Question 1

Withdrawal symptoms do not usually occur with which of the following medications?

Accepted Answer

Answer reason: NSAIDs are not associated with physical dependence or discontinuation syndromes; antidepressants (MAOIs, SSRIs, tetracyclics) can produce withdrawal symptoms if stopped abruptly.

Question 2

An adult is being treated with isoniazid (INH) and streptomycin for active tuberculosis. Which of the following symptoms would suggest a toxic effect of INH?

Accepted Answer

Answer reason: INH commonly causes peripheral neuropathy due to pyridoxine deficiency; streptomycin toxicity causes ototoxicity (tinnitus and deafness).

Question 3

A 70-year-old man with a history of hypertension and closed-angle glaucoma visits the clinic for a routine checkup. Which of the following medications, if ordered by the physician, should the nurse question?

Accepted Answer

Answer reason: Tetrahydrozoline is an alpha-adrenergic vasoconstrictor that can cause mydriasis and precipitate angle-closure by increasing intraocular pressure; it is contraindicated in angle-closure glaucoma. Propranolol and verapamil are acceptable for hypertension, and timolol eye drops lower IOP.

Question 4

One of the following medications is contraindicated in patients with obstructive hypertrophic cardiomyopathy?

Accepted Answer

Answer reason: Digoxin is a positive inotrope that increases contractility and can worsen left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy; beta-blockers, verapamil or diltiazem, and disopyramide reduce contractility and are used as therapy.

Question 5

All of the following are the complications associated with long-term use of corticosteroid therapy, EXCEPT?

Accepted Answer

Answer reason: Long-term corticosteroid use causes hyperlipidemia, osteoporosis, Cushingoid features, and adrenal suppression; hypolipidemia is not a typical effect.

Question 6

A pregnant woman is suffering from a peptic ulcer. The drug that is contraindicated is?

Accepted Answer

Answer reason: Misoprostol is a prostaglandin E1 analog that stimulates uterine contractions and can cause miscarriage; it is pregnancy category X and is contraindicated in pregnant patients. PPIs and H2 blockers are generally considered safer in pregnancy.

Question 7

Which analgesic is safe for pregnant women?

Accepted Answer

Answer reason: Acetaminophen (paracetamol) is the first-line analgesic/antipyretic in pregnancy. NSAIDs (ibuprofen, diclofenac, aspirin) are avoided, especially in late pregnancy, because of fetal risks, and opioids, like tramadol, are not preferred.

Question 8

Magnesium sulfate toxicity in eclampsia is treated with?

Accepted Answer

Answer reason: Calcium gluconate is the specific antidote for magnesium sulfate toxicity, reversing respiratory depression and loss of deep tendon reflexes.

Question 9

The nurse is caring for a client with pneumonia who is allergic to penicillin. Which antibiotic is safest to administer to this client?

Accepted Answer

Answer reason: Macrolides like erythromycin are not beta-lactams and are safe in penicillin-allergic clients. Amoxicillin is a penicillin and cephalosporins (cefazolin, ceftriaxone) carry cross-reactivity risk.

Question 10

Which of the following statements by a client with a seizure disorder who is taking topiramate (Topamax) indicates that the client has understood the nurse's instructions?

Accepted Answer

Answer reason: Topiramate increases the risk of kidney stones; clients are taught to maintain a high fluid intake to prevent nephrolithiasis. The drug does not need to be taken at bedtime or with food, and fruit intake is unrelated.

Question 11

The nurse should be particularly alert for which one of the following problems in a client with a barbiturate overdose?

Accepted Answer

Answer reason: Barbiturate overdose causes profound CNS and respiratory depression; the priority complication to monitor is apnea.

Question 12

A client has been placed on the drug valproic acid (Depakene). Which would indicate to the nurse that the client is experiencing an adverse reaction to this medication?

Accepted Answer

Answer reason: Valproic acid commonly causes CNS depression with drowsiness and sedation; lethargy is a typical adverse effect. Photophobia and visual disturbances are not characteristic, and poor skin turgor is unrelated.

Question 13

A client diagnosed with COPD is receiving theophylline. Morning laboratory values reveal a theophylline level of 38 mcg/mL. The most appropriate action by the nurse would be?

Accepted Answer

Answer reason: The therapeutic theophylline level is about 10–20 mcg/mL; 38 mcg/mL indicates toxicity. The nurse should hold the drug and notify the provider. Other options are unsafe or irrelevant.

