Question

The nurse is reviewing a client's medical history and notes that the client has been diagnosed with peptic ulcer disease. Which medication has most likely been prescribed for this client?

Answer 1

Correct Answers:

Aluminium hydroxide.

Rationale :

💊 Aluminium hydroxide is an antacid that can be used to relieve symptoms associated with peptic ulcer disease (PUD).

💊 It works by neutralizing gastric hydrochloric acid, thereby increasing the pH of stomach contents.

💊 Reducing gastric acidity decreases irritation of the gastric and duodenal mucosa and can relieve epigastric pain and heartburn.

💊 Antacids can provide relatively rapid symptomatic relief, although they do not address the underlying cause of most peptic ulcers.

💊 Current treatment of PUD commonly includes proton pump inhibitors (PPIs), particularly when acid suppression and ulcer healing are required.

💊 Clients with Helicobacter pylori infection typically require antibiotic therapy combined with acid suppression to eradicate the infection and promote healing.

💊 Aluminium-containing antacids can cause constipation, which the nurse should assess for and include in client teaching.

💊 Among the medications listed, aluminium hydroxide is the medication most directly associated with reducing gastric acidity and relieving symptoms of peptic ulcer disease.

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Answer 2

Correct Answers:

Improved level of consciousness.
Decreasing serum ammonia.
Increased bowel movements.

Rationale :

🧠 Improved level of consciousness — CORRECT

🧠 Lactulose is used in clients with liver failure to prevent or treat hepatic encephalopathy.

🧠 Liver failure reduces the liver's ability to metabolize ammonia, allowing ammonia to accumulate in the bloodstream.

🧠 Elevated ammonia can cross the blood-brain barrier and contribute to confusion, altered behavior, lethargy, and decreased level of consciousness.

🧠 Lactulose helps trap ammonia in the colon by converting ammonia (NH₃) into less absorbable ammonium (NH₄⁺).

🧠 Trapped ammonium is then eliminated through the stool, reducing systemic ammonia exposure.

🧠 As ammonia levels decrease, manifestations of hepatic encephalopathy should improve.

🧠 Improved orientation, alertness, cognition, and level of consciousness therefore indicate a therapeutic response.

🧠 Neurologic improvement is an important clinical indicator that lactulose is effectively controlling hepatic encephalopathy.

🧠 Decreasing serum ammonia — CORRECT

🧠 One of the primary purposes of lactulose in liver failure is to reduce ammonia absorption from the gastrointestinal tract.

🧠 Lactulose reaches the colon where intestinal bacteria metabolize it into organic acids.

🧠 Acidification of the colon converts absorbable ammonia into poorly absorbed ammonium ions.

🧠 Ammonium remains primarily within the intestinal lumen and is eliminated in feces.

🧠 This mechanism decreases the amount of ammonia entering the systemic circulation.

🧠 A declining serum ammonia level supports the medication's intended ammonia-lowering effect, although clinical neurologic status is also essential to assess.

🧠 Reduced ammonia exposure helps decrease manifestations such as confusion, altered consciousness, and asterixis.

🧠 Therefore, decreasing serum ammonia together with clinical improvement indicates an effective response to lactulose therapy.

🧠 Increased bowel movements — CORRECT

🧠 Lactulose is a nonabsorbable disaccharide that also acts as an osmotic laxative.

🧠 It draws water into the colon, producing softer and more frequent stools.

🧠 Increased stool elimination helps remove trapped ammonium from the gastrointestinal tract.

🧠 Treatment for hepatic encephalopathy is commonly titrated to produce approximately 2 to 3 soft stools daily.

🧠 Adequate bowel movements indicate that lactulose is reaching the colon and producing its intended gastrointestinal effect.

🧠 Excessive diarrhea is not desirable because it can cause dehydration and electrolyte abnormalities.

🧠 The nurse should monitor stool frequency and consistency while also assessing fluid and electrolyte status.

🧠 Appropriate increased bowel movements therefore support effective ammonia elimination and improvement of hepatic encephalopathy.

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Answer 3

Correct Answers:

Explain to the client that the two tablets of 125 mcg is the same dose as one pill of 250 mcg.
Administer the medication as prescribed, but closely monitor client for possible dosing adjustments.

Rationale :

💗 Explain that two 125 mcg tablets equal one 250 mcg tablet — CORRECT

💗 The nurse should first address the client's concern by explaining that the total prescribed dose has not changed.

💗 Two tablets containing 125 mcg each equal 250 mcg because 125 mcg × 2 = 250 mcg.

💗 The number of tablets administered can vary depending on the strength of the tablets supplied by the pharmacy.

