Hesi Rn 301 pharmacology Exam
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Free Hesi Rn 301 pharmacology Exam Questions
Which assessment finding warrants further intervention?
Reference Range:
White Blood Cell [5000 to 10,000/mm³ (5 to 10 x 10⁹/L)]
Blood Urea Nitrogen [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]
Creatinine [0.5 to 1.1 mg/dL (44 to 97 µmol/L)]
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Serum creatinine level of 1.6 mg/dL (141 µmol), a blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L)
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Reports a sore mouth and three episodes of diarrhea that began this morning
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White blood count of 9,000/mm³ (9 x 10⁹/L) and an oral temperature of 98.2° F (36.7° C) two hours ago
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Urinary output of 400 ml of clear, amber-colored urine in the past eight hours
Explanation
Correct Answer A. Serum creatinine level of 1.6 mg/dL (141 µmol), a blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L)
Explanation:
A creatinine level of 1.6 mg/dL exceeds the normal range and indicates impaired kidney function. Even though the BUN is at the upper limit of normal, the elevated creatinine suggests possible acute or chronic renal impairment, which requires further evaluation and intervention to prevent worsening kidney injury. Monitoring kidney function is essential, especially in patients at risk for nephrotoxic effects or fluid/electrolyte imbalances.
Why Other Options Are Wrong:
B. Reports a sore mouth and three episodes of diarrhea that began this morning.
While these symptoms warrant assessment and possible supportive care, they are not as urgent as the abnormal renal function result, which may indicate significant organ compromise.
C. White blood count of 9,000/mm³ (9 x 10⁹/L) and an oral temperature of 98.2° F (36.7° C) two hours ago.
Both WBC and temperature are within normal limits, so no immediate intervention is required for infection or inflammatory response in this case.
D. Urinary output of 400 ml of clear, amber-colored urine in the past eight hours.
This urinary output is within acceptable limits for an adult (at least 0.5 mL/kg/hr), so it does not indicate acute renal failure by itself. The clear, amber color suggests normal hydration status.
The nurse will teach patients taking rifampin and INH prophylactically secondary to tuberculosis exposure that
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these drugs will only need to be taken for 7 to 10 days.
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INH may decrease serum glucose in susceptible people.
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oral contraceptives become ineffective when given with rifampin.
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tanning beds may be used to counteract the pale skin tone caused by these medications
Explanation
Correct Answer C. oral contraceptives become ineffective when given with rifampin
Explanation:
C. oral contraceptives become ineffective when given with rifampin
Rifampin is a potent hepatic enzyme inducer that accelerates the metabolism of estrogen and progestin in oral contraceptives, reducing their effectiveness. Patients should be counseled to use an alternative, non-hormonal form of contraception during treatment.
Why the other options are incorrect:
A. these drugs will only need to be taken for 7 to 10 days
Treatment or prophylaxis for TB typically lasts for several months, not just 7–10 days. INH prophylaxis may last 6–9 months.
B. INH may decrease serum glucose in susceptible people
INH can affect glucose metabolism, but the more common risk is increasing blood glucose, not decreasing it, especially in patients with diabetes.
D. tanning beds may be used to counteract the pale skin tone caused by these medications
These drugs do not cause skin paleness. Rifampin can cause orange-red discoloration of body fluids, and tanning beds are not advised due to skin cancer risks.
A nurse is explaining to nursing students why a cephalosporin is used in conjunction with an aminoglycoside for a patient with an infection. Which statement by a student indicates understanding of the teaching
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Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls.
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Cephalosporins prevent neuromuscular blockade associated with aminoglycosides
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Cephalosporins prolong the postantibiotic effects of the aminoglycosides so doses can be decreased.
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Cephalosporins reduce bacterial resistance to aminoglycosides.
Explanation
Correct Answer A. Cephalosporins enhance the actions of aminoglycosides by weakening bacterial cell walls.
Explanation:
Cephalosporins disrupt bacterial cell wall synthesis, weakening the structural integrity of bacteria. This allows aminoglycosides to enter the bacteria more readily and reach their target site in the ribosomes, where they inhibit protein synthesis. This synergy increases bactericidal activity against certain organisms, particularly in serious gram-negative infections, making the combination more effective than either drug alone.
Why Other Options Are Incorrect:
B. Cephalosporins prevent neuromuscular blockade associated with aminoglycosides.
Cephalosporins have no role in preventing the rare neuromuscular blockade caused by aminoglycosides. Neuromuscular blockade is managed with calcium salts or reversal agents, not cephalosporins.
C. Cephalosporins prolong the postantibiotic effects of the aminoglycosides so doses can be decreased.
Cephalosporins do not influence aminoglycoside postantibiotic effect duration. Dose adjustments are based on renal function and serum levels, not cephalosporin co-administration.
D. Cephalosporins reduce bacterial resistance to aminoglycosides.
While combination therapy can reduce resistance development in some cases, the primary reason for combining cephalosporins with aminoglycosides is synergy through cell wall weakening, not direct resistance prevention.
