ATI Content Mastery Series Assessments: RN Pharmacology Practice
Assessment A
1. A nurse is providing discharge instructions to a client who has heart failure and a new
prescription for captopril. Which of the following client statements indicates an
understanding of the teaching?
a. "I should take this medication with food."
b. "I should take naproxen if I develop joint pain."
c. "I should tell my provider if I develop a sore throat."
d. "I should expect the medication to cause my urine to look orange."
Answer: c. "I should tell my provider if I develop a sore throat."
Rationale:
The client should report a sore throat to the provider because this can indicate neutropenia, a
serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the
medication is promptly discontinued
2. A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new
prescription for sucralfate. Which of the following actions of sucralfate should the nurse
include in the teaching?
a. Decreases stomach acid and secretion
b. Neutralizes acid in the stomach
c. Forms a protective barrier
d. Treats ulcers by eradicating H. pylori
Answer: c. Forms a protective barrier
Rationale:
Secretions by the parietal chief cells, hydrochloric acid and pepsin, can further irritate the
ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the
ulcer, creating a barrier to hydrochloric acid and pepsin.
3. A nurse is providing teaching to a client who has multiple sclerosis and a new prescription
for methylprednisolone. Which of the following instructions should the nurse include?
(SATA)
a. Blood glucose levels will be monitored during therapy
b. Avoid contact with people who have known infections
c. Take the medication 1 hr before breakfast
d. Decrease dietary intake of foods containing potassium
e. Grapefruit juice can increase the effects of the medication
Answer:
a. Blood glucose levels will be monitored during therapy
b. Avoid contact with people who have known infections
e. Grapefruit juice can increase the effects of the medication
Rationale:
a. The nurse should monitor the client for hyperglycaemia while providing
methylprednisolone to the client. Glucocorticoids such as methylprednisolone, increase
serum glucose levels and can require management with insulin or anti hyperglycaemia.
b. The nurse should instruct the client to avoid exposures to infectious agents, such as contact
with those who have active infections or illnesses Glucocorticoids, which as
methylprednisolone depress the immune system, placing the client at an increased risk for
developing an infection.
e. The nurse should in strict the client that grapefruit and grapefruit juice can increase the
level of methylprednisolone in the body.
4. The nurse is providing discharge teaching about handling medication to a client who is to
continue taking oral transmucosal fentanyl raspberry-flavoured lozenges on a stick. Which of
the following information should the nurse include in the teaching?
a. Chew on the medication stick to release the medication
b. Leave the medication stick in one location of the mouth until melted
c. Allow the medication 1 hr for the analgesia effects to begin
d. Store unused medication sticks in a storage container
Answer: d. Store unused medication sticks in a storage container
Rationale:
The nurse should instruct the client to store unused, or partially used, medications sticks in
the safe storage container that comes in the kit when the medication is initially prescribed.
5. A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure.
The nurse should identify which of the following findings as an indication of hypokalaemia?
a. Tall, tented T waves
b. Presence of U waves
c. Widened QRS complex
d. ST elevation
Answer: b. Presence of U waves
Rationale:
Hypokalaemia often presents with U waves on an ECG due to delayed ventricular
repolarization, indicating low potassium levels in the client receiving furosemide.
6. A nurse is caring for a client and is taking oral morphine and docusate sodium. The nurse
should instruct the client that taking the docusate sodium daily can minimize which of the
following adverse effects of morphine?
a. Constipation
b. Drowsiness
c. Facial flushing
d. Itching
Answer: a. Constipation
Rationale:
Constipation is a common adverse effect of morphine that can be minimized by taking
docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water
and fat in the intestine.
7. A nurse is planning care for a client who is receiving mannitol via continuous IV infusion.
The nurse should monitor for which of the following adverse effects?
a. Weight loss
b. Increased intraocular pressure
c. Auditory hallucinations
d. Bibasilar crackles
Answer: d. Bibasilar crackles
Rationale:
Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema, therefore,
the nurse should recognize lung crackles as an indication of a potential complication and stop
the infusion.
