Question 1

An unconscious client on mechanical ventilation is prescribed intravenous diazepam. The nurse monitors what parameter as a priority when administering this medication?

Accepted Answer

Answer reason: Even on mechanical ventilation, excessive sedation can worsen ventilatory parameters, impair synchrony with the ventilator, and contribute to hypercapnia or oxygenation problems if settings are not adjusted. Priority nursing monitoring focuses on airway/breathing and sedation-related respiratory status rather than renal perfusion measures. Blood pressure can decrease with IV sedatives, but it is generally a secondary priority compared with detecting and preventing respiratory compromise.

Question 2

Your resident has a history of Von Willenbrand's disease. Which of the following medications, if ordered by a physician, should be questioned by the RN?

Accepted Answer

Answer reason: Antiplatelet therapy inhibits platelet aggregation and can significantly worsen mucocutaneous and procedural bleeding, so it should be questioned unless there is a compelling indication with specialist oversight. Clopidogrel irreversibly blocks the platelet ADP receptor (P2Y12), making it particularly concerning in an already bleeding-prone patient. In contrast, the other listed agents are not primary platelet inhibitors and are not classic contraindications specifically tied to von Willebrand–related bleeding risk.

Question 3

A patient with bacterial meningitis is receiving IV vancomycin. What is the most important nursing action during administration?

Accepted Answer

Answer reason: Vancomycin has clinically significant dose-related toxicity risks, especially kidney injury and ototoxicity, so the nurse must prioritize monitoring for early harm while the drug is being administered. Ongoing assessment includes urine output and renal labs (e.g., rising creatinine) and evaluation for auditory/vestibular symptoms, with prompt reporting to prevent permanent injury. Encouraging fluids may be supportive but is not the key safety action and may be inappropriate if the patient has fluid restrictions. Peripheral neuropathy and hyperglycemia are not characteristic primary concerns of vancomycin therapy.

Question 4

Terbutaline (Brethine) is prescribed for a client with bronchitis. A nurse understands that this medication should be used with caution if which of the following medical conditions is present in the client?

Accepted Answer

Answer reason: Terbutaline also can cause tachycardia and tremor, which may mimic or mask symptoms used by some patients to recognize glycemic changes. Among the listed conditions, diabetes is the one with a well-established caution due to potential hyperglycemia. Osteoarthritis and polycystic disease are not typical contraindications or major cautions for inhaled or systemic beta2-agonists, and hypothyroidism is less clinically relevant than hyperthyroidism for sympathomimetic sensitivity.

Question 5

A client is admitted to the recovery room following an exploratory laparotomy. Which medication should be kept nearby?

Accepted Answer

Answer reason: After an exploratory laparotomy, patients commonly receive opioid analgesics intraoperatively and in early recovery, which can cause hypoventilation, decreased level of consciousness, and airway compromise. This medication is a competitive opioid receptor antagonist that can quickly restore ventilation and arousal while supportive airway measures continue. By contrast, the benzodiazepine antidote is only indicated when excessive benzodiazepine sedation is the primary issue, and antihistamines or antihypertensives are not first-line rescue drugs for the most immediate PACU risk.

Question 6

A client with renal failure has an order for erythropoietin (Epogen) to be given subcutaneously. The nurse should teach the client to report which of the following?

Accepted Answer

Answer reason: A severe headache can be a warning sign of significant hypertension and requires prompt evaluation and possible therapy adjustment. Mild nausea is a relatively nonspecific, less urgent symptom and is not the key safety concern taught for this medication. Decreased urination and itching are more consistent with progression/manifestations of renal failure rather than a hallmark adverse effect needing urgent reporting for this drug.

Question 7

The client is being treated with intravenous Vancomycin for MRSA when the nurse notes redness of the client’s neck and chest. Place in ordered sequence the actions to be taken by the nurse?

