Question 1

The nurse completes teaching with the client who will be taking daily doses of disulfiram following treatment for alcoholism. Which client statement indicates correct understanding of the safe use of disulfiram?

Accepted Answer

Answer reason: " Disulfiram blocks aldehyde dehydrogenase, so any alcohol exposure can precipitate an unpleasant and potentially dangerous disulfiram–alcohol reaction (e.g., flushing, throbbing headache, nausea/vomiting, hypotension). Avoiding all sources of alcohol—including OTC cough syrups, elixirs, extracts, and some mouthwashes—is a key safety teaching point. The statement about becoming intoxicated faster is inaccurate because the primary risk is the toxic reaction, not quicker intoxication. Skipping a dose after drinking is unsafe because disulfiram’s effects persist and the priority is strict alcohol avoidance rather than “timing” doses around drinking.

Question 2

Since taking the antidepressant doxepin, the female client has been reporting a decrease in sexual desire. She tells the nurse she “just isn’t that interested” because she “just doesn’t enjoy sex any-more.” She and her partner agree that they miss the excitement they used to share. Which is the most helpful response by the nurse?

Accepted Answer

Answer reason: “This may be due to your medication. How would you feel about talking to your doctor about changing to a different type of antidepressant?” Antidepressants, including tricyclics like doxepin, can commonly cause sexual dysfunction, and recognizing/treating medication adverse effects is a key nursing responsibility. This response validates the client’s concern and correctly links the symptom to a plausible pharmacologic cause rather than attributing it primarily to relationship duration or “normal” changes. It promotes a safe, appropriate next step—collaborating with the prescriber to consider an alternative medication or regimen—without independently directing medication changes. The “wait it out” approach is not reliably safe or helpful because sexual side effects may persist and can undermine adherence and recovery.

Question 3

The client taking lithium for bipolar disorder participated in a recreational game of basketball in the mental health unit gym. The client is now feeling nauseated and shaky, has blurred vision, and is finding it hard to stand. Considering this information, which action should be taken by the nurse?

Accepted Answer

Answer reason: Lithium has a narrow therapeutic index, and exertion with possible dehydration/sodium loss can precipitate acute toxicity. Nausea, tremor/shakiness, blurred vision, and unsteady gait are concerning for clinically significant lithium toxicity that requires immediate evaluation and drug-level confirmation to guide holding doses and further treatment. Resting in a cool place or giving an antiemetic may mask progression while delaying identification of a potentially dangerous medication reaction. Cardiac arrest is not the most immediate expected outcome at this stage; the priority is rapid assessment and lab confirmation so timely interventions can be initiated.

Question 4

The parent of the adolescent taking chlordiazepoxide for the past 2 months telephones the nurse requesting to have the dose increased. The parent states, “Chlordiazepoxide is being given as directed, but my child’s anxiety is increasing.” Which should be the nurse’s best interpretation of this situation?

Accepted Answer

Answer reason: Benzodiazepines can produce tolerance with ongoing use, meaning the same dose yields diminished anxiolytic effect over time. After 2 months of regular administration, escalating anxiety despite adherence is most consistent with reduced clinical response requiring prescriber reassessment rather than automatic dose escalation by a caregiver. Doubling the dose is unsafe and not a nursing conclusion, and “resistance” is not the standard pharmacologic concept used for benzodiazepines in this context. Attributing symptoms to hormones and increasing the dose ignores the medication’s dependence/misuse risks and misses the need to reevaluate the overall treatment plan.

Question 5

The client admitted for inpatient treatment of an anxiety disorder has been taking fluoxetine for the past 9 months. The HCP prescribes a new antianxiety medication and discontinues fluoxetine. What is the nurse’s most appropriate intervention?

Accepted Answer

Answer reason: Abrupt cessation of SSRIs can cause antidepressant discontinuation syndrome (eg, dizziness, irritability, flu-like symptoms, sleep disturbance), and nursing care includes preventing avoidable medication-related harm. A taper is the standard risk-reduction strategy when stopping long-term antidepressant therapy, especially after many months of use. Even though fluoxetine’s long half-life may lower the likelihood/severity compared with other SSRIs, the safest action is to clarify the discontinuation plan before symptoms occur. Monitoring or reassurance alone does not address the preventable cause, and reassurance is unsafe because adverse effects can still occur.

Question 6

The client taking sertraline for treatment of depression for the past 11 months reports feeling much better and wishes to discontinue the medication. Which is the nurse’s most appropriate response?

Accepted Answer

Answer reason:  The core principle is that SSRIs should generally be tapered rather than abruptly discontinued to reduce the risk of antidepressant discontinuation syndrome. Sertraline withdrawal can cause dizziness, nausea, irritability, insomnia, and “electric shock” sensations, so a gradual dose reduction is the safest nursing teaching. The other choices are either incomplete (deferring to the provider without giving key safety guidance), unsafe (suggesting it is simply safe to stop), or overly absolute (implying indefinite therapy for all clients). Emphasizing tapering supports medication safety while still allowing prescriber-guided discontinuation planning.

