Question 1

The nurse is providing instructions to the client newly diagnosed with diabetes mellitus who has been prescribed pramlintide. Which instruction should the nurse include in the discharge teaching?

Accepted Answer

Answer reason:  “Take your prescribed pills 1 hour before or 2 hours after the injection.” Pramlintide slows gastric emptying, which can delay and reduce absorption of oral medications. To avoid altered absorption (especially important for time-critical drugs), oral meds should be taken 1 hour before or 2 hours after pramlintide. The other options give incorrect timing or administration advice and do not address the key interaction precaution.
Category reason: This item tests medication teaching about a prescribed antidiabetic agent (pramlintide), focusing on safe administration timing and expected drug effects/interactions, which fits Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 2

A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective?

Accepted Answer

Answer reason:  Heart rate is 70 beats/min and regular Levothyroxine replacement should resolve hypothyroid manifestations such as bradycardia, fatigue, and slowed metabolism; a normal, regular heart rate indicates improved thyroid hormone effect. Weight stability for only 3 weeks is nonspecific and may lag behind metabolic normalization. Thirst/fluid intake and a normal WBC count do not directly reflect effectiveness of thyroid hormone replacement.
Category reason: This item tests evaluation of a medication’s therapeutic effect (levothyroxine) using expected clinical outcomes, which aligns with Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 3

A client has been given a prescription for gemfibrozil (Lopid). The nurse plans to instruct the client to limit intake of which food while taking this medication?

Accepted Answer

Answer reason: Citrus products. Gemfibrozil is a lipid-lowering fibrate, and some educational sources caution patients to avoid or limit citrus (especially grapefruit) due to potential drug–food interactions that can increase adverse effects or alter drug levels. Teaching to limit citrus products aligns with medication-safety counseling for interactions. The other options (fish, beef, spicy foods) are not standard interaction concerns specific to gemfibrozil.
Category reason: This item tests nursing medication teaching about diet/food interactions and expected safe use while taking gemfibrozil, which fits Pharmacological and Parenteral Therapies (Expected Actions-Outcomes).

Question 4

The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?

Accepted Answer

Answer reason: An episode of diarrhea. Loperamide is an antidiarrheal that decreases intestinal motility and increases absorption of fluids and electrolytes, reducing stool frequency. It is indicated for acute, noninfectious diarrhea and some chronic diarrheal states, not constipation or nonspecific abdominal pain. Hematest-positive nasogastric drainage suggests gastrointestinal bleeding, which requires medical evaluation and is not treated with loperamide.
Category reason: This item tests nursing knowledge of a medication’s therapeutic use/expected outcome (loperamide as an antidiarrheal), which fits Pharmacological and Parenteral Therapies rather than foundational biomedical science.

Question 5

A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client?

Accepted Answer

Answer reason: B. Simethicone (Mylicon). Simethicone is an antiflatulent that decreases bloating and discomfort by breaking up gas bubbles in the GI tract, making it the most appropriate PRN for postoperative flatulence. Ondansetron is an antiemetic for nausea/vomiting, not gas pain. Acetaminophen treats pain/fever but does not relieve intestinal gas. Magnesium hydroxide is a laxative/antacid and may increase GI motility; it is not the targeted treatment for simple gas pains and can cause diarrhea.
Category reason: This item tests the nurse’s selection of the appropriate PRN medication based on the client’s symptom and the expected action/outcome of common drugs, which fits Pharmacological and Parenteral Therapies.

Question 6

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation?

Accepted Answer

Answer reason: B. Urination is not painful. Phenazopyridine is a urinary tract analgesic used to relieve dysuria (pain/burning with urination) associated with UTI, so decreased pain indicates therapeutic effectiveness. Reddish-orange urine discoloration is an expected side effect of the medication and does not indicate symptom relief or UTI improvement. Clear amber urine and absence of urge incontinence are not specific indicators of phenazopyridine’s intended action.
Category reason: This is a medication-evaluation question asking the nurse to identify the expected therapeutic outcome of phenazopyridine, which fits Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 7

The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?

Accepted Answer

Answer reason: Reduction of steatorrhea. Pancrelipase is a pancreatic enzyme replacement (lipase, amylase, protease) used for exocrine pancreatic insufficiency to improve digestion and absorption of nutrients, especially fats. The most direct sign of improved fat digestion is decreased steatorrhea (less bulky, greasy, foul-smelling stools). Weight loss would suggest inadequate absorption, and relief of heartburn is not the intended therapeutic effect. Abdominal pain may have many causes and is not the best indicator of enzyme replacement effectiveness.
Category reason: This item tests evaluation of a medication’s therapeutic effect (pancrelipase) and expected clinical outcome, which is a pharmacotherapy-focused nursing judgment topic under Expected Actions-Outcomes.

