Hesi RN Nursing Exam
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Free Hesi RN Nursing Exam Questions
1. Before administering the initial dose of sumatriptan succinate to a client with a migraine headache, it is most important to determine if the client's history includes which problem?
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Seasonal allergic rhinitis.
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Coronary artery disease.
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Type 2 diabetes mellitus.
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Irritable bowel syndrome.
Explanation
Explanation
Correct Answer: (B) Coronary artery disease
Sumatriptan is a serotonin receptor agonist (triptan) that works by causing vasoconstriction of cranial blood vessels to relieve migraines. Because of its vasoconstrictive mechanism, it is contraindicated in clients with coronary artery disease, as it can precipitate myocardial ischemia, angina, or even a myocardial infarction. Assessing for this history before the first dose is a critical safety priority.
Why the other options are incorrect:
A. Seasonal allergic rhinitis has no known interaction with sumatriptan's vasoconstrictive mechanism and does not present a contraindication or safety concern prior to administration.
C. Type 2 diabetes mellitus is not a contraindication to sumatriptan. While clients with diabetes may have increased cardiovascular risk overall, the diagnosis alone does not preclude the use of this medication.
D. Irritable bowel syndrome does not affect vascular function and has no known interaction with sumatriptan, making it irrelevant to the pre-administration safety assessment.
Correct Answer: (B) Coronary artery disease
Sumatriptan is a serotonin receptor agonist (triptan) that works by causing vasoconstriction of cranial blood vessels to relieve migraines. Because of its vasoconstrictive mechanism, it is contraindicated in clients with coronary artery disease, as it can precipitate myocardial ischemia, angina, or even a myocardial infarction. Assessing for this history before the first dose is a critical safety priority.
Why the other options are incorrect:
A. Seasonal allergic rhinitis has no known interaction with sumatriptan's vasoconstrictive mechanism and does not present a contraindication or safety concern prior to administration.
C. Type 2 diabetes mellitus is not a contraindication to sumatriptan. While clients with diabetes may have increased cardiovascular risk overall, the diagnosis alone does not preclude the use of this medication.
D. Irritable bowel syndrome does not affect vascular function and has no known interaction with sumatriptan, making it irrelevant to the pre-administration safety assessment.
2. The nurse is caring for a client with hypertension, gastroesophageal reflux, and osteoarthritis. While performing a bedside assessment the nurse observes the client is alert and oriented, but is exhibiting signs of jaundice. The nurse should notify the healthcare provider about which scheduled medication?
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Prednisone.
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Captopril.
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Acetaminophen.
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Omeprazole.
Explanation
Explanation
Correct Answer: (C) Acetaminophen
Jaundice is a clinical sign of liver dysfunction, indicated by yellowing of the skin and sclera due to elevated bilirubin levels. Acetaminophen is hepatotoxic in excessive doses or in clients with compromised liver function, and its continued use in a jaundiced client poses a serious risk of worsening liver damage. The nurse must notify the provider so the medication can be reviewed, adjusted, or discontinued.
Why Other Options are Incorrect:
A. Prednisone — While prednisone has several side effects, it is not primarily associated with causing or worsening jaundice and is not the priority medication to flag in this scenario.
B. Captopril — Captopril is an ACE inhibitor used for hypertension. Although rare hepatic side effects exist, it is not the most clinically urgent concern when jaundice is present compared to acetaminophen.
D. Omeprazole — Omeprazole is a proton pump inhibitor used for gastroesophageal reflux and does not carry the same degree of hepatotoxic risk that warrants priority notification in the presence of jaundice.
Correct Answer: (C) Acetaminophen
Jaundice is a clinical sign of liver dysfunction, indicated by yellowing of the skin and sclera due to elevated bilirubin levels. Acetaminophen is hepatotoxic in excessive doses or in clients with compromised liver function, and its continued use in a jaundiced client poses a serious risk of worsening liver damage. The nurse must notify the provider so the medication can be reviewed, adjusted, or discontinued.
