Question 1

The nurse is teaching a client about the toxicity of digoxin. Which one of the following statements made by the client indicates more teaching is needed? I will report:

Accepted Answer

Answer reason: A slow, weak pulse is a serious indicator of digoxin toxicity due to excessive cardiac conduction slowing. The client must recognize this symptom as urgent and report it immediately, so failing to do so reflects a need for further teaching.

Question 2

A client is receiving aminophylline IV. The nurse monitors the theophylline blood level and assesses that the level is within therapeutic range when it is?

Accepted Answer

Answer reason: Theophylline has a narrow therapeutic range of 10–20 µg/mL, and a level around 15 µg/mL indicates that the medication is producing its expected therapeutic effect without reaching toxic levels.

Question 3

What is the antidote for benzodiazepine overdose?

Accepted Answer

Answer reason: Flumazenil reverses the sedative and respiratory depressant effects of benzodiazepines by competitively blocking their action at GABA receptors, restoring expected neurologic function after overdose.

Question 4

Which antihypertensive medications are most appropriate for managing pre-eclampsia during pregnancy?

Accepted Answer

Answer reason: Methyldopa, labetalol, nifedipine, and hydralazine are all safe and effective options for blood-pressure control in pre-eclampsia. They reduce maternal hypertension while minimizing fetal risk.

Question 5

Correct statements listing characteristics of a particular route of drug administration include all of the following, except:

Accepted Answer

Answer reason: Inhalation delivers drugs rapidly to the systemic circulation via the large alveolar surface area and rich blood flow; it is not slow. The other statements are correct for IV, IM, and subcutaneous routes.

Question 6

The nurse practicing in a long-term care facility recognizes that elderly clients are at greater risk for drug toxicity than younger adults because they?

Accepted Answer

Answer reason: Older adults have decreased total body water and lean mass, with increased body fat. This alters drug distribution: water-soluble drugs reach higher plasma concentrations, and fat-soluble drugs have prolonged action, increasing toxicity risk.

Question 7

Which combination of antibiotics provides broad-spectrum coverage against both gram-positive and gram-negative bacteria in a patient with a urinary tract infection?

Accepted Answer

Answer reason: Piperacillin with the β-lactamase inhibitor tazobactam provides very broad gram-positive and gram-negative coverage.

Question 8

Correct statements concerning ketorolac include all of the following except:

Accepted Answer

Answer reason: Ketorolac is an NSAID that inhibits COX, provides short-term analgesia comparable to opioids, and lacks opioid adverse effects, such as respiratory depression and dependence. Therefore, the statement claiming a high potential for dependence or abuse is false.

Question 9

A client is prescribed metformin for type 2 diabetes. What should the nurse monitor to assess the effectiveness of metformin therapy?

Accepted Answer

Answer reason: Metformin lowers hepatic glucose production and improves insulin sensitivity; effectiveness is determined by reduced blood glucose/HbA1c, not by potassium, blood pressure, or urine output.

Question 10

Which of the following opioid analgesics is used in the treatment of acute pulmonary edema?

Accepted Answer

Answer reason: Morphine is used in acute pulmonary edema because it reduces preload via venodilation and relieves anxiety and dyspnea. Codeine is mainly an antitussive; fentanyl lacks the venodilatory effect, and loperamide is an antidiarrheal.

Question 11

When providing nursing measures to relieve a 102-degree Fahrenheit fever in a toddler with an infection, the nurse knows that the most effective intervention is to?

Accepted Answer

Answer reason: In fever caused by infection, the hypothalamic set point is elevated; antipyretic medications lower the set point and are most effective. External cooling or extra clothing can trigger shivering and increase metabolic heat production.

Question 12

What is Omeprazole used for?

Accepted Answer

Answer reason: Omeprazole is a proton pump inhibitor that reduces gastric acid secretion; it is indicated for GERD and acid-related disorders.

Question 13

Following a heart transplant, a client is started on medication to prevent organ rejection. Which category of medication prevents the formation of antibodies against the new organ?

Accepted Answer

Answer reason: Post-transplant rejection is mediated by the immune system. Immunosuppressants (e.g., calcineurin inhibitors and corticosteroids) suppress immune responses and antibody formation against the graft, preventing rejection.

