ATI Pharmacology Proctored Exam With Answers-242 Solved Questions

ATI Pharmacology Proctored EXAM
TESTBANK GRADED A LATEST VERSIONS
A provider prescribes phenobarbital for a client who has a seizure disorder. The medication has a
long half-life of 4 days. How many times per day should the nurse expect to administer this
medication?
A. One
B. Two
C. Three
D. Four
Answer: A. One
Rationale:
(Medications with long half-lives remain at their therapeutic levels between doses for long
periods of time. The nurse should expect to administer this medication once a day.)
A staff educator is reviewing medication dosages and factors that influence medication
metabolism with a group of nurses at an Inservice presentation. Which of the following factors
should the educator include as a reason to administer lower medication dosages? (Select all that
apply.)
A. Increased renal secretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication the same pathway metabolizes
Answer: C. Liver failure
E. Concurrent use of medication the same pathway metabolizes
Rationale:
C. Liver failure decreases metabolism and thus increases the concentration of a medication. This
requires decreasing the dosage.

E. When the same pathway metabolizes two medications, they compete for metabolism, thereby
increasing the concentration of one or both medications. This requires decreasing the dosage of
one or both
A nurse is preparing to administer eye drops to a client. Which of the following actions should
the nurse take? (Select all that apply.)
A. Have the client lie on her side.
B. Ask the client to look up at the ceiling.
C. Tell the client to blink when the drops enter her eye.
D. Drop the medication into the centre of the client's conjunctival sac.
E. Instruct the client to close her eye gently after instillation
Answer: B. Ask the client to look up at the ceiling.
D. Drop the medication into the centre of the client's conjunctival sac.
E. Instruct the client to close her eye gently after instillation
Rationale:
(B. The client should look upward to keep the drops from falling onto her cornea.
D. The nurse should drop the medication into the centre of the conjunctival sac to promote
distribution.
E. The client should close her eye gently to promote distribution of the medication)
A nurse is completing discharge teaching for a client who has a new prescription for transdermal
patches. Which of the following statements should the nurse identify as an indication that the
client understands the instructions?
A. "I will clean the site with an alcohol swab before I apply the patch."
B. "I will rotate the application sites weekly."
C. "I will apply the patch to an area of skin with no hair."
D. "I will place the new patch on the site of the old patch.
Answer: C. "I will apply the patch to an area of skin with no hair."
Rationale:

(The client should apply the patch to a hairless area of skin to promote absorption of the
medication.)
A nurse reviewing a client's medical record notes a new prescription for verifying the trough
level of the client's medication. Which of the following actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
B. Verify that the client has been taking the medication for 24 hr before obtaining a blood
specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Administer the medication, and obtain a blood specimen 30 min late
Answer: A. Obtain a blood specimen immediately prior to administering the next dose of
medication.
Rationale:
(To verify trough levels of a medication, the nurse should obtain a blood specimen immediately
before administering the next dose of medication.)
A nurse is preparing a client's medications. Which of the following actions should the nurse take
in following legal practice guidelines? (Select all that apply.)
A. Maintain skill competency.
B. Determine the dosage.
C. Monitor for adverse effects.
D. Safeguard medications.
E. Identify the client's diagnosis
Answer: A. Maintain skill competency.
C. Monitor for adverse effects.
D. Safeguard medications.
Rationale:
(A. maintaining skill competency and using appropriate administration techniques are legal
responsibilities of the nurse
C. A nurse is legally responsible for monitoring for side and adverse effects of medication

D. Safeguarding of medications, such as controlled substances, is a legal responsibility of the
nurse)
A nurse reviewing a client's health record notes a new prescription for Lisinopril 10 mg PO once
every day. The nurse should identify this as which of the following types of prescription?
A. Single
B. Stat
C. Routine
D. Standing
Answer: C. Routine
Rationale:
(A routine or standard prescription identifies medications to give on a regular schedule with or
without a termination date or a specific number of doses. The nurse will administer this
medication every day until the provider discontinues it.)
A nurse is reviewing a new prescription for Ondansetron 4 mg PO PRN for nausea and vomiting
for a client who has Hyperemesis Gravidarum. The nurse should clarify which of the following
parts of the prescription with the provider?
A. Name
B. Dosage
C. Route
D. Frequency
Answer: D. Frequency
Rationale:
(This prescription does not include the time or frequency of medication administration. The
nurse must clarify this with the prescribing provide)
A nurse is admitting a client and completing a preassessment before administering medications.
Which of the following data should the nurse include in the preassessment? (Select all that
apply.)
A. Use of herbal teas

B. Daily fluid intake
C. Current health status
D. Previous surgical history
E. Food allergies
Answer: A. Use of herbal teas
C. Current health status
E. Food allergies
Rationale:
(A. The nurse should inquire about the client's use of herbal products, which often contain
caffeine, prior to medication administration because caffeine can affect medication
biotransformation
C. The nurse should review the client's current health status because new prescriptions can cause
alterations in current health status
E. The nurse should inquire about food allergies during the preassessment to identify any
potential reactions or interactions)
A nurse orienting a newly licensed nurse is reviewing the procedure for taking a telephone
prescription. Which of the following statements should the nurse identify as an indication that
the newly licensed nurse understands the process?
A. "A second nurse enters the prescription into the client's medical record."
B. "Another nurse should listen to the phone call."
C. "The provider can clarify the prescription when he signs the health record."
D. "I should omit the 'read back' if this is a one-time prescription
Answer: B. "Another nurse should listen to the phone call."
Rationale:
(A second nurse should listen to a telephone prescription to prevent errors in communication.)
A nurse is preparing to administer vancomycin 1 g by intermittent IV bolus. Available is
vancomycin 1 g in 100 mL of dextrose 5% in water (D5W) to infuse over 45 min. The drop
factor of the manual IV tubing is 10 gtt/mL. The nurse should adjust the manual IV infusion to

deliver how many gtt/min? (Round the answer to the nearest whole number. Do not use a trailing
zero.
Answer: 22
Rationale:
To deliver 1 g over 45 minutes at 1 g/100 mL, the infusion rate is 100 mL/45 min = 2.22
mL/min. Using the drop factor of 10 gtt/mL, the rate in gtt/min is 2.22 mL/min × 10 gtt/mL = 22
gtt/min.
A nurse is preparing to administer clindamycin 200 mg by intermittent IV bolus. The amount
available is clindamycin injection 200 mg in 100 mL 0.9% sodium chloride (0.9% NaCl) to
infuse over 30 min. The nurse should set the IV pump to deliver how many mL/hr? (Round the
answer to the nearest whole number. Do not use a trailing zero.
Answer: 200
Rationale:
To deliver 200 mg over 30 minutes with 200 mg/100 mL concentration, the infusion rate is 100
mL/30 min = 3.33 mL/min. Multiplying by 60 minutes to get mL/hr gives 3.33 mL/min × 60
min/hr ≈ 200 mL/hr.
A nurse is preparing to administer furosemide 80 mg PO daily. The amount available is
furosemide oral solution 10 mg/1 mL. how many mL should the nurse administer? (Round the
answer to the nearest whole number. Do not use a trailing zero.)
Answer: 8
Rationale:
To administer 80 mg of furosemide at a concentration of 10 mg/1 mL, the nurse should
administer 80 mg / 10 mg/mL = 8 mL.
A nurse is preparing to administer Haloperidol 2 mg PO every 12hr. The amount available is
haloperidol 1 mg/tablet. how many tablets should the nurse administer? (Round the answer to the
nearest whole number. Do not use a trailing zero).
Answer: 2
Rationale:

To administer 2 mg of Haloperidol every 12 hours, the nurse should administer 2 mg / 1
mg/tablet = 2 tablets.
A nurse is preparing to administer Amoxicillin 20 mg/kg/day PO to divide equally every 12 hr to
a preschooler who weighs 44 lb. The amount available is amoxicillin suspension 250 mg/5 mL.
how many mL should the nurse administer per dose? (Round the answer to the nearest whole
number. Do not use a trailing zero.)
Answer: 4
Rationale:
To calculate the total daily dose for a 44 lb preschooler, convert pounds to kilograms (44 lb / 2.2
lb/kg = 20 kg). Then, administer 20 mg/kg/day * 20 kg = 400 mg/day. Since it's divided equally
every 12 hours, each dose is 400 mg / 2 doses = 200 mg. With a concentration of 250 mg/5 mL,
the nurse should administer 200 mg / 250 mg/5 mL = 4 mL per dose
A nurse is preparing to administer heparin 15,000 units subcutaneously every 12 hr. The amount
available is heparin injection 20,000 units/mL. How many mL should the nurse administer per
dose? (Round the answer to the nearest tenth. Do not use a trailing zero.)
Answer: 0.8
Rationale:
To calculate the mL needed, divide the desired dose (15,000 units) by the concentration of the
heparin solution (20,000 units/mL). This yields 0.75 mL, rounded to the nearest tenth, which is
0.8 mL.
A nurse is preparing to administer acetaminophen 650 mg PO every 6 hr PRN for pain. The
amount available is acetaminophen liquid 500 mg/5 mL. how many mL should the nurse
administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do
not use a trailing zero.
Answer: 6.5
Rationale:
To find the mL needed, divide the desired dose (650 mg) by the concentration of the
acetaminophen liquid (500 mg/5 mL). This yields 6.5 mL, rounded to the nearest tenth.

A nurse is preparing to administer dextrose 5% in water (D5W) 750 mL IV to infuse over 6 hr.
The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest
whole number. Do not use a trailing zero.
Answer: 125
Rationale:
To calculate the mL/hr, divide the total volume (750 mL) by the total infusion time (6 hours).
This yields 125 mL/hr when rounded to the nearest whole number.
A nurse is assessing a client's IV infusion site. Which of the following findings should the nurse
identify as an indication of phlebitis? (Select all that apply.)
A. Pallor
B. Dampness
C. Erythema
D. Coolness
E. Pain
Answer: C. Erythema
E. Pain
Rationale:
(C. Erythema at the insertion site is a manifestation of phlebitis.
E. Pain at the insertion site is a manifestation of phlebitis.)
A nurse manager is reviewing the facility's policies for IV therapy with the members of his team.
The nurse manager should remind the team that which of the following techniques helps
minimize the risk of catheter embolism?
A. Performing hand hygiene before and after IV insertion
B. Rotating IV sites at least every 72 hr
C. Minimizing tourniquet time
D. Avoiding reinserting the needle into an IV catheter
Answer: D. Avoiding reinserting the needle into an IV catheter
Rationale:

(The nurse manager should remind the members of the team to avoid reinserting the stylet needle
into an IV catheter. This action can result in severing the end of the catheter and consequently
cause a catheter embolism)
A nurse is preparing to initiate IV therapy for an older adult client. Which of the following
actions should the nurse plan to take?
A. Use a disposable razor to remove excess hair on the extremity.
B. Select the back of the client's hand to insert the IV catheter.
C. Distend the veins by using a blood pressure cuff.
D. Direct the client to raise his arm above his heart
Answer: C. Distend the veins by using a blood pressure cuff.
Rationale:
(The nurse should distend the veins using a blood pressure cuff to reduce overfilling of the vein,
which can result in a hematoma)
A nurse assessing a client's IV catheter insertion site notes a hematoma. Which of the following
actions should the nurse take? (Select all that apply.)
A. Stop the infusion.
B. Apply alcohol to the insertion site.
C. Apply warm compresses to the insertion site
D. Elevate the client's arm.
E. Obtain a specimen for culture at the insertion site
Answer: C. Apply warm compresses to the insertion site
D. Elevate the client's arm.
Rationale:
(C. Warm compresses can help promote healing of a hematoma.
D. Elevation of the arm helps reduce edema, which can cause pressure and pain and additional
bleeding in the area of the hematoma.)

A nurse in a clinic is caring for a group of clients. The nurse should contact the provider about a
potential contraindication to a medication for which of the following clients? (Select all that
apply.)
A. A client at 8 weeks of gestation who asks for an Influenza immunization
B. A client who takes Prednisone and has a possible Fungal infection
C. A client who has chronic liver disease and is taking Hydrocodone
D. A client who has Peptic Ulcer Disease, takes Sucralfate, and tells the nurse she has started
taking OTC Aluminium Hydroxide
E. A client who has a prosthetic heart valve, takes Warfarin, and reports a suspected pregnancy
Answer: B. A client who takes Prednisone and has a possible Fungal infection
C. A client who has chronic liver disease and is taking Hydrocodone
E. A client who has a prosthetic heart valve, takes Warfarin, and reports a suspected pregnancy
Rationale:
(B. Glucocorticoids should not be taken by a client who has a possible systemic fungal infection.
The nurse should recognize a contraindication and notify the provider.
C. Acetaminophen is contraindicated due to toxicity for a client who has a liver disorder. The
nurse should notify the provider, who can prescribe a medication that does not contain
acetaminophen.
E. Warfarin is a Pregnancy Category X medication, which can cause severe birth defects to the
fetus. The nurse should notify the provider about the suspected pregnancy)
A nurse is preparing to administer an IM dose of penicillin to a client who has a new
prescription. The client states she took penicillin 3 years ago and developed a rash. Which of the
following actions should the nurse take?
A. Administer the prescribed dose.
B. Withhold the medication.
C. Ask the provider to change the prescription to an oral form.
D. Administer an oral antihistamine at the same time
Answer: B. Withhold the medication.
Rationale:

(The nurse should withhold the medication and notify the provider of the client's previous
reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to
penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported
to the provider.)
A nurse is providing discharge instructions for a client who has a new prescription for an
antihypertensive medication. Which of the following statements should the nurse give?
A. "Be sure to limit your potassium intake while taking the medication."
B. "You should check your blood pressure every 8 hours while taking this medication."
C. "Your medication dosage will be increased if you develop tachycardia."
D. "Change positions slowly when you move from sitting to standing."
Answer: D. "Change positions slowly when you move from sitting to standing."
Rationale:
(Orthostatic hypotension is a common adverse effect of antihypertensive medications. The client
should move slowly to a sitting or standing position and should be taught to sit or lie down if
light-headedness or dizziness occurs)
A nurse is reviewing a client's health record and notes that the client experiences permanent
extrapyramidal effects caused by a previous medication. The nurse should recognize that the
medication affected which of the following systems in the client?
A. Cardiovascular
B. Immune
C. Central nervous
D. Gastrointestinal
Answer: C. Central nervous
Rationale:
(The nurse should realize that extrapyramidal effects are movement disorders that can be caused
by a number of central nervous system medications, such as typical antipsychotic medications)

A nurse is caring for a client who is taking oral Oxycodone The client states he is also taking
Ibuprofen in three recommended doses daily. The nurse should identify that an interaction
between these two medications will cause which of the following findings?
A. A decrease in serum levels of ibuprofen, possibly leading to a need for increased doses of this
medication
B. A decrease in serum levels of oxycodone, possibly leading to a need for increased doses of
this medication
C. An increase in the expected therapeutic effect of both medications
D. An increase in expected adverse effects for both medications
Answer: C. An increase in the expected therapeutic effect of both medications
Rationale:
(These medications work together to increase the pain-relieving effects of both medications.
Oxycodone is a narcotic analgesic, and ibuprofen is an NSAID. They work by different
mechanisms, but pain is better relieved when they are taken together)
A nurse is preparing to administer medications to a 4-month-old infant. Which of the following
pharmacokinetic principles should the nurse consider when administering medications to this
client? (Select all that apply.)
A. Infants have a more rapid gastric emptying time.
B. Infants have immature liver function.
C. Infants' blood-brain barrier is poorly developed.
D. Infants have an increased ability to absorb topical medications.
E. Infants have an increased number of protein-binding sites.
Answer: B. Infants have immature liver function.
C. Infants' blood-brain barrier is poorly developed.
D. Infants have an increased ability to absorb topical medications.
Rationale:
(B. Infants have immature liver function until 1 year of age. The nurse should administer
medications the liver metabolizes in smaller dosages.