8. A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for
ranitidine. Which of the following instructions should the nurse include?
a. "Take the medication on an empty stomach for full effectiveness."
b. " You may discontinue this medication when stomach discomfort subsides."
c. "Report yellowing of the skin."
d. "Store the medication in the refrigerator."
Answer: c. "Report yellowing of the skin."
Rationale:
Ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to
monitor for and report yellowing of the skin or eyes to the provider.
9. A nurse is assessing a client after the administering a second dose of cefazolin IV. The
nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following
medications should the nurse administer first?
a. Diphenhydramine
b. Albuterol inhaler
c. Epinephrine
d. Prednisone
Answer: c. Epinephrine
Rationale:
According to evidence-based practice, the nurse should administer epinephrine first to induce
vasoconstriction and bronchodilation during anaphylaxis.
10. A nurse is planning care for a client who has hypertension and is to start taking
metoprolol. Which of the following interventions should the nurse include in the plan of
care?
a. Weight the client weekly
b. Determine apical pulse prior to administering
c. Administer the medication 30 min prior to breakfast
d. Monitor the client for jaundice
Answer: b. Determine apical pulse prior to administering
Rationale:
Life-threatening bradycardia is an adverse effect that might affect the client. Therefore, the
nurse should assess the client's apical pulse prior to administering the medication. If the
client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the
provider.
11. A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who
weighs 44 lb. How many mg should the nurse administer per dose? (Round to the nearest
whole number. Use a leading zero if it applies. Do not use trailing zeros.)
Answer:
300 mg
15mg/1kg x 1kg/2.2lb x 44lb/1patient x
1patient/1dose = 300mg/dose
12. A nurse in an emergency department is caring for a client whose family reports the client
has taken large amounts of diazepam. Which of the following medications should the nurse
anticipate administering?
a. Ondansetron
b. Magnesium sulphate
c. Flumazenil
d. Protamine sulphate
Answer: c. Flumazenil
Rationale:
The nurse should anticipate administering flumazenil, an antidote used to reverse
benzodiazepines with as diazepam.
13. A nurse is reviewing the laboratory results for a client who is receiving heparin via
continuous IV infusion for deep-vein thrombosis. The should should discontinue the
medication infusion for which of the following client findings?
a. Potassium 5.0 mEq/L
b. aPTT 2 times the control
c. Haemoglobin 15 g/dL
d. Platelets 96,000/mm3
Answer: d. Platelets 96,000/mm3
Rationale:
A platelet count of 96,000/mm3 is below the expected range of 150,000 to 400,000/mm3. /a
platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced
thrombocytopenia, a potentially fatal condition that requires stopping the infusion.
14. A nurse is reviewing the medication administration record of a client who has
hypocalcaemia and a new prescription of IV calcium gluconate. The nurse should identify
that which of the following medications can interact which calcium gluconate?
a. Felodipine
b. Guaifenesin
c. Digoxin
d. Regular insulin
Answer: c. Digoxin
Rationale:
The nurse should identify that calcium gluconate can cause hypercalcemia, which increases
the risk of digoxin toxicity.
15. A nurse administers a dose of metformin to a client instead of the prescribed dose of
metoclopramide. Which of the following actions should the nurse take first?
a. Report the incident to the charge nurse
b. Notify the provider
c. Check the client's blood glucose
d. Fill out an incident report
Answer: c. Check the client's blood glucose
Rationale:
The first action the nurse should take using the nursing process is to assess the client. The
client is at risk for hypoglycaemia. The nurse should monitor the client's blood glucose and
provide the client with a snack to reduce the risk for hypoglycaemia.
16. A nurse is teaching a client who is to start taking hydrocodone with acetaminophen
tablets for pain. Which of the following information should the nurse include in the teaching?
a. The medication should be taken 1 hr prior to eating
b. It takes 48 hr for the therapeutic effects to occur
c. Tablets should not be crushed or chewed
d. Decreased respirations might occur
Answer: d. Decreased respirations might occur
Rationale:
The nurse should instruct the client that hydrocodone with acetaminophen might cause
respiratory depression, which is an adverse effect of the medication. The client should avoid
taking over-the-counter medications or newly prescribed medications without consulting their
provider to avoid increased respiratory depression.
