Question 1

While on pentamidine (Pentam) infusion therapy. The nurse must anticipate doing which of the following?

Accepted Answer

Answer reason: Pentamidine can cause clinically significant cardiac dysrhythmias and QT-interval prolongation, so cardiac monitoring is an anticipated safety measure during infusion therapy. Obtaining an ECG helps establish a baseline and detect conduction abnormalities early before they progress to torsades de pointes or other life-threatening rhythms. The drug is also associated with hypotension and electrolyte/glucose disturbances that can further increase arrhythmia risk, making rhythm assessment especially relevant. Retinal damage monitoring is not a characteristic priority for this medication, and routine counseling for low potassium or fluid restriction is not the key anticipated nursing action specific to pentamidine infusion.

Question 2

Which of the following patients should not be prescribed with Alendronate (Fosamax) for osteoporosis?

Accepted Answer

Answer reason: Alendronate is an oral bisphosphonate that can cause significant esophageal irritation/ulceration if it refluxes or remains in contact with the esophageal mucosa. Safe administration requires swallowing with a full glass of water and remaining upright for at least 30 minutes (and until after the first food of the day) to reduce this risk. A patient who must stay supine cannot meet this essential administration requirement, making therapy unsafe. The other options listed are not standard contraindications to alendronate use, whereas inability to remain upright is a key safety limitation.

Question 3

The nurse is educating a client who is prescribed tranylcypromine (Parnate) about the importance of following dietary restrictions. Which of the following symptoms may occur if the client consumes foods high in tyramine while taking this medication?

Accepted Answer

Answer reason: MAO inhibitors can precipitate a hypertensive crisis when combined with tyramine-containing foods because tyramine causes excessive catecholamine release. A sudden severe headache, often described as occipital, is a classic early symptom of this dangerous blood pressure elevation. This finding is a key teaching point that warrants immediate evaluation because it may precede stroke or other end-organ damage. In contrast, a sudden drop in blood pressure is inconsistent with the tyramine–MAOI interaction, which typically produces hypertension rather than hypotension.

Question 4

A 16-year-old patient is prescribed two oral medications: warfarin and ibuprofen. How should the nurse instruct the patient regarding taking these medications?

Accepted Answer

Answer reason: Warfarin therapy carries a significant bleeding risk, and NSAIDs like ibuprofen further increase bleeding by inhibiting platelet function and irritating the gastrointestinal mucosa. Teaching should prioritize preventing a dangerous drug–drug interaction and prompting the patient to use safer alternatives or obtain prescriber approval before taking an NSAID. Timing the two drugs differently does not reduce the interaction because the effect is pharmacodynamic rather than absorption-related. Also, missed warfarin doses should not be “made up” by doubling due to risk of over-anticoagulation and hemorrhage.

Question 5

A patient who is scheduled for a coronary arteriogram is admitted to the hospital on the day of the procedure. Which patient information is most important for the nurse to communicate to the health care provider (HCP) before the procedure?

Accepted Answer

Answer reason: This information may change immediate procedural planning (e.g., delaying the study, checking creatinine/eGFR, implementing hydration, and holding the medication for the recommended interval). The other findings are not as directly tied to a preventable, high-risk contrast–medication interaction: a glucose of 144 mg/dL is mildly elevated, sinus bradycardia at 56 may be baseline and is typically manageable with monitoring, and chest pain yesterday is relevant history but does not represent the same immediate medication safety issue that requires pre-procedure action.

Question 6

Nurse Johnson has instructed a patient taking a xanthine bronchodilator on which beverages to avoid. Which beverage choice from the dietary menu indicates that the patient understands the instructions?

Accepted Answer

Answer reason: g., theophylline) have stimulant effects that can be intensified by additional methylxanthines such as caffeine, increasing risk of tachycardia, palpitations, insomnia, and GI upset. Coffee and many colas contain caffeine, and chocolate-containing drinks can also contribute methylxanthines, so they are beverages to avoid. A non-caffeinated, non-chocolate beverage best reflects correct teaching and reduces additive stimulation. Therefore the juice selection is the safest and demonstrates understanding of the avoidance instructions.

