Question 1

A client with schizophrenia has been taking Thorazine (chlorpromazine) 200mg four times a day. Which finding should be reported to the doctor immediately?

Accepted Answer

Answer reason: Antipsychotics can rarely cause blood dyscrasias such as agranulocytosis, and early infection signs may be subtle. A sore throat can indicate developing neutropenia with high risk for rapid progression to serious infection, so it warrants immediate provider notification and prompt CBC evaluation. The other findings are more consistent with common, less urgent effects of chlorpromazine such as anticholinergic symptoms (thirst/dry mouth), mild weight gain, and sedation. Immediate reporting is prioritized when a symptom suggests a potentially life-threatening adverse drug reaction rather than expected, manageable side effects.

Question 2

The nurse is preparing to administer medications to a client with an asthma exacerbation. Which prescription should the nurse confirm with the health care provider prior to administration? Click on the exhibit button for additional information.?

Accepted Answer

Answer reason: In an asthma exacerbation, bronchodilators and systemic corticosteroids are expected therapies, while prophylactic anticoagulation may be inappropriate if the exhibit indicates low platelets or another bleeding concern. This order should be clarified to prevent serious hemorrhage or worsening thrombocytopenia. By contrast, short-acting beta-agonists and IV steroids directly address airway inflammation/bronchospasm and are commonly indicated in this setting.

Question 3

The client who has been prescribed phenytoin for epilepsy calls the clinic and reports a measles-like rash. Which intervention should the nurse implement?

Accepted Answer

Answer reason: A new rash in a patient taking an anticonvulsant can indicate a potentially serious hypersensitivity reaction that requires prompt clinical evaluation and possible discontinuation. Phenytoin can cause severe cutaneous adverse reactions (including SJS/TEN), and a “measles-like” rash should not be managed with reassurance or topical self-treatment. Immediate assessment allows the provider to evaluate severity, mucosal involvement, systemic symptoms, and determine whether urgent escalation is needed. Asking about grapefruit juice is not the priority because the immediate safety concern is a possible dangerous drug reaction.

Question 4

Mr. Gaugin’s blood pressure has returned to normal and he is to be discharged with a prescription for an oral antihypertensive medication. The nurse is preparing a client education guide for Mr. Gaugin. Which of the following information should be included in Mr.Gaugin’s education Guide?

Accepted Answer

Answer reason: Antihypertensive medications commonly cause orthostatic hypotension due to reduced vascular tone and/or volume, increasing fall risk when standing quickly. Teaching the client to rise slowly from lying to sitting and then standing helps prevent dizziness, syncope, and injury during the initiation and continuation of therapy. This instruction is broadly applicable across many antihypertensive classes and is a key discharge safety point. In contrast, recommending OTC appetite suppressants is unsafe because many contain stimulants that can raise blood pressure and counteract therapy.

Question 5

An elderly client with a history of stable chronic obstructive pulmonary disease, alcohol abuse, and cirrhosis has a serum theophylline level of 25.8 mcg/mL (143 µmol/L). Which clinical manifestation associated with theophylline toxicity should worry the nurse most?

Accepted Answer

Answer reason: With impaired hepatic metabolism (cirrhosis, alcohol use), drug clearance falls and toxic levels are more likely, making severe neurologic effects a priority concern. Seizures are a critical manifestation because they can rapidly lead to hypoxia, aspiration, dysrhythmias, and cardiovascular collapse, requiring immediate emergency management. By contrast, visual color changes and gingival overgrowth are classically associated with other medications, and fever is less specific and typically less immediately life-threatening than convulsions in this context.

Question 6

A teenage client receives a prescription for erythromycin for the treatment of pelvic inflammatory disease. Which medication instruction does the nurse provide to the client?

Accepted Answer

Answer reason: " Macrolide antibiotics can rarely cause ototoxicity, especially with higher doses or prolonged therapy, and early recognition helps prevent potentially persistent auditory damage. New tinnitus, decreased hearing, or vertigo should be reported promptly so the prescriber can evaluate the need to stop or change therapy. Antacids can interfere with absorption of some erythromycin formulations and are not an appropriate routine self-management instruction. Constipation is not a typical prominent adverse effect; gastrointestinal upset/diarrhea is more common.

