Question 1

When the nurse is assessing a client who is being treated for hypothyroidism, which of these findings would indicate a potentially serious complication?

Accepted Answer

Answer reason: New-onset palpitations with chest pain is therefore a red-flag adverse effect requiring prompt assessment, vital signs/ECG, and likely dose adjustment or holding the medication. In contrast, chills/fever/hypotension points more toward infection or shock rather than a typical treatment-related complication of levothyroxine. Decreased visual acuity and thrombocytopenia are not characteristic sentinel complications of hypothyroidism therapy.

Question 2

The nurse is providing education to a client who has been diagnosed with hyperparathyroidism. The nurse determines further teaching is necessary when the client states that they will continue to take?

Accepted Answer

Answer reason: Hyperparathyroidism commonly causes hypercalcemia, so teaching focuses on avoiding medications that further raise serum calcium. Thiazide diuretics decrease renal calcium excretion, which can worsen hypercalcemia and increase risks such as nephrolithiasis, constipation, confusion, and dysrhythmias. In contrast, loop diuretics promote calciuresis and are sometimes used (with IV fluids) to help lower calcium, making thiazides the key contraindicated choice here. Simple analgesics like acetaminophen or aspirin do not directly increase calcium levels in the same way.

Question 3

The nurse is preparing to administer I.V. insulin to a client diagnosed with diabetic ketoacidosis. The client is at risk for which conditions?

Accepted Answer

Answer reason: Even when total body potassium is depleted from osmotic diuresis, the initial serum value may be normal/high; insulin can quickly unmask and worsen hypokalemia, predisposing to dysrhythmias and muscle weakness. Continuous insulin infusions can also overshoot glucose control if dextrose is not added as glucose normalizes, causing hypoglycemia. These predictable adverse effects require frequent bedside glucose checks and close electrolyte/ECG monitoring with potassium replacement as indicated.

Question 4

A 72-year-old male tells the nurse he has been taking saw palmetto by mouth twice a day for the past 3 years as treatment for urinary hesitancy due to an enlarged prostate. What should the nurse assesses the client for?

Accepted Answer

Answer reason: Saw palmetto has been associated (rarely) with hepatotoxicity, so assessing for liver injury symptoms such as jaundice, dark urine, pruritus, and right upper quadrant discomfort is appropriate, especially with long-term use. Hypertension is not a typical adverse effect for this supplement and is less directly linked to a specific toxicity concern. Dry mouth aligns more with anticholinergic medications used for urinary symptoms rather than saw palmetto.

Question 5

The client is prescribed medications on hospital admission. Four days later the client’s serum creatinine level, which was normal at admission, is now 3.7 mg/dL. The nurse should contact the HCP regarding a dosage change for which medication?

Accepted Answer

Answer reason: Cephalosporins are largely renally eliminated, so impaired renal function commonly necessitates reassessing dosing and/or interval based on kidney function. Insulin dosing is primarily guided by blood glucose rather than creatinine alone, and diltiazem is mainly hepatically metabolized. Furosemide can worsen volume depletion and prerenal azotemia, but it is not a medication that is routinely dose-adjusted purely to avoid accumulation from reduced renal clearance in the same way as many antimicrobials.

Question 6

The adolescent, who is receiving morphine sulfate via PCA, has itching. Which medication listed on the client’s MAR should the nurse plan to administer to relieve the itching?

Accepted Answer

Answer reason: An H1 antihistamine is an appropriate PRN medication to reduce itching while allowing analgesia to continue. Naloxone would reverse opioid effects and can worsen pain; it is reserved for clinically significant opioid-induced respiratory depression or severe intolerable effects. Diazepam treats anxiety/muscle spasm and does not address histamine-mediated pruritus, and butenafine is a topical antifungal unrelated to acute opioid itching.

Question 7

The nurse is concerned that the adolescent may be developing a side effect of methotrexate. Which test or exam results should the nurse review prior to administration?

