Question 1

The nurse is caring for a client with idiopathic thrombocytopenic purpura. The client asks the nurse what medication the doctor ordered to improve his platelet count. What is the best response by the nurse?

Accepted Answer

Answer reason: Steroids increase platelet counts by reducing immune destruction and decreasing splenic sequestration, making them the most appropriate medication to “improve platelet count.” Aspirin is contraindicated because it inhibits platelet function and increases bleeding risk despite not raising platelet numbers. Vitamin K corrects vitamin K–dependent clotting factor deficiency (e.g., warfarin effect), not thrombocytopenia, and methotrexate is not a standard first-line agent for this indication.

Question 2

Which statement by the nurse indicates a positive outcome for a client who takes sodium polystyrene sulfonate (Kayexalate)?

Accepted Answer

Answer reason: Sodium polystyrene sulfonate is a cation-exchange resin that treats hyperkalemia by binding potassium in the gastrointestinal tract and promoting its elimination in stool. The desired therapeutic outcome is a reduction in serum potassium toward normal, which directly reflects drug effectiveness. Good urine output is beneficial for renal potassium excretion but does not demonstrate that this medication is working because it does not rely on diuresis for its effect. Nausea or improved affect are nonspecific findings and are not primary outcome measures for hyperkalemia therapy.

Question 3

A 52-year-old client is seen in the local clinic after positive seroconversion of a tuberculin (TB) test. The nurse expects the client to be placed on which medication?

Accepted Answer

Answer reason: A newly positive tuberculin test suggests TB infection and, when active disease is not the focus, management commonly targets latent TB to prevent progression to active disease. The standard first-line preventive therapy is isoniazid, which is active against Mycobacterium tuberculosis and is used for latent TB infection. The other options treat different pathogens: doxycycline is antibacterial but not a first-line TB preventive agent, fluconazole treats fungal infections, and oseltamivir treats influenza. Nursing implications include monitoring for hepatotoxicity and ensuring appropriate duration/adherence to reduce future reactivation risk.

Question 4

A client has potassium level is 5.38 mEq/L. Which drug should the nurse expect the physician to order?

Accepted Answer

Answer reason: Hyperkalemia management aims to lower serum potassium by shifting it intracellularly, removing it from the body, or preventing further increases. For a mild elevation (5.38 mEq/L), a loop diuretic can promote renal potassium excretion when kidney function and urine output are adequate. This directly addresses the elevated potassium while also allowing concurrent management of volume status if needed. Potassium chloride would worsen the condition, and magnesium citrate is a laxative without a targeted potassium-lowering effect. Sodium polystyrene sulfonate can remove potassium via the gut but is typically reserved for more significant elevations or when diuresis is not appropriate, and it has important safety limitations.

Question 5

Which finding indicates that oxycodone (OxyContin) given to a client with breast cancer metastasized to the bone is exerting the desired effect?

Accepted Answer

Answer reason: The primary therapeutic goal of oxycodone, an opioid analgesic, is reduction of moderate-to-severe pain and improved comfort/function. A low reported pain score after administration is the most direct, patient-centered indicator that the medication is producing its intended analgesic effect. Bone density is not an expected short-term outcome of opioid therapy, and alpha-fetoprotein is a tumor marker unrelated to breast cancer bone pain control. Normal serum calcium may be relevant to metastatic bone disease or hypercalcemia monitoring, but it does not specifically demonstrate opioid effectiveness.

Question 6

The client receiving hospice care has cancer pain and requires treatment with a co-analgesic for pain control. Which medication should the nurse request an HCP to prescribe because it gives the best pain-relieving response when given with opioids?

Accepted Answer

Answer reason: This option is an anticonvulsant used as a first-line adjuvant for neuropathic pain and can provide opioid-sparing effects and improved overall analgesia when combined with opioids. The other choices are primarily antiemetics or antihistamines; they may help with nausea, sedation, or itching from opioids but do not reliably enhance analgesia as a co-analgesic. In hospice symptom management, selecting an adjuvant with proven analgesic benefit improves comfort while potentially reducing opioid dose-related adverse effects.

