Question

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range: Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)].

Answer 1

Correct Answers:

Hemoglobin level increased to 12 g/dl. (7.45 mmol/L).

Rationale :

🔷 Epoetin alfa stimulates the bone marrow to produce red blood cells, making an increase in hemoglobin (Hgb) the most objective and direct indicator of effectiveness.

🔷 A hemoglobin level of 12 g/dL reflects a positive therapeutic response in a client with anemia secondary to chronic kidney disease (CKD).

🔷 Subjective improvements like increased energy are helpful but cannot replace lab confirmation.

🔷 The medication’s goal is to raise Hgb to near-normal range, so this result shows it’s working as intended.

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Answer 2

Correct Answers:

Explain that the client should not use the discus more than twice daily.

Rationale :

🔶 Fluticasone/salmeterol (a corticosteroid and long-acting beta-agonist) is used for maintenance of asthma, not for rescue during acute attacks.

🔶 It should only be used twice daily to avoid adverse effects such as oral candidiasis or systemic corticosteroid side effects.

🔶 Overuse increases the risk of toxicity and may lead to worsening asthma control over time.

🔶 Caregivers must understand that it is preventive therapy, not to be used during a crisis.

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Answer 3

Correct Answers:

Administer a second dose of naloxone.

Rationale :

🟡 Naloxone is a short-acting opioid antagonist, and its effects may wear off before the opioid is fully metabolized, leading to recurrent respiratory depression.

🟡 The return of symptoms such as RR 4/min and low O2 saturation strongly suggests opioid re-sedation.

🟡 The priority is to administer another dose of naloxone to restore respiratory effort before considering CPR or GCS scoring.

🟡 Immediate reversal prevents respiratory failure and death.

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Answer 4

Correct Answers:

Take on an empty stomach at least 1 hour before meals.

Rationale :

🔵 Sucralfate binds to the ulcer site and creates a protective barrier against acid and pepsin.

🔵 It must be taken on an empty stomach, at least 1 hour before meals, to ensure proper coating and action.

🔵 Taking it with meals or afterward reduces efficacy, as food interferes with binding to the ulcer base.

🔵 This timing ensures the drug works as a local mucosal protectant.

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Answer 5

Correct Answers:

St. John's Wort can decrease plasma concentrations of cyclosporine.

Rationale :

🟣 St. John’s Wort induces CYP3A4 enzymes, which increase the metabolism of cyclosporine and lower its plasma levels.

🟣 This decreases immunosuppressive protection and significantly raises the risk of organ transplant rejection.

🟣 The most serious consequence of this interaction is graft loss, not minor adverse effects.

🟣 Clients must be educated to avoid herbal supplements without provider consultation post-transplant.

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Answer 6

Correct Answers:

Instruct the client that it is necessary to take nothing but water with the medication.

Rationale :

🔷 Risedronate is a bisphosphonate used to treat osteoporosis and must be taken with plain water only on an empty stomach.

🔷 Taking it with milk or food impairs absorption significantly and reduces therapeutic effect.

🔷 Additionally, clients should remain upright for at least 30 minutes to prevent esophageal irritation or ulceration.

🔷 The nurse should reinforce strict administration instructions to ensure both safety and efficacy.

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Answer 7

Correct Answers:

Respiratory rate.

Rationale :

🔶 Opioids depress the respiratory center in the brain, making respiratory rate the most critical vital sign to assess when sedation or lethargy is observed.

🔶 A drop in respiration can lead to hypoxia, unconsciousness, and possibly respiratory arrest.

🔶 While pulse and blood pressure are also affected, respiratory status reflects the most immediate life threat.

🔶 The nurse should assess breathing first and intervene immediately if the rate is below normal.

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Answer 8

Correct Answers:

Serum potassium level of 3.8 mEq/L (3.8 mmol/L).

Rationale :

🟡 Sodium polystyrene sulfonate (Kayexalate) is used to treat hyperkalemia by binding potassium in the intestine and excreting it.

🟡 A potassium level of 3.8 mEq/L falls within the normal reference range and indicates successful treatment.

🟡 None of the other listed labs directly reflect the drug’s intended action.

🟡 Monitoring serum potassium is essential to evaluate both effectiveness and risk of hypokalemia.

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Answer 9

Correct Answers:

Stop taking the medication if intended effect is not immediate.

Rationale :

🔵 Lorazepam is a benzodiazepine that works relatively quickly for anxiety, but stopping it abruptly without provider guidance is unsafe.

🔵 This could result in withdrawal symptoms, including tremors, irritability, or even seizures.

🔵 The client should be educated to continue medication as prescribed and consult the healthcare provider for dosage concerns.

🔵 This response indicates a misunderstanding of medication safety and adherence.

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Answer 10

Correct Answers:

Body mass index (BMI).

Rationale :

🟣 Orlistat inhibits fat absorption in the GI tract and is prescribed to assist with weight loss.

🟣 The most reliable and objective way to track progress is to measure changes in BMI over time.

🟣 Daily calorie counts and lab values may support the weight management plan, but BMI directly reflects treatment effectiveness.

🟣 The nurse should monitor BMI consistently to assess if orlistat is helping achieve therapeutic goals.

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RN-HESI Pharmacology Exam 3

No.

1 :
A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range: Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)].

2 :
To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

3 :
The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

4 :
The nurse is caring for a client receiving a prescription for sucralfate to treat a peptic ulcer. Which instruction should the nurse provide during discharge education?

6 :
The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

7 :
The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first?

9 :
A client with generalized anxiety disorder (GAD) receives a new prescription for lorazepam. Which statement provided by the client requires additional instruction by the nurse?

10 :
A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication?

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RN-HESI Pharmacology Exam 3

No.

1 : A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range: Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)].

2 : To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

3 : The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

4 : The nurse is caring for a client receiving a prescription for sucralfate to treat a peptic ulcer. Which instruction should the nurse provide during discharge education?

6 : The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

7 : The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first?

9 : A client with generalized anxiety disorder (GAD) receives a new prescription for lorazepam. Which statement provided by the client requires additional instruction by the nurse?

10 : A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication?

1 :
A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range: Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)].

2 :
To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

3 :
The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

4 :
The nurse is caring for a client receiving a prescription for sucralfate to treat a peptic ulcer. Which instruction should the nurse provide during discharge education?

6 :
The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

7 :
The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first?

9 :
A client with generalized anxiety disorder (GAD) receives a new prescription for lorazepam. Which statement provided by the client requires additional instruction by the nurse?

10 :
A client is receiving orlistat as part of a weight management program. Which ongoing assessment should be included in the plan of care to determine the effectiveness of the medication?