Accepted Answer

Answer reason: A CBC directly assesses these cell lines and is therefore the key safety lab to review before giving the medication when toxicity is suspected. Serum electrolytes do not detect this major adverse effect, and aPTT is not the standard monitoring test for methotrexate toxicity. While folate supplementation is often used to reduce some adverse effects, folic acid level is not the primary pre-dose safety screen compared with hematologic monitoring.

Question 8

The nurse is reviewing the medications for all assigned clients on an inpatient psychiatric unit. The nurse anticipates assessing for extrapyramidal symptoms (BPS) in clients taking which antipsychotic medication?

Accepted Answer

Answer reason: High-potency first-generation antipsychotics have the highest risk for acute dystonia, akathisia, parkinsonism, and tardive dyskinesia, so focused monitoring is expected. This medication is a classic high-potency typical antipsychotic and is therefore the most likely to cause EPS compared with the others listed. Atypical agents (e.g., clozapine, ziprasidone) generally carry a lower EPS risk at usual doses due to greater serotonergic activity and/or weaker D2 blockade. While risperidone can cause EPS at higher doses, the risk is typically higher with high-potency typical agents.

Question 9

The muse administers risperidone to the client experiencing hallucinations. Which physiological disorder should the nurse assess for considering the risk of developing this disorder as a side effect of risperidone?

Accepted Answer

Answer reason: Risperidone therefore increases risk for new-onset diabetes or worsening glycemic control in clients with preexisting diabetes, so the nurse should assess for diabetes risk factors and monitor glucose/A1c as indicated. While blood pressure changes may occur indirectly with weight gain, the most classically tested physiologic disorder linked to atypical antipsychotics is dysglycemia/diabetes. Asthma and Crohn’s disease are not expected adverse-effect targets of risperidone therapy.

Question 10

One hour after I.V. furosemide (Lasix) is administered to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which electrolyte imbalance should the nurse suspect?

Accepted Answer

Answer reason: Low potassium increases myocardial excitability and delays repolarization, predisposing to ventricular ectopy and ventricular tachyarrhythmias. In a heart failure patient who develops a new run of ventricular tachycardia shortly after receiving this medication, potassium loss is the most likely cause to assess and correct promptly. Hypernatremia is not the typical acute diuretic-related trigger for ventricular tachycardia, and hypermagnesemia generally causes bradycardia and conduction depression rather than ventricular tachyarrhythmias.

Question 11

The nurse is teaching a client with a peptic ulcer about discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be the most accurate?

Accepted Answer

Answer reason: Nonsteroidal anti-inflammatory drugs and salicylates decrease mucosal protection and can worsen ulcer symptoms or precipitate hemorrhage. The safest routine OTC analgesic choice in this context is the non-NSAID option that does not have significant gastric mucosal effects at therapeutic doses. This teaching prioritizes prevention of complications and reinforces avoidance of common ulcer triggers found in many pain relievers.

Question 12

A client asks the nurse if he can drink alcohol while taking phenytoin. What is the best response by the nurse?

Accepted Answer

Answer reason: Alcohol can interact with antiepileptic therapy by altering drug metabolism and destabilizing seizure control, making therapeutic levels less reliable. With phenytoin, alcohol use (especially chronic use) can increase hepatic enzyme activity and contribute to reduced medication effect and breakthrough seizures, while acute alcohol intake can also create unpredictable serum levels. Teaching should emphasize avoiding alcohol to maintain consistent seizure prophylaxis and medication effectiveness. Option B is incorrect because alcohol generally lowers seizure threshold and can precipitate seizures rather than protect against them.

Question 13

A 3-year-old child is receiving vancomycin for acute epiglottitis. Which of the following assessments would lead the nurse to suspect an adverse effect to vancomycin?

Accepted Answer

Answer reason: This is an adverse drug effect that the nurse can detect on assessment and should prompt slowing the infusion rate and notifying the provider per protocol. Constipation and increased appetite are not typical adverse reactions for this antibiotic. Blood pressure changes with this reaction are more often hypotension rather than hypertension, making that option less consistent.

