2023 ATI Pharmacology Comprehensive Exam With Answers-240 Solved Questions

ATI MODULES CASE STUDY QUESTIONS COMPLETE WITH ANS
PHARMACOLOGY RATED A+ COMPREHENSIVE LATEST 2023
The Neurological System (Part 1)
Case Study Questions 1:
1. Which of the following assessments of this client is most important immediately following the
administration of intravenous diazepam?
A. ECG
B. Seizure Activity
C. Blood Pressure
D. Respiratory Rate
Answer: D. Respiratory Rate
2. The healthcare professional is about to administer a loading dose of phenytoin IV. Which of
the following is essential for the health care professional to do before administering phenytoin
IV?
A. Protect the phenytoin solution from light.
B. Make sure the phenytoin solution is cloudy.
C. Mix phenytoin with a dextrose solution.
D. Infuse phenytoin slowly.
Answer: D. Infuse phenytoin slowly.
3. The health care professional is now assessing the client. Which of the following findings can
be an early indication of phenytoin toxicity?
A. Nystagmus
B. Tachycardia
C. Tachypnea
D. Jaundice
Answer: A. Nystagmus

4. The healthcare professional is talking with the client, who is soon to be discharged to home,
about the adverse effects of phenytoin. Which of the following instructions may help minimize
the adverse effects of phenytoin?
A. Use good oral hygiene.
B. Take the drug on an empty stomach.
C. Use sunblock when outdoors.
D. Decrease dietary fibre.
Answer: A. Use good oral hygiene.
5. The client is taking oral contraceptives for birth control. Which of the following instructions
should the health care professional include?
A. It is safe to discontinue birth control while taking phenytoin.
B. Additional birth control methods may be needed.
C. Oral contraceptives may increase the risk for phenytoin toxicity.
D. Oral contraceptives may reduce the effectiveness of phenytoin.
Answer: B. Additional birth control methods may be needed.
Case Study Questions 2:
6. Which laboratory tests should you monitor for a client who is taking interferon beta-1b to treat
multiple sclerosis? (Select all that apply.)
A. Serum osmolality
B. Blood glucose
C. Thyroid hormones
D. Liver function
E. CBC
Answer: C. Thyroid hormones
D. Liver function
E. CBC
Rationale:
Interferon beta-1b, an immunosuppressant, may cause hepatotoxicity and myelosuppression.
Minot liver studies and CBC. The client should undergo thyroid function testing every 6 months

7. While obtaining a client's medical history, you find that the client is taking levodopa/carbidopa
for Parkinson's disease. Which information in the client's health history alerts you to take further
action?
A. Bradycardia
B. Pancreatic disease
C. Glaucoma
D. Impaired hearing
Answer: C. Glaucoma
Rationale:
The combination of levodopa and carbidopa, both dopamine-replacement drugs, can cause
changes in intraocular pressure.
8. At a visit to the provider's office, an older adult client's partner reports that the client has
nausea, diarrhoea, and a loss of appetite. He has a history of Alzheimer's disease and is taking
donepezil. Which information should be provided by the nurse?
A. Take the drug with food.
B. Stop taking the drug right away.
C. Take a reduced dosage of the drug.
D. Undergo liver function tests right away.
Answer: A. Take the drug with food.
9. You are instructing a client who has multiple sclerosis about how dantrolene will help control
spasticity. With which mechanism is this drug effective in treating this manifestation?
A. Blocks acetylcholine at the neuromuscular junction
B. Interrupts nerve signals from the spinal cord to the muscles
C. Inhibits destruction of acetylcholine by acetylcholinesterase
D. Alters intracellular calcium exchange at the muscles
Answer: D. Alters intracellular calcium exchange at the muscles

10. You are caring for a client who is preoperative and is NPO. The client takes carbamazepine,
200 mg PO BID for a seizure disorder. Which action should the nurse take?
A. Give the oral dose of carbamazepine with a sip of water.
B. Give carbamazepine IV.
C. Withhold the carbamazepine.
D. Administer half the usual morning dose of carbamazepine
Answer: A. Give the oral dose of carbamazepine with a sip of water.
11. You are instructing a school-age child and his parent about the use of amphetaminedextroamphetamine to manage the child's attention-deficit/hyperactivity disorder. Which clinical
manifestations should the nurse instruct the parent to report? (Select all that apply.)
A. Weight loss
B. Insomnia
C. Hallucinations
D. Orthostatic hypotension
E. Flu-like symptoms
Answer: A. Weight loss
B. Insomnia
C. Hallucinations
12. Drag the drug classification in the left column to match it with its therapeutic use in the right
column.
A. Hydantoin: Controls seizures
B. Immunomodulator: Reduces symptoms of multiple sclerosis
C. Dopamine receptor agonist: Reduces the effects of Parkinson's disease
D. Cholinesterase inhibitor: Helps minimize symptoms of Alzheimer's disease
Answer: A. Hydantoin: Controls seizures
B. Immunomodulator: Reduces symptoms of multiple sclerosis
C. Dopamine receptor agonist: Reduces the effects of Parkinson's disease
D. Cholinesterase inhibitor: Helps minimize symptoms of Alzheimer's disease

13. A primary care provider prescribes sumatriptan to treat a client's migraine headaches. Which
instructions should the nurse include when telling the client how to take sumatriptan? (Select all
that apply.)
A. Take the drug after onset of the migraine.
B. Administer one nasal spray into each nostril.
C. Take it once per day to prevent migraine.
D. Repeat the dose once if the headache returns.
E. Allow the tablet to dissolve under the tongue.
Answer: A. Take the drug after onset of the migraine.
D. Repeat the dose once if the headache returns.
14. A client receives spinal anaesthesia with lidocaine and epinephrine. You explain that
epinephrine is used with lidocaine for which of the following reasons?
A. Decreases the risk for a spinal headache
B. Reduces the risk for infection
C. Prolongs the aesthetic effects
D. Prevents respiratory depression
Answer: C. Prolongs the aesthetic effects
15. Drag the drug in the left column to match it with its therapeutic use in the right column.
A. Fentanyl: Anaesthesia or cancer pain management
B. Amphetamine/dextroamphetamine sulphate: Attention-deficit/hyperactivity disorder
C. Dantrolene: Malignant hyperthermia
D. Baclofen: Muscle spasms
Answer: A. Fentanyl: Anaesthesia or cancer pain management
B. Amphetamine/dextroamphetamine sulphate: Attention-deficit/hyperactivity disorder
C. Dantrolene: Malignant hyperthermia
D. Baclofen: Muscle spasms
Pharmacology Made Easy 4.0 The Neurological System (Part 1) Quiz:

16. A nurse is caring for a client who has a new prescription for amphetamine sulphate. The
nurse should monitor the client for which of the following adverse effects?
A. Hypotension
B. Tinnitus
C. Tachycardia
D. Bronchospasm
Answer: C. Tachycardia
Rationale:
Amphetamine sulphate is an amphetamine stimulant. It can cause tachycardia and dysrhythmias.
The client should notify the nurse if they develop palpitations or chest pain.
17. A nurse is caring for a client who has been taking selegiline to treat Parkinson's disease. The
provider is considering the use of analgesics for the client but should be aware that a drug
interaction between selegiline and meperidine can result in which of the following?
A. Frequent urination
B. Jaundice
C. Cellulitis
D. Muscle rigidity
Answer: D. Muscle rigidity
A drug interaction between selegiline and opioids, especially meperidine, can result in rigidity,
stupor, agitation, hypertension, and fever.
18. A nurse is preparing to administer sumatriptan to a client for the first time. The nurse should
instruct the client that sumatriptan is indicated for which of the following conditions?
A. Tonic-clonic seizures
B. Presence of a migraine headache
C. Exacerbation of multiple sclerosis
D. Alzheimer's disease
Answer: B. Presence of a migraine headache
Rationale:
Sumatriptan is used in the treatment of migraine headaches.

19. A nurse is teaching the family of a client who has a new diagnosis of Alzheimer's disease
about donepezil. Which of the following information should the nurse include?
A. Monitor for constipation.
B. The dosage will be increased weekly to provide optimum therapeutic effect.
C. Administering the drug first thing in the morning promotes effectiveness.
D. Avoid the use of NSAIDs for pain.
Answer: D. Avoid the use of NSAIDs for pain.
Rationale:
Combining NSAIDs with donepezil can cause gastrointestinal bleeding. Therefore, the nurse
should instruct the client's family to avoid the use of NSAIDs.
20. A nurse is teaching a client who has a prescription for baclofen. Which of the following
instructions should the nurse include?
A. Avoid driving until the drug's effects are evident.
B. Stop taking the drug immediately if headache occurs.
C. Take the drug as needed for spasticity.
D. Take the drug with antacids to reduce gastric effects.
Answer: A. Avoid driving until the drug's effects are evident.
Rationale:
Baclofen, a centrally-acting muscle relaxant, causes CNS depression. Clients taking the drug
should avoid alcohol and other CNS depressants, and should not drive a vehicle until they know
how the drug will affect them.
21. A nurse is teaching a client who has a prescription for modafinil to treat narcolepsy. Which of
the following instructions should the nurse include?
A. Take the drug in the morning.
B. Take the drug 30 min before bedtime.
C. Anticipate daytime drowsiness.
D. Expect urinary frequency.
Answer: A. Take the drug in the morning.

Rationale:
Modafinil is a nonamphetamine stimulant. Taking it in the morning helps improve wakefulness
for clients who have narcolepsy. Clients taking the drug for shift-work sleepiness should take it 1
hr before work.
22. A nurse is teaching a client about interferon beta-1a. Which of the following instructions
should the nurse give to help the client avoid the adverse effects of this drug?
A. "Premedicate with acetaminophen."
B. "Take the drug with food."
C. "Increase your fluid intake."
D. "Take the drug in the morning."
Answer: A. "Premedicate with acetaminophen."
Rationale:
Interferon beta drugs can cause fever, chills, headaches, and muscle aches. Acetaminophen can
help minimize these symptoms.
23. A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal
muscle spasms. The nurse should instruct the client to report which of the following adverse
effects?
A. Slow heart rate
B. Cough
C. Diarrhoea
D. Hearing loss
Answer: C. diarrheal
Rationale:
Prolonged diarrheal can cause dehydration and other serious effects. diarrhoea, nausea, and
vomiting are adverse effects of dantrolene. The client should report these effects so the nurse can
monitor fluid balance and intervene accordingly.

24. A nurse is teaching a client who has a prescription for carbamazepine. Which of the
following instructions should the nurse include to help the client avoid adverse effects of this
drug?
A. Begin taking the drug at a low dosage.
B. Discontinue the drug immediately if diarrhoea occurs.
C. Have serum glucose levels checked regularly.
D. Take the drug on an empty stomach.
Answer: A. Begin taking the drug at a low dosage.
Rationale:
Visual disturbances, vertigo, and ataxia can result from taking carbamazepine, a drug that treats
seizure disorders. Dosages should be low to minimize or prevent these adverse effects.
25. A nurse is caring for a client who is receiving methohexital sodium. The nurse should
monitor the client for which of the following adverse effects?
A. Cardiac excitability
B. Respiratory depression
C. Hyperthermia
D. Hypertension
Answer: B. Respiratory depression
Rationale:
Methohexital, a short-acting barbiturate, causes respiratory depression. Mechanical ventilation
and continuous monitoring are essential for clients receiving the drug.
26. A nurse is teaching a client who has Alzheimer's disease and their caregiver about
memantine. Which of the following instructions should the nurse include?
A. Increase fluid intake to improve renal excretion.
B. Report memory loss or confusion.
C. Watch for signs of liver impairment, such as jaundice and abdominal pain.
D. Avoid taking over-the-counter antacids.
Answer: D. Avoid taking over-the-counter antacids.
Rationale:

Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug
excretion, ultimately leading to toxicity.
27. A nurse is caring for a client who is taking donepezil to treat Alzheimer's disease. For which
of the following adverse effects should the nurse monitor?
A. Confusion
B. Dry mouth
C. Nausea
D. Double vision
Answer: C. Nausea
Rationale:
The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting,
and diarrhoea. Taking donepezil with food can help minimize adverse effects.
28. A nurse is providing teaching for a client who has a new prescription for valproic acid to treat
a seizure disorder. The nurse should instruct the client to monitor for which of the following
adverse effects?
A. Hirsutism
B. Depression
C. Jaundice
D. Gum irritation
Answer: C. Jaundice
Rationale:
Valproic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain, and nausea.
Clients taking the drug should report these manifestations, and the nurse should monitor liver
function studies prior to treatment and periodically during therapy.
29. A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal
muscle spasms. The nurse should identify that which of the following laboratory tests requires
monitoring?
A. Serum potassium

B. Liver function
C. Serum sodium
D. Thyroid function
Answer: B. Liver function
Rationale:
Liver toxicity is a serious adverse effect of dantrolene. The nurse should monitor the client's liver
function prior to treatment and at regular intervals and advise the client to report jaundice or
abdominal pain.
30. A nurse is teaching a client who is taking levodopa/carbidopa to treat Parkinson's disease.
Which of the following instructions should the nurse include?
A. Change position slowly to prevent orthostatic hypotension.
B. Eat a high-protein snack to increase absorption.
C. Take the drug at bedtime to avoid daytime drowsiness.
D. Expect eye twitching to develop with long-term therapy.
Answer: A. Change position slowly to prevent orthostatic hypotension.
Rationale:
Levodopa/carbidopa can cause orthostatic hypotension.
31. A nurse is teaching a client who has a new prescription for valproic acid to treat a seizure
disorder. The nurse should instruct the client to monitor for which of the following adverse
effects. (Select all that apply.)
A. Hirsutism
B. Drowsiness
C. Headache
D. Ataxia
E. Rash
Answer: B. Drowsiness
C. Headache
E. Rash
Rationale:

B. Drowsiness is correct. Clients taking valproic acid should report CNS depressant effects, such
as sedation or drowsiness, because these adverse effects can indicate the need for a reduction in
dose.
C. Headache is correct. Valproic acid can cause headache, along with other CNS adverse effects,
such as sleep disturbances.
E. Rash is correct. Skin rash is an adverse effect of valproic acid and other antiepileptic drugs.
32. A nurse is caring for a client who has been taking amphetamine/dextroamphetamine sulphate
for the treatment of attention deficit hyperactivity disorder (ADHD) for 2 weeks. The nurse
should report which of the following findings to the provider?
A. Weight loss of 2.3 kg (5 lb)
B. BP 110/70 mm Hg
C. Apical pulse 80/min
D. Respiratory rate 16/min
Answer: A. Weight loss of 2.3 kg (5 lb)
Rationale:
Amphetamine/dextroamphetamine sulphate can cause a decreased appetite and weight loss. The
nurse should instruct the client to weigh themself twice weekly and report unintended weight
loss.
33. A nurse is reviewing the medical record of a client who has a newly diagnosed seizure
disorder and a new prescription for valproic acid and phenytoin. The nurse should identify that
which of the following can occur as a result of an interaction between these drugs?
A. Hyperammonaemia
B. Phenytoin toxicity
C. Hypertension
D. Peptic ulcer disease
Answer: B. Phenytoin toxicity
Rationale:

Valproic acid can cause an increase in phenytoin blood levels, resulting in phenytoin toxicity.
The nurse should monitor serum phenytoin levels and notify the provider if levels begin to
exceed the therapeutic range.
34. A nurse is teaching a client who is about to begin sumatriptan therapy to treat migraine
headaches. The nurse should instruct the client to monitor for which of the following adverse
effects?
A. Chest pain
B. Polyuria
C. Joint pain
D. Insomnia
Answer: A. Chest pain
Rationale:
Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain. Clients should
report any pressure, pain, or tightness in the jaw, chest, or back. Sumatriptan is not an
appropriate choice for clients who have a history of coronary artery disease.
35. A nurse is teaching a client who has a new diagnosis of Parkinson's disease about how
levodopa/carbidopa can help control symptoms. The nurse should identify that the drug has
which of the following pharmacologic effects?
A. Increases available acetylcholine in the brain
B. Inhibits norepinephrine metabolism in the brain
C. Inhibits serotonin metabolism in the brain
D. Increases available dopamine in the brain
Answer: D. Increases available dopamine in the brain
Rationale:
Levodopa/carbidopa, a dopaminergic agent, can increase dopamine in the extrapyramidal centre
of the brain, reducing involuntary motion, or tremors, associated with Parkinson's disease.

