Question 1

Which medication may be indicated if a patient with junctional rhythm is symptomatic?

Accepted Answer

Answer reason: Symptomatic junctional rhythm is bradycardic; first-line treatment for symptomatic bradycardia is atropine. Adenosine treats SVT, amiodarone is for ventricular arrhythmias, and digoxin can precipitate junctional rhythms.

Question 2

Which type of insulin should the nurse expect to administer immediately before a meal to a patient with type 1 diabetes mellitus?

Accepted Answer

Answer reason: Short-acting (regular) insulin is used for prandial coverage and is given around mealtime; long-, intermediate-, and ultra-long-acting insulins provide basal control and are not administered specifically before meals.

Question 3

Which of the following medications is known to increase aPTT levels when taken concurrently?

Accepted Answer

Answer reason: APTT monitors the intrinsic pathway and is used to assess unfractionated heparin therapy; heparin increases aPTT. Warfarin is monitored with PT/INR, and aspirin/clopidogrel affect platelets without changing aPTT.

Question 4

A client with congestive heart failure has been receiving digoxia (Laxoxin). Which finding indicates that the medication is having a desired effect?

Accepted Answer

Answer reason: Digoxin increases myocardial contractility and cardiac output in heart failure, leading to improved renal perfusion and diuresis; increased urine output reflects therapeutic effectiveness. Stabilized weight is nonspecific, and increased pedal edema indicates worsening.

Question 5

The physician has ordered DDAVP (desmopressin acetate) for a client with diabetes insipidus. Which finding indicates that the medication is having its intended effect?

Accepted Answer

Answer reason: Desmopressin is a synthetic ADH that increases renal water reabsorption, reducing polyuria in diabetes insipidus. A decrease in urinary output indicates the medication is effective; the other findings are unrelated.

Question 6

The physician has prescribed Coumadin (sodium warfarin) for a client having transient ischemic attacks. Which laboratory test measures the therapeutic level of Coumadin?

Accepted Answer

Answer reason: Warfarin therapy is monitored by PT/INR because it inhibits vitamin K–dependent clotting factors in the extrinsic pathway. PTT monitors heparin; bleeding time assesses platelets; clot retraction time is not used to monitor warfarin.

Question 7

A post-operative client has an order for Demerol (meperidine) 75mg and Phenergan (promethazine) 25mg IM every 3–4 hours as needed for pain. The combination of the two medications produces a/an?

Accepted Answer

Answer reason: Promethazine potentiates the analgesic and sedative effects of meperidine; together they produce an enhanced response greater than either alone, which is a synergistic effect.

Question 8

The doctor has prescribed aspirin 325mg daily for a client with transient ischemic attacks. The nurse explains that aspirin was prescribed to?

Accepted Answer

Answer reason: For TIA prevention, aspirin irreversibly inhibits COX-1, decreasing thromboxane A2 and thus platelet aggregation, reducing thrombotic events.

Question 9

A client taking Dilantin (phenytoin) for tonic-clonic seizures is preparing for discharge. Which information should be included in the client’s discharge care plan?

Accepted Answer

Answer reason: Phenytoin has a narrow therapeutic index; serum drug levels and labs (e.g., CBC/LFTs) must be monitored regularly. It does not cause dental staining (gingival hyperplasia is the concern), no special avoidance of high-carbohydrate diet is required, and while drowsiness can occur, routine blood monitoring is the key discharge teaching.

Question 10

The physician has ordered nitroglycerin buccal tablets for a client with stable angina. The nurse knows that nitroglycerin?

Accepted Answer

Answer reason: Nitroglycerin is a nitrate that causes vasodilation, including dilation of the coronary arteries, improving myocardial oxygen supply. It does not slow or strengthen contractions and does not increase ventricular filling.

Question 11

The physician has ordered Stadol (butorphanol) for a post-operative client. The nurse knows that the medication is having its intended effect if the client?

Accepted Answer

Answer reason: Butorphanol is an opioid analgesic; its intended effect is pain relief. Falling asleep shortly after administration indicates comfort and adequate analgesia. Other options are unrelated or reflect side effects.

Question 12

The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician's teaching by telling the parents that?

Accepted Answer

Answer reason: Congenital hypothyroidism requires lifelong thyroid hormone replacement. It is taken daily with no drug holidays; thus lifelong therapy is necessary.

