Question 1

The parent of the 2—year—old with asthma has been given instructions about asthma control and Step Therapy. Which statement, if made by the parent, should indicate to the nurse that the parent has an adequate understanding of the instructions?

Accepted Answer

Answer reason:  Asthma step therapy escalates controller treatment when symptoms suggest inadequate control, particularly increased nighttime symptoms and more frequent impairment. Nighttime awakenings at least twice per month in a young child indicates persistent asthma and the need to step up to an inhaled corticosteroid and contact the provider to reassess the plan. Options that trigger stepping up when symptoms are already infrequent (twice a week or less, or needing a bronchodilator less than twice a week) describe well-controlled asthma and would not warrant adding a controller. A respiratory infection can worsen asthma, but stepping up is guided by the pattern of asthma control rather than infection alone without evidence of persistent symptoms.

Question 2

The initial treatment regimen of isoniazid, rifampin, and ethambutol is prescribed for the adolescent who has a positive tuberculin skin test. The client confides that she thinks she may be pregnant and asks if she should be taking these medications. Which rationale should be the basis for the nurse’s response?

Accepted Answer

Answer reason: The guiding principle in pregnancy is to balance fetal medication risk against the maternal–fetal danger of uncontrolled infection. Active or potentially active tuberculosis can lead to maternal morbidity and adverse fetal outcomes (e.g., low birth weight, preterm birth, and perinatal transmission), so effective therapy should not be delayed when treatment is indicated. Standard first-line TB drugs (excluding streptomycin, which is ototoxic to the fetus) are generally used in pregnancy when benefits outweigh risks, with close monitoring for hepatotoxicity. Withholding therapy until postpartum is unsafe because disease progression and infectiousness can worsen during the delay. Suggestions to terminate pregnancy or to postpone solely due to intrapartum hepatitis risk are not evidence-based as routine rationales for management.

Question 3

The nurse is preparing the child with CF for discharge to home. The nurse determines that the parent needs further education when the parent makes which statement?

Accepted Answer

Answer reason:  In cystic fibrosis, exocrine pancreatic insufficiency causes malabsorption, so pancreatic enzymes are prescribed to be taken with all meals and snacks to support digestion and weight gain. Appetite or the presence of a daily stool does not reliably indicate adequate fat absorption; enzymes are still needed to prevent steatorrhea, poor growth, and fat-soluble vitamin deficiencies. Holding enzymes based on these observations reflects misunderstanding of the medication’s purpose and expected outcomes. By contrast, routine airway clearance and infection avoidance strategies are appropriate ongoing home-care measures in CF.

Question 4

The mother asks the nurse why the anticonvulsant valproic acid is being prescribed for her adolescent who is beginning therapy for control of aggressive behaviors. The nurse’s response is based on the fact that valproic acid is helpful in reducing manic and impulsive behavior by what mechanism of action?

Accepted Answer

Answer reason: Enhancing GABA activity reduces neuronal excitability, which helps blunt manic symptoms such as impulsivity, irritability, and aggression. This mechanism aligns with its anticonvulsant effects, where dampening excessive firing is therapeutic. In contrast, dopamine receptor blockade is the primary mechanism of antipsychotics rather than valproate, making that option a common but incorrect distractor.

Question 5

The severely depressed client tells the nurse, “I don’t need these antidepressants; they’re too expensive! I’m going to use St. John’s wort instead.” Which is the most appropriate response by the nurse?

Accepted Answer

Answer reason: “St. John’s wort may cost less, but it has not been shown to improve severe depression.” In severe depression, the priority is maintaining evidence-based treatment efficacy and reducing risk of deterioration, including suicidality. This response provides clear, accurate education about expected treatment outcomes without endorsing an unproven substitute, supporting informed decision-making. It also avoids recommending potentially dangerous combinations; St. John’s wort can interact with antidepressants and increase the risk of serotonin syndrome or reduce drug effectiveness via enzyme induction. The other options either falsely reassure safety, encourage unsafe concurrent use, or inappropriately promote the herbal product.

Question 6

A 14-year-old client sustained a femoral fracture and is in a hip-spica cast. The client has been on bed rest and has not had a bowel movement for 3 days. The physician has ordered Colace (docusate) 100 mg by mouth twice daily. The client asks the nurse, “What is this medication for?” What is the best response by the nurse?

