Question 1

A client is admitted to the hospital with a diagnosis of liver failure with ascites. The physician orders spironolactone (aldactone). The nurse understands that this medication?

Accepted Answer

Answer reason: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist; it promotes excretion of sodium and chloride while conserving potassium and counteracting aldosterone. Therefore A is correct; B and C are opposite of its effects, and D is not the key mechanism and can pose risks (e.g., hyperkalemia) with other agents.

Question 2

The nurse is teaching a client with chronic renal failure (CRF) about medications. The client questions the purpose of aluminum hydroxide (Amphogel) in her medication regimen. What is the best explanation for the nurse to give the client for the use of this medication? This medication is given to?

Accepted Answer

Answer reason: Aluminum hydroxide binds phosphate in the gastrointestinal tract, reducing absorption and thereby lowering elevated serum phosphate levels common in chronic renal failure.

Question 3

The nurse is providing education for a newly diagnosed tuberculosis client. The MOST important information to include is to instruct the client to?

Accepted Answer

Answer reason: Adherence to the full antitubercular regimen is the most critical teaching point to prevent resistance and relapse, even when symptoms improve.

Question 4

A depressed client is experiencing severe insomnia. The physician orders trazodone (Desyrel). The nurse tells the client to expect?

Accepted Answer

Answer reason: Trazodone is a sedating antidepressant commonly used to aid sleep; its expected therapeutic effect is relief of insomnia.

Question 5

Which of the following is an indication for oxygen therapy?

Accepted Answer

Answer reason: Cyanosis is a direct sign of hypoxemia and indicates the need for oxygen therapy. Anorexia is unrelated; anemia is not corrected by oxygen alone; pulmonary edema may require oxygen, but the clear indication among the options is cyanosis.

Question 6

A client receives morphine sulfate after being admitted to the emergency room in acute respiratory distress. He is very anxious, edematous, and cyanotic. Which of the following should the nurse recognize as the desired response to the medication?

Accepted Answer

Answer reason: Morphine’s desired therapeutic effect in this context is relief of anxiety and dyspnea via analgesia/sedation and venodilation. It does not increase pulse pressure, ‘sympathetic depression’ is not a clinical outcome to monitor, and opioids can depress respiration rather than directly enhance ventilation.

Question 7

A 42-year-old man with metastatic lung cancer is admitted to the hospital. His orders include: do not resuscitate (DNR) and morphine 2 mg/h by continuous IV infusion. When the nurse assesses him, his BP is 86/50, respirations are 8, and he is nonresponsive. Naloxone hydrochloride (Narcan), 0.4 mg IV, is ordered STAT. In planning care for this man, it is IMPORTANT for the nurse to know that?

Accepted Answer

Answer reason: Naloxone has a rapid onset and short duration; repeat dosing every 2–3 minutes may be required until adequate ventilation returns. DNR does not preclude giving reversal agents, and naloxone is specific for opioids—not barbiturates or general sedatives.

Question 8

A patient with type I diabetes mellitus (IDDM) asks the nurse why the doctor ordered human insulin instead of beef or pork insulin. Which of the following responses by the nurse is BEST?

Accepted Answer

Answer reason: Human insulin has an amino acid sequence identical to endogenous insulin, making it minimally antigenic and least likely to provoke antibody formation. This is the primary rationale for choosing it over animal-derived insulin. Hypo/hyperglycemia risk and long-term complications are not determined by insulin source.

Question 9

The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse that the medications are effective?

Accepted Answer

Answer reason: Efficacy of H. pylori therapy is reflected by symptom relief; decreased gastric distress indicates improvement. The other options are lifestyle or activity changes and do not measure medication effectiveness.

Question 10

A client is diagnosed with metabolic acidosis, which would the nurse expect the health care provider to order?

Accepted Answer

Answer reason: Metabolic acidosis is treated by buffering excess acid; sodium bicarbonate is the appropriate medication. Potassium would worsen potential hyperkalemia, serum sodium level is a lab test not a treatment, and bronchodilators address airway issues, not acid-base imbalance.

Question 11

When preparing to administer an antibiotic to a client, the nurse understands it will be effective in treatment of an infectious disease process primarily because antibiotics?

