Question 1

The client with tonsillar cancer is receiving filgrastim. Prior to administering the next dose of filgrastim, the nurse notes that the client’s absolute neutrophil count is 11,000/mm3. What is the nurse’s best action?

Accepted Answer

Answer reason: Filgrastim (G-CSF) is used to treat or prevent neutropenia by stimulating neutrophil production, and dosing is typically guided by ANC trends. An ANC of 11,000/mm3 indicates marked neutrophilia rather than neutropenia, suggesting the therapeutic goal has been achieved and continued dosing may be unnecessary or inappropriate. The safest nursing action is to hold and clarify the order with the prescriber to prevent potential complications associated with excessive leukocytosis and unnecessary medication exposure. Neutropenic precautions and enhanced PPE are not indicated when the ANC is elevated; those interventions target patients with low neutrophil counts and high infection risk.

Question 2

The client, hospitalized with a lower respiratory tract infection, has a history of mild liver disease and asthma. Which prescription by an HCP should the nurse question?

Accepted Answer

Answer reason: This order provides 650 mg per dose up to every 4 hours (potentially 3.9 g/day), which increases risk for salicylate toxicity and GI bleeding, and is an unsafe antipyretic/analgesic choice in a patient with liver disease where safer alternatives (e.g., carefully dosed acetaminophen or other strategies per provider) are typically preferred. In addition, aspirin/NSAID sensitivity can trigger bronchospasm in some patients with asthma, making it a medication the nurse should question rather than administer. The other orders are consistent with typical management for asthma exacerbation/bronchospasm (bronchodilator, corticosteroid) and supportive oxygenation goals in respiratory infection.

Question 3

The nurse assesses the client who is at 40 weeks’ gestation before administering misoprostol 25 mcg per vagina one time as prescribed. Which question would be most important for the nurse to ask this client before administering misoprostol?

Accepted Answer

Answer reason:  Misoprostol is a prostaglandin used for cervical ripening/induction and increases uterine contractility, so the key safety screen is risk for uterine rupture. A prior cesarean (or other uterine surgery) creates a uterine scar that substantially raises rupture risk with prostaglandins, making this the highest-priority pre-administration question. Meal timing and bladder emptying may be relevant to comfort or procedures but do not address a major life-threatening contraindication. Analgesic timing does not mitigate the primary maternal-fetal hazard associated with this medication.

Question 4

The nurse completes teaching about doxycycline to the adolescent diagnosed with Lyme disease. The nurse recognizes the need for further education when the client makes which statement?

Accepted Answer

Answer reason:  Doxycycline increases photosensitivity, so patients should avoid tanning beds and excessive sun exposure and use protective measures to reduce risk of severe sunburn. This statement indicates a safety knowledge deficit about a common medication adverse effect/precaution. Completing the full course is appropriate antibiotic teaching to prevent treatment failure. Reporting fever or significant diarrhea is also appropriate because it can signal complications or antibiotic-associated infection.

Question 5

The client is started on citalopram for treatment of depression. Which information is most important for the nurse to include when teaching the client?

Accepted Answer

Answer reason: “Taking St. John's wort with your citalopram can enhance its effectiveness.” Clients taking SSRIs must be taught to avoid interacting serotonergic agents because combined use can precipitate serotonin syndrome, a potentially life-threatening toxicity. St. John’s wort has serotonergic activity and can also alter drug metabolism, increasing the risk of adverse effects or reduced therapeutic control when taken with an SSRI. Teaching that it “enhances effectiveness” is unsafe and directly contradicts the key contraindication education for citalopram. By comparison, exercise and managing sexual side effects are appropriate counseling points but are not the most critical immediate safety teaching.

Question 6

The client is placed on lorazepam for short-term treatment of anxiety. Which instruction by the nurse is most important with lorazepam use?

Accepted Answer

Answer reason:  Benzodiazepines can cause tolerance and physiologic dependence even with relatively short-term use, and escalating doses increases risk for oversedation and respiratory depression. Reporting decreased effectiveness prompts reassessment of the anxiety plan and consideration of tapering, nonpharmacologic strategies, or alternative agents rather than self-increasing the dose. Taking an extra tablet independently is unsafe because it bypasses prescribed dosing and can precipitate excessive CNS depression. Drowsiness and dizziness are expected common effects and are usually managed with safety precautions and dose adjustment guidance, not automatically requiring urgent notification unless severe or worsening.

Question 7

The nurse is developing the teaching plan for the client who is started on amitriptyline. Which information is most appropriate to include?

