Hesi Rn 301 pharmacology Exam
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Free Hesi Rn 301 pharmacology Exam Questions
Prior to administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement
Reference Range:
Calcium 8.5 to 10.5 mg/dL (2.25 to 2.75 mmol/L)
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Hold the calcium carbonate, but administer the calcitriol as scheduled.
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Hold the calcitriol, but administer the calcium carbonate as scheduled.
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Hold both medications until contacting the healthcare provider.
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Administer both medications as scheduled.
Explanation
Correct Answer C. Hold both medications until contacting the healthcare provider.
Explanation:
A calcium level of 14 mg/dL indicates severe hypercalcemia, which can be life-threatening. Both calcitriol and calcium carbonate increase calcium levels, so administering them would worsen the condition. The safest action is to hold both medications and promptly notify the healthcare provider for further orders. Immediate intervention may be required to lower the calcium level and prevent complications such as cardiac arrhythmias, neurological impairment, and kidney damage.
Why Other Options Are Wrong:
A. Hold the calcium carbonate, but administer the calcitriol as scheduled.
Calcitriol increases calcium absorption from the gut, so giving it in hypercalcemia would worsen the problem. It should also be withheld until calcium levels return to normal.
B. Hold the calcitriol, but administer the calcium carbonate as scheduled.
Calcium carbonate directly raises serum calcium. Giving it in the setting of hypercalcemia is contraindicated and could exacerbate the risk of serious complications.
D. Administer both medications as scheduled.
Proceeding with both medications would dangerously elevate calcium levels further. This option ignores the lab finding and puts the patient at significant risk for acute hypercalcemic crisis.
A 72-year-old client with Parkinson’s disease is starting levodopa/carbidopa therapy. The nurse is providing dietary teaching to optimize medication effectiveness and reduce fluctuations in symptom control. Which instruction is essential for this client
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Avoid high-protein meals
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Avoid vitamin C
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Avoid caffeine
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Take at bedtime only
Explanation
Correct Answer A. Avoid high-protein meals
Explanation:
High-protein meals can interfere with the absorption of levodopa in the small intestine and compete with the drug for transport across the blood-brain barrier. This can reduce the medication’s effectiveness and worsen Parkinson’s symptoms. Clients are advised to take levodopa/carbidopa with low-protein meals or spread protein intake evenly throughout the day to prevent “off” periods.
Why Other Options Are Incorrect:
B. Avoid vitamin C
There is no clinical evidence that vitamin C interferes with levodopa/carbidopa absorption or effectiveness, so routine avoidance is unnecessary.
C. Avoid caffeine
Caffeine does not interact with levodopa/carbidopa in a harmful way. In some cases, caffeine may even improve alertness in Parkinson’s patients.
D. Take at bedtime only
Levodopa/carbidopa must be taken at scheduled intervals during waking hours to maintain stable dopamine levels and control symptoms; bedtime-only dosing is ineffective.
A 60-year-old client with hypertension is prescribed hydrochlorothiazide as part of their treatment plan. The nurse knows this medication can affect electrolyte balance. A client taking hydrochlorothiazide should be monitored for which electrolyte imbalance?
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Hyperkalemia
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Hypokalemia
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Hypernatremia
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Hypercalcemia
Explanation
Correct Answer:
Hypokalemia
Explanation:
Hydrochlorothiazide is a thiazide diuretic that increases urinary excretion of sodium and potassium. The loss of potassium can lead to hypokalemia, which may cause muscle weakness, cramps, arrhythmias, and fatigue. Regular potassium level monitoring is important, and the client may require dietary potassium supplementation.
Why Other Options Are Incorrect:
Hyperkalemia
Hydrochlorothiazide does not cause potassium retention; instead, it increases potassium excretion, making hyperkalemia unlikely.
Hypernatremia
While sodium is excreted with hydrochlorothiazide use, water loss generally balances sodium levels; hypernatremia is not a common effect.
Hypercalcemia
Thiazide diuretics actually reduce urinary calcium excretion, so they are more likely to cause mild hypercalcemia, but it is not the primary or most concerning imbalance to monitor for compared to hypokalemia.
Which statement(s) about the care of a patient with aspirin poisoning does the nurse identify as correct
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Hemodialysis or peritoneal dialysis can accelerate salicylate removal.
