HESI Pharmacology Practice Exam

Correct Answer A: Heart rate

Explanation of the Correct Answer: When administering digoxin (Lanoxin), it is essential to assess the heart rate before administration, as this medication is primarily used to increase the force of heart contractions and slow the heart rate in cases of heart failure and atrial fibrillation. A low heart rate, typically below 60 beats per minute, could indicate that the client is at risk for digoxin toxicity, as the medication can further slow the heart rate. If the heart rate is below 60 beats per minute, the nurse should withhold the dose and notify the healthcare provider.

Why the Other Options Are Incorrect:

B. Temperature Although temperature is an important indicator of infection or other systemic issues, it is not the most critical vital sign to assess when administering digoxin. A change in temperature would not immediately affect the decision to administer digoxin.

C. Respirations Respiratory rate is important for monitoring respiratory status, but it is not the most relevant vital sign to assess before giving digoxin. Respiratory issues may arise if the heart failure is severe, but heart rate is more directly influenced by digoxin.

D. Blood pressure While blood pressure is important to monitor in clients with heart failure and in those receiving digoxin, it is not as directly relevant as heart rate for determining whether the medication should be administered. Blood pressure may be affected by the client’s heart condition, but heart rate plays a more direct role in digoxin’s effects and safety.

Summary:

The most important vital sign to assess before administering digoxin is the heart rate because it directly relates to the medication's effects on the heart. If the heart rate is too low, the medication should be withheld to prevent the risk of bradycardia and potential digoxin toxicity.

Correct answe B: 140

Detailed explanation of the correct answer:

The prescribed dose is 600 mg per square meter (mg/m²) per day, divided into 3 doses. The child’s body surface area (BSA) is 0.7 m².

Step 1: Calculate the total daily dose based on the child’s BSA:

Total daily dose = 600 mg/m² × 0.7 m² = 420 mg/day

Step 2: Divide the total daily dose by 3 to determine the dose per administration:

Dose per dose = 420 mg ÷ 3 = 140 mg

Thus, the child should receive 140 mg per dose.

Explanation of why the other options are incorrect:

A. 120 is incorrect because it does not correctly divide the total daily dose by the number of doses.

C. 150 is incorrect because it overestimates the dose per dose based on the calculation.

D. 160 is incorrect because it overestimates the dose per dose based on the calculation.

Summary:

The child should receive 140 mg per dose of acetazolamide (Diamox).

Correct answer C: 95

Detailed explanation of the correct answer:

Step 1: Calculate how much volume has already infused.

Infusion rate = 85 mL/hour

Time elapsed = 2 hours

85 mL/hour × 2 hours = 170 mL infused

Step 2: Subtract the infused volume from the total volume.

Total volume = 265 mL

265 mL – 170 mL = 95 mL remaining

Explanation of why the other options are incorrect:

A. 75 mL would indicate only 190 mL had infused, which is incorrect.

B. 85 mL would reflect just 180 mL infused, also incorrect.

D. 105 mL would suggest only 160 mL infused, which is lower than the actual amount infused over 2 hours at 85 mL/hour.

Summary:

After 2 hours of infusion at 85 mL/hour, 95 mL remain from the original 265 mL secondary infusion. The nurse should report 95 mL remaining to be infused.

Correct Answer B: 14 gtts/minute

Explanation:

We are given the following information:

Infusion rate: 85 ml/hour

Drop factor: 10 gtt/ml

Step 1: Convert the infusion rate from ml/hour to ml/minute:

85 ml/hour ÷ 60 minutes = 1.42 ml/min

Step 2: Calculate the drop rate in gtts/minute:

Drop rate (gtts/min) = Infusion rate (ml/min) × Drop factor (gtt/ml)

Drop rate = 1.42 ml/min × 10 gtt/ml = 14.2 gtts/min

Step 3: Round to the nearest whole number:

14.2 gtts/min rounds to 14 gtts/min.

