Question 1

A client has been prescribed haloperidol. The nurse observes that the client has developed repetitive, involuntary movements of the face and tongue. Which of the following conditions should the nurse suspect?

Accepted Answer

Answer reason: Lip-smacking, tongue protrusion, and grimacing match the described face-and-tongue findings and are classic for this condition. Akathisia presents as inner restlessness and inability to sit still rather than involuntary facial movements. Acute dystonia causes sustained muscle spasms (e.g., torticollis, oculogyric crisis), and neuroleptic malignant syndrome features hyperthermia, rigidity, and autonomic instability rather than isolated orofacial dyskinesias.

Question 2

A nurse is administering Amiodarone to a client with ventricular arrhythmias. Which symptoms should prompt the nurse to immediately stop the administration?

Accepted Answer

Answer reason: These symptoms raise concern for amiodarone-induced pulmonary toxicity (interstitial pneumonitis), a potentially life-threatening adverse effect that requires immediate action. New or worsening dyspnea with cough during therapy is a red-flag finding because pulmonary inflammation/fibrosis can progress rapidly and may be irreversible if exposure continues. Stopping the infusion and promptly notifying the provider allows urgent evaluation (oxygenation assessment, chest imaging, possible corticosteroids) and prevents further lung injury. By contrast, mild nausea, fatigue, and occasional dizziness are more common, less dangerous effects that typically warrant monitoring/supportive care rather than immediate cessation unless severe or accompanied by instability.

Question 3

The nurse is preparing to hang a heparin infusion on his patient. To best support patient safety, what should the nurse do before administration of the drug?

Accepted Answer

Answer reason: Heparin is a high-alert anticoagulant, so baseline and ongoing coagulation monitoring is a key safety step to reduce bleeding risk and guide dosing. Confirming that recent labs were obtained ensures the clinician can evaluate parameters such as aPTT/anti-Xa and platelet count (for heparin-induced thrombocytopenia risk) before starting or adjusting an infusion. A second-RN check is commonly required for insulin or chemo and may be a facility policy, but it is not the primary pharmacologic safety action unique to initiating heparin. The other choices do not address heparin’s main hazard (hemorrhage) and do not provide dosing-safety information.

Question 4

You are providing education to a patient who is started on Tranylcypromine, a monoamine oxidase inhibitor. Which of the following statements from the patient indicates adequate understanding?

Accepted Answer

Answer reason: MAOIs have clinically important food/drug interactions and patients must avoid substances that can precipitate dangerous reactions. Alcohol—particularly certain beers and wines—may contain tyramine and can contribute to hypertensive crisis when combined with an MAOI. The correct patient statement reflects understanding of a key safety restriction that reduces risk of severe headache, hypertension, and potential stroke. In contrast, abruptly stopping therapy is unsafe due to relapse and discontinuation effects, and photosensitivity precautions are not a typical MAOI teaching point. Dizziness/orthostatic hypotension can occur, but it is not universally “expected” to the extent of needing a driver everywhere; safety counseling is individualized.

Question 5

A nurse should monitor for fluid retention and worsening heart failure symptoms in a patient taking which medication?

Accepted Answer

Answer reason: This makes monitoring for edema, rapid weight gain, dyspnea, and crackles particularly important when this drug is used. In contrast, metformin’s major serious concern is lactic acidosis risk in severe renal/hemodynamic compromise rather than causing fluid retention. Therefore, the medication most associated with worsening heart failure via fluid retention is the thiazolidinedione listed.

Question 6

A nurse is reviewing medication orders for several clients. Which of the following prescriptions should the nurse question?

Accepted Answer

Answer reason: Metronidazole has a well-known contraindication with ethanol due to a disulfiram-like reaction caused by impaired alcohol metabolism. Giving it soon after alcohol intake can precipitate flushing, severe nausea/vomiting, tachycardia, headache, and hypotension, creating avoidable patient harm. This is a classic “question the order” safety issue because the timing (only 1 hour after drinking) places the client at high risk. In contrast, fentanyl for acute severe fracture pain is an expected analgesic choice when monitored appropriately.

Question 7

A nurse is administering cyclosporine to a patient. Which assessment finding should be reported to the provider immediately?