Question 14

Which statement by a client taking lithium carbonate indicates a need for further instructions?

Accepted Answer

Answer reason: Reducing salt and fluid intake can raise lithium levels and cause toxicity; patients should maintain consistent sodium and fluid intake.

Question 15

Most non-narcotic analgesics have:

Accepted Answer

Answer reason: Non-narcotic analgesics (especially NSAIDs) typically provide analgesic, antipyretic, and anti-inflammatory effects; hence, all listed effects apply to most agents.

Question 16

In premature labor, which of the following medicines is useful for the newborn?

Accepted Answer

Answer reason: Antenatal corticosteroids, such as dexamethasone, accelerate fetal lung maturation and reduce neonatal respiratory distress and complications in preterm birth.

Question 17

A client with multiple sclerosis is prescribed baclofen. What is the primary purpose of baclofen in the management of multiple sclerosis?

Accepted Answer

Answer reason: Baclofen is a GABA-B agonist and skeletal muscle relaxant used primarily to reduce spasticity in conditions like multiple sclerosis; improvements in mobility or pain are secondary effects.

Question 18

To prevent drug resistance, common to tubercle bacilli, the nurse is aware that clients with tuberculosis are often treated with?

Accepted Answer

Answer reason: TB is treated with multiple drugs to prevent the development of resistance to a single agent; standard therapy uses at least two antitubercular medications.

Question 19

A client has been taking alprazolam (Xanax) for three days. A nursing assessment should reveal which of the following expected effects of the drug?

Accepted Answer

Answer reason: Alprazolam is a benzodiazepine anxiolytic. Its expected therapeutic effects are anxiolysis and sedation, which produce a tranquilizing effect and can blunt emotional responsiveness; it does not provide analgesia.

Question 20

A client is admitted with a blood-alcohol level of 180 mg/dL. The nurse recognizes that the alcohol in the client's system should be fully metabolized within?

Accepted Answer

Answer reason: Ethanol is eliminated at an average rate of about 15–20 mg/dL per hour. At 180 mg/dL, it will take roughly 9 hours (180/20) for it to be fully metabolized. Therefore, 9 hours is the best answer.

Question 21

Insulin use for...?

Accepted Answer

Answer reason: Insulin is administered to control blood glucose levels and treat diabetes mellitus; it is not a therapy for cancer, myocardial infarction, or malaria.

Question 22

In a patient with "swine flu", what is the drug of choice for "swine flu"?

Accepted Answer

Answer reason: Swine flu (H1N1 influenza) is treated with neuraminidase inhibitors; oseltamivir is the drug of choice. Cidofovir and adefovir target CMV and HBV, and acyclovir treats HSV and VZV.

Question 23

A client is prescribed atropine sulfate. What is the primary therapeutic effect of atropine sulfate?

Accepted Answer

Answer reason: Atropine is an antimuscarinic (anticholinergic) that blocks parasympathetic activity, causing effects such as increased heart rate, mydriasis, decreased secretions, and bronchodilation. Among the options, bronchodilation is the correct therapeutic effect; the others are the opposite of atropine's actions.

Question 24

Which of the following drugs is used to treat type II diabetes?

Accepted Answer

Answer reason: Metformin is a biguanide and a first-line oral agent for type II diabetes. The others are not antidiabetic drugs: furosemide is a diuretic, tramadol is an analgesic, and ibuprofen is an NSAID.

Question 25

A client has suffered a severe electrical burn. Which medication would the nurse expect to be ordered for application to the burned area?

Accepted Answer

Answer reason: Mafenide acetate penetrates thick eschar and is effective against organisms, including anaerobes, making it the preferred agent for electrical burns with deep tissue injury. Silver sulfadiazine and silver nitrate have poorer eschar penetration; povidone-iodine is not recommended for burn wounds.

Question 26

The nurse has just admitted a client with emphysema. Arterial blood gas results indicate hypoxia. Which physician's prescription would the nurse implement to best improve the client's hypoxia?

Accepted Answer

Answer reason: In emphysema with documented hypoxia, the most effective immediate intervention from the listed physician orders is low-flow oxygen. Starting O2 at 2 L/min directly increases PaO2 while minimizing the risk of CO2 retention. Positioning and breathing techniques help ventilation but do not correct hypoxemia as rapidly; a bronchodilator may improve airflow, but oxygen best treats hypoxia.

