ATI-Pharmacology

Question 1

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering?
A) Amantadine
B) Bupropion
C) Phenelzine
D) Hydroxyzine

Answer 1

A) Amantadine

Question 2

A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to promote sleep. The nurse should plan to monitor the client for which of the following adverse effects?
A) Ecchymosis
B) Decreased urine output
C) Increased blood pressure
D) Dizziness

Answer 2

D) Dizziness

Question 3

A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older adult client who has Paget’s disease of the bone. Which of the following actions should be the nurse’s priority?
A) Administer the medication to the client before breakfast in the morning.
B) Ambulate the client to a chair prior to administering the medication.
C) Give the medication to the client with water rather than milk.
D) Teach the client how to take the medication at home.

Answer 3

B) Ambulate the client to a chair prior to administering the medication.

Question 4

A nurse is caring for a client who has a new prescription for ergotamine. The nurse should recognize that ergotamine is administered to treat which of the following conditions?

a. Raynaud’s phenomenon
b. Migraine headaches
c. Ulcerative colitis
d. Anemia

Answer 4

B. Migraine headaches

Question 5

A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which of the following medications should the nurse plan to administer?

a. Ibuprofen
b. Naproxen
c. Aspirin
d. Acetaminophen

Answer 5

D. Acetaminophen

Question 6

A nurse is providing teaching to a patient of a child who has asthma and a new prescription for a cromolyn sodium metered dose inhaler. Which of the following statement by the patient indicates the need for further teaching?

A. “I will give my child a dose as soon as wheezing starts.”
B. “My child should rinse out his mouth after using the inhaler.”
C. “My child should exhale completely before placing the inhaler in his mouth.”
D. “If my child has difficulty breathing in the dose, a space can be used.”

Answer 6

A. “I will give my child a dose as soon as wheezing starts.”

Question 7

A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid stimulating hormone (TSH) and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications?

A. Methimazole
B. Somatropin
C. Levothyroxine
D. Propylthiouracil

Answer 7

C. Levothyroxine

Question 8

A nurse is planning care for a client who has a seizure disorder and a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply).

A. BUN
B. PTT
C. Aspartate aminotransferase (AST)
D. Urinalysis
E. Alanine aminotransferase (ALT)

Answer 8

B. PTT
C. Aspartate aminotransferase (AST)
E. Alanine aminotransferase (ALT)

Question 9

A nurse is providing teaching to a client who has a new prescription for hydrochlorothiazide 50 mg PO daily to treat hypertension. Which of the following instructions should the nurse include in the teaching?

A. “Take hydrochlorothiazide as needed for edema.”
B. “Check your weight once each week.”
C. “Take the hydrochlorothiazide on an empty stomach.”
D. “Take the hydrochlorothiazide in the morning.”

Answer 9

D. “Take the hydrochlorothiazide in the morning.”

Question 10

A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The nurse should instruct the client to discontinue taking the medication for which of the following adverse effects?

A. Nausea
B. Metallic taste
C. Fever
D. Drowsiness

Answer 10

C. Fever

Question 11

A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?

A. Jaundice
B. Constipation
C. Oral candidiasis
D. Sedation

Question 12

A nurse is providing teaching to a client who has rheumatoid arthritis and a prescription for long-term prednisone therapy. The nurse should instruct the client to monitor for which of the following adverse effects?

A. Stress fracture
B. Orthostatic hypotension
C. Gingival ulcerations
D. Weight loss

Answer 12

A. Stress fracture

Question 13

A nurse is caring for a client who has a new prescription for enalapril. The nurse should monitor the client for which of the following adverse effects of this medication?

A. Ecchymosis
B. Jaundice
C. Hypotension
D. Hypokalemia

Answer 13

C. Hypotension

Question 14

A nurse is caring for a client who is at 28 weeks of gestation and is experiencing preterm labor. Which of the following medications should the nurse plan to administer?

A. Oxytocin
B. Nifedipine
C. Dinoprostone
D. Misoprostol

Answer 14

B. Nifedipine

Question 15

A nurse is caring for a client who has a new prescription for amphotericin B. The nurse should plan to monitor the client for which of the following adverse effects?

A. Hyperkalemia
B. Hypertension
C. Constipation
D. Nephrotoxicity

Answer 15

D. Nephrotoxicity

Question 16

A nurse is administering subcutaneous epinephrine for a client who is experiencing anaphylaxis. The nurse should monitor the client for which of the following adverse effects?

A. Hypotension
B. Hyperthermia
C. Hypoglycemia
D. Tachycardia

Answer 16

D. Tachycardia

Question 17

A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects?

A. Insomnia
B. Hypotension
C. Bleeding
D. Constipation

Answer 17

C. Bleeding

Question 18

A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication?

A. Hearing examination
B. Glucose tolerance test
C. Electrocardiogram
D. Pulmonary function test

Answer 18

C. Electrocardiogram

Question 19

A nurse is providing teaching to a client who has chronic kidney failure with an AV fistula for hemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching?

A. Reduce blood pressure
B. Inhibits clotting fistula
C. Promotes RBC production
D. Stimulates growth of neutrophils

Answer 19

C. Promotes RBC production

Question 20

A nurse is providing teaching to a newly licensed nurse about caring for a client who has a prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which of the following laboratory tests?

A. Platelet count
B. Electrolyte levels
C. Thyroid function
D. Liver function

Answer 20

D. Liver function

Question 21

A nurse is caring for a client who has been taking isoniazid and rifampin for 3 weeks for the treatment of active pulmonary tuberculosis (TB). The client reports his urine is an orange color. Which of the following statements should the nurse make?

A. “Stop taking the isoniazid for 3 days and the discoloration should go away.”
B. “Rifampin can turn body fluids orange.”
C. “I’ll make an appointment for you to see the provider this afternoon.”
D. “Isoniazid can cause bladder irritation.”

Answer 21

B. “Rifampin can turn body fluids orange.”

Question 22

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. The nurse should recognize that an increase in which of the following values indicates a therapeutic effect of this medication?

A. Erythrocyte count
B. Neutrophil count
C. Lymphocyte count
D. Thrombocyte count

Answer 22

B. Neutrophil count

Question 23

A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the client for which of the following adverse effects?

A. Thrombophlebitis
B. Hyperactive reflexes
C. Muscle weakness
D. Hypoglycemia

Answer 23

C. Muscle weakness

Question 24

A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following information should the nurse include in the teaching?

A. Respiratory depression can occur 7 min after morphine is administered.
B. The morphine will peak in 10 min.
C. Withhold the morphine if the client has a respiratory rate less than 16/min
D. Administer the morphine over 2 min

Answer 24

A. Respiratory depression can occur 7 min after morphine is administered.

Question 25

A nurse is administering subcutaneous heparin to a client who is at risk for DVT. Which of the following actions should the nurse take?