Digoxin and furosemide were prescribed for a client with chronic heart failure, and the home health nurse is evaluating the client's self-care knowledge of these drugs. Which statement indicates that the client has a good understanding about the use of these drugs
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I need to notify my healthcare provider if I lose my appetite or get nauseated.
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I should take my furosemide only if I have shortness of breath or swelling in my feet.
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I need to check my blood pressure three times a day.
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If I lose more than one pound in a week, I should hold my next dose of furosemide.
Explanation
Correct Answer A. I need to notify my healthcare provider if I lose my appetite or get nauseated.
Explanation:
Loss of appetite and nausea are early signs of digoxin toxicity, which can be life-threatening if untreated. Promptly notifying the healthcare provider ensures that digoxin levels can be evaluated and dosage adjustments made if necessary. Early intervention helps prevent severe toxicity and complications such as dangerous cardiac arrhythmias.
Why Other Options Are Wrong:
B. I should take my furosemide only if I have shortness of breath or swelling in my feet.
Furosemide should be taken as prescribed, not based solely on symptom presence. Skipping doses can lead to fluid retention and worsening heart failure.
C. I need to check my blood pressure three times a day.
While monitoring blood pressure is important, it is not the primary focus of patient education for digoxin and furosemide therapy. Daily weight monitoring and symptom reporting are typically more critical.
D. If I lose more than one pound in a week, I should hold my next dose of furosemide.
Mild weight loss in heart failure is often a sign of fluid removal and is expected with diuretic therapy. Holding a dose without provider guidance could lead to fluid overload and worsening symptoms.
A 42-year-old client with newly diagnosed hypothyroidism is prescribed levothyroxine. During a follow-up appointment, the nurse reviews key points about how to take the medication to ensure optimal absorption and therapeutic effect. Which teaching point is essential for the nurse to include?
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Take with breakfast for best absorption
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Take at bedtime with calcium
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Take each morning on an empty stomach, separate from other meds
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Skip a dose if heart rate is above 60/min
Explanation
Correct Answer:
Take each morning on an empty stomach, separate from other meds
Explanation:
Levothyroxine absorption is best when taken in the morning on an empty stomach, at least 30–60 minutes before breakfast. It should also be taken separately (by at least 4 hours) from calcium, iron, and certain other medications that can interfere with its absorption. Consistency in timing and administration is critical for stable thyroid hormone levels.
Why Other Options Are Incorrect:
Take with breakfast for best absorption
Food decreases levothyroxine absorption, so this would reduce its effectiveness.
Take at bedtime with calcium
Calcium significantly interferes with levothyroxine absorption; they should be separated by at least 4 hours.
Skip a dose if heart rate is above 60/min
A heart rate above 60/min is normal; the drug should not be skipped unless signs of overtreatment (tachycardia, palpitations) or toxicity occur and the provider is consulted.
A 68-year-old client with chronic obstructive pulmonary disease (COPD) is admitted for an acute exacerbation. The healthcare provider prescribes a short course of prednisone to reduce airway inflammation. During discharge teaching, the nurse reviews important safety instructions about corticosteroid use. Which instruction is critical for the nurse to give this client?
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Stop abruptly when you feel better
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Report signs of infection promptly
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Avoid all dairy products
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Double your dose if you miss one
Explanation
Correct Answer:
Report signs of infection promptly
Explanation:
Prednisone is an immunosuppressant that can mask classic infection symptoms while increasing the risk of new or worsening infections. Clients must be instructed to monitor for and promptly report fever, sore throat, cough, or other signs of illness. Early detection is essential because infections can progress rapidly in immunosuppressed individuals.
Why Other Options Are Incorrect:
Stop abruptly when you feel better
Corticosteroids should not be stopped suddenly after prolonged use due to the risk of adrenal insufficiency; the dose should be tapered as prescribed.
Avoid all dairy products
No need to avoid dairy; in fact, adequate calcium and vitamin D intake is encouraged to counteract bone loss from corticosteroids.
Double your dose if you miss one
Doubling the dose can cause unnecessary side effects; instead, take the missed dose as soon as remembered unless it’s close to the next scheduled dose.
The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]
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Acetaminophen is a useful drug for the treatment of inflammation, such as rheumatoid arthritis.
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The most common side effect of treatment with the drug is kidney failure.
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Notify your healthcare provider if you notice that your skin or eyes are turning yellow.
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Do not routinely use acetaminophen to prevent vaccine-associated fever and pain.
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Use of this drug can prevent heart attack and stroke
Explanation
Correct Answers:
C. Notify your healthcare provider if you notice that your skin or eyes are turning yellow.
D. Do not routinely use acetaminophen to prevent vaccine-associated fever and pain.
Explanation:
Acetaminophen is primarily an analgesic and antipyretic, not an anti-inflammatory agent. It is safe at therapeutic doses but can cause severe hepatotoxicity with overdose or prolonged high-dose use. Yellowing of the skin or eyes (jaundice) is a sign of possible liver injury and must be reported immediately. It should not be routinely used to prevent post-vaccine fever and pain, as this may blunt the immune response.