Accepted Answer

Answer reason: Tricyclic antidepressants commonly cause anticholinergic and other adverse effects that require proactive client education to promote adherence and safety. Sexual dysfunction is a clinically important and relatively common antidepressant adverse effect, and preparing the client with anticipatory guidance plus support improves persistence with therapy. A sudden elevation in blood pressure is not a typical teaching trigger for abruptly stopping a TCA; instead, clients are generally warned about orthostatic hypotension, sedation, and toxicity risk in overdose. TCAs are usually taken at bedtime due to sedation, so taking it upon waking would worsen daytime drowsiness rather than address insomnia.

Question 8

The nurse observes that the client being treated with antipsychotics is unsteady while standing and walking and that the client’s hands are trembling slightly. What should the nurse do?

Accepted Answer

Answer reason: Antipsychotics commonly cause orthostatic hypotension and extrapyramidal symptoms such as tremor, which increase immediate fall risk. The safest priority nursing action is to assist with ambulation and reduce the chance of injury while the client is unsteady. Giving an anticholinergic without an order is inappropriate, and sedation/rest alone does not address safety during mobility. This presentation is not consistent with tardive dyskinesia, which typically features involuntary mouth/tongue/facial movements rather than simple tremor and unsteadiness.

Question 9

The client calls the clinic to discuss medications being taken and possible adverse effects. The nurse should conclude that the client is experiencing a common side effect of sertraline when the client provides which information?

Accepted Answer

Answer reason: Marked constipation can occur and is a typical, non-emergent side effect that warrants supportive measures and follow-up. Palpitations/irregular heartbeat raise concern for a potentially serious cardiac issue rather than a common expected SSRI effect. Severe hypertension and excessive thirst are also not typical common sertraline effects and should prompt evaluation for other causes or complications.

Question 10

A client who is receiving acetaminophen (Tylenol) for osteoarthritis complains of continuing pain. The health care provider prescribes celecoxib (Celebrex). Which medication instruction should the nurse provide to this client?

Accepted Answer

Answer reason: Celecoxib is a COX-2 selective NSAID, which can still cause serious gastrointestinal adverse effects including ulceration and bleeding. Melena is a key warning sign of upper GI bleeding and requires prompt provider notification. Teaching about constipation is not a priority adverse-effect warning for this medication compared with bleeding risk. Doubling doses after a missed dose increases toxicity risk, and there is no clinically relevant dairy restriction specific to celecoxib.

Question 11

Which client would be most at risk for secondary Parkinson’s disease caused by pharmacotherapy?

Accepted Answer

Answer reason: Typical antipsychotics like chlorpromazine have strong D2 antagonism, making extrapyramidal symptoms (rigidity, tremor, bradykinesia) a well-known adverse effect. This directly increases the client’s risk for parkinsonian features related to pharmacotherapy. In contrast, nitroglycerin, prednisone, and naproxen do not typically cause dopamine blockade-related parkinsonism as a primary adverse effect.

Question 12

Monoamine oxidase inhibitors (MAOIs) have been prescribed for a client with bulimia nervosa. What is the most important information for the nurse to give the client?

Accepted Answer

Answer reason:  MAOIs inhibit breakdown of tyramine, so dietary tyramine can rapidly trigger a hypertensive crisis with severe headache, dangerously high blood pressure, and possible stroke. Teaching strict avoidance of high-tyramine foods is therefore the highest-priority safety instruction because it prevents a life-threatening reaction. Other advice may be generally helpful but does not address the most critical contraindication. Bleeding/bruising is more associated with drugs affecting platelets/serotonin (e.g., SSRIs with NSAIDs), not the hallmark MAOI risk.

Question 13

A client is given triazolam (Halcion) for a sleep disorder. The nurse is reinforcing some teaching precautions concerning the medication. The nurse determines that the client understands the precautions when the client makes which statement?

Accepted Answer

Answer reason: " Medication safety principle: clients must correctly identify high-risk medications by name and purpose to prevent dangerous misuse. Triazolam is a short-acting benzodiazepine hypnotic for insomnia, while haloperidol is an antipsychotic; mixing them up could lead to inappropriate dosing and significant CNS adverse effects. By stating they will not confuse the two, the client demonstrates understanding of a key precaution focused on safe administration. In contrast, driving after a hypnotic is unsafe due to sedation and psychomotor impairment, and taking it with citrus (e.g., grapefruit) can increase benzodiazepine levels via CYP3A4 inhibition.

Question 14

A postpartum client is receiving anticoagulant therapy for deep vein thrombophlebitis. What is the most important information for the nurse to include in discharge teaching?

Accepted Answer

Answer reason: Anticoagulants increase bleeding risk, so teaching must focus on avoiding additional agents that further impair hemostasis. Salicylates (e.g., aspirin and many OTC cold/pain products) inhibit platelet function and can markedly raise the risk of postpartum hemorrhage, GI bleeding, and excessive bruising when combined with anticoagulation. This is a high-yield safety instruction because clients commonly self-medicate with OTC products without realizing they contain aspirin. Shortness of breath is not an expected medication adverse effect and should instead be treated as a warning sign of pulmonary embolism requiring urgent evaluation.

