Question 1

A client with schizophrenia has been taking Clozaril (clozapine) for the past 6 months. This morning the client's temperature was elevated to 102°F. The nurse should give priority to?

Accepted Answer

Answer reason: Clozapine can cause agranulocytosis; a fever of 102°F may indicate infection and requires immediate provider notification and evaluation.

Question 2

A client with schizophrenia spends much of his time pacing the floor, rocking back and forth, and moving from one foot to another. The client's behaviors are an example of?

Accepted Answer

Answer reason: Akathisia is characterized by motor restlessness with pacing, rocking, and shifting from foot to foot. Dystonia involves sustained muscle contractions; tardive dyskinesia causes repetitive involuntary movements (e.g., lip smacking); oculogyric crisis is upward eye deviation.

Question 3

A client with a history of depression is treated with Parnate (tranylcypromine), an MAO inhibitor. Ingestion of foods containing tyramine while taking an MAO inhibitor can result in?

Accepted Answer

Answer reason: MAOIs taken with tyramine-rich foods can precipitate a hypertensive crisis due to excess catecholamines, leading to extreme elevations in blood pressure.

Question 4

The physician has ordered a trivalent botulism antitoxin for a client with botulism poisoning. Before administering the medication, the nurse should assess the client for a history of allergies to?

Accepted Answer

Answer reason: Trivalent botulism antitoxin is derived from equine (horse) serum; patients with horse serum allergy are at risk for hypersensitivity reactions. Therefore assess for allergy to horses.

Question 5

The physician has ordered Pentam (pentamidine) IV for a client with pneumocystis carinii. While receiving the medication, the nurse should carefully monitor the client's?

Accepted Answer

Answer reason: IV pentamidine commonly causes significant hypotension during infusion; therefore blood pressure must be monitored closely.

Question 6

A client with rheumatoid arthritis is receiving injections of Myochrysine (gold sodium thiomalate). Before administering the client's medication, the nurse should?

Accepted Answer

Answer reason: Gold sodium thiomalate can cause renal and bone marrow toxicity. Prior to dosing, labs such as CBC and urinalysis for protein/hematuria must be checked to detect adverse effects.

Question 7

The physician has prescribed a Becloforte (beclomethasone) inhaler two puffs twice a day for a client with asthma. The nurse should tell the client to report?

Accepted Answer

Answer reason: Beclomethasone is an inhaled corticosteroid. Local immunosuppression can cause oropharyngeal candidiasis and throat irritation; a sore throat should be reported. Weight gain and mood changes are systemic steroid effects, and insomnia is more typical of beta-agonists.

Question 8

An elderly client with glaucoma is scheduled for a cholecystectomy. Which medication order should the nurse question?

Accepted Answer

Answer reason: Atropine is an anticholinergic that causes mydriasis and can acutely increase intraocular pressure, making it contraindicated in glaucoma. The other options are not specifically contraindicated for glaucoma.

Question 9

Which instruction would not be included in the discharge teaching of the client receiving chlorpromazine (Thorazine)?

Accepted Answer

Answer reason: Chlorpromazine (a phenothiazine antipsychotic) causes photosensitivity and anticholinergic effects, so sunscreen and hard candy for dry mouth are appropriate; sore throat should be reported due to possible blood dyscrasias. Avoiding aged cheese is an MAOI dietary restriction, not applicable to chlorpromazine.

Question 10

A client with psychotic depression is receiving haloperidol (Haldol). Which of the following adverse effects is associated with haloperidol?

Accepted Answer

Answer reason: Haloperidol, a typical antipsychotic, commonly causes extrapyramidal symptoms such as akathisia. Cataracts are linked to some phenothiazines, diaphoresis is not a typical adverse effect, and polyuria is not characteristic (anticholinergic effects more often cause urinary retention).

Question 11

A 21-year-old male with Hodgkin's lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client?

Accepted Answer

Answer reason: The most immediate, common problem in a young ambulatory client undergoing treatment for Hodgkin's lymphoma is fatigue from chemotherapy. The other options are lower priority or not applicable (not terminal, not on bed rest, sexual effects are important but less urgent).

Question 12

The client presents to the clinic with a serum cholesterol of 275mg/dL and is placed on rosuvastatin (Crestor). Which instruction should be given to the client taking rosuvastatin (Crestor)?

Accepted Answer

Answer reason: Statins such as rosuvastatin can cause myopathy/rhabdomyolysis; clients should promptly report unexplained muscle pain or weakness. Therapeutic lipid changes occur within weeks, not six months; taking with fruit juice is not recommended; insomnia is not a key adverse effect to report urgently.

