Question 1

A client receiving chemotherapy has developed sores in his mouth. He asks the nurse why this happened. The nurse's BEST response would be?

Accepted Answer

Answer reason: Chemotherapy damages rapidly dividing cells; oral mucosal epithelial cells have high turnover, making them particularly sensitive and causing mouth sores (mucositis).

Question 2

The nurse is caring for a 75 year old client in congestive heart failure. Which of the following symptoms suggest that digitalis levels should be reviewed?

Accepted Answer

Answer reason: Fatigue and weakness are early signs of digoxin (digitalis) toxicity; increased appetite, itching, and constipation are not typical indicators.

Question 3

The nurse notes an abrupt onset of confusion in an elderly patient. Which of the following recently-ordered medications would most likely contribute to this change?

Accepted Answer

Answer reason: Antihistamines have strong anticholinergic effects that commonly precipitate acute confusion and delirium in older adults. Anticoagulants and antacids are unlikely causes, and cardiac glycosides more typically cause visual changes and arrhythmias when toxic.

Question 4

A client is receiving a nitroglycerin infusion for unstable angina. What assessment would be PRIORITY for monitoring the effects of this medication?

Accepted Answer

Answer reason: Nitroglycerin causes systemic vasodilation, which can precipitate hypotension; therefore the priority assessment during infusion is frequent blood pressure monitoring.

Question 5

A client with tuberculosis is started on Rifampin. Which one of the following statements by the nurse would be appropriate to include in teaching? You may notice?

Accepted Answer

Answer reason: Rifampin commonly causes harmless red-orange discoloration of urine and other body fluids; patients should be taught to expect this effect.

Question 6

A client taking isoniazide (INH) for tuberculosis asks the nurse about side effects of the medication. The nurse should emphasize immediate report of?

Accepted Answer

Answer reason: INH commonly causes peripheral neuropathy due to pyridoxine deficiency, presenting as tingling and numbness in the extremities and requiring prompt reporting. Visual halos suggest digoxin toxicity; photosensitivity is more typical of other antibiotics; confusion/lightheadedness are not the primary INH concern.

Question 7

You are teaching a client with atrial fibrillation about the use of Coumadin (warfarin) at home. You should emphasize that the client should avoid?

Accepted Answer

Answer reason: Vitamin K antagonizes warfarin and reduces its anticoagulant effect; clients should avoid or keep consistent intake of high–vitamin K foods.

Question 8

A client is to receive 3 doses of potassium chloride 10 mEq in 100cc normal saline to infuse over 30 minutes each. Which of the following is a priority assessment prior to giving this medication?

Accepted Answer

Answer reason: Before administering potassium, verify adequate renal function via urine output to avoid hyperkalemia from impaired excretion. Oral intake, bowel sounds, and grip strength are not priority pre-assessments for IV potassium.

Question 9

A client on warfarin therapy following coronary artery stent placement calls the clinic to ask if he can take Alka-Seltzer for an upset stomach. The nurse should tell this client?

Accepted Answer

Answer reason: Alka-Seltzer contains aspirin, an antiplatelet that potentiates warfarin’s anticoagulant effect and increases bleeding risk; therefore it should be avoided.

Question 10

The nurse administers cimetidine (Tagamet) to a 79 year-old male with a gastric ulcer. Which one of the following may be affected by this drug, and should be closely monitored by the nurse?

Accepted Answer

Answer reason: Cimetidine, an H2 blocker, can cause CNS effects such as confusion, especially in the elderly; therefore monitor mental status closely.

Question 11

A client is receiving digoxin (Lanoxin) 0.25 mg daily. The physician has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the physician?

Accepted Answer

Answer reason: Both digoxin and metoprolol slow the heart, and metoprolol also lowers blood pressure. A systolic BP of 94 indicates hypotension; the dose should be held and the provider notified. The other findings are within normal limits.

