HESI Pharmacology Practice Exam

Correct Answer C: An increased amount of daily Humulin NPH insulin

Why this answer is correct:

Prednisone is a corticosteroid that can increase blood glucose levels by promoting gluconeogenesis (the formation of glucose) in the liver and by reducing insulin sensitivity. This hyperglycemic effect can result in higher blood sugar levels in clients with diabetes mellitus. Therefore, when a client who takes insulin (like Humulin NPH insulin) is prescribed prednisone, the nurse anticipates the need for an increase in the insulin dosage to counteract the rise in blood glucose levels and maintain proper glucose control.

Why the other options are incorrect:

A. An additional dose of prednisone daily

There is no indication that prednisone would require an additional dose beyond the prescribed regimen to manage the client's condition. The dosage adjustments would more likely involve the insulin regimen due to the hyperglycemic effects of prednisone, not the prednisone dose itself.

B. A decreased amount of daily Humulin NPH insulin

Since prednisone causes an increase in blood glucose levels, the client would likely require more insulin, not less. A decrease in insulin would not be appropriate because it could worsen the client's blood glucose control, increasing the risk of hyperglycemia.

D. The addition of an oral hypoglycemic medication daily

Although prednisone can raise blood glucose levels, it is typically managed through adjustments to insulin therapy, especially for clients who are already on insulin. The addition of oral hypoglycemic agents is not typically required for clients on insulin therapy unless they are being switched from insulin to oral medications, which is not the context here.

Summary:

When prednisone is prescribed for a client with diabetes who is already taking Humulin NPH insulin, the nurse anticipates that the insulin dose will need to be increased due to the hyperglycemic effects of prednisone. This adjustment is necessary to manage the increased blood glucose levels caused by the corticosteroid.

Correct Answer A: Tinnitus

Explanation:

Salicylic acid, commonly used for conditions like psoriasis, can lead to systemic toxicity, especially when used in excessive amounts or when the medication is absorbed through the skin over a prolonged period. The primary indicator of systemic toxicity from salicylic acid is tinnitus, which is a ringing or buzzing in the ears. This symptom is a hallmark of salicylate toxicity and should be closely monitored.

Salicylic acid can be absorbed into the bloodstream when applied over large areas of the skin, potentially causing salicylate toxicity. The symptoms of salicylate toxicity are often related to high blood levels of salicylates, and tinnitus is one of the first signs that systemic levels are rising to dangerous levels. The presence of tinnitus indicates that the medication is affecting the central nervous system and may require dose adjustments or discontinuation.

Explanation of Incorrect Options:

B. Diarrhea:

While diarrhea can occur as a side effect of many medications, it is not a typical sign of systemic toxicity from salicylic acid.

C. Constipation:

This is not a common symptom associated with salicylic acid toxicity. In fact, constipation is more likely to be associated with other medications or conditions.

D. Decreased respirations:

While respiratory depression can occur in cases of severe toxicity with certain substances (such as opioids or sedatives), it is not a characteristic symptom of salicylate toxicity. Instead, salicylate toxicity typically causes hyperventilation, not decreased respirations.

Summary:

The nurse should monitor for tinnitus (option A), as it is a key sign of systemic toxicity from salicylic acid. Other symptoms of salicylate toxicity can include nausea, vomiting, confusion, and hyperventilation. If tinnitus occurs, the nurse should reassess the dosage and consult with the healthcare provider to avoid further complications.

Correct answer C: 2

Detailed explanation of the correct answer:

Step 1: Use the formula:

Volume to administer = Desired dose ÷ Concentration

Step 2: Plug in the values:

Desired dose = 4 mg

Concentration = 2 mg/mL

Volume = 4 mg ÷ 2 mg/mL = 2 mL

Explanation of why the other options are incorrect:

A. 1 mL would only provide 2 mg of ondansetron, which is half the prescribed dose.

B. 1.5 mL would provide 3 mg (1.5 mL × 2 mg/mL), which is still less than the ordered dose.

D. 2.5 mL would give 5 mg, which is more than the prescribed 4 mg and would be an overdose.

Summary:

To deliver 4 mg of ondansetron using a 2 mg/mL concentration, the nurse should administer 2 mL.

Correct Answer D: Orthostatic hypotension

Explanation:

Etoposide (VePesid), a chemotherapy agent used in the treatment of small cell lung cancer, is known to cause various side effects. One specific side effect associated with etoposide is orthostatic hypotension. This condition occurs when there is a significant drop in blood pressure when a person moves from a lying or sitting position to a standing position. It can be caused by the vasodilatory effects of chemotherapy agents like etoposide. The exact mechanism is not fully understood, but it is thought that chemotherapy can affect the autonomic nervous system or lead to dehydration, both of which can contribute to orthostatic hypotension. This side effect can cause dizziness, lightheadedness, or fainting upon standing, which the nurse should monitor closely.

