Question 1

A nurse is caring for a patient with opioid use disorder. The patient’s respiration rate is decreased, and their level of consciousness is altered. What should the nurse give this patient for opioid toxicity?

Accepted Answer

Answer reason: The priority treatment is a rapid-acting opioid antagonist that reverses these effects to restore ventilation and improve mental status. This option directly counteracts opioid receptor activity and is used emergently in suspected overdose, with repeat dosing and monitoring because its duration may be shorter than the opioid’s. A common distractor is the benzodiazepine antidote, which would not reverse opioid-induced hypoventilation and can delay appropriate treatment.

Question 2

The nurse is education a patient with Addison’s disease and is using the teach-back method to evaluate understanding. Which statement by the patient would be most concerning?

Accepted Answer

Answer reason:  Addison’s disease causes chronic adrenal insufficiency, so glucocorticoid (and often mineralocorticoid) replacement is lifelong and must not be stopped abruptly. Discontinuing steroids can precipitate adrenal crisis with severe hypotension, shock, hypoglycemia, and electrolyte disturbances, making this statement the highest safety concern. In contrast, dizziness on standing reflects expected orthostatic hypotension from low cortisol/aldosterone, and knowing the condition involves the adrenal glands indicates understanding. Muscle cramping can relate to electrolyte imbalance and is appropriate to report, but it is not as immediately dangerous as stopping prescribed steroid therapy.

Question 3

While caring for a patient with Addison’s disease, which order would be priority for the nurse to question?

Accepted Answer

Answer reason: Abruptly stopping steroid therapy can precipitate severe hypotension, hypoglycemia, and shock, making this order unsafe and the highest priority to question. In contrast, monitoring intake/output supports assessment for dehydration and electrolyte imbalance, which is appropriate. Labetalol may or may not be indicated depending on the patient’s blood pressure and comorbidities, but it is not inherently contraindicated by the diagnosis the way stopping replacement steroids is.

Question 4

A diabetic patient is scheduled for a dose of insulin. The nurse knows that a meal or snack is not required shortly after which insulin?

Accepted Answer

Answer reason: Insulin glargine is a long-acting basal insulin with minimal peak, intended to provide steady background coverage rather than cover a meal. Because it does not have a pronounced early peak, an immediate meal or snack is not routinely required solely due to its administration. By contrast, rapid-acting analogs and premixed insulins include components that act quickly and therefore need coordinated carbohydrate intake.

Question 5

A client with major depressive disorder is starting treatment with sertraline, an SSRI. Which statement by the nurse provides the most important information about this medication?

Accepted Answer

Answer reason: SSRIs have a delayed onset for antidepressant benefit because symptom improvement depends on downstream neuroadaptive changes rather than immediate neurotransmitter increases. Teaching the expected timeline supports adherence and reduces premature discontinuation when the client does not feel better right away. Stopping abruptly is unsafe and can cause discontinuation symptoms and relapse, so advising to stop when feeling better is incorrect. Dietary tyramine restrictions apply to MAOIs, not sertraline, and while serotonin syndrome is a serious risk, routine initial teaching priority is realistic expectations about onset and adherence.

Question 6

Nurse Karen is caring for an 8-year-old patient admitted with rheumatic fever. She needs to determine which clinical finding indicates that the patient should continue taking the salicylates prescribed at home?

Accepted Answer

Answer reason: Salicylates (e.g., aspirin) in acute rheumatic fever are primarily used for their anti-inflammatory and analgesic effects to treat migratory polyarthritis. Ongoing joint pain, swelling, and tenderness indicate persistent inflammation and a continued need for this therapy to control symptoms and reduce inflammatory burden. By contrast, chorea is managed with supportive care and sometimes anticonvulsants/other agents rather than salicylates, and the rash and subcutaneous nodules are not the main targets for salicylate therapy. Therefore, persistent polyarthritis is the clearest finding supporting continuation of the prescribed salicylate regimen at home.