Accepted Answer

Answer reason: A new elevation in temperature can be an early or only sign of infection in an immunosuppressed patient and requires prompt provider notification for evaluation, cultures, and possible antimicrobial therapy or medication adjustment. The other findings listed are not as time-sensitive and may represent nonurgent side effects that can often be managed symptomatically. Immediate reporting prioritizes preventing sepsis and protecting a patient with reduced immune defenses.

Question 8

The nurse is assessing a client who recently started taking tamsulosin. Which client statement would be most concerning?

Accepted Answer

Answer reason: ” Tamsulosin is an alpha-1 adrenergic blocker that can lower blood pressure and contribute to orthostatic hypotension. Phosphodiesterase-5 inhibitors used for erectile dysfunction also cause vasodilation, and combining them can lead to significant symptomatic hypotension, syncope, and falls, especially in a newly started patient. The other statements describe expected effects of tamsulosin such as nasal congestion, dizziness with position changes managed by slow standing, and ejaculatory changes (including retrograde ejaculation). The priority concern is preventing a dangerous medication interaction that increases fall and injury risk.

Question 9

A client taking doxycycline for the treatment of acne vulgaris is experiencing many side effects. To alleviate the most common side effect, what instructions does the nurse provide?

Accepted Answer

Answer reason: " The key principle is that doxycycline commonly causes gastrointestinal upset (nausea, epigastric discomfort), and taking it with food can improve tolerance while maintaining clinical usefulness. Milk is not the best instruction because calcium can bind tetracyclines and reduce absorption, so it may lessen effectiveness even if it feels soothing. Increasing sunlight exposure is unsafe because doxycycline can cause photosensitivity, so patients should limit sun and use protection. Remaining flat increases the risk of pill esophagitis; patients should take it with water and stay upright instead.

Question 10

A patient has been taking risperidone for the last three years. Upon assessing the patient, the nurse notices the patient’s jaw is making chewing motions but the patient’s mouth is empty. A slight tremor is noted in the patient’s left hand. What should be the nurses’ next course of action?

Accepted Answer

Answer reason: Antipsychotics can cause extrapyramidal side effects and tardive dyskinesia due to dopamine blockade, and abnormal oral-buccal movements (chewing motions) after long-term use are particularly concerning for tardive dyskinesia. The appropriate nursing action is to promptly report these findings so the prescriber can evaluate severity and adjust therapy (e.g., dose reduction/switching agents or initiating a VMAT2 inhibitor) to prevent progression. A unilateral hand tremor can also reflect medication-related parkinsonism, reinforcing that this is likely drug-induced rather than a primary neurologic catastrophe. Calling a stroke alert is not supported by the described pattern (no acute focal deficits provided), while offering gum minimizes a potentially serious adverse drug effect. Holding the next dose independently is typically not the nurse’s role unless an emergency/standing hold parameter exists; communication and provider-led management are the priority.

Question 11

A nurse is caring for a client on digoxin. Which statement made by the client should the nurse report immediately to the HCP?

Accepted Answer

Answer reason: Digoxin has a narrow therapeutic index, and toxicity can precipitate dangerous dysrhythmias, which can present as palpitations or a rapid/irregular heartbeat and requires urgent evaluation. This symptom suggests a potentially life-threatening cardiac effect rather than a minor side effect, so it should be reported immediately for assessment (apical pulse/ECG) and possible drug hold and level/electrolyte checks. Visual changes such as yellow halos are also classic for digoxin toxicity, but a new rapid heartbeat signals acute hemodynamic risk and possible malignant arrhythmia. Metallic taste and dry mouth are not typical urgent digoxin-toxicity red flags and are less directly linked to immediate cardiac instability.

Question 12

A client prescribed atorvastatin should contact their healthcare provider immediately if they experience which symptoms?

Accepted Answer

Answer reason: Statins can cause statin-associated myopathy that may progress to rhabdomyolysis, a rare but potentially life-threatening adverse effect. New, unexplained muscle pain, tenderness, cramps, or weakness—especially if severe or associated with dark urine—requires immediate provider notification and evaluation (e.g., CK, renal function). Mild headache, occasional dizziness, and nonspecific fatigue can occur from many benign causes and are not classic urgent red flags specific to atorvastatin toxicity. Early reporting helps prevent kidney injury from myoglobinuria and allows prompt medication adjustment or discontinuation.

Question 13

A nurse is caring for a patient with ADHD. This patient has been prescribed methylphenidate to decrease impulsiveness. What should the nurse monitor for?

