Question 1

A pregnant client is receiving magnesium sulfate therapy for the control of preeclampsia. A nurse discovers that the client is encountering toxicity from the medication in which of the following assessments?

Accepted Answer

Answer reason: Magnesium sulfate is a CNS depressant, and the most dangerous manifestation of toxicity is respiratory depression that can progress to apnea. A respiratory rate of 10/min is below the typical safety threshold (commonly hold infusion and notify provider if

Question 2

A nurse is providing teaching for a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse instruct the client to monitor for which of the following adverse effects?

Accepted Answer

Answer reason: Yellowing of the skin or sclera indicates hyperbilirubinemia from impaired hepatic function and should prompt immediate provider notification and lab evaluation. This adverse effect is especially concerning early in therapy and in higher-risk patients, so monitoring for clinical signs complements routine LFT monitoring. By contrast, gum irritation is more typical of phenytoin-related gingival hyperplasia rather than valproate.

Question 3

A nurse is teaching a client who is taking levodopa/carbon dopa to treat parkinson's disease. Which the following instruction should the nurse include?

Accepted Answer

Answer reason: Teaching the client to rise slowly and stabilize before walking is a key safety instruction to prevent dizziness and syncope. High-protein foods compete with levodopa for transport across the gut and blood-brain barrier, which can reduce rather than increase effectiveness. Eye twitching is not a classic expected long-term effect; instead, clients are more commonly monitored for dyskinesias, hallucinations, and hypotension.

Question 4

A patient is taking tranylcypromine sulfate (Parnate) for depression. What advice should the nurse include in the teaching plan for this medication?

Accepted Answer

Answer reason: MAO inhibitors can precipitate a hypertensive crisis when combined with tyramine-containing foods because tyramine is not adequately metabolized and triggers excessive catecholamine release. Aged cheeses and many beers (especially tap/unpasteurized) are classic high-tyramine items that must be avoided while taking tranylcypromine. This teaching directly prevents a potentially life-threatening adverse effect (severe hypertension, headache, intracranial hemorrhage risk). By contrast, warning primarily about hypotension does not address the most critical diet-related contraindication for this medication. Herbal stimulants like ginseng/ephedra can also increase adrenergic effects and are unsafe with MAOIs rather than recommended.

Question 5

A nurse is providing teaching to a client who has a prescription for lithium carbonate about reducing the risk for lithium toxicity. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: Lithium has a narrow therapeutic index, and anything that reduces renal clearance can raise serum levels into the toxic range. NSAIDs decrease renal prostaglandin synthesis, which can reduce renal blood flow and lithium excretion, increasing toxicity risk. Teaching should emphasize avoiding NSAIDs or using only if specifically approved with monitoring. In contrast, low sodium intake and reduced fluid intake both promote lithium reabsorption in the kidneys and would increase—not decrease—the risk of toxicity.

Question 6

A nurse is obtaining a client's health history. The client reports no allergies but has experienced mild itching while taking amoxicillin in the past. Which of the following responses should the nurse make?

Accepted Answer

Answer reason: Recognizing mild itching as possible allergy risk is important because subsequent exposures can trigger more severe reactions, including urticaria, angioedema, or anaphylaxis. This is not considered an expected benign adverse effect, and “toxicity” is not a typical presentation for amoxicillin. The safest nursing response is to treat the symptom as a potential hypersensitivity indicator and prompt further assessment/documentation and provider notification as appropriate.

Question 7

A nurse is teaching the family of a client who has a new diagnosis of alzheimers disease about donepezil. Which of the following information should the nurse include?

Accepted Answer

Answer reason: Concomitant NSAID use further raises the likelihood of peptic ulcer disease and GI hemorrhage, so clients should be taught to avoid NSAIDs or use them only with provider guidance. Constipation is not the expected cholinergic adverse effect pattern (diarrhea, nausea, vomiting are more typical). Dosing is commonly started low and titrated more slowly than weekly, and administration is often in the evening to minimize daytime GI effects rather than “first thing in the morning” for effectiveness.

Question 8

A nurse is reviewing a drug handbook prior to administering a drug to a client who has kidney disease. The handbook states that the drug can be administered but identifies certain risks. Which of the following terms describes these risks?

