Question 1

Heparin is used to treat and prevent blood clots from forming, especially in the lungs and legs?

Accepted Answer

Answer reason: Heparin is an anticoagulant used to prevent and treat venous thromboembolism, including DVT and pulmonary embolism.

Question 2

The nurse notes that a postoperative client's respirations have dropped from 14 to 6 breaths per minute. The nurse administers Narcan (naloxone) per the standing order. Following administration of the medication, the nurse should assess the client for?

Accepted Answer

Answer reason: Naloxone reverses opioid effects, including analgesia. After administration the client may experience an abrupt return of severe pain, so the nurse should assess for sudden, intense pain.

Question 3

The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?

Accepted Answer

Answer reason: Novolog (insulin aspart) is rapid-acting with a peak about 1–3 hours after injection; planning an afternoon snack (e.g., 3 PM after a noon dose) shows understanding of peak hypoglycemia risk. Other options address onset or general precautions, not peak timing.

Question 4

A health care provider orders 0.5 mg of protamine sulfate for a client who is showing signs of bleeding after receiving a 100-unit dose of heparin. The nurse should expect the effects of the protamine sulfate to be noted in which of the following time frames?

Accepted Answer

Answer reason: IV protamine sulfate neutralizes heparin rapidly; onset is about 5 minutes with near-immediate reversal.

Question 5

An 18-month-old with a congenital heart defect is to receive digoxin twice a day. Which of the following should the nurse instruct the parents about?

Accepted Answer

Answer reason: Digoxin increases cardiac contractility and slows the heart rate, producing a more effective and regular rhythm. Toxicity commonly presents with anorexia, vomiting, and bradycardia (not increased pulse). It should not be relied on to be absorbed better with meals, and doses should not be repeated after vomiting—contact the provider.

Question 6

A client with atrial fibrillation is receiving a continuous heparin infusion at 1,000 units per hour. The nurse determines that the client is receiving the therapeutic effect based on which results?

Accepted Answer

Answer reason: Heparin therapy is monitored with aPTT, with a therapeutic target about 1.5–2.5 times control (~60–80 sec). PT monitors warfarin; 28 sec is subtherapeutic; >120 sec is excessive.

Question 7

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1,000 units per 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. Which action should the nurse take based on the client’s laboratory results?

Accepted Answer

Answer reason: APTT of 32 sec is subtherapeutic for a heparin infusion, and INR of 1.3 is subtherapeutic for warfarin. Heparin should be titrated up to reach a therapeutic aPTT while continuing warfarin until INR becomes therapeutic.

Question 8

At what time of day should the nurse encourage a client with Parkinson's disease to schedule their most demanding physical activities to minimize the effects of hypokinesia?

Accepted Answer

Answer reason: Parkinson’s motor symptoms (hypokinesia/bradykinesia) improve most when dopaminergic medication is at peak effect, so strenuous tasks should be scheduled during the medication “on” period. Morning or post-rest times are less reliable, and family availability is not clinically relevant.

Question 9

An Rh-negative mother should receive globulin?

Accepted Answer

Answer reason: Rh-negative mothers are given Rho(D) immune globulin to prevent Rh alloimmunization. The other options are unrelated tests or incorrect products.

Question 10

The nurse will anticipate which drug is mainly prescribed for a patient with nephrotic syndrome?

Accepted Answer

Answer reason: Corticosteroids are the first-line therapy for most nephrotic syndrome (e.g., minimal change disease) to reduce proteinuria; diuretics and albumin are supportive, and antibiotics are used only if infection is present.

Question 11

The healthcare provider prepares to administer a corticosteroid to a patient with a diagnosis of asthma. What is the rationale for administering this drug to this patient?

Accepted Answer

Answer reason: Corticosteroids are anti-inflammatory agents that reduce airway inflammation and mucosal edema in asthma, thereby decreasing airway swelling. Bronchodilation is produced by beta-agonists, not steroids; steroids do not promote mucus expectoration and can increase infection risk rather than prevent it.

Question 12

About one hour after eating a meal, your patient, who has cystic fibrosis, starts to experience abdominal pain and bloating. Then the patient's stool appears to be greasy and have a foul odor. Which medication below that is being taken by the patient is not providing a desirable outcome for this patient and needs to be re addressed by the physician?

Accepted Answer

Answer reason: Greasy, foul-smelling stools and postprandial pain in cystic fibrosis indicate pancreatic exocrine insufficiency with fat malabsorption. The therapy intended to prevent this is pancreatic enzyme replacement (pancrelipase); persistence of steatorrhea means this medication is not achieving the expected outcome and needs adjustment.

