Question 1

The physician has ordered daily high doses of aspirin for a client with rheumatoid arthritis. The nurse instructs the client to discontinue the medication and contact the physician if which of the following symptoms occurs?

Accepted Answer

Answer reason: Ringing in the ears (tinnitus) is an early sign of salicylate toxicity from high-dose aspirin. This indicates potentially harmful serum levels and requires the client to stop the medication and notify the physician immediately.

Question 2

What is the antidote used for toxicity produced by an overdose of magnesium sulfate?

Accepted Answer

Answer reason: Calcium gluconate is the antidote for magnesium sulfate toxicity because it counteracts the neuromuscular and cardiac depressant effects of excess magnesium, rapidly restoring normal muscle and cardiac function.

Question 3

What is the treatment for magnesium sulfate toxicity in eclampsia?

Accepted Answer

Answer reason: Calcium gluconate reverses the life-threatening neuromuscular and cardiac depression caused by magnesium sulfate toxicity, making it the immediate treatment of choice in eclampsia.

Question 4

A client with a history of hypertension is prescribed lisinopril. Which potential side effect should the nurse instruct the client to report?

Accepted Answer

Answer reason: ACE inhibitors (e.g., lisinopril) commonly cause a persistent dry cough due to bradykinin accumulation.

Question 5

A client has been prescribed morphine sulfate for pain. What is the primary nursing consideration during morphine sulfate therapy?

Accepted Answer

Answer reason: Morphine is an opioid that can cause dose-dependent respiratory depression; the priority nursing action is to monitor respiratory rate and depth and to hold the dose if respirations are depressed.

Question 6

When teaching a client with tuberculosis who is taking INH about follow-up home care, the nurse should emphasize that a laboratory appointment for which of the following tests is critical?

Accepted Answer

Answer reason: Isoniazid (INH) can cause hepatocellular injury and hepatitis; therefore, regular liver function tests are critical.

Question 7

The physician has ordered intravenous fluids with potassium for a client admitted with gastroenteritis and dehydration. Before adding potassium to the intravenous fluids, the nurse should?

Accepted Answer

Answer reason: IV potassium is contraindicated in patients with poor renal function; verify adequate urine output (e.g., >30 mL/hr) to prevent dangerous hyperkalemia.

Question 8

The client is experiencing symptoms of tardive dyskinesia. The nurse would expect to see?

Accepted Answer

Answer reason: Tardive dyskinesia is characterized by involuntary orofacial movements such as tongue protrusion, rapid tongue movements, lip smacking, and chewing motions. This best matches rapid tongue movements.

Question 9

Which statement is true regarding oxygen administration for a client with chronic obstructive pulmonary disease (COPD) experiencing dyspnea and low PaO2?

Accepted Answer

Answer reason: COPD patients partly rely on the hypoxic drive to breathe; administering high concentrations of oxygen can suppress this drive, leading to hypoventilation and CO2 retention. The other statements are false.

Question 10

Which of the following drugs should be avoided in patients with diabetes?

Accepted Answer

Answer reason: Nonselective beta-blockers like propranolol can mask hypoglycemia symptoms and inhibit glycogenolysis, increasing the risk and complicating diabetes management; therefore, they should be avoided in diabetic patients.

Question 11

A client with a history of chronic obstructive pulmonary disease (COPD) has been prescribed oxygen therapy. What nursing intervention is important to prevent oxygen toxicity?

Accepted Answer

Answer reason: To prevent oxygen toxicity, oxygen must be titrated to the lowest effective dose and adjusted strictly according to prescription and monitoring parameters. Continuous or unnecessary high-flow oxygen increases risk; device choice or deep breathing alone does not prevent toxicity.

Question 12

The physician has prescribed Chloromycetin (chloramphenicol) for a client with bacterial meningitis. Which laboratory report should the nurse monitor most carefully?

Accepted Answer

Answer reason: Chloramphenicol can cause serious bone marrow suppression and aplastic anemia. The priority is monitoring for hematologic toxicity via a complete blood count.

Question 13

Aminoglycosides have the following unwanted effects?

Accepted Answer

Answer reason: Aminoglycosides such as gentamicin are associated with damage to the kidneys and the inner ear.

Question 14

The dose-related adverse effect of ethosuximide is?

Accepted Answer

Answer reason: Ethosuximide commonly causes dose-related GI upset (pain, nausea, vomiting), transient lethargy/fatigue, and can worsen concomitant generalized tonic–clonic (grand mal) seizures; therefore, all listed effects apply.