Question 27

The nurse knows that the most reliable client measure for evaluating the desired response to diuretic therapy is to?

Accepted Answer

Answer reason: Daily weight most accurately reflects changes in fluid volume; effective diuretic therapy should show weight loss. Urinalysis, electrolytes, and intake help monitor effects or safety, but are less direct measures of response.

Question 28

A client on a mechanical ventilator begins fighting the ventilator. Which medication will be ordered for the client?

Accepted Answer

Answer reason: Fighting the ventilator indicates ventilator asynchrony; a neuromuscular blocking agent, such as pancuronium, is used to paralyze skeletal muscles and facilitate mechanical ventilation. The others provide analgesia, sedation, or antihistamine effects but do not reliably stop ventilator fighting.

Question 29

Which alpha-2 agonist drug is primarily used to relax blood vessels and manage hypertension, especially during pregnancy?

Accepted Answer

Answer reason: Methyldopa is a centrally acting alpha-2 agonist with a long safety record for treating hypertension during pregnancy; clonidine and guanfacine are not preferred during pregnancy, and dexmedetomidine is used for sedation.

Question 30

A client with chronic kidney disease is prescribed calcitriol (Rocaltrol). What is the primary therapeutic effect of calcitriol?

Accepted Answer

Answer reason: Calcitriol is the active form of vitamin D3 that increases intestinal absorption of calcium; it is used in CKD to treat hypocalcemia and secondary hyperparathyroidism. It does not promote diuresis, phosphate excretion, or sodium retention.

Question 31

A client with chronic obstructive pulmonary disease (COPD) has been prescribed ipratropium bromide. What is the primary action of ipratropium bromide?

Accepted Answer

Answer reason: Ipratropium is an anticholinergic bronchodilator that blocks muscarinic (acetylcholine) receptors in the airways, preventing vagal-mediated bronchoconstriction. This leads to bronchodilation; the mechanism is receptor blockade.

Question 32

A client with tuberculosis who has been on combination therapy with rifampin and isoniazid asks the nurse how long he will have to take the medication. The nurse should tell the client that?

Accepted Answer

Answer reason: Standard treatment for drug-susceptible tuberculosis involves a 6-month regimen (an initial 2 months followed by a 4-month continuation phase).

Question 33

What is a pyrazinamide tablet used for?

Accepted Answer

Answer reason: Pyrazinamide is a first-line antimycobacterial agent used in combination therapy for Mycobacterium tuberculosis.

Question 34

A client is admitted with heart failure and prescribed spironolactone. What is the therapeutic effect of spironolactone in heart failure?

Accepted Answer

Answer reason: Spironolactone is a potassium-sparing diuretic that antagonizes the aldosterone receptor, decreasing sodium and water retention and remodeling in heart failure. It does not directly enhance contractility or primarily lower afterload; preload reduction is secondary.

Question 35

A client with chronic kidney disease has been prescribed erythropoietin. What is the expected therapeutic outcome of erythropoietin therapy?

Accepted Answer

Answer reason: Erythropoietin stimulates bone marrow erythropoiesis, correcting anemia in CKD by increasing RBC production and hemoglobin levels. Increased BP is an adverse effect, not the therapeutic goal; iron absorption is not its primary effect; hemoglobin should rise, not fall.

Question 36

A client with heart failure is prescribed furosemide (Lasix). Which assessment finding indicates that the medication is effective?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that removes excess fluid in heart failure. An effective response is a decrease in fluid overload, evidenced by reduced peripheral edema. The other options reflect inadequate diuresis or opposite effects.

Question 37

The physician has prescribed imipramine (Tofranil) for a client with depression. The nurse should continue to monitor the client's affect because the maximal effects of tricyclic antidepressant medications do not occur for?

Accepted Answer

Answer reason: Tricyclic antidepressants, like imipramine, have a delayed therapeutic onset; maximal antidepressant effects typically appear after about 2–4 weeks, so earlier time frames are too short and months are too long.

Question 38

Intra-arterial chemotherapy primarily benefits the client by delivering higher concentrations of medication directly to the malignant tumor. An additional benefit of intra-arterial chemotherapy is?