Question 7

A client is being discharged on Coumadin after hospitalization for atrial fibrillation. The nurse recognizes that which of the following foods would be restricted while the client is on this medication?

Accepted Answer

Answer reason: Leafy green and cruciferous vegetables are common high–vitamin K foods that can lower the INR and increase thromboembolic risk if intake rises or fluctuates. This choice best matches a food that is typically high in vitamin K compared with the other options listed. The key teaching is not necessarily total avoidance, but keeping vitamin K intake consistent and monitoring INR when diet changes.

Question 8

The nurse provides discharge teaching for the parent of a child newly prescribed methylphenidate for attention-deficit hyperactivity disorder (ADHD). The nurse advises the parent that the child might experience which side effects?

Accepted Answer

Answer reason: Methylphenidate can lead to decreased appetite with possible weight loss and can also cause nervousness, irritability, and restlessness. It more typically increases heart rate and blood pressure rather than lowering blood pressure, making that distractor inconsistent. Insomnia is a known effect, but a dry cough is not a characteristic adverse effect of this medication and makes that option less correct overall.

Question 9

A post-adrenalectomy client is admitted to the ICU and is on IV hydrocortisone. Which nursing intervention should be included in the client’s plan of care?

Accepted Answer

Answer reason: Systemic corticosteroids can cause significant hyperglycemia by increasing gluconeogenesis and inducing insulin resistance, and this risk is heightened in critically ill postoperative patients. After adrenalectomy, hydrocortisone is often given as stress-dose replacement, so close monitoring helps detect and treat steroid-related glucose excursions promptly to prevent complications such as osmotic diuresis, dehydration, and infection risk. Lying flat for 24 hours is not a standard requirement after adrenal surgery and may increase pulmonary complications. Steroids should not be stopped abruptly when stability is achieved because tapering is often needed to avoid adrenal insufficiency/crisis, and wound-care teaching is not the ICU priority compared with immediate medication effects monitoring.

Question 10

The nurse has just completed discharge teaching for a client who had aortic valve replacement with a mechanical heart valve. Which statement by the client indicates that teaching has been effective?

Accepted Answer

Answer reason: " Clients with mechanical heart valves require lifelong anticoagulation, and key discharge teaching focuses on minimizing bleeding risk from everyday activities. Using an electric razor reduces the chance of cuts and prolonged bleeding compared with a blade. In contrast, Ginkgo biloba can increase bleeding risk when combined with anticoagulants, and increasing leafy greens can destabilize INR due to vitamin K content. Applying products like vitamin E to an incision is not the priority teaching point and may irritate the wound or interfere with healing guidance.

Question 11

A client with schizophrenia is receiving haloperidol 2 mg orally three times a day. The client approaches the nurse's station presenting with eyes rolled upward towards the head. The nurse recognizes this finding as what type of side effect?

Accepted Answer

Answer reason: Forced upward deviation of the eyes is characteristic of an oculogyric crisis, which can be distressing and may also involve neck or jaw muscle spasm. This is treated promptly with an anticholinergic (e.g., benztropine) or antihistamine (e.g., diphenhydramine) to reverse the dystonia. Tardive dyskinesia is a delayed-onset syndrome featuring choreoathetoid, repetitive movements (often orofacial) rather than an abrupt eye-rolling episode. Recognizing this pattern is important because it signals an urgent medication adverse effect requiring immediate intervention.

Question 12

A 14-year-old is admitted to the medical ward for status asthmaticus. He has put on IV theophylline. Which manifestation would the nurse consider as a side effect of the drug?

Accepted Answer

Answer reason: Theophylline is a methylxanthine that stimulates the CNS and heart and can increase catecholamine effects, producing tachycardia and dysrhythmia symptoms. An awareness of cardiac stimulation is important in IV administration because toxicity can develop with relatively small increases in serum level. Seizures are more consistent with severe toxicity rather than an expected side effect at therapeutic doses. Headache and sleeplessness can occur, but cardiac symptoms are a key clinically concerning adverse effect nurses monitor closely.

Question 13

A nurse at the Emergency Department attends to a 9-year-old male patient, accompanied by mother, with chief complaints of fatigue. History reveals that the child has a congenital heart defect and has been on the chronic use of digoxin. Which finding would cause the nurse to suspect digoxin toxicity?