Question 15

The client diagnosed with Parkinson disease is being discharged. Which statement made by the client’s significant other indicates a need for more teaching?

Accepted Answer

Answer reason:  Hallucinations in Parkinson disease are more commonly related to dopaminergic therapy adverse effects or Parkinson disease psychosis, not a symptom expected to improve simply because medication “starts working.” Teaching should emphasize monitoring for confusion, hallucinations, and safety risks and reporting them, because medication adjustments or use of appropriate antipsychotic therapy may be needed. The other statements reflect appropriate expectations and management: mood changes can occur, planning activities later in the morning can align with better mobility after routine care/meds, and consistent medication timing helps maintain therapeutic effect and reduces “wearing-off.” This statement signals misunderstanding of medication effects and when to seek provider guidance.

Question 16

The client has been diagnosed with Parkinson disease for 12 years and has been taking levodopa (L-dopa) for the last 8 years. Which symptom would alert the nurse to a possible medication complication?

Accepted Answer

Answer reason: Long-term dopaminergic therapy can cause motor complications, including peak-dose dyskinesias and on-off fluctuations, which represent a medication-related problem rather than baseline disease findings. New involuntary choreiform or writhing movements after years of levodopa use are classic for levodopa-induced dyskinesia and should prompt assessment of dosing/timing and need for regimen adjustment. In contrast, akinesia, masklike facies, and cogwheel rigidity are expected manifestations of Parkinson disease progression. Excessive salivation is also common in Parkinson disease due to impaired swallowing and does not specifically indicate a levodopa complication.

Question 17

A client complains of an urticarial rash, itching, and dyspnea after receiving an intramuscular injection of penicillin G benzathine (Bicillin L-A). Which medication is the most appropriate primary intervention in this circumstance?

Accepted Answer

Answer reason: Epinephrine (Adrenaline) 1:1000 to 0.3 mL IV. This presentation after penicillin (urticaria, pruritus, and dyspnea) is most consistent with an acute IgE-mediated anaphylactic reaction, where immediate reversal of airway edema and bronchospasm is the priority. Epinephrine is first-line because it provides rapid alpha-1 vasoconstriction (reducing mucosal edema) and beta-2 bronchodilation, and it also counteracts mediator release and supports blood pressure. Antihistamines can improve hives/itching but do not rapidly relieve life-threatening respiratory compromise and are adjunctive rather than primary therapy. Corticosteroids have delayed onset and are used to reduce protracted or biphasic reactions, not for immediate stabilization; atropine targets symptomatic bradycardia, which is not the key problem described.

Question 18

A 62-year-old male client has nitroglycerin (Nitrostat) added to his medication regimen. Which statement made by this client indicates that further education is needed?

Accepted Answer

Answer reason: Nitroglycerin is a nitrate vasodilator and PDE5 inhibitors like sildenafil also increase vasodilation; combining them can cause profound, life-threatening hypotension and syncope. The client’s statement shows misunderstanding because there is no “safe” 1-hour waiting period; nitrates are contraindicated within an appropriate washout window after PDE5 inhibitor use (commonly at least 24 hours for sildenafil, longer for some agents). The other statements reflect correct use of sublingual nitroglycerin for acute angina, including placement under the tongue and dosing every 5 minutes up to 3 doses. A key safety teaching is to avoid concurrent PDE5 inhibitors and to seek emergency care if pain persists after initial doses per protocol.

Question 19

The nurse notes that a client has a blood pressure of 102/56 mm Hg, pulse of 94 beats/minute, and respiratory rate of 6 breaths/minute. The client is pale, with cyanotic lips and nail beds. The nurse suspects a reaction to medication. Which medication is most likely the cause of these symptoms?

Accepted Answer

Answer reason: The key principle is that opioid agonists depress the medullary respiratory center, and severe toxicity presents with bradypnea/hypoventilation leading to hypoxemia and cyanosis. A respiratory rate of 6/min with pallor and cyanotic lips/nail beds is most consistent with opioid-induced respiratory depression, which can also be accompanied by hypotension from vasodilation. Nalmefene is an opioid antagonist used to reverse opioid effects, so it would not be the likely cause of profound hypoventilation in this context. Aspirin toxicity more typically causes early tachypnea/respiratory alkalosis, and methylphenidate is a stimulant associated with increased heart rate and blood pressure rather than respiratory depression.

Question 20

To detect life-threatening complications as early as possible in a client receiving a tocolytic agent, the nurse should be alert for which finding?