Question 7

A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client?

Accepted Answer

Answer reason: Oral antidiabetic agents generally require some endogenous insulin production and/or improve insulin sensitivity to lower blood glucose. In type 1 diabetes, autoimmune beta-cell destruction leads to an absolute insulin deficiency, so oral agents cannot replace the missing insulin. Therefore, a client with type 2 diabetes—who typically retains some beta-cell function—is the population in which these drugs can be effective. A common misconception is that oral medications can substitute for insulin in type 1 diabetes; however, insulin therapy remains essential to prevent hyperglycemia and ketoacidosis.

Question 8

A 68-year-old male client with a history of hypertension and angina pectoris experiences sudden crushing chest pain radiating down his left arm at rest. He reports the pain started 5 minutes ago and is at 7 on a pain scale of 0-10. The nurse understands the role of medications in managing this condition. Which of the following medications would the nurse administer FIRST to address this acute episode?

Accepted Answer

Answer reason: Acute angina requires rapid reduction of myocardial oxygen demand and improved coronary perfusion to relieve ischemic chest pain. Sublingual nitroglycerin has a fast onset and provides venodilation (reducing preload) and coronary vasodilation, making it the priority first-line medication for immediate symptom relief. Oral metoprolol may be used for longer-term rate and blood pressure control but has slower onset and is not the immediate first action for acute pain relief. Digoxin targets rate control/contractility in certain dysrhythmias/heart failure, and warfarin is for anticoagulation; neither treats acute ischemic chest pain.

Question 9

A 58-year-old female client with a history of chronic obstructive pulmonary disease (COPD) is admitted to the medical unit following a deep vein thrombus (DVT) in her left leg. The nurse anticipates which medication to be prescribed for this client?

Accepted Answer

Answer reason: This medication is an oral vitamin K antagonist used for longer-term anticoagulation after a DVT, typically following initial parenteral anticoagulation. The other options do not treat venous thrombosis: digoxin is for rate control/heart failure, and metoprolol is a beta-blocker for hypertension/arrhythmias. Thrombolysis (e.g., alteplase) is reserved for select severe cases with high risk/limb-threatening thrombosis or massive PE due to significant bleeding risk, not routine uncomplicated DVT management.

Question 10

What assessment would be most important for the nurse to monitor after initiating valproic acid therapy?

Accepted Answer

Answer reason: Ongoing assessment after starting a mood stabilizer should focus on the intended therapeutic outcome and early signs of clinical response or deterioration. Valproic acid is commonly initiated for acute mania, so monitoring thought process, agitation, sleep, impulsivity, and overall behavioral control best demonstrates whether therapy is working and guides safe titration. The other options do not reflect the primary monitoring priorities for this medication: it is not typically associated with dysrhythmias or hyperglycemia as key nursing monitoring needs. While serious adverse effects like hepatotoxicity or pancreatitis are important to watch for, those are not represented among the provided choices, making mental-status effectiveness monitoring the best answer here.

Question 11

A nurse is providing discharge instructions to a client prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following statements by the nurse is most appropriate?

Accepted Answer

Answer reason:  SSRIs typically require several weeks for clinically meaningful antidepressant effects because adaptive changes in serotonin signaling take time. Teaching the client to continue therapy supports adherence and reduces relapse risk from premature discontinuation. Stopping when mood improves is unsafe because symptoms can return and withdrawal-like effects can occur if the drug is stopped abruptly. It is also inaccurate to promise immediate relief, and early therapy can cause sedation or impaired alertness in some clients, so safety counseling should be cautious rather than endorsing immediate heavy machinery operation.

Question 12

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement?