Question 7

Intravenous heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available in the nursing unit?

Accepted Answer

Answer reason: Protamine is a positively charged compound that binds and neutralizes heparin, rapidly reducing anticoagulant effect in overdose or major hemorrhage. Vitamin K reverses warfarin (not heparin), and aminocaproic acid treats hyperfibrinolysis rather than directly antagonizing heparin. Ensuring access to the specific antidote supports timely management of bleeding complications during infusion.

Question 8

Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the client. Which of the following, if noted in the client’s history, would require physician notification?

Accepted Answer

Answer reason: A history of hepatitis B suggests impaired hepatic reserve and requires prescriber notification for baseline and ongoing liver function monitoring and possible regimen adjustment. Penicillin allergy is not directly relevant because neither medication is a penicillin-class drug. Cardiac history and rheumatic fever do not represent the key contraindication/risk interaction for these first-line TB medications compared with underlying hepatic disease.

Question 9

A client with acquired immunodeficiency syndrome is prescribed with zidovudine (Azidothymidine). Which of the following laboratory results should the nurse monitor while on this medication?

Accepted Answer

Answer reason: Monitoring a CBC allows early detection of declining hemoglobin/hematocrit and white blood cell abnormalities so therapy can be adjusted or held to prevent severe cytopenias. This monitoring is a core safety step because the adverse effect can be dose-limiting and clinically significant in clients with HIV/AIDS. Tests like throat gram stain or uric acid do not directly track the most important predictable toxicity of this medication, and random glucose is not a primary monitoring parameter for AZT.

Question 10

Nurse Amy is caring for a patient with asthma who has been prescribed Montelukast (Singulair). To ensure safe medication therapy, which laboratory values should Nurse Amy prioritize monitoring?

Accepted Answer

Answer reason: Montelukast is primarily metabolized by the liver, so monitoring hepatic function helps detect rare but clinically significant hepatotoxicity early. Transaminase elevations can be an early signal of liver injury and warrant prompt reassessment of therapy and other hepatotoxic exposures. In contrast, routine electrolyte monitoring is not a characteristic safety requirement for this medication in typical asthma management. CBC, calcium, and platelet trends are not the most directly relevant labs for detecting expected serious adverse effects from leukotriene receptor antagonist therapy.

Question 11

Nurse David is reviewing the necessary lab tests for a patient with tuberculosis who is receiving Ethambutol (Myambutol). Which of the following labs would NOT typically need to be monitored for this medication?

Accepted Answer

Answer reason: Ethambutol monitoring focuses on toxicity risks most associated with the drug, especially hyperuricemia (which can precipitate gout) and, clinically, visual changes (optic neuritis) rather than lipid abnormalities. Checking a uric acid level is therefore relevant to detect a known adverse effect trend during therapy. Baseline/periodic CBC and liver function tests may be followed in tuberculosis regimens because multiple anti-TB agents can affect hematologic parameters and hepatic function, and patients are commonly on combination therapy. Serum triglycerides are not a typical safety-monitoring parameter linked to ethambutol toxicity.

Question 12

The mother of a child with hemophilia asks the nurse which over-the-counter medication is suitable for her child’s joint discomfort. The nurse should tell the mother to purchase?

Accepted Answer

Answer reason: In hemophilia, avoiding medications that impair platelet function is essential because they increase bleeding risk and can worsen hemarthrosis-related pain and swelling. Acetaminophen provides analgesia (and antipyresis) without clinically significant platelet inhibition at recommended doses, making it the safest common OTC choice for pain in this setting. NSAIDs such as ibuprofen and naproxen can inhibit platelet aggregation and increase bleeding tendency, so they are generally avoided unless specifically directed. Aspirin irreversibly inhibits platelet function and is contraindicated due to prolonged bleeding risk.

Question 13

A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse about all of these symptoms. Which one is most important to report to the health care provider?