Accepted Answer

Answer reason: New crackles on auscultation are an early bedside indicator of developing pulmonary edema and require prompt intervention (stop/adjust infusion, oxygen, provider notification, and further assessment). A mildly elevated glucose can occur with beta-agonists but is typically not the most immediately life-threatening finding. Bradycardia is more consistent with magnesium sulfate or beta-blocker exposure and is not the classic sentinel finding for acute pulmonary edema from common tocolytics.

Question 21

A 52-year-old client who had gastric bypass surgery is nothing by mouth (NPO) status and is in pain. The nurse administers meperidine (Demerol) 75 mg I.M. as ordered. The client complains of nausea 20 minutes after the injection. The nurse recognizes that the nausea is most likely the result of which factor?

Accepted Answer

Answer reason: The timing (about 20 minutes after administration) strongly supports a medication adverse effect rather than a postoperative complication alone. NPO status does not typically create acute nausea by itself, and postoperative nausea from anesthesia/surgery is possible but is less directly linked to the immediate post-injection onset. Residual blood in the mouth after extubation is more associated with unpleasant taste or gagging/aspiration risk, not a predictable medication-timed nausea response.

Question 22

A client is being treated for premature labor with ritodrine (Yutopar). After receiving this medication for 12 hours, her blood pressure is slightly elevated, her chest is clear, and her pulse is 120 beats/minute. She complains of a little nausea, and the fetal heart rate is 145 beats/minute. Which intervention is correct?

Accepted Answer

Answer reason: Beta-adrenergic tocolytics such as ritodrine commonly cause maternal tachycardia, mild nausea, and can slightly increase fetal heart rate; these findings are expected side effects rather than immediate toxicity when the lungs are clear and fetal status is reassuring. A maternal pulse of 120/min without chest pain, dyspnea, crackles, or hypotension does not by itself indicate pulmonary edema or cardiovascular collapse requiring urgent discontinuation. The fetal heart rate of 145/min is within normal baseline range, supporting continued observation rather than intrauterine resuscitation measures. Immediate provider notification is more appropriate for signs of serious adverse effects (e.g., chest pain, arrhythmias, significant hypertension, or pulmonary edema), which are not present here.

Question 23

The client who is receiving doxorubicin for the first time to treat multiple myeloma develops flushing, facial swelling, headache, chills, and back pain- Which statement made by the nurse is best?

Accepted Answer

Answer reason: The priority principle is recognizing and appropriately educating about expected acute infusion-related reactions with first-time chemotherapy administration while continuing close monitoring for escalation. The symptom cluster of flushing, facial swelling, chills, headache, and back pain is consistent with an acute hypersensitivity/infusion reaction that often occurs early in therapy and is commonly self-limited with supportive care. Reassuring the client about the typical course helps reduce anxiety and supports adherence, while still implying the need to observe and report worsening symptoms. Labeling this as “toxicity” and encouraging refusal is inappropriate and could lead to unsafe interruption of therapy. Giving ondansetron targets nausea/vomiting rather than this reaction pattern, and telling the client to “focus on being cured” is non-therapeutic and dismissive.

Question 24

The client using latanoprost eye drops for treatment of glaucoma calls the ophthalmology clinic after noting a brown pigmentation of the iris. Which nursing action is most appropriate?

Accepted Answer

Answer reason: Latanoprost (a prostaglandin analog) can cause increased brown iris pigmentation that may be permanent, so the client should be evaluated and counseled about risks/benefits and ongoing monitoring. Reassuring the client that it will regress is inaccurate and could delay needed follow-up. Liver function testing and sunglasses do not address the medication-related ocular change or ensure safe continuation of therapy.

Question 25

The client is taking metolazone and diltiazem for treatment of hypertension. Which statement made by the client to the nurse indicates further teaching is needed?

Accepted Answer

Answer reason:  Grapefruit juice inhibits intestinal CYP3A4 and can significantly increase serum levels of diltiazem, raising the risk of excessive bradycardia, hypotension, and conduction disturbances. This is a clinically important food–drug interaction that requires avoidance teaching. The other statements reflect appropriate self-management concepts: metolazone can cause potassium loss, late-day dosing can minimize nocturia during sleep, and avoiding NSAIDs helps prevent blunting of antihypertensive/diuretic effects and renal adverse effects. Therefore, the grapefruit juice statement is the one indicating a knowledge deficit.

Question 26

The client has been receiving clonidine 0.1 mg via transdermal patch once every 7 days. The NA removes the patch with morning cares. Eight hours later, the nurse discovers that the clonidine patch is no longer present. Which assessment finding should be most concerning to the nurse?

Accepted Answer

Answer reason: Abrupt interruption of clonidine can cause rebound sympathetic activity with severe hypertension, which is an urgent, potentially life-threatening adverse effect requiring prompt intervention. The missing transdermal patch for several hours increases risk of uncontrolled blood pressure and end-organ complications (e.g., stroke, myocardial ischemia). A headache and tachycardia can accompany rebound, but the markedly elevated blood pressure best reflects the most dangerous physiologic consequence and guides immediate management. A skin tear is a local issue and does not represent the primary systemic risk of clonidine withdrawal.

