Question 1

A client is prescribed hydrocodone/acetaminophen for pain. What is the primary nursing consideration during hydrocodone/acetaminophen therapy?

Accepted Answer

Answer reason: Hydrocodone/acetaminophen contains acetaminophen, which can cause hepatotoxicity. The key nursing consideration is monitoring liver function and total daily acetaminophen dose.

Question 2

A client is prescribed lorazepam for anxiety. What is the primary nursing consideration when administering lorazepam?

Accepted Answer

Answer reason: Lorazepam is a benzodiazepine that can cause CNS and respiratory depression; the key safety priority is monitoring ventilation and sedation for early signs of respiratory compromise.

Question 3

A 20-year-old female has a prescription for tetracycline. While teaching the client how to take her medicine, the nurse learns that the client is also taking Ortho-Novum oral contraceptive pills. Which instructions should be included in the teaching plan?

Accepted Answer

Answer reason: Tetracycline can reduce the efficacy of combined oral contraceptives by altering enterohepatic recirculation; advise a backup method of contraception.

Question 4

What is the early sign of aspirin toxicity?

Accepted Answer

Answer reason: Early salicylate (aspirin) toxicity commonly presents with tinnitus (ringing in the ears); GI upset can occur but tinnitus is the classic early sign.

Question 5

What is the most common neurological complication associated with the swine flu influenza vaccine?

Accepted Answer

Answer reason: Guillain-Barré syndrome is the recognized neurological complication historically associated with influenza (swine flu) vaccination; increased ICP and epilepsy are not typical vaccine-related complications.

Question 6

A multiparous client using medroxyprogesterone (Depo-Provera) for contraception should be instructed to increase her intake of which nutrient?

Accepted Answer

Answer reason: Depot medroxyprogesterone can decrease bone mineral density due to hypoestrogenic effects. Clients should increase calcium intake (often with vitamin D) to protect bone health.

Question 7

Which of the following is a potential adverse effect associated with long-term use of PPIs?

Accepted Answer

Answer reason: Chronic PPI use can reduce calcium absorption and is linked to decreased bone density and increased risk of osteoporotic fractures. The other options are not characteristic long-term adverse effects.

Question 8

Which medication does the nurse understand to be Category X in pregnancy for a 24-year-old client in the fertility clinic?

Accepted Answer

Answer reason: Statins, including simvastatin, are contraindicated in pregnancy (former FDA Category X) due to teratogenic risk. The other options are not Category X.

Question 9

A patient taking escitalopram (Lexapro) asks about potential drug interactions; which substance should the nurse caution the patient to avoid?

Accepted Answer

Answer reason: St. John’s Wort has serotonergic activity and can precipitate serotonin syndrome when combined with SSRIs like escitalopram; it also induces CYP enzymes altering drug levels. Therefore it should be avoided.

Question 10

A client is prescribed risperidone for schizophrenia. What is the primary nursing consideration during risperidone therapy?

Accepted Answer

Answer reason: Risperidone is an atypical antipsychotic that can cause extrapyramidal symptoms (dystonia, akathisia, parkinsonism, tardive dyskinesia). Monitoring for EPS is a key nursing priority; bleeding and increased ICP are not typical risks, and liver function monitoring is not the primary concern.

Question 11

The nurse caring for a 9 year-old child with a fractured femur is told that a medication error occurred. The child received twice the ordered dose of morphine an hour ago. Which of the following nursing diagnoses is a PRIORITY at this time?

Accepted Answer

Answer reason: Morphine overdose can cause CNS and respiratory depression; ensuring effective breathing is the immediate life-threatening priority over GI or nutrition concerns.

Question 12

You are caring for a depressed client with a new prescription for an SSRI antidepressant. In reviewing the admission history and physical, which of the following should lead you to question the safety of this medication?

Accepted Answer

Answer reason: SSRIs are contraindicated with MAO inhibitors due to risk of serious reactions such as serotonin syndrome; a washout period is required.

Question 13

You are caring for a hypertensive client with a new order for captopril (Capoten). Which information should the nurse include in patient teaching?

Accepted Answer

Answer reason: ACE inhibitors such as captopril can cause potassium retention leading to hyperkalemia. Salt substitutes are potassium-based and should be avoided. No fluid restriction is indicated, green leafy vegetables are not contraindicated, and captopril is best taken 1 hour before meals rather than with meals.

Question 14

A 60-year-old diabetic is taking glyburide (Diabeta) 1.25mg daily to treat Type II diabetes mellitus. Which statement indicates the need for further teaching?