Question 13

A client is admitted with acute gouty arthritis. Which medication does the nurse anticipate the health care provider may prescribe to prevent and treat an acute attack of gout?

Accepted Answer

Answer reason: Colchicine treats acute gout flares and is also used prophylactically to prevent attacks. Probenecid is for chronic urate lowering and is not used during acute attacks; NSAIDs and steroids treat pain/inflammation but are not used for prevention.

Question 14

________ is a drug administered intramuscularly to a woman after delivery of the placenta and membranes to prevent Heamorrhage (PPH)?

Accepted Answer

Answer reason: Oxytocin 10 IU IM is the uterotonic routinely given after placental delivery to promote uterine contraction and prevent postpartum hemorrhage. The other options are analgesic or antifungal agents and do not prevent PPH.

Question 15

Encircle laxative which is used before surgery if needed?

Accepted Answer

Answer reason: Glycerine suppository acts locally in the rectum to soften and evacuate stool without significant systemic fluid or electrolyte shifts, making it the safer choice if a laxative is needed preoperatively. Castor oil, methylcellulose, and magnesium sulphate are oral agents that can cause greater fluid and electrolyte changes and are generally avoided before surgery.

Question 16

A client with myasthenia gravis is prescribed pyridostigmine (Mestinon). What is the expected therapeutic effect of this medication?

Accepted Answer

Answer reason: Pyridostigmine is an acetylcholinesterase inhibitor that increases acetylcholine at the neuromuscular junction, improving muscle contraction and strength in myasthenia gravis.

Question 17

Which IV fluid provides both energy and electrolytes?

Accepted Answer

Answer reason: DNS (dextrose with normal saline) supplies calories from dextrose and electrolytes (Na+, Cl−). 0.9% NaCl and RL provide electrolytes without energy, while D5% provides energy without electrolytes.

Question 18

What is the main use of Injection NaCl 3%?

Accepted Answer

Answer reason: 3% NaCl is a hypertonic saline solution used to raise serum sodium in symptomatic or severe hyponatremia; it does not treat hypoglycemia, fever, or allergies.

Question 19

A client receiving tobramycin (Tobrex) is diagnosed with sepsis. The nurse realized that the client is favorably responding to the medication therapy if which laboratory result is noted?

Accepted Answer

Answer reason: Improvement with an aminoglycoside is shown by normalization of infection markers and preserved renal function. A WBC of 8000 is normal and creatinine 0.9 mg/dL indicates normal kidney function; other options either show irrelevant electrolytes or elevated WBC/BUN.

Question 20

Why is a client undergoing chemotherapy with low hemoglobin and hematocrit prescribed epoetin alfa?

Accepted Answer

Answer reason: Epoetin alfa is recombinant erythropoietin that stimulates erythropoiesis in bone marrow, treating anemia from chemotherapy and raising Hgb/Hct.

Question 21

Which statement by the client about reasons for using combination chemotherapy indicates the need for further explanation?

Accepted Answer

Answer reason: Combination therapy aims to target different cell-cycle phases, decrease drug resistance, and reduce toxicity compared with high-dose single agents. It is not intended to treat side effects simultaneously; thus statement B reflects a misunderstanding.

Question 22

A nurse is working in an endoscopy recovery area. Many of the clients are administered midazolam (Versed) to provide conscious sedation. Which medication is important to have available as an antidote for Versed?

Accepted Answer

Answer reason: Midazolam is a benzodiazepine; its specific reversal agent is flumazenil. Naloxone reverses opioids, diazepam is another benzodiazepine, and fludrocortisone is a mineralocorticoid.

Question 23

A client with cancer who is receiving chemotherapeutic drugs has been given injections of (pegfilgrastim) Neulasta. Which laboratory value reveals that the drug is producing the desired effect?

Accepted Answer

Answer reason: Pegfilgrastim (Neulasta) is a granulocyte colony-stimulating factor that increases neutrophils/WBCs to prevent chemotherapy-induced neutropenia. A normal WBC count (e.g., 6,000/mm) indicates the desired effect. Hemoglobin, platelets, and hematocrit are not targeted by this drug.

Question 24

A client with increased intracranial pressure is receiving Mannitol and Lasix. The nurse recognizes that these two drugs are given to reverse which effect?

Accepted Answer

Answer reason: Mannitol (osmotic diuretic) and furosemide reduce brain water content and intracranial pressure by promoting osmotic diuresis, reversing cerebral/cellular edema rather than energy failure, calcium overload, or glutamate release.

Question 25

Nimotop (Nimodipine) is ordered for the client with a ruptured cerebral aneurysm. The nurse recognizes that the desired effect of this drug is to?