Why Other Options are Incorrect:
A. Prednisone — While prednisone has several side effects, it is not primarily associated with causing or worsening jaundice and is not the priority medication to flag in this scenario.
B. Captopril — Captopril is an ACE inhibitor used for hypertension. Although rare hepatic side effects exist, it is not the most clinically urgent concern when jaundice is present compared to acetaminophen.
D. Omeprazole — Omeprazole is a proton pump inhibitor used for gastroesophageal reflux and does not carry the same degree of hepatotoxic risk that warrants priority notification in the presence of jaundice.
3. A 38-year-old female was brought to the hospital following a workplace accident. She has a deep laceration to her left thigh and a fracture of the left tibia. Her wound was cleaned and dressed in the emergency department, and she was given 2 units of packed red blood cells. She received morphine 2 mg IV for pain during the procedure and cephalexin 1 gram IV as an antibiotic prophylaxis. She is being admitted for neurovascular checks and monitoring for bleeding. The client has a history of bipolar disorder, and she takes chlorpromazine 25 mg PO three times a day.
Nurses' Notes: The client is awake and alert. Temperature 98.4°F (37°C) orally, heart rate 79 beats/minute, respiratory rate 16 breaths/minute, blood pressure 122/56 mm Hg, pain 3 on a 0 to 10 pain scale. Her left pedal pulses are present and equal to the right pedal pulse. Capillary refill to the left foot is 2 seconds. Mild edema noted to the left foot. The client has a rhythmic protrusion and rolling of the tongue and involuntary movements of the face and shoulders.
Complete the diagram by selecting which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
Potential Conditions: A. Postural hypotension B. Opioid withdrawal C. Tardive dyskinesia D. Anaphylaxis
Actions to Take: A. Initiate fall precautions B. Hold the next dose of chlorpromazine C. Assess the client's medication history
Parameters to Monitor: A. Respiratory rate B. Pulse deficit C. Extrapyramidal symptoms D. Standing blood pressure
- Postural hypotension
- Opioid withdrawal
- Tardive dyskinesia
- Anaphylaxis
- Initiate fall precautions
- Hold the next dose of chlorpromazine
- Assess the client's medication history
- Respiratory rate
- Pulse deficit
- Extrapyramidal symptoms
- Standing blood pressure
Explanation
Explanation
Correct Answer:
Potential Condition: (C) Tardive dyskinesia
Actions to Take: (B) Hold the next dose of chlorpromazine and (C) Assess the client's medication history
Parameters to Monitor: (C) Extrapyramidal symptoms and (D) Standing blood pressure
Tardive dyskinesia is a movement disorder caused by prolonged use of dopamine-blocking agents such as antipsychotics, most notably first-generation agents like chlorpromazine. The hallmark signs are involuntary, repetitive movements of the face and body — in this case, the rhythmic protrusion and rolling of the tongue and involuntary movements of the face and shoulders are classic manifestations. Since chlorpromazine is the causative agent, holding the next dose is the immediate priority. Assessing the client's full medication history helps determine the duration of exposure and any other contributing agents. Monitoring for extrapyramidal symptoms tracks the progression or resolution of the movement disorder, while standing blood pressure is relevant because chlorpromazine also causes orthostatic hypotension, placing the client at fall risk.
Why Other Options Are Incorrect:
A. Postural hypotension involves a drop in blood pressure upon standing and presents with dizziness or lightheadedness, not involuntary facial and body movements. The client's blood pressure is stable and there is no report of dizziness.
B. Opioid withdrawal presents with symptoms such as agitation, diaphoresis, nausea, vomiting, tachycardia, and muscle aching. The client received morphine during the procedure but has no history of opioid dependence, making withdrawal highly unlikely in this context.
D. Anaphylaxis presents with urticaria, hypotension, bronchospasm, and angioedema following exposure to an allergen. The client's vital signs are stable and there are no signs of an allergic reaction, making this condition inconsistent with the clinical picture.
