Question 1

Which lab value is most important to assess before giving chemotherapy?

Accepted Answer

Answer reason: Many chemotherapy agents cause myelosuppression, with neutropenia being a major dose-limiting toxicity that increases the risk of life-threatening infection. Therefore, assessing the white blood cell count (and especially the ANC) is critical before administering chemotherapy to determine if it is safe to proceed or if treatment should be held/dose-adjusted. Platelet count and hemoglobin are also monitored because thrombocytopenia and anemia can occur, but infection risk from leukopenia is typically the most immediate safety concern. Blood sugar is not a routine primary pre-chemo safety parameter unless specific comorbidities or drugs (e.g., steroids) make it relevant.
Category reason: This item tests nursing medication safety judgment before administering an antineoplastic therapy, focusing on identifying a key lab contraindication related to chemotherapy adverse effects (myelosuppression), which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 2

The physician has ordered Theo-Our (theophylline) for a client with emphysema. An expected SE associated with the med is?

Accepted Answer

Answer reason: Theophylline is a methylxanthine bronchodilator with stimulant effects on the heart and CNS. Common adverse effects include tachycardia, palpitations, tremor, restlessness, and insomnia, especially as serum levels rise. Dry mouth and anemia are not expected effects, and hyperglycemia is not a typical primary adverse effect of theophylline compared with beta-agonists or corticosteroids.
Category reason: This item tests recognition of an adverse effect of a prescribed medication (theophylline), which is a medication-safety/side-effect knowledge focus within Pharmacological and Parenteral Therapies.

Question 3

Extravasation during IV chemotherapy administration can cause?

Accepted Answer

Answer reason: Extravasation is leakage of IV chemotherapy (especially vesicants) into surrounding tissue, which can cause severe local injury. Vesicant drugs can directly damage cells, leading to blistering, ulceration, and tissue necrosis. The other options (hypertension, muscle cramps, diarrhea) are not characteristic local consequences of extravasation at the infusion site.
Category reason: This item tests recognition of a serious complication of IV medication/chemotherapy administration (extravasation) and its adverse local effect, which aligns with adverse effects and contraindications in pharmacologic/parenteral therapy nursing care.

Question 4

The nurse is caring for a client receiving warfarin and a continuous infusion of heparin. Based on the client's laboratory data, the nurse should take which action? International Normalized Ratio (INR): 2.7 Activated Partial Thromboplastin Time (aPTT): 110 seconds?

Accepted Answer

Answer reason: The INR of 2.7 is within the typical therapeutic range for warfarin for many indications (commonly 2.0–3.0), so warfarin does not need to be held and vitamin K is not indicated. The aPTT of 110 seconds is markedly prolonged above the usual therapeutic range for a heparin infusion, indicating excessive anticoagulation and increased bleeding risk. The safest immediate nursing action is to stop the heparin infusion and notify the provider per protocol for dose adjustment and possible reversal if bleeding is present.
Category reason: This item tests nursing action based on anticoagulant therapy monitoring (interpreting INR/aPTT and adjusting/holding an infusion for safety), which is medication-management and adverse-effect prevention in patient care.

Question 5

The nurse administers furosemide. Which lab should be checked?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that increases urinary excretion of potassium, putting the patient at high risk for hypokalemia. Hypokalemia can cause muscle weakness and dangerous cardiac dysrhythmias, so potassium is a key lab to monitor. While sodium, calcium, and creatinine may also change, potassium monitoring is most directly tied to furosemide’s common, clinically significant adverse effect.
Category reason: This item tests nursing monitoring for a medication’s expected adverse effect (electrolyte loss) after administering furosemide, which is a pharmacologic safety/monitoring judgment rather than foundational physiology alone.

Question 6

Which nursing intervention is essential before administering a dose of lisinopril?

Accepted Answer

Answer reason: Lisinopril is an ACE inhibitor that can increase serum potassium by decreasing aldosterone-mediated potassium excretion, creating a risk for hyperkalemia. Assessing potassium (and typically renal function) before administration helps prevent dangerous dysrhythmias and other complications. Apical pulse checks are more essential for medications like digoxin or beta-blockers, not ACE inhibitors. Respiratory rate and blood glucose monitoring are not primary pre-administration safety checks for lisinopril.
Category reason: The item asks for a nursing safety action prior to giving a medication and focuses on preventing a key adverse effect/contraindication of lisinopril (hyperkalemia), which fits medication administration safety under Pharmacological and Parenteral Therapies.

