HESI-P HESI Pharmacology - Set 2 - Part 2

Correct Answer: Hold the dose and notify the prescriber

The nurse holds digoxin and notifies the prescriber if the apical pulse is less than sixty beats per minute. Bradycardia signals possible toxicity or excessive effect, and administration of another dose could worsen heart rate to a dangerous degree. Option a is incorrect because administering the dose despite bradycardia ignores the chapter's hold parameter and risks worsening the slowed heart rate. Documentation does not substitute for clinical judgment when a vital sign falls outside the safe threshold. Option b is incorrect because giving a partial dose is not authorized by the chapter and does not address the bradycardia. The hold parameter is binary; the dose is held in full and the prescriber is informed for further direction. Option c is incorrect because rechecking the radial pulse adds time without changing the decision; the apical pulse is the standard for digoxin administration. A radial recheck cannot override the apical finding that triggers the hold parameter for thi

Correct Answer: Gastrointestinal symptoms appear first

Early digoxin toxicity presents with gastrointestinal manifestations including anorexia, nausea, vomiting, and diarrhea before heart rate abnormalities and visual disturbances appear. The nurse recognizes this pattern and assesses the digoxin level promptly to confirm. Option a is incorrect because visual disturbances such as yellow-green halos are real digoxin toxicity signs but appear later than the gastrointestinal symptoms. The sequence places gastrointestinal complaints first, so visual changes are not the earliest indicator to expect. Option b is incorrect because bradycardia and other heart rate abnormalities follow gastrointestinal symptoms in the digoxin toxicity sequence. The earliest warning is anorexia, nausea, vomiting, or diarrhea, which prompts the team to assess the level before cardiac signs develop. Option d is incorrect because hypertension is not part of the classic digoxin toxicity presentation. Digoxin tends to slow the heart rather than raise blood pressure, and

Correct Answer: Hypokalemia and hypomagnesemia

Hypokalemia and hypomagnesemia increase digoxin toxicity risk by altering the electrolyte balance at the cardiac membrane. The nurse monitors potassium and magnesium closely in any client on digoxin, particularly when concomitant therapies promote depletion of either ion. Option a is incorrect because hypernatremia and hyperchloremia are not the electrolyte abnormalities that worsen digoxin toxicity. The chapter is specific that the relevant ions are potassium and magnesium, both of which can be depleted by common diuretics and chemotherapies. Option c is incorrect because hyperphosphatemia and hyperuricemia are not implicated in digoxin toxicity in the chapter. The drug's narrow therapeutic window is affected by potassium and magnesium status, not phosphate or uric acid levels in serum chemistry panels. Option d is incorrect because hyperkalemia would actually reduce digoxin's effect rather than increase toxicity risk. The chapter highlights low potassium and low magnesium a

Correct Answer: One every five minutes; three doses

The home protocol is one sublingual nitroglycerin tablet every five minutes, up to three doses, then activation of emergency services if pain persists. The nurse stresses calling for help promptly after the third dose if relief has not occurred. Option b is incorrect because two tablets at once is not the protocol and can drop blood pressure sharply. The sequence is spaced over five-minute intervals so the client can monitor response and avoid the hemodynamic effect of stacking. Option c is incorrect because fifteen-minute intervals are too long for chest pain that may represent an evolving myocardial infarction. The chapter calls for five-minute intervals and a hard stop at three doses before contacting emergency services. Option d is incorrect because taking three tablets at once magnifies hypotensive risk and bypasses staged evaluation between doses. The protocol is sequential, with each dose given only if the prior failed, and three is the maximum in fifteen minutes.

Correct Answer: Tablets may expire within six months

The chapter instructs the client to check the expiration date because sublingual nitroglycerin tablets may expire within six months. Expired tablets will not relieve chest pain, so the client is taught to obtain a fresh supply on schedule. Option a is incorrect because a two-year shelf life does not match the chapter; sublingual nitroglycerin loses potency much more quickly. Clients who assume long shelf life can be caught with ineffective tablets during a genuine angina attack at home. Option b is incorrect because refrigeration is not how the chapter directs storage of sublingual nitroglycerin tablets. The tablets are kept in their original container away from heat and light, and refrigeration does not extend their useful life as written. Option c is incorrect because heat and light impact nitroglycerin tablet potency, which is why the chapter specifies an opaque container and routine expiration checks. Saying these factors have no impact would mislead the client and risk an ineffect

