Question 1

The client diagnosed with atrial fibrillation has experienced a transient ischemic attack (TIA). Which medication would the nurse anticipate being ordered for the client on discharge?

Accepted Answer

Answer reason: Atrial fibrillation promotes thrombus formation in the atria, which increases the risk of embolic stroke/TIA, so long-term stroke prevention is the priority at discharge. Anticoagulation (e.g., a DOAC or warfarin depending on patient factors) reduces cardioembolic risk and is standard secondary prevention after a TIA in the setting of atrial fibrillation. A beta-blocker may be used for rate control but does not adequately prevent clot-related cerebral emboli. Thrombolytics are for acute ischemic stroke within a narrow time window and are not used as routine outpatient discharge therapy.

Question 2

What is the appropriate nursing action when the nurse receives the patient's serum lithium level results of 1.0 mEq/L?

Accepted Answer

Answer reason: 6–1.2 mEq/L, with toxicity risk increasing as levels rise above the therapeutic range. A level of 1.0 mEq/L is within the expected therapeutic window for most patients, so there is no indication to hold the medication solely based on this value. The safest appropriate action is to continue the ordered dose while maintaining routine monitoring and ongoing assessment for toxicity, hydration status, and renal function. Holding the drug or urgently contacting the provider is more appropriate when the level is elevated or the patient shows toxicity symptoms.

Question 3

The nurse on a gastrointestinal unit reviews orders for a planned admission. The client is prescribed dicyclomine hydrochloride. Which client is a candidate for this medication?

Accepted Answer

Answer reason: That therapeutic effect best matches irritable bowel syndrome, where abdominal pain is often driven by functional bowel spasm. In contrast, in severe ulcerative colitis or toxic megacolon, slowing motility with anticholinergics can worsen colonic dilation and increase risk of complications. Reflux esophagitis is primarily managed with acid suppression and lifestyle measures rather than intestinal antispasmodics.

Question 4

Which of the following findings would indicate a therapeutic response for a patient receiving nifedipine?

Accepted Answer

Answer reason: A reading in the normal range indicates the medication is achieving its primary therapeutic goal in treating hypertension. Weight loss is not an expected direct outcome of this drug and could reflect unrelated changes (diet, diuresis, illness). Sinus rhythm and total cholesterol may be desirable findings, but they are not the key expected clinical response used to evaluate nifedipine’s effectiveness.

Question 5

The infant is admitted to the unit with tetralogy of fallot. The nurse would anticipate an order for which medication?

Accepted Answer

Answer reason: A cardiac glycoside can be prescribed to improve myocardial contractility and help manage heart failure signs (e.g., poor feeding, tachycardia, hepatomegaly) when present. The other options are not routine TOF management medications: epinephrine is for acute resuscitation/anaphylaxis, aminophylline is for bronchospasm, and atropine is for symptomatic bradycardia or certain poisonings. Therefore the most reasonable anticipated order among the choices is an inotrope used in pediatric heart failure management.

Question 6

Which of the following medications would NOT be an appropriate prn medication for use during an episode of aggression or violence for the patient with a psychiatric diagnosis?

Accepted Answer

Answer reason: This option is an opioid analgesic intended for pain control, not for managing violent behavior, and it can worsen safety by causing sedation, respiratory depression, delirium, or disinhibition. In contrast, the listed antipsychotics are standard PRN agents for acute agitation and can be given via IM routes when needed. Using an opioid in this context fails to address the underlying psychiatric agitation and introduces unnecessary harm and monitoring burden in a violent scenario.

Question 7

A nurse is caring for a client who is having difficulty remembering to take their prescribed drugs three times a day. The nurse should identify that which of the following alternate forms of the drug can help to promote adherence to the prescribed dosage?

Accepted Answer

Answer reason: An extended-release formulation often converts a three-times-daily schedule into once- or twice-daily dosing while providing more consistent plasma concentrations. Immediate-release products generally require more frequent dosing and do not address the adherence problem. Liquid suspensions and powders change the dosage form but typically do not reduce dosing frequency and can introduce measurement/preparation barriers.

Question 8

The nurse is caring for an 80-year-old female with a diagnosis of osteoporosis and a new T6 compression fracture. The nurse is aware that which of the following vitamins will be used to treat osteoporosis?