Accepted Answer

Answer reason: Antibiotics work by inhibiting bacterial growth or killing bacteria through disruption of essential cellular processes such as cell wall or protein synthesis. They do not primarily reduce inflammation, boost immunity, or simply immobilize bacteria.

Question 12

The nurse is caring for a 10 year-old child who has just been diagnosed with diabetes insipidus. The parents ask about the treatment prescribed, vasopressin. A PRIORITY in teaching the child and family is?

Accepted Answer

Answer reason: Central diabetes insipidus requires vasopressin/desmopressin replacement; children should keep the intranasal spray available for urgent breakthrough polyuria or missed doses. Monitoring for dehydration is important but not the key teaching about the prescribed medication, and therapy is long-term rather than short-term.

Question 13

A diabetic client's blood sugar is 306 this morning. After the nurse reports this lab result and the client's symptoms of excessive hunger and thirst, the nurse would expect the physician to order?

Accepted Answer

Answer reason: Blood glucose of 306 mg/dL with polyphagia/polydipsia indicates hyperglycemia; immediate treatment is short-acting insulin. Regular insulin acts quickly to reduce glucose. Orange juice treats hypoglycemia; NPH is intermediate-acting and not for acute correction; repeating the level delays treatment.

Question 14

While teaching a client about their medications, the client asks how long it will take before the effects of lithium take place. The nurse states it will be?

Accepted Answer

Answer reason: Lithium’s therapeutic effect typically emerges after about 1–2 weeks; two weeks is the best single estimate among the options.

Question 15

A client had 20 mg of Lasix (furosemide) PO at 10 AM. Which would be essential for the nurse to include at the change of shift report?

Accepted Answer

Answer reason: Furosemide is a loop diuretic; the key outcome to monitor and report is urine output to evaluate drug effectiveness and fluid status. Weight change, potassium level, and future dosing are relevant but less essential for immediate handoff.

Question 16

Lactulose (Chronulac) has been prescribed for a client with advanced liver disease. Which of the following assessments would the nurse use to evaluate the effectiveness of this treatment?

Accepted Answer

Answer reason: Lactulose lowers serum ammonia by trapping it in the gut, improving hepatic encephalopathy. Clinical effectiveness is shown by improved mental status, such as decreased lethargy, not changes in appetite, fluid retention, or jaundice.

Question 17

A pregnant client who is at 34 weeks gestation is diagnosed with a pulmonary embolism (PE). The nurse would anticipate the physician ordering?

Accepted Answer

Answer reason: Warfarin (Coumadin) is contraindicated in pregnancy because it crosses the placenta. Therapeutic management of PE in pregnancy uses heparin with dosing adjusted to achieve a target PTT; subcutaneous heparin titrated to maintain PTT about 1.5 times control is appropriate. Fixed low-dose SC heparin is only prophylactic, and IV infusion is not the expected outpatient regimen here.

Question 18

Which drug is used to treat a 'Tet spell' in children with Tetralogy of Fallot?

Accepted Answer

Answer reason: Morphine is first-line for hypercyanotic ('Tet') spells; it reduces infundibular spasm and catecholamine release, calms the child, and improves oxygenation.

Question 19

Which of the following medications is NOT used to treat bipolar disorders?

Accepted Answer

Answer reason: Lithium, valproic acid, and carbamazepine are mood stabilizers used for bipolar disorder. Amphetamine is a stimulant that can precipitate or worsen mania and is not used to treat bipolar disorder.

Question 20

Cremaffin syrup is used to relieve?

Accepted Answer

Answer reason: Cremaffin is a laxative formulation containing liquid paraffin and milk of magnesia (and in some versions sodium picosulfate). It softens stool and draws water into the bowel to promote bowel movements, providing relief from constipation. It has no role in treating cough or fever and is not indicated for heartburn.

Question 21

Telmisartan tablets is used for?

Accepted Answer

Answer reason: Telmisartan is an angiotensin II receptor blocker that inhibits AT1 receptors, leading to decreased vasoconstriction and aldosterone secretion. This reduces systemic vascular resistance and lowers blood pressure, making it indicated for hypertension and cardiovascular risk reduction. It is not a treatment for hyperglycemia or hyperlipidemia, and it has no role in conditions like hyperostosis.

