Question 1

A client receiving warfarin has an INR of 5.0. What is the priority nursing action?

Accepted Answer

Answer reason: An INR of 5.0 indicates supratherapeutic anticoagulation with increased bleeding risk, requiring prompt action to reverse/hold anticoagulation per protocol and provider orders. Vitamin K is the specific antidote for warfarin and helps restore clotting factor activity, reducing hemorrhage risk. Continuing the dose would worsen bleeding risk, and dietary changes (leafy greens) are not an immediate safety intervention. Increasing fluids does not address the coagulation abnormality.
Category reason: This question tests a priority nursing response to an unsafe medication effect (excess anticoagulation) and the appropriate antidote action, aligning with pharmacologic safety and adverse effects management.

Question 2

Which client is most at risk for developing life-threatening complications of hypokalemia?

Accepted Answer

Answer reason: A. A client on digoxin with K 3.2 Hypokalemia increases myocardial sensitivity to digoxin, markedly raising the risk of digoxin toxicity and dangerous dysrhythmias (e.g., ventricular ectopy, heart block). A potassium of 3.2 mEq/L is low enough to potentiate these effects, making the complication risk immediate and potentially fatal. While diarrhea, NPO status, and NG suction can all contribute to potassium loss, they do not inherently carry the same high-risk drug–electrolyte interaction that can precipitate sudden lethal cardiac events.
Category reason: This item requires nursing judgment about a high-risk medication interaction (digoxin) and how hypokalemia increases the chance of severe adverse cardiac effects, fitting Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 3

To treat a client with anxiety disorder, Bupropion (Wellbutrin) is prescribed. Which common side effect of the medication should the nurse inform the client?

Accepted Answer

Answer reason: Bupropion commonly causes anticholinergic-like effects and CNS stimulation, so xerostomia is a frequent patient-reported adverse effect that warrants anticipatory guidance. It is more likely to cause insomnia, agitation, tremor, headache, and tachycardia than sedation or bradycardia. While GI upset can occur, diarrhea is less characteristic than dry mouth for common counseling points.
Category reason: This item tests nursing medication teaching about expected adverse effects of a prescribed psychotropic medication, aligning with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 4

A client who is taking codeine sulfate is provided with instructions by the nurse. What instruction should the nurse provide the client?

Accepted Answer

Answer reason: Codeine can cause dizziness, sedation, and orthostatic hypotension, increasing the risk of falls when standing up quickly. Teaching the client to rise slowly from lying or sitting positions helps prevent syncope and injury. The other options are incorrect because opioids more commonly cause constipation (so fluids and fiber should be increased, not decreased) and alcohol should generally be avoided, but the most directly safety-focused instruction for this adverse effect is gradual position changes.
Category reason: This item asks for nursing teaching related to an opioid’s adverse effects and safe self-administration, which fits medication safety and contraindications under Pharmacological and Parenteral Therapies.

Question 5

A client who is receiving magnesium sulfate for preeclampsia is monitored and assessed by the nurse every 30 minutes. Which finding indicates a need to contact the health provider immediately?

Accepted Answer

Answer reason: Magnesium sulfate can cause toxicity leading to respiratory depression, and a respiratory rate below 12/min is a critical warning sign requiring immediate provider notification and likely stopping the infusion and preparing to administer calcium gluconate per protocol. The other findings are not as immediately dangerous: 2+ reflexes are normal, and an FHR of 116 bpm is within the normal baseline range (110–160). While low urine output can increase risk for magnesium accumulation, respiratory depression is an urgent, life-threatening manifestation that warrants immediate action.
Category reason: This item tests nursing monitoring and urgent response to an adverse effect of an administered medication (magnesium sulfate), which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 6

A nurse is caring for a client with heart failure who is receiving furosemide (Lasix). Which of the following assessment findings is most important for the nurse to report to the healthcare provider?

Accepted Answer

Answer reason: C. Serum potassium level of 3.0 mEq/L Furosemide is a loop diuretic that can cause significant potassium wasting, and a level of 3.0 mEq/L indicates clinically important hypokalemia. Hypokalemia increases the risk of dysrhythmias and can worsen cardiac function in a client with heart failure, making it a priority to report and correct promptly. The other findings are either expected with effective diuresis (modest weight loss) or are not as immediately dangerous in this context as a markedly low potassium level.
Category reason: This question asks the nurse to identify and report a medication-related adverse effect of furosemide (electrolyte loss), which is a pharmacotherapy safety judgment and best fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 7

Patient is taking captopril (Capoten) and spironolactone (Aldactone). Which is the most important to monitor?

