2025 ATI PN PHARMACOLOGY PROCTORED

EXAM WITH NGN: QUESTIONS & 100%

VERIFIED CORRECT ANSWERS (LATEST; 2025)
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1) A nurse is caring for a client with hyperparathyroidism and notes that the
client's serum calcium level is 13 mg/dL. Which medication should the nurse
prepare to administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D - --<<ANSWER IS>>---3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing
hypercalcemia. Calcium gluconate and calcium chloride are medications used for
the treatment of tetany, which occurs as a result of acute hypocalcemia. In
hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid
hormone, decreases the plasma calcium level by inhibiting bone resorption and
lowering the serum calcium concentration.

2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency
anemia. The nurse instructs the mother to administer the iron with which best
food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice - --<<ANSWER IS>>---4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be
instructed to administer the medication with a citrus fruit or a juice that is high in
vitamin C. Milk may affect absorption of the iron. Water will not assist in
absorption. Orange juice contains a greater amount of vitamin C than apple juice.

3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse
monitors the client, knowing that which of the following would indicate the
presence of systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations - --<<ANSWER IS>>---1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism)
can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological
disturbances. Constipation and diarrhea are not associated with salicylism.

4.) The camp nurse asks the children preparing to swim in the lake if they have
applied sunscreen. The nurse reminds the children that chemical sunscreens are
most effective when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun - --<<ANSWER IS>>---4. At least
30 minutes before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure
to the sun so that they can penetrate the skin. All sunscreens should be reapplied
after swimming or sweating.

5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury.
When applying the medication, the client complains of local discomfort and
burning. Which of the following is the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site - --<<ANSWER IS>>---3.
Informing the client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms
and is used to treat burns to reduce bacteria present in avascular tissues. The
client should be informed that the medication will cause local discomfort and
burning and that this is a normal reaction; therefore options 1, 2, and 4 are
incorrect

6.) The burn client is receiving treatments of topical mafenide acetate

(Sulfamylon) to the site of injury. The nurse monitors the client, knowing that
which of the following indicates that a systemic effect has occurred?
1.Hyperventilation
2.Elevated blood pressure
3.Local pain at the burn site
4.Local rash at the burn site - --<<ANSWER IS>>---1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal
excretion of acid, thereby causing acidosis. Clients receiving this treatment should
be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs,
the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe
local rather than systemic effects. An elevated blood pressure may be expected
from the pain that occurs with a burn injury.

7.) Isotretinoin is prescribed for a client with severe acne. Before the
administration of this medication, the nurse anticipates that which laboratory test
will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count - --<<ANSWER IS>>---2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be
measured before treatment and periodically thereafter until the effect on the
triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored
specifically during this treatment.

8.) A client with severe acne is seen in the clinic and the health care provider
(HCP) prescribes isotretinoin. The nurse reviews the client's medication record and
would contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin) - --<<ANSWER IS>>---1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized
intensification of isotretinoin toxicity. Because of the potential for increased
toxicity, vitamin A supplements should be discontinued before isotretinoin
therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse
would monitor for the potential for increased systemic absorption of the
medication if the medication were being applied to which of the following body
areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands - --<<ANSWER IS>>---2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circulation. Absorption is
higher from regions where the skin is especially permeable (scalp, axilla, face,
eyelids, neck, perineum, genitalia), and lower from regions in which permeability
is poor (back, palms, soles).

10.) The clinic nurse is performing an admission assessment on a client. The nurse
notes that the client is taking azelaic acid (Azelex). Because of the medication
prescription, the nurse would suspect that the client is being treated for:
1. Acne
2. Eczema
3. Hair loss
4. Herpes simplex - --<<ANSWER IS>>---1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid
appears to work by suppressing the growth of Propionibacterium acnes and
decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the
client with a partial-thickness burn, which has cultured positive for gram-negative
bacteria. The nurse is reinforcing information to the client about the medication.
Which statement made by the client indicates a lack of understanding about the
treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound." - --<<ANSWER IS>>-
--3. "The medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of
activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is
applied directly to the wound to assist in healing. It does not stain the skin.

12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an
antineoplastic medication. During the infusion, the client complains of pain at the
insertion site. During an inspection of the site, the nurse notes redness and
swelling and that the rate of infusion of the medication has slowed. The nurse
should take which appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion. - --<<ANSWER IS>>--
-1. Notify the registered nurse.
Rationale:
When antineoplastic medications (Chemotheraputic Agents) are administered via
IV, great care must be taken to prevent the medication from escaping into the
tissues surrounding the injection site, because pain, tissue damage, and necrosis
can result. The nurse monitors for signs of extravasation, such as redness or
swelling at the insertion site and a decreased infusion rate. If extravasation occurs,
the registered nurse needs to be notified; he or she will then contact the health
care provider.

13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin
intravenously. The nurse caring for the client anticipates that which diagnostic
study will be prescribed?
1. Echocardiography
2. Electrocardiography
3. Cervical radiography
4. Pulmonary function studies - --<<ANSWER IS>>---4. Pulmonary function studies
Rationale:
Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can
cause interstitial pneumonitis, which can progress to pulmonary fibrosis.
Pulmonary function studies along with hematological, hepatic, and renal function
tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea
and crackles, which indicate pulmonary toxicity. The medication needs to be
discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are
unrelated to the specific use of this medication.

14.) The client with acute myelocytic leukemia is being treated with busulfan
(Myleran). Which laboratory value would the nurse specifically monitor during
treatment with this medication?
1. Clotting time
2. Uric acid level
3. Potassium level
4. Blood glucose level - --<<ANSWER IS>>---2. Uric acid level
Rationale:
Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can
produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3,
and 4 are not specifically related to this medication.

15.) The client with small cell lung cancer is being treated with etoposide
(VePesid). The nurse who is assisting in caring for the client during its
administration understands that which side effect is specifically associated with
this medication?
1. Alopecia
2. Chest pain
3. Pulmonary fibrosis
4. Orthostatic hypotension - --<<ANSWER IS>>---4. Orthostatic hypotension
Rationale:
A side effect specific to etoposide is orthostatic hypotension. The client's blood
pressure is monitored during the infusion. Hair loss occurs with nearly all the
antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to
this medication.

16.) The clinic nurse is reviewing a teaching plan for the client receiving an
antineoplastic medication. When implementing the plan, the nurse tells the client:
1. To take aspirin (acetylsalicylic acid) as needed for headache
2. Drink beverages containing alcohol in moderate amounts each evening
3. Consult with health care providers (HCPs) before receiving immunizations
4. That it is not necessary to consult HCPs before receiving a flu vaccine at the
local health fair - --<<ANSWER IS>>---3. Consult with health care providers (HCPs)
before receiving immunizations
Rationale:
Because antineoplastic medications lower the resistance of the body, clients must
be informed not to receive immunizations without a HCP's approval. Clients also
need to avoid contact with individuals who have recently received a live virus
vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize
the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity
and side effects.

17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The
nurse monitors the client, knowing that which of the following indicates a side
effect specific to this medication?
1. Diarrhea
2. Hair loss
3. Chest pain
4. Numbness and tingling in the fingers and toes - --<<ANSWER IS>>---4.
Numbness and tingling in the fingers and toes
Rationale:
A side effect specific to vincristine is peripheral neuropathy, which occurs in
almost every client. Peripheral neuropathy can be manifested as numbness and
tingling in the fingers and toes. Depression of the Achilles tendon reflex may be
the first clinical sign indicating peripheral neuropathy. Constipation rather than
diarrhea is most likely to occur with this medication, although diarrhea may occur
occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest
pain is unrelated to this medication.

18.) The nurse is reviewing the history and physical examination of a client who
will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults
with the registered nurse regarding the administration of the medication if which
of the following is documented in the client's history?
1. Pancreatitis
2. Diabetes mellitus
3. Myocardial infarction
4. Chronic obstructive pulmonary disease - --<<ANSWER IS>>---1. Pancreatitis
Rationale:
Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis,
or if the client has a history of pancreatitis. The medication impairs pancreatic
function and pancreatic function tests should be performed before therapy begins
and when a week or more has elapsed between administration of the doses. The
client needs to be monitored for signs of pancreatitis, which include nausea,
vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not
contraindicated with this medication.
19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The
nurse understands that the primary action of this medication is to:
1. Increase DNA and RNA synthesis.
2. Promote the biosynthesis of nucleic acids.
3. Increase estrogen concentration and estrogen response.
4. Compete with estradiol for binding to estrogen in tissues containing high
concentrations of receptors. - --<<ANSWER IS>>---4. Compete with estradiol for
binding to estrogen in tissues containing high concentrations of receptors.
Rationale:
Tamoxifen is an antineoplastic medication that competes with estradiol for
binding to estrogen in tissues containing high concentrations of receptors.
Tamoxifen is used to treat metastatic breast carcinoma in women and men.
Tamoxifen is also effective in delaying the recurrence of cancer following
mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse
specifically monitors which laboratory value while the client is taking this
medication?
1. Glucose level
2. Calcium level
3. Potassium level
4. Prothrombin time - --<<ANSWER IS>>---2. Calcium level
Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the
initiation of therapy, a complete blood count, platelet count, and serum calcium
levels should be assessed. These blood levels, along with cholesterol and
triglyceride levels, should be monitored periodically during therapy. The nurse
should assess for hypercalcemia while the client is taking this medication. Signs of
hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting,
constipation, hypotonicity of muscles, and deep bone and flank pain.

21.) A nurse is assisting with caring for a client with cancer who is receiving
cisplatin. Select the adverse effects that the nurse monitors for that are associated
with this medication. Select all that apply.
1. Tinnitus
2. Ototoxicity
3. Hyperkalemia
4. Hypercalcemia
5. Nephrotoxicity
6. Hypomagnesemia - --<<ANSWER IS>>---1. Tinnitus
2. Ototoxicity
5. Nephrotoxicity
6. Hypomagnesemia
Rationale:
Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-
nonspecific medications that affect the synthesis of DNA by causing the cross-
linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity,
tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity.
Amifostine (Ethyol) may be administered before cisplatin to reduce the potential
for renal toxicity.
22.) A nurse is caring for a client after thyroidectomy and notes that calcium
gluconate is prescribed for the client. The nurse determines that this medication
has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone. - --<<ANSWER IS>>---3. Treat
hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are
accidentally removed or injured during surgery. Manifestations develop 1 to 7
days after surgery. If the client develops numbness and tingling around the mouth,
fingertips, or toes or muscle spasms or twitching, the health care provider is
notified immediately. Calcium gluconate should be kept at the bedside.

23.) A client who has been newly diagnosed with diabetes mellitus has been
stabilized with daily insulin injections. Which information should the nurse teach
when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage. - --
<<ANSWER IS>>---2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If
acetone is found in the urine, it may possibly indicate the need for additional
insulin. To minimize the discomfort associated with insulin injections, the insulin
should be administered at room temperature. Injection sites should be
systematically rotated from one area to another. The client should be instructed to
give injections in one area, about 1 inch apart, until the whole area has been used
and then to change to another site. This prevents dramatic changes in daily insulin
absorption.

24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin
and NPH insulin in the same syringe. Which of the following actions, if performed
by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial - --
<<ANSWER IS>>---1. Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the
regular insulin is drawn into the syringe first. This sequence will avoid
contaminating the vial of regular insulin with insulin of another type. Options 2, 3,
and 4 identify the correct actions for preparing NPH and regular insulin.

25.) A home care nurse visits a client recently diagnosed with diabetes mellitus
who is taking Humulin NPH insulin daily. The client asks the nurse how to store the
unopened vials of insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
 4. Keep the insulin at room temperature. - --<<ANSWER IS>>---2. Refrigerate the
insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until needed. Vials
should not be frozen. When stored unopened under refrigeration, insulin can be
used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse
reinforces instructions for the client and tells the client to avoid which of the
following while taking this medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages - --<<ANSWER IS>>---1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction
may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can
also potentiate the hypoglycemic effects of the medication. Clients need to be
instructed to avoid alcohol consumption while taking this medication. The items in
options 2, 3, and 4 do not need to be avoided.

27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A

nurse reviews the client's medical record and would question the prescription if
which of the following is noted in the client's history?
1. Neuralgia
2. Insomnia
3. Use of nitroglycerin
4. Use of multivitamins - --<<ANSWER IS>>---3. Use of nitroglycerin
Rationale:
Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus
cavernosum of the penis, thus sustaining an erection. Because of the effect of the
medication, it is contraindicated with concurrent use of organic nitrates and
nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia
and insomnia are side effects of the medication.

28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with
type 1 diabetes mellitus who takes insulin. The nurse knows that which of the
following is the appropriate intervention?
1. The medication is administered within 60 minutes before the morning and
evening meal.
2. The medication is withheld and the HCP is called to question the prescription
for the client.
3. The client is monitored for gastrointestinal side effects after administration of
the medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for
administration. - --<<ANSWER IS>>---2. The medication is withheld and the HCP is
called to question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It
is not recommended for clients taking insulin. Hence, the nurse should hold the
medication and question the HCP regarding this prescription. Although options 1
and 3 are correct statements about the medication, in this situation the
medication should not be administered. The medication is packaged in prefilled
pens ready for injection without the need for drawing it up into another syringe.
29.) A client is taking Humulin NPH insulin daily every morning. The nurse
reinforces instructions for the client and tells the client that the most likely time
for a hypoglycemic reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours after administration
3. 16 to 18 hours after administration
4. 18 to 24 hours after administration - --<<ANSWER IS>>---2. 4 to 12 hours after
administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it
peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic
reactions most likely occur during peak time.

30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes
mellitus previously had been well controlled with glyburide (DiaBeta) daily, but
recently the fasting blood glucose level has been 180 to 200 mg/dL. Which
medication, if added to the client's regimen, may have contributed to the
hyperglycemia?
1. Prednisone
2. Phenelzine (Nardil)
3. Atenolol (Tenormin)
4. Allopurinol (Zyloprim) - --<<ANSWER IS>>---1. Prednisone
Rationale:
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and
potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a
β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases
urinary excretion of sulfonylurea agents, causing increased levels of the oral
agents, which can lead to hypoglycemia.

31.) A community health nurse visits a client at home. Prednisone 10 mg orally

daily has been prescribed for the client and the nurse reinforces teaching for the
client about the medication. Which statement, if made by the client, indicates that
further teaching is necessary?
1. "I can take aspirin or my antihistamine if I need it."
2. "I need to take the medication every day at the same time."
3. "I need to avoid coffee, tea, cola, and chocolate in my diet."
4. "If I gain more than 5 pounds a week, I will call my doctor." - --<<ANSWER IS>>-
--1. "I can take aspirin or my antihistamine if I need it."
Rationale:
Aspirin and other over-the-counter medications should not be taken unless the
client consults with the health care provider (HCP). The client needs to take the
medication at the same time every day and should be instructed not to stop the
medication. A slight weight gain as a result of an improved appetite is expected,
but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be
reported to the HCP. Caffeine-containing foods and fluids need to be avoided
because they may contribute to steroid-ulcer development.

32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes

insipidus. The nurse monitors the client after medication administration for which
therapeutic response?
1. Decreased urinary output
2. Decreased blood pressure
3. Decreased peripheral edema
4. Decreased blood glucose level - --<<ANSWER IS>>---1. Decreased urinary
output
Rationale:
Desmopressin promotes renal conservation of water. The hormone carries out this
action by acting on the collecting ducts of the kidney to increase their
permeability to water, which results in increased water reabsorption. The
therapeutic effect of this medication would be manifested by a decreased urine
output. Options 2, 3, and 4 are unrelated to the effects of this medication.

33.) The home health care nurse is visiting a client who was recently diagnosed
with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and
metformin (Glucophage) and asks the nurse to explain these medications. The
nurse should reinforce which instructions to the client? Select all that apply.
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia
episodes.
5. Metformin increases hepatic glucose production to prevent hypoglycemia
associated with repaglinide.
6. Muscle pain is an expected side effect of metformin and may be treated with
acetaminophen (Tylenol). - --<<ANSWER IS>>---1. Diarrhea can occur secondary to
the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia
episodes.
Rationale:
Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic
insulin secretion that should be taken before meals, and that should be withheld if
the client does not eat. Hypoglycemia is a side effect of repaglinide and the client
should always be prepared by carrying a simple sugar with her or him at all times.
Metformin is an oral hypoglycemic given in combination with repaglinide and
works by decreasing hepatic glucose production. A common side effect of
metformin is diarrhea. Muscle pain may occur as an adverse effect from
metformin but it might signify a more serious condition that warrants health care
provider notification, not the use of acetaminophen.

34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab

(Remicade). The nurse assisting in caring for the client should take which action to
monitor the effectiveness of treatment?
1. Monitoring the leukocyte count for 2 days after the infusion
2. Checking the frequency and consistency of bowel movements
3. Checking serum liver enzyme levels before and after the infusion
4. Carrying out a Hematest on gastric fluids after the infusion is completed - --
<<ANSWER IS>>---2. Checking the frequency and consistency of bowel
movements
Rationale:
The principal manifestations of Crohn's disease are diarrhea and abdominal pain.
Infliximab (Remicade) is an immunomodulator that reduces the degree of
inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are
unrelated to this medication.
35.) The client has a PRN prescription for loperamide hydrochloride (Imodium).
The nurse understands that this medication is used for which condition?
1. Constipation
2. Abdominal pain
3. An episode of diarrhea
4. Hematest-positive nasogastric tube drainage - --<<ANSWER IS>>---3. An
episode of diarrhea
Rationale:
Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic
diarrhea in conditions such as inflammatory bowel disease. Loperamide also can
be used to reduce the volume of drainage from an ileostomy. It is not used for the
conditions in options 1, 2, and 4.

36.) The client has a PRN prescription for ondansetron (Zofran). For which
condition should this medication be administered to the postoperative client?
1. Paralytic ileus
2. Incisional pain
3. Urinary retention
4. Nausea and vomiting - --<<ANSWER IS>>---4. Nausea and vomiting
Rationale:
Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as
well as nausea and vomiting associated with chemotherapy. The other options are
incorrect.
37.) The client has begun medication therapy with pancrelipase (Pancrease MT).
The nurse evaluates that the medication is having the optimal intended benefit if
which effect is observed?
1. Weight loss
2. Relief of heartburn
3. Reduction of steatorrhea
4. Absence of abdominal pain - --<<ANSWER IS>>---3. Reduction of steatorrhea
Rationale:
Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with
pancreatitis as a digestive aid. The medication should reduce the amount of fatty
stools (steatorrhea). Another intended effect could be improved nutritional status.
It is not used to treat abdominal pain or heartburn. Its use could result in weight
gain but should not result in weight loss if it is aiding in digestion.

38.) An older client recently has been taking cimetidine (Tagamet). The nurse
monitors the client for which most frequent central nervous system side effect of
this medication?
1. Tremors
2. Dizziness
3. Confusion
4. Hallucinations - --<<ANSWER IS>>---3. Confusion
Rationale:
Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially
susceptible to central nervous system side effects of cimetidine. The most
frequent of these is confusion. Less common central nervous system side effects
include headache, dizziness, drowsiness, and hallucinations.
39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g
by mouth four times daily. The nurse schedules the medication for which times?
1. With meals and at bedtime
2. Every 6 hours around the clock
3. One hour after meals and at bedtime
4. One hour before meals and at bedtime - --<<ANSWER IS>>---4. One hour
before meals and at bedtime
Rationale:
Sucralfate is a gastric protectant. The medication should be scheduled for
administration 1 hour before meals and at bedtime. The medication is timed to
allow it to form a protective coating over the ulcer before food intake stimulates
gastric acid production and mechanical irritation. The other options are incorrect.

40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has
been taking misoprostol (Cytotec). The nurse determines that the medication is
having the intended therapeutic effect if which of the following is noted?
1. Resolved diarrhea
2. Relief of epigastric pain
3. Decreased platelet count
4. Decreased white blood cell count - --<<ANSWER IS>>---2. Relief of epigastric
pain
Rationale:
The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) is
prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given
specifically to prevent this occurrence. Diarrhea can be a side effect of the
medication, but is not an intended effect. Options 3 and 4 are incorrect.

41.) The client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory
care nurse evaluates that the client is receiving optimal intended effect of the
medication if the client reports the absence of which symptom?
1. Diarrhea
2. Heartburn
3. Flatulence
4. Constipation - --<<ANSWER IS>>---2. Heartburn
Rationale:
Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The
intended effect of the medication is relief of pain from gastric irritation, often
called heartburn by clients. Omeprazole is not used to treat the conditions
identified in options 1, 3, and 4.

42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection.
The nurse is reinforcing teaching for the client about the medications prescribed,
including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin
(Amoxil). Which statement by the client indicates the best understanding of the
medication regimen?
1. "My ulcer will heal because these medications will kill the bacteria."
2. "These medications are only taken when I have pain from my ulcer."
3. "The medications will kill the bacteria and stop the acid production."
4. "These medications will coat the ulcer and decrease the acid production in my
stomach." - --<<ANSWER IS>>---3. "The medications will kill the bacteria and stop
the acid production."
Rationale:
Triple therapy for Helicobacter pylori infection usually includes two antibacterial
drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are
antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill
the bacteria and decrease acid production.