Accepted Answer

Answer reason: Kidney disease commonly reduces drug clearance, raising the risk of accumulation and toxicity, which is exactly the type of risk flagged under precautions. In contrast, a contraindication means the drug should not be given because the risk clearly outweighs benefit. Adverse effects are potential unintended drug reactions in general and are not the specific labeling used to indicate “can give, but with extra caution due to comorbidity.”.

Question 9

A nurse is providing teaching to a client who has a prescription for chlorpromazine. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: Teaching should therefore emphasize sun protection measures such as sunscreen and limiting direct sunlight. While sore throat can be concerning for rare blood dyscrasias with some psychotropics, abrupt self-discontinuation is not the standard first instruction for this medication and should instead prompt contacting the provider for evaluation. GI upset may occur, but photosensitivity precautions are a higher-yield and more characteristic safety teaching point for chlorpromazine.

Question 10

A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia and who was admitted to the er with spasms of the face and back. Which of the following adverse reactions should the nurse suspect?

Accepted Answer

Answer reason: Facial and back spasms shortly after starting chlorpromazine are classic for acute dystonic reactions (e.g., torticollis, oculogyric crisis, jaw/neck spasm). Serotonin syndrome would require serotonergic medications and typically features hyperreflexia, autonomic instability, and mental status changes rather than focal spasms. Cholinergic crisis is associated with excess acetylcholine (often from cholinesterase inhibitor exposure) and presents with muscarinic symptoms like bradycardia, bronchorrhea, and diarrhea, not isolated dystonic spasms.

Question 11

A nurse is teaching a client who has a new prescription for etanercept. Which the following statements should the nurse make?

Accepted Answer

Answer reason: Teaching should emphasize early recognition and prompt reporting of infection symptoms (fever, malaise, cough, wounds that won’t heal) so therapy can be evaluated and complications prevented. The injection is given subcutaneously (not intramuscularly), so the statement about injecting into the thigh muscle is inaccurate. Live vaccines (e.g., MMR) are generally avoided during biologic immunosuppressant therapy, making that recommendation unsafe.

Question 12

A nurse is providing teaching for a client who has a prescription for phenelzine. The nurse should instruct the client to avoid tyramine-enriched foods because of an increased risk for which of the following adverse reactions?

Accepted Answer

Answer reason: When tyramine is not metabolized, it triggers excessive release of norepinephrine, causing sudden severe vasoconstriction and dangerous blood pressure elevation. This classic “cheese reaction” can present with severe headache, palpitations, diaphoresis, and markedly elevated BP, making it a medical emergency. Serotonin syndrome is associated with serotonergic drug combinations rather than tyramine ingestion, and respiratory depression is not the key interaction risk taught with MAOIs.

Question 13

The nurse should observe for side effects associated with the use of bronchodilators. A com ...?

Accepted Answer

Answer reason: Monitoring vital signs is a core nursing safety action when administering these medications, especially in patients with cardiac disease or when higher doses are used. Among the options, blood-pressure reduction is the most clinically relevant adverse effect to watch for with bronchodilator therapy. By contrast, tinnitus and ataxia are not typical bronchodilator adverse effects and are more suggestive of other drug toxicities. Early recognition of hypotension helps prevent dizziness, syncope, and falls and prompts timely provider notification or dose adjustment.

Question 14

Prednisone is to be given to a 4-year-old child with nephrotic syndrome. Which symptom would the nurse be alert for as a sign of a most serious side effect of the medication?

Accepted Answer

Answer reason: Symptoms such as weakness and muscle pains can signal steroid-related myopathy and electrolyte disturbances, and HPA-axis suppression is reflected by lowered ACTH, indicating a serious endocrine adverse effect requiring provider notification and possible tapering or stress-dose planning. In contrast, weight gain and increased hair growth are common Cushingoid effects that are expected with therapy and are not the most immediately serious. A respiratory rate of 12/min can be normal for a 4-year-old, and metabolic acidosis is not a typical primary toxicity signal of prednisone.

Question 15

A nurse is caring for a pregnant patient who needs treatment for rosacea. The patient asks the nurse about using topical corticosteroids for treatment. Which of the following information should the nurse provide this patient?

