Question 1

A six-month-old is receiving Lanoxin elixir (digoxin) following the repair of a VSD. Which finding should be reported to the physician?

Accepted Answer

Answer reason: In infants, a heart rate of 80 bpm is abnormally low and may signal digoxin toxicity or excessive therapeutic effect, especially post-cardiac repair. The other findings listed are within expected limits for a 6-month-old (RR ~30/min is normal; glucose 100 mg/dL is normal; BP 80/52 can be acceptable depending on baseline and perfusion). Reporting the low heart rate is the safest action because it directly affects cardiac output and can precede dysrhythmias.

Question 2

The nurse cares for a client who is two weeks postchemotherapy and has a potassium level of 6.5 mEq/L. The nurse questions the health care provider (HCP) regarding which prescriptions?

Accepted Answer

Answer reason: In acute hyperkalemia, insulin is used to shift potassium into cells, but it must be paired with dextrose unless the client is already significantly hyperglycemic to prevent dangerous hypoglycemia. A 20-unit IV bolus is an unusually high dose compared with common emergency regimens (often 10 units IV), increasing hypoglycemia risk and therefore warrants clarification before administration. The separate order for an IV push of dextrose suggests the intent was insulin-plus-dextrose therapy, but the insulin dose remains the key safety concern. Other listed therapies can be appropriate depending on acid-base status and overall plan, but this dose presents the clearest immediate medication-safety red flag to question.

Question 3

Which order prescribed for a client with hypercalcemia would the nurse be sure to question?

Accepted Answer

Answer reason: In hypercalcemia, therapy typically promotes calciuresis and dilution (isotonic saline) and may use loop diuretics to enhance calcium excretion after adequate hydration. Telemetry is appropriate because hypercalcemia can cause dysrhythmias and shortened QT interval, so monitoring supports early detection of complications. Therefore this order poses a direct contraindication risk in hypercalcemia and should be clarified with the prescriber.

Question 4

Ms. Teresa is looking over the morning laboratory results. Which client warrants Ms. Teresa notifying the healthcare provider (HCP)?

Accepted Answer

Answer reason: The client receiving IVP digoxin who has a digoxin level of 2.4 mg/dL. Digoxin has a narrow therapeutic index, so a clearly elevated serum level signals high risk for toxicity and requires prompt provider notification. A value of 2.4 is above typical therapeutic ranges and correlates with potentially dangerous dysrhythmias and systemic toxicity, especially with IV administration. In contrast, an INR of 1.2 in a warfarin patient is subtherapeutic but is not an acute toxicity emergency; it usually prompts dose adjustment rather than urgent escalation unless there is a time-critical indication. Potassium of 3.5 mEq/L is low-normal and warrants monitoring with loop diuretic therapy, while cholesterol 205 is only mildly elevated and not an urgent medication-related safety issue.

Question 5

A client with chronic kidney disease is admitted with pneumonia and pleuritis. Which prescription will the nurse question?

Accepted Answer

Answer reason: NSAIDs can reduce renal prostaglandin-mediated perfusion and worsen kidney function, so they are generally avoided or used with extreme caution in chronic kidney disease. Ketorolac is a potent NSAID with a well-known risk of nephrotoxicity and is contraindicated in advanced renal impairment; even short courses can precipitate acute kidney injury and increase bleeding risk from platelet inhibition. In contrast, acetaminophen is typically preferred for fever/pain in CKD when dosed appropriately. Levofloxacin often requires renal dose adjustment, but the order is not inherently contraindicated without knowing the patient’s creatinine clearance, making the NSAID order the clear prescription to question.

Question 6

A client with myocardial infarction is a candidate for alteplase (Activase) therapy. The nurse caring for the client is aware that it will be necessary to monitor for which adverse effect if the client receives this treatment?

Accepted Answer

Answer reason: Alteplase converts plasminogen to plasmin, which breaks down fibrin and can lead to oozing from IV sites, gums, and other mucosal surfaces and can progress to internal or intracranial hemorrhage. Nursing monitoring focuses on overt bleeding, changes in neurologic status, hemodynamic instability, and trending coagulation parameters per protocol. Infection and muscle weakness are not expected pharmacologic effects of fibrinolysis, and hypersensitivity is far less central than hemorrhage risk for alteplase.