Accepted Answer

Answer reason: In older adults, low vitamin D is common due to reduced skin synthesis and dietary intake, worsening bone loss and fracture risk. Supplementation improves bone health by correcting deficiency and supporting antiresorptive therapies’ effectiveness. Vitamin A in excess can actually increase fracture risk, and vitamins C and B are not primary, evidence-based vitamin treatments for osteoporosis prevention of fragility fractures.

Question 9

A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?

Accepted Answer

Answer reason: If paralysis is wearing off, the patient may regain respiratory muscle effort and show dyssynchrony with the ventilator, manifesting as active resistance or asynchrony. This clinical sign most directly indicates inadequate neuromuscular blockade requiring redosing (with concurrent assurance of adequate sedation/analgesia). Isolated small facial or distal limb movements can occur variably and are less specific than clear ventilator dyssynchrony for inadequate paralysis in an intubated, mechanically ventilated patient.

Question 10

A client with post-traumatic stress disorder has recently been prescribed prazosin. What statement by the client would most clearly suggest that the medication is having the desired effect?

Accepted Answer

Answer reason: " Prazosin is an alpha-1 adrenergic blocker commonly used off-label in PTSD to reduce trauma-related nightmares and improve sleep quality. The clearest indicator of therapeutic benefit is a direct report of improved sleep, because this is the primary target symptom for prazosin in PTSD. Changes in patience or emotional availability are nonspecific and could reflect many factors, including psychotherapy or mood changes. A reduction in flashbacks is more directly associated with trauma-focused therapy and overall PTSD symptom control rather than a hallmark response to prazosin.

Question 11

A client with hyperthyroidism is being treated with radioactive iodine (I-131). Which explanation should be included in preparing this client for this treatment?

Accepted Answer

Answer reason: Using “lead shields” for weeks is not standard teaching; instead, clients are instructed on time/distance/hygiene precautions to limit exposing others to body-fluid radiation for a short period. Goiter is not the key expected adverse effect to emphasize as “common” in routine pre-teaching; the major anticipated outcome/risk is gradual thyroid ablation with possible hypothyroidism requiring follow-up and replacement. Symptom improvement is delayed (often weeks) because the thyroid tissue is destroyed over time rather than immediately.

Question 12

The nurse determines that the teaching plan for a client prescribed sertraline (Zoloft) has been effective when the client makes which statement?

Accepted Answer

Answer reason: " SSRIs often require several weeks for maximal antidepressant benefit because downstream neurochemical and receptor-level adaptations take time. This statement reflects accurate expectations about onset of action and recognizes improvement consistent with therapeutic response. Taking sertraline with an MAOI like phenelzine is unsafe due to risk of serotonin syndrome and requires a washout period. Claiming there are no drug interactions is incorrect because SSRIs interact with multiple serotonergic agents and other medications, so ongoing medication review is needed.

Question 13

A client is receiving temazepam (Restoril). Which of these responses should a nurse expect the client to have if the medication is achieving the desired effect?

Accepted Answer

Answer reason: Temazepam is a benzodiazepine hypnotic prescribed for short-term treatment of insomnia, with the primary therapeutic goal of improving sleep duration and continuity. A report of sustained, uninterrupted sleep indicates the medication is producing its intended hypnotic effect. The other responses describe anxiolytic or antipanic outcomes, which are not the primary expected effect when temazepam is used specifically for insomnia. Fragmented sleep with frequent awakenings suggests inadequate symptom control rather than a fully achieved therapeutic outcome.

Question 14

A client who has been prescribed baclofen (Lioresal) returns to the health care provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather?

Accepted Answer

Answer reason: Whether the client has been taking the medication consistently or only when the pain is severe Baclofen is a centrally acting skeletal muscle relaxant used to reduce spasticity and muscle spasms, and it works best when taken on a regular schedule to maintain therapeutic effect. Continued spasms after a week commonly reflect subtherapeutic exposure due to inconsistent dosing or incorrect administration rather than true lack of efficacy. Clarifying adherence directly informs whether the current plan should focus on education about scheduled dosing versus dose adjustment or alternative therapy. Alcohol use and self-increasing the dose are important safety assessments, but they do not most directly explain persistent spasms as a primary cause of treatment failure. Itching skin lesions are not a typical key issue tied to ineffective antispasmodic response.

