HESI LPN
Pharmacology HESI 2023
1. When a client with hepatic encephalopathy is receiving lactulose, which parameter is essential to monitor for a response to the drug?
- A. Serum hepatic enzymes
- B. Fingerstick glucose
- C. Stool color and character
- D. Serum electrolytes and ammonia
Correct answer: D
Rationale: In hepatic encephalopathy, the goal of lactulose therapy is to reduce blood ammonia levels by promoting its excretion in the stool. Therefore, monitoring serum electrolytes and ammonia levels is crucial to assess the effectiveness of lactulose in lowering ammonia levels and improving the client's condition. Options A, B, and C are incorrect because serum hepatic enzymes, fingerstick glucose, and stool color/character are not directly related to monitoring the response to lactulose therapy in hepatic encephalopathy.
2. A client with a history of atrial fibrillation is prescribed digoxin. The nurse should monitor for which sign of digoxin toxicity?
- A. Bradycardia
- B. Tachycardia
- C. Nausea
- D. Vomiting
Correct answer: A
Rationale: Bradycardia is a common sign of digoxin toxicity. Digoxin, a medication used to treat atrial fibrillation, can lead to toxicity manifesting as various cardiac dysrhythmias, with bradycardia being a notable indicator. Monitoring for bradycardia is crucial as it can indicate the need for dosage adjustment or discontinuation of digoxin to prevent adverse effects. Tachycardia, nausea, and vomiting are not typically associated with digoxin toxicity, making them incorrect choices for monitoring in a client receiving this medication.
3. A client is prescribed phenytoin for the management of seizures. What instruction should the practical nurse provide to the client regarding this medication?
- A. Take the medication at the same time every day.
- B. Discontinue the medication if a rash develops.
- C. Avoid consuming dairy products.
- D. Monitor blood pressure regularly.
Correct answer: A
Rationale: The correct instruction the practical nurse should provide to the client regarding phenytoin is to take the medication at the same time every day. This consistency helps maintain a steady level of the medication in the bloodstream, which is crucial for effectively managing seizures. It is important for clients to adhere to their prescribed dosing schedule to optimize the therapeutic benefits of phenytoin. Choices B, C, and D are incorrect because discontinuing the medication without healthcare provider guidance can be dangerous, there is no specific interaction between phenytoin and dairy products, and monitoring blood pressure is not a primary concern with phenytoin therapy for seizures.
4. A client with epilepsy is prescribed lamotrigine. The nurse should monitor for which potential side effect?
- A. Drowsiness
- B. Nausea and vomiting
- C. Skin rash
- D. Dizziness
Correct answer: C
Rationale: When a client is prescribed lamotrigine, the nurse should closely monitor for the potential side effect of skin rash. Lamotrigine is known to cause skin rashes, which can be mild or severe, indicating a serious adverse reaction like Stevens-Johnson syndrome. Monitoring for skin rash is crucial to detect any signs of severe allergic reactions early and prevent further complications. Choices A, B, and D are incorrect as drowsiness, nausea and vomiting, and dizziness are not typically associated with lamotrigine use. While dizziness can be a side effect of some antiepileptic medications, it is not a common side effect of lamotrigine.
5. A 6-month-old infant is prescribed digoxin for the treatment of congestive heart failure. Which observation by the practical nurse (PN) warrants immediate intervention for signs of digoxin toxicity?
- A. Apical heart rate of 60 beats/min
- B. Sweating across the forehead
- C. Poor sucking effort
- D. Respiratory rate of 30 breaths/min
Correct answer: A
Rationale: A heart rate of 60 beats/min for a 6-month-old infant warrants immediate intervention as it falls below the normal range. The normal heart rate for a 6-month-old is 80 to 150 beats/min when awake, and a rate of 70 beats/min while sleeping is considered within normal limits. Bradycardia (heart rate <60 beats/min) in infants can be a sign of digoxin toxicity, necessitating prompt evaluation and intervention to prevent adverse effects. Sweating across the forehead (Choice B) is a non-specific symptom and may not directly indicate digoxin toxicity. Poor sucking effort (Choice C) and a respiratory rate of 30 breaths/min (Choice D) are not typically associated with digoxin toxicity and do not require immediate intervention in the context of this question.
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