Question 15

A newly admitted client has been diagnosed with depression. She complains of "twitching muscles" and a "racing heart," and states she stopped taking Zoloft a few days ago because it was not helping her depression. Instead, she began taking her husband's Parnate. The nurse should immediately assess for?

Accepted Answer

Answer reason: Switching from sertraline (an SSRI) to tranylcypromine (Parnate), an MAOI, without a washout risks serotonin syndrome. Early findings include mental status changes (agitation, confusion), along with autonomic hyperactivity and neuromuscular twitching. Therefore, immediate assessment for mental status changes is a priority.

Question 16

A client with paranoid schizophrenia has an order for Thorazine (chlorpromazine) 400 mg orally twice daily. Which of the following symptoms should be reported to the physician immediately?

Accepted Answer

Answer reason: Chlorpromazine can cause agranulocytosis. Fever, sore throat, and weakness suggest infection or neutropenia and require immediate provider notification. The other options list common, less urgent side effects (anticholinergic effects, sedation, photosensitivity).

Question 17

What is the most common side effect of lamotrigine?

Accepted Answer

Answer reason: Lamotrigine commonly causes a rash, with a risk of serious reactions like Stevens–Johnson syndrome. Weight gain, tremors, and neutropenia are not common effects.

Question 18

Which medication prescription should the nurse question for a client with type 2 diabetes mellitus?

Accepted Answer

Answer reason: Prednisone is a glucocorticoid that increases blood glucose and can precipitate hyperglycemia; its use should be questioned in a client with type 2 diabetes. Metformin, glipizide, and sitagliptin are antidiabetic agents.

Question 19

Which of the following is a complication of tocolytic agents?

Accepted Answer

Answer reason: Tocolytics—especially beta-agonists like terbutaline—can cause maternal cardiovascular and pulmonary complications, notably pulmonary edema. Uterine rupture and hyperstimulation are linked to uterotonics, not tocolytics.

Question 20

What is the reason for stopping the injection of Ceftriaxone and Sulbactam?

Accepted Answer

Answer reason: Active bleeding indicates a serious adverse effect and a contraindication to continuing ceftriaxone–sulbactam, and warrants stopping the medication and notifying the provider. The other options are not valid reasons to stop therapy.

Question 21

A client has been prescribed hydrochlorothiazide for hypertension. What dietary education should the nurse provide regarding hydrochlorothiazide?

Accepted Answer

Answer reason: Hydrochlorothiazide is a thiazide diuretic that can cause loss of potassium and magnesium. Patients should not avoid potassium; instead, increasing intake of magnesium-rich foods helps prevent hypomagnesemia, making magnesium-focused dietary teaching the best choice among the options provided.

Question 22

The nurse is assessing a client who is on long-term glucocorticoid therapy. Which of the following findings would the nurse expect?

Accepted Answer

Answer reason: Chronic glucocorticoid use can cause iatrogenic Cushing syndrome with abnormal fat distribution, including a dorsocervical fat pad (buffalo hump) and truncal obesity. It does not increase muscle mass; instead, it causes muscle wasting. Jaundice and significant peripheral edema are not expected to be hallmark findings.

Question 23

The nurse is performing discharge teaching for a client who is on isoniazid (INH). Which diet selection would let the nurse know that the teaching has been ineffective?

Accepted Answer

Answer reason: Isoniazid can interact with tyramine-rich foods, potentially causing headache and hypertension. Cured and aged meats like ham are high in tyramine, indicating ineffective teaching. The other choices are acceptable.

Question 24

A client is admitted to the surgical unit following a transurethral prostatectomy (TURP). The nurse administers a B&O suppository to help prevent bladder spasms. The nurse would observe the client for?

Accepted Answer

Answer reason: B&O (belladonna and opium) suppositories combine an anticholinergic with an opioid. Common adverse effects include sedation and gastrointestinal upset, such as nausea and vomiting. Diarrhea is unlikely (opioids cause constipation); insomnia or hyperactivity is not typical, and dependence is not an immediate concern after a single dose.

Question 25

All of the following drugs are used in the treatment of severe congestive heart failure, except?

Accepted Answer

Answer reason: Verapamil (a non-dihydropyridine calcium channel blocker) has negative inotropic effects and is contraindicated in severe heart failure, whereas digoxin, dobutamine, and dopamine are positive inotropes used in acute decompensated heart failure.