Question 13

The client is admitted to the hospital with hypertensive crises. Diazoxide (Hyperstat) is ordered. During administration, the nurse should?

Accepted Answer

Answer reason: Diazoxide can cause marked hyperglycemia by inhibiting insulin release; therefore blood glucose must be monitored during administration. It is not light-sensitive like nitroprusside, does not require Trendelenburg positioning, and is given as a bolus rather than via infusion pump.

Question 14

The 6-month-old client with a ventral septal defect is receiving Digitalis for regulation of his heart rate. Which finding should be reported to the doctor?

Accepted Answer

Answer reason: Digoxin toxicity causes bradycardia. A 6‑month‑old should have a much higher heart rate; 60 bpm is dangerously low and must be reported.

Question 15

The client is seen in the clinic for treatment of migraine headaches. The drug Imitrex (sumatriptan succinate) is prescribed for the client. Which of the following in the client's history should be reported to the doctor?

Accepted Answer

Answer reason: Sumatriptan is a serotonin agonist that causes vasoconstriction and can precipitate coronary vasospasm; it is contraindicated in ischemic heart disease or variant (Prinzmetal's) angina. This history must be reported.

Question 16

A primigravida with diabetes is admitted to the labor and delivery unit at 34 weeks gestation. Which doctor's order should the nurse question?

Accepted Answer

Answer reason: Brethine (terbutaline), a beta-agonist tocolytic, can cause significant maternal hyperglycemia and is relatively contraindicated in diabetic patients. The other orders are not inherently contraindicated for a diabetic gravida at 34 weeks.

Question 17

The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is?

Accepted Answer

Answer reason: Therapeutic magnesium can cause CNS depression with drowsiness/somnolence. Loss of deep tendon reflexes and decreased respiratory rate indicate magnesium toxicity, and decreased urine output is not an expected effect but increases toxicity risk.

Question 18

The client with preeclampsia is admitted to the unit with an order for magnesium sulfate. Which action by the nurse indicates the understanding of magnesium toxicity?

Accepted Answer

Answer reason: Magnesium sulfate is renally excreted; decreased urine output increases risk for toxicity. Inserting a Foley allows accurate hourly monitoring of output to detect/avoid toxicity. The other actions do not address magnesium toxicity monitoring.

Question 19

Which of the following instructions should be included in the nurse’s teaching regarding oral contraceptives?

Accepted Answer

Answer reason: Certain antibiotics reduce the effectiveness of oral contraceptives; clients should use a backup method. Weight gain and menstrual flow changes are common, non-urgent effects, and the missed-pill instruction given is incorrect.

Question 20

A client elects to have epidural anesthesia to relieve the discomfort of labor. Following the initiation of epidural anesthesia, the nurse should give priority to?

Accepted Answer

Answer reason: Epidural anesthesia can cause maternal hypotension from sympathetic blockade; the priority is frequent blood pressure monitoring to detect and manage hypotension. Supine positioning is contraindicated, and fetal assessment follows after ensuring maternal stability.

Question 21

An elderly client with an abdominal surgery is admitted to the unit following surgery. In anticipation of complications of anesthesia and narcotic administration, the nurse should?

Accepted Answer

Answer reason: Postoperative elderly clients receiving anesthetics and opioids are at high risk for respiratory depression; naloxone is the specific antidote that should be readily available. Oxygen does not reverse opioid effects, and blood products or CPR are not anticipated for anesthesia/narcotic complications.

Question 22

A client with osteoarthritis has a prescription for Celebrex (celecoxib). Which instruction should be included in the discharge teaching?

Accepted Answer

Answer reason: Celecoxib, a COX-2 NSAID, carries increased risk of serious cardiovascular events; clients should be taught to report symptoms such as chest pain immediately.

Question 23

The physician has ordered an intravenous infusion of Pitocin for the induction of labor. When caring for the obstetric client receiving intravenous Pitocin, the nurse should monitor for?

Accepted Answer

Answer reason: Oxytocin (Pitocin) can cause uterine tachysystole, decreasing uteroplacental perfusion and leading to fetal distress, commonly manifested as fetal bradycardia. Monitoring fetal heart rate is essential.

Question 24

A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following orders should be questioned by the nurse?

Accepted Answer

Answer reason: Morphine can cause spasm of the sphincter of Oddi and may worsen pain in acute pancreatitis; it should be questioned. Meperidine and acid-reducing therapies (Mylanta, cimetidine) are acceptable.

Question 25

A client is receiving Pyridium (phenazopyridine hydrochloride) for a urinary tract infection. The client should be taught that the medication may?