Accepted Answer

Answer reason: Topical corticosteroids used appropriately (lowest effective potency, limited surface area, short duration) have minimal systemic absorption and are generally considered compatible with pregnancy. The key nursing teaching is to balance symptom control with fetal safety by avoiding prolonged use of high-potency products or occlusive dressings, which can increase absorption. The “avoid due to no safety evidence” approach is overly restrictive and not consistent with standard guidance for topical steroids in pregnancy. Advising use only away from the abdomen is not evidence-based, as risk is related to systemic absorption rather than application near the uterus.

Question 16

A nurse is teaching a client who has a prescription for baclofen. Which the following instructions should the nurse include?

Accepted Answer

Answer reason: Baclofen is a centrally acting skeletal muscle relaxant that commonly causes CNS depression such as drowsiness, dizziness, and impaired coordination. Safety teaching prioritizes preventing injury until the patient knows how the medication affects alertness and reaction time. Abrupt discontinuation is generally avoided due to risk of withdrawal/rebound symptoms, so a headache alone is not an indication to stop immediately without guidance. It is typically taken on a scheduled basis for spasticity control rather than PRN, and routine coadministration with antacids is not a standard safety instruction and may affect absorption timing.

Question 17

A nurse caring for a client who is taking codeine. The nurse should identify that which the following assessment is priority to make?

Accepted Answer

Answer reason: A priority assessment focuses on airway and breathing, so monitoring respiratory rate and quality best detects early deterioration and guides the need to hold the medication or administer naloxone. Blood pressure and apical pulse can change with opioids, but these are typically secondary concerns compared with ventilation. Level of consciousness is important because sedation often precedes respiratory depression, yet the direct, critical parameter to assess first is breathing.

Question 18

The client has been diagnosed to have IDDM. Which order should you question?

Accepted Answer

Answer reason: g., tremor, palpitations) and can also impair hepatic glycogenolysis, increasing the risk of severe, unrecognized hypoglycemia in insulin-treated diabetes. This makes propranolol a medication order that warrants clarification in a client with IDDM, especially if there is a history of hypoglycemic episodes or tight glycemic control. In contrast, insulin is expected therapy for IDDM, and acetaminophen does not meaningfully interfere with glucose recognition or counterregulation. Diltiazem does not have the same degree of hypoglycemia-masking risk as a nonselective beta-blocker.

Question 19

A nurse is providing teaching to a client who has a new prescription for fluoxetine. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: Teaching to promptly report persistent or worsening headache supports early recognition of clinically significant side effects and helps prevent complications from untreated adverse reactions. Dose increases are not based on lack of response at 10 days because antidepressant therapeutic effect commonly takes several weeks, so that instruction is misleading. Routine sodium restriction is not a standard teaching point for this medication, and regular weight checks are less immediately safety-focused than monitoring for adverse effects.

Question 20

A nurse is teaching a client about adverse effects of etanercept. Which the following statements by the client indicates understanding of the teaching?

Accepted Answer

Answer reason: Regular blood work helps detect problems such as cytopenias and supports safe continuation of therapy in immunomodulated patients. Alopecia and xerostomia are not characteristic adverse effects taught as key concerns for this medication, making those statements less indicative of correct understanding. Proper handling of the prefilled syringe/autoinjector involves allowing it to warm to room temperature while keeping the cap on to maintain sterility and protect the needle, so leaving it off reflects incorrect technique.

Question 21

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication?

Accepted Answer

Answer reason: Early toxicity classically presents with ringing in the ears due to salicylate effects on the auditory system and acid–base balance. Gastrointestinal changes like diarrhea or constipation are nonspecific and not hallmark signs of salicylate toxicity. Decreased respirations is not expected; salicylate toxicity more typically causes hyperventilation early from respiratory center stimulation, progressing to metabolic derangements if severe.

Question 22

Isotretinoin is prescribed for a client with severe acne. Before administration of this medication, the nurse anticipates that what laboratory test will be prescribed?

Accepted Answer

Answer reason: Measuring triglycerides prior to starting therapy helps identify patients who may require dose adjustment, dietary counseling, or avoidance of the drug if levels are markedly elevated. Lipid elevation can increase the risk of pancreatitis, making triglycerides a high-yield safety lab for this medication. Potassium and HbA1c are not routine pre-treatment monitoring tests for isotretinoin. Total cholesterol may also be monitored, but triglycerides are the most emphasized lab due to the severity of potential complications.