Accepted Answer

Answer reason: The immediate priority is to remove the offending trigger by stopping the infusion to prevent progression to hypotension, angioedema, or respiratory compromise. After stopping the drug, the nurse should assess the patient’s status (including vital signs) and then treat symptoms (e.g., antihistamine) per orders or protocol. The prescriber should be notified after immediate safety actions are taken so the plan can be adjusted (slower rate, premedication, or alternative therapy).

Question 8

A nurse is reviewing the medication orders for a male client diagnosed with bipolar disorder, currently in the manic phase. Which medication would the nurse question?

Accepted Answer

Answer reason: In acute mania, first-line pharmacotherapy focuses on mood stabilizers (e.g., lithium, valproate) and/or antipsychotics to rapidly control agitation, insomnia, and psychosis. An antidepressant order is therefore a safety concern because it can increase mood lability, impulsivity, and risk-taking and may prolong the manic episode. By contrast, an antipsychotic can provide short-term behavioral control while mood stabilizers address the underlying episode.

Question 9

The nurse must instruct a client with glaucoma to avoid taking over-the-counter medications like:

Accepted Answer

Answer reason: OTC drugs with anticholinergic effects can precipitate acute angle-closure glaucoma by causing mydriasis, which narrows the anterior chamber angle and reduces aqueous humor outflow, raising intraocular pressure. Many antihistamines (especially first-generation agents and combination “cold” products) have clinically meaningful anticholinergic activity and are a classic OTC risk for glaucoma patients. The other listed OTC categories do not typically increase intraocular pressure via pupillary dilation or angle narrowing. Patient teaching should emphasize checking labels for antihistamine/anticholinergic ingredients and consulting the provider/pharmacist before using OTC cold/allergy products.

Question 10

The nurse administers oral levothyroxine to a client with hypothyroidism. Which of the following would be the priority for the nurse to monitor for?

Accepted Answer

Answer reason: Palpitations may indicate tachycardia, dysrhythmias, or angina from increased myocardial oxygen demand, which can rapidly become unstable and therefore warrants priority monitoring. GI symptoms and weight loss can occur with over-replacement but are generally less immediately life-threatening than cardiac complications. This is especially important in older adults or clients with underlying coronary artery disease, in whom dose titration and cardiac monitoring are key.

Question 11

The nurse is caring for a client who is receiving newly prescribed salmeterol. Which of the following prescribed medications requires notification to the primary healthcare provider (PHCP)?

Accepted Answer

Answer reason: Labetalol has beta-blocking activity (including beta2), making it a clinically significant interaction/contraindication concern when initiating a LABA. This is more immediately safety-relevant than agents like captopril or clonidine, which do not directly antagonize beta2-mediated bronchodilation. The nurse should notify the PHCP to consider an alternative antihypertensive regimen or reassess the bronchodilator plan.

Question 12

A client diagnosed with bipolar disorder asks the nurse why it is necessary to have a serum lithium level drawn every 3 to 4 months. The nurse’s response should be based on which factor?

Accepted Answer

Answer reason: Regular serum monitoring helps ensure the level remains in the safe therapeutic window and detects rising levels early, especially because renal function, hydration status, and sodium balance can change over time and alter lithium clearance. Toxicity can lead to significant neurologic and GI effects and can become life-threatening if not identified promptly. Monitoring is therefore primarily a safety measure rather than a test of adherence; WBC monitoring is more relevant to drugs like clozapine, not lithium.

Question 13

The nurse is caring for a client receiving oxybutynin. Which of the following findings would require immediate follow-up?

Accepted Answer

Answer reason: Hot, dry, flushed skin signals anhidrosis with risk for hyperthermia/heat stroke, which is a potentially life-threatening complication requiring prompt assessment and intervention (cooling measures, vitals, medication review/hold, provider notification). Constipation and blurred vision are common, expected anticholinergic adverse effects that are usually managed with supportive measures and monitoring. Urinary retention is also an important adverse effect, but the classic systemic red-flag for urgent concern is the overheating/anhidrosis presentation suggesting dangerous anticholinergic burden.