36. A nurse is caring for a client who has a new prescription for pramipexole to treat Parkinson's
disease. The nurse should recognize that which of the following laboratory tests requires
monitoring?
A. C-reactive protein
B. Creatinine clearance
C. Thyroid function
D. CBC
Answer: B. Creatinine clearance
Rationale:
Pramipexole, a direct-acting dopamine receptor agonist, should be used with caution for clients
who have renal disease. Therefore, the nurse should monitor the client's renal function.
37. A nurse is preparing to administer memantine to a client who has Alzheimer's disease. Which
of the following findings in the client's medical history indicates a need to withhold the drug and
notify the provider?
A. Pancreatic cancer
B. Hypotension
C. Cirrhosis
D. Osteoporosis
Answer: C. Cirrhosis
Rationale:
Memantine should be used cautiously in clients who have severe hepatic impairment. The nurse
should contact the provider about the client's history of cirrhosis to see if laboratory testing is
required before starting the drug or if the dosage needs to be adjusted. Memantine should be used
cautiously in clients who have severe hepatic impairment. The nurse should contact the provider
about the client's history of cirrhosis to see if laboratory testing is required before starting the
drug or if the dosage needs to be adjusted.
38. A nurse is caring for a client who is taking interferon beta-1b. The nurse should identify that
which of the following findings indicates a potential serious adverse effect of this drug?
A. Tinnitus

B. Twitching eyelids
C. Blue-green skin discoloration
D. Fatigue
Answer: D. Fatigue
Rationale:
The nurse should identify that potential serious adverse effects of interferon beta-1b include
unexplained bruising, bleeding, and fatigue. Clients should report these adverse effects to their
provider immediately because they can indicate bone marrow suppression and decreased platelet
count.
39. A nurse is administering fentanyl to a client to reduce pain. Which of the following drugs
should the nurse have available to reverse the effects of fentanyl?
A. Neostigmine
B. Succinylcholine
C. Naloxone
D. Dantrolene
Answer: C. Naloxone
Rationale:
Naloxone is an opioid antagonist that reverses the effects of opioids. Fentanyl, an opioid agonist,
can cause severe respiratory depression. The nurse should also have resuscitation equipment
available when administering fentanyl to a client.
40. A nurse is teaching a client who received a prescription for interferon beta-1a for the
treatment of multiple sclerosis. Which of the following information should the nurse include?
A. "Have kidney function tests done every month for a year."
B. "Take an extra dose if muscle aches occur."
C. "Store the drug at room temperature after mixing it."
D. "Administer the drug in your thigh or upper arm."
Answer: D. "Administer the drug in your thigh or upper arm."
Rationale:

Interferon beta-1a is administered via the subcutaneous route. Therefore, the nurse should
instruct the client how to perform subcutaneous injections for self-administration.
Tutorial: Pharmacology Made Easy 4.0 Module: The Neurological System (Part 2)
Case Study Questions 1:
41. Which of the following drug classifications is the first line of therapy for treating open-angle
glaucoma?
A. Glucocorticoids
B. Beta blockers
C. Anticholinergic agents
D. Mast cell stabilizers
Answer: B. Beta blockers
42. Which of the following drugs, used to treat open-angle glaucoma, should primary care
providers use with caution for a client who is taking propranolol?
A. Betaxolol
B. Latanoprost
C. Pilocarpine
D. Echothiophate
Answer: A. Betaxolol
43. The primary care provider prescribes pilocarpine for the client. Which of the following
information should he include when instructing the client about instilling pilocarpine eye drops?
A. Apply gentle pressure to the nasolacrimal duct after instillation.
B. Massage the eyelid after instillation.
C. Cover the eye with a patch after instillation.
D. Blink rapidly to disperse the eye drops after instillation.
Answer: A. Apply gentle pressure to the nasolacrimal duct after instillation.

44. The primary care provider continues to instruct the client about using pilocarpine. He tells the
client to watch for and report which of the following adverse effects of this drug? (Select all that
apply.)
A. Blurred vision
B. Headache
C. Visual floaters
D. Dilated pupils
E. Tachycardia
Answer: A. Blurred vision
B. Headache
C. Visual floaters
45. The client returns to the primary care provider after 1 week. He is sweating and reports
urinary urgency. He suspects systemic effects from the pilocarpine. Which of the following drugs
can reverse systemic toxicity from pilocarpine?
A. Flumazenil
B. Protamine sulphate
C. Naloxone
D. Atropine sulphate
Answer: D. Atropine sulphate
Case Study 2 Questions:
46. A client is to start taking amitriptyline. For which of the following should you instruct the
client to watch for and report? (Select all that apply.)
A. Blurred vision
B. Urinary hesitancy
C. diarrhoea
D. Joint pain
E. Tachycardia
Answer: A. Blurred vision
B. Urinary hesitancy

E. Tachycardia
47. Early clinical manifestations of lithium toxicity include which of the following? (Select all
that apply.)
A. Seizures
B. Nausea
C. Hypotension
D. Ataxia
E. Muscle weakness
Answer: B. Nausea
E. Muscle weakness
48. During an assessment of a client taking chlorpromazine, you note a slow shuffling gait, rigid
facial expression, and fine tremors. These manifestations indicate which of the following?
A. Acute dystonia
B. Tardive dyskinesia
C. Parkinsonism
D. Akathisia
Answer: C. Parkinsonism
49. Which of the following drugs blocks beta-adrenergic receptors and thereby decreases
intraocular pressure (IP) by reducing the amount of aqueous humor produced?
A. Betaxolol
B. Pilocarpine
C. Latanoprost
D. Acetazolamide
Answer: A. Betaxolol
50. Match the drug classification in the left column with its therapeutic use in the right column.

Benzodiazepines

Depression

Cholinergic agonists

Schizophrenia

Antipsychotics

Glaucoma

Monoamine oxidase

Anxiety disorders

inhibitors

Answer:
Benzodiazepines

Anxiety disorders

Cholinergic agonists

Glaucoma

Antipsychotics

Schizophrenia

Monoamine oxidase

Depression

inhibitors

51. You are instructing a client about taking phenelzine to treat depression. Which of the
following foods should you tell the client to avoid?
A. Aged cheese
B. Milk
C. Potato chips
D. Candy
Answer: A. Aged cheese
52. A client is taking risperidone for schizophrenia. Recognizing the adverse effects of
risperidone, you advise the client to watch for and report which of the following?
A. Tremor

B. Weight loss
C. Oral ulcers
D. Bronchospasm
Answer: A. Tremor
53. A client is taking venlafaxine to treat major depression. Which of the following instructions
should you include when advising the client and family about the use of venlafaxine? (Select all
that apply.)
A. Discontinue it immediately for increased depression.
B. Take it with food to reduce gastric disturbances.
C. Monitor and report insomnia.
D. Have blood pressure checked regularly.
E. Check with the primary care provider before taking any herbal supplements.
Answer: B. Take it with food to reduce gastric disturbances.
C. Monitor and report insomnia.
D. Have blood pressure checked regularly.
E. Check with the primary care provider before taking any herbal supplements.
54. Match the drug classification in the left column with its therapeutic use in the right column.
Lithium carbonate

Reduces depression

Venlafaxine

Treats schizophrenia

Betaxolol

Controls manic episodes

Risperidone

Reduces intraocular pressure

Answer:
Lithium carbonate

Controls manic episodes

Venlafaxine

Reduces depression

Betaxolol

Reduces intraocular pressure

Risperidone

Treats schizophrenia

55. When instructing a client about taking buspirone, you tell the client to watch for and report a
paradoxical reaction to buspirone. Which of the following is a paradoxical effect of buspirone?
A. Chest pain
B. Insomnia
C. Diaphoresis
D. Fever
Answer: B. Insomnia
Pharmacology Made Easy 4.0 The Neurological System (Part 2) Quiz:
56. A nurse is providing teaching to a client who has a new prescription for fluoxetine. Which of
the following instructions should the nurse include?
A. "Weigh yourself twice a month."
B. "If you have persistent headaches, let the provider know."
C. "Reduce your daily sodium intake."
D. "If your symptoms don't improve in 10 days, you will need a higher dosage."
Answer: B. "If you have persistent headaches, let the provider know."
Rationale:
The client should report persistent headache, anxiety, or insomnia to the provider as an adverse
drug reaction.
57. When reviewing the indications for various antidepressants, a nurse should identify that
bupropion hydrochloride is an appropriate choice for clients who have which of the following?
(Select all that apply.)
A. Motion sickness

B. Seasonal affective disorder
C. Insomnia
D. Nicotine addiction
E. Depression
Answer: B. Seasonal affective disorder
D. Nicotine addiction
E. Depression
Rationale:
A. Seasonal affective disorder is correct. Bupropion, an atypical antidepressant, helps prevent
and treat seasonal affective disorder, a type of depression associated with the reduction of natural
light during winter months.
D. Nicotine addiction is correct. Bupropion, an atypical antidepressant, is an appropriate adjunct
for clients who are trying to quit smoking.
E. Depression is correct. Bupropion, an atypical antidepressant, can help treat depression.
58. A nurse is caring for a client who has a prescription for alprazolam. For which of the
following adverse effects should the nurse monitor? (Select all that apply.)
A. Tolerance
B. Anxiety
C. Sedation
D. Respiratory depression
E. Constipation
Answer: A. Tolerance
B. Anxiety
C. Sedation
D. Respiratory depression
Rationale:
A. Tolerance is correct. Tolerance and dependence can develop with benzodiazepines, such as
alprazolam. Clients should use these drugs only as needed and for short periods of time.
B. Anxiety is correct. Paradoxical reactions, such as anxiety and insomnia, can develop when
taking alprazolam, especially in older adults. Clients should report these findings.

C. Sedation is correct. CNS depression, manifested as sedation and drowsiness, is an adverse
effect of benzodiazepines, such as alprazolam. Clients should take a benzodiazepine 30 min prior
to bedtime.
D. Respiratory depression is correct. Benzodiazepines, such as alprazolam, can cause CNS
depression when taken with other CNS depressants, especially for older adult clients. It is
important to monitor for respiratory depression and recommend the lowest effective dose. Clients
should avoid alcohol and other CNS depressants while taking a benzodiazepine.
59. A nurse is caring for a client who has been taking alprazolam for an extended period of time
to treat anxiety. The nurse should identify that abruptly stopping alprazolam therapy can result in
which of the following adverse effects?
A. Anterograde amnesia
B. Respiratory depression
C. Paradoxical reaction
D. Withdrawal symptoms
Answer: D. Withdrawal symptoms
Rationale:
Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent
withdrawal symptoms, clients should taper the dose slowly over several weeks.
60. A nurse is providing teaching for a client who has a prescription for phenelzine. The nurse
should instruct the client to avoid tyramine-enriched foods because of an increased risk for which
of the following adverse reactions?
A. Respiratory depression
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
Answer: B. Hypertensive crisis
Rationale:

Tyramine-enriched foods, such as aged cheese and processed meat, can trigger severe
hypertension in clients who are taking phenelzine. Manifestations include hypertension,
headache, and nausea.
61. A nurse is caring for a client who was admitted to the emergency department with a head
injury. The nurse notes that the client has an existing prescription for bupropion hydrochloride to
treat depression. For which of the following adverse effects is the client at increased risk?
A. Ischemic stroke
B. Drowsiness
C. Respiratory depression
D. Seizure activity
Answer: D. Seizure activity
Rationale:
Bupropion, an atypical antidepressant, can cause seizure activity when clients take high doses or
have a seizure disorder, a CNS tumor, or a history of head trauma.
62. A nurse is caring for a client who is about to begin taking lithium carbonate to treat bipolar
disorder. The nurse should instruct the client to monitor for which of the following findings as
indications of lithium toxicity? (Select all that apply.)
A. Tremors
B. Confusion
C. Bronchospasm
D. Nausea
E. Muscle weakness
Answer: A. Tremors
B. Confusion
D. Nausea
E. Muscle weakness
Rationale:
A. Tremors is correct. A fine hand tremor is an early indication of lithium toxicity. A coarse
tremor indicates advanced toxicity that can lead to seizure activity.

B. Confusion is correct. Confusion, slurred speech, and ataxia are indications of lithium toxicity
that develop because of the drug's narrow therapeutic range.
D. Nausea is correct. Nausea, vomiting, and diarrhoea are early indications of lithium toxicity
that develop because of the drug's narrow therapeutic range. Clients should report any of these
adverse effects.
E. Muscle weakness is correct. Muscle weakness is an early indication of lithium toxicity that
develops because of the drug's narrow therapeutic range. The nurse should monitor lithium levels
periodically.
63. A nurse is reviewing the medical history of a client who has a new prescription for a reduced
dosage of alprazolam for anxiety. Which of the following findings should indicate to the nurse
the reason for the prescription modification?
A. Renal function impairment
B. Cataracts
C. Recent weight loss
D. Smoking
Answer: A. Renal function impairment
Rationale:
Alprazolam dosage should be decreased for clients who have renal or hepatic impairment.
64. A nurse is providing teaching to a client who is about to begin amitriptyline therapy to treat
major depressive disorder. Which of the following instructions should the nurse include? (Select
all that apply.)
A. Change positions slowly from sitting or lying to standing.
B. Do not stop taking the drug abruptly.
C. Avoid crushing the tablet.
D. Take the drug at bedtime to prevent daytime drowsiness.
E. Increase fibre and fluid intake.
Answer: A. Change positions slowly from sitting or lying to standing.
B. Do not stop taking the drug abruptly.
D. Take the drug at bedtime to prevent daytime drowsiness.

E. Increase fibre and fluid intake.
Rationale:
A. Change positions slowly from sitting or lying to standing is correct. Amitriptyline, a tricyclic
antidepressant, can cause orthostatic hypotension. Clients should move slowly from sitting or
lying to standing.
B. Do not stop taking the drug abruptly is correct. Relapse and withdrawal symptoms can occur
with abrupt discontinuation of amitriptyline. When discontinuing the drug, it is important to
reduce the dosage over a 2-week period to prevent or minimize withdrawal symptoms.
D. Take the drug at bedtime to prevent daytime drowsiness is correct. Amitriptyline, a tricyclic
antidepressant, can cause drowsiness. Clients should take the drug at bedtime and avoid activities
that require alertness until they know how the drug will affect them.
E. Increase fibre and fluid intake is correct. Amitriptyline, a tricyclic antidepressant, causes
anticholinergic effects, such as dry mouth, constipation, and urinary retention. Clients should
increase fibre and fluid intake during drug therapy and urinate before taking the drug.
65. A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia
and who was admitted to the emergency room with spasms of their face and back. Which of the
following adverse reactions should the nurse suspect?
A. Cholinergic crisis
B. Serotonin syndrome
C. Stevens-Johnson syndrome
D. Acute dystonia
Answer: D. Acute dystonia
Rationale:
Acute dystonia can develop during the first few days of treatment with chlorpromazine.
Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes
immediate administration of an anticholinergic drug, such as diphenhydramine.
66. A nurse is providing teaching to a client who has a prescription for chlorpromazine. Which of
the following instructions should the nurse include?
A. Stop taking the drug immediately with the first sign of a sore throat.

