HESI-P HESI Pharmacology - Set 3 - Part 1

Correct Answer: Back, soles, palms

Topical corticosteroids absorb poorly from the back, palms, and soles, making these low-permeability sites the safest choice. High-absorption regions like the scalp, face, eyelids, axilla, and perineum risk systemic effects and skin atrophy. Option a is incorrect because the eyelids, axilla, and perineum are high-permeability sites where absorption produces systemic glucocorticoid exposure. Applying steroid cream here risks adrenal suppression and skin atrophy, so the nurse must avoid these areas entirely. Option b is incorrect because scalp, face, and neck are among the most permeable skin regions, allowing rapid systemic uptake. Steroid use here can produce Cushingoid features and skin thinning, which is the opposite of the safety goal stated. Option d is incorrect because groin, neck, and scalp are highly permeable, especially the groin where absorption is greatest. Glucocorticoid-induced atrophy and systemic effects can develop, so these sites must be avoided when low-absorption ap

Correct Answer: Donning clean gloves first

Gloves are donned before any topical medication or patch application to prevent the caregiver from absorbing the medication through skin contact. Hands are also washed thoroughly before and after every administration as part of the standard procedure. Option b is incorrect because warming the medication is not a standard step and does nothing to protect the caregiver from absorbing the drug. The protective step required before contact is wearing gloves to block skin uptake. Option c is incorrect because firm massage is not part of routine topical application and could increase irritation or absorption unpredictably. Sparing thin films with gentle rubbing are taught, but the protective first step is putting on gloves before contact. Option d is incorrect because shaving body hair is not required before applying most topical medications and could disrupt skin integrity. The mandatory protective measure is wearing gloves to prevent absorption through the nurse and caregiver own skin.

Correct Answer: Protect treated areas from direct sunlight

Tacrolimus cream sensitizes the skin to sunlight, so treated areas must be protected from direct sun exposure. The medication also raises risk of varicella zoster infection in children and may increase risk of skin cancer and lymphoma long term. Option a is incorrect because bedtime-only use is not a requirement of tacrolimus cream and ignores the central photosensitivity warning. The priority safety teaching addresses sun protection because treated skin becomes vulnerable to UV-related damage. Option b is incorrect because tacrolimus is a topical cream that is not swallowed, so food and water timing does not apply. The most important teaching is shielding treated skin from direct sunlight because the medication causes sensitization. Option c is incorrect because the chapter does not require refrigeration of tacrolimus cream and storage rules are not the priority teaching point. The photosensitivity warning takes precedence because UV exposure on treated skin can cause harm.

Correct Answer: Tinnitus with hyperpnea

Salicylic acid can be absorbed through skin and cause salicylism, marked by tinnitus, dizziness, hyperpnea, and psychological disturbances. It should not be applied to large surface areas or open wounds, where absorption risk is highest. Option a is incorrect because diarrhea and constipation are not features of salicylism and would not signal systemic toxicity from this topical agent. The hallmark warning signs are tinnitus and hyperpnea along with dizziness, which point to systemic absorption. Option c is incorrect because salicylism produces hyperpnea, not a decreased respiratory rate, because salicylate toxicity stimulates breathing through metabolic effects. Reporting slowed breathing would not match the actual presentation expected with this medication. Option d is incorrect because hair loss and dry mouth are not listed as salicylism findings and would not alert the nurse to systemic toxicity. The defining cluster of symptoms includes tinnitus, dizziness, hyperpnea, and psycholo

Correct Answer: White blood cell count three thousand

Silver sulfadiazine can cause leukopenia, so a white blood cell count of three thousand is the priority concern. The provider must be notified because the medication is usually discontinued when leukopenia develops to prevent further immune compromise. Option b is incorrect because a platelet count of three hundred thousand falls within the normal range and does not match any known adverse effect of silver sulfadiazine. The adverse-effect profile centers on leukopenia, not platelet changes. Option c is incorrect because a magnesium of one point five milliequivalents lies in the normal range and has no link to this antibacterial. Burn-wound monitoring for silver sulfadiazine focuses on complete blood counts that track white blood cells. Option d is incorrect because a glucose of ninety-nine milligrams per deciliter falls within expected limits and signals no priority concern. The chapter directs frequent white blood cell checks because leukopenia is the recognized adverse effect requiri