C. Infants have a poorly developed blood-brain barrier, which places them at risk for adverse
effects from medications that pass through the blood-brain barrier. The nurse should administer
these medications in smaller dosages.
D. Because infants have more blood flowing to the skin and their skin is thin, their medication
absorption is increased, making them prone to toxicity from topical medications)
A nurse in a provider's office is reviewing the medical record of a client who is pregnant and is at
her first prenatal visit. Which of the following immunizations may the nurse administer safely to
this client?
A. Varicella vaccine
B. Rubella vaccine
C. Inactivated influenza vaccine
D. Measles vaccine
Answer: C. Inactivated influenza vaccine
Rationale:
(During influenza season, providers recommend the inactivated influenza vaccine for women
who are pregnant)
A nurse on a medical-surgical unit administers a hypnotic medication to an older adult client at
2100. The next morning, the client is drowsy and wants to sleep instead of eating breakfast.
Which of the following factors should the nurse identify as a possible reason for the client's
drowsiness?
A. Reduced cardiac function
B. First-pass effect
C. Reduced hepatic function
D. Increased gastric motility
Answer: C. Reduced hepatic function
Rationale:
(Older adults have reduced hepatic function, which can prolong the effects of medications the
liver metabolizes. The client probably needs a lower dosage of the hypnotic medication)

A nurse working in an emergency department is caring for a client who has Benzodiazepine
toxicity due to an overdose. Which of the following actions is the nurse's priority?
A. Administer flumazenil.
B. Identify the client's level of orientation.
C. Infuse IV fluids.
D. Prepare the client for gastric lavage
Answer: B. Identify the client's level of orientation.
Rationale:
(The first action the nurse should take when using the nursing process is to assess the client.
Identifying the client's level of orientation is the priority action.)
A nurse is teaching a client who has a new prescription for Escitalopram for treatment of
generalized Anxiety disorder. Which of the following statements by the client indicates
understanding of the teaching?
A. "I should take the medication on an empty stomach."
B. "I will follow a low-sodium diet while taking this medication."
C. "I need to discontinue this medication slowly."
D. "I should not crush this medication before swallowing."
Answer: C. "I need to discontinue this medication slowly."
Rationale:
(When discontinuing escitalopram, the client should taper the medication slowly according to a
prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome.)
A nurse is providing teaching to a client who has a new prescription for Buspirone to treat
Anxiety. Which of the following information should the nurse include?
A. "Take this medication on an empty stomach"
B. "Expect optimal therapeutic effects within 24 hr."
C. "Take this medication when needed for anxiety"
D. "This medication has a low risk for dependency." CORRECT
Answer: D. "This medication has a low risk for dependency."
Rationale:

(Buspirone has a low risk for physical or psychological dependence or tolerance.)
A nurse is teaching a client who has OCD and has a new prescription for Paroxetine. Which of
the following instructions should the nurse include?
A. "It can take several weeks before you feel like the medication is helping."
B. "Take the medication just before bedtime to promote sleep."
C. "You should take the medication when needed for obsessive urges."
D. "Monitor for weight gain while taking this medication."
Answer: A. "It can take several weeks before you feel like the medication is helping."
Rationale:
(Paroxetine can take 1 to 4 weeks before the client reaches full therapeutic benefit.)
A nurse is caring for a client who takes Paroxetine to treat PTSD and reports that he grinds his
teeth during the night. The nurse should identify which of the following interventions to manage
Bruxism? (Select all that apply.)
A. Concurrent administration of buspirone
B. Administration of a different SSRI
C. Use of a mouth guard
D. Changing to a different class of antidepressant medication
E. Increasing the dose of paroxetine
Answer: A. Concurrent administration of buspirone
C. Use of a mouth guard
D. Changing to a different class of antidepressant medication
Rationale:
(A. Concurrent administration of a low dose of buspirone is an effective measure to manage the
adverse effects of paroxetine
C. Using a mouth guard during sleep can decrease the risk for oral damage resulting from
bruxism.
D. Changing to different class of antidepressant medication that does not have the adverse effect
of bruxism is an effective measure)

A nurse is caring for a client who has a new prescription for Phenelzine for the treatment of
depression. Which of the following indicates that the client has developed an adverse effect of
this medication?
A. Orthostatic hypotension
B. Hearing loss
C. Gastrointestinal bleeding
D. Weight loss
Answer: A. Orthostatic hypotension
Rationale:
(Orthostatic hypotension is an adverse of effect of mAOIs, including phenelzine.)
A nurse is providing teaching to a client who has a new prescription for Amitriptyline for
treatment of depression. Which of the following should the nurse include in the teaching? (Select
all that apply.)
A. Expect therapeutic effects in 24 to 48 hr.
B. Discontinue the medication after a week of improved mood.
C. Change positions slowly to minimize dizziness.
D. Decrease dietary fiber intake to control diarrhoea.
E. Chew sugarless gum to prevent dry mouth
Answer: C. Change positions slowly to minimize dizziness.
E. Chew sugarless gum to prevent dry mouth
Rationale:
(C. Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect
of amitriptyline
E. Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline)
A nurse is providing discharge teaching to a client who has a new prescription for Fluoxetine for
PTSD. Which of the following statements should the nurse include in the teaching?
A. "You may have a decreased desire for intimacy while taking this medication."
B. "You should take this medication at bedtime to help promote sleep."
C. "You will have fewer urinary adverse effects if you urinate just before taking this medication."

D. "You'll need to wear sunglasses when outdoors due to the light sensitivity caused by this
medication.
Answer: A. "You may have a decreased desire for intimacy while taking this medication."
Rationale:
(Decreased libido is a potential adverse effect of fluoxetine and other SSRIs)
A nurse is caring for a client who has Depression and a new prescription for Venlafaxine. For
which of the following adverse effects should the nurse monitor this client? (Select all that apply)
A. Cough
B. Dizziness
C. Decreased libido
D. Alopecia
E. hypotension
Answer: A. Cough
B. Dizziness
C. Decreased libido
Rationale:
(A. Cough and dyspnea can indicate that the client has developed bronchitis, which is an adverse
effect of venlafaxine.
B. Dizziness is a common adverse effect of venlafaxine.
C. Sexual dysfunction, such as decreased)
A nurse is caring for a client who has been taking Sertraline for the past 2 days. Which of the
following assessment findings should alert the nurse to the possibility that the client is
developing Serotonin syndrome?
A. Bruising
B. Fever
C. Abdominal pain
D. Rash
Answer: B. Fever
Rationale:

(Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as
sertraline)
A nurse is reviewing laboratory findings and notes that a client's plasma Lithium level is 2.1
mEq/L. Which of the following is an appropriate action by the nurse?
A. Perform immediate gastric lavage.
B. Prepare the client for haemodialysis.
C. Administer an additional oral dose of lithium.
D. Request a stat repeat of the laboratory test
Answer: A. Perform immediate gastric lavage.
Rationale:
(Gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma
lithium level of 2.1 mEq/L. This action will lower the client's lithium level.)
A nurse is caring for a client who has a new prescription for Lithium Carbonate. When teaching
the client about ways to prevent Lithium toxicity, the nurse should advise the client to do which
of the following?
A. Avoid the use of acetaminophen for headaches.
B. Restrict intake of foods rich in sodium.
C. Decrease fluid intake to less than 1,500 mL daily
D. Limit aerobic activity in hot weather
Answer: D. Limit aerobic activity in hot weather
Rationale:
(The client should avoid activities that have the potential to cause sodium/water depletion, which
can increase the risk for toxicity)
A nurse is assessing a client who takes Lithium Carbonate for the treatment of Bipolar disorder.
The nurse should recognize which of the following findings as a possible indication of toxicity to
this medication?
A. Severe hypertension
B. Coarse tremors

C. Constipation
D. Muscle spasm
Answer: B. Coarse tremors
Rationale:
(Coarse tremors are an indication of toxicity)
A nurse is caring for a client who has a new prescription for Valproic Acid. The nurse should
instruct the client that while taking this medication he will need to have which of the following
laboratory tests completed periodically? (Select all that apply.)
A. Thrombocyte count
B. Hematocrit
C. Amylase
D. Liver function tests
E. Potassium
Answer: A. Thrombocyte count
C. Amylase
D. Liver function tests
Rationale:
(A. Treatment with valproic acid can result in thrombocytopenia. The client's thrombocyte count
should be monitored periodically.
C. Treatment with valproic acid can result in pancreatitis. The client's amylase should be
monitored periodically.
D. Treatment with valproic acid can result in hepatotoxicity. The client's liver function should be
monitored periodically.)
A nurse is preparing a teaching plan for a female client who has Bipolar disorder and a new
prescription for Carbamazepine. Which of the following instructions should the nurse include in
the teaching? (Select all that apply.)
A. "This medication can safely be taken during pregnancy."
B. "Eliminate grapefruit juice from your diet."

C. "You will need to have a complete blood count and carbamazepine levels drawn periodically."
D. "Notify your provider if you develop a rash."
E. "Avoid driving for the first few days after starting this medication.
Answer: B. "Eliminate grapefruit juice from your diet."
C. "You will need to have a complete blood count and carbamazepine levels drawn periodically."
D. "Notify your provider if you develop a rash."
E. "Avoid driving for the first few days after starting this medication.
Rationale:
(B. Grapefruit juice affects carbamazepine metabolism and should be avoided.
C. Carbamazepine blood levels and the CBC should be monitored during therapy. The client is at
risk for bone marrow depression while taking carbamazepine and should notify the provider for a
sore throat or other manifestations of an infection.
D. Carbamazepine can cause Stevens-Johnson syndrome, which can be fatal. The client should
notify the provider promptly if a rash occurs.
E. CNS effects such as drowsiness or dizziness can occur early in treatment with carbamazepine
and the client should avoid activities requiring alertness until these effects subside)
A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects
of Fluphenazine. Which of the following should the nurse suggest to the client to minimize
anticholinergic effects?
A. Take the medication in the morning to prevent insomnia.
B. Chew sugarless gum to moisten the mouth.
C. Use cooling measures to decrease fever.
D. Take an antacid to relieve nausea
Answer: B. Chew sugarless gum to moisten the mouth.
Rationale:
(Chewing sugarless gum can help the client cope with dry mouth, a potential anticholinergic
effect of fluphenazine)
A nurse is assessing a male client who recently began taking Haloperidol. Which of the
following findings is the highest priority to report to the provider?

A. Shuffling gait
B. Neck spasms
C. Drowsiness
D. Impotence
Answer: B. Neck spasms
Rationale:
(Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid
treatment. This is the greatest risk to the client and is therefore the priority finding.)
A nurse is providing discharge teaching to a client who has a new prescription for Clozapine.
Which of the following statements should the nurse include in the teaching?
A. "You should have a high-carbohydrate snack between meals and at bedtime."
B "You are likely to develop hand tremors if you take this medication for a long period of time."
C. "You may experience temporary numbness of your mouth after each dose."
D. "You should have your white blood cell count monitored every week.
Answer: D. "You should have your white blood cell count monitored every week.
Rationale:
(Due to the risk for fatal agranulocytosis weekly monitoring of the client's WBC count is
recommended while taking clozapine)
A nurse is providing teaching for a male client who has Schizophrenia and is taking Risperidone.
Which of the following instructions should the nurse include in the teaching?
A. "Add extra snacks to your diet to prevent weight loss."
B. "Notify the provider if you develop breast enlargement."
C. "You may begin to have mild seizures while taking this medication."
D." This medication is likely to increase your libido."
Answer: B. "Notify the provider if you develop breast enlargement."
Rationale:
(Gynecomastia (breast enlargement) and galactorrhoea can occur due to an increase in prolactin
levels while taking risperidone. The client should inform the provider if these manifestations
occur.)

A nurse is preparing to perform a follow-up assessment on a client who takes Chlorpromazine
for the treatment of Schizophrenia. The nurse should expect to find the greatest improvement in
which of the following manifestations? (Select all that apply.)
A. Disorganized speech
B. Bizarre behavior
C. Impaired social interactions
D. Hallucinations
E. Decreased motivation
Answer: A. Disorganized speech
B. Bizarre behavior
D. Hallucinations
Rationale:
(A. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should
have the greatest improvement in positive symptoms such as disorganized speech.
B. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should
have the greatest improvement in positive symptoms such as bizarre behavior
D. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should
have the greatest improvement in positive symptoms such as hallucinations.)
A nurse is teaching the parents of a child who has a new prescription for Desipramine. The nurse
should instruct the parents that which of the following adverse effects is the priority to report to
the provider?
A. Constipation
B. Suicidal thoughts
C. Photophobia
D. Dry mouth
Answer: B. Suicidal thoughts
Rationale:
(The greatest risk to this client is injury from a suicide attempt; therefore, this is the priority.
Desipramine can cause suicidal thoughts and behaviours which puts the client at risk. The

parents should monitor and report any indication of increased depression or thoughts of suicidal
behavior.)
A nurse is teaching an adolescent client who has a new prescription for Clomipramine for OCD.
Which of the following instructions should the nurse include to minimize an adverse effect of his
medication?
A. Wear sunglasses when outdoors.
B. Check your temperature daily.
C. Take this medication in the morning.
D. Add extra calories to your die
Answer: A. Wear sunglasses when outdoors.
Rationale:
(Wearing sunglasses when outdoors will decrease photophobia, an anticholinergic effect
associated with TCA use)
A nurse is caring for a school-age child who has a new prescription for Atomoxetine. The nurse
should monitor the client for which of the following adverse effects of this medication?
A. Kidney toxicity
B. Liver damage
C. Seizure activity
D. Adrenal insufficiency
Answer: B. Liver damage
Rationale:
(Liver damage is an adverse effect of atomoxetine. The nurse should monitor for manifestations
such as jaundice, upper abdominal tenderness, darkening of urine, and elevated liver enzymes)
A nurse is teaching the parents of a school-age child about transdermal Methylphenidate. Which
of the following instructions should the nurse include?
A. Apply one patch twice per day.
B. Leave the patch on for 9 hr.
C. Apply the patch to the child's waist.