B. Wear sunscreen when exposed to sunlight.
C. Take the drug with food to reduce gastrointestinal distress.
D. Take the drug in the morning to prevent nocturia.
Answer: B. Wear sunscreen when exposed to sunlight.
Rationale:
Chlorpromazine, a conventional antipsychotic, can cause photosensitivity, or increased
susceptibility to sunburn, when exposed to sunlight. Clients should limit their exposure to
sunlight and wear sunscreen and protective clothing while outdoors.
67. A nurse is reviewing the drug history of a client who is taking lithium carbonate for bipolar
disorder. Which of the following findings should indicate to the nurse to monitor for lithium
toxicity?
A. Furosemide for hypertension
B. Acetaminophen for headaches
C. Ciprofloxacin for a urinary tract infection
D. Montelukast for asthma
Answer: A. Furosemide for hypertension
Rationale:
Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium
reabsorption. The nurse should evaluate the client for lithium toxicity.
68. A nurse is providing teaching to a client about instilling pilocarpine for managing open-angle
glaucoma. Which of the following instructions should the nurse include in the teaching? (Select
all that apply.)
A. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops.
B. Do not touch the tip of the dropper.
C. Wash hands after instilling the drops.
D. Rub eyes gently after instilling the drops.
E. Remove contact lenses prior to instilling the drops.
Answer: A. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops.
B. Do not touch the tip of the dropper.

E. Remove contact lenses prior to instilling the drops.
Rationale:
A. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops is correct.
Applying gentle pressure to the nasolacrimal duct for 1 to 2 min after instillation helps keep the
drug from entering the systemic circulation.
E. Remove contact lenses prior to instilling the drops is correct. Clients should remove contact
lenses before instilling eye drops because they can cause further irritation if left in place.
69. A nurse is providing teaching to a client who has a prescription for buspirone. Which of the
following instructions should the nurse include?
A. Take the drug with grapefruit juice to increase absorption.
B. Use the drug as needed for anxiety.
C. Allow 2 to 4 weeks for full therapeutic effects.
D. Take the drug on an empty stomach.
Answer: C. Allow 2 to 4 weeks for full therapeutic effects.
Rationale:
It can take up to 4 weeks for a client to feel the drug's full therapeutic effects.
70. A nurse is providing teaching to a client who has a prescription for lithium carbonate about
reducing the risk for lithium toxicity. Which of the following instructions should the nurse
include?
A. Consume a low-sodium diet.
B. Reduce fluid intake.
C. Avoid taking NSAIDs.
D. Take the drug with food.
Answer: C. Avoid taking NSAIDs.
Rationale:
NSAIDs increase renal reabsorption of lithium and sodium. Clients who take lithium should not
take NSAIDs.

71. A nurse is providing teaching for a client who has a new prescription for betaxolol eye drops.
Which of the following adverse effects should the nurse include in the teaching?
A. Constricted pupils
B. Discoloration of the iris
C. Hypertension
D. Bradycardia
Answer: D. Bradycardia
Rationale: Betaxolol and timolol can cause bradycardia because of the blockade of cardiac beta1
receptors. Clients should check their pulse rate regularly and report any sustained decreases.
72. A nurse is caring for a client who is taking venlafaxine to treat major depressive disorder. The
nurse should identify that which of the following drugs can cause serotonin syndrome when
taken concurrently with venlafaxine?
A. Alprazolam
B. Phenytoin
C. Phenelzine
D. Pilocarpine
Answer: C. Phenelzine
Rationale:
Clients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor, within 14
days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a lifethreatening complication characterized by anxiety, confusion, hallucinations, and fever.
73. A nurse is providing teaching to a client who has a new prescription for diazepam for anxiety
disorders. Which of the following client statements indicates an understanding of the teaching?
A. "It is not a big deal if I forget my pills for a couple of days."
B. "I should limit alcohol intake to one drink daily while taking this medication."
C. "I will avoid salt because this medication can increase my blood pressure."
D. "If I become pregnant, it is important to let my health care provider know."
Answer: D. "If I become pregnant, it is important to let my health care provider know."
Rationale:

Diazepam can increase the risk of congenital malformations and is contraindicated for clients
who are pregnant.
74. A nurse is caring for a client who has a prescription for fluoxetine and who reports selfadministering St. John's wort daily for the past 2 weeks. Which of the following findings should
the nurse report to the provider as an indication of serotonin syndrome?
A. Hallucinations
B. Decreased temperature
C. Hypersexual behavior
D. Constipation
Answer: A. Hallucinations
Rationale:
Hallucinations are an expected finding of serotonin syndrome. SSRIs are contraindicated with St.
John's wort because the combination can increase the risk of developing serotonin syndrome.
75. A nurse is caring for a client who has schizoaffective disorder and who has been prescribed
chlorpromazine. Which of the following client findings should the nurse monitor after
administering the medication?
A. BUN level
B. Blood pressure
C. Urine specific gravity
D. Pedal pulse strength
Answer: B. Blood pressure
Rationale:
Clients who receive chlorpromazine are at risk for hypotension during and immediately after IV
administration. The client should remain supine for 30 min while the nurse monitors their blood
pressure. The nurse should instruct the client to change positions slowly as a safety precaution to
prevent client injury. This medication can also cause orthostatic hypotension.
76. A nurse is providing teaching to a client who has a prescription for buspirone to treat anxiety.
Which of the following instructions should the nurse include?

A. "Take a missed dose as soon as you remember."
B. "Take the drug as needed at the first sign of anxious feelings."
C. "Take the drug in the morning with a glass of grapefruit juice."
D. "Drink a cup of chamomile tea at night with the drug."
Answer: A. "Take a missed dose as soon as you remember."
Rationale:
Buspirone should be taken on a regular scheduled basis to be therapeutic. If a client misses a
dose, then they should take one as soon as they remember, as long as it is not close to time for
the next scheduled dose.
77. A nurse is caring for a client who is taking lithium carbonate to treat bipolar disorder. Which
of the following diagnostic tests should the nurse recommend that the client undergo
periodically?
A. Chest x-ray
B. Tonometry
C. Thyroid function tests
D. Endoscopic retrograde cholangiopancreatography (ERCP)
Answer: C. Thyroid function tests
Rationale:
Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck
enlargement, weight gain, lethargy, and constipation. They should also have their thyroid
function checked before they begin taking lithium and annually thereafter.
78. A nurse should identify that timolol is contraindicated for a client who has which of the
following disorders?
A. Asthma
B. Seizure disorder
C. Diabetes mellitus
D. Rheumatoid arthritis
Answer: A. Asthma
Rationale:

Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty breathing. Clients
who have asthma or any disorder that compromises respiratory function should not use the drug.
79. A nurse is providing teaching to a client about the adverse effects of drug therapy. The nurse
should include that orthostatic hypotension is a common adverse reaction of which of the
following drugs?
A. Venlafaxine
B. Bupropion
C. Imipramine
D. Valproic acid
Answer: C. Imipramine
Rationale:
Imipramine, a tricyclic antidepressant, can result in orthostatic (postural) hypotension. Clients
who take this drug should change positions slowly from sitting or lying to standing.
80. A nurse is assessing a client who has been taking alprazolam for several days. Which of the
following findings should the nurse identify as an adverse drug reaction caused by alprazolam?
A. Anxiety
B. Ringing in the ears
C. Increased appetite
D. Muscle spasms
Answer: A. Anxiety
Rationale:
The client can experience a paradoxical effect when taking benzodiazepines or buspirone,
indicated by increased anxiety rather than relief of anxiety. The nurse should report this to the
provider, who might consider a different medication.
Tutorial: Pharmacology Made Easy 4.0 Module: The Musculoskeletal System
Case Study Questions 1:
81. Which of the following information in the client's history causes the health care provider to
suspect the client has osteoporosis? (Select all that apply.)

A. Menopause
B. Calcium supplements
C. Long-term corticosteroid use
D. Weight
E. Loss of height
Answer: A. Menopause
C. Long-term corticosteroid use
E. Loss of height
82. The health care provider explains to the client that there may be a drug interaction between
the glucocorticoid and the calcium supplement. Which of the following may occur?
A. The glucocorticoid may cause reduced absorption of the calcium supplement.
B. The glucocorticoid may potentate the effects of the calcium supplement.
C. The oral calcium supplement used with the glucocorticoid may cause bradycardia.
D. The calcium supplement may increase the risk for peptic ulcer disease.
Answer: A. The glucocorticoid may cause reduced absorption of the calcium supplement.
83. The health care provider instructs the client about the importance of taking the prescribed
1,500 mg/day dosage of calcium carbonate (Tums). Which of the following instructions should
the health care provider recommend?
A. Set up a simple reminder system.
B. Take the three tablets at the same time.
C. Reduce fluid intake to increase effectiveness.
D. Take the drug with meals to reduce gastric irritation.
Answer: A. Set up a simple reminder system.
84. The health care provider prescribes alendronate (Fosamax) to reduce bone resorption and
instructs the client to monitor for which of the following indications of a serious adverse effect of
this drug?
A. Calf inflammation
B. Chest pain

C. Dizziness
D. Dysphagia
Answer: D. Dysphagia
85. When instructing the client about alendronate, which of the following information should the
health care provider include? (Select all that apply.)
A. Take the drug on an empty stomach.
B. Take the drug before bedtime.
C. Take the drug with an antacid.
D. Sit upright for 30 minutes following dosage.
E. Take with a full glass of water.
Answer: A. Take the drug on an empty stomach.
D. Sit upright for 30 minutes following dosage.
E. Take with a full glass of water.
Case Study Questions 2:
86. A client is about to start therapy with methotrexate for rheumatoid arthritis. Knowing the
adverse effects of methotrexate, you advise the client to watch for which of the following?
A. Dysphagia
B. Sore throat
C. Edema
D. Paresthesia
Answer: B. Sore throat
87. A primary care provider prescribes etanercept to treat a client's rheumatoid arthritis. Prior to
beginning the treatment, the client requires testing for which of the following?
A. Pancreatitis
B. Hepatitis
C. Tuberculosis
D. Gastritis
Answer: C. Tuberculosis

88. A client who is menopausal is taking a calcium supplement to prevent osteoporosis. You
instruct the client to watch for which of the following indications of hypercalcemia?
A. Eye twitching
B. Bleeding gums
C. Tinnitus
D. Nausea
Answer: D. Nausea
89. Drag the drug used to treat osteoporosis in the left column to match it with its expected
pharmacologic action in the right column.
Calcium supplements

Reduces the number of osteoclasts

Bisphosphonates

Mimics the effects of estrogen on the bones

Calcitonin

Raises calcium levels

Selective estrogen receptor modulators

Increases the excretion of calcium

Answer:
Calcium supplements

Raises calcium levels

Bisphosphonates

Reduces the number of osteoclasts

Calcitonin

Increases the excretion of calcium

Selective estrogen receptor modulators

Mimics the effects of estrogen on the bones

90. A client is about to start taking raloxifene to treat osteoporosis. You advise the client to watch
for which of the following adverse effects?

A. Hot flashes
B. Breast cancer
C. Blurred vision
D. Jaw pain
Answer: A. Hot flashes
91. A nurse is caring for a client taking etanercept. Which of the following adverse effects is
most important to mention when educating this client?
A. Injection site reaction can occur.
B. Elevation of liver enzymes can occur.
C. Gastric perforation can occur.
D. Vision changes can occur.
Answer: A. Injection site reaction can occur.
92. Which of the following drugs are effective in disease prevention as well as treatment of
osteoporosis? (Select all that apply.)
A. Raloxifene
B. Calcitonin-salmon
C. Alendronate
D. NSAIDs
Answer: A. Raloxifene
C. Alendronate
93. A primary care provider prescribes calcitonin salmon for a post-menopausal client. Knowing
the adverse effects of calcitonin, you instruct the client to:
A. increase fluid intake.
B. Brise slowly from a reclining position.
C. increase calcium and vitamin D intake.
D. rest painful joints after exercise.
Answer: C. increase calcium and vitamin D intake.

94. Prior to starting alendronate, the nurse should assess which of the following in the client?
(Select all that apply.)
A. Ability to swallow
B. Baseline vision
C. The client's ability to lay flat
D. Absence of nasal dryness
Answer: A. Ability to swallow
B. Baseline vision
95. A client who has rheumatoid arthritis is taking methotrexate. Which of the following reduces
toxicity from this drug?
A. Folic acid
B. Magnesium sulphate
C. Ferrous sulphate
D. Niacin
Answer: A. Folic acid
Pharmacology Made Easy 4.0 The Musculoskeletal System Quiz:
96. A nurse is caring for a client who has a prescription for etanercept. The nurse should identify
that etanercept treats rheumatoid arthritis by which of the following actions?
A. Inactivation of tumour necrosis factor
B. Inhibition of osteoclast activity
C. Decreasing the reuptake of serotonin
D. Interference with the production of lymphocytes
Answer: A. Inactivation of tumour necrosis factor
Rationale:
Etanercept directly binds to the tumour necrosis factor (TNF), preventing the attachment of TNF
onto the cell's surface. This prevents the autoimmune response and subsequent inflammation of
the joints.

97. A nurse should instruct a client who is taking alendronate to monitor for which of the
following adverse effects? (Select all that apply.)
A. Jaw pain
B. Drowsiness
C. Blurred vision
D. Tinnitus
E. Muscle pain
Answer: A. Jaw pain
C. Blurred vision
E. Muscle pain
Rationale:
A. Jaw pain is correct. Alendronate can cause osteonecrosis of the jaw, and clients who develop
it should report it to the provider.
C. Blurred vision is correct. Alendronate can cause ocular inflammation. The client should report
any eye pain or blurred vision to the provider.
E. Muscle pain is correct. Alendronate can cause musculoskeletal pain. If analgesics do not help,
the client might have to stop taking alendronate.
98. A nurse is planning care for a client who has a new prescription for methotrexate. The nurse
should plan to monitor the client for which of the following adverse effects?
A. Bone marrow depression
B. Thrombocythemia
C. Double vision
D. Constipation
Answer: A. Bone marrow depression
Rationale:
The nurse should monitor the client for bone marrow depression, which is an adverse effect of
folic acid analogs such as methotrexate.
99. A nurse is caring for a client who is currently taking methotrexate for rheumatoid arthritis.
The nurse should identify that which of the following is an adverse effect of this medication?

A. Hypertension
B. Thrombocytopenia
C. Glaucoma
D. Edema
Answer: B. Thrombocytopenia
Rationale:
Methotrexate has many adverse effects that affect the central nervous, respiratory, dermatologic,
and haematology systems, such as anaemia, leukopenia, and thrombocytopenia.
100. A nurse should identify that a client who has diabetes mellitus and is taking etanercept is at
an increased risk for which of the following adverse effects?
A. Kidney toxicity
B. Infection
C. Gout
D. Deep-vein thrombosis
Answer: B. Infection
Rationale:
Etanercept increases the risk of developing a serious infection. Providers should not prescribe
etanercept for clients who have an existing infection and should use it cautiously with clients
who have diabetes mellitus because the disease itself already causes an increased risk for
infection.
101. A nurse is teaching a client about raloxifene. Which of the following information should the
nurse include? (Select all that apply.)
A. Perform a breast self-examination twice per month.
B. Increase physical activity by taking walks.
C. Use a contraceptive if there is any possibility of pregnancy.
D. Take the drug on an empty stomach.
E. Increase intake of calcium and vitamin D.
Answer: B. Increase physical activity by taking walks.
C. Use a contraceptive if there is any possibility of pregnancy.