Question 14

A nurse cares for a client newly diagnosed with asthma. Which medication does the nurse advise the client to avoid?

Accepted Answer

Answer reason: Asthma clients should avoid medications that can trigger bronchospasm by altering arachidonic acid metabolism and increasing leukotrienes. Nonselective NSAIDs such as aspirin can precipitate aspirin-exacerbated respiratory disease with acute wheeze, cough, and dyspnea, especially in susceptible individuals. The other listed drugs are not typical asthma triggers via this mechanism and are commonly used for unrelated indications (expectorant, antihistamine, H2 blocker). Teaching focuses on avoiding known bronchoconstrictive agents and promptly reporting any respiratory worsening after OTC analgesics.

Question 15

The nurse tells the client about which side effect of diphenoxylate?

Accepted Answer

Answer reason: This can lead to difficulty initiating urination and reduced bladder emptying, making urinary retention a key client-teaching adverse effect. Hypertension is not a typical expected effect of this medication class, and increased bleeding time is not mechanistically related. Excessive tearing is not an expected adverse effect; anticholinergic effects more commonly cause dryness rather than increased secretions.

Question 16

Which of the following electrolyte imbalances should the nurse report to the HCP in a patient taking Digoxin for heart failure?

Accepted Answer

Answer reason: This potentiation predisposes the patient to dangerous dysrhythmias (e.g., bradyarrhythmias, AV block, ventricular ectopy) even at therapeutic digoxin levels. In heart failure, concurrent loop/thiazide diuretics commonly lower potassium, making this imbalance especially high-yield to recognize and report promptly. By contrast, elevated potassium more classically accompanies acute overdose and is not the typical electrolyte issue that predisposes to toxicity at usual dosing.

Question 17

A patient is taking spironolactone for the treatment of hypertension. The nurse notices EKG changes on the patient's heart monitor. What blood abnormality should the nurse suspect as the cause of such changes?

Accepted Answer

Answer reason: Hyperkalemia commonly produces ECG changes such as peaked T waves, PR prolongation, and QRS widening, which can progress to dangerous dysrhythmias. In contrast, hypokalemia is more associated with flattened T waves and prominent U waves and is typical of loop or thiazide diuretics rather than spironolactone. Recognizing this adverse effect is critical so potassium can be checked promptly and the medication held or treated as indicated.

Question 18

A nurse is caring for a client taking digoxin. Which of the following findings indicate a possible sign of digoxin toxicity?

Accepted Answer

Answer reason: A pulse of 50/min is a classic toxicity warning sign and should prompt holding the dose and further assessment (e.g., apical pulse, ECG, serum digoxin level, potassium). Hypertension is not a typical hallmark finding of digoxin toxicity compared with rate/rhythm changes. Cough and fever are nonspecific and do not directly reflect digoxin’s toxic cardiac effects.

Question 19

A nurse has the order to begin administering warfarin sodium (Coumadin) to a client. While implementing this order, the nurse ensures that which of the following medications is available on the nursing unit as the antidote for Coumadin ?

Accepted Answer

Answer reason: Administering phytonadione reverses this mechanism by restoring hepatic production of active clotting factors, making it the standard antidote to counteract excessive anticoagulation. Protamine sulfate is used to reverse heparin (not warfarin), so it would not reliably correct an elevated INR from warfarin. Aminocaproic acid is an antifibrinolytic used for certain bleeding states but does not directly reverse warfarin’s depletion of vitamin K–dependent factors.

Question 20

A client has been prescribed lithium carbonate for hyperactive thyroid to inhibit thyroid hormone release. Which comment made by the client will alter the that there is an issues with the prescribed medication?

Accepted Answer

Answer reason: In a patient receiving lithium for thyroid hormone inhibition, these symptoms raise concern for lithium-related renal toxicity even if other symptoms are mild. Weight gain can occur with lithium but is typically not an urgent toxicity indicator by itself and may also reflect hypothyroid effect that is sometimes expected with lithium’s thyroid suppression. Rhinorrhea is nonspecific and blurred vision is less characteristic for lithium’s common serious complications compared with the classic increased thirst and urination pattern.

