Question 1

The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication?

Accepted Answer

Answer reason: Decongestants. Decongestants (especially alpha-adrenergic agonists like pseudoephedrine or phenylephrine) can increase urethral sphincter tone and worsen bladder outlet obstruction, precipitating acute urinary retention in clients with BPH. A cold plus inability to void in a client with BPH should prompt screening for OTC cold products containing these agents. The other options are not classic triggers of acute urinary retention in BPH compared with sympathomimetic decongestants.
Category reason: This question requires nursing judgment about a medication class that can worsen a pre-existing condition (BPH) and cause an adverse effect (urinary retention), which aligns with adverse effects/contraindications in medication therapy.

Question 2

A client with cancer is receiving intravenous morphine sulfate for pain. When writing the plan of care for this client, the nurse should include which action as the priority action?

Accepted Answer

Answer reason: Monitor respiratory status. IV morphine is an opioid that can cause dose-dependent respiratory depression, which is the most immediate life-threatening adverse effect and therefore the priority to monitor (ABCs). Early signs include decreased respiratory rate, decreased depth, rising CO2/sedation, and falling oxygen saturation. Temperature, urine output, and fluids are relevant supportive assessments, but they do not supersede airway and breathing safety in a client receiving IV opioids.
Category reason: This is a nursing prioritization question focused on monitoring for a high-risk adverse effect of an IV medication (opioid), which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 3

A patient taking amlodipine (Norvasc) reports ankle swelling and flushing. Which nursing explanation is most accurate?

Accepted Answer

Answer reason: These are expected effects from peripheral vasodilation. Amlodipine is a dihydropyridine calcium channel blocker that causes arteriolar vasodilation, leading to common adverse effects such as flushing and peripheral (ankle) edema. The edema is due to increased capillary hydrostatic pressure from precapillary dilation (fluid shifts into interstitial space), not sodium-driven fluid retention. Dehydration is not suggested by these symptoms, and while edema can occur in heart failure, the classic medication-related pattern with flushing strongly supports expected CCB vasodilation effects.
Category reason: This is a medication-adverse-effect recognition and patient teaching question about a calcium channel blocker, which aligns with nursing pharmacologic management and contraindication/adverse effect knowledge.

Question 4

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

Accepted Answer

Answer reason: Client take indomethacin for osteoporosis Apixaban is a direct oral anticoagulant, and combining it with an NSAID like indomethacin increases bleeding risk due to additive effects on hemostasis and GI mucosal injury. This drug interaction is a key discharge safety concern because it can lead to serious hemorrhage. The other findings are not inherently dangerous with apixaban: a vegetarian diet is not a major issue for apixaban (unlike warfarin), chronic atrial fibrillation is an indication for anticoagulation, and a platelet count of 200,000/µL is normal.
Category reason: This item tests safe medication use by identifying a clinically significant contraindication/interaction (apixaban plus NSAID) requiring nursing judgment and patient teaching at discharge, fitting Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 5

The nurse is caring for a client with chronic back pain. Codeine has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication?

Accepted Answer

Answer reason: B. Monitor bowel activity. Codeine is an opioid analgesic that commonly causes decreased gastrointestinal motility leading to constipation. Nursing care should include monitoring bowel function and implementing prevention measures (e.g., fluids, fiber as appropriate, stool softener/laxative per orders). Pulse monitoring is not a primary intervention specific to codeine unless there are additional cardiovascular concerns; opioid monitoring is more focused on respiratory depression, sedation, and constipation.
Category reason: This is a medication-specific nursing intervention question focused on monitoring for an adverse effect of an opioid analgesic, which fits Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 6

A client with heart failure is prescribed spironolactone (Aldactone). Which electrolyte imbalance should the nurse monitor closely in this client?

Accepted Answer

Answer reason: Hypokalemia Spironolactone is a potassium-sparing diuretic (aldosterone antagonist), so the key electrolyte risk is hyperkalemia; potassium must be monitored closely to prevent dysrhythmias. None of the listed options include hyperkalemia, making the provided correct choice inconsistent with standard pharmacology. Given the forced single-best selection from the displayed options, Hypokalemia is the closest potassium-related option, but it is not the true adverse effect to monitor for with spironolactone.
Category reason: This item tests nursing monitoring for a medication’s electrolyte adverse effects in a heart failure client, which is a pharmacological safety/contraindication judgment under NCLEX Pharmacological and Parenteral Therapies.

Question 7

The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data?

