Question 1

Acetylsalicylic acid (aspirin) is prescribed for a client diagnosed with coronary artery disease before a percutaneous transluminal coronary angioplasty (PTCA). The nurse administers the medication understanding that it is prescribed for what purpose?

Accepted Answer

Answer reason: Aspirin irreversibly inhibits platelet COX-1, lowering thromboxane A2 and reducing platelet aggregation. Before PTCA, this antiplatelet effect helps prevent acute thrombus formation on disrupted atherosclerotic plaque and around the catheter/stent, lowering risk of peri-procedural myocardial infarction. Its analgesic and anti-inflammatory effects are not the primary pre-PTCA indication compared with antithrombotic protection. Fever prevention is not a relevant expected outcome for this medication in this context.

Question 2

For which of these clients is IV morphine the first-line choice for pain management? 1. A 33-year-old intrapartum client needs pain relief for labor contractions. 2. A 24-year-old client reports severe headache related to being hit in the head. 3. A 56-year-old client reports breakthrough bone pain related to multiple myeloma. 4. A 73-year-old client reports chronic pain associated with hip replacement surgery?

Accepted Answer

Answer reason: Bone pain from multiple myeloma can escalate quickly and requires strong analgesia with immediate effect, making IV opioid therapy a standard initial approach for acute breakthrough episodes. In contrast, head trauma with severe headache raises concern for intracranial injury where opioids can cloud neurologic assessment and depress respirations, so they are not first-line. Labor pain is typically managed with neuraxial analgesia or other obstetric-specific options, and chronic post-arthroplasty pain is usually approached with multimodal/non-opioid strategies before IV opioids.

Question 3

A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse most likely to prepare that addresses questions related to the first-line treatment of cancer pain?

Accepted Answer

Answer reason: The analgesic ladder directly teaches how to start, escalate, and reassess analgesics for ongoing cancer pain, which aligns with standard initial management and patient education needs. Radiation therapy and surgery may help specific pain etiologies but are not the general first-line framework for day-to-day cancer pain control. Nerve blocks are procedural options generally reserved for refractory pain or specific syndromes after optimization of systemic analgesics.

Question 4

The client with a new burn injury asks the nurse why he is receiving intravenous cimetidine (Tagamet). What is the nurse’s best response?

Accepted Answer

Answer reason: Severe burns trigger a stress response that increases gastric acid secretion and reduces gastric mucosal perfusion, predisposing the patient to stress-related mucosal disease (Curling ulcers) and GI bleeding. Cimetidine is an H2-receptor antagonist that decreases acid production, making it appropriate prophylaxis early after major burns. The other options describe outcomes not produced by H2 blockers; preventing hypovolemic shock requires fluid resuscitation, not acid suppression. It also does not directly prevent renal injury, which is more closely tied to perfusion and rhabdomyolysis management when present.

Question 5

Prior to initiating therapy with un fractionated heparin for a patient hospitalized with a deep vein thrombosis, the nurse should plan to?

Accepted Answer

Answer reason: A baseline weight also supports monitoring for occult bleeding-related fluid shifts and guides subsequent anticoagulant management decisions. Giving aspirin concurrently increases bleeding risk and is not a routine pre-initiation nursing action for heparin in DVT. Limiting fluids and undressing do not improve anticoagulation safety or efficacy and are not standard prerequisites before starting therapy.

Question 6

The patient describes a burning sensation in the leg. The health care provider tells the nurse that a medication will be prescribed for neuropathic pain secondary to chemotherapy. The nurse is most likely to question the prescription of which drug?

Accepted Answer

Answer reason: Tricyclic antidepressants (e.g., imipramine) and anticonvulsants (e.g., gabapentin, carbamazepine) are commonly used because they reduce neuronal excitability and are considered first-line/adjunct options for neuropathic symptoms such as burning pain. Opioids can be used for cancer pain but are generally less effective for neuropathic mechanisms and carry higher risk of sedation, constipation, and dependence relative to neuropathic-specific agents. Therefore, this prescription is the one a nurse would most likely question when the stated goal is treating chemotherapy-induced neuropathic pain.

Question 7

Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect?

Accepted Answer

Answer reason: The most direct indicator of therapeutic effectiveness is the patient’s report of reduced or absent nausea after administration. Oral mucosa integrity relates more to mucositis risk from chemotherapy, not antiemetic response. Alopecia and pain control are unrelated to the medication’s primary intended outcome in this context.

Question 8

What nursing implication does NOT accompany the administration of Allopurinol, Colchicine, or Probenecid?