43.) A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse
understands that which medications are H2-receptor antagonists? Select all that
apply.
1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
5. Esomeprazole (Nexium)
6. Lansoprazole (Prevacid) - --<<ANSWER IS>>---1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
Rationale:
H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of
heartburn, and assist in preventing complications of peptic ulcer disease. These
medications also suppress gastric acid secretions and are used in active ulcer
disease, erosive esophagitis, and pathological hypersecretory conditions. The
other medications listed are proton pump inhibitors.
H2-receptor antagonists medication names end with -dine.
Proton pump inhibitors medication names end with -zole.
44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9%
normal saline by nebulizer. The nurse should have which item available for
possible use after giving this medication?
1. Ambu bag
2. Intubation tray
3. Nasogastric tube
4. Suction equipment - --<<ANSWER IS>>---4. Suction equipment
Rationale:
Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen
overdose, or it may be given by inhalation for use as a mucolytic. The nurse
administering this medication as a mucolytic should have suction equipment
available in case the client cannot manage to clear the increased volume of
liquefied secretions.

45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as

needed. The nurse determines that the client understands the most effective use
of this medication if the client states that he or she will:
1. Watch for irritability as a side effect.
2. Take the tablet with a full glass of water.
3. Take an extra dose if the cough is accompanied by fever.
4. Crush the sustained-release tablet if immediate relief is needed. - --<<ANSWER
IS>>---2. Take the tablet with a full glass of water.
Rationale:
Guaifenesin is an expectorant. It should be taken with a full glass of water to
decrease viscosity of secretions. Sustained-release preparations should not be
broken open, crushed, or chewed. The medication may occasionally cause
dizziness, headache, or drowsiness as side effects. The client should contact the
health care provider if the cough lasts longer than 1 week or is accompanied by
fever, rash, sore throat, or persistent headache.

46.) A postoperative client has received a dose of naloxone hydrochloride for

respiratory depression shortly after transfer to the nursing unit from the
postanesthesia care unit. After administration of the medication, the nurse checks
the client for:
1. Pupillary changes
2. Scattered lung wheezes
3. Sudden increase in pain
4. Sudden episodes of diarrhea - --<<ANSWER IS>>---3. Sudden increase in pain
Rationale:
Naloxone hydrochloride is an antidote to opioids and may also be given to the
postoperative client to treat respiratory depression. When given to the
postoperative client for respiratory depression, it may also reverse the effects of
analgesics. Therefore, the nurse must check the client for a sudden increase in the
level of pain experienced. Options 1, 2, and 4 are not associated with this
medication.

47.) A client has been taking isoniazid (INH) for 2 months. The client complains to
a nurse about numbness, paresthesias, and tingling in the extremities. The nurse
interprets that the client is experiencing:
1. Hypercalcemia
2. Peripheral neuritis
3. Small blood vessel spasm
4. Impaired peripheral circulation - --<<ANSWER IS>>---2. Peripheral neuritis
Rationale:
A common side effect of the TB drug INH is peripheral neuritis. This is manifested
by numbness, tingling, and paresthesias in the extremities. This side effect can be
minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse
plans to teach the client to:
1. Drink alcohol in small amounts only.
2. Report yellow eyes or skin immediately.
3. Increase intake of Swiss or aged cheeses.
4. Avoid vitamin supplements during therapy. - --<<ANSWER IS>>---2. Report
yellow eyes or skin immediately.
Rationale:
INH is hepatotoxic, and therefore the client is taught to report signs and
symptoms of hepatitis immediately (which include yellow skin and sclera). For the
same reason, alcohol should be avoided during therapy. The client should avoid
intake of Swiss cheese, fish such as tuna, and foods containing tyramine because
they may cause a reaction characterized by redness and itching of the skin,
flushing, sweating, tachycardia, headache, or lightheadedness. The client can
avoid developing peripheral neuritis by increasing the intake of pyridoxine
(vitamin B6) during the course of INH therapy for TB.

49.) A client has been started on long-term therapy with rifampin (Rifadin). A
nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is forgotten
3. Causes orange discoloration of sweat, tears, urine, and feces
4. May be discontinued independently if symptoms are gone in 3 months - --
<<ANSWER IS>>---3. Causes orange discoloration of sweat, tears, urine, and feces
Rationale:
Rifampin should be taken exactly as directed as part of TB therapy. Doses should
not be doubled or skipped. The client should not stop therapy until directed to do
so by a health care provider. The medication should be administered on an empty
stomach unless it causes gastrointestinal upset, and then it may be taken with
food. Antacids, if prescribed, should be taken at least 1 hour before the
medication. Rifampin causes orange-red discoloration of body secretions and will
permanently stain soft contact lenses.

50.) A nurse has given a client taking ethambutol (Myambutol) information about
the medication. The nurse determines that the client understands the instructions
if the client states that he or she will immediately report:
1. Impaired sense of hearing
2. Problems with visual acuity
3. Gastrointestinal (GI) side effects
4. Orange-red discoloration of body secretions - --<<ANSWER IS>>---2. Problems
with visual acuity
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to
discriminate between the colors red and green. This poses a potential safety
hazard when a client is driving a motor vehicle. The client is taught to report this
symptom immediately. The client is also taught to take the medication with food if
GI upset occurs. Impaired hearing results from antitubercular therapy with
streptomycin. Orange-red discoloration of secretions occurs with rifampin
(Rifadin).
51.) Cycloserine (Seromycin) is added to the medication regimen for a client with
tuberculosis. Which of the following would the nurse include in the client-teaching
plan regarding this medication?
1. To take the medication before meals
2. To return to the clinic weekly for serum drug-level testing
3. It is not necessary to call the health care provider (HCP) if a skin rash occurs.
4. It is not necessary to restrict alcohol intake with this medication. - --<<ANSWER
IS>>---2. To return to the clinic weekly for serum drug-level testing
Rationale:
Cycloserine (Seromycin) is an antitubercular medication that requires weekly
serum drug level determinations to monitor for the potential of neurotoxicity.
Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity.
The medication must be taken after meals to prevent gastrointestinal irritation.
The client must be instructed to notify the HCP if a skin rash or signs of central
nervous system toxicity are noted. Alcohol must be avoided because it increases
the risk of seizure activity.

52.) A client with tuberculosis is being started on antituberculosis therapy with

isoniazid (INH). Before giving the client the first dose, a nurse ensures that which
of the following baseline studies has been completed?
1. Electrolyte levels
2. Coagulation times
3. Liver enzyme levels
4. Serum creatinine level - --<<ANSWER IS>>---3. Liver enzyme levels
Rationale:
INH therapy can cause an elevation of hepatic enzyme levels and hepatitis.
Therefore, liver enzyme levels are monitored when therapy is initiated and during
the first 3 months of therapy. They may be monitored longer in the client who is
greater than age 50 or abuses alcohol.

53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium

avium complex (MAC) disease and tuberculosis. The nurse monitors for which side
effects of the medication? Select all that apply.
1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
4. Vitamin B6 deficiency
5. Ocular pain or blurred vision
6. Tingling and numbness of the fingers - --<<ANSWER IS>>---1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
5. Ocular pain or blurred vision
Rationale:
Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and
tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and
suppresses protein synthesis. Side effects include rash, gastrointestinal
disturbances, neutropenia (low neutrophil count), red-orange body secretions,
uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with
dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling
in the extremities are associated with the use of isoniazid (INH). Ethambutol
(Myambutol) also causes peripheral neuritis.
54.) A nurse reinforces discharge instructions to a postoperative client who is
taking warfarin sodium (Coumadin). Which statement, if made by the client,
reflects the need for further teaching?
1. "I will take my pills every day at the same time."
2. "I will be certain to avoid alcohol consumption."
3. "I have already called my family to pick up a Medic-Alert bracelet."
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is
coated." - --<<ANSWER IS>>---4. "I will take Ecotrin (enteric-coated aspirin) for my
headaches because it is coated."
Rationale:
Ecotrin is an aspirin-containing product and should be avoided. Alcohol
consumption should be avoided by a client taking warfarin sodium. Taking
prescribed medication at the same time each day increases client compliance. The
Medic-Alert bracelet provides health care personnel emergency information.

55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level
of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a
digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that
which of the following is the therapeutic serum level (range) for digoxin?
1. 3 to 5 ng/mL
2. 0.5 to 2 ng/mL
3. 1.2 to 2.8 ng/mL
4. 3.5 to 5.5 ng/mL - --<<ANSWER IS>>---2.) 0.5 to 2 ng/mL
Rationale:
Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3,
and 4 are incorrect.
56.) Heparin sodium is prescribed for the client. The nurse expects that the health
care provider will prescribe which of the following to monitor for a therapeutic
effect of the medication?
1. Hematocrit level
2. Hemoglobin level
3. Prothrombin time (PT)
4. Activated partial thromboplastin time (aPTT) - --<<ANSWER IS>>---4. Activated
partial thromboplastin time (aPTT)
Rationale:
The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and
the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium
doses are determined based on these laboratory results. The hemoglobin and
hematocrit values assess red blood cell concentrations.

57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which
data collection finding would indicate a potential serious complication associated
with propranolol?
1. The development of complaints of insomnia
2. The development of audible expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of
138/72 mm Hg after two doses of the medication
4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of
72 beats/min after two doses of the medication - --<<ANSWER IS>>---2. The
development of audible expiratory wheezes
Rationale:
Audible expiratory wheezes may indicate a serious adverse reaction,
bronchospasm. β-Blockers may induce this reaction, particularly in clients with
chronic obstructive pulmonary disease or asthma. Normal decreases in blood
pressure and heart rate are expected. Insomnia is a frequent mild side effect and
should be monitored.

58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris.
The client tells the nurse that the medication is causing a chronic headache. The
nurse appropriately suggests that the client:
1. Cut the dose in half.
2. Discontinue the medication.
3. Take the medication with food.
4. Contact the health care provider (HCP). - --<<ANSWER IS>>---3. Take the
medication with food.
Rationale:
Isosorbide mononitrate is an antianginal medication. Headache is a frequent side
effect of isosorbide mononitrate and usually disappears during continued therapy.
If a headache occurs during therapy, the client should be instructed to take the
medication with food or meals. It is not necessary to contact the HCP unless the
headaches persist with therapy. It is not appropriate to instruct the client to
discontinue therapy or adjust the dosages.

59.) A client is diagnosed with an acute myocardial infarction and is receiving

tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority
nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
3. Monitor for signs of bleeding.
4. Have heparin sodium available. - --<<ANSWER IS>>---3. Monitor for signs of
bleeding.
Rationale:
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of
any type of thrombolytic medication. The client is monitored for bleeding.
Monitoring for renal failure and monitoring the client's psychosocial status are
important but are not the most critical interventions. Heparin is given after
thrombolytic therapy, but the question is not asking about follow-up medications.

60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a

client. The nurse understands that which of the following are concerns related to
the administration of this medication?
1. Hypouricemia, hyperkalemia
2. Increased risk of osteoporosis
3. Hypokalemia, hyperglycemia, sulfa allergy
4. Hyperkalemia, hypoglycemia, penicillin allergy - --<<ANSWER IS>>---3.
Hypokalemia, hyperglycemia, sulfa allergy
Rationale:
Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a
client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk
for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and
hyperuricemia.

61.) A home health care nurse is visiting a client with elevated triglyceride levels
and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine
(Questran). Which of the following statements, if made by the client, indicates the
need for further education?
1. "Constipation and bloating might be a problem."
2. "I'll continue to watch my diet and reduce my fats."
3. "Walking a mile each day will help the whole process."
4. "I'll continue my nicotinic acid from the health food store." - --<<ANSWER IS>>-
--4. "I'll continue my nicotinic acid from the health food store."
Rationale:
Nicotinic acid, even an over-the-counter form, should be avoided because it may
lead to liver abnormalities. All lipid-lowering medications also can cause liver
abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be
avoided. Constipation and bloating are the two most common side effects.
Walking and the reduction of fats in the diet are therapeutic measures to reduce
cholesterol and triglyceride levels.

62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides
instructions to the client about the medication. Which statement by the client
would indicate an understanding of the instructions?
1. "It is not necessary to avoid the use of alcohol."
2. "The medication should be taken with meals to decrease flushing."
3. "Clay-colored stools are a common side effect and should not be of concern."
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease
the flushing." - --<<ANSWER IS>>---4. "Ibuprofen (Motrin) taken 30 minutes
before the nicotinic acid should decrease the flushing."
Rationale:
Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-
inflammatory drug can be taken 30 minutes before taking the medication to
decrease flushing. Alcohol consumption needs to be avoided because it will
enhance this side effect. The medication should be taken with meals, this will
decrease gastrointestinal upset. Taking the medication with meals has no effect on
the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be
immediately reported to the health care provider (HCP).

63.) A client with coronary artery disease complains of substernal chest pain. After
checking the client's heart rate and blood pressure, a nurse administers
nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest
still hurts." Select the appropriate actions that the nurse should take. Select all
that apply.
1. Call a code blue.
2. Contact the registered nurse.
3. Contact the client's family.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually. - --<<ANSWER IS>>---2.
Contact the registered nurse.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.
Rationale:
The usual guideline for administering nitroglycerin tablets for a hospitalized client
with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for
a total dose of three tablets. The registered nurse should be notified of the client's
condition, who will then notify the health care provider as appropriate. Because
the client is still complaining of chest pain, the nurse would administer a second
nitroglycerin tablet. The nurse would assess the client's pain level and check the
client's blood pressure before administering each nitroglycerin dose. There are no
data in the question that indicate the need to call a code blue. In addition, it is not
necessary to contact the client's family unless the client has requested this.

64.) Nalidixic acid (NegGram) is prescribed for a client with a urinary tract
infection. On review of the client's record, the nurse notes that the client is taking
warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate
for this client?
1. Discontinuation of warfarin sodium (Coumadin)
2. A decrease in the warfarin sodium (Coumadin) dosage
3. An increase in the warfarin sodium (Coumadin) dosage
4. A decrease in the usual dose of nalidixic acid (NegGram) - --<<ANSWER IS>>---
2. A decrease in the warfarin sodium (Coumadin) dosage
Rationale:
Nalidixic acid can intensify the effects of oral anticoagulants by displacing these
agents from binding sites on plasma protein. When an oral anticoagulant is
combined with nalidixic acid, a decrease in the anticoagulant dosage may be
needed.

65.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole.

Which of the following should be included in the list of instructions?
1. Restrict fluid intake.
2. Maintain a high fluid intake.
3. If the urine turns dark brown, call the health care provider (HCP) immediately.
4. Decrease the dosage when symptoms are improving to prevent an allergic
response. - --<<ANSWER IS>>---2. Maintain a high fluid intake.
Rationale:
Each dose of sulfisoxazole should be administered with a full glass of water, and
the client should maintain a high fluid intake. The medication is more soluble in
alkaline urine. The client should not be instructed to taper or discontinue the
dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This
does not indicate the need to notify the HCP.

66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse

should instruct the client to report which symptom if it developed during the
course of this medication therapy?
1. Nausea
2. Diarrhea
3. Headache
4. Sore throat - --<<ANSWER IS>>---4. Sore throat
Rationale:
Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed
about early signs of blood disorders that can occur from this medication. These
include sore throat, fever, and pallor, and the client should be instructed to notify
the health care provider if these symptoms occur. The other options do not
require health care provider notification.

67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for

symptomatic relief of pain resulting from a lower urinary tract infection. The nurse
reinforces to the client:
1. To take the medication at bedtime
2. To take the medication before meals
3. To discontinue the medication if a headache occurs
 4. That a reddish orange discoloration of the urine may occur - --<<ANSWER IS>>-
--4. That a reddish orange discoloration of the urine may occur
Rationale:
The nurse should instruct the client that a reddish-orange discoloration of urine
may occur. The nurse also should instruct the client that this discoloration can
stain fabric. The medication should be taken after meals to reduce the possibility
of gastrointestinal upset. A headache is an occasional side effect of the medication
and does not warrant discontinuation of the medication.

68.) Bethanechol chloride (Urecholine) is prescribed for a client with urinary

retention. Which disorder would be a contraindication to the administration of
this medication?
1. Gastric atony
2. Urinary strictures
3. Neurogenic atony
4. Gastroesophageal reflux - --<<ANSWER IS>>---2. Urinary strictures
Rationale:
Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract
obstruction or weakness of the bladder wall. The medication has the ability to
contract the bladder and thereby increase pressure within the urinary tract.
Elevation of pressure within the urinary tract could rupture the bladder in clients
with these conditions.

69.) A nurse who is administering bethanechol chloride (Urecholine) is monitoring

for acute toxicity associated with the medication. The nurse checks the client for
which sign of toxicity?
1. Dry skin
2. Dry mouth
3. Bradycardia
4. Signs of dehydration - --<<ANSWER IS>>---3. Bradycardia
Rationale:
Toxicity (overdose) produces manifestations of excessive muscarinic stimulation
such as salivation, sweating, involuntary urination and defecation, bradycardia,
and severe hypotension. Treatment includes supportive measures and the
administration of atropine sulfate subcutaneously or intravenously.

70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic
bladder. Which sign would indicate a possible toxic effect related to this
medication?
1. Pallor
2. Drowsiness
3. Bradycardia
4. Restlessness - --<<ANSWER IS>>---4. Restlessness
Rationale:
Toxicity (overdosage) of this medication produces central nervous system
excitation, such as nervousness, restlessness, hallucinations, and irritability. Other
signs of toxicity include hypotension or hypertension, confusion, tachycardia,
flushed or red face, and signs of respiratory depression. Drowsiness is a frequent
side effect of the medication but does not indicate overdosage.

71.) After kidney transplantation, cyclosporine (Sand immune) is prescribed for a

client. Which laboratory result would indicate an adverse effect from the use of
this medication?
1. Decreased creatinine level
2. Decreased hemoglobin level
3. Elevated blood urea nitrogen level
4. Decreased white blood cell count - --<<ANSWER IS>>---3. Elevated blood urea
nitrogen level
Rationale:
Nephrotoxicity can occur from the use of cyclosporine (Sandimmune).
Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN)
and serum creatinine levels. Cyclosporine is an immunosuppressant but does not
depress the bone marrow.

72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for the client. The
nurse reviews the client's medical record and should contact the health care
provider (HCP) regarding which documented finding to verify the prescription?
Refer to chart.
1. Renal insufficiency
2. Chest x-ray: normal
3. Blood glucose, 102 mg/dL
4. Folic acid (vitamin B6) 0.5 mg, orally daily - --<<ANSWER IS>>---1. Renal
insufficiency
Rationale:
Cinoxacin should be administered with caution in clients with renal impairment.
The dosage should be reduced, and failure to do so could result in accumulation of
cinoxacin to toxic levels. Therefore the nurse would verify the prescription if the
client had a documented history of renal insufficiency. The laboratory and
diagnostic test results are normal findings. Folic acid (vitamin B6) may be
prescribed for a client with renal insufficiency to prevent anemia.
73.) A client with myasthenia gravis is suspected of having cholinergic crisis. Which
of the following indicate that this crisis exists?
1. Ataxia
2. Mouth sores
3. Hypotension
4. Hypertension - --<<ANSWER IS>>---4. Hypertension
Rationale:
Cholinergic crisis occurs as a result of an overdose of medication. Indications of
cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea,
abdominal cramps, increased salivation and tearing, miosis, hypertension,
sweating, and increased bronchial secretions.

74.) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The

nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of
the medication. The nurse checks the medication supply to ensure that which
medication is available for administration if a cholinergic crisis occurs?
1. Vitamin K
2. Atropine sulfate
3. Protamine sulfate
4. Acetylcysteine (Mucomyst) - --<<ANSWER IS>>---2. Atropine sulfate
Rationale:
The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for
warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and
acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol).
75.) A client with myasthenia gravis becomes increasingly weak. The health care
provider prepares to identify whether the client is reacting to an overdose of the
medication (cholinergic crisis) or increasing severity of the disease (myasthenic
crisis). An injection of edrophonium (Enlon) is administered. Which of the
following indicates that the client is in cholinergic crisis?
1. No change in the condition
2. Complaints of muscle spasms
3. An improvement of the weakness
4. A temporary worsening of the condition - --<<ANSWER IS>>---4. A temporary
worsening of the condition
Rationale:
An edrophonium (Enlon) injection, a cholinergic drug, makes the client in
cholinergic crisis temporarily worse. This is known as a negative test. An
improvement of weakness would occur if the client were experiencing myasthenia
gravis. Options 1 and 2 would not occur in either crisis.

76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's

disease, and the nurse monitors the client for adverse reactions to the
medication. Which of the following indicates that the client is experiencing an
adverse reaction?
1. Pruritus
2. Tachycardia
3. Hypertension
4. Impaired voluntary movements - --<<ANSWER IS>>---4. Impaired voluntary
movements
Rationale:
Dyskinesia and impaired voluntary movement may occur with high levodopa
dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and
akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also
known as the "on-off phenomenon") are frequent side effects of the medication.