Correct Answer: Systemic metabolic acidosis effect

Mafenide acetate is a carbonic anhydrase inhibitor that can cause metabolic acidosis, prompting hyperventilation as compensation. The provider must be notified, and the medication is usually washed off and discontinued for one to two days. Option a is incorrect because local pain at the burn site would produce restlessness and grimacing, not the deep rapid breathing pattern of compensatory hyperventilation. The chapter ties hyperventilation specifically to systemic metabolic acidosis from this medication. Option b is incorrect because an allergic reaction would more typically show rash, wheezing, or hives rather than the deep rapid breathing of acidosis compensation. Mafenide acetate is known for triggering metabolic acidosis with hyperventilation, which fits this presentation. Option c is incorrect because hypovolemic shock would present with tachycardia, hypotension, and altered mental status before hyperventilation became the defining feature. The chapter explicitly attributes hyper

Correct Answer: The cream stings every time applied

Silver sulfadiazine does not cause stinging when applied to burn wounds, so a client expecting pain with every application has been misinformed. The medication is a broad-spectrum antibacterial applied directly to the wound to help prevent infection. Option a is incorrect because calling silver sulfadiazine an antibacterial agent is accurate because it covers gram-negative, gram-positive, and yeast organisms. This statement reflects correct understanding and does not need further teaching from the nurse. Option b is incorrect because applying the cream directly to the wound is the correct technique because silver sulfadiazine works at the burn surface to prevent sepsis. This statement reflects accurate teaching and would not be the misconception to correct. Option d is incorrect because saying the cream helps the burn heal is correct because preventing bacterial colonization supports healing. This statement does not need correction; the stinging belief is the inaccurate one requiring f

Correct Answer: Premedicate the client for pain

Mafenide acetate causes local pain and stinging when applied, so the nurse premedicates for pain before application. The medication is then applied as a thin film and the burn is kept covered with mafenide acetate at all times. Option a is incorrect because cooling the burn with ice is not directed before mafenide acetate application and could cause additional tissue injury. The priority action is premedicating for pain because the medication causes local pain when applied. Option c is incorrect because gauze covering happens after the medication is applied as a thin film and is not the priority preparation step. Pain medication must be given first because mafenide acetate causes local pain on contact. Option d is incorrect because applying to dry skin only is not an instruction tied to mafenide acetate, which is spread as a thin film. The action required first is premedicating for pain since mafenide causes local pain on contact.

Correct Answer: Serum triglyceride level

Isotretinoin can elevate serum triglyceride levels, so this lab is measured before treatment and periodically afterward. Alcohol use should also be eliminated during therapy because alcohol can further raise triglycerides while the client is taking isotretinoin. Option a is incorrect because hemoglobin A1C measures average glucose control and is not affected by isotretinoin therapy. The chapter directs triglyceride monitoring because isotretinoin elevates this specific value, not glycemic markers. Option b is incorrect because serum potassium is not affected by isotretinoin and is not the lab the chapter requires before treatment. The targeted lab is triglyceride level because this medication can raise fats in the bloodstream. Option c is incorrect because total cholesterol is not the value flagged for isotretinoin monitoring; the medication specifically affects triglycerides. Cholesterol checks are not the chapter-directed baseline lab for this drug.

Correct Answer: Vitamin A supplement

Isotretinoin is a metabolite of vitamin A, so taking vitamin A supplements concurrently produces generalized intensification of isotretinoin toxicity. Vitamin A supplementation must be discontinued before therapy begins, and the provider should be contacted about this finding. Option b is incorrect because calcium carbonate antacids are not contraindicated with isotretinoin and do not intensify its toxicity. The chapter specifically targets vitamin A supplements as the item to discontinue before starting isotretinoin therapy. Option c is incorrect because iron supplements are not flagged as an interaction with isotretinoin and would not prompt provider contact. The specific concern is vitamin A because isotretinoin itself is derived from vitamin A and creates additive toxicity. Option d is incorrect because a multivitamin without vitamin A would not produce additive toxicity since the targeted ingredient is absent. The vitamin A supplement is the item that must be stopped before isotre

