HESI Pharmacology Practice Exam

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: 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 B: Tremors

Explanation of the Correct Answer:

Tremors can be a sign of levothyroxine (Synthroid) toxicity or over-replacement of thyroid hormone. Levothyroxine is used to treat hypothyroidism by supplementing the body's thyroid hormone levels. If the dose is too high, the client may develop symptoms of hyperthyroidism, such as tremors, tachycardia, anxiety, and insomnia. This is why it is essential for the client to notify the healthcare provider if they experience tremors, as it may indicate that the thyroid hormone dosage needs to be adjusted.

Why the Other Options Are Incorrect:

A. Fatigue

Fatigue is more commonly associated with hypothyroidism, which is the condition that levothyroxine treats. When the medication is properly adjusted, fatigue should improve. However, if the fatigue continues, it may require further evaluation, but it is not a specific sign of medication toxicity.

C. Cold intolerance

Cold intolerance is a symptom of hypothyroidism and would indicate that the client’s dose of levothyroxine might need to be adjusted. It is not typically a symptom of levothyroxine toxicity, so the client would not need to notify the HCP for this reason alone. Cold intolerance should improve as the thyroid hormone levels stabilize.

D. Excessively dry skin

Excessively dry skin is also a symptom of hypothyroidism and is not directly related to levothyroxine toxicity. If the dose of levothyroxine is properly adjusted, dry skin should improve. Like cold intolerance, this symptom would not typically require immediate notification to the healthcare provider unless it persists despite appropriate treatment.

Summary:

The nurse should instruct the client to notify the healthcare provider if tremors occur, as this may indicate levothyroxine toxicity or over-replacement of thyroid hormone. Other symptoms such as fatigue, cold intolerance, and dry skin are more likely related to untreated or inadequately treated hypothyroidism rather than levothyroxine overdose.

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: 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 C: Blood pressure of 198/110 mm Hg

Why this answer is correct:

Streptokinase (Streptase) is a thrombolytic agent used to dissolve blood clots, such as those present in pulmonary embolism. However, severe hypertension (a blood pressure of 198/110 mm Hg) is a contraindication to thrombolytic therapy. High blood pressure increases the risk of bleeding, especially in the presence of thrombolytics, because it can cause stress on blood vessel walls, leading to hemorrhage. Before administering streptokinase, the nurse must ensure that the client’s blood pressure is adequately controlled to avoid complications such as intracranial hemorrhage or other forms of bleeding.

Why the other options are incorrect:

A. Adventitious breath sounds

While adventitious breath sounds (e.g., crackles or wheezes) may indicate pulmonary complications such as fluid overload or respiratory distress, they are not an immediate contraindication to the administration of streptokinase. These sounds should be assessed and managed, but they do not pose an immediate threat in the same way that severe hypertension does.

B. Temperature of 99.4° F orally

A mild fever of 99.4°F is generally not a contraindication for thrombolytic therapy. It could be indicative of an infection or the body's response to the clot, but it is not a priority finding that would require withholding the therapy. However, a fever should still be monitored and investigated further.

D. Respiratory rate of 28 breaths/min

A respiratory rate of 28 breaths/min is mildly elevated and may suggest respiratory distress, potentially from the pulmonary embolism or another condition. However, this is not an immediate contraindication to thrombolytic therapy. The respiratory rate should be monitored, but it is not as critical as managing severe hypertension before initiating treatment.

Summary:

A blood pressure of 198/110 mm Hg is a critical finding that requires immediate attention before administering streptokinase due to the high risk of bleeding. Therefore, C is the correct answer.

Correct Answer B: Sulfisoxazole

Explanation:

B. Sulfisoxazole

For a child with spina bifida (myelomeningocele) and a neurogenic bladder, the most likely prophylactic medication prescribed would be an antibiotic like sulfisoxazole, which is used to prevent urinary tract infections (UTIs). Children with neurogenic bladders have an increased risk of developing UTIs due to urinary retention and potential for incomplete emptying of the bladder, making prophylactic antibiotics important in preventing infections. Sulfisoxazole is a sulfonamide antibiotic often used for UTIs and can be prescribed as a preventive measure.

Why the Other Options Are Incorrect:

A. Prednisone

Prednisone is a corticosteroid used to reduce inflammation in a variety of conditions, but it is not used prophylactically for a child with a neurogenic bladder. There is no direct role for prednisone in preventing urinary tract infections or managing a neurogenic bladder in this context.

C. Furosemide (Lasix)

Furosemide (Lasix) is a diuretic that is typically used to treat conditions such as heart failure or fluid retention. It is not used prophylactically in the context of neurogenic bladder to prevent urinary tract infections. Lasix might cause dehydration and electrolyte imbalances, making it inappropriate for preventing UTIs in this case.

D. Intravenous immune globulin (IVIG)

Intravenous immune globulin (IVIG) is used to provide passive immunity and is typically used in conditions related to immunodeficiency or certain autoimmune disorders. It is not used for the prophylaxis of urinary tract infections or in the management of a neurogenic bladder in children with spina bifida.

Summary:

In children with spina bifida and neurogenic bladder, sulfisoxazole (B) is the most likely prophylactic medication to prevent urinary tract infections due to the increased risk of UTIs in these patients. The other options, prednisone (A), furosemide (C), and IVIG (D), are not relevant for this purpose.

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 A: Withdraws the NPH insulin first

Explanation

This action indicates the need for further teaching. When mixing regular (clear) insulin and NPH (cloudy) insulin, the correct technique is to withdraw the regular insulin first, before the NPH. This prevents contamination of the regular insulin vial with any NPH, which could alter the action of the short-acting insulin. Drawing up NPH first could cause cloudy NPH to enter the regular insulin vial, compromising its purity and potency.

Why the Other Options Are Correct:

B. Withdraws the regular insulin first

This is correct technique. The regular insulin is always drawn up first because it is clear and short-acting, and this prevents contaminating the vial with longer-acting, cloudy NPH insulin. Drawing regular insulin first preserves its expected pharmacokinetics.

C. Injects air into NPH insulin vial first

Injecting air into the NPH vial before withdrawing any insulin is also correct. This step prevents creating a vacuum that would make it hard to draw up the dose. Although air is injected into the NPH vial first, insulin is not withdrawn from it until after withdrawing the regular insulin.

D. Injects an amount of air equal to the desired dose of insulin into the vial

This is also correct technique. Injecting air equal to the amount of insulin to be withdrawn helps equalize pressure and makes it easier to draw up the exact dose. This step should be done for both vials before withdrawing any insulin.

Summary:

The nurse should recognize that withdrawing NPH insulin first (A) indicates a need for further teaching. The correct order is to inject air into both vials (NPH first, then regular), then withdraw regular insulin first, followed by NPH. This process ensures accurate dosing and prevents contamination of the short-acting insulin.