Question 7

The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What vital sign is most likely increased?

Accepted Answer

Answer reason: Headache is a frequent symptom of elevated blood pressure and can also reflect cyclosporine neurotoxicity, making hypertension the most testable linked vital-sign change. Pulse and respirations are not characteristic primary vital-sign increases from cyclosporine toxicity in an otherwise stable transplant client. Pulse oximetry is not expected to increase and does not correlate with this adverse-effect pattern.

Question 8

A client admitted to the hospital has been prescribed pyridostigmine. When assessing the client for side effects of the medication, the nurse should ask the client about the presence of which occurrence?

Accepted Answer

Answer reason: Increased cholinergic stimulation can cause abdominal cramping, diarrhea, increased secretions, and skeletal muscle fasciculations or cramps. Asking about muscle cramps helps identify early medication intolerance or impending cholinergic toxicity that may require dose adjustment and monitoring for worsening weakness. Mouth ulcers, mood changes, and weight gain are not typical, clinically expected adverse effects for this medication compared with cholinergic symptoms.

Question 9

51 years-old bed ridden patient in the Geriatric ward was given antipeotic through his nasogastric tube. After an hour the patient went into deep sleep, his breathing pattern changed and he did not respond to calling his name. How should the nurse utilize her critical thinking related to the medication?

Accepted Answer

Answer reason: The abrupt deep sleep with altered breathing and unresponsiveness shortly after administration is most consistent with exaggerated pharmacologic effect/toxicity in a geriatric patient. This critical-thinking point guides the nurse to anticipate heightened sensitivity, monitor closely, and escalate care for possible overdose. While responses can vary among individuals, age-related physiologic changes are a predictable, high-yield risk factor that best explains this presentation. The statement about “higher adverse drug response” is vague and does not reflect a key clinical principle that can be applied prospectively to medication safety.

Question 10

A client with angina is taking nifedipine. What instruction should the nurse give the client?

Accepted Answer

Answer reason: Calcium channel blockers such as nifedipine can cause gingival hyperplasia, so patients should be taught to monitor their gums and maintain meticulous oral hygiene to detect changes early. Early recognition supports prompt dental evaluation and reduces complications like bleeding, infection, and difficulty chewing. Monthly blood pressure monitoring is inadequate because nifedipine can cause hypotension and patients generally need more frequent BP monitoring initially and with dose changes. Limiting green leafy vegetables is relevant to warfarin (vitamin K interactions), not nifedipine.

Question 11

A client is admitted for care after a traumatic brain injury. The client has a history of atrial fibrillation and obesity. Which prescribed medication does the nurse question?

Accepted Answer

Answer reason: A history of atrial fibrillation increases long-term stroke risk, but in the acute post-head-injury period anticoagulants are typically held/avoided unless a provider specifically documents that bleeding has been ruled out and benefits outweigh risks. The nurse should question an order that increases bleeding risk in a patient with potential or evolving intracranial hemorrhage and clarify indication/timing and imaging results. The other listed medications are commonly used supportive therapies (stress-ulcer prophylaxis, nausea control, or ICP management) and do not inherently create the same immediate hemorrhagic danger.

Question 12

A nurse is assessing a client with type 2 diabetes mellitus who was recently started on pioglitazone. Which client data obtained by the nurse is most important to bring to the attention of the health care provider?

Accepted Answer

Answer reason: New-onset peripheral edema after starting this medication is a clinically significant adverse effect that warrants prompt provider notification and possible drug discontinuation or further cardiac evaluation. The blood pressure reading is mildly elevated but not an acute medication-specific red flag. An HbA1c of 6.7% suggests reasonable glycemic control, and prior retinal photocoagulation reflects past diabetic retinopathy management rather than an urgent pioglitazone complication.

Question 13

In the intensive care unit, the nurse cares for a client who is being treated for hypotension with a continuous infusion of dopamine. Which assessment finding indicates that the infusion rate may need to be adjusted for the client?

Accepted Answer

Answer reason: A tachycardic response suggests an excessive adrenergic effect and is a safety signal to reassess and potentially down-titrate or adjust the infusion while evaluating perfusion targets. In contrast, a MAP of 78 mm Hg is generally an adequate perfusion pressure and does not by itself suggest the need for escalation. A CVP of 6 mm Hg and SVR of 900 dynes/sec/cm-5 are within or near typical ranges and are less concerning for an immediate dopamine-related adverse effect than marked tachycardia.