Accepted Answer

Answer reason:  Docusate is a stool softener (surfactant) that promotes mixing of water and fats into stool to reduce surface tension, making stool softer and easier to pass—useful for constipation risk with immobility and a hip-spica cast. It is not an osmotic laxative, which works by drawing water into the bowel lumen. It also does not stimulate intestinal nerve plexuses like stimulant laxatives, which increase peristalsis by irritation. It is distinct from bulk-forming agents that increase stool mass to trigger peristalsis and generally require adequate fluid intake.

Question 7

A 24-year-old male enters the emergency department with a chief complaint of seizure activity that lasted approximately 45 seconds. The client’s vital signs are blood pressure 118/64 mm Hg, pulse 84 beats/minute, respiratory rate 16 breaths/ minute, and pulse oximeter reading of 100% on room air. The client has a past medical history of tonic-clonic seizures. Due to loss of employment for the past 2 weeks, the client has not taken antiseizure medication. Which medication should the nurse administer to this client?

Accepted Answer

Answer reason: A breakthrough generalized tonic-clonic seizure after nonadherence requires prompt re-establishment of antiseizure therapy to prevent recurrence and progression to status epilepticus. Fosphenytoin is an IV/IM prodrug of phenytoin used for acute loading when rapid therapeutic anticonvulsant levels are needed and oral intake/adherence is unreliable. The other options do not treat seizures: furosemide is a loop diuretic, fosinopril is an ACE inhibitor, and famotidine is an H2 blocker. After administration, the nurse should closely monitor for cardiac dysrhythmias/hypotension during infusion and ensure appropriate transition back to maintenance antiepileptic therapy.

Question 8

A 24-year-old female client is admitted for an elective cholecystectomy. The client is complaining of a severe, pounding headache and vomiting. Vital signs are blood pressure 136/88 mm Hg, pulse 86 beats/minute, respiratory rate 20 breaths/minute, temperature 99.6F, and pulse oximetry 96% on room air. The client has a history of migraine headaches, hypertension, and fibromyalgia. The nurse expects the physician will order which medication for this client?

Accepted Answer

Answer reason: Acute migraine treatment is aimed at aborting the attack and relieving associated nausea/vomiting; triptans are first-line migraine-specific agents when no major contraindications exist. This client’s presentation (severe pounding headache with vomiting and a migraine history) fits an acute migraine attack, and subcutaneous dosing provides rapid onset when oral intake is limited by vomiting. Her blood pressure is not severely elevated, making immediate antihypertensive rescue therapy an unlikely priority for this symptom pattern. The other options treat unrelated conditions (viral infection, hyperthyroidism) or are not appropriate as an acute migraine abortive therapy in this context.

Question 9

A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?

Accepted Answer

Answer reason: Initial management of juvenile idiopathic arthritis commonly begins with anti-inflammatory symptom control to reduce pain, stiffness, and functional limitation while further therapy is tailored to subtype and severity. NSAIDs are a standard first-line option because they address inflammation and improve mobility, often used before or alongside DMARDs/biologics when disease activity warrants escalation. Many children do not progress to adult rheumatoid arthritis, and prognosis varies widely with some achieving remission, making broad statements about inevitable deformity inaccurate. Activity is generally encouraged with appropriate balancing of rest and physical therapy to preserve joint range of motion and muscle strength, rather than being minimized.

Question 10

A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following?

Accepted Answer

Answer reason: In ventricular tachycardia, the immediate management depends on whether the patient is stable (adequate perfusion, awake, acceptable blood pressure) or unstable. An awake, alert client with good skin color suggests perfusing (stable) VT, for which antiarrhythmic therapy is appropriate to terminate or suppress the rhythm while ongoing assessment continues. IV amiodarone is a standard antiarrhythmic used for monomorphic VT with a pulse, especially when the patient is not crashing. Defibrillation is prioritized for pulseless VT/VF or unstable VT, and epinephrine is primarily used during cardiac arrest algorithms rather than stable VT with a pulse.

Question 11

A nurse is caring for a 32-year-old client at 36 weeks' gestation who has been diagnosed with severe preeclampsia. The client's blood pressure is 168/112 mmHg, she reports a persistent headache, and her reflexes are hyperactive. The nurse anticipates the provider will prescribe which medication to control the client's blood pressure?

Accepted Answer

Answer reason: An IV antihypertensive commonly used in pregnancy for acute control is a beta/alpha-blocker with a favorable safety profile in this setting. Magnesium sulfate is used for seizure prophylaxis (and treatment) in preeclampsia/eclampsia rather than primary blood pressure control. Oxytocin and methylergonovine are uterotonics for labor/hemorrhage management; methylergonovine can worsen hypertension and is contraindicated in preeclampsia.

