Hesi Pharmacology Detailed Exam with Correct Answers

The nurse is reviewing medical record notes of a client with bladder cancer who is prescribed concentrations of methotrexate followed by leucovorin (citrovorum factor, folic acid). The nurse should include in the client's education which information about the anticipated therapeutic effect of leucovorin? 1. "It promotes medication excretion." 2. "It will promote protein synthesis." 3. "It will help to preserve normal cells." 4. "It speeds up the effect of the methotrexate." - -3. It will help preserve normal cells The administration of leucovorin with methotrexate is known as leucovorin rescue. High concentrations of methotrexate cause harm and damage to normal cells. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Leucovorin rescue is potentially hazardous because failure to administer leucovorin in the right dose at the right time can be fatal. A topical corticosteroid is prescribed for an infant with dermatitis in the gluteal area. The nurse provides instructions to the mother regarding the use of the medication. Which statement by the mother indicates an understanding of the use of the medication? 1."I should not rub the medication into the skin." 2."The medication will help relieve the inflammation." 3."I need to apply the medication in a thick layer to protect the skin." 4."I should protect the area by covering it with a diaper and plastic pants." - -2. The medication will help relieve the inflammation A topical corticosteroid will relieve inflammation. The mother should be advised not to apply a tight-fitting diaper or plastic pants after applying the medication because these items will act as an occlusive dressing. The use of occlusive dressings (bandages or plastic wraps) over the affected site is avoided after application of the topical corticosteroid unless the health care provider specifically prescribes this wound coverage. The medication is gently rubbed into the skin after a thin layer is applied. A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. HESI HESI The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1."It relieves the headaches." 2."It increases water reabsorption." 3."It stimulates the production of aldosterone." 4."It decreases the production of the antidiuretic hormone." - -2. It increases water reabsorption Desmopressin is an antidiuretic hormone (ADH) used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase the permeability to water, which results in increased water reabsorption. Desmopressin does not relieve headaches, stimulate aldosterone, or decrease production of ADH. A client's medication sheet contains a prescription for sertraline. To ensure safe administration of the medication, how should the nurse administer the dose? 1.On an empty stomach 2.At the same time each evening 3.Evenly spaced around the clock 4.As needed when the client complains of depression - -2. At the same time every evening Sertraline is classified as an antidepressant. Sertraline generally is administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. Sertraline is not prescribed for use as needed. The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? 1."I should keep the insulin in the cabinet during the day only." 2."I know I have to keep my insulin in the refrigerator at all times." 3."I can store the open insulin bottle in the kitchen cabinet for 1 month." 4."The best place for my insulin is on the window sill, but in the cupboard is just as good." - -3. I can store thew open insulin bottle in the kitchen cabinet for 1 month An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect. HESI HESI A client is admitted to the hospital emergency department with an acute anterior wall myocardial infarction. The nurse discusses thrombolytic therapy with the client and spouse. The spouse is concerned about the dangers of this treatment. Which statement by the nurse is appropriate? 1."There is no reason to worry. We use this medication all the time." 2."I'm certain you made the correct decision to use this medication." 3."You have concerns about whether this treatment is the best option." 4."Your loved one is very ill. The primary health care provider has made the best decision for you." - -3. You have concerns about whether this treatment is the best option Paraphrasing is restating the client's or family members' own words. This allows the client and family members to express their concerns and talk through the decisions that have been made. Option 1 offers false reassurance. In option 2, the nurse is expressing approval, which can be harmful to the client-nurse or family-nurse relationship. Option 4 represents a communication block that denies the family member's right to an opinion. A nurse provides dietary instructions to a client who will be taking warfarin sodium. The nurse should tell the client to avoid which food item? 1.Grapes 2.Spinach 3.Watermelon 4.Cottage cheese - -2. Spinach Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of phytonadione, which is needed for clotting. When a client is taking an anticoagulant, foods high in phytonadione often are omitted from the diet. Phytonadione-rich foods include green leafy vegetables, fish, liver, coffee, and tea. The nurse has completed giving medication instructions to a client receiving benazepril. Which client statement indicates to the nurse that the client needs further instruction? 1."I need to change positions slowly." 2."I will monitor my blood pressure every week." 3."I will report signs and symptoms of infection immediately." 4."I can use salt substitutes freely and eat foods high in potassium." - -4."I can use salt substitutes freely and eat foods high in potassium." The client taking an angiotensin-converting enzyme (ACE) inhibitor is instructed to take the medication exactly as prescribed, to monitor blood pressure weekly, and to continue with other lifestyle changes to control hypertension. The client should change positions slowly to avoid orthostatic hypotension and report fever, mouth sores, or sore throat HESI HESI (neutropenia) to the health care provider. In addition, salt substitutes and high potassium foods should be avoided because they contain potassium and increase the risk for hyperkalemia. A child with severe seborrheic dermatitis is receiving treatments of topical corticosteroid applied over an extensive area of the body, followed by the application of an occlusive dressing. The nurse should monitor the child closely, knowing that which systemic effect can occur as a result of this treatment? 1.Local infection 2.Growth retardation 3.Thinning of the skin 4.Adrenal hyperactivity - -2. Growth retardation Topical corticosteroid can be absorbed in sufficient amounts to produce systemic toxicity. Principal concerns are growth retardation (in children) and adrenal suppression (in all age groups). Systemic toxicity is more likely under extreme conditions of use, such as with prolonged therapy in which extensive surfaces are treated with high doses of high-potency agents in conjunction with occlusive dressings. Silver sulfadiazine is prescribed for a client with a partial-thickness burn, and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments? 1."The medication is an antibacterial." 2."The medication will help heal the burn." 3."The medication should be applied directly to the wound." 4."The medication is likely to cause stinging every time it is applied." - -4."The medication is likely to cause stinging every time it is applied." Silver sulfadiazine is an antibacterial that has a broad spectrum of activity against gram negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied. Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication should the nurse monitor? Select all that apply. 1.Signs of hepatitis 2.Flu-like syndrome 3.Low neutrophil count 4.Vitamin B6 deficiency 5.Ocular pain or blurred vision 6.Tingling and numbness of the fingers - -1.Signs of hepatitis 2.Flu-like syndrome HESI HESI 3.Low neutrophil count 5.Ocular pain or blurred vision Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include