Question 27

The client taking glyburide 5 mg orally once daily presents in the ED with headache, flushing, nausea, and abdominal cramps. The client’s fingerstick blood sugar result is 56 mg/dL. Which question is most important for the nurse to ask the client?

Accepted Answer

Answer reason:  A blood glucose of 56 mg/dL indicates clinically significant hypoglycemia requiring rapid identification of the most likely precipitating factor and immediate correction. Sulfonylureas such as glyburide increase insulin release, and missed/delayed meals or inadequate carbohydrate intake are common, high-probability causes of symptomatic hypoglycemia. Determining when the client last ate directly assesses a time-critical safety issue and guides urgent management (e.g., giving fast-acting carbohydrate and preventing recurrence after treatment). Asking about protein intake or routine home monitoring does not address the immediate cause, and alcohol history can contribute but is less direct and typically secondary to the fundamental meal/medication mismatch in this presentation.

Question 28

The client is concerned about having brown-colored urine after starting nitrofurantoin for treating a UTI. Which response by the nurse is most appropriate?

Accepted Answer

Answer reason:  A key medication-teaching principle is to distinguish expected, harmless side effects from findings that require stopping a drug or urgent evaluation. Nitrofurantoin commonly causes dark yellow to brown urine discoloration due to drug pigments and this is not, by itself, a sign of worsening infection or dehydration. The safest nursing response is reassurance with guidance to continue the antibiotic as ordered to ensure adequate UTI treatment. Reducing the dose or stopping therapy risks treatment failure and resistance, and advising a large fixed fluid intake is unnecessary and could be inappropriate for clients with fluid restrictions.

Question 29

The nurse in a large urban hospital is admitting a 2-hour-old infant whose mother is positive for HIV. The infant is to receive zidovudine. Which laboratory tests should the nurse analyze before administering the medication?

Accepted Answer

Answer reason: It is also associated with hepatotoxicity and other hepatic adverse effects, making baseline liver enzyme assessment clinically relevant before dosing. PT is not a routine baseline monitoring parameter for zidovudine, and serum protein does not directly monitor its major toxicities. CD4 count is used for HIV disease monitoring, not for assessing immediate safety of neonatal zidovudine prophylaxis.

Question 30

While adding oxytocin to a bag of solution, a 30-year—old nonpregnant female nurse pokes her finger with the needle and then injects some of the oxytocin into her body. The nurse immediately goes to the agency’s health service. Which treatment should the nurse expect in addition to the care of the clean needlestick injury?

Accepted Answer

Answer reason: A small inadvertent self-injection would be expected to cause little to no physiologic effect because there is no pregnancy to act upon and the dose is unlikely to be substantial. Therefore, beyond routine clean needlestick management and observation for unusual symptoms, specific pharmacologic reversal or special restrictions are not indicated. Terbutaline is used for obstetric uterine tachysystole, and fluid restriction is reserved for prolonged/high-dose infusion situations where water intoxication risk is present, making both inappropriate here.

Question 31

The nurse receives HCP orders for four inpatient clients to insert dinoprostone for cervical ripening. The nurse should question the order for which client?

Accepted Answer

Answer reason: A history of cesarean birth is a key contraindication/precaution for prostaglandin cervical ripening, so this order warrants questioning for safety. Post-term gestation (40–41 weeks) is a common indication for induction and does not by itself contraindicate dinoprostone. Diabetes with suspected macrosomia affects delivery planning and shoulder dystocia risk, but it is not the primary medication-specific contraindication compared with prior cesarean scar risk.

Question 32

Before administering oral digoxin to the pediatric client, the nurse assesses that the child has bradycardia and mild vomiting. Which is the nurse’s most appropriate action?

Accepted Answer

Answer reason: Digoxin has a narrow therapeutic index, and early toxicity commonly presents with GI symptoms (e.g., nausea/vomiting) along with cardiac conduction effects such as bradycardia. In a child with bradycardia plus vomiting, the safest nursing action is to hold the medication to prevent worsening dysrhythmias and to promptly notify the provider for further evaluation and possible serum level/electrolyte assessment. Proceeding with administration would increase risk of clinically significant bradyarrhythmia. Combining with a beta blocker can further depress AV conduction and heart rate, increasing danger.

Question 33

The home care nurse is observing the child with asthma self-administer a dose of albuterol via a metered-dose inhaler with a spacer. Within a short time, the child begins to wheeze loudly. What should the nurse do?

