ATI PHARMACOLOGY PROCTORED 2019 B NGN COMPLETE EXAM
ALL 60 QUESTIONS AND CORRECT ANSWERS WITH RATIONALES.
1. A nurse is caring for a pt who is receiving Haloperidol. The nurse should identify which of the
following findings as an adverse effect of the med?
A. Akathisia
B. Paresthesia
C. Excess tear production
D. Anxiety
Answer: A. Akathisia
Explanation:
A. An adverse effect associated with haloperidol is the development of extrapyramidal
manifestations such as dystonia, pseudo parkinsonism, and akathisia.
B. Haloperidol, an antipsychotic neuroleptic medication, can cause CNS adverse effects such as
seizures, confusion, and neuroleptic syndrome. However, paraesthesia is not an adverse effect of
haloperidol.
C. Haloperidol has anticholinergic properties that can cause sensory adverse effects such as
increased intraocular pressure, blurred vision, and dry eyes.
D. Haloperidol can be prescribed to treat severe agitation as well as psychotic manifestations.
2. A nurse is providing teaching to a pt who is to start taking Sumatriptan. Which of the
following adverse effects should the nurse instruct the pt to monitor for and report to the
provider?
A. Chest pressure
B. White patches on the tongue
C. Bruising
D. Insomnia
Answer: A. Chest pressure
Explanation:
A. Sumatriptan is an antimigraine agent which can cause coronary vasospasms, resulting in
angina. The client should report chest pressure or heavy arms to the provider.
B. White patches on the tongue can indicate a fungal infection, which is not an adverse effect of
sumatriptan.
C. Ecchymosis can indicate thrombocytopenia, which is not an adverse effect of sumatriptan.
D. Sumatriptan can cause drowsiness and sedation as an adverse effect of the medication.
3. A nurse is teaching a pt who is starting to take Amitriptyline. Which of the following findings
should the nurse include in the teaching as an adverse effect of the med?
A. Diarrhoea
B. Cough
C. Urinary retention
D. Increased libido
Answer: C. Urinary retention
Explanation:
A. Constipation is an adverse effect of amitriptyline.
B. Developing a cough is not an adverse effect of amitriptyline.
C. The nurse should instruct the client that amitriptyline causes the anticholinergic effect of
urinary retention.
D. A decrease in libido is an adverse effect of amitriptyline.
4. A nurse is assessing a pt who is taking Tamoxifen to treat breast cancer. Which of the
following findings is the priority for the nurse to report to the provider?
A. Hot flashes
B. Gastrointestinal irritation
C. Vaginal dryness
D. Leg tenderness
Answer: D. Leg tenderness
Explanation:
A. The client is at risk for hot flashes as an adverse effect of tamoxifen; however, another finding
is the priority to report to the provider. The nurse should encourage the client to avoid caffeine
and spicy foods to prevent hot flashes.
B. The client is at risk for gastrointestinal irritation (GI) as an adverse effect of tamoxifen;
however, another finding is the priority to report to the provider. The nurse should administer the
medication with food or fluids to reduce GI irritation.
C. The client is at risk for vaginal dryness as an adverse effect of tamoxifen; however, another
finding is the priority to report to the provider. The nurse should encourage the client to use
vaginal moisturizers if dryness occurs.
D. The greatest risk to this client is the development of a thromboembolism, which is an adverse
effect of tamoxifen. The nurse should also monitor the client for other manifestations of a
thromboembolism, including leg tenderness, redness, swelling, and shortness of breath.
5. A nurse is teaching a pt who is taking Allopurinol for the treatment of gout. Which of the
following info should the nurse include in the teaching?
A. Plan to increase the dosage each week by 200 mg increments.
B. Prolonged use of the medication can cause glaucoma.
C. Drink 2 L of water daily.
D. A fine red rash is transient and can be treated with antihistamines.
Answer: C. Drink 2 L of water daily.
Explanation:
A. The nurse should instruct the client to increase the dosage each week by 50 to 100 mg until
they experience relief or reach a maximum of 800 mg daily.
B. The nurse should instruct the client that the prolonged use of allopurinol can cause cataracts;
therefore, the client should have periodic ophthalmic checkups.
C. The nurse should instruct the client to drink at least 2 L of water each day to prevent renal
stone formation and kidney injury, because allopurinol is eliminated through the kidneys.
D. The nurse should instruct the client to report a rash to the provider immediately as this can be
an indication of hypersensitivity syndrome, a life-threatening toxicity. Treatment for allopurinol
toxicity can require haemodialysis or the administration of glucocorticoid medications
6. A nurse is caring for a pt who has diabetes mellitus and is taking Glyburide. The pt reports
feeling confused and anxious. Which of the following actions should the nurse take first?
A. Perform a capillary blood glucose test.
B. Provide the client with a protein-rich snack.
C. Give the client 120 mL (4 oz) of orange juice.
D. Schedule an early meal tray.
Answer: A. Perform a capillary blood glucose test.
Explanation:
A. The greatest risk to this client is injury from hypoglycaemia. Therefore, the nurse should
perform a capillary blood glucose test to determine the client's blood glucose status.
Manifestations of hypoglycaemia include weakness, anxiety, confusion, sweating, and seizures.
B. The nurse should provide the client with a protein-rich snack after determining the client's
blood glucose value and providing a carbohydrate first. However, there is another action that the
nurse should take first.
C. The nurse should give the client 10 to 15 g of carbohydrates, such as 4 oz of orange juice, to
treat hypoglycaemia. However, there is another action that the nurse should take first.
D. The nurse should schedule an early meal tray to maintain the client's blood glucose level
following the initial interventions for hypoglycaemia. However, there is another action the nurse
should take first.
7. A nurse is administering Cefotetan via intermittent IV bolus to a pt who suddenly develops
dyspnea and widespread hives. Which of the following actions should the nurse take first?
A. Administer epinephrine 0.5 mL via IV bolus.
B. Discontinue the medication IV infusion.
C. Elevate the client's legs above the level of the heart.
D. Collect a blood specimen for ABGs.
Answer: B. Discontinue the medication IV infusion.
Explanation:
A. The nurse should administer epinephrine, which is a beta-adrenergic agonist that can stimulate
the heart, cause vasoconstriction of blood vessels in the skin and mucous membranes, and cause
bronchodilation in the lungs. However, there is another action the nurse should take first.
B. The greatest risk to the client is respiratory arrest from anaphylaxis. Therefore, the first action
the nurse should take is to discontinue the medication IV infusion to prevent the client from
receiving more medication. However, the nurse should not remove the IV catheter. Instead, the
nurse should change the tubing and administer 0.9% sodium chloride by continuous IV infusion.
C. The nurse should elevate the client's legs and feet to a level above the client's heart to
facilitate blood flow to the vital organs. However, there is another action the nurse should take
first.
D. The nurse should collect a blood specimen for ABGs levels to evaluate the client's respiratory
status. However, there is another action the nurse should take first.