17. A nurse in an ED is caring for a client who has heroin toxicity. The client is unresponsive
with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications
should the nurse plan to administer?
a. Methadone
b. Naloxone
c. Diazepam
d. Bupropion
Answer: b. Naloxone
Rationale:
The nurse should administer naloxone, an opioid antagonist, to a client who has heroin
toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should
not administer naloxone too quickly because naloxone can cause hypertension, tachycardia,
nausea, vomiting, and might cause the client to enter a state of opioid withdrawal.
18. A nurse is reviewing the medication list of a client who wants to begin taking oral
contraceptives. The nurse should identify that which of the following client medications will
interfere with the effectiveness of oral contraceptives?
a. Carbamazepine
b. Sumatriptan
c. Atenolol
d. Glipizide
Answer: a. Carbamazepine
Rationale:
Carbamazepine causes and accelerated inactivation of oral contraceptives because of its
action on hepatic medication-metabolizing enzymes.
19. A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The
client's BP is 144/86 mmm Hg, heart rate is 55/min, and respiratory rate is 20/min. The nurse
should withhold the medication and contact the provider for which of the following reasons?
a. Diastolic BP
b. Systolic BP
c. Heart rate
d. Respiratory rate
Answer: c. Heart rate
Rationale:
Digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the
heart rate. The nurse should withhold the medication and notify the provider for a heart rate
of 55/min because this is an early indication of digoxin toxicity.
20. A nurse at a clinic is providing follow-up care to a client who us taking fluoxetine for
depression. Which of the following findings should the nurse identify as an adverse effect of
the medication?
a. Tingling toes
b. Sexual dysfunction
c. Absence of dreams
d. Pica
Answer: b. Sexual dysfunction
Rationale:
Sexual dysfunction, including decreased libido, impotence, and delayed orgasm, or
anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who
take the SSRI antidepressant.
21. A nurse is teaching a client about warfarin. The client asks if the can take aspirin while
taking the warfarin. Which of the following responses should the nurse make?
a. "It is safe to take enteric-coated aspirin."
b. "Aspirin will increase the risk of bleeding."
c. "Acetaminophen may be substituted for aspirin."
d. "The INR lab work must be monitored more frequently if aspirin is taken."
Answer: b. "Aspirin will increase the risk of bleeding."
Rationale:
Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant
warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for
bleeding.
22. A nurse is assessing a client who is postoperative following an outpatient endoscopy
procedure using midazolam. The nurse should monitor for which of the following findings as
an indication that the client is ready for discharge?
a. The client's capnography has returned to baseline
b. The client can respond to their name when called
c. The client is passing flatus
d. The client is requesting oral intake
Answer: a. The client's capnography has returned to baseline
Rationale:
The nurse should identify that the client is ready for discharge when the capnography level
indicates that gas exchange is adequate.
23. A nurse is caring for the parent of a newborn. The parents asks the nurse when their
newborn should receive the first diphtheria, tetanus, and pertussis vaccine (DTaP). the nurse
should instruct the parents that their newborn should receive the immunization at which of
the following ages?
a. At birth
b. 2 months
c. 6 months
d. 15 months
Answer: b. 2 months
Rationale: The CDC recommends that newborns receive the first dose of the five-dose series
of the DTaP immunization at 2 months of age.
24. A nurse is caring for a client who received 0.9% sodium chloride 1 L over 4 hr instead of
over 8 hr as prescribed. Which of the following information should the nurse enter as a
complete documentation of the incident?
a. IV fluid infused over 4 hr instead of the prescribed 8 hr. Client tolerated fluids well,
provider notified.
b. 0.9% sodium chloride 1 L IV infused over 4hr. Vital signs stable, provider notified.
c. 1 L of 0.9% sodium chloride completed at 0900. Client denies shortness of breath
Answer: b. 0.9% sodium chloride 1 L IV infused over 4hr. Vital signs stable, provider
notified.