Question 14

The nurse is preparing to teach a client about phenytoin sodium (Dilantin). Which fact would be most important to teach the client about why the drug should not be stopped suddenly?

Accepted Answer

Answer reason: Abrupt withdrawal of antiepileptic drugs like phenytoin can precipitate rebound seizures and life-threatening status epilepticus; therefore, the medication should not be stopped suddenly.

Question 15

A client with chronic obstructive pulmonary disease (COPD) is admitted to the respiratory unit. Which physician's prescription should the nurse question?

Accepted Answer

Answer reason: High-flow oxygen (5 L/min by nasal cannula) can suppress the hypoxic respiratory drive in COPD and lead to CO2 retention; oxygen should be titrated to a low flow to maintain a target saturation (about 88–92%). The steroid and antibiotic orders are appropriate for an exacerbation, and the PRN analgesic is not contraindicated.

Question 16

A burn client begins treatment with silver sulfadiazine (Silvadene) applied to the wounds. The nurse should carefully monitor for which adverse effect associated with this drug?

Accepted Answer

Answer reason: Silver sulfadiazine can cause a transient decrease in the white blood cell count; monitoring for leukopenia is recommended. Electrolyte disturbances and thrombocytopenia are not typical adverse effects.

Question 17

The nurse is assessing the chart of a client with a stroke. MRI results reveal a hemorrhagic stroke in the brain. Which physician's prescription would the nurse question?

Accepted Answer

Answer reason: In hemorrhagic stroke, anticoagulants increase the risk of bleeding and are contraindicated. A heparin infusion could worsen the intracranial hemorrhage. Oxygen, isotonic IV fluids, and a Foley catheter for monitoring are not inherently contraindicated.

Question 18

Which of the following is true about verapamil?

Accepted Answer

Answer reason: Verapamil, a calcium-channel blocker, can cause hypotension due to vasodilation and negative inotropy. It is not indicated for wide-complex tachycardia or PEA, and is contraindicated in severe hypotension.

Question 19

Chloramphenicol has the following unwanted effects?

Accepted Answer

Answer reason: Chloramphenicol can cause bone marrow suppression and idiosyncratic aplastic anemia, leading to pancytopenia. Nephrotoxicity and ototoxicity are classically associated with aminoglycosides, whereas hepatotoxicity is not a hallmark adverse effect of chloramphenicol.

Question 20

A client receiving rifampicin should be taught that the drug may cause?

Accepted Answer

Answer reason: Rifampin commonly causes harmless, red-orange discoloration of body fluids such as urine, saliva, and sputum. Ototoxicity and vestibular dysfunction are associated with aminoglycosides like streptomycin, not rifampin; brain dysfunction is not a typical effect.

Question 21

Which symptom should be watched for in a patient receiving a loop diuretic?

Accepted Answer

Answer reason: Loop diuretics can cause significant potassium loss, leading to hypokalemia and dysrhythmias; a weak, irregular pulse is a key sign to monitor. Increased blood pressure is contrary to the drug's effect, and restlessness and paresthesias are less specific.

Question 22

The client is admitted to the emergency room with shortness of breath, anxiety, and tachycardia. His ECG reveals atrial fibrillation with a ventricular response rate of 130 beats per minute. The doctor orders quinidine sulfate. While he is receiving quinidine, the nurse should monitor his ECG for?

Accepted Answer

Answer reason: Quinidine is a class IA antiarrhythmic that prolongs the action potential and QT interval, increasing risk of torsades de pointes. Therefore the nurse should monitor for QT prolongation rather than P-wave peaking, ST elevation, or isolated T-wave inversion.

Question 23

A client in labor has an order for Demerol (meperidine) 75 mg IM, to be administered 10 minutes before delivery. The nurse should?

Accepted Answer

Answer reason: Meperidine crosses the placenta and can cause neonatal respiratory depression if given close to birth; IM onset is not immediate. An order to administer 10 minutes before delivery is unsafe and should be questioned.

Question 24

A client with a history of schizophrenia is seen at the local health clinic for medication follow-up. To maintain a therapeutic level of medication, the nurse should tell the client to avoid?

Accepted Answer

Answer reason: OTC pain relievers (especially NSAIDs like ibuprofen/naproxen) can increase lithium levels and risk toxicity; clients should avoid them unless approved to maintain a therapeutic drug level. Tyramine foods relate to MAOIs, not antipsychotics; allergy meds mainly add sedation; salt intake should be kept consistent rather than avoided.