Accepted Answer

Answer reason: New or worsening shortness of breath can be an early sign of respiratory compromise from fluid shift or acute cardiopulmonary effects and requires prompt provider evaluation and possible therapy interruption. In contrast, decreased appetite, generalized aches, and insomnia are common, expected flu-like or constitutional effects that are typically managed supportively unless severe. Prioritization favors airway/breathing symptoms because they can rapidly progress and threaten oxygenation.

Question 14

The nurse is reviewing a medication history of a client with BPH. Which medication should be recognized as likely to aggravate BPH?

Accepted Answer

Answer reason: In a client with BPH, this worsens hesitancy, weak stream, and incomplete bladder emptying, and can trigger acute retention. Ipratropium is an anticholinergic bronchodilator, and even inhaled forms can contribute to urinary retention risk in susceptible patients. Metformin does not affect bladder outlet tone, buspirone is not typically associated with urinary retention, and timolol (a beta-blocker) does not commonly aggravate BPH-related obstruction.

Question 15

A client with a history of chest pain is admitted to irritable bowel syndrome. As a nurse, which of the following medicines will you least expect to be a part of the medical management?

Accepted Answer

Answer reason: This medication has been associated with increased risk of cardiovascular ischemic events and is generally avoided in patients with a history suggestive of angina/chest pain. The other options are commonly used for IBS subtypes (e.g., antidiarrheal or constipation-predominant therapies) without the same prominent ischemic-risk warning driving avoidance in this scenario. Therefore, it is the least expected choice in this patient given the chest pain history.

Question 16

Stavudine (Zerit) is prescribed to a client with human immunodeficiency virus seropositive. The nurse observes which of the following most closely while the client is taking the medication?

Accepted Answer

Answer reason: Early neuropathy presents with numbness, tingling, weakness, and impaired balance, which can quickly translate into an unsteady walk and increased fall risk. Monitoring ambulation provides a practical bedside way to detect functional decline from neuropathy and prompts timely provider notification and medication adjustment. While GI effects and constitutional symptoms can occur, they are generally less specific and less safety-critical than new gait instability from neurotoxicity.

Question 17

A male client with breast cancer is receiving Tamoxifen (Nolvadex). The nurse specifically monitors which laboratory value?

Accepted Answer

Answer reason: Monitoring triglycerides helps detect this complication early and supports risk reduction during therapy. aPTT is not a routine monitoring parameter for tamoxifen itself (thromboembolism risk is assessed clinically rather than via aPTT). Fasting glucose and serum electrolytes are not characteristic, high-yield laboratory toxicities specifically associated with tamoxifen use.

Question 18

The client who takes fluoxetine (Prozac) 20 mg each morning complains of daytime fatigue and being able to sleep only five hours per night. Describing feeling less depressed than previously, the client reports feeling bored and anxious after work, even after drinking coffee or class during in the evening while socializing with friends. What recommendation should the nurse make to the client?

Accepted Answer

Answer reason: Caffeine later in the day can worsen sleep latency and reduce total sleep time, which then drives daytime fatigue and anxiety. Reducing and timing caffeine to the morning targets the most modifiable contributor to the client’s sleep disruption without altering prescribed dosing on their own. Switching fluoxetine to bedtime is typically counterproductive when insomnia is present because the medication may increase alertness. Behavioral limits on evening stimulation are safer, evidence-based first nursing advice while monitoring for persistent SSRI-related insomnia that may require prescriber follow-up.

Question 19

A client is admitted to the psychiatric unit for treatment of depression. The health care provider prescribes phenelzine (Nardil). The nurse understands the importance of dietary restrictions for clients taking this medication. Which of the following foods should the nurse advise the client to avoid?

Accepted Answer

Answer reason: Aged cheeses contain high levels of tyramine and are a classic dietary contraindication with phenelzine. The nurse should emphasize avoidance to prevent severe headache, markedly elevated blood pressure, and potential stroke. In contrast, fresh non-aged foods like chicken, apples, and rice are not typical high-tyramine triggers when not fermented, aged, or cured.

Question 20

A Nurse is taking care of a 35-year-old female client with a history of bipolar disorder who is admitted to the psychiatric unit for a manic episode. The health care provider prescribes lithium carbonate to stabilize her mood. Which of the following laboratory values should be monitored closely to assess lithium toxicity and treatment response?