Accepted Answer

Answer reason: Tamoxifen is a selective estrogen receptor modulator used primarily in estrogen receptor–positive breast cancer, including metastatic disease, and it is also used for risk reduction in high-risk individuals. The client’s question is about whether it is appropriate for a different cancer type, and the safest accurate teaching is to describe the established indications rather than suggesting broad or off-label use. Stating it is only for treatment of breast cancer is too absolute because it is also used for prevention/risk reduction in certain patients. Telling the client it can be used for bladder cancer or for “anyone with cancer” is inaccurate and could lead to unsafe self-medication or inappropriate expectations.

Question 13

A diagnosis of latent tuberculosis has been made. The nurse should expect that the client would need?

Accepted Answer

Answer reason: Preventive therapy (classically isoniazid- or rifamycin-based regimens) is recommended to reduce the future risk of developing active, contagious TB, especially in higher-risk clients such as those who are immunosuppressed. Hospital transfer and isolation are generally reserved for suspected or confirmed active pulmonary TB with infectious risk, not latent infection. A repeat Mantoux in 2–3 weeks is used to detect a boosted reaction in some screening contexts, but it is not the expected next step once latent TB has already been diagnosed.

Question 14

A client with urinary tract infection (UTI) is prescribed phenazopyridine. Which instruction would the nurse give the client?

Accepted Answer

Answer reason: Phenazopyridine is a urinary tract analgesic that provides symptomatic relief (dysuria, urgency) but does not eradicate the bacteria causing the UTI. A key expected effect is orange/red discoloration of urine, which can also stain undergarments or contact lenses, so anticipatory guidance prevents alarm and improves adherence. Taking it with food is typically advised to reduce GI upset, making the “before meals” instruction inaccurate. It should not be saved for self-treatment of future UTIs because it can mask symptoms and delay needed evaluation and antibiotics.

Question 15

The client with a duodenal ulcer asks the nurse why an antibiotic is part of the treatment regimen. Which information should the nurse include in the response?

Accepted Answer

Answer reason: The key principle is that eradication of the underlying cause reduces ulcer recurrence and promotes healing. A large proportion of duodenal ulcers are associated with H. pylori infection, so antibiotics are included to eliminate the organism as part of combination therapy (with acid suppression). This targets the pathophysiology rather than treating a nonspecific “secondary infection.” Attempts to “sterilize the stomach” are inaccurate because normal flora and continual exposure prevent true sterilization, and C. difficile is more commonly a complication of antibiotic use than a cause of peptic ulcers.

Question 16

Diltiazem is prescribed for a client with chronic, stable angina. Which statement by the client indicates to the clinic nurse that the client needs additional medication information?

Accepted Answer

Answer reason: Diltiazem (a non-dihydropyridine calcium channel blocker) primarily causes bradycardia, hypotension, dizziness, edema, and possible worsening heart failure, rather than dose-titration–related changes in mental status. Reporting shortness of breath is appropriate because it can signal heart failure exacerbation or significant negative inotropy. Rising slowly is appropriate teaching due to risk of orthostatic hypotension and dizziness. Taking doses consistently (often with food if GI upset occurs) can be acceptable; the concerning misunderstanding is expecting altered mental alertness as a typical adjustment effect.

Question 17

A client has an as-needed prescription for ondansetron. For which condition(s) should the nurse administer this medication?

Accepted Answer

Answer reason: Ondansetron is a selective 5-HT3 receptor antagonist used to prevent and treat nausea and vomiting, including postoperative and chemotherapy-related symptoms. Giving it PRN is appropriate when the client reports nausea or is actively vomiting to reduce emesis and improve oral intake and comfort. It does not treat pain, urinary retention, or bowel motility failure. In fact, constipation is a known adverse effect, so it would not be used to manage paralytic ileus.

Question 18

Which client statement related to Vancomycin indicates a need for further instruction?

Accepted Answer

Answer reason: This statement incorrectly reverses those definitions, indicating misunderstanding of what the trough represents. For drugs like vancomycin, incorrect beliefs about trough meaning can lead to improper timing of blood draws and unsafe dosing adjustments. A common correct teaching point is that trough sampling is obtained just prior to the next scheduled dose to ensure adequate minimum therapeutic concentration without toxicity.