Question 25

Respiratory Disorders: A client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine (Mucomyst). Before administering the first dose, the nurse checks the client's history of asthma. Acetylcysteine must be used cautiously in a client with asthma because it?

Accepted Answer

Answer reason: Acetylcysteine is a mucolytic that can irritate airways and trigger bronchospasm, so it must be used cautiously in clients with asthma.

Question 26

A 78-year-old client with 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: Elderly clients on diuretics are at high risk for orthostatic hypotension and falls. Teaching to change positions slowly reduces this risk. The other options are not key safety teachings specific to furosemide in an older adult.

Question 27

What is the treatment for insulin overdose?

Accepted Answer

Answer reason: Insulin overdose causes hypoglycemia; immediate treatment is rapid IV dextrose (D50W). Normal saline does not correct hypoglycemia and oral hypoglycemics would worsen it.

Question 28

The client has been taking magnesium hydroxide (milk of magnesia) at home in an attempt to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with ongoing use of magnesium-based antacids?

Accepted Answer

Answer reason: Magnesium hydroxide has an osmotic laxative effect; chronic use commonly causes diarrhea. Constipation is associated with aluminum antacids, and anorexia or weight gain are not typical adverse effects.

Question 29

The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking two to three aspirin every four hours for the last week, and it hasn't helped my back." Since acetylsalicylic acid intoxication is suspected, which manifestation should the nurse assess the client for?

Accepted Answer

Answer reason: Salicylate (aspirin) toxicity commonly presents with tinnitus and hearing changes. Diarrhea and constipation are not typical signs, and photosensitivity is associated with other drugs, not aspirin.

Question 30

Prolonged steroid therapy to treat nephrotic syndrome can lead to......?

Accepted Answer

Answer reason: Chronic corticosteroid therapy commonly causes Cushingoid features (moon face, truncal obesity) from glucocorticoid excess. Hypoaldosteronism and cryptorchidism are unrelated, and oliguria is not a typical steroid effect.

Question 31

Your patient with asthma is taking Theophylline. Which product below should the patient avoid consuming?

Accepted Answer

Answer reason: Caffeine is a methylxanthine like theophylline and can increase CNS and cardiac stimulation and raise theophylline levels, risking toxicity; patients should avoid caffeinated products.

Question 32

A patient received a nebulizer of albuterol. What is a side effect of this medication?

Accepted Answer

Answer reason: Albuterol, a beta-2 agonist, commonly causes sympathetic effects such as tremor and tachycardia; bradycardia, drowsiness, and feeling cold are not typical.

Question 33

On prescription of oral pills to the user, the health worker will ask about the following except?

Accepted Answer

Answer reason: When prescribing combined oral contraceptives, clients are counseled and screened for danger signs such as severe headache and calf pain/tenderness or leg swelling suggestive of thromboembolism. The number of live children is not relevant to adverse effects screening, so it is the exception.

Question 34

Patients taking these medications can experience difficulty voiding?

Accepted Answer

Answer reason: Anticholinergics reduce detrusor muscle contraction and can cause urinary retention, leading to difficulty voiding. Aspirin, antibiotics, and acetaminophen do not typically cause urinary retention.

Question 35

A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. Which medication should the nurse question before administration?

Accepted Answer

Answer reason: The client has hyperkalemia; spironolactone is a potassium-sparing diuretic and can worsen hyperkalemia, especially in CKD. The other options are treatments for hyperkalemia.

Question 36

A nurse is preparing to administer digoxin to a patient with heart failure. Which assessment finding requires the nurse to hold the medication and notify the healthcare provider?

Accepted Answer

Answer reason: Hold digoxin if the apical pulse is less than 60 bpm because bradycardia can indicate digoxin toxicity. The other values are within normal limits.

Question 37

Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication, nurse Gina should be prepared for which common adverse effect?

Accepted Answer

Answer reason: Flumazenil, a benzodiazepine antagonist, can precipitate seizures—especially in benzodiazepine-dependent patients or mixed overdoses—so this is the most concerning common adverse effect to anticipate.

Question 38

The nurse is caring for a client with leukemia who has received the drug (daunorubicin) Cerubidine. Which of the following common side effects would cause the most concern?

Accepted Answer

Answer reason: Daunorubicin (an anthracycline) carries a dose-related risk of cardiotoxicity, which is life‑threatening and thus the greatest concern compared with expected effects like nausea, vomiting, and alopecia.

Question 39

The nurse is performing a history on a client admitted for surgery in the morning. Which long-term medication in the client's history would be most important to report to the physician?