Accepted Answer

Answer reason: New or worsening wheeze shortly after a bronchodilator can signal paradoxical bronchospasm, a potentially serious adverse reaction that requires prompt clinical evaluation and stopping the triggering therapy. This timing (minutes after inhalation) makes an adverse medication response more likely than routine asthma fluctuation and it can rapidly compromise ventilation. Reassurance or simply increasing the dose is unsafe because additional beta-agonist could worsen the bronchospasm and delay needed treatment. Technique should be assessed, but “eye contact” causing wheezing is not a plausible mechanism and does not address the immediate safety concern.

Question 34

The nurse is leading a group session for clients with panic disorder. Which statement made by the client indicates that further teaching is needed?

Accepted Answer

Answer reason:  Benzodiazepines are effective for rapid, short-term relief of acute anxiety but carry risks of tolerance, dependence, and withdrawal. This makes them inappropriate as a preferred long-term maintenance strategy for panic disorder teaching. Long-term management more often centers on SSRIs/SNRIs and psychotherapy, with nonpharmacologic coping skills as adjuncts. The statement is incorrect because it wrongly implies diazepam is nonaddictive and the long-term drug of choice, signaling a need for further education.

Question 35

The nurse is educating the client concerning the possible side effects of a newly prescribed traditional antipsychotic medication. Which client statement reflects a need for further education regarding the side effects of this classification of medication?

Accepted Answer

Answer reason:  Traditional (first-generation) antipsychotics commonly cause CNS sedation, orthostatic hypotension, and anticholinergic effects due to receptor blockade, and they are also associated with extrapyramidal symptoms. Insomnia is not a typical expected adverse effect for this medication class; sedation and sleepiness are far more likely than difficulty sleeping. The other statements reflect appropriate teaching for common effects such as orthostatic dizziness and constipation prevention. A key safety issue is also to avoid adding sedatives/hypnotics without provider guidance because combined CNS depression can increase fall and respiratory risk.

Question 36

The client’s dose of mirtazapine was increased from 15 to 30 mg at bedtime two days ago. When the nurse is preparing to administer mirtazapine, the client reports having insomnia, irritability, and panic attacks. What should the nurse do next?

Accepted Answer

Answer reason: New or worsening agitation/anxiety, insomnia, and panic soon after an antidepressant dose increase can indicate an adverse drug reaction (activation) requiring prompt clinical reassessment. The safest immediate nursing action is to withhold the next dose and notify the prescriber so the medication plan can be adjusted and the client can be evaluated for escalating anxiety or suicidality. Requesting an additional sedative treats a symptom while potentially compounding CNS effects without addressing the causative medication change. Reassurance or diversion alone is inappropriate because it delays recognition and management of a potentially significant medication-related complication.

Question 37

The health care provider has prescribed indomethacin (Indocin) for a client with gout. What is the most important information for the nurse to give the client about nonsteroidal anti-inflammatory drugs (NSAIDs)?

Accepted Answer

Answer reason:  NSAIDs inhibit prostaglandin synthesis, which reduces gastric mucosal protection and increases risk for dyspepsia, gastritis, ulceration, and GI bleeding. Taking the medication with food (or milk) is a key safety teaching to lessen GI irritation and improve tolerance, especially with indomethacin. The statement that bleeding is not a problem is unsafe because NSAIDs can impair platelet aggregation and contribute to GI bleeding. Taking NSAIDs on an empty stomach is not recommended for routine use due to increased GI adverse effects, and “excitement” is not a primary teaching point compared with GI risk.

Question 38

Topical treatment with 2.5% hydrocortisone (Cortane) is prescribed for a 6-month-old infant with eczema. The nurse instructs the mother not to use the cream for longer than 1 week. The mother asks the nurse why there is a time limit. What is the best response by the nurse?

Accepted Answer

Answer reason: Topical corticosteroids can cause local adverse effects with overuse, especially in infants who have thinner skin and greater absorption. Limiting duration reduces risk of skin atrophy, fragility, striae, and potential systemic effects from absorption when applied repeatedly. The rationale is safety-focused rather than loss of effectiveness, as tachyphylaxis is not the key teaching point for short-term eczema therapy. Escalating potency or adding antibiotics depends on reassessment and signs of infection, not an automatic step after one week.

Question 39

A client complains of increasing fatigue and pain due to rheumatoid arthritis currently being treated with sulfasalazine (Azulfidine). The client's history includes diabetes mellitus type 2 and chronic obstructive pulmonary disease (COPD). The client's medications include glipizide (Glucotrol) and estradiol (Estrace). Which symptom should the nurse expect to find as a result of medication interactions?

Accepted Answer

Answer reason: Sulfonamide-containing drugs can potentiate the glucose-lowering effects of sulfonylureas by increasing free (unbound) drug and/or inhibiting metabolism, increasing the risk for symptomatic low blood glucose. Sulfasalazine is a sulfonamide derivative and the client is taking glipizide, so an interaction that increases hypoglycemia risk is clinically expected. The fatigue complaint can be consistent with low blood glucose and would warrant bedside glucose assessment and closer monitoring after medication changes. The other options do not represent a typical interaction effect between sulfasalazine and either glipizide or estradiol in this context.