Question 12

A nurse is caring for a client who is prescribed warfarin sodium (Coumadin) for deep vein thrombosis (DVT) prophylaxis. Which of the following statements by the client indicates a need for further teaching?

Accepted Answer

Answer reason: " Warfarin works by inhibiting vitamin K–dependent clotting factor synthesis, so increased dietary vitamin K can reduce the medication’s anticoagulant effect and lower the INR. Teaching focuses on keeping vitamin K intake consistent rather than intentionally increasing (or suddenly decreasing) foods high in vitamin K such as green leafy vegetables. The other statements reflect appropriate safety behaviors: minimizing bleeding risk, taking the drug consistently, and promptly reporting bleeding/bruising. A common error is believing vitamin K should be boosted while on therapy, when in fact stable intake is key to predictable anticoagulation.

Question 13

The nurse has taught a client who is receiving newly prescribed butabarbital. Which of the following statements by the client would require follow-up?

Accepted Answer

Answer reason: ” Barbiturates are central nervous system depressants used for sedation/hypnosis, so the expected effect is drowsiness and decreased alertness rather than increased wakefulness. This statement signals misunderstanding of intended therapeutic action and raises safety concerns (e.g., driving, falls) if the client anticipates stimulation. The other statements reflect accurate teaching: abrupt discontinuation after regular use can cause withdrawal, overdose can cause life-threatening respiratory depression, and tolerance can develop with repeated dosing. Therefore, the client’s expectation of feeling more awake requires follow-up and re-teaching.

Question 14

A client with a history of heart failure calls the clinic and reports a 3-lb (1.4-kg) weight gain over the past 2 days and increased ankle swelling. The nurse reviews the client's medications and anticipates the immediate need for dosage adjustment of which medication?

Accepted Answer

Answer reason: Loop diuretics provide the fastest symptomatic relief by promoting natriuresis and diuresis, so their dose is commonly adjusted promptly based on daily weights and edema. Bumetanide is a loop diuretic and directly targets the immediate problem of volume overload. In contrast, candesartan and carvedilol are disease-modifying therapies that are not titrated urgently for sudden edema and may be held or adjusted cautiously if decompensation is significant, while isosorbide primarily reduces angina/preload but does not reliably correct volume overload.

Question 15

The primary healthcare provider (PHCP) is preparing to intubate a client. The PHCP prescribes succinylcholine. The nurse understands that this medication is intended to?

Accepted Answer

Answer reason: Succinylcholine is a depolarizing neuromuscular blocking agent used to rapidly produce short-term paralysis to facilitate endotracheal intubation. It acts at nicotinic acetylcholine receptors at the neuromuscular junction, preventing effective skeletal muscle contraction including the diaphragm. It does not provide sedation or analgesia, so a separate sedative/induction agent is required. Decreasing secretions and treating vagal bradycardia are roles of anticholinergics (e.g., atropine or glycopyrrolate), not this medication.

Question 16

A client with a history of chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at a flow rate of 2 liters per minute via nasal cannula. The client reports increased shortness of breath and anxiety. The nurse assesses the client and notes increased respiratory rate, use of accessory muscles, and oxygen saturation of 88%. Which of the following actions should the nurse take?

Accepted Answer

Answer reason: A short-acting bronchodilator rapidly decreases airway resistance, improves expiratory flow, and can raise oxygenation while reducing work of breathing and anxiety. Increasing oxygen flow may be needed but does not treat the underlying bronchoconstriction and can risk worsening hypercapnia if done indiscriminately in COPD. Semi-Fowler’s positioning is supportive but insufficient alone for this degree of distress, and intubation is reserved for impending respiratory failure after less invasive measures are attempted.

Question 17

Which clinical manifestation indicates to the nurse that a patient being treated with donepezil for dementia is experiencing a positive outcome?

Accepted Answer

Answer reason: Cholinesterase inhibitors increase central acetylcholine and are used to modestly improve or stabilize cognition and function in Alzheimer-type dementia rather than reverse disease. A positive treatment response is therefore reflected as better overall cognition (e.g., attention, orientation, thinking) compared with baseline. Expecting rapid or “accelerated” restoration of long-term memory is unrealistic because these agents do not regenerate neurons or cure dementia. Functional gains like self-care can occur, but they are downstream and less direct than the core intended outcome of improved cognition.