Accepted Answer

Answer reason: Both an ACE inhibitor (captopril) and a potassium-sparing diuretic (spironolactone) reduce aldosterone-mediated potassium excretion, substantially increasing the risk of hyperkalemia. Hyperkalemia can cause dangerous cardiac dysrhythmias and neuromuscular symptoms, making it the highest-priority lab to trend. Monitoring is especially critical in patients with renal impairment, diabetes, or when using other potassium-raising agents (e.g., supplements, salt substitutes, ARBs).
Category reason: This question tests nursing monitoring for a high-risk medication interaction and prevention of an adverse effect, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 8

As an adjunctive therapy in the treatment of heart failure, Quinapril hydrochloride (Accupril) is prescribed. The nurse should specifically monitor which parameter as the priority after administering the first dose?

Accepted Answer

Answer reason: ACE inhibitors can cause significant first-dose hypotension, especially in clients with heart failure who may be volume-depleted from diuretics. Hypotension can rapidly compromise perfusion and is an immediate safety risk, so it is the priority parameter to assess after the first dose. Other assessments (lung sounds, urine output, respiration) are important for ongoing evaluation of heart failure status but are less urgent than detecting acute hypotension right after initial administration.
Category reason: This item asks for nursing monitoring priority after administering a prescribed medication, emphasizing safety and adverse effect surveillance following drug administration, which aligns with Pharmacological and Parenteral Therapies.

Question 9

The home health nurse visits a client with hypertension whose blood pressure has been well controlled on oral valsartan 320 mg daily. The client’s blood pressure is 190/88 mm Hg, significantly higher than it was 2 weeks ago. The client reports a cold, a stuffy nose, and sneezing for 3 days. Which question is most appropriate for the nurse to ask?

Accepted Answer

Answer reason: Reasoning starts with identifying a common, reversible cause of sudden hypertension despite usual control: OTC cold products. Many decongestants (e.g., pseudoephedrine, phenylephrine) are sympathomimetics that can increase blood pressure and counteract antihypertensive therapy. Assessing OTC medication use is a safety-focused nursing action that directly targets a likely trigger for the acute elevation. The other questions are less likely to explain a sharp BP rise and do not address a high-risk medication interaction.
Category reason: This is a nursing assessment/intervention question about identifying medication-related contributors and contraindicated OTC use in a client with hypertension, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 10

The nurse has administered the first dose of prescribed rivastigmine to a client with Alzheimer's disease. Which clinical data is necessary to monitor while this client takes this medication?

Accepted Answer

Answer reason: Rivastigmine is a cholinesterase inhibitor and commonly causes gastrointestinal adverse effects such as nausea, vomiting, diarrhea, and anorexia. These effects can lead to decreased intake and clinically significant weight loss, especially in older adults, increasing risk for frailty and dehydration. Routine monitoring of body weight helps identify intolerance early and guides dose adjustments or supportive interventions.
Category reason: This question tests nursing monitoring for a medication’s adverse effects and contraindication-related safety while administering drug therapy, which aligns with Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 11

A nurse is caring for a client who underwent a cholecystectomy and is experiencing incisional pain. The nurse administers morphine sulfate IV as prescribed. Which assessment finding indicates a potential adverse effect of morphine sulfate?

Accepted Answer

Answer reason: Morphine is an opioid analgesic that can depress the medullary respiratory center, making respiratory depression the most serious acute adverse effect, especially after IV administration. A decreasing respiratory rate (often with increasing sedation) is an early warning sign that requires prompt intervention and monitoring. While opioids can also cause hypotension from vasodilation and histamine release, this is typically less immediately life-threatening than compromised ventilation. The other findings are inconsistent with expected opioid effects (opioids usually decrease bowel motility and can cause urinary retention rather than increased output).
Category reason: This item focuses on recognizing and monitoring for a medication adverse effect after IV opioid administration, which is a nursing judgment and safety responsibility within Pharmacological and Parenteral Therapies.

Question 12

The nurse noted that sulfasalazine (Azulfidine) has been prescribed by the health care provider to a client. The nurse checked the nursing history form in the client's medical record for documentation of an allergy to which item?

Accepted Answer

Answer reason: Sulfasalazine contains a sulfonamide component, so a history of sulfonamide allergy raises concern for hypersensitivity reactions. The nurse should screen for prior sulfa reactions (e.g., rash, Stevens-Johnson syndrome, anaphylaxis) before administration to reduce risk of serious adverse events. The other listed allergies are not specifically associated with cross-reactivity for this drug in standard nursing contraindication checks.
Category reason: This item tests nursing medication-safety judgment—checking for a contraindicating allergy before administering a prescribed drug—so it fits Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 13

The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication?

