Hesi Rn 301 pharmacology Exam

Correct Answer A. Platelet count of 100,000/mm³ (100 x 10⁹/L)

Explanation:

Enoxaparin, a low molecular weight heparin, carries a risk of heparin-induced thrombocytopenia (HIT), a potentially life-threatening immune reaction that reduces platelet count and increases clotting risk. A platelet count of 100,000/mm³ is significantly below the normal range and requires immediate action, including holding the medication and notifying the healthcare provider. Early recognition is essential to prevent thrombotic complications.

Why Other Options Are Wrong:

B. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L)

This value is at the upper limit of normal and does not indicate an acute problem requiring immediate action in the context of enoxaparin administration.

C. Hematocrit 45% (0.45 volume fraction)

This hematocrit value is within the normal range for adults and does not require intervention. It indicates stable red cell concentration without signs of acute blood loss or anemia.

Correct Answer B. Advise the client that the medication should be stopped gradually rather than abruptly.

Explanation:

High-dose corticosteroids suppress the hypothalamic-pituitary-adrenal (HPA) axis. Abrupt discontinuation can precipitate adrenal insufficiency, a potentially life-threatening condition. The nurse’s priority is to teach the client that the medication must be tapered under medical supervision, allowing the adrenal glands to resume normal cortisol production. This education prevents acute withdrawal complications while addressing the client’s concerns about side effects.

Why Other Options Are Wrong:

A. Assess the client for other indications of adverse effects of corticosteroid use.

While assessment is important, it is not the priority when the client expresses intent to abruptly stop a corticosteroid. Immediate action should focus on preventing dangerous withdrawal effects.

C. Encourage the client to take the medication with food to decrease GI distress.

Taking corticosteroids with food may help manage GI irritation, but this does not address the risk of abrupt discontinuation, which is more urgent and potentially life-threatening.

D. Review the client's dosing schedule to ensure he is taking the prescribed amount.

Checking adherence is valuable, but in this scenario, the client is planning to stop the medication completely. The most critical intervention is educating on the necessity of tapering the dose.

Correct Answer:

Increased energy

Explanation:

Levothyroxine is synthetic T4 used to treat hypothyroidism by restoring normal thyroid hormone levels. A therapeutic effect is the resolution of hypothyroid symptoms, which include fatigue, weight gain, bradycardia, cold intolerance, and depression. Increased energy reflects improved metabolism and is a positive response to treatment.

Why Other Options Are Incorrect:

Decreased heart rate

Hypothyroidism already causes bradycardia; with effective therapy, heart rate typically increases toward normal, not decreases further.

Weight gain

Weight gain is a symptom of untreated or undertreated hypothyroidism; effective therapy often results in modest weight loss.

Cold intolerance

This is also a sign of inadequate thyroid hormone levels; improvement in temperature tolerance suggests the drug is working.

Correct Answer:

C. Explore what the client means by the drug not working.

Explanation:

The nurse should first clarify what the client means by “not working” to accurately assess the situation and guide further interventions. The patient’s statement may refer to symptoms not improving, worsening symptoms, or misconceptions about expected outcomes. Understanding the client’s perception allows the nurse to determine whether the concern stems from medication inefficacy, disease progression, or unrealistic expectations, ensuring that any further assessment or intervention is targeted and appropriate.

Why Other Options Are Wrong:

A. Determine if the client is taking the medication before meals: While medication timing with meals is important for absorption, this is not the initial step when the patient expresses a vague concern. The nurse must first assess the client’s understanding and specific experience before investigating potential causes like timing.

B. Ask if his morning voiding is dark colored: Dark-colored urine can be a harmless side effect of carbidopa-levodopa, but this assessment does not address the patient’s primary concern about the drug’s effectiveness. Jumping to side effects without clarifying the concern could miss critical information.

D. Evaluate the client for signs of dyskinesia: Dyskinesia is a potential side effect of long-term dopaminergic therapy, but the presence or absence of abnormal movements does not necessarily explain why the client feels the drug isn’t working. This check is secondary to clarifying the complaint.

Correct Answer:

I may stop taking the medication if my symptoms clear up.

Explanation:

Stopping an antibiotic prematurely, even if symptoms improve, can lead to incomplete eradication of the infection, recurrence, and the development of antibiotic resistance. The full prescribed course must be completed to ensure effectiveness and prevent resistant bacterial strains. Cephalosporins are generally well tolerated, but adherence to the treatment regimen is essential for optimal outcomes.