A. Administer the medication into the client’s abdomen
B. Inject the medication into a muscle
C. Massage the site after administering the medication
D. Use a 22-gauge needle to administer the medication

Answer 25

A. Administer the medication into the client’s abdomen

Question 26

A nurse is preparing to administer amoxicillin 250 mg liquid suspension PO every 8 hr to an older adult client. The amount available is amoxicillin 50 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Answer 26

5mL

Question 27

A nurse is providing teaching to a client who has a urinary tract infection and new prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the client indicates the need for further teaching?
A. “If the phenazopyridine upsets my stomach, I can take it with meals.”
b. “The phenazopyridine will relieve my discomfort, but the ciprofloxacin will get rid of the infection.”
C. “I need to drink 2 liters of fluid per day while I am taking the ciprofloxacin.”
D.”I should notify my provider immediately if my urine turns an orange coloR

Question 28

A nurse is providing teaching to a group of new parents about medications. The should include aspirin is contraindicated for children who have a viral infection due to the risk of developing which of the following adverse effects?
A. Reye’s Syndrome
B. Visual Disturbances
C. Diabetes Mellitus
D.Wilms Tumor

Answer 28

A. Reye’s Syndrome

Question 29

A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should recognize that tamoxifen has which of the following therapeutic effects?
A. Antiestrogenic
B. Antimicrobial
C. Androgenic
D. Anti-inflammatory

Answer 29

A. Antiestrogenic

Question 30

A nurse is assessing a client who is receiving IV gentamicin three times daily. Which of the following findings indicates that the client is experiencing an adverse effect of this medication?
A. Hypoglycemia
B. Proteinuria
C. Nasal congestion
D. Visual disturbances

Answer 30

B. Proteinuria

Question 31

A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose. The nurse should instruct the client that lactulose has which of the following therapeutic effects?
A. Increases blood pressure
B. Prevents esophageal bleeding
C. Decreases heart rate
D. Reduces ammonia levels

Answer 31

D. Reduces ammonia levels

Question 32

A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should include in the teaching that which of the following conditions is a contraindication to this medication?
A. Hyperthyroidism
B. Intestinal obstruction
C. Glaucoma
D. Low blood pressure

Answer 32

B. Intestinal obstruction

Question 33

A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include a severe allergy to which of the following medications as a contraindication to ceftriaxone?
A. Gentamicin
B. Clindamycin
C. Piperacillin
D. Sulfamethoxazole-trimethoprim

Answer 33

C. Piperacillin

Question 34

A nurse is caring for a client who has a new diagnosis of oral candidiasis after taking tetracycline for 7 days. The nurse should recognize that candidiasis is a manifestation of which of the following adverse effects?
A. Allergic response
B. Superinfection
C. Renal toxicity
D. Hepatotoxicity

Answer 34

B. Superinfection

Question 35

A nurse is reviewing the laboratory values for a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse prepare to take?
A. Administer vitamin K
B. Reduce the infusion rate
C. Give the client a low-dose aspirin
D. Request an INR

Answer 35

B. Reduce the infusion rate

Question 36

A nurse is preparing a discharge teaching plan for a 6-year-old client who has asthma and several prescription medications using metered dose inhalers (MDIs). Which of the following interventions should the nurse include in the plan?
A. Add a spacer to each MDI.
B. Instruct the child to inhale more rapidly than usual when using an MDI.
C. Request that the provider change the child’s medications from inhaled to oral formulations.
D. Administer oxygen by facemask along with the MD.

Answer 36

A. Add a spacer to each MDI.
MDIs are difficult to use correctly and, even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an MDI can make up for lack of hand-lung coordination by increasing the amount of medication delivered to the lungs.

Question 37

A nurse is administering oral hydroxyzine to a client. Which of the following adverse effects should the nurse instruct the client to expect?
A. Diarrhea
B. Anxiety
C. Nausea and vomiting
D. Dry mouth

Answer 37

D. Dry Mouth

Hydroxyzine has anticholinergic properties. Dry mouth is a common adverse effect of this medication. The nurse should instruct the client to take sips of water or suck hard candies to minimize this effect

Question 38

A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40 mg daily, but the client reports that she has been taking extra doses to promote weight loss. Which of the following findings should indicate to the nurse that the client is dehydrated?
A. Urine specific gravity 1.035
B. Distended neck veins
C. BUN 18 mg/d
D. Bounding radial pulses

Answer 38

A. Urine specific gravity 1.035

Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated.

Question 39

A nurse is preparing a discharge teaching plan for a client who is to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan?
A. Stop taking the medication if a rash occurs.
B. Take the medication on an empty stomach to enhance absorption.
C. Schedule the medication on alternate days to decrease adverse effects.
D. Treat shortness of breath with an extra dose of the medication.

Answer 39

C. Schedule the medication on alternate days to decrease adverse effects.

Some of the adverse effects caused by long-term glucocorticoid therapy, such as suppression of the adrenal gland, can be avoided by using alternate-day therapy.

Question 40

A nurse is providing teaching to a client who has hypertension and type 1 diabetes mellitus and a new prescription for metoprolol. Which of the following statements by the client indicates an understanding of the teaching?
A. “I might have difficulty recognizing when my blood sugar is low.”
B. “I will have less risk for developing an infection while I take this medication.”
C. “I should be concerned about losing excess weight while I take this medication.”
D. “I could have more problems with high blood sugars while taking this medication.”

Answer 40

A. “I might have difficulty recognizing when my blood sugar is low.”

Metoprolol, a beta-adrenergic blocker, is used to treat hypertension. Because it decreases heart rate, this common manifestation of hypoglycemia can be masked and hypoglycemia might become more difficult to recognize. The client should be taught to recognize hypoglycemia by other manifestations, such as hunger, nausea, and sweating.

Question 41

A nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following data should the nurse plan to review prior to administration of this medication?
A. Blood pressure
B. Temperature
C. Blood glucose levels
D. Total protein level

Answer 41

A. Blood pressure

Epoetin alfa often causes hypertension, which can lead to stroke or other cardiovascular complications. The nurse should monitor the client’s blood pressure and notify the provider about increases. The client who receives epoetin alfa frequently requires concurrent use of antihypertensive medication.

Question 42

A nurse is planning care for a female client who has severe irritable bowel syndrome with diarrhea (IBS-D) and a new prescription for alosetron. Which of the following interventions should the nurse include in the plan of care?
A. The client must sign an agreement with the provider before beginning alosetron.
B. The client must stop taking alosetron if diarrhea continues 1 week after beginning the medication.
C. The client should expect to have a slower heart rate while taking alosetron.
D. The client should use a barrier birth control method because alosetron interacts with oral contraceptives.

Answer 42

A. The client must sign an agreement with the provider before beginning alosetron.

Alosetron has potentially fatal adverse effects associated with constipation and bowel obstruction. The FDA has allowed alosetron to be placed on the market only if clients sign and adhere to a risk management program, which includes signing a client-provider agreement before starting alosetron.

Question 43

A nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take first?
A. Notify the provider.
B. Contact the nursing supervisor.
C. Assess the client’s apical pulse.
D. Complete an incident report.

Answer 43

C. Assess the client’s apical pulse.

Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client’s status, she must first collect adequate data from the client. Assessing will provide the nurse with knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to assess the client.