Question 8

A 68-year-old patient with a history of chronic heart failure is admitted to the hospital with worsening dyspnea and peripheral edema. The nurse notes jugular venous distention and ascites. Which of the following medications should the nurse anticipate administering to reduce the patient's fluid overload?

Accepted Answer

Answer reason: C. Furosemide Furosemide is a loop diuretic that promotes rapid diuresis by inhibiting sodium and water reabsorption in the loop of Henle, making it the most effective choice for acute fluid overload in heart failure. The patient’s dyspnea, peripheral edema, JVD, and ascites indicate significant volume excess that requires diuresis to reduce preload and relieve congestion. Lisinopril and metoprolol improve long-term outcomes in CHF but do not directly relieve fluid overload as quickly. Digoxin can improve symptoms by increasing contractility and controlling rate in some patients but is not a primary treatment for volume removal.
Category reason: This item tests nursing knowledge of expected medication actions for managing fluid overload in heart failure, focusing on which drug to administer for a desired therapeutic outcome—an NCLEX Pharmacological and Parenteral Therapies concept.

Question 9

Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. Which should the nurse reinforce to the client?

Accepted Answer

Answer reason: D. A reddish-orange discoloration of the urine may occur. Phenazopyridine is a urinary tract analgesic that commonly causes orange to reddish-orange urine discoloration, which is expected and harmless. Reinforcing this effect helps prevent unnecessary alarm and promotes adherence. The medication is typically taken with or after meals to reduce GI upset, not specifically at bedtime, and mild headache alone is not a routine reason to stop it without provider guidance.
Category reason: This is a medication-teaching question focused on expected effects/outcomes and client education about an ordered drug, which fits NCLEX Pharmacological and Parenteral Therapies.

Question 10

Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which is the most appropriate nursing action?

Accepted Answer

Answer reason: Informing the client that this is normal. Mafenide acetate commonly causes local burning, stinging, and discomfort when applied to burn wounds due to its tissue penetration and irritation. This expected adverse sensation alone does not indicate an allergy or dangerous reaction, so the nurse should reassure the client and continue prescribed therapy. Stopping the medication or altering the ordered application (thinner film) can reduce antimicrobial effectiveness and increase infection risk. The provider should be notified only if symptoms are severe or accompanied by signs of hypersensitivity or systemic toxicity.
Category reason: This item tests the nurse’s response to an expected medication effect during administration and appropriate client teaching, which fits medication therapy outcomes and patient education in NCLEX pharmacologic care.

Question 11

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list?

Accepted Answer

Answer reason: Drink 8 to 10 glasses of water per day. Trimethoprim-sulfamethoxazole can promote crystalluria and kidney irritation; encouraging adequate hydration helps maintain urine flow and reduces renal adverse effects. Clients should also be taught to take the medication as prescribed and not self-adjust doses. Option A is unsafe because sulfonamides can cause photosensitivity, so sunscreen is typically recommended; option C is not a classic expected finding to report for this drug compared with signs like rash or severe diarrhea; option D is incorrect because stopping or reducing antibiotics early increases treatment failure and resistance and does not prevent allergy.
Category reason: This item tests nursing discharge teaching about safe administration and expected self-care actions (hydration) for an antibiotic, which aligns with medication therapy outcomes and patient education rather than foundational biomedical science.

Question 12

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching?

Accepted Answer

Answer reason: “It is okay if I skip meals now and then.” Metformin teaching should emphasize taking the medication with meals to reduce gastrointestinal adverse effects and to promote consistent glycemic control. Skipping meals can worsen GI intolerance and contribute to poor diabetes management overall. The other statements reflect appropriate awareness of metformin precautions: reporting unusual fatigue (possible lactic acidosis warning) and avoiding alcohol due to increased lactic acidosis risk; hypoglycemia is less common with metformin alone but monitoring is still reasonable, especially if combined with other agents or with inadequate intake.
Category reason: This item tests patient education about a prescribed medication (metformin), including correct administration and safety teaching, which fits NCLEX patient-care decision-making in Pharmacological and Parenteral Therapies.

Question 13

A client with chronic atrial fibrillation is being started on amiodarone (Cordarone) as maintenance therapy for dysrhythmia suppression. The nurse reinforces instructions to the client about the medication. Which statement by the client indicates a need for further teaching?

