BSN HESI 315 Pharmacology Practice Exam Version 5 (New 2026/ 2027 Update) Full Q&A |100% Correct| Grade A-Nightingale

BSN HESI 315 Pharmacology Practice Exam Version 5 (New 2026/ 2027 Update) Full Q&A |100% Correct| Grade A-Nightingale Q. A client taking atorvastatin develops an increased serum creatine phosphokinase (CK) level. The nurse should assess the client for the onset of which problem? A. Muscle tenderness. B. Nausea and vomiting. C. Excessive bruising. D. Peripheral edema. ANSWER A. Muscle tenderness. Q. An increase in which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease? A. LDL (Low-density lipoprotein) B. Triglycerides (Type of fat) C. HDL (High-density lipoprotein) D. VLDL (Very low-density lipoprotein) ANSWER C. HDL (High-density lipoprotein) NGN - Patient Data Q. Review H and P, and nurse’s note. Identify from the choices below 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 Condition: Methemoglobinemia Actions to Take: 1. Draw blood for a complete blood count 2. Administer methylene blue ANSWER Parameters to Monitor: 1. Methemoglobin level 2. Heart rate and rhythm Q. The nurse provide discharge instructions to a client who has been prescribed gabapentin 300 mg by mouth three times a day for post herpetic neuralgia. Which symptoms should the nurse tell the client to report to the healthcare provider? A. Sexual dysfunction B. Gastric irritation C. Rapid weight gain D. Photosensitivity ANSWER B. Gastric irritation Q. A client with chronic lower back pain has been taking non steroidal anti-inflammatory (NSAID) drug ibuprofen by mouth twice a day for several months. Which assessment is most important for the nurse to complete? A. Assess back pain using numeric scale B. Palpate volume of pedal pulses C. Determine presence of abdominal pain D. Evaluate ongoing sleep patterns ANSWER C. Determine presence of abdominal pain Q. The nurse administers risedrineate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take? A. Instruct the client that it is necessary to take nothing but water with the medication. B. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk. C. Withhold the medication until the client's breakfast tray is available on the unit. D. Consult with a pharmacist about scheduling the dose one hour after the client eats. ANSWER A. Instruct the client that it is necessary to take nothing but water with the medication. Q. Which action should the nurse implement to assess the effectiveness of calcium channel blocker amlodipine? A. Note the clients serum calcium levels B. Monitor the clients serum electrolytes C. Review the clients intake and output D. Measure the clients blood pressure ANSWER D. Measure the clients blood pressure Q. A client is receiving tamsulosin an alpha adrenergic - blocking agent for the management of urinary retention due to benign prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide? A. Use a twice a week dosing schedule B. Stand and sit up slowly C. Take the medication early in the day D. Reduce daily fluid intake ANSWER B. Stand and sit up slowly Q. A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report? A. Nausea B. Involuntary movements C. Diarrhea D. Unusual irritability ANSWER B. Involuntary movements Q. A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication? A. Body mass index B. Depression screening C. Daily calorie count D. Serum protein levels ANSWER A. Body mass index Q. 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? A. Type 2 diabetes mellitus B. Seasonal allergic rhinitis C. Irritable bowel syndrome D. Coronary artery disease ANSWER D. Coronary artery disease Q. A client receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours which is to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5%in water (D5W) 200 mL. How many mL/hr should the nurse program the infusion pump to deliver? 200 mL/hr Rationale: xmL/hr = ANSWER 200 mL x 400 mg = 80,000 = 200 mL/hr 400 mg 1 hr 400 Q. Before administering a laxative to a bed fast client, it is most important for the nurse to perform which assessment? A. Determine the frequency and consistency of bowel movements B. Observe the skin integrity of the clients rectal and sacral areas C. Assess the clients strength in moving and turning the bed D. Evaluate the clients ability to recognize the urge to defecate ANSWER A. Determine the frequency and consistency of bowel movements Q. The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and is now prescribed adalimumab. Which instructions should the nurse provide the client? A. Have a chest x-ray prior to your first dose B. Avoid crowds and people who are sick C. Obtain routine vaccinations as scheduled D. Undergo annual eye examinations ANSWER A. Have a chest x-ray prior to your first dose Q. The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history? A. Pancreatitis B. Diabetes mellitus C. Myocardial infarction D. Chronic obstructive pulmonary disease ANSWER A. Pancreatitis Q. Hormone replacement therapy with 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 of the hormonal agent, levothyroxine? A. Intolerance to cold B. Constipation C. Restlessness D. Decreased appetite ANSWER C. Restlessness A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse? A. Take the medication an hour after antacids. B. Notify the healthcare provider of lethargy. C. Decrease cigarette use to a pack per day. D. Monitor for any signs of sexual dysfunction. C. Decrease cigarette use to a pack per day. The nurse initiates an infusion of piperacillin-tazobactam for a client with a urinary tract infection. Five minutes into the infusion, the client reports not feeling well. Which client manifestation should the nurse identify as a reason to stop the infusion? A: Scratchy throat. B: Pupillary constriction. C: Bradycardia. D: Hypertension. A. Scratchy throat. The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement? A: Determine Glasgow Coma Scale score. B: Initiate cardiopulmonary resuscitation (CPR). C: Prepare to assist with chest tube insertion. D: Administer a second dose of naloxone. D: Administer a second dose of naloxone. Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address? A: Employed as a construction worker. B: Reported history of alcoholism. C: White blood cell count of 8,500/mm3 (8.5 x 10^9/L). D: Toenails appear thick and yellow. B: Reported history of alcoholism. A client is diagnosed with myasthenia gravis receives a prescription for the anticholinesterase medication pyridostigmine. Which intervention should the nurse implement when preparing to administer this medication? Administer the medication thirty minutes prior to meals. A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction? A: Perform a bladder scan. B: Assess urine output. C: Measure blood pressure. D: Monitor daily weights. C: Measure blood pressure. After administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement? A: Administer both prescribed medications as scheduled. B: Hold the calcium carbonate, but administer the calcitriol as scheduled. C: Hold both medications until contacting the healthcare provider. D: Hold the calcitriol, but administer the calcium carbonate as scheduled. C: Hold both medications until contacting the healthcare provider. Rivastigmine, a cholinesterase inhibitor, is prescribed for a female client with early stage Alzheimer's disease. The client's daughter tells the nurse that she plans to start administering the drug when her mother's symptoms are no longer manageable, in hopes that her mother will not have to go to a nursing home. How should the nurse respond? A: Confirm that the daughter is aware of the progressive nature of the disease. B: Affirm the decision to use the medication when the symptoms start to worsen. C: Explain that the drug should be used early in the course of the disease process. D: Assess the client's current mental status before deciding to support the decision. C: Explain that the drug should be used early in the course of the disease process. A client with psychosis who is receiving an antipsychotic medication is continually rubbing the back of the neck. Which nursing intervention is best for the nurse to implement? A: Provide the client a heating pad to place on the neck. B: Obtain a prescription for physical therapy services. C: Give a PRN prescription for benztropine. D: Obtain an extra pillow for the client to use at night. C: Give a PRN prescription for benztropine. A client receives a new prescription for levothyroxine. Which statement made by the client indicates to the nurse that the education was effective? A: Take medication on an empty stomach. B: Consume foods that are high in iodine. C: Administer levothyroxine at bedtime. D: Avoid the use of iron supplements. A: Take medication on an empty stomach. The nurse is administering muscle relaxant baclofen by mouth (PO) to a client diagnosed with multiple sclerosis. Which intervention is the most important for the nurse to implement? A: Advise the client to move slowly and cautiously when rising and walking. B: Evaluate muscle strength every 4 hours. C: Monitor intake and output every 8 hours. D: Ensure the client knows to stop baclofen before using other antispasmodics. A: Advise the client to move slowly and cautiously when rising and walking. A client with atrial fibrillation receives a new prescription for dabigatran. Which instruction should the nurse include in this client's teaching plan? A: Eliminate spinach and other green vegetables in the diet. B: Continue obtaining scheduled laboratory bleeding tests. C: Keep an antidote available in the event of hemorrhage. D: Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs). D: Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs). A client taking atorvastatin develops an increased serum creatine phosphokinase (CK) level. The nurse should assess the client for the onset of which problem? A: Muscle tenderness. B: Nausea and vomiting. C: Excessive bruising. D: Peripheral edema. A: Muscle tenderness. The nurse is planning care for a client with major depression who is receiving a new prescription for duloxetine. Which information is most important for the nurse to obtain? A: Weight change in the last month. B: Liver function laboratory results. C: Recent use of other antidepressants. D: Family history of mental illness. C: Recent use of other antidepressants. A client with Parkinson's disease who is taking carbidopa/levodopa reports the urine appears to be darker in color. Which action should the nurse take? A: Measure the client's urinary output. B: Explain the color change is normal. C: Obtain a specimen for a urine culture. D: Encourage an increase in oral intake. B: Explain the color change is normal. Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address? A: Employed as a construction worker. B: Reported history of alcoholism. C: White blood cell count of 8,500/mm3 (8.5 x 10^9/L). D: Toenails appear thick and yellow B: Reported history of alcoholism. Prior to administering the evening dose of carbamazepine, the nurse notes that the client's morning carbamazepine level was 84 mcg/L (35.6 mmol/L). Which action should the nurse take? A: Notify the healthcare provider of the carbamazepine level. B: Administer the carbamazepine as prescribed. C: Assess the client for side effects of carbamazepine. D: Withhold this dose of the carbamazepine. A: Notify the healthcare provider of the carbamazepine level. The health care provider prescribes the antibiotic tetracycline HCl for an adult client who arrived at an outpatient clinic. Which instruction should the nurse include in the teaching plan for this client? A: Protect the skin from sunlight while taking the drug. B: Take with orange juice to enhance GI absorption. C: Return to the clinic weekly to obtain serum drug levels. D: Take with milk or antacids to prevent gastrointestinal (GI) irritation. A: Protect the skin from sunlight while taking the drug. The nurse prepares to administer a scheduled dose of labetalol by mouth to a client with hypertension. The client's vital signs are temperature 99° F (37.2° C), heart rate 48 beats/minute, respirations 16 breaths/minute, and blood pressure 150/90 mm Hg. Which action should the nurse take? A: Assess for orthostatic hypotension before administering the dose. B: Administer the dose and monitor the client's BP regularly. C: Apply a telemetry monitor before administering the dose. D: Withhold the scheduled dose and notify the health care provider. D: Withhold the scheduled dose and notify the health care provider. A client is receiving intravenous (IV) vancomycin and the nurse plans to draw blood for a peak and trough to determine the serum level of the medication. Which of the following collection times provide the best determination of these levels? A: Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication. B: One hour after completion of the IV dose and one hour before the next administration of the medication. C: Two hours after completion of the IV dose and two hours before