Question 21

The nurse is reviewing the client’s medications and she noticed a prescription of Versed. The medication that is significant to have available for clients who have received Versed is ________.?

Accepted Answer

Answer reason: This option directly reverses benzodiazepine effects by competitively inhibiting GABA-A receptor benzodiazepine binding sites, improving level of consciousness and ventilation when oversedation occurs. Naloxone is an opioid antagonist and would not reverse benzodiazepine-induced sedation unless opioids are also involved. A key safety consideration is monitoring for resedation due to the antidote’s shorter half-life and for seizures in patients with benzodiazepine dependence or mixed overdoses.

Question 22

The nurse is caring for a client prescribed a monoamine oxidase inhibitor (MAOI). During the therapy, the nurse recommends that the client monitor their?

Accepted Answer

Answer reason: MAOIs can cause clinically significant blood pressure changes, including orthostatic hypotension and potentially hypertensive crisis when combined with tyramine-containing foods or interacting drugs. Monitoring blood pressure helps detect early warning signs (e.g., severe headache, palpitations, neck stiffness, markedly elevated readings) so treatment and emergency evaluation can occur promptly. This is a higher-risk, medication-specific safety concern compared with routine pulse checks, which are less specific and may not identify crisis early. Blood glucose and daily weight monitoring are not standard primary monitoring parameters for MAOIs unless comorbid conditions warrant them.

Question 23

A nurse is caring for a patient who has been prescribed diazepam (Valium) for anxiety. Which of the following findings should the nurse prioritize monitoring during the initial administration of the medication?

Accepted Answer

Answer reason: The earliest life-threatening complication to detect is hypoventilation, so airway and breathing assessment takes priority over other routine parameters. Monitoring breathing rate and quality allows prompt intervention (stimulation, oxygen, holding doses, escalation of care) before hypoxia occurs. Heart rate may change secondarily, but it is not the primary, most dangerous early adverse effect compared with impaired ventilation. Urine output and skin integrity are not expected acute safety threats from initial diazepam dosing.

Question 24

Which measure should the nurse teach a client prescribed fluphenazine daily to minimize a common side effect?

Accepted Answer

Answer reason: Antipsychotics with anticholinergic effects commonly cause dry mouth, which increases discomfort and risk for dental caries. Stimulating salivation with sugarless gum or hard sour candy is a practical teaching intervention that directly targets xerostomia without adding excess sugar exposure. Monitoring temperature is more aligned with detecting rare but serious neuroleptic malignant syndrome rather than a common side effect to “minimize.” Routine weekly blood pressure checks are less helpful than teaching slow position changes for orthostatic hypotension, and do not directly prevent symptoms.

Question 25

The nurse is providing dietary teaching for a client who takes isocarboxazid. Which of the following Thanksgiving dinner meal items should the nurse instruct the client to avoid?

Accepted Answer

Answer reason: Smoked/aged/cured meats are classic high-tyramine items and are specifically restricted on an MAOI diet. This option describes a smoked cured meat, making it the highest-risk choice for a dangerous blood pressure surge, severe headache, and potential stroke. The other foods listed are not typical high-tyramine foods and therefore are not the primary dietary avoidance for MAOI therapy.

Question 26

The client has increased intracranial pressure with cerebral edema, and mannitol is administered. Which assessment should the nurse make to evaluate if a complication from the mannitol is occurring?

Accepted Answer

Answer reason: Crackles on lung auscultation are an early, clinically important sign of developing pulmonary congestion and are therefore a key assessment to detect this complication promptly. Increased urine output is an expected therapeutic effect rather than a complication, so it does not evaluate harm. An improving GCS reflects desired reduction in intracranial pressure, and dependent pitting edema is less sensitive and less urgent than assessing for pulmonary edema.