Question 14

A 2-year-old child with neonatal chronic lung disease (bronchopulmonary dysplasia) is placed on furosemide (Lasix) once per day. The parents are being educated on foods that are rich in potassium. Which food should the nurse recommend?

Accepted Answer

Answer reason: Citrus fruits are a common dietary source of potassium and are appropriate to recommend for a child taking daily furosemide. In contrast, apples and peaches are not typically high-potassium choices compared with citrus. Monitoring for hypokalemia symptoms (e.g., weakness, cramps, dysrhythmias) is also part of safe diuretic education.

Question 15

A 2-year-old child with status asthmaticus is admitted to the pediatric unit and begins to receive continuous treatment with albuterol (Proventil), given by nebulizer. The nurse should observe for which of the following?

Accepted Answer

Answer reason: With continuous nebulized dosing, sympathetic side effects are more likely, and increased heart rate is a key adverse effect requiring monitoring. Bradycardia is not expected with beta-agonists, and lethargy would be more concerning for worsening respiratory failure or hypoxia rather than a typical medication effect. Tachypnea is common in asthma exacerbations but is not the primary medication-related effect the nurse is being asked to observe for.

Question 16

The nurse is teaching the family of a client who has been prescribed thiothixene (Navane). Which of the following adverse reactions concerning this medication would be the most accurate for the nurse to discuss?

Accepted Answer

Answer reason: This can present with akinesia/bradykinesia and other parkinsonian features (rigidity, tremor), which may significantly impair function and requires prompt reporting for management (e.g., dose adjustment or anticholinergic therapy). While orthostatic hypotension and sedation can occur via alpha-1 and histamine blockade, they are less defining for high-potency typical agents compared with EPS. Weight gain is more characteristic of many second-generation antipsychotics and some low-potency typicals, so it is not the most accurate priority teaching point here.

Question 17

A schizophrenic client who is receiving antipsychotic medication reports that he feels nervous. He paces, fidgets, and can’t seem to stay still. The primary cause of these behaviors is most likely which disorder?

Accepted Answer

Answer reason: The symptoms occur relatively early after initiating or increasing dopamine-blocking agents and are often misinterpreted as worsening agitation or anxiety. Tardive dyskinesia instead causes choreoathetoid, involuntary movements (often oral–facial) after longer exposure, not primarily subjective restlessness. Akinesia is a parkinsonian-type effect with bradykinesia and rigidity rather than motor hyperactivity and constant movement.

Question 18

A client who takes tranylcypromine (Parnate) is changed to fluoxetine (Prozac). Which manifestation indicates a serious interaction between these two medications?

Accepted Answer

Answer reason: Combining (or switching without an adequate washout between) an MAOI like tranylcypromine and an SSRI like fluoxetine can precipitate serotonin syndrome, a potentially life-threatening toxicity. A hallmark manifestation is hyperthermia due to autonomic instability, often accompanied by agitation, diaphoresis, tachycardia, and neuromuscular hyperactivity. This reflects excessive serotonergic activity and requires urgent recognition and intervention. In contrast, decreased salivary secretions is more consistent with anticholinergic effects and is not the key dangerous interaction expected with this drug combination.

Question 19

For which client would the use of acetaminophen (Tylenol) pose a higher risk?

Accepted Answer

Answer reason: Chronic alcohol use increases susceptibility to acetaminophen-induced hepatotoxicity because it can induce hepatic CYP2E1 (increasing formation of the toxic metabolite NAPQI) and is often associated with depleted glutathione stores needed to detoxify NAPQI. This makes liver injury more likely even at doses closer to the therapeutic range, and especially with repeated dosing. In contrast, asthma is not a typical contraindication for acetaminophen, and sickle-cell anemia often requires analgesia where acetaminophen is commonly used when dosed safely. Cocaine abuse does not specifically heighten acetaminophen liver toxicity risk to the same degree as chronic alcohol use.