Rationale:
The nurse should document the type and amount of fluid, how long it took to infuse, provider
notification, and the client's physical status.
25. A nurse is assessing a client who is taking propylthiouracil for treatment of Graves'
disease. Which of the following findings should the nurse identify as an indication that the
medication has been effective?
a. Decrease in WBC count
b. Decrease in amount of time sleeping
c. Increase in appetite
d. Increase in ability to focus
Answer: d. Increase in ability to focus
Rationale:
A client who has Graves' disease can experience psychological manifestations such as
difficulty focusing, restlessness, and manic-type behaviours. Propylthiouracil is a thyroid
hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of
hyperthyroidism. An increased ability to focus indicates that the medication has been
effective.
26. A nurse is preparing to administer medications to a client who tells the nurse, "I don't
want to take my fluid pill until I get home today." Which of the following actions should the
nurse take first?
a. Document the refusal and inform the client's provider.
b. File an incident report with the risk manager.
c. Contact the pharmacist to pick up the medication.
d. Give the client the medication to take at home and document that it was administered.
Answer: a. Document the refusal and inform the client's provider.
Rationale:
The nurse has the responsibility to verify that the client understands the risks of refusing the
medication so that an informed decision can be made. The nurse should then document the
refusal in the client's medical record and notify the health care provider.
27. A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the
following findings should the nurse report to the provider immediately?
a. Dyspepsia
b. Diarrhoea
c. Dizziness
d. Dyspnea
Answer: d. Dyspnea
Rationale:
When Using the airway, breathing, circulation approach to client care, the nurse should report
the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first.
Bronchoconstriction, dyspepsia, diarrhoea, and dizziness are caused by the increase in
acetylcholine levels which is a primary effect of donepezil.
28. A nurse is assessing a client who has myasthenia gravis and is taking neostigmine. Which
of the following findings should indicate to the nurse that the client is experiencing an
adverse effect?
a. Tachycardia
b. Oliguria
c. Xerostomia
d. Miosis
Answer: d. Miosis
Rationale:
Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the
excessive muscarinic stimulation that causes difficulty with visual accommodation.
29. A nurse is teaching a client about cyclobenzaprine. Which of the following client
statements should indicate to the nurse that the teaching is effective?
a. "I will have increased saliva production."
b. "I will continue taking the medication until the rash disappears."
c. "I will taper off the medication before discontinuing it."
d. "I will report any urinary incontinence."
Answer: c. "I will taper off the medication before discontinuing it."
Rationale:
The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence
syndrome or rebound insomnia.
30. A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary
incontinence which of the following symptoms should the nurse tell the client to expect.
(SATA)
a. Dry mouth
b. Tinnitus
c. Blurred vision
d. Bradycardia
e. Dry eyes
Answer: a. Dry mouth
c. Blurred vision
e. Dry eyes
Rationale:
a. Oxybutynin is an anticholinergic agent that can cause dry mouth.
c. Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in
intraocular pressure.
e. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil
dilation.
31. The nurse is preparing to administer dextrose 5% in water (D5W)400 mL IV to infuse
over 1 hr. The drop factor of the manual IV tubing is 15gtt/mL. The nurse should set the
manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole
number. Use a leading zero if it applies. Do not use a trailing zero.)
Answer:
100 gtt/min
400mL/1hr x 1hr/60min x 15gtt/1mL = 100gtt/min
32. A nurse is providing teaching to a client who is taking bupropion as an aid to quit
smoking. Which of the following findings should the nurse add tiff as an adverse effect of the
medication?
a. Cough
b. Ioint pain
c. Alopecia
d. Insomnia
Answer: d. Insomnia
Rationale:
Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation,
tremors, mania, and insomnia
33. A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse
should report which of the following findings to the provider as a manifestation of the
neuroleptic malignant syndrome (NMS)?
a. Temperature of 39.7C (103.5F)
b. Urinary retention
c. Heart rate 56/min
d. Muscle flaccidity
Answer: a. Temperature of 39.7C (103.5F)
Rationale:
The nurse should report fever to the provider as an indication of NMS, an acute lifethreatening emergency. Other manifestations can include respiratory distress, diaphoresis,
and either hyper- or hypotension.