Question 27

A patient in severe respiratory distress is prescribed continuous albuterol nebulizers. Which of the following side effects should the nurse expect?

Accepted Answer

Answer reason: Continuous albuterol increases risk of skeletal muscle tremor due to beta-2 stimulation in muscle tissue. A key safety contrast is that albuterol more often causes tachycardia (not bradycardia) from beta-agonist spillover and reflex effects. It also shifts potassium into cells, tending toward hypokalemia rather than hyperkalemia, so monitoring electrolytes is important during high-dose therapy.

Question 28

A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct?

Accepted Answer

Answer reason: " Nitrates relax vascular smooth muscle via nitric oxide, producing venodilation and some arterial/cerebral vasodilation that commonly triggers headache. The safest nursing response is to provide accurate anticipatory guidance that this effect is expected, often improves with continued use, and can be managed rather than stopping therapy abruptly. In contrast, advising discontinuation could place the patient at risk for uncontrolled angina. Intracranial bleeding is not a typical nitrate adverse effect; the more relevant serious concern is hypotension/syncope, not hemorrhage.

Question 29

The healthcare provider is performing an assessment on a patient who is taking propranolol (Inderal) for supraventricular tachycardia. Which assessment finding is an indication the patient is experiencing an adverse effect of this drug?

Accepted Answer

Answer reason: Propranolol is used to control SVT, but excessive pharmacologic effect commonly presents as bradycardia and may progress to hypotension, dizziness, or syncope. This finding is a priority because it directly reflects potentially dangerous cardiac suppression and may require dose adjustment or holding the medication. Urinary retention and dry mouth are more typical of anticholinergic drugs, and paresthesia is not a hallmark adverse effect of propranolol.

Question 30

The charge nurse is reviewing the medication administration records for several clients. Which situation needs to be brought to the attention of the prescribing health care provider?

Accepted Answer

Answer reason: Stimulant laxatives increase intestinal peristalsis and can worsen inflammation-related bowel conditions, raising risk for perforation, bleeding, and severe pain. Diverticulitis involves an inflamed colonic wall, so using a stimulant agent is a safety concern and should prompt provider notification and reevaluation of the bowel regimen. In contrast, magnesium hydroxide may be used as an antacid/laxative (with attention to renal function), and polyethylene glycol-electrolyte solutions are standard for bowel prep under prescribed supervision. New-onset constipation in an older adult warrants assessment for causes, but psyllium itself is not an immediate contraindication if hydration is adequate.

Question 31

The nurse administers a dose of subcutaneous heparin to a client. Which client statement most concerns the nurse?

Accepted Answer

Answer reason: " Generalized itching after a medication can signal a hypersensitivity reaction, which can rapidly progress to urticaria, angioedema, bronchospasm, or anaphylaxis and requires immediate assessment and possible discontinuation of the drug. Heparin can cause allergic-type reactions, and diffuse pruritus is more concerning than common, expected minor effects. New bruising can occur with anticoagulants and is important to monitor, but it is often anticipated and not as immediately life-threatening as a possible allergy. Upset stomach and mild fever are nonspecific and less directly indicative of an acute dangerous reaction to heparin.

Question 32

The nurse is preparing to discharge a client newly prescribed a MAO inhibitor, phenelzine. Which foods should the nurse instruct the client to avoid?

Accepted Answer

Answer reason: Aged cheeses and cured/fermented meats are classic high-tyramine items and therefore are unsafe with phenelzine. This option includes both aged cheeses and pepperoni (a cured meat), directly matching the high-risk dietary restriction. Citrus juices and most nuts are not the key contraindication for MAOIs (grapefruit interactions are more typical with CYP3A4-metabolized drugs), and fresh vegetables are generally safe unless specifically fermented/aged.

Question 33

Mrs. Bower is a 94-year-old woman in a long-term care facility. She has periods of confusion and requires supplemental oxygen during sleep. She tells the nurse that she is experiencing 7/10 back pain. Given the patient's condition, the nurse knows that which of the following medications would be best indicated for this patient?