Question 15

Which assessment finding indicates to the nurse that the muscarinic agent bethanechol (Urecholine) is effective for a client diagnosed with urinary retention?

Accepted Answer

Answer reason: The most objective indicator of therapeutic effect is restoration of adequate urine elimination, reflected by balanced intake and output with improved urinary output. Findings like terminal dribbling or stress incontinence relate more to sphincter/pelvic floor function than to detrusor activation. Xerostomia is an anticholinergic effect; its absence does not specifically demonstrate that a cholinergic medication is working for urinary retention.

Question 16

The nurse administers donepezil hydrochloride (Aricept) to a client with Alzheimers disease as an intervention for which client problem?

Accepted Answer

Answer reason: Donepezil is intended to slow worsening of memory and thinking, supporting improved cognition and function rather than treating pain, breathing, or fluid balance. Nursing evaluation focuses on whether orientation, attention, and ability to perform activities improve or decline more slowly. A common distractor is pain, but donepezil has no analgesic effect and instead has cholinergic adverse effects (e.g., GI upset, bradycardia) that require monitoring.

Question 17

The nurse has instructed the client with Myasthenia Gravis to take drugs on time and to eat meals 45 to 60 minutes after taking the cholinistic drug. The client asked why the timing of the meal is so important, what is the nurse`s best response?

Accepted Answer

Answer reason:  Anticholinesterase therapy in myasthenia gravis is scheduled to coincide with meals so skeletal muscle strength peaks during eating. Maximizing neuromuscular transmission at mealtime improves chewing and swallowing and reduces aspiration/choking risk. This is a safety-focused medication-outcome teaching point tied to the drug’s expected onset/peak effect. Blood pressure effects and gastric ulceration are not the primary rationale for the specific 45–60 minute pre-meal timing, making those distractors less accurate.

Question 18

The nurse anticipates the health care provider to order which of the following for an 8-year-old child with a diagnosis of acute inflammatory bowel disease?

Accepted Answer

Answer reason: Systemic or locally acting corticosteroids are commonly ordered to decrease cytokine-mediated inflammation, reduce edema, and improve symptoms during acute exacerbations. Antibiotics are not routine unless there is suspected infection or complications (e.g., abscess, perianal disease) and therefore are less generally anticipated. Antiemetics may be supportive for nausea but do not treat the underlying inflammatory process driving an acute flare.

Question 19

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

Accepted Answer

Answer reason: In a depressed client with severe insomnia, the most likely expected therapeutic outcome is improved sleep rather than daytime activation. The other options do not match trazodone’s primary clinical effects; for example, it is not an analgesic for arthritis and does not treat nasal congestion. Patient teaching should also include monitoring for next-day drowsiness/orthostatic hypotension and avoiding alcohol or other CNS depressants.

Question 20

A client with diabetes has a blood sugar is 306 this morning. After the nurse reports this lab result and the client's symptoms of excessive hunger and thirst, what would the nurse expect the health care provider to order?

Accepted Answer

Answer reason: Short-acting insulin is used for rapid glucose lowering and is commonly ordered as correctional (sliding-scale) coverage when a capillary glucose is significantly elevated. NPH has a delayed onset and peak, making it less appropriate for immediate correction of a high morning glucose. Orange juice is used to treat hypoglycemia, and repeating the glucose may be done for confirmation but does not address the urgent need to lower a clearly dangerous value.

Question 21

A client is being maintained on heparin therapy for deep vein thrombosis. The nurse must closely monitor which of the following laboratory values?

Accepted Answer

Answer reason: Maintaining aPTT in the target therapeutic range reduces clot propagation while limiting bleeding risk. Platelet count is monitored to detect heparin-induced thrombocytopenia, but it does not measure anticoagulant intensity. Bleeding time and clotting time are not the standard, reliable tests for titrating heparin therapy in routine practice.

Question 22

When caring for a client receiving warfarin sodium (Coumadin), which lab test would the nurse monitor to determine therapeutic response to the drug?

Accepted Answer

Answer reason: Monitoring PT/INR verifies that the medication is producing the intended anticoagulant effect while balancing bleeding risk. aPTT is used to evaluate the intrinsic pathway and is the standard monitoring test for unfractionated heparin, not warfarin. Bleeding time reflects platelet function and does not reliably measure warfarin’s therapeutic effect.