E. Increase intake of calcium and vitamin D.
Rationale:
A. Increase physical activity by taking walks is correct. Clients who take raloxifene should avoid
long periods of inactivity to prevent deep-vein thrombosis. Furthermore, walking, and other
weight-bearing exercises, can help increase bone density.
C. Use a contraceptive if there is any possibility of pregnancy is correct. Raloxifene is a
pregnancy category X drug and can cause severe fetal harm. Women who are pregnant,
breastfeeding, or might become pregnant should not take the drug.
E. Increase intake of calcium and vitamin D is correct. An increased intake of calcium and
vitamin D helps improve the effectiveness of raloxifene and increases bone mass.
102. Alendronate is contraindicated for administration to clients who have which of the
following conditions?
A. Heart failure
B. Fish protein allergy
C. Inability to sit upright
D. Tuberculosis
Answer: C. Inability to sit upright
Rationale:
Alendronate is contraindicated for administration to a client who cannot sit upright or stand for
30 min. Clients should drink 240 mL (8 oz) of water after taking the drug and sit upright or stand
for at least 30 min to prevent esophagitis.
103. A nurse is teaching a client about calcitonin-salmon intranasal spray to treat osteoporosis.
Which of the following information should the nurse include? (Select all that apply.)
A. Report rash or itching.
B. Deliver two sprays to each nostril.
C. Prime the pump before the first dose.
D. Report nasal irritation.
E. Hold the pump horizontally.
Answer: A. Report rash or itching.

C. Prime the pump before the first dose.
D. Report nasal irritation.
Rationale:
A. Report rash or itching is correct. The nurse should tell the client to stop using the drug and
seek medical attention if any swelling or rash develops.
C. Prime the pump before the first dose is correct. The client should prime the pump before using
the spray for the first time to ensure proper dosage.
D. Report nasal irritation is correct. The client should report any nasal irritation or bleeding. The
client might require parenteral administration if there is severe nasal irritation.
104. A nurse is teaching about self-administering methotrexate to a client who has rheumatoid
arthritis. Which of the following statements should the nurse make?
A. "Use a nonsteroidal anti-inflammatory drug to reduce toxicity."
B. "If you miss a dose, go ahead and take it with the next scheduled dose."
C. "Drink a minimum of 2 Liters of water per day to promote the drug's excretion."
D. "Take it in the morning to prevent insomnia."
Answer: C. "Drink a minimum of 2 litters of water per day to promote the drug's excretion."
Rationale:
Methotrexate can cause kidney damage. Adequate hydration optimizes drug excretion and helps
prevent kidney damage. Clients can also take sodium bicarbonate tablets to increase urine
alkalinity and reduce the drug precipitation that can lead to kidney damage.
105. Which of the following is a therapeutic action of raloxifene?
A. Blocks the effects of estrogen on endometrial tissue
B. Mimics the effects of estrogen on bone tissue
C. Stimulates secretion of parathyroid hormone
D. Stimulates menstruation
Answer: B. Mimics the effects of estrogen on bone tissue
Rationale:
Raloxifene mimics the effects of estrogen on bone tissue, minimizing or stopping bone loss.

106. A nurse is teaching a client about adverse effects of etanercept. Which of the following
statements by the client indicates understanding of the teaching?
A. "I will need to get my blood drawn periodically while on this medication."
B. "I may lose part or all of my hair."
C. "I may wake up with a very dry mouth."
D. "I will leave the needle cap off during the time the medication comes to room temperature."
Answer: A. "I will need to get my blood drawn periodically while on this medication."
Rationale:
Etanercept places the client at risk for systemic fungal infections and other opportunistic
infections. Therefore, the client will need to have their CBC monitored periodically while on this
medication.
107. A nurse is caring for a client who has a new prescription for etanercept. Which of the
following actions should the nurse take?
A. Administer a tuberculin skin test prior to starting the medication.
B. Teach the client that fevers are common while taking this medication.
C. Determine if the client has chronic hypertension.
D. Mix the medication with methotrexate prior to administration.
Answer: A. Administer a tuberculin skin test prior to starting the medication.
Rationale:
Etanercept is contraindicated for administration to clients who have a history of exposure to
tuberculosis. Therefore, the nurse should administer a tuberculin skin test prior to starting the
medication.
108. A nurse is caring for a client who is taking etanercept for rheumatoid arthritis. The nurse
should monitor the client for which of the following indications of a serious adverse reaction to
the drug?
A. Excessive salivation
B. Increased thirst
C. Blood in the urine
D. Shortness of breath

Answer: D. Shortness of breath
Rationale:
Etanercept can cause heart failure, manifesting as shortness of breath, cough, elevated blood
pressure and heart rate, and pink-tinged sputum.
109. A nurse is teaching a client about methotrexate therapy for rheumatoid arthritis. Which of
the following information should the nurse include? (Select all that apply.)
A. Avoid being near people who are sick with a communicable illness.
B. Periodic laboratory tests are required.
C. The drug's effects are immediate.
D. Report bruising or petechiae.
E. Avoid drinking alcohol.
Answer: A. Avoid being near people who are sick with a communicable illness.
B. Periodic laboratory tests are required.
D. Report bruising or petechiae.
E. Avoid drinking alcohol.
Rationale:
A. Avoid being near people who are sick with a communicable illness is correct. Methotrexate
causes bone marrow suppression and increases the risk for infection. Clients taking the drug
should avoid contact with large crowds or people who are sick with a communicable illness.
B. Periodic laboratory tests are required is correct. Periodic laboratory tests help the provider
monitor for kidney and liver damage. It is important to assess for jaundice and abdominal pain
because these findings can indicate liver damage.
C. Report bruising or petechiae is correct. Methotrexate can cause thrombocytopenia. Clients
should report bruising or petechiae, because these findings indicate a low platelet count. The
nurse should monitor the client's laboratory values for a decrease in platelets and red and white
blood cells.
E. Avoid drinking alcohol is correct. Alcohol ingestion can increase the risk of liver damage.
Clients who are taking methotrexate should avoid drinking alcohol.

110. A nurse is caring for a client who was diagnosed with postmenopausal osteoporosis. Which
of the following actions should the nurse take prior to administering calcitonin-salmon to the
client for the first time?
A. Check the client's urine for sedimentation.
B. Assess the client's liver function.
C. Use skin testing to check the client for allergies.
D. Evaluate the client's breath sounds.
Answer: C. Use skin testing to check the client for allergies.
Rationale:
Calcitonin-salmon is developed using salmon. The nurse should perform skin testing to check for
an allergy to salmon or fish protein, and have epinephrine, antihistamines, and resuscitation
equipment available.
111. A nurse is teaching a client about methotrexate. The nurse should inform the client to
monitor for which of the following as an adverse effect of this drug?
A. Muscle pain
B. Peripheral edema
C. Black, tarry stools
D. Redness in the calf
Answer: C. Black, tarry stools
Rationale:
Methotrexate can cause gastric intestinal ulceration, which can lead to perforation and bleeding.
The client should monitor for blood in stools or emesis and report either to the provider
immediately.
112. A nurse is caring for a client who is taking alendronate to treat postmenopausal
osteoporosis. The nurse should explain to the client that alendronate increases bone mass by
which of the following actions?
A. Decreases activity of osteoclasts
B. Increases calcium excretion
C. Promotes intestinal absorption of calcium and phosphorus

D. Reduces action of osteoblasts
Answer: D. Reduces action of osteoblasts
Rationale:
Osteoclasts are cells that cause bone resorption or bone loss. Alendronate reduces the activity of
osteoclasts, reducing bone loss and increasing bone mass.
113. A nurse is teaching a client who has a prescription for calcium citrate about manifestations
of hypercalcemia. Which of the following manifestations should the nurse include in the
teaching?
A. Muscle twitching
B. Laryngospasm
C. Paresthesia
D. Vomiting
Answer: D. Vomiting
Rationale:
The nurse should teach the client that hypercalcemia can occur when taking this drug.
Manifestations of hypercalcemia include nausea, vomiting, flank pain, lethargy, and deep bone
pain.
114. A nurse is teaching a client about methotrexate therapy for rheumatoid arthritis. Which of
the following statements by the client indicates understanding of the teaching?
A. "I will take a birth control pill every day."
B. "Methotrexate decreases my chances of developing an infection."
C. "I take methotrexate every day with breakfast."
D. "I will aim to drink five 8-ounce glasses of water per day."
Answer: A. "I will take a birth control pill every day."
Rationale:
Methotrexate is teratogenic to a fetus and is contraindicated during pregnancy. Therefore, a client
of childbearing age should use birth control while on this medication.

115. A nurse is teaching a client who has a prescription for prednisone and takes 1,500 mg/day of
calcium carbonate to reduce the risk of osteoporosis. Which of the following information should
the nurse include? (Select all that apply.)
A. Take the calcium tablets with food.
B. Drink 240 mL (8 oz) of water with the calcium tablets.
C. Chew calcium tablets before swallowing them.
D. Take the drugs 1 hr apart.
E. Divide the daily dosage of calcium into three 500-mg doses.
Answer:
B. Drink 240 mL (8 oz) of water with the calcium tablets.
C. Chew calcium tablets before swallowing them.
D. Take the drugs 1 hr apart.
E. Divide the daily dosage of calcium into three 500-mg doses.
Rationale:
B. Drink 240 mL (8 oz) of water with the calcium tablets is correct. Clients should drink 240 mL
(8 oz) of water after taking the calcium carbonate to ensure complete passage of the drug and to
maintain hydration.
C. Chew calcium tablets before swallowing them is correct. Clients should chew the tablets
before swallowing them to increase bioavailability. Clients should not swallow chewable tablets
whole.
D. Take the drugs 1 hr apart is correct. Glucocorticoids, such as prednisone, reduce the
absorption of calcium carbonate. Clients should allow 1 hr in between the two to ensure optimal
absorption.
E. Divide the daily dosage of calcium into three 500-mg doses is correct. Clients should not take
more than 600 mg of calcium carbonate at one time. Clients should divide the daily dosage into
three doses to increase absorption of the calcium carbonate.
116. A nurse is teaching a client who has a new prescription for etanercept. Which of the
following statements should the nurse make?
A. "You will inject this medication once a week in your thigh muscle."
B. "You should report signs of infection to your provider immediately."

C. "You will need to avoid taking ibuprofen while on this medication."
D. "You will need to receive an MMR vaccine 1 month after starting this medication."
Answer: B. "You should report signs of infection to your provider immediately."
Rationale:
The nurse should teach the client that they are susceptible to infections when taking DMARD II
medications such as etanercept. The client should report symptoms of infection, such as fever,
cough, malaise, weight loss, and dyspnea, to the provider immediately to prevent further
complications.
117. A nurse is caring for a client who has a prescription for methotrexate. Which of the
following drugs would likely be prescribed in conjunction during the initial treatment for
rheumatoid arthritis?
A. Aspirin
B. Salicylates
C. Sulfonylureas
D. Ibuprofen
Answer: D. Ibuprofen
Rationale:
NSAID analgesics, such as ibuprofen, are often prescribed along with methotrexate during the
initial course of treatment for rheumatoid arthritis. It can take weeks for DMARDs to reach
therapeutic levels and begin relieving joint inflammation and pain, so ibuprofen can be
administered concurrently to help make the client more comfortable while waiting for
methotrexate's therapeutic effects.
118. A nurse is teaching a client who is taking etanercept for rheumatoid arthritis. The nurse
should instruct the client to monitor for which of the following indications of an adverse reaction
to this drug?
A. Skin rash
B. Tinnitus
C. diarrhoea
D. Dysphagia

Answer: A. Skin rash
Rationale:
Etanercept can cause serious skin infections. Clients should immediately report any skin rashes
or blisters, because an infection can cause a serious reaction, such as Stevens-Johnson syndrome
or toxic epidermal necrolysis.
119. A nurse is teaching a client about raloxifene therapy to prevent osteoporosis. The nurse
should instruct the client to monitor for which of the following indications of an adverse reaction
to this drug?
A. Loss of hair
B. Numbness of the fingertips
C. Calf pain
D. Blisters on mucous membranes
Answer: C. Calf pain
Rationale:
Raloxifene can increase the risk of deep-vein thrombosis, which can lead to a pulmonary
embolism or cerebrovascular accident. Clients should avoid long periods of inactivity and report
any pain, redness, or swelling in the calf.
120. A nurse is preparing to administer alendronate to a client who has osteoporosis. The nurse
should recognize which of the following as an adverse effect of alendronate?
A. Venous thromboemboli
B. Ventricular dysrhythmias
C. Breast cancer
D. Joint pain
Answer: D. Joint pain
Rationale:
Alendronate can cause joint and muscle pain. Clients can treat joint pain with analgesics. Other
adverse effects of this drug include nausea, visual disturbances, and esophagitis.
Tutorial: Pharmacology Made Easy 4.0

Module: The Reproductive and Genitourinary Systems
Case Study Questions 1:
121. The provider talks with the client about clomiphene therapy. Which of the following
instructions should the provider include?
A. Take it once a day until they can confirm pregnancy.
B. Begin taking it on the first day and stop on the last day of menstruation.
C. Begin 5 days after menstruation begins and take it every day for next 5 days.
D. Take it once, 17 to 19 days after the onset of menstruation.
Answer: C. Begin 5 days after menstruation begins and take it every day for next 5 days.
122. One month later, the client tells the provider that she has developed some adverse effects.
Which of the following effects does clomiphene cause? (Select all that apply.)
A. Blurred vision
B. Hot flashes
C. Breast engorgement
D. Muscle pain
E. Nausea
Answer: A. Blurred vision
B. Hot flashes
C. Breast engorgement
E. Nausea
123. The provider should instruct the client to do which of the following?
A. Take half the usual dosage.
B. Continue the usual dosage.
C. Take a pregnancy test.
D. Double the previous dosage.
Answer: C. Take a pregnancy test.
124. Recognizing the adverse effects of terbutaline, the nurse should monitor the client for which
of the following?

A. Hypoglycaemia
B. Tachycardia
C. Hyperkalaemia
D. Wheezing
Answer: B. Tachycardia
125. Which of the following drugs should the nurse have available to reverse the adverse effects
of terbutaline?
A. Naloxone
B. Neostigmine (Prostigmin)
C. Propranolol (Inderal)
D. Atropine
Answer: C. Propranolol (Inderal)
Case Study Questions 2:
126. A client is given conjugated estrogen and medroxyprogesterone acetate to treat
postmenopausal vasomotor symptoms. The health care provider instructs the client to monitor
for which of the following, which may indicate a serious adverse effect of the conjugated
estrogen and medroxyprogesterone acetate?
A. Ringing in ears
B. Insomnia
C. Swelling or pain in calf
D. Difficulty swallowing
Answer: C. Swelling or pain in calf
127. Match the pharmacologic term in the left column with a therapeutic use in the right column.
Sildenafil

Urinary incontinence

Finasteride

Male puberty induction

Oxybutynin chloride

Erectile dysfunction

Testosterone

Benign prostatic hypertrophy

Answer:
Sildenafil

Erectile dysfunction

Finasteride

Benign prostatic hypertrophy

Oxybutynin chloride

Urinary incontinence

Testosterone

Male puberty induction

128. Combination oral contraceptives, such as ethinyl estradiol and drospirenone, should be used
with caution in clients with which of the following disorders?
A. Diabetes
B. Hypothyroidism
C. Thrombocytopenia
D. Osteoporosis
Answer: A. Diabetes
129. A client is prescribed testosterone to treat testicular failure. The nurse instructs the client to
monitor and report which of the following?
A. Dizziness
B. Paresthesia
C. Weight gain
D. Shortness of breath
Answer: C. Weight gain
130. A client is prescribed finasteride to treat benign prostatic hypertrophy. When providing
instructions about the finasteride, the nurse should include which of the following information?
A. Avoid high-fat foods.
B. Allow 6 to 12 months to see improvement.
C. Wear protective clothing and sunscreen.
D. Avoid activities that require alertness until drug effects are known.
Answer: B. Allow 6 to 12 months to see improvement.