Why Other Options Are Incorrect:

I should eat yogurt while taking this medication.

Consuming yogurt with live cultures can help restore healthy gut flora and reduce the risk of antibiotic-associated diarrhea, so this is a beneficial practice.

I should stop taking the drug and call my provider if I develop a rash.

A rash can indicate an allergic reaction to cephalosporins, especially in those with penicillin allergies, so this statement reflects appropriate safety awareness.

I will not consume alcohol while taking this medication.

Some cephalosporins can cause a disulfiram-like reaction with alcohol, leading to flushing, headache, nausea, and hypotension, so avoiding alcohol is correct.

Correct Answer A. Black, tarry stools

Explanation:

Black, tarry stools (melena) indicate gastrointestinal bleeding, which is a potentially life-threatening adverse effect of clopidogrel due to its platelet inhibition. Early recognition and reporting are critical to prevent severe blood loss and hemodynamic compromise. Clopidogrel can cause bleeding anywhere in the body, but gastrointestinal and intracranial sites are of highest concern. Clients should be educated to promptly report signs such as melena, hematemesis, hematuria, or unusual prolonged bleeding.

Why Other Options Are Incorrect:

B. Mild headache

Common and usually benign unless severe, persistent, or accompanied by neurological changes suggesting intracranial bleeding.

C. Bruising on forearm

Minor bruising is common with antiplatelet therapy and not urgent unless extensive, spontaneous, or rapidly worsening.

D. Nasal congestion

Not a typical adverse effect of clopidogrel and not an urgent finding.

Correct Answer:

Orthostatic hypotension

Explanation:

Amitriptyline can cause orthostatic hypotension due to its alpha-adrenergic blocking effects, which is especially dangerous in older adults because it increases the risk of dizziness, falls, and injury. Safety measures—such as rising slowly from sitting or lying positions—should be emphasized. This is an immediate safety priority over other side effects because of the risk of trauma.

Why Other Options Are Incorrect:

Dry mouth

A common anticholinergic effect that can be managed with increased fluids, sugar-free gum, or saliva substitutes; not typically urgent.

Constipation

Also related to anticholinergic effects and important to address, but not immediately life-threatening.

Blurred vision

May affect daily activities and safety, but it generally does not pose as immediate a risk for injury as orthostatic hypotension does in older adults.

Correct Answer A. Aged cheese

Explanation:

Aged cheese is high in tyramine, which can cause a hypertensive crisis when combined with MAOIs due to excessive norepinephrine release. Avoiding aged or fermented foods is critical for client safety while on MAOIs.

Why Other Options Are Incorrect:

B. White bread

White bread is low in tyramine and does not interact with MAOIs, so it is safe to consume.

C. Apple juice

Apple juice does not contain tyramine and is safe to drink with MAOI therapy.

D. Rice

Rice is low in tyramine and does not cause dangerous interactions with MAOIs. It can be eaten freely.

Correct Answer A. Alternate the use of each nostril when administering the nasal spray each day.

Explanation:

Calcitonin nasal spray can cause local nasal irritation and rhinitis due to repeated administration in the same nostril. Alternating nostrils daily helps reduce localized inflammation, allows tissue recovery time, and decreases the likelihood of persistent nasal symptoms. Patients should also ensure the nasal passage is clear before administration and follow proper spray technique to optimize absorption and minimize irritation. Monitoring for persistent nasal problems is important, as the healthcare provider may need to reassess therapy if symptoms worsen.

Why Other Options Are Incorrect:

B. Do not lie down within thirty minutes of use of the nasal spray.

This precaution is more relevant for oral medications to prevent reflux or aspiration, not for nasal sprays like calcitonin.

C. Use a nonsteroidal anti-inflammatory drug (NSAID) PRN to reduce any inflammation that may occur.

NSAIDs are not recommended for routine management of nasal irritation from calcitonin spray. Local irritation is best managed by technique adjustments, not systemic anti-inflammatory drugs that can have side effects.

D. Take an over-the-counter antihistamine with each daily dose of nasal spray.

Antihistamines are not indicated for preventing calcitonin-related nasal irritation. They may help with allergic rhinitis but do not address irritation from repeated nasal spray use in the same nostril.