Accepted Answer

Answer reason: B. The white blood cell counts and platelet counts. Etanercept (a TNF-alpha inhibitor) can cause immunosuppression and bone marrow suppression, increasing the risk of serious infection and cytopenias. Monitoring CBC parameters such as WBCs (infection risk) and platelets is a priority safety assessment during therapy. Injection-site reactions and symptom reports are relevant but are less critical than detecting potentially dangerous hematologic suppression early.
Category reason: This is a medication-administration safety question focused on monitoring for serious adverse effects of etanercept, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 8

A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140 mcmol/L). Which finding would be expected as a result of this laboratory result?

Accepted Answer

Answer reason: Slurred speech. A phenytoin level of 35 mcg/mL is above the typical therapeutic range (~10–20 mcg/mL) and indicates toxicity. Expected toxicity findings are primarily CNS-related, including nystagmus, ataxia, dizziness, and slurred speech. Hypotension is more associated with rapid IV administration rather than an elevated maintenance serum level, and “no abnormal finding” is inconsistent with a toxic level.
Category reason: This is a medication-safety question requiring recognition of an abnormal drug level and expected adverse effects, which aligns with NCLEX Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 9

The nurse is preparing to administer furosemide (Lasix) to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to review before administering this medication?

Accepted Answer

Answer reason: A. Potassium level. Furosemide is a loop diuretic that can cause significant potassium wasting, putting the client at risk for hypokalemia and dysrhythmias, which is especially critical in heart failure. Reviewing potassium helps prevent dangerous complications and guides whether potassium replacement or holding the dose is needed. Renal function tests (BUN/creatinine) are also relevant for diuretic safety and dosing, but potassium is the most immediate electrolyte risk directly worsened by furosemide. Cholesterol is not pertinent to acute administration safety.
Category reason: This is a medication-administration safety question requiring nursing judgment about which lab to check to prevent an adverse drug effect, fitting NCLEX Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 10

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints?

Accepted Answer

Answer reason: The client is experiencing a pulmonary reaction requiring cessation of the medication. Nitrofurantoin can cause an acute pulmonary hypersensitivity reaction characterized by fever, chills, cough, and dyspnea. These are not expected therapeutic effects and warrant immediate discontinuation of the drug and prompt evaluation. While anaphylaxis can cause respiratory distress, it typically presents with rapid onset wheezing/bronchospasm, hypotension, and often urticaria/angioedema rather than the classic nitrofurantoin pulmonary syndrome.
Category reason: This item tests nursing recognition of a serious adverse drug reaction and the appropriate interpretation/action (stop medication and seek evaluation), which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 11

The nurse is describing the medication side and adverse effects to a client who is taking oxazepam. Which information should the nurse incorporate in the discussion?

Accepted Answer

Answer reason: Increase fluids and bulk in the diet. Oxazepam (a benzodiazepine) can cause constipation as a side effect, and nonpharmacologic management includes increasing fluids and dietary fiber/bulk. A low-fiber diet would worsen constipation. Palpitations/tachycardia and diarrhea are not common expected effects for which routine client teaching would focus, and self-treating diarrhea with antidiarrheals is not appropriate without assessment of the cause.
Category reason: This is a medication-teaching question focused on expected side/adverse effects and appropriate nursing guidance for managing them, which aligns with Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 12

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

Accepted Answer

Answer reason: Protamine sulfate Protamine sulfate is the specific antidote used to reverse the anticoagulant effects of unfractionated heparin, so it must be readily available when initiating IV heparin due to bleeding risk. Vitamin K reverses warfarin, not heparin. Aminocaproic acid is an antifibrinolytic used for certain bleeding states (e.g., after thrombolytic therapy) but is not the standard reversal agent for heparin. Potassium chloride is unrelated to heparin reversal and could be dangerous if given inappropriately.
Category reason: This item tests nursing medication safety and preparedness for managing a high-risk IV anticoagulant, specifically knowing the reversal agent for heparin therapy, which fits Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 13

A client is scheduled for discharge and will be taking phenobarbital for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety?

Accepted Answer

Answer reason: D. Avoid drinking alcohol while taking this medication. Phenobarbital is a barbiturate that causes CNS depression, and alcohol can additively increase sedation and respiratory depression, creating an immediate safety risk (falls, impaired driving, overdose). Teaching to avoid alcohol directly prevents dangerous drug–substance interactions and potential life-threatening complications. The other options support adherence or tolerability but are less urgent than preventing severe CNS/respiratory depression.
Category reason: This item tests safe medication teaching about a contraindicated interaction (alcohol with phenobarbital) to prevent adverse effects, which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 14

Which of the following foods should a client taking warfarin (Coumadin) avoid due to potential drug interaction?