Question 7

A patient on furosemide (Lasix) should be monitored for?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that increases excretion of sodium and water and also causes significant potassium loss in the urine. This places the patient at risk for hypokalemia, which can lead to muscle weakness and potentially dangerous cardiac dysrhythmias. While hyponatremia can occur with diuretics, the classic and most emphasized electrolyte adverse effect of loop diuretics is hypokalemia. Hyperkalemia is more associated with potassium-sparing diuretics, not furosemide.
Category reason: The item tests nursing monitoring for a medication’s common adverse effect (electrolyte loss) during therapy, which is a pharmacologic safety concern under adverse effects/contraindications.

Question 8

A client is prescribed furosemide (Lasix) for heart failure. Which finding is most concerning to the nurse?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that can cause significant potassium loss, making hypokalemia a priority safety concern. A potassium of 3.0 mmol/L increases the risk of dangerous dysrhythmias (and potentiates digoxin toxicity if the client is taking it), requiring prompt intervention and/or provider notification. The other findings are expected or less urgent with effective diuresis in heart failure (increased urine output and some overnight weight loss) and a BP of 100/70 may be acceptable if perfusion is adequate.
Category reason: The question tests nursing judgment about a medication’s adverse effect and which assessment/lab finding requires the most urgent concern while administering a prescribed drug, fitting Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications.

Question 9

The client on warfarin has INR 5.2. What is the priority action?

Accepted Answer

Answer reason: An INR of 5.2 indicates supratherapeutic anticoagulation from warfarin and a significantly increased risk of bleeding. The priority is to reverse/mitigate warfarin’s effect; vitamin K is the antidote that restores clotting factor activation. Continuing the dose would worsen bleeding risk, stopping heparin is irrelevant unless the client is also receiving it and does not address the warfarin effect, and encouraging fluids does not correct coagulopathy. Clinically, warfarin is typically held and vitamin K administered per severity and bleeding status; among the listed options, vitamin K is the best priority action.
Category reason: This item tests nursing management of a medication-related adverse effect (excess anticoagulation) and the appropriate reversal agent, which fits Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications.

Question 10

Tracy is receiving combination chemotherapy for treatment of metastatic carcinoma. Nurse Ruby should monitor the client for the systemic side effect of?

Accepted Answer

Answer reason: Combination chemotherapy commonly causes bone marrow suppression, leading to decreased white blood cell counts (leukopenia/neutropenia), which increases infection risk. Monitoring CBC with differential and assessing for fever or other infection signs are key nursing priorities during chemotherapy. Ascites is more related to advanced malignancy or liver disease, nystagmus is not a typical systemic chemotherapy effect, and polycythemia is the opposite of the expected marrow effect.
Category reason: The question asks what adverse systemic effect a nurse should monitor for during chemotherapy, which is a medication-related safety/monitoring judgment under pharmacological therapies.

Question 11

Which opioid side effect is most concerning and requires immediate intervention?

Accepted Answer

Answer reason: Respiratory depression is the most dangerous opioid adverse effect because it can rapidly progress to hypoxia, apnea, and death. It requires immediate assessment of airway and breathing, holding further opioid doses, and prompt interventions such as stimulation, supplemental oxygen, and naloxone as indicated. Constipation, nausea, and urinary retention are common opioid effects but are typically non-emergent and managed with supportive measures.
Category reason: The item tests nursing recognition of a life-threatening medication adverse effect and the need for immediate intervention, which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 12

A client with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement?

Accepted Answer

Answer reason: IV glucocorticoids such as methylprednisolone can cause hyperglycemia by increasing gluconeogenesis and inducing insulin resistance, so blood glucose monitoring is a key nursing intervention. While monitoring electrolytes, I&O, and daily weights can be appropriate with vomiting and adrenal insufficiency, the intervention most directly tied to the medication’s common adverse effect is checking glucose as ordered. Early detection of steroid-induced hyperglycemia helps prevent complications and guides need for insulin or adjustment in therapy.
Category reason: The stem asks which nursing intervention to implement while administering IV glucocorticoids, emphasizing monitoring for medication-related adverse effects, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 13

A man is prescribed lithium to treat bipolar disorder. The nurse is most concerned about lithium toxicity when he notices which of these assessment findings?