Accepted Answer

Answer reason: I will stop taking the prescribed anticoagulant after starting this new medication. Amiodarone helps control atrial fibrillation rhythm/rate but does not eliminate the risk of thromboembolism; anticoagulation is often still required based on stroke-risk assessment. Stopping the anticoagulant without provider direction increases the risk of stroke/systemic emboli. The other statements are appropriate because amiodarone can cause corneal/optic toxicity (eye follow-up), photosensitivity (sun protection), and thyroid dysfunction (thyroid monitoring).
Category reason: This question tests patient teaching about medication management and expected ongoing therapies/monitoring with amiodarone and anticoagulants, which is a nursing medication education/judgment task.

Question 14

A patient has been taking lansoprazole (Prevacid). For the relief of which symptom should the nurse monitor the client?

Accepted Answer

Answer reason: Heartburn Lansoprazole is a proton pump inhibitor that suppresses gastric acid secretion, so it is used to relieve symptoms of acid reflux and peptic-related dyspepsia. Decreasing acid exposure reduces burning substernal discomfort commonly described as heartburn. Diarrhea, flatulence, and constipation can occur as adverse effects but are not the primary symptom the medication is intended to relieve.
Category reason: This question tests a medication’s expected therapeutic effect (what symptom should improve) and requires nursing evaluation/monitoring of drug outcomes, which aligns with Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 15

A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. Which response is the most accurate to give to the client?

Accepted Answer

Answer reason: D. Triamterene is a potassium-retaining diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic. Hydrochlorothiazide is a thiazide diuretic that increases urinary potassium loss and can cause hypokalemia. Triamterene is a potassium-sparing diuretic that reduces potassium excretion, helping counterbalance the potassium-wasting effect of the thiazide while providing additive diuresis/antihypertensive effect. This combination is commonly used to maintain more stable serum potassium levels and reduce the need for potassium supplementation. The other choices misclassify the drugs’ potassium effects or give incorrect reasons for combining them.
Category reason: This is a nursing medication-teaching question focused on explaining the expected action/outcome of combining a thiazide diuretic with a potassium-sparing diuretic.

Question 16

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen?

Accepted Answer

Answer reason: The medications will kill the bacteria and stop the acid production. This regimen is standard H. pylori therapy: two antibiotics eradicate the organism while a proton pump inhibitor suppresses gastric acid to promote mucosal healing and improve antibiotic effectiveness. The medications are taken on a scheduled basis for the full prescribed course, not only when symptoms occur. “Coating” the ulcer is the action of agents like sucralfate or bismuth, which are not listed here, making that statement inaccurate. Option A is incomplete because it omits the acid-suppression component that is key to healing and symptom control.
Category reason: This question tests patient teaching about the expected therapeutic actions and outcomes of a prescribed medication regimen (antibiotics plus a proton pump inhibitor), which is a medication-administration/education competency within Pharmacological and Parenteral Therapies.

Question 17

A client with bipolar disorder is talking rapidly, pacing, and says, “I haven’t slept in days!” Which medication is most likely to be prescribed?

Accepted Answer

Answer reason: The presentation is consistent with an acute manic episode (pressured speech, psychomotor agitation, markedly decreased need for sleep). Mood stabilizers are core long-term therapy for bipolar disorder to control mania and prevent relapse, and this agent is a classic first-line option. A benzodiazepine can be used short-term for agitation/insomnia, and an antipsychotic may be added for acute severe mania, but an SSRI can worsen mania if not paired with a mood stabilizer. Therefore, the most likely prescribed medication for bipolar mania management is a mood stabilizer.
Category reason: This question tests nursing knowledge of appropriate psychotropic medication selection and expected therapeutic use in a patient-care scenario, aligning with pharmacologic therapy decisions rather than basic biomedical science.

Question 18

A patient is prescribed dobutamine for heart failure. Which assessment finding indicates the medication is achieving its therapeutic effect?

Accepted Answer

Answer reason: Dobutamine is a beta-1 agonist that increases myocardial contractility and cardiac output in heart failure. Improved forward flow enhances renal perfusion, which commonly shows up as increased urine output—an important indicator of better end-organ perfusion beyond just “better vitals.” A large tachycardic response suggests excessive beta stimulation and can worsen myocardial oxygen demand, and a lower respiratory rate or modest BP decrease are less direct and less reliable markers of improved cardiac output.
Category reason: This is a medication-effectiveness evaluation question requiring nursing assessment of therapeutic outcomes of an inotrope (dobutamine) in a heart failure patient, which fits NCLEX Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 19

Which of the following medications is administered to prevent fluid overload following a blood transfusion?