D. Use opened tray within 6 months.
Answer: B. Leave the patch on for 9 hr.
Rationale:
(Transdermal methylphenidate is administered for 9 hr/day.)
A nurse is teaching a school-age child and his parents about a new prescription for
Lisdexamfetamine. Which of the following information should the nurse include in the teaching?
(Select all that apply.)
A. An adverse effect of this medication is CNS stimulation.
B. Administer the medication before bedtime.
C. Monitor blood pressure while taking this medication.
D. Therapeutic effects of this medication will take 1 to 3 weeks to fully develop.
E. This medication raises the levels of dopamine in the brain
Answer: A. An adverse effect of this medication is CNS stimulation.
C. Monitor blood pressure while taking this medication.
E. This medication raises the levels of dopamine in the brain
Rationale:
(A. An adverse effect of lisdexamfetamine is CNS stimulation such as insomnia and restlessness.
C. The nurse should instruct the client to monitor his blood pressure due to potential
cardiovascular effects of lisdexamfetamine.
E. Lisdexamfetamine, a CNS stimulant, works by raising the levels of norepinephrine and
dopamine in the CNS)
A nurse is providing teaching for a client who is withdrawing from alcohol and has a new
prescription for Propranolol. Which of the following information should the nurse to include in
the teaching?
A. Increases the risk for seizure activity
B. Provides a form of aversion therapy
C. Decreases cravings
D. Results in mild hypertension
Answer: C. Decreases cravings

Rationale:
(Propranolol is an adjunct medication used during withdrawal to decrease he client's craving for
alcohol)
A charge nurse is planning a staff education session to discuss medications used during the care
of a client experiencing alcohol withdrawal. Which of the following medications should the
charge nurse include in the discussion? (Select all that apply.)
A. Lorazepam
B. Diazepam
C. Disulfiram
D. Naltrexone
E. Acamprosate
Answer: A. Lorazepam
B. Diazepam
Rationale:
(A. Lorazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and
reduce the risk for seizures.
B. Diazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce
the risk for seizure)
A nurse is providing teaching to a client who has a new prescription for Clonidine to assist with
maintenance of abstinence from opioids. The nurse should instruct the client to monitor for
which of the following adverse effects?
A. Diarrhea
B. Dry mouth
C. Insomnia
D. Hypertension
Answer: B. Dry mouth
Rationale:
(Dry mouth is a common adverse effect associated with clonidine use)

A nurse is teaching a female client who has tobacco use disorder about Nicotine replacement
therapy. Which of the following statements by the client indicates understanding of the teaching?
A. "I should avoid eating right before I chew a piece of nicotine gum."
B. "I will need to stop using the nicotine gum after 1 year."
C. "I know that nicotine gum is a safe alternative to smoking if I become pregnant."
D. "I must chew the nicotine gum quickly for about 15 minutes.
Answer: A. "I should avoid eating right before I chew a piece of nicotine gum."
Rationale:
(The client should avoid eating or drinking 15 min prior to and while chewing the nicotine gum)
A nurse in an acute mental health facility is caring for a client who is experiencing withdrawal
from Opioid use and has a new prescription for Clonidine. Which of the following actions should
the nurse identify as the priority?
A. Administer the clonidine on the prescribed schedule.
B. Provide ice chips at the client's bedside.
C. Educate the client on the effects of clonidine.
D. Obtain baseline vital signs
Answer: D. Obtain baseline vital signs
Rationale:
(Assessment is the initial step of the nursing process. Obtaining the client's baseline vital signs is
the priority nursing action)
A nurse in the post-anaesthesia recovery unit is caring for a client who received a
nondepolarizing neuromuscular blocking agent and has muscle weakness. The nurse should
anticipate a prescription for which of the following medications?
A. Neostigmine
B. Naloxone
C. Dantrolene
D. Vecuronium
Answer: A. Neostigmine
Rationale:

(Neostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing
neuromuscular blockers)
A nurse is providing information to a client who has early Parkinson's disease and a new
prescription for pramipexole. The nurse should instruct the client to monitor for which of the
following adverse effects of this medication?
A. Hallucinations
B. Increased salivation
C. Diarrhea
D. Discoloration of urine
Answer: A. Hallucinations
Rationale:
(Pramipexole can cause hallucinations within 9 months of the initial dose and might require
discontinuation.)
A nurse is teaching a client who has a new prescription for Levodopa/Carbidopa for Parkinson's
disease. Which of the following instructions should the nurse include?
A. Increase intake of protein-rich foods.
B. Expect muscle twitching to occur.
C. Take this medication with food.
D. Anticipate relief of manifestations in 24 h
Answer: C. Take this medication with food.
Rationale:
(The client should take this medication with food to reduce GI effects.)
A nurse is preparing to administer a medication to a client who has absence seizures. The nurse
should anticipate administering which of the following medications to the client? (Select all that
apply.)
A. Phenytoin
B. Ethosuximide
C. Gabapentin

D. Carbamazepine
E. Valproic acid
F. Lamotrigine
Answer: B. Ethosuximide
E. Valproic acid
F. Lamotrigine
Rationale:
(B. Ethosuximide's only mechanism of action is to treat a client who has absence seizures
E. Valproic acid has a therapeutic effect when treating a client who has absence seizures and all
other forms of seizures.
F. Lamotrigine has a therapeutic effect when treating a client who has absence seizures and all
other forms of seizure)
A nurse is reviewing a new prescription for oxcarbazepine with a female client who has partial
seizures. Which of the following instructions should the nurse include? (Select all that apply.)
A. "Use caution if given a prescription for a diuretic medication."
B. "Consider using an alternate form of contraception if you are using oral contraceptives."
C. "Chew gum to increase saliva production."
D. "Avoid driving until you see how the medication affects you."
E. "Notify your provider if you develop a skin rash
Answer: A. "Use caution if given a prescription for a diuretic medication."
B. "Consider using an alternate form of contraception if you are using oral contraceptives."
D. "Avoid driving until you see how the medication affects you."
E. "Notify your provider if you develop a skin rash
Rationale:
(A. Diuretic medications are administered with caution because of the high risk for hyponatremia
when taking oxcarbazepine.
B. An alternate form of contraception is recommended for clients taking oral contraceptives
because oxcarbazepine decreases oral contraceptive levels
D. The client should avoid driving if CNS effects of dizziness, drowsiness, and double vision
develop.

E. The client should notify the provider if a skin rash occurs because life-threatening skin
disorders can develop.)
A nurse is instructing a client who has a new prescription for Timolol how to insert eye drops.
The nurse should instruct the client to press on which of the following areas to prevent systemic
absorption of the medication?
A. Bony orbit
B. Nasolacrimal duct
C. Conjunctival sac
D. Outer canthus
Answer: B. Nasolacrimal duct
Rationale:
(Pressing on the nasolacrimal duct blocks the lacrimal punctum and prevents systemic absorption
of the medication)
A nurse is teaching a client who has a new prescription for Brimonidine ophthalmic drops and
wears soft contact lenses. Which of the following instructions should the nurse include in the
teaching?
A. "This medication can stain your contacts."
B. "This medication can cause your pupils to constrict."
C. "This medication can absorb into your contacts."
D. "This medication can slow your heart rate."
Answer: C. "This medication can absorb into your contacts."
Rationale:
(Brimonidine can absorb into soft contact lenses. The client should remove his contacts then
instil the medication and wait at least 15 min before putting in his contacts back in.)
A nurse in an emergency unit is reviewing the medical record of a client who is being evaluated
for angle-closure Glaucoma. Which of the following findings are indicative of this condition?
A. Insidious onset of painless loss of vision
B. Gradual reduction in peripheral vision

C. Severe pain around eyes
D. Intraocular pressure 12mm Hg
Answer: C. Severe pain around eyes
Rationale:
(Severe pain around eyes that radiates over the face is a manifestation of acute angle-closure
glaucoma)
A nurse is teaching a client about preventing Otitis Externa. Which of the following instructions
should the nurse include?
A. Clean the ear with a cotton-tipped swab daily
B. Place earplugs in the ears when sleeping at night.
C. Use a cool water irrigation solution to remove earwax.
D. Tip the head to the side to remove water from the ears after showering
Answer: D. Tip the head to the side to remove water from the ears after showering
Rationale:
(The client should remove water from the ear after showering or swimming to reduce the risk for
otitis externa)
A nurse in a provider's office is instructing a parent of a toddler how to administer ear drops.
Which of the following instructions should the nurse include? (Select all that apply.)
A. "Place the child on his unaffected side when you are ready to administer the medication."
B. "Warm the medication by gently rolling it between your hands for a few minutes."
C. "Gently shake medication that is in suspension form."
D. "keep the child on his side for 5 minutes after instillation of the ear drops."
E. "Tightly pack the ear with cotton after instillation of the ear drops.
Answer: A. "Place the child on his unaffected side when you are ready to administer the
medication."
B. "Warm the medication by gently rolling it between your hands for a few minutes."
C. "Gently shake medication that is in suspension form."
D. "keep the child on his side for 5 minutes after instillation of the ear drops."
Rationale:

(A. The parent should have the child on his unaffected side to allow access to the affected ear
and to promote drainage of the medication by gravity into the ear.
B. The parent should warm the medication by rolling it between his hands. Administering the
medication cold can cause dizziness.
C. The parent should gently shake medication that is in suspension form to evenly- disperse the
medication.
D. The parent should keep the child on his side to promote drainage of the medication by gravity
into the ear)
A nurse in the operating room is caring for a client who received a dose of Succinylcholine.
During the operation, the client suddenly develops rigidity, and his body temperature begins to
rise. The nurse should anticipate a prescription for which of the following medications?
A. Neostigmine
B. Naloxone
C. Dantrolene
D. Vecuronium
Answer: C. Dantrolene
Rationale:
(muscle rigidity and a sudden rise in temperature is a manifestation of malignant hyperthermia.
Dantrolene acts on skeletal muscles to reduce metabolic activity and treat malignant
hyperthermia.)
A nurse in the post-anaesthesia care unit is caring for a client who is experiencing malignant
hyperthermia. Which of the following actions should the nurse take? (Select all that apply.)
A. Place a cooling blanket on the client.
B. Administer oxygen at 100%.
C. Administer iced 0.9% sodium chloride.
D. Administer potassium chloride IV.
E. Monitor core body temperature
Answer: A. Place a cooling blanket on the client.
B. Administer oxygen at 100%.

C. Administer iced 0.9% sodium chloride.
E. Monitor core body temperature
Rationale:
(A. The nurse should apply a cooling blanket and apply ice to the axilla and groin.
B. The nurse should administer oxygen at 100% to treat decreased oxygen saturation.
C. The nurse should take action to decrease the client's body temperature by administering iced
IV fluids.
E. The nurse should monitor core body temperature to prevent hypothermia and to determine
progress with treatment measures)
A nurse is teaching a client who has a new prescription for Baclofen to treat muscle spasms.
Which of the following statements by the client indicates an understanding of the teaching?
(Select all that apply.)
A. "I will stop taking this medication right away if I develop dizziness."
B. "I know the doctor will gradually increase my dose of this medication for a while."
C. "I should increase fiber to prevent constipation from this medication."
D. "I won't be able to drink alcohol while I'm taking this medication."
E. "I should take this medication on an empty stomach each morning."
Answer: B. "I know the doctor will gradually increase my dose of this medication for a while."
C. "I should increase fiber to prevent constipation from this medication."
D. "I won't be able to drink alcohol while I'm taking this medication."
Rationale:
(B. The provider starts the client on a low dose, and the dose is increased gradually to prevent
CNS depression.
C. The client should increase fluids and fiber to reduce the risk for constipation.
D. The intake of alcohol and other CNS depressants can exacerbate the CNS depressant effects
of baclofen. Therefore, the client is instructed to avoid CNS depressants while taking baclofen)
A nurse is reviewing the health care record of a client who reports urinary incontinence and asks
about a prescription for Oxybutynin. The nurse should recognize that Oxybutynin is
contraindicated in the presence of which of the following conditions?

A. Bursitis
B. Sinusitis
C. Depression
D. Glaucoma
Answer: D. Glaucoma
Rationale:
(Oxybutynin is an anticholinergic and can increase intraocular pressure. It is contraindicated for
clients who have glaucoma)
A nurse is caring for a client who has a prescription for Bethanechol to treat urinary retention.
The nurse should recognize that which of the following findings is a manifestation of muscarinic
stimulation?
A. Dry mouth
B. Hypertension
C. Excessive perspiration
D. Fecal impaction
Answer: C. Excessive perspiration
Rationale:
(Bethanechol is a muscarinic agonist. muscarinic stimulation can result in sweating)
A nurse is providing instructions to a client who has been experiencing Insomnia and has a new
prescription for Temazepam. The nurse should inform the client that which of the following
manifestations are adverse effects of temazepam? (Select all that apply.)
A. Incoordination
B. Hypertension
C. Pruritus
D. Sleep driving
E. Amnesia
Answer: A. Incoordination
D. Sleep driving
E. Amnesia

Rationale:
(A. Due to CNS depression, incoordination is an adverse effect of temazepam
D. Sleep driving (driving after taking the medication without memory of doing so) is an adverse
effect of temazepam.
E. Retrograde amnesia, the inability to remember the events that occurred after taking the
medication, can occur as an adverse effect of temazepam)
A nurse is caring for a client who is receiving moderate sedation with Diazepam IV. The client is
over sedated. Which of the following medications should the nurse anticipate administering to
this client?
A. Ketamine
B. Naltrexone
C. Flumazenil
D. Fluvoxamine
Answer: C. Flumazenil
Rationale:
(Flumazenil is a competitive benzodiazepine antagonist used to reverse the sedation and other
effects of benzodiazepines)
A nurse is teaching a client who has a new prescription for Ramelteon. The nurse should instruct
the client to avoid which of the following foods while taking this medication?
A. Baked potato
B. Fried chicken
C. Whole-grain bread
D. Citrus fruits
Answer: B. Fried chicken
Rationale:
(high-fat foods, such as fried chicken prolong the absorption of ramelteon and should be
avoided)

A nurse is caring for a client who is admitted to undergo a surgical procedure. Which of the
following preexisting conditions can be a contraindication for the use of Ketamine as an
intravenous aesthetic?
A. Peptic ulcer disease
B. Breast cancer
C. Diabetes mellitus
D. Schizophrenia
Answer: D. Schizophrenia
Rationale:
(Ketamine can produce psychological effects, such as hallucinations. Therefore, schizophrenia
can be a contraindication for the use of Ketamine)
A nurse is providing instructions to a female client who has a new prescription for Zolpidem.
Which of the following instructions should the nurse include?
A. "Notify the provider if you plan to become pregnant."
B. "Take the medication 1 hr before you plan to go to sleep."
C. "Allow at least 6 hr for sleep when taking zolpidem.
D. "To increase the effectiveness of zolpidem, take it with a bedtime snack.
Answer: A. "Notify the provider if you plan to become pregnant."
Rationale:
(Zolpidem is Pregnancy Risk Category C. The client should notify the provider if she plans to
become pregnant)
A nurse is teaching a client who has a new prescription for Beclomethasone. Which of the
following instructions should the nurse include?
A. "Rinse your mouth after each use of this medication."
B. "Limit fluid intake while taking this medication."
C. "Increase your intake of vitamin B12 while taking this medication."
D. "You can take the medication as needed.
Answer: A. "Rinse your mouth after each use of this medication."
Rationale:

(The client should rinse her mouth after each use to reduce the risk of oral fungal infection)
A nurse is providing instructions to a client who has a new prescription for Albuterol and
Beclomethasone inhalers for the control of asthma. Which of the following instructions should
the nurse include in the teaching?
A. Take the albuterol at the same time each day.
B. Administer the albuterol inhaler prior to using the beclomethasone inhaler.
C. Use beclomethasone if experiencing an acute episode.
D. Avoid shaking the beclomethasone before us
Answer: B. Administer the albuterol inhaler prior to using the beclomethasone inhaler.
Rationale:
(When a client is prescribed an inhaled beta2-agonist (such as albuterol) and an inhaled
glucocorticoid (such as beclomethasone), the client should take the beta2-agonist first. The
beta2-agonist promotes bronchodilation and enhances absorption of the glucocorticoid.)
A nurse is providing instructions to the parent of an adolescent client who has a new prescription
for Albuterol, PO. Which of the following instructions should the nurse include?
A. "You can take this medication to abort an acute asthma attack."
B. "Tremors are an adverse effect of this medication."
C. "Prolonged use of this medication can cause hyperglycaemia."
D. "This medication can slow skeletal growth rate."
Answer: B. "Tremors are an adverse effect of this medication."
Rationale:
(Tremors can occur due to excessive stimulation of beta2 receptors of skeletal muscles)
A nurse is teaching a client who has a prescription for long-term use of oral prednisone for
treatment of chronic asthma. The nurse should instruct the client to monitor for which of the
following adverse effects of this medication?
A. Weight gain
B. Nervousness
C. Bradycardia

D. Constipation
Answer: A. Weight gain
Rationale:
(Weight gain and fluid retention are adverse effects of oral prednisone due to the effect of sodium
and water retention)
A nurse is caring for a client who states she has been taking Phenylephrine nasal drops for the
past 10 days for Sinusitis. The nurse should assess the client for which of the following adverse
effects of this medication?
A. Sedation
B. Nasal congestion
C. Productive cough
D. Constipation
Answer: B. Nasal congestion
Rationale:
(When used for over 5 days, rebound nasal congestion can occur when taking nasal
sympathomimetic medications, such as phenylephrine)
A nurse is teaching a client who has a new prescription for Dextromethorphan to suppress a
cough. The nurse should instruct the client to monitor for which of the following adverse effects
of this medication?
A. Diarrhea
B. Anxiety
C. Sedation
D. Palpitations
Answer: C. Sedation
Rationale:
(Dextromethorphan can cause sedation. Advise the client to avoid activities that require
alertness)

A nurse is teaching the family of a child who has Cystic Fibrosis and a new prescription for
Acetylcysteine. Which of the following information should the nurse include in the instructions?
A. "Expect this medication to suppress your cough."
B. "Expect this medication to smell like rotten eggs."
C. "Expect this medication to cause euphoria."
D. "Expect this medication to turn your urine orange."
Answer: B. "Expect this medication to smell like rotten eggs."
Rationale:
(Acetylcysteine has a sulphur content that causes a rotten-egg Odor)
A nurse is teaching a client who has a new prescription for Diphenhydramine for allergic
Rhinitis. The nurse should instruct the client to monitor for which of the following adverse
reactions of this medication? (Select all that apply.)
A. Dry mouth
B. Nonproductive cough
C. Skin rash
D. Drowsiness
E. Urinary hesitation
Answer: A. Dry mouth
D. Drowsiness
E. Urinary hesitation
Rationale:
(A. Dry mouth is an anticholinergic manifestation that can occur when a client takes
diphenhydramine
D. Drowsiness is an adverse reaction of this medication. Diphenhydramine is administered to
treat insomnia.
E. Urinary retention is an anticholinergic manifestation that can occur when a client takes
diphenhydramine.)
A nurse is teaching a client about the use of Fluticasone to treat Perennial Rhinitis. Which of the
following statements by the client indicates an understanding of the teaching?