Accepted Answer

Answer reason: Diarrhea can be an early sign of lithium toxicity and may also indicate fluid/electrolyte loss leading to dehydration, which decreases renal clearance of lithium and raises serum levels. Lithium has a narrow therapeutic index, so symptoms such as persistent GI upset warrant immediate assessment and possible holding of the dose while notifying the provider. A manic episode or severe depression reflects mood state rather than toxicity, and a rash/pruritus is not a classic hallmark of lithium toxicity. The listed lithium level of 1.3 mcg/L appears inconsistent with standard reporting (typically mEq/L) and is not clearly toxic as written, making the symptomatic finding (daily diarrhea) the most concerning.
Category reason: This item tests nursing recognition of a medication adverse effect/toxicity and the associated safety concern, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 14

Which symptom should the nurse report immediately in a client taking lithium?

Accepted Answer

Answer reason: Diarrhea and vomiting can indicate lithium toxicity and also cause dehydration and sodium loss, which further increases lithium reabsorption in the kidneys and worsens toxicity. These GI symptoms are an early warning sign that requires immediate reporting and prompt evaluation of lithium level and hydration status. Mild thirst, increased urination, and fine hand tremor are common, expected side effects at therapeutic doses and are typically monitored rather than immediately escalated unless severe or worsening.
Category reason: The question tests nursing recognition of an urgent adverse effect of a medication (lithium) and the appropriate immediate reporting action, which aligns with pharmacologic adverse effects and contraindications in patient care.

Question 15

Which lab value places a client on digoxin at highest risk for toxicity?

Accepted Answer

Answer reason: Hypokalemia (K+ 2.8 mEq/L) increases digoxin’s effects because digoxin and potassium compete for binding at the Na+/K+-ATPase pump; low potassium enhances digoxin binding and predisposes to toxicity. This raises the risk of serious dysrhythmias and other toxicity manifestations. The other values listed do not increase digoxin toxicity risk as strongly: magnesium is normal, creatinine is normal (no impaired clearance), and mild hyponatremia is not a primary driver of digoxin toxicity risk.
Category reason: This question tests recognition of a medication-related risk factor (electrolyte abnormality increasing digoxin toxicity) to guide safe medication management, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications.

Question 16

The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication?

Accepted Answer

Answer reason: Clients with BPH are at risk for acute urinary retention from medications that increase urinary sphincter tone. Many OTC cold decongestants (e.g., pseudoephedrine, phenylephrine) are alpha-adrenergic agonists that can constrict the bladder neck/prostatic urethra and precipitate inability to void. Therefore, the nurse should specifically ask about decongestant use when a client with BPH presents with urinary retention. The other options are not as directly associated with triggering acute urinary retention in BPH.
Category reason: This question tests nursing recognition of a medication contraindication/adverse effect (OTC decongestants worsening urinary retention in BPH) and appropriate assessment in a client-care scenario, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 17

A client with severe preeclampsia is receiving magnesium sulfate. Which assessment requires immediate action?

Accepted Answer

Answer reason: Absent deep tendon reflexes and a respiratory rate of 10/min are classic signs of magnesium sulfate toxicity with respiratory depression, which can rapidly progress to respiratory arrest. This requires immediate nursing action: stop the magnesium infusion, maintain airway/oxygenation, and prepare to administer calcium gluconate per protocol while notifying the provider. The other findings are expected/less urgent in severe preeclampsia: mild proteinuria and BP 150/92 do not indicate acute magnesium toxicity, and urine output 40 mL/hr is still above the typical minimum threshold of 30 mL/hr for safe magnesium clearance.
Category reason: This item tests nursing monitoring and rapid intervention for an adverse effect of an IV medication (magnesium sulfate) in a pregnant client, which fits Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications.

Question 18

A client with metastatic endometrial carcinoma is prescribed megestrol acetate, an antineoplastic medication. Which is a contraindication that would require the nurse to contact the client's healthcare provider?

Accepted Answer

Answer reason: Megestrol acetate is a progestin with a known risk of thromboembolic events (e.g., DVT/PE). A current or history of venous thromboembolism is therefore a key contraindication/major precaution and should prompt contacting the provider before administration. The other listed conditions are not the classic contraindication most directly tied to megestrol’s highest safety risk (thrombosis).
Category reason: The question asks the nurse to identify a medication contraindication and take appropriate action (contact the provider), which is a patient-safety medication-management judgment under Pharmacological and Parenteral Therapies.

Question 19

A nurse is assessing a patient receiving digoxin for heart failure. Which finding requires immediate intervention?