Accepted Answer

Answer reason: Spinach and kale Spinach and kale are high in vitamin K, which antagonizes warfarin’s anticoagulant effect and can lower the INR, increasing the risk of clot formation. Patients on warfarin should avoid sudden increases in vitamin K intake and keep vitamin K consumption consistent. The other listed foods are not major sources of vitamin K and are less likely to significantly affect warfarin activity.
Category reason: This question tests nursing medication safety teaching about food–drug interactions with warfarin, which fits Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 15

A nurse is teaching a parent about home care for a child with acute gastroenteritis and dehydration. Which statement by the parent indicates a need for further teaching?

Accepted Answer

Answer reason: "I will give loperamide (Imodium) to stop the diarrhea." Antidiarrheal agents like loperamide are generally not recommended for children with acute infectious gastroenteritis because they can mask worsening illness and may increase risk of complications (e.g., ileus, toxic megacolon) in certain infections. The priority home care is preventing and treating dehydration with oral rehydration solution given in small, frequent amounts. Avoiding sugary drinks and continuing breastfeeding are appropriate supportive measures.
Category reason: This is a patient-care teaching scenario focused on safe medication use and identifying a contraindicated/unsafe caregiver action, which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 16

Pharmacology A nurse would expect which of the following findings in a patient experiencing acute alcohol withdrawal?

Accepted Answer

Answer reason: Hand Tremors Acute alcohol withdrawal causes CNS hyperexcitability due to loss of alcohol’s chronic GABAergic depressant effect, leading to autonomic overactivity. Common early findings include tremors, anxiety, diaphoresis, tachycardia, hypertension, and possible seizures. Slurred speech is more consistent with acute alcohol intoxication, and hypotension is not typical because withdrawal generally increases sympathetic tone.
Category reason: This item tests recognition of clinical manifestations of a substance-related condition and the nurse’s assessment expectations/safety implications, fitting NCLEX-style patient care judgment rather than basic science alone.

Question 17

A nurse is administering terbutaline to a client at 31 weeks in preterm labor. Which finding is an adverse effect?

Accepted Answer

Answer reason: Tachycardia Terbutaline is a beta-2 adrenergic agonist used as a tocolytic, and it commonly causes maternal cardiovascular stimulation, including tachycardia and palpitations. This occurs due to some beta-1 activity and reflex responses to vasodilation. Clinically, rising maternal heart rate is a key adverse effect that requires close monitoring and may necessitate dose adjustment or discontinuation.
Category reason: This question tests recognition of a medication adverse effect and nursing monitoring while administering a tocolytic, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 18

The client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs?

Accepted Answer

Answer reason: Atropine sulfate. A cholinergic crisis from pyridostigmine overdose causes excessive muscarinic stimulation (e.g., bradycardia, bronchorrhea/bronchospasm, increased secretions, diarrhea). Atropine is an antimuscarinic antidote that counteracts these life-threatening muscarinic effects and is used in acute management. Vitamin K reverses warfarin, acetylcysteine treats acetaminophen toxicity, and protamine reverses heparin, so they do not treat cholinergic crisis.
Category reason: This item tests nursing judgment about recognizing and preparing to treat an adverse medication effect/overdose (cholinergic crisis) and selecting the appropriate antidote, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 19

True or False: Vancomycin trough levels must be monitored to prevent nephrotoxicity.

Accepted Answer

Answer reason: True Vancomycin can cause nephrotoxicity, and higher drug exposure increases risk, especially with prolonged therapy or concurrent nephrotoxic agents. Monitoring trough concentrations (or more modern AUC-guided monitoring) helps ensure therapeutic levels while limiting excessive exposure. This monitoring is particularly important in patients with renal impairment, unstable kidney function, or serious MRSA infections requiring higher targets.
Category reason: This item tests safe medication management by monitoring drug levels to prevent an adverse effect (nephrotoxicity), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 20

A nurse is preparing to administer subcutaneous terbutaline (Brethine) to a patient experiencing preterm labor. Which of the following findings would require the nurse to withhold the medication and notify the healthcare provider?

Accepted Answer

Answer reason: Maternal heart rate of 130 beats/min Terbutaline is a beta-adrenergic agonist used as a tocolytic and commonly causes maternal tachycardia and palpitations. A maternal HR of 130 beats/min is significant tachycardia and increases risk for dysrhythmias and other cardiovascular complications, so the dose should be held and the provider notified. The other findings are expected/acceptable: BP 110/70 is normal, fetal HR 140 is within normal baseline range, and uterine contractions are the indication for tocolysis.
Category reason: This is a medication-administration safety question requiring nursing judgment about withholding terbutaline due to an adverse effect/contraindication (maternal tachycardia), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 21

A patient with a history of anaphylaxis to penicillin should avoid cephalosporins.?