A. "I should use the spray every 4 hours while I am awake."
B. "It can take as long as 3 weeks before the medication takes a maximum effect."
C. "This medication can also be used to treat motion sickness."
D. "I can use this medication when my nasal passages are blocked.
Answer: B. "It can take as long as 3 weeks before the medication takes a maximum effect."
Rationale:
(The client can see some benefits of the medication within a few hours, but the maximum
benefits can take up to 3 weeks.)
A nursing is planning care for a client who is receiving Furosemide IV for peripheral edema.
Which of the following interventions should the nurse include in the plan of care? (Select all that
apply.)
A. Assess for tinnitus.
B. Report urine output 50 mL/hr.
C. Monitor serum potassium levels.
D. Elevate the head of bed slowly before ambulation.
E. Recommend eating a banana daily
Answer: A. Assess for tinnitus.
C. Monitor serum potassium levels.
D. Elevate the head of bed slowly before ambulation.
E. Recommend eating a banana daily
Rationale:
(A. An adverse effect of furosemide is ototoxicity. manifestations of tinnitus should be reported
to the provider
C. A decrease in serum potassium levels is an adverse effect of furosemide, and the nurse should
notify the provider.
D. Slowly elevating the head of the bed will prevent the client from developing orthostatic
hypotension, which is a manifestation of hypovolemia.
E. A banana is high in potassium. The nurse should encourage the client to eat foods high in
potassium to prevent hypokalaemia.)

A nurse is providing information to a client who has a new prescription for Hydrochlorothiazide.
Which of the following information should the nurse include?
A. Take the medication with food.
B. Plan to take the medication at bedtime.
C. Expect increased swelling of the ankles.
D. Fluid intake should be limited in the morning.
Answer: A. Take the medication with food.
Rationale:
(The client should take hydrochlorothiazide with or after meals to prevent gastrointestinal upset)
A nurse is monitoring a client who is receiving spironolactone. Which of the following findings
should the nurse report to the provider?
A. Serum Sodium 144 mEq/L
B. Urine output 120 mL in 4 hr
C. Serum Potassium 5.2 mEq/L
D. Blood Pressure 140/90 mm Hg
Answer: C. Serum Potassium 5.2 mEq/L
Rationale:
(Serum potassium of 5.2 mEq/L indicates hyperkalaemia. Because spironolactone causes
potassium retention, the nurse should withhold the medication and notify the provider)
A nurse is caring for a client who has increased intracranial pressure and is receiving Mannitol.
Which of the following findings should the nurse report to the provider?
A. Blood glucose 150 mg/dL
B. Urine output 40 mL/hr
C. Dyspnea
D. Bilateral equal pupil size
Answer: C. Dyspnea
Rationale:
(Dyspnea is a manifestation of heart failure, an adverse effect of mannitol. The nurse should stop
the medication and notify the provider.)

A nurse is planning caring for a client who is has a new prescription for Torsemide. The nurse
should plan to monitor for which of the following adverse reactions of this medications? (Select
all that apply.)
A. Respiratory acidosis
B. Hypokalaemia
C. Hypotension
D. Ototoxicity
E. Ventricular dysrhythmias
Answer: B. Hypokalaemia
C. Hypotension
D. Ototoxicity
E. Ventricular dysrhythmias
Rationale:
(B. The nurse should plan to monitor for hypokalaemia, which is an adverse effect of a loop
diuretic.
C. The nurse should plan to monitor for hypotension.
D. The nurse should plan to monitor the client for ototoxicity.
E. The nurse should plan to monitor for ventricular dysrhythmias, which is a manifestation of
hypokalaemia, an adverse effect of torsemide)
A nurse is reviewing the health record of a client who asks about using Propranolol to treat
hypertension. The nurse should recognize which of the following conditions is a contraindication
for taking propranolol?
A. Asthma
B. Glaucoma
C. Hypertension
D. Tachycardia
Answer: A. Asthma
Rationale:

(Propranolol is a nonselective beta-adrenergic blocker that blocks both beta1 and beta2 receptors.
Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in
clients who have asthma)
A nurse is teaching a client who has a new prescription for Verapamil to control Hypertension.
Which of the following instructions should the nurse include?
A. Increase the amount of dietary fiber in the diet.
B. Drink grapefruit juice daily to increase vitamin C intake.
C. Decrease the amount of calcium in the diet.
D. Withhold food for 1 hr after the medication is taken
Answer: A. Increase the amount of dietary fiber in the diet.
Rationale:
(Increasing dietary fiber intake can help prevent constipation, an adverse effect of verapamil)
A nurse is caring for a client who has a new prescription for Captopril for hypertension. The
nurse should monitor the client for which of the following adverse effects of this medication?
A. Hypokalaemia
B. Hypernatremia
C. Neutropenia
D. Bradycardia
Answer: C. Neutropenia
Rationale:
(Neutropenia is a serious adverse effect that can occur in clients taking an ACE inhibitor. The
nurse should monitor the client's CBC and teach the client to report indications of infection to the
provider.)
A nurse in an acute care facility is caring for a client who is receiving IV Nitroprusside for
hypertensive crisis. The nurse should monitor the client for which of the following adverse
reactions to this medication?
A. Intestinal ileus
B. Neutropenia

C. Delirium
D. Hyperthermia
Answer: C. Delirium
Rationale:
(Delirium and other mental status changes can occur in thiocyanate toxicity when IV
nitroprusside is infused at a high dosage. monitor thiocyanate level during therapy to remain
below 10 mg/dL.)
A nurse is planning to administer a first dose of Captopril to a client who has hypertension.
Which of the following medications can intensify first dose hypotension? (Select all that apply.)
A. Simvastatin
B. Hydrochlorothiazide
C. Phenytoin
D. Clonidine
E. Alis Kiren
Answer: B. Hydrochlorothiazide
D. Clonidine
E. Alis Kiren
Rationale:
(B. Hydrochlorothiazide, a thiazide diuretic, is often used to treat hypertension. Diuretics can
intensify first-dose orthostatic hypotension caused by captopril and can continue to interact with
antihypertensive medications to cause hypotension. The nurse should monitor clients carefully
for hypotension, especially after the first dose of captopril and keep the client safe from injury
D. Clonidine, a centrally acting alpha2 agonist, is an antihypertensive medication that can
interact with captopril to intensify first-dose orthostatic hypotension. The nurse should monitor
clients carefully for hypotension, especially after the first dose of captopril, and keep the client
safe from injury.
E. Alis Kiren, a direct renin inhibitor, is an antihypertensive medication that can interact with
captopril to intensify its first-dose orthostatic hypotension. The nurse should monitor clients
carefully for hypotension, especially after the first dose of captopril, and keep the client safe
from injury)

A nurse in a provider's office is monitoring serum electrolytes for four older adult clients who
take digoxin. Which of the following electrolyte values increases a client's risk for Digoxin
toxicity?
A. Calcium 9.2 mg/dL
B. Calcium 10.3 mg/dL
C. Potassium 3.4 mEq/L
D. Potassium 4.8 mEq/
Answer: C. Potassium 3.4 mEq/L
Rationale:
(Potassium 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin
toxicity. Low Potassium can cause fatal dysrhythmias, especially in older clients who take
Digoxin. The nurse should notify the provider, who might prescribe a potassium supplement or a
potassium-sparing diuretic for the client)
A nurse is caring for an older adult client who has a new prescription for Digoxin and takes
multiple other medications. The nurse should recognize that concurrent use of which of the
following medications places the client at risk for Digoxin toxicity?
A. Phenytoin
B. Verapamil
C. Warfarin
D. Aluminium hydroxide
Answer: B. Verapamil
Rationale:
(Verapamil, a calcium-channel blocker, can increase digoxin levels. If these medications are
given concurrently, the digoxin dosage might be decreased and the nurse should monitor digoxin
levels carefully)
A nurse is administering a Dopamine infusion at a low dose to a client who has severe heart
failure. Which of the following findings is an expected effect of this medication?
A. Lowered heart rate

B. Increased myocardial contractility
C. Decreased conduction through the AV node
D. Vasoconstriction of renal blood vessel
Answer: B. Increased myocardial contractility
Rationale:
(The nurse should expect dopamine to cause increased myocardial contractility, which also
increases cardiac output. This occurs with the stimulation of beta1 receptors and is a positive
inotropic effect of dopamine when it is administered at a low dose)
A nurse is providing teaching to a client who has a new prescription for Digoxin. The nurse
should instruct the client to monitor and report which of the following adverse effects that is a
manifestation Digoxin toxicity? (Select all that apply.)
A. Fatigue
B. Constipation
C. Anorexia
D. Rash
E. Diplopia
Answer: A. Fatigue
C. Anorexia
E. Diplopia
Rationale:
(A. Fatigue and weakness are early CNS findings that can indicate digoxin toxicity.
C. GI disturbances, such as anorexia, are manifestations of digoxin toxicity.
E. Visual changes, such as diplopia and yellow-tinged vision, are manifestations of digoxin
toxicity)
A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which
of the following instructions should the nurse include in the teaching?
A. Contact provider if heart rate is less than 60/min.
B. Check pulse rate for 30 seconds and multiply result by 2.
C. Increase intake of sodium.

D. Take with food if nausea occur
Answer: A. Contact provider if heart rate is less than 60/min.
Rationale:
(The client should contact the provider for a heart rate less than 60/min)
A nurse is teaching a client who has Angina Pectoris and is learning how to treat acute Anginal
attacks. The clients asks, "What is my next step if I take one tablet, wait 5 minutes, but still have
Anginal pain?" Which of the following responses should the nurse make?
A. "Take two more sublingual tablets at the same time."
B. "Call the emergency response team."
C. "Take a sustained-release nitro-glycerine capsule."
D. "Wait another 5 minutes then take a second sublingual tablet."
Answer: B. "Call the emergency response team."
Rationale:
(The next step is to call 911 and then take a second sublingual tablet. If the first tablet does not
work, the client might be having a myocardial infarction. The client can take a third tablet if the
second one has not relieved the pain after waiting an additional 5 minutes.)
A nurse is teaching a client who has a new prescription for Nitro-glycerine transdermal patch for
Angina Pectoris. Which of the following instructions should the nurse include?
A. Remove the patch each evening.
B. Cut each patch in half if angina attacks are under control.
C. Take off the nitro-glycerine patch for 30 min if a headache occurs.
D. Apply a new patch every 48 hr
Answer: A. Remove the patch each evening.
Rationale:
(In order to prevent tolerance to nitro-glycerine, the client should remove the patch for 10 to 12
hr during each 24-hr period)

A nurse is taking a medication history from a client who has Angina and is to begin taking
Ranolazine. The nurse should report which of the following medications in the client's history
that can interact with Ranolazine? (Select all that apply.)
A. Digoxin
B. Simvastatin
C. Verapamil
D. Amlodipine
E. Nitro-glycerine transdermal patch
Answer: A. Digoxin
B. Simvastatin
C. Verapamil
Rationale:
(A. Concurrent use with ranolazine increases serum levels of digoxin, so digoxin toxicity can
result.
B. Concurrent use with ranolazine increases serum levels of simvastatin, so liver toxicity can
result.
C. Verapamil is an inhibitor of CYP3A4, which can increase levels of ranolazine and lead to the
dysrhythmia torsade’s de pointes.)
A nurse is caring for a client who is prescribed Isosorbide Mononitrate for chronic stable Angina
and develops reflex tachycardia. Which of the following medications should the nurse expect to
administer?
A. Furosemide
B. Captopril
C. Ranolazine
D. Metoprolol
Answer: D. Ranolazine
Rationale:
(metoprolol, a beta adrenergic blocker, is used to treat hypertension and stable angina pectoris,
and is often prescribed to decrease heart rate in clients who have tachycardia)

A nurse is teaching a client who has angina how to use nitro-glycerine transdermal ointment. The
nurse should include which of the following instructions?
A. "Remove the prior dose before applying a new dose."
B. "Rub the ointment directly into your skin until it is no longer visible."
C. "Cover the applied ointment with a clean gauze pad."
D. "Apply the ointment to the same skin area each time.
Answer: A. "Remove the prior dose before applying a new dose."
Rationale:
(The client should remove the prior dose before applying a new dose to prevent toxicity)
A nurse is assessing a client who is taking Amiodarone to treat Atrial Fibrillation. Which of the
following findings is a manifestation of Amiodarone toxicity?
A. Light yellow urine
B. Report of tinnitus
C. Productive cough
D. Blue-Gray skin discoloration
Answer: C. Productive cough
Rationale:
(Productive cough can indicate pulmonary toxicity or heart failure. The nurse should assess for
cough, chest pain, and shortness of breath)
A nurse is caring for a client who received IV Verapamil to treat supraventricular tachycardia
(SVT). The client's pulse rate is now 98/min and his blood pressure is 74/44 mg hg. The nurse
should anticipate a prescription for which of the following IV medications?
A. Calcium gluconate
B. Sodium bicarbonate
C. Potassium chloride
D. Magnesium sulphate
Answer: A. Calcium gluconate
Rationale:

(Reverse severe hypotension caused by Verapamil with Calcium gluconate, given slowly IV. The
calcium counteracts vasodilation caused by verapamil. Other measures to increase blood pressure
can include IV fluid therapy and placing the client in a modified Trendelenburg position.)
A nurse is assessing a client who is taking Digoxin to treat heart failure. Which of the following
findings is a manifestation of digoxin toxicity?
A. Bruising
B. Report of metallic taste
C. Muscle pain
D. Report of anorexia
Answer: D. Report of anorexia
Rationale:
(Anorexia, blurred vision, stomach pain, and diarrhoea are manifestations of digoxin toxicity)
A nurse is assessing a client who has taken Procainamide to treat dysrhythmias for the last 12
months. The nurse should assess the client for which of the following adverse effects of this
medication? (Select all that apply.)
A. Hypertension
B. Widened QRS complex
C. Narrowed QT interval
D. Easy bruising
E. Swollen joints
Answer: B. Widened QRS complex
D. Easy bruising
E. Swollen joints
Rationale:
(B. On the ECG, procainamide can cause a widened QRS complex, which is a manifestation of
cardiotoxicity if the QRS complex becomes widened by more than 50% of the expected
reference range
D. Procainamide can cause bone marrow depression, with neutropenia (infection) and
thrombocytopenia (easy bruising, bleeding)

