Hesi Rn 301 pharmacology Exam
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Free Hesi Rn 301 pharmacology Exam Questions
A 64-year-old client with heart failure is taking lisinopril and spironolactone. The nurse reviews the client’s latest laboratory results to identify any values requiring prompt intervention.
Which finding in this client requires action?
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Potassium 5.7 mEq/L
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Sodium 138 mEq/L
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Creatinine 1.0 mg/dL
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BP 128/76 mm Hg
Explanation
Correct Answer:
Potassium 5.7 mEq/L
Explanation:
Both ACE inhibitors and spironolactone increase potassium levels, and using them together significantly raises the risk of hyperkalemia. A potassium level of 5.7 mEq/L is above the normal range (3.5–5.0 mEq/L) and can cause dangerous cardiac arrhythmias. This requires immediate provider notification and possible medication adjustment.
Why Other Options Are Incorrect:
Sodium 138 mEq/L
This is within the normal sodium range (135–145 mEq/L) and does not require intervention.
Creatinine 1.0 mg/dL
This is a normal kidney function value and requires no action.
BP 128/76 mm Hg
This is a normal blood pressure reading and does not indicate any problem requiring action.
What is the MOST common drug used to treat oral candidiasis?
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Oseltamivir (Tamiflu)
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Griseofulvin (Fulvicin P/G)
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Amantadine (Symmetrel)
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Nystatin (Mycostatin)
Explanation
The Correct Answer is:
D. Nystatin (Mycostatin)
Explanation:
Nystatin (Mycostatin) is the most commonly prescribed medication for oral candidiasis, also known as thrush. It is an antifungal drug that works by binding to fungal cell membranes, causing leakage of cell contents and ultimately fungal cell death. Nystatin is usually given as an oral suspension that the patient swishes and swallows or spits out, allowing direct contact with the fungal lesions in the mouth. It is well tolerated, safe for most age groups, and effective against Candida species without systemic absorption.
Why the other options are incorrect:
A. Oseltamivir (Tamiflu)
This is an antiviral drug used to treat and prevent influenza A and B. It has no antifungal properties and is not effective against Candida infections.
B. Griseofulvin (Fulvicin P/G)
This antifungal is used primarily for dermatophyte (ringworm) infections of the skin, hair, and nails. It is not a first-line agent for oral candidiasis because it is less effective against Candida species.
C. Amantadine (Symmetrel)
This is an antiviral medication historically used to treat influenza A and Parkinson’s disease. It does not have antifungal activity and is unrelated to oral thrush treatment.
A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? (Select all that apply.)
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Ibuprofen [Advil]
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Naproxen [Aleve]
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Aspirin [Bayer]
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Acetaminophen [Tylenol]
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Indomethacin [Indocin]
Explanation
Correct Answers:
Ibuprofen [Advil]
Acetaminophen [Tylenol]
Explanation for Correct Answers:
Ibuprofen [Advil]
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can be used safely in children over 6 months of age to reduce fever and pain. It does not carry the risk of Reye’s syndrome in children with viral illnesses such as influenza.
Acetaminophen [Tylenol]
Acetaminophen is an analgesic and antipyretic that is safe for use in children with influenza. It works by acting on the hypothalamus to reduce fever and relieve discomfort without the risks associated with aspirin in viral infections.
Why Other Options Are Incorrect:
Naproxen [Aleve]
Although naproxen is an NSAID, it is generally not recommended for routine fever control in young children and has more potential for gastrointestinal irritation and adverse effects compared to ibuprofen.
Aspirin [Bayer]
Aspirin is contraindicated in children with viral illnesses such as influenza or varicella due to the risk of Reye’s syndrome, a rare but potentially fatal condition affecting the liver and brain.
Indomethacin [Indocin]
Indomethacin is a potent NSAID with significant gastrointestinal and central nervous system side effects. It is not recommended for routine fever management in children and is reserved for specific conditions under close medical supervision.