8. A nurse is preparing to administer 0.9% Sodium Chloride 1000mL IV over 8hr to a pt. The
drop factor of the manual IV tubing is 15gtt/mL. The nurse should set the manual IV infusion to
deliver how many gtt/min? (round to nearest whole #, do not use trailing zero)
Answer: 31 gtt/min.
Explanation:
The nurse should set the manual IV infusion to deliver 0.9% sodium chloride IV at 31 gtt/min.
9. A nurse is teaching about a new prescription for Ciprofloxan to a pt who has a UTI. The nurse
should identify which of the following statements as an indication that the pt understands the
teaching?
A."I will take this medication with an antacid to prevent gastrointestinal upset."
B. "I will stop taking this medication when I no longer have pain upon urination."
C. "I will report any signs of tendon pain or swelling."
D. "I will take this medication with milk."
Answer: C. "I will report any signs of tendon pain or swelling."
Explanation:
A. The client should avoid taking ciprofloxacin with an antacid containing aluminium,
magnesium, or calcium because this can decrease the effectiveness of the medication. The nurse
should instruct the client to take antacids 2 hr before or 6 hr after the ciprofloxacin.
B. The client should take the full course of ciprofloxacin to prevent reoccurring colonization of
bacteria.
C. Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture. This risk is
increased in older adult clients, so the client should notify the provider at the onset of tendon
pain or swelling.
D. The client should take ciprofloxacin with water and increase fluids to 2 to 3 L daily to avoid
the development of crystals in the kidneys. Milk products will decrease the absorption of the
medication.
10. A nurse is preparing to teach a pt who is to start a new prescription for extended release
Verapamil. Which of the following instructions should the nurse plan to include?
A. Take the medication on an empty stomach.
B. Avoid crowds.
C. Discontinue the medication if palpitations occur.
D. Change positions slowly.
Answer: D. Change positions slowly.
Explanation:
A. The nurse should instruct the client to take extended release verapamil with food to minimize
gastric distress.
B. Avoiding crowds is not necessary for the client who is taking verapamil because it does not
cause an immunosuppression disorder.
C. The nurse should instruct the client that verapamil can cause palpitations, which should be
reported to the provider. The client should never discontinue the medication abruptly because the
client might experience chest pain.
D. The nurse should instruct the client to change positions gradually to prevent orthostatic
hypotension and syncope.
11. A nurse is caring for a pt who is refusing to take their scheduled morning Furosemide. Which
of the following statements should the nurse make?
A. "By not taking your furosemide, you might retain fluid and develop swelling."
B. "You can double your dose of furosemide this evening if that would be better for you."
C. "If you do not take your furosemide, we might get in trouble."
D. "I'll go ahead and mix the furosemide into your breakfast cereal."
Answer: A. "By not taking your furosemide, you might retain fluid and develop swelling."
Explanation:
A. The nurse should respect the client's right to refuse the medication and inform the client of the
risks of not taking the medication, notify the provider, and document the refusal. Furosemide is a
loop diuretic given to reduce edema.
B. The nurse should respect the client's right to refuse the medication and identify that the client
should not double the medication dose if missed.
C. The nurse should respect the client's right to refuse the medication and inform the client of the
risks of not taking the medication, notify the provider, and document the refusal. This response
uses nontherapeutic communication because the nurse is threatening the client.
D. The nurse should respect the client's right to refuse the medication and inform the client of the
risks of not taking the medication, notify the provider, and document the refusal. This response is
dismissing the client's right to refuse a medication.
12. A nurse is providing teaching to a pt who has a prescription for
Trimethoprim/Sulfamethoxazole. Which of the following instructions should the nurse include in
the teaching?
A. Take the medication with food.
B. Expect a fine, red rash as a transient effect.
C. Drink 8 to 10 glasses of water daily.
D. Store the medication in the refrigerator.
Answer: C. Drink 8 to 10 glasses of water daily.
Explanation:
A. The nurse should instruct the client to take the medication on an empty stomach either 1 hr
before or 2 hr after meals.
B. The nurse should instruct the client to notify the provider if a rash develops, because this can
be an indication of Stevens-Johnson syndrome. However, the client should not expect to have a
fine, red rash as a transient effect.
C. The nurse should instruct the client to increase water intake to 1,920 to 2,400 mL (65 to 81 oz)
a day to decrease the chance of kidney damage from crystallization.
D. The nurse should inform the client to store trimethoprim/sulfamethoxazole in a light-resistant
container at room temperature.
13. A nurse in a clinic is caring for a pt who is taking Aspirin for treatment of arthritis. The nurse
should identify which of the following findings as an indication that the pt is beginning to exhibit
salicylism?
A. Gastric distress
B. Oliguria
C. Excessive bruising
D. Tinnitus
Answer: D. Tinnitus
Explanation:
A. Gastric distress is a possible adverse effect of aspirin therapy, but it is not an indication of
salicylism. Gastric distress can be minimized by taking aspirin with food or an enteric form of
the medication.
B. Kidney impairment is an adverse effect associated with aspirin use. Manifestations include
reduced urinary output, weight gain, and elevated BUN and creatinine levels. However, oliguria
is not an indication of salicylism.
C. Excessive bruising is a possible adverse effect of aspirin therapy, caused by the antiplatelet
effects of the medication. However, excessive bruising is not an indication of salicylism.
D. Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations
include sweating, headache, and dizziness.
14. A nurse is caring for a pt who has heart failure and a prescription for Enalapril. The nurse
should monitor the pt for which of the following findings as an adverse effect of the med?
A. Bradycardia
B. Hyperkalemia
C. Loss of smell
D. Hypoglycemia
Answer: B. Hyperkalemia
Explanation:
A. Enalapril is an ACE inhibitor that has several cardiovascular adverse effects including
hypotension, tachycardia, and dysrhythmias.
B. Enalapril improves cardiac functioning in clients who have heart failure and can cause
hyperkalemia due to potassium retention by the kidneys.
C. Enalapril can cause several sensory adverse effects such as a loss of taste. However, it does
not cause a loss of smell.
D. Enalapril does not cause hypoglycemia.
15. A circulating nurse is planning care for a pt who is scheduled for surgery and has a latex
allergy. Which of the following actions should the nurse include in the plan of care?
A. Schedule the client for the last surgery of the day.
B. Place monitoring cords and tubes in a stockinet
C. Choose rubber injection ports for fluid administration.
D. Ensure phenytoin IV is readily available.
Answer: B. Place monitoring cords and tubes in a stockinet
Explanation:
A. The nurse should schedule the client for the first surgery of the day to minimize the client's
exposure to latex, including latex dust.
B. The nurse should place monitoring devices in a stockinet to prevent direct contact with the
client's skin.
C. The nurse should ensure that latex-free products are used in the care of this client. Rubber
injection ports contain latex, which puts the client at risk for a severe allergic reaction.
D. The nurse should ensure that epinephrine is readily available in the operating room in case of
an anaphylactic reaction caused by an accidental exposure to latex.
16. A nurse is precepting a newly licensed nurse who is caring for 4 pts. The nurse should
complete an incident report for which of the following actions by the newly licensed nurse?
A. Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg
B. Administers digoxin to a client who has a heart rate of 92/min
C. Administers regular insulin to a client who has a blood glucose of 250 mg/dL
D. Administers heparin to a client who has an aPTT of 70 seconds
Answer: A. Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg
Explanation:
A. Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate
leads to vasodilation, which can result in hypotension. The nurse should withhold the medication
and notify the provider if the client's systolic blood pressure is below the expected reference
range of 120/80.
B. Digoxin is a cardiac glycoside used for clients who have heart failure because it strengthens
the contractility of the heart, increasing cardiac output. A slowing of the heart rate is an effect of
digoxin, so it should be withheld if the client's heart rate is less than 60/min.
C. Insulin is a hormone that promotes the uptake of glucose into the cells, thereby decreasing
circulating glucose. A blood glucose value of 250 mg/dL is above the expected reference range,
so the nurse should administer regular insulin.
D. Heparin is an anticoagulant that decreases the coagulability of the blood and is used for
clients who have thrombus. Dosing of heparin is dependent upon achieving a therapeutic aPTT
level. An aPTT of 70 seconds is within the expected reference range when administering heparin.
17. A nurse is caring for a pt who has sickle cell anemia and is taking Hydroxyurea. Which of the
following findings should the nurse report to the provider? (Select all that apply)
A. Haemoglobin 7.0 g/dL
B. Platelets 75,000/mm3
C. Potassium 5.2 mEq/L
D. Creatinine 1 mg/dL
E. RBC 4.7 million/mm3
Answer: C. Potassium 5.2 mEq/L
Explanation:
A. A haemoglobin level of 7.0 g/dL indicates hydroxyurea toxicity. This haemoglobin level is
below the expected reference range of 14 to 19 g/dL for a male client and 12 to 16 g/dL for a
female client. Therefore, the nurse should report this finding to the provider
B. A platelet level of 75,000/mm3 indicates hydroxyurea toxicity. This platelet level is below the
expected reference range of 150,00 to 400,000/mm3. Therefore, the nurse should report this
finding to the provider.
C. A potassium level of 5.2 mEq/L indicates tumour lysis syndrome. This potassium level is
above the expected reference range of 3.5 to 5 mEq/L. Therefore, the nurse should report this
finding to the provider.
D. A creatinine level of 1 mg/dL is within the expected reference range of 0.5 mg/dL to 1.2
mg/dL.
E. An RBC count of 4.7 million/mm3 is within the expected reference range of 4.7 to 6.1
million/mm3 for a male client and 4.2 to 5.4 million/mm3 for a female client.
18. A nurse is caring for a pt who has a magnesium level of 3.1mEq/L. The nurse should expect
to administer which of the following meds?
A. Magnesium gluconate
B. Cinacalcet
C. Calcium gluconate
D. Regular insulin
Answer: C. Calcium gluconate
Explanation:
A. A magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L.
Magnesium gluconate is administered to treat hypomagnesemia.
B. Cinacalcet is administered to treat hypercalcemia.
C. The nurse should expect to administer IV calcium gluconate to the client and prepare to
provide ventilatory support. This client is at risk for respiratory depression and cardiac
dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of
1.3 to 2.1 mEq/L.
D. Regular insulin is administered to treat hyperkalaemia.
19. A nurse is preparing to mix and administer Dantrolene via IV bolus to a pt who has
developed malignant hyperthermia during surgery. Which of the following actions should the
nurse take?
A. Administer the reconstituted medication slowly over 5 min.
B. Store the reconstituted medication in the refrigerator.
C. Use the reconstituted medication within 12 hr.
D. Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent
Answer: D. Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic
agent
Explanation:
A. The nurse should administer reconstituted dantrolene via IV bolus rapidly through a large
bore IV or central line.
B. The nurse should store the reconstituted medication at room temperature and protect it from
light until use.
C. The nurse should use the reconstituted medication within 6 hr.
D. The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic
agent and inject rapidly.
20. A nurse contacts a pt’s provider on the telephone to obtain a prescription for pain medication.
Which of the following actions should the nurse take?
A. Write the order on a prescription pad designated for the client's provider.
B. Have the provider spell out the unfamiliar medication names
C. Read the prescription back to the provider using abbreviations.
D. Consult with a second nurse for any questions regarding dosage.
Answer: B. Have the provider spell out the unfamiliar medication names
Explanation:
A. The nurse should write the order on the provider's order form in the client's medical record or
place the order into the computer on the provider's order form according to facility policy.
B. The nurse should ask the provider to spell out the name of the medication if the stated name is
one the nurse is not familiar with.
C. The nurse should read the prescription back to the provider using words in place of
abbreviations to reduce the risk of error. The nurse should ask the provider to acknowledge that
the prescription is correct after having it read back.
D. The nurse should consult the provider about any questions concerning the prescription.
21. A nurse is providing teaching for a pt who has multiple sclerosis and a new prescription for
Methylprednisolone. Which of the following instructions should the nurse include? (select all
that apply)
A. Blood glucose levels will be monitored during therapy
B. Avoid contact with people who have known infections
C. Grapefruit juice can increase the effects of the medication
D. Take the medication 1 hr before breakfast.
E. Decrease dietary intake of foods containing potassium
Answer: A. Blood glucose levels will be monitored during therapy
B. Avoid contact with people who have known infections
C. Grapefruit juice can increase the effects of the medication
Explanation:
A. The nurse should monitor the client for hyperglycaemia while providing methylprednisolone
to the client. Glucocorticoids, such as methylprednisolone, increase serum glucose levels and can
require management with insulin or antihyperglycemics.
B. The nurse should instruct the client to avoid exposure to infectious agents, such as contact
with those who have active infections or illnesses. Glucocorticoids, such as methylprednisolone,
depress the immune system, placing the client at an increased risk for developing an infection.
C. The nurse should instruct the client that grapefruit and grapefruit juice can increase the level
of methylprednisolone in the body.
D. The nurse should instruct the client to take the medication with food or milk to decrease
gastrointestinal upset.
E. The nurse should instruct the client to increase dietary intake of potassium-rich foods while
taking this medication. Glucocorticoids, such as methylprednisolone, deplete potassium in the
body, which manifests as hypokalaemia.
22. A nurse is teaching about Zolpidem to a pt who has insomnia. The nurse should identify that
which of the following pt statements indicates an understanding of the teaching?
A. "I will need to get laboratory testing prior to a refill of this medication."
B. "I will use this medication for a short period of time."
C. "I will need to take this medication for 1 week before results are seen."
D. "I will need to change the medications to prevent building up a tolerance."
Answer: B. "I will use this medication for a short period of time."
Explanation:
A. Laboratory testing is not needed when taking this medication for sleep.
B. Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should
reassess the client before refilling the prescription.
C. The client who takes zolpidem should experience improved sleep within 2 days of starting this
medication.
D. The client who takes zolpidem should not build up a tolerance to the medication with shortterm use.
23. A nurse is providing teaching to a pt about the use of Ethinyl estradiol/ norelgestromin. The
nurse should identify that which of the following statements by the pt indicates an understanding
of the teaching?