Question 7

The client experiences local burning and stinging when mafenide cream is applied to treat a burn injury. Which action should be taken by the nurse?

Accepted Answer

Answer reason: Mafenide acetate topical is known to cause local burning and stinging on application, especially over open burn wounds, and this expected effect alone does not indicate allergy or toxicity. The safest nursing action is to educate and reassure the client while continuing to monitor for true adverse reactions (e.g., rash, wheezing, progressive swelling, systemic symptoms). Removing the medication or urgently contacting the provider is not indicated for an anticipated, self-limited local sensation. Verifying concentration is reasonable only if the reaction is unusually severe or accompanied by signs suggesting misuse or hypersensitivity.

Question 8

The client has been successful at controlling gastroesophageal reflux symptoms without prescription medications. Which OTC medication should the nurse explore whether the client is taking for symptom control?

Accepted Answer

Answer reason: Famotidine is an OTC H2-receptor blocker that decreases gastric acid secretion, which directly reduces reflux-related heartburn. In contrast, aspirin and ibuprofen are NSAIDs that can irritate the gastric mucosa and worsen dyspepsia/GERD symptoms. Desloratadine is an antihistamine for allergic rhinitis/urticaria and does not treat gastric acid reflux.

Question 9

The nurse is caring for the client who has received sumatriptan. The nurse evaluates that sumatriptan has been an effective treatment when the client reports which change?

Accepted Answer

Answer reason: Its therapeutic action involves cranial vasoconstriction and inhibition of trigeminal neurotransmitter release, which directly targets migraine pathophysiology. Mood improvement is more consistent with antidepressants, and decreased muscle spasms aligns with antispasmodics or muscle relaxants rather than triptans. Increased ability to fall asleep is not an expected clinical outcome and could suggest sedation from other agents rather than successful migraine-specific treatment.

Question 10

The client with CRF receives a sodium polystyrene sulfonate enema. Which finding indicates that the medication is achieving the desired therapeutic effect?

Accepted Answer

Answer reason: Serum potassium level 4.0 mEq/L Sodium polystyrene sulfonate is a cation-exchange resin used to treat hyperkalemia, especially in chronic renal failure, by binding potassium in the gut and promoting its elimination in stool. The desired outcome is a reduction of elevated serum potassium into the normal range. A value of 4.0 mEq/L reflects effective lowering to a safe, normal potassium level. Retaining the enema is a process measure rather than the therapeutic endpoint, and changes in stool color or constipation relief do not demonstrate potassium removal.

Question 11

The nurse is assessing the client with herpes zoster. The nurse determines that acyclovir is an effective treatment when which finding is noted?

Accepted Answer

Answer reason: Clinical effectiveness is reflected by progression of zoster vesicles toward drying, crusting, and healing, along with reduced new lesion formation and pain duration. Findings related to genital lesions point more toward herpes simplex rather than zoster distribution. Improvement of urticaria/pruritus suggests an allergic/histamine-mediated process and is not a targeted outcome of antiviral therapy.

Question 12

The pregnant client received a dinoprostone insert. The nurse determines that the client had the desired therapeutic response when obtaining which assessment finding?

Accepted Answer

Answer reason: A desired therapeutic response is the onset of a regular, appropriately spaced contraction pattern consistent with labor progress. Contractions occurring about every 2–5 minutes (e.g., every 4 minutes) indicate the medication is producing its intended uterotonic effect. Normal fetal heart rate and maternal blood pressure are important safety assessments but do not demonstrate that the drug achieved its primary goal, and deep tendon reflexes are not an outcome measure for this medication.

Question 13

The child with CF is prescribed vitamin A supplements. Which finding by the clinic nurse indicates that the vitamin has been effective?