Question 13

The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirm a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is?

Accepted Answer

Answer reason: Myasthenia gravis is treated with acetylcholinesterase inhibitors such as neostigmine (Prostigmine) to increase acetylcholine at the neuromuscular junction. Edrophonium (Tensilon) is used for diagnosis, atropine is anticholinergic, and etidronate treats bone disorders.

Question 14

A client with diabetes insipidus is receiving DDAVP (desmopressin acetate). Which lab finding indicates that the medication is having its intended effect?

Accepted Answer

Answer reason: Desmopressin replaces ADH in diabetes insipidus, decreasing urine output and increasing urine concentration. A specific gravity of 1.020 is within normal range and indicates effective therapy. The other values are unrelated to DI response.

Question 15

A client receiving chemotherapy for breast cancer has an order for Zofran (ondansetron) 8mg PO to be given 30 minutes before induction of the chemotherapy. The purpose of the medication is to?

Accepted Answer

Answer reason: Ondansetron is a 5-HT3 receptor antagonist antiemetic given prophylactically before chemotherapy to prevent nausea and vomiting.

Question 16

The doctor has prescribed Claratin (loratidine) for a client with seasonal allergies. The feature that separates Claratin from other antihistamines such as diphenhydramine is that the medication?

Accepted Answer

Answer reason: Loratadine is a second-generation antihistamine that minimally crosses the blood–brain barrier, making it essentially non-sedating, unlike diphenhydramine. It does not stimulate appetite, is not used for motion sickness, and cost is not its distinguishing feature.

Question 17

A child is admitted to the emergency room following ingestion of a bottle of Children's Tylenol. The nurse is aware that Tylenol poisoning is treated with?

Accepted Answer

Answer reason: N-acetylcysteine is the specific antidote for acetaminophen (Tylenol) toxicity. Deferoxamine treats iron overdose; edetate calcium disodium treats lead poisoning. Activated charcoal can be used for early decontamination but does not reverse toxicity.

Question 18

What is Imodium used for?

Accepted Answer

Answer reason: Imodium (loperamide) is an antidiarrheal that reduces intestinal motility to treat acute diarrhea; it is not used for leukorrhea, headache, or anesthesia.

Question 19

Which medication is commonly used to relieve urinary frequency, urgency, and incontinence in overactive bladder?

Accepted Answer

Answer reason: Oxybutynin is an antimuscarinic that relaxes the detrusor muscle, reducing urgency, frequency, and urge incontinence seen in overactive bladder. Tamsulosin is for BPH, ranitidine is an H2 blocker, and simvastatin is a statin.

Question 20

What is an acetaminophen tablet used for?

Accepted Answer

Answer reason: Acetaminophen is an analgesic (and antipyretic) used to relieve mild to moderate pain; it is not for cough or allergies.

Question 21

HepamErz injection is used for the treatment of which condition?

Accepted Answer

Answer reason: HepaMerz (L-ornithine L-aspartate) reduces hyperammonemia in hepatic disease and is used for hepatic encephalopathy associated with liver cirrhosis, not for heart attack, AIDS, or IBS.

Question 22

Ampicillin is used to treat which of the following conditions?

Accepted Answer

Answer reason: Ampicillin, a penicillin antibiotic, treats several bacterial infections including bacterial meningitis (e.g., Listeria). It is not indicated for tuberculosis, nonspecific diarrhea, or arthritis.

Question 23

Which injection is used to prevent and control bleeding from the uterus after childbirth?

Accepted Answer

Answer reason: Oxytocin is the first-line uterotonic given postpartum to stimulate uterine contractions and prevent/control uterine atony and hemorrhage. RhoGAM prevents Rh sensitization, methylergonovine is used when additional uterotonic effect is needed, and heparin is an anticoagulant.

Question 24

A patient is having lyme disease came to physician so what should be the best choice of drug?

Accepted Answer

Answer reason: Doxycycline is the recommended first-line agent for Lyme disease and for post–tick-bite prophylaxis as a single 200 mg dose within 72 hours. Fluoroquinolones are not recommended, and macrolides are less effective alternatives, not the best choice.

Question 25

A client has been diagnosed to have chronic renal failure. Sodium polysterene sulfonate (exchange resin kayexalate) is prescribed. The action of the medication is that it releases?