Question 7

The 30-year-old has been taking olanzapine for the past 5 years for the treatment schizophrenia. The client, who has a positive family history of DM, is now overweight but is not showing signs of hyperglycemia. When the client asks about the next steps for treatment, how should the nurse respond?

Accepted Answer

Answer reason:  Second-generation antipsychotics such as olanzapine can cause significant metabolic adverse effects, including weight gain, insulin resistance, and new-onset diabetes, so ongoing screening is a key safety step. This client has major risk factors (family history of diabetes and current overweight) but no symptoms, making objective monitoring the appropriate next action rather than initiating treatment for hyperglycemia. A fasting plasma glucose is a standard screening test to detect early dysglycemia before symptoms develop and to guide any future interventions. Starting oral agents or insulin without confirmed hyperglycemia is inappropriate and could cause harm. Discontinuing the antipsychotic is not the immediate next step without evidence of uncontrolled metabolic effects or failure of monitoring and risk-reduction strategies.

Question 8

The client is beginning treatment with bupropion for depression. After meeting with the HCP, the client tells the nurse, “I’m also taking Zyban to help me stop smoking.” Which is the most appropriate action for the nurse?

Accepted Answer

Answer reason: Bupropion and Zyban are the same medication, and duplicate therapy can cause excessive total daily dosing and raise seizure risk, a key safety concern with this drug. The nurse’s priority is medication safety and prevention of adverse effects by ensuring the prescriber has complete, accurate medication information. Notifying the HCP allows prompt reconciliation and adjustment (e.g., discontinue one product or modify dosing) before the client continues both. Supportive cessation teaching is appropriate only after addressing the potentially harmful duplication.

Question 9

A client provides a list of medications for the nurse. The medications include atorvastatin (Lipitor), clopidogrel (Plavix), and phenelzine sulfate (Nardil). Which statement indicates the client requires further education regarding medications?

Accepted Answer

Answer reason: I’m looking forward to my birthday celebration tonight. I’m even going to have wine with my meal! Alcohol use is contraindicated or should be avoided with several high-risk medications due to additive toxicity and safety concerns. With atorvastatin, alcohol can increase the risk of hepatotoxicity, so clients should limit/avoid alcohol and report symptoms of liver injury. With clopidogrel, alcohol can further increase bleeding risk, especially GI bleeding, making routine drinking unsafe. While MAOIs like phenelzine have key dietary restrictions (tyramine-containing foods) and caution with substances, the clearest medication-safety teaching failure here is planning to drink wine while on this regimen.

Question 10

An elderly client is prescribed spironolactone (Aldactone) with the addition of potassium chloride (Kaochlor). Which is a true statement regarding the use of these two medications together?

Accepted Answer

Answer reason: Spironolactone is a potassium-sparing diuretic that reduces potassium excretion, so adding potassium supplementation increases the risk of hyperkalemia. Older adults are particularly vulnerable because reduced renal reserve and common comorbidities can limit potassium clearance. Hyperkalemia can precipitate dangerous dysrhythmias, making this combination a key contraindication unless there is a compelling indication with very close monitoring. A common distractor is confusing spironolactone with loop diuretics, which typically waste potassium and may require supplementation.

Question 11

One of the side effects that can occur in nitrates is a process called reflex tachycardia. What is the mechanism of action that causes this effect?

Accepted Answer

Answer reason: Nitrates produce vasodilation that lowers systemic blood pressure and reduces effective arterial filling, which unloads baroreceptors. Baroreceptor-mediated sympathetic activation then increases heart rate to maintain perfusion, producing reflex tachycardia. Venodilation also increases venous capacitance, functionally reducing preload and contributing to the sensed drop in circulatory filling. A common distractor is attributing the response to increased oxygen demand as the primary trigger, but the initiating event is the rapid fall in pressure from vasodilation with compensatory sympathetic drive.

Question 12

Which statement made by the nurse to the client who is given hydrocodone bitartrate (Vicodin) for pain control indicates knowledge of possible side effects of this medication?

Accepted Answer

Answer reason: Opioid analgesics commonly decrease gastrointestinal motility, making constipation a predictable and clinically important adverse effect. Teaching increased fluids and dietary fiber targets prevention of opioid-induced constipation and supports safe home management. The other options describe issues more consistent with different drug classes (e.g., food restrictions suggest MAOIs/warfarin, neuromuscular symptoms suggest electrolyte disturbances), not typical hydrocodone effects. Although opioids can cause urinary retention and sedation/respiratory depression, urinary incontinence is not a characteristic expected effect to teach as routine.

Question 13

An 82-year-old female client is prescribed meperidine (Demerol) to be given every 4 hours as needed for pain. Why should the nurse question this order?

Accepted Answer

Answer reason: Meperidine is generally avoided in older adults because its metabolite (normeperidine) can accumulate when renal clearance is reduced, increasing the risk of CNS toxicity (e.g., agitation, tremor, seizures) and prolonged adverse effects. Age-related decreases in kidney function make this accumulation more likely even at standard PRN dosing intervals. This makes the order a safety concern and warrants questioning for a safer opioid alternative and/or dose adjustment. A common distractor is assuming pain-rating difficulty causes overdose; the bigger issue is pharmacokinetics and toxic metabolite buildup rather than pain reporting.