Accepted Answer

Answer reason: Vitamin A is a fat-soluble vitamin important for epithelial tissue integrity and maintenance of skin and mucous membranes. Children with cystic fibrosis commonly have fat malabsorption from pancreatic insufficiency, leading to deficiency signs such as dry, rough skin and impaired epithelial health. Improvement to supple, healthy skin is a direct clinical indicator that supplementation is correcting the deficiency and restoring normal epithelial function. Decreased secretion viscosity is related to airway hydration/mucolytics rather than vitamin A status. Reduced bleeding would reflect vitamin K repletion, and pancreatic enzyme absorption is not a targeted outcome of vitamin A therapy.

Question 14

The nurse is developing the plan of care for the 7-year-old with encopresis who has been started on lactulose. Which outcome would be most appropriate for the nurse to establish?

Accepted Answer

Answer reason: The most appropriate measurable outcome is establishing regular, soft bowel movements to prevent stool retention and overflow soiling. Nighttime continence relates more to urinary elimination and is not the primary therapeutic goal of lactulose therapy. Weight gain and blood glucose targets are not expected therapeutic endpoints for treating constipation/encopresis and do not reflect the medication’s intended action.

Question 15

The nurse is teaching the client newly started on propranolol for acute situational anxiety disorder. In addition to treating the client's anxiety, the nurse should inform the client that propranolol's use is effective in treating which associated problem?

Accepted Answer

Answer reason: In performance/acute situational anxiety it is commonly used to control these physical symptoms, making tremor a typical associated problem it can improve. Bradycardia is an adverse effect of beta-blockade rather than a condition it is used to treat. Muscle spasms are not an expected target of beta-blockers, and hypertensive crisis requires rapid-acting antihypertensives and is not managed as an “associated problem” of situational anxiety teaching.

Question 16

The nurse telephones the HCP to request a pm anxiolytic medication order for a hospitalized client having occasional anxiety. Which medication, if prescribed, should the nurse question regarding its effectiveness for prn use?

Accepted Answer

Answer reason: This medication is not effective as an as-needed agent because it has a delayed onset and requires consistent scheduled dosing over days to weeks to produce therapeutic benefit. Benzodiazepines have faster onset and can be effective for short-term PRN relief, though they carry sedation and dependence risks. Therefore, the nurse should question an order for this drug if the intent is PRN management of occasional anxiety.

Question 17

A client is diagnosed with uncomplicated rheumatoid arthritis. The nurse explains to the client that nonsteroidal anti-inflammatory drugs (NSAIDs) are used in the treatment plan. Which NSAID medication is used to treat rheumatoid arthritis?

Accepted Answer

Answer reason: In uncomplicated RA, an NSAID is commonly used for symptomatic control (pain and stiffness) even though it does not alter long-term disease progression. Among the choices, ibuprofen is a classic NSAID used for inflammatory arthritis. Methotrexate is a DMARD used to modify disease activity rather than an NSAID, while furosemide and haloperidol treat unrelated conditions.

Question 18

A client was admitted to the hospital because of a transient ischemic attack secondary to atrial fibrillation. The nurse anticipates the physician will prescribe which medication?

Accepted Answer

Answer reason: After a TIA attributed to atrial fibrillation, the key medication goal is secondary prevention with systemic anticoagulation to reduce future embolic events. This option directly addresses the underlying mechanism by inhibiting vitamin K–dependent clotting factors and lowering stroke risk. Rate-control agents like digoxin or diltiazem may improve ventricular response but do not adequately prevent cardioembolic stroke on their own. Antiarrhythmics such as quinidine focus on rhythm control and carry proarrhythmic/toxicity risks without being the primary therapy for preventing recurrent embolic events after a TIA.

Question 19

A client with a positive skin test for tuberculosis (TB) is not showing signs of active disease and is treated with isoniazid, 300 mg daily. The nurse explains to the client that the medication should be taken for how long?

Accepted Answer

Answer reason: Isoniazid monotherapy requires months of continuous dosing because mycobacteria replicate slowly and are relatively tolerant in latent states. Short courses measured in days or weeks are inadequate for sterilizing latent infection and would not meaningfully reduce reactivation risk. A multi-month option is closer, but classic INH preventive therapy is extended to around 9 months (often described as 9–12 months in older exam references) to optimize effectiveness.

