HESI Pharmacology IV Exam

Correct answer:

A. Mood swings.

C. Increased weight gain.

E. Delayed incisional wound healing.

Explanation of the correct answers:

A. Mood swings.

Dexamethasone is a corticosteroid, and one of its common side effects is mood swings. Corticosteroids, including dexamethasone, can affect mood by altering brain chemistry, leading to symptoms like irritability, anxiety, or euphoria. Long-term use or high doses of dexamethasone can exacerbate these effects. Therefore, it is important for the nurse to monitor for changes in the client’s mood during therapy.

C. Increased weight gain.

Weight gain is a well-known side effect of corticosteroids like dexamethasone. This is due to fluid retention and increased appetite, both of which are common with corticosteroid use. The nurse should monitor the client’s weight regularly and be aware that significant weight gain can indicate fluid retention or changes in metabolism.

E. Delayed incisional wound healing.

Corticosteroids like dexamethasone can impair wound healing due to their effect on immune response and collagen formation. After neurosurgery, it is important to monitor for delayed wound healing, as dexamethasone can slow down the healing process. This can increase the risk of infection or poor wound closure, making it essential for the nurse to assess the surgical site regularly.

Why the other options are incorrect:

B. Decreased appetite.

Decreased appetite is not a typical side effect of dexamethasone. In fact, corticosteroids like dexamethasone usually increase appetite, leading to weight gain. Therefore, decreased appetite would not be a primary concern for a client receiving dexamethasone. The nurse should monitor for increased appetite, not decreased.

D. Serum glucose level of 65 mg/dl.

While dexamethasone can increase blood glucose levels, leading to hyperglycemia, a serum glucose level of 65 mg/dl is low, not high. Corticosteroids typically cause hyperglycemia, so the nurse would be more concerned if the glucose level was elevated rather than low. A serum glucose of 65 mg/dl could indicate hypoglycemia, which is less likely to be directly caused by dexamethasone.

F. Serum hemoglobin level of 9 mg/dl.

A serum hemoglobin level of 9 mg/dl is low, indicating anemia. Although dexamethasone can cause a variety of blood-related side effects, such as thrombocytosis or leukocytosis, it is not typically associated with causing low hemoglobin or anemia directly. The low hemoglobin level may be due to other factors, such as blood loss during surgery or nutritional deficits. Therefore, while important, it is not a direct side effect of dexamethasone.

Summary:

When a client is receiving dexamethasone after neurosurgery, the nurse should monitor for mood swings, increased weight gain, and delayed wound healing, as these are common side effects of corticosteroids. Decreased appetite, low glucose levels, and low hemoglobin are not typical side effects of dexamethasone.

Correct Answer C: Hypokalemia, hyperglycemia, sulfa allergy

Explanation of the Correct Answer:

C. Hypokalemia, hyperglycemia, sulfa allergy

Hydrochlorothiazide (HydroDIURIL) is a thiazide diuretic, commonly used to treat conditions such as hypertension and edema. The primary concerns related to this medication include:

Hypokalemia: Thiazide diuretics like hydrochlorothiazide increase the excretion of potassium in the urine, which can lead to low potassium levels (hypokalemia). This can cause symptoms such as muscle weakness, cramping, and arrhythmias.

Hyperglycemia: Hydrochlorothiazide can also impair glucose metabolism, leading to elevated blood sugar levels (hyperglycemia), which is particularly concerning for patients with diabetes or those at risk for diabetes.

Sulfa allergy: Hydrochlorothiazide is a sulfonamide-based drug, and patients with a sulfa allergy may experience hypersensitivity reactions, such as rashes, fever, or even more severe reactions like Stevens-Johnson syndrome.

Why the Other Options Are Incorrect:

A. Hypouricemia, hyperkalemia

Hypouricemia (low uric acid levels) is not typically a concern with hydrochlorothiazide. Instead, thiazide diuretics can cause hyperuricemia, which may increase the risk of gout attacks.