Question 20

A client with a closed head injury requests pain medication for headache. Which medication is most likely contraindicated in this client?

Accepted Answer

Answer reason: After a head injury, medications that increase bleeding risk are avoided because an unrecognized intracranial bleed can expand and worsen neurologic outcomes. NSAIDs inhibit platelet function and can contribute to bleeding, making them relatively contraindicated when intracranial hemorrhage is a concern. In contrast, acetaminophen is generally preferred for headache pain because it does not affect platelets. Opioid combinations may be used cautiously but can confound neurologic assessment due to sedation; the bleeding risk is the clearer contraindication among these choices.

Question 21

Which assessment finding should alert a nurse to a potential problem in a client who has received morphine I.V. for postoperative pain?

Accepted Answer

Answer reason: A rate of 8/min indicates clinically significant respiratory depression and risk of hypoxia and CO2 retention, requiring prompt intervention (stimulation, oxygen, holding opioid, and possible naloxone per protocol). Mild sedation with easy arousal can be expected after opioid administration and is not by itself an emergency. Hypotension can occur with opioids, but a low respiratory rate is the more immediate life-threatening complication that must be prioritized.

Question 22

A client has not voided 10 hours following an inguinal hernia repair. The nurse determines that the nursing diagnosis for this client would be urinary retention related to which of the following?

Accepted Answer

Answer reason: Anticholinergics such as atropine inhibit parasympathetic stimulation of the bladder, reducing detrusor muscle contraction and promoting retention, especially after surgery. This directly explains an inability to void for many hours after an inguinal hernia repair. By contrast, dehydration more often leads to low urine output rather than an inability to empty a distended bladder.

Question 23

The nurse is administering mannitol IV to decrease the client’s ICP following a craniotomy. Which laboratory test result should the nurse monitor during the client’s treatment with mannitol?

Accepted Answer

Answer reason: Because its therapeutic effect and major toxicity are directly tied to serum osmolality, monitoring this value helps ensure effectiveness while preventing excessive hyperosmolarity and dehydration. Elevated osmolality increases risk for renal injury and worsening fluid/electrolyte disturbances, so trending it guides whether to hold or adjust dosing. The other listed labs (WBC, cholesterol, ESR) do not reflect mannitol’s mechanism or its primary safety risks during therapy.

Question 24

The nurse is assessing the laboratory test results for the male client receiving testosterone replacement therapy for treatment of hypogonadism. Which laboratory test result is most important for the nurse to review?

Accepted Answer

Answer reason: Identifying dyslipidemia early guides risk reduction (lifestyle changes, dose adjustment, or additional therapy) and helps prevent long-term complications. Coagulation monitoring with partial thromboplastin time is not a routine, direct monitoring parameter for testosterone replacement. Serum potassium and routine urinalysis are not primary toxicity/monitoring targets for testosterone in most clients unless other comorbidities indicate them.

Question 25

The HCP prescribed mifepristone for the 35-year-old female to treat a leiomyoma. Before the client begins the medication, which information is most important for the nurse to obtain?

Accepted Answer

Answer reason: The most safety-critical premedication assessment is therefore to rule out an existing pregnancy before initiating therapy for leiomyoma. While hepatic status may influence medication choice and monitoring, it is not as immediately determinative of whether the drug can be started safely as confirming nonpregnant status. Baseline vital signs and anthropometrics are useful but do not address this primary, high-risk contraindication.

Question 26

The 9–year-old with SLE is receiving large doses of prednisolone- Which laboratory finding should the nurse recognize as an untoward effect of the medication?

Accepted Answer

Answer reason: A random glucose of 130 mg/dL is above typical expected random values in children and signals steroid-related impaired glucose control that warrants monitoring and possible intervention. Leukocytosis can occur with steroids from demargination and may not represent harm by itself, making it a weaker indicator of an untoward effect. Hyponatremia is not a typical steroid effect (they more often promote sodium retention), and an isolated elevated bilirubin is not a characteristic corticosteroid adverse effect pattern.