E. Systemic lupus erythematosus-like syndrome can occur as an adverse effect of procainamide.
manifestations include swollen, painful joints. Clients who take procainamide in large doses or
for more than 1 year are at risk)
A nurse is preparing to administer Propranolol to a client who has a dysrhythmia. Which of the
following actions should the nurse plan to take?
A. Hold propranolol for an apical pulse greater than 100/min.
B. Administer propranolol to increase the client's blood pressure.
C. Assist the client when she sits up or stands after taking this medication.
D. Check for hypokalaemia frequently due to the risk for propranolol toxicity.
Answer: C. Assist the client when she sits up or stands after taking this medication.
Rationale:
(Propranolol can cause orthostatic hypotension, so it is important assess for dizziness during
ambulation or when moving to a sitting position.)
A nurse is providing teaching to a client who is starting Simvastatin. Which of the following
information should the nurse include in the teaching?
A. Take this medication in the evening.
B. Change position slowly when rising from a chair.
C. Maintain a steady intake of green leafy vegetables.
D. Consume no more than 1 L/day of fluid
Answer: A. Take this medication in the evening.
Rationale:
(The client should take simvastatin in the evening because nighttime is when the most
cholesterol is synthesized in the body. Taking statin medications in the evening increases
medication effectiveness)
A nurse is collecting data from a client who is taking Gemfibrozil. Which of the following
assessment findings should the nurse identify as an adverse reaction to the medication?
A. Mental status changes
B. Tremor

C. Jaundice
D. Pneumonia
Answer: C. Tremor
Rationale:
(Jaundice, anorexia, and upper abdominal discomfort can be findings in liver impairment, which
can occur in clients taking gemfibrozil.)
A nurse is teaching a client who is taking Digoxin and has a new prescription for Colesevelam.
Which of the following instructions should the nurse include in the teaching?
A. "Take digoxin with your morning dose of colesevelam."
B. "Your sodium and potassium levels will be monitored periodically while taking colesevelam."
C. "Watch for bleeding or bruising while taking colesevelam."
D. "Take colesevelam with food and at least one glass of water.
Answer: D. "Take colesevelam with food and at least one glass of water.
Rationale:
(Colesevelam should be taken with food and at least 8 oz of water)
A nurse is completing a nursing history for a client who takes Simvastatin. The nurse should
identify which of the following disorders as a contraindication to adding Ezetimibe to the client's
medications?
A. History of severe constipation
B. History of hypertension
C. vActive hepatitis C
D. Type 2 diabetes mellitus
Answer: C. vActive hepatitis C
Rationale:
(Ezetimibe is contraindicated in clients who have an active moderate-to-severe liver disorder,
especially if the client is already taking a statin, such as simvastatin)

A nurse is caring for a client who has a new prescription for Niacin to reduce cholesterol. The
nurse should monitor for which of the following findings as an adverse effect of Niacin? (Select
all that apply.)
A. Muscle aches
B. Hyperglycaemia
C. Hearing loss
D. Flushing of the skin
E. Jaundice
Answer: B. Hyperglycaemia
D. Flushing of the skin
E. Jaundice
Rationale:
(B. hyperglycaemia can occur as an adverse effect of Niacin. The nurse should plan to monitor
blood glucose periodically.
D. Flushing of the skin, along with tingling of the extremities, occurs soon after taking niacin.
The effect should decrease in a few weeks, and can be minimized by taking an aspirin tablet 30
min before the Niacin.
E. Niacin can cause liver disorders, so the nurse should monitor for jaundice, abdominal pain,
and anorexia.)
A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of
Enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following
actions should the nurse plan to take?
A. Expel the air bubble from the prefilled syringe before injecting.
B. Insert the needle completely into the client's tissue.
C. Administer the injection in the client's thigh.
D. Aspirate carefully after inserting the needle into the client's skin
Answer: B. Insert the needle completely into the client's tissue.
Rationale:
(The nurse should inject the needle on the prefilled syringe completely when administering
enoxaparin in order to administer the medication by deep subcutaneous injection.)

A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein
thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the
following medications should the nurse prepare to administer?
A. Vitamin k1
B. Atropine
C. Protamine
D. Calcium gluconate
Answer: C. Protamine
Rationale:
(Protamine reverses the anticoagulant effect of heparin)
A nurse is planning to administer IV Alteplase to a client who is demonstrating manifestations of
a massive Pulmonary Embolism. Which of the following interventions should the nurse plan to
take?
A. Administer IM Enoxaparin along with the Alteplase dose.
B. Hold direct pressure on puncture sites for up to 30 min.
C. Administer Aminocaproic acid IV prior to alteplase infusion.
D. Prepare to administer Alteplase within 8 hr of manifestation onset.
Answer: B. Hold direct pressure on puncture sites for up to 30 min.
Rationale:
(The nurse should plan to hold direct pressure on puncture sites for 10 to 30 min or until oozing
of blood stops)
A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify
which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that
apply.)
A. Hypertension
B. Coffee-ground emesis
C. Tinnitus
D. Paresthesias of the extremities

E. Nausea
Answer: B. Coffee-ground emesis
C. Tinnitus
E. Nausea
Rationale:
(B. GI bleeding with dark stools or coffee-ground emesis can be an adverse effect of aspirin
therapy.
C. Tinnitus and hearing loss can occur as an adverse effect of aspirin therapy
E. Nausea, vomiting, and abdominal pain can occur as a result of aspirin therapy)
A nurse is caring for a client who has Atrial Fibrillation and a new prescription for Dabigatran to
prevent development of Thrombosis. Which of the following medications is prescribed
concurrently to treat an adverse effect of Dabigatran?
A. Vitamin k1
B. Protamine
C. Omeprazole
D. Probenecid
Answer: C. Omeprazole
Rationale:
(Omeprazole or another proton pump inhibitor is prescribed for a client who is taking dabigatran
and has abdominal pain and other GI findings that can occur as adverse effects of dabigatran.
The nurse should advise the client who has GI effects to take dabigatran with food)
A nurse is caring for a client who is receiving daily doses of Oprelvekin. Which of the following
laboratory values should the nurse monitor to determine effectiveness of this medication?
A. Haemoglobin
B. Absolute neutrophil count
C. Platelet count
D. Total white blood count
Answer: C. Platelet count
Rationale:

(The expected outcome for oprelvekin is a platelet count greater than 50,000/mm^3.)
A nurse is preparing to administer Filgrastim for the first time to a client who has just undergone
a bone marrow transplant. Which of the following interventions is appropriate?
A. Administer I’m in a large muscle mass to prevent injury.
B. Ensure that the medication is refrigerated until just prior to administration.
C. Shake vial gently to mix well before withdrawing dose.
D. Discard vial after removing one dose of the medication
Answer: D. Discard vial after removing one dose of the medication
Rationale:
(Only one dose of filgrastim should be withdrawn from the vial and the vial should then be
discarded.)
A nurse is monitoring a client who is receiving Epoetin alfa for adverse effects. The nurse should
identify which of the following findings as an adverse effect of this medication? (Select all that
apply)
A. Leucocytosis
B. Hypertension
C. Edema
D. Blurred vision
E. Headache
Answer: B. Hypertension
E. Headache
Rationale:
(B. Hypertension is an adverse effect of epoetin alfa that the nurse should monitor for throughout
treatment.
E. headache is an adverse effect of epoetin alfa)
A nurse is assessing a client who has chronic Neutropenia and who has been receiving
Gilgrastim. Which of the following actions should the nurse take to assess for an adverse effect
of filgrastim?

A. Assess for bone pain.
B. Assess for right lower quadrant pain.
C. Auscultate for crackles in the bases of the lungs.
D. Auscultate the chest to listen for a heart murmur
Answer: A. Assess for bone pain.
Rationale:
(Bone pain is a dose-related adverse effect of Filgrastim. It can be treated with acetaminophen
and, if necessary, an opioid analgesic)
A nurse is preparing to administer a transfusion of 300 mL of pooled platelets for a client who
has severe Thrombocytopenia. The nurse should plan to administer the transfusion over which of
the following time frames?
A. Within 30 min/unit
B. Within 60 min/unit
C. Within 2 hr/unit
D. Within 4 hr/unit
Answer: A. Within 30 min/unit
Rationale:
(Platelets are fragile and should be administered quickly to reduce the risk of clumping. The
nurse should administer the platelets within 15 to 30 min/unit)
A nurse is transfusing a unit of packed Red blood cells (PRBCs) for a client who has Anaemia
due to Chemotherapy. The client reports a sudden headache and chills. The client's temperature is
2° F higher than her baseline. In addition to notifying the provider, which of the following
actions should the nurse take? (Select all that apply.)
A. Stop the transfusion.
B. Place the client in an upright position with feet down.
C. Remove the blood bag and tubing from the IV catheter.
D. Obtain a urine specimen.
E. Infuse dextrose 5% in water through the IV CORRECT
Answer: A. Stop the transfusion.

C. Remove the blood bag and tubing from the IV catheter.
D. Obtain a urine specimen.
Rationale:
(A. The nurse should stop the transfusion for a rise in temperature of 2° F and reports of chills
and fever. The client can be having a haemolytic reaction to the blood or a febrile reaction
C. The nurse should avoid infusing more PRBCs into the client's vein, and should remove the
blood bag and tubing from the client's IV catheter.
D. Obtaining a urine specimen to check for haemolysis is standard procedure when the client has
a reaction to a blood transfusion)
A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) for a client who has
severe anaemia. Which of the following interventions will prevent an acute haemolytic reaction?
A. Ensure that the client has a patent IV line before obtaining blood product from the
refrigerator.
B. Obtain help from another nurse to confirm the correct client and blood product.
C. Take a complete set of vital signs before beginning transfusion and periodically during the
transfusion.
D. Stay with the client for the first 15 to 30 min of the transfusion
Answer: B. Obtain help from another nurse to confirm the correct client and blood product.
Rationale:
(Identifying and matching the correct blood product with the correct client will prevent an acute
haemolytic reaction from occurring because this reaction is caused by ABO or Rh
incompatibility)
A nurse is caring for a hospitalized client who has an activated partial thromboplastin time
(aPTT) greater than 1.5 times the expected reference range. Which of the following blood
products should the nurse prepare to transfuse?
A. Whole blood
B. Platelets
C. Fresh frozen plasma
D. Packed red blood cells

Answer: C. Fresh frozen plasma
Rationale:
(Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces
coagulation factors and can help prevent bleeding)
A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a
cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should
anticipate a prescription for which of the following medications?
A. Epinephrine
B. Lorazepam
C. Furosemide
D. Diphenhydramine
Answer: C. Furosemide
Rationale:
(Furosemide, a loop diuretic, may be prescribed to relieve manifestations of circulatory overload)
A nurse is providing instructions to a client who has a prescription for Amoxicillin and
Clarithromycin to treat a Peptic Ulcer. Which of the following information should the nurse
include in the teaching?
A. "Take these medications with food."
B. "These medications can turn your stool black"
C. "These medications can cause photosensitivity."
D. "The purpose of these medications is to decrease the ph of gastric juices in the stomach."
Answer: A. "Take these medications with food."
Rationale:
(The nurse should instruct the client to take these medications with food to reduce GI
disturbances)
A nurse is teaching a client who has a new prescription for Omeprazole for management of
heartburn. Which of the following information should the nurse include in the teaching?
A. Take this medication at bedtime.

B. This medication decreases the production of gastric acid.
C. Take this medication 2 hr after eating.
D. This medication can cause hyperkalemia
Answer: B. This medication decreases the production of gastric acid.
Rationale:
(Omeprazole reduces gastric acid secretion by inhibiting the enzyme that produces gastric acid)
A nurse is teaching a client who is taking Sucralfate PO for Peptic Ulcer Disease has a new
prescription for phenytoin to control seizures. Which of the following instructions should the
nurse include?
A. Take an antacid with the sucralfate.
B. Take sucralfate with a glass of milk.
C. Allow a 2-hr interval between these medications.
D. Chew the sucralfate thoroughly before swallowing
Answer: C. Allow a 2-hr interval between these medications.
Rationale:
(Sucralfate can interfere with the absorption of phenytoin, so the client should allow a 2-hr
interval between the sucralfate and phenytoin.)
A nurse is caring for four clients who have Peptic Ulcer Disease. The nurse should recognize
Misoprostol is contraindicated for which of the following clients?
A. A client who is pregnant
B. A client who has osteoarthritis
C. A client who has a kidney stone
D. A client who has a urinary tract infection
Answer: A. A client who is pregnant
Rationale:
(misoprostol can induce labor and is contraindicated in pregnancy.)
A nurse is providing a client who has Peptic Ulcer Disease with instructions about managing his
condition. Which of the following instructions should the nurse include? (Select all that apply.)

A. "Eat a bedtime snack."
B. "Drink decaffeinated coffee"
C. "Low-dose aspirin therapy should be avoided."
D. "Seek measures to reduce stress."
E. "Avoid smoking."
Answer: D. "Seek measures to reduce stress."
E. "Avoid smoking."
Rationale:
(D. Reducing stress is beneficial for healing of the ulcer and prevention of complications.
E. Smoking inhibits healing of the ulcer.)
A nurse is caring for a client who received Prochlorperazine 4 hr ago. The client reports spasms
of his face. The nurse should anticipate a prescription for which of the following medications?
A. Fomepizole
B. Naloxone
C. Phytonadione
D. Diphenhydramine
Answer: D. Diphenhydramine
Rationale:
(An adverse effect of prochlorperazine is acute dystonia, which is evidenced by spasms of the
muscles in the face, neck, and tongue. Diphenhydramine is used to suppress extrapyramidal
effects of prochlorperazin)
A nurse is planning to administer Ondansetron IV for an older adult client who has a history of
diabetes mellitus and cardiac myopathy and is receiving chemotherapy for cancer. For which of
the following adverse effects of ondansetron should the nurse monitor? (Select all that apply.)
A. Headache
B. Diarrhea
C. Shortened PR interval
D. Hyperglycaemia
E. Prolonged QT interval

Answer: A. Headache
B. Diarrhea
E. Prolonged QT interval
Rationale:
(A. headache is a common adverse effect of ondansetron.
B. Diarrhea or constipation are both adverse effects of ondansetron
E. A prolonged QT interval is a possible adverse effect of ondansetron that can lead to torsade’s
de pointes, a serious dysrhythmia.)
A nurse is providing instructions about the use of laxatives to a client who has heart failure. The
nurse should tell the client he should avoid which of the following laxatives?
A. Sodium phosphate
B. Psyllium
C. Bisacodyl
D. Polyethylene glycol
Answer: A. Sodium phosphate
Rationale:
(Typically, clients who have heart failure are on a sodium-restricted diet. Absorption of sodium
from sodium phosphate causes fluid retention and is contraindicated for clients who have heart
failure.)
A nurse is caring for a client who has Diabetes and is experiencing Nausea due to Gastroparesis.
The nurse should anticipate a prescription for which of the following medications?
A. Lubiprostone
B. Metoclopramide
C. Bisacodyl
D. Loperamide
Answer: B. Metoclopramide
Rationale:
(Metoclopramide is a dopamine antagonist that is used to treat nausea and also increases gastric
motility. It can relieve the bloating and nausea of diabetic gastroparesis.)

A nurse is providing information about Probiotic supplements to a male client. Which of the
following information should the nurse include? (Select all that apply.)
A. "Probiotics are micro-organisms that are normally found in the GI tract."
B. "Probiotics are used to treat Clostridium difficile."
C. "Probiotics are used to treat benign prostatic hyperplasia.”
D. "You can experience bloating while taking probiotic supplements."
E. "If you are prescribed an antibiotic, you should take it at the same time you take your
probiotic supplement."
Answer: A. "Probiotics are micro-organisms that are normally found in the GI tract."
B. "Probiotics are used to treat Clostridium difficile."
D. "You can experience bloating while taking probiotic supplements."
Rationale:
(A. Probiotics consist of lactobacilli, bifidobacteria, and Saccharomyces boulardii, which
normally are found in the digestive tract.
B. Probiotics are used to treat a number of GI conditions, including irritable bowel syndrome,
diarrhoea associated with Clostridium difficile, and ulcerative colitis
D. Flatulence and bloating are adverse effects of probiotic supplements.)
A nurse is teaching a client who has Anaemia and a new prescription for a liquid Iron
supplement. Which of the following information should the nurse include in the teaching?
(Select all that apply.)
A. "Add foods that are high in fiber to your diet."
B. "Rinse your mouth after taking the medication."
C. "Expect stools to be green or black in colour."
D. "Take the medication with a glass of milk."
E. "Add red meat to your diet."
Answer: A. "Add foods that are high in fiber to your diet."
B. "Rinse your mouth after taking the medication."
C. "Expect stools to be green or black in colour."
E. "Add red meat to your diet."