A. "I will apply the patch once a week for 2 weeks."
B."I will leave the existing patch on for 4 hours after applying the new patch."
C. "I will fold the sticky sides of the old patch together before disposing it."
D. "I will apply the patch within 14 days of menses."
Answer: C. "I will fold the sticky sides of the old patch together before disposing it."
Explanation:
A. The client should apply the patch once a week for 3 weeks and then go without the patch for 1
week to promote menstruation.
B. The client should remove and dispose the old patch before applying a new patch to prevent
toxicity by combining the remaining medication on the old patch with the medication on the new
patch.
C. The client should fold the sticky sides of the old patch together and then place it in a
childproof container to ensure safe disposal of the patch.
D. The client should apply the patch within 7 days of menses to prevent ovulation and the need
for another contraceptive method.
24. A nurse is providing teaching to a pt who has a new prescription for Ferrous sulphate. The
nurse should instruct the pt to take the medication with which of the following to promote
absorption?
A. Vitamin E
B. Orange juice
C. Milk
D. Antacids
Answer: B. Orange juice
Explanation:
A. Vitamin E has no effect on iron absorption.
B. The absorption of ferrous sulphate is enhanced by a vitamin C source, such as orange juice.
C. Milk inhibits iron absorption.
D. Antacids inhibit iron absorption.
25. A nurse is reviewing the lab results of a pt who is taking Carbamazepine for a seizure
disorder. Which of the following findings should the nurse report to the provider?
A. Potassium 4.1 mEq/L
B. 24-hour urine glucose 300 mg/day
C. Carbamazepine level 7 mcg/mL
D. WBC 3,500/mm3
Answer: D. WBC 3,500/mm3
Explanation:
A. A potassium level of 4.1 mEq/L is within the expected reference range of 3.5 to 5 mEq/L. The
nurse does not need to monitor potassium levels for a client taking carbamazepine; however, the
nurse should monitor sodium levels due to the potential adverse effect of hyponatremia.
B. A 24-hour urine glucose of 300 mg/day is within the expected reference range of 50 to 300
mg/day. The nurse should continue to monitor this value because carbamazepine can cause an
elevation in urine glucose levels.
C. A carbamazepine level of 7 mcg/mL is within the expected reference range of 5 to 12 mcg/mL
and is an expected finding
D. A WBC count of 3,500/mm3 is below the expected reference range of 5,000 to 10,000/mm3.
Leukopenia is an adverse effect of carbamazepine. The nurse should report this finding to the
provider and monitor the client for manifestations of infection.
26. A nurse is reviewing the medical record of a pt who has schizophrenia and a prescription for
Clozapine. Which of the following lab tests should the nurse review before administering the
medication?
A. Troponin
B. Total cholesterol
C. Creatinine
D. Thyroid stimulating hormone
Answer: B. Total cholesterol
Explanation:
A. The nurse should review the troponin level of a client who has chest pain and possible
myocardial infarction.
B. The nurse should review the client's total cholesterol before administering clozapine, because
this medication can cause hyperlipidaemia.
C. Clozapine is not metabolized by the kidneys. Therefore, the nurse does not need to review the
creatinine level before administering the medication.
D. The nurse should review the thyroid stimulating hormone level of a client who has
hypothyroidism or hyperthyroidism.
27. A nurse is planning to teach about inhalant medications to a pt who has a new diagnosis of
exercise induced asthma. Which of the following medications should the nurse plan to instruct
the pt to use prior to physical activity?
A. Cromolyn
B. Beclomethasone
C. Budesonide
D. Tiotropium
Answer: A. Cromolyn
Explanation:
A. Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other
inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to
exercise to prevent bronchospasms.
B. Beclomethasone is a prophylactic glucocorticoid inhalant medication that suppresses the
inflammatory and humoral immune responses. Beclomethasone should be administered with a
fixed schedule, not for PRN use before physical exercise.
C. Budesonide is a glucocorticoid medication used to treat asthma as a long-term inhaled agent.
This medication is administered by inhalation twice daily, not prior to physical activity.
D. Tiotropium is an anticholinergic medication that decreases mucus production and produces
bronchodilation. Tiotropium is used for maintenance therapy of bronchospasms and has a
duration of 24 hr.
28. A nurse is providing teaching to a pt who is to start therapy with Digoxin. For which of the
following adverse effects should the nurse instruct the pt to monitor and report to the provider?
A. Dry cough
B. Pedal edema
C. Bruising
D. Yellow-tinged vision
Answer: D. Yellow-tinged vision
Explanation:
A. Clients taking an ACE inhibitor, such as captopril, might develop a dry cough due to a
buildup of bradykinin and should report this adverse effect to the provider. However, respiratory
adverse effects are not associated with digoxin.
B. Clients taking a calcium channel blocker, such as verapamil, might develop pedal edema and
should report this adverse effect to the provider. However, peripheral edema is not associated
with digoxin.
C. Clients taking an anticoagulant, such as enoxaparin, might develop bruising and should report
this adverse effect to the provider. However, hematologic adverse effects are not associated with
digoxin.
D. The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a
sign of digoxin toxicity. Other manifestations of digoxin toxicity include nausea, vomiting, loss
of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac
dysrhythmias.
29. A nurse is caring for a pt who is to receive treatment for opioid use disorder. Which of the
following medications should the nurse expect to administer?
A. Bupropion
B. Disulfiram
C. Methadone
D. Modafinil
Answer: C. Methadone
Explanation:
A. The nurse should administer bupropion to assist the client with smoking cessation.
B. The nurse should administer disulfiram as an aversion therapy to assist with maintaining
abstinence from alcohol.
C. The nurse should expect to administer methadone for treatment of opioid use disorder.
Methadone can be administered for withdrawal and to assist with maintenance and suppressive
therapy.
D. The nurse should administer modafinil to assist with the fatigue and prolonged sleep from
methamphetamine withdrawal.
30. A nurse is caring for a pt who has heart failure and is receiving an IV infusion of Dopamine.
Which of the following findings indicates that the medication is effective?
A. Decreased blood pressure
B. Increased heart rate
C. Increased cardiac output
D. Decreased serum potassium
Answer: C. Increased cardiac output
Explanation:
A. Dopamine is an adrenergic that causes a receptor specificity effect, which increases blood
pressure.
B. Tachycardia is an adverse effect of dopamine and does not indicate the medication's
effectiveness.
C. Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac
output and improves perfusion.
D. Dopamine does not affect serum potassium levels.
31. A nurse administered Digoxin immune Fab to a pt who received the incorrect dose of
Digoxin over a period of 3 days. The nurse should identify that which of the following findings
indicates the antidote was effective?
A. Normal sinus rhythm
B. Digoxin level of 2.5 ng/mL
C. Decrease in blood pressure
D. Potassium level of 3.2 mEq/L
Answer: A. Normal sinus rhythm
Explanation:
A. Dysrhythmias are a life-threatening adverse effect of digoxin toxicity. The return of the heart
to normal sinus rhythm indicates a therapeutic response to the antidote. Digoxin immune Fab is
administered to a client who is experiencing severe digoxin toxicity. It binds with digoxin and
works to reduce the client's blood digoxin level.