Accepted Answer

Answer reason: Albuterol is a short-acting beta2-agonist that can also stimulate beta1 receptors, causing tachycardia, palpitations, and tremor; this is a common expected adverse effect after nebulized treatments. Ipratropium (an anticholinergic) can add dryness and mild systemic anticholinergic effects, but the most typical patient-reported effect from this combination is feeling the heart race. Constipation can occur with anticholinergics but severe constipation over several days suggests another problem and is not the most expected immediate effect. Watery eyes and bloating are not characteristic expected effects of this inhaled combination.
Category reason: This is a medication-administration question focused on recognizing expected adverse effects of bronchodilator therapy, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 14

A nurse provides instructions to a client about lithium carbonate that is prescribe for acute mania. Which information should the nurse provide the client?

Accepted Answer

Answer reason: Lithium has a narrow therapeutic index, and neurologic/visual changes can be early signs of toxicity requiring prompt evaluation and possible dose adjustment. Clients should maintain consistent sodium and fluid intake because low sodium can increase lithium levels; therefore they should not avoid salt. Serum lithium levels are monitored more frequently than yearly, especially during initiation and dose changes. Vomiting and diarrhea are not “expected” benign effects; they can indicate toxicity and can also cause dehydration that further raises lithium levels.
Category reason: This item tests patient teaching and recognition of adverse effects/toxicity for a prescribed medication (lithium), which is an NCLEX medication-safety judgment topic under Pharmacological and Parenteral Therapies.

Question 15

A client was instructed by the nurse on a tyramine-restricted diet about foods that are acceptable to eat. Which item(s) in the diet should the nurse tell the client to consume? 1. Pizza 2. Apples 3. Chicken 4. Tomatoes 5. Homemade bread?

Accepted Answer

Answer reason: Fresh fruits are generally low in tyramine and are acceptable on a tyramine-restricted diet, which is commonly taught for clients taking MAOIs to prevent hypertensive crisis. Foods to avoid are typically aged, fermented, cured, or yeast-extract–containing items that can raise tyramine levels. The other listed items can be problematic when they contain aged cheese or yeast (e.g., pizza with cheese; homemade bread made with yeast) or if processed/aged components are present.
Category reason: This item tests nursing teaching about dietary restrictions used to prevent medication-related adverse effects (tyramine interaction with MAOIs), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 16

Which assessment should be done on patient with morphine therapy?

Accepted Answer

Answer reason: Morphine is an opioid that can depress the brainstem respiratory center, causing decreased respiratory rate, depth, and oxygenation, which is the most life-threatening adverse effect. Nursing monitoring should prioritize respiratory rate/effort, sedation level, and oxygen saturation, and hold the dose/notify the provider if respirations are significantly decreased. While urinary retention can occur, it is typically less immediately dangerous than respiratory depression, making respiratory monitoring the key assessment during therapy.
Category reason: This item tests nursing monitoring for a medication’s major adverse effect and safety risk, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications rather than foundational physiology alone.

Question 17

A nurse is providing discharge teaching to a client who had a kidney transplant and has a prescription for oral cyclosporine. Which of the following statements by the client indicates understanding of the teaching?

Accepted Answer

Answer reason: B. I am likely to develop higher bp while taking this medication Cyclosporine is a calcineurin inhibitor used to prevent organ rejection and a key teaching point is recognition of common adverse effects. Hypertension is a well-known and clinically significant side effect, often related to vasoconstriction and renal effects, and requires monitoring and possible antihypertensive therapy. The other statements are incorrect because immunosuppressants are typically long-term, cyclosporine does not “boost” immunity, and hair loss is not the characteristic finding (it more commonly causes hirsutism and gingival hyperplasia).
Category reason: This item tests patient teaching about a transplant immunosuppressant’s adverse effects and monitoring, which aligns with medication safety and side-effect recognition.

Question 18

A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention?

Accepted Answer

Answer reason: Psychobiological interventions focus on biologic treatments, particularly psychotropic medications and their physiologic impact. Nursing care includes ongoing surveillance for side effects (e.g., EPS, metabolic syndrome, serotonin syndrome, orthostatic hypotension) to detect complications early and promote safety. The other options are primarily psychotherapeutic or educational interventions rather than biologic/medication-focused care.
Category reason: This item tests nursing action related to safe administration and monitoring of psychotropic medications, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 19

A client is prescribed digoxin for heart failure. Which finding requires immediate intervention?