Accepted Answer

Answer reason: Lithium has a narrow therapeutic index, so small dose changes, dehydration, or renal impairment can quickly lead to toxic concentrations. Measuring the drug level directly is the most reliable way to confirm the medication is in the therapeutic range and to detect early toxicity before severe neurologic or cardiac complications develop. Monitoring levels also guides dose titration to ensure symptom control in acute mania. Liver testing is not the key safety marker because lithium is primarily renally cleared, and glucose/hemoglobin do not assess efficacy or toxicity.

Question 21

The nurse is providing teaching about potential pharmacologic interactions to a client diagnosed with atrial fibrillation who is prescribed warfarin. What statement by the client requires follow-up?

Accepted Answer

Answer reason: " Warfarin’s anticoagulant effect is altered by vitamin K intake, so teaching emphasizes consistency rather than complete avoidance of vitamin K–rich foods. Saying they must avoid green leafy vegetables suggests the client may unnecessarily restrict diet and risk unstable INR if intake varies dramatically. The safer instruction is to keep vitamin K intake steady and have INR monitored with any major diet changes. In contrast, avoiding concurrent aspirin and checking with a provider before supplements are appropriate because they can increase bleeding risk or alter anticoagulation.

Question 22

A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if the client states?

Accepted Answer

Answer reason: Aspirin irreversibly inhibits platelet aggregation, increasing perioperative bleeding risk until new platelets are produced. For many elective procedures, it is typically held in advance based on surgical bleeding risk and provider guidance, rather than continued up to the day of surgery. The other statements reflect appropriate understanding that aspirin can prolong bleeding and impair clotting and that the prescriber should direct when to stop it. Continuing it without provider instruction indicates misunderstanding and need for additional teaching.

Question 23

A young child who has been taking growth hormone for 1 month is complaining of flank pain, colic, and GI symp toms. The nurse concludes that this client is at increased risk for which adverse effect that is more likely to occur during the first few months of treatment?

Accepted Answer

Answer reason: The child’s flank pain with colicky character is a classic renal colic pattern and fits a stone more directly than inflammatory renal disease. GI symptoms can accompany renal colic via referred pain and nausea/vomiting during acute episodes. Acute glomerulonephritis would more typically present with hematuria, edema, and hypertension rather than colicky flank pain. Bowel obstruction or duodenal ulcer do not primarily produce flank colic and are not characteristic early adverse effects tied to growth hormone use.

Question 24

The nurse is teaching the client about prescribed prednisone. Which statement, if made by the client, indicates that further teaching is necessary?

Accepted Answer

Answer reason: Systemic corticosteroids increase GI irritation and bleeding risk, and combining them with aspirin/NSAIDs further raises the risk of peptic ulcer and hemorrhage. Teaching should emphasize avoiding aspirin unless specifically prescribed and to consult the provider before adding OTC medications. Prednisone can also increase susceptibility to adverse effects and mask symptoms, so unsupervised self-medication is unsafe. By contrast, monitoring for rapid weight gain aligns with steroid-related fluid retention and should prompt provider notification.

Question 25

What is the priority nursing assessment for a client who has experienced ototoxicity as a result of chemotherapy administration?

Accepted Answer

Answer reason: Dizziness and balance disturbance place the client at high risk for falls and injury, requiring prompt identification and implementation of fall precautions and provider notification. Hearing-related symptoms are also common, but they are not offered here; among the listed choices, vestibular involvement is the most direct manifestation of ototoxicity. Confusion and visual changes are not typical primary findings of ototoxicity and suggest alternative etiologies (e.g., CNS effects, metabolic derangements) rather than inner-ear toxicity. Chronic pain is not specific to ototoxicity and does not address the most immediate complication risk.

Question 26

A toddler with Kawasaki disease is going home on aspirin therapy. What should be the priority element in parent teaching at the time of discharge?