Accepted Answer

Answer reason: It is a loop diuretic that promotes rapid diuresis, helping prevent or treat transfusion-associated circulatory overload by reducing intravascular volume and pulmonary congestion risk. It is commonly given prophylactically in patients at higher risk (e.g., older adults, heart failure, renal impairment) during or after transfusion. The other agents are used for anaphylaxis (adrenaline) or allergic transfusion reactions (hydrocortisone, chlorpheniramine), not for volume overload prevention.
Category reason: This question focuses on selecting the appropriate medication to prevent a transfusion complication (circulatory overload), which is a nursing medication-therapy decision aligned with expected actions/outcomes of drugs used with parenteral therapies.

Question 20

A client receiving IV heparin asks why they are also prescribed warfarin. What is the nurse’s best response?

Accepted Answer

Answer reason: Heparin provides immediate anticoagulation, whereas warfarin has a delayed onset because it works by reducing synthesis of vitamin K–dependent clotting factors. During the first days of warfarin therapy, anticoagulant effect may be inadequate (and protein C/S fall early), so stopping heparin too soon can increase thrombosis risk. Overlap therapy is continued until the INR is therapeutic, ensuring continuous protection against clot formation.
Category reason: This question tests nursing medication teaching about anticoagulant therapy timing and expected onset/therapeutic monitoring, which fits pharmacologic expected actions and outcomes in client care.

Question 21

Which finding indicates a therapeutic response to furosemide in a client with heart failure?

Accepted Answer

Answer reason: Furosemide is a loop diuretic used in heart failure to reduce fluid overload by promoting diuresis. A therapeutic response is evidenced by increased urine output, which helps decrease pulmonary/systemic congestion and improve symptoms such as dyspnea and edema. Decreased blood pressure can occur as a side effect but is not the most direct indicator of effective diuresis. Increased edema would indicate worsening fluid retention, and decreased heart rate is not a primary expected effect of loop diuretics.
Category reason: This question tests evaluation of an expected medication effect of a diuretic in a heart failure client, which aligns with medication outcomes monitoring under Pharmacological and Parenteral Therapies.

Question 22

A client asks why they are taking aspirin after a heart attack. What is the correct response?

Accepted Answer

Answer reason: Aspirin is an antiplatelet medication that inhibits platelet aggregation, lowering the risk of additional thrombus formation after myocardial infarction. This helps prevent recurrent coronary artery occlusion and reduces the risk of another heart attack. It does not lyse existing clots (that is the role of thrombolytics/PCI), does not directly increase myocardial contractility, and is not a cholesterol-lowering drug.
Category reason: This item tests client medication teaching about the therapeutic purpose and expected outcome of aspirin following a myocardial infarction, which aligns with pharmacologic therapy expectations in patient care.

Question 23

A child with asthma is experiencing wheezing and a prolonged expiratory phase. Which medication should the nurse anticipate administering?

Accepted Answer

Answer reason: This presentation reflects acute bronchospasm with airflow obstruction, for which a short-acting beta2-agonist is the priority rescue therapy. It rapidly relaxes bronchial smooth muscle to improve expiratory airflow and relieve wheezing. The other choices are controller medications (leukotriene receptor antagonist or inhaled corticosteroid) or a long-acting beta2-agonist that is not used for immediate relief and should not be used as monotherapy in asthma exacerbations.
Category reason: This item tests nursing action regarding which medication to administer for an acute asthma symptom presentation, emphasizing expected effects and appropriate use of bronchodilators versus controller therapies.

Question 24

Mannitol (Osmitrol) is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which indicates the therapeutic action of this medication?

Accepted Answer

Answer reason: Mannitol is an osmotic diuretic that is freely filtered at the glomerulus and not significantly reabsorbed, so it increases tubular fluid osmolality and reduces reabsorption of water, producing diuresis. By pulling water out of tissues into the intravascular space, it helps reduce cerebral edema and thereby lowers intracranial pressure. Options A and B incorrectly describe preventing filtration at the glomerulus. Option C describes enhanced reabsorption and reduced water loss, which is the opposite of mannitol’s effect.
Category reason: This question tests the expected therapeutic action of a medication (mannitol) used in a clinical scenario, aligning with pharmacologic therapy knowledge needed for nursing care decisions.

Question 25

A newly diagnosed child with type 1 diabetes mellitus receiving insulin suddenly experiences signs of hypoglycemic reaction. Which item should the nurse immediately give to the child?

Accepted Answer

Answer reason: Immediate treatment of symptomatic hypoglycemia is a fast-acting carbohydrate dose of about 15 g to rapidly raise blood glucose. Skim milk provides carbohydrate in an amount consistent with this initial treatment and is an appropriate oral option when the child can safely swallow. Diet cola contains essentially no carbohydrate, so it will not correct hypoglycemia. One teaspoon of sugar or honey provides only about 5 g carbohydrate, which is typically insufficient as the initial treatment dose.
Category reason: This item tests the nurse’s immediate intervention for an insulin-related complication (hypoglycemia) and the expected action to correct it, which aligns with medication-related nursing care.