Initiating fall precautions alone without addressing the causative medication would be incomplete. Monitoring respiratory rate and pulse deficit are more relevant to opioid toxicity or cardiovascular compromise rather than tardive dyskinesia, making them less appropriate parameters in this scenario.
Correct Answer:
Potential Condition: (C) Tardive dyskinesia
Actions to Take: (B) Hold the next dose of chlorpromazine and (C) Assess the client's medication history
Parameters to Monitor: (C) Extrapyramidal symptoms and (D) Standing blood pressure
Tardive dyskinesia is a movement disorder caused by prolonged use of dopamine-blocking agents such as antipsychotics, most notably first-generation agents like chlorpromazine. The hallmark signs are involuntary, repetitive movements of the face and body — in this case, the rhythmic protrusion and rolling of the tongue and involuntary movements of the face and shoulders are classic manifestations. Since chlorpromazine is the causative agent, holding the next dose is the immediate priority. Assessing the client's full medication history helps determine the duration of exposure and any other contributing agents. Monitoring for extrapyramidal symptoms tracks the progression or resolution of the movement disorder, while standing blood pressure is relevant because chlorpromazine also causes orthostatic hypotension, placing the client at fall risk.
Why Other Options Are Incorrect:
A. Postural hypotension involves a drop in blood pressure upon standing and presents with dizziness or lightheadedness, not involuntary facial and body movements. The client's blood pressure is stable and there is no report of dizziness.
B. Opioid withdrawal presents with symptoms such as agitation, diaphoresis, nausea, vomiting, tachycardia, and muscle aching. The client received morphine during the procedure but has no history of opioid dependence, making withdrawal highly unlikely in this context.
D. Anaphylaxis presents with urticaria, hypotension, bronchospasm, and angioedema following exposure to an allergen. The client's vital signs are stable and there are no signs of an allergic reaction, making this condition inconsistent with the clinical picture.
Initiating fall precautions alone without addressing the causative medication would be incomplete. Monitoring respiratory rate and pulse deficit are more relevant to opioid toxicity or cardiovascular compromise rather than tardive dyskinesia, making them less appropriate parameters in this scenario.
4. During a home visit, the nurse assesses a client with Alzheimer's disease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is not sleeping well at night. Which action should the nurse take?
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Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed.
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Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's insomnia.
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Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.
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Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's safety.
Explanation
Explanation
Correct Answer: (C) Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.
Rivastigmine is a cholinesterase inhibitor used to slow cognitive decline in Alzheimer's disease. Insomnia is a well-documented, commonly occurring side effect that tends to resolve as the body adjusts to the medication. Since the client is already showing cognitive improvement, the appropriate nursing action is to educate the caregiver rather than alter or discontinue therapy.
Why the other options are incorrect:
A. Rivastigmine is not prescribed to promote sleep and advising the caregiver otherwise would provide inaccurate information. Its intended purpose is to improve cognitive function, and the caregiver's report of clearer thinking confirms it is working as expected.
B. Increasing the dosage is not an appropriate response to insomnia. Escalating the dose without clinical indication could intensify side effects and does not address the underlying concern, which is caregiver education.
D. Withholding a prescribed medication without a direct order from the healthcare provider is outside the nurse's independent scope of practice. Doing so could interrupt the client's cognitive improvement without any therapeutic justification.
Correct Answer: (C) Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.
Rivastigmine is a cholinesterase inhibitor used to slow cognitive decline in Alzheimer's disease. Insomnia is a well-documented, commonly occurring side effect that tends to resolve as the body adjusts to the medication. Since the client is already showing cognitive improvement, the appropriate nursing action is to educate the caregiver rather than alter or discontinue therapy.
Why the other options are incorrect:
A. Rivastigmine is not prescribed to promote sleep and advising the caregiver otherwise would provide inaccurate information. Its intended purpose is to improve cognitive function, and the caregiver's report of clearer thinking confirms it is working as expected.