Question 18

The nurse has taught a client with anemia who is receiving ferrous sulfate. Which of the following statements by the client would indicate a correct understanding of the teaching?

Accepted Answer

Answer reason: ” Oral iron is absorbed best on an empty stomach, so taking it between meals improves absorption and supports correction of iron-deficiency anemia. Black or green stools are an expected, harmless effect of iron therapy and do not require notifying the provider unless accompanied by other concerning symptoms (e.g., GI bleeding signs). Antacids can decrease iron absorption by raising gastric pH and should be separated from iron dosing. Liquid iron is typically diluted (often in water or juice) and taken through a straw to reduce tooth staining rather than taken undiluted.

Question 19

The nurse is caring for a client with angle-closure glaucoma. Which prescription should the nurse anticipate from the primary healthcare provider?

Accepted Answer

Answer reason: A carbonic anhydrase inhibitor lowers aqueous humor production, providing prompt intraocular pressure reduction while definitive measures are arranged. In contrast, anticholinergic or sympathomimetic agents can precipitate or worsen angle closure by causing pupillary dilation and narrowing the iridocorneal angle. Tricyclic antidepressants and first-generation antihistamines have anticholinergic properties and are therefore unsafe in this setting, making them poor choices compared with a pressure-lowering medication.

Question 20

The clinic nurse cares for a 49-year-old client who reports dyspareunia and vaginal discomfort, dryness, and itching. The client denies having a menstrual cycle for the past 1.5 years. Which of the following prescriptions should the nurse anticipate?

Accepted Answer

Answer reason: Local estrogen therapy restores vaginal epithelium thickness and lubrication, improving symptoms and reducing tissue fragility. A SERM like raloxifene is used primarily for osteoporosis risk reduction and does not reliably relieve vaginal atrophy symptoms and can worsen hot flashes. Antifungal therapy (miconazole) or topical steroid (hydrocortisone) would be indicated for candidiasis or inflammatory dermatoses, which are not the primary pattern suggested by 18 months of amenorrhea and classic atrophic symptoms.

Question 21

A client is afraid of receiving vitamin B12 injections because of potential toxic reactions. Which is the nurse's best response to relieve these fears?

Accepted Answer

Answer reason: " Water-soluble vitamins have low risk of accumulation because excess amounts are typically excreted, so true dose-related toxicity is uncommon compared with fat-soluble vitamins. This directly addresses the client’s fear by explaining why toxic reactions are not expected with vitamin B12 injections. The other responses either introduce inaccurate “warning signs” of toxicity or shift attention to minor side effects without reassuring about the core concern of toxicity. A balanced response should acknowledge that minor reactions can occur while emphasizing that systemic toxicity is unlikely with this vitamin.

Question 22

The nurse in the GI lab is providing moderate sedation on a client undergoing a colonoscopy. Administration of midazolam and fentanyl is given. Which of the following desired effects does the nurse expect with the use of moderate sedation?

Accepted Answer

Answer reason: Midazolam, a benzodiazepine, commonly produces sedation and anterograde amnesia, so the patient has little to no memory of the procedure. This is a desired effect in endoscopy when combined with fentanyl for analgesia. Loss of gag reflex and complete immobility/complete analgesia are features more consistent with deep sedation or general anesthesia and represent increased airway and respiratory risk.

Question 23

A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. Which statement made by the student would require intervention by the nurse?

Accepted Answer

Answer reason: "Sucralfate acts locally by coating the ulcer base, and it can bind to other medications in the GI tract, reducing their absorption and therapeutic effect. Because of this interaction risk, it should be taken on an empty stomach and separated from other oral drugs (commonly by at least 2 hours). Telling the client to take it with other stomach medications can make concurrent therapies less effective, especially acid-suppressing agents or other oral medications taken for GI symptoms. The other statements are consistent with key teaching: take before meals, separate from other important meds like cardiac drugs, and anticipate constipation as a common adverse effect.

Question 24

A nurse is caring for a client who is receiving heparin therapy. Which laboratory value should the nurse monitor?

Accepted Answer

Answer reason: Unfractionated heparin potentiates antithrombin and primarily affects the intrinsic and common coagulation pathways, so therapy is titrated to a target anticoagulation range using aPTT (or anti-Xa where used). Monitoring this value helps ensure the infusion is therapeutic while minimizing bleeding risk. PT/INR are used to monitor warfarin effect, not heparin, so they are less appropriate for dose adjustment. Platelet count is important to detect heparin-induced thrombocytopenia, but it does not measure anticoagulant intensity for heparin titration.

