HESI Exam Flashcards
A client with heart failure is prescribed spironolactone. Which information is most important for the nurse to provide to the client about diet modifications?
Do not add salt to foods during preparation.
Refrain from eating foods high in potassium.
Restrict fluid intake to 1000 ml per day.
Increase intake of milk and milk products.
Refrain from eating foods high in potassium
(Spironolactone, an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes which generally contain potassium chloride, which can lead to hyperkalemia.)
Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside for chemotherapy?
Hydrate the client with IV fluids before and after infusion.
Assess the client for numbness and tingling of extremities.
Inspect the client’s oral mucosa for ulcerations.
Monitor the client’s urine pH for increased acidity.
Inspect the patient’s oral mucosa for ulcerations
(Cytosine arabinoside affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity.)
An antacid, calcium carbonate, is prescribed for a client with peptic ulcer disease. The nurse knows that the purpose of this medication is to?
Decrease production of gastric secretions.
Produce an adherent barrier over the ulcer.
Maintain a gastric pH of 3.5 or above.
Decrease gastric motor activity.
Maintain a gastric pH of 3.5 or above
(The objective of antacids is to neutralize gastric acids and keep a pH of 3.5 or above which is necessary for pepsinogen inactivity.)
A client is taking hydromorphone PO every 4 hours at home. Following surgery, hydromorphone IV every 4 hours PRN and butorphanol tartrate IV every 4 hours PRN are prescribed for pain. The client received a dose of the hydromorphone IV four hours ago and is again requesting pain medication. What intervention should the nurse implement?
Alternate the two medications every 4 hours PRN for pain.
Alternate the two medications every 2 hours PRN for pain.
Administer only the hydromorphone every 4 hours PRN for pain.
Administer only the butorphanol tartrate every 4 hours PRN for pain.
Administer only the hydromorphone every 4 hours PRN for pain.
(Hydromorphone is an opioid agonist. Butorphanol tartrate is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms and should be avoided.)
The healthcare provider prescribes digitalis for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digitalis?
Observe respiratory rate and depth.
Assess the serum potassium level.
Obtain the client’s blood pressure.
Monitor the serum glucose level.
Assess the serum potassium level
(Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digitalis. The nurse should monitor the client’s serum potassium levels. Blood pressure and respiratory rate will not inform the nurse about potential safety issues with digitalis.)
A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. Which adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider?
Tinnitus and dizziness.
Tachycardia and chest pain.
Dry skin and intolerance to cold.
Weight gain and increased appetite.
Tachycardia and chest pain
(Thyroid replacement hormone increases the metabolic rate of all tissues, so common signs and symptoms of toxicity include tachycardia and chest pain.)
A client receiving albuterol tablets complains of nausea every evening with her 9:00 p.m. dose. Which action can the nurse take to alleviate this side effect?
Change the time of the dose.
Hold the 9 p.m. dose.
Administer the dose with a snack.
Administer an antiemetic with the dose.
Administer the dose with a snack
(Administering oral doses of albuterol with foods helps minimize GI discomfort).
An older client with a decreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process?
Absorption.
Metabolism.
Elimination.
Distribution.
Distribution
(A decreased lean body mass in an older adult affects the distribution of drugs which affects the pharmacokinetics of drugs. In contrast, decreased gastric pH, delayed gastric emptying, decreased splanchnic blood flow, decreased gastrointestinal absorption surface areas and motility affects absorption in the older adult population. Decreased hepatic blood flow, decreased hepatic mass, and decreased activity of hepatic enzymes affect metabolism in older adults. Decreased renal blood flow, decreased glomerular filtration rate, decreased tubular secretion, and decreased number of nephrons affect elimination in an older adult.)
In teaching a client who had a liver transplant about cyclosporine, the nurse should encourage the client to report which adverse response to the healthcare provider?
Changes in urine color.
Presence of hand tremors.
Increasing body hirsutism.
Nausea and vomiting.
Nausea and vomiting
(Neurological complications, such as hand tremors, occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine color typically do not occur. Nausea is a common side effect but is not usually severe.)
The healthcare provider prescribes naloxone for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective?
Statement that the chest pain is better.
Respiratory rate is 16 breaths/minute.
Seizure activity has stopped temporarily.
Pupils are constricted bilaterally.
Respiratory rate is 16 breaths/ minute
(Naloxone is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.)
The nurse is transcribing a new prescription for spironolactone for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement?
Verify both prescriptions with the healthcare provider.
Report the medication interactions to the nurse manager.
Hold the ACE inhibitor and give the new prescription.
Transcribe and send the prescription to the pharmacy.
Verify both prescriptions with the healthcare provider
(The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client’s medication regimen and provides the safest action before administering the medication.)
The nurse is teaching a client with cancer about opioid management for intractable pain and tolerance-related side effects. The nurse should prepare the client on which side effect that is most likely to persist during long-term use of opioids?
Sedation.
Constipation.
Urinary retention.
Respiratory depression.
Constipation
(The client should be prepared to implement measures for constipation which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.)
Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.)
1 albuterol puffs
2 gentamicin IM
3 salmeterol
4 prednisone orally
albuterol puffs
salmeterol
prednisone orally
gentamicin IM
(Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short-acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol, with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client’s respiratory distress begins to resolve. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence.)
A client with Parkinson’s disease is taking levodopa-carbidopa. Which observation by the nurse would indicate that the desired outcome of the medication is being achieved?
Decreased blood pressure.
Lessening of tremors.
Increased salivation.
Increased attention span.
Lessening of tremors
(Levodopa-carbidopa increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson’s, such as involuntary movements, resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased salivation.)
An adult client has prescriptions for morphine sulfate 2.5 mg IV every 6 hours and ketorolac 30 mg IV every 6 hours. Which action should the nurse implement?
Administer both medications according to the prescription.
Hold the ketorolac to prevent an antagonistic effect.
Hold the morphine to prevent an additive drug interaction.
Contact the healthcare provider to clarify the prescription.
Administer both medications according to the prescription
(Morphine and ketorolac can be administered concurrently and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Ketorolac is an antiinflammatory analgesic and does not have an antagonistic effect with morphine.)