Question 14

The nurse reviews the lab results for a patient with heart failure and finds that the patient is hypernatremic, hyperkalemic, hypocalcemic, and hyperglycemic. Which of the following order should the nurse question? Select one?

Accepted Answer

Answer reason: Spironolactone is a potassium-sparing diuretic (aldosterone antagonist) commonly used in heart failure, and it can worsen potassium elevation. The other orders are consistent with the lab pattern: insulin helps lower glucose and also shifts potassium intracellularly, calcium gluconate treats clinically significant hypocalcemia and helps stabilize the myocardium in hyperkalemia, and furosemide can promote renal potassium excretion. Therefore, the medication most contraindicated by the current labs is the potassium-sparing diuretic.

Question 15

What is the potential risk of abruptly stopping the use of antidepressants?

Accepted Answer

Answer reason: This commonly produces sleep disturbance, including insomnia, along with other symptoms such as dizziness, irritability, anxiety, and flu-like complaints. Tapering the dose gradually reduces the risk and severity of these symptoms. While worsening depression with suicidal ideation is a serious concern, it reflects relapse/clinical deterioration rather than the most typical direct discontinuation effect tested here compared with the other options.

Question 16

A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?

Accepted Answer

Answer reason: Nitroglycerin is a potent venous (and at higher doses arterial) vasodilator that can rapidly lower preload and systemic blood pressure. Starting an IV nitroglycerin infusion in an already hypotensive client risks worsening hypotension, syncope, decreased coronary perfusion, and shock, so this finding requires immediate provider notification and reassessment before initiation/titration. ST elevation indicates acute myocardial injury and is an indication for urgent ischemia management, but it is not a contraindication to nitroglycerin when hemodynamics are stable. A potassium of 3.5 and heart rate of 61 are within acceptable limits and are less immediately dangerous than profound hypotension.

Question 17

An older female adult patient who has been treated with Clozapine (Clozaril) for 9 months calls to cancel a clinic appointment because of flulike symptoms, including a sore throat, fever, and tiredness. Which statement shows the best understanding regarding the management of the patient's symptoms?

Accepted Answer

Answer reason: " Clozapine can cause severe neutropenia/agranulocytosis, and early warning signs can mimic a viral illness (fever, sore throat, fatigue). The safest nursing response is to urgently evaluate for infection risk and obtain a CBC/ANC rather than offering routine “flu” self-care or delaying follow-up. Continuing the visit with same-day blood work aligns with clozapine monitoring requirements and allows timely decisions about holding medication and initiating treatment if neutropenia is present. Advising a week delay risks rapid progression to serious infection/sepsis, while directing straight to the hospital “at once” may be excessive without first arranging immediate evaluation unless the patient is unstable or severely ill.

Question 18

A nurse is caring for a client receiving a continuous morphine infusion who had a respiratory rate of 20/min 4 hr ago. Currently, the respiratory rate is 12/min. Which of the following is the appropriate nursing intervention?

Accepted Answer

Answer reason: A rate of 12/min is lower than baseline but not yet an emergency threshold in most adults, making titration down (per protocol/prescriber parameters) the safest immediate intervention while reassessing sedation and oxygenation. Naloxone is typically reserved for clinically significant opioid toxicity (e.g., markedly low RR, decreased level of consciousness, hypoxia), because it can abruptly reverse analgesia and precipitate withdrawal. Flushing the line risks delivering residual morphine and worsening respiratory depression, and elevating the head of bed is supportive but does not address the cause.

Question 19

The nurse is administering medications to a client who is being evaluated for a brain malignancy. The client is scheduled for a CT scan with IV iodinated contrast the next morning. Which medication should the nurse clarify with the health care provider?

Accepted Answer

Answer reason: For contrast studies, this medication is typically held at the time of the procedure (or before, per protocol) and restarted only after renal function is reassessed and stable (often ~48 hours). The nurse should clarify orders because continuing it without considering kidney function exposes the client to a preventable, high-risk adverse effect. The other listed medications do not carry this specific contrast-related lactic acidosis risk and are not routinely stopped solely due to iodinated contrast.