Question 25

A 45-year-old male client with a history of hypertension and type 2 diabetes mellitus is admitted to the hospital for chest pain and shortness of breath. The client is diagnosed with acute myocardial infarction (AMI) and is prescribed various medications including aspirin, metoprolol, lisinopril, and atorvastatin. The client asks the nurse about the purpose of each medication. Which of the following response should the nurse make?

Accepted Answer

Answer reason: " ACE inhibitors reduce angiotensin II formation, causing vasodilation and decreased afterload/preload, which lowers myocardial oxygen demand after an MI. This supports improved forward blood flow and decreases the heart’s workload, aligning with post-AMI cardioprotective goals. The aspirin statement is inaccurate because its key role in AMI is antiplatelet therapy to prevent further thrombus formation, not analgesia. The metoprolol option is incorrect because beta-blockers do not dissolve clots, and the atorvastatin option is incorrect because statins primarily lower LDL and stabilize plaques rather than controlling heart rate or rhythm.

Question 26

The nurse has taught a client with newly diagnosed gastroesophageal reflux disease. Which of the following statements by the client demonstrates understanding of the teaching?

Accepted Answer

Answer reason: GERD management relies on consistent acid suppression to promote esophageal healing and prevent recurrent symptoms and complications. Proton pump inhibitors are most effective when taken regularly as prescribed (often before meals) rather than only when discomfort occurs. This statement reflects adherence to a preventive, scheduled regimen rather than symptom-driven use that can allow ongoing mucosal injury. A common misconception is using soothing measures like peppermint, which can relax the lower esophageal sphincter and worsen reflux.

Question 27

A nurse is caring for a client who is diagnosed with tuberculosis. To achieve the desired outcome, which is the best nursing action?

Accepted Answer

Answer reason: Tuberculosis treatment requires prolonged multidrug therapy to eradicate the organism and prevent relapse and transmission. Missed doses promote treatment failure and the development of drug-resistant TB, which is harder to cure and increases public health risk. Nursing teaching that emphasizes strict adherence (often via directly observed therapy when indicated) most directly supports the desired outcome of cure and reduced infectivity. The other options do not address the core determinant of TB outcomes; for example, frequent exercise is not a priority during acute illness and does not prevent resistance.

Question 28

The client is taking rifampin 600mg po daily to treat his tuberculosis. Which action by the nurse indicates understanding of the medication?

Accepted Answer

Answer reason: This counseling helps prevent unnecessary alarm and improves adherence to the TB regimen. Taking rifampin “with juice” is not a key teaching point; the major administration guidance is typically to take it on an empty stomach when possible and to monitor for hepatotoxicity and drug interactions. Instructing use only “if night sweats occur” implies PRN use, which is unsafe because TB therapy requires strict daily adherence to prevent resistance.

Question 29

A patient is asking the nurse about her medications. The patient states “I don’t understand why I need to take two of these pills to help me pee – my kidneys work fine.” The nurse sees the patient is prescribed spironolactone and furosemide. The nurse understands that?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that provides strong natriuresis/diuresis for rapid fluid removal. Spironolactone is a potassium-sparing aldosterone antagonist that promotes mild diuresis while counteracting potassium loss and maladaptive aldosterone effects seen in heart failure. Using them together targets different nephron sites and improves fluid management while reducing the risk of loop-diuretic–induced hypokalemia. The statement that loop diuretics are “not potent enough” is incorrect, and needing two diuretics is not a universal rule; therapy is individualized.

Question 30

The nurse has instructed a client scheduled for an injection of dulaglutide for diabetes mellitus (type two). Which of the following statements by the client would require follow-up?

Accepted Answer

Answer reason: " Dulaglutide is a GLP-1 receptor agonist administered as a once-weekly injection and is not timed to meals like rapid-acting prandial insulin. Meal-dependent timing implies an incorrect understanding of its administration and could lead to unnecessary dosing errors or confusion about when to inject. New or severe abdominal pain with vomiting is an important warning sign for possible pancreatitis and should be reported promptly, reflecting correct teaching. Efficacy is appropriately monitored by improvement in HbA1c over time, and weekly dosing is the correct schedule.

