HESI RN
HESI Pharmacology Exam 2 Questions
Extract:
Question 1 of 5
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?
Correct Answer: D
Rationale: St. John’s Wort induces liver enzymes, reducing cyclosporine levels, an immunosuppressant critical for preventing transplant rejection. This interaction directly contributes to graft rejection, making it the most significant finding. Sodium intake, corticosteroid needs, or depression treatment are less relevant to the acute issue.
Extract:
History and Physical
The client is a 54-year-old male with a history of hypertension and type 2 diabetes. He takes spironolactone
25 mg per day, metformin 500 mg twice a day, and 25 units of insulin glargine.
Orders
2/18/2021
Prescription for captopril 25mg by mouth twice a day.
4/10/2021
Discontinue spironolactone. Start hydrochlorothiazide 25mg daily.
Question 2 of 5
The nurse notifies the provider that the client is having trouble remembering to take his second dose of captopril. Which ACE inhibitors can be given only once per day? Select all that apply.
Correct Answer: B,C,D
Rationale: Lisinopril, ramipril, and trandolapril have long durations, allowing once-daily dosing, improving adherence for the client. Quinapril and captopril require twice-daily dosing due to shorter half-lives.
Extract:
Nurses Notes
The client is a 26-year-old female with acute appendicitis. She has a 12-year history of type 1 diabetes and no other significant medical history. The appendectomy was completed without issue, and the client will be admitted to the surgical floor to recover.
Laboratory Results
0730
Admitted the client. She is awake and alert. She rates her pain 2/10. Her pulses are equal bilaterally. Heart rate is 76 beats per minute, normal sinus rhythm. Her oxygen saturation is 100% on room air. She has a gauze dressing over her surgical site, which is clean and dry. Her temperature is 98.5° F (37° C). She urinated 50 ml upon arrival in the unit and is stating she is very thirsty. The patient states her last insulin glargine dose was this morning before surgery.
Flow Sheet
0745
2 units insulin lispro given
1800
12 units insulin glargine given
The client ate 45 carbohydrates from her dinner tray. 3 units of insulin lispro given.
Orders
• Admit to the surgical floor
• Dextrose 5% and 0.9% sodium chloride to infuse at 125 mL/hr
• Advance diet as tolerated
• Insulin glargine 12 units subcutaneous every 12 hours
• Ceftriaxone 2 g IV every 24 hours for 3 days, first dose given in surgery
• Insulin lispro 1 unit subcutaneously per 15 carbohydrates
Question 3 of 5
The nurse is preparing the client for discharge and discussing home medications. What home medications may affect the amount of insulin needed by the client? Select all that apply.
Correct Answer: A,B,C,E
Rationale: St. John’s Wort may reduce insulin effectiveness, corticosteroids cause insulin resistance, fluconazole enhances hypoglycemia, and oral contraceptives increase glucose levels, all requiring insulin adjustments. Ibuprofen has minimal impact on glucose control.
Extract:
Question 4 of 5
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?
Correct Answer: A
Rationale: Assessing the client’s pain level using a pain scale provides objective data to determine the appropriate dose and urgency of pain management, guiding safe administration. Diversional strategies, drug history, or prior dose timing are secondary to understanding current pain intensity.
Question 5 of 5
A female client who is a vegetarian has a new prescription for warfarin. The client states she eats leafy green vegetables every day. How should the nurse respond?
Correct Answer: B
Rationale: Warfarin’s anticoagulant effect is reduced by vitamin K, abundant in leafy greens. Informing the healthcare provider about the client’s consistent intake allows for dose adjustments to maintain therapeutic anticoagulation. Replacing vegetables is unnecessary, commending the diet ignores the interaction, and leafy greens may reduce warfarin’s efficacy, not enhance it.