HESI RN 31I Pharmacology Exam

The correct answer is A: Eliminate use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Explanation:

Lithium carbonate is a mood stabilizer commonly prescribed for bipolar disorder to help control the highs (mania) and lows (depression). However, it has a narrow therapeutic range, meaning that its levels in the blood need to be carefully monitored to avoid toxicity.

NSAIDs can interact with lithium and increase lithium levels, which can lead to lithium toxicity. This happens because NSAIDs reduce the renal clearance of lithium, leading to an accumulation of the drug in the body. Symptoms of lithium toxicity include nausea, vomiting, diarrhea, tremors, confusion, and even more severe effects such as seizures or kidney damage.

Therefore, clients taking lithium should be instructed to avoid NSAIDs unless specifically prescribed by a healthcare provider who is aware of the client’s lithium treatment.

Why the other options are incorrect:

B. Notify healthcare provider prior to dental procedures:

While it is generally important to inform healthcare providers about medications before any procedure, this instruction is more specific to medications that can affect bleeding (e.g., anticoagulants) or those that interact with anesthesia. Lithium does not typically require this kind of precaution before dental procedures unless other factors, such as sedation or drug interactions, are involved.

C. Avoid consuming all foods that contain iodine:

This is not necessary for clients taking lithium. While iodine and thyroid function are important to monitor in clients taking lithium (since lithium can affect thyroid function), avoiding iodine-rich foods is not a specific requirement. In fact, iodine is a necessary nutrient, and clients should not unnecessarily restrict it. Instead, monitoring thyroid function through regular blood tests is more important.

D. Monitor blood glucose levels daily:

Lithium does not typically affect blood glucose levels in a direct way. This instruction would be more relevant for clients on medications such as steroids or antipsychotics, which can affect glucose metabolism. Clients taking lithium do not need to monitor blood glucose levels unless they have other conditions (like diabetes) that warrant it.

Correct Answers:

A – Assign the client to a single room,

C – Give concise and firm directions for hygiene and dressing,

D – Invite for a walk when client's energy is high.

Explanation:

A – Assign the client to a single room:

Clients in the manic phase of bipolar disorder can be intrusive, overly talkative, hypersexual, and distractible. Assigning the client to a single room helps reduce stimulation and minimize conflicts with others. It also decreases environmental triggers that could escalate manic behavior, supports better rest, and protects other clients from inappropriate comments or actions.|

C – Give concise and firm directions for hygiene and dressing:

During mania, concentration and decision-making are impaired, so it’s important to give simple, structured commands. Clear and brief instructions help guide the client through tasks they might otherwise neglect or be unable to complete due to distractibility or grandiosity.

D – Invite for a walk when client's energy is high:

Clients in a manic state often have excessive energy and restlessness. Channeling this energy into noncompetitive, structured physical activity (like walking) helps reduce agitation and promote safe expression of energy. It also aids in improving focus and rest.

Why Other Options Are Incorrect:

B – Provide television programs with suspense to keep attention engaged:

Suspenseful or stimulating content can increase agitation, paranoia, or disorganized thinking in a manic client. It’s better to provide calming, low-stimulation activities that support grounding and rest.

E – Engage the client in competitive activities:

Competitive activities can exacerbate manic symptoms, increase irritability, and trigger aggression or interpersonal conflict. Structured, low-stimulation, and non-competitive tasks are more appropriate to maintain emotional stability.

Correct Answer A: Do you need a drink in the morning to get rid of a hangover?

Explanation:

This question addresses a physiological symptom of alcohol dependence — the presence of withdrawal symptoms and the need for alcohol to relieve them. Using alcohol first thing in the morning to avoid or relieve hangover symptoms is a strong indicator of physical dependence. It suggests the development of tolerance and withdrawal, both of which are hallmark features of alcohol use disorder. This behavior is not just about problematic drinking patterns but points directly to the body’s reliance on alcohol to function normally, making it the most clinically significant of the four CAGE questions.

Why Other Options Are Incorrect:

B: Have you ever felt guilty about drinking?

While this question reflects emotional and psychological awareness of a problem, guilt alone is a subjective emotion and does not confirm dependency. Many people may feel guilty after drinking excessively on a single occasion, without meeting criteria for alcoholism. It helps identify problematic behavior, but it’s not the strongest indicator of physiological addiction.

C: Have you ever felt you needed to cut down on your drinking?

This question is common in early recognition of problematic drinking. It shows insight into the behavior but may be present in social drinkers who don't have dependence. It signals concern but does not confirm the presence of addiction or physical need.