Accepted Answer

Answer reason: Nimodipine is a dihydropyridine calcium channel blocker used after subarachnoid hemorrhage to prevent cerebral vasospasm by blocking calcium entry into vascular smooth muscle. It does not normalize BP, act as an anti-inflammatory, or dissolve clots.

Question 26

A client with gallstones and obstructive jaundice is experiencing severe itching. The physician has prescribed cholestyramine (Questran). The client asks, “How does this drug work?” What is the nurse’s best response?

Accepted Answer

Answer reason: Cholestyramine is a bile acid sequestrant that binds bile acids in the intestine, promoting fecal excretion and reducing circulating bile salts that cause pruritus in obstructive jaundice.

Question 27

Diphenoxylate hydrochloride and atropine sulfate (Lomotil) is prescribed for the client with ulcerative colitis. The nurse realizes that the medication is having a therapeutic effect when the following is noted?

Accepted Answer

Answer reason: Diphenoxylate-atropine is an antidiarrheal that decreases intestinal motility; therapeutic effect is fewer diarrheal stools. Absence of peristalsis or increased cramping/abdominal girth would indicate complications or worsening.

Question 28

What is the appropriate initial nursing action for a patient experiencing chest pain suspected to be Prinzmetal angina?

Accepted Answer

Answer reason: Variant (Prinzmetal) angina is due to coronary vasospasm; sublingual nitroglycerin rapidly relieves spasm and pain. Vital signs and ECG are important but should not delay immediate nitroglycerin administration.

Question 29

What is the primary action of metoclopramide prescribed for a patient diagnosed with GERD?

Accepted Answer

Answer reason: Metoclopramide is a prokinetic dopamine antagonist that increases gastric motility and emptying and enhances lower esophageal sphincter tone, helping GERD. It does not reduce or neutralize acid or coat the esophagus.

Question 30

Which intervention should be prioritized to reduce ammonia levels in a patient with cirrhosis who has developed hepatic encephalopathy?

Accepted Answer

Answer reason: Lactulose acidifies the colon and traps ammonia as ammonium for excretion, lowering serum ammonia and improving hepatic encephalopathy. High-protein diet can worsen ammonia; fluid restriction and vitamin K do not reduce ammonia.

Question 31

What is the expected outcome of chlorothiazide (Diuril) for a client with a stasis ulcer and 2+ pitting edema?

Accepted Answer

Answer reason: Chlorothiazide is a thiazide diuretic that promotes sodium and water excretion, reducing intravascular volume and thereby lowering blood pressure. Other options are not direct expected outcomes of this medication.

Question 32

Which statement by a client taking tricyclic antidepressants indicates the medication is working properly?

Accepted Answer

Answer reason: Joining a social activity reflects improved mood, energy, and interest—therapeutic response to tricyclic antidepressants. The other options indicate continued depression (A), oversedation (C), or adverse effect/tachycardia (D).

Question 33

A postoperative client is at risk for deep vein thrombosis (DVT). What nursing intervention is essential for preventing DVT?

Accepted Answer

Answer reason: Prophylactic anticoagulants (e.g., heparin/LMWH) reduce clot formation in high‑risk postoperative patients. Cold compresses and dependent dangling increase venous stasis, and elevation alone is not as effective as pharmacologic prophylaxis.

Question 34

The physician has ordered Eskalith (lithium carbonate) 500mg three times a day and Risperdal (risperidone) 2mg twice daily for a client admitted with bipolar disorder, acute manic episodes. The best explanation for the client's medication regimen is?

Accepted Answer

Answer reason: Risperidone provides rapid control of agitation/psychosis during acute mania while lithium takes time to reach therapeutic effect; thus the antipsychotic manages excitement until mood stabilizes.

Question 35

__________ is a drug administered intramuscularly to a woman after delivery of the placenta and membranes to prevent hemorrhage (PPH)?

Accepted Answer

Answer reason: Oxytocin 10 IU IM is routinely given after placental delivery to promote uterine contraction and prevent postpartum hemorrhage. The other options are analgesic or antifungal agents and do not prevent PPH.

Question 36

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: Child household contacts of active TB are given isoniazid prophylaxis for approximately one year to prevent progression to active disease.

Question 37

A client is receiving heparin therapy. What laboratory value should the nurse monitor to assess the effectiveness of heparin?

Accepted Answer

Answer reason: Heparin therapy is monitored with the aPTT. INR/PT assess warfarin, and platelet count helps detect HIT but not heparin effectiveness.

Question 38

A client is admitted with a suspected overdose of acetaminophen. What is the priority nursing intervention?