Accepted Answer

Answer reason: Gout management aims to reduce uric acid crystal formation and promote renal excretion, which is supported by hydration and avoiding triggers that raise uric acid. Acidic diets reduce uric acid solubility and can promote crystal precipitation, so recommending high-acid foods is counterproductive rather than beneficial. Adequate fluids help dilute urine and decrease stone/crystal risk, and limiting alcohol reduces dehydration and hyperuricemia risk. Taking these medications with food can improve GI tolerance, especially with colchicine.

Question 9

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

Accepted Answer

Answer reason: A tricyclic antidepressant can reduce burning “electric” neuropathic symptoms and is commonly dosed at night, which also helps when pain is worse at bedtime due to its sedating effect. Opioids are not first-line for chronic diabetic neuropathy because they do not target the neuropathic mechanism and carry high risks (sedation, constipation, dependence). Corticosteroids do not treat diabetic peripheral neuropathy pain and can worsen glycemic control, and benzodiazepines treat anxiety/insomnia but are not analgesics.

Question 10

A nurse is teaching a client who is receiving newly prescribed propylthiouracil. Which of the following information should the nurse include?

Accepted Answer

Answer reason: Propylthiouracil is an antithyroid medication used for hyperthyroidism, and clients should be taught safety measures related to their diagnosis and treatment in case urgent care is needed. Carrying medical identification helps ensure rapid, accurate management if symptoms of severe hypothyroidism, thyroid storm history, or medication-related complications occur when the client cannot communicate. Agranulocytosis is a rare but serious adverse effect; teaching should emphasize reporting fever or sore throat promptly because the drug is typically stopped rather than simply dose-reduced. Effective therapy tends to normalize metabolism and may lead to weight gain (not weight loss), and increased iodine intake can counteract antithyroid therapy by providing more substrate for thyroid hormone production.

Question 11

A client develops severe, crushing chest pain radiating to the left shoulder and arm. Which of the following PRN medications should the nurse administer?

Accepted Answer

Answer reason: Suspected acute coronary syndrome presents with crushing substernal chest pain radiating to the left arm/shoulder, and first-line PRN therapy is a rapid-acting nitrate to reduce myocardial oxygen demand via venodilation and to improve coronary blood flow. The sublingual route provides fast onset, making it appropriate for immediate symptom relief while further evaluation and emergency response occur. Morphine can be used if pain persists after nitrates and other initial measures, but it is not the preferred first PRN choice due to risks such as hypotension and masking symptom progression. Diazepam and IM meperidine do not treat myocardial ischemia and would delay appropriate cardiac management.

Question 12

A client who is being treated for acute heart failure has the following vital signs: blood pressure (BP), 85/50 mm Hg; pulse, 96 beats per minute; respirations, 26 breaths per minute. The primary health care provider prescribes digoxin. To evaluate a therapeutic response to this medication, which changes in the client's vital signs should the nurse expect?

Accepted Answer

Answer reason: Improved forward flow and decreased sympathetic drive typically raise blood pressure modestly and lower heart rate toward normal. Better perfusion and reduced pulmonary congestion should also decrease the work of breathing, leading to a lower respiratory rate. Options showing worsening tachycardia or persistent hypotension do not reflect therapeutic improvement in acute heart failure.

Question 13

A client who has peptic ulcer disease from chronic nonsteroidal anti-inflammatory drug (NSAID) use is prescribed misoprostol (Cytotec). In educating the client regarding this drug's action, the nurse would be most accurate in informing the client that this drug?

Accepted Answer

Answer reason: Misoprostol is a prostaglandin E1 analog used to prevent NSAID-induced gastric mucosal injury by increasing mucus and bicarbonate secretion and improving mucosal blood flow, thereby strengthening the stomach’s protective barrier. This directly addresses the pathophysiology of NSAID-related ulcers, which occur from reduced prostaglandin-mediated mucosal protection. Options about gas reduction or increased gastric emptying describe actions of antiflatulents or prokinetics, not misoprostol. Increasing lower esophageal sphincter pressure is a goal of some GERD therapies and is not this medication’s primary mechanism.

Question 14

The nurse is teaching a client with migraine headaches who is receiving newly prescribed sumatriptan. Which of the following information should the nurse include?

Accepted Answer

Answer reason: " Triptans are abortive migraine therapies that are intended to stop an attack once it starts, not to be taken on a scheduled basis for prevention. Teaching should emphasize taking the dose at the onset of migraine symptoms for best effect and avoiding use for other headache types without provider guidance. Flushing and tingling are common, expected adverse effects of sumatriptan and do not require stopping the drug unless severe or accompanied by concerning symptoms (e.g., chest pain). The other instructions do not match standard administration/storage guidance for typical sumatriptan formulations.