Question 26

The RN is teaching a client about the initiation of the prescribed abstinence therapy using disulfiram (Antabuse). What information should the client acknowledge understanding?

Accepted Answer

Answer reason: Disulfiram inhibits aldehyde dehydrogenase, so alcohol intake leads to acetaldehyde accumulation and a potentially severe reaction (flushing, nausea/vomiting, hypotension, tachycardia). Starting therapy requires the client to avoid alcohol beforehand to prevent triggering this reaction immediately after the first dose. Education should also emphasize avoiding hidden alcohol sources (e.g., cough syrups, mouthwash, some foods) because even small amounts can precipitate symptoms. The other options are not the key safety teaching for initiating this medication and do not address its mechanism-related risk.
Category reason: This question tests medication teaching and expected therapeutic/safety outcomes for disulfiram initiation, which is a nursing pharmacotherapy responsibility rather than foundational science.

Question 27

A client with hyperthyroidism is receiving propranolol (Inderal). Which finding indicates that the medication is having the desired effect?

Accepted Answer

Answer reason: Propranolol is a nonselective beta-blocker used in hyperthyroidism to control adrenergic symptoms such as tachycardia, palpitations, and tremor. The desired therapeutic outcome is improvement in these symptoms, most directly reflected by a lower heart rate. It does not primarily treat the underlying thyroid hormone excess, so serum T4 and goiter size are not expected to normalize from beta-blockade alone. Blood pressure would not be expected to increase as a desired effect of this medication.
Category reason: This question asks the nurse to evaluate a medication’s therapeutic effect in a client with hyperthyroidism, which is a pharmacologic expected outcome in patient care.

Question 28

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that increases urinary excretion of potassium, placing the client at risk for hypokalemia. Teaching should include dietary potassium intake and monitoring for signs of low potassium such as muscle weakness, cramps, and dysrhythmias. Taking the dose at bedtime can worsen nocturia and disrupt sleep, so it is typically taken earlier in the day. Swelling of hands and feet is more consistent with fluid overload and should prompt evaluation rather than being expected.
Category reason: This item tests medication teaching about a diuretic’s expected effects and how to prevent common adverse outcomes (electrolyte loss), which fits Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 29

A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer?

Accepted Answer

Answer reason: With mild hyperkalemia (K+ 5.3 mEq/L), a loop diuretic promotes renal potassium excretion and can help lower serum potassium while managing fluid status. An ACE inhibitor (lisinopril) can increase potassium and may worsen hyperkalemia. Digoxin toxicity risk increases with hypokalemia rather than hyperkalemia and it does not treat elevated potassium. Potassium iodide is unrelated to potassium level management and does not address hyperkalemia.
Category reason: This item requires nursing judgment about administering a scheduled medication based on an abnormal lab value (hyperkalemia) and expected medication effects, which fits Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 30

A 36-year-old, female patient has consumed approximately 25 tablets of acetaminophen in an attempt to commit suicide. Which of the following medications would the nurse expect to be administered?

Accepted Answer

Answer reason: Acetaminophen overdose causes hepatotoxicity via accumulation of the toxic metabolite NAPQI after glutathione depletion. This medication replenishes glutathione stores and directly detoxifies NAPQI, reducing liver injury when given as early as possible (and still beneficial even if delayed). The other options are antidotes for different toxicities (e.g., naloxone for opioids, flumazenil for benzodiazepines, protamine for heparin) and would not treat acetaminophen poisoning. In suspected intentional overdose, treatment is typically started based on history and acetaminophen level/timing using established protocols.
Category reason: This is a patient-care question about anticipating the correct antidote/medication to administer in an overdose emergency, which aligns with NCLEX nursing judgment in pharmacologic therapy and expected treatment outcomes.

Question 31

A patient with an ETT is biting the tube. What do you do FIRST?

Accepted Answer

Answer reason: Biting an endotracheal tube can acutely obstruct airflow and compromise ventilation/oxygenation, so the priority is to restore ventilator synchrony and airway patency rapidly. In an intubated patient, inadequate sedation (and/or analgesia) is a common cause of agitation and tube biting; promptly treating this addresses the underlying problem and prevents hypoxemia and barotrauma from high airway pressures. Restraints do not correct the physiologic cause and can worsen agitation, while cuff deflation risks loss of the sealed airway and aspiration. Repositioning may be needed after stabilization, but it does not reliably stop tube occlusion from biting.
Category reason: This is a priority nursing intervention for an intubated patient requiring immediate medication-based management to ensure effective ventilation, aligning with pharmacologic therapy actions and expected outcomes in acute care.