Question 44

A nurse is providing discharge teaching to a client who has angina pectoris and a new prescription for verapamil. The client tells the nurse, “My brother takes verapamil for high blood pressure. Do you think the provider made a mistake?” Which of the following responses should the nurse make?
A. “Verapamil is used to treat both high blood pressure and angina.”
B. “You should talk to your provider to make sure the prescription is correct for you.”
C. “Are you concerned that you might have high blood pressure?”
D. “Your provider has prescribed verapamil so that you will not develop high blood pressure.”

Answer 44

A. “Verapamil is used to treat both high blood pressure and angina.”

Verapamil is a calcium channel blocker that is used for both hypertension and anginal pain because of its ability to dilate arteries and decrease afterload

Question 45

A nurse is providing discharge teaching to a client who had a kidney transplant and has a prescription for oral cyclosporine. Which of the following statements by the client indicates an understanding of the teaching?
A. “I will be able to stop taking this medication 6 months after my surgery.”
B. “I am likely to develop higher blood pressure while taking this medication.”
C. “I am likely to lose my hair while taking this medication.”
D. “I am taking this medication to boost my immune system.”

Answer 45

B. “I am likely to develop higher blood pressure while taking this medication.”

Half the clients who take cyclosporine develop a 10% to 15% increase in blood pressure and might need to start antihypertensive therapy.

Question 46

A nurse is providing discharge teaching to a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching?
A. Take ibuprofen as needed for headache or other minor pains.
B. Carry a medic alert ID card.
C. Report to the laboratory weekly to have blood drawn for aPTT.
D. Increase intake of dark green vegetables.

Answer 46

B. Carry a medic alert ID card.

A client who is taking warfarin is at increased risk for bleeding. In the case of an emergency, it is important that any medical personnel are aware of the client’s medication history.

Question 47

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take?
A. Administer a small test dose before giving the full dose.
B. Infuse the medication over 30 seconds.
C. Monitor the client closely for hypertension after the infusion.
D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs.

Answer 47

A. Administer a small test dose before giving the full dose.

A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. It is recommended that a small test dose be administered over 5 min before giving the full dose. The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose.

Question 48

A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client reports nausea and refuses to eat breakfast. Which of the following actions should the nurse take first?
A. Encourage the client to eat the toast on the breakfast tray.
B. Administer an antiemetic.
C. Inform the client’s provider.
D. Check the client’s apical pulse.

Answer 48

D. Check the client’s apical pulse.

Nausea, anorexia, fatigue, visual effects, and cardiac dysrhythmias, often caused by a slow pulse rate, are possible findings in digoxin toxicity. Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider about a change in the client’s status, she must first collect adequate data from the client. Assessing will provide the nurse with knowledge to make an appropriate decision.

Question 49

A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe urinary tract infection (UTI). The client asks why both medications are needed. Which of the following responses should the nurse make?
A. “Phenazopyridine decreases adverse effects of ciprofloxacin hydrochloride.”
B. “Combining phenazopyridine with ciprofloxacin hydrochloride shortens the course of therapy.”
C. “The use of phenazopyridine allows for a lower dosage of ciprofloxacin hydrochloride.”
D. “Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain.”

Answer 49

D. “Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain.”

Ciprofloxacin hydrochloride is a broad-spectrum quinolone antibiotic and phenazopyridine is a bladder analgesic/anesthetic that relieves burning and pain in the bladder mucosa caused by bladder spasm and inflammation.

Question 50

A nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching?
A. “I will administer a spray into each nostril daily.”
B. “I should expect nasal bleeding for the first week.”
C. “I will need to depress the side arms to activate the pump.”
D. “I should expect to take this medication for a short-term course of treatment.”

Answer 50

C. “I will need to depress the side arms to activate the pump.”

The nurse should instruct the client to activate the pump on the initial use by holding the bottle upright and depressing the two white side arms toward the bottle six times.

Question 51

A nurse is caring for a client who has heart failure and is taking oral furosemide 40 mg daily. For which of the following adverse effects should the client be taught to monitor and notify the provider if it occurs?
A. Nasal congestion
B. Tremors
C. Tinnitus
D. Frontal headache

Answer 51

C. Tinnitus

Loop diuretics, such as furosemide, can cause ototoxicity. The client should be taught to notify the provider if tinnitus, a full feeling in the ears, or hearing loss occurs.

Question 52

A nurse is teaching a client who has chronic stable angina pectoris and a prescription for sublingual nitroglycerin tablets. Identify the sequence of instructions that the nurse should tell the client to use if he experiences chest pain. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Wait 5 mins.
Stop Activity.
Call 911 if the pain is not relieved.
Place a tablet under the tongue.

Answer 52

Stop Activity.
Place a tablet under the tongue.
Wait 5 mins.
Call 911 if the pain is not relieved.

Question 53

A hospice nurse is caring for a client who has cancer and is taking naproxen 250 mg three times daily PO and gabapentin 1,800 mg three times daily PO to manage pain. The client tells the nurse, “I’m having pain that keeps me from doing what I’d like most of the time.” Which of the following additions should the nurse anticipate to the client’s medication regimen?
A. Oral meperidine
B. Parenteral naloxone
C. Parenteral diazepam
D. Oral oxycodone

Answer 53

D. Oral oxycodone

The client’s current pain regimen consists of a nonopioid analgesic, naproxen, and an adjuvant medication for neuropathic pain, gabapentin. According to the WHO analgesic ladder for cancer pain management, the next addition to the pain regimen is an opioid for moderate pain. Oxycodone is an oral opioid that relieves moderate to moderately severe pain; therefore, it is an appropriate choice to add to the client’s pain regimen

Question 54

A nurse is planning to administer diphenhydramine 50 mg via IV bolus to a client who is having an allergic reaction. The client has an IV infusion containing a medication that is incompatible with diphenhydramine in solution. Which of the following actions should the nurse take?
A. Choose an IV port for IV bolus injection of the diphenhydramine as near as possible to the client’s hanging IV bag.
B. Flush the IV tubing with 2 mL of 0.9% sodium chloride before and after administering diphenhydramine.
C. Allow the IV infusion to keep running while administering the diphenhydramine via IV bolus.
D. Aspirate to check for IV patency before administering the diphenhydramine.

Answer 54

D. Aspirate to check for IV patency before administering the diphenhydramine.

It is important to confirm IV patency prior to administering an IV bolus. Some medications cause severe tissue damage when inadvertently administered into tissue rather than into a vein.

Question 55

A nurse is providing teaching to a client who has heart failure and is taking spironolactone. Which of the following statements by the client indicates an understanding of the teaching?
A. “I will increase my intake of citrus fruits, bananas, and potatoes.”
B. “I will use salt substitutes on my food.”
C. “I will drink as much water as I can while taking this medication.”
D. “I will watch for increased breast tissue growth while taking this medication.”

Answer 55

D. “I will watch for increased breast tissue growth while taking this medication.”

Spironolactone, which is derived from steroids, can cause adverse endocrine effects, such as gynecomastia, impotence in men and irregular menses and hirsutism in women. The nurse should instruct the client that these changes can occur.