Question 23

A client with severe acne is seen in the clinic and the HCP prescribes isotretinoin. The nurse reviews vital client's medication record and would contact the HCP if the client is also taking which medication?

Accepted Answer

Answer reason: Isotretinoin is a vitamin A (retinoid) derivative, so combining it with vitamin A supplements can produce additive toxicity. This raises the risk of hypervitaminosis A manifestations such as severe headache/pseudotumor cerebri, hepatotoxicity, and marked mucocutaneous dryness. Therefore the nurse should contact the prescriber to stop vitamin A supplementation and avoid duplication of retinoid effects. The other listed medications are not the classic contraindicated combination driving a high-yield safety concern with isotretinoin.

Question 24

When teaching a patient who is receiving allopurinol, what should the nurse encourage the patient to do?

Accepted Answer

Answer reason: Long-term allopurinol therapy can be associated with ocular effects (e.g., cataract-related changes), so periodic eye monitoring supports early detection of complications. Teaching should emphasize surveillance for adverse effects and routine follow-up, especially with chronic use. Dietary advice to eat more meat would worsen hyperuricemia and gout risk, making it unsafe guidance. Instructions about timing before meals are not a primary safety teaching point compared with monitoring for medication-related complications.

Question 25

A patient is taking aspirin for arthritis. Which adverse reaction should the nurse teach the patient to report to the health care provider?

Accepted Answer

Answer reason: This symptom can occur even before severe metabolic derangements develop, so it warrants prompt reporting and dose evaluation. The other options are not typical early warning signs of aspirin toxicity in routine arthritis dosing. Teaching patients to report this symptom helps prevent progression to more serious toxicity (e.g., acid–base disturbances and bleeding).

Question 26

When administering Phenytoin you should monitor?

Accepted Answer

Answer reason: Neurobehavioral changes (e.g., confusion, ataxia, nystagmus, irritability) can signal adverse CNS effects and should be tracked during therapy. Although uncommon, serious cutaneous reactions such as Stevens–Johnson syndrome/TEN are critical to detect early because prompt discontinuation can be life-saving. Because each listed parameter reflects either therapeutic monitoring or severe adverse-effect surveillance required with this drug, the most complete choice is the combined option.

Question 27

A nurse is about to administer Propanolol to a patient. The nurse takes the patient's pulse and documents it as 58 bpm. How should the nurse continue?

Accepted Answer

Answer reason: A pulse of 58 bpm is below typical safe administration thresholds (commonly hold if

Question 28

A client is receiving anti-infective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection?

Accepted Answer

Answer reason: A sore mouth is a common early symptom of thrush and may be accompanied by oral irritation and white plaques, making it a key nursing cue during antibiotic treatment. Headache and ear fullness are nonspecific and are not classic indicators of a flora-imbalance superinfection. Constipation may occur with various medications or decreased mobility postoperatively but does not specifically suggest opportunistic infection overgrowth.

Question 29

A nurse is caring for a client who is experiencing vomiting due to digoxin toxicity. Which medication should the nurse prepare to administer?

Accepted Answer

Answer reason: Lidocaine is an antiarrhythmic that can be used for ventricular dysrhythmias associated with digoxin toxicity, making it the best choice among the options. Atropine is used primarily for symptomatic bradycardia/AV block rather than GI manifestations and is not the general “go-to” medication for digoxin-related vomiting. Lisinopril and amlodipine do not address digoxin toxicity effects and would not reverse the toxicity-related symptoms.

Question 30

The nurse is reviewing prescriptions for the assigned clients. Which prescription should the nurse question?

Accepted Answer

Answer reason: This order would increase bowel hypomotility, contributing to abdominal distension, delayed passage of flatus/stool, and risk of bowel complications. By contrast, allopurinol is an appropriate therapy to reduce uric acid burden in tumor lysis syndrome. Levofloxacin is not a beta-lactam and is generally safe in penicillin anaphylaxis (though allergy history should still be verified), and morphine may contribute to constipation but is not an absolute contraindication when pain control is needed with monitoring and bowel regimen.