Question 20

A client diagnosed with chronic obstructive pulmonary disease (COPD) undergoes admission for an acute exacerbation. The nurse assesses a BP of 162/100 mm Hg, P 78 beats/min, R 30 breaths/min, and labored respiratory effort with wheezing. The nurse questions which prescribed medication?

Accepted Answer

Answer reason: Nonselective beta-blockers can precipitate or worsen bronchospasm by blocking beta-2 receptors in bronchial smooth muscle, which is unsafe in a client with COPD and active wheezing. In an acute exacerbation with tachypnea and labored breathing, avoiding medications that increase airway resistance is a priority. Anticholinergic bronchodilators like ipratropium are expected therapies to relieve bronchoconstriction. While theophylline requires monitoring for toxicity and drug interactions, it is not contraindicated solely by the provided vitals, whereas propranolol poses a direct respiratory risk.

Question 21

A nurse is reinforcing teaching about comfort measures with the parent of a 10-year-old child who has a viral infection. The nurse should plan to tell the parent that aspirin is contraindicated because of the risk for which of the following conditions?

Accepted Answer

Answer reason: This is the hallmark of Reye syndrome, which is why salicylates are generally avoided for fever/pain control in pediatric viral infections. The stem focuses on parent teaching and medication safety (contraindication based on adverse outcome), making this the most directly tested risk. The other options are not the classic aspirin-related viral illness complication in children.

Question 22

Prior to administering tissue plasminogen activator (t-PA), the nurse should assess the client for which contradiction to administering the drug?

Accepted Answer

Answer reason: A prior intracranial (cerebral) hemorrhage is a major/absolute contraindication because it predicts a high likelihood of catastrophic rebleeding in the brain. By contrast, older age and smoking increase vascular risk but do not by themselves prohibit use; they are weighed as risk factors rather than strict contraindications. Heart failure is not a primary contraindication to t-PA, although clinicians still monitor closely for bleeding and hemodynamic instability.

Question 23

The client has a prescription for a calcium carbonate compound to neutralize stomach acid. The nurse should assess the client for?

Accepted Answer

Answer reason: Therefore, monitoring bowel pattern and assessing for reduced stool frequency, straining, or hard stools is a key nursing consideration. Diarrhea is more typical with magnesium-containing antacids, making it a common distractor here. Electrolyte effects like hypomagnesemia or hyperphosphatemia are not the characteristic primary adverse effect expected with calcium carbonate used as an antacid.

Question 24

A client with a history of heart failure is due for a morning dose of furosemide. Which serum potassium level, if noted in the client's laboratory report, should be reported before administering the dose of furosemide?

Accepted Answer

Answer reason: Loop diuretics increase renal potassium excretion, so giving a dose when potassium is already low increases the risk of clinically significant hypokalemia. Hypokalemia predisposes to ventricular dysrhythmias and can worsen digoxin-related toxicity risk in many heart failure patients. A potassium of 3.2 mEq/L is below the typical lower limit of normal and warrants provider notification and likely potassium replacement before administering the medication. A value like 3.8 mEq/L is within normal range and would not usually require holding the dose solely for potassium concerns.

Question 25

A client with Addison’s disease was admitted to the medical ward due to nausea and vomiting for the last 72 hours. The client is prescribed intravenous glucocorticoids. Which nursing action is most appropriate?

Accepted Answer

Answer reason: Systemic glucocorticoids increase hepatic gluconeogenesis and reduce peripheral glucose uptake, so hyperglycemia is a key predictable adverse effect that requires monitoring. With IV administration, onset is rapid and clinically significant glucose changes can occur even in patients without diabetes, making point-of-care glucose checks an immediate safety priority. In a client with prolonged vomiting and physiologic stress, glycemic instability can worsen dehydration and contribute to complications. While electrolyte and fluid balance monitoring is important in Addison’s disease, the question links the nursing action specifically to starting IV glucocorticoids, which most directly mandates glucose surveillance.

Question 26

A male client is being prescribed nitrates to manage symptoms of heart failure. Which assessment finding made by the nurse is of greatest concern? Select one?