Question 20

A child is receiving prednisone after undergoing a heart transplant. The parents of the child ask the nurse what the purpose of the medication is. The best response by the nurse would be?

Accepted Answer

Answer reason: ” After a heart transplant, the core goal of therapy is to prevent rejection by reducing the recipient’s immune attack on the donated organ. Prednisone is a glucocorticoid immunosuppressant that decreases inflammatory cytokine production and T-cell activity, lowering the risk of acute rejection. While increased appetite and fluid retention can occur as side effects of corticosteroids, they are not the therapeutic purpose. Corticosteroids also tend to impair (not improve) wound healing by inhibiting inflammation and collagen formation.

Question 21

A client experiences an opioid overdose. Which medication antagonizes the effects of opioids?

Accepted Answer

Answer reason: Naloxone (Narcan) 0.4 mg IV up to a total of 10 mg. Opioid overdose causes life-threatening respiratory depression via opioid receptor activation, so the priority is rapid reversal of opioid effects. Naloxone is a competitive opioid receptor antagonist that quickly restores ventilation and level of consciousness when opioids are the cause. Flumazenil reverses benzodiazepines, not opioids, and can precipitate seizures in mixed overdoses. Dimercaprol is a heavy-metal chelator, and atropine treats symptomatic bradycardia or cholinergic toxicity rather than opioid receptor–mediated respiratory depression.

Question 22

The nurse is preparing to administer medications at 1700 to multiple clients with GI problems. Which medication should be the nurse’s priority when the meal trays are due to arrive at 1700?

Accepted Answer

Answer reason: This drug is a prostaglandin analog used to prevent NSAID-induced gastric ulcers and is typically administered with meals (and at bedtime) to improve tolerability and align with its protective action on the gastric mucosa. Giving it when the meal tray arrives best matches its administration instructions and helps limit diarrhea and abdominal cramping. In contrast, H2 blockers like famotidine/cimetidine can often be given without strict synchronization to the exact moment a meal tray arrives, and a stimulant laxative like bisacodyl is not tied to mealtime in this way.

Question 23

A client with schizophrenia has been prescribed risperidone (Risperdal). The client’s symptoms include hallucinations, delusions, and withdrawal. A nurse explains that the medication will help improve which symptoms?

Accepted Answer

Answer reason: Hallucinations and delusions are positive symptoms, and social withdrawal is a negative symptom, so the expected therapeutic effect is improvement across both domains. Risperidone is commonly used because it is effective for positive symptoms and can provide modest improvement in negative symptoms compared with older typical agents. “Paranoid symptoms” is not a separate symptom class in standard schizophrenia symptom grouping; persecutory delusions are part of positive symptoms.

Question 24

At a follow-up clinic visit, the client who had a sigmoid colectomy for colon cancer is instructed to take 325 mg of aspirin per day. The nurse explains to the client that the aspirin will have which effect?

Accepted Answer

Answer reason: The intent is chemoprevention/secondary prevention rather than symptom control. It is not prescribed primarily to promote incision healing, and routine daily aspirin is not a standard intervention for postoperative incisional recovery. While metastasis prevention is an overspecific claim for patient teaching; recurrence risk reduction is the more accurate counseling point.

Question 25

The client taking carbamazepine XR for seizure control reports that pieces of the medication are being passed into the stool. Which action by the nurse is most important?

Accepted Answer

Answer reason: Extended-release tablets may leave an intact or partially intact shell/matrix that can appear in stool as “ghost tablets,” while the medication has already been released and absorbed. The priority nursing action is to provide patient teaching and reassurance to reduce anxiety and support adherence, since stopping or altering the dose could precipitate breakthrough seizures. This finding alone does not indicate malabsorption or treatment failure unless seizure control worsens or other signs of poor absorption appear. Provider notification is appropriate only if there are clinical concerns such as increased seizure activity, significant GI symptoms, or suspected nonadherence/incorrect administration (e.g., crushing XR tablets).