Accepted Answer

Answer reason: Methylphenidate increases central dopamine/norepinephrine activity, which is associated with reduced appetite and caloric intake. Ongoing monitoring of weight (and often height/growth trajectory) helps detect clinically significant nutritional or growth effects early. Drowsiness and increased appetite are not typical expected adverse effects for this stimulant class, making them less likely than appetite suppression with subsequent weight decline.

Question 14

The nurse educates a patient taking metformin to report nausea, fatigue, and muscle cramps to the provider due to risk for which complication associated with metformin?

Accepted Answer

Answer reason: Early symptoms can be nonspecific (e.g., nausea, profound fatigue/malaise) and may include myalgias or muscle cramping, so prompt reporting is essential. This complication presents as a high anion gap metabolic acidosis, not an alkalosis. The other options are not characteristic metformin-associated toxicities, making this the best match to the symptom cluster and medication risk.

Question 15

A nurse is providing patient education to a client who has been prescribed Methotrexate. Which of the following instructions should the nurse include in the teaching plan?

Accepted Answer

Answer reason: Methotrexate can suppress bone marrow and immune function, increasing susceptibility to infection and reducing the ability to mount a normal inflammatory response. Prompt reporting of fever, sore throat, mouth sores, or other infection symptoms is critical so therapy can be evaluated and serious complications prevented. Skipping doses is unsafe because dosing schedules are designed to balance efficacy and toxicity and require prescriber guidance for any changes. Alcohol should be avoided due to additive hepatotoxicity risk, and folic acid is commonly supplemented to reduce mucositis and other adverse effects rather than avoided.

Question 16

A neuromuscular blocking agent is administered to a client before electroconvulsive therapy. The nurse should observe the client for which adverse effect?

Accepted Answer

Answer reason: During ECT, these agents are used to minimize motor manifestations of the induced seizure, so airway and ventilation become the critical safety focus. The most clinically dangerous adverse effect to monitor for is impaired respirations requiring assisted ventilation and airway support. Nausea/vomiting and dizziness are not the key life-threatening effect of neuromuscular blockade, and seizures are intended with ECT rather than an adverse effect of the paralytic itself.

Question 17

A client with no previous cardiac history reports central chest pain. Which data could result in the nurse holding sublingual nitroglycerin?

Accepted Answer

Answer reason: A low baseline systolic BP (often

Question 18

A nurse is teaching a client with atrial fibrillation who is on warfarin. Which dietary instruction should the nurse include?

Accepted Answer

Answer reason: Warfarin’s anticoagulant effect is reduced by vitamin K intake because vitamin K supports synthesis of clotting factors II, VII, IX, and X. Green, leafy vegetables are a major dietary source of vitamin K, so high or fluctuating intake can lower the INR and increase thromboembolic risk in atrial fibrillation. Teaching should focus on avoiding large increases and maintaining consistent vitamin K intake; among the choices, reducing leafy greens best addresses this interaction. Citrus fruits are not the key interaction for warfarin teaching (grapefruit concerns are more prominent with many CYP3A4-metabolized drugs rather than warfarin), and changing dairy or protein intake does not directly target INR stability.

Question 19

A client is prescribed digoxin for heart failure. Which laboratory value should the nurse prioritize monitoring before administering the drug?

Accepted Answer

Answer reason: Hypokalemia predisposes the client to dangerous dysrhythmias (e.g., ventricular ectopy, bradyarrhythmias) when digoxin is given. Heart failure clients are commonly on loop/thiazide diuretics, making potassium depletion a frequent and high-impact safety issue to assess before dosing. While magnesium and calcium can also influence arrhythmia risk, potassium is the most direct and routinely prioritized lab tied to digoxin safety before administration.

Question 20

Which of the following statements by a patient with hepatitis indicates a need for further teaching?

Accepted Answer

Answer reason: ” In hepatitis, impaired hepatic metabolism increases vulnerability to drug-induced liver injury, so hepatotoxic medications must be avoided or used only with explicit provider guidance. Acetaminophen is metabolized by the liver and can worsen hepatic inflammation or precipitate acute liver failure, especially if taken in higher-than-recommended doses or combined with other acetaminophen-containing products. Patient teaching emphasizes avoiding alcohol and other hepatotoxins and using safer alternatives only as prescribed. Nutritional measures like small, frequent meals and adequate calories (often with sufficient carbohydrates) support energy needs during decreased appetite and do not contradict typical hepatitis care.

