HESI RN
HESI Bsn 225 RN Pharmacology Questions
Extract:
History and physical
POD 5
1015
The client is alert and oriented. Rates her pain a 3 on a 0 to 10 pain scale. The client says that she has fullness in her abdomen. Heart sounds are regular and rhythmic. Pulses 1+ in all extremities and equal. Her last bowel movement was POD 2. Healthcare provider notified. The client voided 150 mL of urine.
1100
Bisacodyl suppository given as prescribed.
Reported slight rectal burning when administered.
Nurses notes
POD 5
1015
The client is alert and oriented. Rates her pain a 3 on a 0 to 10 pain scale. The client says that she has fullness in her abdomen. Heart sounds are regular and rhythmic. Pulses 1+ in all extremities and equal. Her last bowel movement was POD 2. Healthcare provider notified. The client voided 150 mL of urine.
1100
Bisacodyl suppository given as prescribed.
Reported slight rectal burning when administered.
1200
Rates her pain a 7 on a 0 to 10 pain scale. Pulses 1+ in all extremities and equal. Morphine given as prescribed. She asked to use the restroom but felt dizzy. Voided 600 mL urine in the bedpan.
Flowsheet
Vital Signs
POD 5
1015
Temperature 97.2° F (36.2° C) orally
Heart rate 77 beats/minute
Respiratory rate 14 breaths/minute
Blood pressure 119/75 mm Hg
1200
• Temperature 97° F (36.1° C) orally
Question 1 of 5
Review H and P, nurse's notes, flow sheet, and prescriptions. Mark whether the assessment finding represents a therapeutic result of the lactulose administered, a non-therapeutic side-effect, or an unrelated finding. Each row must have only one option selected.
| Options | Therapeutic result | Non therapeutic side effect | Unrelated finding |
|---|---|---|---|
| Reported slight rectal burning sensation: Non-therapeutic side effect | |||
| Large, soft stool: Therapeutic result | |||
| Dizziness: Non-therapeutic side effect | |||
| Pain level of 3 on a 0 to 10 pain scale: Unrelated finding | |||
| 600ml of urine: Unrelated finding | |||
| Abdomen soft and flat: Unrelated finding | |||
| Respiratory rate 13 breaths/min: Unrelated finding |
Correct Answer:
Rationale: The question refers to bisacodyl, not lactulose. A: Rectal burning is a bisacodyl side effect. B: Soft stool is the therapeutic effect. C: Dizziness may relate to morphine, not bisacodyl. D, E, F, G: Pain, urine output, abdomen, and respiratory rate are unrelated to bisacodyl.
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Question 2 of 5
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Question 3 of 5
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Question 5 of 5
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