Question 56

A nurse is providing teaching to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider?
A. Weight gain
B. Myalgia
C. Hypoglycemia
D. Severe constipation

Answer 56

B. Myalgia

Myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which rarely occur while taking metformin due to blockage of lactic acid oxidation. The nurse should instruct the client to report these findings promptly to the provider.

Question 57

A nurse is assessing a client who reports using several herbal and vitamin supplements daily, including saw palmetto. The nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects?
A. Urinary health promotion
B. Immune system stimulation
C. Decreased leg pain from arterial disease
D. Prevention of nausea caused by motion sickness.

Answer 57

A. Urinary health promotion

Saw palmetto is used primarily for manifestations related to prostatic conditions, such as benign prostatic hypertrophy (BPH). Its effectiveness has not been scientifically proven, however. The nurse should teach the client to check with the provider about interactions between saw palmetto and other medications.

Question 58

A nurse is caring for a client who is in preterm labor and has a new prescription for nifedipine. The client states she is concerned because her father takes nifedipine for his angina pectoris. The nurse should explain to the client that nifedipine works for clients who are pregnant by which of the following mechanisms?
A. It decreases the incidence of bacterial vaginosis, thus preventing uterine contractions.
B. It inhibits uterine contractions by blocking entry of calcium into uterine cells.
C. It decreases the activity within the CNS, which regulates all smooth muscle.
D. It stimulates beta2 receptors in the uterus, which results in decreased frequency of contractions.

Answer 58

B. It inhibits uterine contractions by blocking entry of calcium into uterine cells.

Nifedipine, a calcium channel blocker, causes uterine relaxation by blocking the flow of calcium to the myometrial cells of the uterus.

Question 59

A nurse is assessing a client who takes oral theophylline for relief of chronic bronchitis. The nurse should recognize that which of the following findings indicates toxicity to theophylline?
A. Constipation
B. Tremors
C. Fatigue
D. Bradycardia

Answer 59

B. Tremors

Theophylline is a xanthine derivative bronchodilator. An early manifestation of toxicity is CNS stimulation, often seen as tremors. Seizures can occur if blood levels continue to rise.

Question 60

A nurse is caring for a client who was brought to the emergency department by friends who report the client has overdosed on heroin. Which of the following findings should the nurse expect to assess?
A. Temperature 39.2° C (102.6° F)
B. Respiratory rate 30/min
C. Pinpoint pupils
D. Severe abdominal cramping

Answer 60

C. Pinpoint pupils

Pinpoint pupils are an expected finding in opioid toxicity. Increased pupil size is seen in opioid withdrawal.

Question 61

A nurse is providing discharge teaching to a client who has been hospitalized for major depressive disorder and has a prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching?
A. “I will take amitriptyline in the morning because I’m likely to have trouble falling asleep if I take it in the evening.”
B. “I will move slowly when I stand up because amitriptyline can cause my blood pressure to decrease.”
C. “I can drink a glass of beer or wine with my evening meal because amitriptyline doesn’t interact with alcohol.”
D. “I will avoid foods high in fiber because amitriptyline can cause diarrhea.”

Answer 61

B. “I will move slowly when I stand up because amitriptyline can cause my blood pressure to decrease.”

Amitriptyline can cause orthostatic hypotension. The nurse should instruct the client to take precautions to prevent injury due to falls while taking amitriptyline.

Question 62

A nurse is providing teaching to a client who is to start taking hydrochlorothiazide for hypertension. The nurse instructs the client to eat foods rich in potassium. Which of the following statements by the client indicates an understanding of the teaching?
A. “This medication will not work unless I have enough potassium.”
B. “Potassium will increase the therapeutic effect of my blood pressure medication.”
C. “Potassium will lower my blood pressure.”
D. “This medication can cause a loss of potassium.”

Answer 62

D. “This medication can cause a loss of potassium.”

Hydrochlorothiazide can result in hypokalemia caused by excessive potassium excretion by the kidneys. The client should supplement his diet with potassium-rich foods to avoid the occurrence of hypokalemia. Foods that are high in potassium include bananas, raisins, baked potatoes, pumpkins, and milk.

Question 63

A nurse is administering adenosine via IV bolus for a client who has developed paroxysmal atrial tachycardia. For which of the following findings should the nurse assess the client during administration of adenosine?
A. Seizures
B. Cinchonism
C. Dyspnea
D. Transient pallor of the face

Answer 63

C. Dyspnea

Dyspnea can occur during administration of adenosine due to bronchoconstriction. Since adenosine has a very short half-life of about 10 seconds, this effect should be short-lived.

Question 64

A nurse is planning discharge teaching for a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine?
A. Broiled beef steak
B. Macaroni and cheese
C. Pepperoni pizza
D. Smoked salmon

Answer 64

A. Broiled beef steak

Phenelzine, an MAOI, is an antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume.

Question 65

A nurse is caring for a client who has alcohol use disorder and is admitted with lower extremity fractures following a motor-vehicle crash. A few hours after admission, the client develops restlessness and tremors. Which of the following medications should the nurse anticipate administering to the client first?
A. Acamprosate
B. Naltrexone
C. Chlordiazepoxide
D. Disulfiram

Answer 65

C. Chlordiazepoxide

Chlordiazepoxide, a long-acting oral benzodiazepine, is a first-line medication to use for a client who is experiencing manifestations of acute alcohol withdrawal. For clients who are nauseated or vomiting, another benzodiazepine, such as lorazepam, can be administered via IV. The nurse should apply the acute versus chronic priority-setting framework when caring for this client. Using this framework, acute needs (manifestations of acute alcohol withdrawal) are typically the priority need because they pose more of a threat to the client. Because chronic needs usually develop over a period of time, the client has more of an opportunity to adapt to the alteration in health.

Question 66

A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate onset of action of the insulin at which of the following times?
A. 0800
B. 0745
C. 0900
D. 1030

Answer 66

B. 0745

Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following administration of the insulin

Question 67

A nurse is providing teaching to the parents of a school-age child who has asthma about medications for bronchospasm. Which of the following inhaled medications should the nurse instruct the parents to use to relieve an acute asthma attack?
A. Salmeterol
B. Cromolyn
C, Fluticasone
D. Albuterol

Answer 67

D. Albuterol

Albuterol is a short-acting beta2-adrenergic agonist that is used to provide immediate relief for an acute asthma attack. One or two puffs every 4 to 6 hr PRN is the usual prescribed dose for a school-age child. If higher or more frequent doses are needed, the provider should evaluate the client for worsening asthma.

Question 68

A nurse is preparing to administer oxytocin to a client who is at 41 weeks of gestation and is experiencing ineffective labor. Which of the following actions should the nurse plan to take?
A. Place the oxytocin from a pre-filled syringe into the posterior fornix of the vagina every 10 min until effective labor occurs.
B. Check the client’s blood pressure and pulse every 15 min while induction of labor is occurring.
C. Stop the oxytocin for contractions that continue longer than 30 seconds.
D. Increase the dose of oxytocin to obtain uterine contractions that occur every 2 to 3 min`

Answer 68

D. Increase the dose of oxytocin to obtain uterine contractions that occur every 2 to 3 min

Effective uterine contractions should occur every 2 to 3 min.

