Question 1

A client with schizophrenia has been taking Thorazine (chlorpromazine) 200mg four times a day. Which finding should be reported to the doctor immediately?

Accepted Answer

Answer reason: Sore throat may indicate agranulocytosis/neutropenia, a serious adverse effect of chlorpromazine that requires immediate provider notification. Thirst, mild weight gain, and daytime drowsiness are common nonurgent effects.

Question 2

Which medication should be avoided when used concomitantly with proton pump inhibitors due to an increased risk of hypomagnesemia?

Accepted Answer

Answer reason: PPIs can cause hypomagnesemia; loop diuretics like furosemide increase renal magnesium loss, so using them together raises the risk. Spironolactone is magnesium-sparing, and digoxin/atorvastatin do not cause hypomagnesemia.

Question 3

The client is in the cardiac intensive care unit on dopamine, a vasoconstrictor, and B/P increases to 210/130. Which intervention should the intensive care nurse implement first?

Accepted Answer

Answer reason: Severe hypertension while on a vasoconstrictor indicates an adverse medication effect. The priority is to stop the offending infusion (dopamine) to prevent further harm, then notify the provider. Hydralazine would require an order and is a vasodilator, not a vasopressor; assessing neuro status can follow after removing the cause.

Question 4

The nurse is administering medications to clients in the cardiac critical care area. Which client should the nurse question administering the medication?

Accepted Answer

Answer reason: Grapefruit juice inhibits CYP3A4 and can markedly increase serum levels of many calcium channel blockers, risking hypotension and bradycardia. The other scenarios are within normal/therapeutic parameters.

Question 5

Which of the following drugs should be stopped before surgery?

Accepted Answer

Answer reason: High-dose aspirin irreversibly inhibits platelet function and increases perioperative bleeding risk; it is typically discontinued 7–10 days before elective surgery.

Question 6

The doctor has ordered 80mg of furosemide (Lasix) two times per day. The nurse notes the patient's potassium level to be 2.5meq/L. The nurse should?

Accepted Answer

Answer reason: Potassium 2.5 mEq/L indicates severe hypokalemia. Furosemide is potassium-wasting and could worsen the imbalance and precipitate dysrhythmias. Hold the medication and notify the provider.

Question 7

The 84-year-old male has returned from the recovery room following a total hip repair. He complains of pain and is medicated with morphine sulfate and promethazine. Which medication should be kept available for the client being treated with opioid analgesics?

Accepted Answer

Answer reason: Naloxone is an opioid antagonist that reverses opioid-induced respiratory depression; it should be available when administering opioids. Ketorolac and aspirin are NSAIDs, and atropine is an anticholinergic, none of which reverse opioid effects.

Question 8

An obstetrical client decides to have an epidural anesthetic to relieve pain during labor. Following administration of the anesthesia, the nurse should monitor the client for?

Accepted Answer

Answer reason: Epidural analgesia, especially when opioids are used, can cause maternal respiratory depression; the nurse should monitor respiratory rate and depth. Seizures and hematuria are not expected, and the typical blood pressure change is hypotension, not hypertension.

Question 9

The patient is prescribed metronidazole (Flagyl) for adjunct treatment for a duodenal ulcer. When teaching about this medication, the nurse would include?

Accepted Answer

Answer reason: Metronidazole has a disulfiram-like reaction with alcohol; patients must avoid alcoholic beverages and products containing alcohol. The drug should be completed as prescribed, may be taken with food to reduce GI upset, and photosensitivity is not a key concern.

Question 10

The nurse is assisting in the assessment of the patient admitted with "extreme abdominal pain." The nurse asks the client about the medication that he has been taking because?

Accepted Answer

Answer reason: During assessment for abdominal pain, reviewing current medications is essential because many oral drugs (e.g., NSAIDs, antibiotics, iron, potassium, steroids, opioids) can irritate or affect the GI tract and cause abdominal pain.

Question 11

The client has an order for gentamycin to be administered. Which lab results should be reported to the doctor before beginning the medication?

Accepted Answer

Answer reason: Gentamycin (aminoglycoside) is nephrotoxic. Serum creatinine reflects renal function; abnormal values must be reported and dosing adjusted before administration.

Question 12

The client is taking rifampin 600mg po daily to treat his tuberculosis. Which action by the nurse indicates understanding of the medication?

Accepted Answer

Answer reason: Rifampin commonly causes harmless red-orange discoloration of body fluids (urine, tears, sweat). The other options are incorrect: it is typically taken on an empty stomach, not just with juice; timing at bedtime is not required; and it should be taken daily, not only when symptoms occur.