Question 14

After administering the final dose of Magnesium Sulfate on a postpartum client, the nurse observes the client becoming drowsy, bradypneic, and bradycardic. Which medication should the nurse anticipate to be ordered by the physician?

Accepted Answer

Answer reason: Calcium gluconate directly antagonizes magnesium’s neuromuscular and cardiac depressant effects and is the recommended reversal agent in obstetric care. Immediate reversal is prioritized because progressive toxicity can lead to loss of deep tendon reflexes, respiratory arrest, and hemodynamic instability. A common distractor is atropine, which may treat symptomatic bradycardia but does not reverse the underlying magnesium overdose causing respiratory depression. Furosemide may increase magnesium excretion but is slower and not the primary emergency reversal intervention.

Question 15

A client diagnosed with multiple sclerosis (MS) presented with vision problems, difficulty in keeping balance, numbness in the arms and legs with stiff muscles. The healthcare provider orders baclofen. Which of the following assessment findings on the client would indicate a potential overdose of the prescribed drug?

Accepted Answer

Answer reason: Overdose can progress beyond mild sedation to life-threatening respiratory depression, and severe toxicity may also produce seizures and coma. This option best captures the dangerous overdose pattern that requires immediate airway and ventilation assessment and emergency management. Drowsiness and dizziness are common expected adverse effects at therapeutic doses and are not as specific for overdose severity as ventilatory compromise.

Question 16

The nurse is preparing to administer newly prescribed cyclobenzaprine to a client who had surgery 3 days ago on the lumbar spine. Which of the following would be a contraindication to administer the medication?

Accepted Answer

Answer reason: Cyclobenzaprine is structurally related to tricyclic antidepressants and has significant serotonergic and anticholinergic properties. Concomitant use with MAO inhibitors such as phenelzine is contraindicated because it can precipitate serious, potentially life-threatening reactions (e.g., hyperpyrexia, hypertensive crisis, seizures, serotonin toxicity) due to excessive monoamine activity. A history of narcotic abuse is not a specific contraindication for this non-opioid muscle relaxant, though sedation monitoring is appropriate. Constipation risk can occur from anticholinergic effects, but lack of a bowel movement for 2 days is not an absolute contraindication; it warrants assessment and bowel regimen planning rather than withholding by default.

Question 17

The nurse is planning care for a client with type 2 diabetes who is taking metformin. Which of the following would be a priority for the nurse to include in the plan of care?

Accepted Answer

Answer reason: The safest nursing priority is to prevent this high-stakes medication complication by ensuring metformin is held around contrast administration and renal function is verified as stable before restarting. Routine glucose checks may be appropriate but do not address an immediate, potentially life-threatening contraindication. Daily creatinine monitoring is not universally required in stable outpatients and is less protective than preventing the contrast-related interaction in the first place.

Question 18

A nurse cares for a client taking moxifloxacin for the treatment of endocarditis. The nurse monitors the client’s heart rhythm for which unwanted effect of quinolone therapy?

Accepted Answer

Answer reason: This is clinically important because QT prolongation increases the risk of torsades de pointes and sudden ventricular dysrhythmias, especially with electrolyte abnormalities or other QT-prolonging drugs. Moxifloxacin is among the fluoroquinolones with a more notable QT-prolonging potential, so rhythm monitoring targets this complication. ST elevation is more consistent with acute myocardial injury, while PR or QRS changes are not the characteristic conduction effect of this medication class.

Question 19

A nurse is caring for a client with type 2 diabetes mellitus who was recently started on pioglitazone. Which client data obtained by the nurse is most important to report to the registered nurse?

Accepted Answer

Answer reason: New or worsening dependent edema is an early warning sign that requires prompt provider evaluation and possible medication change or further assessment (e.g., weight gain, dyspnea, crackles). In contrast, a BP of 140/88 is elevated but not an acute medication-related danger signal compared with signs of volume overload. An HbA1c of 6.7% indicates reasonable recent glycemic control, and prior retinal photocoagulation reflects chronic microvascular disease rather than an urgent adverse drug effect.

Question 20

The home care nurse evaluates a client diagnosed with tuberculosis and receiving isoniazid, rifampin, and pyrazinamide. Which client statement requires further assessment by the nurse?

Accepted Answer

Answer reason: " Anti-tuberculosis therapy with isoniazid, rifampin, and pyrazinamide carries significant risk for hepatotoxicity, so alcohol use is a key contraindication/risk amplifier that requires follow-up. Regular alcohol intake increases the likelihood of elevated liver enzymes, hepatitis, and liver failure and should prompt assessment of drinking patterns, counseling to avoid alcohol, and monitoring for symptoms such as anorexia, nausea, dark urine, or jaundice. The cough etiquette statement reflects appropriate infection-control behavior in the home. Weight gain can reflect improved appetite/clinical recovery during effective treatment rather than an urgent adverse effect requiring immediate concern.

Question 21

The nurse is administering verapamil, a calcium channel blocker, to a patient. The nurse should assess for which side effect(s)?