Question 15

A client diagnosed with asthma has been prescribed salmeterol. What statement by the client indicates that discharge teaching regarding this medication was effective?

Accepted Answer

Answer reason: Salmeterol is a long-acting beta2-agonist used for maintenance therapy to prevent bronchospasm, so it is taken on a fixed schedule rather than as needed. Standard dosing is twice daily (about every 12 hours) to maintain bronchodilation and reduce symptoms over time. It has a slower onset and is not appropriate for rapid relief of acute wheezing or an asthma attack, which should be treated with a short-acting bronchodilator. Taking it every four hours reflects short-acting rescue dosing and increases risk of adverse beta-agonist effects without improving acute control. Correct understanding is demonstrated by scheduled, twice-daily use for prevention.

Question 16

A client with a diagnosis of atrial fibrillation has just been placed on warfarin therapy. The registered nurse (RN) overhears a student nurse teaching the client about potential food-drug interactions. Which statement made by the student nurse requires an intervention by the RN?

Accepted Answer

Answer reason: " Warfarin’s anticoagulant effect is reduced by vitamin K intake, so teaching focuses on maintaining a consistent amount of vitamin K rather than eliminating it. Telling the client they “will not be able” to eat green leafy vegetables is inaccurate and can lead to unnecessary dietary restriction and unstable INR if the client later resumes these foods unpredictably. Appropriate guidance is to keep vitamin K-rich foods steady day to day and to report major dietary changes so dosing can be adjusted. In contrast, monitoring vitamin K intake and regular blood testing (INR) are correct components of safe warfarin management.

Question 17

The nurse cares for several clients in the medical-surgical unit. Which of the following clients will require an order of aluminum hydroxide (Amphojel)?

Accepted Answer

Answer reason: Opioids reduce gastrointestinal motility, so constipation is an expected and common adverse effect that often needs prophylactic or therapeutic management. Aluminum hydroxide can act as an antacid and, importantly in many nursing test banks, is associated with causing constipation, which can be leveraged as a desired effect when loose stools/diarrhea are present. The other options represent problems that are not treated with this medication: hypocalcemia from hypoparathyroidism requires calcium/vitamin D, emphysema with respiratory acidosis requires ventilatory/respiratory management, and post-MI PVCs require cardiac evaluation and antiarrhythmic/ischemia management. Therefore, the client scenario most aligned with this drug’s expected effect profile is the one involving constipation management considerations.

Question 18

After 3 defibrillation attempts and amiodarone administration, the client continues to be in a pulseless, ventricular tachycardia, and an intravenous lidocaine bolus is administered. The nurse should expect which resulting therapeutic response?

Accepted Answer

Answer reason: The therapeutic goal in pulseless VT/VF is reduced ventricular irritability to facilitate termination of the malignant rhythm with ongoing resuscitation efforts. A normal heart rate or improved consciousness are not expected outcomes while the patient remains pulseless, and conversion to ventricular fibrillation represents deterioration rather than a desired effect. Therefore the best expected response is decreased ventricular irritability.

Question 19

The nurse is administering alteplase to a client diagnosed with massive pulmonary embolism (PE). Which data indicates the medication is effective?

Accepted Answer

Answer reason: Alteplase is a thrombolytic that dissolves the pulmonary clot, improving pulmonary perfusion and reducing pleural irritation from pulmonary infarction. Clinical improvement—such as reduced pleuritic (inspiratory) chest pain and easier breathing—best indicates the drug is achieving its intended effect. A therapeutic PTT reflects heparin effect/monitoring and does not demonstrate clot lysis. A normal chest x-ray is not expected to reliably confirm PE resolution, and ability to ambulate is nonspecific and may be limited by ongoing hypoxemia or hemodynamic instability.

Question 20

A 70-year-old male presented to the Emergency Department with shortness of breath, crackles in the bases and middle of the lung fields bilaterally, +2 pitting edema bilaterally of the lower extremities, and a weight increase of 6 lb. in one week. His heart rate is 82 and his blood pressure is 162/90. Per physician’s order, the nurse administers 40 mg of furosemide intravenously. The nurse knows that which of the following indicates effectiveness of the medication?

Accepted Answer

Answer reason: In a fluid-overloaded patient with pulmonary crackles and peripheral edema, diuresis directly reflects reduction of intravascular volume. A lower heart rate or blood pressure can occur secondary to volume changes but may also indicate adverse effects (e.g., hypotension) rather than therapeutic success. Persistent crackles and diminished breath sounds suggest ongoing pulmonary congestion, not improvement.

Question 21

A client who delivered vaginally is diagnosed with postpartum hemorrhage due to uterine atony. Which medication should the nurse anticipate administering?