Question 26

Which of the following symptoms contraindicate the use of haloperidol (Haldol) and warrant withholding the dose?

Accepted Answer

Answer reason: Severe depression is a contraindication to haloperidol, and a rash or blood dyscrasia is a serious adverse reaction; its presence warrants withholding the dose and notifying the provider.

Question 27

Prior to administering tPA (alteplase) to a client admitted for a cerebrovascular accident (CVA), it is critical that the nurse assess?

Accepted Answer

Answer reason: Before thrombolytic therapy with tPA, coagulation studies (PT/PTT/INR) must be checked to rule out bleeding risk and contraindications. Other assessments are important but are not the critical prerequisite.

Question 28

A child is treated with calcium disodium edetate (calcium EDTA) for lead poisoning. Which of the following must the nurse assess first?

Accepted Answer

Answer reason: Calcium disodium EDTA is nephrotoxic; the priority assessment is to monitor renal function by measuring urine output.

Question 29

The nurse is assessing a client who has been taking Haldol (haloperidol) for several months. Which of the following is a side effect of this medication and must be reported immediately to the physician?

Accepted Answer

Answer reason: Haloperidol can cause acute dystonia (an extrapyramidal reaction), which may threaten the airway and requires immediate reporting and treatment with anticholinergics.

Question 30

Which of the following lab studies should be performed periodically if the client is taking warfarin sodium (Coumadin)?

Accepted Answer

Answer reason: Warfarin increases risk of bleeding; periodic fecal occult blood testing helps detect occult GI bleeding. WBC and glucose are unrelated, and erythrocyte count is less sensitive and nonspecific for occult bleeding.

Question 31

The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimer's disease. Which side effect is most often associated with this drug?

Accepted Answer

Answer reason: Rivastigmine is a cholinesterase inhibitor. The most common adverse effects are gastrointestinal, particularly nausea and vomiting.

Question 32

A client is being discharged on Coumadin after hospitalization for a deep vein thrombosis. Which food would the nurse recognize should be restricted while the client is on this medication?

Accepted Answer

Answer reason: Warfarin’s effect is reduced by foods high in vitamin K. Leafy greens, like lettuce, are rich in vitamin K and should be limited or kept consistent, unlike apples, potatoes, or macaroni.

Question 33

A patient prescribed oral cyclosporine should be advised to avoid?

Accepted Answer

Answer reason: Grapefruit juice inhibits CYP3A4, increasing cyclosporine levels and the risk of toxicity (e.g., nephrotoxicity).

Question 34

A patient's potassium is 6.2. Their renal function is normal. You are reviewing their home medications. Which of the following would be least likely to cause a potassium of 6.2?

Accepted Answer

Answer reason: HCTZ (a thiazide diuretic) tends to lower serum potassium, causing hypokalemia. Spironolactone is potassium-sparing, and ACE inhibitors (lisinopril) and ARBs (losartan) can increase potassium, making them more likely causes of hyperkalemia.

Question 35

Which medication on the client's list requires follow-up with the primary healthcare provider when the client is newly prescribed warfarin?

Accepted Answer

Answer reason: Saw palmetto has antiplatelet and anticoagulant effects and can potentiate warfarin, increasing bleeding risk; it requires provider follow-up. The other listed drugs have minimal interaction with warfarin.

Question 36

Which of the following medications is least likely to have anticholinergic effects?

Accepted Answer

Answer reason: Atropine and scopolamine are antimuscarinics, and diphenhydramine has strong anticholinergic properties. Metoclopramide is a dopamine antagonist prokinetic with minimal or no anticholinergic effect, making it the least likely.

Question 37

A client is prescribed amitriptyline for depression. What is the primary nursing consideration during amitriptyline therapy?

Accepted Answer

Answer reason: Amitriptyline is a tricyclic antidepressant with prominent anticholinergic adverse effects (dry mouth, constipation, urinary retention, blurred vision, tachycardia). Monitoring and teaching about these effects are the primary nursing considerations.

Question 38

A patient has taken a drug due to which he is developing deafness. Identify that drug from the following?

Accepted Answer

Answer reason: Ototoxicity, leading to hearing problems, is classically linked to some antibiotics. Among the listed options, Ketoconazole (a tetracycline) can cause vestibular or ototoxic adverse effects, whereas ketoconazole and 5-fluorouracil are not associated with deafness.

Question 39

A hypertensive client is started on atenolol (Tenormin). The nurse instructs the client to report immediately?