Question 69

A nurse is providing discharge teaching to a client who has heart failure and a prescription for digoxin 0.125 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching?
A. “I know that blurred vision is something I will expect to happen while taking digoxin.”
B. “I will measure my urine output each day and document it in my diary.”
C. “I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute.”
D. “I will eat fruits and vegetables that have high potassium content every day.”

Answer 69

D. “I will eat fruits and vegetables that have high potassium content every day.”

Hypokalemia is an adverse effect of diuretic therapy. Because the client is taking digoxin, it is important to maintain the potassium level between 3.5 to 5.0 mg/dL to avoid digoxin toxicity

Question 70

A nurse is caring for a client who has a positive tuberculin skin test and is beginning a prescription for isoniazid. The nurse should teach the client that which of the following laboratory values should be monitored while taking isoniazid?
A. Thyroid Stimulating Hormone level (TSH)
B. Aspartate aminotransferase (AST)
C. Potassium
D. Sodium

Answer 70

B. Aspartate aminotransferase (AST)

Isoniazid can be toxic to the liver. Therefore, it is important to monitor liver enzymes, such as AST, during therapy with isoniazid. In addition, the nurse should instruct the client to notify the provider of jaundice, nausea, dark-colored urine or other findings indicating hepatitis.

Question 71

A nurse is planning to administer diltiazem via IV bolus to a client who has atrial fibrillation. When assessing the client, the nurse should recognize that which of the following findings is a contraindication to administration of diltiazem?
A. Hypotension
B. Tachycardia
C. Decreased level of consciousness
D. History of diuretic use

Answer 71

A. Hypotension

Diltiazem can be a treatment option for essential hypertension. This medication will lower blood pressure and is contraindicated for a client who is hypotensive. The nurse should teach the client to self-monitor blood pressure and keep a record of the readings.

Question 72

A nurse is assessing a client who has hypothyroidism and takes levothyroxine. Which of the following findings should alert the nurse that the client is experiencing acute levothyroxine overdose?
A. Bradycardia
B. Cold intolerance
C. Tremor
D. Hypothermia

Answer 72

C. Tremor

Tremor and anxiety are expected findings in acute levothyroxine overdose. These findings are similar to those seen in hyperthyroidism

Question 73

A nurse is providing discharge teaching about lithium toxicity to a client who has a new prescription for lithium. Which of the following statements by the client indicates an understanding of the teaching?
A. “I should take naproxen if I have a headache because aspirin can cause lithium toxicity.”
B. “I can develop lithium toxicity if I eat foods with lots of sodium.”
C. “I can develop lithium toxicity if I experience vomiting or diarrhea.”
D. “I might need to take a daily diuretic along with my lithium to prevent lithium toxicity.”

Answer 73

C. “I can develop lithium toxicity if I experience vomiting or diarrhea.”

Vomiting or diarrhea can cause electrolyte imbalances. If serum sodium decreases, lithium is retained by the kidneys and the risk for lithium toxicity increases.

Question 74

A nurse is monitoring laboratory values for a male client who has leukemia and is receiving weekly chemotherapy with methotrexate via IV infusion. Which of the following laboratory values should the nurse report to the provider?
A. BUN 18 mg/dl
B. Platelets 78,000/mm
C. Hemoglobin 14.2 g/dL
D. Aspartate aminotransferase (AST) 35 units/L

Answer 74

B. Platelets 78,000/mm

The nurse should monitor the platelet count of a client who is taking methotrexate because the medication can cause thrombocytopenia. This client’s platelet count is very low and puts the client at risk for severe bleeding. The nurse should report this finding promptly to the provider.

Question 75

A nurse is providing discharge teaching to a client who had a bleeding duodenal ulcer and is prescribed omeprazole. Which of the following statements should the nurse include in the teaching?
A. “You will need to take this medication for the next 6 months.”
B. “Taking this medication will decrease your risk for acquiring pneumonia.”
C. “You should take this medication before breakfast every day.”
D. “Watch for the serious adverse effects of tachycardia and heart palpitations while taking this medication.”

Answer 75

C. “You should take this medication before breakfast every day.”

Clients who have active duodenal ulcer or gastric reflux disease should take omeprazole once daily before a meal (usually breakfast) because the medication is less effective when taken with food.

Question 76

A nurse is providing teaching to a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching?
A. Discontinue the medication if a rash develops.
B. Expect increased salivation during the first few weeks of therapy.
C. Minimize fiber intake to prevent diarrhea.
D. Avoid driving until the client’s reaction to the medication is known.

Answer 76

D. Avoid driving until the client’s reaction to the medication is known.

Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client’s response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease.

Question 77

A home health nurse is visiting an older adult client who has Alzheimer’s disease. His caregiver tells the nurse she has been administering prescribed lorazepam, 1 mg three times per day, to the client for restlessness and anxiety during the past few days. For which of the following adverse effects should the nurse assess the client?
A. Low-grade fever
B. Sedation
C. Diuresis
D. Tonic-clonic seizures

Answer 77

B. Sedation

Lorazepam is a benzodiazepine with anti-anxiety and sedative effects. Older adult clients, especially, are at risk for central nervous system depression even with low doses of benzodiazepines. Clients who are 50 years or older can have a more profound and prolonged sedation than younger clients.

Question 78

A nurse is assessing a client who was recently admitted and has a history of alcohol use disorder. The client displays ataxia, an altered level of consciousness, and nystagmus. Which of the following medications should the nurse anticipate administering to the client?
A. Parenteral thiamine
B. Niacin extended-release capsules
C. Parenteral pyridoxine
D. Riboflavin tablets

Answer 78

A. Parenteral thiamine

The nurse should identify that a client who has a history of alcohol use disorder and displays ataxia, an altered level of consciousness, and nystagmus is exhibiting manifestations of Wernicke-Korsakoff syndrome due to a thiamine deficiency. Therefore, the nurse should anticipate administering parenteral thiamine.

Question 79

A nurse is caring for a client who received spinal anesthesia 30 minutes ago. The client reports feeling dizzy, and the nurse notes that the client’s blood pressure is 84/54 mmHg. Which of the following actions should the nurse take?
A. Place the client in the head-down position
B. Assess the placement of the catheter
C. Prepare to administer an IV reversal agent

D. Assist the client in passive range of motion movements

Answer 79

A. Place the client in the head-down position

The nurse should identify the client is experiencing an adverse effect from receiving the spinal anesthesia. Hypotension is the common adverse effect of spinal anesthesia due to the loss of venous tone and decreased venous return to the heart. Therefore, the nurse should position the client in a 10° to 15°, head-down position to rapidly promote venous return to the heart, which increases the client’s blood pressure.

Question 80

A nurse is teaching a client who had kidney transplant surgery about immunosuppressive medications. Which of the following adverse effects of these medications should the nurse include in the teaching?
A. Increased urinary output
B. Increased susceptibility to infection
C. Increased hair loss
D. Increased risk of autoimmune disorders

Answer 80

B. Increased susceptibility to infection

Immunosuppressive medications such as cyclosporine increase the risk of infection. As the medication classification indicates, these medications impair immunity and adversely affect the client’s ability to resist and fight infection.