131. For which of the following clients should a health care provider question the use of
sildenafil to treat erectile dysfunction. A client who is taking:
A. Oxybutynin chloride for urinary incontinence
B. Phenytoin for a seizure disorder
C. Thyroid for hypothyroid
D. Nitroglycerin as needed for chest pain
Answer: D. Nitro-glycerine as needed for chest pain
132. Match the pharmacologic term in the left column with a therapeutic use in the right column.
Medroxyprogesterone

Stimulates ovulation

Terbutaline

Treats endometriosis

Human chorionic gonadotropin

Induces uterine contractions

Dinoprostone

Stops uterine contractions

Answer:
Medroxyprogesterone

Treats endometriosis

Terbutaline

Stops uterine contractions

Human chorionic gonadotropin

Stimulates ovulation

Dinoprostone

Induces uterine contractions

133. A client is prescribed clomiphene for infertility. The health care provider instructs the client
on clomiphene to monitor for which of the following?
A. Shortness of breath
B. Pelvic pain
C. diarrhoea
D. Fever
Answer: B. Pelvic pain
134. For rapid relief of urinary obstruction due to prostatic enlargement, the health care provider
should choose which of the following drugs?
A. Sildenafil

B. Tamsulosin
C. Finasteride
D. Oxybutynin
Answer: B. Tamsulosin
135. The health care provider administers oxytocin for induction of labor. The health care
provider should monitor which of the following in order to assess for an adverse reaction to
oxytocin? (Select all that apply)
A. Urine output
B. Blood pressure
C. Level of consciousness
D. Duration of contractions
E. Fetal heart rate
Answer: A. Urine output
B. Blood pressure
D. Duration of contractions
E. Fetal heart rate
Pharmacology Made Easy 4.0 The Reproductive and Genitourinary System Quiz:
136. A nurse is providing teaching to a client about sildenafil to treat erectile dysfunction. Which
of the following instructions should the nurse include?
A. Take the drug with a glass of grapefruit juice.
B. Do not take the drug with high-fat foods.
C. Increase intake of foods rich in vitamin K.
D. Avoid aged cheeses and red wine.
Answer: B. Do not take the drug with high-fat foods.
Rationale:
High-fat foods delay absorption and reduce peak effects of sildenafil. Clients who take the drug
should not take it with high-fat foods.

137. A nurse is caring for a client who has a new prescription for transdermal conjugated
estrogen and medroxyprogesterone to treat postmenopausal symptoms. The nurse should explain
to the client that this drug combination includes which of the following therapeutic effects?
(Select all that apply.)
A. Reduces the risk of ovarian cancer
B. Relieves hot flashes
C. Prevents osteoporosis
D. Reduces the risk of breast cancer
E. Reduces the risk of thromboembolism
Answer: A. Reduces the risk of ovarian cancer
B. Relieves hot flashes
C. Prevents osteoporosis
Rationale:
A. Reduces the risk of ovarian cancer is correct. Drug therapy with an estrogen and progesterone
combination reduces the risk of ovarian cancer. However, the use of estrogen alone without
progesterone can increase the risks of endometrial and ovarian cancer.
B. Relieves hot flashes is correct. Drug therapy with an estrogen and progesterone combination
or estrogen alone reduces hot flashes and the sweating and sleep disturbances they cause.
C. Prevents osteoporosis is correct. Drug therapy with an estrogen and progesterone combination
or estrogen alone increases bone density and prevents osteoporosis.
138. A provider has prescribed a dinoprostone vaginal insert to promote cervical ripening in a
client who is at 40 weeks of gestation. When administering dinoprostone, which of the following
actions should the nurse take? (Select all that apply.)
A. Encourage the client to urinate prior to insertion.
B. Remove the pouch when active labor begins.
C. Monitor for uterine hyperstimulation.
D. Encourage the client to walk after insertion.
E. Monitor the client's temperature.
Answer: A. Encourage the client to urinate prior to insertion.
B. Remove the pouch when active labor begins.

C. Monitor for uterine hyperstimulation.
E. Monitor the client's temperature.
Rationale:
A. Encourage the client to urinate prior to insertion is correct. The client should urinate prior to
the insertion of the dinoprostone pouch. This action does not specifically relate to the therapeutic
effects of the drug, but it promotes comfort and prevents interruption of the administration
protocol.
B. Remove the pouch when active labor begins is correct. The nurse should remove the pouch
when active labor begins or 12 hr after the insertion of the dinoprostone, whichever is sooner.
C. Monitor for uterine hyperstimulation is correct. Uterine stimulation can cause fetal distress.
The nurse should monitor uterine activity and fetal heart rate and remove the insert for fetal
distress or uterine hyperstimulation.
E. Monitor the client's temperature is correct. Dinoprostone can cause a fever. The nurse should
monitor the client's temperature and report any changes to the provider.
139. A nurse is caring for a client who is about to begin clomiphene therapy to treat infertility.
The nurse should monitor the client for which of the following adverse effects?
A. Breast cancer
B. Deep-vein thrombosis
C. Ovarian hyperstimulation syndrome
D. Restless leg syndrome
Answer: C. Ovarian hyperstimulation syndrome
Rationale:
Pelvic pain can indicate ovarian hyperstimulation and can lead to ovarian cyst rupture. The nurse
should monitor a client who is taking clomiphene for ovarian enlargement and advise them to
seek medical attention immediately for sudden or severe pelvic pain.
140. A nurse is caring for a client who is taking combination oral contraceptive ethinyl estradiol
and drospirenone and is about to begin taking rifampin to treat tuberculosis. Which of the
following instructions should the nurse give the client due to a possible drug interaction?
A. "Increase the rifampin dose."

B. "Increase the oral contraceptive dose."
C. "Wait 2 hours between taking each drug."
D. "Use additional birth control methods."
Answer: D. "Use additional birth control methods."
Rationale:
Rifampin can increase the metabolism of oral contraceptives, reducing the effectiveness. Clients
who are taking oral contraceptives and rifampin should use additional contraceptive methods to
prevent an unwanted pregnancy. Other drugs that can reduce the effects of oral contraceptives
include some antifungal agents and anticonvulsants.
141. A nurse is teaching a client about receiving leuprolide to treat endometriosis. The nurse
should instruct the client to expect which of the following side effects?
A. Vaginal dryness
B. Hypertension
C. Blurred vision
D. Orthostatic hypotension
Answer: A. Vaginal dryness
Rationale:
Leuprolide can cause vaginal dryness. The nurse should suggest that the client use water based
vaginal lubricants to help minimize this effect.
142. A nurse is caring for a client who received human menopausal gonadotropin (hMG). Which
of the following findings should the nurse expect?
A. Prolactin secretion
B. Estrogen release
C. Follicular maturation
D. Oxytocin secretion
Answer: C. Follicular maturation
Rationale:
C. Before a client receives human chorionic gonadotropin (hCG) to stimulate ovulation, they
must receive a drug that induces follicular maturation, such as hMG, which is a mixture of LH

and FSH, clomiphene, or follitropin. Clients receive hCG 1 day after the last dose of hMG or
follitropin or 7 to 9 days after the last clomiphene dose.
143. A nurse is teaching a client who has a new prescription for transdermal testosterone gel to
treat delayed puberty. Which of the following instructions should the nurse include? (Select all
that apply.)
A. "Apply the gel to the scrotum."
B. "Cover the area of application with clothing."
C. "Wash your hands after applying the gel."
D. "Do not shower for several hours after applying the gel."
E. "Apply the gel to the gums above an upper”
Answer: B. "Cover the area of application with clothing."
C. "Wash your hands after applying the gel."
D. "Do not shower for several hours after applying the gel."
Rationale:
B. "Cover the area of application with clothing" is correct. Clothing helps to prevent exposing
others to the drug. Clients should let the gel dry before covering the application site with a shirt.
C. "Wash your hands after applying the gel" is correct. Clients should wash their hands after
application to prevent exposing others to the drug.
D. "Do not shower for several hours after applying the gel" is correct. Clients should not shower
or swim for several hours following application of transdermal testosterone gel to avoid washing
off the gel.
144. A nurse is caring for a male client who has hyperthyroidism and is not responding to
treatment. The nurse should identify that hyperthyroidism is a contraindication for which of the
following drugs?
A. Sildenafil
B. Bethanechol
C. Tamsulosin
D. Finasteride
Answer: B. Bethanechol

Rationale:
Bethanechol, a cholinergic drug, can cause cardiac dysrhythmias in clients who have
hyperthyroidism by triggering the release of norepinephrine. This reaction does not occur in
clients who do not have hyperthyroidism.
145. A nurse is assessing a client who has a new prescription of oxybutynin to treat neurogenic
bladder. Which of the following assessment findings should the nurse identify as an adverse
effect of the drug? (Select all that apply.)
A. Diaphoresis
B. Dilated pupils
C. Dizziness
D. Distended bladder
E. Fever
Answer: B. Dilated pupils
C. Dizziness
D. Distended bladder
E. Fever
Rationale:
B. Dilated pupils is correct. Oxybutynin can cause mydriasis or dilated pupils, dry eyes, and
blurred vision. Clients who take the drug should use lubricating eye drops to help reduce
dryness.
C. Dizziness is correct. Oxybutynin can cause dizziness and drowsiness. Clients who take the
drug should use caution with activities that require alertness until they know how the drug will
affect them.
D. Distended bladder is correct. Oxybutynin can cause urinary retention and bladder distention.
E. Fever is correct. Oxybutynin can cause heat exhaustion and fever. Clients who take the drug
should use it with caution in hot weather.
146. A nurse is caring for a client who has benign prostatic hypertrophy and is taking tamsulosin.
The nurse should question the use of the drug if the client also has which of the following?
A. A seizure disorder for which he takes carbamazepine

B. Erectile dysfunction for which he takes sildenafil
C. Diabetes mellitus for which he takes glyburide
D. Angle-closure glaucoma for which he takes pilocarpine
Answer: B. Erectile dysfunction for which he takes sildenafil
Rationale:
Drugs that lower blood pressure, such as sildenafil, can exacerbate hypotension in combination
with tamsulosin. Clients who take sildenafil should not take tamsulosin.
147. A nurse is caring for a client who is about to begin taking cabergoline to treat infertility. The
nurse should explain to the client the need to monitor which of the following laboratory values?
A. Potassium
B. Glucose
C. BUN and creatinine
D. Prolactin level
Answer: D. Prolactin level
Rationale:
Cabergoline inhibits the secretion of prolactin. The provider should monitor prolactin levels to
determine the appropriate dosage.
148. A nurse is providing safety education to a client who is scheduled to begin treatment with
tamsulosin for benign prostatic hypertrophy (BPH). Which of the following instructions should
the nurse include in the teaching?
A. Change positions slowly.
B. Crush the medication.
C. Take the medication on an empty stomach.
D. Report increased urinary output immediately.
Answer: A. Change positions slowly.
Rationale:
Alpha adrenergic blockers such as tamsulosin are also used to treat hypertension. These drugs
can cause the blood pressure to drop, leading to orthostatic hypotension. Therefore, the nurse
should instruct the client to change positions slowly to prevent harm.

149. A nurse is assessing a client who has a new prescription for the combination oral
contraceptive ethinyl estradiol and drospirenone. Which of the following findings should the
nurse identify as a contraindication to use of this medication?
A. Drinks a glass of wine each night
B. Smokes half a pack of cigarettes a day
C. Runs marathons regularly
D. Drives a school bus
Answer: B. Smokes half a pack of cigarettes a day
Rationale:
Smoking increases the risks of thromboembolic events, hypertension, and cardiovascular disease
for clients who are taking combination oral contraceptives, especially for those clients who are
older than 35 years. Clients should quit smoking before starting this drug therapy.
150. A nurse should question the use of conjugated equine estrogen by a client who has a history
of which of the following?
A. Osteoporosis
B. Peptic ulcer disease
C. Rheumatoid arthritis
D. Blood clots
Answer: D. Blood clots
Rationale:
Clients who have a history of thromboembolic disease should not use estrogen replacement
therapy because of the risks of thrombophlebitis, myocardial infarction, pulmonary embolism,
and cerebrovascular accident.
151. A nurse is caring for a client who missed a dose of her oral contraceptive. Which of the
following instructions should the nurse give the client?
A. Take a pregnancy test.
B. Double up on pills for remainder of the pack.
C. Take the missed dose as soon as possible.

D. Stop the oral contraceptive and use a different contraceptive.
Answer: C. Take the missed dose as soon as possible.
Rationale:
The nurse should tell the client to take the missed dose along with the next dose. Should the
client miss two doses, she should take an additional dose each day for the next 2 days and add an
additional method of birth control for the remainder of the cycle.
152. A nurse is providing teaching to a client about using leuprolide to treat endometriosis.
Which of the following instructions should the nurse include?
A. Perform weight-bearing activities.
B. Wear sunscreen or protective clothing.
C. Take the drug with food to increase absorption.
D. Avoid drinking grapefruit juice.
Answer: A. Perform weight-bearing activities.
Rationale:
Leuprolide suppresses estrogen and can cause bone loss. The nurse should instruct the client to
perform weight-bearing activities and increase their intake of calcium and vitamin D.
153. A nurse is caring for a client who has a new prescription for conjugated equine estrogen.
The nurse should instruct the client to report which of the following indications of a serious
adverse reaction?
A. Hot flashes
B. Urinary tract infection
C. Vaginal bleeding
D. Bone pain
Answer: C. Vaginal bleeding
Rationale:
Estrogen hormone replacement therapy increases the risk of endometrial cancer. The nurse
should instruct clients using the drugs to report recurrent or persistent vaginal bleeding and
pelvic pain.

154. A nurse is teaching a client about conjugated estrogen and medroxyprogesterone. Which of
the following instructions should the nurse include?
A. Monitor for rectal bleeding.
B. Avoid drinking alcoholic beverages.
C. Have blood pressure checked regularly.
D. Sit up for 30 min after taking the drug.
Answer: C. Have blood pressure checked regularly.
Rationale:
Using conjugated estrogen and medroxyprogesterone, a combination of estrogen and progestin
for hormone replacement, can cause hypertension. Clients taking the drug combination should
have their blood pressure checked regularly and report headache or edema.
155. A nurse is teaching a client who has a new prescription for a testosterone transdermal patch.
Which of the following statements made by the client indicates an understanding of the teaching?
A. "I should have pancreatic function tests obtained while taking this drug."
B. "I should have my white blood cell count checked annually."
C. "I should take off the patch to shower."
D. "I should apply the medication to a different site each time."
Answer: D. "I should apply the medication to a different site each time."
Rationale:
The client should rotate the application sites with each application to prevent skin irritation.
156. After administering terbutaline to a client to inhibit preterm labor, the nurse should assess
which of the following?
A. Peripheral pulses
B. Temperature
C. Vision
D. Heart rate
Answer: D. Heart rate
Rationale:

Terbutaline can cause tachycardia, chest pain, and palpitations. The nurse should monitor the
client's ECG for tachycardia and other dysrhythmias and monitor fetal heart rate and rhythm.
157. A nurse is preparing to administer finasteride to a client who has benign prostatic
hypertrophy (BPH). Which of the following precautions should the nurse plan to take when
administering this drug?
A. Administer medication while client is sitting or reclining.
B. Withhold the medication if the client doesn't eat.
C. Wear gloves when handling the tablet.
D. Monitor heart rate prior to administration.
Answer: C. Wear gloves when handling the tablet.
Rationale:
The nurse should avoid touching the drug because it can be absorbed through the skin. For
women, this can potentially cause harm if they are pregnant and have a male fetus. Women
should also avoid exposure to semen from individuals who are taking finasteride.
158. A nurse should question the use of ethinyl estradiol and drospirenone by a client who has
renal disease due to the increased risk of which of the following?
A. Hyperkalemia
B. Hyponatremia
C. Hypoglycemia
D. Respiratory alkalosis
Answer: A. Hyperkalemia
Rationale:
Ethinyl estradiol and drospirenone can cause potassium retention, so a client who has renal,
adrenal, or liver disease should not take the drug combination. The nurse should monitor the
serum potassium levels of a client taking the drug and use it with caution with other drugs that
can increase serum potassium, such as potassium-sparing diuretics.
159. A nurse is providing teaching to a client who is taking bethanechol for urinary retention.
Which of the following instructions should the nurse include? (Select all that apply.)