Question 32

A nurse is assessing a school-age child who has heart failure and is taking furosemide. Which of the following findings should the nurse identify as an indication that the medication is effective?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that promotes renal excretion of sodium and water, reducing intravascular volume and venous congestion in heart failure. As preload and capillary hydrostatic pressure fall, interstitial fluid accumulation improves, so edema should lessen. Increased venous pressure and decreased cardiac output indicate worsening heart failure rather than therapeutic response. Loop diuretics commonly lower potassium, so an increase in potassium would not be expected as a sign of effectiveness.
Category reason: This question asks the nurse to evaluate a medication’s therapeutic effect in a patient with heart failure, which is a medication expected outcome and nursing assessment focus.

Question 33

The nurse must plan health teaching for a patient with generalized anxiety disorder who is taking lorazepam (Ativan). Which topic should be included?

Accepted Answer

Answer reason: Caffeine is a central nervous system stimulant that can worsen anxiety symptoms (e.g., restlessness, insomnia, palpitations), counteracting the goal of therapy. Teaching to limit stimulants supports symptom control and helps the patient distinguish medication effects from caffeine-related arousal. Lorazepam can cause sedation and impaired coordination; reducing caffeine also avoids masking these effects and promotes safer self-monitoring.
Category reason: This item focuses on patient education related to expected therapeutic outcomes and safe self-management while taking an anxiolytic medication, which aligns with Pharmacological and Parenteral Therapies.

Question 34

A client is prescribed warfarin. What is a priority teaching point?

Accepted Answer

Answer reason: Vitamin K antagonizes the anticoagulant effect, so fluctuating or increased intake can reduce therapeutic effectiveness and increase clotting risk. Teaching focuses on diet consistency and avoiding high–vitamin K foods that can interfere with INR control. Increasing green leafy vegetables would commonly increase vitamin K and counteract therapy. Clients should not self-hold doses for bruising; instead they should contact the provider for assessment and possible INR testing.
Category reason: This question tests nursing medication teaching about expected effects and interactions of an anticoagulant, which falls under Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 35

Methylergonovine is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication, the nurse checks which important client parameter?

Accepted Answer

Answer reason: Methylergonovine is a uterotonic used to treat uterine atony; the priority pre-administration assessment is ongoing bleeding and the response of postpartum uterine involution. Lochial amount and characteristics reflect the severity of hemorrhage and help determine whether the medication is urgently indicated and whether bleeding is improving after uterine contraction. Temperature is more related to infection screening, and urine output is a perfusion/shock marker but is not the key parameter for deciding uterotonic administration for atony.
Category reason: This is a medication-administration judgment question focused on assessing therapeutic response/bleeding status in a postpartum client, which fits NCLEX Pharmacological and Parenteral Therapies (Expected Actions-Outcomes).

Question 36

A nurse in a provider’s office is reinforcing teaching with a client who has anemia and has been taking ferrousgluconate for several weeks. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: Oral iron is best absorbed on an empty stomach, so spacing it between meals improves effectiveness for treating iron-deficiency anemia. Vitamin C enhances iron absorption, so restricting it would be counterproductive. Calcium in milk decreases absorption, making concurrent use undesirable. Whole grains are not routinely restricted; the key teaching is to avoid taking iron with absorption-inhibiting foods/antacids and to optimize timing for absorption.
Category reason: This is a medication-teaching question about how to take an oral iron supplement to optimize therapeutic effect and avoid interactions, which is a nursing intervention within Pharmacological and Parenteral Therapies.

Question 37

A client with heart failure is prescribed furosemide. Which finding indicates the medication is effective?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that promotes renal excretion of sodium and water, reducing intravascular volume and fluid overload in heart failure. An improvement in fluid overload is reflected by reduced peripheral swelling and often improved lung sounds and weight reduction. Increased blood pressure would be unexpected, and increased heart rate does not directly demonstrate diuretic effectiveness. A drop in potassium is a common adverse effect, not a therapeutic goal.
Category reason: This question asks the nurse to evaluate the therapeutic effect of a prescribed medication, which is an Expected Actions-Outcomes focus within Pharmacological and Parenteral Therapies.

Question 38

A nurse is caring for a client who has diabetes insipidus. Which of the following medications should the nurse plan to administer?

Accepted Answer

Answer reason: Diabetes insipidus results from deficient antidiuretic hormone (ADH) effect, leading to excessive dilute urine output and risk for dehydration and hypernatremia. Desmopressin is an ADH analog that increases renal water reabsorption, thereby reducing polyuria and correcting serum osmolality. Regular insulin treats diabetes mellitus, not DI. Furosemide and lithium can worsen polyuria (lithium is a classic cause of nephrogenic DI).
Category reason: This item primarily tests the nurse’s knowledge of the therapeutic medication used to treat a condition and expected outcomes of that drug in a patient-care context, fitting NCLEX Pharmacological and Parenteral Therapies.