Explanation of Incorrect Options:

A. 12 gtts/minute – This would deliver less than the required 85 ml/hour.

C. 16 gtts/minute – This would deliver more than the required 85 ml/hour.

D. 18 gtts/minute – This would deliver even more than the required 85 ml/hour.

Summary:

The nurse should regulate the drop rate to deliver 14 gtts/minute, which is B. 14 gtts/minute.

Correct Answer A: I can skip a dose once a week.

Explanation of the Correct Answer:

It is important for clients taking lisinopril (Prinivil, Zestril), an angiotensin-converting enzyme (ACE) inhibitor, to take their medication consistently each day as prescribed. Skipping doses can lead to inconsistent blood pressure control and potential increases in hypertension, increasing the risk of cardiovascular events. The statement that the client can skip a dose once a week demonstrates a lack of understanding of the importance of adhering to the prescribed medication schedule. This indicates a need for further teaching regarding the proper use of lisinopril.

Why the Other Options Are Correct:

B. I need to change my position slowly.

This statement is correct because lisinopril can cause orthostatic hypotension, particularly when starting the medication or after increasing the dose. It is essential for the client to change positions slowly, particularly from a sitting or lying position to a standing position, to avoid dizziness or fainting caused by a sudden drop in blood pressure.

C. I take the pill after breakfast each day.

This statement is correct because lisinopril can be taken with or without food, and the timing of the dose can be adapted to the client’s routine. Taking it after breakfast is a common way to incorporate the medication into a daily routine. As long as the medication is taken at the same time every day, the specific time is flexible.

D. If I get a bad headache, I should call my doctor immediately.

This statement is correct because a severe headache can sometimes be a sign of hypertensive crisis or a serious side effect of the medication. It is important for the client to seek medical attention if they experience a bad headache, particularly if it is associated with other symptoms like nausea, vision changes, or chest pain, as these could be signs of complications.

Summary:

The correct answer is A, as skipping doses can lead to inadequate blood pressure control. The other statements are accurate and align with proper medication management and safety guidelines for clients taking lisinopril. The nurse should reinforce the importance of consistent medication adherence and proper monitoring of side effects.

Correct Answer C: Consult with health care providers (HCPs) before receiving immunizations

Explanation:

When a patient is receiving an antineoplastic (chemotherapy) medication, they are often immunocompromised due to the medication's effects on the immune system. Many chemotherapy agents can weaken the immune system, making the patient more vulnerable to infections. As a result, it is crucial for the nurse to instruct the patient to consult with their healthcare provider (HCP) before receiving any immunizations, as live vaccines or certain other vaccines may not be appropriate during chemotherapy. The healthcare provider can guide the patient on which vaccines are safe to receive and when.

Explanation of Incorrect Options:

A. To take aspirin (acetylsalicylic acid) as needed for headache – This is not appropriate advice. Aspirin can increase the risk of bleeding, especially for patients undergoing chemotherapy, as chemotherapy can affect platelet counts and blood clotting. Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin should generally be avoided during chemotherapy unless specifically prescribed by the healthcare provider.

B. Drink beverages containing alcohol in moderate amounts each evening – Alcohol can interfere with the immune system, increase the risk of liver toxicity, and exacerbate side effects of chemotherapy, such as nausea and fatigue. Patients receiving chemotherapy should avoid alcohol unless specifically cleared by their healthcare provider.

D. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair – This is incorrect. As mentioned in option C, patients receiving chemotherapy should consult their healthcare provider before receiving any vaccines, including the flu vaccine. Flu vaccines are typically inactivated (not live), but it is still crucial to consult with the healthcare provider to ensure the vaccine is appropriate for the patient’s current condition and immune status.

Summary:

Patients receiving antineoplastic medications should consult with their healthcare provider before receiving any immunizations due to their compromised immune system. Correct answer: C. Consult with health care providers (HCPs) before receiving immunizations.

Correct Answer A: Withhold the medication.