Question 23

A client with a panic disorder has a new prescription for Xanax (Alprazolam). In teaching the client about the drug's actions and side effects, which of the following should the nurse emphasize?

Accepted Answer

Answer reason: Alprazolam typically begins working quickly, making patient teaching focus on near-immediate symptom relief and the need for adjunct long-term strategies (e.g., SSRIs/therapy) for sustained control. It is not a stimulant; sedation, impaired coordination, and respiratory depression (especially with alcohol/opioids) are key safety concerns. Dose escalation is not a routine goal because tolerance, dependence, and misuse risk increase with higher/longer use. Many early adverse effects (e.g., drowsiness) may lessen with time, so telling clients they often continue is misleading.

Question 24

When providing nursing measures to relieve a 102-degree Fahrenheit fever in a toddler with an infection, what is the most effective intervention?

Accepted Answer

Answer reason: Antipyretics (e.g., acetaminophen/ibuprofen as appropriate) reduce prostaglandin activity in the CNS, lowering the set point and allowing heat loss mechanisms to work with less physiologic stress. External cooling measures alone can provoke vasoconstriction and shivering, increasing metabolic demand and potentially raising core temperature discomfort. Cool-water immersion is uncomfortable and can worsen shivering, and doing a tepid bath before antipyretic is less effective than first lowering the set point pharmacologically.

Question 25

The nurse is preparing a client for discharge following in-patient treatment for pulmonary tuberculosis. Which of these instructions should be given to the client?

Accepted Answer

Answer reason: The safest discharge teaching is strict adherence to the exact regimen and duration ordered, even if symptoms improve early. Stopping when the client “feels better” is a common cause of treatment failure and development of resistant TB. Avoiding specific groups is not the primary discharge instruction because infectiousness is determined by sputum status and adherence to therapy with appropriate precautions. Advising antacids like aluminum hydroxide can interfere with absorption of some TB drugs and is not a standard blanket recommendation.

Question 26

The nurse is teaching administration of albuterol inhalation to an adult with asthma. Which of the following demonstrates proper teaching?

Accepted Answer

Answer reason: " Increasing reliance on a short-acting beta2-agonist suggests worsening asthma control and higher risk of exacerbation, so it requires reassessment and possible step-up of controller therapy. The correct teaching focuses on monitoring effectiveness and recognizing when symptoms are not adequately managed rather than simply repeating rescue dosing. Bedtime use to “promote rest” is inappropriate because this medication can cause nervousness and insomnia and is not intended as a sleep aid. Dizziness alone is a potential side effect, but stopping the medication without guidance could leave bronchospasm untreated; the safer guidance is to evaluate overall control and seek provider input when use increases.

Question 27

The nurse is giving instructions to the mother of a newborn infant with oral candidiasis. Which statement by the mother would indicate the need for further teaching?

Accepted Answer

Answer reason: " Antifungal therapy for infant oral candidiasis should be continued for the full prescribed duration (often for several days after lesions resolve) to eradicate yeast and prevent relapse. Visible white plaques can clear before the organism is fully eliminated, so stopping early increases the chance of recurrence and ongoing transmission. Correct administration timing after feeds helps keep medication in contact with oral mucosa, improving effectiveness. Cleaning/sterilizing feeding equipment reduces reinoculation from contaminated nipples or pacifiers, which is an important adjunct to treatment.

Question 28

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

Accepted Answer

Answer reason: " IV immune globulin provides passive antibodies to patients who cannot mount an adequate humoral immune response, thereby reducing risk of recurrent or severe infections. Children with AIDS are immunocompromised and are particularly vulnerable to bacterial pathogens, so prophylaxis/supportive immunotherapy is an expected purpose of this treatment. It does not act as an antiretroviral and therefore does not directly inhibit viral replication. Broad statements about improving overall health or boosting other medications are nonspecific and do not explain the primary therapeutic effect.

Question 29

The nurse has given discharge instructions to parents of a child on phenytoin (Dilantin). Which of the following statements suggests that the teaching was effective?

