HESI RN
HESI Pharmacology Practice Exam
1. Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?
- A. Discontinuation of warfarin sodium (Coumadin)
- B. A decrease in the warfarin sodium (Coumadin) dosage
- C. An increase in the warfarin sodium (Coumadin) dosage
- D. A decrease in the usual dose of nalidixic acid (NegGram)
Correct answer: B
Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma proteins. When an oral anticoagulant, like warfarin sodium (Coumadin), is combined with nalidixic acid, a decrease in the anticoagulant dosage may be necessary to avoid excessive anticoagulation and potential bleeding risks. Therefore, the correct action for the nurse to anticipate in this situation is a decrease in the warfarin sodium (Coumadin) dosage. Choice A is incorrect because discontinuing warfarin sodium abruptly can lead to thrombosis or embolism. Choice C is incorrect as increasing the warfarin sodium dosage can potentiate the anticoagulant effect, leading to bleeding complications. Choice D is incorrect as reducing the dose of nalidixic acid would not directly address the interaction with warfarin sodium.
2. A 30-year-old male client reports difficulty sleeping due to anxiety about his upcoming surgery. What intervention would be most appropriate for the nurse to suggest?
- A. Suggest taking a mild sedative before bed.
- B. Encourage physical activity before bedtime.
- C. Advise listening to calming music before bed.
- D. Recommend reading a book before bed.
Correct answer: A
Rationale: The most appropriate intervention for the nurse to suggest to a 30-year-old male client experiencing difficulty sleeping due to anxiety about his upcoming surgery is to recommend taking a mild sedative before bed. A mild sedative can help manage anxiety and improve sleep in such situations. Encouraging physical activity before bedtime, advising to listen to calming music, or recommending reading a book may not directly address the client's anxiety and may not be as effective in promoting sleep in this scenario.
3. To evaluate the effectiveness of cognitive-behavioral techniques, which client outcomes should the nurse include in the plan of care?
- A. Relates insights into problematic relationships
- B. Demonstrates a healthy relationship with her husband
- C. Describes how the family can resolve problems
- D. Changes thought patterns related to problem-solving
Correct answer: D
Rationale: The correct answer is D. Cognitive-behavioral therapy focuses on changing thought patterns by guiding the client to engage in problem-solving strategies to address the current situation. This approach helps individuals modify negative thinking patterns and develop more adaptive ways to cope with challenges. Choices A, B, and C are incorrect because while they may be important aspects to consider in therapy, the primary focus in cognitive-behavioral therapy is on identifying and changing negative thought patterns rather than exploring relationships or family problem-solving skills.
4. Which assessment data would provide the most accurate determination of proper placement of a nasogastric tube?
- A. Aspirating gastric contents to assure a pH value of 4 or less.
- B. Hearing air pass in the stomach after injecting air into the tubing.
- C. Examining a chest x-ray obtained after the tubing was inserted.
- D. Checking the remaining length of tubing to ensure that the correct length was inserted.
Correct answer: C
Rationale: The most accurate method to confirm the proper placement of a nasogastric tube is by examining a chest x-ray obtained after the tubing was inserted. This visual assessment allows healthcare providers to directly visualize the position of the tube in relation to anatomical landmarks, ensuring it is correctly placed in the stomach. Aspirating gastric contents or hearing air pass may provide some information but are not as definitive as a chest x-ray for confirming placement. Checking the remaining length of tubing is not a reliable method for determining proper placement as it does not indicate where the tip of the tube lies within the body.
5. A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. What action should the nurse instruct the patient to perform?
- A. Increase fluid intake.
- B. Take diphenhydramine.
- C. Stop taking TMP-SMX immediately.
- D. Continue taking the medication.
Correct answer: C
Rationale: When a patient develops an all-over rash while taking trimethoprim-sulfamethoxazole (TMP-SMX), it may indicate a serious drug reaction. In this case, the patient should stop taking the medication immediately and notify their healthcare provider. Increasing fluid intake (Choice A) may be beneficial in some cases but is not the priority when a serious drug reaction is suspected. Taking diphenhydramine (Choice B) may help with itching but does not address the underlying issue of a potential drug reaction. Continuing the medication (Choice D) is not advisable when a serious adverse reaction such as a widespread rash occurs.