Accepted Answer

Answer reason: Visual disturbances (e.g., yellow/green vision or halos) are a classic, concerning sign of digoxin toxicity and warrant prompt action such as holding the medication and notifying the provider. Toxicity can precipitate life-threatening dysrhythmias, so this finding is prioritized for immediate intervention. An apical pulse of 58 bpm is bradycardic and would prompt holding digoxin/assessment, but it is less specific for toxicity than new visual changes. A level of 1.6 ng/mL is within or near therapeutic range in many settings, and nausea/vomiting is less specific and may be multifactorial unless accompanied by other toxicity indicators.
Category reason: This question tests nursing recognition and immediate response to a medication adverse effect (digoxin toxicity), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 20

A client with acute myocardial infarction (MI) is prescribed nitroglycerin sublingually. The nurse should monitor for which most common side effect?

Accepted Answer

Answer reason: Nitroglycerin causes venodilation and arterial vasodilation, which commonly leads to cerebral vasodilation and a throbbing headache. This is the most frequent adverse effect seen with sublingual dosing, along with flushing and dizziness. Hypertension is opposite of the expected effect (hypotension is more likely), and bradycardia is not typical because reflex tachycardia may occur. Dry mouth is not a common or key adverse effect to prioritize.
Category reason: This item tests nursing monitoring for a medication’s expected adverse effects in an acute MI treatment context, which falls under Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 21

A nurse is reviewing he laboratory results of a client who has a prescription for sodium polystyrene sulfonate (Kayexalate) every 6 hr. which of the following should the nurse report to the provider?

Accepted Answer

Answer reason: Sodium polystyrene sulfonate is ordered to treat elevated potassium, so a potassium level above the normal range indicates ongoing hyperkalemia that may require prompt provider evaluation and possible escalation of therapy. Hyperkalemia can precipitate dangerous cardiac dysrhythmias, so abnormal potassium values are priority to report. The other listed values are within expected adult reference ranges and do not indicate an urgent problem in this context.
Category reason: This question tests nursing judgment about monitoring and reporting an abnormal lab value related to a prescribed medication’s indication and potential risks, fitting Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 22

A nurse is providing teaching to a client who has renal failure and an elevated phosphorus level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client?

Accepted Answer

Answer reason: Aluminum hydroxide is an aluminum-based antacid/phosphate binder used in renal failure to reduce serum phosphate by binding it in the gut. A common adverse effect of aluminum-containing agents is constipation due to decreased GI motility. The other options are less characteristic for aluminum hydroxide in this context; muscle spasms are more consistent with electrolyte disturbances (e.g., hypocalcemia) rather than this medication’s typical side-effect profile.
Category reason: This item tests nursing medication teaching about a prescribed phosphate binder and recognizing common adverse effects, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 23

A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client?

Accepted Answer

Answer reason: A. Constipation Aluminum hydroxide is an aluminum-based antacid/phosphate binder commonly used in renal failure to reduce serum phosphate by binding dietary phosphate in the gut. A frequent adverse effect of aluminum-containing agents is decreased bowel motility leading to constipation. Headache is not a typical primary adverse effect for this medication, and muscle spasms are more suggestive of electrolyte abnormalities (e.g., hypocalcemia) rather than a common direct effect expected from this drug teaching point.
Category reason: This item tests medication teaching about a prescribed phosphate binder and identifying a common adverse effect, which is a pharmacologic safety concept under Adverse Effects-Contraindications.

Question 24

A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium?

Accepted Answer

Answer reason: A. Bananas Furosemide is a loop diuretic that increases renal potassium loss, putting the client at risk for hypokalemia. Teaching should emphasize potassium-rich foods to help prevent complications such as muscle weakness, cramps, and dysrhythmias. Among the choices, bananas are a well-known high-potassium food and provide more potassium per typical serving than cooked carrots, cheddar cheese, or 2% milk.
Category reason: This question tests nursing medication teaching related to a common adverse effect of a diuretic (potassium loss) and appropriate dietary counseling, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 25

Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher than before the medication was administered. The nurse’s best?

Accepted Answer

Answer reason: C. This is normal side-effect of AtSO4 Atropine is an anticholinergic medication that commonly causes dry mouth due to reduced salivary gland secretion. It also increases heart rate by blocking vagal (parasympathetic) effects on the SA node, so a higher pulse after administration is expected. These findings are consistent with predictable pharmacologic effects rather than an allergic reaction (which would more likely include rash, wheeze, hypotension) or anxiety alone. The appropriate nursing action is to recognize these as expected effects and continue monitoring for excessive tachycardia or other anticholinergic toxicity.
Category reason: This item tests recognition of expected versus concerning medication effects (dry mouth and tachycardia after atropine), which falls under medication adverse/expected effects and contraindications in Pharmacological and Parenteral Therapies.