Accepted Answer

Answer reason: Digoxin increases vagal tone and slows conduction through the AV node, so toxicity commonly presents with clinically significant bradycardia and other dysrhythmias. In a child on chronic digoxin therapy who presents with fatigue, an abnormally slow pulse is a high-yield red flag that should prompt immediate assessment of heart rate/rhythm and consideration of serum digoxin and electrolyte (especially potassium) evaluation. Confusion can occur with toxicity but is less specific and less immediately predictive than a conduction-related change. Dyspnea and weight loss are more consistent with underlying cardiac disease or other chronic conditions rather than a classic toxic effect.

Question 14

Hydrochlorothiazide (HydroDiuril) has been prescribed for a client. The nurse contacts the physician to verify the prescription if which of the following conditions is noted in the assessment data?

Accepted Answer

Answer reason: Verifying with the prescriber helps determine reaction severity, alternative diuretics, and monitoring needs if use is still considered. Hypertension is a common indication for this medication, not a reason to question it. An egg allergy is unrelated to this drug’s structure and typical contraindications.

Question 15

Soon after admission of a primigravid client at 38 weeks’ gestation with severe preeclampsia, the primary healthcare provider (HCP) prescribes a continuous intravenous infusion of 5% dextrose in Ringer’s solution and 4 g of magnesium sulfate. While the medication is being administered, which assessment finding should the nurse report immediately?

Accepted Answer

Answer reason: A respiratory rate at the low end of normal in a patient receiving magnesium warrants immediate evaluation, holding the infusion, and readiness to administer calcium gluconate if worsening occurs. A +2 patellar reflex is normal (loss of deep tendon reflexes is more concerning for toxicity). Severe-range blood pressure is expected in severe preeclampsia but is not a new infusion-related toxicity indicator, and urine output exceeding intake is not consistent with magnesium accumulation risk (decreased output would increase toxicity risk).

Question 16

The nurse cares for a client receiving quinidine. It is MOST important for the nurse to include which information in the client's teaching plan?

Accepted Answer

Answer reason: Quinidine can cause cinchonism, a toxicity syndrome characterized by tinnitus, hearing changes, headache, and visual disturbances, and it may precede more serious complications. Teaching the client to promptly report tinnitus supports early recognition and discontinuation/adjustment before dysrhythmias or other toxicity worsens. Checking the pulse is more classically emphasized for drugs like digoxin or some beta-blockers and is not the key safety teaching for this medication. Dietary vitamin C and dark amber urine are not priority, clinically specific safety points for quinidine therapy.

Question 17

A patient with UTI on treatment, after administration of Nitrofurentoin (furadentin) the patient was complain of dark colour urine , the nurse what to do ....?

Accepted Answer

Answer reason: The appropriate nursing action is to recognize it as a normal adverse effect, provide reassurance/teaching as needed, and record it in the chart. Notifying the provider or obtaining a urine sample is unnecessary unless other concerning symptoms occur (e.g., jaundice, dyspnea, flank pain, hematuria). Catheter irrigation is unrelated and could introduce infection or cause trauma if not indicated.

Question 18

A client with acne has been using isotretinoin. She tells the nurse that she recently learned she is pregnant. She asks "Will my pregnancy interfere with the medication's effectiveness?" Which of the following is the appropriate response by the nurse?

Accepted Answer

Answer reason: " Isotretinoin is a known potent teratogen, so pregnancy is an absolute contraindication due to high risk of severe fetal malformations. The safest, most clinically appropriate nursing response is to address the urgent safety issue rather than the client’s concern about efficacy. Suggesting route changes implies it could be continued safely, which is incorrect and unsafe. Reassuring continuation or focusing on self-esteem fails to recognize and respond to the immediate medication-related fetal risk and the need to stop the drug and notify the prescriber promptly.

Question 19

A client is prescribed ciprofloxacin as treatment for a urinary tract infection. About which potential adverse effect does the nurse instruct this client?

Accepted Answer

Answer reason: Client education should emphasize reporting new tendon pain, swelling, or difficulty moving (often Achilles), and stopping the drug while seeking evaluation if these occur. This risk is clinically important because tendon rupture can cause significant morbidity and may occur even early in therapy, especially in older adults or those on corticosteroids. The other options are not characteristic teaching priorities for ciprofloxacin compared with tendon-related toxicity.