B. Increasing the dosage is not an appropriate response to insomnia. Escalating the dose without clinical indication could intensify side effects and does not address the underlying concern, which is caregiver education.
D. Withholding a prescribed medication without a direct order from the healthcare provider is outside the nurse's independent scope of practice. Doing so could interrupt the client's cognitive improvement without any therapeutic justification.
5. Based on a client's serum digoxin level, the client is diagnosed with digoxin toxicity. Which action should the nurse expect to implement?
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Begin cardioversion to stabilize heart rhythm.
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Check acid-base and electrolyte values.
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Administer potassium to stabilize the heart rate.
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Give digoxin by another route to slow absorption.
Explanation
Explanation
Correct Answer: (B) Check acid-base and electrolyte values
Digoxin toxicity is closely associated with electrolyte imbalances, particularly hypokalemia, hypomagnesemia, and hypercalcemia, all of which potentiate digoxin's toxic effects on the heart. Checking acid-base and electrolyte values is the priority action because it identifies the underlying conditions contributing to toxicity and guides appropriate corrective treatment. This assessment directly informs all subsequent interventions.
Why the other options are incorrect:
A. Begin cardioversion to stabilize heart rhythm — Cardioversion is not the standard first-line intervention for digoxin toxicity and can actually be dangerous in this setting, potentially triggering life-threatening ventricular arrhythmias in a digitalis-toxic heart.
C. Administer potassium to stabilize the heart rate — While hypokalemia does worsen digoxin toxicity and potassium replacement may ultimately be needed, potassium must never be administered blindly without first checking electrolyte levels. Administering potassium to a client who is not hypokalemic or who has renal impairment could cause fatal hyperkalemia.
D. Give digoxin by another route to slow absorption — This is dangerous and contraindicated. Digoxin toxicity means the client already has excessive drug levels. Administering more digoxin by any route would worsen toxicity and could be fatal.
Correct Answer: (B) Check acid-base and electrolyte values
Digoxin toxicity is closely associated with electrolyte imbalances, particularly hypokalemia, hypomagnesemia, and hypercalcemia, all of which potentiate digoxin's toxic effects on the heart. Checking acid-base and electrolyte values is the priority action because it identifies the underlying conditions contributing to toxicity and guides appropriate corrective treatment. This assessment directly informs all subsequent interventions.
Why the other options are incorrect:
A. Begin cardioversion to stabilize heart rhythm — Cardioversion is not the standard first-line intervention for digoxin toxicity and can actually be dangerous in this setting, potentially triggering life-threatening ventricular arrhythmias in a digitalis-toxic heart.
C. Administer potassium to stabilize the heart rate — While hypokalemia does worsen digoxin toxicity and potassium replacement may ultimately be needed, potassium must never be administered blindly without first checking electrolyte levels. Administering potassium to a client who is not hypokalemic or who has renal impairment could cause fatal hyperkalemia.
D. Give digoxin by another route to slow absorption — This is dangerous and contraindicated. Digoxin toxicity means the client already has excessive drug levels. Administering more digoxin by any route would worsen toxicity and could be fatal.
6. The nurse is providing discharge instructions for a client with metastatic cancer who is prescribed morphine for bone pain. Which information from the client indicates to the nurse an understanding of the medication?
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Observe bowel movement pattern and take a stool softener.
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Do not drink grapefruit juice after taking morphine.
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Take the benzodiazepine at the same time as taking the morphine.
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Watch for signs of agitation and record any insomnia.
Explanation
Explanation
Correct Answer: (A) Observe bowel movement pattern and take a stool softener.
Constipation is the most common and predictable side effect of opioid analgesics such as morphine, occurring because opioids bind to receptors in the gastrointestinal tract and slow intestinal motility. Unlike many other opioid side effects, constipation does not diminish with continued use. The client demonstrating awareness of the need to monitor bowel patterns and use a stool softener proactively shows a clear and accurate understanding of morphine's expected effects and how to manage them safely at home.