Accepted Answer

Answer reason: This commonly produces flushing and dizziness, particularly after dosing or with position changes. In contrast, hypertension is opposite the expected hemodynamic effect, since verapamil typically lowers blood pressure. A new need for supplemental oxygen is not an expected direct adverse effect and would prompt evaluation for another acute problem rather than being anticipated as a typical side effect.

Question 22

The home care nurse evaluates a client diagnosed with tuberculosis and receiving isoniazid, rifampin, and pyrazinamide. Which client statement requires further assessment by the nurse?

Accepted Answer

Answer reason: " Isoniazid, rifampin, and pyrazinamide are all potentially hepatotoxic, and concurrent alcohol use increases the risk of drug-induced hepatitis. This statement signals an avoidable risk factor that warrants immediate follow-up teaching and assessment for liver injury (e.g., anorexia, nausea, dark urine, jaundice) and review of baseline/ongoing LFT monitoring. In contrast, covering the mouth when coughing is appropriate infection-control behavior, and avoiding tuna is not a key interaction for these first-line TB medications. A modest weight gain can occur as appetite and health improve during treatment and is not, by itself, an urgent adverse effect.

Question 23

The nurse is teaching a client who has hypertension about the newly prescribed medication, diltiazem. Which of the following should the nurse include in the teaching?

Accepted Answer

Answer reason: " Diltiazem is a calcium channel blocker metabolized by CYP3A4, and grapefruit juice inhibits this pathway, which can raise drug levels and increase risk of hypotension and bradycardia. Patient teaching should therefore emphasize avoiding grapefruit products to prevent unintended toxicity. A persistent cough is classically associated with ACE inhibitors, not non-dihydropyridine calcium channel blockers. Increased urination and potassium supplementation teaching align more with diuretics or RAAS-acting medications rather than diltiazem.

Question 24

The client is started on a new regimen of isocarboxazid. Which statement by the client reflects the need for further teaching?

Accepted Answer

Answer reason: MAOIs like isocarboxazid have significant drug–drug interaction risks and require a washout period before switching to many other antidepressants or serotonergic agents to prevent serotonin syndrome or hypertensive crisis. Teaching must emphasize not stopping or switching medications independently and to consult the prescriber before any medication changes, including OTC and herbal products. The other statements reflect appropriate understanding: avoiding tyramine-containing foods/alcohol reduces hypertensive crisis risk, severe hypertension can lead to stroke, and reporting suicidal ideation is essential safety monitoring. The unsafe belief that switching is harmless indicates inadequate understanding and need for further teaching.

Question 25

The nurse is teaching a client with HIV who is beginning antiretroviral therapy with abacavir. Which of the following information should the nurse include?

Accepted Answer

Answer reason: " Abacavir can cause a potentially fatal hypersensitivity reaction, and early recognition of systemic symptoms is critical to prevent progression. Fever and mucosal symptoms can be warning signs that require immediate evaluation and prompt discontinuation rather than “waiting it out.” Patients should be taught not to adjust doses independently because interrupted or restarted therapy after a reaction can worsen outcomes. A common distractor is the statement about “curing” HIV, which is incorrect because ART suppresses viral replication but does not eradicate infection.

Question 26

The nurse cares for a client with ulcerative colitis who is prescribed mesalamine, 1,000 mg QID. Which lab result indicates a possible adverse reaction to mesalamine?

Accepted Answer

Answer reason: Creatinine 1.8 mg/dL Mesalamine (5-ASA) can cause nephrotoxicity, including interstitial nephritis, so rising serum creatinine is a key lab sign of an adverse drug reaction. A creatinine of 1.8 mg/dL is abnormally elevated and suggests decreased renal function that warrants prompt evaluation and possible discontinuation. In contrast, BUN of 9 mg/dL is within the typical reference range and does not indicate renal injury. Hyponatremia is more consistent with fluid/electrolyte issues from diarrhea/volume status than a specific mesalamine toxicity, and an elevated A1c reflects chronic hyperglycemia rather than an acute medication adverse effect.

Question 27

The nurse is collecting a medication history for a client who has meloxicam (Mobic) prescribed. Which of the following drugs that the client is taking should the nurse question?

Accepted Answer

Answer reason: Meloxicam and diclofenac both inhibit prostaglandin synthesis, compounding GI ulcer/bleeding risk and renal hypoperfusion/acute kidney injury, and potentially increasing cardiovascular risk. This is a medication-safety “duplicate therapy” issue that the nurse should flag and clarify with the prescriber. By contrast, a statin, bisphosphonate, or PPI does not represent the same direct therapeutic duplication with meloxicam, though each has its own monitoring considerations.

Question 28

A client has been prescribed phenelzine. Which client statement indicates to the nurse a need for further education?

Accepted Answer

Answer reason: " Orthostatic hypotension is a common, expected adverse effect of phenelzine (an MAOI), especially early in therapy, and is usually managed with safety strategies like rising slowly, adequate hydration, and fall precautions rather than emergency evaluation. Immediate hospital evaluation is more consistent with severe reactions such as hypertensive crisis (e.g., severe headache, chest pain, markedly elevated BP) or serotonin syndrome when interacting drugs are involved. The other statements reflect appropriate teaching: reporting suicidality, avoiding tyramine-containing items due to hypertensive crisis risk, and checking with the provider before adding any medications to prevent dangerous interactions. Therefore, the dizziness/standing statement indicates misunderstanding of what requires urgent care versus routine self-management and provider notification.