Accepted Answer

Answer reason: The safest initial approach to non-malignant musculoskeletal back pain is to start with a non-opioid analgesic when not contraindicated. This option provides analgesia without clinically significant respiratory suppression and has a more favorable cognitive safety profile than opioids. The other choices are opioid doses/routes that are relatively aggressive for a 94-year-old and could worsen mental status and ventilation, especially during sleep.

Question 34

The nurse is caring for a client with hypertension who is taking lisinopril. Which of the following client findings is most concerning?

Accepted Answer

Answer reason: This finding signals a potential anaphylactoid emergency requiring immediate assessment of airway and discontinuation of the drug, with urgent escalation of care. A persistent dry cough is a common, non-life-threatening ACE-inhibitor effect. Mildly elevated blood pressure and orthostatic lightheadedness are concerning for efficacy/tolerance issues but are less immediately dangerous than evolving airway edema.

Question 35

What to Do if Lithium Toxicity is Suspected?

Accepted Answer

Answer reason: Medication toxicity management prioritizes stopping further exposure to prevent worsening serum levels and end-organ injury. Suspected lithium toxicity requires immediately withholding the next dose because continued administration can rapidly push levels higher due to lithium’s narrow therapeutic index and renal handling. After withholding, nursing actions focus on rapid assessment for neurologic/GI findings, drawing a stat level, hydration to enhance renal excretion when safe, and prompt provider notification for potential escalation (e.g., IV fluids or dialysis). Options involving monitoring, fluids, and notification are appropriate adjuncts, but they should not precede stopping the offending medication.

Question 36

A nurse is providing instructions to a client receiving Baclofen (Lioresal). Which of the following would be included in the teaching plan?

Accepted Answer

Answer reason: Baclofen is a centrally acting skeletal muscle relaxant (GABA-B agonist) that commonly causes CNS depression such as drowsiness, dizziness, and impaired coordination. Alcohol potentiates these sedative effects, increasing the risk of falls, accidents, and respiratory/CNS depression, so teaching should include avoiding or limiting alcohol. Limiting fluids is not a routine precaution for baclofen and could contribute to constipation. Diarrhea is not a typical adverse effect requiring automatic holding, and generalized weakness can occur from muscle relaxation but is usually monitored and dose-adjusted rather than treated as an immediate “notify the provider” trigger unless severe or progressive.

Question 37

The LPN/LVN administers glipizide (Glucotrol) 5 mg. before breakfast to an older client. At 10:30 am, the client reports a headache and hunger, and the LPN/LVN notes the client is irritable. Which action should the LPN/LVN take FIRST?

Accepted Answer

Answer reason: Sulfonylureas like glipizide increase insulin release and can precipitate hypoglycemia, especially in older adults. Headache, hunger, and irritability are early neurogenic/neuroglycopenic cues that require immediate treatment to prevent progression to confusion, seizures, or loss of consciousness. The first priority is rapid-acting carbohydrate to raise blood glucose quickly, with juice being an appropriate fast source. Waiting for lunch delays correction, and exercise can further lower glucose; calling the provider is not the immediate life/safety priority when hypoglycemia is suspected.

Question 38

The nurse is caring for a client who has been prescribed infusions of amphotericin b. Which laboratory data is necessary for the nurse to monitor during treatment?

Accepted Answer

Answer reason: Amphotericin B commonly causes nephrotoxicity with renal tubular wasting of electrolytes. This leads to clinically important hypokalemia (and often hypomagnesemia), which increases risk for dysrhythmias, muscle weakness, and worsened renal complications. Therefore potassium must be monitored closely during therapy and replaced as needed. Lipid and glycemic markers like triglycerides, HDL, and hemoglobin A1C are not the key safety labs for amphotericin toxicity monitoring.

Question 39

The nurse is caring for a client who is postoperative following a lobectomy. The client is receiving fentanyl via an epidural. The nurse should monitor the client for which complication?