Question 19

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is?

Accepted Answer

Answer reason: Warfarin effect is assessed by the degree PT is prolonged compared with control (or by INR), with a typical therapeutic goal around 1.5–2 times the control value for many thromboembolic indications. A PT of 20 seconds with a control of 11 seconds is about 1.8 times control, consistent with therapeutic anticoagulation. This level suggests adequate protection against clot extension/embolization without clearly indicating excessive anticoagulation. A markedly higher ratio would raise concern for bleeding risk, whereas a near-control PT would suggest under-anticoagulation.

Question 20

The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy?

Accepted Answer

Answer reason: ” H2-receptor antagonists decrease gastric acid secretion by blocking histamine-2 receptors on parietal cells, which reduces acidity and supports ulcer healing. This statement accurately describes the therapeutic effect expected from cimetidine in peptic ulcer disease. Sucralfate primarily forms a protective barrier over the ulcer base rather than “changing stomach fluid,” and antacids mainly neutralize existing acid rather than coating the stomach. Omeprazole is a proton pump inhibitor that suppresses acid production; it does not directly coat the ulcer.

Question 21

SITUATION: Enalapril (Vasotec) has been prescribed to a client diagnosed with heart failure. The nurse should explain to the client that this drug is an angiotensin-converting enzyme inhibitor that works to improve the cardiac output primarily by?

Accepted Answer

Answer reason: ACE inhibitors block conversion of angiotensin I to angiotensin II, lowering systemic vascular resistance and afterload so the failing left ventricle can eject blood more effectively. Reduced afterload (and some reduced preload via decreased aldosterone) increases forward flow and improves cardiac output without increasing myocardial oxygen demand. This mechanism is best captured by vasodilation of systemic (and to a lesser degree coronary) vessels. In contrast, increasing contractility is the action of inotropes, not ACE inhibitors.

Question 22

SITUATION: A client admitted to the hospital was diagnosed with congestive heart failure and is scheduled to be discharged. The doctor prescribed furosemide (Lasix) and digoxin (Lanoxin). Which of the following indicators would determine that the medications do not have a therapeutic effect?

Accepted Answer

Answer reason: A rapid gain of 1–2 kg over a few days indicates significant fluid retention (roughly 1 L per kg), suggesting ongoing congestion despite therapy. This finding is a key discharge self-monitoring red flag that the loop diuretic is not achieving the desired effect and the overall regimen is not controlling volume status. In contrast, urine output of 1.5–2 L/day is consistent with adequate diuretic response, and appetite is not a primary therapeutic endpoint for these medications.

Question 23

Based on the food list that the client usually eats, which of the following foods should the nurse instruct the client that is safe to consume while on phenelzine?

Accepted Answer

Answer reason: Aged cheeses and cured/processed meats are high in tyramine due to fermentation/aging and are therefore unsafe. Plain wheat breads are not a significant tyramine source and are generally permitted on an MAOI diet. A common pitfall is focusing on “healthy vs unhealthy” foods rather than identifying aged/fermented items that raise tyramine levels.

Question 24

SITUATION: A nurse is teaching a client who has been prescribed levothyroxine (Synthroid) for hypothyroidism. Which of the following statements by the client indicates a need for further teaching?

Accepted Answer

Answer reason: " Levothyroxine replacement has a delayed clinical effect because normalization of metabolic rate and tissue response occurs gradually as thyroid hormone levels and downstream gene transcription equilibrate. While some improvement can begin within 1–2 weeks, full symptom relief commonly takes several weeks, and TSH often takes about 6–8 weeks to stabilize after dose changes. Expecting a noticeable boost in only a few days reflects unrealistic expectations and can lead to premature self-discontinuation or dose misuse. The other statements align with key teaching: take on an empty stomach for absorption, report signs of excessive dose (e.g., tachycardia/angina), and anticipate long-term therapy for chronic hypothyroidism.