A. Avoid driving and activities that require alertness.
B. Increase fluid intake.
C. Take the drug with food.
D. Stay close to a bathroom after taking the drug.
E. Increase weight-bearing activities.
Answer: A. Avoid driving and activities that require alertness.
B. Increase fluid intake.
D. Stay close to a bathroom after taking the drug.
Rationale:
A. Avoid driving and activities that require alertness is correct. Bethanechol, a muscarinic
agonist, can cause dizziness and fainting. Clients who take the drug should use caution with
activities that require alertness until they know how the drug will affect them.
B. Increase fluid intake is correct. Bethanechol can cause diarrhoea and increased salivary and
gastric secretions. Clients who take the drug should maintain hydration by increasing their fluid
intake.
D. Stay close to a bathroom after taking the drug is correct. Bethanechol can cause rapid relief of
urinary retention or diarrhoea, with fecal incontinence. Clients who take the drug should stay
near a bathroom or have a bedpan or urinal ready.
160. A nurse is caring for a client who is about to begin taking finasteride to treat benign
prostatic hypertrophy. The nurse should explain to the client the need to monitor which of the
following laboratory values?
A. Prostate-specific antigen (PSA)
B. BUN
C. Creatine phosphokinase (CPK)
D. ALT
Answer: A. Prostate-specific antigen (PSA)
Rationale:
The nurse should monitor PSA levels at baseline and periodically thereafter. Increases in PSA
can indicate prostate cancer. PSA levels should decrease with finasteride therapy.

Tutorial: Pharmacology Made Easy 4.0 Module: The Immune System
Case Study Questions 1:
161. You're administering cyclophosphamide and mesna to a client. Mesa, a chemoprotective
agent, helps prevent which adverse reactions to cyclophosphamide?
A. Retinopathy
B. Seizure activity
C. Haemorrhagic cystitis
D. Cardiotoxicity
Answer: C. Haemorrhagic cystitis
162. You should monitor this client for which of the following indications of an adverse reaction
to cyclophosphamide?
A. Gynecomastia
B. Dilated pupils
C. Bradycardia
D. Fever
Answer: D. Fever
163. When talking with the client about chemotherapy with doxorubicin, you explain the need
for periodic diagnostic tests. The result of which of the following diagnostic tests or procedures
requires monitoring?
A. Lumbar puncture
B. IV pyelogram
C. Bone density scan
D. ECG
Answer: D. ECG
164. You should give the client which of the following instructions about chemotherapy with
doxorubicin? (Select all that apply.)
A. Report vaginal itching.
B. Expect red-tinged tears.

C. Use effective contraception.
D. Expect regrowth after hair loss.
E. Increase intake of calcium and vitamin D.
Answer: A. Report vaginal itching.
B. Expect red-tinged tears.
C. Use effective contraception.
D. Expect regrowth after hair loss.
165. During IV administration of doxorubicin, the infusion site becomes swollen, red, and
painful. Which of the following actions should you take?
A. Slow the infusion rate.
B. Apply pressure to the site.
C. Stop the IV infusion.
D. Apply ice and continue the infusion.
Answer: C. Stop the IV infusion.
Case Study Questions 2:
166. You are about to administer cisplatin to a client who has ovarian cancer. Before beginning
the infusion, you should take which of the following actions? (Select all that apply.)
A. Infuse 1 to 2 L of IV fluid.
B. Check the client's peripheral pulses.
C. Administer an antiemetic.
D. Evaluate the client's hearing.
E. Determine the client's weight.
Answer: A. Infuse 1 to 2 L of IV fluid.
C. Administer an antiemetic.
D. Evaluate the client's hearing.
E. Determine the client's weight.

167. A client is about to start taking mercaptopurine to treat acute lymphocytic leukaemia. You
should instruct the client to watch for and report which of the following indications of an adverse
effect of this drug?
A. Bruising
B. Paraesthesia
C. Blurred vision
D. Tinnitus
Answer: A. Bruising
168. A client is about to start therapy with topotecan to treat metastatic ovarian cancer. To
minimize neutropenia, an adverse effect of topotecan, you should administer filgrastim at which
of the following times?
A. 24 hr before the topotecan infusion
B. At the same time as the topotecan infusion
C. 24 hr after the topotecan infusion
D. 1 hr before the topotecan infusion
Answer: C. 24 hr after the topotecan infusion
169. Drag the drug in the left column to match it with its therapeutic use in the right column.
Tamoxifen

Advanced or resistant HIV disease

Flutamide

HIV-1 infection

Delavirdine

Prostate cancer

Enfuvirtide

Estrogen-receptor-positive breast cancer

Answer:
Tamoxifen

Estrogen-receptor-positive breast cancer

Flutamide

Prostate cancer

Delavirdine

HIV-1 infection

Enfuvirtide

Advanced or resistant HIV disease

170. You are assessing a client who is receiving imatinib to treat chronic myeloid leukaemia.
Which of the following findings might indicate an adverse reaction to this drug?
A. Bradycardia
B. Dry mouth
C. Constricted pupils
D. Crackles at lung bases
Answer: D. Crackles at lung bases
171. While administering trastuzumab IV to a client who has breast cancer, you should ensure
that you have which of the following drug available to treat an adverse reaction to this drug?
A. Protamine
B. Epinephrine
C. Glucagon (GlucaGen)
D. Atropine
Answer: B. Epinephrine
172. You are caring for a client who is pregnant and is HIV-positive. Which of the following
drugs helps prevent the transfer of HIV to the fetus?
A. Anastrozole (Arimidex)
B. Zidovudine (Retrovir)
C. Tamoxifen ( Soltamox)
D. Trastuzumab (Herceptin)
Answer: B. Zidovudine (Retrovir)
173. A client is about to start taking ritonavir to treat HIV-1 infection. Which of the following
instructions should you include when talking with the client about taking this drug? (Select all
that apply.)
A. Expect periodic blood glucose testing.
B. Take it on an empty stomach.
C. Watch for and report jaundice.
D. Increase weight-bearing activity.

E. Expect periodic cholesterol testing.
Answer: A. Expect periodic blood glucose testing.
C. Watch for and report jaundice.
D. Increase weight-bearing activity.
E. Expect periodic cholesterol testing.
174. Drag the drug in the left column to match it with its therapeutic use in the right column.
Carmustine

Multiple myeloma

Paclitaxel

Gastrointestinal adenocarcinoma

Cyclophosphamide

Kaposi's sarcoma

Cytarabine

Acute myelocytic leukemia

Answer:
Carmustine

Gastrointestinal adenocarcinoma

Paclitaxel

Kaposi's sarcoma

Cyclophosphamide

Multiple myeloma

Cytarabine

Acute myelocytic leukemia

175. You should instruct a client who is taking tamoxifen to treat breast cancer to watch for and
report which of the following serious adverse effects of this drug?
A. Abnormal menstrual bleeding
B. Muscle pain and weakness
C. Yellowing of skin and eyes
D. Peripheral edema
Answer: A. Abnormal menstrual bleeding
Pharmacology Made Easy 4.0 The Immune System Quiz:
176. A nurse is teaching a client about maraviroc. Which of the following instructions should the
nurse include?
A. "It is important to report any noticeable rash immediately as it might indicate an issue with
your liver."

B. "Make sure you take this medication without any other medications first thing in the
morning."
C. "You might experience flu-like symptoms for which you can take any over-the-counter
medication."
D. "The side effects of this medication are minimal, so you can continue to work and drive as
normal."
Answer: A. "It is important to report any noticeable rash immediately as it might indicate an
issue with your liver."
Rationale:
Hepatic injury can manifest as a rash in clients who take maraviroc and should be reported to the
provider regardless of how mild it appears.
177. A nurse is teaching a guardian of a child about the recommended age range to receive the
human papillomavirus (HPV) vaccine. Which of the following age ranges should the nurse
include?
A. 11 to 12 years old
B. 7 to 9 years old
C. 13 to 15 years old
D. 15 to 17 years old
Answer: A. 11 to 12 years old
Rationale:
Three doses of the vaccine for HPV are recommended for adolescents ages 11 to 12 years old.
178. A nurse is considering drug therapy options for a client who has metastatic breast cancer
that is positive for human epidermal growth factor receptor 2 (HER2). Which of the following
drugs should the nurse expect the provider to prescribe?
A. Trastuzumab
B. Imatinib
C. Leuprolide
D. Flutamide
Answer: A. Trastuzumab

Rationale:
Trastuzumab, a monoclonal antibody and a pregnancy risk category D drug, treats and helps
control the cell growth of metastatic breast cancer with tumors that overexpress HER2. This form
of breast cancer accounts for up to 30% of metastatic breast tumors.
179. A nurse is caring for a client who has a new prescription for topotecan therapy to treat
resistant, small cell lung cancer. The nurse should advise the client against taking which of the
following types of over-the-counter drugs while receiving the therapy?
A. Folic acid
B. St. John's wort
C. Ibuprofen
D. Aluminium hydroxide
Answer: C. Ibuprofen
Rationale:
NSAIDs, anticoagulants, and antiplatelet drugs increase the client's risk for bleeding while
receiving topotecan, a topoisomerase inhibitor. The nurse should advise the client against taking
aspirin, ibuprofen, and other NSAIDs during therapy.
180. A nurse is caring for a client who has a new prescription for intrathecal cytarabine therapy
to treat meningeal leukaemia. The nurse should inform the client that they will also receive
which of the following drugs to reduce the risk of neurotoxicity?
A. Diphenhydramine
B. Leucovorin
C. Folic acid
D. Dexamethasone
Answer: D. Dexamethasone
Rationale:
Clients who have a prescription for the intrathecal form of cytarabine should also receive
dexamethasone, a glucocorticoid, to help decrease the inflammation of the arachnoid that the
drug can cause. IV dexamethasone reduces the client's risk for neurotoxicity.

181. A nurse should recognize that enfuvirtide can be prescribed to clients who have which of the
following conditions?
A. Advanced prostate cancer
B. Primary brain tumours
C. Advanced HIV
D. Metastatic ovarian cancer
Answer: C. Advanced HIV
Rationale:
Enfuvirtide, a fusion inhibitor, treats HIV that is advanced or resistant to other types of treatment.
The nurse should always administer the drug with other antiretroviral drugs.
182. A nurse is caring for a client who is prescribed zidovudine. Which of the following
laboratory values should the nurse report to the provider?
A. Haemoglobin 7.1 g/dL
B. RBC count 5.2/mm3
C. Neutrophil 57%
D. Triglycerides 125 mg/Dl
Answer: A. Haemoglobin 7.1 g/dL
Rationale:
The provider might consider dose reduction, discontinuation of therapy, or blood transfusions if
the client's haemoglobin is less than 7.5 g/dL or has a reduction of greater than 25% from
baseline.
183. A nurse is instructing a client how to self-administer enfuvirtide. Which of the following
instructions should the nurse include?
A. "Allow the vial to sit until the solution is completely clear and without particulates."
B. "After reconstituting with sterile water, vigorously shake the vial to mix the solution."
C. "Use the medication immediately upon removing from the refrigerator."
D. "Use the same location for five injections before rotating to a new site."
Answer: A. "Allow the vial to sit until the solution is completely clear and without particulates."
Rationale:

When administering enfuvirtide, the client should inject sterile water to reconstitute it and gently
roll the vial between the hands. Then, the client should let the vial sit until the solution is
completely clear and without particulates, which might take up to 45 min. The client should
allow the vial to warm to room temperature before the injection and refrigerate any unused
portion.
184. A nurse is caring for a client who is receiving vincristine to treat lung cancer. The nurse
should monitor the client and recognize which of the following manifestations as an indication
that the client is experiencing an adverse effect of the drug.
A. Weak hand grasps
B. Constricted pupils
C. Bradycardia
D. Crackles
Answer: A. Weak hand grasps
Rationale:
Vincristine, a vinca alkaloid, can cause peripheral neuropathy. The nurse should monitor deeptendon reflexes and the strength and movement of the hands and feet. The nurse should instruct
the client to report paraesthesia or reduced sensation in the hands or feet.
185. A nurse should recognize that raltegravir is used to treat clients who have which of the
following conditions?
A. Hairy cell leukaemia
B. Thyroid cancer
C. Kaposi's sarcoma
D. Resistant HIV
Answer: D. Resistant HIV
Rationale:
Raltegravir, an integrase inhibitor, along with other antiretroviral drugs, treats HIV that is
resistant to other drugs. The nurse should administer raltegravir with other antiretroviral drugs.

186. A nurse is teaching the guardian of a 4-month-old infant about recommended immunizations
for the infant. Which of the following immunizations should the nurse include?
A. Haemophilus influenzae type B vaccine (Hib)
B. Varicella vaccine
C. Meningococcal conjugate vaccine (MCV4)
D. Tetanus-diphtheria-acelluar pertussis vaccine (Tdap)
Answer: A. Haemophilus influenzae type B vaccine (Hib)
Rationale:
The nurse should inform the guardian that the Haemophilus influenzae type B vaccine (Hib) is
recommended for infants and children to prevent a serious type of meningitis commonly seen in
young children.
187. A nurse is teaching a client about recommended immunizations. Which of the following
immunizations should the nurse recommend the client receive starting at 50 years of age?
A. Herpes zoster vaccine
B. Human papillomavirus vaccine (HPV)
C. Pneumococcal vaccine
D. Haemophilus influenzae type B vaccine (Hib)
Answer: A. Herpes zoster vaccine
Rationale:
The herpes zoster, or shingles vaccine, is recommended for adults older than 50 years of age.
188. A nurse is assessing a client following a trastuzumab infusion to treat metastatic breast
cancer. Which of the following findings should the nurse recognize as an indication that the
client is experiencing an adverse reaction to the drug? (Select all that apply.)
A. Wheezing
B. Dysrhythmias
C. Hypotension
D. Fever
E. Ascites
Answer: A. Wheezing

B. Dysrhythmias
C. Hypotension
D. Fever
Rationale:
A. Wheezing is correct. Trastuzumab, a monoclonal antibody, can cause a severe allergic
reaction, manifesting as hives, bronchospasm, dyspnea, and wheezing. The nurse should have
epinephrine ready to treat anaphylaxis.
B. Dysrhythmias is correct. Trastuzumab can cause cardiotoxicity, manifesting as ventricular
dysfunction, heart failure, and dysrhythmias. The nurse should monitor the client's ECG.
C. Hypotension is correct. Trastuzumab can cause a severe allergic reaction, manifesting as
hives, dyspnea, hypotension, and hypoxia. The nurse should have epinephrine ready to treat
anaphylaxis.
D. Fever is correct. Trastuzumab can cause flu-like reactions, manifesting as fever, chills, nausea,
and headache. The nurse should monitor the client's temperature.
189. A nurse is caring for a client who has a new prescription for delavirdine therapy to treat
HIV-1. The nurse should instruct the client to report which of the following adverse reactions to
the drug?
A. Rash
B. Insomnia
C. Rhinitis
D. Alopecia
Answer: A. Rash
Rationale:
Delavirdine, a non-nucleoside reverse transcriptase inhibitor, can cause a rash. The nurse should
instruct the client to report a rash, which can occur 1 to 3 weeks after therapy, because it can
develop into Stevens-Johnson syndrome, a potentially life-threatening complication.
190. A nurse is teaching a client about immunizations. Which of the following information
should the nurse include in the teaching?
A. "You should receive a tetanus booster every 10 years."