Explanation of Incorrect Options:

A. Alopecia – While alopecia (hair loss) is a common side effect of many chemotherapy agents, including etoposide, it is not the most specifically associated with it in this case. Alopecia occurs due to the chemotherapy's effect on rapidly dividing cells, but the most direct association here is with orthostatic hypotension.

B. Chest pain – Chest pain is not typically associated with etoposide therapy. It can occur in some cases due to underlying conditions or other causes, but it is not a known or common side effect of etoposide.

C. Pulmonary fibrosis – Pulmonary fibrosis is more commonly associated with other chemotherapy agents, such as bleomycin, and is less of a concern with etoposide. While some lung toxicity can occur, pulmonary fibrosis is not a primary side effect of etoposide.

Summary:

Orthostatic hypotension is a side effect specifically associated with etoposide (VePesid) due to its vasodilatory effects and impact on the autonomic nervous system. Correct answer: D. Orthostatic hypotension.

Correct Answer B: Renal failure

Explanation of Correct Answer:

Colcrys (colchicine) is used to treat acute gout attacks by reducing inflammation. However, renal failure is a contraindication for colchicine use because the kidneys are responsible for eliminating the drug from the body. In clients with renal failure, the excretion of colchicine can be impaired, leading to accumulation of the drug in the body and a higher risk of toxicity, particularly muscle pain, weakness, or bone marrow suppression. Therefore, colchicine should not be used in clients with renal failure or significantly impaired kidney function.

Why the Other Options Are Incorrect:

A. Myxedema

Myxedema refers to severe hypothyroidism, and although it can cause various health problems, it is not a direct contraindication for colchicine use. Hypothyroid patients can typically tolerate colchicine, as long as their renal function is normal. However, as with any medication, renal function should be monitored in such patients.

C. Hypothyroidism

While hypothyroidism can have various systemic effects, it is not a contraindication for the use of colchicine. In fact, colchicine can be used for gout in patients with hypothyroidism, provided there are no renal impairments or other contraindications present.

D. Diabetes mellitus

Colchicine is not contraindicated in diabetes mellitus. However, care should be taken with any medication in diabetic patients, particularly with respect to blood glucose levels and other medications, but it is not an inherent contraindication for colchicine.

Summary:

Colchicine is contraindicated in clients with renal failure because of the risk of toxicity due to impaired excretion. The other conditions listed, such as myxedema, hypothyroidism, and diabetes mellitus, do not directly contraindicate the use of colchicine. Monitoring of renal function is crucial when administering colchicine to avoid adverse effects.

Correct Answer D: Take the medication with a full glass of water after rising in the morning.

Explanation of Correct Answer:

Alendronate (Fosamax) is a bisphosphonate used to treat and prevent osteoporosis by inhibiting bone resorption. The medication is poorly absorbed and has specific administration instructions to reduce gastrointestinal side effects and enhance absorption. It should be taken first thing in the morning on an empty stomach, with a full glass (6–8 ounces) of plain water, and the client must remain upright (sitting or standing) for at least 30 minutes afterward to prevent esophageal irritation or ulceration, which is a known adverse effect. This routine maximizes absorption and minimizes GI risks.

Why the Other Options Are Incorrect:

A. Take the medication at bedtime

This is incorrect because taking alendronate at bedtime increases the risk of esophageal reflux and irritation, as the client is lying flat. Upright posture is necessary after administration to allow the medication to move quickly through the esophagus into the stomach.

B. Take the medication in the morning with breakfast

This is incorrect because food significantly reduces the absorption of alendronate. It must be taken before eating or drinking anything other than water to ensure proper absorption. Taking it with breakfast renders the drug ineffective.

C. Lie down for 30 minutes after taking the medication

This is the opposite of the correct instruction. The client should remain upright for at least 30 minutes to prevent esophageal irritation and facilitate passage of the medication into the stomach.

Summary:

Alendronate must be taken first thing in the morning on an empty stomach, with a full glass of plain water, and the client must remain upright for at least 30 minutes to prevent esophageal damage and maximize absorption. Therefore, Option D is correct, while the others either impair drug absorption or increase the risk of adverse effects.