Correct Answer: Apply thirty minutes before sun exposure

Sunscreens are most effective when applied at least thirty minutes before sun exposure so they can penetrate the skin. Reapplication is needed every two to three hours and after swimming or sweating to maintain protection over time. Option a is incorrect because applying right before swimming does not allow enough time for the sunscreen to penetrate the skin. Effective protection requires the thirty-minute lead time so the product can bind to the skin before UV contact. Option b is incorrect because five minutes is too short for chemical sunscreens to penetrate the skin and reach full effectiveness. The chapter directs a minimum thirty-minute interval before sun exposure to allow adequate skin absorption. Option d is incorrect because applying after the first hour outdoors leaves the skin unprotected during initial exposure and defeats the purpose of prevention. Sunscreen must be in place before exposure begins, ideally thirty minutes ahead.

Correct Answer: Itching at the application site

Azelaic acid commonly causes burning, itching, stinging, and redness of the skin, with itching being one of the recognized local adverse effects. It can cause hypopigmentation in clients with darker skin complexions and would be reported to the provider. Option a is incorrect because drowsiness is not a recognized adverse effect of topical azelaic acid, which acts only at the skin level. The expected complaints are local skin reactions like itching, burning, stinging, and redness at the application site. Option b is incorrect because frequent urination is unrelated to topical azelaic acid because the medication does not affect urinary or renal function. The recognized complaints involve the skin where the medication is applied. Option c is incorrect because euphoria is not associated with azelaic acid because the medication acts locally on skin and does not cross into the central nervous system. The expected complaints involve skin sensations like itching.

Correct Answer: Withdraws the NPH insulin first

When mixing insulins, the shortest-acting insulin is drawn into the syringe first to avoid contaminating the regular insulin vial with NPH. The mnemonic is RN: Regular before NPH, then administer the mixed dose within five to fifteen minutes. Option b is incorrect because injecting air into the NPH vial first is correct technique because both vials need air to overcome the vacuum. The error in this scenario is withdrawing NPH first not regular, which contaminates the short-acting insulin. Option c is incorrect because rolling the NPH vial between the palms is correct because NPH is a cloudy suspension that must be evenly mixed. Vigorous shaking creates bubbles, so gentle rolling is the proper preparation step. Option d is incorrect because injecting equal air volumes proportional to each dose into both vials is standard correct technique. The action requiring correction is the sequence of withdrawing NPH before regular insulin, which violates the RN mixing rule.

Correct Answer: Refrigerate the unopened vials

Unopened insulin vials should be refrigerated until needed and can be used up to the expiration date on the vial. Insulin should never be frozen or exposed to direct sunlight, and should be warmed before injection. Option a is incorrect because freezing damages insulin and is explicitly prohibited by the chapter for unopened vials. Refrigeration is the correct method to preserve potency until the expiration date is reached. Option c is incorrect because room temperature storage is only appropriate for an opened vial in use within one month. Unopened vials must be refrigerated for long-term storage to maintain potency. Option d is incorrect because a sunny window exposes insulin to direct sunlight and heat, both of which damage the medication. Unopened vials require refrigeration to preserve the drug for extended periods.

Correct Answer: Before dinnertime later that day

NPH given in the morning peaks six to fourteen hours later, so hypoglycemia is most likely before dinnertime when the intermediate-acting insulin reaches its peak action. Clients should carry a quick source of sugar to treat episodes. Option a is incorrect because regular insulin onset is thirty to sixty minutes, so injection-time hypoglycemia is unlikely immediately after the dose. The peak effect of NPH later in the day creates the actual high-risk window before dinner. Option b is incorrect because two hours after a morning injection falls within regular insulin peak window of one to five hours, but the dinnertime risk from NPH peak is the chapter-cited concern with this combined dosing pattern. Option d is incorrect because overnight hypoglycemia is not the chapter-identified risk for morning-dose NPH and regular insulin combinations. The intermediate-acting peak occurs later that day, producing the late-afternoon to dinnertime hypoglycemia risk.