Question 21

A nurse is caring for a patient who takes phenelzine. The patient wants to order a snack. Which of the following foods should the patient choose?

Accepted Answer

Answer reason: Eggs are a fresh, non-aged protein and are low in tyramine, making them a safe snack choice. In contrast, aged/fermented foods such as cured meats and aged cheeses are classic high-tyramine triggers and are unsafe with MAOIs. Avocado (especially overripe) and chocolate can contain higher tyramine or related amines and are commonly taught as foods to limit/avoid with MAOI therapy.

Question 22

The nurse should educate a patient taking spironolactone to decrease their dietary intake of which electrolyte?

Accepted Answer

Answer reason: Patient teaching therefore focuses on limiting high-potassium foods and avoiding potassium supplements or salt substitutes containing potassium. Hyperkalemia can precipitate dangerous cardiac dysrhythmias and neuromuscular symptoms, so prevention is a key safety priority. In contrast, sodium restriction may be advised for conditions like heart failure but is not the specific electrolyte that becomes elevated due to this medication’s mechanism.

Question 23

A nurse is assessing a patient for the presence of extrapyramidal side effects (EPS). Which of the following findings should the nurse recognize as a sign of EPS?

Accepted Answer

Answer reason: Tremor is a hallmark parkinsonian EPS finding and may occur with rigidity and bradykinesia. In contrast, blurred vision and urinary retention reflect anticholinergic effects rather than EPS. Pressured speech is more consistent with mania/anxiety and is not a medication-induced motor side effect pattern.

Question 24

A client who has osteoarthritis and is taking acetaminophen (Tylenol) orally and applying capsaicin cream topically to the knees develops a rash. Based on an understanding of the action of the drugs, which of the following is most likely the cause of the rash?

Accepted Answer

Answer reason: An oral acetaminophen reaction can include rash, but it is less directly linked to a new localized knee rash than a topical agent applied to that exact area. The timing and distribution of a rash where the cream is used most strongly implicate the topical medication as the cause. It is incorrect to say rash is not an adverse effect because cutaneous reactions are a known potential adverse response, especially with topical therapies. The “both drugs” option is less likely because it does not fit the typical local-contact pattern expected from the topical agent.

Question 25

What finding does the nurse expect in a child with a serum digoxin level of 2.6 ng/mL?

Accepted Answer

Answer reason: 6 ng/mL is above the typical therapeutic range and is consistent with digoxin toxicity. Toxicity increases vagal tone and slows AV nodal conduction, making bradycardia and other dysrhythmias a key expected assessment finding. Decreased deep tendon reflexes is more characteristic of sedative effects or electrolyte/neuromuscular issues rather than cardiac glycoside toxicity. Hypoxemia (SpO2 85%) and flight of ideas are not classic primary manifestations of elevated digoxin levels compared with cardiac rate/rhythm changes.

Question 26

Nurse Johnson is advising a patient prescribed glipizide (Glucotrol) for diabetes mellitus. What should the patient avoid?

Accepted Answer

Answer reason: Alcohol can precipitate prolonged hypoglycemia by inhibiting gluconeogenesis, especially with missed meals or poor intake. Some sulfonylureas are also associated with a disulfiram-like reaction with alcohol, making avoidance the safest teaching point. The other options are general diet considerations in diabetes but are not specific contraindications tied to this medication’s adverse-effect profile.

Question 27

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?

Accepted Answer

Answer reason: A key adverse effect is cardiovascular stimulation, which manifests as palpitations and increased heart rate and can precipitate angina or dysrhythmias in susceptible patients. This finding is therefore a high-yield safety cue for overreplacement and the need to reassess dosing and thyroid labs. Dysuria and leg cramps are not typical toxicity signals for thyroid hormone, and blurred vision is not a classic early adverse effect compared with cardiac symptoms.

Question 28

The nurse is caring for a patient prescribed amitriptyline. The nurse should monitor the patient for which of the following side effects?

Accepted Answer

Answer reason: Alpha-1 blockade can lead to peripheral vasodilation with a drop in blood pressure on standing, so monitoring for dizziness, falls, and orthostatic vital sign changes is essential. Diarrhea and drooling are more consistent with cholinergic excess, whereas TCAs typically cause constipation and dry mouth. A metallic taste is not a hallmark adverse effect compared with sedation and cardiovascular effects (including hypotension and conduction abnormalities).