Rationale:
(A. Foods high in fiber can prevent constipation, which can occur when taking iron supplements.
B. Iron supplements can stain teeth when taken in a liquid form. The client should rinse orally
after taking the medication.
C. Dark green or black stools can occur when taking iron supplements. The client should
anticipate this effect.
E. Red meats are high in iron and recommended for a client to improve anaemia when taken
concurrently with iron supplements.)
A nurse is caring for a client who has increased liver enzymes and is taking herbal supplements.
Which of the following herbal supplements should the nurse report to the provider?
A. Glucosamine
B. Saw palmetto
C. Kava
D. St. John's wort
Answer: C. Kava
Rationale:
(Chronic use or high doses of kava can cause liver damage, including severe liver failure)
A nurse is evaluating a group of clients at a health fair to identify the need for folic acid therapy.
Which of the following clients require folic acid therapy? (Select all that apply.)
A. 12-year-old child who has iron deficiency anaemia
B. 24-year-old female who has no health problems
C. 44-year-old male who has hypertension
D. 55-year-old female who has alcohol use disorder
E. 35-year-old male who has type 2 diabetes mellitus
Answer: B. 24-year-old female who has no health problems
D. 55-year-old female who has alcohol use disorder
Rationale:
(B. The female client of childbearing age should take folic acid to prevent neural tube defects in
the fetus

D. The client who has alcohol use disorder can require folic acid therapy. Excess alcohol
consumption leads to poor dietary intake of folic acid and injury to the liver)
A nurse is preparing to administer Potassium Chloride IV to a client who has Hypokalaemia.
Which of the following actions should the nurse take? (Select all that apply.)
A. Infuse medication through a large-bore needle.
B. Monitor urine output to ensure at least 20 mL/hr.
C. Administer medication via direct IV bolus.
D. Implement cardiac monitoring.
E. Administer the infusion using an IV pump
Answer: A. Infuse medication through a large-bore needle.
D. Implement cardiac monitoring.
E. Administer the infusion using an IV pump
Rationale:
(A. Infuse potassium through a large-bore needle to prevent vein irritation, phlebitis, and
infiltration.
D. Implement cardiac monitoring to detect cardiac dysrhythmias in a client receiving IV
potassium.
E. Administer IV potassium using an infusion pump to prevent fatal hyperkalaemia due to a rapid
infusion rate)
A nurse is caring for a client who requests information on the use of Feverfew. Which of the
following responses should the nurse make?
A. "It is used to treat skin infections."
B. "It can decrease the frequency of migraine headaches."
C. "It can lessen the nasal congestion in the common cold."
D. "It can relieve nausea of morning sickness during pregnancy."
Answer: B. "It can decrease the frequency of migraine headaches."
Rationale:
(Feverfew is used to decrease the frequency of migraine headaches, but it has not been proven to
relieve an existing migraine headache.)

A nurse is completing an assessment of a client's current medications. The client states she also
takes Gingko Biloba. Which of the following medications is contraindicated for a client taking
Gingko Biloba?
A. Acetaminophen
B. Warfarin
C. Digoxin
D. Lisinopri
Answer: B. Acetaminophen
Rationale:
(Warfarin is contraindicated for a client taking gingko biloba because ginkgo biloba can suppress
coagulation and increase the risk of bleeding or haemorrhage)
A nurse is reviewing the health care record of a client who is asking about conjugated equine
oestrogens. The nurse should inform the client this medication is contraindicated in which of the
following conditions?
A. Atrophic vaginitis
B. Dysfunctional uterine bleeding
C. Osteoporosis
D. Thrombophlebitis
Answer: D. Thrombophlebitis
Rationale:
(Estrogen increases the risk of thrombolytic events. estrogen use is contraindicated for a client
who has a history of thrombophlebitis)
A nurse is providing teaching to a female client who is taking
Testosterone to treat advanced breast cancer. The nurse should tell the client that which of the
following are adverse effects of this medication? (Select all that apply.)
A. Deepening voice
B. Weight gain
C. Low blood pressure

D. Dry mouth
E. Facial hair
Answer: A. Deepening voice
B. Weight gain
E. Facial hair
Rationale:
(A. Virilization, the development of adult male characteristics in a female, is an adverse effect of
testosterone. The nurse should tell the client that a deepening voice is an adverse effect of
testosterone.
B. Edema and weight gain are adverse effects of testosterone
E. Virilization is an adverse effect of testosterone. The nurse should tell the client that the
development of facial hair is an adverse effect of testosterone)
A nurse is explaining the mechanism of action of combination oral contraceptives to a group of
clients. The nurse should tell the clients that which of the following actions occur with the use of
combination oral contraceptives? (Select all that apply.)
A. Thickening the cervical mucus
B. Inducing maturation of ovarian follicle
C. Increasing development of the corpus luteum
D. Altering the endometrial lining
E. Inhibiting ovulation
Answer: A. Thickening the cervical mucus
D. Altering the endometrial lining
E. Inhibiting ovulation
Rationale:
(A. Oral contraceptives cause thickening of the cervical mucus, which slows sperm passage
D. Oral contraceptives alter the lining of the endometrium, which inhibits implantation of the
fertilized egg.
E. Oral contraceptives prevent pregnancy by inhibiting ovulation.)

A nurse is providing teaching to a client who will start Alfuzosin for treatment of Benign
Prostatic Hyperplasia. The nurse should instruct the client that which of the following is an
adverse effect of this medication?
A. Bradycardia
B. Edema
C. Hypotension
D. Tremor
Answer: C. Hypotension
Rationale:
(Alfuzosin relaxes muscle tone in veins and cardiac output decreases, which leads to
hypotension. Clients taking this medication are advised to rise slowly from a sitting or lying
position.)
A nurse is caring for a client who has angina and asks about obtaining a prescription for
sildenafil to treat erectile dysfunction. Which of the following medications is contraindicated
with Sildenafil?
A. Aspirin
B. Isosorbide
C. Clopidogrel
D. Atorvastatin
Answer: B. Isosorbide
Rationale:
(Isosorbide is an organic nitrate that manages pain from angina. Concurrent use of it is
contraindicated because fatal hypotension can occur. The client should avoid taking a nitrate
medication for 24 hr after taking isosorbide.)
A nurse is teaching a client about Terbutaline. Which of the following statements by the client
indicates understanding of the teaching?
A. "This medication will stop my contractions."
B. "This medication will prevent vaginal bleeding."
C. "This medication will promote blood flow to my baby."

D. "This medication will increase my prostaglandin production
Answer: A. "This medication will stop my contractions."
Rationale:
(Terbutaline blocks beta2-adrenergic receptors, which causes uterine smooth muscle relaxation)
A nurse is caring for a client who has Preeclampsia and is receiving Magnesium Sulphate IV
continuous infusion. Which of the following findings should the nurse report to the provider?
A. 2+ deep tendon reflexes
B. 2+ pedal edema
C. 24 mL/hr urinary output
D. Respirations 12/mi
Answer: C. 24 mL/hr urinary output
Rationale:
(Urine output less than 25 to 30 mL/hr is associated with magnesium sulphate toxicity and
should be reported to the provider)
A nurse is caring for a client who has a new prescription for Oxytocin to stimulate uterine
contractions. Which of the following interventions should the nurse make? (Select all that apply.)
A. Use an infusion pump for medication administration.
B. Obtain vital signs frequently and with every dosage change.
C. Stop infusion if uterine contractions occur every 4 min and last 45 seconds.
D. Increase medication infusion rate rapidly.
E. Monitor fetal heart rate continuously
Answer: A. Use an infusion pump for medication administration.
B. Obtain vital signs frequently and with every dosage change.
E. Monitor fetal heart rate continuously
Rationale:
(A. Oxytocin must be administered by an infusion pump to ensure precise dosage.
B. Vital signs are monitored to assess for hypertension, an adverse effect of oxytocin.
E. Continuous FHR monitoring is required to assess for fetal distress)

A nurse is caring for a client who is in labor and receiving IV Opioid analgesics. Which of the
following actions should the nurse take?
A. Instruct the client to self-ambulate every 2 hr.
B. Offer oral hygiene every 2 hr.
C. Anticipate medication administration 2 hr prior to delivery.
D. Monitor fetal heart rate every 2 hr
Answer: B. Offer oral hygiene every 2 hr.
Rationale:
(Oral hygiene should be offered on a regular basis to a client receiving opioid analgesics due to
the adverse effects of dry mouth, nausea, and vomiting)
A nurse is reviewing a new prescription for Terbutaline with a client who has a history of preterm
labor. Which of the following client statements indicates understanding of the teaching?
A. "I can increase my activity now that I've started on this medication."
B. "I will increase my daily fluid intake to 3 quarts."
C. "I will report increasing intensity of contractions to my doctor."
D. "I am glad this will prevent preterm labor."
Answer: C. "I will report increasing intensity of contractions to my doctor."
Rationale:
(The client should report increasing intensity, frequency, or duration of contractions to the
provider because these are manifestations of preterm labor)
A nurse is providing teaching for a client who has gout and a new prescription for Allopurinol.
For which of the following adverse effects should the client be taught to monitor? (Select all that
apply.)
A. Stomatitis
B. Insomnia
C. Nausea
D. Rash
E. Increased gout pain
Answer: C. Nausea

D. Rash
E. Increased gout pain
Rationale:
(C. Nausea and vomiting are adverse effects that can be caused by allopurinol.
D. Rash and other hypersensitivity reactions can be caused by allopurinol. The client should be
taught to contact the provider for any manifestation of hypersensitivity so that the medication can
be discontinued.
E. An increase in gout attacks can occur during the first few months in a client who is taking
allopurinol.)
A nurse is caring for a client who has a new prescription for Adalimumab for Rheumatoid
Arthritis. Based on the route of administration of Adalimumab, which of the following should the
nurse plan to monitor?
A. The vein for thrombophlebitis during IV administration
B. The subcutaneous site for redness following injection
C. The oral mucosa for ulceration after oral administration
D. The skin for irritation following removal of transdermal patch
Answer: B. The subcutaneous site for redness following injection
Rationale:
(Adalimumab is administered subcutaneously, and injection-site redness and swelling are
common. It is appropriate for the nurse to assess the site for redness following injection.)
A nurse is preparing to administer Belimumab for a client who has Systemic Lupus
Erythematosus. Which of the following actions should the nurse plan to take?
A. Warm the medication to room temperature over 1 hr before administering.
B. Administer the medication by IV bolus over 5 min.
C. Dilute the medication in 5% dextrose and water solution.
D. Monitor the client for hypersensitivity reactions
Answer: D. Monitor the client for hypersensitivity reactions
Rationale:

(Belimumab can cause severe infusion reactions and can cause anaphylaxis. The nurse should
carefully monitor the client during infusion of this medication and be prepared to slow or stop
the medication if a reaction occurs.)
A nurse is caring for a client who has a new diagnosis of Fibromyalgia. Which of the following
medications should the nurse anticipate being prescribed for this client?
A. Colchicine
B. Hydroxychloroquine
C. Auranofin
D. Duloxetine
Answer: D. Duloxetine
Rationale:
(Duloxetine is a serotonin-norepinephrine reuptake inhibitor used to treat fibromyalgia. Other
uses for this medication include treating depression and diabetic peripheral neuropathy)
A nurse is evaluating teaching for a client who has Rheumatoid Arthritis and a new prescription
for Methotrexate. Which of the following statements by the client indicates understanding of the
teaching?
A. "I will be sure to return to the clinic at least once a year to have my blood drawn while I'm
taking methotrexate."
B. "I will take this medication on an empty stomach."
C. "I'll let the doctor know if I develop sores in my mouth while taking this medication.
D. "I should stop taking oral contraceptives while I'm taking methotrexate."
Answer: C. "I'll let the doctor know if I develop sores in my mouth while taking this medication.
Rationale:
(Ulcerations in the mouth, tongue, or throat are often the first signs of methotrexate toxicity and
should be reported to the provider immediately)
A nurse is providing teaching to a client who is taking Raloxifene to prevent Postmenopausal
Osteoporosis. The nurse should advise the client that which of the following are adverse effects
of this medication? (Select all that apply.)

A. Hot flashes
B. Lump in breast
C. Swelling or redness in calf
D. Shortness of breath
E. Difficulty swallowing
Answer: A. Hot flashes
C. Swelling or redness in calf
D. Shortness of breath
Rationale:
(A. Raloxifene can cause hot flashes or increase existing hot flashes.
C. Raloxifene increases the risk for thrombophlebitis, which can cause swelling or redness in the
calf.
D. Raloxifene increases the risk for pulmonary embolism, which can cause shortness of breath.)
A nurse is teaching a client who has Osteoporosis and a new prescription for Alendronate. Which
of the following instructions should the nurse provide? (Select all that apply.)
A. Take medication in the morning before eating.
B. Chew tablets to increase bioavailability.
C. Drink an 8 oz glass of water with each tablet.
D. Take medication with an antacid if heartburn occurs.
E. Avoid lying down after taking this medication CORRECT
Answer: A. Take medication in the morning before eating.
C. Drink an 8 oz glass of water with each tablet.
E. Avoid lying down after taking this medication CORRECT
Rationale:
(A. Take alendronate first thing in the morning before eating to increase absorption
C. Clients should drink at least 240 mL (8 oz) water with alendronate tablets.
E. Clients should sit upright or stand for at least 30 min after taking alendronate.)

A nurse is caring for a client who has a new prescription for Calcitonin-salmon for Osteoporosis.
Which of the following tests should the nurse tell the client to expect before beginning this
medication?
A. Skin test for allergy to the medication
B. ECG to rule out cardiac dysrhythmias
C. Mantoux test to rule out exposure to tuberculosis
D. Liver function tests to assess risk for medication toxicity
Answer: A. Skin test for allergy to the medication
Rationale:
(Anaphylaxis can occur if the client is allergic to calcitonin-salmon. A skin test to determine
allergy might be done before starting this medication. The nurse also should ask the client about
previous allergies to fish)
A nurse is caring for a young adult client whose serum Calcium is 8.8 mg/dL. Which of the
following medications should the nurse anticipate administering to this client?
A. Calcitonin-salmon
B. Calcium carbonate
C. Zoledronic acid
D. Ibandronate
Answer: B. Calcium carbonate
Rationale:
(The client's serum calcium level is below the expected reference range. Calcium carbonate is an
oral form of calcium used to increase serum calcium to the expected reference range.)
A nurse is providing instruction to a client who has a new prescription for Calcitonin-salmon for
postmenopausal Osteoporosis. Which of the following instructions should the nurse include in
the teaching?
A. Swallow tablets on an empty stomach with plenty of water.
B. Watch for skin rash and redness when applying calcitonin-salmon topically.
C. Mix the liquid medication with juice and take it after meals.
D. Alternate nostrils each time calcitonin-salmon is inhale

Answer: D. Alternate nostrils each time calcitonin-salmon is inhale
Rationale:
(Calcitonin-salmon can be administered I’m or subcutaneously, but is commonly administered
intranasally for postmenopausal osteoporosis. The client should alternate nostrils daily.)
A nurse is assessing a client who has salicylism. Which of the following findings should the
nurse expect? (Select all that apply.)
A. Dizziness
B. Diarrhea
C. Jaundice
D. Tinnitus
E. Headache
Answer: A. Dizziness
D. Tinnitus
E. Headache
Rationale:
(A. The client who has salicylism can have dizziness, which is an expected finding.
D. The client who has salicylism can have tinnitus, which is an expected finding.
E. The client who has salicylism can have a headache, which is an expected finding)
A nurse is admitting a toddler to the hospital after an Acetaminophen overdose. Which of the
following medications should the nurse anticipate administering to this client?
A. Acetylcysteine
B. Pegfilgrastim
C. Misoprostol
D. Naltrexone
Answer: A. Acetylcysteine
Rationale:
(The nurse should administer acetylcysteine, which is the antidote for acetaminophen overdose.)