Accepted Answer

Answer reason: Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin that releases sodium and binds potassium in the gut, facilitating potassium excretion to treat hyperkalemia.

Question 26

While caring for the patient with fluid volume excess the nurse understands that the diuretic therapy for the patient is not helpful if the patient is suffering from?

Accepted Answer

Answer reason: Diuretics require functioning nephrons to promote urine output. In end-stage renal disease patients are often anuric, so diuretics are largely ineffective. Diuretics are commonly beneficial for CHF, hypertension, and pulmonary congestion.

Question 27

Which of the following is the action of calcium gluconate given to a patient with hyperkalemia?

Accepted Answer

Answer reason: Calcium gluconate stabilizes cardiac cell membranes, temporarily antagonizing the myocardial effects of hyperkalemia without lowering serum potassium.

Question 28

As a knowledgeable nurse, you know that the primary goals of antiretroviral therapy (ART) include all, EXCEPT?

Accepted Answer

Answer reason: ART suppresses viral replication to restore immune function and reduce morbidity, but it does not eradicate HIV from the body.

Question 29

The client is admitted to the postpartum unit with an order to continue the infusion of Pitocin. The nurse is aware that Pitocin is working if the fundus is?

Accepted Answer

Answer reason: Oxytocin increases uterine tone and contraction postpartum; effective therapy results in a firm, midline fundus. Deviation suggests bladder distention, and a boggy uterus indicates atony.

Question 30

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: Household pediatric contacts commonly receive isoniazid prophylaxis for about 6 months; 3 months is too short, 1 year is reserved for certain LTBI regimens, and 2 years is unnecessary.

Question 31

The client with a recent liver transplant asks the nurse how long he will have to take an immunosuppressant. Which response would be correct?

Accepted Answer

Answer reason: Organ transplant recipients require lifelong immunosuppression to prevent acute and chronic rejection; therapy is not stopped after a set number of years.

Question 32

The client is admitted from the emergency room with multiple injuries sustained from an auto accident. His doctor prescribes a histamine blocker. The nurse is aware that the reason for this order is to?

Accepted Answer

Answer reason: H2-receptor histamine blockers reduce gastric acid secretion, which is prescribed in trauma patients to prevent stress-related mucosal damage and ulcers.

Question 33

Lidocaine is a medication frequently ordered for the client experiencing?

Accepted Answer

Answer reason: Lidocaine (class Ib antiarrhythmic) is indicated for ventricular arrhythmias such as ventricular tachycardia and PVCs. It is not used for atrial tachycardia and is contraindicated in heart block or bradycardia.

Question 34

The client is receiving heparin for thrombophlebitis of the left lower extremity. Which of the following drugs reverses the effects of heparin?

Accepted Answer

Answer reason: Protamine sulfate binds and inactivates heparin, rapidly reversing its anticoagulant effect. Cyanocobalamine is vitamin B12, streptokinase is a thrombolytic, and sodium warfarin is an oral anticoagulant, not an antidote to heparin.

Question 35

A client has been receiving cyanocobalamin (B12) injections for the past six weeks. Which laboratory finding indicates that the medication is having the desired effect?

Accepted Answer

Answer reason: Effective vitamin B12 therapy for pernicious/megaloblastic anemia increases erythropoiesis; by several weeks the reticulocyte count returns to normal (~0.5–1.5%). WBC differential values do not indicate B12 effectiveness.

Question 36

The client with cirrhosis of the liver is receiving Lactulose. The nurse is aware that the rationale for the order for Lactulose is?

Accepted Answer

Answer reason: Lactulose acidifies the colon and traps ammonia as ammonium, promoting its excretion to treat hepatic encephalopathy; thus it lowers serum ammonia.

Question 37

The nurse is teaching the mother regarding treatment for enterobiasis. Which instruction should be given regarding the medication?

Accepted Answer

Answer reason: Enterobiasis (pinworm) is highly contagious; standard therapy includes treating all household contacts to prevent reinfestation. Other options are incorrect: treatment is safe for young children, therapy is not for a year (usually single dose repeated in ~2 weeks), and antibiotics/IV therapy are not used.

Question 38

Which medication is used to treat iron toxicity?

Accepted Answer

Answer reason: Deferoxamine (Desferal) is an iron-chelating agent used for iron overdose. Narcan treats opioid toxicity, Digibind treats digoxin toxicity, and dexrazoxane is for anthracycline cardioprotection.