Question 31

A client with obesity has just started taking orlistat. Which statement by the client indicates a need for further teaching?

Accepted Answer

Answer reason: " Orlistat inhibits gastrointestinal lipases, reducing fat absorption and also decreasing absorption of fat-soluble vitamins (A, D, E, K). Because of this interaction, multivitamins should be taken at least 2 hours apart (often at bedtime) rather than at the same time as the medication dose. The other statements reflect appropriate teaching: common adverse GI effects are expected, a low-fat diet reduces side effects, and dosing is tied to fat-containing meals. Therefore this statement signals incorrect timing of supplementation and a need for further teaching.

Question 32

The nurse is caring for a client with diabetes who is being discharged with a prescription for glyburide. Which statement by the client indicates a need for further instruction?

Accepted Answer

Answer reason: " Sulfonylureas stimulate pancreatic insulin secretion, so a key expected outcome is improved glycemic control with a significant risk of hypoglycemia rather than weight loss. Increased circulating insulin commonly promotes weight gain, making this belief an unsafe misunderstanding of medication effects. Avoiding alcohol is appropriate because it can increase hypoglycemia risk and may contribute to disulfiram-like reactions with some sulfonylureas. Reading labels (including “sugarless”) supports carbohydrate management and recognizing that “sugar-free” products may still contain carbs, and reporting very low glucose reflects appropriate concern for hypoglycemia.

Question 33

The clinic nurse is reinforcing teaching to a client about levothyroxine, which the health care provider has prescribed for newly diagnosed hypothyroidism. Which statement made by the client indicates that further teaching is needed?

Accepted Answer

Answer reason: " Levothyroxine absorption is reduced by several agents that bind it or alter gastric pH, including antacids (especially those containing calcium, aluminum, or magnesium). Taking these together can lead to subtherapeutic thyroid hormone levels and persistent hypothyroid symptoms despite adherence. Clients should be taught to separate levothyroxine from antacids and other binding agents (e.g., calcium/iron) by several hours and to take it consistently on an empty stomach, typically in the morning. The other statements reflect appropriate teaching: monitoring labs for dose titration, likely long-term therapy, and once-daily morning dosing.

Question 34

Which medication should the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis?

Accepted Answer

Answer reason: This option reduces prostaglandin-mediated inflammation, improving both pain and stiffness and addressing the underlying inflammatory component of symptoms. Opioids like codeine or meperidine may reduce pain but do not treat inflammation and carry sedation/respiratory and dependence risks, so they are not preferred as initial therapy for chronic inflammatory arthritis. Alprazolam is an anxiolytic and has no direct analgesic or anti-inflammatory effect, making it inappropriate for RA pain control.

Question 35

The nurse cares for a client with metastatic pancreatic cancer. The nurse questions which approach for pain management with the healthcare provider (HCP)?

Accepted Answer

Answer reason: This option provides only PRN dosing for both agents, which risks uncontrolled persistent pain and repeated peaks/troughs rather than maintaining steady analgesia. It also uses two different short-acting opioids concurrently, increasing complexity and risk for dosing errors and additive opioid adverse effects without a clear benefit. In contrast, regimens that pair an extended/controlled-release opioid with an immediate-release opioid PRN better match evidence-based practice for chronic malignant pain.

Question 36

The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks "What is that for? I don't take it at home." Which reply by the nurse is most appropriate?

Accepted Answer

Answer reason: " Proton pump inhibitors reduce gastric acid secretion, which helps prevent stress-related mucosal injury and gastrointestinal bleeding in the immediate postoperative period. A client who does not take it at home may still receive it in the hospital for short-term ulcer prophylaxis when physiologic stress and other risk factors are present. The nausea/emptying statement describes a prokinetic effect and is not the mechanism of omeprazole. The antibiotic/infection statement is incorrect because acid suppression does not prevent infection and is not the purpose of this medication in this context.

Question 37

A client undergoing chemotherapy treatment for uterine cancer asks the nurse how chemotherapeutic medications work. Which statement made by the nurse is correct?

Accepted Answer

Answer reason: " Chemotherapy is designed to target cellular processes involved in rapid cell division, which is a hallmark of many cancers. Because these drugs are not perfectly selective, they also affect normal tissues with high turnover (e.g., bone marrow, GI mucosa, hair follicles), explaining common adverse effects like myelosuppression, mucositis, and alopecia. The DNA-focused statement is too narrow because not all antineoplastics work primarily by altering DNA structure; some act on mitotic spindles or other cell-cycle mechanisms. The statement about stimulating division is the opposite of the therapeutic goal, and “make the cancer cells weak” is imprecise and does not accurately describe the mechanism of action.