Accepted Answer

Answer reason: Discharge teaching should prioritize recognition of serious, actionable adverse effects that require prompt evaluation, such as hematemesis, melena, easy bruising, or prolonged bleeding. Kawasaki disease often uses aspirin for its anti-inflammatory/antiplatelet effect, so families must know what complications to monitor while the child is at home. The other options do not address a high-likelihood, high-harm medication complication needing urgent intervention.

Question 27

The nurse has given medication instructions to the client receiving nicardipine for angina. What client statement should indicate to the nurse that further client teaching is needed?

Accepted Answer

Answer reason: Calcium channel blockers such as nicardipine can cause peripheral edema, but it should not be framed as “expected” and therefore ignored; new or worsening edema/rapid weight gain can indicate problematic fluid retention or worsening cardiac status and warrants evaluation. Teaching should emphasize monitoring for this effect and notifying the provider, rather than accepting it as normal. Tracking angina frequency is appropriate because increased episodes can signal inadequate control or progression. General missed-dose guidance to take it when remembered unless close to the next dose is consistent with safe medication administration principles for many scheduled oral drugs.

Question 28

A client with diabetes mellitus is newly diagnosed with hypertension. After learning that the client has a 15-year history of smoking one pack of cigarettes daily, the nurse would consult with the prescriber regarding which antihypertensive medication?

Accepted Answer

Answer reason: This makes this choice the one the nurse should specifically question/clarify with the prescriber before administration. In addition, beta-blockers may mask adrenergic warning signs of hypoglycemia in diabetes, increasing risk for unrecognized low blood glucose. By contrast, a calcium channel blocker like diltiazem does not carry the same bronchospasm risk and is commonly used for hypertension when clinically appropriate.

Question 29

A client with angina pectoris received nitroglycerin tablets sublingually for chest pain. The client reports a severe headache shortly after the medication is administered. What interpretation should the nurse make based on the client’s statement?

Accepted Answer

Answer reason: Nitrates commonly cause headache due to vasodilation, including dilation of cerebral vessels, and this is an expected effect rather than a dangerous complication in isolation. A headache occurring shortly after sublingual administration aligns with the rapid onset of nitroglycerin and its predictable vascular effects. With continued exposure, patients often develop tolerance to nitrate-related headaches, so symptoms may lessen over time even though nitrate tolerance can also reduce antianginal effect. An immediate prescriber notification is more appropriate for severe hypotension, syncope, or lack of chest-pain relief after appropriate dosing rather than headache alone.

Question 30

The nurse has taught a client who is receiving newly prescribed fluoxetine. Which of the following statements by the client would indicate a correct understanding of the teaching?

Accepted Answer

Answer reason: " Muscle rigidity can be an early sign of serotonin syndrome, a potentially life-threatening adverse reaction associated with SSRIs like fluoxetine, especially if combined with other serotonergic agents. Prompt reporting allows rapid evaluation and discontinuation of offending drugs and supportive care before progression to hyperthermia, autonomic instability, and seizures. The food restriction of aged cheeses/alcohol is classically linked to MAOIs due to tyramine-induced hypertensive crisis, not SSRIs. Therapeutic mood improvement commonly takes several weeks, so stopping after 1 week reflects incorrect teaching and risks relapse/withdrawal effects.

Question 31

Nurse Lewis is monitoring a patient who has been prescribed azathioprine. Which of the following laboratory tests should Nurse Lewis prioritize to assess for potential adverse effects of this medication?

Accepted Answer

Answer reason: Monitoring blood cell lines is therefore the priority because it directly detects myelosuppression early, allowing prompt dose adjustment or discontinuation to prevent severe infection or bleeding. ESR reflects inflammation activity rather than medication toxicity. BUN and electrolytes are not the primary labs for azathioprine’s most clinically important adverse effect compared with hematologic suppression.

Question 32

Tissue plasminogen activator (t-PA) is considered for the treatment of a patient who arrives in the emergency department following the onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?

Accepted Answer

Answer reason: A history of cerebral hemorrhage indicates a high baseline risk for recurrent intracranial hemorrhage that can rapidly become fatal with t-PA. In contrast, chest pain timing relates to eligibility windows rather than bleeding risk, and a prior MI alone does not inherently prohibit thrombolysis. Hypertension is only a contraindication when severe/uncontrolled (because it increases hemorrhagic stroke risk), but “history of cerebral hemorrhage” is the clearest definitive contraindication among the choices.