Question 31

The nurse is reviewing medication lists for several clients. Which medication is most important for the nurse to question? 1. Testosterone transdermal gel for a client who has prostate cancer 2. Metformin for a client whose only diagnosis is polycystic ovary syndrome 3. Sildenafil for a client who is also taking hydrochlorothiazide for hypertension 4. Medroxyprogesterone for a client who has infertility associated with endometriosis?

Accepted Answer

Answer reason: This makes the order a high-risk safety issue requiring immediate clarification before administration. By contrast, metformin is commonly used off-label in PCOS to address insulin resistance and improve ovulatory function. Sildenafil’s major dangerous interaction is with nitrates (not thiazide diuretics), while hormonal therapies like progestins may be used in endometriosis management depending on goals and specialist plan.

Question 32

The client is a new admission diagnosed with Alzheimer's disease (AD). The nurse reviews all drugs (including complementary & integrated health therapies) routinely taken at home with a family member. Which of the following treatments would be a concern for the nurse?

Accepted Answer

Answer reason: This agent is associated with increased bleeding risk (antiplatelet effect) and can interact with anticoagulants/antiplatelets and perioperative care, making it a common safety concern in older adults. In an older client with cognitive impairment, unsupervised use also increases the chance of dosing errors and delayed recognition of adverse effects. By contrast, prescribed cholinesterase inhibitor therapy for AD is expected and monitored, while common dietary supplements are generally less concerning unless interacting with other therapies or causing toxicity.

Question 33

A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. How should the nurse respond to the client?

Accepted Answer

Answer reason: Ginseng has been associated with hypoglycemic effects, which can compound the action of insulin in type 1 diabetes and increase risk for symptomatic low blood sugar. The safest nursing response is to warn the client about this risk and encourage monitoring and provider consultation before use. Claims such as memory improvement are not the priority compared with preventing a potentially dangerous adverse effect. Advising to pair it with carbohydrates is unreliable because dosing and glucose-lowering effect are unpredictable and could still lead to hypoglycemia.

Question 34

Following norepinephrine (Levophed) administration, it is essential to the nurse to assess?

Accepted Answer

Answer reason: Nursing monitoring must therefore focus on early signs of excessive vasoconstriction and tissue ischemia, especially in distal extremities. Coolness, pallor, or mottling of fingers/toes can signal compromised circulation and risk for ischemic injury, which requires prompt reassessment of dose and overall hemodynamics. Arrhythmias can occur with catecholamines, but the hallmark safety concern that bedside assessment can detect early is peripheral ischemia from intense vasoconstriction.

Question 35

When administering octreotide (Sandostatin) to a patient, it is most important for the nurse to assess which parameter?

Accepted Answer

Answer reason: Because this effect can produce clinically important hypo- or hyperglycemia, point-of-care glucose monitoring is a priority nursing assessment to detect and treat abnormalities early. This is especially critical in patients with diabetes, those receiving enteral/parenteral nutrition, or those who are acutely ill where glucose swings worsen outcomes. Other monitoring (e.g., gallbladder effects or mild hepatic changes) may be relevant with longer therapy, but glucose changes are a key immediate safety concern during administration.

Question 36

Which sign/symptom indicates that a client being treated with haloperidol may be experiencing an adverse effect of this medication?

Accepted Answer

Answer reason: Excessive drooling can indicate drug-induced parkinsonism with impaired swallowing/secretions handling or an acute dystonic reaction affecting oropharyngeal muscles, both clinically important adverse effects requiring prompt assessment and possible anticholinergic treatment (e.g., benztropine) or medication adjustment. Compared with more nonspecific complaints like nausea, drooling is more suggestive of EPS and can raise aspiration risk. Hypotension and blurred vision are more characteristic of agents with stronger alpha-1 and anticholinergic effects than haloperidol, making them less discriminating here.

Question 37

A nurse is caring for a client who has developed bradycardia. Which prescription would the nurse question?

Accepted Answer

Answer reason: In a client who has developed bradycardia, this order should be questioned/held pending provider review and assessment of hemodynamic stability. The other medications listed are not primarily negative chronotropes; they more commonly affect preload/afterload or electrolytes rather than directly slowing conduction. A common safety step is to verify apical pulse/ECG rhythm and follow hold parameters before administering rate-slowing agents.