Accepted Answer

Answer reason: Hypokalemia (K+ 3.0 mEq/L) increases myocardial sensitivity to digoxin and substantially raises the risk of digoxin toxicity and life-threatening dysrhythmias, so it requires immediate intervention. The priority action is to address the low potassium and evaluate for toxicity (e.g., ECG changes, digoxin level as ordered). A heart rate of 60 bpm is at the low end of normal and would be monitored, but it is less immediately dangerous than hypokalemia in a digoxin-treated patient. Nausea/fatigue can be early, nonspecific adverse effects, and a BP of 110/70 mmHg is stable.
Category reason: This is a patient-care safety question about recognizing a medication-related contraindication/adverse risk (hypokalemia increasing digoxin toxicity) and requiring prompt nursing intervention, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 20

A client recently diagnosed with diabetes mellitus has been prescribed metformin. Which of the following side effects does the nurse include in health teaching?

Accepted Answer

Answer reason: Metformin commonly causes gastrointestinal adverse effects, especially diarrhea, nausea, abdominal discomfort, and a metallic taste; these are key points for patient teaching. Unlike insulin or sulfonylureas, metformin by itself typically does not cause hypoglycemia, so “low blood sugar levels” and associated diaphoresis are not expected primary side effects. Facial edema is not a typical metformin adverse effect and would raise concern for an allergic reaction or another cause. Therefore, diarrhea and nausea is the best answer.
Category reason: The item asks which medication side effect to teach for metformin, focusing on adverse reactions and patient education related to drug therapy, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 21

During the follow-up teaching session with a client who has been discharged 4 weeks ago, which information about the side effects and adverse effects of fluoxetine should the nurse be aware of?

Accepted Answer

Answer reason: Fluoxetine is an SSRI, and common side effects include gastrointestinal upset such as nausea, diarrhea, and anorexia, which are frequently emphasized in patient teaching. At 4 weeks, these effects may still be present and are important for adherence counseling and monitoring. Eye dryness and exaggerated diaphoresis are more classically associated with anticholinergic or other medication profiles rather than being hallmark effects of fluoxetine. “Symptoms of heart disease” is not a typical primary teaching point for fluoxetine compared with monitoring for GI effects and other SSRI-related adverse reactions.
Category reason: The question is centered on patient teaching about medication side effects/adverse effects of fluoxetine, which falls under nursing medication knowledge and monitoring for adverse effects within Pharmacological and Parenteral Therapies.

Question 22

A client is treated for cardiac dysrhythmias. The health care provider prescribes the calcium channel blocker verapamil, 80 mg orally every 6 hours. Which assessment finding does the nurse identify as a serious adverse effect of the medication?

Accepted Answer

Answer reason: Verapamil (a non-dihydropyridine calcium channel blocker) slows SA/AV node conduction and decreases heart rate and contractility. A serious adverse effect is excessive AV nodal blockade leading to symptomatic bradycardia and potentially heart block or hypotension. Dizziness and flushing can occur from vasodilation, and peripheral edema is more common with calcium channel blockers but is generally less immediately dangerous than bradycardia in a dysrhythmia patient.
Category reason: The question asks the nurse to recognize a serious adverse medication effect of verapamil and interpret an assessment finding, which is medication safety/monitoring within pharmacological therapy.

Question 23

A client takes digoxin and furosemide. Which lab value warrants holding digoxin and notifying the provider?

Accepted Answer

Answer reason:  Potassium 2.9 mEq/L (2.9 mmol/L) Furosemide can cause hypokalemia, and low potassium increases digoxin’s binding to the Na+/K+ ATPase, raising the risk of digoxin toxicity and dysrhythmias. A potassium of 2.9 mEq/L is clinically significant hypokalemia and is a safety reason to hold digoxin and notify the provider for correction and further orders. The other listed values are not as directly associated with acute increased digoxin toxicity risk in this context.
Category reason: This item tests nursing medication safety: recognizing a lab abnormality (hypokalemia from a loop diuretic) that contraindicates giving digoxin due to increased toxicity risk, which fits Adverse Effects-Contraindications.

Question 24

A client takes digoxin and furosemide. Which lab value warrants holding digoxin and notifying the provider?

Accepted Answer

Answer reason:  Potassium 2.9 mEq/L (2.9 mmol/L) Furosemide can cause potassium wasting, and hypokalemia increases myocardial sensitivity to digoxin, significantly raising the risk of digoxin toxicity and dysrhythmias. A potassium of 2.9 mEq/L is critically low and warrants holding digoxin and notifying the provider for correction and further orders. The other values listed (mild hyponatremia, normal creatinine, mildly low hemoglobin) do not pose the same immediate, specific toxicity risk with digoxin as hypokalemia does.
Category reason: This is a medication safety question requiring nursing judgment about when to hold a drug and notify the provider based on lab values related to adverse effects/contraindications (digoxin toxicity risk with hypokalemia).