34. A nurse is caring for a client who is in labor. The client is receiving oxytocin by
continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates
late decelerations. Which of the following actions should the nurse take first?
a. Turn the client to a side-lying position
b. Discontinue the client's oxytocin from the maintenance IV
c. Apply oxygen tot eh client by face mask
d. Increase the client's maintenance IV infusion
Answer: a. Turn the client to a side-lying position
Rationale:
The greatest risk to the fetus experiences late decelerations is injury from uteroplacental
insufficiency. Therefore, the priority act the nurse should take is to place the client in a lateral
position.
35. A nurse is teaching a group of unit nurses as out medication reconciliation. Which of the
following information should the nurse include in the teaching?
a. The client's provider is required to complete medication reconciliation.
b. Medication reconciliation at discharge is limited to the medication ordered at the time of
discharge.
c. A transition in care requires the nurse to conduct medication reconciliation.
d. Medical reconciliation is limited to the name of the medications that the client
Answer: c. A transition in care requires the nurse to conduct medication reconciliation.
Rationale:
The nurse should conduct medication reconciliation anytime the client is undergoing a
change in care such as admission, transfer from one unit to another, or discharge. A complete
listing of all prescriptions and over-the-counter. Educations should be reviewed
36. A nurse in an emergency department is caring for a client who has myasthenia gravis and
is in a cholinergic crisis. Which of the following medications should the nurse plan to
administer?
a. Potassium chloride
b. Glucagon
c. Atropine
d. Protamine
Answer: c. Atropine
Rationale:
a cholinergic crisis is caused by an excess amount of choline storage inhibitor, such as
neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to
reverse cholinergic toxicity.
37. A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The
nurse should report which of the following findings to the provider as an adverse effect of the
medication?
a. Constipation
b. Tinnitus
c. Hypoglycaemia
d. Joint pain
Answer: b. Tinnitus
Rationale:
Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and
deafness. The nurse should monitor the client for high-pitched ringing in the ears and
headaches and should notify the provider if these occur.
38. A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast
cancer. Which of the following adverse effects should the nurse include in the teaching?
a. Hot flashes
b. Urinary retention
c. Constipation
d. Bradycardia
Answer: a. Hot flashes
Rationale:
The estragon receptor blocking action of tamoxifen commonly results in the adverse effect of
hot flashes.
39. A nurse for a client who is experiencing acute alcohol withdrawal. For which of the
following client ones should the nurse administer chlordiazepoxide?
a. Minimize diaphoresis
b. Maintain abstinence
c. Lessen craving
d. Prevent delirium tremens
Answer: d. Prevent delirium tremens
Rationale:
Chlordiazepoxide, a benzodiazepine, is used to prevent severe withdrawal symptoms, such as
delirium tremens, which can occur during acute alcohol withdrawal.
40. A nurse at an urgent care clinic is collecting a history from a female client who has a
urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse
should identify that which of the following client statements indicates a contraindication for
administering this medication?
a. "I have tendonitis, so I haven't been able to exercise."
b. "I take a stool softener for chronic constipation."
c. "I take medication for my thyroid."
d. "I am allergic to sulphate."
Answer: a. "I have tendonitis, so I haven't been able to exercise."
Rationale:
The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the
risk of tendon rupture.
41. A nurse is collection a medication history from a client who has a new prescription for
lithium. The nurse should identify that the client should discontinue which of the following
over-the- counter medications?
a. Aspirin
b. Ibuprofen
c. Ranitidine
d. Bisacodyl
Answer: b. Ibuprofen
Rationale:
Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take
ibuprofen and lithium concurrently.
42. A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers
the antibiotic is not present in the client's medication drawer. The nurse should identify that
administration of the medication can occur at which of the following time periods without
requiring an incident report?
a. 1000
b. 0900
c. 0830
d. 1200
Answer: c. 0830
Rationale:
The nurse should identify that an antibiotic scan be administered 30 min before or after the
scheduled time to maintain therapeutic blood levels without requiring an incident report.