the next administration of the medication. D: Immediately after completion of the IV dose and 30 minutes before the next administration of the medication. B: One hour after completion of the IV dose and one hour before the next administration of the medication. After taking orlistat for one week, a female client tells the home health nurse that she is experiencing increasingly frequent oily stools and flatus. Which action should the nurse take? A: Instruct the client to increase her intake of saturated fats over the next week. B: Advise the client to stop taking the drug and contact her healthcare provider. C: Obtain a stool specimen to evaluate for occult blood and fat content. D: Ask the client to describe her dietary intake history for the last several days. D: Ask the client to describe her dietary intake history for the last several days. A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client's plan of care? A: Replace salt with a salt substitute. B: Monitor skin for excessive bruising. C: Cover your skin before going outside. D: Limit intake of high-potassium foods. D: Limit intake of high-potassium foods. The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take? A: Instruct the client that it is necessary to take nothing but water with the medication. B: Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk. C: Consult with a pharmacist about scheduling the dose one hour after the client eats. D: Withhold the medication until the client's breakfast tray is available on the unit. A: Instruct the client that it is necessary to take nothing but water with the medication. A client with hepatic encephalopathy is receiving lactulose. Which assessment provides the nurse with the best information to evaluate the client's therapeutic response to the drug? A: Stool color and character. B: Serum electrolytes and ammonia. C: Serum hepatic enzymes. D: Fingerstick glucose. B: Serum electrolytes and ammonia. The nurse admits a client with a diagnosis of stage 4 cancer. The client has a prescription to wear a subcutaneous morphine sulfate patch for pain. The client is short of breath and difficult to arouse. While performing a head to toe assessment, the nurse discovers four patches on the client's body. Which action should the nurse take first? A: Apply oxygen face mask. B: Remove the morphine patches. C: Administer a narcotic reversal drug. D: Monitor blood pressure. B: Remove the morphine patches. An older adult with iron deficiency anemia is being discharged with a prescription for ferrous sulfate enteric-coated tablets. To promote best absorption of the medication, which information should the nurse include in the discharge instructions? A: Take the tablet with a daily multivitamin. B: Bedtime is the best time to take the tablet. C: Wait 2 hours after meals to take the tablet. D: Crush the tablets and mix with pudding. C: Wait 2 hours after meals to take the tablet. A client in the surgical recovery area asks the nurse to bring the largest possible dose of pain medication available. Which action should the nurse implement first? A: Determine when the last dose was administered. B: Encourage the client to use diversional thoughts to manage pain. C: Review the history for a past use of recreational drugs. D: Ask the client to rate the current level of pain using a pain scale. D: Ask the client to rate the current level of pain using a pain scale. The nurse is caring for a client who is taking diclofenac, a nonsteroidal anti-inflammatory (NSAID) drug for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client's serum laboratory values is most important for the nurse to review? A: Glucose. B: Total protein. C: Sodium. D: Hemoglobin. D: Hemoglobin. Which nursing action has the highest priority when administering a dose of codeine with acetaminophen to a client? A: Instruct the client to request assistance when ambulating to the bathroom. B: Administer a stool softener/laxative at the same time as the analgesic. C: Advise the client that the medication should start to work in about 30 minutes. D: Tell the client to notify the nurse if the pain is not relieved. A: Instruct the client to request assistance when ambulating to the bathroom. A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client? A: Stop the oral contraceptive immediately. B: Avoid prolonged exposure to direct sunlight. C: Take the medications at least 12 hours apart. D: Use an additional form of contraception. D: Use an additional form of contraception. The nurse is planning to administer the antiulcer gastrointestinal (GI) agent sucralfate to a client with peptic ulcer disease. Which action should the nurse include in this client's plan of care? A: Administer sucralfate once a day, preferably at bedtime. B: Give sucralfate on an empty stomach. C: Monitor for electrolyte imbalance. D: Assess for secondary Candida infection. B: Give sucralfate on an empty stomach. A client with a seizure disorder is seen at the clinic for a follow-up visit and a prescription renewal for phenytoin. Which assessment finding warrants immediate intervention by the nurse? A: Blood pressure 100/78 mm Hg. B: Double vision. C: Puffy, bleeding gums. D: Chronic insomnia. B: Double vision. To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers? A: When using the discus, have the client breathe out rapidly into the mouthpiece. B: Offer the discus to the client for use during an acute asthma attack. C: Clients using the discus may experience decreased blood pressure. D: Explain that the client should not use the discus more than twice daily. D: Explain that the client should not use the discus more than twice daily. A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history, the nurse determines that the client has been self-administering St. John's Wort, an herbal preparation, on the advice of a friend. Which information is most significant about this finding? A: St. John's Wort can decrease plasma concentrations of cyclosporine. B: Adding the herb can decrease the need for corticosteroids. C: The client probably used this herb to treat depression. D: Ingestion of St. John's Wort can reduce the client's intake of sodium. A: St. John's Wort can decrease plasma concentrations of cyclosporine. A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? A: Reports of increased energy levels and decreased fatigue. B: Food diary shows increased consumption of iron-rich foods. C: Takes concurrent iron therapy without adverse effects. D: Hemoglobin level increased to 12 