Question 13

The client is diagnosed with multiple myloma. The doctor has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the client?

Accepted Answer

Answer reason: Cyclophosphamide can cause hemorrhagic cystitis; aggressive hydration helps flush the bladder and reduce toxicity, so encouraging high fluid intake is the key instruction.

Question 14

The child with seizure disorder is being treated with phenytoin (Dilantin). Which of the following statements by the patient's mother indicates to the nurse that the patient is experiencing a side effect of Dilantin therapy?

Accepted Answer

Answer reason: Phenytoin commonly causes gingival hyperplasia, presenting as enlarged gums. The mother's report that her child's gums look too big for her teeth matches this adverse effect.

Question 15

The physician has prescribed tranylcypromine sulfate (Parnate) 10mg bid. The nurse should teach the client to refrain from eating foods containing tyramine because it may cause?

Accepted Answer

Answer reason: MAOIs like tranylcypromine inhibit tyramine metabolism; ingesting tyramine causes excessive norepinephrine release leading to a hypertensive crisis.

Question 16

The physician prescribes captopril (Capoten) 25mg po tid for the client with hypertension. Which of the following adverse reactions can occur with administration of Capoten?

Accepted Answer

Answer reason: ACE inhibitors like captopril commonly cause a persistent dry cough due to bradykinin accumulation; the other listed effects are not typical hallmark adverse reactions.

Question 17

The nurse is providing discharge teaching for a client taking disulfiram (Antabuse). The nurse should instruct the client to avoid eating?

Accepted Answer

Answer reason: Disulfiram reacts with alcohol; clients must avoid alcohol-containing foods such as vinegar products. Pickles and vinaigrette contain vinegar, posing risk for a disulfiram–ethanol reaction. The other options do not contain alcohol.

Question 18

The client is scheduled for a Tensilon test to check for Myasthenia Gravis. Which medication should be kept available during the test?

Accepted Answer

Answer reason: Edrophonium (Tensilon) can cause severe cholinergic effects such as bradycardia during testing; atropine sulfate is the antidote and must be on hand.

Question 19

The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug?

Accepted Answer

Answer reason: Carbamazepine can cause bone marrow suppression including agranulocytosis. A WBC count of 2000/mm3 indicates significant leukopenia and signals a serious adverse effect.

Question 20

An adolescent client is hospitalized with menarthrosis from a Hemophilia A bleeding episode. Which of the following orders should be questioned by the nurse?

Accepted Answer

Answer reason: Aspirin inhibits platelet aggregation and increases bleeding risk, so it is contraindicated in clients with active bleeding from Hemophilia A. Factor VIII replacement and immobilization are appropriate.

Question 21

When caring for a client who is receiving a thrombolytic agent to open a clot occluded coronary artery after a myocardial infarction, which of the following findings would be of GREATEST concern to the nurse?

Accepted Answer

Answer reason: Thrombolytics carry a high risk of major bleeding; vomiting blood indicates active GI hemorrhage, a life-threatening adverse effect. Minor oozing (gums, slight hematuria) can occur, and pink frothy sputum suggests heart failure but is not the primary medication-related danger.

Question 22

When providing discharge teaching to a client with asthma, the nurse will warn against the use of which of the following over-the-counter medications?

Accepted Answer

Answer reason: Aspirin and other NSAIDs can precipitate bronchospasm and asthma exacerbations; the other listed OTC products are not typical triggers.

Question 23

In providing care for a client with pain from a sickle cell crisis, which one of the following medication orders for pain control should be questioned by the nurse?

Accepted Answer

Answer reason: Meperidine (Demerol) is contraindicated in sickle cell disease due to accumulation of its metabolite normeperidine, which can cause neurotoxicity and seizures. Morphine, methadone, and codeine are preferred options.

Question 24

Which of the following assessments by the nurse would indicate that the client is having a possible adverse response to the INH?

Accepted Answer

Answer reason: INH (isoniazid) can cause drug-induced hepatitis. Jaundice indicates liver injury, making it the best sign of an adverse response compared with the other options.

Question 25

The nurse is caring for a client with asthma who has developed gastroesophageal reflux disease (GERD). Which of the following medications prescribed for the client may aggravate GERD?

Accepted Answer

Answer reason: Anticholinergics can relax the lower esophageal sphincter and delay gastric emptying, increasing reflux. Histamine blockers treat GERD; antibiotics and corticosteroids are not typical causes of reflux.

Question 26

The nurse is teaching a child and the family about the medication phenytoin (Dilantin) prescribed for seizure control. Which of the following side effects is MOST likely to occur?