Accepted Answer

Answer reason: True Because penicillins and cephalosporins both contain a beta-lactam ring, there is a clinically important risk of cross-reactive immediate hypersensitivity in some patients. A prior anaphylactic reaction indicates an IgE-mediated allergy with potential for life-threatening recurrence, so the safest approach is to avoid related beta-lactams unless a specialist evaluation (e.g., allergy testing/graded challenge) supports use. In routine nursing practice and exam scenarios, this history is treated as a contraindication and should prompt use of non–beta-lactam alternatives and clear allergy documentation.
Category reason: This item tests medication safety by identifying a contraindication/cross-allergy risk when administering antibiotics, which is nursing pharmacologic judgment rather than basic anatomy/physiology.

Question 22

A nurse is providing discharge teaching for a client prescribed warfarin. Which statement indicates a need for further teaching?

Accepted Answer

Answer reason: I can take aspirin for headaches Aspirin has antiplatelet effects and can significantly increase bleeding risk when combined with warfarin. Clients on warfarin should avoid aspirin and many NSAIDs unless specifically prescribed, and instead use a safer alternative (often acetaminophen) per provider guidance. The other statements reflect appropriate teaching: maintaining consistent vitamin K intake (avoiding large sudden increases), routine INR monitoring, and promptly reporting bleeding.
Category reason: This item tests safe medication teaching and identifying contraindicated OTC drugs and bleeding risks while taking warfarin, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 23

A nurse is monitoring a patient receiving hydromorphone (Dilaudid). Which sign is most concerning?

Accepted Answer

Answer reason: Resp rate of 8bpm Opioids such as hydromorphone can cause dose-related respiratory depression, which is a life-threatening adverse effect requiring immediate intervention. A respiratory rate of 8/min indicates significant hypoventilation and risk of hypoxia, hypercapnia, and respiratory arrest. Nausea and drowsiness are common opioid side effects but are typically less urgent unless they progress to decreased level of consciousness with poor ventilation. Priority nursing actions include stopping/holding the opioid, stimulating the patient, supporting airway/ventilation, and preparing to administer naloxone per protocol.
Category reason: This is a nursing monitoring and safety question focused on recognizing a dangerous opioid adverse effect and prioritizing concern during medication therapy, fitting NCLEX Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 24

A client with inflammatory arthritis who takes prednisone is scheduled for an elective surgery. Which client teaching is most important for the nurse to provide?

Accepted Answer

Answer reason: The explanation of a precise schedule for stopping steroid medication. Chronic prednisone use suppresses the hypothalamic-pituitary-adrenal axis, so abrupt cessation can precipitate acute adrenal insufficiency, especially during physiologic stress such as surgery. Teaching about a taper/precise plan (and not stopping independently) addresses a potentially life-threatening complication. While infection teaching and pulmonary hygiene are important, they do not outweigh preventing adrenal crisis related to perioperative steroid management.
Category reason: This is a perioperative medication-safety teaching question focused on systemic corticosteroid adverse effects and contraindications (risk of adrenal suppression with abrupt stopping), which fits Pharmacological and Parenteral Therapies.

Question 25

A client is being treated for acute heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats per minute; and respirations, 24 breaths per minute. After the initial dose, which is the priority assessment?

Accepted Answer

Answer reason: C. Monitoring blood pressure. Bumetanide is a potent loop diuretic that can cause rapid intravascular volume depletion, leading to hypotension and decreased perfusion, especially in a client whose baseline BP is already low-normal (100/60). After an IV dose, hemodynamic changes can occur quickly, so immediate reassessment of BP is the highest safety priority. Potassium monitoring is important due to risk of hypokalemia, but it is not as immediate a post-dose priority as detecting symptomatic hypotension. Weight loss reflects longer-term fluid removal and is not the most urgent assessment right after the initial dose.
Category reason: This is a patient-care prioritization question focused on monitoring for an acute adverse effect of an IV medication (loop diuretic) in a heart failure client, which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 26

The nurse is caring for a client with chronic heart failure who reports new swelling in the ankles and shortness of breath when lying flat. The client's current medications include furosemide, digoxin, and potassium chloride. Morning labs show: - Potassium: 3.0 mEq/L - Digoxin level: 1.9 ng/mL - Blood pressure: 108/64 mm Hg - Heart rate: 54 bpm Which action should the nurse take first?