Question 29

A nurse is providing teaching on the symptoms of serotonin syndrome for a patient taking an SSRI. Which of the following is a symptom of this condition?

Accepted Answer

Answer reason: Sweating is a common manifestation of autonomic hyperactivity and often occurs alongside hyperthermia, tachycardia, hypertension, tremor, and hyperreflexia. In contrast, bradycardia and hypotension are not typical early findings because the syndrome generally drives sympathetic overactivity. Pupillary changes are more commonly dilated pupils rather than constriction, making that option less consistent.

Question 30

Nurse Roberts is educating a client about intranasal Vasopressin (Pitressin). What specific side effect of this medication should the nurse highlight to the client?

Accepted Answer

Answer reason: Intranasal vasopressin commonly causes local nasal mucosal irritation because the drug is administered directly to nasal tissues. This leads to rhinitis-type symptoms such as runny nose, congestion, sneezing, or nasal discomfort, which are route-specific adverse effects important for client teaching. While systemic effects like headache or nausea can occur with vasopressin from water retention or vasoconstriction, they are not as specifically tied to the intranasal formulation as local nasal symptoms. Teaching this expected local reaction also helps the client distinguish it from signs of more serious complications (e.g., water intoxication) that require prompt evaluation.

Question 31

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication?

Accepted Answer

Answer reason: Isoetharine is an inhaled sympathomimetic used to relax bronchial smooth muscle, and its most clinically important monitoring parameter is cardiovascular stimulation. Constipation and diarrhea are not typical primary adverse effects of inhaled beta-agonists. Bradycardia would be the opposite of the expected sympathetic effect and is therefore a less plausible choice.

Question 32

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

Accepted Answer

Answer reason: Protamine sulfate is the specific antidote that neutralizes heparin by forming a stable inactive complex, making it the appropriate medication to have immediately available. Vitamin K reverses warfarin (not heparin), and aminocaproic acid is an antifibrinolytic used for certain bleeding states but is not the standard reversal agent for heparin. Ensuring availability of the correct antidote is a key medication-safety step when initiating high-alert anticoagulant therapy.

Question 33

A client with BPH is being treated with terazosin (Hytrin) 2 mg at bedtime. The nurse should monitor the client’s?

Accepted Answer

Answer reason: This vasodilation can cause first-dose orthostatic hypotension and syncope, which is why it is commonly started at bedtime. Monitoring blood pressure helps detect clinically significant hypotension early and guides safety measures such as fall precautions and slow position changes. Pulse may rise reflexively, but blood pressure changes are the primary dangerous effect being monitored. Urinary nitrites and WBC count relate to infection assessment, not expected medication effects.

Question 34

Which of the following laboratory tests must be monitored for pregnant patients receiving dexamethasone?

Accepted Answer

Answer reason: Systemic corticosteroids increase hepatic gluconeogenesis and create insulin resistance, which can raise maternal blood glucose and worsen or unmask gestational diabetes. In pregnancy, even short courses of dexamethasone can cause clinically meaningful hyperglycemia, so point-in-time glucose monitoring is a safety priority. This directly assesses the most common and immediate metabolic adverse effect relevant to fetal and maternal outcomes. Serum calcium and RBC count are not the primary, expected monitoring labs for a typical antenatal steroid course, and uric acid is more aligned with preeclampsia evaluation than steroid toxicity monitoring.

Question 35

A nurse cares for a client taking moxifloxacin for the treatment of endocarditis. The nurse monitors the client’s heart rhythm for which unwanted effect of quinolone therapy?

Accepted Answer

Answer reason: This creates risk for torsades de pointes, so ECG monitoring focuses on detecting QT prolongation, especially in clients with electrolyte abnormalities or on other QT-prolonging drugs. ST elevation is more consistent with acute myocardial injury patterns rather than a typical fluoroquinolone adverse effect. QRS widening is classically associated with sodium-channel blockade (e.g., tricyclic antidepressant toxicity) rather than quinolone therapy.

Question 36

A client is receiving heparin infusion. Which finding is most important to report immediately?