Question 25

The client who is human immunodeficiency virus seropositive has been taking saquinavir (Invirase). The nurse provides medication instructions and advises the client to?

Accepted Answer

Answer reason: Saquinavir, a protease inhibitor, should be taken with food to enhance absorption and ensure therapeutic drug levels. Taking it on an empty stomach reduces effectiveness. While protease inhibitors can cause metabolic effects such as hyperlipidemia, dietary modifications are not the primary medication instruction. Other options are incorrect because saquinavir is not taken before meals, does not commonly require photosensitivity precautions, and weight gain is not a predictable or appropriate counseling point.

Question 26

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates that he understood your instructions about their treatment regimen?

Accepted Answer

Answer reason: Pernicious anemia is due to autoimmune loss of intrinsic factor, causing impaired intestinal absorption of cobalamin and requiring parenteral replacement. Standard management is a loading phase with frequent injections followed by long-term (often lifelong) maintenance dosing to prevent recurrence of megaloblastic anemia and neurologic complications. A fixed “every 6 months then done” plan is unsafe because the underlying absorption problem persists. Waiting until symptoms return before receiving injections indicates misunderstanding and risks irreversible neurologic injury.

Question 27

A nurse is caring for a client who was prescribed an antidepressant based on its ability to prevent the reuptake of neurotransmitters. The nurse should identify that which of the following terms describes why this drug was prescribed to the client?

Accepted Answer

Answer reason: Preventing the reuptake of neurotransmitters (e.g., serotonin and/or norepinephrine) explains how the medication produces symptom improvement. This property describes what the drug does in the body, which is the pharmacological action. Route and chemical stability do not explain the therapeutic rationale, and adverse effects describe undesirable outcomes rather than the intended benefit.

Question 28

A nurse is teaching a client who is beginning fluticasone propionate/salmeterol therapy. Which of the following instruction should the nurse include?

Accepted Answer

Answer reason: Inhaled corticosteroid–containing therapies can contribute to decreased bone mineral density with long-term use, so clients should be taught strategies that support bone health. Weight-bearing exercise helps maintain or improve bone density and is a practical preventive measure to reduce osteoporosis risk. This combination product is a maintenance controller and is not appropriate for immediate relief of acute bronchospasm, making the “as needed for acute asthma” instruction unsafe. Alternate-day dosing is not used with inhaled controller combinations because consistent daily dosing is needed for control.

Question 29

Following the administration of sublingual nitroglycerin, which assessment finding indicates that the medication was effective?

Accepted Answer

Answer reason: The primary therapeutic goal in an acute angina episode is symptom relief, so a reduction in chest pain is the most direct indicator of effectiveness. Blood pressure typically decreases rather than increases, making that option inconsistent with expected effects. Breath sounds and urine output are not primary, immediate outcomes used to judge response to a sublingual dose for angina.

Question 30

The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose?

Accepted Answer

Answer reason: An opioid antagonist rapidly reverses these effects and is indicated when mental status declines toward coma and ventilation is at risk. Naloxone competitively displaces opioids at receptors, improving respiratory drive and level of consciousness within minutes. Atropine treats symptomatic bradycardia, vitamin K reverses warfarin-related coagulopathy, and flumazenil (Romazicon) reverses benzodiazepines rather than opioids. Because naloxone’s duration may be shorter than many opioids, close monitoring for re-sedation is required.

Question 31

The nurse is discharging a patient with asthma. As part of the discharge instruction, the nurse instructs the patient to prevent exacerbation by?

Accepted Answer

Answer reason: Asthma control depends on consistent use of controller therapy to suppress airway inflammation and prevent symptom flares. Adherence to the prescribed regimen reduces bronchial hyperresponsiveness and lowers the risk of exacerbations after discharge. Relying on symptom-driven dosing can delay anti-inflammatory treatment and allows inflammation to worsen before rescue therapy is used. Follow-up testing and activity limits may be appropriate for monitoring or recovery, but they do not directly prevent exacerbations as effectively as proper medication adherence.