77.) Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for
a client for seizure control. The nurse reinforces instructions regarding the
medication to the client. Which statement by the client indicates an
understanding of the instructions?
1. "I will use a soft toothbrush to brush my teeth."
2. "It's all right to break the capsules to make it easier for me to swallow them."
3. "If I forget to take my medication, I can wait until the next dose and eliminate
that dose."
4. "If my throat becomes sore, it's a normal effect of the medication and it's
nothing to be concerned about." - --<<ANSWER IS>>---1. "I will use a soft
toothbrush to brush my teeth."
Rationale:
Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling,
and tenderness of the gums can occur with the use of this medication. The client
needs to be taught good oral hygiene, gum massage, and the need for regular
dentist visits. The client should not skip medication doses, because this could
precipitate a seizure. Capsules should not be chewed or broken and they must be
swallowed. The client needs to be instructed to report a sore throat, fever,
glandular swelling, or any skin reaction, because this indicates hematological
toxicity.
78.) A client is taking phenytoin (Dilantin) for seizure control and a sample for a
serum drug level is drawn. Which of the following indicates a therapeutic serum
drug range?
1. 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL - --<<ANSWER IS>>---2. 10 to 20 mcg/mL
Rationale:
The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20
mcg/mL.
** A helpful hint may be to remember that the theophylline therapeutic range
and the acetaminophen (Tylenol) therapeutic range are the same as the phenytoin
(Dilantin) therapeutic range.**

79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take
the medication:
1. With 8 oz of milk
2. In the morning after arising
3. 60 minutes before breakfast
4. At bedtime on an empty stomach - --<<ANSWER IS>>---1. With 8 oz of milk
Rationale:
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be
given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4
are incorrect.
80.) A nurse is caring for a client who is taking phenytoin (Dilantin) for control of
seizures. During data collection, the nurse notes that the client is taking birth
control pills. Which of the following information should the nurse provide to the
client?
1. Pregnancy should be avoided while taking phenytoin (Dilantin).
2. The client may stop taking the phenytoin (Dilantin) if it is causing severe
gastrointestinal effects.
3. The potential for decreased effectiveness of the birth control pills exists while
taking phenytoin (Dilantin).
4. The increased risk of thrombophlebitis exists while taking phenytoin (Dilantin)
and birth control pills together. - --<<ANSWER IS>>---3. The potential for
decreased effectiveness of the birth control pills exists while taking phenytoin
(Dilantin).
Rationale:
Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can
decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not
accurate.

81.) A client with trigeminal neuralgia is being treated with carbamazepine

(Tegretol). Which laboratory result would indicate that the client is experiencing
an adverse reaction to the medication?
1. Sodium level, 140 mEq/L
2. Uric acid level, 5.0 mg/dL
3. White blood cell count, 3000 cells/mm3
4. Blood urea nitrogen (BUN) level, 15 mg/dL - --<<ANSWER IS>>---3. White blood
cell count, 3000 cells/mm3
Rationale:
Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including
aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular
disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.
Options 1, 2, and 4 identify normal laboratory values.

82.) A client is receiving meperidine hydrochloride (Demerol) for pain. Which of

the following are side effects of this medication. Select all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory rate - --<<ANSWER IS>>---2. Tremors
3. Drowsiness
4. Hypotension
Rationale:
Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory
depression, drowsiness, hypotension, constipation, urinary retention, nausea,
vomiting, and tremors.

83.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During
the administration of etanercept (Enbrel), it is most important for the nurse to
check:
1. The injection site for itching and edema
2. The white blood cell counts and platelet counts
3. Whether the client is experiencing fatigue and joint pain
4. A metallic taste in the mouth, with a loss of appetite - --<<ANSWER IS>>---2.
The white blood cell counts and platelet counts
Rationale:
Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory
studies are performed before and during drug treatment. The appearance of
abnormal white blood cell counts and abnormal platelet counts can alert the
nurse to a potentially life-threatening infection. Injection site itching is a common
occurrence following administration. A metallic taste with loss of appetite are not
common signs of side effects of this medication.

84.) Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The
nurse assists in planning care, knowing that the primary therapeutic effect of this
medication is which of the following?
1. Increased muscle tone
2. Decreased muscle spasms
3. Increased range of motion
4. Decreased local pain and tenderness - --<<ANSWER IS>>---2. Decreased muscle
spasms
Rationale:
Baclofen is a skeletal muscle relaxant and central nervous system depressant and
acts at the spinal cord level to decrease the frequency and amplitude of muscle
spasms in clients with spinal cord injuries or diseases and in clients with multiple
sclerosis. Options 1, 3, and 4 are incorrect.

85.) A nurse is monitoring a client receiving baclofen (Lioresal) for side effects
related to the medication. Which of the following would indicate that the client is
experiencing a side effect?
1. Polyuria
2. Diarrhea
3. Drowsiness
4. Muscular excitability - --<<ANSWER IS>>---3. Drowsiness
Rationale:
Baclofen is a central nervous system (CNS) depressant and frequently causes
drowsiness, dizziness, weakness, and fatigue. It can also cause nausea,
constipation, and urinary retention. Clients should be warned about the possible
reactions. Options 1, 2, and 4 are not side effects.

86.) A nurse is reinforcing discharge instructions to a client receiving baclofen

(Lioresal). Which of the following would the nurse include in the instructions?
1. Restrict fluid intake.
2. Avoid the use of alcohol.
3. Stop the medication if diarrhea occurs.
4. Notify the health care provider if fatigue occurs. - --<<ANSWER IS>>---2. Avoid
the use of alcohol.
Rationale:
Baclofen is a central nervous system (CNS) depressant. The client should be
cautioned against the use of alcohol and other CNS depressants, because baclofen
potentiates the depressant activity of these agents. Constipation rather than
diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluids, but
the client should be warned that urinary retention can occur. Fatigue is related to
a CNS effect that is most intense during the early phase of therapy and diminishes
with continued medication use. It is not necessary that the client notify the health
care provider if fatigue occurs.
87.) A client with acute muscle spasms has been taking baclofen (Lioresal). The
client calls the clinic nurse because of continuous feelings of weakness and fatigue
and asks the nurse about discontinuing the medication. The nurse should make
which appropriate response to the client?
1. "You should never stop the medication."
2. "It is best that you taper the dose if you intend to stop the medication."
3. "It is okay to stop the medication if you think that you can tolerate the muscle
spasms."
4. "Weakness and fatigue commonly occur and will diminish with continued
medication use." - --<<ANSWER IS>>---4. "Weakness and fatigue commonly occur
and will diminish with continued medication use."
Rationale:
The client should be instructed that symptoms such as drowsiness, weakness, and
fatigue are more intense in the early phase of therapy and diminish with
continued medication use. The client should be instructed never to withdraw or
stop the medication abruptly, because abrupt withdrawal can cause visual
hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform
the client that these symptoms will subside and encourage the client to continue
the use of the medication.

88.) Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor

spasms, and the client asks the nurse about the action of the medication. The
nurse responds, knowing that the therapeutic action of this medication is which of
the following?
1. Depresses spinal reflexes
2. Acts directly on the skeletal muscle to relieve spasticity
3. Acts within the spinal cord to suppress hyperactive reflexes
 4. Acts on the central nervous system (CNS) to suppress spasms - --<<ANSWER
IS>>---2. Acts directly on the skeletal muscle to relieve spasticity
Rationale:
Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary
action is the suppression of calcium release from the sarcoplasmic reticulum. This
in turn decreases the ability of the skeletal muscle to contract.
**Options 1, 3, and 4 are all comparable or alike in that they address CNS
suppression and the depression of reflexes. Therefore, eliminate these options.**

89.) A nurse is reviewing the laboratory studies on a client receiving dantrolene

sodium (Dantrium). Which laboratory test would identify an adverse effect
associated with the administration of this medication?
1. Creatinine
2. Liver function tests
3. Blood urea nitrogen
4. Hematological function tests - --<<ANSWER IS>>---2. Liver function tests
Rationale:
Dose-related liver damage is the most serious adverse effect of dantrolene. To
reduce the risk of liver damage, liver function tests should be performed before
treatment and periodically throughout the treatment course. It is administered in
the lowest effective dosage for the shortest time necessary.
**Eliminate options 1 and 3 because these tests both assess kidney function.**

90.) A nurse is reviewing the record of a client who has been prescribed baclofen
(Lioresal). Which of the following disorders, if noted in the client's history, would
alert the nurse to contact the health care provider?
1. Seizure disorders
2. Hyperthyroidism
3. Diabetes mellitus
4. Coronary artery disease - --<<ANSWER IS>>---1. Seizure disorders
Rationale:
Clients with seizure disorders may have a lowered seizure threshold when
baclofen is administered. Concurrent therapy may require an increase in the
anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern
when the client is taking baclofen.

91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms,

and the nurse is reviewing the client's record. Which of the following disorders, if
noted in the client's record, would indicate a need to contact the health care
provider regarding the administration of this medication?
1. Glaucoma
2. Emphysema
3. Hyperthyroidism
4. Diabetes mellitus - --<<ANSWER IS>>---1. Glaucoma
Rationale:
Because this medication has anticholinergic effects, it should be used with caution
in clients with a history of urinary retention, angle-closure glaucoma, and
increased intraocular pressure. Cyclobenzaprine hydrochloride should be used
only for short-term 2- to 3-week therapy.
92.) In monitoring a client's response to disease-modifying antirheumatic drugs
(DMARDs), which findings would the nurse interpret as acceptable responses?
Select all that apply.
1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degeneration
4. An increased range of motion in the affected joints 3 months into therapy
5. Inflammation and irritation at the injection site 3 days after injection is given
6. A low-grade temperature upon rising in the morning that remains throughout
the day - --<<ANSWER IS>>---1. Symptom control during periods of emotional
stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degeneration
4. An increased range of motion in the affected joints 3 months into therapy
Rationale:
Because emotional stress frequently exacerbates the symptoms of rheumatoid
arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow
progression of joint degeneration. In addition, the improvement in the range of
motion after 3 months of therapy with normal blood work is a positive finding.
Temperature elevation and inflammation and irritation at the medication injection
site could indicate signs of infection.

93.) The client who is human immunodeficiency virus seropositive has been taking
stavudine (d4t, Zerit). The nurse monitors which of the following most closely
while the client is taking this medication?
1. Gait
2. Appetite
3. Level of consciousness
4. Hemoglobin and hematocrit blood levels - --<<ANSWER IS>>---1. Gait
Rationale:
Stavudine (d4t, Zerit) is an antiretroviral used to manage human
immunodeficiency virus infection in clients who do not respond to or who cannot
tolerate conventional therapy. The medication can cause peripheral neuropathy,
and the nurse should monitor the client's gait closely and ask the client about
paresthesia. Options 2, 3, and 4 are unrelated to the use of the medication.

94.) The client with acquired immunodeficiency syndrome has begun therapy with
zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors
which of the following laboratory results during treatment with this medication?
1. Blood culture
2. Blood glucose level
3. Blood urea nitrogen
4. Complete blood count - --<<ANSWER IS>>---4. Complete blood count
Rationale:
A common side effect of therapy with zidovudine is leukopenia and anemia. The
nurse monitors the complete blood count results for these changes. Options 1, 2,
and 3 are unrelated to the use of this medication.

95.) The nurse is reviewing the results of serum laboratory studies drawn on a
client with acquired immunodeficiency syndrome who is receiving didanosine
(Videx). The nurse interprets that the client may have the medication discontinued
by the health care provider if which of the following significantly elevated results
is noted?
1. Serum protein
2. Blood glucose
3. Serum amylase
4. Serum creatinine - --<<ANSWER IS>>---3. Serum amylase
Rationale:
Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased
1.5 to 2 times normal may signify pancreatitis in the client with acquired
immunodeficiency syndrome and is potentially fatal. The medication may have to
be discontinued. The medication is also hepatotoxic and can result in liver failure.

96.) The nurse is caring for a postrenal transplant client taking cyclosporine
(Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's
vital signs, and the client is complaining of a headache. What is the vital sign that
is most likely increased?
1. Pulse
2. Respirations
3. Blood pressure
4. Pulse oximetry - --<<ANSWER IS>>---3. Blood pressure
Rationale:
Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf,
Neoral), and because this client is also complaining of a headache, the blood
pressure is the vital sign to be monitoring most closely. Other adverse effects
include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated
to the use of this medication.
97.) Amikacin (Amikin) is prescribed for a client with a bacterial infection. The
client is instructed to contact the health care provider (HCP) immediately if which
of the following occurs?
1. Nausea
2. Lethargy
3. Hearing loss
4. Muscle aches - --<<ANSWER IS>>---3. Hearing loss
Rationale:
Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides
include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal
irritation, palpitations, blood pressure changes, nephrotoxicity, and
hypersensitivity. The nurse instructs the client to report hearing loss to the HCP
immediately. Lethargy and muscle aches are not associated with the use of this
medication. It is not necessary to contact the HCP immediately if nausea occurs. If
nausea persists or results in vomiting, the HCP should be notified.
**(most aminoglycoside medication names end in the letters -cin)**

98.) The nurse is assigned to care for a client with cytomegalovirus retinitis and
acquired immunodeficiency syndrome who is receiving foscarnet. The nurse
should check the latest results of which of the following laboratory studies while
the client is taking this medication?
1. CD4 cell count
2. Serum albumin
3. Serum creatinine
4. Lymphocyte count - --<<ANSWER IS>>---3. Serum creatinine
Rationale:
Foscarnet is toxic to the kidneys. Serum creatinine is monitored before therapy,
two to three times per week during induction therapy, and at least weekly during
maintenance therapy. Foscarnet may also cause decreased levels of calcium,
magnesium, phosphorus, and potassium. Thus these levels are also measured
with the same frequency.

99.) The client with acquired immunodeficiency syndrome and Pneumocystis

jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The
client develops a temperature of 101° F. The nurse does further monitoring of the
client, knowing that this sign would most likely indicate:
1. The dose of the medication is too low.
2. The client is experiencing toxic effects of the medication.
3. The client has developed inadequacy of thermoregulation.
4. The result of another infection caused by leukopenic effects of the medication.
- --<<ANSWER IS>>---4. The result of another infection caused by leukopenic
effects of the medication.
Rationale:
Frequent side effects of this medication include leukopenia, thrombocytopenia,
and anemia. The client should be monitored routinely for signs and symptoms of
infection. Options 1, 2, and 3 are inaccurate interpretations.

100.) Saquinavir (Invirase) is prescribed for the client who is human

immunodeficiency virus seropositive. The nurse reinforces medication instructions
and tells the client to:
1. Avoid sun exposure.
2. Eat low-calorie foods.
3. Eat foods that are low in fat.
4. Take the medication on an empty stomach. - --<<ANSWER IS>>---1. Avoid sun
exposure.
Rationale:
Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other
antiretroviral medications to manage human immunodeficiency virus infection.
Saquinavir is administered with meals and is best absorbed if the client consumes
high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse
should instruct the client to avoid sun exposure.

101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select

the interventions that the nurse includes when administering this medication.
Select all that apply.
1. Restrict fluid intake.
2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
4. Administer the medication with an antacid.
5. Instruct the client to avoid exposure to the sun.
6. Administer the medication on an empty stomach. - --<<ANSWER IS>>---2.
Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
5. Instruct the client to avoid exposure to the sun.
Rationale:
Ketoconazole is an antifungal medication. It is administered with food (not on an
empty stomach) and antacids are avoided for 2 hours after taking the medication
to ensure absorption. The medication is hepatotoxic and the nurse monitors liver
function studies. The client is instructed to avoid exposure to the sun because the
medication increases photosensitivity. The client is also instructed to avoid
alcohol. There is no reason for the client to restrict fluid intake. In fact, this could
be harmful to the client.

102.) A client with human immunodeficiency virus is taking nevirapine

(Viramune). The nurse should monitor for which adverse effects of the
medication? Select all that apply.
1. Rash
2. Hepatotoxicity
3. Hyperglycemia
4. Peripheral neuropathy
5. Reduced bone mineral density - --<<ANSWER IS>>---1. Rash
2. Hepatotoxicity
Rationale:
Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI)
that is used to treat HIV infection. It is used in combination with other
antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-
Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia,
peripheral neuropathy, and reduced bone density are not adverse effects of this
medication.

103.) A nurse is caring for a hospitalized client who has been taking clozapine
(Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study
prescribed for the client will the nurse specifically review to monitor for an
adverse effect associated with the use of this medication?
1. Platelet count
2. Cholesterol level
3. White blood cell count
4. Blood urea nitrogen level - --<<ANSWER IS>>---3. White blood cell count
Rationale:
Hematological reactions can occur in the client taking clozapine and include
agranulocytosis and mild leukopenia. The white blood cell count should be
checked before initiating treatment and should be monitored closely during the
use of this medication. The client should also be monitored for signs indicating
agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2,
and 4 are unrelated to this medication.

104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric
health care clinic. The nurse is collecting data on the client and is providing
instructions regarding the use of this medication. Which is most important for the
nurse to determine before administration of this medication?
1. A history of hyperthyroidism
2. A history of diabetes insipidus
3. When the last full meal was consumed
4. When the last alcoholic drink was consumed - --<<ANSWER IS>>---4. When the
last alcoholic drink was consumed
Rationale:
Disulfiram is used as an adjunct treatment for selected clients with chronic
alcoholism who want to remain in a state of enforced sobriety. Clients must
abstain from alcohol intake for at least 12 hours before the initial dose of the
medication is administered. The most important data are to determine when the
last alcoholic drink was consumed. The medication is used with caution in clients
with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and
hepatic disease. It is also contraindicated in severe heart disease, psychosis, or
hypersensitivity related to the medication.
105.) A nurse is collecting data from a client and the client's spouse reports that
the client is taking donepezil hydrochloride (Aricept). Which disorder would the
nurse suspect that this client may have based on the use of this medication?
1. Dementia
2. Schizophrenia
3. Seizure disorder
4. Obsessive-compulsive disorder - --<<ANSWER IS>>---1. Dementia
Rationale:
Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to
moderate dementia of the Alzheimer type. It enhances cholinergic functions by
increasing the concentration of acetylcholine. It slows the progression of
Alzheimer's disease. Options 2, 3, and 4 are incorrect.

106.) Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces
instructions to the client regarding the administration of the medication. Which
statement by the client indicates an understanding about administration of the
medication?
1. "I should take the medication with my evening meal."
2. "I should take the medication at noon with an antacid."
3. "I should take the medication in the morning when I first arise."
4. "I should take the medication right before bedtime with a snack." - --
<<ANSWER IS>>---3. "I should take the medication in the morning when I first
arise."
Rationale:
Fluoxetine hydrochloride is administered in the early morning without
consideration to meals.
**Eliminate options 1, 2, and 4 because they are comparable or alike and indicate
taking the medication with an antacid or food.**

107.) A client receiving a tricyclic antidepressant arrives at the mental health

clinic. Which observation indicates that the client is correctly following the
medication plan?
1. Reports not going to work for this past week
2. Complains of not being able to "do anything" anymore
3. Arrives at the clinic neat and appropriate in appearance
4. Reports sleeping 12 hours per night and 3 to 4 hours during the day - --
<<ANSWER IS>>---3. Arrives at the clinic neat and appropriate in appearance
Rationale:
Depressed individuals will sleep for long periods, are not able to go to work, and
feel as if they cannot "do anything." Once they have had some therapeutic effect
from their medication, they will report resolution of many of these complaints as
well as demonstrate an improvement in their appearance.

108.) A nurse is performing a follow-up teaching session with a client discharged 1

month ago who is taking fluoxetine (Prozac). What information would be
important for the nurse to gather regarding the adverse effects related to the
medication?
1. Cardiovascular symptoms
2. Gastrointestinal dysfunctions
3. Problems with mouth dryness
4. Problems with excessive sweating - --<<ANSWER IS>>---2. Gastrointestinal
dysfunctions
Rationale:
The most common adverse effects related to fluoxetine include central nervous
system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects
the GI system by causing nausea and vomiting, cramping, and diarrhea. Options 1,
3, and 4 are not adverse effects of this medication.

109.) A client taking buspirone (BuSpar) for 1 month returns to the clinic for a
follow-up visit. Which of the following would indicate medication effectiveness?
1. No rapid heartbeats or anxiety
2. No paranoid thought processes
3. No thought broadcasting or delusions
4. No reports of alcohol withdrawal symptoms - --<<ANSWER IS>>---1. No rapid
heartbeats or anxiety
Rationale:
Buspirone hydrochloride is not recommended for the treatment of drug or alcohol
withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting
or delusions). Buspirone hydrochloride is most often indicated for the treatment
of anxiety and aggression.

110.) A client taking lithium carbonate (Lithobid) reports vomiting, abdominal

pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as
a part of the routine follow-up and the level is 3.0 mEq/L. The nurse knows that
this level is:
1. Toxic
2. Normal
3. Slightly above normal
4. Excessively below normal - --<<ANSWER IS>>---1. Toxic
Rationale:
The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L
indicates toxicity.

111.) A client arrives at the health care clinic and tells the nurse that he has been
doubling his daily dosage of bupropion hydrochloride (Wellbutrin) to help him get
better faster. The nurse understands that the client is now at risk for which of the
following?
1. Insomnia
2. Weight gain
3. Seizure activity
4. Orthostatic hypotension - --<<ANSWER IS>>---3. Seizure activity
Rationale:
Bupropion does not cause significant orthostatic blood pressure changes. Seizure
activity is common in dosages greater than 450 mg daily. Bupropion frequently
causes a drop in body weight. Insomnia is a side effect, but seizure activity causes
a greater client risk.