Question 12

A client has been taking furosemide (Lasix) for the past week. The nurse recognizes which of the following symptoms may indicate the client is experiencing a negative side effect from the medication?

Accepted Answer

Answer reason: Furosemide can cause hypokalemia; symptoms include anorexia/decreased appetite, fatigue, and weakness. Weight gain and ankle edema reflect fluid retention, not an adverse effect of a diuretic.

Question 13

A client is admitted to the hospital because of heart failure and digoxin toxicity. At home, the client was taking digoxin (Lanoxin) and furosemide (Lasix). Which of the following symptoms would the nurse anticipate finding on the initial assessment?

Accepted Answer

Answer reason: Digoxin used with furosemide predisposes to hypokalemia, which commonly presents with muscle weakness and cramping and increases risk for digoxin toxicity. Confusion, hematuria, and tinnitus are less expected initial findings.

Question 14

A client is receiving digitalis. The nurse should instruct the client to report which of the following side effects?

Accepted Answer

Answer reason: Digoxin (digitalis) toxicity commonly presents with GI symptoms and fatigue; patients should report nausea, vomiting, and fatigue. Other options reflect allergic reaction, hyperglycemia, or hypoglycemia rather than expected adverse effects of digitalis.

Question 15

The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq KCL in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued?

Accepted Answer

Answer reason: Tall peaked T waves are the classic EKG sign of hyperkalemia, an adverse effect of potassium infusion, warranting stopping the KCl and notifying the provider. U waves indicate hypokalemia; narrowed QRS and shortened PR are not typical for hyperkalemia.

Question 16

A client is receiving erythromycin 500mg IV every 6 hours to treat a pneumonia. Which of the following is the MOST common side effect of the medication?

Accepted Answer

Answer reason: Erythromycin commonly causes gastrointestinal upset, especially nausea and vomiting; the other options are not typical adverse effects.

Question 17

When inquiring about allergies during a health history, the nurse should do all of the following except?

Accepted Answer

Answer reason: Nurses should differentiate true allergies from nonallergic adverse effects or intolerances. Asking about other allergens, reaction severity, and possible cross-reactivity are appropriate actions; labeling any untoward reaction as an allergy is incorrect.

Question 18

The physician prescribes lithium carbonate (Lithobid) 300 mg PO QID for a 47-year-old woman. The nurse in the outpatient clinic teaches the client about the medication. The nurse should encourage the client to make sure her diet has adequate?

Accepted Answer

Answer reason: Lithium and sodium compete for renal reabsorption; low sodium intake increases lithium reabsorption and risk of toxicity. Teach the client to maintain adequate, consistent sodium intake.

Question 19

A 69-year-old man is receiving dexamethasone (Decadron) 3 mg PO TID for chronic lymphocytic leukemia. It is MOST important for the nurse to report which of the following findings to the physician?

Accepted Answer

Answer reason: Dexamethasone can cause potassium loss; K+ of 3.4 mEq/L is low and poses risk for dysrhythmias, requiring prompt reporting. The other listed labs are within normal limits.

Question 20

Which finding indicates that the client prescribed sotalol is experiencing an adverse effect of the medication?

Accepted Answer

Answer reason: Sotalol (a nonselective beta-blocker with class III antiarrhythmic effects) can cause proarrhythmia, including QT prolongation and torsades. New or worsening arrhythmias present as palpitations, making this the key adverse effect finding.

Question 21

When taking oral anticoagulants, which vitamin should be avoided to take concurrently?

Accepted Answer

Answer reason: Vitamin K antagonizes the effect of warfarin and other vitamin K–dependent oral anticoagulants, reducing their anticoagulation. Patients should avoid vitamin K supplements or large intake changes.

Question 22

The doctor has ordered chlorpromazine (Thorazine) to control an alcoholic client's restlessness, agitation, and irritability following surgery. The nurse should check the order with the doctor based on which of the following rationales?

