HESI-P HESI Pharmacology - Set 4 - Part 3

Correct Answer: Normal saline with inline filter, slow rate

Intravenous phenytoin is diluted in normal saline because dextrose causes precipitation. The medication is infused through an inline filter at no faster than twenty-five to fifty milligrams per minute to prevent hypotension and cardiac dysrhythmias. Option a is incorrect because dextrose five percent causes phenytoin to precipitate in the line and cannot be used as a diluent. The chapter directs normal saline as the only acceptable diluent for intravenous phenytoin administration in emergency settings. Option b is incorrect because sterile water rapid push violates both the diluent and rate requirements for intravenous phenytoin. The chapter directs normal saline with a controlled slow rate through an inline filter. Option d is incorrect because lactated ringer is not the chapter-directed diluent, and thirty seconds infusion is far too rapid. The chapter specifies normal saline at a controlled slow rate to prevent cardiovascular complications.

Correct Answer: Discontinue medication seventy-two hours before

Raloxifene is contraindicated in clients with venous thromboembolic events and must be discontinued seventy-two hours before prolonged immobilization including extended bed rest or long travel. This precaution reduces the risk of venous thrombosis significantly during inactivity. Option b is incorrect because calcium supplementation supports bone mineralization and works as adjunct therapy for the underlying osteoporosis. Adding daily calcium would not interrupt the prothrombotic state created by selective estrogen receptor modulator activity during the extended airplane immobility. Option c is incorrect because a high-protein vegetarian diet relates to general nutrition rather than thrombus prevention during travel. Choosing this advice answers a different clinical question and leaves the clotting risk fully present throughout the extended seated period. Option d is incorrect because sunscreen use protects against ultraviolet skin damage and would suit photosensitivity-inducing drugs

Correct Answer: Alternate nostrils and watch hypocalcemia

Calcitonin-salmon intranasal spray is administered by alternating nostrils to reduce nasal irritation. The nurse monitors for hypocalcemia, since calcitonin inhibits osteoclastic bone resorption and reduces calcium release from bone into the systemic circulation. Option a is incorrect because using the same nostril repeatedly causes nasal irritation that can lead to discontinuation of therapy. The chapter directs alternating nostrils for each dose so the nasal mucosa has time to recover between administrations during treatment. Option b is incorrect because head positioning is a general inhaler technique consideration but the chapter focuses on nostril rotation and hypocalcemia monitoring. The chapter-identified priority teaching elements differ from positioning details for this medication in clinical practice. Option c is incorrect because discarding the bottle after one week is not the chapter-specified instruction for calcitonin-salmon storage or use. The chapter directs alternating

Correct Answer: Hepatic fibrosis and bone marrow suppression

Methotrexate causes hepatic fibrosis, bone marrow suppression, gastrointestinal ulceration, and pneumonitis as recognized adverse effects. Routine laboratory monitoring of liver enzymes and complete blood counts during therapy guides safe long-term administration in rheumatoid arthritis. Option a is incorrect because skin pigmentation and brittle nails are not the chapter-described primary methotrexate adverse effects. The hepatic and hematologic profile drives the routine monitoring plan for this disease-modifying antirheumatic drug in clinical practice. Option c is incorrect because cardiac arrhythmia and pulmonary hypertension belong to monitoring profiles for agents like amiodarone or pulmonary vasodilators. They miss the hepatic and hematologic toxicities that determine whether this antimetabolite can continue at the prescribed dosage. Option d is incorrect because cataract development and glaucoma onset are associated with corticosteroids rather than methotrexate. The chapter ide

Correct Answer: Visual disturbance or change

Hydroxychloroquine is associated with retinal damage that can permanently impair vision. The client must contact the prescriber if visual disturbances occur during therapy, and baseline plus periodic eye examinations are part of safe long-term monitoring. Option a is incorrect because a mild headache after a dose is not the chapter-identified urgent reporting symptom for hydroxychloroquine. The retinal damage warning makes visual disturbance the chapter's priority concern requiring prompt prescriber contact during therapy with this medication. Option b is incorrect because slight nausea before meals is a mild complaint typically handled by taking the dose with food. Choosing nausea overlooks the irreversible ocular toxicity that defines the eye examinations scheduled at baseline and every six months. Option d is incorrect because brief muscle aching after exercise reflects ordinary musculoskeletal soreness rather than a drug-specific adverse event. Reporting transient myalgia woul