Question 29

A client is receiving morphine for postoperative pain. Which assessment finding requires immediate action by the nurse?

Accepted Answer

Answer reason: A respiratory rate of 8/min indicates hypoventilation and potential impending respiratory arrest, requiring immediate nursing intervention (stimulate, hold opioid, support airway/oxygenation, consider naloxone per protocol). The other findings are expected or non-urgent: moderate pain (4/10) is not an emergency, reactive pupils do not indicate toxicity, and a BP of 110/70 is within normal limits for many adults. Prioritization follows ABCs, making ventilation the immediate concern.

Question 30

The laboratory has just notified the nurse that a patient on the unit has a phenytoin level of 32mg/dl. What symptoms should the nurse anticipate from this client?

Accepted Answer

Answer reason: Expected early-to-moderate toxicity findings include unsteady gait/poor coordination, dizziness, nystagmus, slurred speech, and altered mental status such as confusion or lethargy. The key nursing concern is increased fall risk and neurologic compromise rather than a breakthrough seizure pattern. Seizures are more consistent with subtherapeutic anticonvulsant effect, not supratherapeutic levels.

Question 31

A nurse is caring for a client at 34 weeks gestation with preeclampsia who is receiving magnesium sulfate for seizure prophylaxis. Which finding should the nurse report to the provider immediately?

Accepted Answer

Answer reason: Magnesium sulfate is renally excreted, so oliguria increases the risk of magnesium accumulation and toxicity. A urine output below about 30 mL/hr is a key early warning sign that warrants immediate provider notification and likely adjustment/holding of the infusion. The other findings are expected or reassuring while on therapy: 2+ reflexes are normal, an RR of 18/min is adequate, and warmth/flushing is a common benign side effect. Prompt recognition prevents progression to respiratory depression, loss of reflexes, and cardiac conduction problems.

Question 32

A client is receiving Digoxn. Which laboratory result should the nurse monitor closely?

Accepted Answer

Answer reason:  Digoxin has a narrow therapeutic index, and electrolyte disturbances significantly change myocardial sensitivity to the drug. Hypokalemia increases digoxin binding to the Na+/K+ ATPase and raises the risk of toxicity, including dangerous dysrhythmias. Many patients on digoxin are also taking loop/thiazide diuretics that can lower potassium, making this lab especially high-yield to trend. Sodium is not a primary driver of digoxin toxicity, and while calcium can potentiate arrhythmias, potassium abnormalities are the classic, most clinically actionable precipitant to monitor closely.

Question 33

A client is being discharged with a prescription for apixaban after being treated for a pulmonary embolus. Which clinical data is most concerning to the nurse?

Accepted Answer

Answer reason: Indomethacin is an NSAID that raises the risk of GI bleeding and also contributes to platelet dysfunction, making the combination particularly hazardous at discharge. Chronic atrial fibrillation is a common indication for anticoagulation rather than a contraindication, and a vegetarian diet does not create the key vitamin K interaction concern seen with warfarin. A platelet count of 176 x10^3/mm^3 is within normal range and is not an immediate bleeding red flag by itself.

Question 34

The postoperative client on hydromorphone becomes hypoxic, and naloxone is administered per protocol. What is most important for the nurse to consider in the follow-up care of this client?

Accepted Answer

Answer reason: The priority in follow-up care is ongoing assessment of ventilation and oxygenation with readiness to repeat naloxone and support the airway if needed. Monitoring around an hour after administration helps detect re-sedation and declining respiratory drive early, when intervention is most effective. Documentation and changing analgesics are important but are secondary to preventing immediate deterioration in breathing.

Question 35

An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently?

Accepted Answer

Answer reason: Serum creatinine is 2.3 mg/dL (203 µmol/L) Digoxin has a narrow therapeutic index and is primarily eliminated by the kidneys, so impaired renal function increases serum levels and toxicity risk even at standard doses. An elevated creatinine indicates reduced clearance, making frequent monitoring of drug levels and closer dose titration necessary, especially in older adults. In contrast, an apical rate of 62/min is low-normal and would prompt pulse-holding parameters assessment, but it does not by itself indicate impaired drug clearance requiring frequent level checks. Hyperglycemia and fluoxetine use are not the key determinants of digoxin accumulation compared with renal dysfunction in this scenario.

Question 36

Patients taking warfarin should be taught that which types of foods are high in vitamin K?

Accepted Answer

Answer reason: Foods richest in vitamin K are typically dark green vegetables (e.g., spinach, kale, collards, broccoli). Teaching focuses on maintaining a consistent intake to avoid unpredictable anticoagulation and bleeding or clotting risk. Dairy, fruits, and most meats are not major dietary sources of vitamin K compared with leafy green vegetables.

Question 37

The nurse is caring for a client who is receiving continuous IV midazolam during a bedside procedure. Which of the following medications should the nurse have available on hand in case of midazolam overdose?