112.) A hospitalized client is started on phenelzine sulfate (Nardil) for the

treatment of depression. The nurse instructs the client to avoid consuming which
foods while taking this medication? Select all that apply.
1. Figs
2. Yogurt
3. Crackers
4. Aged cheese
5 Tossed salad
6. Oatmeal cookies - --<<ANSWER IS>>---1. Figs
2. Yogurt
4. Aged cheese
Rationale:
Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The client
should avoid taking in foods that are high in tyramine. Use of these foods could
trigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt,
aged cheeses, smoked or processed meats, red wines, and fruits such as avocados,
raisins, and figs.

113.) A nurse is reinforcing discharge instructions to a client receiving

sulfisoxazole. Which of the following would be included in the plan of care for
instructions?
1. Maintain a high fluid intake.
2. Discontinue the medication when feeling better.
3. If the urine turns dark brown, call the health care provider immediately.
4. Decrease the dosage when symptoms are improving to prevent an allergic
response. - --<<ANSWER IS>>---1. Maintain a high fluid intake.
Rationale:
Each dose of sulfisoxazole should be administered with a full glass of water, and
the client should maintain a high fluid intake. The medication is more soluble in
alkaline urine. The client should not be instructed to taper or discontinue the
dose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. This
does not indicate the need to notify the health care provider.
114.) A postoperative client requests medication for flatulence (gas pains). Which
medication from the following PRN list should the nurse administer to this client?
1. Ondansetron (Zofran)
2. Simethicone (Mylicon)
3. Acetaminophen (Tylenol)
4. Magnesium hydroxide (milk of magnesia, MOM) - --<<ANSWER IS>>---2.
Simethicone (Mylicon)
Rationale:
Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in
the gastrointestinal tract. Ondansetron is used to treat postoperative nausea and
vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an
antacid and laxative.

115.) A client received 20 units of NPH insulin subcutaneously at 8:00 AM. The
nurse should check the client for a potential hypoglycemic reaction at what time?
1. 5:00 PM
2. 10:00 AM
3. 11:00 AM
4. 11:00 PM - --<<ANSWER IS>>---1. 5:00 PM
Rationale:
NPH is intermediate-acting insulin. Its onset of action is 1 to 2½ hours, it peaks in 4
to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most
likely occur during peak time.
116.) A nurse administers a dose of scopolamine (Transderm-Scop) to a
postoperative client. The nurse tells the client to expect which of the following
side effects of this medication?
1. Dry mouth
2. Diaphoresis
3. Excessive urination
4. Pupillary constriction - --<<ANSWER IS>>---1. Dry mouth
Rationale:
Scopolamine is an anticholinergic medication for the prevention of nausea and
vomiting that causes the frequent side effects of dry mouth, urinary retention,
decreased sweating, and dilation of the pupils. The other options describe the
opposite effects of cholinergic-blocking agents and therefore are incorrect.

117.) A nurse has given the client taking ethambutol (Myambutol) information
about the medication. The nurse determines that the client understands the
instructions if the client immediately reports:
1. Impaired sense of hearing
2. Distressing gastrointestinal side effects
3. Orange-red discoloration of body secretions
4. Difficulty discriminating the color red from green - --<<ANSWER IS>>---4.
Difficulty discriminating the color red from green
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to
discriminate between the colors red and green. This poses a potential safety
hazard when driving a motor vehicle. The client is taught to report this symptom
immediately. The client is also taught to take the medication with food if
gastrointestinal upset occurs. Impaired hearing results from antitubercular
therapy with streptomycin. Orange-red discoloration of secretions occurs with
rifampin (Rifadin).

118.) A nurse is caring for an older client with a diagnosis of myasthenia gravis and
has reinforced self-care instructions. Which statement by the client indicates that
further teaching is necessary?
1. "I rest each afternoon after my walk."
2. "I cough and deep breathe many times during the day."
3. "If I get abdominal cramps and diarrhea, I should call my doctor."
4. "I can change the time of my medication on the mornings that I feel strong." - --
<<ANSWER IS>>---4. "I can change the time of my medication on the mornings
that I feel strong."
Rationale:
The client with myasthenia gravis should be taught that timing of
anticholinesterase medication is critical. It is important to instruct the client to
administer the medication on time to maintain a chemical balance at the
neuromuscular junction. If not given on time, the client may become too weak to
swallow. Options 1, 2, and 3 include the necessary information that the client
needs to understand to maintain health with this neurological degenerative
disease.

119.) A client with diabetes mellitus who has been controlled with daily insulin
has been placed on atenolol (Tenormin) for the control of angina pectoris.
Because of the effects of atenolol, the nurse determines that which of the
following is the most reliable indicator of hypoglycemia?
1. Sweating
2. Tachycardia
3. Nervousness
4. Low blood glucose level - --<<ANSWER IS>>---4. Low blood glucose level
Rationale:
β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs
and symptoms of acute hypoglycemia, which would include nervousness,
increased heart rate, and sweating. Therefore, the client receiving this medication
should adhere to the therapeutic regimen and monitor blood glucose levels
carefully. Option 4 is the most reliable indicator of hypoglycemia.

120.) A client is taking lansoprazole (Prevacid) for the chronic management of

Zollinger-Ellison syndrome. The nurse advises the client to take which of the
following products if needed for a headache?
1. Naprosyn (Aleve)
2. Ibuprofen (Advil)
3. Acetaminophen (Tylenol)
4. Acetylsalicylic acid (aspirin) - --<<ANSWER IS>>---3. Acetaminophen (Tylenol)
Rationale:
Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client
should avoid taking medications that are irritating to the stomach lining. Irritants
would include aspirin and nonsteroidal antiinflammatory drugs (ibuprofen). The
client should be advised to take acetaminophen for headache.
**Remember that options that are comparable or alike are not likely to be correct.
With this in mind, eliminate options 1 and 2 first.**

121.) A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been

started on triamterene (Dyrenium) as well. The client asks the nurse why both
medications are required. The nurse formulates a response, based on the
understanding that:
1. Both are weak potassium-losing diuretics.
2. The combination of these medications prevents renal toxicity.
3. Hydrochlorothiazide is an expensive medication, so using a combination of
diuretics is cost-effective.
4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a
potassium-losing diuretic. - --<<ANSWER IS>>---4. Triamterene is a potassium-
sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.
Rationale:
Potassium-sparing diuretics include amiloride (Midamor), spironolactone
(Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in
combination with potassium-losing diuretics. This combination is useful when
medication and dietary supplement of potassium is not appropriate. The use of
two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an
effective and inexpensive generic form of the thiazide classification of diuretics.
**It is especially helpful to remember that hydrochlorothiazide is a potassium-
losing diuretic and triamterene is a potassium-sparing diuretic**

122.) A client who has begun taking fosinopril (Monopril) is very distressed, telling
the nurse that he cannot taste food normally since beginning the medication 2
weeks ago. The nurse provides the best support to the client by:
1. Telling the client not to take the medication with food
2. Suggesting that the client taper the dose until taste returns to normal
3. Informing the client that impaired taste is expected and generally disappears in
2 to 3 months
 4. Requesting that the health care provider (HCP) change the prescription to
another brand of angiotensin-converting enzyme (ACE) inhibitor - --<<ANSWER
IS>>---3. Informing the client that impaired taste is expected and generally
disappears in 2 to 3 months
Rationale:
ACE inhibitors, such as fosinopril, cause temporary impairment of taste
(dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to
3 months, even with continued therapy, and provide nutritional counseling if
appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions.
Taking this medication with or without food does not affect absorption and action.
The dosage should never be tapered without HCP approval and the medication
should never be stopped abruptly.

123.) A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse

plans to check which of the following before giving the medication?
1. Respiratory rate
2. Blood pressure and heart rate
3. Heart rate and respiratory rate
4. Level of consciousness and blood pressure - --<<ANSWER IS>>---2. Blood
pressure and heart rate
Rationale:
Amlodipine is a calcium channel blocker. This medication decreases the rate and
force of cardiac contraction. Before administering a calcium channel blocking
agent, the nurse should check the blood pressure and heart rate, which could
both decrease in response to the action of this medication. This action will help to
prevent or identify early problems related to decreased cardiac contractility, heart
rate, and conduction.
**amlodipine is a calcium channel blocker, and this group of medications
decreases the rate and force of cardiac contraction. This in turn lowers the pulse
rate and blood pressure.**

124.) A client with chronic renal failure is receiving ferrous sulfate (Feosol). The
nurse monitors the client for which common side effect associated with this
medication?
1. Diarrhea
2. Weakness
3. Headache
4. Constipation - --<<ANSWER IS>>---4. Constipation
Rationale:
Feosol is an iron supplement used to treat anemia. Constipation is a frequent and
uncomfortable side effect associated with the administration of oral iron
supplements. Stool softeners are often prescribed to prevent constipation.
**Focus on the name of the medication. Recalling that oral iron can cause
constipation will easily direct you to the correct option.**

125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a

client with heart failure. Which vital sign is most important for the nurse to check
before administering the medication?
1. Heart rate
2. Temperature
3. Respirations
4. Blood pressure - --<<ANSWER IS>>---1. Heart rate
Rationale:
Digoxin is a cardiac glycoside that is used to treat heart failure and acts by
increasing the force of myocardial contraction. Because bradycardia may be a
clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute
before administering the medication. If the pulse rate is less than 60 beats/minute
in an adult client, the nurse would withhold the medication and report the pulse
rate to the registered nurse, who would then contact the health care provider.

126.) A nurse is caring for a client who has been prescribed furosemide (Lasix) and
is monitoring for adverse effects associated with this medication. Which of the
following should the nurse recognize as a potential adverse effect Select all that
apply.
1. Nausea
2. Tinnitus
3. Hypotension
4. Hypokalemia
5. Photosensitivity
6. Increased urinary frequency - --<<ANSWER IS>>---2. Tinnitus
3. Hypotension
4. Hypokalemia
Rationale:
Furosemide is a loop diuretic; therefore, an expected effect is increased urinary
frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity
is an occasional side effect. Adverse effects include tinnitus (ototoxicity),
hypotension, and hypokalemia and occur as a result of sudden volume depletion.
127.) The nurse provides medication instructions to an older hypertensive client
who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates
the need for further teaching when the client states which of the following?
1. "I can skip a dose once a week."
2. "I need to change my position slowly."
3. "I take the pill after breakfast each day."
4. "If I get a bad headache, I should call my doctor immediately." - --<<ANSWER
IS>>---1. "I can skip a dose once a week."
Rationale:
Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor.
The usual dosage range is 20 to 40 mg per day. Adverse effects include headache,
dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific
client teaching points include taking one pill a day, not stopping the medication
without consulting the health care provider (HCP), and monitoring for side effects
and adverse reactions. The client should notify the HCP if side effects occur.

128.) A nurse is providing instructions to an adolescent who has a history of

seizures and is taking an anticonvulsant medication. Which of the following
statements indicates that the client understands the instructions?
1. "I will never be able to drive a car."
2. "My anticonvulsant medication will clear up my skin."
3. "I can't drink alcohol while I am taking my medication."
4. "If I forget my morning medication, I can take two pills at bedtime." - --
<<ANSWER IS>>---3. "I can't drink alcohol while I am taking my medication."
Rationale:
Alcohol will lower the seizure threshold and should be avoided. Adolescents can
obtain a driver's license in most states when they have been seizure free for 1
year. Anticonvulsants cause acne and oily skin; therefore a dermatologist may
need to be consulted. If an anticonvulsant medication is missed, the health care
provider should be notified.

129.) Megestrol acetate (Megace), an antineoplastic medication, is prescribed for

the client with metastatic endometrial carcinoma. The nurse reviews the client's
history and contacts the registered nurse if which diagnosis is documented in the
client's history?
1. Gout
2. Asthma
3. Thrombophlebitis
4. Myocardial infarction - --<<ANSWER IS>>---3. Thrombophlebitis
Rationale:
Megestrol acetate (Megace) suppresses the release of luteinizing hormone from
the anterior pituitary by inhibiting pituitary function and regressing tumor size.
Megestrol is used with caution if the client has a history of thrombophlebitis.
**megestrol acetate is a hormonal antagonist enzyme and that a side effect is
thrombotic disorders**

130.) The nurse is analyzing the laboratory results of a client with leukemia who
has received a regimen of chemotherapy. Which laboratory value would the nurse
specifically note as a result of the massive cell destruction that occurred from the
chemotherapy?
1. Anemia
2. Decreased platelets
3. Increased uric acid level
4. Decreased leukocyte count - --<<ANSWER IS>>---3. Increased uric acid level
Rationale:
Hyperuricemia is especially common following treatment for leukemias and
lymphomas because chemotherapy results in a massive cell kill. Although options
1, 2, and 4 also may be noted, an increased uric acid level is related specifically to
cell destruction.

131.) The nurse is reinforcing medication instructions to a client with breast

cancer who is receiving cyclophosphamide (Neosar). The nurse tells the client to:
1. Take the medication with food.
2. Increase fluid intake to 2000 to 3000 mL daily.
3. Decrease sodium intake while taking the medication.
4. Increase potassium intake while taking the medication. - --<<ANSWER IS>>---2.
Increase fluid intake to 2000 to 3000 mL daily.
Rationale:
Hemorrhagic cystitis is a toxic effect that can occur with the use of
cyclophosphamide. The client needs to be instructed to drink copious amounts of
fluid during the administration of this medication. Clients also should monitor
urine output for hematuria. The medication should be taken on an empty
stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from
the use of the medication; therefore the client would not be told to increase
potassium intake. The client would not be instructed to alter sodium intake.

132.) The client with non-Hodgkin's lymphoma is receiving daunorubicin

(DaunoXome). Which of the following would indicate to the nurse that the client is
experiencing a toxic effect related to the medication?
1. Fever
2. Diarrhea
3. Complaints of nausea and vomiting
4. Crackles on auscultation of the lungs - --<<ANSWER IS>>---4. Crackles on
auscultation of the lungs
Rationale:
Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy
manifested as congestive heart failure is a toxic effect of daunorubicin. Bone
marrow depression is also a toxic effect. Nausea and vomiting are frequent side
effects associated with the medication that begins a few hours after
administration and lasts 24 to 48 hours. Fever is a frequent side effect, and
diarrhea can occur occasionally. The other options, however, are not toxic effects.
**keep in mind that the question is asking about a toxic effect and think: ABCs—
airway, breathing, and circulation**

133.) A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for

adverse effects to the medication. Which of the following indicates the presence
of an adverse effect?
1. Insomnia
2. Drowsiness
3. Weight loss
4. Increased urination - --<<ANSWER IS>>---2. Drowsiness
Rationale:
Water intoxication (overhydration) or hyponatremia is an adverse effect to
desmopressin. Early signs include drowsiness, listlessness, and headache.
Decreased urination, rapid weight gain, confusion, seizures, and coma also may
occur in overhydration.
**Recall that this medication is used to treat diabetes insipidus to eliminate
weight loss and increased urination.**

134.) A nurse reinforces instructions to a client who is taking levothyroxine

(Synthroid). The nurse tells the client to take the medication:
1. With food
2. At lunchtime
3. On an empty stomach
4. At bedtime with a snack - --<<ANSWER IS>>---Rationale:
Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to
enhance absorption. Dosing should be done in the morning before breakfast.
**Note that options 1, 2, and 4 are comparable or alike in that these options
address administering the medication with food.**

135.) A nurse reinforces medication instructions to a client who is taking

levothyroxine (Synthroid). The nurse instructs the client to notify the health care
provider (HCP) if which of the following occurs?
1. Fatigue
2. Tremors
3. Cold intolerance
4. Excessively dry skin - --<<ANSWER IS>>---2. Tremors
Rationale:
Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of
hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness,
insomnia, hyperthermia, heat intolerance, and sweating. The client should be
instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of
hypothyroidism.

136.) A nurse performs an admission assessment on a client who visits a health

care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is
taken daily. The nurse continues to collect data from the client, suspecting that
the client has a history of:
1. Myxedema
2. Graves' disease
3. Addison's disease
4. Cushing's syndrome - --<<ANSWER IS>>---2. Graves' disease
Rationale:
PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or
Graves' disease. Myxedema indicates hypothyroidism.
Cushing's syndrome and Addison's disease are disorders related to adrenal
function.

137.) A nurse is reinforcing instructions for a client regarding intranasal

desmopressin acetate (DDAVP). The nurse tells the client that which of the
following is a side effect of the medication?
1. Headache
2. Vulval pain
3. Runny nose
4. Flushed skin - --<<ANSWER IS>>---3. Runny nose
Rationale:
Desmopressin administered by the intranasal route can cause a runny or stuffy
nose. Headache, vulval pain, and flushed skin are side effects if the medication is
administered by the intravenous (IV) route.

138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces

instructions to the client regarding administration of the medication and instructs
the client that the best time to take this medication is:
1. At noon
2. At bedtime
3. Early morning
4. Anytime, at the same time, each day - --<<ANSWER IS>>---3. Early morning
Rationale:
Corticosteroids (glucocorticoids) should be administered before 9:00 AM.
Administration at this time helps minimize adrenal insufficiency and mimics the
burst of glucocorticoids released naturally by the adrenal glands each morning.
**Note the suffix "-sone," and recall that medication names that end with these
letters are corticosteroids.**

139.) Prednisone is prescribed for a client with diabetes mellitus who is taking
Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following
prescription changes does the nurse anticipate during therapy with the
prednisone?
1. An additional dose of prednisone daily
2. A decreased amount of daily Humulin NPH insulin
3. An increased amount of daily Humulin NPH insulin
4. The addition of an oral hypoglycemic medication daily - --<<ANSWER IS>>---3.
An increased amount of daily Humulin NPH insulin
Rationale:
Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus
may need their dosages of insulin or oral hypoglycemic medications increased
during glucocorticoid therapy. Therefore the other options are incorrect.

140.) The client has a new prescription for metoclopramide (Reglan). On review of
the chart, the nurse identifies that this medication can be safely administered with
which condition?
1. Intestinal obstruction
2. Peptic ulcer with melena
3. Diverticulitis with perforation
4. Vomiting following cancer chemotherapy - --<<ANSWER IS>>---4. Vomiting
following cancer chemotherapy
Rationale:
Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a
GI stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation.
It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

141.) The nurse has reinforced instructions to a client who has been prescribed
cholestyramine (Questran). Which statement by the client indicates a need for
further instructions?
1. "I will continue taking vitamin supplements."
2. "This medication will help lower my cholesterol."
3. "This medication should only be taken with water."
 4. "A high-fiber diet is important while taking this medication." - --<<ANSWER
IS>>---3. "This medication should only be taken with water."
Rationale:
Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol
level, and client compliance is a problem because of its taste and palatability. The
use of flavored products or fruit juices can improve the taste. Some side effects of
bile acid sequestrants include constipation and decreased vitamin absorption.
**Note the closed-ended word "only" in option 3**

142.) A health care provider has written a prescription for ranitidine (Zantac), once
daily. The nurse should schedule the medication for which of the following times?
1. At bedtime
2. After lunch
3. With supper
4. Before breakfast - --<<ANSWER IS>>---1. At bedtime
Rationale:
A single daily dose of ranitidine is usually scheduled to be given at bedtime. This
allows for a prolonged effect, and the greatest protection of the gastric mucosa.
**recall that ranitidine suppresses secretions of gastric acids**

143.) A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans
to monitor this client for relief of:
1. Heartburn
2. Constipation
3. Abdominal pain
4. Nausea and vomiting - --<<ANSWER IS>>---4. Nausea and vomiting
Rationale:
Trimethobenzamide is an antiemetic agent used in the treatment of nausea and
vomiting. The other options are incorrect.

144.) A client is taking docusate sodium (Colace). The nurse monitors which of the
following to determine whether the client is having a therapeutic effect from this
medication?
1. Abdominal pain
2. Reduction in steatorrhea
3. Hematest-negative stools
4. Regular bowel movements - --<<ANSWER IS>>---4. Regular bowel movements
Rationale:
Docusate sodium is a stool softener that promotes the absorption of water into
the stool, producing a softer consistency of stool. The intended effect is relief or
prevention of constipation. The medication does not relieve abdominal pain, stop
gastrointestinal (GI) bleeding, or decrease the amount of fat in the stools.

145.) A nurse has a prescription to give a client albuterol (Proventil HFA) (two
puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs), by
metered-dose inhaler. The nurse administers the medication by giving the:
1. Albuterol first and then the beclomethasone dipropionate
2. Beclomethasone dipropionate first and then the albuterol
3. Alternating a single puff of each, beginning with the albuterol
4. Alternating a single puff of each, beginning with the beclomethasone
dipropionate - --<<ANSWER IS>>---1. Albuterol first and then the beclomethasone
dipropionate
Rationale:
Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid.
Bronchodilators are always administered before glucocorticoids when both are to
be given on the same time schedule. This allows for widening of the air passages
by the bronchodilator, which then makes the glucocorticoid more effective.

146.) A client has begun therapy with theophylline (Theo-24). The nurse tells the
client to limit the intake of which of the following while taking this medication?
1. Oranges and pineapple
2. Coffee, cola, and chocolate
3. Oysters, lobster, and shrimp
4. Cottage cheese, cream cheese, and dairy creamers - --<<ANSWER IS>>---2.
Coffee, cola, and chocolate
Rationale:
Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the
intake of xanthine-containing foods while taking this medication. These include
coffee, cola, and chocolate.