B. A digoxin level of 2.5 ng/mL is above the expected reference range of 0.8 to 2 ng/mL.
Therefore, this finding does not indicate a therapeutic response to the antidote.
C. A decrease in blood pressure is not an indication of a therapeutic response to the antidote.
D. A potassium level of 3.2 mEq/L is below the expected reference range of 3.5 to 5.0 mEq/L. A
decreased potassium level can lead to toxicity in a client who is taking digoxin. However,
digoxin immune Fab is administered only for severe toxicity.
32. A nurse is caring for a pt who has hypocalcaemia and is receiving Calcium citrate. The nurse
should identify that which of the following findings indicates a therapeutic response to the
medication?
A. Positive Chvostek's sign
B. Client report of decreased paraesthesia
C. Client report of increased thirst
D. Calcium level of 8.8 mg/dL
Answer: B. Client report of decreased paraesthesia
Explanation:
A. A positive Chvostek's sign is a manifestation of hypocalcaemia and does not indicate a
therapeutic response to calcium citrate.
B. Paraesthesia is a manifestation of hypocalcaemia. A client report of a decrease in paraesthesia
is an indication of a therapeutic response to calcium citrate. The nurse should also monitor for a
decrease in other manifestations of hypocalcaemia, including muscle twitching and cardiac
dysrhythmias.
C. An increase in thirst is a manifestation of hypercalcemia and can be an indication of calcium
toxicity. The nurse should monitor the client for other manifestations of hypercalcemia, such as
nausea, vomiting, or anorexia.
D. A calcium level of 8.8 mg/dL is below the reference range of 9.0 to 10.5 mg/dL and does not
indicate a therapeutic response to calcium citrate.
33. A nurse is caring for a pt who is taking Atorvastatin for hyperlipidaemia. Which of the
following pt laboratory values should the nurse monitor?
A. Creatinine kinase
B. Erythrocyte sedimentation rate
C. International normalized ratio
D. Potassium
Answer: A. Creatinine kinase
Explanation:
A. The client who is taking atorvastatin can develop an adverse effect called rhabdomyolysis,
which causes muscle weakness or pain and can progress to myositis. Creatinine kinase levels rise
in response to enzymes released with muscle injury.
B. Erythrocyte sedimentation rates (ESR) evaluate the speed at which red blood cells settle in
plasma over a set amount of time. The nurse should monitor ESR for clients who have multiple
myeloma, rheumatoid arthritis, and systemic lupus erythematosus. However, ESR is not affected
by statins, such as atorvastatin.
C. The international normalized ratio (INR) measures clotting abilities of the blood. The nurse
should monitor INR for clients who are receiving warfarin therapy.
D. Potassium is a major electrolyte that maintains acid-base balance, oncotic pressure, and
cardiac rhythm. The nurse should monitor potassium levels in clients who are receiving loop
diuretics, such as bumetanide.
34. A nurse is caring for a pt who is receiving end of life care and has a prescription for Fentanyl
patches. Which of the following information regarding the adverse effects of Fentanyl should the
nurse plan to give to the pt and family?
A. The provider will prescribe naloxone at home for respiratory depression.
B. Remove the patch to reverse the adverse effects immediately.
C. Expect an increase in urinary output.
D. Take a stool softener on a daily basis
Answer: D. Take a stool softener on a daily basis
Explanation:
A. Naloxone is only for use in an acute care setting for the reversal of severe respiratory
depression.
B. After removing the patch, the effects will persist for several hours due to the absorption of the
residual medication on the skin.
C. Urinary retention is an adverse effect of opioids, including fentanyl.
D. Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of
this adverse effect.
35. A nurse is preparing to administer 0.9% Sodium Chloride (NaCl) 1,500 mL to infuse over 8hr
to a client who is postoperative. The nurse should set the IV pump to deliver how many mL/hr?
(Round to nearest whole #. Use a leading zero if it applies. Do not use a trailing zero)
Answer:
187.5 mL/hr = 188 mL/hr.
Explanation:
The nurse should set the IV pump to deliver 0.9% sodium chloride IV at 188 mL/hr.
36. A nurse is providing discharge instructions to a pt who is to self-administer insulin at home.
Which of the following pt statements should indicate to the nurse that the teaching is effective?
A. "I should avoid getting rid of the air bubble in the syringe."
B. "I should inject the insulin into my thigh for the fastest absorption."
C. "I will store my unopened bottles of insulin in the refrigerator."
D. "I need to shake the insulin before using it to make sure it is well mixed."
Answer: C. "I will store my unopened bottles of insulin in the refrigerator."
Explanation:
A. The nurse should instruct the client to expel all air bubbles in the syringe to ensure an accurate
dosage is delivered.
B. The nurse should instruct the client that the fastest absorption of insulin occurs with
abdominal injections. Absorption is slowest when the injection is into the thigh.
C. The client should store unopened vials of insulin in the refrigerator to maintain medication
viability. Once opened, the insulin can remain at room temperature for up to 1 month.
D. The nurse should instruct the client to mix insulin by rolling the insulin in the palm of their
hand to prevent frothing, which can cause the drawing up of an inaccurate dose of insulin.
37. A nurse is caring for a pt who has developed hypomagnesemia due to long term therapy with
Lansoprazole. The nurse should monitor the client for which of the following manifestations?
A. Bradycardia
B. Hypotension
C. Muscle weakness
D. Disorientation
Answer: D. Disorientation
Explanation:
A. The nurse should monitor the client for tachycardia as a manifestation of hypomagnesemia.
B. The nurse should monitor the client for hypertension as a manifestation of hypomagnesemia.
C. The nurse should monitor the client for neuromuscular irritability, such as tremors, as a
manifestation of hypomagnesemia.
D. The nurse should monitor the client for disorientation and confusion as manifestations of
hypomagnesemia. The nurse should also assess the client for a positive Chvostek's and
Trousseau's signs.
38. A nurse is teaching a pt who has a new prescription for Docusate sodium about the
medication’s mechanism of action. Which of the following information should the nurse include
in the teaching?
A. Docusate sodium reduces the surface tension of the stools to change their consistency
B. Docusate sodium causes rectal contractions.
C. Docusate sodium acts as a fibre agent, increasing bulk in the intestines.
D. Docusate sodium stimulates the motility of the intestines.
Answer: A. Docusate sodium reduces the surface tension of the stools to change their
consistency
Explanation:
A. Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water
to penetrate more easily into the stool.
B. Osmotic laxatives, such as glycerine suppositories, act by lubricating the lower colon and
initiating reflex contractions of the rectum.
C. Bulk-forming laxatives, such as methylcellulose, mimic the action of dietary fibre, forming a
viscous compound that softens the fecal mass and increases its bulk, which stimulates peristalsis.
D. Stimulant laxatives, such as bisacodyl, stimulate the intestinal wall to cause peristalsis by
pulling water into the intestines.
39. A nurse is administering Baclofen for a pt who has a spinal cord injury. Which of the
following findings should the nurse document as a therapeutic outcome?