Question 26

The client with glaucoma is prescribed pilocarpine hydrochloride 1% eye drops to both eyes four times per day. The nurse knows that this medication has which expected action?

Accepted Answer

Answer reason: This mechanically opens the trabecular meshwork and canal of Schlemm, promoting drainage of aqueous humor and lowering intraocular pressure, which is the therapeutic goal in glaucoma. Because it produces miosis, it typically worsens rather than improves vision in dim light. It does not increase aqueous humor production, and it does not enhance pupillary dilation since it has parasympathomimetic effects.

Question 27

The client seeking treatment for insomnia tells the nurse about researching complementary therapies for promoting sleep. Which are herbal remedies for promoting sleep that the client may wish to discuss with the nurse?

Accepted Answer

Answer reason: Chamomile is commonly used as a calming bedtime tea, and hops has traditional sedative properties often cited in sleep-promoting preparations. In contrast, fennel/ginger and peppermint are more associated with gastrointestinal comfort, and feverfew is typically used for migraine prevention rather than sleep. Echinacea and goldenseal are generally discussed for immune support, not as sleep aids, so they are not the best match for insomnia.

Question 28

The nurse is preparing to administer ranitidine (Zantac) to a client diagnosed with peptic ulcer disease. The client asks the nurse what the purpose of the medication is. What is the most appropriate response by the nurse?

Accepted Answer

Answer reason: This reduced acidity helps relieve ulcer pain and promotes healing in peptic ulcer disease by minimizing acid-related mucosal injury. Neutralizing acid is the role of antacids, which act locally rather than suppressing secretion. Protecting the mucosal barrier is primarily associated with agents like sucralfate or misoprostol, not ranitidine.

Question 29

A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which reason?

Accepted Answer

Answer reason: The client’s restlessness/confusion with ipsilateral pupillary dilation suggests worsening ICP and possible herniation risk, making rapid ICP reduction the priority. After mobilizing fluid intravascularly, mannitol promotes diuresis to help remove this excess water via the kidneys, further decreasing cerebral edema. While mannitol can also be used to reduce intraocular pressure, the clinical picture here is neurologic deterioration from increased ICP, not an eye-pressure problem.

Question 30

Which statement by the parent of a child being treated for pinworms indicates to the nurse that further teaching is necessary?

Accepted Answer

Answer reason: Pinworm infections commonly require repeat dosing because initial therapy may kill adult worms but not eggs, leading to reinfestation when eggs hatch. Teaching typically includes administering the prescribed treatment regimen as directed (often a second dose about 2 weeks later) and treating/assessing household contacts as recommended to prevent recurrence. Stating the plan is for only a single dose suggests misunderstanding of expected medication management and outcomes. By contrast, hand hygiene and keeping nails short are key measures to reduce fecal–oral transmission and autoinoculation.

Question 31

Alpha-adrenergic blocking agents include medications such as doxazosin (Cardura) and prazosin hydrochloride (Minipress). The mechanism of action for these medications is to?

Accepted Answer

Answer reason: Alpha-1 adrenergic receptors mediate sympathetic vasoconstriction in vascular smooth muscle and contribute to increased peripheral resistance and blood pressure. Doxazosin and prazosin block these alpha-1 receptors, reducing sympathetic tone at the receptor level and leading to vasodilation and lower blood pressure. Because they are antagonists, they do not “stimulate” either autonomic branch. A common distractor is confusing alpha blockers with anticholinergics, but these drugs do not target parasympathetic (muscarinic) receptors; their main clinically relevant effect is reduced sympathetic-mediated vasoconstriction with risks like orthostatic hypotension.

Question 32

A client with chronic pyelonephritis is preparing to be discharged from the hospital. What is the most important information for the nurse to tell the client?

Accepted Answer

Answer reason: Chronic pyelonephritis implies persistent or recurrent upper urinary tract infection with risk of renal scarring, so eradication often requires prolonged antimicrobial therapy and strict adherence. Teaching that therapy can extend for weeks to months prepares the client to complete the full course and reduces relapse and progression to chronic kidney damage. Bed rest is not a key long-term discharge priority once acute systemic symptoms have resolved and can promote deconditioning. Routine long-term analgesic use is inappropriate due to adverse effects and does not treat the underlying infection; follow-up cultures may be done, but at individualized intervals and are less central than completing antibiotics.