Accepted Answer

Answer reason: Chlorpromazine (a phenothiazine antipsychotic) is not first-line for alcohol withdrawal and can lower the seizure threshold. Alcohol withdrawal is best managed with benzodiazepines, so the nurse should question the order.

Question 23

When teaching a client about the use of sublingual nitroglycerin, the nurse should emphasize that the MOST common side effect is?

Accepted Answer

Answer reason: Nitroglycerin causes systemic vasodilation, commonly producing headache; this is the most frequent adverse effect to teach patients about.

Question 24

You are caring for a client with Parkinson's disease who has developed hallucinations. Which of the following medications that the client is receiving may have been a contributing factor?

Accepted Answer

Answer reason: Levodopa can precipitate psychosis and hallucinations in Parkinson's patients, especially at higher doses; this is a known adverse effect and most likely contributor among the options.

Question 25

The nurse is teaching a client about precautions with Coumadin. The nurse should instruct the client to avoid foods with excessive amounts of?

Accepted Answer

Answer reason: Vitamin K counteracts warfarin’s anticoagulant effect; high intake lowers INR and reduces effectiveness, so patients should avoid excessive vitamin K foods.

Question 26

A 42 year-old male client refuses to take propranolol hydrochloride (Inderal) as prescribed. Which of the following client statements from the assessment data is likely to explain his noncompliance?

Accepted Answer

Answer reason: Propranolol, a nonselective beta-blocker, commonly causes sexual dysfunction (decreased libido/impotence), a frequent reason for nonadherence. Diarrhea is not typical, insomnia is less characteristic, and jitteriness would be alleviated rather than caused by beta-blockade.

Question 27

The nurse is administering an intravenous piggyback infusion of penicillin. Which of the following client statements would require the nurse's IMMEDIATE attention?

Accepted Answer

Answer reason: Generalized itching during IV penicillin suggests an acute allergic reaction/anaphylaxis risk, requiring immediate cessation of the infusion. The other statements are not urgent or life-threatening.

Question 28

A client is receiving dexamethasone (Decadron) therapy. The nurse plans to monitor the client's?

Accepted Answer

Answer reason: Dexamethasone is a glucocorticoid that increases gluconeogenesis and can cause hyperglycemia; therefore blood glucose should be monitored regularly, e.g., every 12 hours.

Question 29

The nurse is caring for a 2 year-old who is being treated with chelation therapy, calcium disodium edetate, for lead poisoning. The nurse should be alert for which of the following side effects?

Accepted Answer

Answer reason: Calcium disodium edetate (EDTA) chelation can cause renal tubular injury; monitoring for nephrotoxicity is essential in children treated for lead poisoning.

Question 30

Clients taking which of the following drugs are at risk for depression?

Accepted Answer

Answer reason: Corticosteroids are known to cause mood changes, including depressive symptoms. Diuretics, folic acid, and aspirin are not typical causes of depression.

Question 31

A client has been receiving lithium (Lithane) for the past two weeks for the treatment of bipolar illness. When planning client teaching, the nurse understands that it is important to emphasize that the client must?

Accepted Answer

Answer reason: Lithium has a narrow therapeutic index, so regular monitoring of serum levels (about every 1–3 months in a stable client and more often when doses or clinical status change) is essential to prevent toxicity. The client should also maintain consistent sodium and fluid intake and contact the provider if vomiting, diarrhea, or heavy sweating occur, because these can precipitate toxicity.

Question 32

The use of atropine for treatment of symptomatic bradycardia is contraindicated for a client with which of the following conditions?

Accepted Answer

Answer reason: Atropine is an anticholinergic that can increase intraocular pressure and precipitate acute angle-closure glaucoma, making glaucoma a contraindication. The other listed conditions are not specific contraindications.

Question 33

To which of the following nursing home residents could the nurse safely administer tricyclic antidepressants without questioning the physician's order, a client with?