Question 32

The nurse is caring for a pregnant client who is at 16 weeks gestation. She developed a pulmonary embolism and was initiated on heparin therapy two days ago. She is getting ready to be discharged. Which of the following medications do you expect the healthcare provider to order at discharge?

Accepted Answer

Answer reason: For outpatient treatment of pulmonary embolism in a stable pregnant client, LMWH is preferred due to predictable pharmacokinetics, lower risk of osteoporosis and heparin-induced thrombocytopenia than unfractionated heparin, and feasibility for home administration. Warfarin crosses the placenta and is associated with fetal bleeding and embryopathy, so it is avoided during pregnancy. Direct oral anticoagulants (e.g., factor Xa inhibitors) are generally not recommended in pregnancy due to insufficient safety data and concern for placental transfer.

Question 33

A 5-year-old is a family contact to the client with tuberculosis. Isoniazid (INH) has been prescribed for the client. The nurse is aware that the length of time that the medication will be taken is?

Accepted Answer

Answer reason: The nurse’s role is to anticipate the prescribed regimen length and reinforce adherence over the full course to ensure efficacy. Shorter regimens exist but typically involve different drug combinations, so a brief duration with INH alone is less consistent with common prophylaxis standards. Very prolonged durations are not routine and would increase risk of adverse effects without added preventive benefit.

Question 34

The nurse is administering warfarin (Coumadin) to a patient with deep vein thrombophlebitis. Which laboratory value indicates warfarin is at therapeutic levels?

Accepted Answer

Answer reason: A PT about 1.5–2 times control corresponds to effective anticoagulation for typical venous thromboembolism treatment goals. PTT is used to monitor unfractionated heparin, making that option a common distractor. An INR of 3–4 is generally higher than the usual target range for DVT (often 2–3) and would raise bleeding risk. Hematocrit does not measure anticoagulant intensity and can be abnormal for many non-anticoagulation reasons.

Question 35

A 45-year-old client with atrial fibrillation has been prescribed diltiazem. Which client outcome would best indicate that the medication has had its intended effect?

Accepted Answer

Answer reason: The key therapeutic endpoint is improved rate control, typically reflected by a meaningful drop in ventricular rate. Conversion to sinus rhythm is not diltiazem’s primary intended effect in most AF management (that would align more with antiarrhythmic rhythm-control strategies). A normal blood pressure reading or absence of stroke does not directly demonstrate that AV nodal rate control has been achieved.

Question 36

The nurse is assisting in monitoring a client who just received a dose of nitroglycerin sublingually. The nurse should monitor for which intended effect of the medication?

Accepted Answer

Answer reason: The primary intended therapeutic outcome when given sublingually for angina is rapid reduction of ischemic chest discomfort. Headache, flushing, and hypotension are common vasodilatory adverse effects that can occur and should be monitored, but they are not the desired clinical endpoint. If chest pain persists after appropriate dosing intervals, it suggests ongoing ischemia and requires escalation of care.

Question 37

A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will you advocate for first?

Accepted Answer

Answer reason: Gabapentin is a first-line option for burning, electric pain and is especially useful for nocturnal symptoms because it reduces abnormal nerve firing. Opioids like hydromorphone are not first-line for chronic neuropathic pain due to limited neuropathic efficacy and higher risks (sedation, dependence, constipation), and they are generally reserved for refractory cases. Corticosteroids do not treat diabetic peripheral neuropathy pain and carry significant adverse effects such as hyperglycemia. Lorazepam treats anxiety/insomnia but does not address the neuropathic pain mechanism and can worsen fall risk through sedation.

Question 38

The nurse has completed giving medication instructions to a client receiving benazepril to treat hypertension. Which statement made by the client indicates to the nurse that the client needs further teaching?