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Warming blankets are routinely used to raise the patient's temperature.
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Activated charcoal is contraindicated in the treatment of aspirin poisoning.
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Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylate.
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Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning.
Explanation
Correct Answers:
A) Hemodialysis or peritoneal dialysis can accelerate salicylate removal.
D) Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylate.
Explanation:
Aspirin (salicylate) poisoning can cause metabolic acidosis, respiratory alkalosis, and multi-organ effects. Severe toxicity may require hemodialysis or peritoneal dialysis to rapidly remove salicylates, especially in patients with renal impairment or very high serum levels. Bicarbonate infusions help correct metabolic acidosis and alkalinize the urine, enhancing renal salicylate excretion. These measures, along with supportive care, reduce toxicity and complications.
Why Other Options Are Incorrect:
B) Warming blankets are routinely used to raise the patient's temperature
Aspirin poisoning often causes hyperthermia, not hypothermia. Cooling measures, not warming, are used if the patient’s temperature is elevated.
C) Activated charcoal is contraindicated in the treatment of aspirin poisoning
Activated charcoal is indicated early after ingestion to reduce absorption of salicylates, especially within the first hour. It is not contraindicated unless the airway is unprotected or there is risk of aspiration.
E) Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning
Aspirin poisoning more commonly leads to dehydration from hyperventilation, fever, and diaphoresis. Fluids are often replaced, not restricted, unless there is another condition causing overload.
A 54-year-old client with hypokalemia is prescribed potassium chloride (KCl) 20 mEq IV. Before starting the infusion, the nurse must ensure the medication can be given safely to prevent complications. What is the priority action before giving IV potassium chloride?
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Confirm urine output is adequate
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Check blood glucose
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Administer by IV push for rapid correction
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Mix with dextrose solution
Explanation
Correct Answer:
Confirm urine output is adequate
Explanation:
Potassium is excreted through the kidneys, and administering IV potassium to a client with poor urine output can cause life-threatening hyperkalemia. The nurse must confirm adequate urine output (generally >30 mL/hr) before infusion. Potassium chloride must also be diluted and infused slowly—never given IV push—to avoid cardiac arrest.
Why Other Options Are Incorrect:
Check blood glucose
This is important for diabetic clients, but it is not the priority for potassium administration safety.
Administer by IV push for rapid correction
IV push potassium is contraindicated because it can cause immediate fatal arrhythmias.
Mix with dextrose solution
Dextrose can worsen hypokalemia in some cases by stimulating insulin release, which drives potassium into cells. This is not standard unless specifically ordered.
A nurse is reviewing the medication profiles of several clients before administering enoxaparin, a low molecular weight heparin used for anticoagulation. The nurse must identify which client is at the highest risk for bleeding complications. Which client is most at risk for bleeding while on enoxaparin?
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Client on daily aspirin therapy
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Client on levothyroxine
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Client on metoprolol
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Client on amlodipine
Explanation
Correct Answer:
Client on daily aspirin therapy
Explanation:
Enoxaparin increases the risk of bleeding by inhibiting clot formation. Aspirin has antiplatelet effects that also increase bleeding risk. When combined, the risk of hemorrhage is significantly elevated. Clients on both medications require close monitoring for signs of bleeding such as bruising, hematuria, melena, or prolonged bleeding from cuts.
Why Other Options Are Incorrect:
Client on levothyroxine
Levothyroxine affects thyroid hormone levels but does not have anticoagulant or antiplatelet effects.
Client on metoprolol
Metoprolol is a beta-blocker that controls heart rate and blood pressure; it does not directly increase bleeding risk.
Client on amlodipine
Amlodipine is a calcium channel blocker used for hypertension and angina; it does not have significant bleeding risk when used with enoxaparin.
A patient arrives at the emergency department complaining of back pain. He reports taking at least 3 acetaminophen tablets every three hours for the past week without relief. Which of the following symptoms suggests acetaminophen toxicity?
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Tinnitus.
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Diarrhea.
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Hypertension.
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Hepatic damage.