💗 A client may receive one 250 mcg tablet at home while the healthcare facility stocks 125 mcg tablets.

💗 Medication administration is based on the total prescribed dose, rather than simply the number of tablets.

💗 Providing this explanation promotes the client's understanding and supports the client's right to question medications before taking them.

💗 The nurse should verify the medication prescription and available tablet strength before administration as part of safe medication practice.

💗 Explaining the equivalent dosage resolves the discrepancy without incorrectly suggesting that the client's prescribed digoxin dose has changed.

💗 Administer the medication as prescribed, but closely monitor the client for possible dosing adjustments — CORRECT

💗 Once the nurse confirms the prescription for digoxin 250 mcg, administering two 125 mcg tablets provides the prescribed dose.

💗 The nurse should assess the client's apical pulse for 1 full minute before administering digoxin.

💗 Digoxin is generally withheld and the healthcare provider notified when the adult client's apical pulse is below 60 beats/minute, according to the prescription and facility protocol.

💗 Older adults require careful monitoring because changes in renal function can increase the risk of digoxin accumulation and toxicity.

💗 The nurse should monitor for toxicity manifestations such as nausea, vomiting, anorexia, weakness, confusion, bradycardia, and dysrhythmias.

💗 Visual disturbances such as blurred vision or yellow-green vision can also indicate digoxin toxicity.

💗 Potassium levels and renal function are important because hypokalemia can increase sensitivity to digoxin and increase toxicity risk.

💗 Administering the verified prescribed dose while appropriately monitoring the client therefore represents safe medication administration.

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Answer 4

Correct Answers:

Low sodium antacid.

Rationale :

💙 Antacids neutralize gastric acid and can provide relatively rapid relief of occasional heartburn and acid indigestion.

💙 The client's symptoms occurring when lying down after dinner are consistent with gastroesophageal reflux, because the supine position facilitates reflux of gastric contents into the esophagus.

💙 A client with heart failure (HF) should avoid antacids containing large amounts of sodium because excess sodium promotes fluid retention.

💙 Fluid retention can increase circulating volume and cardiac workload, potentially worsening heart failure.

💙 Excess fluid accumulation can contribute to peripheral edema, pulmonary congestion, weight gain, and dyspnea.

💙 A low-sodium antacid is therefore preferable when an OTC antacid is being considered for a client with heart failure.

💙 The nurse should encourage consultation with the healthcare provider before regular OTC medication use because antacids can interact with other medications and persistent heartburn requires evaluation.

💙 Additional measures such as avoiding lying down for 2 to 3 hours after eating, eating smaller meals, and elevating the head of the bed can also decrease reflux symptoms.

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Answer 5

Correct Answers:

Fentanyl

Rationale :

💜 Fentanyl is a potent opioid analgesic commonly used to manage severe chronic cancer pain, including pain requiring palliative or hospice management.

💜 A major advantage of fentanyl is that it can be administered transdermally, providing continuous systemic analgesia over an extended period.

💜 Transdermal fentanyl can be especially useful when clients have difficulty swallowing or need consistent management of persistent pain.

💜 Fentanyl undergoes primarily hepatic metabolism, but unlike some opioids it does not produce clinically significant active metabolites that accumulate with renal dysfunction.

💜 The dose must still be used cautiously in clients with significant hepatic impairment, because liver dysfunction can alter drug metabolism and increase opioid effects.

💜 Transdermal fentanyl is generally appropriate for clients who are opioid tolerant and require continuous opioid therapy, rather than opioid-naïve clients with acute pain.

💜 The nurse should monitor for sedation, respiratory depression, hypotension, constipation, and altered mental status during opioid therapy.

💜 In hospice care, the primary objective is comfort and quality of life, making a potent long-acting opioid such as fentanyl a likely medication for appropriately selected clients with advanced metastatic cancer.

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Answer 6

Correct Answers:

Psyllium hydrophilic should be taken with a full glass of water.

Rationale :

🌾 Psyllium is a bulk-forming laxative that absorbs water in the intestine and increases the size and moisture content of stool.

🌾 Adequate fluid is essential because psyllium must absorb water to form a soft, bulky stool that can move through the colon more easily.

🌾 Each dose should be mixed with and followed by an adequate amount of fluid, generally at least 8 oz (240 mL) of water, unless fluids are restricted.

🌾 Taking psyllium with insufficient fluid can cause the medication to swell before reaching the stomach, increasing the risk of choking or esophageal obstruction.

🌾 Adequate hydration also reduces the risk of intestinal obstruction or fecal impaction associated with bulk-forming laxatives.