Accepted Answer

Answer reason: Phenazopyridine is a urinary analgesic that commonly turns urine an orange-red color; diarrhea, confusion, and taste changes are not expected teaching points.

Question 26

Which of the following tests should be performed before beginning a prescription of Accutane?

Accepted Answer

Answer reason: Isotretinoin (Accutane) is highly teratogenic; a documented negative pregnancy test is required before initiation. Calcium level, apical pulse, and creatinine are not routine pre-initiation requirements for this drug.

Question 27

A client with AIDS is taking Zovirax (acyclovir). Which nursing intervention is most critical during the administration of acyclovir?

Accepted Answer

Answer reason: Acyclovir can cause crystalluria and nephrotoxicity; maintaining adequate hydration is the most critical nursing intervention during administration to protect renal function.

Question 28

The nurse is caring for the client receiving Amphotericin B. Which of the following indicates that the client has experienced toxicity to this drug?

Accepted Answer

Answer reason: Amphotericin B can produce neurotoxicity, which may present as visual disturbances. Nausea is a common but nonspecific side effect, urinary frequency is not typical of its nephrotoxicity (which more often causes decreased output), and changes in skin color are not characteristic.

Question 29

Which dermatological adverse effects are associated with fluoroquinolone therapy?

Accepted Answer

Answer reason: Fluoroquinolones are well known to cause photosensitivity/phototoxicity as a characteristic dermatologic adverse effect; eczema is not typical.

Question 30

Which of the following adverse effects is associated with long-term use of Proton Pump Inhibitors (PPIs)?

Accepted Answer

Answer reason: Chronic PPI therapy reduces gastric acidity, predisposing to C. difficile overgrowth and infection. Hypokalemia, nephrotoxicity, and hepatotoxicity are not typical long-term adverse effects of PPIs.

Question 31

The physician has ordered Basalgel (aluminum carbonate gel) for a client with recurrent indigestion. The nurse should teach the client common side effects of the medication, which include?

Accepted Answer

Answer reason: Aluminum-containing antacids like aluminum carbonate commonly cause constipation; magnesium antacids cause diarrhea. Urinary retention and confusion are not typical effects.

Question 32

The nurse is preparing to discharge a client who is taking an MAOI. The nurse should instruct the client to?

Accepted Answer

Answer reason: MAOIs interact with sympathomimetic agents commonly found in OTC cold and hayfever products, risking hypertensive crisis; other options are not specific teaching for MAOIs.

Question 33

A client with Addison’s disease has been receiving glucocorticoid therapy. Which finding indicates a need for dosage adjustment?

Accepted Answer

Answer reason: Rapid weight gain indicates fluid retention from glucocorticoid overreplacement and warrants dose reduction. Dry skin and orthostatic dizziness suggest underreplacement, and insomnia is a common expected effect that can often be managed by timing rather than changing dose.

Question 34

An elderly client with glaucoma has been prescribed Timoptic eyedrops. Timoptic should be used with caution in clients with a history of?

Accepted Answer

Answer reason: Timoptic (timolol) is a nonselective beta-blocker; systemic absorption can cause bronchoconstriction and should be avoided or used cautiously in clients with COPD/emphysema.

Question 35

An adolescent client with cystic acne has a prescription for Accutane (isotretinoin). Which lab work is needed before beginning the medication?

Accepted Answer

Answer reason: Isotretinoin can cause hepatotoxicity; baseline liver function tests (liver profile) are required before starting. CBC, urinalysis, and thyroid tests are not routine prerequisites.

Question 36

A client receiving Parnate (tranylcypromine) is admitted in a hypertensive crisis. Which food is most likely to produce a hypertensive crisis when taken with the medication?

Accepted Answer

Answer reason: Tranylcypromine is an MAOI; foods high in tyramine, especially aged cheeses like cheddar, can precipitate hypertensive crisis. Cottage and cream cheese and most processed cheeses are low in tyramine.

Question 37

The nurse is teaching the mother of a child with attention deficit disorder regarding the use of Ritalin (methylphenidate). The nurse recognizes that the mother understands her teaching when she states the importance of?

Accepted Answer

Answer reason: Methylphenidate commonly suppresses appetite and can cause weight loss; encouraging high-calorie snacks helps maintain growth. It does not typically cause infection risk, photosensitivity, or oversedation (it is a stimulant, often causing insomnia).

Question 38

A child with cystic fibrosis is being treated with inhalation therapy with Pulmozyme (dornase alfa). A side effect of the medication is?