A. Increase in seizure threshold
B. Decrease in flexor and extensor spasticity
C. Increase in cognitive function
D. Decrease in paralysis of the extremities
Answer: B. Decrease in flexor and extensor spasticity
Explanation:
A. A client who has a seizure disorder and takes baclofen can have a decrease in the seizure
threshold, which can result in seizure activity.
B. A client who has a spinal cord injury and takes baclofen can experience a decrease in the
frequency and severity of muscle spasms and in flexor and extensor spasticity.
C. A client who takes baclofen can experience the adverse effect of memory impairment and a
decrease in cognitive function.
D. A client who takes baclofen can experience the adverse effect of inhibited reflexes at the
spinal level; however, this medication does not decrease the effects of paralysis.
40. A nurse in a provider’s office is assessing a pt who has been taking Aspirin daily for the past
year. For which of the following findings should the nurse notify the provider immediately?
A. Hyperventilation
B. Heartburn
C. Anorexia
D. Swollen ankles
Answer: A. Hyperventilation
Explanation:
A. When using the urgent vs. nonurgent approach to client care, the nurse should determine that
the priority finding is hyperventilation. This finding indicates the client might have acute
salicylate poisoning, which causes respiratory alkalosis in the early stages.
B. Heartburn is nonurgent because the client who is taking aspirin can experience gastrointestinal
distress. Therefore, there is another finding that is the nurse's priority.
C. Anorexia is nonurgent because the client who is taking aspirin can experience a decrease in
appetite. Therefore, there is another finding that is the nurse's priority.
D. Swollen ankles are nonurgent because the client who is taking aspirin can experience sodium
and fluid retention. Therefore, there is another finding that is the nurse's priority.
41. A nurse is monitoring for adverse effects of Hydrochlorothiazide after administering the
medication to an older adult pt who has heart failure. Which of the following findings should the
nurse identify as an adverse effect of the medication?
A. Hypoglycaemia
B. Orthostatic hypotension
C. Bradycardia
D. Xanthopsia
Answer: B. Orthostatic hypotension
Explanation:
A. Hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause
hyperglycaemia.
B. The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic
medication, which can cause orthostatic hypotension and light headedness. Therefore, the nurse
should instruct the client to rise slowly when moving from a recumbent to a standing position.
C. The nurse should identify palpitations as an adverse effect of hydrochlorothiazide, which is an
antihypertensive thiazide diuretic medication.
D. The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic
medication and has an adverse effect of blurred vision. Xanthopsia causes objects to appear
yellow and is not an adverse effect of this medication.
42. A nurse is preparing to administer a new prescription of Amoxicillin / Clavulanic to a client.
The client tells the nurse that they are allergic to Penicillin. Which of the following actions
should the nurse take first?
A. Update the client's medical record.
B. Notify the provider.
C. Withhold the medication
D. Inform the pharmacist of the client's allergy to penicillin.
Answer: C. Withhold the medication
Explanation:
A. It is important to update the client's medical record to have complete information available;
however, the nurse should take another action first.
B. It is important to notify the provider because the client will need a new prescription; however,
the nurse should take another action first.
C. When using the urgent vs nonurgent approach to client care, the nurse should determine that
the priority action is to withhold the medication to prevent injury to the client.
D. It is important to inform the pharmacist of the allergy to promote continuity of care; however,
the nurse should take another action first.
43. A nurse is providing teaching to a client who has depression and a new prescription for
Fluoxetine. Which of the following statements by the client indicates an understanding of the
teaching?
A. "I should start to feel better within 24 hours of starting this medication."
B. "I will be sure to follow a strict diet to avoid foods with tyramine."
C. "I will continue to take St. John's Wort to increase the effects of the medication."
D. "I should take acetaminophen instead of ibuprofen for my headaches while taking this
medication."
Answer: D. "I should take acetaminophen instead of ibuprofen for my headaches while taking
this medication."
Explanation:
A. The nurse should inform the client that the therapeutic levels of fluoxetine can take between 1
and 4 weeks to achieve desired effects. The client should take the medication as prescribed and
use other strategies to manage depression in the interim.
B. Clients taking fluoxetine, a selective serotonin reuptake inhibitor, are not required to restrict
their dietary intake of tyramine. A client who is taking an MAOI, such as selegiline, should avoid
products containing tyramine.
C. Concurrent use of St. John's Wort and fluoxetine can increase the client's risk for serotonin
syndrome, a potentially life-threatening complication. Manifestations of serotonin syndrome
include confusion, hallucinations, hyperreflexia, excessive sweating, and fever.
D. Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used
concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine
should take acetaminophen for headaches or pain, since acetaminophen does not suppress
platelet aggregation.
44. A nurse is assessing a client who has received Atropine eye drops during an eye examination.
Which of the following findings should the nurse expect as an adverse effect of the medication?
A. Difficulty seeing in the dark
B. Pinpoint pupils
C. Blurred vision
D. Excessive tearing
Answer: C. Blurred vision
Explanation:
A. A client who has received atropine eye drops can experience photosensitivity, which causes
difficulty seeing in brightly lit areas due to the muscarinic receptors causing mydriasis.
B. Dilation of pupils, or mydriasis, is an expected finding following the administration of
atropine eye drops.
C. Blurred vision is an expected finding following the administration of atropine eye drops. This
is due to the cycloplegic effects of the medication, which cause distant objects to appear blurry to
the client.
D. Excessive tearing is not an expected finding following the administration of atropine eye
drops.
45. A nurse is providing discharge teaching to a client who has a new prescription for
Furosemide twice daily. The nurse should include which of the following instructions in the
teaching? (Select all that apply)
A. "Increase intake of potassium-rich foods"
B. "Monitor for muscle weakness"
C. "Dangle your legs from the side of the bed before standing"
D. "Take the second dose at bedtime"
E. "Obtain your weight weekly"
Answer: A. "Increase intake of potassium-rich foods"
B. "Monitor for muscle weakness"
C. "Dangle your legs from the side of the bed before standing"
Explanation:
A. Loop diuretics, such as furosemide, act at the loop of Henle by blocking the resorption of
sodium, water, and potassium. An adverse effect of the medication is the development of
electrolyte imbalances such as hyponatremia, hypochloraemia, and hypokalaemia. To prevent
hypokalaemia, the client should increase intake of potassium-rich foods, such as potatoes,
spinach, dried fruit, and nuts.
B. Furosemide, a loop diuretic, causes a loss of potassium, which can result in manifestations of
hypokalaemia such as difficulty concentrating, shallow respirations, hyporeflexia, and muscle
weakness. The nurse should instruct the client to monitor for these manifestations and report
them to the provider.
C. Loop diuretics, such as furosemide, reduce vascular tone and increase fluid excretion. These
effects decrease blood return to the heart and can manifest as dizziness and light-headedness
when going from a lying to a standing position. The client should change positions slowly to
minimize orthostatic hypotension.
D. Furosemide is a loop diuretic that causes diuresis. When taken twice daily, the client should
take the second dose of furosemide by 1400 hr to prevent nocturia.