Accepted Answer

Answer reason: Regional intra-arterial delivery limits systemic exposure, reducing bone marrow suppression compared with systemic chemotherapy and thus helps prevent therapy-induced anemia.

Question 39

Which drug is commonly used to manage diarrhea?

Accepted Answer

Answer reason: Loperamide is an OTC antidiarrheal that slows intestinal motility. Omeprazole treats acid-related disorders, and paregoric (an opioid) is not commonly used due to abuse risk.

Question 40

The use of heparin is recommended for the treatment of deep venous thrombosis. This statement is?

Accepted Answer

Answer reason: Heparin (UFH or LMWH) is the standard initial therapy for acute DVT to prevent clot propagation and the formation of new thrombi.

Question 41

Cetirizine hydrochloride is used for?

Accepted Answer

Answer reason: Cetirizine (cetrizine) is an antihistamine used to treat allergic symptoms such as rhinitis and urticaria; it is not indicated for pain, vomiting, or fever.

Question 42

Oxytocin is usually given after the placenta has been delivered and not before because?

Accepted Answer

Answer reason: Administering a uterotonic before placental separation can cause strong uterine contractions and cervical closure, potentially trapping the placenta; therefore, it is given after placental delivery.

Question 43

Which of the following is the antidote for the toxin benzodiazepines?

Accepted Answer

Answer reason: Flumazenil is a benzodiazepine receptor antagonist that reverses benzodiazepine effects. Methylene blue treats methemoglobinemia, deferoxamine chelates iron, and urine alkalinization is used for salicylate and phenobarbital toxicity.

Question 44

The nurse is caring for a client who abuses narcotics. The client is exhibiting a respiratory rate of 10 and dilated pupils. Which drug would the nurse expect to administer?

Accepted Answer

Answer reason: Respiratory depression suggests an opioid overdose. Naloxone is the opioid antagonist that rapidly reverses narcotic effects and improves respiration. The other drugs do not treat opioid toxicity.

Question 45

A client who has been diagnosed with lung cancer is starting a smoking cessation program. Which of the following drugs would the nurse expect to be included in the program's plan?

Accepted Answer

Answer reason: Bupropion SR is approved for smoking cessation; the others are a bronchodilator (metaproterenol), an anticholinergic bronchodilator (oxitropium), and an anxiolytic (alprazolam), none of which are standard agents for nicotine dependence treatment.

Question 46

A client delivered a nine-pound infant two hours ago. The client has an IV of D5W with oxytocin. The nurse determines that the medication is achieving the desired effect when she observes?

Accepted Answer

Answer reason: Oxytocin promotes uterine contractions to decrease postpartum bleeding. A firm uterine fundus indicates effective action; increased lochia, a rise in BP, or changes in pain are not desired therapeutic effects.

Question 47

A client is complaining of chest pain. Nursing assessment reveals a blood pressure of 78/40, shortness of breath, and a third-degree AV block on the heart monitor. What medication would the nurse prepare for initial administration?

Accepted Answer

Answer reason: Symptomatic complete heart block with hypotension requires immediate chronotropic support; atropine is the initial drug to increase AV nodal conduction and heart rate. Verapamil can worsen the block, and lidocaine and procainamide treat ventricular arrhythmias.

Question 48

Which drug provides relief from anxiety and decreases preload and afterload?

Accepted Answer

Answer reason: Morphine relieves anxiety and pain and causes venous and some arterial dilation, reducing both preload and afterload. Amrinone and dobutamine are inotropes without anxiolytic effects; furosemide reduces preload via diuresis but does not relieve anxiety.

Question 49

When John was given paracetamol, his fever was brought down dramatically from 40 degrees Celsius to 36.7 degrees in a matter of 10 minutes. The nurse would assess this event as?

Accepted Answer

Answer reason: The fever was reduced, but the drop was excessively rapid and did not match the expected or desired outcome parameters for antipyretic therapy. Thus the goal was met, but not according to the predefined outcome criteria.

Question 50

For which condition is digoxin used?

Accepted Answer

Answer reason: Digoxin, a cardiac glycoside, increases myocardial contractility and helps manage symptoms of heart failure and certain arrhythmias. Among the options, heart failure is correct.

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