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.

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Expected Actions-Outcomes Practice Test 14

Expected Actions-Outcomes NCLEX Practice Test

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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?

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?

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

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

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?

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

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

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?

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

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

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?

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

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