Correct Answer: NPH insulin

NPH is the only insulin that is a suspension and therefore appears cloudy in the vial, and it must be rolled between the palms before use. All other insulin types are solutions and appear clear in their vials. Option b is incorrect because regular insulin is a short-acting solution that appears clear in the vial and does not require rotation. The cloudy suspension that needs rolling between palms is NPH, not regular insulin. Option c is incorrect because insulin glargine is a long-acting clear solution that cannot be mixed with any other insulin. It is not cloudy and does not require the palm-rolling step that NPH requires before each injection. Option d is incorrect because insulin lispro is a rapid-acting clear solution and does not have the cloudy suspension appearance. NPH is the only insulin in the cloudy category that requires gentle rolling before drawing up.

Correct Answer: Withhold dose and call the provider

Exenatide is an incretin mimetic used for type 2 diabetes only and is not recommended for clients taking insulin. The nurse should withhold the medication and contact the provider to question the prescription before any dose is administered. Option a is incorrect because administering the dose as ordered would be unsafe because exenatide is contraindicated for clients with type 1 diabetes who use insulin. The nurse must withhold and clarify with the provider before any administration. Option b is incorrect because teaching hypoglycemia recognition is a useful general intervention but does not address the immediate safety concern with this prescription. The medication should be withheld and questioned before any client teaching occurs. Option c is incorrect because switching the route is not within nursing scope and does nothing about the central problem that the medication is wrong for type 1 diabetes. Withholding and contacting the provider is the correct first action.

Correct Answer: Skip repaglinide if a meal is missed

Repaglinide is a rapid-acting meglitinide that stimulates pancreatic insulin secretion and is taken about thirty minutes before meals. If the client does not eat, the dose must be withheld because taking it without food would cause hypoglycemia. Option a is incorrect because bedtime dosing is incorrect because repaglinide is taken before each meal, not nightly. The medication stimulates insulin release in response to a meal, so missing food creates hypoglycemia risk that must be prevented by withholding. Option c is incorrect because taking repaglinide one hour after eating misses the timing required for insulin release coordinated with carbohydrate absorption. The medication must be taken thirty minutes before the meal, and skipped if no meal is eaten. Option d is incorrect because linking repaglinide solely to metformin dosing ignores its meal-timed function and creates hypoglycemia risk. The key safety rule is withholding repaglinide whenever the client skips a meal.

Correct Answer: Must always watch for low blood sugar

Metformin does not stimulate insulin release and therefore poses little risk for hypoglycemia, making this statement inaccurate. Metformin is well suited for clients who skip meals, but unusual somnolence may signal lactic acidosis and must be reported. Option a is incorrect because telling the provider about unusual tiredness is correct because somnolence is an early sign of lactic acidosis with metformin. This statement reflects accurate teaching and does not require correction by the nurse. Option b is incorrect because skipping a meal is acceptable with metformin because the medication does not stimulate insulin release and carries little hypoglycemia risk. This statement is correct and does not indicate a knowledge gap. Option d is incorrect because avoiding excessive alcohol is correct because drinking can trigger an adverse reaction when combined with this biguanide. The client demonstrates safe understanding, so no further reinforcement of this alcohol guideline is needed.

Correct Answer: Prednisone added one week ago

Prednisone is a corticosteroid that decreases the effects of oral hypoglycemics, insulin, diuretics, and potassium supplements, leading to hyperglycemia. The other listed medications would not cause this rise and may actually increase hypoglycemia risk in some cases. Option b is incorrect because atenolol is a beta-blocker with intrinsic hypoglycemic activity and can also mask hypoglycemia signs, so it does not produce hyperglycemia. The added prednisone is the corticosteroid that raises blood glucose levels significantly. Option c is incorrect because phenelzine is a monoamine oxidase inhibitor with intrinsic hypoglycemic activity and would not cause hyperglycemia. The newly added prednisone explains the rising fasting blood glucose values in this client scenario. Option d is incorrect because allopurinol decreases urinary excretion of sulfonylurea agents, raising glyburide levels and potentially causing hypoglycemia, not hyperglycemia. The corticosteroid prednisone is the cause behin