Question 26

A patient with atrial fibrillation is prescribed warfarin. Which patient statement indicates a need for further teaching?

Accepted Answer

Answer reason: e." 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 use safer alternatives (e.g., acetaminophen in appropriate doses) after consulting the provider. Monitoring for bleeding and medication interactions is a core part of warfarin safety teaching. This statement shows misunderstanding of a major drug–drug interaction.
Category reason: This item tests nursing medication-teaching and safety regarding warfarin interactions and bleeding risk, which aligns with pharmacologic adverse effects and contraindications in patient care.

Question 27

Penicillin V potassium (Pen-Vee-K) 500 mg PO qid is ordered for an adult client. He reports that he took penicillin for the first time two months ago. What should the nurse do?

Accepted Answer

Answer reason: Penicillin can cause hypersensitivity reactions even after prior exposure, and the first priority after administering/initiating therapy is monitoring for early signs such as rash, urticaria, wheeze, or anaphylaxis. Skin testing is not routinely required before giving penicillin to a client without a history of allergy. Withholding the medication or notifying the provider is indicated if the client reports a past allergic reaction or develops symptoms suggestive of hypersensitivity.
Category reason: This item tests nursing management of a prescribed medication by assessing for and responding to potential adverse drug reactions, which falls under pharmacological therapy safety and contraindications.

Question 28

After giving IV Diazepam, monitor for?

Accepted Answer

Answer reason: IV diazepam (a benzodiazepine) can cause dose-related CNS depression with decreased respiratory drive, especially with rapid IV administration or when combined with other sedatives/opioids. The priority nursing assessment after administration is airway and breathing, including respiratory rate, depth, and oxygen saturation. Fever, hypertension, and diuresis are not expected primary adverse effects of diazepam; hypotension and sedation are more typical concerns.
Category reason: This item asks the nurse what adverse effect to monitor for after administering an IV medication, emphasizing post-administration assessment and medication safety, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 29

A newly diagnosed client with type 1 diabetes mellitus is taking Humulin N insulin at 0700 daily. Which signs and symptoms should the nurse monitor the client closely for in the late afternoon?

Accepted Answer

Answer reason: NPH (Humulin N) is an intermediate-acting insulin with a peak several hours after the morning dose, which can place the client at higher risk for hypoglycemia later in the day if meals/snacks are delayed or insufficient. Hypoglycemia commonly presents with adrenergic symptoms such as tremor/shakiness, diaphoresis, pallor, and a cool, clammy feeling along with hunger and anxiety. The other options describe hyperglycemia/diabetic ketoacidosis features (polyuria, polydipsia, dry skin, fruity breath, Kussmaul respirations) rather than a peak-insulin low glucose episode.
Category reason: This item tests nursing monitoring for an insulin adverse effect (hypoglycemia) related to medication peak timing, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 30

The nurse is analyzing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication?

Accepted Answer

Answer reason: Dantrolene carries a clinically important risk of hepatotoxicity, including hepatitis and potentially fatal liver failure, especially with prolonged therapy or higher doses. Monitoring AST/ALT and other hepatic markers detects early liver injury so the drug can be reduced or discontinued promptly. Renal indices (BUN/creatinine) are not the primary toxicity concern for this medication, and platelet count is not a typical key adverse-effect marker.
Category reason: This item tests nursing monitoring for a medication-related adverse effect and the appropriate lab to assess toxicity, which aligns with pharmacologic therapy safety and adverse effects.

Question 31

A client reports taking excessive doses of paracetamol for persistent headaches over the past week. Which symptom should the nurse prioritize as an indication of paracetamol toxicity?

Accepted Answer

Answer reason: D. Hepatic damage. Acetaminophen (paracetamol) overdose primarily causes dose-dependent hepatotoxicity due to accumulation of the toxic metabolite NAPQI when glutathione is depleted. Early symptoms can be nonspecific, so evidence of liver injury (e.g., right upper quadrant pain, jaundice, elevated AST/ALT) is the key toxicity concern to recognize and act on. Tinnitus is more characteristic of salicylate toxicity, and diarrhea or hypertension are not classic priority indicators of acetaminophen overdose.
Category reason: This item tests nursing recognition and prioritization of an adverse drug effect (toxicity) from a commonly used medication, aligning with medication safety and adverse effects/contraindications in NCLEX pharmacological care.