Explanation
Correct Answer:
D. Hepatic damage.
Explanation:
Acetaminophen overdose is one of the leading causes of acute liver failure. Excessive doses saturate normal metabolic pathways, leading to accumulation of toxic metabolites that cause hepatocellular injury. Early signs of toxicity may be mild (nausea, malaise), but as damage progresses, patients can develop elevated liver enzymes, jaundice, right upper quadrant pain, coagulopathy, and encephalopathy. Timely treatment with N-acetylcysteine is critical to prevent irreversible hepatic failure.
Why Other Options Are Incorrect:
A. Tinnitus
Tinnitus is associated with salicylate (aspirin) toxicity, not acetaminophen. Overuse of acetaminophen does not cause ringing in the ears.
B. Diarrhea
While diarrhea can occur in some medication-related gastrointestinal disturbances, it is not a hallmark symptom of acetaminophen toxicity. Liver damage is the primary concern with overdose.
C. Hypertension
Acetaminophen toxicity does not typically present with hypertension. Cardiovascular effects are not a primary feature; instead, liver injury is the major life-threatening complication.
A client on warfarin has an INR of 5.2 and no signs of bleeding. What is the nurse’s priority action?
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Hold the next dose and notify the provider
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Administer vitamin K immediately
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Continue the same dose
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Give fresh frozen plasma
Explanation
Correct Answer:
Hold the next dose and notify the provider
Explanation:
An INR above the therapeutic range (typically 2–3 for most indications) indicates increased bleeding risk. Without active bleeding, holding warfarin and contacting the provider is appropriate. The provider may adjust dosing or prescribe vitamin K if INR is critically high.
Why Other Options Are Incorrect:
Administer vitamin K immediately
Reserved for serious elevation or active bleeding.
Continue the same dose
Would maintain unsafe INR.
Give fresh frozen plasma
Used for active bleeding or urgent reversal.
A 32-year-old client is brought to the emergency department after ingesting a large quantity of acetaminophen in a suicide attempt. The provider orders treatment to prevent severe liver damage. What is the antidote for acetaminophen overdose
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N-acetylcysteine
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Naloxone
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Protamine sulfate
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Vitamin K
Explanation
Correct Answer A. N-acetylcysteine
Explanation:
N-acetylcysteine (NAC) is the specific antidote for acetaminophen toxicity. It works by replenishing glutathione stores, which detoxifies the harmful metabolite (NAPQI) produced in the liver. Early administration within 8–10 hours of ingestion is most effective in preventing liver damage.
Why Other Options Are Incorrect:
B. Naloxone
Naloxone is an opioid antagonist used to reverse respiratory depression from opioid overdose, not acetaminophen toxicity.
C. Protamine sulfate
Protamine sulfate is used to reverse the anticoagulant effects of heparin, not for acetaminophen overdose.
D. Vitamin K
Vitamin K is used to treat warfarin-induced bleeding by aiding clotting factor synthesis, not acetaminophen toxicity.
A client with chronic kidney disease (CKD) is receiving calcium acetate 667 mg PO. A decrease in which blood value indicates to the nurse that the medication is having the desired effect
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Phosphate.
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PH.
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Calcium.
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Potassium.
Explanation
Correct Answer D. Phosphate.
Explanation:
Calcium acetate is a phosphate binder used in clients with CKD to reduce high serum phosphate levels. It works by binding dietary phosphate in the gastrointestinal tract to form insoluble calcium phosphate, which is excreted in the feces. This prevents phosphate absorption into the bloodstream, lowering serum phosphate levels and reducing the risk of complications like bone disease, vascular calcification, and secondary hyperparathyroidism. The therapeutic goal is a measurable decrease in serum phosphate toward normal range.
Why Other Options Are Incorrect:
A. PH.
Calcium acetate does not directly influence systemic pH. While phosphate balance can indirectly affect acid–base status, calcium acetate’s mechanism is not aimed at correcting pH disturbances. pH changes are managed through other interventions in CKD, such as bicarbonate therapy.
B. Calcium.
Although calcium acetate contains calcium, its primary therapeutic purpose is phosphate binding, not calcium supplementation. Serum calcium levels may increase slightly, but monitoring focuses on avoiding hypercalcemia rather than targeting a decrease.
C. Potassium.
Calcium acetate does not bind or lower potassium. Hyperkalemia in CKD is treated with dietary restriction, loop diuretics, potassium binders like sodium zirconium cyclosilicate or patiromer, or emergency interventions—not calcium acetate.
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