Accepted Answer

Answer reason: Nitrates are potent vasodilators that can cause significant decreases in blood pressure. When combined with phosphodiesterase-5 inhibitors commonly used for erectile dysfunction (e.g., sildenafil, tadalafil), the vasodilatory effects are synergistic, creating a high risk of profound hypotension, syncope, myocardial ischemia, and shock. This interaction is a key contraindication and requires immediate provider notification and medication reconciliation before giving nitrates. Hypertension, diabetes, and acetaminophen use do not create the same acute, life-threatening interaction risk as concurrent PDE-5 inhibitor therapy.

Question 27

An older adult is admitted to the hospital with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for?

Accepted Answer

Answer reason: Hypokalemia increases myocardial sensitivity to digoxin by reducing competition at the Na+/K+ ATPase, raising the risk of toxicity even at therapeutic serum levels. Early toxicity commonly presents with gastrointestinal symptoms such as anorexia, nausea, and vomiting, which fits the client’s week-long nausea and recent emesis. Older adults are particularly vulnerable due to altered pharmacokinetics and potential decreases in drug clearance. The priority assessment is therefore for toxicity manifestations, including dysrhythmias and neurologic/visual changes, rather than attributing symptoms primarily to worsening heart failure or acid–base disturbance.

Question 28

The nurse is caring for a client with bipolar disorder and has been prescribed carbamazepine. Which laboratory tests would need to be monitored for adverse effects?

Accepted Answer

Answer reason: Carbamazepine can cause serious hematologic toxicity, including leukopenia, agranulocytosis, aplastic anemia, and thrombocytopenia. Monitoring a CBC allows early detection of falling white blood cells, hemoglobin/hematocrit changes, or platelet suppression before infection or bleeding complications occur. This is a key nursing safety action when administering this medication for bipolar disorder. By contrast, urinalysis, cardiac enzymes, and lipid panels do not directly screen for the most clinically significant adverse effects of carbamazepine.

Question 29

Early sign of magnesium toxicity in PIH treatment is?

Accepted Answer

Answer reason: In PIH/preeclampsia management, nursing monitoring focuses on patellar reflexes, respiratory rate, and urine output because rising magnesium levels can progress to respiratory depression and cardiac conduction problems. Hypertension and hyperreflexia are typical preeclampsia findings prior to adequate magnesium effect rather than signs of toxicity. Increased urine output would lower magnesium levels, whereas oliguria increases toxicity risk due to reduced renal clearance.

Question 30

A 65-year-old patient with pneumonia is receiving garamycin (Gentamicin). It would be most important for a nurse to monitor which of the following laboratory values in this patient?

Accepted Answer

Answer reason: BUN and creatinine reflect kidney filtration and will rise with impaired renal function, helping detect toxicity early and guide dose adjustment, especially in older adults who are at higher risk. Other choices are not the primary safety labs for this drug: hemoglobin/hematocrit do not track aminoglycoside toxicity, and platelet/clotting studies are more relevant for anticoagulants. Sodium and potassium may be affected indirectly with renal failure but are less specific and not the key monitoring values for gentamicin toxicity.

Question 31

A client receiving magnesium sulfate has a drop in urinary output from 180 mL at 10 am to 140 mL at 11 am. What would be the priority nursing intervention?

Accepted Answer

Answer reason: Magnesium sulfate is renally excreted, so declining urine output raises concern for impaired clearance and rising serum magnesium levels. Elevated magnesium can rapidly depress neuromuscular and respiratory function, making toxicity prevention the immediate safety priority. The safest immediate nursing action is to discontinue the medication to prevent further accumulation while the client is assessed (e.g., respirations, reflexes, level of consciousness) and further orders are obtained. Waiting to reassess or only decreasing the rate allows continued drug delivery despite a potential early contraindication sign, and notifying the provider should follow after the infusion is stopped.

Question 32

A client with a history of cardiac disease is due for a morning dose of furosemide. Which serum potassium level, if noted in the client's laboratory report, should be reported before administering the dose of furosemide?

Accepted Answer

Answer reason: 3.2 mEq/L (3.2 mmol/L) Loop diuretics increase urinary potassium loss, so giving them when potassium is already low can precipitate clinically significant hypokalemia. In a client with cardiac disease, hypokalemia increases myocardial irritability and risk for dysrhythmias, especially if other proarrhythmic factors are present (e.g., digoxin therapy). A potassium of 3.2 mEq/L is below the typical normal range (~3.5–5.0) and should be reported/treated before administration. The other values listed are within normal limits and do not carry the same immediate safety risk when administering furosemide.