Accepted Answer

Answer reason: Chronic corticosteroid use (prednisone) can suppress the adrenal axis and impair wound healing; the surgeon/anesthesiologist must be notified to provide perioperative stress-dose steroids. The other listed medications are less critical preoperatively.

Question 40

The nurse is assessing the laboratory results of a client scheduled to receive phenytoin (Dilantin). The Dilantin level, drawn 2 hours ago, is 30 mcg/mL. What is the appropriate nursing action?

Accepted Answer

Answer reason: Therapeutic phenytoin level is 10–20 mcg/mL; 30 mcg/mL indicates toxicity risk. The nurse should hold the dose and notify the provider.

Question 41

The nurse is caring for a client with leukemia who is receiving the drug doxorubicin (Adriamycin). Which toxic effects of this drug would be reported to the physician immediately?

Accepted Answer

Answer reason: Doxorubicin can cause dose-related cardiotoxicity leading to heart failure. Rales and jugular venous distention are signs of heart failure and require immediate reporting. Red urine is an expected harmless effect of doxorubicin with adequate output, and nausea/vomiting are common non-emergent effects. Elevated BUN/dry skin are not hallmark toxicities of doxorubicin.

Question 42

A client is admitted with Parkinson’s disease who has been taking Carbidopa/levodopa (Sinemet) for 1 year. Which clinical manifestation would be most important to report?

Accepted Answer

Answer reason: Spasmodic eye winking (blepharospasm) indicates levodopa toxicity/dyskinesia and should be reported. Dry mouth and dark urine are common/benign effects; dizziness may occur from orthostatic hypotension but is less urgent than signs of toxicity.

Question 43

The nurse is performing an admission history for a client recovering from a stroke. Medication history reveals the drug clopidogrel (Plavix). Which clinical manifestation alerts the nurse to an adverse effect of this drug?

Accepted Answer

Answer reason: Clopidogrel is an antiplatelet; its key adverse effect is bleeding. Epistaxis (nosebleed) indicates excessive bleeding.

Question 44

A client with angina is experiencing migraine headaches. The physician has prescribed Sumatriptan succinate (Imitrex). Which nursing action is most appropriate?

Accepted Answer

Answer reason: Sumatriptan can cause coronary vasospasm and is contraindicated in clients with ischemic heart disease or angina; the nurse should question the order.

Question 45

The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug?

Accepted Answer

Answer reason: Carbamazepine can cause bone marrow suppression, including leukopenia/agranulocytosis. A WBC of 4,000/mm³ is abnormally low and signals this serious adverse effect; the other values are within normal limits.

Question 46

A client with advanced Alzheimer’s disease has been prescribed haloperidol (Haldol). What clinical manifestation suggests that the client is experiencing side effects from this medication?

Accepted Answer

Answer reason: Haloperidol commonly causes extrapyramidal symptoms such as tremors; cough, diarrhea, and pitting edema are not typical adverse effects.

Question 47

A client with Alzheimer's disease has been prescribed donepezil (Aricept). Which information should the nurse include in the teaching plan for a client on Aricept?

Accepted Answer

Answer reason: Donepezil, a cholinesterase inhibitor, can cause dizziness and syncope (often from bradycardia). Teach orthostatic precautions such as rising slowly. It does not need to be taken with meals, missed doses should not be doubled, and it tends to lower rather than increase heart rate.

Question 48

A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin (Lovenox). What education should the nurse provide regarding enoxaparin?

Accepted Answer

Answer reason: Enoxaparin is an anticoagulant; concurrent NSAIDs increase bleeding risk and should be avoided. It is not given IM (given subcutaneously). Routine BP monitoring is not specific to enoxaparin. Minor bruising at the site may occur, but the priority teaching is to avoid NSAIDs.

Question 49

A client being treated with warfarin has a prothrombin time of 120 seconds; which nursing intervention is most important to include in the care plan?

Accepted Answer

Answer reason: A PT of 120 seconds indicates severe over-anticoagulation with high hemorrhage risk. The priority nursing intervention is to assess for abnormal bleeding; dosage should not be increased.

Question 50

A client receiving gentamicin IV therapy reports new onset ringing in the ears. What is the nurse’s priority action?

Accepted Answer

Answer reason: Gentamicin is an aminoglycoside antibiotic associated with ototoxicity. Tinnitus is an early sign of cochlear damage and indicates potential toxicity. The medication should be held immediately and the provider notified to prevent permanent hearing loss.

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