Why the other options are incorrect:
B. Grapefruit juice interactions are primarily associated with medications metabolized by the CYP3A4 enzyme system, such as certain statins, calcium channel blockers, and immunosuppressants. Morphine is not significantly metabolized through this pathway, making this instruction clinically inaccurate for morphine therapy.
C. Taking a benzodiazepine concurrently with morphine is a dangerous combination. Both are central nervous system depressants, and combining them significantly increases the risk of respiratory depression, sedation, and death. This statement indicates a dangerous misunderstanding rather than correct medication knowledge.
D. Agitation and insomnia are not the primary side effects the client should be monitoring for with morphine. The more clinically significant concerns include constipation, respiratory depression, sedation, nausea, and urinary retention, making this response an inaccurate reflection of medication understanding.
Correct Answer: (A) Observe bowel movement pattern and take a stool softener.
Constipation is the most common and predictable side effect of opioid analgesics such as morphine, occurring because opioids bind to receptors in the gastrointestinal tract and slow intestinal motility. Unlike many other opioid side effects, constipation does not diminish with continued use. The client demonstrating awareness of the need to monitor bowel patterns and use a stool softener proactively shows a clear and accurate understanding of morphine's expected effects and how to manage them safely at home.
Why the other options are incorrect:
B. Grapefruit juice interactions are primarily associated with medications metabolized by the CYP3A4 enzyme system, such as certain statins, calcium channel blockers, and immunosuppressants. Morphine is not significantly metabolized through this pathway, making this instruction clinically inaccurate for morphine therapy.
C. Taking a benzodiazepine concurrently with morphine is a dangerous combination. Both are central nervous system depressants, and combining them significantly increases the risk of respiratory depression, sedation, and death. This statement indicates a dangerous misunderstanding rather than correct medication knowledge.
D. Agitation and insomnia are not the primary side effects the client should be monitoring for with morphine. The more clinically significant concerns include constipation, respiratory depression, sedation, nausea, and urinary retention, making this response an inaccurate reflection of medication understanding.
7. When administering zolpidem to an older client, which computer documentation indicates that the desired outcome has been achieved?
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Sleeps soundly through the night.
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Improved ability to concentrate.
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Decreased episodes of incontinence.
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Exhibits fewer emotional outbursts.
Explanation
Explanation
Correct Answer: (A) Sleeps soundly through the night.
Zolpidem is a sedative-hypnotic agent prescribed specifically for the treatment of insomnia. The primary therapeutic goal of zolpidem is to help the client initiate and maintain sleep. Documentation that the client sleeps soundly through the night directly reflects achievement of the intended therapeutic outcome and confirms the medication is working as prescribed.
Why Other Options Are Incorrect:
B. Improved ability to concentrate is not a therapeutic goal of zolpidem. Cognitive enhancement is associated with medications such as cholinesterase inhibitors used in dementia management, not sedative-hypnotics.
C. Decreased episodes of incontinence is unrelated to zolpidem's mechanism of action. Urinary incontinence management involves entirely different pharmacological agents and interventions.
D. Fewer emotional outbursts are outcomes associated with mood-stabilizing or antipsychotic medications. Zolpidem acts on GABA receptors to induce sleep and has no direct effect on emotional regulation or behavioral disturbances.
Correct Answer: (A) Sleeps soundly through the night.
Zolpidem is a sedative-hypnotic agent prescribed specifically for the treatment of insomnia. The primary therapeutic goal of zolpidem is to help the client initiate and maintain sleep. Documentation that the client sleeps soundly through the night directly reflects achievement of the intended therapeutic outcome and confirms the medication is working as prescribed.
Why Other Options Are Incorrect:
B. Improved ability to concentrate is not a therapeutic goal of zolpidem. Cognitive enhancement is associated with medications such as cholinesterase inhibitors used in dementia management, not sedative-hypnotics.