Accepted Answer

Answer reason: Activated charcoal should be given early after acetaminophen ingestion to adsorb drug in the GI tract and reduce absorption. The other options do not address toxicity.

Question 39

A client is admitted with a suspected myocardial infarction. What is the priority nursing intervention?

Accepted Answer

Answer reason: In suspected MI, early chewable aspirin is the priority because it rapidly inhibits platelet aggregation, limiting thrombus growth and reducing mortality. Nitroglycerin relieves pain but is secondary and may be contraindicated with hypotension or PDE5 inhibitor use. The other options do not address the immediate life-threatening process.

Question 40

A client is admitted with exacerbation of chronic obstructive pulmonary disease (COPD). What is the priority nursing intervention?

Accepted Answer

Answer reason: During COPD exacerbation the immediate priority is to improve ventilation. Short-acting bronchodilators provide rapid bronchodilation and symptom relief. Corticosteroids act more slowly, glucose monitoring is not primary, and fluid restriction is inappropriate.

Question 41

A client with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium (Atrovent). What is the primary therapeutic effect of ipratropium?

Accepted Answer

Answer reason: Ipratropium is an anticholinergic (SAMA) that blocks muscarinic receptors in the airways, reducing bronchoconstriction and producing bronchodilation. It does not thin mucus, increase respiratory rate, or recruit alveoli.

Question 42

A client is diagnosed with hypothyroidism. What medication is commonly prescribed for this condition?

Accepted Answer

Answer reason: Hypothyroidism is treated with thyroid hormone replacement; levothyroxine (synthetic T4) is first-line. Methimazole and propylthiouracil are antithyroid drugs for hyperthyroidism; liothyronine (T3) is not first-line.

Question 43

A client is prescribed diltiazem for atrial fibrillation. What is the primary therapeutic effect of diltiazem?

Accepted Answer

Answer reason: Diltiazem, a non-dihydropyridine calcium channel blocker, slows AV nodal conduction to control ventricular response in atrial fibrillation, thereby reducing heart rate. It does not increase blood pressure, is a negative inotrope, and while it can cause vasodilation, its primary use here is rate control.

Question 44

A client with rheumatoid arthritis is prescribed methotrexate. What should the nurse instruct the client regarding folic acid supplementation?

Accepted Answer

Answer reason: Folic acid supplementation is recommended with methotrexate therapy to reduce adverse effects such as stomatitis and GI upset; it should be taken as prescribed during MTX treatment.

Question 45

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

Accepted Answer

Answer reason: Acute angle-closure glaucoma requires rapid lowering of intraocular pressure. Acetazolamide, a carbonic anhydrase inhibitor, decreases aqueous humor production. Diphenhydramine, phenylephrine, and nortriptyline can cause mydriasis and may worsen angle closure.

Question 46

Which drug should a patient with a history of rheumatic heart disease take prior to scheduled invasive procedures to prevent bacterial endocarditis?

Accepted Answer

Answer reason: High-risk patients for infective endocarditis receive antibiotic prophylaxis before certain invasive procedures; amoxicillin is the standard first-line agent.

Question 47

The nurse is caring for a client with cirrhosis of the liver who is receiving lactulose. Which of the following findings would indicate a therapeutic response?

Accepted Answer

Answer reason: Lactulose lowers serum ammonia in hepatic encephalopathy; improvement is reflected by better mental status and increased level of consciousness. It does not increase liver enzymes, urinary calcium is unrelated, and it affects colonic—not gastric—pH.

Question 48

For a patient experiencing frequent atrial premature complexes, which of the following medications might be appropriately prescribed?

Accepted Answer

Answer reason: Beta-blockers decrease sympathetic stimulation and suppress atrial ectopy, making them first-line for symptomatic frequent PACs. Nitrates treat angina, class IA agents are not first-line and carry proarrhythmic risk, and calcium channel blockers are less effective for PAC suppression.

Question 49

What is the primary goal of administering magnesium sulfate to women with pre-eclampsia?

Accepted Answer

Answer reason: Magnesium sulfate is administered in pre-eclampsia for maternal seizure prophylaxis to prevent progression to eclampsia; antihypertensives lower BP and MgSO4 is not primarily for labor prevention or headache relief.

Question 50

A client is admitted with hyperthyroidism and is prescribed propranolol. What is the primary therapeutic effect of propranolol in hyperthyroidism?

Accepted Answer

Answer reason: Propranolol, a nonselective beta-blocker, treats hyperthyroid symptoms by blunting adrenergic effects, lowering heart rate and blood pressure; it does not alter thyroid hormone production.

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