Accepted Answer

Answer reason: Epidural analgesia can block sympathetic nerve outflow, leading to peripheral vasodilation and decreased systemic vascular resistance. This makes decreased blood pressure a key complication to monitor for, especially in the immediate postoperative period when volume status may be marginal. Opioids more commonly cause respiratory depression rather than increased respiratory rate, making hyperventilation a poor fit. Opioids typically reduce GI motility (constipation) and can cause urinary retention rather than diarrhea or urinary incontinence.

Question 40

You are caring for a patient who is receiving dopamine continuously into a peripheral IV site. You note that the catheter site and surrounding skin is cool and edemetous. You immediately discontinue the dopamine as you know it is a drug which may cause tissue necrosis if extravasation occurs. Which of the following steps should you anticipate performing (or assisting with)?

Accepted Answer

Answer reason: The specific antidote is local infiltration of phentolamine, an alpha-adrenergic blocker, around the affected site to reverse vasoconstriction and restore blood flow. This intervention is time-sensitive and is the standard immediate pharmacologic management after stopping the infusion and addressing the IV access per protocol. Debridement or surgery are not first-line actions and are considered only if tissue injury progresses despite appropriate early management.

Question 41

A patient has been receiving vancomycin (Vancocin), a small therapeutic index antibiotic, for six days. As the nurse is preparing to administer the antibiotic, she assesses the patient and suspects that the patient may be experiencing toxicity to the drug. What is the nurse's first priority?

Accepted Answer

Answer reason: Vancomycin toxicity risk increases with elevated trough levels and is associated with nephrotoxicity and ototoxicity, so verifying serum levels guides whether to hold, adjust, or continue therapy safely. Changing the antibiotic is not the nurse’s independent first action and requires a prescriber order after assessment data are obtained. Giving the dose despite concern increases risk of worsening toxicity, and an “antidote” is not indicated because toxicity is different from an acute allergic/anaphylactic reaction.

Question 42

A patient calls the triage line at a clinic, stating she is going out of town on business for several weeks and is concerned she will have difficulty sleeping, as she has experienced sleeplessness during previous business trips. The provider gives the patient a prescription for zolpidem tartrate (Ambien) 5 mg orally at bedtime as needed. The patient should be cautioned that she may experience which of the following side effects when taking zolpidem tartrate (Ambien)?

Accepted Answer

Answer reason: These behaviors include performing activities while not fully awake, with little to no memory afterward, which creates major safety risks. Patients must be warned to take the medication only when able to devote a full night to sleep and to avoid driving or other hazardous activities after use. While other parasomnias can occur, the most clinically emphasized and dangerous adverse effect that warrants explicit caution is engaging in activities like driving while asleep.

Question 43

An elderly diabetic who has been maintained on metformin (Glucophage) is scheduled for a cardiac catheterization. Which instruction should be given to the client?

Accepted Answer

Answer reason: Cardiac catheterization typically involves IV contrast, and older adults are at higher risk for reduced renal reserve. Therefore, the safest pre-procedure instruction is to stop metformin (commonly on the day of the procedure and for ~48 hours after) until renal function is confirmed stable. Options suggesting continuing the drug (with or without water) do not address this contrast-related contraindication, and protein restriction is not the key preventive measure for this medication-specific risk.

Question 44

Which of the following lab values should be closely monitored in a patient receiving propylthiouracil (PTU)?

Accepted Answer

Answer reason: PTU can cause serious bone marrow suppression, most notably agranulocytosis, which may present with fever, sore throat, or other infection symptoms. Monitoring the white blood cell count helps detect this potentially life-threatening adverse effect early so the medication can be stopped and the patient evaluated promptly. BUN and potassium are not the primary toxicity concerns for PTU, and phosphate monitoring is not routinely indicated for safety surveillance with this drug. Clinically, a falling WBC/ANC or new infection symptoms while taking PTU warrants urgent assessment and provider notification.