Accepted Answer

Answer reason: Misoprostol is a prostaglandin that increases uterine tone and is used for prevention/treatment of postpartum hemorrhage when atony is present. The other listed drugs (terbutaline, magnesium sulfate, nifedipine) are tocolytics or smooth muscle relaxants that decrease uterine contractions and would worsen uterine atony-related bleeding. Therefore the nurse should anticipate administering a uterotonic agent from the choices provided.

Question 22

A client experiencing difficulty breathing and increased pulmonary congestion was prescribed furosemide 40mg to be given intravenously. After an hour which assessment value indicates that the therapy has been effective?

Accepted Answer

Answer reason: IV furosemide is a loop diuretic that rapidly promotes diuresis, decreasing intravascular volume and pulmonary venous pressures, which helps relieve pulmonary congestion. Within about an hour, the most direct measurable indicator of therapeutic effect is increased urine output. Clear lungs may take longer to fully resolve and is less immediate/quantifiable in the first hour. A drop in blood pressure or potassium reflects potential adverse effects of diuresis rather than the desired primary outcome to confirm effectiveness.

Question 23

The nurse administers insulin glulisine by subcutaneous injection to a client diagnosed with diabetes mellitus (DM). Which time after the injection will the nurse expect the greatest risk for hypoglycemia to occur?

Accepted Answer

Answer reason: Hypoglycemia risk is greatest at the time of peak insulin activity, when glucose uptake is maximally driven and hepatic glucose output is most suppressed. Insulin glulisine is a rapid-acting insulin with onset in minutes and a peak effect roughly around 1 hour after subcutaneous administration. Therefore, the client is most likely to experience the lowest blood glucose and highest hypoglycemia risk at about 60 minutes post-injection. Earlier times like 12–30 minutes may coincide with onset and rising effect but typically precede the peak, so the risk is not yet at its maximum. Clinically, this is why rapid-acting insulin should be coordinated closely with meal timing and glucose monitoring around the expected peak.

Question 24

The RN administers dobutamine to a patient with heart failure following a cardiac procedure. Which of the following should the nurse recognize as an intended effect of this medication?

Accepted Answer

Answer reason: Dobutamine is a beta-1 adrenergic agonist primarily used as an inotrope to improve myocardial contractility in acute decompensated heart failure or low-output states after cardiac procedures. By increasing stroke volume and contractility, it raises cardiac output, which is the therapeutic goal. It has comparatively less alpha-1 activity than agents like norepinephrine, so vasoconstriction is not the main intended effect. Heart rate and blood pressure can increase as secondary effects, but the primary expected outcome the nurse should recognize is improved cardiac output.

Question 25

The nurse is devising the plan of care for a client with sarcoidosis. Which pharmacologic therapy should the nurse expect to be prescribed initially?

Accepted Answer

Answer reason: This medication is typically started initially when treatment is needed, with dosing then tapered based on clinical response and adverse effects. Methotrexate is commonly used as a steroid-sparing agent for chronic disease or when steroids are not tolerated, rather than as the initial drug in most cases. NSAIDs like ibuprofen may help arthralgias but do not treat the underlying granulomatous process, and cyclophosphamide is generally reserved for severe refractory organ-threatening disease due to toxicity.

Question 26

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?

Accepted Answer

Answer reason: Heparin dosing is titrated to achieve a therapeutic aPTT, and a value of 32 seconds is subtherapeutic for treatment of an intracardiac clot, indicating inadequate anticoagulation. Warfarin requires several days to produce a therapeutic INR, so bridging with therapeutic heparin is necessary until the INR reaches goal. Because the INR is only 1.3, stopping heparin would leave the client under-anticoagulated and at higher risk for embolization. The safest action is to adjust the heparin infusion upward per protocol/prescription while continuing the scheduled warfarin to build toward a therapeutic INR.

Question 27

An antenatal client receives education concerning medications that are safe to use during pregnancy. The nurse evaluates the client's understanding of the instructions and determines that she needs further information when she states which of the following?

Accepted Answer

Answer reason: " Stimulant laxatives are generally not first-line in pregnancy because they can cause uterine stimulation/cramping and electrolyte disturbances, so they are used only if safer measures fail. Initial management of constipation in pregnancy emphasizes nonpharmacologic strategies (fiber, fluids, activity) and, if needed, bulk-forming agents or stool softeners (e.g., psyllium, docusate). Magnesium hydroxide is commonly considered acceptable for short-term use, while mineral oil is avoided due to impaired absorption of fat-soluble vitamins. Therefore, calling a stimulant laxative “preferred” indicates misunderstanding and need for further teaching.