Accepted Answer

Answer reason: Tricyclic antidepressants have strong anticholinergic effects and can worsen narrow-angle glaucoma and BPH; they also pose cardiac conduction risks for CAD. Mild hypertension is not a contraindication, so it is the safest option.

Question 34

A client is receiving nitroprusside IV for the treatment of acute heart failure with pulmonary edema. What diagnostic lab value should the nurse monitor in relation to this medication?

Accepted Answer

Answer reason: Nitroprusside metabolism can produce cyanide and thiocyanate; with prolonged/high-dose infusion thiocyanate accumulates and causes toxicity. Therefore thiocyanate levels should be monitored. Potassium, ABGs, and BUN are not specific for nitroprusside toxicity.

Question 35

The nurse is caring for a pregnant woman with pregnancy induced hypertension receiving magnesium sulfate intravenously. In assessing the client, it is noted that respirations are 12, pulse and blood pressure have dropped significantly, and 8 hour output is 200 ml. What should the nurse do FIRST?

Accepted Answer

Answer reason: Findings suggest magnesium sulfate toxicity: hypotension, bradycardia, respiratory rate at 12, and oliguria (200 mL/8 h = 25 mL/h). The priority first action is to stop the infusion to prevent further toxicity, then notify the provider and prepare antidote if needed.

Question 36

The nurse instructs the client taking dexamethasone (Decadron) to take it with food or milk because this medication?

Accepted Answer

Answer reason: Glucocorticoids like dexamethasone increase gastric acid secretion, raising risk of GI irritation and ulcers; taking with food or milk helps protect the stomach.

Question 37

A client receiving chlorpromazine HCL (Thorazine) is in psychiatric home care. During a home visit the nurse observes the client smacking her lips alternately with grinding her teeth. The nurse assesses this as?

Accepted Answer

Answer reason: Lip-smacking and teeth-grinding are orofacial choreoathetoid movements typical of tardive dyskinesia from chronic antipsychotic use, not acute dystonia, akathisia (restlessness), or bradykinesia.

Question 38

While teaching the family of a child who will take phenytoin (Dilantin) regularly for seizure control, it is MOST important for the nurse to teach them to?

Accepted Answer

Answer reason: Phenytoin commonly causes gingival hyperplasia; emphasize meticulous oral hygiene and regular dental care. The other options are incorrect or unrelated to phenytoin therapy.

Question 39

An 80 year-old client on digitalis (Lanoxin) reports nausea, vomiting, abdominal cramps and halo vision. Which of the following laboratory results should the nurse analyze FIRST?

Accepted Answer

Answer reason: Digoxin toxicity presents with GI symptoms and visual halos and is precipitated by hypokalemia. Therefore, assessing potassium level is the priority.

Question 40

A 14 month-old child ingested half a bottle of aspirin tablets. Which of the following would the nurse expect to see in the child?

Accepted Answer

Answer reason: Aspirin overdose impairs platelet function and prolongs bleeding time, so bleeding manifestations such as epistaxis are expected. Hypothermia, edema, and dyspnea are not characteristic primary findings.

Question 41

A client being treated for hypertension returns to the clinic for follow up. He says, "I know these pills are important, but I just can't take these water pills anymore. I drive a truck for a living, and I can't be stopping every 20 minutes to go to the bathroom." The MOST appropriate nursing diagnosis would be?

Accepted Answer

Answer reason: He values the medication but cannot adhere due to the diuretic's bothersome side effect (urinary frequency), indicating noncompliance related to medication side effects rather than lack of knowledge, coping issues, or occupation itself.

Question 42

Which of the following drugs are contraindicated in children below 18 years?

Accepted Answer

Answer reason: Fluoroquinolones such as ciprofloxacin are generally avoided in patients under 18 years because of risk of cartilage and tendon toxicity; therefore ciprofloxacin is contraindicated in children.

Question 43

Which medication is considered safe for treating nausea and vomiting during pregnancy?