Question 33

A nurse is caring for a client to whom IV oxytocin (Pitocin) is given to stimulate contractions during labor. The nurse correctly identifies which of the following as a serious adverse effect of this medication?

Accepted Answer

Answer reason: Reduced urine output is an early and clinically important warning sign that excess free water is being retained. This is considered a serious adverse effect because progressing fluid overload and hyponatremia can precipitate neurologic complications (e.g., confusion, seizures) and respiratory compromise. The other options are not characteristic serious toxicities of oxytocin in labor compared with its well-known risk of water retention and related complications.

Question 34

A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding would the nurse instruct the student to report immediately?

Accepted Answer

Answer reason: A respiratory rate in the 8–10/min range indicates clinically significant respiratory depression that requires immediate nursing action (assessment, stimulation, provider notification, and preparedness for naloxone/airway support). The pain decrease reflects expected therapeutic effect of oxycodone rather than a complication. A heart rate of 90–100/min is within normal to mildly elevated range and is not as immediately life-threatening as hypoventilation.

Question 35

The nurse cares for a client who is two weeks post-chemotherapy and has a potassium level of 6.5 mEq/L. The nurse questions the health care provider (HCP) regarding which prescriptions?

Accepted Answer

Answer reason: Immediate hyperkalemia management uses insulin with dextrose to shift potassium into cells while preventing hypoglycemia. A large IV bolus of 20 units regular insulin is an unusually high dose for this indication and increases the risk of severe, prolonged hypoglycemia, especially in a potentially nutritionally depleted post-chemotherapy patient. Standard regimens more commonly use lower insulin doses given IV with dextrose and close glucose monitoring, so this order warrants clarification. In contrast, bicarbonate (particularly if acidosis is suspected) and potassium-binding resins can be appropriate adjuncts depending on the overall clinical picture and ECG findings.

Question 36

You received Patient post op when assessing the site of operation you found betadine and skin slightly red your action will be?

Accepted Answer

Answer reason: Promptly reporting and documenting the finding supports early evaluation and prevents further exposure that could worsen skin injury or progress to systemic symptoms. Simply treating it as normal risks missing an early allergic reaction and delays appropriate orders (e.g., alternative antiseptic, topical therapy). Applying soap/lotion is not a prescribed postoperative wound-care intervention and can contaminate or irritate the surgical site, and “mark and check” without escalation is insufficient for a possible reaction.

Question 37

The client who has been prescribed phenytoin for epilepsy calls the clinic and reports a measles- like rash. Which intervention should the nurse implement?

Accepted Answer

Answer reason: A new measles-like rash in a client taking an anticonvulsant can represent a potentially serious hypersensitivity reaction that requires prompt in-person assessment and possible discontinuation. Phenytoin is associated with severe cutaneous adverse reactions (e.g., Stevens-Johnson syndrome/TEN), where early symptoms may begin as a diffuse rash and can rapidly progress. Telling the client it is “common” or treating symptomatically with topical steroids risks delaying urgent evaluation and increasing harm. Grapefruit juice interactions are not the priority when a possible severe drug reaction is reported.

Question 38

The patient taking lithium for bipolar disorder is experiencing vomiting, diarrhea, and blurred vision. Their lithium level is 2.5 mEq/L(0.6 - 1.2 mEq/L). The nurse suspects which finding is occurring?

Accepted Answer

Answer reason: Lithium has a narrow therapeutic index, and levels above the typical therapeutic range are associated with toxicity. A serum level of 2.5 mEq/L is markedly elevated compared with the stated range and aligns with symptomatic toxicity. Early-to-moderate toxicity commonly causes GI upset (nausea/vomiting/diarrhea) and neurologic/visual symptoms such as blurred vision, with risk of progression to severe CNS effects if untreated. An allergic reaction would be more consistent with rash, pruritus, bronchospasm, or angioedema rather than a toxic serum concentration with GI/CNS findings. The level is clearly not low and the symptoms are not expected “normal” effects at therapeutic dosing.

Question 39

The nurse is preparing to administer prescribed niacin to an assigned client. Which of the following findings would be a priority to follow up before administering the medication?