A nurse is teaching a client about the a new prescription for Celecoxib. Which of the following
information should the nurse include in the teaching?
A. Increases the risk for a myocardial infarction
B. Decreases the risk of stroke
C. Inhibits COX-1
D. Increases platelet aggregation
Answer: A. Increases the risk for a myocardial infarction
Rationale:
(The client who takes celecoxib has an increased risk for a myocardial infarction secondary to
suppressing vasodilation)
A nurse is taking a history for a client who reports that he is taking Aspirin about four times daily
for a sprained wrist. Which of the following prescribed medications taken by the client is
contraindicated with aspirin?
A. Digoxin
B. Metformin
C. Warfarin
D. Nitro-glycerine
Answer: C. Warfarin
Rationale:
(The effect of warfarin and other anticoagulants is increased by aspirin, which inhibits platelet
aggregation. This client would have an increased risk for bleeding. Use of aspirin generally is
contraindicated for clients who take warfarin.)
A nurse in an emergency department is performing an admission assessment for a client who has
severe Aspirin toxicity. Which of the following findings should the nurse expect?
A. Body temperature 35° C (95° F)
B. Lung crackles
C. Cool, dry skin
D. Respiratory depression
Answer: D. Respiratory depression

Rationale:
(Respiratory depression due to increasing respiratory acidosis is an expected manifestation of
severe aspirin toxicity.)
A nurse is preparing to administer an Opioid agonist to a client who has acute pain. Which of the
following complications should the nurse monitor?
A. Urinary retention
B. Tachypnoea
C. Hypertension
D. Irritating cough
Answer: A. Urinary retention
Rationale:
(The nurse should monitor for urinary retention because morphine can suppress awareness that
the bladder is full.)
A nurse is caring for a client who has end-stage cancer and is receiving Morphine. The client's
daughter asks why the provider prescribed Methylnaltrexone. Which of the following responses
should the nurse make?
A. "The medication will increase your mother's respirations."
B. "The medication will prevent dependence on the Morphine
C. "The medication will relieve your mother's constipation."
D. "The medication works with the Morphine to increase pain relief.
Answer: C. "The medication will relieve your mother's constipation."
Rationale:
(Methylnaltrexone is an opioid antagonist used for treating severe constipation that is unrelieved
by laxatives in clients who are opioid-dependent. The medication blocks the mu opioid receptors
in the GI tract.)
A nurse is preparing to administer Butorphanol to a client who has a history of substance use
disorder. The nurse should identify which of the following information as true regarding
Butorphanol?

A. Butorphanol has a greater risk for abuse than morphine.
B. Butorphanol causes a higher incidence of respiratory depression than morphine.
C. Butorphanol cannot be reversed with an opioid antagonist.
D. Butorphanol can cause abstinence syndrome in opioid-dependent clients
Answer: D. Butorphanol can cause abstinence syndrome in opioid-dependent clients
Rationale:
(Opioid agonist/antagonist medications, such as butorphanol, can cause abstinence syndrome in
opioid-dependent clients. manifestations include abdominal pain, fever, and anxiety)
A nurse is planning to administer Morphine IV to a client who is postoperative. Which of the
following actions should the nurse take?
A. Monitor for seizures and confusion with repeated doses.
B. Protect the client's skin from the severe diarrhoea that occurs with morphine.
C. Withhold this medication if respiratory rate is less than 12/min.
D. Give Morphine intermittent via IV bolus over 30 seconds or less
Answer: C. Withhold this medication if respiratory rate is less than 12/min.
Rationale:
(The nurse should withhold all opioids if the respiratory rate is 12/min or less, and notify the
provider.)
A nurse is reviewing the medication administration record for a client who is receiving
transdermal Fentanyl for severe pain. Which of the following medications should the nurse
expect to cause an adverse effect when administered concurrently with Fentanyl?
A. Ampicillin
B. Diazepam
C. Furosemide
D. Prednisone
Answer: B. Diazepam
Rationale:

(Diazepam, a benzodiazepine, is a CNS depressant, which can interact by causing the client to
become severely sedated when administered concurrently with an opioid agonist or
agonist/antagonist.)
A nurse is caring for a client who has cancer and is taking Morphine and Carbamazepine or pain.
Which of the following effects should the nurse monitor for when giving the medications
together? (Select all that apply.)
A. Need for reduced dosage of the opioid
B. Reduced adverse effects of the opioid
C. Increased analgesic effects
D. Enhanced CNS stimulation
E. Increased opioid tolerance
Answer: A. Need for reduced dosage of the opioid
B. Reduced adverse effects of the opioid
C. Increased analgesic effects
Rationale:
(A. Dosage of the opioid can be reduced when adjuvant medications are added for pain.
B. Adverse effects of the opioid can be reduced when adjuvant medications are added for pain.
C. Analgesic effects are increased when adjuvant medications are added for pain)
A nurse is planning care for a client who has brain cancer and is experiencing headaches. Which
of the following adjuvant medications are indicated for this client?
A. Dexamethasone
B. Methylphenidate
C. Hydroxyzine
D. Amitriptyline
Answer: A. Dexamethasone
Rationale:
(Dexamethasone, a glucocorticoid, decreases inflammation and swelling. It is used to reduce
cerebral edema and relieve pressure from the tumour.)

A nurse is preparing to administer Pamidronate to a client who has bone pain related to cancer.
Which of the following precautions should the nurse take when administering pamidronate?
A. Inspect the skin for redness and irritation when changing the intradermal patch.
B. Assess the IV site for Thrombophlebitis frequently during administration.
C. Instruct the client to sit upright or stand for 30 min following oral administration.
D. Watch for manifestations of anaphylaxis for 20 min after I’m administration
Answer: B. Assess the IV site for Thrombophlebitis frequently during administration.
Rationale:
(Pamidronate is administered by IV infusion. This medication is irritating to veins, and the nurse
should assess for thrombophlebitis during administration)
A nurse is planning care for a client who has cancer and is taking a Glucocorticoid as an adjuvant
medication for pain control. Which of the following interventions should the nurse include in the
plan of care? (Select all that apply.)
A. Monitor for urinary retention.
B. Monitor serum glucose.
C. Monitor serum potassium level.
D. Monitor for gastric bleeding.
E. Monitor for respiratory depression
Answer: B. Monitor serum glucose.
C. Monitor serum potassium level.
D. Monitor for gastric bleeding.
Rationale:
(B. monitoring serum glucose is important because glucocorticoids raise the glucose level,
especially in clients who have diabetes mellitus.
C. monitoring serum potassium level is important because glucocorticoids can cause
hypokalaemia.
D. monitoring for gastric bleeding is important because glucocorticoids irritate the gastric
mucosa and put the client at risk for a peptic ulcer.)

A nurse is administering Amitriptyline to a client who is experiencing cancer pain. For which of
the following adverse effects should the nurse monitor?
A. Decreased appetite
B. Explosive diarrhoea
C. Decreased pulse rate
D. Orthostatic hypotension
Answer: D. Orthostatic hypotension
Rationale:
(Amitriptyline can cause orthostatic hypotension. The nurse should assess for this effect and
instruct the client to move slowly from lying down or sitting after taking this medication.)
A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the
following instructions should the nurse provide? (Select all that apply.)
A. Take Ergotamine as a prophylaxis to prevent a migraine headache.
B. Identify and avoid trigger factors.
C. Lie down in a dark quiet room at the onset of a migraine.
D. Avoid foods that contain Tyramine.
E. Avoid exercise that can increase heart rate
Answer: B. Identify and avoid trigger factors.
C. Lie down in a dark quiet room at the onset of a migraine.
D. Avoid foods that contain Tyramine.
Rationale:
(B. Identifying and avoiding trigger factors is an important action that can help to prevent some
migraines.
C. Lying down in a dark, quiet room at the onset of a migraine can prevent the onset of more
severe manifestations.
D. Foods that contain tyramine can be a trigger for some migraines and should be avoided.)
A nurse is planning care for a client who is to receive Tetracaine prior to a Bronchoscopy. Which
of the following actions should the nurse include in the plan of care?
A. Keep the client NPO until pharyngeal response returns.

B. Monitor the insertion site for a hematoma.
C. Palpate the bladder to detect urinary retention.
D. Maintain the client on bed rest for 12 hr following the procedure
Answer: A. Keep the client NPO until pharyngeal response returns.
Rationale:
(The nurse should keep the client NPO following the procedure until normal pharyngeal
sensation returns (approximately 1 hr) and should then monitor the client's first oral intake to
ensure aspiration does not occur)
A nurse is caring for a client who receives a local anaesthetic of Lidocaine during the repair of a
skin laceration. For which of the following adverse reactions should the nurse monitor the client?
A. Seizures
B. Tachycardia
C. Hypertension
D. Fever
Answer: A. Seizures
Rationale:
(Seizure activity is an adverse effect that can occur as a result of local aesthetic injection.)
A nurse is reviewing the health history of a client who has migraine headaches and is to begin
prophylaxis therapy with Propranolol. Which of the following findings in the client history
should the nurse report to the provider?
A. The client had a prior myocardial infarction.
B. The client takes warfarin for atrial fibrillation.
C. The client takes an SSRI for depression.
D. An ECG indicates a first-degree heart block
Answer: D. An ECG indicates a first-degree heart block
Rationale:
(Propranolol is contraindicated in clients who have a first-degree heart block. The nurse should
report this finding to the provider.)

A nurse is providing teaching to a client who has migraine headaches and a new prescription for
Ergotamine. For which of the following adverse effects should the nurse instruct the client to
stop taking the medication and notify the provider? (Select all that apply.)
A. Nausea
B. Visual disturbances
C. Positive home pregnancy test
D. Numbness and tingling in fingers
E. Muscle pain
Answer: C. Positive home pregnancy test
D. Numbness and tingling in fingers
E. Muscle pain
Rationale:
(C. A client who has a positive home pregnancy test should stop taking ergotamine and notify the
provider. Ergotamine is classified as Pregnancy Risk Category X and can cause fetal abortion.
D. Numbness and tingling in fingers or toes can be a finding in ergotamine overdose. The
medication should be stopped and the provider notified.
E. Unexplained muscle pain can be a finding in ergotamine overdose. The medication should be
stopped and the provider notified)
A nurse is teaching clients in an outpatient facility about the use of Insulin to treat type 1
Diabetes Mellitus. For which of the following types of insulin should the nurse tell the clients to
expect a peak effect 1 to 5 hr after administration?
A. Insulin glargine
B. NPH insulin
C. Regular insulin
D. Insulin lispro
Answer: C. Regular insulin
Rationale:
(Regular insulin has a peak effect around 1 to 5 hr following administration)

A nurse is caring for a client in an outpatient facility who has been taking Acarbose for type 2
Diabetes Mellitus. Which of the following laboratory tests should the nurse plan to monitor?
A. WBC
B. Serum potassium
C. Platelet count
D. Liver function test
Answer: D. Liver function test
Rationale:
(Acarbose can cause liver toxicity when taken long-term. Liver function tests should be
monitored periodically while the client takes this medication)
A nurse is providing teaching to a client who has type 2 Diabetes Mellitus and is starting
Repaglinide. Which of the following statements by the client indicates understanding of the
administration of this medication?
A. "I'll take this medicine with my meals."
B. "I'll take this medicine 30 minutes before I eat."
C. "I'll take this medicine just before I go to bed."
D. "I'll take this medicine as soon as I wake up in the morning."
Answer: B. "I'll take this medicine 30 minutes before I eat."
Rationale:
(Repaglinide causes a rapid, short-lived release of insulin. The client should take this medication
within 30 min before each meal so that insulin is available when food is digested.)
A nurse is providing teaching for a client who has a new prescription for Metformin. Which of
the following adverse effects of Metformin should the nurse instruct the client to report to the
provider?
A. Somnolence
B. Constipation
C. Fluid retention
D. Weight gain
Answer: A. Somnolence

Rationale:
(Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness,
hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by
metformin and should be reported to the provider.)
A nurse is providing teaching to a client who has a prescription for Pramlintide for type 1
Diabetes Mellitus. Which of the following should the nurse include in the teaching? (Select all
that apply.)
A. "Take oral medications 1 hr before injection."
B. "Use upper arms as preferred injection sites."
C. "Mix pramlintide with breakfast dose of insulin."
D. "Inject pramlintide just before a meal."
E. "Discard open vials after 28 days.
Answer: D. "Inject pramlintide just before a meal."
E. "Discard open vials after 28 days.
Rationale:
(D. Pramlintide can cause hypoglycaemia, especially when the client also takes insulin, so it is
important to eat a meal after injecting this medication.
E. Unused medication in the open pramlintide vial should be discarded after 28 days)
A nurse is caring for a client who is taking Propylthiouracil. For which of the following adverse
effects of this medication should the nurse monitor?
A. Bradycardia
B. Insomnia
C. Heat intolerance
D. Weight loss
Answer: A. Bradycardia
Rationale:
(Bradycardia is an adverse effect of propylthiouracil. The nurse should monitor for bradycardia)

A nurse is teaching a client who has Graves' disease about her prescribed medications. Which of
the following statements by the client indicates an understanding of the use of Propranolol in the
treatment of Graves' disease?
A. "Propranolol helps increase blood flow to my thyroid gland."
B. "Propranolol is used to prevent excess glucose in my blood."
C. "Propranolol will decrease my tremors and fast heart beat."
D. "Propranolol promotes a decrease of thyroid hormone in my body
Answer: C. "Propranolol will decrease my tremors and fast heart beat."
Rationale:
(Propranolol is a beta-adrenergic antagonist that decreases heart rate and controls tremors.)
A nurse is caring for an older adult client in a long-term care facility who has Hypothyroidism
and a new prescription for Levothyroxine. Which of the following dosage schedules should the
nurse expect for this client?
A. The client will start at a high dose, and the dose will be tapered as needed.
B. The client will remain on the initial dosage during the course of treatment.
C. The client's dosage will be adjusted daily based on blood levels.
D. The client will start on a low dose, which will be gradually increased
Answer: D. The client will start on a low dose, which will be gradually increased
Rationale:
(The nurse should expect that levothyroxine will be started at a low dose and gradually increased
over several weeks. This is especially important in older adult clients to prevent toxicity)
A nurse is caring for a client who is taking for Somatropin to stimulate growth. The nurse should
plan to monitor the client's urine for which of the following?
A. Bilirubin
B. Protein
C. Potassium
D. Calcium
Answer: D. Calcium
Rationale:

(A large amount of calcium can be present in the urine of a client who takes somatropin. This
puts the client at risk for renal calculi)
A nurse is assessing a client who takes Desmopressin for Diabetes Insipidus. For which of the
following adverse effects should the nurse monitor?
A. Hypovolemia
B. Hypercalcemia
C. Agitation
D. Headache
Answer: D. Headache
Rationale:
(Headache during desmopressin therapy is an indication of water intoxication)
A nurse is admitting a client to an acute care facility for a total hip arthroplasty. The client takes
hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority?
A. Administering a supplemental dose of hydrocortisone
B. Instructing the client about coughing and deep breathing
C. Collecting additional information from the client about his history of Addison's disease
D. Inserting an indwelling urinary catheter
Answer: A. Administering a supplemental dose of hydrocortisone
Rationale:
(Acute adrenal insufficiency (adrenal crisis) is the greatest risk to a client who has Addison's
disease, is taking a glucocorticoid, and is undergoing surgery. To prevent acute adrenal
insufficiency, supplemental doses are administered during times of increased stress)
A nurse is caring for several clients who came to the clinic for a seasonal influenza
immunization. The nurse should identify that which of the following clients is a candidate to
receive the vaccine via nasal spray rather than an injection?
A. 1-year-old who has no health problems
B. 17-year-old who has a hypersensitivity to Penicillin
C. 25-year-old who is pregnant

D. 52-year-old who takes a multivitamin supplement
Answer: B. 17-year-old who has a hypersensitivity to Penicillin
Rationale:
(A 17-year-old can be immunized for influenza with the LAIV via nasal spray. A hypersensitivity
to penicillin is not a contraindication for an influenza immunization)
A nurse is teaching a group of new parents about immunizations. The nurse should instruct the
parents that the series for which of the following vaccines is completed prior to the first
birthday?
A. Pneumococcal conjugate vaccine
B. Meningococcal conjugate vaccine
C. Varicella vaccine
D. Rotavirus vaccine
Answer: D. Rotavirus vaccine
Rationale:
(Rotavirus vaccine is administered only to infants less than 8 months, 0 days of age)
A nurse at a provider's office is preparing to administer RV, DTaP, hib, PCV13, and IPV
immunizations to a 4-month-old infant. Which of the following actions should the nurse plan to
take? (Select all that apply.)
A. Administer IPV orally
B. Administer subcutaneous injections in the anterolateral thigh.
C. Administer I’m injections in the deltoid muscle.
D. Give the infant his pacifier during vaccine injections.
E. Teach parents to give aspirin on a schedule for 24 hr after immunization
Answer: B. Administer subcutaneous injections in the anterolateral thigh.
D. Give the infant his pacifier during vaccine injections.
Rationale:
(B. Subcutaneous immunizations may be administered in either the anterolateral thigh or the
outer aspect of the upper arm to infants and children.