Accepted Answer

Answer reason: Flumazenil competitively blocks benzodiazepine receptors, reversing sedation and helping restore ventilation and airway reflexes when benzodiazepines are the cause. Naloxone would treat opioid toxicity rather than benzodiazepine toxicity, making it a common but incorrect distractor here. Acetylcysteine is an antidote for acetaminophen toxicity, and protamine reverses heparin, neither addressing midazolam’s mechanism. Ongoing airway support and monitoring remain essential because reversal can be incomplete or short-lived relative to the sedative infusion.

Question 38

The nurse is admitting a client with fibromyalgia and a fractured hip who is taking sertraline (Zoloft) and diazepam (Valium). The physician orders morphine 10 mg IV push for the acute pain. Which of the following adverse reactions is a priority for the nurse to consider before administering the morphine?

Accepted Answer

Answer reason: Diazepam is a benzodiazepine that potentiates opioid-induced sedation and can precipitate oversedation with hypoventilation, especially with an IV push dose. This is an immediate, life-threatening safety concern that must be assessed (level of consciousness, respiratory rate, oxygenation) before giving the medication. Constipation and GI upset are common but not acute airway/breathing threats, and dizziness is less directly predictive of respiratory compromise than sedation in this combination.

Question 39

The nurse provides education to a client who begins taking St. John’s wort. Which is the priority nursing action based on the current data?

Accepted Answer

Answer reason: " The priority principle is preventing high-risk drug–herb interactions that can cause serious adverse effects. St. John’s wort has serotonergic activity and can interact with SSRIs/SNRIs/TCAs/MAOIs and other antidepressants, increasing the risk for serotonin syndrome and other toxicities. Identifying concurrent antidepressant use immediately guides urgent teaching (avoid combination, monitor for agitation, hyperreflexia, diaphoresis, fever) and provider notification. By comparison, photosensitivity and bipolar screening are relevant but typically less time-critical than a potentially life-threatening interaction; the fermented food question is mainly an MAOI tyramine issue and is indirect compared with first confirming antidepressant use.

Question 40

The nurse is providing care for a woman with in labor who is receiving terbutaline due to a non-reassuring fetal heart pattern. Which assessment would be included to identify side effects of the drug?

Accepted Answer

Answer reason: Beta-agonism increases heart rate and can produce palpitations, so monitoring maternal pulse and symptoms of rapid heartbeat is the most direct safety assessment. In contrast, checking DTRs is targeted to magnesium sulfate toxicity rather than beta-agonist therapy. Terbutaline is more associated with hyperglycemia (and hypokalemia), not hypoglycemia, making glucose-lowering assessment a poorer fit for expected side effects.

Question 41

A patient is starting corticosteroid therapy. The nurse reviews important safety instructions before discharge. Which statement indicates a need for further teaching?

Accepted Answer

Answer reason: ” Corticosteroids must not be stopped abruptly after sustained use because they suppress the hypothalamic-pituitary-adrenal axis and sudden withdrawal can precipitate adrenal insufficiency. The safest teaching is to take the medication exactly as prescribed and taper the dose only under provider direction. The other statements reflect appropriate safety knowledge: long-term use increases risk of cataracts/glaucoma warranting eye exams, can cause fluid retention/edema, and inhaled forms require mouth rinsing to prevent oral candidiasis. This option signals misunderstanding that could lead to a serious, preventable complication.

Question 42

An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension. Which client statement should be reported to the health care provider immediately?

Accepted Answer

Answer reason: "Will you look at my tongue? It feels thicker than normal." ACE inhibitors can cause angioedema, a potentially life-threatening adverse effect due to airway swelling. Tongue or throat “thickening” is an early warning sign that can rapidly progress to airway obstruction and requires immediate provider notification and urgent evaluation. African American clients have a higher risk of ACE-inhibitor–associated angioedema, increasing the urgency. In contrast, a dry cough and mild orthostatic dizziness are common, typically non-emergent effects that can be addressed with routine follow-up and medication adjustment.

Question 43

During a routine office visit, the nurse documents the list of current medications of a client with a history of hypertension. Which statement by the client would cause the most concern?

Accepted Answer

Answer reason: " NSAIDs can raise blood pressure and worsen hypertension by promoting sodium/water retention and reducing renal perfusion via prostaglandin inhibition. Regular ibuprofen use also increases risk of kidney injury and can blunt the effectiveness of common antihypertensives (especially diuretics and ACE inhibitors/ARBs). In a client with hypertension, this combination increases cardiovascular and renal risk and warrants assessment for safer pain-control alternatives. The other listed medications are not typically associated with worsening blood pressure to the same degree when used appropriately.

Question 44

For which unique toxicity should the nurse monitor in a patient taking nitroprusside?

Accepted Answer

Answer reason: Risk increases with high infusion rates, prolonged administration, and impaired hepatic/renal clearance, and can present with severe metabolic (lactic) acidosis, altered mental status, and cardiovascular instability despite adequate oxygen delivery. Monitoring acid–base status, lactate, and clinical response helps identify early toxicity before collapse occurs. Other listed toxicities are not characteristic risks of this medication and would not be the expected unique monitoring focus.

Question 45

The nurse is reinforcing education to a client with a venous thromboembolism who is prescribed rivaroxaban. Which statement by the client indicates the medication teaching has been effective?