g/dL (7.45 mmol/L). D: Hemoglobin level increased to 12 g/dL (7.45 mmol/L). The nurse is administering sodium polystyrene sulfonate to a client in acute kidney injury (AKI). Which laboratory finding indicates that the medication has been effective? A: Serum ammonia level of 30 Mcg/dL (17.62 mmol/L). B: Hemoglobin level of 13.5 g/dL (135 g/L). C: Serum potassium level of 3.8 mEq/L (3.8 mmol/L). D: Serum glucose level of 120 mg/dL (6.7 mmol/L). C: Serum potassium level of 3.8 mEq/L (3.8 mmol/L). A client with chemotherapy-induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report? A: Nausea. B: Involuntary movements. C: Unusual irritability. D: Diarrhea. B: Involuntary movements. While assessing a client who takes acetaminophen for chronic pain, the nurse observes that the client's skin looks yellow in color. Which action should the nurse take in response to this finding? A: Report the finding to the healthcare provider. B: Check the client's capillary glucose level. C: Use a pulse oximeter to assess oxygen saturation. D: Advise the client to reduce the medication dose. A: Report the finding to the healthcare provider. A client with nasal congestion receives a prescription for phenylephrine 10 mg by mouth every 4 hours. Which client condition should the nurse report to the healthcare provider before administering the medication? A: Diarrhea. B: Bronchitis. C: Hypertension. D: Edema. C: Hypertension. When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)? A: Lorazepam. B: Digoxin. C: Sucralfate. D: Vancomycin. D: Vancomycin. A glucagon emergency kit is prescribed for a client with type 1 diabetes mellitus to be used at home. When should the nurse instruct the client and family that glucagon needs to be administered? A: At the onset of signs of diabetic ketoacidosis. B: Before meals to prevent hyperglycemia. C: When unable to eat during sick days. D: When signs of severe hypoglycemia occur. D: When signs of severe hypoglycemia occur. Rivastigmine, a cholinesterase inhibitor, is prescribed for a female client with early stage Alzheimer's disease. The client's daughter tells the nurse that she plans to start administering the drug when her mother's symptoms are no longer manageable, in hopes that her mother will not have to go to a nursing home. How should the nurse respond? A: Confirm that the daughter is aware of the progressive nature of the disease. B: Affirm the decision to use the medication when the symptoms start to worsen. C: Explain that the drug should be used early in the course of the disease process. D: Assess the client's current mental status before deciding to support the decision. C: Explain that the drug should be used early in the course of the disease process. A client who receives multiple antihypertensive medications experiences syncope due to a drop in blood pressure to 70/40 mm Hg. Which is the rationale for the nurse's decision to hold the client's scheduled antihypertensive medications? A: Increased urinary clearance of the multiple medications has produced diuresis and lowered the blood pressure. B: The synergistic effect of the multiple medications has resulted in drug toxicity and hypotension. C: The antagonistic interaction among the various blood pressure medications has reduced their effectiveness. D: The additive effect of multiple medications has caused the blood pressure to drop too low. D: The additive effect of multiple medications has caused the blood pressure to drop too low. A client reports confusion and blurred vision after receiving a dose of glipizide. Which action should the nurse implement? A: Perform a neurological exam. B: Obtain a fingerstick blood glucose. C: Administer glucagon intramuscularly. D: Measure the client's vital signs. B: Obtain a fingerstick blood glucose. The nurse is providing instructions about a client's new medications. How should the nurse explain the purpose of probenecid, a uricosuric drug? A: Decreases pain and burning during urination. B: Increases the strength of the urine stream. C: Prevents the formation of kidney stones. D: Promotes excretion of uric acid in the urine. D: Promotes excretion of uric acid in the urine. Which intervention is most important for the nurse to implement for a client who is receiving insulin lispro? A: Keep an oral liquid or glucose source available. B: Provide meals at the same time this insulin is given. C: Assess for hypoglycemia between meals. D: Check blood glucose levels every six hours. B: Provide meals at the same time this insulin is given. A client with open-angle glaucoma asks the nurse how long the prescribed eye drops will need to be used. Which response made by the nurse is accurate? A: Until the excess pressure is reduced. B: For long-term control of pain and swelling. C: Until a smaller angle can be restored. D: For long-term control of normal eye pressure. D: For long-term control of normal eye pressure. A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse? A: Take the medication an hour after antacids. B: Notify the healthcare provider of lethargy. C: Decrease cigarette use to a pack per day. D: Monitor for any signs of sexual dysfunction. C: Decrease cigarette use to a pack per day. A female client with multiple sclerosis reports having less fatigue and improved memory since she began using the herbal supplement, ginkgo biloba. Which information is most important for the nurse to include in the teaching plan for this client? A: Ginkgo biloba use should be limited and not taken during pregnancy. B: Aspirin and non-steroidal anti-inflammatory drugs interact with ginkgo. C: Nausea and diarrhea can occur when using this supplement. D: Anxiety and headaches increase with the use of ginkgo biloba. B: Aspirin and non-steroidal anti-inflammatory drugs interact with ginkgo. A client with a history of chronic obstructive pulmonary disease (COPD) receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed? A: Primes the inhaler with 7 pumps. B: Rinses the mouth after each use. C: Stores the medication at room temperature. D: Attaches spacer device to the inhaler. A: Primes the inhaler with 7 pumps. A client who is taking albendazole reports experiencing fatigue, nausea, and dark urine. The nurse observes a yellowing of the client's skin and sclera. Which laboratory result should the nurse review? A: Basic metabolic panel. B: Thyroid function test. C: Renal function panel. D: Liver function test. D: Liver function test. NGN - Patient Data History and Physical The client is a 75-year-old