Pharm Hesi Exam V1 Exam

1. The home health nurse observes that a female client is using a topical preparation that contains echinacea to treat a canker sore. Her husband expresses concern regarding the effectiveness and safety of using herbs. How should the nurse respond? a. many of the herbal preparations are helpful primarily because of their placebo effect b. this product is essentially harmless, but also is not very beneficial in treating skin infections c. topical echinacea is usually used to soothe burns and can cause damage to the skin d. echinacea seems to be useful in the treatment of some infections such as canker sores - d. echinacea seems to be useful in the treatment of some infections such as canker sores echinacea stimulates the immune system and seems to be useful in the prevention and treatment of some infections including its topical use to treat canker sores. e. while a placebo can play a role in disease management, herbal remedies have evidence of effectiveness f. if used improperly it can be harmful g. aloe vera is used to soothe burns 2. When preparing to administer the next scheduled dose of fentanyl (Sublimaze) transdermal patch to a client with metastatic cancer and renal insufficiency. The nurse notes that the client has shallow respiration at 8 breath/ minute. What action should the nurse take first? a. apply the transdermal patch b. notify the healthcare provider c. give a breakthrough pain medication d. assess deep tendon reflexes - b. notify the healthcare provider respiratory depression is a side effect of opioid analgesics in a client with renal failure. the HCP should be notified so Rx changes can be made 3. A client diagnosed with myasthenia gravis receives a prescription for the anticholinesterase medication, pyridostigmine (Mestinon). Which intervention should the nurse implement when preparing to administer this medication? a. administer the medication thirty minutes prior to meals b. schedule the medication to be given just before bedtime c. instruct the client to avoid dairy products for 30 minutes d. break the medication into small pieces and sprinkle onto food - a. administer the med 30 minutes prior to meals this medication should be administered before meals because it increases muscle strength to help enhance chewing and swallowing b. this would not help improve strength during the day c. it can be taken with dairy to minimize side effects d. do not sprinkle on food 4. A nurse administered a second dose of an opioid containing codeine and acetaminophen to a client fifteen after a first dose was administered by another nurse, because the first dose was not documented in the medication record. Which intervention is most important for the nurse to implement? a. obtain a serum liver panel b. complete a medication error form c. evaluate vital signs d. assess the client's pain on a 10 point scale - c. evaluate the client's vital signs an opioid containing codeine and acetaminophen can cause CNS depression and the nurse's highest priority is to assess the client's vital signs and LOC e. high doses of acetaminophen can cause liver toxicity, but it is not the highest priority b/d. also important but not as important 5. The nurse retrieves hydromorphone (Dilaudid) 4mg/ ml from the Pyxis Medstation, an automated dispensing system, for a client who is receiving Dilaudid 3 mg IM q6 hours PRN severe pain. How many ml should the nurse administer to the client. (Enter the numerical value only. If rounding is required round to the nearest tenth. - *not multiple choice 0.8 d/h x v = 3mg/ 4mg x 1 ml = 0.75 = 0.8 ml 6. A client with emphysema is complaining of difficulty breathing and is exhibiting audible wheezing. The nurse administers albuterol (Proventil) as prescribed for the third time within the last 12 hours. Which assessment finding warrants immediate intervention by the nurse? a. throat irritation b. increased anxiety c. irregular rapid heart beat d. uncontrollable shaking - c. irregular rapid heart beat A critical side effect of Proventil is an irregular rapid heart beat that requires immediate intervention for a potential life-threatening dysrhythmia a/b/d. these are common side effects that should resolve without intervention 7. A client is receiving tamsulosin (Flomax), an alpha adrenergic blocking agent, for the management of urinary retention due to BPH. Which instruction is most important for the nurse to provide. a. take the medication early in the day b. stand and sit up slowly c. use a twice-a-week dosing schedule d. reduce daily fluid intake - b. stand and sit up slowly Perpheral vasodilation is the therapeutic outcome of alpha adrenergic blocking agents such as tamsulosin, which relay veins, arteries, and in the client with BPH also relaxes the muscle in the prostate and bladder neck to ease initiating a urinary stream. Orthostatic hypotension due to rapid mobilization is a common side effect. a/c/d- Flomax is prescribed once daily and should be taken half an hour following the same meal each day 8. After taking lactulose (cholac) for several days. What therapeutic response for a patient with hepatic encephalopathy? a) reduce liquid stools b) improve mental status c) increase urine output d) ability to ambulate independently - b. improved mental status Lactulose, a hyperosmotic laxative, draws water into the gut, reduces the formation of ammonia in the gut, and lowers serum ammonia levels, which are elevated in hepatic encephalopathy and cause confusion that can lead to precoma and coma. The client's mental status should improve after taking lactulose. a/c/d- not expected outcomes 9. What action should the nurse take prior to administering digoxin (Lanoxin) PO? a. Obtain a left radial pulse for 30 seconds b. listen to the heart at the left 5th intercostal space c. check the client for signs of orthostatic hypotension d. verify that the urine output exceeds 30 ml/ hour - b. listen to the heart at the left 5th intercostal space Bradycardia, a late sign of digtox, should be assessed for by counting the client's apical heart rate (with the stethoscope positioned at the 4th or 5th intercostal space at the midclavicular line) for a full minute. e. is often irregular and can vary significantly from apical rate c/d. can provide information but not priority assessments 10. The nurse is instructing a client with allergic rhinitis about the correct technique for using an intranasal inhaler. What instruction is most important for the nurse to provide to this client? a. use the inhaler when first awakening in the morning b. avoid shaking the inhaler immediately before using c. hold one nostril closed while spraying the other nostril d. angle the tip of the inhaler upward while spraying - c. hold one nostril closed while spraying the other nostril to receive the medication as prescribed, one nostril should be held closed while the other is sprayed. e. inhaler use is not limited to morning f. the inhaler should be shaken before use g. this is not necessary 11. A client with multiple sclerosis starts a new prescription, baclofen, to control muscle spasticity. Three days later, the client calls the clinic nurse and reports feeling fatigue and dizzy. What instruction should the nurse provide? a. stop taking the medication immediately b. avoid hazardous activities until symptoms subside c. increase intake of fluids and high protein foods d. obtain transportation to the ED - b. avoid hazardous activities until symptoms subside fatigue and dizziness are common side effects of baclofen, so the client should be instructed to avoid hazardous activities until symptoms subside a- abrupt withdrawal of baclofen may precipitate withdrawal symtoms c/d- not necessary