147.) A client with a prescription to take theophylline (Theo-24) daily has been
given medication instructions by the nurse. The nurse determines that the client
needs further information about the medication if the client states that he or she
will:
1. Drink at least 2 L of fluid per day.
2. Take the daily dose at bedtime.
3. Avoid changing brands of the medication without health care provider (HCP)
approval.
4. Avoid over-the-counter (OTC) cough and cold medications unless approved by
the HCP. - --<<ANSWER IS>>---2. Take the daily dose at bedtime.
Rationale:
The client taking a single daily dose of theophylline, a xanthine bronchodilator,
should take the medication early in the morning. This enables the client to have
maximal benefit from the medication during daytime activities. In addition, this
medication causes insomnia. The client should take in at least 2 L of fluid per day
to decrease viscosity of secretions. The client should check with the physician
before changing brands of the medication. The client also checks with the HCP
before taking OTC cough, cold, or other respiratory preparations because they
could cause interactive effects, increasing the side effects of theophylline and
causing dysrhythmias.

148.) A client is taking cetirizine hydrochloride (Zyrtec). The nurse checks for
which of the following side effects of this medication?
1. Diarrhea
2. Excitability
3. Drowsiness
4. Excess salivation - --<<ANSWER IS>>---3. Drowsiness
Rationale:
A frequent side effect of cetirizine hydrochloride (Zyrtec), an antihistamine, is
drowsiness or sedation. Others include blurred vision, hypertension (and
sometimes hypotension), dry mouth, constipation, urinary retention, and
sweating.
149.) A client taking fexofenadine (Allegra) is scheduled for allergy skin testing and
tells the nurse in the health care provider's office that a dose was taken this
morning. The nurse determines that:
1. The client should reschedule the appointment.
2. A lower dose of allergen will need to be injected.
3. A higher dose of allergen will need to be injected.
4. The client should have the skin test read a day later than usual. - --<<ANSWER
IS>>---1. The client should reschedule the appointment.
Rationale:
Fexofenadine is an antihistamine, which provides relief of symptoms caused by
allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before
allergy skin testing to avoid false-negative readings. This client should have the
appointment rescheduled for 3 days after discontinuing the medication.

150.) A client complaining of not feeling well is seen in a clinic. The client is taking
several medications for the control of heart disease and hypertension. These
medications include a β-blocker, digoxin (Lanoxin), and a diuretic. A tentative
diagnosis of digoxin toxicity is made. Which of the following assessment data
would support this diagnosis?
1. Dyspnea, edema, and palpitations
2. Chest pain, hypotension, and paresthesia
3. Double vision, loss of appetite, and nausea
4. Constipation, dry mouth, and sleep disorder - --<<ANSWER IS>>---3. Double
vision, loss of appetite, and nausea
Rationale:
Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional
signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations
such as green and yellow vision or seeing spots or halos, confusion, vomiting,
diarrhea, decreased libido, and impotence.
**gastrointestinal (GI) and visual disturbances occur with digoxin toxicity**

151.) A client is being treated for acute congestive heart failure with intravenously
administered bumetanide. The vital signs are as follows: blood pressure, 100/60
mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial
dose, which of the following is the priority assessment?
1. Monitoring weight loss
2. Monitoring temperature
3. Monitoring blood pressure
4. Monitoring potassium level - --<<ANSWER IS>>---3. Monitoring blood pressure
Rationale:
Bumetanide is a loop diuretic. Hypotension is a common side effect associated
with the use of this medication. The other options also require assessment but are
not the priority.
**priority ABCs—airway, breathing, and circulation**

152.) Intravenous heparin therapy is prescribed for a client. While implementing

this prescription, a nurse ensures that which of the following medications is
available on the nursing unit?
1. Protamine sulfate
2. Potassium chloride
3. Phytonadione (vitamin K )
4. Aminocaproic acid (Amicar) - --<<ANSWER IS>>---1. Protamine sulfate
Rationale:
The antidote to heparin is protamine sulfate; it should be readily available for use
if excessive bleeding or hemorrhage occurs. Potassium chloride is administered for
a potassium deficit. Vitamin K is an antidote for warfarin sodium. Aminocaproic
acid is the antidote for thrombolytic therapy.

153.) A client is diagnosed with pulmonary embolism and is to be treated with

streptokinase (Streptase). A nurse would report which priority data collection
finding to the registered nurse before initiating this therapy?
1. Adventitious breath sounds
2. Temperature of 99.4° F orally
3. Blood pressure of 198/110 mm Hg
4. Respiratory rate of 28 breaths/min - --<<ANSWER IS>>---3. Blood pressure of
198/110 mm Hg
Rationale:
Thrombolytic therapy is contraindicated in a number of preexisting conditions in
which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant
therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled
hypertension because of the risk of cerebral hemorrhage. Therefore the nurse
would report the results of the blood pressure to the registered nurse before
initiating therapy. The findings in options 1, 2, and 4 may be present in the client
with pulmonary embolism.

154.) A nurse is reinforcing dietary instructions to a client who has been

prescribed cyclosporine (Sandimmune). Which food item would the nurse instruct
the client to avoid?
1. Red meats
2. Orange juice
3. Grapefruit juice
4. Green, leafy vegetables - --<<ANSWER IS>>---3. Grapefruit juice
Rationale:
A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a
result, the consumption of grapefruit juice can raise cyclosporine levels by 50% to
100%, thereby greatly increasing the risk of toxicity. Grapefruit juice needs to be
avoided. Red meats, orange juice, and green leafy vegetables are acceptable to
consume.

155.) Mycophenolate mofetil (CellCept) is prescribed for a client as prophylaxis for

organ rejection following an allogeneic renal transplant. Which of the following
instructions does the nurse reinforce regarding administration of this medication?
1. Administer following meals.
2. Take the medication with a magnesium-type antacid.
3. Open the capsule and mix with food for administration.
4. Contact the health care provider (HCP) if a sore throat occurs. - --<<ANSWER
IS>>---4. Contact the health care provider (HCP) if a sore throat occurs.
Rationale:
Mycophenolate mofetil should be administered on an empty stomach. The
capsules should not be opened or crushed. The client should contact the HCP if
unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever
occurs because these are adverse effects of the medication. Antacids containing
magnesium and aluminum may decrease the absorption of the medication and
therefore should not be taken with the medication. The medication may be given
in combination with corticosteroids and cyclosporine.
**neutropenia can occur with this medication**
156.) A nurse is reviewing the laboratory results for a client receiving tacrolimus
(Prograf). Which laboratory result would indicate to the nurse that the client is
experiencing an adverse effect of the medication?
1. Blood glucose of 200 mg/dL
2. Potassium level of 3.8 mEq/L
3. Platelet count of 300,000 cells/mm3
4. White blood cell count of 6000 cells/mm3 - --<<ANSWER IS>>---1. Blood
glucose of 200 mg/dL
Rationale:
A blood glucose level of 200 mg/dL is elevated above the normal range of 70 to
110 mg/dL and suggests an adverse effect. Other adverse effects include
neurotoxicity evidenced by headache, tremor, insomnia; gastrointestinal (GI)
effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia.

157.) A client receiving nitrofurantoin (Macrodantin) calls the health care

provider's office complaining of side effects related to the medication. Which side
effect indicates the need to stop treatment with this medication?
1. Nausea
2. Diarrhea
3. Anorexia
4. Cough and chest pain - --<<ANSWER IS>>---4. Cough and chest pain
Rationale:
Gastrointestinal (GI) effects are the most frequent adverse reactions to this
medication and can be minimized by administering the medication with milk or
meals. Pulmonary reactions, manifested as dyspnea, chest pain, chills, fever,
cough, and the presence of alveolar infiltrates on the x-ray, would indicate the
need to stop the treatment. These symptoms resolve in 2 to 4 days following
discontinuation of this medication.
**Eliminate options 1, 2, and 3 because they are similar GI-related side effects.
Also, use the ABCs— airway, breathing, and circulation**

158.) A client with chronic renal failure is receiving epoetin alfa (Epogen, Procrit).
Which laboratory result would indicate a therapeutic effect of the medication?
1. Hematocrit of 32%
2. Platelet count of 400,000 cells/mm3
3. White blood cell count of 6000 cells/mm3
4. Blood urea nitrogen (BUN) level of 15 mg/dL - --<<ANSWER IS>>---1.
Hematocrit of 32%
Rationale:
Epoetin alfa is used to reverse anemia associated with chronic renal failure. A
therapeutic effect is seen when the hematocrit is between 30% and 33%. The
laboratory tests noted in the other options are unrelated to the use of this
medication.

159.) A nurse is caring for a client receiving morphine sulfate subcutaneously for
pain. Because morphine sulfate has been prescribed for this client, which nursing
action would be included in the plan of care?
1. Encourage fluid intake.
2. Monitor the client's temperature.
3. Maintain the client in a supine position.
4. Encourage the client to cough and deep breathe. - --<<ANSWER IS>>---4.
Encourage the client to cough and deep breathe.
Rationale:
Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to
cough and deep breathe to prevent pneumonia.
**ABCs—airway, breathing, and circulation**

160.) Meperidine hydrochloride (Demerol) is prescribed for the client with pain.
Which of the following would the nurse monitor for as a side effect of this
medication?
1. Diarrhea
2. Bradycardia
3. Hypertension
4. Urinary retention - --<<ANSWER IS>>---4. Urinary retention
Rationale:
Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this
medication include respiratory depression, orthostatic hypotension, tachycardia,
drowsiness and mental clouding, constipation, and urinary retention.

161.) A nurse is caring for a client with severe back pain, and codeine sulfate has
been prescribed for the client. Which of the following would the nurse include in
the plan of care while the client is taking this medication?
1. Restrict fluid intake.
2. Monitor bowel activity.
3. Monitor for hypertension.
4. Monitor peripheral pulses. - --<<ANSWER IS>>---2. Monitor bowel activity.
Rationale:
While the client is taking codeine sulfate, an opioid analgesic, the nurse would
monitor vital signs and monitor for hypotension. The nurse should also increase
fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds,
and monitor the pattern of daily bowel activity and stool consistency (codeine can
cause constipation). The nurse should monitor respiratory status and initiate
breathing and coughing exercises. In addition, the nurse monitors the
effectiveness of the pain medication.

162.) Carbamazepine (Tegretol) is prescribed for a client with a diagnosis of

psychomotor seizures. The nurse reviews the client's health history, knowing that
this medication is contraindicated if which of the following disorders is present?
1. Headaches
2. Liver disease
3. Hypothyroidism
4. Diabetes mellitus - --<<ANSWER IS>>---2. Liver disease
Rationale:
Carbamazepine (Tegretol) is contraindicated in liver disease, and liver function
tests are routinely prescribed for baseline purposes and are monitored during
therapy. It is also contraindicated if the client has a history of blood dyscrasias. It is
not contraindicated in the conditions noted in the incorrect options.

163.) A client with trigeminal neuralgia tells the nurse that acetaminophen
(Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The
nurse reviews the client's laboratory results and determines that which of the
following indicates toxicity associated with the medication?
1. Sodium of 140 mEq/L
2. Prothrombin time of 12 seconds
3. Platelet count of 400,000 cells/mm3
4. A direct bilirubin level of 2 mg/dL - --<<ANSWER IS>>---4. A direct bilirubin
level of 2 mg/dL
Rationale:
In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is
an indicator of liver function and is the only option that indicates an abnormal
laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet
count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13
seconds. The normal sodium level is 135 to 145 mEq/L.

164.) A client receives a prescription for methocarbamol (Robaxin), and the nurse
reinforces instructions to the client regarding the medication. Which client
statement would indicate a need for further instructions?
1. "My urine may turn brown or green."
2. "This medication is prescribed to help relieve my muscle spasms."
3. "If my vision becomes blurred, I don't need to be concerned about it."
4. "I need to call my doctor if I experience nasal congestion from this medication."
- --<<ANSWER IS>>---3. "If my vision becomes blurred, I don't need to be
concerned about it."
Rationale:
The client needs to be told that the urine may turn brown, black, or green. Other
adverse effects include blurred vision, nasal congestion, urticaria, and rash. The
client needs to be instructed that, if these adverse effects occur, the health care
provider needs to be notified. The medication is used to relieve muscle spasms.
165.) The client has been on treatment for rheumatoid arthritis for 3 weeks.
During the administration of etanercept (Enbrel), it is most important for the
nurse to assess:
1. The injection site for itching and edema
2. The white blood cell counts and platelet counts
3. Whether the client is experiencing fatigue and joint pain
4. A metallic taste in the mouth and a loss of appetite - --<<ANSWER IS>>---2. The
white blood cell counts and platelet counts
Rationale:
Infection and pancytopenia are adverse effects of etanercept (Enbrel). Laboratory
studies are performed before and during treatment. The appearance of abnormal
white blood cell counts and abnormal platelet counts can alert the nurse to a
potential life-threatening infection. Injection site itching is a common occurrence
following administration of the medication. In early treatment, residual fatigue
and joint pain may still be apparent. A metallic taste and loss of appetite are not
common signs of side effects of this medication.

166.) Alendronate (Fosamax) is prescribed for a client with osteoporosis. The

client taking this medication is instructed to:
1. Take the medication at bedtime.
2. Take the medication in the morning with breakfast.
3. Lie down for 30 minutes after taking the medication.
4. Take the medication with a full glass of water after rising in the morning. - --
<<ANSWER IS>>---4. Take the medication with a full glass of water after rising in
the morning.
Rationale:
Precautions need to be taken with administration of alendronate to prevent
gastrointestinal side effects (especially esophageal irritation) and to increase
absorption of the medication. The medication needs to be taken with a full glass
of water after rising in the morning. The client should not eat or drink anything for
30 minutes following administration and should not lie down after taking the
medication.

167.) A nurse prepares to reinforce instructions to a client who is taking

allopurinol (Zyloprim). The nurse plans to include which of the following in the
instructions?
1. Instruct the client to drink 3000 mL of fluid per day.
2. Instruct the client to take the medication on an empty stomach.
3. Inform the client that the effect of the medication will occur immediately.
4. Instruct the client that, if swelling of the lips occurs, this is a normal expected
response. - --<<ANSWER IS>>---1. Instruct the client to drink 3000 mL of fluid per
day.
Rationale:
Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels.
Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full
therapeutic effect may take 1 week or longer. Allopurinol is to be given with or
immediately following meals or milk to prevent gastrointestinal irritation. If the
client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or
she should contact the health care provider because this may indicate
hypersensitivity.

168.) Colcrys (colchicine) is prescribed for a client with a diagnosis of gout. The
nurse reviews the client's medical history in the health record, knowing that the
medication would be contraindicated in which disorder?
1. Myxedema
2. Renal failure
3. Hypothyroidism
4. Diabetes mellitus - --<<ANSWER IS>>---2. Renal failure
Rationale:
Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic
or cardiac disorders, or with blood dyscrasias. Clients with impaired renal function
may exhibit myopathy and neuropathy manifested as generalized weakness. This
medication should be used with caution in clients with impaired hepatic function,
older clients, and debilitated clients.
**Note that options 1, 3, and 4 are all endocrine-related disorders:
Myxedema=Hypothyroidism**

169.) Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The
nurse tells the client that it is best to take the insulin:
1. 1 hour after each meal
2. Once daily, at the same time each day
3. 15 minutes before breakfast, lunch, and dinner
4. Before each meal, on the basis of the blood glucose level - --<<ANSWER IS>>---
2. Once daily, at the same time each day
Rationale:
Insulin glargine is a long-acting recombinant DNA human insulin used to treat type
1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is
administered once a day, at the same time each day.
170.) Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The
nurse should perform which of the following as a priority action before
administering the medication?
1. Listen to the client's lung sounds.
2. Check the client's blood pressure.
3. Check the recent electrolyte levels.
4. Assess the client for muscle weakness. - --<<ANSWER IS>>---2. Check the
client's blood pressure.
Rationale:
Atenolol hydrochloride is a beta-blocker used to treat hypertension. Therefore the
priority nursing action before administration of the medication is to check the
client's blood pressure. The nurse also checks the client's apical heart rate. If the
systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per
minute or lower, the medication is withheld and the registered nurse and/or
health care provider is notified. The nurse would check baseline renal and liver
function tests. The medication may cause weakness, and the nurse would assist
the client with activities if weakness occurs.
**Beta-blockers have "-lol" at the end of the medication name**

171.) A nurse is preparing to administer furosemide (Lasix) to a client with a

diagnosis of heart failure. The most important laboratory test result for the nurse
to check before administering this medication is:
1. Potassium level
2. Creatinine level
3. Cholesterol level
4. Blood urea nitrogen - --<<ANSWER IS>>---1. Potassium level
Rationale:
Furosemide is a loop diuretic. The medication causes a decrease in the client's
electrolytes, especially potassium, sodium, and chloride. Administering
furosemide to a client with low electrolyte levels could precipitate ventricular
dysrhythmias. Options 2 and 4 reflect renal function. The cholesterol level is
unrelated to the administration of this medication.

172.) A nurse provides dietary instructions to a client who will be taking warfarin
sodium (Coumadin). The nurse tells the client to avoid which food item?
1. Grapes
2. Spinach
3. Watermelon
4. Cottage cheese - --<<ANSWER IS>>---2. Spinach
Rationale:
Warfarin sodium is an anticoagulant. Anticoagulant medications act by
antagonizing the action of vitamin K, which is needed for clotting. When a client is
taking an anticoagulant, foods high in vitamin K often are omitted from the diet.
Vitamin K-rich foods include green, leafy vegetables, fish, liver, coffee, and tea.

173.) A nurse reviews the medication history of a client admitted to the hospital
and notes that the client is taking leflunomide (Arava). During data collection, the
nurse asks which question to determine medication effectiveness?
1. "Do you have any joint pain?"
2. "Are you having any diarrhea?"
3. "Do you have frequent headaches?"
4. "Are you experiencing heartburn?" - --<<ANSWER IS>>---1. "Do you have any
joint pain?"
Rationale:
Leflunomide is an immunosuppressive agent and has an anti-inflammatory action.
The medication provides symptomatic relief of rheumatoid arthritis. Diarrhea can
occur as a side effect of the medication. The other options are unrelated to
medication effectiveness.

174.) A client with portosystemic encephalopathy is receiving oral lactulose

(Chronulac) daily. The nurse assesses which of the following to determine
medication effectiveness?
1. Lung sounds
2. Blood pressure
3. Blood ammonia level
4. Serum potassium level - --<<ANSWER IS>>---3. Blood ammonia level
Rationale:
Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent
or treat portosystemic encephalopathy, including hepatic precoma and coma. It
also is used to treat constipation. The medication retains ammonia in the colon
(decreases the blood ammonia concentration), producing an osmotic effect. It
promotes increased peristalsis and bowel evacuation, expelling ammonia from the
colon.

175.) A nurse notes that a client is receiving lamivudine (Epivir). The nurse
determines that this medication has been prescribed to treat which of the
following?
1. Pancreatitis
2. Pharyngitis
3. Tonic-clonic seizures
 4. Human immunodeficiency virus (HIV) infection - --<<ANSWER IS>>---4. Human
immunodeficiency virus (HIV) infection
Rationale:
Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral
medication. It slows HIV replication and reduces the progression of HIV infection.
It also is used to treat chronic hepatitis B and is used for prophylaxis in health care
workers at risk of acquiring HIV after occupational exposure to the virus.
**Note the letters "-vir" in the trade name for this medication**

176.) A nurse notes that a client is taking lansoprazole (Prevacid). On data

collection, the nurse asks which question to determine medication effectiveness?
1. "Has your appetite increased?"
2. "Are you experiencing any heartburn?"
3. "Do you have any problems with vision?"
4. "Do you experience any leg pain when walking?" - --<<ANSWER IS>>---2. "Are
you experiencing any heartburn?"
Rationale:
Lansoprazole is a gastric acid pump inhibitor used to treat gastric and duodenal
ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat
gastroesophageal reflux disease (GERD). It is not used to treat visual problems,
problems with appetite, or leg pain.
**NOTE: "-zole" refers to gastric acid pump inhibitors**

177.) A nurse is assisting in caring for a pregnant client who is receiving

intravenous magnesium sulfate for the management of preeclampsia and notes
that the client's deep tendon reflexes are absent. On the basis of this data, the
nurse reports the finding and makes which determination?
1. The magnesium sulfate is effective.
2. The infusion rate needs to be increased.
3. The client is experiencing cerebral edema.
4. The client is experiencing magnesium toxicity. - --<<ANSWER IS>>---4. The
client is experiencing magnesium toxicity.
Rationale:
Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of
magnesium sulfate toxicity relate to the central nervous system depressant effects
of the medication and include respiratory depression; loss of deep tendon
reflexes; sudden decrease in fetal heart rate or maternal heart rate, or both; and
sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema.
An absence of reflexes indicates magnesium toxicity. The therapeutic serum level
of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L
(5 to 8 mg/dL).

178.) Methylergonovine (Methergine) is prescribed for a client with postpartum

hemorrhage caused by uterine atony. Before administering the medication, the
nurse checks which of the following as the important client parameter?
1. Temperature
2. Lochial flow
3. Urine output
4. Blood pressure - --<<ANSWER IS>>---4. Blood pressure
Rationale:
Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. It
stimulates contraction of the uterus and causes arterial vasoconstriction. Ergot
alkaloids are avoided in clients with significant cardiovascular disease, peripheral
disease, hypertension, eclampsia, or preeclampsia. These conditions are
worsened by the vasoconstrictive effects of the ergot alkaloids. The nurse would
check the client's blood pressure before administering the medication and would
follow agency protocols regarding withholding of the medication. Options 1, 2,
and 3 are items that are checked in the postpartum period, but they are unrelated
to the use of this medication.