Accepted Answer

Answer reason: Phenytoin commonly causes gingival hyperplasia, and meticulous oral hygiene helps reduce gum overgrowth, bleeding, and secondary infection risk. This statement reflects correct preventive self-care teaching that directly targets a predictable adverse effect. Calling the provider for acne reflects misunderstanding of typical priority adverse effects for this drug, and skipping doses with illness risks subtherapeutic levels and breakthrough seizures. Stopping antiseizure medication after a fixed seizure-free interval without prescriber direction is unsafe because discontinuation requires careful medical evaluation and usually gradual tapering.

Question 30

The nurse is caring for an 81 year-old client with colorectal cancer. The client's pain has been managed until now with acetaminophen with codeine. Because of increased pain, intravenous morphine is added. What should the nurse recognize about the validity of this order?

Accepted Answer

Answer reason: Escalation of cancer pain is appropriately managed by stepping up opioid therapy to a stronger agent and route when weaker opioids no longer provide adequate relief. IV morphine is a valid order for significant increased pain, and in older adults the nurse should anticipate and monitor common opioid effects such as sedation and delirium, using dose titration and safety precautions. Respiratory depression is a known risk but is not a reason to label the order inappropriate when opioids are titrated to effect with monitoring of respiratory status and level of consciousness. Calling the order poor pain-control knowledge is incorrect because timely opioid escalation is consistent with evidence-based cancer pain management.

Question 31

A pregnant client who is at 34 weeks gestation is diagnosed with a pulmonary embolism (PE). Which of these medications would the nurse anticipate the health care provider ordering?

Accepted Answer

Answer reason: Heparin infusion to maintain the PTT at 1.5-2.5 times the control value In pregnancy with acute PE, the priority is rapid therapeutic anticoagulation using an agent that does not cross the placenta. Unfractionated heparin given as an IV infusion can be titrated quickly to a therapeutic aPTT range (commonly 1.5–2.5× control), allowing close control of anticoagulation intensity. Warfarin is avoided in pregnancy due to teratogenicity and fetal bleeding risk. A fixed low-dose subcutaneous regimen (e.g., 5000 units b.i.d.) is prophylactic rather than therapeutic for an acute PE.

Question 32

The nurse is caring for a 15 month-old child with a first episode of otitis media. Which of the following interventions should the nurse include in instructions to the child's parents?

Accepted Answer

Answer reason: Key teaching for acute otitis media treated with antibiotics is adherence to the prescribed course to ensure eradication of bacteria, reduce symptom relapse, and lower risk of complications. This instruction is universally appropriate for a first episode and directly supports therapeutic effectiveness and antimicrobial stewardship. Information about myringotomy tubes or tympanocentesis applies to recurrent, chronic, or complicated cases and is not routine parent education for an initial uncomplicated episode. A follow-up visit may be needed if symptoms persist or worsen, but completing the prescribed therapy is the most immediate and consistently indicated instruction.

Question 33

The nurse is teaching a client with asthma about the correct use of the Azmacort (triamcinolone) inhaler. Which of the following statements, if made by the client, would indicate that the teaching was effective?

Accepted Answer

Answer reason: " Inhaled corticosteroids can deposit in the oropharynx and increase the risk of local adverse effects such as oral candidiasis and dysphonia. Rinsing the mouth (and spitting) after each use reduces residual medication and helps prevent thrush. Using it “whenever I feel short of breath” confuses a controller steroid with a rescue bronchodilator, which can lead to undertreatment of acute symptoms. Doubling the next dose after a missed dose is unsafe and unnecessary, and spacers are generally helpful to improve delivery and reduce oropharyngeal deposition.

Question 34

A client with heart failure has Lanoxin (digoxin) ordered. What would the nurse expect to find when evaluating for the therapeutic effectiveness of this drug?

Accepted Answer

Answer reason: Better forward flow reduces pulmonary congestion, leading to improved respiratory status (less dyspnea and better oxygenation). Improved renal perfusion also promotes diuresis, so urinary output increases as fluid overload resolves. Options describing increased heart rate conflict with digoxin’s tendency to slow AV conduction, and diaphoresis with decreased urine output suggests worsening perfusion rather than therapeutic effect.

Question 35

The nurse has received a prescription for rivaroxaban. The nurse understands that this medication is prescribed to treat which condition?