Explanation:

A. Withhold the medication.

Metoprolol (Lopressor) is a beta-blocker used to manage conditions such as hypertension and arrhythmias by reducing heart rate and blood pressure. Metoprolol should be withheld if the apical pulse (AP) is less than 60 beats per minute (bradycardia), as this is a common contraindication for administration. The client's AP is 58 beats per minute, which is below the threshold of 60 beats/min, indicating that the heart rate is too low for the medication to be safely administered. Administering metoprolol in this scenario could cause further bradycardia or exacerbate the condition.

Why the Other Options Are Incorrect:

B. Notify the registered nurse immediately.

While it is always appropriate to notify the registered nurse if there is any concern about the medication, the primary action in this scenario is to withhold the medication due to the low apical pulse. The nurse should take appropriate action first (withholding the medication), and then notify the registered nurse if needed for further guidance or clarification.

C. Administer the medication as prescribed.

Administering the medication as prescribed is not appropriate in this situation because the client’s apical pulse (58 beats/min) is below the recommended threshold of 60 beats/min. Administering metoprolol with a pulse rate this low could cause worsening bradycardia and potential complications, such as hypotension or even heart failure.

D. Administer half of the prescribed medication.

Administering half the dose is not an appropriate action when the apical pulse is below 60 beats per minute. The dose of metoprolol should either be given as prescribed or withheld based on the clinical assessment of the heart rate. Reducing the dose is not a standard practice for low pulse rates in this context, and withholding the medication is the correct course of action to prevent possible complications.

Summary:

The appropriate action in this scenario is to withhold the medication (A) because the client’s apical pulse is below 60 beats/min, which is a contraindication for administering metoprolol. The nurse should notify the registered nurse (B) if necessary, but the first step should always be to withhold the medication to ensure patient safety. Administering the medication (C) or a reduced dose (D) could be harmful and is not the correct response.

Correct Answer B: Calcium level

Explanation:

Tamoxifen is known to cause an increase in serum calcium levels, particularly in clients with bone metastases. This occurs because tamoxifen can have estrogen agonist effects on bone tissue, leading to increased bone resorption early in therapy. As a result, calcium is released into the bloodstream, potentially causing hypercalcemia. Therefore, it is essential to monitor calcium levels in clients receiving tamoxifen, especially during the initial weeks of therapy.

Explanation of Incorrect Options:

A. Glucose level – Tamoxifen does not have a significant effect on glucose metabolism, and glucose monitoring is not specifically required due to this medication.

C. Potassium level – There is no known direct effect of tamoxifen on potassium levels. Electrolyte disturbances like hypokalemia or hyperkalemia are not commonly associated with tamoxifen.

D. Prothrombin time – Although tamoxifen has a potential risk for thromboembolic events, routine monitoring of prothrombin time is not a primary concern unless the client is on anticoagulant therapy.

Summary:

Tamoxifen may increase serum calcium levels, particularly in clients with bone metastases. Therefore, calcium levels should be monitored closely. Correct answer: B. Calcium level.

Correct Answer A:  At bedtime

Why this answer is correct:

Ranitidine (Zantac) is a histamine-2 (H2) blocker that reduces stomach acid production. It is commonly prescribed to treat conditions like peptic ulcers or gastroesophageal reflux disease (GERD). The most effective time to administer ranitidine is at bedtime, as this helps to reduce nocturnal acid secretion and prevents acid reflux during sleep. This is especially helpful for clients who experience symptoms of acid reflux or ulcers at night.

Why the other options are incorrect:

B. After lunch

This is not the ideal time for administering ranitidine because it may not be as effective in controlling nighttime acid production, which is often when reflux or ulcers cause significant symptoms.

C. With supper

While taking ranitidine with a meal might help control symptoms after eating, the optimal time is at bedtime to address acid secretion during the night. Administering it with supper may not provide the same level of benefit for nocturnal symptoms.

D. Before breakfast

Taking ranitidine before breakfast is not as effective as taking it at bedtime for managing nocturnal acid secretion. While it could provide some benefit during the day, it would not address nighttime symptoms as effectively.

Summary:

Ranitidine (Zantac) should be taken at bedtime to maximize its effectiveness in controlling nocturnal acid secretion, which is especially important for conditions like GERD and peptic ulcers.