female who was admitted to the preop area to prepare for pacemaker insertion. She states that she needs this procedure because her heart rate has been very low, she feels tired all the time, and she has fainted once due to low heart rate. She has a history of worsening symptomatic bradycardia and atrial fibrillation controlled by medication. She has been off anticoagulants for four days to prepare for the procedure. Orders: Diphenhydramine 25 mg IV now Methylprednisolone 100 mg IV now For each body system, select to specify the potential nursing intervention that would be appropriate for the care of the client. Each body system may support more than one potential nursing intervention. Each category must have at least one response option selected. Body System: Respiratory (A) A. Assess lung sounds B. Provide a calm environment C. Pain medication D. Chest x-ray Body System: Cardiovascular (A,B,C) A. Monitor vital signs continuously B. Provide warmth C. Defibrillator at bedside D. EHO Body System: Immunological (A,D) A. Administer antihistamine B. IV fluids C. Assess rash D. Administer steroid NGN - Patient Data History and Physical The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. Nurses Notes 1400: Started continuous morphine in the left antecubital vein peripheral intravenous line. No redness, edema, or bleeding noted at the site. Vital signs are heart rate 77 bpm, blood pressure 118/74 mmHg, respiratory rate 16 breaths/min. Orders: - Admit to the surgical floor - Clear liquid diet, advance as tolerated - Continuous cardiorespiratory monitoring - Morphine 1 mg/hr intravenously - Alert surgeon to signs of bleeding or infection in the surgical site What other medications would the nurse expect the surgeon to prescribe along with morphine? Select all that apply. A. Ibuprofen B. Propofol C. Methadone D. Senna E. Docusate sodium F. Naloxone A. Ibuprofen D. Senna E. Docusate sodium NGN - Patient Data History and Physical The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. Nurses Notes 1400: Started continuous morphine in the left antecubital vein peripheral intravenous line. No redness, edema, or bleeding noted at the site. Vital signs are heart rate 77 bpm, blood pressure 118/74 mmHg, respiratory rate 16 breaths/min. The charge nurse places a fall precautions sign on the client's door. What side effects of morphine could contribute to this client's fall risk? Select all that apply. A. Seizures B. Nausea C. Orthostatic hypotension D. Sedation E. Euphoria F. Itching G. Urinary retention B. Nausea C. Orthostatic hypotension D. Sedation NGN - Patient Data History and Physical The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. Nurses Notes 1400: Started continuous morphine in the left antecubital vein peripheral intravenous line. No redness, edema, or bleeding noted at the site. For each statement, click to indicate whether the statements by the student nurse indicate understanding or no understanding of naloxone. A. "You can give naloxone intravenously, intramuscularly, or subcutaneously." B. "Naloxone works best on pure agonist opioids." C. "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression." D. "Naloxone will not affect the client's level of pain." E. "When given IV, naloxone starts working immediately and can last several hours." A. "You can give naloxone intravenously, intramuscularly, or subcutaneously." = Understanding B. "Naloxone works best on pure agonist opioids." = Understanding C. "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression." = No understanding D. "Naloxone will not affect the client's level of pain." = No understanding E. "When given IV, naloxone starts working immediately and can last several hours." = No understanding NGN - Patient Data History and Physical The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. Orders: - Admit to the surgical floor - Clear liquid diet, advance as tolerated - Continuous cardiorespiratory monitoring - Morphine 1 mg/hr intravenously - Alert surgeon to signs of bleeding or infection in the surgical site The nurse is discussing the client's pain management with a student nurse. Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. Morphine is a(n) ____(A)___and it activates ___(B)__receptors and is used to relieve __(C)___. A) Pure opioid antagonist B) Mu C) Severe pain NGN - Patient Data History and Physical The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. What should the nurse do immediately? Select all that apply. A. Print an electrocardiogram strip B. Provide rescue breaths with a manual ventilation bag C. Give naloxone 2 mg intravenously D. Apply oxygen via nasal cannula E. Perform chest compressions F. Call for rapid response B. Provide rescue breaths with a manual ventilation bag C. Give naloxone 2 mg intravenously F. Call for rapid response NGN - Patient Data History and Physical The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. What actions should the nurse take to ensure safety during morphine administration? Select all that apply. A. Take an initial respiratory rate B. Perform a 12-lead electrocardiogram C. Suction the client to clear the airway D. Have a manual resuscitation bag at the bedside E. Ask the client about other medications she takes F. Restrain the client with soft restraints A. Take an initial respiratory rate D. Have a manual resuscitation bag at the bedside E. Ask the client about other medications she takes The nurse is planning discharge teaching for a client with diabetes mellitus who has a new prescription for insulin glargine. What action should the nurse plan to include in the discharge teaching? A. Teach the client self injection skills for daily subcutaneous administration B. Provide information on increasing medication dosage if ketoacidosis occurs C. Demonstrate how to select dose based on before meal blood sugar readings D. Explain to the family how to inject this medication for severe hypoglycemia A. Teach the client self injection skills for daily subcutaneous administration A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for pulmonary embolism. Which information in the clients history requires follow up by the nurse? A. Metal hip prosthesis was placed twenty years ago B. Takes metformin hydrochloride for type 2 diabetes millitus C. CT scan that was performed six months earlier D. Report of clients sobriety for the last five years B. Takes metformin hydrochloride for type 2 diabetes millitus A male client reports to the nurse that he is experiencing gastrointestinal