Accepted Answer

Answer reason: Glyburide (a sulfonylurea) can cause hypoglycemia; meals should not be skipped. Carrying candy, limiting sun exposure due to photosensitivity risk, and wearing medical ID are appropriate.

Question 15

A client with benign prostatic hypertrophy has been started on Proscar (finasteride). The nurse's discharge teaching should include?

Accepted Answer

Answer reason: Finasteride is teratogenic to a male fetus; women who are or may become pregnant should not handle the tablets (especially crushed/broken). Other options are incorrect: it does not need meals, onset takes months—not 1–2 weeks—and bedtime dosing doesn’t prevent nocturia.

Question 16

A client treated for depression has developed signs of serotonin syndrome. The nurse recognizes that serotonin syndrome is caused by?

Accepted Answer

Answer reason: Serotonin syndrome results from excessive serotonergic activity, commonly from combining MAOIs with SSRIs. Tyramine and pseudoephedrine relate to hypertensive crisis with MAOIs, and dopamine decreases are unrelated.

Question 17

Hydralazine (a vasodilator) can produce?

Accepted Answer

Answer reason: Hydralazine commonly causes reflex tachycardia and a drug-induced lupus-like syndrome; seizures, acute hepatitis, and aplastic anemia are not typical adverse effects.

Question 18

The physician prescribes estrogen (Premarin) 0.625 mg daily for a 43-year-old woman. The nurse knows which of the following symptoms is a common initial side effect of this medication?

Accepted Answer

Answer reason: Oral estrogen commonly causes early gastrointestinal upset such as nausea; visual changes, tinnitus, and ataxia are not typical initial effects.

Question 19

Anxiolytic dosage reduction is recommended?

Accepted Answer

Answer reason: Cimetidine inhibits hepatic metabolism of many anxiolytics, hepatic dysfunction reduces drug clearance, and older adults have decreased clearance and increased sensitivity; therefore lower doses are recommended in all these cases.

Question 20

Which assessment findings indicate pancytopenia in a client taking felbamate (Felbatol) for seizures?

Accepted Answer

Answer reason: Felbamate can cause aplastic anemia (pancytopenia). An early warning sign of neutropenia is sore throat due to infection risk, which should be reported immediately.

Question 21

A pregnant woman with upper RTI due to streptococcus bacteria has history of penicillin allergy. The suitable drug is?

Accepted Answer

Answer reason: Macrolides such as azithromycin are safe in pregnancy and cover streptococcal URIs. Amoxicillin is a penicillin (avoid with penicillin allergy). Doxycycline and chloramphenicol are contraindicated in pregnancy.

Question 22

A client is prescribed prednisone for the treatment of inflammation. What is the nurse's priority assessment before administering prednisone?

Accepted Answer

Answer reason: Prednisone, a glucocorticoid, can cause hyperglycemia by increasing gluconeogenesis and insulin resistance. Checking blood glucose is the priority assessment before administration.

Question 23

A client with heart failure is prescribed digoxin. The nurse should monitor for which sign of digoxin toxicity?

Accepted Answer

Answer reason: Digoxin toxicity commonly causes bradycardia due to increased vagal tone and slowed AV conduction. Hypertension, hyperactivity, and increased appetite are not typical signs (anorexia is more common).

Question 24

A client is prescribed digoxin for heart failure. What electrolyte imbalance increases the risk of digoxin toxicity?

Accepted Answer

Answer reason: Low potassium increases digoxin binding to Na+/K+ ATPase, potentiating its effects and predisposing to toxicity and dysrhythmias.

Question 25

A client with hypertension is prescribed a diuretic. What electrolyte imbalance should the nurse monitor for with diuretic therapy?

Accepted Answer

Answer reason: Most diuretics increase renal sodium loss and water excretion, predisposing patients to hyponatremia. Hyperkalemia occurs with potassium-sparing agents; calcium effects vary by class.

Question 26

A client is prescribed spironolactone. What laboratory value should the nurse monitor closely?

Accepted Answer

Answer reason: Spironolactone is a potassium-sparing diuretic and can cause hyperkalemia; therefore, serum potassium must be monitored closely.

Question 27

A client is prescribed clozapine for the treatment of schizophrenia. What is the primary concern that the nurse should monitor for with clozapine therapy?

Accepted Answer

Answer reason: Clozapine carries a black box warning for agranulocytosis; nurses must monitor ANC/WBC closely as the primary safety concern.