Accepted Answer

Answer reason: Yellowing of the sclera suggests jaundice from elevated bilirubin and possible significant hepatic dysfunction, which requires holding the medication and notifying the provider or obtaining liver function tests per protocol. Headache and pruritus are commonly related to niacin-induced flushing and are usually manageable with dosing strategies rather than urgent withholding. Postural hypotension can occur but is typically less immediately concerning than signs of acute liver injury unless severe or symptomatic.

Question 40

The RN is preparing to administer drugs to a group of patients with gastrointestinal disorders. Which drug is most important to discuss with the health care provider before administration?

Accepted Answer

Answer reason: Diphenoxylate is an opioid antidiarrheal that decreases intestinal motility, so giving it to a constipated patient can worsen bowel hypomotility and increase risk for ileus or obstruction, requiring clarification before administration. The atropine component is added to deter abuse and can further reduce GI motility and cause anticholinergic adverse effects, compounding the risk. In contrast, the other pairings are generally appropriate: PPIs for PUD, H2 blockers for GERD, and ondansetron for chemotherapy-induced nausea when ordered and monitored.

Question 41

Before administering Metholtrexate (Trexall) orally to the client with cancer, the nurse should check the?

Accepted Answer

Answer reason: Checking electrolytes before dosing helps identify patients at risk for dysrhythmias, seizures, and acute kidney injury who may need prophylaxis (hydration/allopurinol/rasburicase) or a delay in treatment. Oral administration makes an IV-site assessment irrelevant, and blood gases are not routine prechecks for this medication. While vital signs are important general assessments, they are less specific than electrolyte monitoring for anticipated high-risk complications in oncology treatment.

Question 42

A client with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. Which blood test trend is most important for the nurse to review when preparing to administer this medication?

Accepted Answer

Answer reason: Serum creatinine reflects glomerular filtration and rising values signal declining clearance, prompting dose adjustment or holding therapy per protocol. After several days of therapy, nephrotoxicity can emerge, making trend review more safety-critical than infection response markers. Blood cultures and WBC trends help evaluate treatment effectiveness, but they do not directly determine whether giving the next dose is safe. Magnesium is not a primary monitoring parameter for vancomycin toxicity.

Question 43

A woman admitted to the hospital in premature labor has been treated successfully. The client is to be sent home on an oral regimen of terbutaline. Which of the following statements by the client indicates to the nurse that the client understands the discharge teaching about the medication?

Accepted Answer

Answer reason: " Terbutaline is a beta-adrenergic agonist used as a tocolytic, and beta stimulation commonly causes maternal tachycardia and skeletal muscle tremors. A client who anticipates these expected effects demonstrates accurate medication teaching and can better recognize when symptoms are within expected limits versus concerning. The statement about being sure she will not deliver prematurely is incorrect because tocolytics reduce contractions but do not guarantee prevention of preterm birth. Bed rest is not required for the drug to “work,” and fetal movement counting is general pregnancy surveillance rather than a key teaching point specific to terbutaline’s effects.

Question 44

A nurse on the behavioral health unit is reviewing medication prescriptions for 4 clients. Which combination of medications does the nurse question?

Accepted Answer

Answer reason: Selegiline is an MAOI (at antidepressant doses), and escitalopram is an SSRI, so this pairing represents a high-risk drug interaction that should be questioned before administration. The safer approach is to ensure an appropriate washout period between these classes when switching therapies. By contrast, an SSRI with a short-term benzodiazepine can be used for anxiety while the SSRI takes effect, with sedation monitoring. Risperidone with lithium is a common bipolar regimen, though it still requires monitoring for toxicity and adverse effects.

Question 45

The nurse is caring for a client with hypokalemia scheduled to receive the prescribed 20 mEq of intravenous (IV) potassium. Which client assessment requires notification of the primary healthcare provider (PHCP)?

Accepted Answer

Answer reason: IV potassium is contraindicated or must be used with extreme caution when urine output is low because impaired renal excretion can rapidly cause hyperkalemia and life-threatening dysrhythmias. Oliguria suggests reduced kidney perfusion/function, so the infusion should be held and the prescriber notified to reassess renal status and replacement plan. The other findings are consistent with hypokalemia itself and do not specifically signal a dangerous inability to clear administered potassium. The key safety issue is preventing iatrogenic potassium accumulation before giving IV replacement.

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