distress from a high dose of corticosteroid and is planning to stop taking the medication. In response to the clients statement, which nursing action is most important for the nurse to implement? A. Advise the client that the medication should be stopped gradually rather than abruptly B. encourage the client to take the medication with food to decrease GI distress C. Assess the client for other indications of adverse effects of corticosteroid use D. review the clients dosing schedule to ensure he is taking the prescribed amount A. Advise the client that the medication should be stopped gradually rather than abruptly A client is receiving pilocarpine hydrochloride opthalmic drops for glaucoma. The client calls the clinic nurse and reports difficulty seeing at night. Which explanation should the nurse provide? A. The drug can cause the lens to become more opaque B. The drops increase the fluid in the eyes and cloud the visual field C. The eye drops slow pupil response to accommodate for darkness D. The medication causes pupils to dilate, which reduces night vision C. The eye drops slow pupil response to accommodate for darkness A client is receiving rifampin, an antitubercular medication. Which statement by this client should prompt the nurse to notify the healthcare provider of a potential problem? A. Reports that the sclera are yellow B. Voids urine that is orange colored C. uses condoms for contraception D. complains of persistent tinnitus A. Reports that the sclera are yellow A male client has been receiving the antibiotic gentamicin sulfate, IV piggyback every 12 hours for several days. Which observation by the nurse indicates that the client may be experiencing an adverse effect of gentamicin? A. Decreased blood urea nitrogen B. Reports of photophobia C. Hearing has decreased D. White blood cell count of 6,000/mm3 C. Hearing has decreased An older adult client with restlessness syndrome begins taking melatonin at bedtime. When evaluating the effectiveness of the herb, which client assessment should the nurse complete? A.) determine sleep patterns B.) palpate pedal pulse volume C.) assess anxiety level D.) observe for peripheral edema A.) determine sleep patterns To evaluate the effectiveness of a clients prescription for rosuvastatin, which action should the nurse implement? A.) evaluate the clients serum cholesterol level results B.) measure skin folds for body mass index calculations C.) obtain the clients heart rate and blood pressure D.) review the clients daily food and weight log A.) evaluate the clients serum cholesterol level results A client receives a prescription to itraconazole. Which information provide by the client requires additional instruction by the nurse? A.) monitor for changes in stool color B.) report any difficulty with breathing C.) take the medication with antacids D.) avoid the consumption of grapefruit juice C.) take the medication with antacids When caring for a client with diabetes insipidus who is receiving an antidiuretic hormone intranasally, which serum lab test is most important for the nurse to monitor? A.) calcium B.) osmolality C.) glucose D.) platelets B.) osmolality When preparing to apply a scheduled fentanyl transdermal patch, the nurse notes that the previously applied patch is intact on the clients upper back and the client denies pain. Which action should the nurse take? A.) remove the patch and consult with the healthcare provider about the clients pain resolution B.) administer an oral analgesic and evaluate its effectiveness before applying the new patch C.) apply the new patch in a different location after removing the original patch D.) place the patch on the clients shoulder and leave both patches in place for 12 hrs C.) apply the new patch in a different location after removing the original patch The nurse is caring for an older client with multiple comorbidities. Which medication should the nurse recognize as increasing the clients risk for fractures? A.) metformin B.) Lansoprazole C.) amlodipine D.) simvastain B.) Lansoprazole The nurse is preparing a discharge teaching plan for a client who is taking ciprofloxacin hydrochloride tablets, which were prescribed because of a suspected anthrax exposure. Which instructions should be included in the teaching plan? (Select all that apply.) A.) use NSAIDs to relieve mild joint aches and pains caused by the medication B.) crush and mix the tablets with pudding if you have trouble swallowing the tablets C.) increase fluid intake while taking this medication D.) limit exposure to sunlight and avoid tanning beds E.) report any tendon pain or swelling to the healthcare provider immediately C.) increase fluid intake while taking this medication D.) limit exposure to sunlight and avoid tanning beds E.) report any tendon pain or swelling to the healthcare provider immediately The client is in the provider’s office for a physical. He states that he has been monitoring his blood pressure, but it is continuing to go up. The physician has given the client a prescription for captopril. Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. Captopril is a ____________ that works by _________________. A. non-steroidal anti-inflammatory drug B. angiotensin II receptor blocker C. angiotensin-converting enzyme inhibitor D. aldosterone antagonist C. angiotensin - converting enzyme inhibitor Captopril (Capoten) Adverse Effects: - Persistent nonproductive cough - Rash - Hypotension - Hyperkalemia (higher than normal amounts of potassium in the blood associated with kidney failure or use of diuretic drugs) - Hyponatremia (excessive amounts of sodium in the blood, possibly DM) Contraindications -DO NOT GIVE: - 2nd and 3rd trimester of pregnancy (causes injury to the fetus BLACK BOX) - Hypersensitivity - other ACE inhibitors (cross sensitivity) Lisinopril (Prinivil, Zestril) Adverse Effects: - Cough - Headache - Dizziness - Orthostatic hypotension - Rash - Hyperkalemia - Effects include taste disturbances - Chest pain - Nausea - Vomiting - Diarrhea - Angioedema Contraindications: - Patients with hyperkalemia and in those who have previously experienced angioedema caused by ACE inhibitor therapy. - Should not be used during pregnancy. The healthcare provider prescribes Ceftazidime 1,500 mg IV every 12 hours. The available vial is labeled, "Ceftazidime 1 gram", and the instruction for reconstitution state, "For IV use add 10mL sterile water for injection. Concentration after reconstitution = 100 mg/mL. How many mL should the nurse administer? 