Accepted Answer

Answer reason: Phenytoin commonly causes gingival hyperplasia, especially in children; oral hygiene education is essential. Other listed effects are less characteristic.

Question 27

The nurse is administering albuterol (Proventil) to a child with asthma. Which of the following assessments by the nurse indicate the need for an adjustment of the medication?

Accepted Answer

Answer reason: Albuterol, a beta-2 adrenergic agonist, commonly causes tachycardia. An apical pulse of 112 indicates an adverse effect requiring dosage adjustment, whereas fever or peripheral edema are not expected effects.

Question 28

A 4 month-old child taking digoxin (Lanoxin) has a blood pressure of 92/78, resting pulse of 78; respirations 28 and a potassium level of 4.8 mEq/L. The client is irritable and has vomited twice since the morning dose of digoxin. The nurse recognizes that the most common sign of digoxin toxicity is?

Accepted Answer

Answer reason: In infants, the most common and reliable sign of digoxin toxicity is bradycardia due to increased vagal tone; symptoms like vomiting or irritability can occur but are less specific.

Question 29

A hospitalized 8 month-old is receiving gentamicin (Cidomycin). In monitoring the infant for drug toxicity, the nurse should review which laboratory results FIRST?

Accepted Answer

Answer reason: Gentamicin, an aminoglycoside, is nephrotoxic. The priority labs to detect toxicity are renal function tests such as BUN (and creatinine); other listed labs are unrelated.

Question 30

A hospitalized eight month-old infant is receiving digoxin for the treatment of Tetralogy of Fallot. Prior to administering the next dose of medication, the infant's parent reports that the baby has vomited one time, just after breakfast. The heart rate is 72. The INITIAL response of the nurse should be to?

Accepted Answer

Answer reason: Vomiting and marked bradycardia (HR 72 in an 8‑month‑old) suggest possible digoxin toxicity; withhold the dose and notify the provider.

Question 31

The nurse is caring for a 20 lbs (9 kg) six month-old with a 3 day history of diarrhea, occasional vomiting and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which of the following should be reported to the physician IMMEDIATELY?

Accepted Answer

Answer reason: Oliguria while receiving IV fluids containing potassium suggests impaired renal perfusion/function; potassium is contraindicated without adequate urine output due to risk of hyperkalemia. This requires immediate notification. The other findings are less urgent.

Question 32

A client with schizophrenia is receiving Haloperidol (Haldol) 5 mg t.i.d. The client's family is alarmed and calls the clinic when "his eyes rolled upward." The nurse recognizes this as?

Accepted Answer

Answer reason: Upward deviation of the eyes is an acute dystonic reaction (oculogyric crisis), a known extrapyramidal side effect of haloperidol. Tardive dyskinesia involves late-onset oral-facial movements; nystagmus is rhythmic eye oscillation; dysphagia is difficulty swallowing.

Question 33

A client complained of nausea, a metallic taste in her mouth, and fine hand tremors 2 hours after her first dose of lithium carbonate (Lithane). The nurse's BEST explanation would be?

Accepted Answer

Answer reason: Early lithium effects include GI upset, metallic taste, and fine tremor; they are common and usually resolve in a few days. Do not stop the drug, avoid empty stomach advice (food helps), and do not restrict sodium/fluids as this increases toxicity risk.

Question 34

Which of the following conditions assessed by the nurse would contraindicate the use of benztropine (Cogentin)?

Accepted Answer

Answer reason: Benztropine is an anticholinergic; it is contraindicated in conditions worsened by anticholinergic effects such as glaucoma, myasthenia gravis, and prostatic hypertrophy.

Question 35

Which of the following nursing assessments indicate immediate discontinuance of an antipsychotic medication?

Accepted Answer

Answer reason: These findings indicate neuroleptic malignant syndrome (NMS)—a life‑threatening reaction to antipsychotics requiring immediate discontinuation and emergency management. Other options describe extrapyramidal symptoms such as tardive dyskinesia or akathisia.

Question 36

Which of the following should be included when the nurse is teaching a client about chlorpromazine HCL (Thorazine)?

Accepted Answer

Answer reason: Chlorpromazine, a phenothiazine antipsychotic, causes marked photosensitivity. Client teaching includes avoiding direct sunlight and using sun protection. The tyramine and yeast restrictions apply to MAOIs, and avoiding canned citrus drinks is not specific to chlorpromazine.

Question 37

A client who has been receiving urokinase has a large bloody bowel movement. Which action would be best for the nurse to take immediately?

Accepted Answer

Answer reason: Urokinase is a thrombolytic; a large bloody stool indicates serious bleeding. The priority is to stop the drug and notify the provider. Vitamin K reverses warfarin, not thrombolytics, and heparin would worsen bleeding.