Accepted Answer

Answer reason: Dornase alfa commonly causes throat irritation/pharyngitis and voice changes; weight gain, hair loss, and brittle nails are not typical adverse effects.

Question 39

A client with emphysema is receiving intravenous aminophylline. Which aminophylline level is associated with signs of toxicity?

Accepted Answer

Answer reason: Therapeutic theophylline/aminophylline serum levels are about 10–20 mcg/mL; toxicity occurs at levels >20 mcg/mL. Therefore 25 mcg/mL indicates toxicity.

Question 40

A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the doctor immediately if he notices?

Accepted Answer

Answer reason: Ethambutol may cause optic neuritis with decreased red-green color discrimination and visual changes; these require immediate reporting. Hearing changes suggest streptomycin toxicity, red body fluids are expected with rifampin, and gastric upset is less urgent.

Question 41

The doctor has prescribed Cortone (cortisone) for a client with systemic lupus erythematosis. Which instruction should be given to the client?

Accepted Answer

Answer reason: Corticosteroids commonly cause increased appetite and weight gain; clients should be instructed to monitor and report significant changes. They should be taken with food (not before meals), sunglasses do not prevent steroid-induced cataracts, and vaccines require provider guidance when immunosuppressed.

Question 42

A home health nurse is visiting a client who is receiving diuretic therapy for congestive heart failure. Which medication places the client at risk for the development of hypokalemia?

Accepted Answer

Answer reason: Torsemide is a loop diuretic, which increases urinary potassium loss and commonly causes hypokalemia. The other listed agents (spironolactone, triamterene, amiloride) are potassium-sparing diuretics and more likely cause hyperkalemia.

Question 43

A client with schizoaffective disorder is exhibiting Parkinsonian symptoms. Which medication is responsible for the development of Parkinsonian symptoms?

Accepted Answer

Answer reason: Antipsychotics, including olanzapine, can cause extrapyramidal/parkinsonian symptoms via dopamine D2 blockade. Cogentin and Benadryl are used to treat EPS, and Depakote is a mood stabilizer not typically causing parkinsonism.

Question 44

A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness?

Accepted Answer

Answer reason: Statins are hepatotoxic and are contraindicated in active liver disease such as acute hepatitis A. The other listed medications are not specifically contraindicated with hepatitis.

Question 45

A preterm infant with sepsis is receiving Gentamycin (garamycin). Which physiological alteration places the preterm infant at increased risk for toxicity related to aminoglycoside therapy?

Accepted Answer

Answer reason: Aminoglycosides are primarily eliminated by the kidneys; preterm infants have immature renal function, decreasing drug clearance and increasing risk for nephro/ototoxicity.

Question 46

The physician has prescribed Cognex (tacrine) for a client with dementia. The nurse should monitor the client for adverse reactions, which include?

Accepted Answer

Answer reason: Tacrine (Cognex), an acetylcholinesterase inhibitor for Alzheimer’s disease, is associated with hepatotoxicity; nurses should monitor liver function and signs such as jaundice.

Question 47

A pediatric client with burns to the hands and arms has dressing changes with Sulfamylon (mafenide acetate) cream. The nurse is aware that the medication?

Accepted Answer

Answer reason: Mafenide acetate (Sulfamylon) commonly causes a painful burning/stinging sensation on application. Dark staining is seen with silver nitrate, a cooling sensation with silver sulfadiazine, and thyroid effects with iodine-containing agents.

Question 48

The physician has ordered Dilantin (phenytoin) for a client with generalized seizures. When planning the client's care the nurse should?

Accepted Answer

Answer reason: Phenytoin commonly causes gingival hyperplasia. Priority nursing care includes meticulous oral hygiene and gum care to prevent and manage this adverse effect. The other options are not specific or appropriate for phenytoin administration.

Question 49

The nurse is caring for a client receiving Capoten (captopril). The nurse should be alert for adverse reactions to the drug, which include?

Accepted Answer

Answer reason: Captopril, an ACE inhibitor, can cause leukopenia/neutropenia as a rare but serious adverse effect. The other options are not characteristic adverse reactions (ACE inhibitors more commonly cause hyperkalemia rather than hyponatremia, and they do not increase RBC or calcium levels).

Question 50

A client with Lyme’s disease is being treated with Achromycin (tetracycline HCl). The nurse should tell the client that the medication will be rendered ineffective if taken with?

Accepted Answer

Answer reason: Tetracyclines chelate with divalent/trivalent cations in antacids (Ca, Mg, Al), forming insoluble complexes that prevent absorption, making the drug ineffective. The other options do not significantly reduce tetracycline efficacy.

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