E. Loop diuretics cause an increase in fluid excretion and can cause dehydration. While
manifestations of dehydration, such as increased thirst and decreased urine output, can assist in
the diagnosis of dehydration, the most reliable method of identifying the onset of dehydration is
by loss of weight. The client should obtain daily weights to monitor for the diuresis effect of the
medication.
46. A nurse is teaching a client who is to start taking Ranitidine for peptic ulcer disease. Which
of the following client statements should the nurse identify as understanding of the teaching?
A. "I will stop taking ranitidine when my stomach pain is gone."
B. "I know smoking makes ranitidine less effective"
C. "I will take ranitidine anytime my stomach hurts."
D. "I know that ranitidine will turn my stools black."
Answer: B. "I know smoking makes ranitidine less effective"
Explanation:
A. The nurse should instruct the client to take ranitidine on a continuous basis for the prescribed
time.
B. The nurse should instruct the client that smoking decreases the effectiveness of ranitidine by
exacerbating the ulcer manifestations.
C. The nurse should instruct the client to take ranitidine on a continuous basis for the prescribed
time.
D. Ranitidine does not cause stools to appear black. However, a bleeding peptic ulcer can cause a
client's stools to turn black.
47. A nurse is preparing to administer Hydrochlorothiazide (HCTZ) to a client. Which of the
following actions should the nurse take prior to administering the medication?
A. Ask the client to drink 8 oz of water.
B. Review the client's most recent Hgb level.
C. Obtain the client's blood pressure
D. Determine if the client is allergic to NSAIDs.
Answer: C. Obtain the client's blood pressure
Explanation:
A. HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure
and edema. The client does not need to drink 8 oz of water prior to taking the medication.
B. HCTZ does not affect Hgb levels. The nurse should monitor the client's electrolytes,
especially potassium, before and periodically while the client is taking this medication.
C. HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure
and edema. The nurse should obtain the client's blood pressure prior to administration of the
medication.
D. The nurse should assess the client for an allergy to sulfonamides due to the potential of crosssensitivity with HCTZ. NSAIDs can decrease the effectiveness of HCTZ.
48. A nurse is caring for a client who is recovering from deep vein thrombosis DVT and is to
start taking Warfarin. For which of the following findings should the nurse monitor as an adverse
effect to Warfarin?
A. Hypertension
B. Low INR
C. Constipation
D. Bleeding gums
Answer: D. Bleeding gums
Explanation:
A. The nurse should monitor for hypotension, which can indicate bleeding.
B. The nurse should monitor the INR daily until it increases to a therapeutic level.
C. The nurse should monitor for gastrointestinal irritation, which can include diarrhoea, nausea,
and vomiting.
D. The nurse should monitor the client for bleeding gums, which is an adverse effect of warfarin,
an anticoagulant.
49. A nurse is planning discharge teaching for a client who has a prescription for Furosemide.
The nurse should plan to include which of the following statements in the teaching?
A. "This medication increases your risk for hypertension."
B. "Avoid potassium-rich foods in your diet."
C. "Take each dose of medication in the evening before bed."
D. "Drink a glass of milk with each dose of medication"
Answer: D. "Drink a glass of milk with each dose of medication"
Explanation:
A. The client who takes furosemide has an increased risk of hypotension due to fluid loss from
the diuretic effect of the medication.
B. The client who takes furosemide has an increased risk for potassium loss because of the
diuretic effect of the medication that causes excretion of potassium through the kidneys. The
client should increase their intake of potassium-rich foods.
C. The client should take each dose of medication in the morning to avoid sleep disturbances
from nocturia.
D. The client should take furosemide with food or milk to reduce gastric irritation.
50. A nurse is teaching a client who is starting to take Diltiazem. Which of the following
statements should the nurse identify as an indication that the client understands the teaching?
A. "I will stop taking the medication if I get dizzy."
B. "I should not drink orange juice while taking this medication."
C. "I should expect to gain weight while taking this medication."
D. "I will check my heart rate before I take the medication"
Answer: D. "I will check my heart rate before I take the medication"
Explanation:
A. Diltiazem is a calcium channel blocker that causes vascular dilation, which can result in
orthostatic hypotension. The client should rise slowly when standing and avoid hazardous
activities until there is a stabilization of the medication and dizziness no longer occurs.
B. The client should not drink grapefruit juice while taking diltiazem because it can interfere
with metabolism of the medication by increasing the blood levels of diltiazem and leading to
toxicity.
C. Diltiazem, a calcium channel blocker, can decrease myocardial contraction, which can lead to
heart failure. If the client gains weight or develops shortness of breath, they should notify the
provider.
D. Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes,
which can lead to bradycardia. The client should check their heart rate before taking the
medication and notify the provider if it falls below the expected reference range.
51. A nurse is administering Diazepam to a client who is having a colonoscopy. Which of the
following actions should the nurse take?
A. Ensure flumazenil is available to administer for toxicity management
B. Monitor the client for an increase in blood pressure.
C. Expect the client to become unconscious within 30 seconds.
D. Measure the capnography level every hour until the client is awake and oriented.
Answer: A. Ensure flumazenil is available to administer for toxicity management
Explanation:
A. The nurse should monitor the client for manifestations of diazepam toxicity, such as
respiratory depression and hypotension. The nurse should be prepared to administer flumazenil
to reverse the effects of diazepam.
B. The nurse should monitor the client for the adverse effect of hypotension.
C. When diazepam is administered IV for induction of anaesthesia, the nurse should expect the
client to develop the full effect of the medication in 2 min.
D. The nurse should measure the capnography level every 15 to 30 min until the client is awake
and oriented and vital signs have returned to baseline.
52. A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant
and that she has not told her provider yet. The nurse should identify that pregnancy is a
contraindication for receiving which of the following medications?
A. Acetaminophen
B. Ipratropium
C. Benzonatate
D. Doxycycline
Answer: D. Doxycycline
Explanation:
A. Acetaminophen treats mild pain and is not contraindicated for the client at this time.
Acetaminophen IV is used with caution among clients who are pregnant or lactating.
B. Ipratropium is a long-acting bronchodilator and is not contraindicated for a client who is
pregnant.
C. Benzonatate is a cough suppressant and is not contraindicated for a client who is pregnant.
D. Doxycycline is a tetracycline antibiotic. The nurse should identify that doxycycline can cause
teratogenic effects such as staining of the infant's teeth when exposed to this medication.
Therefore, this medication is contraindicated for the client.
53. A nurse is caring for a client who reports lethargy and myalgia after taking Clozapine for 6
months. Which of the following actions should the nurse plan to take?
A. Infuse 0.9% sodium chloride 1,000 mL IV fluid bolus.
B. Schedule the client for an electroencephalogram.
C. Obtain WBC with absolute neutrophil count
D. Place the client on a tyramine-free diet.
Answer: C. Obtain WBC with absolute neutrophil count
Explanation:
A. The client who is dehydrated can receive 0.9% sodium chloride IV bolus, but it is not used to
treat the adverse effects of lethargy, myalgia, and weakness associated with clozapine.
