danazol. The client should be instructed to proceed to the closest emergency room immediately for further evaluation and management of the possible clot.

Correct Answer C: Informing the client that this is normal

Explanation of the Correct Answer:

C. Informing the client that this is normal is correct because mafenide acetate (Sulfamylon) often causes a burning or stinging sensation when applied, particularly to partial-thickness burn wounds. This side effect is common and expected, especially during the first few applications. It typically subsides with continued use. Unless the client exhibits signs of an allergic reaction or systemic effects, the discomfort alone does not require discontinuation or immediate medical intervention.

Why the other options are incorrect:

A. Notifying the registered nurse is unnecessary at this point because the reaction described is anticipated. Unless the pain becomes unmanageable or there are signs of severe hypersensitivity, notifying the RN is not the immediate appropriate step.

B. Discontinuing the medication is incorrect because the discomfort is not an indication of an adverse reaction but rather a common local effect. Stopping the medication would be inappropriate without a more serious clinical indication.

D. Applying a thinner film than prescribed to the burn site is incorrect because this can reduce the effectiveness of the antimicrobial coverage. Mafenide acetate should be applied in a thick, even layer as prescribed to maintain therapeutic efficacy and prevent bacterial colonization.

Summary:

Mafenide acetate often causes local discomfort or burning upon application, which is a normal and expected effect, not a reason to withhold the medication. The most appropriate nursing action is to reassure the client and continue treatment as prescribed, while monitoring for any signs of allergic or systemic reactions.

Correct answer A: Rash.

Explanation of the correct answer:

A. Rash.

A rash is a potentially serious side effect of sulfisoxazole, as it can indicate an allergic reaction or a more severe adverse reaction, such as Stevens-Johnson syndrome, which is a life-threatening condition. If a client develops a rash while taking sulfisoxazole, especially if it is accompanied by other symptoms like fever or blistering, it is critical to report this finding immediately to the healthcare provider for further evaluation. Discontinuing the medication may be necessary to prevent a more severe reaction.

Why the other options are incorrect:

B. Diarrhea.

Diarrhea is a relatively common side effect of sulfisoxazole, and while it may be uncomfortable, it is not usually life-threatening. The nurse should monitor the client for dehydration or severe diarrhea, but unless it is particularly severe or prolonged, it does not require immediate reporting to the healthcare provider.

C. Hematuria.

Hematuria (blood in the urine) is a potential but less common side effect of sulfisoxazole. It could indicate a more serious complication such as kidney damage or a UTI complication. However, it is not as immediately concerning as a rash in the context of an allergic reaction. The nurse should monitor the situation closely, but it does not require the same urgency as a rash.

D. Muscle cramping.

Muscle cramping is a side effect that can occur with many medications, including sulfisoxazole. While it may be uncomfortable, it is not typically a sign of a severe reaction. If muscle cramping becomes severe or persistent, it should be reported, but it does not require immediate reporting to the healthcare provider in the same way that a rash does.

Summary:

A rash is the most concerning side effect of sulfisoxazole, especially if it may indicate a serious allergic reaction like Stevens-Johnson syndrome. This requires immediate attention from the healthcare provider. Diarrhea, hematuria, and muscle cramping are less urgent but should still be monitored.

Correct answer B: It is best that you taper the dose if you intend to stop the medication.

Explanation of the correct answer:

The appropriate response is B because abruptly stopping baclofen (Lioresal) can lead to serious withdrawal symptoms, including muscle rigidity, hallucinations, seizures, and other CNS disturbances. Tapering the medication gradually allows the body to adjust, reducing the risk of withdrawal. Therefore, the nurse should recommend that the client taper the dose under the guidance of a healthcare provider if discontinuation is necessary.

Why the other options are incorrect:

A. You should never stop the medication.

This statement is incorrect. While it’s important to avoid stopping baclofen abruptly, there are circumstances when discontinuing the medication is necessary, but it should always be done gradually under medical supervision. The key point is not to stop the medication suddenly but to taper it down safely if stopping is required.

C. It is okay to stop the medication if you think that you can tolerate the muscle spasms.

This response is also incorrect because stopping baclofen abruptly could lead to serious withdrawal symptoms. It is not advisable to stop the medication without consulting the healthcare provider, even if the client feels they can tolerate muscle spasms. Gradual tapering is the safer approach.