Question 22

Ondansetron used for ___?

Accepted Answer

Answer reason: Ondansetron is a selective 5-HT3 receptor antagonist that blocks serotonin receptors in the chemoreceptor trigger zone and the GI tract. This inhibits the emetogenic signaling responsible for nausea and vomiting. It is commonly used for postoperative and chemotherapy-induced nausea and vomiting, not for fever, allergies, or pain.

Question 23

Which factors might influence the decision to start a GLP-1RA in a high-risk patient with obesity?

Accepted Answer

Answer reason: GLP-1 receptor agonists are considered for patients with obesity, especially with BMI ≥30 or ≥27 plus comorbidities. Hypertension is a common obesity-related comorbidity that strengthens the rationale due to GLP-1RA benefits on weight and modest BP reduction. In high cardiovascular-risk patients with suboptimal lipid control or statin intolerance, GLP-1RAs can provide additional cardiometabolic and CV outcome benefits, which may influence initiation. Therefore, all listed factors could support starting a GLP-1RA.

Question 24

A client being treated for chronic cholecystitis should be given which of the following instructions?

Accepted Answer

Answer reason: In chronic cholecystitis, anticholinergics decrease gallbladder motility and biliary spasm, helping relieve biliary colic and dyspeptic symptoms. Antacids are not contraindicated and may be used for dyspepsia, so avoiding them is unnecessary. Increasing protein is not a targeted dietary recommendation; the key focus is usually limiting fat. While rest may be beneficial in general, it is nonspecific compared with the evidence-based instruction to use prescribed anticholinergics.

Question 25

Which of the following drugs is used post–myocardial infarction?

Accepted Answer

Answer reason: Post–myocardial infarction care includes antiplatelet therapy to prevent further thrombus formation and reduce mortality; aspirin is first-line for this indication. Vitamin E has no proven benefit in post-MI outcomes. Amoxicillin is an antibiotic without a role in MI management, and diazepam is a benzodiazepine used for anxiety or sedation, not for secondary prevention after MI.

Question 26

A nurse reviews the physician’s prescription for a client with heart failure. The nurse expects to note which of the following?

Accepted Answer

Answer reason: Digoxin is a positive inotrope that increases myocardial contractility and can improve symptoms and exercise tolerance in heart failure, particularly with reduced ejection fraction and/or concomitant atrial fibrillation. Cardizem (diltiazem) is a nondihydropyridine calcium-channel blocker that has negative inotropic effects and is generally avoided in systolic HF. Propranolol is a nonselective beta-blocker not used for HF management; evidence-based beta-blockers are metoprolol succinate, carvedilol, or bisoprolol. Metronidazole is an antimicrobial with no role in heart failure treatment.

Question 27

Ondansteron tablets is used for?

Accepted Answer

Answer reason: Ondansetron is a selective 5‑HT3 receptor antagonist that prevents and treats nausea and vomiting, especially postoperative and chemotherapy- or radiation-induced emesis. It works by blocking serotonin receptors in the gastrointestinal tract and the chemoreceptor trigger zone. It does not treat malaria, allergic conditions, or syphilis.

Question 28

A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion, which of the following symptoms is NOT expected?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that promotes natriuresis and diuresis, leading to increased urine output. In congestive heart failure, this reduces intravascular volume, which decreases edema and often lowers blood pressure. Pain relief is not a direct or expected pharmacologic effect of furosemide. Therefore, decreased pain would not be anticipated following the infusion.

Question 29

A nurse is caring for a client with heart failure. Which interventions should the nurse include in the plan of care?

Accepted Answer

Answer reason: Heart failure care typically includes diuretics to reduce fluid overload and pulmonary/systemic congestion, improving symptoms such as edema and dyspnea. Daily weights at the same time each day are used to detect early fluid retention. Elevating the head of bed helps decrease venous return and improves ventilation, reducing dyspnea, and limiting sodium intake helps prevent water retention. Encouraging 3 L/day fluid intake is generally inappropriate in HF because fluids are often restricted to avoid worsening volume overload.

Question 30

The nurse is caring for a patient diagnosed with Multiple Sclerosis (MS). The nurse should anticipate a prescription for which medication?