Question 32

A patient receives morphine for pain. What is a priority nursing intervention?

Accepted Answer

Answer reason: Morphine is an opioid that can cause dose-dependent respiratory depression, which is the most immediate life-threatening adverse effect. Airway and breathing take priority, so assessing respiratory rate (and depth/sedation level) is essential after administration. Blood pressure, urine output, and GI upset are relevant but are generally secondary concerns compared with potential hypoventilation.
Category reason: This item focuses on a nursing priority intervention and monitoring for a serious medication adverse effect after opioid administration, which aligns with Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 33

A client with major depression who is taking fluoxetine calls the psychiatric clinic reporting being more agitated, irritable, and anxious than usual. Which intervention should the nurse implement?

Accepted Answer

Answer reason: New or worsening agitation, irritability, and anxiety after starting an SSRI can indicate activation syndrome and may precede suicidal ideation, especially early in treatment or after dose changes. This represents a potentially unsafe adverse response requiring prompt clinical evaluation to assess suicide risk and determine whether medication adjustment or additional treatment is needed. Reassurance alone is inappropriate because it delays assessment of a possible serious complication. Timing the dose with food may help mild GI effects but does not address emergent behavioral changes.
Category reason: This item tests nursing judgment in response to a potentially serious medication-related adverse effect and the safest immediate intervention, fitting Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 34

A client on warfarin has an INR of 4.5. What is the nurse's priority action?

Accepted Answer

Answer reason: B. Hold the dose and notify the provider An INR of 4.5 indicates supratherapeutic anticoagulation and increased bleeding risk. The safest immediate nursing action is to withhold further anticoagulant dosing and promptly communicate the abnormal value so the prescriber can adjust therapy and consider additional evaluation. Administering the next or an increased dose would worsen bleeding risk. Vitamin K is typically reserved for significantly elevated INR and/or active bleeding, so it is not the first priority at this level without bleeding.
Category reason: This item tests safe nursing action in response to an adverse/contraindicated medication effect (supratherapeutic warfarin with elevated INR), fitting Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 35

A client on levothyroxine reports tachycardia. What should the nurse do?

Accepted Answer

Answer reason: B. Hold the dose and notify the provider Tachycardia can indicate excessive thyroid hormone effect from over-replacement, which increases sympathetic activity and myocardial oxygen demand. The safe nursing action is to withhold the medication and promptly communicate the adverse effect so the prescriber can reassess dosing and order appropriate evaluation (e.g., thyroid labs, ECG if indicated). Continuing or increasing the dose could worsen toxicity and precipitate dysrhythmias or angina. Treating with a beta-blocker may be part of medical management but should not replace holding the causative medication and obtaining provider direction.
Category reason: This question tests nursing recognition and response to an adverse medication effect and appropriate immediate action (withholding a dose and notifying the provider), which aligns with NCLEX pharmacologic safety and contraindications.

Question 36

A nurse is admitting a client who has arthritic pain and reports taking ibuprofen several times daily for 3 years. Which of the following test should the nurse monitor?

Accepted Answer

Answer reason: Long-term, frequent NSAID use increases the risk of gastrointestinal mucosal injury, including gastritis and peptic ulcer disease, which can lead to occult or overt GI bleeding. Monitoring for occult blood helps detect chronic blood loss early, even before symptoms like hematemesis or melena appear. While ibuprofen can also affect renal function, white blood cells in urine are not a typical screening marker for NSAID toxicity; occult GI bleeding is a more direct and common serious adverse effect to monitor.
Category reason: This question focuses on monitoring for adverse effects from long-term NSAID therapy, which is a nursing medication-safety and complication surveillance decision in Pharmacological and Parenteral Therapies.

Question 37

A nurse is preparing to administer furosemide 40 mg IV to a patient with heart failure. What is the priority assessment before administration?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that can cause significant potassium loss, increasing the risk of dysrhythmias and worsening cardiac instability, especially in heart failure. Checking electrolytes before IV dosing helps identify hypokalemia that may require holding the dose and notifying the provider or replacing potassium. While vital signs are important, electrolyte safety is the most medication-specific priority for preventing serious adverse effects with this drug.
Category reason: This question asks for a priority nursing assessment to prevent medication-related harm before giving an IV diuretic, which aligns with recognizing adverse effects and contraindications in medication administration.

Question 38

A nurse is administering morphine 2 mg IV to a patient with acute pain. What is the most important action to monitor?