Correct Answer C: An episode of diarrhea

Explanation:

C. An episode of diarrhea

Loperamide hydrochloride (Imodium) is an antidiarrheal medication used to treat acute diarrhea or to help manage chronic diarrhea. It works by slowing down intestinal motility, allowing more time for water and electrolytes to be absorbed. The medication is typically prescribed PRN (as needed) for episodes of diarrhea, making it the appropriate choice for this situation.

Why the Other Options Are Incorrect:

A. Constipation

Loperamide is not used to treat constipation. In fact, it can potentially worsen constipation by slowing down bowel movements. Medications used to treat constipation are typically laxatives or fiber supplements, not antidiarrheals.

B. Abdominal pain

Loperamide does not directly treat abdominal pain. While it can reduce diarrhea-related discomfort by slowing bowel movements, it is not specifically indicated for pain management. For abdominal pain, other medications, such as analgesics or antispasmodics, may be more appropriate depending on the cause of the pain.

D. Hematest-positive nasogastric tube drainage

Loperamide is not indicated for managing Hematest-positive nasogastric tube drainage (which suggests the presence of blood in the stomach or gastrointestinal tract). Loperamide is used to control diarrhea and would not be appropriate for bleeding or other serious gastrointestinal issues, which would require different interventions.

Summary:

Loperamide hydrochloride (Imodium) is prescribed for episodes of diarrhea (C) to reduce symptoms by slowing intestinal motility. It is not used for constipation, abdominal pain, or Hematest-positive drainage.

Correct Answer B: Check the client's blood pressure.

Explanation of Correct Answer:

Atenolol hydrochloride (Tenormin) is a beta-blocker primarily used to manage hypertension and angina. Before administering this medication, it is essential to assess the client’s blood pressure, as beta-blockers work by lowering heart rate and blood pressure. If the blood pressure is already low, administering the medication could lead to further hypotension, potentially causing adverse effects such as dizziness, fainting, or shock. Therefore, checking the blood pressure is a priority to ensure the safety and effectiveness of the medication.

Why the Other Options Are Incorrect:

A. Listen to the client's lung sounds.

Although assessing lung sounds is important in certain clinical situations (e.g., to evaluate for pulmonary edema or other respiratory issues), it is not the priority action when preparing to administer atenolol. The primary concern with atenolol administration is monitoring the client’s blood pressure to avoid excessive lowering.

C. Check the recent electrolyte levels.

Electrolyte levels are important to monitor in clients taking certain medications, especially diuretics or ACE inhibitors. However, they are not a primary concern before administering atenolol. The primary concern is assessing blood pressure to ensure that the medication does not cause an unsafe decrease in pressure.

D. Assess the client for muscle weakness.

Muscle weakness is not typically associated with atenolol use. While muscle weakness can be a side effect of some medications (such as statins), it is not a primary concern with beta-blockers like atenolol. The blood pressure assessment remains the priority action to ensure safe administration.

Summary:

Before administering atenolol (Tenormin), the nurse should prioritize checking the client's blood pressure. Since atenolol lowers heart rate and blood pressure, it is crucial to confirm that the client’s blood pressure is within an acceptable range to avoid the risk of hypotension. Other assessments, such as lung sounds, electrolyte levels, and muscle weakness, are important but not the priority in this situation.

Correct Answer B: Monitor bowel activity

Why this answer is correct:

Codeine sulfate is an opioid analgesic, and one of its most common side effects is constipation due to decreased gastrointestinal motility. Therefore, it is essential for the nurse to monitor bowel activity and assess for signs of opioid-induced constipation. The nurse may also need to encourage increased fluid intake, dietary fiber, and possibly administer stool softeners or laxatives as prescribed to prevent complications such as fecal impaction.

Why the other options are incorrect:

A. Restrict fluid intake

This is incorrect. Clients taking codeine should actually be encouraged to increase fluid intake, not restrict it. Adequate hydration helps prevent constipation, which is a known side effect of opioid therapy.

C. Monitor for hypertension

This is incorrect. Opioids like codeine typically cause hypotension, not hypertension, especially if given in high doses or if the client is volume-depleted. Monitoring blood pressure is appropriate, but hypertension is not a common adverse effect of codeine.

D. Monitor peripheral pulses

This is not necessary in the context of codeine administration unless the client has specific cardiovascular issues. Codeine does not typically affect peripheral perfusion or circulation to the extent that would warrant routine monitoring of peripheral pulses.

Summary:

The most appropriate nursing action for a client taking codeine sulfate is to monitor bowel activity, as constipation is a common side effect. Restricting fluids, monitoring for hypertension, or checking peripheral pulses are not primary concerns related to codeine. Therefore, the correct answer is B.