15 mL xmL = mL x 1,500 mg = 1,500 = 15 mL 100 mg 1 1 The nurse retrieves hydromorphone (Dilaudid) 4 mg/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) 0.8 mL xmL = mL x 3 mg = 3 = 0.75 = 0.8 4 mg 1 4 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 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 A client with muscle spasticity receives a prescription for baclofen. Which information provided by the client requires additional instruction by the nurse? A. Use a stool softener as needed B. Take medication with meals C. Discontinue when spasms cease D. Avoid the ingestion of alcohol C. Discontinue when spasms cease A male client who has erectile dysfunction (ED) recently received a new prescription for sildenafil citrate. During a clinic visit, the client reports the onset of nasal congestion, dizziness, nausea, and dyspepsia. Which nursing assessment takes priority? A. Palpate abdomen for distention or tenderness B. Measure blood pressure while lying and standing C. Assess for the presence of muscle or back pain D. Auscultate and compare breath sounds bilaterally. B. Measure blood pressure while lying and standing A client who is experiencing vasomotor symptoms related to menopause receives a new prescription for estrogen replacement. Which client condition should the nurse report the healthcare provider prior to administering the first dose of the medication? A. Dyspareunia. B. Osteoporosis C. Colorectal cancer D. Pulmonary embolism A. Dyspareunia. A female client with history of peptic ulcer disease received a prescription for misopprostol. Which information provided by the client indicates to the nurse a need for further teaching? Ensure a negative pregnancy test results 2 weeks before therapy. A client who developed syndrome of inappropriate antidiuretic hormone (SIADH) associated with small carcinoma of the lung is preparing for discharge. When teaching the client about self-management with demeclocycline (Declomycin), the nurse should instruct the client to report which condition to the health care provider? Enamel hypoplasia The nurse assess a client with intermittent claudification who is receiving pentoxifylline. Which assessment should the nurse perform to determine the effectiveness of the medication? Monitor numeric pain scale On admission, the healthcare provider prescribes a broad spectrum antibiotic, ticarcillin, for a client with a gram negative infection. Before administering the first does, it is most important for the nurse to implement which prescription? Complete blood count and serum electrolytes A home health nurse observes a client self-administering an epinephrine injection using an auto-injector pen. Which client action requires intervention by the nurse? Cleanse the injection pen for re-use Which assessment data indicates to the nurse that a client is having an anaphylactic reaction to a medication? Wheezing and dyspnea A client diagnosed with MS who self-administers beta 1 a interferon, reports feeling increasingly depressed. Which action should the nurse implement? Notify the healthcare provider of the findings immediately. 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? CAD A client receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours which is to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5%in water (D5W) 200mL. How many mL/hr should the nurse program the infusion pump to deliver? 200 Before administering a laxative to a bedfast client it is most important for the nurse to perform which assessment? Determine the frequency and consistency of bowel movements. Hormone replacement therapy with 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 of the hormonal agent levothyroxine sodium? Restlessness A male client reports to the nurse that he is experiencing gastrointestinal distress from a high dose of a corticosteroid and is planning to stop taking the medication. In response to the client's statement which nursing action is most important for the nurse to implement? Advise the client that medication should be gradually stopped rather than abruptly. A client is receiving pilocarpine hydrochloride ophthalmic drops for glaucoma. The client calls the clinic nurse and reports difficulty seeing at night. Which explanation should the nurse provide? The eye drops slow pupil response to accommodate for darkness A client is receiving rifampin an antitubercular medication. Which statement by this client should prompt the nurse to notify the healthcare provider of a potential problem? Reports that the sclera are yellow. Which action should the nurse implement to assess the effectiveness of the Calcium channel blocker amlodipine? Measure the client's BP. A male client has been receiving the antibiotic gentamicin sulfate IV piggyback every 12 hours for several days. Which observation by the nurse indicates that the client may be experiencing an adverse effect of gentamicin? Hearing has decreased. An older adult client with restless legs syndrome begins taking melatonin at bedtime. When evaluating the effectiveness of the herb which assessment should the nurse complete? Determine sleep patterns. The nurse prepares to administer a scheduled dose of labetalol by mouth to a client with HTN. The client's V/Signs are temp 99% (37.2*C) heart rate 48 beats/ minute RR 16 breaths/min and BP 150/90 mm/Hg. Which action should the nurse take? Withhold the scheduled dose and notify the healthcare provider. The nurse is planning discharge teaching for a client with DM who has a new prescription for insulin glargine. Which action should the nurse plan to include in the discharge teaching? Teach the client self-injection skills for daily subcutaneous administration. The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and is now prescribed adalimumab. Which instructions should the nurse provide the client? Have a chest x ray prior to your first dose. The nurse provide discharge instructions to a client who has been prescribed gabapentin 300 mg by mouth three times a day for post herpetic neuralgia. Which symptoms should the nurse tell the client to report to the healthcare provider? Gastric irritation To evaluate the effectiveness of a client's prescription for rosuvastatin which action should the nurse implement? Obtain the client's HR, and BP. A client receives a prescription for itraconazole. Which information provided by the client requires additional instruction by the nurse? Take the medication with antacids. The nurse is preparing a client