Question 33

A client has been taking prednisone (Deltasone) 20 mg once a day to treat severe seborrheic dermatitis. Which of the following assessment findings is of most concern?

Accepted Answer

Answer reason: Systemic corticosteroids increase the risk of gastritis and peptic ulcer disease and can precipitate GI bleeding, so new epigastric pain is a potential warning sign requiring prompt evaluation. This finding may indicate mucosal injury that can progress to perforation or hemorrhage, which is more immediately dangerous than expected metabolic effects. Mild hypertension, mild hyperglycemia, and increased appetite are common prednisone effects that are typically monitored and managed unless severe or symptomatic. Therefore, epigastric pain is the most concerning assessment finding in this context.

Question 34

A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client’s history. Which preexisting condition would contraindicate the use of pyridostigmine?

Accepted Answer

Answer reason: In the presence of a mechanical intestinal obstruction, stimulating peristalsis can worsen cramping, increase intraluminal pressure, and raise perforation risk, making it a contraindication. Ulcerative colitis may be exacerbated by increased motility/secretions but is not a strict contraindication compared with obstruction. Blood dyscrasias and spinal cord injury are not primary contraindications for cholinesterase inhibitors in this context.

Question 35

The client at highest risk for nephrotoxicity with aminoglycoside use is a?

Accepted Answer

Answer reason: Male with a creatinine of 1.7 and BUN of 52 on a 10-day regimen. Aminoglycosides can cause dose- and duration-related acute tubular necrosis, and risk rises markedly with pre-existing renal impairment and longer courses. Elevated creatinine and markedly elevated BUN indicate reduced renal clearance, which increases drug accumulation and nephrotoxic exposure. A prolonged regimen further increases the likelihood of renal injury compared with shorter therapy. Normal renal labs indicate low baseline risk, and a history of cystitis or kidney stones does not predict aminoglycoside nephrotoxicity as strongly as current renal dysfunction.

Question 36

Methylergonovine (Methergine) is prescribed to a patient who is having postpartum bleeding. Prior to giving the medication, the nurse contacts the physician who prescribed the medication if which of the following condition is documented in the patient’s chart?

Accepted Answer

Answer reason: In patients with underlying coronary artery disease, this vasospastic effect can precipitate angina, ischemia, or myocardial infarction, making it a key contraindication/precaution that warrants notifying the prescriber before administration. By contrast, uterine atony is a primary indication for giving a uterotonic to control postpartum hemorrhage. Hypotension and acute gastroenteritis are not the major safety-limiting conditions compared with cardiovascular disease risk for this medication.

Question 37

A nurse is evaluating a client who is HIV positive who is prescribed with pentamidine (Pentam) IV for the treatment of Pneumocystis carinii pneumonia. Which of the following assessment after the administration is the most important to relay to the physician?

Accepted Answer

Answer reason: Pentamidine can cause clinically significant dysglycemia, including acute hypoglycemia that may present with adrenergic symptoms such as diaphoresis and hunger and can rapidly progress to neuroglycopenia. This finding indicates a potentially dangerous adverse drug reaction requiring immediate glucose assessment and prompt treatment and possible therapy adjustment. In contrast, mild mouth dryness or unusual taste is generally a non-urgent side effect. Local redness and pain may suggest phlebitis/extravasation and should be addressed, but it is typically less immediately life-threatening than symptomatic hypoglycemia.

Question 38

Tom is admitted to the emergency department with an acute spinal cord injury. Methylprednisolone is contraindicated for treatment when the injury?

Accepted Answer

Answer reason: High-dose methylprednisolone for acute spinal cord injury (per older NASCIS-based protocols) was time-dependent, with any potential neurologic benefit limited to initiation within a narrow early window. After about 8 hours post-injury, the risk–benefit balance shifts because complications such as infection, GI bleeding, and impaired wound healing increase without demonstrated functional gain. Therefore, delayed presentation beyond that window is treated as a contraindication to starting the regimen. Earlier time points (e.g., within 8 hours) are when it was historically considered, regardless of the lesion level.