Question 39

A nurse is preparing to administer a dose of warfarin. Which laboratory value should be monitored?

Accepted Answer

Answer reason: Warfarin inhibits vitamin K–dependent clotting factor synthesis, so its anticoagulant effect is assessed by the prothrombin time standardized as the INR. Monitoring this value guides dose adjustment to maintain a therapeutic range and reduce the risk of bleeding or thrombosis. Hemoglobin may drop with bleeding but is not the primary lab used to titrate therapy. WBC and BUN do not measure anticoagulation effect.
Category reason: This item tests nursing management of a medication by identifying the correct monitoring laboratory for anticoagulant therapy, which fits Pharmacological and Parenteral Therapies (Expected Actions-Outcomes).

Question 40

While caring for a client who is taking furosemide (Lasix), the nurse recognizes dietary teaching has been effective if the patient includes which of the following foods in his daily menus?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that commonly causes increased urinary potassium loss, placing the client at risk for hypokalemia. Effective teaching includes encouraging potassium-rich foods to help maintain normal potassium levels and reduce risks such as muscle weakness and dysrhythmias. Bananas and melon are well-known dietary sources of potassium and fit this goal better than the other listed combinations.
Category reason: This item tests nursing education and expected outcomes for a prescribed diuretic (monitoring/preventing electrolyte imbalance through diet), which is a medication-related patient-care decision under Pharmacological and Parenteral Therapies.

Question 41

While providing medications to clients on the cardiac unit, the nurse anticipates that hydralazine hydrochloride and isosorbide dinitrate (BiDil) would most likely be prescribed for which of the following clients?

Accepted Answer

Answer reason: Hydralazine plus isosorbide dinitrate is a vasodilator combination shown to improve symptoms and outcomes in patients with heart failure with reduced ejection fraction, with specific evidence supporting benefit in African American patients when added to standard therapy. The other options describe rhythm disorders (atrial fibrillation, sick sinus syndrome) that are not primary indications for this combination. Hypertension alone can be treated with many agents, but this specific fixed-dose combination is most characteristically used for heart failure management in the indicated population.
Category reason: This is primarily about selecting an appropriate medication regimen based on diagnosis and expected therapeutic outcomes, which fits Pharmacological and Parenteral Therapies—Expected Actions-Outcomes.

Question 42

While caring for a patient scheduled for knee replacement surgery, the nurse provides cefazolin (Ancef) as ordered 30 minutes pre-operatively. The nurse teaching has been effective if the following client statement is?

Accepted Answer

Answer reason: y." Cefazolin is a perioperative prophylactic antibiotic commonly administered within 60 minutes before incision to decrease the risk of surgical site infection. It is not an analgesic and does not provide pain relief. It also does not replace vitamins/minerals or help visualize bone destruction; its purpose is antimicrobial prevention in the operative period.
Category reason: This item tests nursing understanding of the expected purpose/outcome of a preoperative medication order (perioperative antibiotic prophylaxis), which fits medication teaching within Pharmacological and Parenteral Therapies.

Question 43

Scenario: A patient using a PCA pump reports 6/10 pain. What should the nurse do first?

Accepted Answer

Answer reason: PCA is designed to allow the patient to self-administer preset, safe doses to match pain needs; inadequate pain control often reflects underuse or misunderstanding of the device. Teaching and encouraging appropriate use is an immediate nursing intervention within scope and can improve analgesia without adding unscheduled opioids. Giving additional IV morphine or requesting a dose increase bypasses the PCA safety design and typically requires further assessment/authorization. Waiting 30 minutes without intervening delays pain relief and does not address likely correctable underdosing.
Category reason: This question asks for the nurse’s first action in managing pain with a PCA pump, emphasizing appropriate nursing intervention and evaluation of analgesic therapy outcomes rather than foundational pharmacology facts.

Question 44

Which intervention is most important for a client in preterm labor at 32 weeks?

Accepted Answer

Answer reason: At 32 weeks’ gestation, antenatal corticosteroids are the highest-impact intervention because they accelerate fetal lung maturation and reduce neonatal respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Tocolytics like terbutaline may be used briefly to delay birth, but their primary value is to buy time for steroid administration rather than improve neonatal outcomes on their own. Ambulation can worsen contractions and is not a priority intervention. Amniotomy can precipitate delivery and increase infection risk, making it inappropriate in threatened preterm labor.
Category reason: This is a patient-care priority question focusing on selecting the best medication-related intervention in preterm labor to improve neonatal outcomes, which aligns with NCLEX pharmacologic therapy and expected outcomes.