Accepted Answer

Answer reason: Multiple sclerosis commonly causes spasticity due to upper motor neuron involvement, and baclofen (a GABA-B agonist) is a first-line medication used to reduce muscle spasm and tone. Anticipating baclofen aligns with expected pharmacologic management of MS-related spasticity. Risperidone is an antipsychotic, prazosin is typically used for hypertension and PTSD-related nightmares, and topiramate is primarily an anticonvulsant/migraine prophylactic rather than a standard MS spasticity treatment.

Question 31

Which of the following foods should be avoided when taking a drug like tetracycline to prevent decreased absorption?

Accepted Answer

Answer reason: Tetracyclines chelate with divalent and trivalent cations (especially calcium) found in dairy products, forming insoluble complexes in the GI tract. This markedly reduces tetracycline absorption and can lead to subtherapeutic antibiotic levels and treatment failure. Therefore, milk, cheese, yogurt, and other calcium-rich dairy should be avoided around the time of dosing (and similarly calcium/iron/magnesium-containing supplements or antacids).

Question 32

The nurse is caring for an infant with Respiratory Distress Syndrome (RDS). To promote the production of surfactant, the nurse anticipates that the physician will prescribe?

Accepted Answer

Answer reason: Neonatal RDS is primarily caused by surfactant deficiency, leading to alveolar collapse and impaired gas exchange. Poractant alfa is an exogenous surfactant replacement that directly increases surfactant availability in the lungs and improves lung compliance and oxygenation. Dexamethasone (antenatal corticosteroids) can accelerate fetal lung maturation before birth, but in a diagnosed infant with RDS the expected prescription to address surfactant deficiency is surfactant therapy. Theophylline and albuterol are bronchodilators/respiratory stimulants and do not correct the underlying surfactant deficiency.

Question 33

What is the most appropriate pain management plan for a post-C-section patient breastfeeding her newborn?

Accepted Answer

Answer reason: For postpartum pain control in a breastfeeding patient, scheduled non-opioid analgesics (acetaminophen and an NSAID such as ibuprofen) are recommended as first-line because they are effective for post-cesarean pain and are compatible with breastfeeding. Exclusive nonpharmacologic methods are usually insufficient after abdominal surgery, and avoiding all medications can lead to uncontrolled pain, impaired mobility, and delayed recovery. Routine prolonged opioid therapy such as morphine PCA for 7 days is excessive for typical post-cesarean recovery and increases maternal adverse effects and infant exposure risk; opioids are reserved for breakthrough pain at the lowest effective dose and duration.

Question 34

A nurse is teaching a client with tuberculosis (TB) about medication compliance. Which statement indicates effective teaching?

Accepted Answer

Answer reason: Tuberculosis requires prolonged, consistent multidrug therapy (typically around 6 months for drug-susceptible TB) to fully eradicate the organism and prevent relapse. Stopping early when feeling better, taking only a few weeks, or taking medications only when symptomatic promotes treatment failure and increases the risk of drug resistance. Therefore, the statement committing to taking all medications for at least 6 months best demonstrates correct understanding and adherence.

Question 35

Which of the following orders should the RN question?

Accepted Answer

Answer reason: Insulin glargine is a long-acting basal insulin that should not be used for pre-meal (AC) coverage because it has no significant peak and is intended to provide steady 24-hour control. Ordering it AC and HS implies it is being used as both prandial and bedtime dosing, which is inappropriate and could increase hypoglycemia risk and duplicative basal dosing. Regular insulin is appropriately given AC (and may be ordered at bedtime depending on regimen), glargine at HS is a common basal order, and NPH twice daily is also a standard basal/intermediate regimen. Therefore, the glargine AC and HS order should be questioned/clarified.

Question 36

While working on your med/surg floor, you have a patient who has been seizing for 8 minutes. Which of the following medications would you administer?

Accepted Answer

Answer reason: A seizure lasting 8 minutes meets criteria for convulsive status epilepticus, requiring rapid termination with a benzodiazepine as first-line therapy. IV lorazepam is preferred due to fast onset and longer CNS duration compared with some alternatives, making it effective for stopping active seizures. Oral administration is inappropriate during an active seizure (aspiration risk and delayed absorption), and phenytoin is typically used as second-line/adjunct therapy to prevent recurrence after initial benzodiazepine control rather than as the immediate first medication to stop the seizure.