Question 39

Which of the following groups of clients are most at risk for GI bleeding from the use of NSAIDs?

Accepted Answer

Answer reason: NSAIDs inhibit COX enzymes, decreasing protective gastric prostaglandins and increasing the likelihood of mucosal injury and bleeding; risk is higher when drug exposure is prolonged or clearance is reduced. Renal failure reduces NSAID elimination and is commonly associated with uremic platelet dysfunction, both of which increase bleeding tendency and make any NSAID-related mucosal injury more clinically significant. Patients with renal impairment may also require concomitant medications (e.g., antiplatelets/anticoagulants) and have comorbid illness that further amplifies hemorrhage risk. In contrast, dysmenorrhea or headaches describe indications for short-term use and do not inherently increase bleeding risk compared with the physiologic vulnerability present in renal failure.

Question 40

The nurse is monitoring a post-renal transplantation client taking cyclosporine (Neoral). The nurse observes an elevation in one of the client’s vital signs and the client is complaining of sweating and headache. Which of the following vital signs is most likely increased?

Accepted Answer

Answer reason: Headache and diaphoresis are consistent with elevated blood pressure and sympathetic activation, making this the most likely vital-sign change. Temperature increase would point more toward infection, which is critical post-transplant but is not a typical direct cyclosporine adverse effect pattern. Respiratory rate and pulse can rise with pain/anxiety, but they are less characteristic than hypertension for cyclosporine toxicity/side effects.

Question 41

You observe changes in mentation, irritability, restlessness, and decreased concentration in a patient with cancer of the liver. Hepatic encephalopathy is suspected and the patient is ordered neomycin enemas. Which of the following information in the patient’s history would be a contraindication of this order?

Accepted Answer

Answer reason: The most important dose-limiting toxicity is nephrotoxicity, and reduced renal reserve markedly increases the risk of accumulation and kidney injury. A history of having only one kidney implies decreased renal reserve, so this makes the order unsafe compared with the other histories listed. While aminoglycosides can also cause ototoxicity/neuromuscular blockade, the options provided do not represent a stronger, direct contraindication than impaired renal reserve.

Question 42

A nurse is caring for a client on lithium therapy who is experiencing vomiting, diarrhea and ataxia. Which action should the nurse take first?

Accepted Answer

Answer reason: Vomiting, diarrhea, and ataxia are classic signs of lithium toxicity, and ongoing GI losses can worsen toxicity by causing dehydration and reduced renal clearance of the drug. The priority nursing action is to prevent further exposure by withholding the medication and promptly escalating care for evaluation (e.g., serum lithium level, renal function, and supportive management). Adjusting dose or frequency is a prescriber decision and is unsafe to do independently when toxicity is suspected. Continuing or increasing the medication risks progression to severe neurotoxicity (confusion, seizures, coma) and dysrhythmias.

Question 43

When caring for a client diagnosed with acute myocardial infarction,which potential side effects of nitroglycerin should the nurse monitor?

Accepted Answer

Answer reason: Nitroglycerin is a nitrate vasodilator that decreases preload/afterload and can lower systemic blood pressure, so hypotension is a key adverse effect to monitor closely in acute MI. Cerebral vasodilation commonly causes headache, which is a frequent and expected side effect. Options listing hypertension are inconsistent with nitrates’ primary hemodynamic effect of vasodilation. While reflex tachycardia can occur with hypotension, the classic high-yield monitoring pair is low blood pressure with headache.

Question 44

A 75-year-old female client with a history of hypertension and newly diagnosed atrial fibrillation is started on warfarin. Which one of the following lab values should be the most important for the nurse to monitor while the client is taking warfarin?

Accepted Answer

Answer reason: INR directly guides dosing to maintain a therapeutic range (commonly 2.0–3.0 for atrial fibrillation) and is the key safety lab for preventing over- or under-anticoagulation. Hemoglobin/hematocrit can suggest bleeding after it occurs but do not quantify anticoagulant intensity or guide dose titration. Platelets are more relevant for heparin-induced thrombocytopenia risk, and BUN does not assess warfarin effect.