Accepted Answer

Answer reason: ACE inhibitors like benazepril can increase serum potassium by decreasing aldosterone, and patients are typically taught to avoid potassium-containing salt substitutes and be cautious with added salt products used for seasoning. Advising “moderate” salt use suggests the client may not understand dietary counseling for hypertension, where sodium reduction is generally emphasized to improve blood pressure control. The other statements align with expected teaching: orthostatic precautions, routine BP monitoring, and reporting infection symptoms (possible neutropenia/agranulocytosis is a rare but serious adverse effect). Therefore this statement reflects incomplete or incorrect understanding and requires further teaching.

Question 39

The nurse is providing medication teaching to a client recently prescribed clopidogrel 75 mg PO Q daily for the prevention of myocardial infarction (MI). The nurse explains that clopidogrel is?

Accepted Answer

Answer reason: This mechanism is used for secondary prevention of MI and stroke and after coronary stent placement. Teaching should emphasize bleeding risk (e.g., easy bruising, GI bleeding, prolonged bleeding) and the need to report unusual bleeding and avoid unsupervised NSAID use. ACE inhibitors, statins, and diuretics reduce cardiovascular risk through blood pressure, lipid, or volume effects rather than directly inhibiting platelet function.

Question 40

A client is prescribed procainamide. Which does the nurse monitor before giving this medication?

Accepted Answer

Answer reason: Baseline vital signs—especially heart rate and blood pressure—are therefore key safety parameters to assess before administration and to trend during therapy. This directly evaluates both therapeutic effect (rate control/antiarrhythmic action) and early toxicity or intolerance. In contrast, renal indices (BUN/creatinine) are useful for longer-term dosing/clearance considerations but do not provide the immediate hemodynamic safety check required right before giving a dose. Monitoring urine output/osmolality or H/H is not the primary pre-administration assessment for this medication.

Question 41

The client diagnosed with atrial fibrillation has experienced a transient ischemic attack (TIA). Which medication would the nurse anticipate being ordered for the client on discharge?

Accepted Answer

Answer reason: Atrial fibrillation increases the risk of cardioembolic stroke from left atrial appendage thrombus, and a TIA is treated as a high-risk warning event requiring secondary stroke prevention. Long-term oral anticoagulation reduces future embolic events more effectively than antiplatelet therapy in nonvalvular atrial fibrillation when not contraindicated. Beta blockers may help with rate control but do not adequately prevent thromboembolism on their own. Thrombolytics are for acute ischemic stroke within a time window and are not used as a discharge medication after a resolved TIA.

Question 42

A client recently diagnosed with an inflammatory bowel disease is given sulfasalazine. Which of the following side effects of the drug should the nurse educate the client?

Accepted Answer

Answer reason: Sulfasalazine can cause harmless discoloration of body fluids (notably urine and sometimes skin/tears) due to its metabolites, and this is a teaching point to reduce anxiety and improve adherence. Expected/common effects also include gastrointestinal upset, headache, and possible orange staining of soft contact lenses. In contrast, constipation and urinary retention are not typical expected effects for this medication in IBD therapy. New chest pain would be more concerning for an adverse reaction/complication and is not an anticipated routine side effect to normalize as expected teaching.

Question 43

The nurse is providing patient teaching regarding phenazopyridine. A medication used to treat pain resulting from a urinary tract infection. Which priority teaching should the nurse provide to this patient?

Accepted Answer

Answer reason: Phenazopyridine is a urinary tract analgesic whose expected effect is discoloration of urine due to its azo dye properties. Teaching this prevents unnecessary alarm and improves adherence while the underlying infection is treated with appropriate therapy. Discoloration is not an indication to stop the medication unless other concerning symptoms occur, making stopping for discoloration alone an unsafe instruction. It is typically taken with food to decrease GI upset, and there is no rationale for restricting dosing to bedtime only.

Question 44

When a patient presents to the Emergency Department with a toxic acetaminophen (Tylenol) level, drug should the nurse expect to administer?