Why Other Options Are Incorrect:
A. Acetaminophen is a useful drug for the treatment of inflammation, such as rheumatoid arthritis.
Incorrect because acetaminophen has minimal anti-inflammatory properties; NSAIDs are preferred for inflammatory conditions like rheumatoid arthritis.
B. The most common side effect of treatment with the drug is kidney failure.
Kidney failure can occur in severe overdose cases, but the primary organ affected by acetaminophen toxicity is the liver, not the kidneys.
E. Use of this drug can prevent heart attack and stroke.
This is false; aspirin, not acetaminophen, has antiplatelet properties used in prevention of heart attack and stroke. Acetaminophen does not provide cardiovascular protection
A male client with dementia is admitted to the emergency department (ED) because he accidentally self-administered several doses of diltiazem. Which intervention is most important for the nurse to implement
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Frequently assess the patient's blood pressure.
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Observe the client for signs of gastric irritation.
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Monitor electrocardiogram (ECG) continuously.
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Assess for changes in level of consciousness.
Explanation
Correct Answer C. Monitor electrocardiogram (ECG) continuously.
Explanation:
Diltiazem is a calcium channel blocker that can cause serious cardiac effects in overdose, including bradycardia, AV block, and other conduction abnormalities. Continuous ECG monitoring is the priority because it allows for rapid detection and intervention if life-threatening arrhythmias occur. Early recognition of cardiac conduction changes is essential to prevent cardiac arrest.
Why Other Options Are Wrong:
A. Frequently assess the patient's blood pressure.
While blood pressure monitoring is important with calcium channel blocker use, ECG monitoring takes priority in overdose situations due to the immediate risk of severe arrhythmias that can be fatal if not promptly recognized.
B. Observe the client for signs of gastric irritation.
Gastric irritation is not a primary concern with diltiazem toxicity. The main risks are cardiovascular in nature, making gastrointestinal observation a lower priority in this context.
D. Assess for changes in level of consciousness.
Although changes in mental status can occur with hypotension or hypoperfusion, they are secondary to the primary cardiac risks. Continuous ECG monitoring addresses the root cause by detecting early cardiac disturbances that could lead to altered consciousness.
The nurse is administering SUBQ enoxaparin to a client following knee replacement surgery to prevent a deep vein thrombosis. Which laboratory result requires immediate action by the nurse
Reference Range:
Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]
Platelets [150,000 to 400,000/mm³ (150 to 400 x 10⁹/L)]
Creatinine [0.5 to 1.1 mg/dL (44 to 97 µmol/L)]
Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]
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Platelet count of 100,000/mm³ (100 x 10⁹/L)
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Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L)
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Hematocrit 45% (0.45 volume fraction)
Explanation
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.
A nurse is preparing to administer IV potassium chloride to a client with hypokalemia. Which action is appropriate?
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Use an infusion pump for administration
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Administer undiluted by slow IV push
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Mix with dextrose solution to prevent irritation
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Give via IM injection for faster absorption
Explanation
Correct Answer:
Use an infusion pump for administration
Explanation:
IV potassium chloride (KCl) must be carefully controlled because rapid or accidental bolus administration can cause lethal arrhythmias. Using an infusion pump ensures precise rate control and dose accuracy. KCl should always be diluted (commonly 10 mEq in 100 mL normal saline for peripheral lines) and infused slowly. Typical maximum rates: peripheral line ≤10 mEq/hr; central line (with continuous ECG monitoring) may allow up to 20 mEq/hr per institutional policy. Additional safety measures include confirming adequate urine output (>30 mL/hr), verifying a recent serum potassium and magnesium (low Mg impairs K correction), using a large vein to reduce phlebitis, and continuous cardiac monitoring when higher rates or central infusions are used. Avoid mixing with dextrose-containing solutions because dextrose can stimulate insulin release and shift potassium intracellularly, worsening hypokalemia. Never give KCl IV push, IM, or subcutaneous due to risk of tissue necrosis and fatal dysrhythmias.
Why Other Options Are Incorrect:
Administer undiluted by slow IV push
Never appropriate. Undiluted or IV push KCl can precipitate immediate, fatal ventricular arrhythmias. KCl must be diluted and infused via pump at controlled rates.
Mix with dextrose solution to prevent irritation
Dextrose can trigger insulin release, driving potassium into cells and further lowering serum potassium. Use normal saline (not dextrose) unless a specific order states otherwise.
Give via IM injection for faster absorption
KCl is caustic to tissues; IM or subcutaneous administration can cause severe pain, tissue necrosis, and compartment injury. Only administer IV (diluted, via pump) or orally in appropriate formulations.
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