Question 45

SITUATION: A client with depression is admitted to the psychiatric unit and is given the prescribed drug phenelzine sulfate (Nardil). Upon discharge, the nurse educates the client on the foods that are allowed and not allowed. Based on the food list that the client usually eats, which of the following foods should the nurse instruct the client that is safe to consume while on phenelzine?

Accepted Answer

Answer reason: Aged cheeses and cured/processed meats are classic high-tyramine items and therefore unsafe. Plain wheat breads are generally low in tyramine and are not among the restricted foods for MAOI therapy. A common distractor is cheddar cheese, which is specifically avoided due to high tyramine content.

Question 46

A postpartum client has an epidural catheter in place following delivery of an infant via cesarean section. The nurse determines that which medication is a priority to have on hand for use if needed?

Accepted Answer

Answer reason: The priority rescue medication is an opioid antagonist that can rapidly reverse these effects while supporting airway and ventilation until the patient stabilizes. Keeping it immediately available addresses the highest-risk adverse event associated with opioid-containing epidural infusions or boluses. Other listed drugs do not treat opioid-induced respiratory depression (and uterotonics like carboprost are for postpartum hemorrhage, not an epidural opioid complication).

Question 47

A client scheduled for discharge after coronary artery bypass grafting (CABG) reports new onset of anorexia and nausea. The client’s new medications include digoxin, metoprolol, and furosemide. The nurse plans to report this finding to the healthcare provider after checking the result of which laboratory test drawn earlier in the morning?

Accepted Answer

Answer reason: Checking the trough level helps determine whether symptoms correlate with supratherapeutic exposure and guides holding the medication and adjusting the dose. Post-CABG clients may have fluctuating renal perfusion, and reduced clearance increases the risk of toxic accumulation. Although furosemide-related hypokalemia can predispose to toxicity and dysrhythmias, it does not directly confirm digoxin excess and is secondary to confirming the suspected adverse drug effect.

Question 48

Nurse Jessica is monitoring a pediatric patient with asthma who has just received Omalizumab (Xolair). She is alert for any signs of a serious adverse reaction. Which of the following symptoms would indicate that the patient might be experiencing a life-threatening effect?

Accepted Answer

Answer reason: This finding suggests angioedema as part of anaphylaxis, which can rapidly progress to airway obstruction and respiratory failure. Omalizumab carries a known risk of anaphylaxis that may occur after injection, so early recognition of airway/facial swelling is critical for immediate emergency response. By contrast, headache/dizziness, joint pain, and nausea/vomiting can occur as less dangerous adverse effects and do not specifically indicate impending airway compromise. The priority is identifying signs that threaten breathing and circulation and require urgent treatment (e.g., epinephrine and airway support).

Question 49

Nurse Karen is reviewing the medical history of a patient with chronic obstructive pulmonary disease (COPD) who has been prescribed an older formulation of Ipratropium (Combivent) containing soy lecithin. She becomes concerned about the prescription upon discovering which of the following in the patient's history?

Accepted Answer

Answer reason: Older formulations of ipratropium inhalers contained soy lecithin, which could trigger hypersensitivity reactions in patients with soy or peanut allergies. Therefore, a history of peanut allergy required careful assessment before administration. Other options, such as smoking history or previous infection, are common in COPD and are not contraindications to ipratropium use.

Question 50

Which of the following nursing diagnoses is appropriate for a patient receiving famotidine (Pepcid)?

Accepted Answer

Answer reason: A core medication-safety principle is that nursing diagnoses should anticipate clinically meaningful adverse effects of the drug being administered. Famotidine (an H2-receptor antagonist) can rarely cause hematologic effects such as thrombocytopenia, which raises bleeding risk and warrants monitoring for bruising, petechiae, and abnormal bleeding. Immunosuppression is not a typical effect of H2 blockers, making infection risk from that mechanism a poor fit. Urinary retention and hypertension-related perfusion problems are not characteristic or high-yield adverse effects associated with famotidine compared with the hematologic concern.

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