Hyperkalemia (high potassium levels) is also not commonly associated with thiazide diuretics. In fact, thiazide diuretics are more likely to cause hypokalemia due to potassium excretion.

B. Increased risk of osteoporosis

While chronic use of thiazide diuretics may slightly reduce calcium excretion, leading to a small protective effect on bone density, osteoporosis is not a significant concern associated with hydrochlorothiazide. This is not one of the primary risks.

D. Hyperkalemia, hypoglycemia, penicillin allergy

Hyperkalemia is not associated with hydrochlorothiazide, as it tends to cause hypokalemia instead.

Hypoglycemia is not typically caused by hydrochlorothiazide. However, hyperglycemia is a concern (as mentioned above).

A penicillin allergy is not directly relevant to hydrochlorothiazide therapy, as this is unrelated to sulfonamide-based drugs.

Summary:

The primary concerns when administering hydrochlorothiazide (HydroDIURIL) are hypokalemia, hyperglycemia, and the possibility of a sulfa allergy. Regular monitoring of potassium levels and blood glucose is essential to prevent complications in patients on thiazide diuretics.

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 C: Use of nitroglycerin

Explanation of the Correct Answer:

C. Use of nitroglycerin is correct because nitroglycerin is a nitrate, and combining nitrates with sildenafil (Viagra) can lead to a severe drop in blood pressure. Both nitrates and sildenafil work by vasodilation (widening of blood vessels), and their combined effect can result in hypotension (low blood pressure), which can be dangerous and potentially life-threatening. The nurse would question the prescription for sildenafil if the client is using nitroglycerin or other nitrate medications.

Why the other options are incorrect:

A. Neuralgia is incorrect because it is not a contraindication for using sildenafil. Neuralgia refers to nerve pain, and sildenafil does not have any direct contraindications related to treating this condition.

B. Insomnia is incorrect because it is not related to sildenafil’s contraindications. While sildenafil may have some side effects, insomnia is not a known concern when taking the medication. However, insomnia could be a side effect of other medications or conditions, but it does not directly affect the use of sildenafil.

D. Use of multivitamins is incorrect because multivitamins do not interact with sildenafil in a way that would necessitate questioning its use. Multivitamins generally do not have contraindications with sildenafil, though clients should always inform their healthcare provider about any supplements they are taking to ensure there are no interactions.

Summary:

Sildenafil should not be prescribed to clients who are using nitroglycerin or other nitrate medications due to the risk of severe hypotension. Neuralgia, insomnia, and multivitamin use do not pose contraindications for sildenafil use. The nurse should review the client’s medications for nitrate use and question the sildenafil prescription if the client is taking these drugs.

Correct answers:

B. Normal white blood cell counts, platelet, and neutrophil counts

C. Radiological findings that show nonprogression of joint degeneration

D. An increased range of motion in the affected joints 3 months into therapy

Explanation of the correct answers:

B. Normal white blood cell counts, platelet, and neutrophil counts

Disease-modifying antirheumatic drugs (DMARDs) can suppress the immune system to slow the progression of rheumatoid arthritis (RA) or other autoimmune diseases. One expected and acceptable response to DMARD therapy is the maintenance of normal blood cell counts (WBC, platelets, and neutrophils). Monitoring these levels is crucial because immunosuppressive effects can lead to bone marrow suppression, but maintaining normal levels is a positive sign that the medication is not causing harmful side effects.

C. Radiological findings that show nonprogression of joint degeneration

The primary goal of DMARDs is to slow the progression of joint damage and degeneration caused by autoimmune diseases like RA. Radiological findings showing nonprogression of joint degeneration are an acceptable and positive response to DMARD therapy, indicating that the disease is being controlled.

D. An increased range of motion in the affected joints 3 months into therapy

An increased range of motion (ROM) in the affected joints is a positive response to therapy, indicating that joint inflammation and stiffness are improving. DMARDs can help reduce inflammation, which can allow the joints to become more mobile and function better over time.