Correct Answer: Sulfa drug allergy history

Hydrochlorothiazide is sulfa-based, so a sulfa drug allergy must be assessed before the first dose. The nurse asks specifically about prior reactions to sulfonamide antibiotics and notifies the prescriber if such a history is identified by the client. Option a is incorrect because iodine contrast allergy is relevant to radiology procedures and certain other drugs, not to this thiazide diuretic specifically. The chapter ties hydrochlorothiazide's allergy concern to the sulfonamide chemical class rather than to iodine. Option b is incorrect because latex sensitivity affects glove and equipment choices but is not the chemical concern with hydrochlorothiazide. The drug's molecular structure places it in the sulfa family, and that is what drives the pre-administration screening question. Option d is incorrect because egg or chicken allergy is relevant to certain vaccines such as influenza, not to hydrochlorothiazide. The chapter is specific that the diuretic's allergy concern

Correct Answer: Push slowly over one to two minutes

Intravenous furosemide is administered slowly over one to two minutes to prevent ototoxicity and hearing loss. The nurse also monitors for tinnitus and difficulty hearing as warning signs that the rate may have been too rapid for this client. Option b is incorrect because pushing as fast as the line allows ignores the documented risk of ototoxicity with rapid furosemide. The chapter is explicit about slow administration, and a fast push can produce permanent hearing damage in vulnerable clients. Option c is incorrect because running the dose over thirty seconds falls below the recommended one to two minute window. Even a brisk push of less than a minute increases ototoxicity risk, so the chapter sets the lower boundary higher. Option d is incorrect because bolus administration of the entire dose at once is what the chapter prohibits for intravenous furosemide. The slow push is the protective measure against the drug's known auditory toxicity in clients receiving high-dose loop diu

Correct Answer: Cough often subsides; do not discontinue

A persistent dry cough is a common complaint with angiotensin-converting enzyme inhibitors and often subsides after a few weeks. The nurse instructs the client not to discontinue the medication and to discuss persistent cough with the prescriber at follow-up. Option a is incorrect because stopping the medication independently leaves hypertension untreated and may not be necessary if the cough resolves. The chapter advises informing the prescriber not discontinuing on the client's own initiative without clinical evaluation of the symptom. Option c is incorrect because a pulmonary embolism would typically present with sudden onset, pleuritic pain, and respiratory distress, not an isolated dry cough tied to a new prescription. The chapter attributes this cough pattern to angiotensin-converting enzyme inhibitors. Option d is incorrect because ignoring the cough without communication misses an opportunity to alert the prescriber and consider alternative agents if it persists. The chapt

Correct Answer: Hyperkalemia from combined effects

Combining an angiotensin-converting enzyme inhibitor with a potassium-sparing diuretic increases hyperkalemia risk because both drugs retain potassium. The nurse monitors serum potassium closely and teaches the client to avoid potassium supplements and salt substitutes during this regimen. Option a is incorrect because hyponatremia from fluid retention is not the dominant electrolyte concern with this drug pairing. The chapter highlights the cumulative potassium effect, which moves serum potassium upward and creates the risk requiring monitoring not sodium effects. Option b is incorrect because hypocalcemia is not the relevant electrolyte risk with angiotensin-converting enzyme inhibitor and spironolactone combination. The chapter identifies hyperkalemia as the predictable interaction, since both agents reduce potassium excretion through different mechanisms in the kidney. Option c is incorrect because hypoglycemia is not the metabolic concern of this combination, which acts on the ren

Correct Answer: Eat potassium-rich fruits and vegetables

The nurse teaches the client to consume potassium-rich foods such as fruits, vegetables, and potatoes to offset the diuretic's depleting effect. Adequate dietary potassium reduces the risk of hypokalemia and supports cardiac stability during ongoing thiazide therapy. Option a is incorrect because reducing dietary potassium would worsen the hypokalemia already promoted by the thiazide. The chapter teaches the opposite: increase potassium-rich foods to compensate for renal losses driven by the diuretic during ongoing therapy. Option b is incorrect because limiting intake only to water between meals does not address the potassium-specific issue the chapter highlights. Hydration is helpful but does not replace the electrolyte; potassium-rich foods are the targeted teaching for this client. Option d is incorrect because avoiding leafy greens removes a key potassium source the chapter specifically encourages with thiazide therapy. The teaching is to include potassium-rich produce, not e