179.) A nurse provides medication instructions to a client who had a kidney

transplant about therapy with cyclosporine (Sandimmune). Which statement by
the client indicates a need for further instruction?
1. "I need to obtain a yearly influenza vaccine."
2. "I need to have dental checkups every 3 months."
3. "I need to self-monitor my blood pressure at home."
4. "I need to call the health care provider (HCP) if my urine volume decreases or
my urine becomes cloudy." - --<<ANSWER IS>>---1. "I need to obtain a yearly
influenza vaccine."
Rationale:
Cyclosporine is an immunosuppressant medication. Because of the medication's
effects, the client should not receive any vaccinations without first consulting the
HCP. The client should report decreased urine output or cloudy urine, which could
indicate kidney rejection or infection, respectively. The client must be able to self-
monitor blood pressure to check for the side effect of hypertension. The client
needs meticulous oral care and dental cleaning every 3 months to help prevent
gingival hyperplasia.

180.) A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25
mg daily. The nurse teaches the client about the medication and tells the client
that it is important to:
1. Count the radial and carotid pulses every morning.
2. Check the blood pressure every morning and evening.
3. Stop taking the medication if the pulse is higher than 100 beats per minute.
4. Withhold the medication and call the HCP if the pulse is less than 60 beats per
minute. - --<<ANSWER IS>>---4. Withhold the medication and call the HCP if the
pulse is less than 60 beats per minute.
Rationale:
An important component of taking this medication is monitoring the pulse rate;
however, it is not necessary for the client to take both the radial and carotid
pulses. It is not necessary for the client to check the blood pressure every morning
and evening because the medication does not directly affect blood pressure. It is
most important for the client to know the guidelines related to withholding the
medication and calling the HCP. The client should not stop taking a medication.

181.) A client is taking ticlopidine hydrochloride (Ticlid). The nurse tells the client
to avoid which of the following while taking this medication?
1. Vitamin C
2. Vitamin D
3. Acetaminophen (Tylenol)
4. Acetylsalicylic acid (aspirin) - --<<ANSWER IS>>---4. Acetylsalicylic acid (aspirin)
Rationale:
Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease
the risk of thrombotic strokes in clients with precursor symptoms. Because it is an
antiplatelet agent, other medications that precipitate or aggravate bleeding
should be avoided during its use. Therefore, aspirin or any aspirin-containing
product should be avoided.
182.) A client with angina pectoris is experiencing chest pain that radiates down
the left arm. The nurse administers a sublingual nitroglycerin tablet to the client.
The client's pain is unrelieved, and the nurse determines that the client needs
another nitroglycerin tablet. Which of the following vital signs is most important
for the nurse to check before administering the medication?
1. Temperature
2. Respirations
3. Blood pressure
4. Radial pulse rate - --<<ANSWER IS>>---Rationale:
Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing
relaxation and dilation. As a result, hypotension can occur. The nurse would check
the client's blood pressure before administering the second nitroglycerin tablet.
Although the respirations and apical pulse may be checked, these vital signs are
not affected as a result of this medication. The temperature also is not associated
with the administration of this medication.

183.) A client who received a kidney transplant is taking azathioprine (Imuran),

and the nurse provides instructions about the medication. Which statement by
the client indicates a need for further instructions?
1. "I need to watch for signs of infection."
2. "I need to discontinue the medication after 14 days of use."
3. "I can take the medication with meals to minimize nausea."
4. "I need to call the health care provider (HCP) if more than one dose is missed."
- --<<ANSWER IS>>---2. "I need to discontinue the medication after 14 days of
use."
Rationale:
Azathioprine is an immunosuppressant medication that is taken for life. Because
of the effects of the medication, the client must watch for signs of infection, which
are reported immediately to the HCP. The client should also call the HCP if more
than one dose is missed. The medication may be taken with meals to minimize
nausea.

184.) A nurse preparing a client for surgery reviews the client's medication record.
The client is to be nothing per mouth (NPO) after midnight. Which of the following
medications, if noted on the client's record, should the nurse question?
1. Cyclobenzaprine (Flexeril)
2. Alendronate (Fosamax)
3. Allopurinol (Zyloprim)
4. Prednisone - --<<ANSWER IS>>---4. Prednisone
Rationale:
Prednisone is a corticosteroid that can cause adrenal atrophy, which reduces the
body's ability to withstand stress. Before and during surgery, dosages may be
temporarily increased. Cyclobenzaprine is a skeletal muscle relaxant. Alendronate
is a bone-resorption inhibitor. Allopurinol is an antigout medication.

185.) Which of the following herbal therapies would be prescribed for its use as an
antispasmodic? Select all that apply.
1.Aloe
2.Kava
3.Ginger
4.Chamomile
5.Peppermint oil - --<<ANSWER IS>>---4.Chamomile
5.Peppermint oil
Rationale:
Chamomile has a mild sedative effect and acts as an antispasmodic and anti-
inflammatory. Peppermint oil acts as an antispasmodic and is used for irritable
bowel syndrome. Topical aloe promotes wound healing. Aloe taken orally acts as a
laxative. Kava has an anxiolytic, sedative, and analgesic effect. Ginger is effective in
relieving nausea.

186.) A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to

a client. Before administering the medication, the nurse reviews the action of the
medication and understands that it:
1. Releases bicarbonate in exchange for primarily sodium ions
2. Releases sodium ions in exchange for primarily potassium ions
3. Releases potassium ions in exchange for primarily sodium ions
4. Releases sodium ions in exchange for primarily bicarbonate ions - --<<ANSWER
IS>>---2. Releases sodium ions in exchange for primarily potassium ions
Rationale:
Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of
hyperkalemia. The resin either passes through the intestine or is retained in the
colon. It releases sodium ions in exchange for primarily potassium ions. The
therapeutic effect occurs 2 to 12 hours after oral administration and longer after
rectal administration.

187.) A clinic nurse prepares to administer an MMR (measles, mumps, rubella)

vaccine to a child. How is this vaccine best administered?
1. Intramuscularly in the deltoid muscle
2. Subcutaneously in the gluteal muscle
3. Subcutaneously in the outer aspect of the upper arm
4. Intramuscularly in the anterolateral aspect of the thigh - --<<ANSWER IS>>---3.
Subcutaneously in the outer aspect of the upper arm
Rationale:
The MMR vaccine is administered subcutaneously in the outer aspect of the upper
arm. The gluteal muscle is most often used for intramuscular injections. The MMR
vaccine is not administered by the intramuscular route.

188.) The nurse should anticipate that the most likely medication to be prescribed
prophylactically for a child with spina bifida (myelomeningocele) who has a
neurogenic bladder would be:
1. Prednisone
2. Sulfisoxazole
3. Furosemide (Lasix)
4. Intravenous immune globulin (IVIG) - --<<ANSWER IS>>---2. Sulfisoxazole
Rationale:
A neurogenic bladder prevents the bladder from completely emptying because of
the decrease in muscle tone. The most likely medication to be prescribed to
prevent urinary tract infection would be an antibiotic. A common prescribed
medication is sulfisoxazole. Prednisone relieves allergic reactions and
inflammation rather than preventing infection. Furosemide promotes diuresis and
decreases edema caused by congestive heart failure. IVIG assists with antibody
production in immunocompromised clients.

189.) Prostaglandin E1 is prescribed for a child with transposition of the great

arteries. The mother of the child asks the nurse why the child needs the
medication. The nurse tells the mother that the medication:
1. Prevents hypercyanotic (blue or tet) spells
2. Maintains an adequate hormone level
3. Maintains the position of the great arteries
4. Provides adequate oxygen saturation and maintains cardiac output - --
<<ANSWER IS>>---4. Provides adequate oxygen saturation and maintains cardiac
output
Rationale:
A child with transposition of the great arteries may receive prostaglandin E1
temporarily to increase blood mixing if systemic and pulmonary mixing are
inadequate to maintain adequate cardiac output. Options 1, 2, and 3 are
incorrect. In addition, hypercyanotic spells occur in tetralogy of Fallot.
**Use the ABCs—airway, breathing, and circulation—to <<ANSWER IS>> the
question. The correct option addresses circulation**

190.) A child is hospitalized with a diagnosis of lead poisoning. The nurse assisting
in caring for the child would prepare to assist in administering which of the
following medications?
1. Activated charcoal
2. Sodium bicarbonate
3. Syrup of ipecac syrup
4. Dimercaprol (BAL in Oil) - --<<ANSWER IS>>---4. Dimercaprol (BAL in Oil)
Rationale:
Dimercaprol is a chelating agent that is administered to remove lead from the
circulating blood and from some tissues and organs for excretion in the urine.
Sodium bicarbonate may be used in salicylate poisoning. Syrup of ipecac is used in
the hospital setting in poisonings to induce vomiting. Activated charcoal is used to
decrease absorption in certain poisoning situations. Note that dimercaprol is
prepared with peanut oil, and hence should be avoided by clients with known or
suspected peanut allergy.

191.) A child is brought to the emergency department for treatment of an acute

asthma attack. The nurse prepares to administer which of the following
medications first?
1. Oral corticosteroids
2. A leukotriene modifier
3. A β2 agonist
4. A nonsteroidal anti-inflammatory - --<<ANSWER IS>>---3. A β2 agonist
Rationale:
In treating an acute asthma attack, a short acting β2 agonist such as albuterol
(Proventil HFA) will be given to produce bronchodilation. Options 1, 2, and 4 are
long-term control (preventive) medications.

192.) A nurse is collecting medication information from a client, and the client
states that she is taking garlic as an herbal supplement. The nurse understands
that the client is most likely treating which of the following conditions?
1. Eczema
2. Insomnia
3. Migraines
4. Hyperlipidemia - --<<ANSWER IS>>---4. Hyperlipidemia
Rationale:
Garlic is an herbal supplement that is used to treat hyperlipidemia and
hypertension. An herbal supplement that may be used to treat eczema is evening
primrose. Insomnia has been treated with both valerian root and chamomile.
Migraines have been treated with feverfew.

193.) Sodium hypochlorite (Dakin's solution) is prescribed for a client with a leg
wound containing purulent drainage. The nurse is assisting in developing a plan of
care for the client and includes which of the following in the plan?
1. Ensure that the solution is freshly prepared before use.
2. Soak a sterile dressing with solution and pack into the wound.
3. Allow the solution to remain in the wound following irrigation.
4. Apply the solution to the wound and on normal skin tissue surrounding the
wound. - --<<ANSWER IS>>---1. Ensure that the solution is freshly prepared before
use.
Rationale:
Dakin solution is a chloride solution that is used for irrigating and cleaning necrotic
or purulent wounds. It can be used for packing necrotic wounds. It cannot be used
to pack purulent wounds because the solution is inactivated by copious pus. It
should not come into contact with healing or normal tissue, and it should be
rinsed off immediately if used for irrigation. Solutions are unstable and the nurse
must ensure that the solution has been prepared fresh before use.
**Eliminate options 2 and 3 first because they are comparable or alike. It makes
sense to ensure that the solution is freshly prepared; therefore, select option 1**

194.) A nurse provides instructions to a client regarding the use of tretinoin (Retin-
A). Which statement by the client indicates the need for further instructions?
1. "Optimal results will be seen after 6 weeks."
2. "I should apply a very thin layer to my skin."
3. "I should wash my hands thoroughly after applying the medication."
4. "I should cleanse my skin thoroughly before applying the medication." - --
<<ANSWER IS>>---2. "I should apply a very thin layer to my skin."
Rationale:
Tretinoin is applied liberally to the skin. The hands are washed thoroughly
immediately after applying. Therapeutic results should be seen after 2 to 3 weeks
but may not be optimal until after 6 weeks. The skin needs to be cleansed
thoroughly before applying the medication.

195.) A nurse is caring for a client who is taking metoprolol (Lopressor). The nurse
measures the client's blood pressure (BP) and apical pulse (AP) immediately
before administration. The client's BP is 122/78 mm/Hg and the AP is 58
beats/min. Based on this data, which of the following is the appropriate action?
1. Withhold the medication.
2. Notify the registered nurse immediately.
3. Administer the medication as prescribed.
4. Administer half of the prescribed medication. - --<<ANSWER IS>>---1. Withhold
the medication.
Rationale:
Metoprolol (Lopressor) is classified as a beta-adrenergic blocker and is used in the
treatment of hypertension, angina, and myocardial infarction. Baseline nursing
assessments include measurement of BP and AP immediately before
administration. If the systolic BP is below 90 mm/Hg and the AP is below 60
beats/min, the nurse should withhold the medication and document this action.
Although the registered nurse should be informed of the client's vital signs, it is
not necessary to do so immediately. The medication should not be administered
because the data is outside of the prescribed parameters for this medication. The
nurse should not administer half of the medication, or alter any dosages at any
point in time.
196.) A client has been prescribed amikacin (Amikin). Which of the following
priority baseline functions should be monitored?
1. Apical pulse
2. Liver function
3. Blood pressure
4. Hearing acuity - --<<ANSWER IS>>---4. Hearing acuity
Rationale:
Amikacin (Amikin) is an antibiotic. This medication can cause ototoxicity and
nephrotoxicity; therefore, hearing acuity tests and kidney function studies should
be performed before the initiation of therapy. Apical pulse, liver function studies,
and blood pressure are not specifically related to the use of this medication.

197.) Collagenase (Santyl) is prescribed for a client with a severe burn to the hand.
The nurse provides instructions to the client regarding the use of the medication.
Which statement by the client indicates an accurate understanding of the use of
this medication?
1. "I will apply the ointment once a day and leave it open to the air."
2. "I will apply the ointment twice a day and leave it open to the air."
3. "I will apply the ointment once a day and cover it with a sterile dressing."
4. "I will apply the ointment at bedtime and in the morning and cover it with a
sterile dressing." - --<<ANSWER IS>>---3. "I will apply the ointment once a day and
cover it with a sterile dressing."
Rationale:
Collagenase is used to promote debridement of dermal lesions and severe burns.
It is usually applied once daily and covered with a sterile dressing.
198.) Coal tar has been prescribed for a client with a diagnosis of psoriasis, and
the nurse provides instructions to the client about the medication. Which
statement by the client indicates a need for further instructions?
1. "The medication can cause phototoxicity."
2. "The medication has an unpleasant odor."
3. "The medication can stain the skin and hair."
4. "The medication can cause systemic effects." - --<<ANSWER IS>>---4. "The
medication can cause systemic effects."
Rationale:
Coal tar is used to treat psoriasis and other chronic disorders of the skin. It
suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an
unpleasant odor, can frequently stain the skin and hair, and can cause
phototoxicity. Systemic toxicity does not occur.
**The name of the medication will assist in eliminating options 2 and 3**

199.) A nurse is applying a topical glucocorticoid to a client with eczema. The

nurse monitors for systemic absorption of the medication if the medication is
being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands - --<<ANSWER IS>>---2. Axilla
Rationale:
Topical glucocorticoids can be absorbed into the systemic circulation. Absorption
is higher from regions where the skin is especially permeable (scalp, axillae, face,
eyelids, neck, perineum, genitalia), and lower from regions where penetrability is
poor (back, palms, soles).
**Eliminate options 3 and 4 because these body areas are similar in terms of skin
characteristics**

200.) A client is seen in the clinic for complaints of skin itchiness that has been
persistent over the past several weeks. Following data collection, it has been
determined that the client has scabies. Lindane is prescribed, and the nurse is
asked to provide instructions to the client regarding the use of the medication.
The nurse tells the client to:
1. Apply a thick layer of cream to the entire body.
2. Apply the cream as prescribed for 2 days in a row.
3. Apply to the entire body and scalp, excluding the face.
4. Leave the cream on for 8 to 12 hours and then remove by washing. - --
<<ANSWER IS>>---4. Leave the cream on for 8 to 12 hours and then remove by
washing.
Rationale:
Lindane is applied in a thin layer to the entire body below the head. No more than
30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours
later. Usually, only one application is required.

201.) A nurse is preparing to administer eardrops to an infant. The nurse plans to:
1. Pull up and back on the ear and direct the solution onto the eardrum.
2. Pull down and back on the ear and direct the solution onto the eardrum.
3. Pull down and back on the ear and direct the solution toward the wall of the
canal.
 4. Pull up and back on the ear lobe and direct the solution toward the wall of the
canal. - --<<ANSWER IS>>---3. Pull down and back on the ear and direct the
solution toward the wall of the canal.
Rationale:
When administering eardrops to an infant, the nurse pulls the ear down and
straight back. In the adult or a child older than 3 years, the ear is pulled up and
back to straighten the auditory canal. The medication is administered by aiming it
at the wall of the canal rather than directly onto the eardrum.

202.) A nurse is collecting data from a client about medications being taken, and
the client tells the nurse that he is taking herbal supplements for the treatment of
varicose veins. The nurse understands that the client is most likely taking which of
the following?
1. Bilberry
2. Ginseng
3. Feverfew
4. Evening primrose - --<<ANSWER IS>>---1. Bilberry
Rationale:
Bilberry is an herbal supplement that has been used to treat varicose veins. This
supplement has also been used to treat cataracts, retinopathy, diabetes mellitus,
and peripheral vascular disease. Ginseng has been used to improve memory
performance and decrease blood glucose levels in type 2 diabetes mellitus.
Feverfew is used to prevent migraine headaches and to treat rheumatoid arthritis.
Evening primrose is used to treat eczema and skin irritation.

203.) A nurse is preparing to give the postcraniotomy client medication for

incisional pain. The family asks the nurse why the client is receiving codeine
sulfate and not "something stronger." In formulating a response, the nurse
incorporates the understanding that codeine:
1. Is one of the strongest opioid analgesics available
2. Cannot lead to physical or psychological dependence
3. Does not cause gastrointestinal upset or constipation as do other opioids
4. Does not alter respirations or mask neurological signs as do other opioids - --
<<ANSWER IS>>---4. Does not alter respirations or mask neurological signs as do
other opioids
Rationale:
Codeine sulfate is the opioid analgesic often used for clients after craniotomy. It is
frequently combined with a nonopioid analgesic such as acetaminophen for
added effect. It does not alter the respiratory rate or mask neurological signs as do
other opioids. Side effects of codeine include gastrointestinal upset and
constipation. The medication can lead to physical and psychological dependence
with chronic use. It is not the strongest opioid analgesic available.

204.) A client receives a dose of edrophonium (Enlon). The client shows

improvement in muscle strength for a period of time following the injection. The
nurse interprets that this finding is compatible with:
1. Multiple sclerosis
2. Myasthenia gravis
3. Muscular dystrophy
4. Amyotrophic lateral sclerosis - --<<ANSWER IS>>---2. Myasthenia gravis
Rationale:
Myasthenia gravis can often be diagnosed based on clinical signs and symptoms.
The diagnosis can be confirmed by injecting the client with a dose of
edrophonium . This medication inhibits the breakdown of an enzyme in the
neuromuscular junction, so more acetylcholine binds to receptors. If the muscle is
strengthened for 3 to 5 minutes after this injection, it confirms a diagnosis of
myasthenia gravis. Another medication, neostigmine (Prostigmin), also may be
used because its effect lasts for 1 to 2 hours, providing a better analysis. For either
medication, atropine sulfate should be available as the antidote.

205.) A nurse is assisting in preparing to administer acetylcysteine (Mucomyst) to

a client with an overdose of acetaminophen (Tylenol). The nurse prepares to
administer the medication by:
1. Administering the medication subcutaneously in the deltoid muscle
2. Administering the medication by the intramuscular route in the gluteal muscle
3. Administering the medication by the intramuscular route, mixed in 10 mL of
normal saline
4. Mixing the medication in a flavored ice drink and allowing the client to drink
the medication through a straw - --<<ANSWER IS>>---4. Mixing the medication in
a flavored ice drink and allowing the client to drink the medication through a
straw
Rationale:
Because acetylcysteine has a pervasive odor of rotten eggs, it must be disguised in
a flavored ice drink. It is consumed preferably through a straw to minimize contact
with the mouth. It is not administered by the intramuscular or subcutaneous
route.
**Knowing that the medication is a solution that is also used for nebulization
treatments will assist you to select the option that indicates an oral route**

206.) A client is receiving baclofen (Lioresal) for muscle spasms caused by a spinal
cord injury. The nurse monitors the client, knowing that which of the following is a
side effect of this medication?
1. Muscle pain
2. Hypertension
3. Slurred speech
4. Photosensitivity - --<<ANSWER IS>>---Rationale:
Side effects of baclofen include drowsiness, dizziness, weakness, and nausea.
Occasional side effects include headache, paresthesia of the hands and feet,
constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion.
Paradoxical central nervous system excitement and restlessness can occur, along
with slurred speech, tremor, dry mouth, nocturia, and impotence.
**Option 3 is most closely associated with a neurological disorder**

207.) A client is suspected of having myasthenia gravis, and the health care
provider administers edrophonium (Enlon) to determine the diagnosis. After
administration of this medication, which of the following would indicate the
presence of myasthenia gravis?
1. Joint pain
2. A decrease in muscle strength
3. An increase in muscle strength
4. Feelings of faintness, dizziness, hypotension, and signs of flushing in the client -
--<<ANSWER IS>>---3. An increase in muscle strength
Rationale:
Edrophonium is a short-acting acetylcholinesterase inhibitor used as a diagnostic
agent. When a client with suspected myasthenia gravis is given the medication
intravenously, an increase in muscle strength would be seen in 1 to 3 minutes. If
no response occurs, another dose is given over the next 2 minutes, and muscle
strength is again tested. If no increase in muscle strength occurs with this higher
dose, the muscle weakness is not caused by myasthenia gravis. Clients receiving
injections of this medication commonly demonstrate a drop of blood pressure,
feel faint and dizzy, and are flushed.