Question 39

In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia, the nurse should expect?

Accepted Answer

Answer reason: Oxytocin (Pitocin) augments uterine contractions to advance labor; effectiveness is shown by ongoing cervical change, specifically progressive dilation, not rapid delivery or infrequent contractions.

Question 40

The nurse is caring for a child receiving albuterol (Proventil) for asthma. The parents ask the nurse why their child is receiving this medication. The nurse should explain that "Albuterol is prescribed to?

Accepted Answer

Answer reason: Albuterol is a short-acting beta-2 adrenergic agonist that relaxes bronchial smooth muscle, causing bronchodilation. It does not primarily reduce airway edema, decrease secretions, or stimulate the respiratory center.

Question 41

The nurse administered intravenous gamma globulin to an 18 month-old child with AIDS. The parent asks why this medication is being given. The BEST response is?

Accepted Answer

Answer reason: IV immune globulin provides passive antibodies to reduce and prevent bacterial infections in immunocompromised children with AIDS; it is not an antiviral and does not enhance other drugs.

Question 42

A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize?

Accepted Answer

Answer reason: Early and continuous levothyroxine therapy in congenital hypothyroidism prevents neurocognitive impairment and growth delay; it is not always hereditary, and untreated disease—not treated—causes developmental issues.

Question 43

A client has been receiving dexamethasone (Decadron) for control of cerebral edema. Which of the following assessments would indicate that the treatment is effective?

Accepted Answer

Answer reason: Dexamethasone reduces cerebral edema and intracranial pressure, so improvement is shown by better neurologic responses such as increased response to motor stimuli. A positive Babinski and widening pulse pressure indicate increased ICP; 37 C is nonspecific.

Question 44

Which of the following medications may retard the progression of Alzheimer's disease deterioration?

Accepted Answer

Answer reason: Donepezil, an acetylcholinesterase inhibitor, can slow cognitive decline in Alzheimer’s disease. L-dopa treats Parkinson’s, prednisone is a glucocorticoid without benefit for AD progression, and vitamin B12 helps deficiency-related cognitive issues, not Alzheimer’s deterioration.

Question 45

What is the antidote for heparin?

Accepted Answer

Answer reason: Protamine sulfate binds and neutralizes heparin. Vitamin K reverses warfarin; aminocaproic acid is an antifibrinolytic; the last option is not an antidote for heparin.

Question 46

A client being discharged form the cardiac step-down unit following an MI is given a prescription for a beta-clocking drug. A nursing student asks the clinical specialist why this drug would be used by a client who is not hypertensive. An appropriate response by the nurse is?

Accepted Answer

Answer reason: Beta-blockers reduce myocardial oxygen demand by lowering heart rate and contractility and decreasing blood pressure, thereby decreasing the heart’s workload post-MI. The other statements are incorrect.

Question 47

An older adult client is to receive and antibiotic, gentamicin. What diagnostic finding indicates the client may have difficult excreting the medication?

Accepted Answer

Answer reason: Gentamicin is primarily renally excreted. An elevated serum creatinine indicates reduced renal function, which would impair excretion and increase risk of drug accumulation.

Question 48

The client with goiter is treated with potassium iodide preoperatively. The nurse recognizes that the purpose of this medication is to?

Accepted Answer

Answer reason: Preoperative potassium iodide (Lugol's solution) is given to shrink the thyroid and reduce its vascularity, decreasing intraoperative bleeding risk. It does not treat chronic hyperthyroidism, ablate the gland, or balance electrolytes.

Question 49

A client diagnosed with cirrhosis is started on lactulose (Cephulac). The nurse understands the main purpose of the drug for this client is to?

Accepted Answer

Answer reason: Lactulose acidifies the colon, trapping ammonia as ammonium and reducing its absorption, thus lowering serum ammonia in cirrhosis; effects on peristalsis are secondary and it does not treat portal hypertension or act as dietary fiber.

Question 50

The nurse is teaching a group of women in a community clinic about prevention of osteoporosis. Which of the following over-the-counter medications should the nurse recognize as having the most elemental calcium per tablet?

Accepted Answer

Answer reason: Calcium carbonate provides the highest percentage of elemental calcium (about 40%) compared with citrate, chloride, or gluconate, giving the most elemental calcium per tablet.

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