Question 45

Scenario: The nurse administers IV morphine for a pain level of 8/10. When should the nurse reassess the pain?

Accepted Answer

Answer reason: IV morphine has a rapid onset, so analgesic effectiveness and adverse effects should be evaluated soon after administration. Early reassessment helps confirm adequate pain relief and detects oversedation or respiratory depression promptly, allowing timely interventions (e.g., dose adjustment, airway support, naloxone if needed). Waiting 15–30 minutes, 1 hour, or until the next dose risks delayed recognition of inadequate analgesia or opioid-related complications.
Category reason: This item tests nursing judgment about evaluating therapeutic response and monitoring for adverse effects after IV opioid administration, which aligns with medication outcomes monitoring in Pharmacological and Parenteral Therapies.

Question 46

A client on a continuous IV nitroglycerin infusion for angina develops a BP of 84/50 mmHg. What is the nurse's priority action?

Accepted Answer

Answer reason: D. Titrate the infusion rate per protocol IV nitroglycerin commonly causes dose-related hypotension due to venodilation and reduced preload, so the safest first response is to reduce the dose according to the standing titration parameters. Protocol-based titration treats the immediate adverse effect while maintaining some antianginal benefit and avoids abrupt discontinuation that may precipitate rebound chest pain. After adjusting and reassessing blood pressure, symptoms, and perfusion, escalation (including contacting the provider) is done if hypotension persists or the client shows signs of shock.
Category reason: This is a nursing management question about responding to an adverse hemodynamic effect from an IV medication infusion, which fits NCLEX Pharmacological and Parenteral Therapies focusing on expected actions/outcomes and safe titration.

Question 47

A 30-week pregnant client is in preterm labor. What medication delays contractions?

Accepted Answer

Answer reason: As a beta-2 adrenergic agonist, it relaxes uterine smooth muscle and is used as a tocolytic to suppress preterm uterine contractions short-term. Oxytocin and misoprostol stimulate uterine contractions, making them inappropriate for delaying labor. Methylergonovine is an ergot alkaloid that causes sustained uterine contraction and is used to manage postpartum hemorrhage, not preterm labor. Therefore, the best choice to delay contractions in this scenario is the beta-agonist tocolytic.
Category reason: This item tests nursing knowledge of medication effects and expected outcomes in managing preterm labor, which fits Pharmacological and Parenteral Therapies (Expected Actions-Outcomes).

Question 48

A nurse is teaching a client post-MI about beta-blockers. Which statement indicates a need for further teaching?

Accepted Answer

Answer reason: C. "I should stop this medication if I feel better." Beta-blockers are commonly continued long-term after MI to reduce myocardial oxygen demand, decrease risk of reinfarction, and improve survival. Stopping them abruptly can cause rebound tachycardia and hypertension, which can precipitate angina or another cardiac event. The other statements reflect expected effects and common adverse effects (fatigue and lowered blood pressure) and indicate correct understanding.
Category reason: This is a medication-teaching question focused on expected actions/outcomes and safe continuation of prescribed therapy, which aligns with Pharmacological and Parenteral Therapies.

Question 49

A primigravida at 39 weeks is admitted in early labor. BP 152/96; 3+ proteinuria; reflexes brisk with 3+ . No seizure activity. Which medication is most likely anticipated to prevent complications?

Accepted Answer

Answer reason: She has signs of preeclampsia with severe features (hypertension, significant proteinuria, and hyperreflexia), which places her at high risk for progression to eclampsia. The key preventable complication is seizure activity, and the standard prophylaxis is an anticonvulsant given intrapartum and postpartum. This medication reduces neuromuscular excitability and decreases the risk of seizures; monitoring is required for toxicity (respirations, reflexes, urine output). Oxytocin and misoprostol are uterotonics and do not prevent seizures, while terbutaline is a tocolytic and is not indicated here.
Category reason: This question asks the nurse to anticipate the appropriate medication to prevent an obstetric complication (eclamptic seizures) in a patient-care scenario, which is an NCLEX-style medication/therapeutic intervention decision.

Question 50

A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective?

Accepted Answer

Answer reason: Mannitol is an osmotic diuretic that draws water from edematous brain tissue into the intravascular space, thereby reducing ICP. An expected, measurable therapeutic effect is increased urine output as the kidneys excrete the mobilized fluid. Fixed, dilated nonreactive pupils indicate worsening neurologic status rather than improvement. Blood pressure and renal labs may be relevant to monitoring safety, but they do not most directly demonstrate the intended immediate action of mannitol on ICP.

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