Question 40

A client takes the following medications: labetolol hydrochloride (Normodyne) 100 milligrams twice a day, ketorolac tromethamine (Toradol) 10 milligrams as needed, and mirtazapine (Remeron) 15 milligrams at bedtime. Which nursing diagnosis is most appropriate for this client?

Accepted Answer

Answer reason: The key safety principle is that medications causing orthostatic hypotension and sedation increase fall and injury risk. Labetalol (a beta-blocker with alpha-blocking effects) can lower blood pressure and commonly contributes to dizziness/orthostasis, and mirtazapine taken at bedtime can add sedation that worsens nighttime or position-change falls. This combination most directly supports a nursing diagnosis focused on preventing injury from medication effects. The other options are less supported because these drugs are not primarily associated with clinically significant dehydration, seizure-threshold lowering, or common severe dermatologic breakdown as the most likely nursing problem.

Question 41

A client is prescribed the following medications: cefprazil (Cefzil) 500 mg PO twice a day, digoxin (Lanoxin) 0.125 mg PO daily, magaldrate (Riopan) 10 mL PO ac meals, and zolpidem tartrate (Ambien) 10 mg HS. Which medications should not be given together?

Accepted Answer

Answer reason: Antacids containing aluminum and magnesium can bind certain medications in the GI tract and reduce their absorption. This interaction can lower oral digoxin bioavailability, risking subtherapeutic effect and poor control of the cardiac condition for which it is prescribed. The safest nursing action is to avoid administering them at the same time and separate dosing (commonly by at least 2 hours) to minimize chelation/adsorption effects. The other pairs do not have a primary, high-yield absorption interaction that would routinely require avoidance as the key safety issue in this medication list.

Question 42

An elderly client receives instructions regarding the use of warfarin sodium (Coumadin). Which statement indicates the client understands the possible food interactions which may occur with this medication?

Accepted Answer

Answer reason: Warfarin’s anticoagulant effect is altered by dietary vitamin K, so consistent intake of vitamin K–rich foods is essential to avoid INR fluctuations. Salads commonly contain leafy green vegetables (e.g., spinach, kale) that are high in vitamin K and can reduce anticoagulation when intake increases. This statement shows the client understands the need to monitor and keep intake steady rather than making large changes. Alcohol can affect bleeding risk, but the classic and most testable food interaction for warfarin teaching is vitamin K variability from leafy greens.

Question 43

A client is given haloperidol (Haldol) as a form of chemical restraint. During physical assessment, the client has blood pressure of 80/50 mm Hg, heart rate of 120 beats/minute, and experiences an acute dystonic reaction. Which statement is most accurate?

Accepted Answer

Answer reason: Acute dystonia is an extrapyramidal symptom caused by dopamine D2 blockade from high-potency antipsychotics. The sudden sustained muscle contractions described are a known adverse effect requiring prompt recognition and treatment (typically with anticholinergics such as diphenhydramine or benztropine) and supportive monitoring. The concurrent hypotension and tachycardia can reflect antipsychotic-related orthostasis or physiologic stress and heighten the need for safety-focused assessment. One distractor uses an incorrect drug/class for dystonia, reinforcing that the key issue is identifying a medication adverse effect rather than implementing unrelated interventions.

Question 44

The clinic nurse is checking diagnostic test results. Which diagnostic test result would warrant notifying the client immediately?

Accepted Answer

Answer reason: Toxic anticonvulsant drug levels can quickly cause dangerous neurologic and cardiac effects, so they require prompt provider notification and intervention. Therapeutic total phenytoin levels are typically about 10–20 mcg/mL, and a level of 28 mcg/dL indicates toxicity risk (e.g., nystagmus, ataxia, slurred speech, confusion, and potentially severe CNS depression). In contrast, a carbamazepine level of 10 mcg/mL is within the usual therapeutic range (~4–12 mcg/mL), and a sodium of 143 mEq/L is normal. Low bone density can be an important long-term adverse effect of some antiepileptics, but it is not an immediate, acute toxicity that typically demands urgent notification in the same way as a supratherapeutic phenytoin level.

Question 45

A client who receives intravenous fluid therapy and an intravenous injection of diphenhydramine (Benadryl) suddenly complains of chest tightness and light-headedness. The nurse notes that the client has a flushed face and an irregular pulse of 120 beats/minute. Which is the most likely cause of this reaction in this client?