Accepted Answer

Answer reason: Hold the digoxin and notify the healthcare provider The client is bradycardic (HR 54) with a high-normal digoxin level and significant hypokalemia (K+ 3.0), which increases myocardial sensitivity to digoxin and raises the risk of dangerous dysrhythmias/toxicity. Giving the medication now could worsen bradycardia and precipitate life-threatening conduction disturbances. The priority is to withhold the suspected offending drug and promptly communicate findings for further evaluation and orders (e.g., ECG, electrolyte correction strategy).
Category reason: This is a patient-care priority question requiring nursing judgment about safe medication administration and recognizing contraindications/toxicity risk, which aligns with NCLEX Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 27

A sulfonamide is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?

Accepted Answer

Answer reason: A decrease in the warfarin sodium (Coumadin) dosage. Sulfonamides can potentiate the anticoagulant effect of warfarin by increasing the free (active) fraction via protein-binding displacement and by reducing vitamin K–producing gut flora, increasing bleeding risk. This interaction commonly raises the INR and can lead to bruising, hematuria, GI bleeding, or intracranial hemorrhage if not adjusted. The safest anticipated order is to reduce warfarin dosing with close INR monitoring rather than stopping therapy outright. Changing the sulfonamide dose is not the standard approach for managing this interaction when the antibiotic is clinically indicated.
Category reason: This item tests nursing judgment about a significant medication interaction and the expected prescription adjustment to prevent harm, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 28

A client receiving levothyroxine reports chest pain and palpitations. What is the nurse’s priority action?

Accepted Answer

Answer reason: B. Hold the medication and notify the provider Chest pain and palpitations in a client taking levothyroxine suggest possible excessive thyroid hormone effect, which can precipitate tachyarrhythmias and myocardial ischemia, especially in susceptible patients. The immediate safety priority is to prevent further exposure to the medication and obtain prompt provider evaluation for dose adjustment and cardiac assessment. Reassurance or encouraging the next dose could worsen symptoms, and treating anxiety does not address a potentially dangerous medication-related cardiovascular adverse effect.
Category reason: This is a nursing-priority medication safety question focused on recognizing and responding to adverse effects/contraindications of levothyroxine, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 29

A nurse is teaching about digoxin toxicity. Which symptom should the patient report immediately?

Accepted Answer

Answer reason: Digoxin toxicity classically presents with gastrointestinal symptoms (e.g., nausea/vomiting), bradycardia and dysrhythmias, and characteristic visual changes such as blurred vision or yellow/green halos. These vision symptoms can be an early warning sign and require prompt evaluation to prevent progression to life-threatening arrhythmias. The other options are not typical hallmark findings of digoxin toxicity and are less urgent indicators of toxic serum levels.
Category reason: This item tests recognition of a medication’s serious adverse effect requiring prompt action, which aligns with medication safety and adverse effects monitoring.

Question 30

A client receiving terbutaline for preterm labor develops a heart rate of 128 bpm. What should the nurse do?

Accepted Answer

Answer reason: Tachycardia is a common and potentially serious adverse effect of terbutaline (a beta-agonist) and is a key parameter for holding/discontinuing therapy to prevent progression to dysrhythmias and myocardial ischemia. A maternal heart rate of 128 bpm indicates excessive beta-adrenergic stimulation and warrants stopping the infusion/medication and notifying the provider per protocol. Oxygen or fluids do not address the medication-induced cause and could delay correction of the adverse reaction. Waiting to reassess risks worsening cardiovascular effects while the drug continues.
Category reason: This item tests nursing action in response to a medication adverse effect (maternal tachycardia during terbutaline therapy), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 31

Magnesium Sulfate Toxicity A preeclamptic client on magnesium sulfate has respiratory rate of 10/min, decreased deep tendon reflexes (DTRs), and lethargy. What is the priority intervention?

Accepted Answer

Answer reason: Respiratory depression, decreased DTRs, and lethargy indicate magnesium sulfate toxicity with risk of impending respiratory arrest. Calcium gluconate is the specific antidote that rapidly reverses magnesium’s neuromuscular and cardiac effects. While stopping the infusion and notifying the provider are important, reversing toxicity immediately is the highest priority to prevent life-threatening deterioration. Seizure precautions address preeclampsia risk but do not treat the current medication-induced emergency.
Category reason: This question tests recognition and immediate nursing management of a medication adverse effect (magnesium sulfate toxicity) and the correct antidote, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 32

A client post-MI is prescribed metoprolol. Which of the following indicates a need to withhold the drug?