43. A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis.
The nurse should identify which of the following statements as an indication that the client
understands the teaching?
a. "I will drink a glass of milk when I take the risedronate."
b. "I will take the risedronate 15 min after my evening meal."
c. "I should take an antacid with the risedronate to avoid nausea."
d. "I should sit up for 30 minutes after taking the risedronate."
Answer: d. "I should sit up for 30 minutes after taking the risedronate."
Rationale:
Sitting upright for at least 30 min after taking risedronate will reduce the adverse
gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a
client who cannot sit or stand upright for this length of time.
44. A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion
to treat a pulmonary embolism. Which of the following findings should the nurse identify as
an adverse effect of the medication and report to the provider?
a. Vomiting
b. Blood in the urine
c. Positive Chvostek's sign
d. Ringing in the ears
Answer: b. Blood in the urine
Rationale:
The nurse should report blood in the urine to the provider because this can be a manifestation
of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and
tachycardia.
45. A nurse is developing a teaching plan for a client who has a new prescription for
simvastatin. Which of the following instructions should the nurse include I the teaching plan?
(SATA)
a. Report muscle pain to the provider
b. Avoid taking the medication with grapefruit juice
c. Take the medication in the early morning
d. Expect a flushing of the skin as a reaction to the medication
e. Expect therapy with this medication to be lifelong
Answer: a. Report muscle pain to the provider
b. Avoid taking the medication with grapefruit juice
e. Expect therapy with this medication to be lifelong
Rationale:
a. Myopathy is an adverse effect of simvastatin that can lead to rhabdomyolysis. The nurse
should instruct the client to report this to the provider.
b. When taken with grapefruit juice, simvastatin increases the risk of muscle injury from
elevations in creatinine kinase.
e. If medication therapy is discontinued, cholesterol levels will return to their pretreatment
range within several weeks to months.
46. A nurse is caring for a 20-year-old female client who has a prescription for isotretinoin
for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should
advise the client that whiff the following test is required?
a. Serum calcium
b. Pregnancy test
c. 24-hr urine collection for protein
d. Aspartate aminotransferase level
Answer: b. Pregnancy test
Rationale:
The nurse should instruct the client that isotretinoin has teratogenic effects; therefore,
pregnancy must be ruled out before the client can obtain a refill. The client must provide two
negative pregnancy tests for the initial prescription and one negative test before monthly
refills.
47. A nurse is planning care for a client who is prescribed metoclopramide following bowel
surgery, for which of the following adverse effects should the nurse monitor?
a. Muscle weakness
b. Sedation
c. Tinnitus
d. Peripheral edema
Answer: b. Sedation
Rationale:
Metoclopramide has multiple CNS adverse effects, including dizziness, fatigue, and sedation.
48. A nurse is providing teaching to a client who has a prescription for ergotamine sublingual
to treat migraine headaches. Which of the following information should the nurse include in
the instructions?
a. "Take one tablet three times a day before meals."
b. "Take one tablet at onset of migraine."
c. "Take up to eight tablets as needed within a 24-hr period."
d. "Take one tablet every 15 minutes until migraine subsides."
Answer: b. "Take one tablet at onset of migraine."
Rationale:
The client should take one tablet immediately after the onset of aura or headache.
49. A nurse is preparing to administer heparin subcutaneously to a client. Which of the
following actions should the nurse plan to take?
a. Administer the medication outside the 5-cm (2-in) radius of the umbilicus.
b. Aspirate for blood return before injecting.
c. Rub vigorously after the injection to promote absorption.
d. Place a pressure dressing on the injection site to prevent bleeding.
Answer: a. Administer the medication outside the 5-cm (2-in) radius of the umbilicus.
Rationale:
The nurse should administer the heparin by subcutaneous injection to the abdomen in an area
that above the iliac crest and at least 5 cm (2 in) away from the umbilicus.