Question 28

The health care provider (HCP) prescribes paroxetine to a client with depression. What statement by the client indicates proper understanding of the medication?

Accepted Answer

Answer reason: " Paroxetine is an SSRI, and a common longer-term adverse effect is weight gain, so anticipating lifestyle measures to limit it reflects appropriate medication teaching. SSRIs should not be stopped abruptly or solely because symptoms improve due to relapse risk and discontinuation syndrome. Clinical improvement typically requires several weeks, so judging efficacy at 1–2 weeks is premature. SSRIs more commonly cause sexual dysfunction (eg, decreased libido, delayed orgasm) rather than improved sexual performance.

Question 29

A male client with Type 1 diabetes mellitus takes a combination of short-acting and intermediate-acting insulin drugs. The client complains of headaches when awakening and his blood glucose average for the past week has been 210 mg/dl. The nurse recognizes the client experiencing a daily Somogyi, or rebound, effect. Which dosing method is likely to relieve these symptoms?

Accepted Answer

Answer reason: Somogyi effect is early-morning hyperglycemia caused by counterregulatory hormone release after unrecognized nocturnal hypoglycemia. Shifting the intermediate-acting insulin (e.g., NPH) to bedtime better targets overnight glucose control and helps prevent the hypoglycemic trigger that leads to rebound morning highs and headaches. Increasing evening intermediate-acting insulin with the meal can worsen overnight hypoglycemia and intensify rebound hyperglycemia. Adjusting the lunchtime short-acting dose or delaying morning insulin does not address the nocturnal hypoglycemia driving the pattern.

Question 30

The nurse is caring for a child with nocturnal enuresis that was not responsive to non-pharmacological medications. The nurse anticipates the primary healthcare provider (PHCP) to provide which medication?

Accepted Answer

Answer reason: Nocturnal enuresis that persists despite behavioral strategies is commonly treated with an antidiuretic approach to reduce nighttime urine production. This medication is a synthetic analog of ADH that decreases urine volume overnight, improving the child’s ability to remain dry while asleep. It is a standard pharmacologic option for pediatric nocturnal enuresis when nonpharmacologic measures are insufficient. A common safety consideration is monitoring and teaching to limit evening fluids to reduce the risk of water intoxication and hyponatremia.

Question 31

The nurse instructs a client who is taking iron supplements that?

Accepted Answer

Answer reason: Oral iron commonly causes harmless dark/black discoloration of stools due to unabsorbed iron, and patients should be warned to prevent unnecessary alarm. This is an expected effect rather than a sign of bleeding when it occurs after starting therapy without other GI warning symptoms. Taking iron on an empty stomach can improve absorption but is often limited by GI upset and is not the single best universal instruction. Liquid iron can stain teeth, so stating it will not discolor teeth is incorrect.

Question 32

A nurse on the postpartum floor is caring for a new mother of twins. Review of daily laboratory results reveals a hemoglobin of 8.6 and hematocrit of 24.8. The doctor has ordered the supplement ferrous sulfate (iron) 325 mg by mouth daily for six weeks. The nurse is giving the patient discharge instructions. The nurse should include which of the following when discussing the iron supplement?

Accepted Answer

Answer reason: Vitamin C enhances gastrointestinal absorption of non-heme iron by keeping it in a more absorbable (ferrous) form and forming soluble complexes. Taking the dose with orange juice (or another vitamin C source) improves the likelihood of correcting postpartum iron-deficiency anemia. Milk and calcium-containing products decrease iron absorption, so pairing iron with milk or taking it alongside calcium supplements is counterproductive. Also, iron more commonly causes constipation and dark/black stools rather than diarrhea and light brown stools, making that teaching inaccurate.

Question 33

The nurse is caring for a client with chronic pain who is requesting a dose of a prescribed opioid analgesic every 1 to 2 hours. Which of the following statements would be appropriate for the nurse to make?

Accepted Answer

Answer reason: "You don't seem to be experiencing relief from the medication. Let's talk with your primary health care provider about a different medication." Persistent requests for very frequent opioid dosing suggest inadequate analgesia, rapid wearing off, or poorly matched regimen rather than automatically indicating addiction. A therapeutic nursing response is to assess effectiveness and advocate for reassessment of the pain plan (e.g., different opioid, dose adjustment, or long-acting plus breakthrough dosing) with the prescriber. Stating the client “may not receive additional doses” is nontherapeutic and ignores individualized pain management and potential need for provider re-evaluation. Focusing on addiction risk as the primary message can undermine trust and does not address the immediate problem of uncontrolled pain.

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Expected Actions-Outcomes Practice Test 14

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