Accepted Answer

Answer reason: Metoclopramide (a dopamine antagonist) has extensive safety data in pregnancy and is recommended as a second-line agent for nausea and vomiting of pregnancy after pyridoxine/doxylamine. Codeine is an opioid and not indicated for nausea, with maternal and fetal risks. Ibuprofen is contraindicated especially later in pregnancy due to risks such as premature ductus arteriosus closure. Ondansetron may be used when others fail but has mixed safety data in early pregnancy; metoclopramide is generally preferred.

Question 44

Aspirin is contraindicated in?

Accepted Answer

Answer reason: Aspirin inhibits COX-1, reducing gastric mucosal protection and platelet aggregation, which increases the risk of gastrointestinal irritation and bleeding. Therefore it is contraindicated in patients with active peptic ulcer disease. Diabetes and hypertension are not absolute contraindications; aspirin may be used with caution based on cardiovascular risk. Cancer is not a contraindication.

Question 45

A regimen of captopril and triamterene in a hypertensive patient will cause?

Accepted Answer

Answer reason: Captopril, an ACE inhibitor, lowers aldosterone levels, decreasing sodium reabsorption and potassium excretion, which raises serum potassium. Triamterene is a potassium-sparing diuretic that blocks epithelial sodium channels in the collecting duct, further reducing potassium excretion. The combination significantly increases the risk of hyperkalemia. Hypernatremia or hypercalcemia are not expected effects, and thrombocytopenia is not a characteristic interaction of these drugs.

Question 46

Ringer lactant is contraindicated in?

Accepted Answer

Answer reason: Lactated Ringer’s contains sodium lactate, which is metabolized by the liver to bicarbonate. In lactic acidosis, serum lactate is already elevated and hepatic clearance may be impaired, so administering additional lactate can worsen hyperlactatemia and acid–base disturbance. RL is appropriate for volume resuscitation in hypovolemia from burns or diarrhea, but is avoided in lactic acidosis or severe liver dysfunction.

Question 47

Generally, what is the maximum treatment period for patients taking Z-drugs?

Accepted Answer

Answer reason: Nonbenzodiazepine hypnotics (Z-drugs such as zolpidem, zopiclone, zaleplon) are recommended only for short-term treatment of insomnia due to risks of tolerance, dependence, rebound insomnia, and complex sleep behaviors. Most guidelines limit therapy to 2–4 weeks, including the period to taper. Exceeding about 1 month increases adverse effects without improving long‑term sleep outcomes. Therefore, the general maximum treatment period is 1 month.

Question 48

Which of the following can cause electrolyte imbalance?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that blocks the Na-K-2Cl cotransporter in the thick ascending limb, promoting large diuresis with renal loss of sodium, potassium, chloride, magnesium, and calcium. This commonly leads to hypokalemia and hyponatremia, causing muscle weakness or arrhythmias. Vitamin C and cetirizine do not typically disturb electrolytes. While NSAIDs like ibuprofen can rarely contribute to hyperkalemia in renal impairment, electrolyte imbalance is a classic and expected adverse effect of furosemide.

Question 49

Timolol eyedrops should be used with caution if the patient has history of?

Accepted Answer

Answer reason: Timolol is a nonselective beta-blocker; even as eye drops it can be systemically absorbed and block beta-2 receptors in bronchial smooth muscle, causing bronchoconstriction. Therefore it is contraindicated or used with caution in patients with COPD, including emphysema and asthma. Glaucoma is the indication for timolol, and pericarditis or pancreatitis are not typical concerns with this medication.

Question 50

What important information should the nurse provide to a client with anxiety disorders who has been prescribed diazepam?

Accepted Answer

Answer reason: Diazepam is a benzodiazepine that causes CNS depression; drowsiness and sedation are common and clinically important for safety counseling (e.g., avoid driving and alcohol). Grapefruit juice can increase levels, but the priority teaching is recognition of sedation risk. It does not require administration with a full glass of water, and it does not need to be taken on an empty stomach—taking with food may lessen GI upset.

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