Question 27

The clinic nurse is reviewing prescriptions with the parents of the school-aged child with newly diagnosed generalized contact dermatitis. Which prescription should the nurse question with the HCP?

Accepted Answer

Answer reason: For uncomplicated contact dermatitis, first-line treatment is trigger avoidance plus topical anti-inflammatory and antipruritic measures. The other prescriptions listed are typical supportive options: topical low-potency steroid for inflammation, calamine for soothing, and an antihistamine for itch/sleep. Therefore, the systemic steroid is the order that warrants clarification about indication, dose, and duration before starting.

Question 28

The nurse assesses that the client with acute mania has coarse hand tremors, and the serum lithium level is 1.8 m Eq/L. What should the nurse do?

Accepted Answer

Answer reason: Lithium has a narrow therapeutic index, and a level of 1.8 mEq/L with coarse tremors indicates toxicity rather than an expected side effect. The priority nursing action is to stop further exposure to the drug and promptly communicate with the prescriber for urgent management and further orders (e.g., repeat levels, hydration strategy, possible hospitalization). Continuing the medication risks progression to severe neurotoxicity (confusion, ataxia, seizures) and cardiac dysrhythmias. Limiting fluids would worsen lithium retention because dehydration increases lithium reabsorption, and treating the tremor symptomatically does not address the potentially dangerous elevated serum level.

Question 29

New medications are prescribed for the client taking lithium. Which medication, if prescribed, should the nurse question with the HCP?

Accepted Answer

Answer reason: Loop diuretics can cause volume depletion and sodium loss, leading the kidneys to reabsorb more lithium along with sodium, raising serum lithium concentrations. A relatively high daily dose further heightens dehydration/electrolyte shifts, making this order particularly concerning. The other listed medications do not have the same well-known, clinically significant interaction pattern with lithium related to renal clearance and sodium balance.

Question 30

The client has been prescribed clonidine for the unlabeled purpose of easing the discomfort associated with smoking cessation. Which body system should be the nurse’s initial focus when completing the client’s physical assessment?

Accepted Answer

Answer reason: The highest immediate risk is hypotension, orthostatic changes, and bradycardia, so the nurse should prioritize assessing vital signs and overall cardiovascular status. Early identification of dizziness, syncope risk, and baseline BP/HR guides safe dosing and patient teaching (e.g., slow position changes). Neurologic sedation can occur, but it is typically secondary to hemodynamic safety concerns. Abrupt discontinuation can cause rebound hypertension, further reinforcing the need for cardiovascular monitoring.

Question 31

The health care provider prescribed salicylates for a client with osteoarthritis. The nurse assesses the client and determines further intervention is necessary when the client exhibits which of the following?

Accepted Answer

Answer reason: g., aspirin) can cause salicylism, an early toxicity syndrome characterized by tinnitus and decreased hearing. New-onset hearing changes signal the need to hold the medication and notify the provider because rising serum salicylate levels can progress to more serious toxicity. Joint pain fluctuations can occur from disease activity and are not a classic toxicity marker requiring urgent intervention. Calcium absorption and bone demineralization are not expected adverse effects that would specifically indicate salicylate toxicity.

Question 32

In which client is the use of the drug tetracycline hydrochloride (Tetracycline) appropriate?

Accepted Answer

Answer reason: Tetracyclines are contraindicated in pregnancy and generally avoided during breastfeeding because they can cross the placenta and enter breast milk, posing risk of fetal/infant bone growth inhibition and permanent tooth discoloration. They are also avoided in children younger than 8 years for the same teeth and bone toxicity concerns. The 58-year-old is neither pregnant, breastfeeding, nor a young child, so she lacks the major age/pregnancy-related contraindications. A common distractor is focusing on parity; the number of children does not itself create a contraindication to this medication.