Why the other options are incorrect:

A. Symptom control during periods of emotional stress

DMARDs are not typically used to manage symptoms related to emotional stress. Emotional stress can exacerbate autoimmune disease symptoms, but DMARDs primarily focus on long-term disease modification and inflammation control, not immediate stress response. Therefore, symptom control related to stress would not be an expected or acceptable response.

E. Inflammation and irritation at the injection site 3 days after injection is given

Injection site irritation may occur after receiving a DMARD injection, but persistent inflammation and irritation 3 days after the injection is generally not considered an acceptable response. Mild redness or swelling may be expected immediately after an injection, but prolonged irritation could indicate an allergic reaction or infection, and the healthcare provider should be contacted.

F. A low-grade temperature upon rising in the morning that remains throughout the day

A low-grade temperature could be a sign of infection, which is a potential side effect of DMARD therapy due to their immunosuppressive properties. Persistent fever throughout the day should not be considered an acceptable response, as it could signal an underlying infection or other serious complication.

Summary:

The acceptable responses to DMARD therapy include maintaining normal blood counts, seeing nonprogression of joint degeneration in radiological findings, and experiencing an increased range of motion. The other responses, such as symptoms from emotional stress, prolonged injection site irritation, and persistent low-grade fever, would require further investigation and possible intervention.

Correct Answer D: Contact the health care provider (HCP)

Explanation of the Correct Answer:

D. Contact the health care provider (HCP)

A chronic headache is a common side effect of isosorbide mononitrate (Imdur), which is a nitrate used to prevent angina. The headache is typically caused by the vasodilation effect of nitrates, which dilate blood vessels and can lead to increased blood flow to the head, causing discomfort. Since this side effect is common but bothersome, it is important to contact the healthcare provider (HCP) to discuss the symptoms. The healthcare provider may decide to adjust the dose, prescribe an additional medication to relieve the headache, or switch to another medication.

Why the Other Options Are Incorrect:

A. Cut the dose in half

Reducing the dose without consulting the healthcare provider is not advisable because it could reduce the effectiveness of the medication in controlling angina. Isosorbide mononitrate works by relaxing and dilating blood vessels, improving blood flow to the heart, and reducing angina. Lowering the dose could compromise its therapeutic effect.

B. Discontinue the medication

Discontinuing the medication without guidance from the healthcare provider can be risky, as isosorbide mononitrate is essential for preventing angina attacks. Stopping the medication abruptly could increase the risk of angina episodes or heart-related complications. Therefore, this is not a recommended course of action without consulting the healthcare provider.

C. Take the medication with food

Taking isosorbide mononitrate with food is not a recommended solution for headaches caused by the medication. The side effect of headache is related to the medication's action and not necessarily affected by food intake. Therefore, taking it with food may not alleviate the headache and is unlikely to address the root cause.

Summary:

The best course of action for the client is to contact the healthcare provider (HCP) (Option D) to discuss the chronic headache caused by isosorbide mononitrate (Imdur). The HCP may adjust the dose, provide additional medication for headache relief, or switch the client to another medication to manage the angina while minimizing side effects. Cutting the dose, discontinuing the medication, or taking it with food are not appropriate responses without professional guidance.

Correct answer D: Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing.

Explanation of the correct answer: Nicotinic acid (niacin) is commonly prescribed to treat hyperlipidemia, and one of the common side effects is flushing. Taking ibuprofen 30 minutes before the nicotinic acid can help reduce this flushing by preventing the release of prostaglandins, which are thought to cause the flushing. This is a well-known strategy to help manage this side effect.

Why the other options are incorrect:

A. It is not necessary to avoid the use of alcohol.

This statement is incorrect because alcohol should be avoided when taking nicotinic acid (niacin). Alcohol can increase the risk of liver damage, especially when combined with niacin. Clients should be advised to limit or avoid alcohol intake to reduce this risk.