A client receives an IV dose of lorazepam for acute anxiety. The nurse prepares to monitor the client closely for potential adverse effects. What is the priority assessment after giving IV lorazepam?
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Respiratory rate
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Blood glucose
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Urine output
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Bowel sounds
Explanation
Correct Answer:
Respiratory rate
Explanation:
Lorazepam is a benzodiazepine that can cause CNS depression, leading to respiratory depression, especially when given IV. Monitoring respiratory rate and depth is the top priority to detect early signs of hypoventilation or apnea, which can be life-threatening.
Why Other Options Are Incorrect:
Blood glucose
Lorazepam does not significantly affect blood glucose; routine monitoring is unnecessary unless the client has diabetes.
Urine output
Although overall hydration status is important, lorazepam does not directly cause acute changes in urine output.
Bowel sounds
Lorazepam is not known to impair gastrointestinal motility to the point where bowel sound assessment is a priority immediately after administration.
A 68-year-old client is prescribed an oral antibiotic for a complicated urinary tract infection. The nurse educates the client on potential adverse effects and stresses the importance of reporting sudden tendon pain or swelling, as the medication may increase the risk of tendon rupture in older adults. Which drug is associated with this risk?
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Ciprofloxacin
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Azithromycin
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Amoxicillin
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Doxycycline
Explanation
Correct Answer:
Ciprofloxacin
Explanation:
Ciprofloxacin is a fluoroquinolone antibiotic linked to tendinitis and tendon rupture, particularly of the Achilles tendon. The risk is higher in adults over 60, those on corticosteroids, and individuals with kidney disease. The drug interferes with collagen synthesis and tendon repair, making tendons more vulnerable to injury. Symptoms such as tendon pain, swelling, or movement difficulty should prompt immediate discontinuation and medical evaluation to prevent permanent damage.
Why Other Options Are Incorrect:
Azithromycin
A macrolide antibiotic primarily used for respiratory and skin infections. It is not associated with tendon injury; its main risks include gastrointestinal upset, QT prolongation, and rare hepatotoxicity.
Amoxicillin
A penicillin-class antibiotic with no known link to tendon damage. Side effects are generally limited to allergic reactions, gastrointestinal upset, and possible C. difficile–associated diarrhea.
Doxycycline
A tetracycline antibiotic used for acne, respiratory infections, and tick-borne diseases. It does not cause tendon injury. Common side effects include photosensitivity, gastrointestinal upset, and tooth discoloration in children if given during tooth development.
A 42-year-old client is brought to the emergency department after being found unresponsive at home. Paramedics report the presence of multiple empty benzodiazepine pill bottles at the scene. The healthcare provider suspects benzodiazepine overdose and prepares to administer the appropriate reversal agent. Which drug should be used in this situation?
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Flumazenil
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Naloxone
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Atropine
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Protamine sulfate
Explanation
Correct Answer:
Flumazenil
Explanation:
Flumazenil is a benzodiazepine receptor antagonist used to reverse the sedative effects of benzodiazepine overdose. It works by competitively inhibiting the binding of benzodiazepines to the GABA-A receptor, quickly restoring consciousness and improving respiratory drive. However, it must be used cautiously in chronic benzodiazepine users, as it can precipitate acute withdrawal and seizures. Continuous monitoring of airway, breathing, and vital signs is essential after administration because the duration of flumazenil’s effect may be shorter than that of the ingested benzodiazepine, requiring repeated dosing or observation.
Why Other Options Are Incorrect:
Naloxone
Reverses opioid overdose by antagonizing opioid receptors, not benzodiazepines. It has no effect on benzodiazepine-induced sedation or respiratory depression.
Atropine
An anticholinergic drug used to treat bradycardia or organophosphate poisoning. It does not reverse benzodiazepine effects.
Protamine sulfate
A reversal agent for heparin anticoagulation, used to neutralize bleeding risk. It has no action on benzodiazepine receptors or sedation.