Question 33

A client admitted to the hospital takes isoniazid (INH), metoprolol succinate (toprol-XL), and paroxetine hydrochloride (Paxil). Which lab test indicates a contraindication to the continuation of isoniazid (INH)?

Accepted Answer

Answer reason: Isoniazid can cause clinically significant hepatotoxicity, so rising transaminases (AST/SGOT and ALT) are a key safety signal to stop or hold therapy depending on severity and symptoms. An elevated SGOT indicates liver injury and represents a contraindication to continuing INH because ongoing exposure can progress to hepatitis or liver failure. Hyponatremia is more consistent with SSRI-related SIADH risk from paroxetine rather than INH toxicity. Elevated creatinine reflects renal impairment, but INH’s primary serious dose-limiting toxicity is hepatic, making liver enzyme elevation the most direct contraindicating lab finding here.

Question 34

A client with chronic low back pain receives injections of meperidine hydrochloride (Demerol) every other day for 4 weeks. Which symptom exhibited by this patient could be an adverse reaction caused by this medication?

Accepted Answer

Answer reason: Meperidine has a neurotoxic metabolite (normeperidine) that can accumulate with repeated dosing, especially over weeks, leading to CNS excitation. This toxicity is classically associated with tremors, agitation, and seizures rather than the expected opioid CNS/respiratory depression. The dosing pattern and duration increase the risk of metabolite buildup, making new-onset seizures a concerning adverse effect. In contrast, opioid effects more typically include miosis and urinary retention/constipation, not mydriasis or polyuria.

Question 35

Hydrochlorothiazide (Microzide) is ordered for a client as an antihypertensive. Which should the nurse expect to be included in the client's list of current medications?

Accepted Answer

Answer reason: Thiazide diuretics increase renal potassium excretion, so a key expected adverse effect is hypokalemia. Clients may already be taking potassium supplementation or be prescribed it to prevent or correct low potassium while on the diuretic. Monitoring for symptoms and ECG changes of low potassium is part of safe medication management with this drug class. The other options are used for unrelated indications (e.g., cyanide poisoning/vasodilator toxicity, bowel evacuation, or acute hypocalcemia) and do not address the characteristic electrolyte loss from hydrochlorothiazide.

Question 36

A client is given a prescription for amiodarone (Cordarone) in addition to digoxin (Lanoxin). Which action should the nurse take?

Accepted Answer

Answer reason: Amiodarone inhibits P-glycoprotein and can increase serum digoxin concentrations, significantly raising the risk of digoxin toxicity (e.g., bradyarrhythmias, AV block, GI and visual symptoms). When a new interacting medication is added, the nurse should not independently alter the prescribed dose but must promptly notify the prescriber so the digoxin dose can be reduced and levels/ECG can be monitored. “No action” ignores a high-risk interaction with potentially life-threatening dysrhythmias. Taking both at the same time does not mitigate the pharmacokinetic interaction and could worsen adverse effects if toxicity develops.

Question 37

A client uses budesonide (Pulmocort Turbuhaler) twice a day. Why should the nurse give instruction for the client to rinse the mouth out after each use?

Accepted Answer

Answer reason: Inhaled corticosteroids can deposit medication in the oropharynx, causing local immunosuppression of the mucosa. This increases the risk of oral candidiasis (thrush) and hoarseness, especially with regular use. Rinsing and spitting after each dose removes residual steroid from the mouth and throat, reducing fungal overgrowth risk. The other options focus on absorption, taste, or efficacy, but rinsing is primarily a safety measure to prevent a predictable adverse effect.

Question 38

A 57-year-old male client who has a history of hypertension expresses concern about his sexual functioning to the nurse. What is the most important assessment data for the nurse to review?