Accepted Answer

Answer reason: The antidote replenishes glutathione stores and enhances non-toxic metabolism, reducing hepatocellular necrosis when given promptly based on timing/level. This is the expected emergency treatment for a toxic acetaminophen concentration. A common distractor is flumazenil, which reverses benzodiazepines and does not treat acetaminophen toxicity. Chelators like succimer and deferoxamine are used for heavy metal poisonings, not acetaminophen.

Question 45

When providing care to the client who has undergone a dilatation and curettage (D&C) after a spontaneous abortion, the nurse administers hydroxyzine as prescribed. Which of the following is an expected outcome?

Accepted Answer

Answer reason: Hydroxyzine is an antihistamine with antiemetic and anxiolytic/sedative properties, so a common therapeutic goal is reduction of nausea and vomiting in peri-procedural settings. After a D&C, it can be used to help control nausea related to anesthesia, opioids, or emotional distress. It is not a primary analgesic, so it would not be expected to minimize pain on its own compared with true pain medications. It also does not enhance uterine contractions or directly treat uterine cramping, which are addressed with uterotonics or appropriate analgesics/antispasmodics.

Question 46

A nurse is caring for a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings indicates to the nurse that the medication is having a therapeutic effect?

Accepted Answer

Answer reason: A therapeutic response is evidenced by improved muscle tone control, fewer spasms, and easier movement/ambulation. Increased mental alertness would be inconsistent because CNS depression (drowsiness, dizziness) is a common adverse effect rather than a desired outcome. Changes in urinary output or heart rate are not the primary expected therapeutic endpoints for this medication in MS-related spasticity.

Question 47

The nurse is caring for a client with chronic, stable angina. The client takes the long-acting nitrate isosorbide mononitrate. Which client outcome indicates that the drug is effective?

Accepted Answer

Answer reason: The most meaningful effectiveness outcome is improved functional capacity with fewer or no anginal episodes during routine activity. Reduced stress/anxiety and improved sleep are nonspecific and can occur without improved myocardial ischemia control. A normal blood pressure and heart rate do not demonstrate angina prevention and may be present even when ischemia persists.

Question 48

The healthcare provider is caring for a patient with a diagnosis of Kawasaki disease. Which of the following medications should the healthcare provider expect to administer to decrease the inflammation and thrombosis of Kawasaki disease?

Accepted Answer

Answer reason: High-dose therapy provides anti-inflammatory effects during the acute phase, then it is continued at antiplatelet dosing to reduce clot formation in affected coronary vessels. This directly targets both inflammation and thrombosis risk in a standard treatment plan (along with IVIG). Anticoagulants like heparin or warfarin are reserved for selected high-risk coronary aneurysm cases rather than routine initial therapy, and corticosteroids are not the primary medication for thrombosis prevention.

Question 49

Which of the following laboratory tests should the nurse monitor when the client is receiving warfarin sodium (Coumadin) therapy?

Accepted Answer

Answer reason: Tracking this lab guides dose titration to maintain the target anticoagulation range and prevent hemorrhage or thrombosis. PTT is used to monitor unfractionated heparin rather than warfarin. Potassium and ABGs do not reflect the anticoagulant intensity of warfarin therapy.

Question 50

The nurse has attended a staff education conference about highly active antiretroviral therapy. Which of the following statements by the nurse would indicate a correct understanding of the conference?

Accepted Answer

Answer reason: " The core principle of antiretroviral therapy is sustained suppression of HIV replication to improve immune function and reduce disease progression and transmission risk. Viral load is the most direct marker of active replication, and effective regimens aim to reduce it to undetectable levels. Successful therapy is expected to reduce—not increase—opportunistic infections by allowing immune recovery. Standard HAART typically uses a combination of about 3 drugs from at least 2 classes, and effective treatment is associated with an increase (not decrease) in CD4/T4 counts over time.

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