🌾 Psyllium can be useful for clients with diverticulosis because maintaining soft, regular stools helps reduce constipation and excessive straining.

🌾 The client should take psyllium exactly as directed and maintain adequate daily fluid intake unless contraindicated by another medical condition.

🌾 Therefore, taking psyllium with a full glass of water is one of the most important safety instructions for this medication.

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Answer 7

Correct Answers:

Urinary output equals intake.

Rationale :

🚻 Bethanechol is a direct-acting cholinergic (muscarinic) agonist used to treat nonobstructive urinary retention.

🚻 It stimulates muscarinic receptors in the urinary bladder, producing contraction of the detrusor muscle.

🚻 Detrusor contraction increases bladder tone and promotes bladder emptying.

🚻 Effective bladder emptying results in an increase in spontaneous urinary output and a reduction in retained urine.

🚻 When urinary output appropriately corresponds with fluid intake, this indicates that the client is eliminating urine effectively rather than retaining it.

🚻 The nurse can also evaluate effectiveness by assessing for decreased bladder distention and reduced postvoid residual urine.

🚻 Bethanechol should not be used when urinary retention results from a mechanical urinary obstruction, because stimulating bladder contraction against an obstruction can cause harm.

🚻 Therefore, urinary output that appropriately reflects the client's intake provides the best evidence listed that bethanechol is producing its desired urinary elimination effect.

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Answer 8

Correct Answers:

Rinsing the mouth with water should be one after each use.

Rationale :

🌬️ Rinsing the mouth after inhaler use is particularly important when the inhaler contains an inhaled corticosteroid (ICS).

🌬️ Inhaled corticosteroids can leave medication residue in the mouth and oropharynx after administration.

🌬️ Residual corticosteroid can promote the development of oral candidiasis (thrush).

🌬️ Clients can also develop hoarseness or throat irritation from local corticosteroid exposure.

🌬️ The client should rinse the mouth thoroughly with water and spit it out after using an inhaled corticosteroid.

🌬️ The rinse water should not be routinely swallowed because the purpose is to remove residual medication from the mouth.

🌬️ Proper inhaler technique, including use of a spacer when appropriate, can further improve medication delivery to the lungs and decrease medication deposition in the mouth.

🌬️ Therefore, the statement about rinsing the mouth after inhaler use best demonstrates understanding of appropriate inhaler teaching among the choices provided.

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Answer 9

Correct Answers:

Replacement of the heparin infusion with warfarin PO daily.

Rationale :

🫀 Following implantation of an artificial heart valve, anticoagulation is necessary to reduce the risk of thrombus formation and systemic embolization.

🫀 Unfractionated heparin provides rapid anticoagulation immediately after surgery and is monitored primarily using the aPTT.

🫀 An aPTT of 60 seconds can represent a therapeutic response when it falls within the prescribed target of approximately 1.5 to 2.5 times the control value.

🫀 Warfarin is an oral anticoagulant commonly used for longer-term anticoagulation in clients with mechanical prosthetic heart valves.

🫀 Warfarin does not produce immediate therapeutic anticoagulation because several days are required for existing vitamin K-dependent clotting factors to decrease.

🫀 Heparin is therefore commonly used as bridging anticoagulation while warfarin is initiated and the INR approaches the prescribed therapeutic range.

🫀 An INR of 2 is elevated above the normal range but may still be below the required therapeutic target for some mechanical aortic valves; the specific target depends on the valve and additional thromboembolic risk factors.

🫀 Once warfarin produces the prescribed therapeutic INR and adequate overlap has occurred, the heparin infusion can be discontinued, making transition to oral warfarin the expected change in therapy.

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Answer 10

Correct Answers:

At the first sign of an asthma attack the client uses the albuterol inhaler.

Rationale :

🌬️ A. Uses the albuterol inhaler at the first sign of an asthma attack — CORRECT

🌬️ Albuterol is a short-acting beta₂-adrenergic agonist (SABA) used as a rescue bronchodilator.

🌬️ It should be used promptly when the client develops early symptoms of acute bronchospasm, such as wheezing, chest tightness, coughing, or shortness of breath.

🌬️ Albuterol stimulates beta₂ receptors in bronchial smooth muscle, producing rapid bronchodilation.

🌬️ Its onset of action is relatively rapid, making it appropriate for quick relief of acute asthma symptoms.

🌬️ Early administration can prevent bronchospasm from progressing to more severe airway obstruction and respiratory distress.

🌬️ Clients may also be instructed to use albuterol before exercise when exercise-induced bronchospasm is anticipated.