Correct Answer: Bronchospasm in asthma clients

Beta-blockers cause bronchospasm in asthma clients by blocking beta-2 receptors in the airway. The nurse questions the order and may suggest a cardioselective alternative that has less effect on bronchial smooth muscle for this client with reactive airways. Option b is incorrect because hypertensive crisis would not be the expected effect when an antihypertensive is added; the drug lowers not raises blood pressure. The chapter ties the asthma concern to airway bronchospasm specifically, not to blood pressure spikes. Option c is incorrect because severe diarrhea is not a class effect of beta-blockers and is not the chapter's flagged concern. The airway risk is specific to beta-2 blockade in bronchial smooth muscle, which contracts the airways in asthma clients. Option d is incorrect because urinary retention belongs to anticholinergic drug classes, not to beta-blockers. The chapter's concern in an asthmatic client receiving a beta-blocker is airway constriction, which is unrel

Correct Answer: The drug masks hypoglycemia symptoms

Beta-blockers mask the early adrenergic symptoms of hypoglycemia such as tachycardia and tremor, leaving the diabetic client without the usual warning signs. The nurse teaches close glucose monitoring so low values are caught before serious symptoms develop. Option a is incorrect because raising blood sugar markedly is not a class effect of beta-blockers and would be the opposite concern. The flagged risk is the symptom-masking effect that hides falling glucose, not a rise in serum glucose values. Option b is incorrect because worsening insulin absorption is not the mechanism the chapter highlights for this combination. Beta-blockers interfere with the recognition of hypoglycemia by blocking sympathetic warning signs, rather than altering how insulin is taken up. Option c is incorrect because speeding insulin clearance is not the chapter's described interaction. The clinical risk is that the client may not notice an episode of low blood glucose because the adrenergic alarm symptom

Correct Answer: Peripheral edema, constipation, bradycardia

Calcium channel blockers cause peripheral edema, constipation, bradycardia, and atrioventricular conduction delays. The nurse anticipates these effects and teaches the client to report new ankle swelling, severe constipation, or unusual fatigue from a slowed heart rate. Option a is incorrect because bronchospasm and dry cough match beta-blocker and angiotensin-converting enzyme inhibitor profiles, respectively, not calcium channel blockers. The chapter's calcium channel blocker profile centers on edema and conduction effects rather than on airway or cough symptoms. Option c is incorrect because hyperglycemia belongs to thiazide diuretics and some bronchodilators rather than to amlodipine or related agents. Glucose elevation is not a prominent side effect for this class, so teaching focused on it would mislead the client. Option d is incorrect because tinnitus belongs to loop diuretic and aspirin toxicity profiles, and photosensitive rash belongs to sulfonamides and amiodarone. The

Correct Answer: Unexplained muscular pain

The nurse teaches the client to report any unexplained muscle pain immediately because statins carry a risk of myopathy and rhabdomyolysis. Annual eye exams are also recommended to monitor for cataract development during long-term statin therapy. Option a is incorrect because a chronic head cold is not the warning sign the chapter highlights for statin therapy. The serious adverse effect to teach about is muscle pain because it can signal rhabdomyolysis, unrelated to upper-respiratory symptoms. Option b is incorrect because a persistent runny nose is not connected to statin safety monitoring. The specific symptom the nurse teaches about is muscle pain, which can indicate myopathy or rhabdomyolysis requiring prompt evaluation and possible dose change. Option d is incorrect because mild seasonal hay fever symptoms are unrelated to statin toxicity surveillance. The chapter is specific about muscle pain as the priority symptom, since it marks the early phase of the class's skeletal mu

Correct Answer: Pulmonary fibrosis, blue skin, corneal deposits

Amiodarone causes pulmonary fibrosis, blue skin discoloration, corneal deposits, hypothyroidism, photosensitivity, and QT prolongation with torsades risk. The nurse monitors lung function, skin and eye changes, thyroid panel, and the QT interval on the electrocardiogram. Option b is incorrect because this profile mixes anticholinergic and bronchodilator effects that do not match amiodarone toxicity. The chapter assigns amiodarone a distinct multi-organ toxicity pattern with lung, skin, eye, and thyroid components, none of which match this list. Option c is incorrect because hypoglycemia, ototoxicity, photophobia, and tinnitus describe a mix of effects from diuretics, aminoglycosides, and other drug classes. None of these match the chapter's amiodarone profile, which centers on lung, skin, eye, thyroid, and conduction findings. Option d is incorrect because severe diarrhea and gum hyperplasia are not amiodarone effects, and the chapter does not pair fever and rash with this drug. T