Question 33

The nurse is caring for the client who is experiencing symptoms associated with pheochromocytoma. Which intervention should be included in the plan of care for this client?

Accepted Answer

Answer reason: Pheochromocytoma causes episodic catecholamine surges that can produce severe hypertension and life-threatening complications (e.g., stroke, dysrhythmias). Immediate nursing priorities include controlling blood pressure with appropriate antihypertensive therapy to reduce end-organ risk. An IV calcium channel blocker can be used for acute BP control when ordered and closely monitored. Nonpharmacologic calming measures may help reduce stimulation, but they do not adequately treat dangerous hypertension, and frequent visitors or increased activity can increase sympathetic stimulation and worsen symptoms.

Question 34

The client diagnosed with chronic pancreatitis is concerned about pain control. The nurse explains that the initial plan for chronic pancreatic pain control involves the administration of which of the following?

Accepted Answer

Answer reason: Pancreatic enzyme replacement can decrease cholecystokinin-mediated pancreatic secretion and may lessen pain in some patients, and acid suppression helps protect enzyme activity and reduce gastric acidity-related symptoms. Opioids are often needed for severe, refractory pain but are not typically presented as the initial foundational strategy due to dependence risk and adverse effects. Celiac plexus or other nerve-directed injections are reserved for persistent pain not controlled with conservative/pharmacologic measures.

Question 35

The client with CRF is receiving epoetin alfa. Which finding should indicate to the nurse that the action of the medication has been effective?

Accepted Answer

Answer reason: Effectiveness is best demonstrated by objective improvement in red blood cell indices, especially rising hemoglobin and hematocrit into an appropriate target range. Urine output is not a direct therapeutic endpoint of epoetin and may remain low in CRF despite effective anemia treatment. Vital signs and subjective energy can improve, but they are nonspecific and less reliable than measured hemoglobin/hematocrit for confirming drug effect.

Question 36

The nurse is assessing the client with severe preeclampsia who has been receiving IV magnesium sulfate for 24 hours. The nurse should conclude that the medication is effective in treating preeclampsia when obtaining which finding?

Accepted Answer

Answer reason: An increase in urine output indicates improved renal blood flow and is also a key safety marker that the drug can be cleared, lowering risk for magnesium toxicity. Rising blood pressure would indicate worsening disease rather than therapeutic effect. Decreasing platelets and increasing hematocrit suggest progression toward HELLP/hemoconcentration rather than improvement.

Question 37

Prior to delivery, the client had prolonged rupture of her membranes. Since delivery 48 hours ago, she has been receiving IV cefotaxime. Which outcome would be most important for the nurse to establish?

Accepted Answer

Answer reason: The most important expected outcome to confirm antibiotic effectiveness and maternal safety is lack of ongoing systemic infection, best reflected by no high fever 48 hours postpartum. Normal postpartum findings like lochia rubra can occur even in the presence of infection and therefore are less discriminating as a treatment outcome. Adequate voiding and bowel movements are important for comfort and recovery but are not the primary indicator that the infection risk tied to prolonged membrane rupture is controlled.

Question 38

The child, admitted to the ED, is experiencing nausea and vomiting, salivation, respiratory muscle weakness, and depressed reflexes an hour after exposure to pesticides. Which medications should the nurse anticipate administering to the child?

Accepted Answer

Answer reason: Atropine is given to counter life-threatening muscarinic effects, especially airway secretions and bronchospasm/bradycardia. Pralidoxime reactivates acetylcholinesterase (most effective when given early) and helps reverse nicotinic manifestations such as muscle weakness that can progress to respiratory failure. Flumazenil and naloxone are antidotes for benzodiazepines and opioids, and digoxin immune Fab is specific for digoxin toxicity, so they do not match this toxidrome.