C. Decreased episodes of incontinence is unrelated to zolpidem's mechanism of action. Urinary incontinence management involves entirely different pharmacological agents and interventions.
D. Fewer emotional outbursts are outcomes associated with mood-stabilizing or antipsychotic medications. Zolpidem acts on GABA receptors to induce sleep and has no direct effect on emotional regulation or behavioral disturbances.
8. Levothyroxine sodium is prescribed for a client with hypothyroidism. The nurse should instruct the client to report which symptom because it indicates that the client is taking too much levothyroxine sodium?
-
Restlessness.
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Constipation.
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Decreased appetite.
-
Intolerance to cold.
Explanation
Explanation
Correct Answer: (A) Restlessness
Levothyroxine replaces deficient thyroid hormone in hypothyroid clients. When too much levothyroxine is taken, the client develops symptoms consistent with hyperthyroidism, which include restlessness, nervousness, palpitations, insomnia, heat intolerance, and unintended weight loss. Restlessness is a clear indicator of over-replacement and must be reported to the healthcare provider so the dosage can be adjusted.
Why the other options are incorrect:
B. Constipation is a hallmark symptom of hypothyroidism itself, reflecting slowed gastrointestinal motility from insufficient thyroid hormone. Its presence would suggest the current dose is too low, not too high.
C. Decreased appetite is not a feature of levothyroxine overdose. Hyperthyroid states typically produce increased appetite accompanied by weight loss, not a reduction in appetite.
D. Intolerance to cold is a classic symptom of untreated or undertreated hypothyroidism, indicating the thyroid hormone level remains too low. It points to an inadequate dose rather than excess medication.
Correct Answer: (A) Restlessness
Levothyroxine replaces deficient thyroid hormone in hypothyroid clients. When too much levothyroxine is taken, the client develops symptoms consistent with hyperthyroidism, which include restlessness, nervousness, palpitations, insomnia, heat intolerance, and unintended weight loss. Restlessness is a clear indicator of over-replacement and must be reported to the healthcare provider so the dosage can be adjusted.
Why the other options are incorrect:
B. Constipation is a hallmark symptom of hypothyroidism itself, reflecting slowed gastrointestinal motility from insufficient thyroid hormone. Its presence would suggest the current dose is too low, not too high.
C. Decreased appetite is not a feature of levothyroxine overdose. Hyperthyroid states typically produce increased appetite accompanied by weight loss, not a reduction in appetite.
D. Intolerance to cold is a classic symptom of untreated or undertreated hypothyroidism, indicating the thyroid hormone level remains too low. It points to an inadequate dose rather than excess medication.
9. Prior to administering an oral dose of methylprednisolone, the nurse determines the client's serum total calcium level is 5.5 mg/dL (1.4 mmol/L). Which action is most important for the nurse to take?
Reference Range: Total Calcium [9 to 10.4 mg/dL (2.3 to 2.6 mmol/L)]
-
Administer the medication with a glass of milk.
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Notify the healthcare provider of the finding.
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Teach the client about foods high in calcium.
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Begin tapering the drug dose per protocol.
Explanation
Explanation
Correct Answer: (B) Notify the healthcare provider of the finding.
The client's serum calcium level of 5.5 mg/dL is critically low, well below the normal reference range of 9 to 10.4 mg/dL. This indicates severe hypocalcemia, which places the client at immediate risk for life-threatening complications including tetany, laryngospasm, seizures, and cardiac arrhythmias. Additionally, corticosteroids such as methylprednisolone further reduce calcium absorption and increase urinary calcium excretion, meaning administering the medication in the context of existing severe hypocalcemia could worsen the client's condition. Notifying the healthcare provider immediately is the most important and urgent nursing action before proceeding with medication administration.
Why the other options are incorrect:
A. Administering the medication with a glass of milk does not adequately address a critically low calcium level. While milk contains calcium, this intervention is far too minor to correct severe hypocalcemia and does not substitute for prompt medical evaluation and treatment.