50. The nurse is caring for a client who is taking acetazolamide for chronic open-angle
glaucoma. For which of the following adverse effects should the nurse instruct the client to
monitor and report?
a. Tingling of fingers
b. Constipation
c. Weight gain
d. Oliguria
Answer: a. Tingling of fingers
Rationale:
The nurse should instruct the client to report the adverse effect of parenthesis, a tingling
sensation in the extremities, when taking acetazolamide.
51. The nurse is preparing to administer medication to a client who has gout. The nurse
discovers that an error was made during the previous shift and the client received atenolol
instead of allopurinol, which of the following actions should the nurse take first?
a. Obtain the client's blood pressure
b. Contact the client's provider
c. Inform the charge nurse
d. Complete an incident report
Answer: a. Obtain the client's blood pressure
Rationale:
When using the nursing process, the first action the nurse should take to prevent injury the
client is to assess the client for adverse effects of atenolol, such as hypotension.
52. A see is preparing to administer PO sodium polystyrene sulfonate to a client who has
hyperkalaemia. Which of the following actions should the nurse plan to take?
a. Hold the client's other oral medications for 8 hr post administration.
b. Inform the this medication can turn still a light tan colour.
c. Keep the client's solution in the refrigerator for up to 72 hr.
d. Monitor the client for constipation.
Answer: d. Monitor the client for constipation.
Rationale:
The nurse should monitor the client for the adverse effect of constipation and report it to the
provider because this can lead to fecal impaction.
53. A nurse is planning to teach about the use of a spacer to a child who has a new
prescription for a fluticasone inhaler to treat chronic asthma. The nurse should include that
the spacer decreases the risk for which of the following adverse effects of the medication?
a. Oral candidiasis
b. Headache
c. Joint pain
d. Adrenal suppression
Answer: a. Oral candidiasis
Rationale:
Dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. Using a spacer
and rinsing the mouth after inhalation will minimize the amount of medication remaining in
the oropharynx, preventing the development of these adverse effects.
54. A nurse is reviewing the laboratory results of a client who is taking digoxin for heart
failure. Which of the following results should the nurse report to the provider?
a. Calcium level 9.2 mg/dL
b. Magnesium level 1.6 mEq/L
c. Digoxin level 1.1 ng/mL
d. Potassium level 2.8 mEq/L
Answer: d. Potassium level 2.8 mEq/L
Rationale:
A potassium level of 2.8 mEq/L is below the expected reference range of 3.5 to 5 mEq/L. The
nurse should notify the provider if a client has hypokalaemia prior to administration of
digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias.
55. A nurse receives a verbal order from the provider to administer morphine five milligrams
every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of
the following entries as the correct format for the medication administration record (MAR)?
a. MSO4 5 mg sub cut every 4 hr PRN severe pain
b. Morphine 5 mg sub cut every 4 hr PRN severe pain
c. MSO4 5 mg SQ every 4 hr PRN severe pain
d. Morphine 5.0 mg subcutaneously every 4 hr PRN severe pain
Answer: b. Morphine 5 mg sub cut every 4 hr PRN severe pain
Rationale:
The nurse should identify this entry as the correct format for the MAR. The medication name
is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use"
list included in the transcription.
56. A nurse is providing discharge instructions to a client who has heart failure and a new
prescription for captopril. Which of the following client statements indicates an
understanding of the teaching?
a. "I should take the medication with food."
b. I should take naproxen if I develop joint pain."
c. "I should tell my provider if I develop a sore throat."
d. "I should expect the medication to cause my urine to look orange."
Answer: c. "I should tell my provider if I develop a sore throat."
Rationale:
The client should report a sore throat to the provider because this can indicate neutropenia, a
serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the
medication is promptly discontinued.
57. A nurse is caring for a client who has acute acetaminophen toxicity, the nurse should
anticipate administering which of the following medications?
a. Vitamin K
b. Acetylcysteine
c. Benztropine
Answer: b. Acetylcysteine
Rationale:
Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury
when given orally or by IV infusion within 8 to 10 hr.