Question 38

A 27-year-old patient comes to the clinic because she has had insomnia for the past three months. She is prescribed zolpidem. The nurse is providing the patient with medication education. Which of the following statements made by the patient indicate the need for further education?

Accepted Answer

Answer reason: " Zolpidem is a non-benzodiazepine sedative-hypnotic used for insomnia, not an anxiolytic indicated for treating anxiety disorders. Teaching should emphasize its intended therapeutic effect (sleep initiation) and that using it for anxiety can promote inappropriate use and increased risk of adverse CNS depression. Appropriate patient education includes taking it immediately before bedtime and expecting possible next-day drowsiness due to residual sedation. It is also typically recommended for short-term management of insomnia because of risks such as dependence, tolerance, and complex sleep behaviors. Although uncommon, hypersensitivity reactions including angioedema can occur and should prompt urgent medical attention.

Question 39

The nurse is reinforcing teaching to a client being discharged on enoxaparin therapy following total knee replacement surgery. Which statement made by the nurse is most appropriate?

Accepted Answer

Answer reason: " Low-molecular-weight heparins commonly cause minor local injection-site reactions, and anticipatory guidance helps the client distinguish expected effects from dangerous bleeding. Mild bruising or redness can occur due to small capillary trauma and the anticoagulant effect, especially with repeated subcutaneous injections. Vitamin K dietary restrictions and routine PT/INR monitoring apply to warfarin, not enoxaparin. NSAIDs such as ibuprofen increase bleeding risk through platelet inhibition and should generally be avoided unless specifically approved by the prescriber.

Question 40

The nurse is providing care for a patient with cystic fibrosis. They can expect to administer which medication with the patient’s meals and snacks?

Accepted Answer

Answer reason: Pancreatic enzyme replacement must be taken with all meals and snacks so enzymes are present in the intestine when food arrives, improving digestion and nutrient absorption. Airway meds like dornase alfa and bronchodilators are timed around respiratory therapy rather than food intake. Antibiotics such as amoxicillin are given on an infection-driven schedule and are not routinely required with every meal/snack.

Question 41

The nurse is caring for a patient who is unconscious and has a blood glucose level of 24 mg/dL. Which medication should the nurse administer?

Accepted Answer

Answer reason: In an unconscious patient, oral therapies are contraindicated due to aspiration risk. Glucagon is appropriate when the patient cannot take oral carbohydrates and it increases blood glucose by stimulating hepatic glycogenolysis and gluconeogenesis, especially when IV access is not immediately available. D5W provides insufficient dextrose concentration for profound symptomatic hypoglycemia compared with IV dextrose bolus (e.g., D50W), and insulin would worsen the hypoglycemia.

Question 42

A 25 year old female client has recently been diagnosed with a seizure disorder. She was prescribed carbamazepine by the HCP. Which of the following statements by the client indicates further education is needed?

Accepted Answer

Answer reason: Pregnancy planning with carbamazepine requires prompt provider contact to balance seizure control with teratogenic risk, adjust dosing as needed, and ensure appropriate folic acid supplementation and monitoring rather than sudden discontinuation. Education should emphasize not stopping the medication without medical guidance and to notify the HCP immediately if pregnancy occurs or is planned. A common distractor is focusing only on fetal risk; uncontrolled maternal seizures can pose more immediate harm than a carefully managed medication regimen.

Question 43

The nurse is caring for a client with a peptic ulcer disease. Which medication should the nurse anticipate administering to provide gastric acid reduction?

Accepted Answer

Answer reason: Peptic ulcer disease treatment aims to reduce gastric acid secretion to promote mucosal healing and symptom relief. Proton pump inhibitors directly inhibit the H+/K+ ATPase in parietal cells, producing the most potent and sustained acid suppression among common antiulcer drug classes. This makes it the best choice when the question asks specifically for gastric acid reduction. Metoclopramide primarily increases GI motility and is not an acid-suppressing therapy, while misoprostol is mainly used for NSAID-induced ulcer prophylaxis rather than being the first-line general acid reducer.

Question 44

The nurse is caring for a client with type 2 diabetes. One hour after taking an oral diabetic drug, the client becomes nauseated and vomits. Which nursing intervention should be taken?