Accepted Answer

Answer reason: Morphine is an opioid that can depress the brainstem respiratory center, making hypoventilation and apnea the most life-threatening acute adverse effects, especially after IV administration with rapid onset. Monitoring ventilation allows early detection of opioid-induced respiratory depression so the dose can be held and naloxone/supportive measures initiated if needed. Blood pressure can decrease due to vasodilation and histamine release, but this is typically secondary to airway/breathing safety. Urine output and temperature are not priority acute safety parameters for immediate opioid toxicity.
Category reason: This question tests nursing monitoring for a high-risk IV medication and recognition of its most dangerous adverse effect, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 39

An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first?

Accepted Answer

Answer reason: D. Hold the next dosage and notify the health care provider. Older adults have reduced renal clearance and total body water, which can increase serum concentrations of water-soluble drugs and raise toxicity risk when dosed like younger adults. The safest immediate nursing action is to prevent further exposure by withholding the next dose while promptly contacting the prescriber for dose adjustment orders. Checking serum levels is important but does not stop additional drug accumulation in the meantime, and starting IV fluids is not indicated without specific orders and assessment of fluid tolerance.
Category reason: This question tests immediate nursing action to prevent medication-related harm and manage potential adverse effects from inappropriate dosing, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 40

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?

Accepted Answer

Answer reason: Iodinated contrast used during cardiac catheterization can precipitate acute kidney injury, and reduced renal clearance increases the risk of metformin-associated lactic acidosis. Holding it before and for 48 hours after contrast exposure allows time to assess renal function and ensure safe elimination. Other listed diabetes medications do not carry this specific contrast-related lactic acidosis risk and are not routinely held for this duration solely due to contrast administration.
Category reason: This question tests a nursing medication-safety decision around holding a drug due to a procedure-related contraindication (iodinated contrast), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 41

During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. John's wort to prevent depression. The nurse should alert the staff in the postanesthesia recovery area that the patient may?

Accepted Answer

Answer reason: St. John’s wort can induce hepatic drug-metabolizing enzymes and alter the effects of many perioperative medications, including anesthetic and sedative agents. This interaction can make achieving and maintaining the desired anesthetic depth less predictable and can prolong emergence and recovery. Because the patient is heading to the PACU, anticipating delayed recovery allows closer monitoring and timely adjustment of supportive care.
Category reason: This question tests nursing recognition of an herbal supplement’s perioperative medication interactions and resulting recovery implications, which fits adverse effects/contraindications within pharmacological therapies.

Question 42

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask like facial expression and is experiencing involuntary movements and tremoring. Which of the following medications should the nurse anticipate administering?

Accepted Answer

Answer reason: a. Amantadine The symptoms described (mask-like facies, tremor, involuntary movements) are extrapyramidal symptoms related to dopamine blockade from chlorpromazine. Management includes agents that restore dopaminergic activity or reduce cholinergic tone; amantadine can improve drug-induced parkinsonism by increasing dopamine release and decreasing reuptake. The other options do not treat extrapyramidal reactions and could worsen safety (e.g., inappropriate antidepressants or sedating antihistamine without correcting the underlying mechanism).
Category reason: This question centers on recognizing and treating an adverse effect of an antipsychotic and selecting the appropriate medication to manage it, which is a pharmacologic patient-care decision under adverse effects/contraindications.

Question 43

A nurse is preparing to administer morphine 4 mg IV to a patient with acute pain. What is the priority assessment before administration?

Accepted Answer

Answer reason: Morphine is an opioid that can cause dose-related respiratory depression and hypotension, which are the most immediate, life-threatening adverse effects to screen for before IV administration. Establishing baseline respirations and oxygenation-related status helps determine safety and whether to hold the medication or notify the provider. Checking blood pressure is also important because IV opioids can worsen hypotension and increase fall/syncope risk. The other assessments are less directly tied to urgent opioid contraindications and immediate safety.
Category reason: This item tests a nursing safety assessment required before administering an opioid and recognizing major adverse effects/contraindications, which fits medication-related clinical judgment in Pharmacological and Parenteral Therapies.

Question 44

A nurse is preparing to administer heparin 5,000 units IV to a client with a pulmonary embolism. What should the nurse assess first?

Accepted Answer

Answer reason: Heparin can cause heparin-induced thrombocytopenia, which is a serious, potentially life-threatening adverse effect that increases thrombosis risk and can contraindicate continuation of therapy. Establishing a baseline platelet count (and ensuring it is not already low) helps identify bleeding risk and supports early detection of a heparin-related platelet drop. While vital signs and urine output are important for overall monitoring, they do not address the most critical medication-specific safety assessment prior to administering IV heparin.
Category reason: This question centers on safe administration of an anticoagulant by assessing for a key contraindication/adverse effect risk (thrombocytopenia) before giving the medication, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 45

A client receives morphine 2 mg IV for pain. The nurse should monitor for which adverse effect?