Question 25

A nurse reviews labs for a patient taking valproic acid. Which finding is most concerning?

Accepted Answer

Answer reason: Platelets 70,000/mm³ Valproic acid can cause thrombocytopenia, and a platelet count of 70,000/mm³ is significantly low, increasing risk for bleeding. This abnormal lab finding warrants prompt provider notification and assessment for bleeding (e.g., bruising, petechiae, GI bleeding). The other values shown (Na 138, K 4.1, glucose 110) are within typical reference ranges and are not specifically concerning for valproate toxicity.
Category reason: This item tests nursing recognition of a clinically significant adverse drug effect (valproate-associated thrombocytopenia) and appropriate concern for patient safety based on lab monitoring, which fits Pharmacological and Parenteral Therapies: Adverse Effects-Contraindications.

Question 26

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy?

Accepted Answer

Answer reason: Sore throat. Trimethoprim-sulfamethoxazole can rarely cause serious blood dyscrasias (e.g., agranulocytosis) that increase infection risk; a sore throat can be an early sign of neutropenia/infection and must be reported promptly. Nausea, diarrhea, and headache are more common, typically non-urgent side effects that may be managed with supportive measures unless severe or persistent. Reporting a sore throat helps ensure timely assessment and discontinuation/labs if a serious adverse reaction is developing.
Category reason: This question tests nursing teaching about recognizing and reporting a potentially serious adverse effect of an antibiotic (TMP-SMX), which aligns with medication adverse effects and contraindications.

Question 27

An older client recently has been taking cimetidine (Tagamet). The nurse should monitor the client for which most frequent central nervous system side effect of this medication?

Accepted Answer

Answer reason: Confusion. Cimetidine (an H2 receptor antagonist) can cause CNS effects, especially in older adults due to increased sensitivity and reduced clearance. The most commonly reported CNS adverse effect is confusion, which can present as acute changes in mental status. Hallucinations and tremors can occur but are less frequent than confusion in this population.
Category reason: This item tests nursing monitoring for a medication’s adverse effect (cimetidine CNS effects in older adults), which is a pharmacologic safety judgment under Adverse Effects-Contraindications.

Question 28

The nurse is applying a topical corticosteroid to a client with eczema. The nurse should monitor for the potential for increased systemic absorption of the medication if the medication is being applied to which body area?

Accepted Answer

Answer reason: Axilla. Systemic absorption of topical corticosteroids increases when applied to thin, highly vascular skin and in areas prone to occlusion and moisture. The axilla is an intertriginous, warm, moist area where skin-to-skin contact creates occlusion, enhancing percutaneous absorption. In contrast, palms and soles have very thick stratum corneum that markedly limits absorption, and the back is generally less absorptive than intertriginous areas.
Category reason: This item tests nursing knowledge of medication administration and monitoring for systemic adverse effects related to topical corticosteroid absorption at different application sites, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 29

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect?

Accepted Answer

Answer reason: Drowsiness. Baclofen is a centrally acting skeletal muscle relaxant (GABA-B agonist) and commonly causes CNS depression, leading to drowsiness, dizziness, and sedation. This adverse effect is clinically important because it increases fall risk and can be worsened by other CNS depressants (e.g., opioids, benzodiazepines, alcohol). Polyuria and diarrhea are not typical hallmark adverse effects of baclofen, and muscular excitability is opposite of the expected CNS depressant/muscle relaxant effect.
Category reason: This item tests recognizing an expected medication adverse effect and monitoring a patient on drug therapy, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 30

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder should alert the nurse to contact the health care provider?

Accepted Answer

Answer reason: Seizure disorders. Baclofen is a centrally acting skeletal muscle relaxant, and abrupt withdrawal can precipitate seizures and other severe CNS effects. A history of seizure disorder increases concern for seizure threshold changes and requires prescriber notification for risk assessment and monitoring plan. The other listed conditions are not primary contraindications/major alerts compared with seizure risk considerations for baclofen.
Category reason: This question tests nursing action related to medication safety—identifying a condition that represents a potential contraindication/precaution and determining when to contact the provider—so it fits Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 31

A client scheduled for discharge is receiving phenobarbital and will remain on the medication for an extended period of time. What is the teaching priority to maintain patient safety?