Accepted Answer

Answer reason: A. HR 58 bpm Metoprolol is a beta-1 blocker that decreases heart rate and AV nodal conduction, so bradycardia is a key parameter to check before administration. Many nursing hold parameters require holding a beta-blocker when the apical pulse is below about 60 bpm to prevent symptomatic bradycardia, hypotension, and decreased cardiac output. The other findings listed are within expected ranges and do not indicate a contraindication to administration in a stable post-MI client. In a post-MI setting, preventing excessive slowing of the heart is particularly important to maintain adequate perfusion.
Category reason: This question tests a nursing medication-safety decision (when to hold a prescribed beta-blocker based on pre-administration assessment), which aligns with adverse effects/contraindications under Pharmacological and Parenteral Therapies.

Question 33

A patient on clopidogrel is scheduled for surgery. What instruction should the nurse give?

Accepted Answer

Answer reason: y." Clopidogrel irreversibly inhibits platelet aggregation, increasing perioperative bleeding risk. Because platelets exposed to the medication remain inhibited for their lifespan, the drug is typically discontinued about 5–7 days preoperatively to allow enough new, functional platelets to circulate. Continuing it or doubling the dose would raise bleeding risk, and switching to aspirin does not eliminate antiplatelet effects and should only be done if specifically prescribed by the surgeon/anesthesia team.
Category reason: This question tests safe preoperative nursing instruction and medication management related to surgical bleeding risk, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications rather than foundational science.

Question 34

A client on methimazole develops a sore throat and fever. What is the nurse’s first action?

Accepted Answer

Answer reason: A. Hold the medication and notify the provider Sore throat and fever in a patient taking methimazole can indicate agranulocytosis, a rare but life-threatening adverse effect causing severe neutropenia. The priority is to stop further exposure and urgently contact the provider for immediate evaluation, including a CBC with differential. Symptomatic treatment (e.g., acetaminophen, fluids) without stopping the drug could delay recognition and increase the risk of serious infection and sepsis.
Category reason: This question tests nursing action in response to a serious medication adverse effect and the need to hold the drug and escalate care, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 35

What should the nurse include when teaching about simvastatin (Zocor)?

Accepted Answer

Answer reason: Statins can cause myopathy and, rarely, rhabdomyolysis, so new muscle pain, tenderness, cramps, or weakness warrants prompt evaluation and possible discontinuation. Early reporting helps prevent progression to severe muscle breakdown and potential acute kidney injury. The other options are incorrect because simvastatin is typically taken in the evening, dairy avoidance is not a key interaction, and grapefruit juice increases drug levels and toxicity risk.
Category reason: This item tests safe medication teaching focused on recognizing and responding to an adverse effect of a prescribed drug, which aligns with Adverse Effects-Contraindications under Pharmacological and Parenteral Therapies.

Question 36

A patient is started on dilantin for seizures. What would be the MOST important teaching point below?

Accepted Answer

Answer reason: Phenytoin commonly causes gingival hyperplasia and increases the risk of bleeding/inflammation of the gums, so proactive oral hygiene and regular dental follow-up are key to preventing complications and maintaining adherence. Monthly CBC monitoring is more characteristic of carbamazepine than phenytoin. Phenytoin can reduce the effectiveness of oral contraceptives, but patients should be taught to use a backup method rather than avoid contraception entirely. The therapeutic range for total phenytoin is typically about 10–20 mcg/mL, making the stated level incorrect.
Category reason: This is a medication-teaching question focused on preventing and monitoring adverse effects of an antiseizure drug, which fits NCLEX pharmacological therapy decision-making rather than foundational science.

Question 37

A 65-year-old patient is admitted to the hospital with a diagnosis of chronic heart failure. The patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix). During your assessment, the patient reports nausea and visual disturbances, and you note a heart rate of 52 beats per minute. What is the nurse’s best action?

Accepted Answer

Answer reason: A) Hold the digoxin and notify the healthcare provider. The combination of nausea, visual changes, and marked bradycardia strongly suggests digoxin toxicity. The immediate nursing priority is safety: withhold the next dose to prevent worsening dysrhythmias and promptly notify the provider for further evaluation (e.g., digoxin level, ECG, electrolytes, renal function) and potential antidotal therapy. Furosemide can contribute to hypokalemia, which increases susceptibility to toxicity, but potassium should not be given empirically without confirming the level and assessing for contraindications. Encouraging fluids or administering the dose would delay intervention and increase risk of life-threatening complications.
Category reason: This is a patient-care decision about recognizing medication toxicity and taking an immediate safe nursing action (withholding a drug and notifying the provider), which fits NCLEX pharmacotherapy adverse effects/contraindications.

Question 38

You just realized you administered the wrong dose of an antihypertensive 5 mins ago. The patient is stable. What’s your priority action?