208.) A client with myasthenia gravis verbalizes complaints of feeling much weaker
than normal. The health care provider plans to implement a diagnostic test to
determine if the client is experiencing a myasthenic crisis and administers
edrophonium (Enlon). Which of the following would indicate that the client is
experiencing a myasthenic crisis?
1. Increasing weakness
2. No change in the condition
3. An increase in muscle spasms
4. A temporary improvement in the condition - --<<ANSWER IS>>---auto-define
"A client with myasthen..."
Rationale:
Edrophonium (Enlon) is administered to determine whether the client is reacting
to an overdose of a medication (cholinergic crisis) or to an increasing severity of
the disease (myasthenic crisis). When the edrophonium (Enlon) injection is given
and the condition improves temporarily, the client is in myasthenic crisis. This is
known as a positive test. Increasing weakness would occur in cholinergic crisis.
Options 2 and 3 would not occur in either crisis.

209.) A client with multiple sclerosis is receiving diazepam (Valium), a centrally

acting skeletal muscle relaxant. Which of the following would indicate that the
client is experiencing a side effect related to this medication?
1. Headache
2. Drowsiness
3. Urinary retention
4. Increased salivation - --<<ANSWER IS>>---2. Drowsiness
Rationale:
Incoordination and drowsiness are common side effects resulting from this
medication. Options 1, 3, and 4 are incorrect.

210.) Dantrolene (Dantrium) is prescribed for a client with a spinal cord injury for
discomfort resulting from spasticity. The nurse tells the client about the
importance of follow-up and the need for which blood study?
1. Creatinine level
2. Sedimentation rate
3. Liver function studies
4. White blood cell count - --<<ANSWER IS>>---3. Liver function studies
Rationale:
Dantrolene can cause liver damage, and the nurse should monitor liver function
studies. Baseline liver function studies are done before therapy starts, and regular
liver function studies are performed throughout therapy. Dantrolene is
discontinued if no relief of spasticity is achieved in 6 weeks.

211.) A client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to
control seizures. A phenytoin blood level is drawn, and the results reveal a level of
35 mcg/ml. Which of the following symptoms would be expected as a result of
this laboratory result?
1. Nystagmus
2. Tachycardia
3. Slurred speech
4. No symptoms, because this is a normal therapeutic level - --<<ANSWER IS>>---
3. Slurred speech
Rationale:
The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20
mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level
higher than 30 mcg/mL, ataxia and slurred speech occur.

212.) Mannitol (Osmitrol) is being administered to a client with increased

intracranial pressure following a head injury. The nurse assisting in caring for the
client knows that which of the following indicates the therapeutic action of this
medication?
1. Prevents the filtration of sodium and water through the kidneys
2. Prevents the filtration of sodium and potassium through the kidneys
3. Decreases water loss by promoting the reabsorption of sodium and water in
the loop of Henle
4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby
inhibiting tubular reabsorption of water and solutes - --<<ANSWER IS>>---4.
Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby
inhibiting tubular reabsorption of water and solutes
Rationale:
Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic
pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water
and solutes. It is used to reduce intracranial pressure in the client with head
trauma.

213.) A client is admitted to the hospital with complaints of back spasms. The
client states, "I have been taking two or three aspirin every 4 hours for the past
week and it hasn't helped my back." Aspirin intoxication is suspected. Which of
the following complaints would indicate aspirin intoxication?
1. Tinnitus
2. Constipation
3. Photosensitivity
4. Abdominal cramps - --<<ANSWER IS>>---1. Tinnitus
Rationale:
Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is
commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing
in the ears) is the most frequently occurring effect noted with intoxication.
Hyperventilation may occur because salicylate stimulates the respiratory center.
Fever may result because salicylate interferes with the metabolic pathways
involved with oxygen consumption and heat production. Options 2, 3, and 4 are
incorrect.

214.) A health care provider initiates carbidopa/levodopa (Sinemet) therapy for

the client with Parkinson's disease. A few days after the client starts the
medication, the client complains of nausea and vomiting. The nurse tells the client
that:
1. Taking an antiemetic is the best measure to prevent the nausea.
2. Taking the medication with food will help to prevent the nausea.
3. This is an expected side effect of the medication and will decrease over time.
4. The nausea and vomiting will decrease when the dose of levodopa is stabilized.
- --<<ANSWER IS>>---2. Taking the medication with food will help to prevent the
nausea.
Rationale:
If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the
client that taking the medication with food will prevent the nausea. Additionally,
the client should be instructed not to take the medication with a high-protein
meal because the high-protein will affect absorption. Antiemetics from the
phenothiazine class should not be used because they block the therapeutic action
of dopamine.
**eliminate options 3 and 4 because they are comparable or alike**

215.) A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a

daily basis. Which medication dose should the nurse expect the client to be
taking?
1. 1 g daily
2. 4 g daily
3. 325 mg daily
4. 1000 mg daily - --<<ANSWER IS>>---2. 4 g daily
Rationale:
Aspirin may be used to treat the client with rheumatoid arthritis. It may also be
used to reduce the risk of recurrent transient ischemic attack (TIA) or brain attack
(stroke) or reduce the risk of myocardial infarction (MI) in clients with unstable
angina or a history of a previous MI. The normal dose for clients being treated
with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being
treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided
doses. Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in
divided doses.
**Eliminate options 1 and 4 because they are alike**

216.) A nurse is caring for a client with gout who is taking Colcrys (colchicine). The
client has been instructed to restrict the diet to low-purine foods. Which of the
following foods should the nurse instruct the client to avoid while taking this
medication?
1. Spinach
2. Scallops
3. Potatoes
4. Ice cream - --<<ANSWER IS>>---2. Scallops
Rationale:
Colchicine is a medication used for clients with gout to inhibit the reabsorption of
uric acid by the kidney and promote excretion of uric acid in the urine. Uric acid is
produced when purine is catabolized. Clients are instructed to modify their diet
and limit excessive purine intake. High-purine foods to avoid or limit include organ
meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp,
mackerel, gravy, and yeast.

217.) A health care provider prescribes auranofin (Ridaura) for a client with
rheumatoid arthritis. Which of the following would indicate to the nurse that the
client is experiencing toxicity related to the medication?
1. Joint pain
2. Constipation
3. Ringing in the ears
4. Complaints of a metallic taste in the mouth - --<<ANSWER IS>>---4. Complaints
of a metallic taste in the mouth
Rationale:
Ridaura is the one gold preparation that is given orally rather than by injection.
Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of
appetite are common early in therapy, but these usually subside in the first 3
months of therapy. Early symptoms of toxicity include a rash, purple blotches,
pruritus, mouth lesions, and a metallic taste in the mouth.

218.) A film-coated form of diflunisal has been prescribed for a client for the
treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because
of difficulty swallowing the tablets. Which initial instruction should the nurse
provide to the client?
1. "Crush the tablets and mix them with food."
2. "Notify the health care provider for a medication change."
3. "Open the tablet and mix the contents with food."
4. "Swallow the tablets with large amounts of water or milk." - --<<ANSWER IS>>-
--4. "Swallow the tablets with large amounts of water or milk."
Rationale:
Diflunisal may be given with water, milk, or meals. The tablets should not be
crushed or broken open. Taking the medication with a large amount of water or
milk should be tried before contacting the health care provider.

219.) A health care provider instructs a client with rheumatoid arthritis to take
ibuprofen (Motrin). The nurse reinforces the instructions, knowing that the
normal adult dose for this client is which of the following?
1. 100 mg orally twice a day
2. 200 mg orally twice a day
3. 400 mg orally three times a day
4. 1000 mg orally four times a day - --<<ANSWER IS>>---3. 400 mg orally three
times a day
Rationale:
For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult
dose is 400 to 800 mg three or four times daily.

220.) A adult client with muscle spasms is taking an oral maintenance dose of
baclofen (Lioresal). The nurse reviews the medication record, expecting that which
dose should be prescribed?
1. 15 mg four times a day
2. 25 mg four times a day
3. 30 mg four times a day
4. 40 mg four times a day - --<<ANSWER IS>>---1. 15 mg four times a day
Rationale:
Baclofen is dispensed in 10- and 20-mg tablets for oral use. Dosages are low
initially and then gradually increased. Maintenance doses range from 15 to 20 mg
administered three or four times a day.

221.) A nurse is reviewing the health care provider's prescriptions for an adult
client who has been admitted to the hospital following a back injury. Carisoprodol
(Soma) is prescribed for the client to relieve the muscle spasms; the health care
provider has prescribed 350 mg to be administered four times a day. When
preparing to give this medication, the nurse determines that this dosage is:
1. The normal adult dosage
2. A lower than normal dosage
3. A higher than normal dosage
4. A dosage requiring further clarification - --<<ANSWER IS>>---1. The normal
adult dosage
Rationale:
The normal adult dosage for carisoprodol is 350 mg orally three or four times
daily.

222.) A nurse has administered a dose of diazepam (Valium) to a client. The nurse
would take which important action before leaving the client's room?
1. Giving the client a bedpan
2. Drawing the shades or blinds closed
3. Turning down the volume on the television
4. Per agency policy, putting up the side rails on the bed - --<<ANSWER IS>>---4.
Per agency policy, putting up the side rails on the bed
Rationale:
Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant
properties. The nurse should institute safety measures before leaving the client's
room to ensure that the client does not injure herself or himself. The most
frequent side effects of this medication are dizziness, drowsiness, and lethargy.
For this reason, the nurse puts the side rails up on the bed before leaving the
room to prevent falls. Options 1, 2, and 3 may be helpful measures that provide a
comfortable, restful environment, but option 4 is the one that provides for the
client's safety needs.

223.) A client with a psychotic disorder is being treated with haloperidol (Haldol).
Which of the following would indicate the presence of a toxic effect of this
medication?
1. Nausea
2. Hypotension
3. Blurred vision
4. Excessive salivation - --<<ANSWER IS>>---4. Excessive salivation
Rationale:
Toxic effects include extrapyramidal symptoms (EPS) noted as marked drowsiness
and lethargy, excessive salivation, and a fixed stare. Akathisia, acute dystonias, and
tardive dyskinesia are also signs of toxicity. Hypotension, nausea, and blurred
vision are occasional side effects.

224.) Neuroleptic malignant syndrome is suspected in a client who is taking

chlorpromazine. Which medication would the nurse prepare in anticipation of
being prescribed to treat this adverse effect related to the use of chlorpromazine?
1. Protamine sulfate
2. Bromocriptine (Parlodel)
3. Phytonadione (vitamin K)
4. Enalapril maleate (Vasotec) - --<<ANSWER IS>>---2. Bromocriptine (Parlodel)
Rationale:
Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of
neuroleptic malignant syndrome. Vitamin K is the antidote for warfarin
(Coumadin) overdose. Protamine sulfate is the antidote for heparin overdose.
Enalapril maleate is an antihypertensive used in the treatment of hypertension.

225.) A nursing student is assigned to care for a client with a diagnosis of

schizophrenia. Haloperidol (Haldol) is prescribed for the client, and the nursing
instructor asks the student to describe the action of the medication. Which
statement by the nursing student indicates an understanding of the action of this
medication?
1. It is a serotonin reuptake blocker.
2. It inhibits the breakdown of released acetylcholine.
3. It blocks the uptake of norepinephrine and serotonin.
 4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in
the brain. - --<<ANSWER IS>>---4. It blocks the binding of dopamine to the
postsynaptic dopamine receptors in the brain.
Rationale:
Haloperidol acts by blocking the binding of dopamine to the postsynaptic
dopamine receptors in the brain. Imipramine hydrochloride (Tofranil) blocks the
reuptake of norepinephrine and serotonin. Donepezil hydrochloride (Aricept)
inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride
(Prozac) is a potent serotonin reuptake blocker.

226.) A client receiving lithium carbonate (Lithobid) complains of loose, watery

stools and difficulty walking. The nurse would expect the serum lithium level to be
which of the following?
1. 0.7 mEq/L
2. 1.0 mEq/L
3. 1.2 mEq/L
4. 1.7 mEq/L - --<<ANSWER IS>>---4. 1.7 mEq/L
Rationale:
The therapeutic serum level of lithium ranges from 0.6 to 1.2 mEq/L. Serum
lithium levels above the therapeutic level will produce signs of toxicity.

227.) When teaching a client who is being started on imipramine hydrochloride

(Tofranil), the nurse would inform the client that the desired effects of the
medication may:
1. Start during the first week of administration
2. Not occur for 2 to 3 weeks of administration
3. Start during the second week of administration
4. Not occur until after a month of administration - --<<ANSWER IS>>---2. Not
occur for 2 to 3 weeks of administration
Rationale:
The therapeutic effects of administration of imipramine hydrochloride may not
occur for 2 to 3 weeks after the antidepressant therapy has been initiated.
Therefore options 1, 3, and 4 are incorrect.

228.) A client receiving an anxiolytic medication complains that he feels very

"faint" when he tries to get out of bed in the morning. The nurse recognizes this
complaint as a symptom of:
1. Cardiac dysrhythmias
2. Postural hypotension
3. Psychosomatic symptoms
4. Respiratory insufficiency - --<<ANSWER IS>>---2. Postural hypotension
Rationale:
Anxiolytic medications can cause postural hypotension. The client needs to be
taught to rise to a sitting position and get out of bed slowly because of this
adverse effect related to the medication. Options 1, 3, and 4 are unrelated to the
use of this medication.

229.) A client who is taking lithium carbonate (Lithobid) is scheduled for surgery.
The nurse informs the client that:
1. The medication will be discontinued a week before the surgery and resumed 1
week postoperatively.
 2. The medication is to be taken until the day of surgery and resumed by injection
immediately postoperatively.
3. The medication will be discontinued 1 to 2 days before the surgery and
resumed as soon as full oral intake is allowed.
4. The medication will be discontinued several days before surgery and resumed
by injection in the immediate postoperative period. - --<<ANSWER IS>>---3. The
medication will be discontinued 1 to 2 days before the surgery and resumed as
soon as full oral intake is allowed.
Rationale:
The client who is on lithium carbonate must be off the medication for 1 to 2 days
before a scheduled surgical procedure and can resume the medication when full
oral intake is prescribed after the surgery.
**lithium carbonate is an oral medication and is not given as an injection**

230.) A client is placed on chloral hydrate (Somnote) for short-term treatment.

Which nursing action indicates an understanding of the major side effect of this
medication?
1. Monitoring neurological signs every 2 hours
2. Monitoring the blood pressure every 4 hours
3. Instructing the client to call for ambulation assistance
4. Lowering the bed and clearing a path to the bathroom at bedtime - --
<<ANSWER IS>>---3. Instructing the client to call for ambulation assistance
Rationale:
Chloral hydrate (a sedative-hypnotic) causes sedation and impairment of motor
coordination; therefore, safety measures need to be implemented. The client is
instructed to call for assistance with ambulation. Options 1 and 2 are not
specifically associated with the use of this medication. Although option 4 is an
appropriate nursing intervention, it is most important to instruct the client to call
for assistance with ambulation.

231.) A client admitted to the hospital gives the nurse a bottle of clomipramine
(Anafranil). The nurse notes that the medication has not been taken by the client
in 2 months. What behaviors observed in the client would validate noncompliance
with this medication?
1. Complaints of hunger
2. Complaints of insomnia
3. A pulse rate less than 60 beats per minute
4. Frequent handwashing with hot, soapy water - --<<ANSWER IS>>---4. Frequent
handwashing with hot, soapy water
Rationale:
Clomipramine is commonly used in the treatment of obsessive-compulsive
disorder. Handwashing is a common obsessive-compulsive behavior. Weight gain
is a common side effect of this medication. Tachycardia and sedation are side
effects. Insomnia may occur but is seldom a side effect.

232.) A client in the mental health unit is administered haloperidol (Haldol). The
nurse would check which of the following to determine medication effectiveness?
1. The client's vital signs
2. The client's nutritional intake
3. The physical safety of other unit clients
4. The client's orientation and delusional status - --<<ANSWER IS>>---4. The
client's orientation and delusional status
Rationale:
Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to
determine medication effectiveness, the nurse would check the client's
orientation and delusional status. Vital signs are routine and not specific to this
situation. The physical safety of other clients is not a direct assessment of this
client. Monitoring nutritional intake is not related to this situation.

233.) Diphenhydramine hydrochloride (Benadryl) is used in the treatment of

allergic rhinitis for a hospitalized client with a chronic psychotic disorder. The
client asks the nurse why the medication is being discontinued before hospital
discharge. The nurse responds, knowing that:
1. Allergic symptoms are short in duration.
2. This medication promotes long-term extrapyramidal symptoms.
3. Addictive properties are enhanced in the presence of psychotropic
medications.
4. Poor compliance causes this medication to fail to reach its therapeutic blood
level. - --<<ANSWER IS>>---3. Addictive properties are enhanced in the presence
of psychotropic medications.
Rationale:
The addictive properties of diphenhydramine hydrochloride are enhanced when
used with psychotropic medications. Allergic symptoms may not be short term
and will occur if allergens are present in the environment. Poor compliance may
be a problem with psychotic clients but is not the subject of the question.
Diphenhydramine hydrochloride may be used for extrapyramidal symptoms and
mild medication-induced movement disorders.

234.) A hospitalized client is started on phenelzine sulfate (Nardil) for the

treatment of depression. At lunchtime, a tray is delivered to the client. Which food
item on the tray will the nurse remove?
1. Yogurt
2. Crackers
3. Tossed salad
4. Oatmeal cookies - --<<ANSWER IS>>---1. Yogurt
Rationale:
Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should
avoid taking in foods that are high in tyramine. These foods could trigger a
potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged cheeses,
smoked or processed meats, red wines, and fruits such as avocados, raisins, or
figs.

235.) A tricyclic antidepressant is administered to a client daily. The nurse plans to

monitor for the common side effects of the medication and includes which of the
following in the plan of care?
1. Offer hard candy or gum periodically.
2. Offer a nutritious snack between meals.
3. Monitor the blood pressure every 2 hours.
4. Review the white blood cell (WBC) count results daily. - --<<ANSWER IS>>---1.
Offer hard candy or gum periodically.
Rationale:
Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth
rinsing with water, sucking on hard candy, and chewing gum will alleviate this
common side effect. It is not necessary to monitor the blood pressure every 2
hours. In addition, it is not necessary to check the WBC daily. Weight gain is a
common side effect and frequent snacks will aggravate this problem.
236.) A client is being treated for depression with amitriptyline hydrochloride.
During the initial phases of treatment, the most important nursing intervention is:
1. Prescribing the client a tyramine-free diet
2. Checking the client for anticholinergic effects
3. Monitoring blood levels frequently because there is a narrow range between
therapeutic and toxic blood levels of this medication
4. Getting baseline postural blood pressures before administering the medication
and each time the medication is administered - --<<ANSWER IS>>---4. Getting
baseline postural blood pressures before administering the medication and each
time the medication is administered
Rationale:
Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat
depression. It causes orthostatic changes and can produce hypotension and
tachycardia. This can be frightening to the client and dangerous because it can
result in dizziness and client falls. The client must be instructed to move slowly
from a lying to a sitting to a standing position to avoid injury if these effects are
experienced. The client may also experience sedation, dry mouth, constipation,
blurred vision, and other anticholinergic effects, but these are transient and will
diminish with time.

237.) A client who is on lithium carbonate (Lithobid) will be discharged at the end
of the week. In formulating a discharge teaching plan, the nurse will instruct the
client that it is most important to:
1. Avoid soy sauce, wine, and aged cheese.
2. Have the lithium level checked every week.
3. Take medication only as prescribed because it can become addicting.
4. Check with the psychiatrist before using any over-the-counter (OTC)
medications or prescription medications. - --<<ANSWER IS>>---4. Check with the
psychiatrist before using any over-the-counter (OTC) medications or prescription
medications.
Rationale:
Lithium is the medication of choice to treat manic-depressive illness. Many OTC
medications interact with lithium, and the client is instructed to avoid OTC
medications while taking lithium. Lithium is not addicting, and, although serum
lithium levels need to be monitored, it is not necessary to check these levels every
week. A tyramine-free diet is associated with monoamine oxidase inhibitors.

238.) Ribavirin (Virazole) is prescribed for the hospitalized child with respiratory
syncytial virus (RSV). The nurse prepares to administer this medication via which
of the following routes?
1. Orally
2. Via face mask
3. Intravenously
4. Intramuscularly - --<<ANSWER IS>>---2. Via face mask
Rationale:
Ribavirin is an antiviral respiratory medication used mainly in hospitalized children
with severe RSV and in high-risk children. Administration is via hood, face mask, or
oxygen tent. The medication is most effective if administered within the first 3
days of the infection.