Accepted Answer

Answer reason: Do not consume alcohol while on this medication. Phenobarbital is a barbiturate CNS depressant, and combining it with alcohol can cause additive sedation and respiratory depression, significantly increasing risk of injury, overdose, and death. This is the highest-priority safety teaching compared with routine adherence strategies. While taking doses consistently and using organizers can help effectiveness, they do not address the most dangerous contraindicated interaction.
Category reason: This item tests discharge teaching to prevent a harmful drug interaction and adverse outcome while taking phenobarbital, which is a medication safety/contraindication focus under Pharmacological and Parenteral Therapies.

Question 32

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication?

Accepted Answer

Answer reason: D. Bronchospasm. Cromolyn sodium (a mast cell stabilizer) can cause local airway irritation when inhaled, leading to cough, throat irritation, wheezing, and paradoxical bronchospasm. This is an important adverse effect to teach because it directly affects breathing and may require stopping the drug and using a rescue bronchodilator. Insomnia, constipation, and hypotension are not typical adverse effects associated with inhaled cromolyn.
Category reason: This item tests nursing teaching about a medication’s adverse effect profile and safety considerations, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 33

A potassium-retaining diuretic is prescribed for a client with heart failure. Which foods should the nurse instruct the client to avoid?

Accepted Answer

Answer reason: Bananas. Potassium-retaining (potassium-sparing) diuretics (e.g., spironolactone, triamterene, amiloride) increase the risk of hyperkalemia, which can cause dangerous cardiac dysrhythmias. Clients should avoid foods high in potassium to reduce this risk. Bananas are a classic high-potassium food and are commonly emphasized in patient teaching. The other listed options are not as consistently high in potassium or are not standard key foods to avoid for hyperkalemia prevention.
Category reason: This question tests nursing medication teaching about a potassium-sparing diuretic and prevention of an adverse effect (hyperkalemia), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 34

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

Accepted Answer

Answer reason: Tinnitus. Systemic absorption of salicylates (including topical salicylic acid, especially when used over large areas or under occlusion) can cause salicylism, an early hallmark of which is tinnitus. Other early findings can include dizziness, headache, nausea/vomiting, and hyperventilation due to respiratory alkalosis. Diarrhea/constipation are not classic indicators of salicylate toxicity, and decreased respirations is more consistent with late, severe CNS/respiratory depression rather than an early toxicity sign to monitor for.
Category reason: This is a nursing monitoring question focused on recognizing an adverse/systemic toxic effect of a medication, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 35

A new order for Warfarin has been entered for a client who is prescribed levothyroxine for hypothyroidism. Which recommendation should the nurse make to the client's primary health care provider to ensure client safety?

Accepted Answer

Answer reason: A lower dose of Warfarin. Levothyroxine can increase the anticoagulant effect of warfarin by increasing the metabolism/clearance of vitamin K–dependent clotting factors, raising bleeding risk. When thyroid hormone therapy is present or increased, the client may require a reduced warfarin dose to maintain a therapeutic INR. The safest recommendation is to start/adjust warfarin conservatively and closely monitor INR for bleeding. Changing the levothyroxine dose is not indicated solely due to initiating warfarin.
Category reason: This is a medication-safety nursing judgment question focused on managing a clinically significant drug interaction (levothyroxine increasing warfarin effect) and preventing adverse outcomes, which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 36

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which is noted on data collection?

Accepted Answer

Answer reason: Respirations of 10 breaths per minute. Magnesium sulfate toxicity causes central nervous system and respiratory depression; a respiratory rate

Question 37

Which statements show correct understanding about lithium?

Accepted Answer

Answer reason: “I’ll drink 2–3 liters of water daily.” Lithium is cleared by the kidneys and is closely tied to sodium and water balance; dehydration can increase lithium reabsorption and raise serum levels, increasing toxicity risk. Adequate daily fluid intake (often about 2–3 L/day unless contraindicated) helps maintain stable levels. By contrast, NSAIDs like ibuprofen can increase lithium levels, crash diets can alter sodium/fluid balance, and skipping doses is unsafe. While consistent salt intake is also correct teaching, the single best answer emphasizing toxicity prevention is maintaining adequate hydration.
Category reason: This is primarily medication-teaching about lithium safety and prevention of adverse effects/toxicity, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 38

Before giving digoxin to a client with AFib, findings are apical pulse 54/min, potassium 3.0 mEq/L, and nausea. What should the nurse do?

Accepted Answer

Answer reason: Hold the dose and notify the provider An apical pulse of 54/min is below the typical hold parameter for digoxin (commonly

Question 39

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect?