C. Teaching the client about calcium-rich foods is an appropriate long-term intervention for mild or chronic hypocalcemia, but it is entirely insufficient as an immediate response to a critically abnormal laboratory value that requires urgent medical attention.
D. Tapering methylprednisolone is a process that requires a specific provider order and is not the nurse's independent action in this situation. Furthermore, tapering addresses the medication management over time and does not resolve the immediate danger posed by the critically low calcium level the client is currently experiencing.
Correct Answer: (B) Notify the healthcare provider of the finding.
The client's serum calcium level of 5.5 mg/dL is critically low, well below the normal reference range of 9 to 10.4 mg/dL. This indicates severe hypocalcemia, which places the client at immediate risk for life-threatening complications including tetany, laryngospasm, seizures, and cardiac arrhythmias. Additionally, corticosteroids such as methylprednisolone further reduce calcium absorption and increase urinary calcium excretion, meaning administering the medication in the context of existing severe hypocalcemia could worsen the client's condition. Notifying the healthcare provider immediately is the most important and urgent nursing action before proceeding with medication administration.
Why the other options are incorrect:
A. Administering the medication with a glass of milk does not adequately address a critically low calcium level. While milk contains calcium, this intervention is far too minor to correct severe hypocalcemia and does not substitute for prompt medical evaluation and treatment.
C. Teaching the client about calcium-rich foods is an appropriate long-term intervention for mild or chronic hypocalcemia, but it is entirely insufficient as an immediate response to a critically abnormal laboratory value that requires urgent medical attention.
D. Tapering methylprednisolone is a process that requires a specific provider order and is not the nurse's independent action in this situation. Furthermore, tapering addresses the medication management over time and does not resolve the immediate danger posed by the critically low calcium level the client is currently experiencing.
10. A client with narcolepsy receives a new prescription for methylphenidate. Prior to administration of the medication, the nurse should review the medical record for which condition?
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Hypercholesterolemia.
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Bronchitis.
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Hypertension.
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Diabetes mellitus.
Explanation
Explanation
Correct Answer: (C) Hypertension
Methylphenidate is a central nervous system stimulant used for narcolepsy and attention deficit hyperactivity disorder. It works by increasing dopamine and norepinephrine levels, which elevates heart rate and blood pressure as a direct pharmacological effect. Reviewing the medical record for pre-existing hypertension is essential because methylphenidate can significantly worsen blood pressure control and increase cardiovascular risk in hypertensive clients.
Why the other options are incorrect:
A. Hypercholesterolemia — Elevated cholesterol levels are not directly affected by methylphenidate and do not represent a primary safety concern prior to initiating this medication.
B. Bronchitis — Methylphenidate does not significantly affect respiratory function or bronchial inflammation, making bronchitis a low-priority consideration before administration.
D. Diabetes mellitus — While stimulant medications can have minor effects on appetite and metabolism, diabetes mellitus is not a primary contraindication or major safety concern that requires priority review before administering methylphenidate.
Correct Answer: (C) Hypertension
Methylphenidate is a central nervous system stimulant used for narcolepsy and attention deficit hyperactivity disorder. It works by increasing dopamine and norepinephrine levels, which elevates heart rate and blood pressure as a direct pharmacological effect. Reviewing the medical record for pre-existing hypertension is essential because methylphenidate can significantly worsen blood pressure control and increase cardiovascular risk in hypertensive clients.
Why the other options are incorrect:
A. Hypercholesterolemia — Elevated cholesterol levels are not directly affected by methylphenidate and do not represent a primary safety concern prior to initiating this medication.
B. Bronchitis — Methylphenidate does not significantly affect respiratory function or bronchial inflammation, making bronchitis a low-priority consideration before administration.
D. Diabetes mellitus — While stimulant medications can have minor effects on appetite and metabolism, diabetes mellitus is not a primary contraindication or major safety concern that requires priority review before administering methylphenidate.
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