Question 81

A nurse is teaching a client who has severe generalized rheumatoid arthritis and is scheduled to start taking prednisone for long-term therapy. The nurse should instruct the client to report which of the following as an adverse effect of prednisone?
A. Thrombosis
B. Immunosuppression
C. Gastric ulceration
D. Liver toxicity

Answer 81

C. Gastric ulceration

The nurse should instruct the client to monitor for gastric ulceration as an adverse effect of the long-term use of prednisone. Other adverse effects of this medication include osteoporosis and adrenal suppression.

Question 82

A nurse is providing teaching to a client who has a new prescription for a fentanyl transdermal patch. Which of the following statements by the client indicates an understanding of the teaching?
A. “The patch will not cause constipation like other pain medications do.”
B. “I will have to stop drinking grapefruit juice while using the patch.”
C. “I will place a heating pad over the patch to boost its effectiveness.”
D. “The patch will give me relief from my pain faster than pills can.”

Answer 82

B.”I will have to stop drinking grapefruit juice while using the patch.”

The nurse should instruct the client to avoid drinking grapefruit juice while using the fentanyl transdermal patch. Grapefruit juice can increase the absorption of the medication, raising the amount of fentanyl in the client’s blood. This effect can place the client at risk for CNS and respiratory depression.

Question 83

A nurse is caring for a client who takes warfarin 2.5 mg PO daily and has an INR of 6.2. The nurse should anticipate a prescription from the provider for which of the following medications?

A. Protamine sulfate
B. Fondaparinux
C. Vitamin K
D. Bivalirudin

Answer 83

C. Vitamin K The nurse should anticipate the provider to prescribe vitamin K for a client who has an INR of 6.2. Vitamin K antagonizes warfarin’s actions, which can reverse warfarin-induced inhibition of clotting factor synthesis.

Question 84

A hospice nurse is caring for a client who has cancer and is taking naproxen 250 mg 3 times daily PO and gabapentin 1,800 mg 3 times daily PO to manage pain. The client tells the nurse, “I’m having pain that keeps me from doing what I’d like most of the time.” Which of the following additions should the nurse anticipate to the client’s medication regimen?
A. Oral meperidine
B. Parenteral naloxone
C. Parenteral diazepam
D. Oral oxycodone

Answer 84

D.

The client’s current pain regimen consists of a nonopioid analgesic (naproxen) and an adjuvant medication for neuropathic pain (gabapentin). According to the WHO analgesic ladder for cancer pain management, the next addition to the pain regimen is an opioid for moderate pain. Oxycodone is an oral opioid that relieves moderate to moderately severe pain; therefore, it is an appropriate choice to add to the client’s pain regimen.

Question 85

A nurse is caring for a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following findings should the nurse identify as an indication that the client requires intervention?
A. Heart rate 106/min
B. Dry skin
C. Oral temperature 36.8°C (98.2°F)
D. Lethargy

Answer 85

A. Heart rate 106/min

Tachycardia can be a manifestation of hyperthyroidism, possibly due to excessive hormone replacement. The client might require a lower dosage of levothyroxine.

Question 86

A nurse is providing teaching to the parents of a child who has a new prescription for lamotrigine for a seizure disorder. The nurse should instruct the parents that which of the following adverse effects is the priority to report to the provider?
A. Diplopia
B. Dizziness
C. Rash
D. Headache

Answer 86

C. Rash

The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow’s hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. The greatest risk to this client is an injury from Stevens-Johnson syndrome or toxic epidermal necrolysis, which are life-threatening reactions that manifest initially as a rash in the first 2 to 8 weeks of treatment with lamotrigine. The nurse should instruct the parents to report a rash immediately to the provider.

Question 87

A nurse is providing teaching to a client with chronic bronchitis about administering acetylcysteine using a hand-held nebulizer (HHN). Which of the following client statements indicates an understanding of the teaching?
A. “I should discard an open vial of the medication after 24 hr.”
B. “I should limit my fluid intake while taking this medication.”
C. “I should try to cough productively just before I begin the treatment.”
D. “If the medication becomes discolored, I should throw it out and get a new supply.”

Answer 87

C. “I should try to cough productively just before I begin the treatment.”

A productive cough prior to beginning the treatment will clear sputum from lung surfaces, allowing better absorption of the medication.

Question 88

A charge nurse is monitoring a newly licensed nurse who is caring for a postoperative client who is receiving morphine through a PCA pump. Which of the following actions by the newly licensed nurse requires intervention?
A. Instructing the client to administer a PCA dose prior to a dressing change
B. Providing increased fluids while the client is using the PCA pump
C. Informing the client’s partner that only the client should administer the PCA doses
D. Maintaining the client on bed rest while the PCA pump is in use

Answer 88

D.%Maintaining the client on bed rest while the PCA pump is in use

Use of a PCA pump does not prevent ambulation following surgery. Early ambulation should be encouraged. The nurse should instruct the client to sit at the side of the bed prior to standing to reduce the risks of orthostatic hypotension and falls.

Question 89

A nurse is administering brimonidine eye drops to a client who has glaucoma. Which of the following ocular effects should the nurse expect?
A. Decreased intraocular pressure
B. Blocked growth of new blood vessels
C. Paralysis of accommodation
D. Mydriasis

Answer 89

A. Decreased intraocular pressure

Brimonidine is an alpha-2 adrenergic agonist used for the long-term treatment of open-angle glaucoma. It decreases intraocular pressure by reducing aqueous humor production.

Question 90

A nurse is caring for a client with Alzheimer’s disease who has a new prescription for memantine. Which of the following laboratory results should the nurse identify as increasing the client’s risk for decreased clearance of the medication?
A. Alanine aminotransferase (ALT) 30 units/L
B. Creatinine clearance 35 mL/min
C. HbA1c 5%
D. BMI 31

Answer 90

B. Creatinine clearance 35 mL/min

Creatinine clearance is an estimate of the glomerular filtration rate and the kidney’s ability to filter waste. A creatinine clearance of 35 mL/min indicates moderate renal impairment. The kidneys excrete memantine, and decreased clearance occurs with moderate renal impairment.

Question 91

A nurse has administered a medication to a client. Which of the following circumstances should the nurse identify as a medication error that resulted from a performance deficit by the nurse?
A. A medication safety coordinator was not present.
B. A verbal prescription was transcribed incorrectly.
C. A medication with a similar name was dispensed instead of the correct medication.
D. An intramuscular injection was given instead of a subcutaneous injection.

Answer 91

D. An intramuscular injection was given instead of a subcutaneous injection.

Performance deficits such as using an improper route of administration for a medication are the most common causes of medication errors that result from human error. The nurse can effectively reduce medication errors in clinical practice by implementing a safety checklist and diligently using the rights of medication administration. If the nurse is not following the rights of medication administration, then the nurse has a performance deficit.