B. "You should not receive the influenza immunization if you have a common cold."
C. "You do not have to receive the shingles vaccine if you have received two doses of the
varicella virus vaccine."
D. "As long as you don't have risk factors, you will start receiving the pneumococcal vaccine
when you are 50 years old."
Answer: A. "You should receive a tetanus booster every 10 years."
Rationale:
The nurse should inform the client that the tetanus-diphtheria (Td) vaccine is recommended
every 10 years.
191. A nurse is preparing to administer the measles, mumps, and rubella (MMR) vaccine to a
child. The nurse should recognize that the MMR vaccine provides which of the following types
of immunity?
A. Artificial active immunity
B. Active immunity
C. Passive
D. Artificial passive immunity
Answer: A. Artificial active immunity
Rationale:
The nurse should recognize that the MMR vaccine provides artificial active immunity to the
child. A vaccine contains a form of the disease that is live, attenuated, or killed, which will allow
the body to build up an active immunity against the disease.
192. A nurse is caring for a client who has a new prescription for cisplatin to treat testicular
cancer. The nurse should instruct the client to report which of the following adverse effects?
(Select all that apply.)
A. Paraesthesia
B. Sore throat
C. Flank pain
D. Tinnitus
E. Conjunctivitis

Answer: A. Paraesthesia
B. Sore throat
C. Flank pain
D. Tinnitus
Rationale:
A. Paraesthesia is correct. Cisplatin, a platinum compound, can cause peripheral neuropathy. The
nurse should tell the client to report numbness, tingling, or decreased sensation in the hands or
feet.
B. Sore throat is correct. Cisplatin can cause bone marrow depression. The nurse should tell the
client to report fever, sore throat, bruising, or fatigue.
C. Flank pain is correct. Cisplatin can cause kidney toxicity. Prior to therapy, the nurse should
hydrate the client with 1 to 2 L of IV fluid and continue for 24 hr following therapy to flush the
kidneys and help prevent kidney toxicity.
D. Tinnitus is correct. Cisplatin can cause ototoxicity. The nurse should monitor the client's
hearing and instruct the client to report hearing loss, vertigo, or tinnitus.
193. A nurse is teaching a client who has a new diagnosis of breast cancer about the drug
tamoxifen. The nurse should tell the client that which of the following conditions is a
contraindication for taking tamoxifen?
A. Deep-vein thrombosis
B. COPD
C. Diabetes mellitus
D. Alcohol use disorder
Answer: A. Deep-vein thrombosis
Rationale:
Tamoxifen, an estrogen receptor blocker, can cause thromboembolism. Its use requires cautious
use with clients who have deep-vein thrombosis.
194. A nurse is teaching a client who has a new prescription for mercaptopurine to treat
leukaemia. Which of the following instructions should the nurse include? (Select all that apply.)
A. Use contraception if pregnancy is a risk.

B. Perform oral hygiene frequently.
C. Avoid activities that require mental alertness.
D. Perform hand hygiene frequently.
E. Avoid activities that can cause injury.
Answer: A. Use contraception if pregnancy is a risk.
B. Perform oral hygiene frequently.
D. Perform hand hygiene frequently.
E. Avoid activities that can cause injury.
Rationale:
A. Use contraception if pregnancy is a risk is correct. Mercaptopurine, a purine analog, is a
pregnancy risk category D drug. Clients of childbearing age who take the drug should use
contraception, and the nurse should confirm nonpregnancy before starting therapy.
B. Perform oral hygiene frequently is correct. Mercaptopurine can cause stomatitis. The nurse
should instruct the client to perform frequent oral hygiene to help prevent or minimize this
adverse effect.
D. Perform hand hygiene frequently is correct. Mercaptopurine can cause neutropenia. The nurse
should instruct the client to wash hands thoroughly or use an alcohol-based hand rub frequently
and to avoid crowds and contact with people who have communicable infections.
E. Avoid activities that can cause injury is correct. Mercaptopurine can cause thrombocytopenia.
The nurse should monitor the client's CBC throughout treatment and instruct the client to avoid
activities that can cause injury and report any unexplained bruising or bleeding.
195. A nurse is preparing to administer paclitaxel IV to a client who has ovarian cancer. Which of
the following actions should the nurse take? (Select all that apply.)
A. Give the client an antihistamine.
B. Infuse the drug over 1 hr.
C. Administer the drug through non-PVC tubing.
D. Use an in-line filter.
E. Add heparin to the paclitaxel solution.
Answer: A. Give the client an antihistamine.
C. Administer the drug through non-PVC tubing.

D. Use an in-line filter.
Rationale:
A. Give the client an antihistamine is correct. Prior to administering paclitaxel, an antimitotic
drug, the nurse should give the client an antihistamine, such as diphenhydramine, a proton-pump
inhibitor, such as cimetidine, and a glucocorticoid, such as dexamethasone, to prevent a
hypersensitivity reaction.
C. Administer the drug through non-PVC tubing is correct. Paclitaxel is incompatible with PVC
tubing.
D. Use an in-line filter is correct. Paclitaxel requires administration through an in-line filter.
196. A nurse is caring for a client who has a new prescription for ritonavir and zidovudine
therapy to treat HIV-1. The nurse should inform the client that zidovudine is prescribed with
ritonavir for which of the following reasons?
A. To prevent an infusion reaction
B. To increase platelet production
C. To protect healthy cells from the toxic effects of ritonavir
D. To prevent drug resistance
Answer: D. To prevent drug resistance
Rationale:
The nurse should explain that zidovudine, a nucleoside reverse transcriptase inhibitor, is
administered along with ritonavir, a protease inhibitor, to reduce the risk for drug resistance and
to increase drug effectiveness. Monotherapy with zidovudine quickly results in drug resistance,
as is also the case with monotherapy with ritonavir.
197. A nurse is teaching a client who has a new prescription for imatinib to treat chronic myeloid
leukaemia. Which of the following instructions should the nurse include? (Select all that apply.)
A. Clean fruits and vegetables thoroughly.
B. Increase calcium intake.
C. Weigh yourself daily.
D. Perform hand hygiene frequently.
E. Avoid grapefruit and grapefruit juice.

Answer: A. Clean fruits and vegetables thoroughly.
C. Weigh yourself daily.
D. Perform hand hygiene frequently.
E. Avoid grapefruit and grapefruit juice.
Rationale:
A. Clean fruits and vegetables thoroughly is correct. Imatinib, a targeted antineoplastic drug, can
cause bone marrow suppression. The nurse should instruct the client to clean fruits and
vegetables carefully and completely to prevent transmission of bacteria.
C. Weigh yourself daily is correct. Imatinib can cause fluid retention and weight gain. The nurse
should instruct the client to record daily weights and monitor for edema.
D. Perform hand hygiene frequently is correct. Imatinib can cause bone marrow suppression. The
nurse should instruct the client to wash hands or use an alcohol-based hand rub frequently and to
avoid exposure to illness.
E. Avoid grapefruit and grapefruit juice is correct. Grapefruit and grapefruit juice can cause the
blood levels of imatinib to be higher than normal. The nurse should instruct the client to avoid
grapefruit and grapefruit juice during therapy.
198. A nurse is preparing to administer enfuvirtide to a client. Which of the following actions
should the nurse should plan to perform? (Select all that apply.)
A. Administer the drug subcutaneously.
B. Discard the unused portion.
C. Roll the vial gently to reconstitute the solution.
D. Inject the solution at room temperature.
E. Expect a cloudy solution.
Answer: A. Administer the drug subcutaneously.
C. Roll the vial gently to reconstitute the solution.
D. Inject the solution at room temperature.
Rationale:
A. Administer the drug subcutaneously is correct. The nurse should administer enfuvirtide, a
fusion inhibitor, subcutaneously, twice per day. This is the only appropriate route of
administration for the drug.

C. Roll the vial gently to reconstitute the solution is correct. The nurse should roll the vial of
enfuvirtide gently between the palms of the hands after adding sterile water for injection. This
reconstitutes the drug.
D. Inject the solution at room temperature is correct. The nurse can store unused solutions of
enfuvirtide in a refrigerator up to 24 hr but should restore it to room temperature before injection.
Expect a cloudy solution is incorrect. Enfuvirtide should be clear and without particulates after
reconstitution. The nurse should not administer a cloudy solution.
199. A nurse is caring for a client who has a new prescription for maraviroc therapy. The nurse
should instruct the client to report which of the following adverse effects? (Select all that apply.)
A. Paresthesia
B. Cough
C. Tinnitus
D. Jaundice
E. Fever
Answer: A. Paresthesia
B. Cough
D. Jaundice
E. Fever
Rationale:
A. Paresthesia is correct. Maraviroc, a chemokine receptor 5 antagonist, can cause paresthesia,
dizziness, and musculoskeletal pain.
B. Cough is correct. Maraviroc can cause a cough and upper respiratory infection.
D. Jaundice is correct. Maraviroc can cause liver damage. The nurse should instruct the client to
report an allergic reaction, such as a rash, because it can precede liver damage, manifested as
jaundice or abdominal pain.
E. Fever is correct. Maraviroc can cause a fever and sinus infection.
200. A nurse should recognize that maraviroc is used in the treatment of which of the following
conditions?
A. Diabetes mellitus

B. Meningeal infection
C. Pancreatitis
D. Chemokine receptor 5 (CCR5)-tropic HIV-1
Answer: D. Chemokine receptor 5 (CCR5)-tropic HIV-1
Rationale:
Maraviroc, a CCR5 antagonist, acts by binding to CCR5 and preventing HIV-1 from entering the
cell. It is used in the treatment of clients who have CCR5-tropic HIV-1.
Tutorial: Pharmacology Made Easy 4.0 Module: Pain and Inflammation
Case Study Questions 1:
201. Because the client is taking celecoxib (Celebrex) for osteoarthritis, he knows to watch for
and report which of the following possible indications of an adverse reaction to celecoxib?
A. Tinnitus
B. Weight gain
C. Anxiety
D. Tremor
Answer: B. Weight gain
202. In addition to celecoxib, the client takes low-dose aspirin daily for which of the following
purposes?
A. Decreases the risk for anaphylaxis
B. Potentates the therapeutic effects of celecoxib
C. Reduces the risk of a cardiovascular event
D. Increases renal perfusion
Answer: C. Reduces the risk of a cardiovascular event
203. Which of the following instructions should the health care provider give the client regarding
the use of aspirin prior to the surgery?
A. Continue to take it once a day.
B. Stop taking it 1 week before surgery.
C. Increase the dose to twice a day.

D. Reduce the dose to every other day.
Answer: B. Stop taking it 1 week before surgery.
204. The health care provider prepares to give the client morphine IV for pain. Knowing the
adverse drug reactions of morphine, she should monitor the client for which of the following?
A. Jaundice
B. Fever
C. Hypertension
D. Respiratory depression
Answer: D. Respiratory depression
205. As the health care provider prepares to give the client morphine IV for pain, she makes sure
she has which of the following drugs available?
A. Naloxone
B. Protamine sulphate
C. Flumazenil
D. Physostigmine
Answer: A. Naloxone
Case Study Questions 2:
206. A client is about to start taking aspirin to prevent cardiovascular events. You should instruct
the client to watch for and report which adverse drug reaction of aspirin?
A. Dyspnea
B. Constipation
C. Calf pain
D. Petechiae
Answer: D. Petechiae
207. Drag the drug in the left column to match it with its classification in the right column.
Naloxone

Non-Steroidal Anti-inflammatory drug

Ibuprofen

Opioid analgesic

Prednisone

Opioid antagonist

Morphine

Glucocorticoid

Answer:
Naloxone

Opioid antagonist

Ibuprofen

Non-Steroidal Anti-inflammatory drug

Prednisone

Glucocorticoid

Morphine

Opioid analgesic

208. A client is about to start taking oral morphine to treat acute pain from an injury. Which of
the following instructions should you include when talking with the client about taking
morphine? (Select all that apply.)
A. Take it with food.
B. Rise slowly from sitting or reclining.
C. Take it on a fixed schedule.
D. Increase fluid and fibre intake.
E. Do not take it before driving.
Answer: A. Take it with food.
B. Rise slowly from sitting or reclining.
D. Increase fluid and fibre intake.
E. Do not take it before driving.
209. A provider prescribes prednisone for a client who has type 1 diabetes mellitus. Recognizing
the risk for an adverse drug reaction to the prednisone, which of the following precautions should
the primary care provider take for this client?
A. Reduce the insulin dose.
B. Increase carbohydrate intake.
C. Reduce the prednisone dose.
D. Increase serum glucose monitoring.
Answer: D. Increase serum glucose monitoring.

210. A client is about to start taking tramadol to treat moderate pain. Which of the following
instructions should you include when talking with the client about taking this drug?
A. Allow 1 hr for it to take effect.
B. Take it on an empty stomach.
C. Chew the extended-release tablets.
D. Do not take it with grapefruit juice.
Answer: A. Allow 1 hr for it to take effect.
211. A client who is receiving chemotherapy takes allopurinol prior to the chemotherapy to
reduce the risk for which condition?
A. Agranulocytosis
B. Hyperuricemia
C. Aplastic anaemia
D. Thrombocytopenia
Answer: B. Hyperuricemia
212. Drag the drug in the left column to match it with its therapeutic use in the right column.
Morphine

Anaesthesia adjunct

Prednisone

Fever Reduction

Acetaminophen

Sedation

Butorphanol

Prevention of organ rejection

Answer:
Morphine

Sedation

Prednisone

Prevention of organ rejection

Acetaminophen

Fever Reduction

Butorphanol

Anaesthesia adjunct

213. A client arrives at the emergency room immediately following an acetaminophen overdose.
Which drug should you prepare to administer?
A. Atropine
B. Naloxone

C. Acetylcysteine
D. Flumazenil
Answer: C. Acetylcysteine
214. Butorphanol is an unsafe analgesic choice for clients who:
A. take glucocorticoids for rheumatoid arthritis.
B. use a fentanyl patch for chronic pain.
C. have type 1 diabetes mellitus and use an insulin pump.
D. take warfarin for thrombophlebitis.
Answer: B. use a fentanyl patch for chronic pain.
215. A client is about to begin celecoxib therapy for osteoarthritis. You should instruct the client
to watch for and report which of the following possible indications of a serious reaction to this
drug?
A. Black, tarry stools
B. Polyuria
C. Bone pain
D. Dry mouth
Answer: A. Black, tarry stools
Pharmacology Made Easy 4.0 Pain and Inflammation Quiz:
216. A nurse is teaching a client who has a new prescription for allopurinol. Which of the
following instructions should the nurse include?
A. Avoid driving or activities that require mental alertness.
B. Avoid crushing the tablets.
C. Limit fluid intake during therapy.
D. Limit potassium while taking allopurinol.
Answer: A. Avoid driving or activities that require mental alertness.
Rationale:
Allopurinol can cause drowsiness. The nurse should instruct the client to avoid driving or
activities that require mental alertness until they know the effect the drug will have on them.