Correct Answer: Last dose six hours before bedtime

The last dose of an attention-deficit hyperactivity disorder stimulant medication should be taken at least six hours before bedtime, or fourteen hours before bedtime for extended-release forms. This timing prevents insomnia caused by central nervous system stimulation overnight. Option b is incorrect because bedtime dosing of a central nervous system stimulant predictably causes insomnia. Lights-out administration delivers peak catecholamine effect precisely when the child needs sleep onset, undoing the school-day benefit and creating overnight sleep disturbance. Option c is incorrect because rigid four-hourly dosing around the clock would deliver doses overnight, guaranteeing insomnia and wasting medication when behavioral targets are absent. Fixed interval schedules do not match attention-deficit hyperactivity disorder treatment principles for school-age children. Option d is incorrect because evening meal dosing typically falls too close to bedtime for the stimulant effect to wear o

Correct Answer: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome features hyperpyrexia, autonomic dysfunction, skeletal muscle rigidity, altered consciousness, and elevated creatine phosphokinase. The nurse notifies the prescriber, prepares to discontinue the antipsychotic, and initiates cooling measures with supportive care immediately. Option a is incorrect because tardive dyskinesia involves involuntary tongue protrusion, chewing motions, and limb movements rather than fever and rigidity. The described constellation matches neuroleptic malignant syndrome rather than the chronic movement disorder of tardive dyskinesia in any setting. Option b is incorrect because hypertensive crisis from tyramine relates to monoamine oxidase inhibitor therapy rather than antipsychotic medication. A food-drug interaction would present with sudden blood pressure spikes and headache, lacking the hyperpyrexia and lead-pipe rigidity seen here. Option c is incorrect because acute dystonic reaction features sudden involuntary muscle contrac

Correct Answer: Wear eye patch until reflex returns

Topical eye anesthetics produce temporary loss of the corneal blink reflex, leaving the cornea vulnerable to injury. The nurse provides an eye patch to protect the cornea until sensation returns. Option a is incorrect because rubbing the eye can damage the unprotected cornea while anesthesia is active and the blink reflex is absent. The chapter directs the client not to rub or touch the eye. Option b is incorrect because topical eye anesthetics are not given to the client for home use or self-administration. The chapter clearly states these agents are restricted to clinical settings under supervised administration rather than independent client use at home. Option d is incorrect because driving home immediately is unsafe because of reduced corneal protection and the additional pupillary effects from preprocedure medications. The chapter directs not driving after eye examinations involving mydriatic or anesthetic instillation in standard practice.

Correct Answer: Dilute in sterile water; slow infuse

Intravenous morphine is diluted in at least five milliliters of sterile water and administered over four to five minutes. The nurse withholds morphine for a respiratory rate below twelve and keeps naloxone available for opioid overdose reversal. Option a is incorrect because undiluted rapid push of intravenous morphine increases the risk of severe respiratory depression and hypotension. The chapter directs dilution in sterile water and slow administration over several minutes to allow titration and observation during delivery. Option c is incorrect because the chapter directs sterile water rather than dextrose as the diluent, with slow rather than rapid infusion. Rapid administration intensifies respiratory depression risk and bypasses the safety window for observation during opioid delivery in adults. Option d is incorrect because maximum-rate bolus through a filter does not match the chapter-directed slow controlled administration of intravenous morphine. The chapter specifies diluti

Correct Answer: Endophthalmitis from intravitreal injection

Endophthalmitis is an eye inflammation from bacterial, viral, or fungal infection that may follow intravitreal injection for macular degeneration. The nurse teaches the client to report severe pain, redness, or vision change after the injection promptly. Option a is incorrect because mild eye discomfort and dryness are common minor effects but not the chapter-identified serious infectious complication. The chapter highlights endophthalmitis as the most serious bacterial or fungal complication of intravitreal anti-vascular endothelial growth factor therapy. Option b is incorrect because temporary photosensitivity to light is not a recognized adverse effect of this injectable retinal treatment. Photosensitivity belongs to medications like amiodarone and tetracyclines, missing the postinjection infection risk that demands immediate symptom reporting. Option c is incorrect because slight blurring lasting one day reflects expected vitreous disturbance from the needle entry rather than a vis