Question 28

A client is prescribed isoniazid (INH) for the treatment of tuberculosis. What should the nurse instruct the client to avoid while taking INH?

Accepted Answer

Answer reason: Isoniazid is hepatotoxic; alcohol increases the risk of liver damage and should be avoided during therapy.

Question 29

A client is prescribed digoxin for heart failure. What is the primary nursing consideration during digoxin therapy?

Accepted Answer

Answer reason: Hypokalemia increases the risk of digoxin toxicity; therefore potassium must be closely monitored. The other options are not primary concerns for digoxin therapy.

Question 30

A client with heart failure is prescribed furosemide (Lasix). What electrolyte imbalance should the nurse monitor for with furosemide therapy?

Accepted Answer

Answer reason: Loop diuretics like furosemide increase urinary excretion of magnesium (and potassium), predisposing to hypomagnesemia. Among the options listed, hypomagnesemia is the most characteristic imbalance to monitor.

Question 31

A client is prescribed fluoxetine for depression. What is the primary nursing consideration during fluoxetine therapy?

Accepted Answer

Answer reason: Fluoxetine is an SSRI; a key safety priority is monitoring for serotonin syndrome (agitation, confusion, hyperreflexia, fever). Bleeding risk can occur but is less primary than identifying this life‑threatening adverse effect; increased ICP and routine liver monitoring are not typical priorities with fluoxetine.

Question 32

A client is prescribed amiodarone for atrial fibrillation. What is the primary nursing consideration during amiodarone therapy?

Accepted Answer

Answer reason: Amiodarone’s most serious toxicity is pulmonary toxicity (e.g., pneumonitis/fibrosis). Priority nursing action is baseline and periodic pulmonary function monitoring and assessment for respiratory symptoms.

Question 33

A client is prescribed digoxin for heart failure. What is the primary nursing consideration during digoxin therapy?

Accepted Answer

Answer reason: Digoxin has a narrow therapeutic index and risk of toxicity; monitoring serum digoxin levels is the primary nursing action to ensure therapeutic dosing and prevent toxicity.

Question 34

Which drug is contraindicated in head injury?

Accepted Answer

Answer reason: Opioids like morphine can depress respiration, raise CO2, increase intracranial pressure, and mask neurologic assessment, so they are contraindicated in head injury. Antibiotics, oxygen, and IV fluids are not inherently contraindicated.

Question 35

Which assessment finding indicates a serious adverse effect of the calcium channel blocker verapamil in a client treated for cardiac dysrhythmias?

Accepted Answer

Answer reason: Verapamil depresses SA/AV node conduction and can cause significant bradycardia or AV block, which is a serious adverse effect requiring intervention. Dizziness, flushing, and peripheral edema are more common but less serious effects.

Question 36

Which of the following is a common side effect of chemotherapy?

Accepted Answer

Answer reason: Chemotherapy targets rapidly dividing cells, including hair follicles, leading to alopecia (hair loss). The other options are not common chemo effects.

Question 37

Which of these medications can cause this condition?

Accepted Answer

Answer reason: Amiodarone is associated with distinctive adverse effects such as blue-gray skin discoloration, thyroid dysfunction, corneal deposits, and pulmonary toxicity; this makes it the best match for a medication causing the depicted condition.

Question 38

Which medications should clients avoid when taking lithium carbonate due to increased risk of lithium toxicity?

Accepted Answer

Answer reason: Diuretics, especially thiazides, promote sodium loss, which increases renal reabsorption of lithium and raises serum lithium levels, elevating the risk of toxicity.

Question 39

Which anti-emetic medication is considered safe for use during pregnancy?

Accepted Answer

Answer reason: Doxylamine (often combined with pyridoxine) is first-line for nausea and vomiting of pregnancy with strong safety data, making it the safest choice among the listed antiemetics.

Question 40

Which effect may be exhibited by a child with acute leukemia who is started on chemotherapy including Prednisone?

Accepted Answer

Answer reason: Prednisone, a corticosteroid used in chemotherapy regimens, commonly causes mood and behavioral changes (e.g., irritability, euphoria). It typically increases appetite and can cause weight gain, not anorexia or weight loss; alopecia is more related to other chemo agents.

Question 41

A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for?

Accepted Answer

Answer reason: Streptokinase is derived from streptococci; prior streptococcal infection can produce antistreptokinase antibodies, increasing risk of allergic reactions and reducing efficacy. Therefore assess for a history of streptococcal infections.