239.) Which of the following precautions will the nurse specifically take during the
administration of ribavirin (Virazole) to a child with respiratory syncytial virus
(RSV)?
1. Wearing goggles
2. Wearing a gown
3. Wearing a gown and a mask
4. Handwashing before administration - --<<ANSWER IS>>---1. Wearing goggles
Rationale:
Some caregivers experience headaches, burning nasal passages and eyes, and
crystallization of soft contact lenses as a result of administration of ribavirin.
Specific to this medication is the use of goggles. A gown is not necessary. A mask
may be worn. Handwashing is to be performed before and after any child contact.

240.) A client with Parkinson's disease has been prescribed benztropine

(Cogentin). The nurse monitors for which gastrointestinal (GI) side effect of this
medication?
1. Diarrhea
2. Dry mouth
3. Increased appetite
4. Hyperactive bowel sounds - --<<ANSWER IS>>---2. Dry mouth
Rationale:
Common GI side effects of benztropine therapy include constipation and dry
mouth. Other GI side effects include nausea and ileus. These effects are the result
of the anticholinergic properties of the medication.
**Eliminate options 1 and 4 because they are comparable or alike. Recall that the
medication is an anticholinergic, which causes dry mouth**

241.) A client with a history of simple partial seizures is taking clorazepate

(Tranxene), and asks the nurse if there is a risk of addiction. The nurse's response
is based on the understanding that clorazepate:
1. Is not habit forming, either physically or psychologically
2. Leads to physical tolerance, but only after 10 or more years of therapy
3. Leads to physical and psychological dependence with prolonged high-dose
therapy
4. Can result in psychological dependence only, because of the nature of the
medication - --<<ANSWER IS>>---3. Leads to physical and psychological
dependence with prolonged high-dose therapy
Rationale:
Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-
hypnotic (benzodiazepine). One of the concerns with clorazepate therapy is that
the medication can lead to physical or psychological dependence with prolonged
therapy at high doses. For this reason, the amount of medication that is readily
available to the client at any one time is restricted.
**Eliminate options 2 and 4 first because of the closed-ended word "only"**

242.) A client who was started on anticonvulsant therapy with clonazepam

(Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting
the medication. The client is visibly upset by these manifestations and asks the
nurse what to do. The nurse's response is based on the understanding that these
symptoms:
1. Usually occur if the client takes the medication with food
2. Are probably the result of an interaction with another medication
3. Indicate that the client is experiencing a severe untoward reaction to the
medication
4. Are worse during initial therapy and decrease or disappear with long-term use -
--<<ANSWER IS>>---4. Are worse during initial therapy and decrease or disappear
with long-term use
Rationale:
Drowsiness, unsteadiness, and clumsiness are expected effects of the medication
during early therapy. They are dose related and usually diminish or disappear
altogether with continued use of the medication. It does not indicate that a severe
side effect is occurring. It is also unrelated to interaction with another medication.
The client is encouraged to take this medication with food to minimize
gastrointestinal upset.
**Eliminate options 2 and 3 first because they are comparable or alike and
because of the word "severe" in option 3**

243.) A hospitalized client is having the dosage of clonazepam (Klonopin) adjusted.

The nurse should plan to:
1. Weigh the client daily.
2. Observe for ecchymosis.
3. Institute seizure precautions.
4. Monitor blood glucose levels. - --<<ANSWER IS>>---3. Institute seizure
precautions.
Rationale:
Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy
and during periods of dosage adjustment, the nurse should initiate seizure
precautions for the client. Options 1, 2, and 4 are not associated with the use of
this medication.

244.) A client has a prescription for valproic acid (Depakene) orally once daily. The
nurse plans to:
1. Administer the medication with an antacid.
2. Administer the medication with a carbonated beverage.
3. Ensure that the medication is administered at the same time each day.
 4. Ensure that the medication is administered 2 hours before breakfast only, when
the client's stomach is empty. - --<<ANSWER IS>>---3. Ensure that the medication
is administered at the same time each day.
Rationale:
Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may
be administered with or without food. It should not be taken with an antacid or
carbonated beverage because these products will affect medication absorption.
The medication is administered at the same time each day to maintain therapeutic
serum levels.
**Use general pharmacology guidelines to assist in eliminating options 1 and 2.
Eliminate option 4 because of the closed-ended word "only."**

245.) A client taking carbamazepine (Tegretol) asks the nurse what to do if he

misses one dose. The nurse responds that the carbamazepine should be:
1. Withheld until the next scheduled dose
2. Withheld and the health care provider is notified immediately
3. Taken as long as it is not immediately before the next dose
4. Withheld until the next scheduled dose, which should then be doubled - --
<<ANSWER IS>>---3. Taken as long as it is not immediately before the next dose
Rationale:
Carbamazepine is an anticonvulsant that should be taken around the clock,
precisely as directed. If a dose is omitted, the client should take the dose as soon
as it is remembered, as long as it is not immediately before the next dose. The
medication should not be double dosed. If more than one dose is omitted, the
client should call the health care provider.

-dipine - --<<ANSWER IS>>---Ca+ channel blocker

Slows movement of calcium into smooth muscle= arterial dilation & decreased BP
Tx: angina, HTN (verapamil & diltiazem may be used for AFIB, A flutter, SVT
S/S: Constipation, reflex tachycardia, peripheral edema, toxicity
Common meds- nifedipine (procardia), verapamil, diltiazem

nifedipine (procardia), verapamil, diltiazem - --<<ANSWER IS>>---Slows movement

of calcium into smooth muscle= arterial dilation & decreased BP
Tx: angina, HTN (verapamil & diltiazem may be used for AFIB, A flutter, SVT
S/S: Constipation, reflex tachycardia, peripheral edema, toxicity

-afil - --<<ANSWER IS>>---Erectile dysfunction

s/s: headache, heartburn, diarrhea, flushing, nosebleeds, parathesias, changes in
color vision
Contradicted in clients taking nitrates, anticoags, anti HTN
Common meds- sildenafil (viagra)

sildenafil (viagra) - --<<ANSWER IS>>---s/s: headache, heartburn, diarrhea,

flushing, nosebleeds, parathesias, changes in color vision
Contradicted in clients taking nitrates, anticoags, anti HTN

-pril - --<<ANSWER IS>>---ACE inhibitor

Block the conversion of angiotensin I to angiotensin II
TX: HTN, HF, MI, diabetic nephropathy
S/S: Anigoedema, Cough, Electrolyte imbalance (^k+)
NI: Monitor K+ levels, BP
Common med- catopril, lisinopril, enalapril (vastotec)

catopril, lisinopril, enalapril (vastotec) - --<<ANSWER IS>>---Block the conversion

of angiotensin I to angiotensin II
TX: HTN, HF, MI, diabetic nephropathy
S/S: Anigoedema, Cough, Electrolyte imbalance (^k+)
NI: Monitor K+ levels, BP

-pam, -lam - --<<ANSWER IS>>---Benzodiazipines

TX: Sedative-hypnotics for sleep, Adjuncts to anesthesia to induce relaxation and
amnesia (procedural memory loss), To reduce anxiety (anxiolytic), Panic disorders,
To treat or prevent seizures, For alcohol withdrawal, Muscle relaxant

lorazepam - --<<ANSWER IS>>---TX: Sedative-hypnotics for sleep, Adjuncts to

anesthesia to induce relaxation and amnesia (procedural memory loss), To reduce
anxiety (anxiolytic), Panic disorders, To treat or prevent seizures, For alcohol
withdrawal, Muscle relaxant

-statin - --<<ANSWER IS>>---Antilipidemic

aid in lowering LDL & increasing HDL
S/S: muscle aches, hepatotoxicity, myopathy, rhabdomyolysis, peripheral
neruopathy
NI: take in evening, monitor renal and liver function, low fat/high fiber diet, drug
interactions: digoxin, warfarin, NSAIDs, etc.
Common meds- lovastatin (mevacor)
lovastatin (mevacor) - --<<ANSWER IS>>---aid in lowering LDL & increasing HDL
S/S: muscle aches, hepatotoxicity, myopathy, rhabdomyolysis, peripheral
neruopathy
NI: take in evening, monitor renal and liver function, low fat/high fiber diet, drug
interactions: digoxin, warfarin, NSAIDs, etc.

-asone, -solone
- onide
Pred-
Cort- - --<<ANSWER IS>>---Corticosteroid
prevent inflammatory response
S/S: Hyperglycemia, peptic ulcer, fluid retention (increased appetite), withdrawal
symptoms, euphoria, insomnia, psychotic behavior
NI: admin w/ meals, DO NOT take with NSAIDS, teach DO NOT stop abruptly
Common meds- prednisone (deltasone), betamethasone (celestone),
hydrocortisone sodium succinate (Solu-cortef), Methylprednisolone sodium
succinate (solu-medrol), fluticasone propionate (advair, flovent)

rednisone (deltasone), betamethasone (celestone), hydrocortisone sodium

succinate (Solu-cortef), Methylprednisolone sodium succinate (solu-medrol),
fluticasone propionate (advair, flovent) - --<<ANSWER IS>>---prevent
inflammatory response
S/S: Hyperglycemia, peptic ulcer, fluid retention (increased appetite), withdrawal
symptoms, euphoria, insomnia, psychotic behavior
NI: admin w/ meals, DO NOT take with NSAIDS, teach DO NOT stop abruptly
-olol - --<<ANSWER IS>>---Beta Blocker
inhibit stimulation of receptor sites= decreased cardiac excitability, CO, myocaridal
O2 demand, lower BP by decreasing release of renin in the kidney
TX: HTN, angina, tachydysryhmias, HF, MI
S/S: Bradycardia, Bradypena, Bronchospasms, decreased BP
NI: Monitor DM for hypoglycemia
Common meds- metropolol, labetalol, propanolol

metropolol, labetalol, propanolol - --<<ANSWER IS>>---inhibit stimulation of

receptor sites= decreased cardiac excitability, CO, myocaridal O2 demand, lower
BP by decreasing release of renin in the kidney
TX: HTN, angina, tachydysryhmias, HF, MI
S/S: Bradycardia, Bradypena, Bronchospasms, decreased BP
NI: Monitor DM for hypoglycemia

-cillin - --<<ANSWER IS>>---Penicillin

TX: pneumonia, upper respiratory infections, septicemia, endocarditis, rheumatic
fever, GYN infections
NI: hypersensitivity w/ poss. anaphylaxis

Penicillin - --<<ANSWER IS>>---TX: pneumonia, upper respiratory infections,

septicemia, endocarditis, rheumatic fever, GYN infections
NI: hypersensitivity w/ poss. anaphylaxis
-ide - --<<ANSWER IS>>---Oral hypoglycemic
Used in conjunction with diet & exercise; type II
NI: teach s/s of hypoglycemia, HbA1C
metformin (glucophage): withhold 48 hrs before/after test w/ contrast

(biguanide) Metformin - --<<ANSWER IS>>---Oral hypoglycemic

Used in conjunction with diet & exercise; type II
NI: teach s/s of hypoglycemia, HbA1C
metformin (glucophage): withhold 48 hrs before/after test w/ contrast

-prazole - --<<ANSWER IS>>---Proton pump inhibitor

S/S: D,V, N, can increase risk for fractures,, pneumonia, & acid rebound
NI: DO NOT crush, chew, break, notify PROVIDER if GI bleeding!
Common meds- omepazole (prilosec)

omepazole (prilosec) - --<<ANSWER IS>>---S/S: D,V, N, can increase risk for

fractures,, pneumonia, & acid rebound
NI: DO NOT crush, chew, break, notify PROVIDER if GI bleeding!

-vir - --<<ANSWER IS>>---Antiviral

-ase - --<<ANSWER IS>>---Thrombolytic

dissolves clots
TX: acute MI, DVT, massive PE, ischemic stroke
S/S: serious bleeding risks from recent wounds, puncture sites, weakened vessels,
hypotension
NI: Must take 4-6 hrs of onset
Common meds- alteplase (activase, tPA)

-azine
- setron - --<<ANSWER IS>>---Antiemtic
reduce N & V
S/S: drowsiness, anticholenergic effects, restlessness, tardive dyskinesia, EPS
NI: monitor VS
Common meds- promethazine (phenergan), metaoclopramide (reglan),
ondansertron (zofran)

alteplase (activase, tPA) - --<<ANSWER IS>>---dissolves clots

TX: acute MI, DVT, massive PE, ischemic stroke
S/S: serious bleeding risks from recent wounds, puncture sites, weakened vessels,
hypotension
NI: Must take 4-6 hrs of onset

-phylline,
-terol - --<<ANSWER IS>>---Bronchodilator
S/S: tachcardia, palpitations, tremors
Common meds- albeuterol
promethazine (phenergan), metaoclopramide (reglan), ondansertron (zofran) - --
<<ANSWER IS>>---reduce N & V
S/S: drowsiness, anticholenergic effects, restlessness, tardive dyskinesia, EPS
NI: monitor VS

-arin - --<<ANSWER IS>>---Anticoagulant

inhibit clotting factors (warfarin = factors VII, IX, X)
TX: evolving stroke, pulmonary embolism, massive deep vein thrombosis, cardiac
cath, MI, DIC
S/S: hemorrhage, heparin induced thrombocytopenia, toxicity/overdose
Common meds- warfarin (coumadin) {admin once daily, avoid NSAIDs & aspirin},
enoxaparin (lovenox)

albuterol - --<<ANSWER IS>>---Bronchodilator

S/S: tachcardia, palpitations, tremors

-tidine - --<<ANSWER IS>>---Antiulcer

S/S: lethargy, depression, confusion, decreased libido
Common meds- ranitidine hydrochloride (zantac), cimetidine (tagamet),
famotidine (pepcid)

warfarin (coumadin) {admin once daily, avoid NSAIDs & aspirin}, enoxaparin
(lovenox) - --<<ANSWER IS>>---inhibit clotting factors (warfarin = factors VII, IX, X)
TX: evolving stroke, pulmonary embolism, massive deep vein thrombosis, cardiac
cath, MI, DIC
S/S: hemorrhage, heparin induced thrombocytopenia, toxicity/overdose

-zine - --<<ANSWER IS>>---Antihistamine

S/S: anticholenergic effects (cant see, spit, pee, poop), drowsiness
NI: use cautiously pts w/ HTN, PUD, urinary retention, assess hypokalemia, BP,
Advise to take @ night
Common meds- diphenhydramine (benadryl), loratadine (claratin), cetirizine
(zyrtec), fexofenadrine (allegra)

-cycline,
-floxacin - --<<ANSWER IS>>---Antibiotic

diphenhydramine (benadryl), loratadine (claratin), cetirizine (zyrtec),

fexofenadrine (allegra) - --<<ANSWER IS>>---S/S: anticholenergic effects (cant see,
spit, pee, poop), drowsiness
NI: use cautiously pts w/ HTN, PUD, urinary retention, assess hypokalemia, BP,
Advise to take @ night

-mycin - --<<ANSWER IS>>---Aminoglycoside

(Antimicrobials)
TX: pneumonia, meningitis, septicemia
NI: high risk for ototoxicity, nephrotoxicity, monitor creatinine & BUN
Common meds- gentamicin sulfate (garamycin) therapeutic range: 4-12mcg/dL
-tyline - --<<ANSWER IS>>---Tricyclic antidepressant
S/S: anticholenergic effects, sedation, toxicity
NI: DO NOT admin with MAOIs, avoid alcohol, contradicted in clients w/ seizures
Common meds- amitripytyline (elavil)

gentamicin sulfate - --<<ANSWER IS>>---TX: pneumonia, meningitis, septicemia

NI: high risk for ototoxicity, nephrotoxicity, monitor creatinine & BUN

-pram, -ine - --<<ANSWER IS>>---SSRIs

S/S: weight gain, fatigue, sexual dysfunction, drowsiness
NI: avoid alcohol, do not discontinue abrubptly, monitor for serotonin syndrome!
(agitation, confusion, hallucinations) within first 72 hrs

amitripytyline (elavil) - --<<ANSWER IS>>---TCA

S/S: anticholenergic effects, sedation, toxicity
NI: DO NOT admin with MAOIs, avoid alcohol, contradicted in clients w/ seizures

-iprazole
-apine
-idone - --<<ANSWER IS>>---Second Generation Antipsychotic (SGA)

-gliptin
-glitazone - --<<ANSWER IS>>---Diabetes Mellitus

Duloxetine (Cymbalta)
Fluoxetine (Provac)
Escitalopram (Lexapro)
Sertraline (Zoloft) - --<<ANSWER IS>>---S/S: weight gain, fatigue, sexual
dysfunction, drowsiness
NI: avoid alcohol, do not discontinue abrubptly, monitor for serotonin syndrome!
(agitation, confusion, hallucinations) within first 72 hrs

-zosin - --<<ANSWER IS>>---HTN/Prostate

Patient identifiers - --<<ANSWER IS>>----Medical record number
-home telephone number

What lab values should a nurse monitor for a patient with chronic renal failure? - -
-<<ANSWER IS>>---■ Urinalysis

☐ Hematuria, proteinuria, and alterations in specific gravity

☐ Serum creatinine

- Gradual increase of 1 to 2 mg/dL per every 24 to 48 hr for acute renal

failure (ARF)
- Gradual increase over months to years for chronic renal failure (CRF)
exceeding 4 mg/dL
■ Blood urea nitrogen (BUN)
- 80 to 100 mg/dL within 1 week with ARF
- Gradual increase with elevated serum creatinine over months to years for
CRF
- 180-200 mg/dL with (CRF)
■ Serum electrolytes
- Decreased sodium (dilutional) and calcium, increased potassium,
phosphorus, and magnesium
■ Complete blood count (CBC)
- Decreased hemoglobin

What food should you increase when taking Lasix? - --<<ANSWER IS>>----
increased amounts of potassium-rich foods (e.g., bananas, prunes, raisins, and
orange juice)

Patient reports IV discomfort, what is your first action? - --<<ANSWER IS>>---color

and temperature

Sumatriptan (treats migraine headaches) adverse effect - --<<ANSWER IS>>---pain,

tightness, pressure, or heaviness in the chest, throat, neck, and/or jaw

slow or difficult speech

Know about Transdermal patch - --<<ANSWER IS>>----• Apply at the same time
once each day,
preferably in the morning. Keep patch on
for 12 to 14 hr each day.
• Remove the patch at night to reduce
the risk of developing tolerance to
nitroglycerin. Be medication-free a
minimum of 10 to 12 hr each day (usually
at night).
• Do not cut patches to ensure appropriate
dosage.
• Place the patch on a hairless area of skin
(chest, back, or abdomen) and rotate sites
to prevent skin irritation.
• Wash skin with soap and water and dry
thoroughly before applying new patch.

RBC Blood transfusion - --<<ANSWER IS>>---

http://www.atitesting.com/ati_next_gen/FocusedReview/data/datacontext/RM%
20AMS%20RN%208.0%20Chp%2044.pdf (prime with normal saline and infuse
with sodium chloride).

What to understand about Parkinson's Meds? - --<<ANSWER IS>>----they don't

cure disease, they slow the process.

NEUPOGEN (filgrastim)-what is the appropriate route of this med? - --<<ANSWER

IS>>---administered by subcutaneous injection or IV infusion
Lisinopril therapeutic effect - --<<ANSWER IS>>---blood pressure <<ANSWER IS>>
(e.g. 120/80)

Medication for Schizophrenia - --<<ANSWER IS>>---risperidone, Risperdal

Macrodantin medication - --<<ANSWER IS>>---used to treat or prevent certain

urinary tract infections

Haldol-inform if you are taking ____________ medication. - --<<ANSWER IS>>----

benzodiazepine class of anti-anxiety drugs (all ending with "pam") and even,
Xanax.

Fosomax - --<<ANSWER IS>>---same as-Alendronate is used for treating

osteoporosis in men and postmenopausal women.

Lipitor - --<<ANSWER IS>>----lowers cholesterol in blood, "statins". Reduce LDL

and total cholesterol. Raise HDL.

Garamycin- - --<<ANSWER IS>>---Antibiotic that is toxic to the kidney, injected for

radiology studies.

Digoxin side effects - --<<ANSWER IS>>----Fatigue

-Bradycardia
-Anorexia
-Nausea/Vomiting
Singulair - --<<ANSWER IS>>---used before exercise to prevent breathing problems
during exercise (bronchospasm).

What medication to administer with Tylenol overdose? - --<<ANSWER IS>>---

acetylcysteine (Mucomyst) must be given IV

HPV vaccine - --<<ANSWER IS>>---Human Papilloma Virus (HPV2, HPV4) - -Three

doses should be given over a 6 month
-interval for females at 11 to 12 years of age (minimum age is 9 years).
-The second dose should be administered 2 months after the first dose, and the
third dose should be administered 6 months after the first dose.
-HPV4 may be given to males starting at age 9 years of age.

Opioid toxicity-what to check first - --<<ANSWER IS>>---oxygen saturation

Valporic Acid lab - --<<ANSWER IS>>---liver

Lithium report immediately - --<<ANSWER IS>>---slurred speech

Prednisone report - --<<ANSWER IS>>---sore throat

Food to avoid when taking Lithium - --<<ANSWER IS>>----salty foods

-alcoholic beverages
Labs for patients taking hydrothiazide - --<<ANSWER IS>>---Periodic
determination of serum electrolytes to detect possible electrolyte imbalance
should be done at appropriate intervals.