A 58-year-old client with hyperlipidemia has been taking atorvastatin for 4 months. The provider orders routine laboratory monitoring to check for potential adverse effects.
Which lab should be monitored for a client on atorvastatin?
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ALT and AST
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BUN and creatinine
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Hemoglobin and hematocrit
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PT and INR
Explanation
Correct Answer:
ALT and AST
Explanation:
Atorvastatin, like other statins, can cause hepatotoxicity. Liver enzymes—alanine aminotransferase (ALT) and aspartate aminotransferase (AST)—should be measured before starting therapy and periodically thereafter. Persistent elevations may indicate liver injury and require discontinuation or dose adjustment. The nurse should also monitor for symptoms of hepatotoxicity such as jaundice, dark urine, and fatigue.
Why Other Options Are Incorrect:
BUN and creatinine
These measure kidney function, which is not the primary concern with atorvastatin unless there is concern for rhabdomyolysis with secondary renal injury.
Hemoglobin and hematocrit
These assess anemia; not routinely monitored for statin therapy.
PT and INR
These measure coagulation, primarily used for monitoring warfarin—not atorvastatin.
An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?
Reference Range:
Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]
-
Instruct the client that since the hematocrit remains low, the daily injections are still necessary.
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Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition.
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Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.
Explanation
Correct Answer C. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.
Explanation:
Pernicious anemia requires lifelong vitamin B12 replacement, often via intramuscular cyanocobalamin. While the client’s hematocrit is now within normal range, treatment must continue to prevent relapse. Teaching self-administration can reduce discomfort, improve adherence, and give the client more control over their care. This approach addresses the client’s concern about pain while supporting ongoing therapy for a chronic condition.
Why Other Options Are Wrong:
A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary.
This statement is inaccurate because the hematocrit is normal at 43%, not low. It also does not address the client’s concern about the pain associated with daily injections.
B. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition.
While factually correct, this option fails to address the client’s expressed problem—pain from injections. It provides information but no strategy to improve comfort or increase the client’s participation in care.
A nurse is reviewing medication orders for several clients. Propranolol has been prescribed. The nurse must determine which client has a condition that makes propranolol potentially dangerous. Which client should avoid propranolol
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Client with migraines
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Client with asthma
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Client with essential tremor
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Client with hyperthyroidism
Explanation
Correct Answer B. Client with asthma
Explanation:
Propranolol blocks both beta-1 (cardiac) and beta-2 (pulmonary) receptors. Blocking beta-2 receptors in the lungs can cause bronchoconstriction, which may trigger or worsen bronchospasms in clients with asthma or other reactive airway diseases. Therefore, nonselective beta-blockers like propranolol should be avoided in these clients.
Why Other Options Are Incorrect:
A. Client with migraines
Propranolol is often prescribed for migraine prevention and is safe in clients without contraindications.
C. Client with essential tremor
Propranolol is actually a first-line treatment for essential tremor.
D. Client with hyperthyroidism
Propranolol can be used to control hyperthyroidism symptoms such as tachycardia, tremor, and anxiety until other treatments take effect.
A client receiving digoxin for heart failure reports nausea and visual disturbances described as “yellow halos.” Which laboratory value should the nurse review first?
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Serum digoxin level
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Serum potassium
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BNP
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WBC count
Explanation
Correct Answer:
Serum digoxin level
Explanation:
Digoxin toxicity can manifest as gastrointestinal symptoms (nausea, vomiting), visual disturbances, and arrhythmias. The therapeutic range is typically 0.5–2.0 ng/mL. Levels above this increase the risk for serious complications, especially in clients with hypokalemia. Monitoring serum levels confirms toxicity and guides treatment, which may include withholding the drug and administering digoxin-specific antibody fragments.
Why Other Options Are Incorrect:
Serum potassium
Important for digoxin safety but not the direct indicator of current toxicity level.
BNP
Reflects heart failure severity, not drug toxicity.
WBC count
Monitors infection risk, unrelated to digoxin levels.
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