Question 38

The nurse is administering chlorpromazine (Thorazine), a traditional antipsychotic medication, to the client diagnosed with schizophrenia. Which intervention should the nurse implement when administering this medication?

Accepted Answer

Answer reason: First-generation (typical) antipsychotics commonly cause extrapyramidal symptoms due to dopamine D2 blockade in the nigrostriatal pathway. Nursing care prioritizes early assessment for acute dystonia and akathisia because they can be distressing, impair adherence, and may require prompt treatment (e.g., anticholinergics for dystonia). Tyramine restrictions apply to MAO inhibitors, not typical antipsychotics. Routine RBC monitoring is not a key safety intervention for this medication; agranulocytosis monitoring is classically associated with clozapine (WBC/ANC), not chlorpromazine.

Question 39

The nurse has given morphine sulfate 4 mg IV to a client who is having an acute myocardial infarction. When evaluating the client's response 5 minutes after giving the medication, which finding indicates a need for immediate further action?

Accepted Answer

Answer reason: A drop to 12/min within minutes warrants prompt reassessment of depth/effort of breathing, oxygenation, level of consciousness, and readiness to intervene (e.g., stimulate, oxygen, consider naloxone per protocol) if ventilation is inadequate. A mild blood pressure decrease is a common effect from venodilation and reduced sympathetic tone and is not inherently emergent if perfusion remains adequate. Sinus rhythm at 96 is acceptable, and near-complete pain relief with a residual 1/10 is not an urgent complication.

Question 40

Which of the following statements regarding peritoneal dialysis requires further education?

Accepted Answer

Answer reason: Peritoneal dialysis uses the peritoneal membrane for diffusion and osmosis and does not require systemic anticoagulation as part of routine therapy. Heparin may be added to the dialysate in selected situations (e.g., fibrin/clotting in the effluent), but it is not a standard scheduled requirement and systemic anticoagulation would add unnecessary bleeding risk. Nighttime automated peritoneal dialysis is a common modality and is appropriate education. A displaced or obstructed catheter can interrupt therapy and increase infection/leak risk, so urgent evaluation is appropriate, making that statement less concerning than the anticoagulation claim.

Question 41

A patient with familial hypercholesterolemia is prescribed atorvastatin 10 mg once a day. Which finding will the nurse immediately report to the health care provider?

Accepted Answer

Answer reason: New or unexplained muscle pain/soreness is an early warning sign, especially when it is persistent or accompanied by weakness or dark urine, so it warrants immediate reporting. In contrast, mild GI effects such as stomach upset, constipation, and bloating are relatively common and are typically managed with supportive measures and monitoring. Prompt notification allows the provider to assess creatine kinase and renal function and reduce risk of acute kidney injury from muscle breakdown.

Question 42

The pediatrician has diagnosed tinea capitis in an 8- year-old girl and has placed her on oral griseofulvin. The nurse should emphasize which of these instructions to the mother and/or child?

Accepted Answer

Answer reason: Teaching about expected and reportable adverse effects is a key nursing responsibility when initiating an antifungal. Griseofulvin commonly causes GI upset and CNS effects such as headache and dizziness, and decreased appetite can occur, so monitoring helps identify intolerance or need for provider notification. The medication is typically better absorbed with fatty foods rather than on an empty stomach, so that instruction would be incorrect. Stopping therapy early based on taste changes or symptom improvement risks treatment failure because tinea capitis requires a prolonged full course to eradicate infection in hair follicles.

Question 43

A client with an inflammatory ophthalmic disorder has been receiving repeated courses of a corticosteroid ointment, one-half inch in the lower conjunctival sac four times a day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent?

Accepted Answer

Answer reason: Topical ophthalmic corticosteroids can raise intraocular pressure and precipitate steroid-induced ocular hypertension or glaucoma, especially with repeated or prolonged courses. Headache with blurred vision is a concerning symptom cluster for elevated IOP and warrants prompt evaluation to prevent optic nerve damage. These findings are not typical “expected effects” that should fade and are unsafe to ignore. Incorrect ointment technique more commonly causes local irritation or contamination rather than a pattern of headache and visual blurring suggestive of pressure elevation.

Question 44

A client's opioid therapy is being tapered off, and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?