D: Have people annoyed you by criticizing your drinking?

This question reflects the impact of drinking on social relationships and defensiveness about alcohol use. While it supports the possibility of misuse, it is external and subjective, relying on the client’s perception of others’ opinions. It does not confirm dependence or compulsion to drink.

Correct Answer C: Witness to an accident.

Explanation:

Witness to an Accident and Trauma-Related Nightmares:

Nightmares can be a hallmark symptom of post-traumatic stress disorder (PTSD). If the client has witnessed a traumatic event, especially a violent or life-threatening incident, it can trigger recurrent distressing dreams or nightmares related to the trauma. In this case, the client’s history of being a witness to an accident suggests the possibility of a trauma-related nightmare. The brain may repeatedly process the traumatic event during sleep, often leading to intense, vivid nightmares that reflect the stress and emotional impact of what was witnessed.

Why Other Options Are Incorrect:

A: Family history of dementia

While a family history of dementia may raise concerns about cognitive decline and possible sleep disturbances later in life, new-onset violent nightmares are more directly associated with trauma exposure rather than genetic predisposition to dementia. Therefore, trauma history is a more significant factor in this case.

B: Inadequate diversional activity

Lack of diversional activity or stimulation can lead to boredom or restlessness, but it would not directly explain the violent nightmares. Nightmares are typically linked to emotional distress, and diversional activities would have less of an impact on this.

D: Alcohol use

Although alcohol use can contribute to sleep disturbances and may exacerbate nightmares, witnessing an accident is more closely tied to the development of trauma-induced nightmares. If the client’s nightmares began after a traumatic event such as an accident, it is important to explore that event further as it might be the root cause of the current distress.

Correct Answer A: Measure and document size, shape, and color of the bruised areas.

Explanation:

Objective Documentation as the First Priority:

When elder abuse is suspected, the nurse's first step is to collect and document objective data. Accurately measuring and describing the bruises — including size, shape, color, and location — provides essential evidence. This documentation establishes a clear, unbiased clinical record that may later support legal or protective interventions. Objective findings carry more weight than subjective interpretations and help differentiate between accidental injuries and potential abuse.

Legality and Professional Responsibility:

Nurses are mandated reporters, meaning they are legally required to report suspected abuse. But before a formal report can be made, detailed, factual evidence must be collected. Describing the bruises clearly and precisely in the medical record ensures that any further evaluation, whether medical or legal, starts from a credible foundation. Jumping to conclusions or asking leading questions without proper assessment could compromise the investigation or violate the client’s rights.

Why Other Options Are Incorrect:

B: Report family conversations and anger towards the client when visiting

While it's important to be aware of and document concerning behavior from visitors, this option is subjective and secondary to physical evidence. The nurse should focus on what's directly observable before interpreting behavior or intent. Documentation of conversations may follow, but it is not the first or most critical action.

C: Ask the client specific questions about someone causing the bruising

Although it's important to eventually speak with the client, this should come after an initial objective assessment. Also, the client may be fearful or unable to speak openly in certain situations. Asking too directly or too soon may cause withdrawal or anxiety without gathering essential physical evidence.

D: Question the family members and caregiver how the bruising occurred

This may become necessary, but should not be the nurse’s first response. Family members or caregivers might not provide truthful answers, especially if abuse is occurring. Confrontation before collecting physical evidence could alert them and jeopardize the client's safety or the integrity of any investigation.

The correct answer is B: Rapid weight gain.

Explanation of the correct answer:

B. Rapid weight gain.

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat depression. One of the potential side effects of SSRIs is weight gain, and rapid weight gain can sometimes signal serious side effects such as serotonin syndrome or a more severe adverse reaction to the medication. It could also be a sign of fluid retention, which may indicate heart failure or other underlying issues that need immediate medical attention. Therefore, rapid weight gain should be reported to the healthcare provider as it may signal an adverse or serious condition.

Why the other options are incorrect:

A. Gastric irritation.

Gastric irritation, including symptoms like nausea or mild stomach upset, is a common and mild side effect of SSRIs like sertraline, especially during the early stages of treatment. While it can be uncomfortable, it is generally not considered a serious adverse effect that requires immediate reporting unless it persists or worsens.

C. Dry mucosal membranes.

Dry mouth or dry mucosal membranes are also a common side effect of SSRIs and are typically mild and temporary. While uncomfortable, it is not usually a sign of a serious condition and does not need to be urgently reported unless it leads to severe discomfort or difficulty swallowing, which could indicate dehydration or other issues that need attention.