Accepted Answer

Answer reason: Several antihypertensives (notably thiazide diuretics, some beta-blockers, and central alpha-agonists) can contribute to decreased libido or erectile dysfunction, and changing the regimen can often improve symptoms safely. Reviewing current prescriptions, recent dose changes, and use of other agents (e.g., antidepressants, OTC products, alcohol/substances) helps distinguish iatrogenic causes and guides safe referrals or provider notification. In contrast, sexual practices are important for holistic assessment but do not address a frequent, reversible etiology tied to his diagnosis and treatment.

Question 39

A client receiving phenothiazine has become restless and fidgety and has been pacing the hallway continuously for the past hour. This behavior suggests to the nurse that the client may be experiencing which adverse reaction to phenothiazine?

Accepted Answer

Answer reason: Phenothiazines (typical antipsychotics) can block dopamine in the nigrostriatal pathway, precipitating this reaction early in therapy or after dose increases. The client’s continuous pacing and restlessness match this pattern more closely than dystonia, which presents as sustained muscle spasms (e.g., torticollis, oculogyric crisis). Parkinsonian effects produce bradykinesia, rigidity, and tremor rather than agitation, and tardive dyskinesia is typically late-onset with choreoathetoid mouth/tongue movements.

Question 40

A nurse is caring for a 7-year-old client receiving cyclophosphamide (Cytoxan). In addition to administering mesna (Mesnex), which action should the nurse take?

Accepted Answer

Answer reason: Mesna helps neutralize these metabolites in the urinary tract, and frequent voiding further reduces bladder exposure time and lowers injury risk. Adequate hydration and scheduled/frequent urination are standard supportive measures during therapy. Limiting fluids would worsen risk by concentrating urine, and platelet transfusion is not a routine pre-med unless significant thrombocytopenia/bleeding is present.

Question 41

Steroids, such as prednisone and methylprednisolone, are used to suppress the inflammatory immune response following a kidney transplant. Which information should be given to a client with a transplant?

Accepted Answer

Answer reason: Systemic corticosteroids can cause significant metabolic adverse effects, including increased appetite, hyperglycemia, and dyslipidemia. Client teaching after transplant should include awareness that lipid levels may rise and may require monitoring and treatment to reduce cardiovascular risk. Weight loss is not expected; steroids more commonly lead to weight gain and fluid retention. Alopecia is not a typical corticosteroid effect, and while potassium changes can occur, elevated cholesterol is a more characteristic and commonly emphasized teaching point for chronic steroid therapy.

Question 42

The nurse is teaching a 24-year-old female with severe cystic acne who is prescribed a systemic retinoic acid drug. Which question is priority?

Accepted Answer

Answer reason: Systemic retinoic acid drugs for severe acne (e.g., isotretinoin) are highly teratogenic, so pregnancy prevention and assessing pregnancy risk are the most urgent safety priorities before and during therapy. Determining sexual activity helps the nurse assess the need for reliable contraception, pregnancy testing, and required risk-management program counseling to prevent fetal harm. While mucocutaneous dryness and adherence are important teaching points, they are not as immediately safety-critical as avoiding exposure in pregnancy. A vitamin A “allergy” is uncommon and is less clinically actionable than identifying and reducing teratogenic risk.

Question 43

An older adult with PD is prescribed levodopa and carbidopa. What information should the nurse include when teaching the client and spouse?

Accepted Answer

Answer reason: Levodopa/carbidopa can cause orthostatic hypotension, dizziness, and dyskinesias, which increase fall risk, especially in older adults. Teaching should emphasize slow position changes, monitoring for lightheadedness, and implementing home safety measures. Advising cessation of vitamins is not routinely required; interactions are more specific (e.g., high-dose pyridoxine without carbidopa) rather than “multiple vitamins” broadly. It is also inaccurate to claim the drug has very few adverse effects, since nausea, hypotension, hallucinations, and motor fluctuations are clinically important.

Question 44

The client is to receive a first dose of oral sulfamethoxazole 1 g every 12 hours for treatment of recurrent UTIs. Which information about the client should prompt the nurse to question the medication order?