Accepted Answer

Answer reason: It is indicated for treatment of deep vein thrombosis and pulmonary embolism and for reducing the risk of recurrence. The other choices are managed with different medication classes (e.g., pulmonary hypertension with pulmonary vasodilators, heart failure with diuretics/RAAS blockade/beta-blockers, hyperlipidemia with statins). Because its primary therapeutic effect is anticoagulation, the condition that best matches is VTE.

Question 36

The nurse is caring for a 40-year-old patient experiencing alcohol withdrawal syndrome and advocates for which medication for the patient?

Accepted Answer

Answer reason: This option is a benzodiazepine and directly targets tremor, agitation, autonomic instability, and seizure risk during withdrawal. Disulfiram is used to support abstinence after detoxification and does not treat acute withdrawal symptoms. Methadone and naloxone are opioid-related therapies and do not address the pathophysiology of alcohol withdrawal.

Question 37

A client has the diagnosis of left ventricular failure and a high pulmonary capillary wedge pressure (PCWP). The physician orders dopamine to improve ventricular function. The nurse will know the medication is working if the client's?

Accepted Answer

Answer reason: With improved forward flow in left ventricular failure, perfusion pressure commonly improves, reflected by an increased blood pressure. A falling cardiac index would indicate worsening pump function rather than improvement. A rising PCWP reflects increased left-sided filling pressures and congestion, which would not be an expected sign of effective inotropic therapy.

Question 38

The nurse is caring for an 8-year-old child with a diagnosis of nephrotic syndrome. The child is being treated with a corticosteroid and has not had diuresis. The nurse anticipates the health care provider to order which of the following medications?

Accepted Answer

Answer reason: A loop diuretic provides potent natriuresis and water excretion to reduce fluid overload and improve urine output. Potassium-sparing agents are weaker for rapid edema mobilization and are more adjunctive than first-line for this problem. Immunosuppressants like cyclophosphamide are reserved for steroid-resistant/frequently relapsing disease rather than for immediate lack of diuresis.

Question 39

The nurse is caring for a patient who had a below-the-knee amputation yesterday and is experiencing phantom pain. The nurse is aware that which of the following medications will help reduce the phantom pain?

Accepted Answer

Answer reason: Gabapentin decreases neuronal excitability by modulating calcium channels and is commonly used for neuropathic pain, making it a targeted choice for phantom pain. Opioids like hydromorphone can relieve acute nociceptive postoperative pain but are less specific for neuropathic mechanisms and carry higher risk of sedation/respiratory depression. Acetaminophen is best for mild nociceptive pain/fever and typically does not adequately treat neuropathic pain. Calcitonin is primarily used for disorders of bone metabolism and is not a standard first-line therapy for phantom limb pain.

Question 40

A client is prescribed warfarin (Coumadin) for deep vein thrombosis. Which of the following foods should the client avoid or consume in moderation?

Accepted Answer

Answer reason: Leafy green vegetables (e.g., spinach, kale, collards) are vitamin K–rich and therefore should be limited and, more importantly, kept consistent to avoid INR fluctuations. This makes them the key dietary item to avoid or consume in moderation when on warfarin. The other options are not typical high–vitamin K foods that reliably counteract warfarin’s intended effect in routine counseling.

Question 41

A client with pancreatitis has requested pain medication. Which pain medication is indicated for the client with pancreatitis?

Accepted Answer

Answer reason: This makes meperidine the “indicated” choice in many NCLEX-style questions compared with morphine or codeine, which are commonly taught to potentially worsen biliary/pancreatic duct pressures. Ketorolac is an NSAID and may be inadequate for severe pancreatitis pain and carries bleeding/renal/GI risks, especially in acutely ill clients. Therefore, among the listed options, meperidine best matches the exam-expected analgesic choice for pancreatitis pain control.

Question 42

A nurse is teaching a client diagnosed with migraines. Which of the following client statements indicate that teaching was effective?

Accepted Answer

Answer reason: " Abortive migraine therapy is most effective when taken early in the attack before central sensitization becomes established. Taking prescribed agents promptly at onset can shorten duration and reduce severity, improving functional outcomes. Chest pain with triptans is a potential ischemic warning symptom and should be reported rather than ignored, making that statement unsafe. Relying on medication alone without attention to triggers (including diet) reflects incomplete self-management education.

Question 43

A nurse is caring for a client who has a urinary tract infection (UTI). Which of the following is the priority action the nurse should take?