Question 39

Prior to administering filgrastim, the nurse reviews the laboratory report results for the 3-year-old who completed the second round of chemotherapy three weeks ago. Which finding indicates a therapeutic response to filgrastim?

Accepted Answer

Answer reason: A WBC value in the normal range for a child suggests marrow recovery and an expected therapeutic effect of the medication. Hematocrit reflects red blood cell mass and would be improved by erythropoietic support rather than G-CSF. Platelet count reflects megakaryocyte function and is not the primary target of filgrastim, while eosinophil percentage does not specifically indicate recovery from neutropenia.

Question 40

The nurse is teaching the 14-year-old who is being given captopril for the first time. Which explanation would be most appropriate?

Accepted Answer

Answer reason:  Captopril is an ACE inhibitor that lowers blood pressure by decreasing angiotensin II–mediated vasoconstriction and reducing aldosterone-driven sodium and water retention. Teaching should focus on the medication’s expected therapeutic effect so the adolescent can understand why it is prescribed and what outcome to monitor. The other choices describe effects associated with different medication classes (e.g., bronchodilators for asthma, beta-blockers for heart rate control, insulin/oral hypoglycemics for blood sugar). This explanation aligns with safe medication education and sets appropriate expectations for therapy.

Question 41

Which intervention has the most impact in delaying the development of acquired immunodeficiency syndrome (AIDS) once a client has been infected with human immunodeficiency virus (HIV)?

Accepted Answer

Answer reason: Adherence maintains therapeutic drug levels, reduces viral load, decreases opportunistic infection risk, and limits development of resistant strains that accelerate treatment failure. Diet, rest, and sleep support general health but do not directly and reliably prevent immune deterioration in HIV the way effective ART does. Plasmapheresis is not a standard or effective strategy to delay HIV progression.

Question 42

The nurse is preparing to administer vasopressin to a client who has undergone a hypophysectomy. What is the purpose of the medication?

Accepted Answer

Answer reason: Vasopressin is an exogenous form of ADH that increases renal water reabsorption in the collecting ducts, reducing urine output and stabilizing serum osmolality. This medication is given to correct the expected hormonal deficit rather than to prevent SIADH, which represents excess ADH. Growth failure relates to growth hormone deficiency, and reducing intracranial pressure is not the therapeutic role of vasopressin.

Question 43

A child with a ventricular septal defect repair is receiving dopamine (Intropin) postoperatively. The parents ask the nurse why the child is getting the medication. What is the best response by the nurse?

Accepted Answer

Answer reason: After congenital heart surgery, transient low cardiac output syndrome can occur, so the medication is given to enhance forward flow and oxygen delivery to tissues. A key nursing teaching point is that the goal is improved circulation and organ perfusion, which is reflected clinically by improved blood pressure, capillary refill, mental status, and urine output. Options suggesting decreased contractility or decreased urine output contradict dopamine’s expected hemodynamic and perfusion effects; decreased heart rate is not the primary therapeutic intent and tachycardia can occur as an adverse effect.

Question 44

Timolol maleate (Timoptic) is ordered for a client with a diagnosis of open-angle glaucoma. The nurse knows this medication reduces intraocular pressure through which expected action?

Accepted Answer

Answer reason: Timolol is a nonselective beta-adrenergic blocker that lowers intraocular pressure primarily by decreasing aqueous humor formation by the ciliary body. In open-angle glaucoma, reducing production is an effective way to decrease IOP when outflow is chronically impaired. An inflammation-reducing mechanism would point to corticosteroids/NSAIDs, which do not treat glaucoma’s elevated IOP and can sometimes worsen it. The other listed actions (antifibrinolytic, ocular analgesic) are unrelated to the pathophysiology of glaucoma and timolol’s pharmacodynamics.

Question 45

A client is admitted for minor injuries sustained in a motorcycle accident. The physician order reads: desmopressin acetate (DDAVP) 0.3 mcg/kg IV × 1 dose. The nurse knows this medication is ordered to manage the client’s?