Accepted Answer

Answer reason: Rapid IV administration of certain medications can cause an acute toxic reaction characterized by flushing, chest tightness, dizziness/light-headedness, and tachycardia with dysrhythmias. Diphenhydramine given too quickly IV is a known trigger for this “speed shock” presentation due to abrupt cardiovascular effects. Circulatory overload would more typically show dyspnea, crackles, hypertension, and edema rather than sudden flushing and irregular tachycardia immediately after an IV push. Sepsis and chylothorax do not fit the abrupt onset tightly linked to IV medication administration.

Question 46

A 62-year-old female client has been taking vitamin C 500 mg by mouth (P.O.) daily, multivitamins 1 tablet P.O. every day, and ibuprofen 400 mg every 6 hours as needed for arthritic pain for 4 days. The nurse notices that the client’s stool is becoming darker and that a test for occult blood is positive. What is the most appropriate nursing judgment?

Accepted Answer

Answer reason: NSAIDs inhibit prostaglandin synthesis, which reduces gastric mucosal protection and increases the risk of GI erosion and bleeding, especially in older adults. Darkening stool with a positive occult blood test is consistent with upper GI bleeding/melena and should prompt stopping the suspected offending medication and notifying the provider. Vitamins may cause mild GI upset but do not typically cause occult GI bleeding, making them less plausible etiologies here. Hemorrhoids more often cause bright red blood on the toilet tissue or surface of stool rather than melena with a positive occult test.

Question 47

The nurse is reviewing admission orders for a 78-year-old client with a pneumonia diagnosis. The client has no known drug allergies, and the client’s serum labs are as follows: white blood cells (WBC) 15.2 K/ml, hemoglobin 11.2 g/dl, blood urea nitrogen (BUN) 29 mg/dl, and creatinine 2.8 mg/dl. The nurse should contact the physician to question which of the following orders?

Accepted Answer

Answer reason: Gentamicin 150 mg I.V. piggyback (IVPB) every 24 hours Aminoglycosides are nephrotoxic and require cautious use with renal impairment, with dosing adjusted based on kidney function and often drug levels. This client’s creatinine of 2.8 mg/dl (with elevated BUN) indicates significantly reduced renal clearance, increasing the risk of accumulation and toxicity (renal injury and ototoxicity). The nurse should clarify the order to ensure appropriate renal dosing/extended-interval strategy and monitoring (peak/trough or random level per protocol). In contrast, ceftriaxone and azithromycin are not typically avoided solely for this degree of renal dysfunction, and doxycycline generally does not require major renal adjustment.

Question 48

The client is admitted to the ED with tachypnea, tachycardia, and hypotension. The client has been taking theophylline for treatment of asthma and erythromycin for an upper respiratory tract infection. Which conclusion and action taken by the nurse is correct?

Accepted Answer

Answer reason: The core principle is that macrolide antibiotics can inhibit hepatic metabolism of theophylline, raising serum concentrations and precipitating toxicity. Theophylline toxicity commonly causes tachycardia and can progress to serious dysrhythmias and hemodynamic instability, so the priority is to confirm and quantify the drug level to guide urgent management. Ordering a serum theophylline level directly evaluates the likely medication-related cause given the specific drug interaction history. An asthma exacerbation would more typically present with prominent wheezing/bronchospasm and would not be best explained by the erythromycin interaction. Allergic reaction to erythromycin would usually include rash, urticaria, angioedema, or bronchospasm rather than this interaction-consistent toxicity picture.

Question 49

The nurse working on the pediatric unit has scheduled medications to administer at this time. Which assessments should prompt the nurse to conclude that the prescribed medication should be withheld and the HCP immediately notified?

Accepted Answer

Answer reason: Antipyretics are non-urgent compared with the need to assess for allergy, severity (hives, mucosal involvement), and respiratory compromise, so the dose should be held pending evaluation. In contrast, dizziness with an opioid-acetaminophen combination may reflect expected CNS effects and would prompt closer assessment (sedation/respirations) rather than automatic withholding. Drowsiness with phenobarbital is a common, expected adverse effect unless accompanied by concerning respiratory depression or toxicity signs.

Question 50

The client who is taking amitriptyline 150 mg daily is scheduled for elective surgery. Which statement reflects accurate understanding of safety concerns in this situation?

Accepted Answer

Answer reason: Tricyclic antidepressants can create perioperative safety issues because of anticholinergic effects, cardiac conduction risks (e.g., arrhythmias), and potentiation of hypotension/sedation when combined with anesthetics and other perioperative drugs. For an elective procedure, reducing these risks is best accomplished by planned, provider-directed tapering rather than abrupt cessation. A gradual discontinuation also helps prevent withdrawal symptoms and rebound insomnia/anxiety that can occur with sudden stopping. Switching to another TCA does not eliminate the same class-related perioperative concerns, and routine “take oral meds 4 hours before surgery” is not a safe universal rule.

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