217. A nurse is caring for a group of postoperative clients. The nurse should identify that
morphine is contraindicated for which of the following clients?
A. A client who had a mastectomy
B. A client who had a knee arthroplasty
C. A client who had a colectomy
D. A client who had a cholecystectomy
Answer: D. A client who had a cholecystectomy
Rationale:
Morphine can cause biliary colic. It should not be administered to a client who has just had
biliary tract surgery, such as a cholecystectomy.
218. A nurse is reviewing the drug list for a client who has a new prescription for allopurinol.
The nurse should identify that which of the following drugs interacts with allopurinol?
A. Warfarin
B. Ibuprofen
C. Insulin
D. Furosemide
Answer: A. Warfarin
Rationale:
Allopurinol can increase the effectiveness of warfarin. A lower dosage of warfarin might be
required.
219. A nurse is caring for a client who has a new prescription for butorphanol. The nurse should
monitor the client for which of the following adverse drug reactions? (Select all that apply.)
A. Infection
B. Nausea
C. Tachycardia
D. Dizziness
E. Headache
Answer: B. Nausea

D. Dizziness
E. Headache
Rationale:
B. Nausea is correct. Butorphanol, an opioid agonist-antagonist, can cause nausea. Clients who
are taking the drug should lie down when feeling nauseated.
D. Dizziness is correct. Butorphanol, an opioid agonist-antagonist, can cause dizziness and
drowsiness. Clients who are taking the drug should avoid activities that require alertness.
E. Headache is correct. Butorphanol, an opioid agonist-antagonist, can cause headaches and
increased intracranial pressure. Clients who are taking the drug should report severe headaches.
220. A nurse is caring for a client who has a prescription for aspirin to treat an ankle sprain. The
nurse should instruct the client to report which of the following adverse drug reactions?
A. Polyuria
B. Bone pain
C. Weight gain
D. Infection
Answer: C. Weight gain
Rationale:
Aspirin use can cause renal impairment, which can result in the retention of salt and water.
Clients should report reduced urine output, weight gain, edema, or bloating. The nurse should
monitor BUN and creatinine levels and stop aspirin therapy for clients who develop signs of
renal dysfunction.
221. A nurse is caring for a child who has a viral infection. The nurse should identify that which
of the following drugs can increase the risk of Reye syndrome in children who have viral
infections?
A. Butorphanol
B. Acetaminophen
C. Tramadol
D. Aspirin
Answer: D. Aspirin

Rationale:
Aspirin can increase the risk for Reye syndrome in children who have a viral infection,
particularly chickenpox or influenza. Manifestations of Reye syndrome include lethargy and
persistent vomiting.
222. A nurse is teaching a client who has a new prescription for prednisone. Which of the
following instructions should the nurse include? (Select all that apply.)
A. Reduce the dose during periods of stress.
B. Discontinue the drug gradually.
C. Report illness or infection.
D. Increase intake of calcium and vitamin D.
E. Monitor for signs of gastric bleeding.
Answer: B. Discontinue the drug gradually.
C. Report illness or infection.
D. Increase intake of calcium and vitamin D.
E. Monitor for signs of gastric bleeding.
Rationale:
B. Discontinue the drug gradually is correct. Prednisone, a glucocorticoid, suppresses adrenal
function. The nurse should instruct the client to taper the dosage before discontinuing it to allow
for resumption of adrenal activity.
C. Report illness or infection is correct. Clients can need higher doses of prednisone during
illness or infection. The nurse should instruct the client to report signs of infection.
D. Increase intake of calcium and vitamin D is correct. Prednisone, a glucocorticoid, can cause
bone loss and reduced calcium absorption. The nurse should instruct the client to increase their
intake of calcium and vitamin D.
E. Monitor for signs of gastric bleeding is correct. Prednisone, a glucocorticoid, can cause peptic
ulcer disease. The nurse should instruct the client to report signs of gastric bleeding, such as
hematemesis or black tarry stools.
223. A nurse is teaching a client who has a new prescription for allopurinol. The nurse should
instruct the client to report which of the following adverse drug reactions? (Select all that apply.)

A. Palpitations
B. Sore throat
C. Vertigo
D. Bruising
E. Vision changes
Answer: B. Sore throat
C. Vertigo
D. Bruising
E. Vision changes
Rationale:
B. Sore throat is correct. Allopurinol, an antigout drug, can cause agranulocytosis. The nurse
should monitor the client's WBC count, and instruct the client to report fever or sore throat. The
nurse should also instruct the client to avoid crowds or exposure to people who might have
communicable diseases.
C. Vertigo is correct. Allopurinol, an antigout drug, can cause drowsiness and vertigo. The nurse
should instruct the client to report these adverse effects and avoid activities that require mental
alertness until they know how the drug will affect them.
D. Bruising is correct. Allopurinol, an antigout drug, can cause thrombocytopenia. The nurse
should monitor the client's platelet count and instruct the client to report any bleeding or
bruising.
E. Vision changes is correct. Allopurinol, an antigout drug, can cause cataracts with extended
use. The nurse should instruct the client to report vision changes, such as cloudiness or halos
around lights, and have eye examinations at recommended intervals.
224. A nurse is caring for a client who currently takes furosemide and has a new prescription for
prednisone. The nurse should monitor the client for which of the following manifestations during
concurrent use of the two drugs?
A. Hypercalcemia
B. Hypoglycaemia
C. Hypothermia
D. Hypokalaemia

Answer: D. Hypokalaemia
Rationale:
Prednisone, a glucocorticoid, can cause hypokalaemia. The risk for this electrolyte imbalance
increases when the client is taking potassium-depleting diuretics, such as furosemide. The nurse
should clarify the prescription with the provider and monitor the client's potassium levels.
225. A nurse is reviewing the medical record of a client who has a new prescription for tramadol.
The nurse should identify that which of the following conditions is a contraindication for
tramadol?
A. Hyperthyroidism
B. Seizure disorder
C. Rheumatoid arthritis
D. Urinary incontinence
Answer: B. Seizure disorder
Rationale
Tramadol, a nonopioid analgesic, can cause seizure activity. Clients who have seizure disorders,
head injuries, or increased intracranial pressure should not take tramadol.
226. A nurse is caring for a client who has a new prescription for celecoxib. The nurse should tell
the client to report which of the following adverse drug reactions?
A. Tinnitus
B. Chest pain
C. Constipation
D. Diaphoresis
Answer: B. Chest pain
Rationale:
Celecoxib, a COX-2 inhibitor, can cause cardiovascular or cerebrovascular events. Clients
should report chest pain, shortness of breath, headache, numbness, weakness, or confusion.
Providers should prescribe the lowest effective dosage of the drug for the shortest time period
possible.

227. A nurse is reviewing the medical record of a client who has a new prescription for
celecoxib. The nurse should identify that which of the following conditions is a contraindication
to celecoxib?
A. Rheumatoid arthritis
B. Ankylosing spondylitis
C. Sulfonamide allergy
D. Adrenocortical insufficiency
Answer: C. Sulfonamide allergy
Rationale:
Clients who are allergic to sulfonamides can have severe allergic reactions to celecoxib, a COX2 inhibitor. Clients who are allergic to salicylates can also react adversely to celecoxib.
228. A nurse is caring for a client who is taking acetaminophen at regular intervals for mild
discomfort. The nurse should tell the client to report which of the following early indications of
acetaminophen toxicity? (Select all that apply.)
A. Diaphoresis
B. Palpitations
C. Shortness of breath
D. Nausea
E. diarrhoea
Answer: A. Diaphoresis
D. Nausea
E. diarrhoea
Rationale:
A. Diaphoresis is correct. Acetaminophen toxicity can cause diaphoresis, anorexia, and,
eventually, liver damage. Clients should follow the dosage guidelines on the labels of over-the
counter drugs carefully to avoid toxicity.
D. Nausea is correct. Acetaminophen toxicity can cause nausea, vomiting, and anorexia, and can
lead to liver damage.
E. diarrhoea is correct. Acetaminophen toxicity can cause diarrhoea, lethargy, and, eventually,
liver damage.

229. A nurse is teaching a client who is taking allopurinol about minimizing adverse effects.
Which of the following instructions should the nurse include?
A. Eat a small meal before taking the drug.
B. Suck on hard candy or chew gum.
C. Take a stool softener daily. Avoid the use of NSAIDs.
D. Taking allopurinol after eating a meal or drinking a glass of milk can prevent stomach upset.
Answer: D. Taking allopurinol after eating a meal or drinking a glass of milk can prevent
stomach upset.
230. A nurse is teaching a client who has a new prescription for tramadol. Which of the following
instructions should the nurse include? (Select all that apply.)
A. Increase fibre and fluid intake.
B. Take the drug with food.
C. Avoid driving after taking the drug.
D. Change positions gradually.
E. Reduce exercise level temporarily.
Answer: A. Increase fibre and fluid intake.
B. Take the drug with food.
C. Avoid driving after taking the drug.
D. Change positions gradually.
Rationale:
A. Increase fibre and fluid intake is correct. Tramadol can cause constipation and dry mouth.
Clients taking the drug should increase fluid and fibre intake to minimize constipation, and sip
water, suck on hard candy, or chew gum to relieve dry mouth.
B. Take the drug with food is correct. Tramadol can cause nausea and vomiting. Clients should
take the drug with food or milk and lie down if feeling nauseated.
C. Avoid driving after taking the drug is correct. Tramadol can cause sedation and drowsiness.
Clients taking the drug should avoid driving or other activities that require alertness.
D. Change positions gradually is correct. Tramadol can cause sedation and dizziness. Clients
taking the drug should use caution when changing positions and ambulating.

231. A nurse is caring for a client who is opioid dependent and has a new prescription for
butorphanol. The nurse should monitor the client for which of the following manifestations of
abstinence syndrome? (Select all that apply.)
A. Bronchospasm
B. Vomiting
C. Peripheral edema
D. Abdominal cramps
E. Hypertension
Answer: B. Vomiting
D. Abdominal cramps
E. Hypertension
Rationale:
B. Vomiting is correct. Abstinence syndrome can cause nausea, vomiting, and anorexia.
D. Abdominal cramps is correct. Abstinence syndrome can cause abdominal cramps and
anorexia.
E. Hypertension is correct. Abstinence syndrome can cause hypertension, tremors, and fever.
232. A nurse is caring for a client who is receiving morphine to relieve severe pain. The nurse
should monitor the client for which of the following adverse drug reactions? (Select all that
apply.)
A. diarrhoea
B. Urinary retention
C. Respiratory depression
D. Sedation
E. Orthostatic hypotension
Answer: B. Urinary retention
C. Respiratory depression
D. Sedation
E. Orthostatic hypotension
Rationale:

B. Urinary retention is correct. Morphine can cause urinary retention. The nurse should monitor
the client's fluid intake and output and assess for bladder distention.
C. Respiratory depression is correct. Morphine can cause severe respiratory depression. The
nurse should withhold the drug for a respiratory rate below 12/min.
D. Sedation is correct. Morphine can cause sedation, dizziness, and light-headedness. Clients
who are taking the drug should avoid activities that require alertness.
E. Orthostatic hypotension is correct. Morphine can cause hypotension and postural hypotension.
Clients who are taking the drug should change positions gradually.
233. A nurse is caring for a client who has a new prescription for prednisone for long-term
treatment of rheumatoid arthritis. The nurse should monitor the client for which of the following
adverse drug reactions?
A. Pulmonary embolism
B. Hepatitis
C. Bone loss
D. Breast Cancer
Answer: C. Bone loss
Rationale:
Prednisone, a glucocorticoid, can cause osteoporosis, especially with long-term use. Clients who
are taking the drug should increase weight-bearing activity and report back pain. The nurse
should monitor the client's bone density.
234. A nurse is caring for a client who is taking allopurinol to treat gout. The nurse should
monitor the client for which of the following manifestations of hypersensitivity syndrome?
A. Muscle pain
B. Fever
C. Anxiety
D. Tremors
Answer: B. Fever
Rationale:

Allopurinol, an antigout drug, can cause hypersensitivity syndrome. The nurse should monitor
the client for rash, itching, or fever, as manifestations of hypersensitivity syndrome, which can
lead to renal or liver dysfunction. Clients who develop this type of reaction should stop taking
the drug.
235. A nurse is caring for a client who is taking naloxone to treat acute morphine toxicity. The
nurse should monitor the client for which of the following adverse drug reactions? (Select all that
apply.)
A. Increased respiratory rate
B. Increased pain
C. Thrombophlebitis
D. Ventricular arrhythmias
E. Hypertension
Answer: A. Increased respiratory rate
B. Increased pain
D. Ventricular arrhythmias
E. Hypertension
Rationale:
A. Increased respiratory rate is correct. Naloxone treats respiratory depression, but it can cause
hyperventilation. It is essential for the nurse to monitor the client's respiration and oxygenation.
B. Increased pain is correct. Naloxone reverses the analgesic effects of opioids and can cause
increased pain and discomfort. The nurse should assess the client's pain frequently.
D. Ventricular arrhythmias is correct. Naloxone can cause ventricular arrhythmias. The nurse
should monitor the client’s heart rate and ECG.
E. Hypertension is correct. Naloxone can cause hypertension. The nurse should monitor the
client's blood pressure.
236. A nurse is planning care for a client who has started taking prednisone. Which of the
following interventions should the nurse include?
A. Monitor the client's blood glucose.
B. Administer an antacid 30 min prior to prednisone.

C. Administer aspirin rather than NSAIDs if the client has pain.
D. Monitor the client for hyperkalaemia.
Answer: A. Monitor the client's blood glucose.
Rationale:
Prednisone can cause hyperglycaemia. The nurse should monitor the client's blood glucose
regularly.
237. A nurse is caring for a client who asks about taking acetaminophen. The nurse should
identify that acetaminophen is indicated for which of the following conditions? (Select all that
apply.)
A. To reduce fever
B. To decrease inflammation
C. To relieve mild pain
D. To promote sedation
E. To alleviate anxiety
Answer: A. To reduce fever
C. To relieve mild pain
Rationale:
A. To reduce fever is correct. Acetaminophen reduces fever. It is important, however, to monitor
clients taking the drug for signs of hepatotoxicity.
C. To relieve mild pain is correct. Acetaminophen relieves mild to moderate pain. It is important,
however, to monitor clients who take high doses for early signs of toxicity, including sweating,
nausea, diarrhoea, and abdominal discomfort.
238. A nurse is caring for a client who is about to begin taking aspirin. The nurse should instruct
the client to report which of the following manifestations of salicylism? (Select all that apply.)
A. Fever
B. Tinnitus
C. Diaphoresis
D. Thrombophlebitis
E. Dizziness

Answer: A. Fever
B. Tinnitus
C. Diaphoresis
E. Dizziness
Rationale:
A. Fever is correct. Late manifestations of acute aspirin poisoning, or salicylism, include fever.
B. Tinnitus is correct. Tinnitus, or ringing or buzzing in the ears, can indicate salicylism. Clients
should report this reaction and stop taking aspirin at least until tinnitus resolves.
C. Diaphoresis is correct. Sweating and headache can indicate salicylism. Clients should report
these effects and stop taking aspirin at least until the effects resolve.
E. Dizziness is correct. Dizziness can indicate salicylism. Clients should report this effect and
stop taking aspirin at least until dizziness resolves.
239. A nurse is caring for a client who takes low-dose aspirin to prevent cardiovascular events.
The client asks the nurse about taking ibuprofen to treat rheumatoid arthritis. Which of the
following responses should the nurse make?
A. "Ibuprofen will increase your risk for developing salicylism."
B. "Ibuprofen will reduce the cardioprotective effects of low-dose aspirin."
C. "Low-dose aspirin will reduce the anti-inflammatory effects of ibuprofen."
D. "Low-dose aspirin will reduce the analgesic effects of ibuprofen."
Answer: B. "Ibuprofen will reduce the cardioprotective effects of low-dose aspirin."
Rationale:
Ibuprofen, an NSAID, does not increase the client's risk for salicylism, a complication of taking
salicylates such as aspirin. However, when clients take ibuprofen with anticoagulants or
glucocorticoids, their risk for bleeding increases.
240. A nurse is reviewing the medical record of a client who reports taking acetaminophen at
home. The nurse should identify that which of the following client conditions is a
contraindication for acetaminophen?
A. Asthma
B. Diabetes mellitus

C. Heart failure
D. Alcohol use disorder
Answer: D. Alcohol use disorder
Rationale:
Acetaminophen can cause liver toxicity. Clients who have a history of alcohol use disorder
should not take acetaminophen.