Question 92

A nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take first?
A. Notify the provider
B. Contact the nursing supervisor
C. Assess the client’s apical pulse
D. Complete an incident report 11 12 13

Answer 92

C. Assess the client’s apical pulse

Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client’s status, she must first collect adequate data from the client. An assessment will provide the nurse with the knowledge needed to make an appropriate decision.

Question 93

A nurse is preparing to administer an IM injection for a client. Which of the following factors should the nurse identify as a potential contraindication to administering the medication via the IM route?
A. The medication is a depot preparation.
B. The client is taking an anticoagulant.
C. The medication is a particulate suspension.
D. The client has been vomiting. 11 12 13

Answer 93

B. The client is taking an anticoagulant.

Because of the risk of bleeding from the injection site, anticoagulant therapy (e.g. warfarin) is a contraindication to receiving medications via the IM route.

Question 94

A nurse is caring for a client who has a prescription for an oral contraceptive to prevent pregnancy. The nurse should identify that which of the following actions is the purpose of this medication?
A. Inhibition of ovulation
B. Thinning of the endometrial lining
C. Inhibition of luteinizing hormone
D. Thinning of cervical mucus

Answer 94

A. Inhibition of ovulation

The nurse should identify that this medication inhibits ovulation to prevent pregnancy.

Question 95

A nurse in a provider’s office is reviewing a client’s medication history. The client asks the nurse if she should begin taking high-dose vitamins as she ages. Which of the following pieces of information should the nurse provide about high doses of vitamin supplements?
A. High doses of water-soluble vitamins enhance their therapeutic actions.
B. High doses of water-soluble vitamins can have adverse effects.
C. High doses of vitamin supplements are restricted to use during pregnancy.
D. Tolerance might develop, resulting in an increased vitamin need.

Answer 95

B. High doses of water-soluble vitamins can have adverse effects.

High doses of vitamins can cause harm to the body. Any vitamin supplements consumed should not exceed the recommended dietary allowance. Elevated levels of vitamin A can increase the risk of developing osteoporosis and cause birth defects when taken during pregnancy. Excessive intake of beta-carotene can increase the risk of lung cancer in clients who smoke. In addition, increased doses of vitamin E can increase the risk of death in clients who have chronic illnesses.

Question 96

A nurse is caring for a client with asthma who has been taking an inhaled glucocorticoid and long-acting beta2-agonist combination dry-powdered inhaler (DPI) for maintenance therapy. The nurse should identify that which of the following is a disadvantage of this medication?
A. Restricted dosage flexibility
B. Complicated delivery device
C. Serious systemic effects
D. Limited efficacy over time

Answer 96

A.Restricted dosage flexibility

The nurse should identify that a disadvantage of an inhaled glucocorticoid and a long-acting beta2-agonist being combined is that the dosages of these medications are fixed, so the dose cannot be adjusted.

Question 97

A nurse is caring for a client who has a positive tuberculin skin test and is beginning a prescription for isoniazid. Which of the following laboratory values should be monitored while the client is taking isoniazid?
A. Thyroid Stimulating Hormone level (TSH)
B. Aspartate aminotransferase (AST)
C. Potassium
D. Sodium

Answer 97

B. Aspartate aminotransferase (AST)

Isoniazid can be toxic to the liver. Therefore, it is important to monitor liver enzymes such as AST during therapy with isoniazid. In addition, the nurse should instruct the client to notify the provider of jaundice, nausea, dark-colored urine, or other findings indicating hepatitis.

Question 98

A nurse is educating a client with urethritis who has a new prescription for oral erythromycin. Which of the following statements should the nurse include in the teaching?
A. “Report persistent diarrhea to the provider.”
B. “Take this medication with a full glass of milk.”
C. “Some people who take erythromycin experience vision loss.”
D. “Antacids will reduce the extent of absorption of this medication.”

Answer 98

A.”Report persistent diarrhea to the provider.”

Although gastrointestinal disturbances are the most common adverse effects of erythromycin, clients should report persistent or severe gastrointestinal reactions to the provider. Erythromycin can cause superinfection of the bowel because it destroys some sensitive flora in the gastrointestinal system.

Question 99

A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following pieces of information should the nurse include in the teaching?
A. Respiratory depression can occur 7 min after the morphine is administered.
B. The morphine will peak in 10 min.
C. Withhold the morphine if the client has a respiratory rate of <16/min.
D. Administer the morphine over 2 min.

Answer 99

A. Respiratory depression can occur 7 min after the morphine is administered.

Respiratory depression can occur within 7 minutes of the administration of IV bolus morphine. The nurse should monitor the client’s respirations and have naloxone available to reverse the effects of the morphine.

Question 100

A nurse is caring for a client who is experiencing an acute gout attack. The nurse should anticipate a prescription from the provider for which of the following medications?
A. Colchicine
B. Allopurinol
C. Probenecid
D. Pegloticas

Answer 100

A. Colchicine

The nurse should anticipate a prescription for colchicine because it is the medication of choice for an acute gout attack. The client can experience relief from the attack within hours of receiving this medication. Colchicine can also be prescribed for long-term use to prevent future attacks from occurring.

Question 101

A nurse is teaching a client who is about to start taking propylthiouracil to treat hyperthyroidism. Which of the following statements should the nurse identify as an indication that the teaching has been effective?
A. “I will need laboratory tests to check my liver function.”
B. “I should take this medication once daily.”
C. “If I get a rash, I am probably having an allergic reaction.”
D. “If I have difficulty sleeping, it is probably because of this medication.”

Answer 101

A.”I will need laboratory tests to check my liver function.”

Propylthiouracil is hepatotoxic and can cause severe liver injury. The nurse should instruct the client to report dark urine and yellowing of the eyes, which can indicate an injury to the liver.

Question 102

A nurse is providing teaching to a client with a seizure disorder who has a new prescription for carbamazepine. Which of the following statements should the nurse include in the teaching?
A. “This medication will decrease the effectiveness of oral contraceptives.”
B. “Once you are seizure-free for a month, you will be able to stop taking the medication.”
C. “You can cut the dose in half if gastrointestinal upset occurs.”
D. “This medication might initially increase the frequency of your seizures.”

Answer 102

A. “This medication will decrease the effectiveness of oral contraceptives.”

Question 103

A nurse is teaching a group of nurses about the effects of a client receiving spinal anesthesia. Which of the following pieces of information should the nurse include in the teaching?
A. Lidocaine toxicity will cause the client to develop tachycardia.
B. Most clients develop a headache from spinal anesthesia.
C. Hypotension is an adverse effect of spinal anesthesia.
D. Urinary urgency occurs when the client has spinal anesthesia.

Answer 103

C. Hypotension is an adverse effect of spinal anesthesia.

The local anesthetic can cause the client’s blood pressure to decrease due to venous dilation secondary to a sympathetic nervous system response. If hypotension occurs, the nurse should lower the head of the client’s bed, increase fluids if applicable, and administer vasoconstrictive medication as indicated by the provider.