Accepted Answer

Answer reason: " Rivaroxaban is a direct factor Xa inhibitor, and the priority teaching is to reduce additive bleeding risk from other antithrombotic agents. Aspirin (and many NSAIDs) can increase bleeding through platelet inhibition and GI mucosal injury, so avoiding it unless specifically prescribed reflects correct understanding. Avoiding spinach/kale applies to warfarin due to vitamin K interactions, not rivaroxaban. Routine coagulation monitoring (e.g., INR) is not required for rivaroxaban, so that statement indicates ineffective teaching.

Question 46

A client with supraventricular tachycardia is prescribed esmolol. What should the nurse monitor in the client because of this medication?

Accepted Answer

Answer reason: The key nursing safety concern is development of bradycardia and hypotension, which may require dose reduction or discontinuation due to its IV titratable use. Continuous cardiac monitoring and frequent BP checks are standard while initiating and titrating therapy for SVT. Changes in consciousness are not the primary expected adverse effect to monitor compared with hemodynamic parameters, and ocular/intracranial pressures are not typical monitoring targets for this medication.

Question 47

Your client, who is taking an anticonvulsant medication, is also using herbs and other alternative therapies at home. The client tells you that some of these substances include "ginkgo biloba, garlic supplements, and evening primrose." How should you respond to this client's statement?

Accepted Answer

Answer reason: The key principle is recognizing herb–drug interactions that can worsen seizure control or increase adverse effects in clients taking anticonvulsants. Evening primrose oil is associated with lowering the seizure threshold, which can increase the risk of breakthrough seizures, so the nurse should provide this safety-focused education. Option A is nontherapeutic and discourages disclosure of complementary therapy use. While some herbs can affect bleeding risk, the most direct anticonvulsant-specific safety concern among the listed substances is the lowered seizure threshold linked to evening primrose.

Question 48

A client receiving Vancocin (vancomycin) has a serum level of 20mcg/mL. The nurse knows that the therapeutic range for vancomycin is?

Accepted Answer

Answer reason: A commonly taught therapeutic trough range for vancomycin is roughly 10–20 mcg/mL for many infections, with higher targets used for severe/deep infections, so 20 mcg/mL can still fall within a therapeutic window. Among the choices, the only range that appropriately contains 20 mcg/mL and reflects standard teaching is 10–25 mcg/mL. The lower range would suggest subtherapeutic exposure, while the higher ranges trend toward levels associated with increased toxicity risk.

Question 49

The nurse is caring for assigned clients. After administering prescribed medications, the nurse should immediately intervene if the client reports?

Accepted Answer

Answer reason: Rapid-acting insulin can precipitate acute hypoglycemia, and adrenergic symptoms such as palpitations, tremor, and diaphoresis signal a potentially dangerous drop in blood glucose that requires prompt assessment and treatment. Immediate nursing action includes checking a bedside glucose and giving fast-acting carbohydrate (or IV dextrose/glucagon if severe or unable to swallow) to prevent progression to seizures or loss of consciousness. By contrast, nausea during amphotericin B infusion is a common infusion-related effect that is typically managed with premedication and monitoring unless accompanied by severe reactions. Drowsiness after fentanyl can be expected with opioids unless it is associated with respiratory depression, and perineal itching with IV dexamethasone is a known transient sensation that is generally not harmful.

Question 50

Which of the following is the appropriate assessment for respiratory depression in the older adult after the administration of an opioid for analgesia? Respiratory depression is?

Accepted Answer

Answer reason: Opioids can acutely depress the medullary respiratory center by reducing brainstem responsiveness to rising CO2, and this risk is heightened in older adults due to increased pharmacodynamic sensitivity and reduced physiologic reserve. The highest-risk period is soon after initiation or dose escalation, when tolerance has not developed and peak drug effect can newly suppress ventilation. Therefore, close monitoring of respiratory rate, depth, sedation level, and oxygenation is especially important after the first dose. The “several doses” distractor implies cumulative dosing is always the main trigger, but clinically the greatest danger is early therapy or after increases before tolerance develops. Oral administration can still produce significant respiratory depression, so route does not make it unlikely.

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The nurse completes teaching with the client who will be taking daily doses of disulfiram following treatment for alcoholism. Which client statement indicates correct understanding of the safe use of disulfiram?

The client admitted for inpatient treatment of an anxiety disorder has been taking fluoxetine for the past 9 months. The HCP prescribes a new antianxiety medication and discontinues fluoxetine. What is the nurse’s most appropriate intervention?

The client taking sertraline for treatment of depression for the past 11 months reports feeling much better and wishes to discontinue the medication. Which is the nurse’s most appropriate response?

The 30-year-old has been taking olanzapine for the past 5 years for the treatment schizophrenia. The client, who has a positive family history of DM, is now overweight but is not showing signs of hyperglycemia. When the client asks about the next steps for treatment, how should the nurse respond?

The client is beginning treatment with bupropion for depression. After meeting with the HCP, the client tells the nurse, “I’m also taking Zyban to help me stop smoking.” Which is the most appropriate action for the nurse?