D. Weakness and fatigue commonly occur and will diminish with continued medication use.

While drowsiness and weakness can be common side effects of baclofen, this response is not appropriate because it dismisses the client’s concerns. If these symptoms are persistent or severe, the nurse should suggest discussing the symptoms with the healthcare provider rather than simply reassuring the client that the side effects will diminish.

Summary:

The most appropriate advice is to taper the medication if the client intends to stop baclofen, as discontinuing it abruptly can lead to withdrawal symptoms. The nurse should emphasize the importance of consulting the healthcare provider before making any changes to the medication regimen.

Correct answer A: Loss of balance and dizziness.

Explanation of the correct answer:

Minocycline (Minocin) is a tetracycline antibiotic that is often used to treat inflammatory conditions like rheumatoid arthritis. One important and potentially serious side effect of minocycline is vestibular toxicity, which can lead to dizziness, loss of balance, and vertigo. These symptoms occur due to the drug’s impact on the inner ear, and if they become severe, they can affect a person’s ability to perform daily activities safely, such as walking. While dizziness and loss of balance may not always be life-threatening, they can be debilitating and should be reported to the healthcare provider.

Why the other options are incorrect:

B. Nausea and vomiting:

Nausea and vomiting are common and relatively mild side effects of minocycline, which usually do not require discontinuation of the drug unless they become severe. These symptoms are not as urgent as dizziness and loss of balance.

C. Headache and mouth sores:

Headache and mouth sores are possible side effects of minocycline, but these are typically less alarming compared to vestibular symptoms like dizziness. While bothersome, they are not usually considered urgent unless they become persistent or severe.

D. Abdominal pain and diarrhea:

While abdominal pain and diarrhea are side effects that could indicate a more serious complication, such as Clostridium difficile infection, they are not as immediately concerning as loss of balance or dizziness in this context. However, these symptoms should still be monitored and reported if they occur.

Summary:

The nurse should prioritize monitoring for loss of balance and dizziness, as these can be early signs of vestibular toxicity associated with minocycline. If the client experiences these symptoms, the healthcare provider should be notified promptly.

Correct answer A: Serum liver enzymes

Explanation of the correct answer:

A. Serum liver enzymes

When a client reports muscle pain and weakness while taking a combination of a statin and gemfibrozil (Lopid), it raises immediate concern for a serious adverse reaction known as rhabdomyolysis. This condition involves the breakdown of muscle tissue, releasing myoglobin into the bloodstream, which can lead to acute kidney injury and other systemic complications. Although creatine kinase (CK) levels are the most specific lab to confirm muscle breakdown, evaluating serum liver enzymes (specifically AST and ALT) is also critical because these enzymes may be elevated in response to muscle damage or hepatic toxicity—both of which are associated with statin and gemfibrozil use. Gemfibrozil increases the risk of statin-induced myopathy and rhabdomyolysis by interfering with statin metabolism, particularly when used concurrently. Therefore, assessing serum liver enzymes helps the nurse determine the extent of organ involvement, identify early signs of toxicity, and prompt timely intervention, such as discontinuation of the drug or further diagnostic evaluation.

Why the other options are incorrect:

B. T3 and T4 blood levels

While thyroid dysfunction, particularly hypothyroidism, can contribute to muscle weakness and cramps, these symptoms in a client actively taking a statin and gemfibrozil are more likely related to medication-induced myopathy. Thyroid hormones would be considered in a broader differential diagnosis but are not the most urgent or relevant assessment in this case.

C. Bowel function

Bowel function is not directly related to the muscle symptoms reported. Although some lipid-lowering drugs can cause gastrointestinal side effects such as constipation or diarrhea, muscle pain and weakness suggest a more serious systemic complication rather than a gastrointestinal issue.

D. Peripheral sensation

Peripheral neuropathy involves changes in sensation such as tingling, numbness, or burning, which differ significantly from muscle pain and weakness. This symptomatology does not align with statin- or gemfibrozil-induced myopathy. While evaluating sensory changes might be appropriate for long-term diabetic clients or those on neurotoxic drugs, it is not the most important assessment here.

Summary:

The combination of a statin and gemfibrozil increases the risk of rhabdomyolysis, a serious condition marked by muscle pain and weakness. Evaluating serum liver enzymes can help detect early signs of liver involvement or systemic toxicity and guide further management. Prompt identification is essential to prevent life-threatening complications.