Question 20

The nurse prepares to administer a prescribed dose of sodium polystyrene sulfonate to a client with hyperkalemia. Which action by the nurse is most important prior to administering the dose?

Accepted Answer

Answer reason: Baseline assessment of abdominal status and recent stool pattern screens for constipation, ileus, or obstruction—conditions that raise the risk of serious GI adverse effects (e.g., fecal impaction/ischemic bowel) and reduce effectiveness. Ensuring the client can pass stool also supports evaluation of treatment response after administration. Helping to a commode, teaching, or checking daily weights may be helpful, but they do not address the key immediate safety contraindication before giving this medication.

Question 21

A licensed practical nurse (LPN) is reviewing the medication list of the client with a history of glaucoma. The LPN should consult with the registered nurse if which medication is prescribed for the client?

Accepted Answer

Answer reason: This makes the medication a key contraindication/precaution that warrants escalation to the RN for clarification and safety screening. In contrast, pilocarpine is a miotic that increases trabecular outflow and is used to lower intraocular pressure, and topical beta-blockers such as carteolol also reduce aqueous production. Consulting the RN helps prevent precipitating acute glaucoma worsening and potential vision loss.

Question 22

The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet (Foscavir), an antiviral. The nurse checks the latest results of which of the following laboratory studies while the client is taking this medication?

Accepted Answer

Answer reason: Serum creatinine is a direct, routinely used marker of kidney function and is expected to rise with drug-induced renal injury. Clients with AIDS/CMV may already have comorbid risks for renal impairment, increasing the need for close monitoring during therapy. CD4 and lymphocyte counts reflect immune status and disease progression but do not monitor for this medication’s most clinically important toxicity. Albumin is a nutrition/protein status marker and is not the priority safety lab for this drug.

Question 23

The nurse is caring for a client who is receiving tacrolimus daily. Which finding indicates to the nurse that the client is experiencing an adverse effect of the medication?

Accepted Answer

Answer reason: A decreased urine output is a clinically important warning sign that requires prompt assessment of renal function (BUN/creatinine), tacrolimus level, and hydration/hemodynamics. The other findings listed are not characteristic hallmark adverse effects to monitor for this medication compared with renal impairment. Recognizing oliguria early helps prevent progression to acute kidney injury and guides timely provider notification and dose adjustment.

Question 24

A nurse cares for a newborn in the neonatal intensive care unit (NICU). The client weighs 2.9 kg and has experienced a seizure. The nurse administers phenobarbital 43.5 mg IV as prescribed. Which assessment is most important for this newborn?

Accepted Answer

Answer reason: Newborns are particularly vulnerable to hypoventilation and apnea, especially when sedating anticonvulsants are given or seizures have recently occurred. Monitoring respiratory rate, effort, oxygen saturation, and signs of apnea directly addresses airway and breathing (ABCs) and guides immediate supportive actions. Cardiovascular effects can occur, but respiratory depression is the most critical and common acute adverse effect requiring rapid intervention.

Question 25

Which medication should be avoided by the client with acute pancreatitis?

Accepted Answer

Answer reason: Therefore, a nursing safety consideration is to avoid morphine in this setting when alternatives are available. Meperidine has historically been preferred for pancreatitis pain because it was thought to cause less sphincter of Oddi spasm (even though modern practice often favors other opioids for safety/efficacy reasons). H2 blockers like famotidine or ranitidine do not worsen pancreatitis via this mechanism and are not the key medication to avoid here.

Question 26

A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the doctor immediately if he notices?

Accepted Answer

Answer reason: This adverse effect is clinically urgent because it can become irreversible if the drug is not stopped promptly. The other options are more consistent with toxicities of different TB drugs (e.g., ototoxicity with aminoglycosides, red-orange secretions with rifampin) or are less specific/less emergent. Prompt reporting allows immediate evaluation and medication adjustment to prevent permanent visual damage.

Question 27

A nurse is assessing a client who is taking pregabalin to treat neuropathy pain. The nurse should document which of the following findings as an adverse effect of the medication?

Accepted Answer

Answer reason: New or worsening drowsiness is a typical adverse effect that the nurse should recognize and document because it increases fall risk and may require dose adjustment. Dilated pupils and excessive salivation are not characteristic adverse effects for pregabalin and suggest other drug classes/toxicities. Weight change with pregabalin is more often weight gain related to increased appetite and fluid retention rather than weight loss.