Question 37

Nurse Johnson is educating a client prescribed phenazopyridine (Pyridium) for symptomatic relief of a urinary tract infection. What information regarding potential side effects should Nurse Johnson prioritize?

Accepted Answer

Answer reason: Phenazopyridine is a urinary analgesic that commonly causes orange-red discoloration of urine (and can also stain clothing and contact lenses). This effect is benign but can alarm clients if they are not warned, so it is a high-priority teaching point to promote adherence and reduce anxiety. The other listed effects are not the characteristic, most expected client education priority for this medication.

Question 38

A nurse is caring for a client after a femoral fracture. Which intervention prevents venous thromboembolism (VTE)?

Accepted Answer

Answer reason: After a femoral fracture, the client is at high risk for VTE due to immobility and endothelial injury, so pharmacologic prophylaxis is indicated. Low molecular weight heparin reduces clot formation by inhibiting clotting factors and is a standard evidence-based VTE prevention measure in orthopedic trauma/postoperative care. Keeping the limb immobile increases venous stasis and raises VTE risk, and calf massage is contraindicated because it can dislodge a clot. Limb elevation may reduce edema but is not a primary or reliable VTE-prevention intervention compared with anticoagulant prophylaxis.

Question 39

What would the nurse expect to administer to a client who presents to the emergency department with a toxic acetaminophen level?

Accepted Answer

Answer reason: N-acetylcysteine (acetylcysteine) is the antidote for acetaminophen toxicity because it replenishes hepatic glutathione, allowing detoxification of the toxic metabolite (NAPQI) and preventing hepatic necrosis. Deferoxamine is used for iron poisoning, succimer is a chelator used for lead (and some other heavy metals), and flumazenil reverses benzodiazepines. Therefore, acetylcysteine is the expected medication for a toxic acetaminophen level.

Question 40

A client with diabetes mellitus is receiving insulin therapy. The nurse understands that hypoglycemia may occur if the client?

Accepted Answer

Answer reason: Insulin lowers blood glucose by facilitating cellular uptake of glucose; if a client takes insulin but then skips a meal, there is insufficient carbohydrate intake to match the insulin effect, increasing the risk for hypoglycemia. Increased carbohydrate intake would generally raise glucose and reduce hypoglycemia risk. Administering insulin after meals (particularly rapid-acting/short-acting with appropriate timing) is less likely to cause hypoglycemia than giving insulin without eating. Regular exercise can contribute to hypoglycemia, but the most directly tested classic trigger is skipping a meal while on insulin.

Question 41

A post-operative client receives a stat dose of injection Diclofenic IM, after one hour, the nurse checks on pain relief. Which steps of the nursing process is the nurse using here?

Accepted Answer

Answer reason: After administering IM diclofenac, checking the client’s pain relief one hour later is determining whether the intervention achieved the expected outcome. This is the evaluation step of the nursing process, where the nurse compares the client’s current status to the goal (pain reduction). Assessment is broader data collection, implementation is giving the medication, and planning is setting goals/interventions before the action.

Question 42

A patient presents with supraventricular tachycardia (SVT) and is hemodynamically stable. Which medication do you anticipate administering?

Accepted Answer

Answer reason: For a hemodynamically stable patient with regular narrow-complex SVT, adenosine is the first-line medication after vagal maneuvers because it transiently blocks AV nodal conduction and can terminate AV node–dependent reentrant rhythms. Epinephrine is used for cardiac arrest or anaphylaxis and would worsen tachycardia. Atropine is indicated for symptomatic bradycardia, not SVT. Amiodarone is more commonly used for ventricular dysrhythmias or refractory SVT when adenosine/AV-nodal blockers are not appropriate.

Question 43

A patient in septic shock has a blood pressure of 78/42 mmHg despite fluid resuscitation. Which medication should the nurse prepare to administer?

Accepted Answer

Answer reason: In septic shock with persistent hypotension despite adequate fluid resuscitation, the priority is to restore perfusion with a vasopressor. Dopamine has dose-dependent beta-1 and alpha-1 activity that can increase cardiac output and systemic vascular resistance, raising blood pressure. Nitroprusside is a potent vasodilator that would worsen hypotension, furosemide can decrease intravascular volume and exacerbate shock, and atorvastatin is not an acute hemodynamic rescue medication.