Accepted Answer

Answer reason: Vomiting shortly after taking an oral antidiabetic medication may prevent proper absorption, placing the client at risk for hyperglycemia rather than hypoglycemia. The safest action is to monitor blood glucose and assess for signs of elevated levels before taking further action. Option A risks overdosing if some medication was absorbed. Option B is premature without glucose data. Option C is less likely because the medication may not have been absorbed sufficiently to cause hypoglycemia.

Question 45

A client with deep vein thrombosis (DVT) is receiving a continuous infusion of unfractionated heparin. The client asks the nurse what the heparin is for. How should the nurse respond?

Accepted Answer

Answer reason: " Unfractionated heparin is an anticoagulant that inhibits clot propagation by enhancing antithrombin activity, thereby reducing further thrombin and factor Xa effects. Its primary therapeutic goal in acute DVT is to prevent extension of the existing thrombus and reduce the risk of additional thrombus formation while the body’s fibrinolytic system works. It does not directly dissolve an established clot, so describing it as dissolving the clot is inaccurate. Explaining the expected outcome in patient-centered terms supports understanding and adherence while remaining within nursing education scope.

Question 46

A nurse is providing patient education to a client who has been prescribed Metronidazole. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: Metronidazole can cause a disulfiram-like reaction when combined with alcohol due to impaired alcohol metabolism, leading to flushing, nausea/vomiting, tachycardia, and hypotension. Teaching should emphasize complete avoidance of all alcohol-containing beverages and products during therapy and for a period after the last dose because the interaction risk can persist. The 48-hour window is a standard safety recommendation to reduce the chance of adverse effects as the drug clears. Options allowing “moderation,” same-day separation, or limiting only hard liquor are unsafe because even small amounts of alcohol can trigger the reaction regardless of timing within the day or beverage type.

Question 47

A client, who is overweight and has diabetes, has a blood pressure of 148/92 mm Hg. The client's urinalysis reveals microalbuminuria. The client does not want to take drugs despite a family history of brain attack (cerebrovascular accident [CVA]). The correct response by a nurse is?

Accepted Answer

Answer reason: " Diabetes with hypertension and microalbuminuria indicates elevated cardiovascular and renal risk, so prompt BP control is needed to reduce stroke risk and slow progression of diabetic kidney disease. Medication therapy is recommended at this level of BP rather than delaying care for lifestyle changes alone, especially given evidence of target-organ involvement. Lifestyle interventions (weight loss, diet, exercise) remain essential but take time and are typically adjuncts, not substitutes, in higher-risk patients. Advising herbal products is unsafe due to variable efficacy and drug-herb interactions, and simply rechecking weekly fails to address an already abnormal BP with end-organ risk markers.

Question 48

A client with Parkinson's disease has been prescribed Selegiline. Which of the following statements by the client indicates a need for further teaching?

Accepted Answer

Answer reason: ” Selegiline is an MAO-B inhibitor used for symptom control in Parkinson disease and should be taken consistently as prescribed to maintain therapeutic benefit and avoid symptom worsening. Stopping antiparkinsonian therapy abruptly can lead to a significant return or worsening of motor symptoms and functional decline. Appropriate teaching includes taking it earlier in the day to reduce stimulant-like insomnia and recognizing dietary precautions related to tyramine to reduce hypertensive reactions. Therefore, the statement about stopping the medication at will reflects unsafe, incorrect understanding and requires further teaching.

Question 49

During a home visit to a client with chronic pyelonephritis, which nursing action is the highest priority?

Accepted Answer

Answer reason: The priority in managing chronic pyelonephritis is evaluating the effectiveness of antibiotic therapy, as ongoing infection can lead to kidney damage. Monitoring clinical response ensures that the treatment is working and allows timely intervention if it is not. Other actions are supportive but secondary.

Question 50

A client prescribed chemotherapy for breast cancer reports nausea, vomiting, and anorexia. Which prescribed medication that stimulates appetite while also treating nausea and vomiting should the nurse include in the client’s plan of care?

Accepted Answer

Answer reason: This medication is a cannabinoid that can reduce nausea and vomiting while stimulating appetite, which directly addresses both priority symptoms. Ondansetron and metoclopramide are effective antiemetics but do not reliably improve appetite, so they don’t meet the combined goal in the stem. Scopolamine is primarily for motion sickness/vestibular nausea and is not a typical choice for chemotherapy-related anorexia.

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