Correct Answer: An acidic urine pH for efficacy

Methenamine requires acidic urine, with a pH at or below five and a half, to be effective. High fluid intake reduces the drug's antibacterial effect by diluting it and raising the urine pH, so excessive water intake is avoided. Option a is incorrect because a neutral urine pH is not the condition under which methenamine is active. The drug releases its antibacterial action only in acidic urine, so the chapter directs the team to maintain that specific condition. Option b is incorrect because an alkaline urine pH inactivates methenamine rather than supporting its action. The chapter is explicit that the drug requires acidic conditions, so alkalinizing agents and antacids that raise urine pH are avoided during therapy. Option c is incorrect because extremely high urine output dilutes methenamine concentration and raises urine pH, both of which reduce efficacy. The chapter cautions against excessive fluid intake on this drug because of those two effects rather than recommending it.

Correct Answer: Brown urine is a harmless drug effect

Brown urine is a harmless effect of nitrofurantoin and does not require stopping the medication. The nurse reassures the client and continues to monitor for the more serious pulmonary reaction, which would present with cough, fever, and dyspnea. Option a is incorrect because stopping nitrofurantoin for a brown urine color alone would interrupt antibiotic therapy without cause. The chapter classifies this color change as harmless, and discontinuation should be reserved for genuine adverse effects such as pulmonary symptoms. Option b is incorrect because renal failure presents with changes in urine output, lab values such as creatinine, and systemic findings, not isolated color change tied to an antibiotic. The brown tint here is a known harmless effect of nitrofurantoin. Option d is incorrect because increasing water intake will not change the drug's color effect and is not the recommended action. The chapter directs the nurse to reassure the client not alter fluid intake based on

Correct Answer: Withhold drug, notify the prescriber

Sulfonamides can produce a range of hypersensitivity reactions including Stevens-Johnson syndrome, so the nurse withholds the drug and notifies the prescriber when a rash appears. Continuing therapy could allow a serious cutaneous reaction to evolve rapidly. Option a is incorrect because applying topical steroid and continuing the drug ignores the possibility that a rash may herald a severe hypersensitivity reaction. The chapter directs the nurse to withhold the medication and inform the prescriber not mask it. Option c is incorrect because ignoring the rash because vital signs are stable misjudges the trajectory of sulfonamide hypersensitivity reactions, which can escalate quickly. The chapter is explicit about withholding the drug and notifying the prescriber at the first rash. Option d is incorrect because reducing the dose and proceeding without prescriber input does not address the hypersensitivity risk the rash signals. The correct response is to stop administration and let the p

Correct Answer: Urine turns reddish-orange and stains clothing

Phenazopyridine causes a reddish-orange discoloration of urine and can stain clothing, tears, and contact lenses. The drug also interferes with glucose and ketone urine testing, so the nurse alerts diabetic clients to alternate testing methods if needed. Option b is incorrect because clear and odorless urine is not the expected effect of phenazopyridine, which is known specifically for producing a striking reddish-orange tint. The chapter warns clients to expect the color change so they are not alarmed. Option c is incorrect because dark blue or green discoloration is not the phenazopyridine pattern; the drug produces reddish-orange color. Blue or green tints can occur with other drug classes, but they do not match the chapter's description here. Option d is incorrect because no color or odor changes contradicts the well-known cosmetic effect the chapter teaches. Failure to warn the client risks alarm when the reddish-orange tint appears and may lead to staining of fabrics and len

Correct Answer: Continue antibiotic; phenazopyridine relieves pain only

Phenazopyridine is an analgesic only and does not treat infection. The client must continue the antibiotic to clear bacteria, even if the burning and urgency are improving from the analgesic effect alone. Option a is incorrect because stopping the antibiotic because pain has eased misunderstands phenazopyridine's role and leaves infection untreated. Bacteria persist regardless of analgesic relief, and stopping early invites worsening infection or resistant organisms. Option b is incorrect because increasing phenazopyridine to replace the antibiotic is dangerous because the drug treats symptoms, not infection. The chapter is explicit that analgesic urinary agents do not eradicate bacteria, so substitution leaves infection untreated. Option c is incorrect because switching antibiotics is a prescriber decision based on culture results, not a response to symptomatic improvement from the analgesic. The current antibiotic remains appropriate unless culture data justify a change, regardl