Question 104

A nurse is monitoring a client who is receiving terbutaline to suppress preterm labor. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of the medication?
A. BP 132/84 mmHg
B. Blood glucose 106 mg/dL
C. Decreased deep tendon reflexes
D. Maternal heart rate >120/min

Answer 104

D. Maternal heart rate >120/min

A client who is receiving terbutaline can experience tachycardia, which poses a significant risk to the mother. Therefore, when the maternal heart rate exceeds 120/min, the medication should be stopped. Adverse effects result from activating beta1 receptors as well as beta2 receptors.

Question 105

A nurse is administering a prescription for nifedipine to a client who is pregnant. Which of the following pieces of information related to nifedipine should the nurse monitor and document?
A. Hypoglycemia
B. Uterine ripening
C. Increased blood pressure
D. Number of uterine contractions

Answer 105

D. Number of uterine contractions

A client who is going into preterm labor can have a prescription for nifedipine, which is a calcium channel blocker that inhibits the entry of calcium into myometrial cells, which can delay labor.

Question 106

A nurse is teaching the guardian of an infant about the diphtheria, tetanus, and pertussis (DTaP) vaccine. Which of the following pieces of information should the nurse include in the teaching?
A. “Routine immunization for DTaP consists of 3 injections.”
B. “The first immunization for DTaP in the series is given at 2 months.”
C. “DTaP immunization has been replaced with DTP.”
D. “This immunization is administered subcutaneously.”

Answer 106

B. “The first immunization for DTaP in the series is given at 2 months.”

The nurse should tell the guardian that the first immunization of DTaP is given at 2 months, with the rest of the vaccinations occurring at 4 months, 6 months, 15 to 18 months, and 4 to 6 years of age.

Question 107

A nurse is caring for a male client who has been taking cimetidine for the treatment of a duodenal ulcer. Which of the following manifestations related to the medication should the nurse report to the provider?
A. Emesis that looks like coffee grounds
B. Erectile dysfunction
C. Muscle pain
D. Gynecomasti

Answer 107

A. Emesis that looks like coffee grounds

The nurse should identify that coffee-ground emesis is a manifestation of a gastrointestinal bleed as a result of the duodenal ulcer and can indicate that treatment with cimetidine has been ineffective. Therefore, the nurse should report this finding to the provider immediately

Question 108

A nurse is preparing to administer raloxifene to a client. Which of the following conditions is a contraindication for the administration of this medication?
A. Osteoporosis
B. Hyperthyroidism
C. Myocardial infarction
D. Deep-vein thrombosis

Answer 108

D. Deep-vein thrombosis

The nurse should identify that raloxifene, like estrogen, increases the risk of deep-vein thrombosis, pulmonary embolism, and stroke. Raloxifene is contraindicated for clients who have a history of venous thrombotic events.

Question 109

A nurse is teaching a client who has a new prescription for amitriptyline to treat depression. Which of the following client statements indicates an understanding of the teaching?
A. “I should take this medication when I experience active symptoms.”
B. “I should take this medication before bedtime.”
C. “This medication may cause excess salivation.”
D. “I might experience weight loss while taking this medication.”

Answer 109

B. “I should take this medication before bedtime.”

The nurse should instruct the client that an adverse effect of amitriptyline is sedation. The nurse should instruct the client to take the medication at bedtime to minimize sedation during waking hours while promoting sleep.

Question 110

A nurse is providing teaching about antiretroviral medication therapy to a client who has a new diagnosis of AIDS. Which of the following statements should the nurse include in the teaching?
A. “Your provider will prescribe a single antiretroviral medication at a time.”
B. “You should take antiretroviral medications on a routine schedule.”
C. “You should increase your intake of raw fruits and vegetables while taking antiretroviral medications.” .
D. “Your provider will prescribe antiretroviral therapy to kill the HIV.”

Answer 110

B. “You should take antiretroviral medications on a routine schedule.”

The nurse should inform the client of the need to take antiretroviral therapy exactly as prescribed and to avoid delaying or skipping any doses, which can result in medication resistance.

Question 111

A nurse is caring for a client who is taking an agonist medication. The nurse should expect which of the following actions from this type of medication?
A. Acts with a partial agonist molecule to block receptors fully
B. Temporarily occupies receptors instead of other competitive molecules
C. Blocks receptors and prevents them from activating with a regulatory molecule
D. Binds to receptors and mimics regulatory molecule

Answer 111

D. Binds to receptors and mimics regulatory molecules

Full agonist medications act by binding to receptors and mimicking the actions of the body’s regulatory molecules. Agonists activate receptors to produce the expected effects. Hormones are an example of agonists.

Question 112

A nurse is reviewing the medical record for a client who has a migraine and a prescription for sumatriptan. Which of the following factors in the client’s medical history should the nurse identify as a contraindication to receiving sumatriptan? A. Renal impairment B. Ischemic heart disease C. Severe osteoporosis D. Cirrhosis

Answer 112

B. Ischemic heart disease

The nurse should identify that ischemic heart disease is a contraindication to receiving sumatriptan. Sumatriptan is a serotonin receptor agonist that can cause vasoconstriction and coronary vasospasm. This medication is also contraindicated in clients who had a myocardial infarction or clients who have coronary artery disease, uncontrolled hypertension, or other types of heart disease.

Question 113

A nurse is preparing to administer warfarin to a client who has a new onset of atrial fibrillation. The client asks the nurse, “What should this medication do?” Which of the following responses should the nurse make?
A. “It helps your heart return to a normal rhythm.”
B. “It dissolves blood clots.”
C. “It can reduce your risk of having a stroke.”
D. “It helps to prevent bleeding in atrial fibrillation.”

Answer 113

C. “It can reduce your risk of having a stroke.”

The nurse should identify that atrial fibrillation increases the client’s risk of having a stroke due to clot formation in the atrium. Warfarin can prevent clot formation when used long-term, which will reduce the client’s risk of having a stroke.

Question 114

A nurse is providing teaching to a client with a new diagnosis of heart failure who has a prescription for furosemide. Which of the following statements should the nurse include in the teaching?
A. “You can take ibuprofen for headaches while taking this medication.”
B. “You may experience increased swelling in your lower extremities while taking this medication.”
C. “You should eat foods that are high in potassium while taking this medication.”
D. “You should take this medication at bedtime

Answer 114

C. “You should eat foods that are high in potassium while taking this medication.”

The nurse should instruct this client who has a prescription for furosemide to consume foods that are high in potassium. Furosemide is a high-ceiling loop diuretic that depletes potassium, sodium, chloride, magnesium, and water.

Question 115

A nurse is teaching a client who has persistent cancer pain about the adverse effects of opioids. Which of the following statements should the nurse include in the teaching?
A. “Opioids do not relieve pain without causing severe adverse effects.”
B. “Physical dependence is not the same as addiction.”
C. “Tolerance typically means that the medication will no longer be effective.”
D. “The most common adverse effect is respiratory depression with prolonged use.”

Answer 115

B. “Physical dependence is not the same as addiction.”

The nurse should explain that physical dependence can occur in all clients who take opioids, and the client may develop abstinence syndrome if the opioid is abruptly withdrawn. Physical dependence is not the same as addiction, but it can result in addiction. Addiction results when the opioid is continued despite physical or psychological harm.