B. The medication should be taken with meals to decrease flushing.

While taking niacin with food may help to some extent in reducing the gastrointestinal side effects (such as nausea), it does not significantly reduce the flushing caused by the medication. Flushing is better managed with pre-treatment with ibuprofen or by taking extended-release formulations of niacin.

C. Clay-colored stools are a common side effect and should not be of concern.

This statement is incorrect. Clay-colored stools are not a common side effect of niacin. Instead, they can indicate liver dysfunction, which is a serious side effect of niacin use. Any occurrence of clay-colored stools should be reported to a healthcare provider immediately.

Summary:

The correct statement is D, where taking ibuprofen before nicotinic acid can help reduce flushing. The other options are incorrect as they either provide inaccurate information about alcohol consumption, side effects, or precautions related to niacin use.

Correct answer B: Refrain from eating foods high in potassium.

Explanation of the correct answer:

B. Refrain from eating foods high in potassium

Spironolactone (Aldactone) is a potassium-sparing diuretic, which means it helps the body retain potassium while excreting excess sodium and water. This can lead to an increased risk of hyperkalemia (high potassium levels in the blood). Therefore, it is important for clients on spironolactone to avoid consuming foods high in potassium (such as bananas, oranges, potatoes, and tomatoes) and potassium supplements unless directed by the healthcare provider. Monitoring potassium levels is essential to avoid potentially dangerous complications like arrhythmias.

Why the other options are incorrect:

A. Do not add salt to foods during preparation

While reducing salt intake is generally recommended for clients with heart failure to prevent fluid retention and worsen the condition, this is not the most important dietary modification when taking spironolactone. The risk of hyperkalemia is more directly related to potassium intake rather than sodium intake. Salt restrictions are important, but potassium restrictions are more critical with spironolactone.

C. Restrict fluid intake to 1000 ml per day

Fluid restriction is typically advised in certain cases of heart failure, especially if the client is experiencing symptoms of fluid overload (e.g., edema or shortness of breath). However, this is not directly related to the action of spironolactone. The more urgent concern when taking spironolactone is potassium balance rather than fluid balance, making this less important in the context of spironolactone therapy.

D. Increase intake of milk and milk products

There is no specific indication for increasing milk and dairy intake for clients taking spironolactone. In fact, dairy products are not directly related to the side effects or interactions of spironolactone, nor would they help with managing potassium levels or fluid balance in heart failure.

Summary:

The most important dietary modification for clients taking spironolactone is to avoid foods that are high in potassium to prevent hyperkalemia, which could be life-threatening. Therefore, option B is the correct choice.

Correct answer A: With 8 oz of milk

Explanation of the correct answer:

A. With 8 oz of milk

Ibuprofen (Advil) is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to relieve pain, inflammation, and fever. One of the most common adverse effects of NSAIDs is gastrointestinal irritation, which can lead to symptoms such as stomach upset, heartburn, gastritis, or even ulcers with prolonged use. To minimize these gastrointestinal side effects, ibuprofen should be taken with food, milk, or a full glass of water. Taking it with 8 oz of milk helps coat the stomach lining and reduce the risk of irritation.

Why the other options are incorrect:

B. In the morning after arising

Taking ibuprofen first thing in the morning on an empty stomach increases the risk of gastric irritation. It should be taken with food or milk, regardless of the time of day.

C. 60 minutes before breakfast

Taking ibuprofen before eating can cause gastric mucosal irritation, especially if done regularly. It is best avoided unless specifically directed by a healthcare provider for certain indications.

D. At bedtime on an empty stomach

Taking ibuprofen at bedtime without food may increase the risk of gastrointestinal discomfort or damage overnight while the client is lying flat. It should be taken with food or milk, even at night.

Summary:

To prevent gastrointestinal side effects, ibuprofen should be taken with 8 oz of milk, food, or water. This practice helps protect the stomach lining and ensures safer use of the medication.