with COPD and chronic productive cough for discharged home. Which prescribed medication should the nurse review with the client to manage this symptom? Guaifenesin When caring for a client with diabetes insipidus who is receiving an antidiuretic hormone intranasally which serum lab test is most important for the nurse to monitor? Osmolality A client is receiving tamsulosin an alpha adrenergic - blocking agent for the management of urinary retention due to benign prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide? Stand and sit up slowly. A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report? Involuntary movements A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication? Body mass index A client who received a renal transplant three months ago is readmitted to the acute care unit with signs of graft rejection. While taking the client's history the nurse determines that the client has been self-administering St. John's wort an herbal preparation on the advice of a friend. Which information is most significant about this finding? St John's Wort can decrease plasma concentrations of cyclosporine When preparing to apply a scheduled fentanyl transdermal patch the nurse notes that the previously applied patch is intact on the client's upper back and the client denies pain. Apply the new patch in a different location after removing the original patch. 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? Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started. Based on a client's serum digoxin level the client is diagnosed with digoxin toxicity. Which action should the nurse expect to implement? Begin cardioversion to stabilize heart rhythm. The nurse administering IV fluconazole to client who has systemic candidiasis. After reviewing the client's diagnostic studies the nurse identifies a rising trend in the liver enzyme levels for aspartate aminotransferase (AST also called SGOT). Which action should the nurse implement? Hold the dose and notify the HCP of the changes in the laboratory studies. A client with muscle spasticity receives a prescription for baclofen. Which information provided by the client requires additional instruction by the nurse? Discontinue when spasms cease. A postoperative client has a prescription for ketorolac 30 mg IV every 6 hours. Which intervention should the nurse implement to determine if the expected outcome of the medication has been achieved? Perform a pain assessment using a numeric scale. A client uses transdermal contraceptive calls to the clinic because she forgot to apply a new patch three days ago. Which instruction should the nurse provide to the client? Apply the new patch today and use a backup method for 7 days. A female client with a history of PUD receives a prescription for misoprostol. Which information provided by the client indicates to the nurse a need for further teaching? Ensure a negative pregnancy test results 2 weeks before therapy. The nurse is caring for an older client with multiple comorbidities. Which medication should the nurse recognize as increasing the client's risk for fractures? Lansoprazole 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? Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started The nurse is preparing a discharge teaching plan for a client who is taking ciprofloxacin hydrochloride tablets which were prescribed because of a suspected anthrax exposure. Which instructions should be included in the teaching plan? Increase fluid intake while taking the medication Limit exposure to sunlight and avoid tanning beds. Report any tendon pain or swelling to the HCP immediately. A client with emphysema is complaining of difficulty breathing and is exhibiting audible wheezing. The nurse administers albuterol as prescribed for the third time within last 12 hours. Which assessment finding warrants immediate intervention by the nurse? Irregular rapid heartbeat The healthcare provider prescribes ceftazidime 1500 mg intravenously (IV) every 12 hours. The available vial is labeled "ceftazidime 1 gram." And the instructions for reconstitution state for IV use add 10 ml sterile water for injection. Concentration after reconstitution 100 mg/ml. How many ml should the nurse administer? 15 The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which V/S should the nurse obtain first? RR The home health nurse observes a client self - administering an epinephrine injection using an auto-injector pen. Which client requires intervention by the nurse? Cleanses the injection pen for re-use. A client has a prescription for clopidogrel bisulfate 75mg by mouth daily at 0900. In which situation should the nurse hold this medication? Elective surgery is scheduled in two hours An adolescent with MDD has been taking duloxetine for the past 12 days. Which assessment finding requires immediate follow up? Describes life as without purpose A male client with a newly diagnosed seizure disorder starts a prescription for clonazepam. One week later the nurse observes that his speech is slurred and he has an ataxic gait. Which action should the nurse implement? Explain the need to refrain from alcohol use while taking the drug. Which assessment data indicates to the nurse that a client is having an anaphylactic reaction to a medication? Wheezing and dyspnea A client with schizophrenia receives a prescription for fluphenazine. Which instruction is most important for the nurse to include when teaching the client about this drug? Notify your HCP immediately if involuntary movements develop Two months after taking nitrofurantoin for a bacterial infection a client reports the onset of severe watery diarrhea to the home health nurse. How should the nurse respond? Determine if the full course of the initial prescription of medication was taken The nurse assesses a client with intermittent claudication who is receiving pentoxifylline. Monitor numeric pain scale A client is taking clonazepam benztropine haloperidol and divalproex. The nurse suspects that the client is experiencing akathisia because the client is rocking back and forth in the chair and having difficulty still. Which medication is most likely to the cause of this condition? HALOperidol The adult client recently has been diagnosed with asthma. Which medication is recommended to treat this problem? Omeprazole daily. Nurse Victoria is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: u Alcohol abuse and smoking Learn More You can also click the terms or definitions to blur or reveal them