Question 28

The nurse is assigned to care for a client diagnosed with acquired immunodeficiency syndrome (AIDS) who is receiving amphotericin B for a fungal respiratory infection. Which would indicate an adverse effect of the medication?

Accepted Answer

Answer reason: This renal loss manifests as low serum potassium, which is a classic, testable adverse effect requiring monitoring and replacement as needed. In contrast, elevated potassium is not the expected pattern with this drug’s tubular wasting effect. Recognizing this adverse effect is important because hypokalemia increases risk for dysrhythmias and neuromuscular symptoms, particularly in medically fragile clients.

Question 29

A client with severe acne is seen in the clinic and the primary health care provider (PHCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the PHCP if the client is also taking which medication?

Accepted Answer

Answer reason: This increases risk of hypervitaminosis A manifestations such as severe headache/intracranial hypertension, dry skin and mucous membranes, hepatotoxicity, and other systemic adverse effects. The nurse should flag this interaction as a contraindicated/unsafe combination requiring prescriber notification. The other listed drugs do not represent a classic high-risk interaction that would routinely require holding isotretinoin based solely on concomitant use.

Question 30

A client with deep vein thrombosis has been receiving warfarin for 2 months. The client is to go to an anticoagulant monitoring laboratory every 3 weeks. The last visit to the laboratory was 2 weeks ago. The client reports bleeding gums, increased bruising, and dark stools. What should the nurse instruct the client to do?

Accepted Answer

Answer reason: These findings suggest excessive anticoagulation and possible gastrointestinal bleeding, which is a potentially serious adverse effect requiring prompt medical evaluation. Nursing teaching should prioritize safety by directing the client to seek provider guidance for urgent assessment, INR/PT testing, and possible dose adjustment or reversal rather than making independent medication changes. Dark stools can indicate melena and ongoing blood loss, increasing risk for hemodynamic instability and anemia. Advising self-adjustment of dose or diet is unsafe because it can worsen bleeding or destabilize anticoagulation control.

Question 31

A client has been prescribed a nitroglycerin infusion. Which medication does the nurse ensure is available related to common side effects of nitroglycerin?

Accepted Answer

Answer reason: An analgesic like acetaminophen is appropriate to manage the headache while the infusion continues, supporting comfort without significantly worsening hypotension. Epinephrine and diphenhydramine are more consistent with treating anaphylaxis, which is not a typical nitroglycerin reaction. Morphine may be used for chest pain in acute coronary syndromes, but it does not specifically address the most common nitroglycerin side effect and can add risks such as hypotension and respiratory depression.

Question 32

Your pregnant client has been hospitalized with hyperemesis gravidium. She is given ondansetron to treat this illness. What serious side effect should the hospital nurses be watching for?

Accepted Answer

Answer reason: Ondansetron can delay cardiac repolarization and increase the QT interval, which can precipitate torsades de pointes and sudden dysrhythmias. This risk is clinically important in hospitalized patients, especially if dehydration and electrolyte losses from hyperemesis (hypokalemia/hypomagnesemia) are present. Nursing monitoring should therefore include ECG/QT assessment and correction of electrolytes and avoidance of other QT-prolonging drugs. Constipation is common but not the key serious toxicity; persistent nausea/vomiting indicates lack of efficacy rather than a dangerous adverse effect.

Question 33

The nurse is performing medication reconciliation to a patient in the Respiratory clinic recently prescribed with terbutaline. Which medication shall the nurse be concerned about?

Accepted Answer

Answer reason: Beta-agonists like terbutaline stimulate beta-2 receptors to cause bronchodilation, so concurrent beta-blocker therapy can blunt the therapeutic effect and potentially worsen bronchospasm. Atenolol is a beta-blocker (beta-1 selective but not completely), and selectivity can be lost at higher doses or in sensitive patients with reactive airway disease. This interaction is clinically important in a respiratory clinic setting because it can reduce symptom relief and increase risk of breathing difficulty. The other listed drugs do not directly antagonize beta-2 bronchodilation in the same way and are less concerning as primary interactions with terbutaline.

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Adverse Effects-Contraindications Practice Test 24

Adverse Effects-Contraindications NCLEX Practice Test

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