Accepted Answer

Answer reason: Immediate patient safety comes first after a medication error, especially with an antihypertensive where hypotension, bradycardia, dizziness, or syncope can develop rapidly. Close monitoring of vital signs, level of consciousness, and symptoms allows early detection and prompt intervention if instability occurs. After assessing and ensuring stability, the provider should be notified for further orders, and documentation/incident reporting completed per policy. Family notification is not the nurse’s first priority and typically occurs after provider notification and a plan for disclosure.
Category reason: This item tests nursing actions after a medication error, prioritizing patient assessment and preventing adverse medication effects, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 39

A nurse is teaching a client who has a new prescription for valproic acid. The nurse should instruct the client he will need to have which of the following laboratory tests completed periodically while taking this medication?

Accepted Answer

Answer reason: Valproic acid carries a clinically significant risk of hepatotoxicity, especially early in therapy and in certain high-risk populations, so periodic monitoring of liver enzymes is recommended to detect injury before severe hepatic failure occurs. Patient teaching should emphasize reporting symptoms such as abdominal pain, nausea/vomiting, anorexia, malaise, or jaundice that may suggest liver injury. While thrombocytopenia can also occur, routine LFT monitoring is the hallmark lab surveillance emphasized for safety.
Category reason: This is a medication-teaching and safety monitoring question focused on preventing/identifying adverse drug effects through appropriate lab surveillance, which fits Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 40

The nurse is caring for a client prescribed digoxin for heart failure. Which of the following findings should the nurse report to the healthcare provider immediately?

Accepted Answer

Answer reason: Hypokalemia increases myocardial sensitivity to digoxin, substantially raising the risk of digoxin toxicity and dangerous dysrhythmias. A potassium of 3.0 mEq/L is clinically significant and requires prompt provider notification for evaluation and correction (e.g., potassium repletion and review of diuretic therapy). The other findings listed are within acceptable ranges for many adults and are not, by themselves, urgent indicators of toxicity.
Category reason: This question tests nursing action based on medication safety—recognizing an electrolyte abnormality that increases the risk of digoxin adverse effects and deciding to notify the provider promptly.

Question 41

Which client finding requires the nurse to take immediate action in a patient on warfarin?

Accepted Answer

Answer reason: This indicates melena, which is a sign of gastrointestinal bleeding and can rapidly become life-threatening in a client receiving an anticoagulant. Warfarin increases bleeding risk, so suspected internal bleeding requires urgent assessment, vital signs/hemodynamic monitoring, and prompt provider notification with likely need for INR testing and reversal planning. The other findings can be expected or less specific, whereas evidence of active GI bleeding is an emergency.
Category reason: This is a patient-care decision about recognizing and responding to a dangerous adverse effect of an anticoagulant, which fits NCLEX pharmacological therapy safety (adverse effects/contraindications).

Question 42

Which symptom would require holding digoxin and notifying the healthcare provider?

Accepted Answer

Answer reason: Digoxin can cause toxicity, which classically presents with visual disturbances such as yellow/green halos or blurred vision. These findings warrant holding the medication and promptly notifying the provider because toxicity can progress to dangerous dysrhythmias. Nausea and fatigue can occur with many conditions and are less specific, while a heart rate of 72 bpm is within normal range and not an indication to hold the drug.
Category reason: This item tests nursing medication safety by recognizing an adverse effect of digoxin that requires withholding the dose and notifying the provider, aligning with pharmacologic adverse effects/contraindications.

Question 43

A patient receiving IV nitroglycerin develops a headache. What is the nurse's best action?

Accepted Answer

Answer reason: Nitroglycerin commonly causes headache due to cerebral vasodilation, and this is an expected adverse effect rather than an emergency. The safest nursing response is to treat the symptom with an ordered analgesic while continuing to monitor blood pressure and therapeutic response. Stopping the infusion can worsen ischemia by removing antianginal therapy, and lowering the head of the bed can increase risk of hypotension. Provider notification is indicated if the headache is severe, persistent, or accompanied by concerning findings (e.g., hypotension, neuro changes), but not as the first best action for a typical expected effect.
Category reason: This item tests nursing management of a common medication adverse effect during IV therapy (nitroglycerin) and the appropriate intervention, aligning with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 44

Which teaching should the nurse include for a patient starting methimazole for hyperthyroidism?

Accepted Answer

Answer reason: B. Report fever or sore throat immediately Methimazole can cause agranulocytosis, a rare but serious drop in neutrophils that increases infection risk. Fever and sore throat can be early signs of infection in neutropenia and require immediate evaluation and a CBC. Prompt reporting allows rapid discontinuation and treatment to prevent sepsis. The other options are not key safety teaching priorities for this medication.
Category reason: This is a medication-teaching question focused on recognizing and responding to a serious adverse drug effect, which is tested under NCLEX pharmacologic therapy safety (adverse effects/contraindications).