Question 44

Ferrous sulfate is prescribed for a client. She returns to the clinic in two weeks. Which assessment by the nurse indicates that she has NOT been taking iron as ordered?

Accepted Answer

Answer reason: Oral ferrous sulfate commonly causes dark/black or greenish stools due to unabsorbed iron, so the absence of darkening suggests the client may not be taking the medication. Nausea is a frequent adverse effect and would be consistent with taking iron. Improved energy after a couple of weeks can indicate response to iron therapy for iron-deficiency anemia. Flushed cheeks are nonspecific and do not reliably indicate adherence.

Question 45

Which medication is given to prevent stress ulcers in critically ill patients?

Accepted Answer

Answer reason: Stress-ulcer prophylaxis in critically ill patients is commonly achieved by reducing gastric acid secretion using a proton pump inhibitor (PPI) or an H2-receptor antagonist. Omeprazole is a PPI that suppresses gastric acid production and is commonly used for ICU stress-ulcer prophylaxis. Metoclopramide is a prokinetic/antiemetic and does not prevent stress ulcers. Sucralfate coats the mucosa but does not suppress acid and is less commonly used than acid suppression for prophylaxis.

Question 46

A client with atrial fibrillation is prescribed warfarin. Which lab value should the nurse monitor?

Accepted Answer

Answer reason: Warfarin is a vitamin K antagonist that prolongs prothrombin time, and its anticoagulant effect is monitored using the INR. INR guides dosing to achieve therapeutic anticoagulation while minimizing bleeding risk (commonly INR 2.0–3.0 for atrial fibrillation). aPTT is used to monitor unfractionated heparin, not warfarin. Platelet count and hemoglobin can indicate bleeding or other problems but do not measure warfarin’s therapeutic effect.

Question 47

A patient is brought to the emergency department with signs of opioid overdose, including respiratory depression and pinpoint pupils. Which of the following medications should the nurse anticipate administering?

Accepted Answer

Answer reason: The presentation of respiratory depression with pinpoint pupils is classic for opioid overdose, and naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression. Flumazenil reverses benzodiazepines, not opioids, and N-acetylcysteine is the antidote for acetaminophen toxicity. Atropine is used for symptomatic bradycardia and organophosphate poisoning and does not reverse opioid effects.

Question 48

A patient experiencing an acute ischemic stroke is likely to receive which medication initially?

Accepted Answer

Answer reason: In acute ischemic stroke, IV thrombolysis with tissue plasminogen activator (tPA, e.g., alteplase) may be given early to dissolve the occluding clot and improve neurologic outcomes when the patient meets strict eligibility criteria and is within the treatment window. Heparin and warfarin are not used as the initial acute treatment because they do not rapidly lyse the clot and can increase bleeding risk. Aspirin is typically started after hemorrhage is excluded and generally after the tPA decision (and if tPA is given, aspirin is delayed for about 24 hours). Therefore, the most likely initial medication is tPA.

Question 49

A client is taking warfarin. Which lab value indicates a therapeutic effect?

Accepted Answer

Answer reason: Warfarin anticoagulation is monitored using the INR, with a typical therapeutic target range of about 2.0–3.0 for most indications (e.g., atrial fibrillation, DVT/PE). An INR of 2.5 falls within this range, indicating therapeutic anticoagulant effect. An INR of 1.0 is essentially normal (not anticoagulated), and 1.8 is usually subtherapeutic, increasing risk of thrombosis.

Question 50

When a patient has long-term atrial fibrillation, the nurse would expect to include which drug in the plan of care to minimize the greatest risk that is commonly associated with atrial fibrillation?

Accepted Answer

Answer reason: The greatest common risk of long-term atrial fibrillation is thromboembolism, especially ischemic stroke, due to blood stasis and clot formation in the left atrial appendage. Anticoagulants (e.g., warfarin or DOACs when appropriate) reduce clot formation and substantially lower stroke risk. Beta blockers, digitalis, and antiarrhythmics help with rate/rhythm control and symptoms but do not provide adequate stroke prevention on their own.

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