Question 45

A nurse is caring for a client who has heart failure and is receiving furosemide. Which finding should the nurse report to the provider first?

Accepted Answer

Answer reason: Serum potassium of 3.1 mEq/L Loop diuretics increase renal potassium losses, so hypokalemia is a predictable adverse effect that can quickly become life-threatening. A potassium of 3.1 mEq/L is clinically significant and raises the risk of dysrhythmias (especially in heart failure clients who may also be on digoxin) and requires prompt provider notification for replacement and regimen adjustment. Mild pedal edema is a common heart-failure finding and not immediately dangerous compared with an electrolyte abnormality. A urine output of 900 mL/24 hr is low but is less immediately arrhythmogenic than marked hypokalemia, and a BP of 138/86 mm Hg is not an urgent abnormality in this context.

Question 46

A 78-year-old client who has hypertension is beginning treatment with furosemide (Lasix). Considering the client's age, what should the nurse teach the client to do?

Accepted Answer

Answer reason: Older adults are at increased risk for orthostatic hypotension and falls due to age-related decreased baroreceptor sensitivity and vascular tone. Loop diuretics can contribute to volume depletion and lower blood pressure, making postural drops more likely, especially early in therapy. Teaching slow position changes (lying to sitting to standing) helps prevent dizziness, syncope, and injury. A common distractor is limiting fluids at bedtime, but routine fluid restriction is not indicated for hypertension management with furosemide and can worsen dehydration and hypotension.

Question 47

A nurse is caring for a client who has a history of heart failure and is taking digoxin 0.125 mg daily. Upon assessment, the client has dyspnea, orthopnea, nausea, and vomiting. Which of the following actions should the nurse take?

Accepted Answer

Answer reason: Digoxin has a narrow therapeutic index, so new gastrointestinal symptoms (nausea/vomiting) raise concern for toxicity and warrant stopping the medication pending evaluation. Continuing the dose risks progression to serious dysrhythmias, especially if contributing factors like renal impairment or electrolyte abnormalities are present. The safest nursing action is to withhold the drug and promptly communicate with the prescriber for further orders (e.g., apical pulse, ECG, digoxin level, potassium). A “catch-up” dose is unsafe for any missed dose scenario, and adding a diuretic without assessment can worsen hypokalemia, increasing toxicity risk.

Question 48

A client with chronic heart failure developed an intractable cough and an incident of angioedema after starting enalapril. Which prescription does the nurse anticipate for this client?

Accepted Answer

Answer reason: An ARB provides similar heart failure benefits through angiotensin II receptor blockade without increasing bradykinin, making it the preferred substitute when these reactions occur. Another ACE inhibitor would carry the same class risk and is contraindicated after angioedema. Symptomatic cough suppression does not address the underlying drug reaction or the need for ongoing guideline-directed heart failure therapy.

Question 49

The nurse working on the medical-surgical unit understands that anticholinergic drugs, such as atropine, is contraindicated in which client condition?

Accepted Answer

Answer reason: A large post-void residual indicates incomplete bladder emptying and high risk for worsening retention or acute urinary obstruction if an anticholinergic is given. This is especially concerning in settings like BPH or neurogenic bladder, where anticholinergics can precipitate acute urinary retention requiring catheterization. Loose stools would more often improve with anticholinergic effects (reduced GI motility), not represent a contraindication. Diplopia and strep throat infection are not classic direct contraindications compared with existing significant urinary retention.

Question 50

The nurse is caring for a client who was newly prescribed warfarin. Which medication on the client's medication list requires follow-up with the primary healthcare provider (PHCP)?

Accepted Answer

Answer reason: Herbal supplements are a common source of clinically significant interactions because patients may not consider them “medications” and their anticoagulant/antiplatelet effects can be unpredictable. This supplement has been associated with increased bleeding risk, which could raise the risk of bruising, GI bleeding, or elevated INR when combined with warfarin. In contrast, the other listed agents are not typical high-risk combinations requiring immediate follow-up compared with an interacting herbal product.

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