Accepted Answer

Answer reason: A platelet count of 50,000/mm³ suggests possible heparin-induced thrombocytopenia (HIT), a serious immune-mediated complication that can lead to thrombosis. This requires immediate intervention and discontinuation of heparin. Mild bleeding or elevated APTT may occur, but HIT poses a higher immediate risk.

Question 37

Which Vaccine is contraindicated in child with history of Convulsions?

Accepted Answer

Answer reason: DPT (pertussis component) is relatively contraindicated in children with a history of seizures or neurologic disorders due to risk of adverse neurologic reactions.

Question 38

The client is a child with attention-deficit hyperactivity disorder (ADHD) who is receiving methylphenidate (Ritalin). The nurse teaches the parents to carefully monitor which of the following in the child?

Accepted Answer

Answer reason: Tracking weight helps detect clinically significant appetite suppression and inadequate caloric intake early. Monitoring height over time helps identify growth deceleration that may prompt dose adjustment, timing changes, medication holidays, or reassessment of therapy. The other options are not the primary high-yield adverse-effect monitoring parameters for methylphenidate compared with growth trends in pediatric clients.

Question 39

A client is receiving diazepam to treat painful muscle spasms. The nurse would monitor the client for which frequent side effect of the medication?

Accepted Answer

Answer reason: With diazepam used as a muscle relaxant, a frequent and clinically important effect is gait instability and unsteady movements, increasing fall risk. This makes coordination changes a key nursing monitoring focus, especially in older adults or those ambulating. Diarrhea is not a typical common benzodiazepine effect, and cardiovascular stimulation such as hypertension is not expected with CNS depressants.

Question 40

A client with diabetes mellitus is prescribed metformin. Which of the following client statements indicates an understanding of the teaching regarding metformin?

Accepted Answer

Answer reason: " Metformin carries a rare but serious risk of lactic acidosis, and alcohol increases this risk by impairing hepatic lactate clearance and promoting hypoglycemia. Avoiding alcohol demonstrates understanding of a key contraindication/precaution that reduces the chance of this life-threatening adverse effect. Stopping the medication independently for low blood sugar is unsafe because metformin usually does not cause hypoglycemia alone and medication changes should be provider-directed. Increasing carbohydrate intake is not an appropriate teaching point for metformin and can worsen glycemic control.

Question 41

A client begins therapy with theophylline. The nurse plans to teach the client to limit the intake of which items while taking this medication?

Accepted Answer

Answer reason: Caffeine-containing products can intensify CNS stimulation and cardiac effects, leading to jitteriness, insomnia, palpitations, nausea/vomiting, and potentially dysrhythmias or seizures at higher serum levels. Teaching focuses on limiting dietary caffeine sources to reduce these additive effects and help maintain stable symptoms while on therapy. The other options are not standard dietary interactions that meaningfully increase theophylline side effects in typical NCLEX teaching.

Question 42

Assessment of a client taking a nonsteroidal anti-inflammatory drug (NSAID) for pain management should include specific questions regarding which of the following systems?

Accepted Answer

Answer reason: NSAIDs inhibit COX enzymes and reduce protective gastric prostaglandins, increasing the risk of dyspepsia, gastritis, peptic ulcer disease, and GI bleeding. Nursing assessment should therefore target red-flag GI symptoms such as epigastric pain, heartburn, nausea, black/tarry stools, or hematemesis and review concurrent risks (e.g., alcohol use, anticoagulants, history of ulcers). Although renal injury can occur due to decreased renal perfusion, the most classically tested and immediately dangerous adverse-effect cluster for routine symptom screening is GI ulceration/bleeding. Pulmonary and cardiac effects are less central to NSAID-specific routine adverse-effect questioning in a general pain-management context.

Question 43

Situation : Knowledge of the drug propantheline bromide [Probanthine] is necessary in treatment of various disorders. What should the nurse caution the client when using this medication?

Accepted Answer

Answer reason: Propantheline is an anticholinergic that can cause blurred vision, dizziness, and drowsiness, increasing risk of injury with tasks requiring alertness. Nursing teaching prioritizes safety by warning clients to avoid driving or operating machinery until they know how the medication affects them. A common distractor is doubling a missed dose, which is unsafe and increases adverse anticholinergic effects such as tachycardia, urinary retention, and confusion. While timing on an empty stomach may be an administration tip, the key caution emphasized for client safety is avoidance of hazardous activities.