Question 38

The nurse is teaching the client regarding use of sodium warfarin. Which statement made by the client would require further teaching?

Accepted Answer

Answer reason: Aspirin increases bleeding risk when taken with warfarin and is generally contraindicated unless specifically prescribed. Monthly INR checks and using an electric razor are appropriate; monitoring skin is reasonable for adverse effects/bleeding signs.

Question 39

Which drug should be kept ready during the Tensilon test?

Accepted Answer

Answer reason: Edrophonium (Tensilon) can cause severe bradycardia and other muscarinic effects; atropine is the antidote to reverse these effects and must be on hand during the test.

Question 40

Which medication should be used with caution in the obstetric client with diabetes?

Accepted Answer

Answer reason: Brethine (terbutaline), a beta-adrenergic tocolytic, can cause maternal hyperglycemia; therefore it should be used cautiously in clients with diabetes.

Question 41

Which of the following medications may cause a complication with the treatment plan of a client with diabetes?

Accepted Answer

Answer reason: Glucocorticoids increase insulin resistance and hepatic glucose production, causing hyperglycemia that worsens glycemic control in diabetics.

Question 42

Which one of the following statements, if made by the client, indicates teaching about Inderal (propranolol) has been effective: "I should not stop taking the Inderal suddenly because it may cause"?

Accepted Answer

Answer reason: Abrupt withdrawal of beta blockers like propranolol can cause rebound sympathetic activity leading to angina, dysrhythmias, hypertension, and myocardial infarction; thus the correct concern is a heart attack.

Question 43

A client has received her first dose of fluphenazine (Prolixin) 2 hours ago. She suddenly experiences torticollis and involuntary spastic muscle movement. In addition to administering the ordered anticholinergic drug, the nurse should?

Accepted Answer

Answer reason: Sudden torticollis and spastic movements after first dose of fluphenazine indicate an acute dystonic reaction that can progress to laryngospasm; besides giving an anticholinergic, airway support must be immediately available.

Question 44

In discharge teaching, the nurse should emphasize that which of the following is a common side effect of clozapine (Clozaril) therapy?

Accepted Answer

Answer reason: Clozapine commonly causes sialorrhea (hypersalivation), a distinctive adverse effect; dry mouth or dry skin are not typical with this drug.

Question 45

A post-operative client is admitted to the post-anesthesia recovery room. The anesthetist reports that malignant hyperthermia occurred during surgery. You recognize that this complication is related to?

Accepted Answer

Answer reason: Malignant hyperthermia is an inherited disorder (commonly due to ryanodine receptor mutation) triggered by inhaled anesthetics and/or succinylcholine; it is not due to allergy, infection, or the type of surgery.

Question 46

A client confides in the RN that a friend has told her the medication she takes for depression, Wellbutrin, was taken off the market because it caused seizures. An appropriate response would be to tell the client?

Accepted Answer

Answer reason: Bupropion (Wellbutrin) had a seizure risk at higher doses and was reintroduced with dose limits; appropriate patient education is to acknowledge prior issues and explain that dosing recommendations were changed to reduce risk.

Question 47

You are caring for a client with a diagnosis of schizophrenia who has been treated with Quetiapine (Seroquel) for one month. Today the client is increasingly agitated and complains of muscle stiffness. Critical assessments to report are?

Accepted Answer

Answer reason: Antipsychotic use with rigidity and agitation raises concern for neuroleptic malignant syndrome; priority findings to report are hyperthermia and diaphoresis.

Question 48

A 55 year-old woman is taking Prednisone and Aspirin as part of her treatment for rheumatoid arthritis. Which one of the following would be an appropriate intervention for the nurse?

Accepted Answer

Answer reason: Prednisone and aspirin increase risk of GI irritation and bleeding; monitoring for occult blood in stool is the appropriate nursing intervention. Other options do not address this adverse effect.

Question 49

A client with a history of heart disease takes prophylactic aspirin daily. The nurse should monitor which of the following to prevent aspirin toxicity?

Accepted Answer

Answer reason: Aspirin is highly protein-bound; low serum albumin increases unbound salicylate levels and risk of toxicity. Monitoring serum albumin helps prevent toxic effects.

Question 50

You are assigned to care for a client newly diagnosed with angina. As part of discharge teaching, it is important to remind the client to remove the nitroglycerine patch after 12 hours in order to prevent?

Accepted Answer

Answer reason: Transdermal nitroglycerin requires a daily nitrate-free interval (about 10–12 hours) to prevent tolerance; removing the patch after 12 hours helps maintain drug effectiveness.

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