B. The client who develops seizures can have an electroencephalogram, but it is not used to treat
or diagnose the client who has lethargy and myalgia.
C. The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect
of agranulocytosis. Therefore, monitoring the WBC with absolute neutrophil count weekly for
the first 6 months of treatment is recommended. After 6 months, monitoring can occur every 2
weeks up to 1 year.
D. The client can take clozapine with or without food and does not need to follow a tyraminefree diet. A client who is taking monoamine oxidase inhibitors should follow a tyramine-free
diet.
54. A nurse is assessing a client who is taking Amitriptyline for depression. Which of the
following findings should the nurse identify as an adverse effect of the medication?
A. Tinnitus
B. Urinary frequency
C. Dry mouth
D. Diarrhoea
Answer: C. Dry mouth
Explanation:
A. Amitriptyline is a tricyclic antidepressant medication that has anticholinergic properties. The
nurse should assess for sensory neurologic adverse effects such as blurred vision or an increased
sensitivity to light. However, tinnitus is not an expected finding.
B. The nurse should assess the client for genitourinary anticholinergic effects such as urinary
hesitancy or retention due to the blocking of acetylcholine receptors that cause anticholinergic
responses. However, urinary frequency is not an expected finding.
C. The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine
receptors that cause anticholinergic responses.
D. The nurse should assess the client for gastrointestinal anticholinergic effects such as
constipation. However, diarrhoea is not an expected finding.
55. A nurse administers Ceftazidime to a client who has a severe Penicillin allergy. The nurse
should identify which of the following client findings as an indication that she should complete
an incident report?
A. The client reports shortness of breath
B. The client is also taking lisinopril.
C. The client's pulse rate is 60/min.
D. The client's WBC count is 14,000/mm3.
Answer: A. The client reports shortness of breath
Explanation:
A. A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin
antibiotic, due to the potential for cross sensitivity. Shortness of breath can indicate the client is
developing anaphylaxis.
B. Lisinopril is an ACE inhibitor medication that has no known interaction with cephalosporins.
C. Cephalosporins do not affect the client's pulse rate. The client's pulse rate of 60/min is within
the expected reference range.
D. An elevated WBC count is an indication the client has an infection and should receive
antibiotic therapy.
56. A nurse is reviewing laboratory results for a client who is to receive a dose of Ceftazidime
via intermittent IV bolus. Which of the following laboratory Findings is the priority for the nurse
to report to the provider before administering the medication?
A. Total bilirubin 0.4 mg/dL
B. Alanine aminotransferase 26 units/L
C. Platelet count 360,000/mm3
D. Creatinine 2.6 mg/dL
Answer: D. Creatinine 2.6 mg/dL
Explanation:
A. Ceftazidime, a cephalosporin, can cause elevated liver function tests, such as bilirubin.
However, a total bilirubin value of 0.4 mg/dL is within the expected reference range.
B. Ceftazidime can cause elevated liver function tests, such as alanine aminotransferase.
However, an alanine aminotransferase value of 26 units/L is within the expected reference range.
C. Ceftazidime can cause thrombocytopenia. However, a platelet count of 360,000/mm 3 is within
the expected reference range.
D. Ceftazidime is excreted primarily by the renal system. A serum creatinine level above 1.3
mg/dL can indicate a kidney disorder requiring a reduction in the dose administered. The nurse
should notify the provider, who is likely to prescribe a lowered dose of medication.
57. A nurse is assessing a client who is receiving Epoetin alfa to treat anaemia. Which of the
following findings should the nurse monitor?
A. Paraesthesia
B. Increased blood pressure
C. Fever
D. Respiratory depression
Answer: B. Increased blood pressure
Explanation:
A. Epoetin alfa stimulates the bone marrow to increase production of red blood cells. Adverse
effects include neurological manifestations such as seizures, headache, and dizziness. However,
epoetin alfa does not cause paraesthesia.
B. The therapeutic effect of epoetin alfa is an increase in haematocrit levels, which can result in
an increase in a client's blood pressure. If the client's haematocrit level rises too rapidly,
hypertension and seizures can result. The nurse should monitor the client's blood pressure and
ensure hypertension is controlled prior to administering the medication.
C. Adverse effects of epoetin alfa include neurological manifestations such as coldness and
sweating. However, it does not cause fever.
D. Heart failure is an adverse effect of epoetin alfa. The nurse should monitor the client's
respiratory status and notify the provider if the client develops crackles or rhonchi. However,
epoetin alfa does not cause respiratory depression.
58. A nurse is completing an incident report for a medication error. Which of the following
information should the nurse include on the report?
A. This could have been avoided if I had double checked the medication administration record
with the client's identification band.
B. It was easy to get confused because another client is receiving a similar sounding medication.
C. Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for
the medication
D. While I rarely make medication errors, the client was given 80 mg of propranolol by mistake
at 1800.
Answer: C. Administered propranolol 80 mg PO at 1800 to the client who did not have a
prescription for the medication
Explanation:
A. The incident report should clearly and thoroughly report the facts of the error. It should not
include the nurse's opinion as to how the error might have been prevented.
B. The incident report should clearly and thoroughly report the facts of the error. It should not
include the nurse's opinion as to why the error might have occurred.
C. The incident report should clearly and thoroughly report the facts of the error.
D. The incident report should clearly and thoroughly report the facts of the error. It should not
include statements by the nurse regarding personal characteristics.
59. A nurse is teaching about self-administration of transdermal medication with a male client
who has a prescription for Nitro-glycerine. The nurse should identify that which of the following
statements by the client indicates an understanding of the teaching?
A. "I can apply the patch to a chest area that has hair."
B. "I can take this medication while using an erectile dysfunction product."
C. "I will remove the patch after 14 hours"
D. "I need to apply a new patch to the same area every day."
Answer: C. "I will remove the patch after 14 hours"
Explanation:
A. The client should apply the patch to an area of the skin that is hairless to enhance absorption
of the medication.
B. The client should not use erectile dysfunction products while taking nitro-glycerine because
this combination can cause severe hypotension and death.
C. The client should remove the patch after 12 to 14 hr to prevent tolerance of the medication.
D. The client should rotate the location of the patch daily to avoid irritation of the skin.
60. A nurse is reviewing the medical record of a client who has hypertension. The nurse should
identify which of the following findings as a contraindication for receiving Propranolol?
A. Cholelithiasis
B. Asthma
C. Angina pectoris
D. Tachycardia
Answer: B. Asthma
Explanation:
A. Cholelithiasis is not a contraindication for receiving propranolol.
B. Asthma is a contraindication for receiving propranolol. Propranolol is an adrenergic
antagonist which blocks the beta2 receptors in the lungs, causing bronchoconstriction and
leading to serious airway resistance and possibly respiratory arrest.
C. The client who has angina pectoris can receive propranolol to decrease heart rate and
contractility, resulting in a reduction of oxygen demand. Propranolol is contraindicated for use
when a client has vasospastic angina.
D. Tachycardia is not a contraindication for receiving propranolol. Propranolol is administered to
slow a client's heart rate and decrease oxygen demand.