Question 44

A nurse is teaching a patient prescribed a SSRI for their depression about supplement use during therapy. What supplement should the patient be advised not to take with their medication?

Accepted Answer

Answer reason: SSRIs increase synaptic serotonin, and adding other serotonergic agents can dangerously amplify this effect. This supplement has serotonergic activity and also induces drug-metabolizing enzymes, which can both increase toxicity risk and make antidepressant levels unpredictable. The major clinical concern is serotonin syndrome (agitation, tremor, hyperreflexia, diaphoresis, fever, diarrhea) and patients should be taught to avoid it unless specifically directed by the prescriber. By contrast, magnesium and vitamin D do not meaningfully raise serotonin and are not typical causes of this interaction in standard dosing.

Question 45

The nurse is collecting a medication history to a client who has meloxicam (Mobic) prescribed. Which of the following drugs that the client is taking should the nurse question?

Accepted Answer

Answer reason: Meloxicam is an NSAID; diclofenac is also an NSAID, so this combination represents therapeutic duplication with additive adverse effects. The nurse should clarify the regimen with the prescriber/pharmacist and assess for any OTC NSAID use as well. A common distractor is omeprazole, which may actually be used to reduce NSAID-related gastric irritation rather than worsen it.

Question 46

Nurse Carla is educating a patient who has been prescribed a Cromolyn sodium (Intal) inhaler to manage their asthma. She reviews the potential side effects with the patient. What should Nurse Carla mention as a possible undesirable effect of this medication?

Accepted Answer

Answer reason: Cromolyn is an inhaled mast-cell stabilizer used for prophylaxis and can cause local airway irritation rather than immediate bronchodilation. Because it may irritate the bronchial mucosa, bronchospasm with cough and wheeze can occur as an adverse effect, especially right after inhalation. This makes new or worsening wheezing a key undesirable effect to teach and report. In contrast, hypotension, insomnia, and constipation are not typical clinically relevant adverse effects for inhaled cromolyn compared with local respiratory reactions.

Question 47

Nurse Brooks is providing discharge instructions to a patient prescribed levothyroxine (Synthroid). Which of the following symptoms should prompt the patient to notify their physician?

Accepted Answer

Answer reason: Levothyroxine replacement that is excessive can produce symptoms of hyperthyroidism from overstimulation of the sympathetic nervous system. New tremors suggest over-replacement/toxicity and can precede more dangerous effects such as tachycardia, palpitations, and dysrhythmias, so the prescriber should be notified for dose adjustment and thyroid labs. In contrast, cold intolerance and coarse, dry hair are typical hypothyroid findings and suggest inadequate treatment rather than an urgent adverse effect. Muscle cramps are nonspecific and not a classic warning sign of levothyroxine excess.

Question 48

A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient?

Accepted Answer

Answer reason: Subcutaneous morphine still has systemic effects, so frequent monitoring of respiratory rate (and level of sedation) helps detect early hypoventilation before hypoxia occurs. Heart rate, temperature, and urine output may change with illness or medication, but they are not the most immediate life-threatening adverse effect to monitor with morphine. If respirations are low or the patient is difficult to arouse, the nurse should hold further opioid doses and escalate care per protocol (including consideration of naloxone).

Question 49

When a client with chronic obstructive pulmonary disease is taking theophylline also receives ciprofloxacin (Cipro), which of the following interactions would occur?

Accepted Answer

Answer reason: Because theophylline has a narrow therapeutic index, modest increases can precipitate clinically significant toxicity. Expected manifestations include nausea/vomiting, tremor, insomnia, tachycardia/arrhythmias, and seizures, prompting the need for level monitoring and dose adjustment. The interaction is not primarily a reduction in antibiotic effect, and it does not make theophylline ineffective; it increases the risk of toxicity.

Question 50

When assessing clients for evidence of a penicillin allergy, which of the following symptoms may not be considered to be a true hypersensitivity reaction?

Accepted Answer

Answer reason: Gastrointestinal upset such as nausea is more consistent with a predictable medication side effect or intolerance rather than an IgE-mediated allergy. In contrast, wheezing reflects bronchospasm and urticaria reflects histamine-mediated skin involvement, both classic allergy manifestations. Angioneurotic edema signals deeper tissue swelling with potential airway threat and should be treated as a true allergic reaction requiring urgent evaluation.

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