Accepted Answer

Answer reason: A near-term client therefore represents a high-risk contraindication that should prompt the nurse to question the order and request an alternative antibiotic. E. coli is a common cause of UTIs and does not itself create a safety contraindication to this drug choice. Diabetes and a history of gastric ulcer may require monitoring for side effects or interactions, but they are not the classic immediate “do not give” concern compared with late pregnancy.

Question 45

The nurse assesses the client in labor at 39 weeks’ gestation receiving epidural anesthesia. Which findings require immediate nursing intervention because the client may be experiencing symptoms of IV injection?

Accepted Answer

Answer reason: Ringing in the ears and a metallic taste are hallmark prodromal symptoms that can rapidly progress to seizures and cardiovascular collapse if not addressed immediately. This finding should prompt stopping the infusion/injection, calling for help, and preparing for airway support and lipid emulsion therapy per protocol. Hypotension is common from sympathetic blockade with a correctly placed epidural and is not as specific for intravascular injection as the characteristic sensory symptoms.

Question 46

The nurse is assessing the 13-year-old who has been taking somatropin recombinant. Which findings should the nurse report to an HCP?

Accepted Answer

Answer reason: A random glucose of 158 mg/dL is above normal for a child/adolescent and suggests impaired glucose tolerance that may progress if therapy continues. This warrants assessment for symptoms of hyperglycemia and consideration of further testing (e.g., fasting glucose/HbA1c) and dose/therapy adjustments. By contrast, a BP of 122/74 mm Hg can be within expected adolescent ranges depending on height percentile and is not as directly tied to a serious medication complication as elevated glucose.

Question 47

The 5-year–old who received a kidney transplant is receiving cyclosporine. Which laboratory finding should the nurse recognize as indicating that the treatment is having an adverse effect?

Accepted Answer

Answer reason: A total cholesterol of 220 mg/dL is abnormally high for a child and fits a known adverse effect profile that warrants follow-up and management. The low hemoglobin is more consistent with anemia from chronic kidney disease or postoperative/chronic illness rather than a typical direct cyclosporine toxicity marker. Elevated ammonia points toward hepatic failure/urea cycle issues, and hypoglycemia is not a characteristic adverse effect of cyclosporine.

Question 48

The client with a BPD is prescribed phenelzine for decreasing impulsivity and self destructive acts. The nurse teaches the client to avoid foods high in tyramine when taking phenelzine to prevent What effect?

Accepted Answer

Answer reason: This leads to acute severe hypertension with headache, diaphoresis, palpitations, and risk of intracranial hemorrhage, which is why tyramine restriction is essential. The key adverse interaction is pressor in nature, not a drop in blood pressure. Rhythm changes can occur secondarily, but they are not the primary preventable effect targeted by the tyramine warning.

Question 49

The school-aged child taking guanfacine for treating ADHD is being seen by the nurse at school. The child is pale, diaphoretic, and feeling dizzy. What should the nurse do first?

Accepted Answer

Answer reason: The priority is to assess for an immediately dangerous medication adverse effect by obtaining vital signs, with blood pressure being the most directly relevant assessment. If significant hypotension is present, the nurse can then initiate appropriate safety actions (e.g., have the child sit/lie down, monitor, and escalate care). Checking glucose can be considered if symptoms persist or history suggests hypoglycemia, but it is less directly tied to this medication’s expected risk profile than hypotension.

Question 50

The nurse is performing a health history on the child with ADHD who is being evaluated for treatment with psychostimulants. Which information is most critical to collect prior to treatment with psychostimulants?

Accepted Answer

Answer reason: A focused cardiovascular history helps identify congenital heart defects, arrhythmias, syncope, chest pain, exercise intolerance, or a family history of sudden cardiac death that could make stimulant therapy unsafe or require further evaluation. This information directly affects medication selection, need for baseline vitals/ECG, and monitoring intensity. The other histories may be relevant to overall assessment but do not address the most safety-critical contraindication risk for stimulant initiation.

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