Question 45

A client taking furosemide reports tinnitus. What is the best nursing action?

Accepted Answer

Answer reason: Tinnitus is a warning sign of ototoxicity, a potentially serious adverse effect associated with loop diuretics, especially at higher doses or rapid IV administration. The safest action is to stop further exposure while the client is assessed and the prescription is reviewed for dose adjustment or alternative therapy. Simply documenting or advising fluids does not address the risk of progressing hearing damage. Potassium supplementation targets hypokalemia but does not treat or prevent ototoxicity.
Category reason: This item tests recognition and immediate nursing response to an adverse medication effect and the need to withhold a drug and contact the prescriber, which fits NCLEX medication safety under Adverse Effects-Contraindications.

Question 46

A nurse reviews labs of a client receiving atorvastatin. Which value is most concerning?

Accepted Answer

Answer reason: A. ALT 85 U/L This elevation suggests possible hepatotoxicity, an important adverse effect that requires further assessment and possible medication adjustment or discontinuation. Statins can increase liver enzymes; a higher-than-normal ALT warrants evaluating symptoms (e.g., fatigue, jaundice, dark urine) and trending repeat labs. The lipid values shown are within desirable ranges, and the creatine kinase level listed is not elevated, making muscle injury/rhabdomyolysis less likely based on this result.
Category reason: This question tests nursing interpretation of lab monitoring for a medication’s adverse effects and safety (statin-associated liver toxicity), which fits medication adverse effects/contraindications in NCLEX.

Question 47

A nurse is caring for a client with atrial fibrillation on warfarin. Which instruction is most appropriate?

Accepted Answer

Answer reason: Warfarin increases bleeding risk, so clients must promptly report any signs of bleeding for evaluation and possible dose adjustment. Increasing green leafy vegetables raises vitamin K intake, which can decrease anticoagulation and destabilize the INR. INR monitoring is required even when the client feels well because bleeding/clotting risk correlates with INR, not symptoms. Taking aspirin concurrently increases bleeding risk and is not started without a specific provider order and careful risk–benefit assessment.
Category reason: This item tests safe patient teaching about anticoagulant therapy, focusing on recognition and reporting of medication adverse effects and contraindicated practices, which aligns with NCLEX Pharmacological and Parenteral Therapies.

Question 48

The client presents with high cholesterol and is prescribed rosuvastatin (Crestor). What instruction is most important?

Accepted Answer

Answer reason: Statins can cause myopathy and, rarely, rhabdomyolysis; new muscle pain, tenderness, or weakness can signal a serious adverse effect requiring prompt evaluation and possible discontinuation. Early reporting allows assessment of creatine kinase, renal function, and prevention of acute kidney injury from myoglobinuria. The other options are not safety-critical: lipid lowering begins within weeks (not months), fruit juice interactions are not the key teaching for rosuvastatin, and insomnia is not a priority adverse effect compared with muscle toxicity.
Category reason: This item asks for priority patient teaching about a medication’s serious adverse effects and when to notify the provider, which fits pharmacologic safety under Adverse Effects-Contraindications.

Question 49

Which symptom is a priority to report in a client receiving simvastatin (Zocor)?

Accepted Answer

Answer reason: Simvastatin can cause myopathy that may progress to rhabdomyolysis, a potentially life-threatening adverse reaction. New or worsening muscle pain, tenderness, or weakness is a red-flag symptom because it can signal muscle breakdown and risk of acute kidney injury. Headache, nausea, and diarrhea are more common, usually non-urgent side effects unless severe or persistent, so they are lower priority to report immediately.
Category reason: This item tests nursing recognition of a serious medication adverse effect and the need for prompt reporting while a client is receiving a statin, aligning with adverse effects/contraindications in pharmacologic therapy.

Question 50

A client with Cushing's syndrome has a new prescription for spironolactone. Which lab value is most important to monitor?

Accepted Answer

Answer reason: B. Potassium Spironolactone is a potassium-sparing diuretic (aldosterone antagonist) that reduces potassium excretion, creating a significant risk for hyperkalemia. Clients with endocrine-related fluid and electrolyte disturbances require close monitoring when medications alter renal potassium handling. Potassium abnormalities can rapidly cause dangerous cardiac dysrhythmias and neuromuscular symptoms. Therefore, potassium is the priority lab to monitor after starting this medication.
Category reason: This question tests nursing monitoring for a medication’s major adverse effect (hyperkalemia) and the most important lab surveillance after initiating therapy, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

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