Accepted Answer

Answer reason: Desmopressin increases endothelial release of von Willebrand factor and factor VIII, improving platelet adhesion and shortening bleeding time in responsive bleeding disorders. A single IV dose is commonly used peri-procedure or after minor trauma to reduce mucosal/soft-tissue bleeding in mild von Willebrand disease. It is not a treatment for DIC, where widespread consumption of clotting factors requires treating the underlying cause and targeted blood product support. It also does not treat sickle-cell anemia, and hemophilia B (Christmas disease, factor IX deficiency) does not respond because DDAVP does not raise factor IX levels.

Question 46

A client diagnosed with hypertensive crisis develops the following symptoms: headache, muscle twitching, chest pain, nausea, vomiting, and confusion. Which medication should the nurse administer?

Accepted Answer

Answer reason: These findings are most consistent with acute heavy metal toxicity, particularly lead, where neurologic symptoms (headache, confusion), GI distress (nausea/vomiting), and neuromuscular irritability can occur along with hypertension. The appropriate immediate therapy is chelation to bind circulating metal and enhance renal excretion. Calcium disodium EDTA is a standard chelator used for significant lead poisoning and related symptomatic presentations. The other options treat different toxicologic emergencies (cyanide or organophosphates) or support cardiac output rather than addressing the underlying cause.

Question 47

A client with acquired immunodeficiency syndrome has developed Pneumocystis carinii pneumonia and has begun treatment with pentamidine isethionate (Pentam). Based on the diagnosis and treatment, the nurse determines that treatment is appropriate when the physician's order includes which medication?

Accepted Answer

Answer reason: An order including co-trimoxazole aligns with standard therapy choices for this opportunistic infection and indicates appropriate antimicrobial coverage. Amphotericin B and fluconazole are antifungals used for candidiasis/cryptococcosis rather than Pneumocystis. Sulfadiazine is typically paired with pyrimethamine for toxoplasmosis, not Pneumocystis pneumonia.

Question 48

The client with Raynaud’s disease is seen in a vascular clinic 6 weeks after nifedipine has been prescribed. The nurse evaluates that the medication has been effective when which findings are noted?

Accepted Answer

Answer reason: Raynaud’s disease involves episodic vasospasm of peripheral arteries, leading to ischemic symptoms such as pain, numbness, and color changes in fingers/toes, often triggered by cold or stress. Nifedipine (a dihydropyridine calcium channel blocker) reduces vasospasm by promoting peripheral vasodilation, so effective therapy is reflected by fewer/less severe ischemic symptoms. A normal blood pressure can occur with or without therapeutic benefit and does not specifically indicate improved digital perfusion. Improved heat tolerance and relief of intermittent claudication point to different problems (heat intolerance and peripheral arterial disease with exertional ischemia) rather than classic Raynaud symptom improvement.

Question 49

The client undergoing intensive chemotherapy for Hodgkin’s lymphoma (I-II) is hospitalized with fever and depressed immune system functioning. The nurse is administering filgrastim subcutaneously daily. Which laboratory value should the nurse monitor to determine the medication’s effectiveness?

Accepted Answer

Answer reason: The most direct lab marker of this therapeutic effect is the ANC, which reflects circulating neutrophil availability for host defense. Hemoglobin and platelet count assess erythropoiesis and thrombopoiesis, which are not the primary targets of G-CSF therapy. Reed-Sternberg cells relate to diagnostic pathology of Hodgkin lymphoma rather than monitoring response to a neutrophil-stimulating agent.

Question 50

The client diagnosed with acute myeloid leukemia receives a bone marrow transplant. Which medication to prevent grafiversus-host disease (GVHD) should the nurse plan to administer?

Accepted Answer

Answer reason: Calcineurin inhibitors reduce T-cell activation and cytokine production, making them standard agents used to prevent GVHD in transplant recipients. Antibiotics may be used for infection prophylaxis during neutropenia but do not prevent immune-mediated GVHD. Chemotherapy and interferon are not appropriate GVHD-prevention strategies in this setting and would not address the underlying donor-versus-host immune reaction.

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