Accepted Answer

Answer reason: Morphine is an opioid agonist that can suppress the medullary respiratory center, leading to decreased respiratory rate and depth. This risk is higher with IV administration due to rapid onset and peak effect, so close monitoring of respirations, oxygen saturation, and level of consciousness is essential. Hypertension is not typical because opioids more commonly cause vasodilation and hypotension. Hyperglycemia is not a characteristic acute adverse effect of morphine.
Category reason: This item tests nursing monitoring for a medication’s adverse effect after IV opioid administration, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 46

The nurse is discharging a patient with a new patient for ranitidine (Zantac). Which information would be important to include in the discharge teaching?

Accepted Answer

Answer reason: Discharge teaching for acid-suppressing therapy should include recognition of rare but serious hematologic adverse effects that warrant immediate evaluation. Thrombocytopenic purpura presents with bruising, petechiae, bleeding, and may be accompanied by systemic findings, making early identification critical for patient safety. The other choices are not key safety warnings for this medication as a primary discharge focus and can mislead about appropriate co-medication or expected effects.
Category reason: This question tests patient education about a medication’s important adverse effect to report, which is a nursing responsibility under medication safety and contraindications.

Question 47

A client with heart failure is prescribed spironolactone. Which lab result should the nurse monitor most closely?

Accepted Answer

Answer reason: C. Potassium Spironolactone is a potassium-sparing diuretic (aldosterone antagonist) that reduces potassium excretion in the kidneys. This places the client at risk for hyperkalemia, which can cause dangerous cardiac conduction changes and dysrhythmias, especially in heart failure patients who may also be on ACE inhibitors/ARBs. Therefore potassium is the lab value that requires the closest monitoring to prevent life-threatening complications.
Category reason: This question tests nursing monitoring for a medication’s key adverse effect and contraindication risk (hyperkalemia) in a heart failure client, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 48

A nurse is caring for a client with hypertensive crisis receiving IV nitroprusside. Which lab result is most important to monitor?

Accepted Answer

Answer reason: Nitroprusside is metabolized to cyanide ions, and with prolonged infusion or high doses (or in renal/hepatic impairment) cyanide/thiocyanate can accumulate and cause serious toxicity. Monitoring for cyanide toxicity is critical because it can rapidly lead to altered mental status, metabolic acidosis, cardiovascular instability, and death if not recognized early. Electrolytes like potassium and sodium and hemoglobin are not the primary toxicity risk unique to this medication compared with cyanide accumulation.
Category reason: This question tests nursing monitoring for a high-alert IV antihypertensive and its serious adverse effect (cyanide toxicity), which is a medication-related safety concern under Pharmacological and Parenteral Therapies.

Question 49

A client reports an allergy to penicillin. Which medication order should the nurse question?

Accepted Answer

Answer reason: A. Amoxicillin Amoxicillin is a penicillin-class (beta-lactam) antibiotic, so a reported penicillin allergy raises concern for a hypersensitivity reaction. The nurse should clarify the nature and severity of the prior reaction and notify the prescriber before administering a penicillin derivative. The other listed antibiotics are from different classes (macrolide, tetracycline, fluoroquinolone) and are not penicillins, so they are generally used as alternatives when clinically appropriate. Because anaphylaxis risk can be life-threatening, verifying allergies and questioning contraindicated orders is a priority safety action.
Category reason: This item tests nursing judgment about medication safety in the setting of a reported drug allergy (contraindication screening), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 50

A client with atrial fibrillation is receiving digitalization IV. The heart rate drops to 42 bpm. What is the nurse's priority?

Accepted Answer

Answer reason: B. Stop the infusion A heart rate of 42 bpm during IV digitalization indicates clinically significant bradycardia consistent with digoxin toxicity or excessive effect, and the immediate safety action is to stop further medication delivery. After stopping the infusion, the nurse should assess hemodynamic stability (blood pressure, perfusion, mental status) and obtain an ECG as indicated. Atropine may be needed if the patient is symptomatic/unstable, but it is not the first step before halting the offending infusion. Provider notification follows initial nursing actions and reassessment per protocol.
Category reason: This item centers on recognizing and responding to an adverse medication effect during IV therapy and choosing the safest immediate nursing intervention, which maps to Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

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