Accepted Answer

Answer reason: Atenolol is a beta blocker that can cause bradycardia. A slow, bounding pulse indicates potentially dangerous bradycardia and should be reported immediately.

Question 40

Which laboratory test result should the nurse monitor in a client receiving fondaparinux?

Accepted Answer

Answer reason: Fondaparinux is renally eliminated and does not require routine PT/INR or aPTT monitoring. Renal function should be monitored. Check serum creatinine.

Question 41

Which sign should the nurse monitor in a patient receiving an osmotic diuretic that indicates a risk for dehydration?

Accepted Answer

Answer reason: Osmotic diuretics promote diuresis and can cause fluid loss. A key sign of dehydration is dry mucous membranes. The other options indicate fluid overload, not dehydration.

Question 42

A client is prescribed simvastatin for hypercholesterolemia. What laboratory value should the nurse monitor closely during simvastatin therapy?

Accepted Answer

Answer reason: Statins, including simvastatin, can cause hepatotoxicity. The nurse should monitor liver enzymes (AST and ALT) to detect liver injury during therapy.

Question 43

A client is prescribed enalapril for hypertension. What education should the nurse provide regarding enalapril?

Accepted Answer

Answer reason: ACE inhibitors, like enalapril, commonly cause a persistent dry cough due to bradykinin accumulation and should be reported. Potassium should not be increased because of the risk of hyperkalemia; it does not need to be taken with food; blood pressure reduction is not immediate.

Question 44

The most common dose-related adverse effects of carbamazepine are?

Accepted Answer

Answer reason: Carbamazepine's common dose-related toxicities are neurologic (diplopia, ataxia) and gastrointestinal upset (nausea). Gingival hyperplasia and hirsutism are associated with phenytoin; sedation and dependence are typical of barbiturates and benzodiazepines; hemeralopia and myasthenic syndrome are not characteristic.

Question 45

A nurse is caring for a client who is receiving methyldopa hydrochloride (Aldomet) intravenously. Which of the following assessment findings would indicate to the nurse that the client may be having an adverse reaction to the medication?

Accepted Answer

Answer reason: Methyldopa is a central alpha-2 agonist with CNS adverse effects, such as sedation, depression, and mood changes. These mental status alterations signal an adverse reaction. Hyperkalemia and palpitations are not characteristic adverse effects of methyldopa, and headache is nonspecific.

Question 46

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: Calcium carbonate antacids commonly cause constipation and can lead to hypercalcemia or kidney stones. They do not cause diarrhea (magnesium salts do), and are not associated with hyperphosphatemia or hypomagnesemia.

Question 47

A client with hyperthyroidism is taking lithium carbonate to inhibit the release of thyroid hormone. Which complaint by the client should alert the nurse to a problem with the client's medication?

Accepted Answer

Answer reason: Lithium can cause nephrogenic diabetes insipidus, leading to polyuria and polydipsia. Increased thirst and urination signal a medication-related problem requiring evaluation.

Question 48

Which supplemental medication is most frequently ordered with furosemide (Lasix)?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that increases urinary potassium loss, risking hypokalemia; potassium supplementation is commonly prescribed to prevent this.

Question 49

Which laboratory tests should the client receive before prophylactic drug therapy for tuberculosis is started?

Accepted Answer

Answer reason: Tuberculosis prophylaxis commonly includes isoniazid (INH) (and sometimes rifampin). INH is associated with hepatotoxicity (asymptomatic transaminase elevation to clinical hepatitis). Baseline liver enzymes (AST/ALT) are needed before therapy to identify pre-existing liver disease and to provide a comparison if symptoms of hepatitis develop (e.g., fatigue, anorexia, nausea, dark urine, jaundice, right upper quadrant pain). Serum creatinine/BUN are not the primary baseline tests for INH prophylaxis, and CBC/hematocrit do not monitor the major serious toxicity of INH. Potassium monitoring is not relevant to TB prophylactic therapy.

Question 50

A client with AIDS who is receiving antiretroviral therapy tells the nurse he regularly takes echinacea to boost his immune system. The nurse should tell the client:

Accepted Answer

Answer reason: Echinacea and other herbal supplements can interact with antiretroviral medications by altering drug metabolism and effectiveness. There is no evidence that these supplements prolong life, decrease viral load, or prevent viral replication in clients with HIV/AIDS. Because interference with prescribed antiretroviral therapy can reduce treatment effectiveness, clients should be advised accordingly.

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