Accepted Answer

Answer reason: This sympathetic surge commonly presents first with sweating, restlessness, and anxiety before more prominent gastrointestinal symptoms evolve. Nausea and abdominal cramping are typical but tend to appear as withdrawal progresses and GI hypermotility becomes more pronounced. Fever is not a classic early hallmark and should prompt assessment for other causes such as infection.

Question 45

You have administered a mildly sedating medication to promote sleep. An hour after your client was given this medication, your client is jittery and hyperactive. What has most likely occurred?

Accepted Answer

Answer reason: Paradoxical excitation can occur with some sedating medications (notably benzodiazepines and some antihistamines), causing agitation, jitteriness, and hyperactivity rather than sedation. This represents an unusual, patient-specific response that is not the intended therapeutic effect and is not predictable from typical pharmacology. That pattern best fits an idiosyncratic (paradoxical) reaction rather than a general adverse effect expected in many patients. A medication error would require evidence of wrong drug/dose/route/time, which is not provided, and a sentinel event implies serious harm (e.g., death or major permanent loss of function), which is not indicated here.

Question 46

A clients transfusion of packed red blood cells has been infusing for 2 hours. She is complaining of a raised, itchy rash and shortness of breath. She is wheezing, anxious, and very restless. The nurse knows these assessment findings are congruent with?

Accepted Answer

Answer reason: Anxiety and restlessness are consistent with developing respiratory compromise during a transfusion reaction. A febrile reaction is driven by cytokines/antibodies and typically causes fever and chills rather than hives and wheeze. Circulatory overload more often causes hypertension, crackles, and JVD, and an acute hemolytic reaction is characterized by fever, flank pain, hypotension, and hemoglobinuria.

Question 47

A patient receiving amphotericin B (AMBISONE) develops a fever, chills, and a headache. What is the nurse’s best action?

Accepted Answer

Answer reason: Fever, chills, and headache during amphotericin B administration are classic acute infusion-related reactions that can rapidly worsen and may be difficult to distinguish initially from more serious hypersensitivity-type reactions. The immediate nursing priority is to prevent further drug exposure while assessing the patient’s airway, breathing, circulation, and vital signs, and then notify the provider for next steps (e.g., slowing rate, premedication, or changing therapy). Giving an antipyretic can be appropriate later as prescribed but does not address the priority of stopping the offending infusion first. Blood cultures and isolation address infectious etiologies, but the timing with an active infusion makes an infusion reaction the most likely and urgent to manage.

Question 48

A patient with Parkinson's disease is switched from levodopa to ropinirole. The nurse should be alert for which side effect unique to ropinirole?

Accepted Answer

Answer reason: g., avoid driving). This effect is important for nurses to anticipate because it can lead to falls, motor vehicle accidents, and injury without warning. Orthostatic hypotension and psychosis can occur with multiple antiparkinsonian dopaminergic therapies, so they are not distinctive. Dry mouth is more typical of anticholinergic agents used in Parkinsonism rather than being a defining concern of ropinirole.

Question 49

A client is admitted for care after a traumatic brain injury. The client has a history of atrial fibrillation and obesity. Which prescribed medication does the nurse question?

Accepted Answer

Answer reason: A history of atrial fibrillation creates thromboembolic risk, but in an acute head trauma the immediate priority is preventing catastrophic bleeding, so an order for an oral vitamin K antagonist should be questioned and clarified. Mannitol may be appropriate to reduce elevated intracranial pressure, and pantoprazole is commonly used for stress-ulcer prophylaxis in critically ill patients. Ondansetron can be used for nausea/vomiting and is not a primary contraindication related to TBI in the way anticoagulation is.

Question 50

A client taking valproic acid for the management of seizure disorder reports to the laboratory for follow-up blood tests. The nurse should check the results of which laboratory test to monitor for medication toxicity?

Accepted Answer

Answer reason: Monitoring AST/ALT (and often bilirubin) helps detect toxicity promptly so the medication can be adjusted or discontinued before severe hepatic failure develops. The other listed tests are not primary toxicity surveillance for this drug; glucose and ESR are nonspecific, and routine electrolytes do not screen for the key organ toxicity associated with valproate. This is a safety-focused medication monitoring question aimed at preventing adverse outcomes from therapy.

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