🌬️ Frequent reliance on a rescue inhaler can indicate poorly controlled asthma and should prompt evaluation of the client's long-term treatment plan.

🌬️ Using albuterol at the first sign of an asthma attack therefore demonstrates appropriate understanding of its role as a rescue medication.

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HESI Pharamcology Exam IV

No.

1 :
The nurse is reviewing a client's medical history and notes that the client has been diagnosed with peptic ulcer disease. Which medication has most likely been prescribed for this client?

2 :
The nurse is monitoring a client who has liver failure and is taking lactulose. Which finding(s) indicate that the medication is having the desired effect? Select all that apply.

💗 Explain that two 125 mcg tablets equal one 250 mcg tablet — CORRECT

💗 Administer the medication as prescribed, but closely monitor the client for possible dosing adjustments — CORRECT

4 :
A client with a history of heart failure (HF) reports episodes of heartburn when lying down after dinner. The home health nurse should encourage the client to talk to the healthcare provider (HCP) about using which over the counter (OTC) medication to relieve this problem?

5 :
The nurse is assessing the medication history for a hospice client with metastatic liver cancer. Which medication is likely prescribed for this client?

6 :
The client with a history of diverticulosis has a prescription for psyllium hydrophilic laxative and the nurse is planning medication teaching. Which instruction should the nurse include when teaching the client about this medication?

7 :
Which assessment finding indicates to the nurse that the prescription bethanechol is effective for a client diagnosed with urinary retention?

8 :
The nurse is teaching a client how to use an inhaler device. Which client statement indicates to the nurse that the client understands the instructions?

10 :
The inhaler albuterol, is prescribed for a client with reactive airway disease. Which behaviour indicates to the nurse that the client understands the teaching concerning this medication?

🌬️ A. Uses the albuterol inhaler at the first sign of an asthma attack — CORRECT

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HESI Pharamcology Exam IV

No.

1 : The nurse is reviewing a client's medical history and notes that the client has been diagnosed with peptic ulcer disease. Which medication has most likely been prescribed for this client?

2 : The nurse is monitoring a client who has liver failure and is taking lactulose. Which finding(s) indicate that the medication is having the desired effect? Select all that apply.

💗 Explain that two 125 mcg tablets equal one 250 mcg tablet — CORRECT

💗 Administer the medication as prescribed, but closely monitor the client for possible dosing adjustments — CORRECT

4 : A client with a history of heart failure (HF) reports episodes of heartburn when lying down after dinner. The home health nurse should encourage the client to talk to the healthcare provider (HCP) about using which over the counter (OTC) medication to relieve this problem?

5 : The nurse is assessing the medication history for a hospice client with metastatic liver cancer. Which medication is likely prescribed for this client?

6 : The client with a history of diverticulosis has a prescription for psyllium hydrophilic laxative and the nurse is planning medication teaching. Which instruction should the nurse include when teaching the client about this medication?

7 : Which assessment finding indicates to the nurse that the prescription bethanechol is effective for a client diagnosed with urinary retention?

8 : The nurse is teaching a client how to use an inhaler device. Which client statement indicates to the nurse that the client understands the instructions?

10 : The inhaler albuterol, is prescribed for a client with reactive airway disease. Which behaviour indicates to the nurse that the client understands the teaching concerning this medication?

🌬️ A. Uses the albuterol inhaler at the first sign of an asthma attack — CORRECT

1 :
The nurse is reviewing a client's medical history and notes that the client has been diagnosed with peptic ulcer disease. Which medication has most likely been prescribed for this client?

2 :
The nurse is monitoring a client who has liver failure and is taking lactulose. Which finding(s) indicate that the medication is having the desired effect? Select all that apply.

4 :
A client with a history of heart failure (HF) reports episodes of heartburn when lying down after dinner. The home health nurse should encourage the client to talk to the healthcare provider (HCP) about using which over the counter (OTC) medication to relieve this problem?

5 :
The nurse is assessing the medication history for a hospice client with metastatic liver cancer. Which medication is likely prescribed for this client?

6 :
The client with a history of diverticulosis has a prescription for psyllium hydrophilic laxative and the nurse is planning medication teaching. Which instruction should the nurse include when teaching the client about this medication?

7 :
Which assessment finding indicates to the nurse that the prescription bethanechol is effective for a client diagnosed with urinary retention?

8 :
The nurse is teaching a client how to use an inhaler device. Which client statement indicates to the nurse that the client understands the instructions?

10 :
The inhaler albuterol, is prescribed for a client with reactive airway disease. Which behaviour indicates to the nurse that the client understands the teaching concerning this medication?