Accepted Answer

Answer reason: Administering the prescribed antimicrobial therapy directly treats the infection and is the most definitive priority compared with supportive comfort measures. Increasing oral fluids can help flush the urinary tract, but it does not treat the underlying pathogen and may be inappropriate in clients with fluid restrictions. Bladder training and sitz baths may reduce symptoms or support long-term management, but they are secondary to initiating effective antimicrobial therapy.

Question 44

The nurse has obtained a prescription for desmopressin to treat diabetes insipidus (DI). The nurse understands that it is essential to monitor the client's?

Accepted Answer

Answer reason: Monitoring sodium helps detect excessive free-water retention before neurologic complications (headache, confusion, seizures) develop. In treated DI, urine output should decrease and urine specific gravity should rise; if sodium is falling, the dose or fluid intake may need adjustment. Serum glucose is not the key parameter for DI therapy (it is central in diabetes mellitus), and magnesium/calcium are not the expected electrolyte disturbances from desmopressin.

Question 45

A patient taking propylthiouracil should be instructed to avoid what food or food product in the diet?

Accepted Answer

Answer reason: Antithyroid medications reduce thyroid hormone synthesis by interfering with iodine utilization and thyroid peroxidase–mediated hormone formation. Increasing dietary iodine can counteract the intended pharmacologic effect by supplying more substrate for hormone production, potentially reducing therapeutic control of hyperthyroidism. Iodized salt is a common, significant source of iodine exposure in the diet and is therefore the most relevant item to avoid or limit. The other listed foods are not notable iodine sources and do not meaningfully oppose the medication’s action.

Question 46

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results?

Accepted Answer

Answer reason: Unfractionated heparin is titrated to a therapeutic aPTT, typically about 1.5–2.5 times the laboratory control (often roughly 45–70 seconds depending on the institution). An aPTT of 60 seconds falls within this common therapeutic range, indicating effective anticoagulation for preventing thromboembolism in atrial fibrillation. A PT value is used to monitor warfarin rather than heparin, so it does not reflect the infusion’s effect. An aPTT of 28 seconds is subtherapeutic, while values >120 seconds are generally excessively anticoagulated and raise bleeding risk.

Question 47

The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Toprol). Which monitoring is essential when administering the medication?

Accepted Answer

Answer reason: In ACS and atrial fibrillation, this medication is often used for rate control and to reduce myocardial oxygen demand, making pulse/HR monitoring essential to ensure the intended therapeutic effect without causing harm. A low HR (or new/worsening AV block) is a common reason to hold the dose and notify the provider. ST-segment changes and cardiac biomarkers reflect ischemia/infarction assessment, but they do not directly indicate whether the beta-blocker is producing an unsafe hemodynamic effect at the time of administration.

Question 48

A nurse is preparing a patient for a procedure requiring conscious sedation. The nurse will administer which short-acting benzodiazepine?

Accepted Answer

Answer reason: Midazolam is short-acting and commonly chosen for procedural sedation because it is easily titratable and has a relatively brief clinical effect. In contrast, diazepam and chlordiazepoxide have longer durations and active metabolites, making them less desirable when rapid post-procedure recovery is needed. Lorazepam lasts longer and is more often used for anxiety, status epilepticus, or agitation rather than brief procedures.

Question 49

The nurse is caring for a client newly diagnosed with mastitis. The nurse anticipates a prescription for which medication?

Accepted Answer

Answer reason: A first-generation cephalosporin provides appropriate coverage and is commonly used while allowing continued breastfeeding. Antivirals and topical immune modulators do not treat typical bacterial breast infections. An oral azole antifungal would be reserved for suspected Candida involvement (e.g., nipple thrush), which is a different clinical picture than acute bacterial mastitis.

Question 50

The nurse is caring for a client with angle-closure glaucoma. Which prescription should the nurse anticipate from the primary healthcare provider (PHCP)?

Accepted Answer

Answer reason: A carbonic anhydrase inhibitor decreases aqueous humor production, producing a meaningful reduction in intraocular pressure and is commonly used acutely while definitive therapy is arranged. In contrast, anticholinergic or sympathomimetic agents can precipitate or worsen angle closure by causing mydriasis and further narrowing the anterior chamber angle. A tricyclic antidepressant also has anticholinergic effects and would be unsafe in this condition.

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