A client provides a list of medications for the nurse. The medications include atorvastatin (Lipitor), clopidogrel (Plavix), and phenelzine sulfate (Nardil). Which statement indicates the client requires further education regarding medications?

An elderly client is prescribed spironolactone (Aldactone) with the addition of potassium chloride (Kaochlor). Which is a true statement regarding the use of these two medications together?

One of the side effects that can occur in nitrates is a process called reflex tachycardia. What is the mechanism of action that causes this effect?

Which statement made by the nurse to the client who is given hydrocodone bitartrate (Vicodin) for pain control indicates knowledge of possible side effects of this medication?

An 82-year-old female client is prescribed meperidine (Demerol) to be given every 4 hours as needed for pain. Why should the nurse question this order?

After administering the final dose of Magnesium Sulfate on a postpartum client, the nurse observes the client becoming drowsy, bradypneic, and bradycardic. Which medication should the nurse anticipate to be ordered by the physician?

The nurse is preparing to administer newly prescribed cyclobenzaprine to a client who had surgery 3 days ago on the lumbar spine. Which of the following would be a contraindication to administer the medication?

The nurse is planning care for a client with type 2 diabetes who is taking metformin. Which of the following would be a priority for the nurse to include in the plan of care?

A nurse cares for a client taking moxifloxacin for the treatment of endocarditis. The nurse monitors the client’s heart rhythm for which unwanted effect of quinolone therapy?

A nurse is caring for a client with type 2 diabetes mellitus who was recently started on pioglitazone. Which client data obtained by the nurse is most important to report to the registered nurse?

The home care nurse evaluates a client diagnosed with tuberculosis and receiving isoniazid, rifampin, and pyrazinamide. Which client statement requires further assessment by the nurse?

The nurse is administering verapamil, a calcium channel blocker, to a patient. The nurse should assess for which side effect(s)?

The home care nurse evaluates a client diagnosed with tuberculosis and receiving isoniazid, rifampin, and pyrazinamide. Which client statement requires further assessment by the nurse?

The nurse is teaching a client who has hypertension about the newly prescribed medication, diltiazem. Which of the following should the nurse include in the teaching?

The client is started on a new regimen of isocarboxazid. Which statement by the client reflects the need for further teaching?

The nurse is teaching a client with HIV who is beginning antiretroviral therapy with abacavir. Which of the following information should the nurse include?

The nurse cares for a client with ulcerative colitis who is prescribed mesalamine, 1,000 mg QID. Which lab result indicates a possible adverse reaction to mesalamine?

The nurse is collecting a medication history for a client who has meloxicam (Mobic) prescribed. Which of the following drugs that the client is taking should the nurse question?

A client has been prescribed phenelzine. Which client statement indicates to the nurse a need for further education?

A client is receiving morphine for postoperative pain. Which assessment finding requires immediate action by the nurse?

The laboratory has just notified the nurse that a patient on the unit has a phenytoin level of 32mg/dl. What symptoms should the nurse anticipate from this client?

A nurse is caring for a client at 34 weeks gestation with preeclampsia who is receiving magnesium sulfate for seizure prophylaxis. Which finding should the nurse report to the provider immediately?

A client is receiving Digoxn. Which laboratory result should the nurse monitor closely?

A client is being discharged with a prescription for apixaban after being treated for a pulmonary embolus. Which clinical data is most concerning to the nurse?

The postoperative client on hydromorphone becomes hypoxic, and naloxone is administered per protocol. What is most important for the nurse to consider in the follow-up care of this client?

An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently?

Patients taking warfarin should be taught that which types of foods are high in vitamin K?

The nurse is caring for a client who is receiving continuous IV midazolam during a bedside procedure. Which of the following medications should the nurse have available on hand in case of midazolam overdose?

The nurse provides education to a client who begins taking St. John’s wort. Which is the priority nursing action based on the current data?

The nurse is providing care for a woman with in labor who is receiving terbutaline due to a non-reassuring fetal heart pattern. Which assessment would be included to identify side effects of the drug?

A patient is starting corticosteroid therapy. The nurse reviews important safety instructions before discharge. Which statement indicates a need for further teaching?

An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension. Which client statement should be reported to the health care provider immediately?

During a routine office visit, the nurse documents the list of current medications of a client with a history of hypertension. Which statement by the client would cause the most concern?

For which unique toxicity should the nurse monitor in a patient taking nitroprusside?

The nurse is reinforcing education to a client with a venous thromboembolism who is prescribed rivaroxaban. Which statement by the client indicates the medication teaching has been effective?

A client with supraventricular tachycardia is prescribed esmolol. What should the nurse monitor in the client because of this medication?

Your client, who is taking an anticonvulsant medication, is also using herbs and other alternative therapies at home. The client tells you that some of these substances include "ginkgo biloba, garlic supplements, and evening primrose." How should you respond to this client's statement?

A client receiving Vancocin (vancomycin) has a serum level of 20mcg/mL. The nurse knows that the therapeutic range for vancomycin is?

The nurse is caring for assigned clients. After administering prescribed medications, the nurse should immediately intervene if the client reports?

Which of the following is the appropriate assessment for respiratory depression in the older adult after the administration of an opioid for analgesia? Respiratory depression is?

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