Question 42

While obtaining information about the client's current medication use, the nurse learns that the client takes ginkgo to improve mental alertness. The nurse should tell the client to?

Accepted Answer

Answer reason: Ginkgo biloba can inhibit platelet aggregation and increase bleeding risk; clients should report bruising or bleeding. Photosensitivity is associated with St. John’s wort, supplements aren’t FDA-approved, and increasing vitamin E would further increase bleeding risk.

Question 43

A client with Hodgkin’s lymphoma is receiving Platinol (cisplatin). To help prevent nephrotoxicity, the nurse should?

Accepted Answer

Answer reason: Cisplatin is highly nephrotoxic; aggressive hydration and diuresis help prevent renal tubular injury. Other options do not directly prevent nephrotoxicity (ringing in ears relates to ototoxicity).

Question 44

A client has been receiving Rheumatrex (methotrexate) for severe rheumatoid arthritis. The nurse should tell the client to avoid taking?

Accepted Answer

Answer reason: NSAIDs such as aspirin reduce renal clearance of methotrexate and increase toxicity and bleeding risk; clients should avoid aspirin while on methotrexate. The other options are not specific contraindications in typical RA dosing.

Question 45

A client hospitalized for treatment of congestive heart failure is to be discharged with a prescription for Digitek (digoxin) 0.25mg daily. Which of the following statements indicates that the client needs further teaching?

Accepted Answer

Answer reason: Antacids decrease digoxin absorption and should not be taken concurrently; take digoxin at the same time daily and report visual changes. High-fiber foods can also reduce absorption, so they are not used to prevent toxicity.

Question 46

A client with myasthenia gravis is admitted in a cholinergic crisis. Signs of cholinergic crisis include?

Accepted Answer

Answer reason: Cholinergic crisis (excess acetylcholine from anticholinesterase excess) causes muscarinic effects such as miosis and hypotension; tachycardia and hypertension are more consistent with myasthenic crisis.

Question 47

A client with bipolar disorder is discharged with a prescription for Depakote (divalproex sodium). The nurse should remind the client of the need for?

Accepted Answer

Answer reason: Valproate (divalproex) requires regular monitoring of liver function tests and platelets due to risks of hepatotoxicity and thrombocytopenia. Dental visits relate to phenytoin; increased fluids or sodium are counseling points for lithium, not valproate.

Question 48

The physician has ordered Coumadin (sodium warfarin) for a client with a history of clots. The nurse should tell the client to avoid which of the following vegetables?

Accepted Answer

Answer reason: Warfarin’s effect is reduced by vitamin K. Green leafy vegetables like lettuce are high in vitamin K and should be avoided or kept consistent.

Question 49

A client has recently been diagnosed with open-angle glaucoma. The nurse should tell the client to avoid taking?

Accepted Answer

Answer reason: Diphenhydramine has anticholinergic effects that can cause mydriasis and raise intraocular pressure, which is contraindicated in glaucoma. The other options (NSAID, acetaminophen, expectorant) do not increase IOP.

Question 50

A client tells the nurse that she takes St. John's wort (hypericum perforatum) three times a day for mild depression. The nurse should tell the client that?

Accepted Answer

Answer reason:St. John’s wort has serotonergic activity and enzyme-inducing effects. When combined with other antidepressants (especially SSRIs, SNRIs, or MAOIs), it can increase the risk of serotonin syndrome and reduce medication effectiveness. Therefore, clients should be instructed not to take St. John’s wort concurrently with other antidepressants.

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A client is prescribed hydrocodone/acetaminophen for pain. What is the primary nursing consideration during hydrocodone/acetaminophen therapy?

A client is prescribed lorazepam for anxiety. What is the primary nursing consideration when administering lorazepam?

A 20-year-old female has a prescription for tetracycline. While teaching the client how to take her medicine, the nurse learns that the client is also taking Ortho-Novum oral contraceptive pills. Which instructions should be included in the teaching plan?

What is the early sign of aspirin toxicity?

What is the most common neurological complication associated with the swine flu influenza vaccine?

A multiparous client using medroxyprogesterone (Depo-Provera) for contraception should be instructed to increase her intake of which nutrient?

Which of the following is a potential adverse effect associated with long-term use of PPIs?

Which medication does the nurse understand to be Category X in pregnancy for a 24-year-old client in the fertility clinic?