Accepted Answer

Answer reason: Impaired voluntary movements. Carbidopa-levodopa can cause dyskinesias (involuntary movements), such as choreiform or dystonic movements, as a dose-related adverse effect from excess dopaminergic stimulation. This finding suggests the medication effect is excessive and may require dose adjustment. Tachycardia and hypertension are not the classic hallmark adverse effect compared with dyskinesias, and pruritus is not a typical primary adverse reaction for this drug combination.
Category reason: This item tests nursing monitoring for medication side/adverse effects and recognizing a clinically significant reaction requiring intervention, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 40

A man is has been taking lisinopril for CHF. The patient is seen in the emergency room for persistent diarrhea. The nurse is concerned about which side effect of lisinopril?

Accepted Answer

Answer reason: Hypotension Lisinopril (an ACE inhibitor) can cause hypotension, and persistent diarrhea increases the risk by causing fluid volume depletion. In a CHF patient with possible dehydration, ACE inhibitor–related blood pressure lowering can become clinically significant (dizziness, syncope, poor perfusion). The classic ACE inhibitor side effect of a dry cough is common but is not the key acute concern prompted by persistent diarrhea. Palpitations and vertigo are not hallmark lisinopril adverse effects and are less directly linked to diarrhea-related volume loss.
Category reason: This question tests nursing recognition of a medication adverse effect and how a current symptom (diarrhea/volume depletion) increases risk, which aligns with NCLEX pharmacology safety and contraindications.

Question 41

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder?

Accepted Answer

Answer reason: Kidney disease. Colchicine is primarily metabolized hepatically but is also cleared by the kidneys, and reduced renal function increases the risk of drug accumulation and toxicity. In kidney disease, patients are at higher risk for serious adverse effects such as gastrointestinal toxicity and myopathy/neuropathy, especially if doses are not adjusted. Therefore, colchicine should be used with caution and dosing may need modification in renal impairment. The other listed conditions are not the primary contraindication/major caution compared with renal dysfunction.
Category reason: This question tests nursing medication safety by identifying a condition (renal impairment) that increases risk of toxicity and requires caution/possible dose adjustment, which fits Adverse Effects-Contraindications under Pharmacological and Parenteral Therapies.

Question 42

A client with heart failure is prescribed furosemide (Lasix). Which assessment finding should the nurse prioritize monitoring?

Accepted Answer

Answer reason: Serum potassium levels Furosemide is a loop diuretic that can cause significant potassium loss, placing the client at risk for hypokalemia. Hypokalemia can precipitate dangerous dysrhythmias, especially in clients with heart failure who may have underlying cardiac instability or be taking other cardiac medications. Therefore, monitoring serum potassium is the priority safety assessment to prevent complications and guide replacement if needed.
Category reason: This question centers on nursing monitoring for a medication’s major adverse effect (loop diuretic–induced electrolyte loss) and prioritizing what to assess to prevent harm, which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 43

A client is taking ticlopidine hydrochloride. The nurse tells the client to avoid which substance while taking this medication?

Accepted Answer

Answer reason: Acetylsalicylic acid (aspirin). Ticlopidine is an antiplatelet medication that inhibits platelet aggregation, increasing bleeding risk. Aspirin also has antiplatelet effects, so combining them can significantly increase the risk of bleeding (e.g., GI bleeding, bruising, prolonged bleeding). Acetaminophen is generally preferred for mild pain/fever in patients on antiplatelet therapy because it does not inhibit platelet function to the same degree. Therefore, the client should avoid aspirin unless specifically prescribed and monitored.
Category reason: This question tests nursing teaching about a medication interaction/contraindication (avoiding aspirin due to additive antiplatelet bleeding risk), which fits Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 44

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution?

Accepted Answer

Answer reason: Diabetes mellitus. Terbutaline is a beta-2 adrenergic agonist that can increase glycogenolysis and gluconeogenesis, leading to elevated blood glucose levels. It can also cause sympathetic effects (e.g., tremor, tachycardia) that may complicate diabetes management and mask hypoglycemia symptoms. Therefore, clients with diabetes require closer glucose monitoring and cautious use when receiving terbutaline.
Category reason: This item tests nursing medication safety by identifying a condition that increases risk for adverse effects or requires monitoring when administering terbutaline, which fits Adverse Effects-Contraindications under Pharmacological and Parenteral Therapies.