D. Photosensitivity.

Photosensitivity, or increased sensitivity to sunlight, is a possible side effect of some medications, including certain SSRIs. However, it is typically not a common or serious reaction to sertraline and does not usually require immediate reporting unless it leads to severe sunburns or other significant reactions.

The correct answer is A: Somatization.

Explanation of the correct answer:

A. Somatization

Somatization refers to the expression of psychological distress through physical symptoms. When someone experiences intense emotional or psychological stress—such as the grief from losing a spouse—they may develop bodily symptoms like numbness, tingling, or pain that do not have an identifiable physical cause. This is a common response during acute grief or emotional trauma, especially when the individual is unable or not ready to process the emotional impact directly. In this case, the client’s recent loss and sudden onset of physical symptoms strongly suggest somatization.

Why the other options are incorrect:

B. Disorganization

Disorganization is one of the phases of grief (according to some models), where a person may feel hopeless, depressed, or lost. However, it refers to emotional and behavioral disarray, not physical symptoms like numbness or tingling.

C. Reexperience

Reexperience is a term typically associated with post-traumatic stress disorder (PTSD). It refers to reliving the traumatic event through flashbacks, nightmares, or intrusive thoughts. It does not involve physical symptoms like numbness or tingling.

D. Preoccupation

Preoccupation with the deceased is a normal grief response, where the individual persistently thinks about or longs for the person who died. While it can be mentally and emotionally intense, it does not typically manifest as neurological or physical symptoms.

The correct answer is D: Guide through deep breathing and grounding techniques.

Explanation of the correct answer:

D. Guide through deep breathing and grounding techniques

When a client with PTSD is experiencing a dissociative episode, the priority is to help them regain orientation to the present and feel safe in their current environment. Grounding techniques and deep breathing are first-line interventions that help the client reconnect with their body and surroundings, reduce anxiety, and de-escalate the episode. This is a non-invasive, immediate, and therapeutic response to stabilize the situation.

Why the other options are incorrect:

A. Encourage exploration of the feelings being experienced

This may be helpful later, once the client is stable and grounded, but during an acute dissociative episode, the client is not in a psychological state to process or reflect. Pushing for emotional exploration at this moment can increase anxiety or worsen the episode.

B. Notify the nurse supervisor what is occurring on the unit

While it's important to keep the team informed, this is not the immediate priority when the client is actively dissociating. Intervening therapeutically with the client takes precedence over administrative communication in this moment.

C. Look for objects that can be used in a dangerous manner

Safety is always a priority, but unless the client is exhibiting aggressive or self-harming behavior, this step is secondary to grounding them. If the client begins showing signs of being a danger to self or others, then environmental safety becomes more urgent.

Correct Answer C: Begin with questions that are less sensitive in nature.

Explanation:

Building Trust and Rapport Through a Gradual Approach:

When assessing a client for suicidal ideation, establishing trust and rapport is critical. Beginning with less sensitive questions allows the nurse to create a safe and non-threatening environment, which encourages the client to open up more comfortably. As the conversation progresses and the client becomes more at ease, the nurse can gradually transition into more emotionally charged or personal topics, such as suicidal thoughts. This strategy supports therapeutic communication by respecting the client’s emotional readiness and protecting their psychological safety.

Psychological Safety and Effective Communication:

Asking directly about suicide is important, but it should be done after building rapport to reduce the risk of the client shutting down or becoming defensive. A stepwise approach improves the accuracy and depth of the client’s responses, allowing the nurse to assess risk more thoroughly. Trust is particularly important with suicidal clients, who may already feel isolated, judged, or misunderstood.

Why Other Options Are Incorrect:

A: Share personal values to put the client at ease

Sharing personal values during an assessment is inappropriate and non-therapeutic. It shifts the focus away from the client and can lead to bias or judgment. The nurse should maintain professional boundaries and use active listening rather than self-disclosure.

B: Get the most difficult questions over with first

Jumping into difficult questions—such as directly asking about suicide—without building rapport may feel abrupt or intrusive to the client. This can increase resistance, cause emotional shutdown, and limit the client’s willingness to share openly. A sudden, intense approach may escalate distress.

D: Ask questions in a vague, non-specific format

Vague or indirect questions can lead to misinterpretation or denial, especially when discussing serious topics like suicide. For example, asking, “You’re not thinking of doing anything bad, are you?” can confuse the client or make them feel judged. Suicidal ideation should be explored using clear and direct language—after rapport is established.