A patient taking escitalopram (Lexapro) asks about potential drug interactions; which substance should the nurse caution the patient to avoid?

A client is prescribed risperidone for schizophrenia. What is the primary nursing consideration during risperidone therapy?

The nurse caring for a 9 year-old child with a fractured femur is told that a medication error occurred. The child received twice the ordered dose of morphine an hour ago. Which of the following nursing diagnoses is a PRIORITY at this time?

You are caring for a depressed client with a new prescription for an SSRI antidepressant. In reviewing the admission history and physical, which of the following should lead you to question the safety of this medication?

You are caring for a hypertensive client with a new order for captopril (Capoten). Which information should the nurse include in patient teaching?

A 60-year-old diabetic is taking glyburide (Diabeta) 1.25mg daily to treat Type II diabetes mellitus. Which statement indicates the need for further teaching?

A client with benign prostatic hypertrophy has been started on Proscar (finasteride). The nurse's discharge teaching should include?

A client treated for depression has developed signs of serotonin syndrome. The nurse recognizes that serotonin syndrome is caused by?

Hydralazine (a vasodilator) can produce?

The physician prescribes estrogen (Premarin) 0.625 mg daily for a 43-year-old woman. The nurse knows which of the following symptoms is a common initial side effect of this medication?

Anxiolytic dosage reduction is recommended?

Which assessment findings indicate pancytopenia in a client taking felbamate (Felbatol) for seizures?

A pregnant woman with upper RTI due to streptococcus bacteria has history of penicillin allergy. The suitable drug is?

A client is prescribed prednisone for the treatment of inflammation. What is the nurse's priority assessment before administering prednisone?

A client with heart failure is prescribed digoxin. The nurse should monitor for which sign of digoxin toxicity?

A client is prescribed digoxin for heart failure. What electrolyte imbalance increases the risk of digoxin toxicity?

A client with hypertension is prescribed a diuretic. What electrolyte imbalance should the nurse monitor for with diuretic therapy?

A client is prescribed spironolactone. What laboratory value should the nurse monitor closely?

A client is prescribed clozapine for the treatment of schizophrenia. What is the primary concern that the nurse should monitor for with clozapine therapy?

A client is prescribed isoniazid (INH) for the treatment of tuberculosis. What should the nurse instruct the client to avoid while taking INH?

A client is prescribed digoxin for heart failure. What is the primary nursing consideration during digoxin therapy?

A client with heart failure is prescribed furosemide (Lasix). What electrolyte imbalance should the nurse monitor for with furosemide therapy?

A client is prescribed fluoxetine for depression. What is the primary nursing consideration during fluoxetine therapy?

A client is prescribed amiodarone for atrial fibrillation. What is the primary nursing consideration during amiodarone therapy?

A client is prescribed digoxin for heart failure. What is the primary nursing consideration during digoxin therapy?

Which drug is contraindicated in head injury?

Which assessment finding indicates a serious adverse effect of the calcium channel blocker verapamil in a client treated for cardiac dysrhythmias?

Which of the following is a common side effect of chemotherapy?

Which of these medications can cause this condition?

Which medications should clients avoid when taking lithium carbonate due to increased risk of lithium toxicity?

Which anti-emetic medication is considered safe for use during pregnancy?

Which effect may be exhibited by a child with acute leukemia who is started on chemotherapy including Prednisone?

A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for?

While obtaining information about the client's current medication use, the nurse learns that the client takes ginkgo to improve mental alertness. The nurse should tell the client to?

A client with Hodgkin’s lymphoma is receiving Platinol (cisplatin). To help prevent nephrotoxicity, the nurse should?

A client has been receiving Rheumatrex (methotrexate) for severe rheumatoid arthritis. The nurse should tell the client to avoid taking?

A client hospitalized for treatment of congestive heart failure is to be discharged with a prescription for Digitek (digoxin) 0.25mg daily. Which of the following statements indicates that the client needs further teaching?

A client with myasthenia gravis is admitted in a cholinergic crisis. Signs of cholinergic crisis include?

A client with bipolar disorder is discharged with a prescription for Depakote (divalproex sodium). The nurse should remind the client of the need for?

The physician has ordered Coumadin (sodium warfarin) for a client with a history of clots. The nurse should tell the client to avoid which of the following vegetables?

A client has recently been diagnosed with open-angle glaucoma. The nurse should tell the client to avoid taking?

A client tells the nurse that she takes St. John's wort (hypericum perforatum) three times a day for mild depression. The nurse should tell the client that?

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