Question 45

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

Accepted Answer

Answer reason: B. Triglyceride level. Isotretinoin commonly causes hypertriglyceridemia and other lipid abnormalities, so baseline (and periodic) lipid monitoring is recommended prior to and during therapy. Elevated triglycerides increase the risk for pancreatitis, making this a clinically important pre-treatment lab. While CBC parameters (WBC/platelets) can rarely change, lipid monitoring is a key routine safety requirement for isotretinoin compared with the other options provided.
Category reason: This item asks the nurse to anticipate a required safety lab related to a medication’s adverse effects, which is medication-management nursing judgment and fits Pharmacological and Parenteral Therapies (Adverse Effects-Contraindications).

Question 46

Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which should the nurse monitor as a side effect of this medication?

Accepted Answer

Answer reason: Urinary retention. Meperidine is an opioid analgesic that commonly causes decreased gastrointestinal motility and urinary retention due to increased sphincter tone and reduced bladder detrusor activity. Nurses should monitor intake/output, bladder distention, and difficulty initiating urination, especially in older adults or those with BPH. Diarrhea is not typical (constipation is), and hypertension is not a classic opioid adverse effect; bradycardia can occur with opioids but urinary retention is a more characteristic and commonly tested side effect.
Category reason: This question tests nursing monitoring for medication adverse effects and contraindications of an opioid analgesic, which is a pharmacologic patient-care judgment topic under Pharmacological and Parenteral Therapies.

Question 47

A client is receiving furosemide IV for fluid overload. Which lab value requires immediate action?

Accepted Answer

Answer reason: Potassium 3.2 mEq/L. Furosemide is a loop diuretic that increases renal potassium excretion, putting the client at risk for hypokalemia. A potassium of 3.2 mEq/L is below normal and can precipitate dangerous dysrhythmias, especially with ongoing IV diuresis. The other values listed (Na 139 mEq/L, Ca 9.0 mg/dL, Mg 2.0 mg/dL) are within typical reference ranges and are not the most urgent.
Category reason: This item tests nursing action based on medication therapy (IV furosemide) and recognition of an adverse electrolyte effect requiring prompt intervention, which aligns with Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

Question 48

Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the health care provider about the administration of this medication?

Accepted Answer

Answer reason: Glaucoma. Cyclobenzaprine has significant anticholinergic (atropine-like) effects. Anticholinergic medications can precipitate or worsen angle-closure glaucoma by increasing intraocular pressure, so this history warrants contacting the provider before giving the drug. Emphysema, hypothyroidism, and diabetes mellitus are not primary contraindications for cyclobenzaprine in the same way as glaucoma.
Category reason: This item tests nursing judgment about medication safety by identifying a contraindication/condition that requires notifying the provider before administering cyclobenzaprine, which fits Adverse Effects-Contraindications.

Question 49

A patient with heart failure has been prescribed digoxin. Which symptom indicates digoxin toxicity?

Accepted Answer

Answer reason: Visual disturbances Digoxin toxicity classically presents with visual changes (e.g., blurred vision, yellow-green halos) along with GI and cardiac manifestations. While digoxin can cause dangerous dysrhythmias, tachycardia is not the hallmark “tell-tale” symptom tested compared with visual disturbances. Hyperkalemia can be associated with acute digoxin toxicity but is a lab finding rather than a symptom, and increased urination is not a characteristic toxicity sign.
Category reason: This item tests recognition of a medication adverse effect/toxicity and safe monitoring for digoxin, which is a pharmacological patient-care judgment topic under Pharmacological and Parenteral Therapies.

Question 50

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test(s) would identify an adverse effect associated with the administration of this medication?

Accepted Answer

Answer reason: Liver function tests. Dantrolene can cause hepatotoxicity, including hepatitis and potentially fatal liver failure, especially with prolonged use or higher doses. Monitoring AST/ALT, alkaline phosphatase, and bilirubin helps detect liver injury early. Creatinine and BUN primarily assess renal function and are not the key adverse-effect monitoring labs for dantrolene. Hematologic toxicity is not the primary serious adverse effect associated with this medication compared with liver injury.
Category reason: This is a medication-safety/monitoring question asking which lab tests detect an adverse drug effect, which fits NCLEX Pharmacological and Parenteral Therapies—Adverse Effects-Contraindications.

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A client is taking ticlopidine hydrochloride. The nurse tells the client to avoid which substance while taking this medication?

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

Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which should the nurse monitor as a side effect of this medication?

A client is receiving furosemide IV for fluid overload. Which lab value requires immediate action?

Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the health care provider about the administration of this medication?

A patient with heart failure has been prescribed digoxin. Which symptom indicates digoxin toxicity?

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test(s) would identify an adverse effect associated with the administration of this medication?

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