D. Giving the infant a pacifier during injections is a comfort measure that should be encouraged
by the nurse.)
A 12-month-old child just received the first measles, mumps, and rubella (mmR) vaccine. For
which of the following possible reactions to this vaccine should the nurse teach the parents to
monitor? (Select all that apply.)
A. Rash
B. Swollen glands
C. Bruising
D. Headache
E. Inconsolable crying
Answer: A. Rash
B. Swollen glands
C. Bruising
Rationale:
(A. A rash and fever can develop in children 1 to 2 weeks Following mmR immunization.
B. Swollen glands can develop in children 1 to 2 weeks following mmR immunization.
C. A temporary low platelet count, causing bruising or bleeding, can occur occasionally
following mmR immunization)
A nurse is caring for a group of clients who are not protected against Varicella. The nurse should
prepare to administer the Varicella vaccine at this time to which of the following clients?
A. 24-year-old woman in the third trimester of pregnancy
B. 12-year-old child who has a severe allergy to neomycin
C. 2-month-old infant who has no health problems
D. 32-year-old man who has essential hypertension
Answer: D. 32-year-old man who has essential hypertension
Rationale:
(A 32-year-old man who has essential hypertension and did not receive two doses of varicella
vaccine earlier in life should be immunized. Essential hypertension is not a contraindication for
this vaccine)

A nurse is caring for a client who has breast cancer and asks why she is receiving a combination
therapy of Cyclophosphamide, Methotrexate, and Fluorouracil. The response by the nurse should
include that combination chemotherapy is used to do which of the following? (Select all that
apply.)
A. Decrease medication resistance
B. Attack cancer cells at different stages of cell growth
C. Block chemotherapy agent from entering healthy cells
D. Stimulate immune system
E. Decrease injury to normal body cells
Answer:
A. Decrease medication resistance
B. Attack cancer cells at different stages of cell growth
E. Decrease injury to normal body cells
Rationale:
(A. medication resistance is decreased with combination therapy because the chance of
developing resistance to several medication is less than to only one medication.
B. Each medication kills cancer cells at a different stage of growth. A combination of
medications can kill more cancer cells than only one medication.
E. Injury to normal body cells can be decreased by combination therapy because the medications
used have different toxicities)
A nurse is preparing to administer Cyclophosphamide IV to a client who has Hodgkin's disease.
Which of the following medications should the nurse expect to administer concurrently with the
chemotherapy to prevent an adverse effect of Cyclophosphamide?
A. Uroprotectant agent, such as mesna
B. Opioid, such as morphine
C. Loop diuretic, such as furosemide
D. H1 receptor antagonist, such as diphenhydramine
Answer: A. Uroprotectant agent, such as mesna
Rationale:

(Mesna is a uroprotectant agent that can help prevent hemorrhagic cystitis when administered IV
with a nitrogen mustard chemotherapy medication)
A nurse is preparing to administer Leucovorin to a client who has cancer and is receiving
chemotherapy with Methotrexate. Which of the following responses should the nurse use when
the client asks why Leucovorin is being given?
A. "Leucovorin reduces the risk of a transfusion reaction from methotrexate."
B. "Leucovorin increases platelet production and prevents bleeding."
C. "Leucovorin potentiates the cytotoxic effects of methotrexate."
D. "Leucovorin protects healthy cells from methotrexate's toxic effect."
Answer: D. "Leucovorin protects healthy cells from methotrexate's toxic effect."
Rationale:
(Leucovorin, a folic acid derivative and an antagonist to methotrexate, is given within 12 hr of
high doses of methotrexate to protect healthy cells from the toxic effects of methotrexate)
A nurse is teaching a client who has breast cancer about Tamoxifen. Which of the following
adverse effects of tamoxifen should the nurse discuss with the client?
A. Irregular heart beat
B. Abnormal uterine bleeding
C. Yellow sclera or dark-colored urine.
D. Difficulty swallowing
Answer: B. Abnormal uterine bleeding
Rationale:
(Vaginal discharge and bleeding are adverse effects of tamoxifen. The client who takes tamoxifen
is also at increased risk for endometrial cancer, so any abnormal uterine bleeding should be
carefully monitored and evaluated)
A nurse is caring for a client who is being treated with Interferon alfa-2b for Malignant
Melanoma. For which of the following adverse effects should the nurse monitor? (Select all that
apply.)
A. Tinnitus

B. Muscle aches
C. Peripheral neuropathy
D. Bone loss
E. Depression
Answer: B. Muscle aches
C. Peripheral neuropathy
E. Depression
Rationale:
(B. muscle aches and other flu-like manifestations are common adverse effects of interferon alfa2b. Acetaminophen may be prescribed to relieve these manifestations.
C. Peripheral neuropathy, dizziness, and fatigue are CNS effects that can occur when taking
interferon alfa-2b. These should be reported to the provider, and the nurse should teach the client
to prevent injury from falls.
E. Depression and mental status changes can occur with interferon alfa-2b treatment. The nurse
should assess the client for suicidal thoughts.)
A nurse is caring for a client who receives Rituximab to treat Non-Hodgkin’s Leukaemia and
who asks the nurse how Rituximab works. Which of the following should the nurse include?
A. Blocks hormone receptors
B. Increases immune response
C. Binds with specific antigens on tumour cells
D. Stops DNA replication during cell division
Answer: C. Binds with specific antigens on tumour cells
Rationale:
(Rituximab is a monoclonal antibody that binds to specific antigens on B-lymphocytes and then
destroying cancer cells.)
A nurse is implementing a plan of care for a client who has a wound infection. Which of the
following actions should the nurse perform first?
A. Administer antibiotic medication.
B. Obtain a wound specimen for culture.

C. Review WBC laboratory findings.
D. Apply a dressing to the wound
Answer: B. Obtain a wound specimen for culture.
Rationale:
(When using the urgent vs. nonurgent approach to care, the nurse's priority action is to obtain a
culture of the wound before initiating antibiotic therapy)
A nurse is caring for a client who has a UTI and a history of recurrence of this type of infection.
The client asks why the provider has not yet prescribed an antibiotic. The nurse should explain
that the provider has to wait for the results of which of the following laboratory tests to identify
which antibiotic to prescribe?
A. Gram stain
B. Culture
C. Sensitivity
D. Specific gravity
Answer: C. Sensitivity
Rationale:
(A sensitivity test identifies the most effective antibiotic to prescribe to treat a specific microorganism.)
A nurse is preparing information for the unit's nurses about the effectiveness of antimicrobial
therapy for clients who have bacterial infections. Which of the following host factors should the
nurse include as conditions that affect antimicrobial effectiveness? (Select all that apply.)
A. Meningitis
B. Pacemaker
C. Endocarditis
D. Pneumonia
E. Pyelonephriti
Answer: A. Meningitis
B. Pacemaker
C. Endocarditis

Rationale:
(A. Some clients who have meningitis have difficulty responding to antimicrobial therapy
because it is difficult for the medication to cross the blood-brain barrier to reaching the infecting
micro-organisms.
B. Some clients who have a pacemaker have difficulty responding to antimicrobial therapy due
to colonization of micro-organisms around the pacemaker and the inability of phagocytic cells to
destroy those micro-organisms.
C. Some clients who have endocarditis have difficulty responding to antimicrobial therapy
because the medication cannot penetrate the vegetative thrombus that develops on the injured
endocardium)
A nurse is caring for a group of clients who are receiving antimicrobial therapy. Which of the
following clients should the nurse plan to monitor for manifestations of antibiotic toxicity?
A. An adolescent client who has a sinus infection
B. An older adult client who has prostatitis
C. A client who is postpartum and has mastitis
D. A middle adult client who has a urinary tract infection
Answer: B. An older adult client who has prostatitis
Rationale:
(An older adult client who has prostatitis and is receiving antibiotics is at risk for toxicity due to
the age-related reduction in medication metabolism and excretion)
A charge nurse is teaching a group of nurses about the importance of prophylactic antimicrobial
therapy. Which of the following information should the charge nurse include in the teaching?
(Select all that apply.)
A. Administer prophylactic antimicrobial therapy to clients who report exposure to a sexually
transmitted infection.
B. Administer prophylactic antimicrobial therapy to clients who are having orthopaedic surgery.
C. Instruct clients who have a prosthetic heart valve about the need for prophylactic
antimicrobial therapy before dental work.

D. Consult the provider for prophylactic antimicrobial therapy for clients who have recurrent
urinary tract infections.
E. Instruct clients to request prophylactic antimicrobial therapy immediately when they have an
upper respiratory infection
Answer: A. Administer prophylactic antimicrobial therapy to clients who report exposure to a
sexually transmitted infection.
B. Administer prophylactic antimicrobial therapy to clients who are having orthopaedic surgery.
C. Instruct clients who have a prosthetic heart valve about the need for prophylactic
antimicrobial therapy before dental work.
D. Consult the provider for prophylactic antimicrobial therapy for clients who have recurrent
urinary tract infections.
Rationale:
(A. Clients who suspect exposure to a sexually transmitted infection require prophylactic
antimicrobial therapy to prevent an infection.
B. Clients who are having orthopaedic surgery require prophylactic antimicrobial therapy to
prevent an infection.
C. Clients who are having dental work and have a prosthetic heart valve should receive
prophylactic antimicrobial therapy to prevent an infection.
D. Clients who have recurrent urinary tract infections should receive prophylactic antimicrobial
therapy to prevent an infection)
A nurse in an outpatient facility is preparing to administer Nafcillin I’m to an adult client who
has an infection. Which of the following actions should the nurse plan to take? (Select all that
apply.)
A. Select a 25-gauge, ½-inch needle for the injection.
B. Administer the medication deeply into the ventrogluteal muscle.
C. Ask the client about an allergy to penicillin before administering the medication.
D. Monitor the client for 30 min following the injection.
E. Tell the client to expect a temporary rash to develop following the injection
Answer: B. Administer the medication deeply into the ventrogluteal muscle.
C. Ask the client about an allergy to penicillin before administering the medication.

D. Monitor the client for 30 min following the injection.
Rationale:
(B. It is important to administer nafcillin I’m into a deep muscle mass, such as the ventrogluteal
site.
C. It is important to ask the client about an allergy to penicillin or other antibiotics before
administering nafcillin. An allergy to another penicillin or to a cephalosporin is a
contraindication for administering nafcillin.
D. When administering a penicillin or other antibiotic parenterally, it is important to monitor the
client for 30 min for an allergic reaction)
A nurse is preparing to administer Cefotaxime IV to a client who has a severe infection and has
been receiving Cefotaxime for the past week. Which of the following findings indicates a
potentially serious adverse reaction to this medication that the nurse should report to the
provider?
A. Diaphoresis
B. Epistaxis
C. Diarrhea
D. Alopecia
Answer: C. Diarrhea
Rationale:
(Diarrhea is an adverse effect of cefotaxime and other cephalosporins that requires reporting to
the provider. Severe diarrhoea might indicate that the client has developed antibiotic-associated
pseudomembranous colitis, which could be life-threatening.)
A nurse is obtaining a medication history from a client who is to receive Imipenem-cilastatin IV
to treat an infection. Which of the following medications the client also receives puts him at risk
for a medication interaction?
A. Regular insulin
B. Furosemide
C. Valproic acid
D. Ferrous sulphate

Answer: C. Valproic acid
Rationale:
(Imipenem-cilastatin decreases the blood levels of valproic acid, an antiseizure medication,
putting the client at risk for increased seizure activity. If the client must take these two
medications concurrently, the nurse should monitor for seizures)
A nurse is caring for a client who has a Cerebrospinal fluid infection with gram-negative
bacteria. Which of the following Cephalosporin antibiotics should the nurse expect to administer
IV to treat this infection?
A. Cefaclor
B. Cefazolin
C. Cefepime
D. Cephalexin
Answer: C. Cefepime
Rationale:
(Cefepime, a fourth-generation cephalosporin, is more likely to be effective against this infection
than the other medications, which are from the first or second generation. medications from each
progressive generation of cephalosporins are more effective against gram-negative bacteria, more
resistant to destruction by beta-lactamase, and more able to reach cerebrospinal fluid)
A nurse is preparing to administer Penicillin V to a client who has a streptococcal infection. The
client tells the nurse that she has difficulty swallowing tablets and doesn't "do well" with liquid
or chewable medications because the taste gags her, even when the a nurse mixes the medication
with food. The nurse should request a prescription for which of the following medications?
A. Fosfomycin
B. Amoxicillin
C. Nafcillin
D. Cefaclor
Answer: C. Nafcillin
Rationale:

(Nafcillin is an acceptable alternative within the penicillin classification because it is available
for Imor IV use.)
A nurse is teaching a client about taking Tetracycline to treat a GI infection due to Helicobacter
pylori, Which of the following statements should the nurse identify as an indication that the
client understands the instructions?
A. "I will take this medication with 8 ounces of milk."
B. "I will let my doctor know if I start having diarrhoea."
C. "I can stop taking this medication when I feel completely well."
D. "I can take this medication just before bedtime.
Answer: B. "I will let my doctor know if I start having diarrhoea."
Rationale:
(Diarrhea can indicate that the client is developing a superinfection, which can be very serious.
The client should notify the provider if diarrhoea occurs.)
A nurse is administering gentamicin by IV infusion at 0900. The medication will take 1 hr to
infuse. When should the nurse plan to obtain a blood sample for a peak serum level of
gentamicin?
A. 1000
B. 1030
C. 1100
D. 1130
Answer: B. 1030
Rationale:
(The nurse should obtain the blood specimen for the peak serum level at 1030, 30 min after the
end of the IV infusion. For the trough level, the nurse should collect the blood sample just before
starting the infusion)
A nurse is caring for a client who is starting a course of gentamicin IV for a serious respiratory
infection. For which of the following manifestations should the nurse monitor as an adverse
effect of this medication? (Select all that apply.)

A. Pruritus
B. Haematuria
C. Muscle weakness
D. Difficulty swallowing
E. Vertigo
Answer: A. Pruritus
B. Haematuria
C. Muscle weakness
E. Vertigo
Rationale:
(A. Paresthesias of the hands and feet, urticaria, rash, and pruritus are indications of a
hypersensitivity reaction that can occur in clients taking gentamicin.
B. haematuria is an indication of acute kidney toxicity due to gentamicin.
C. muscle weakness and respiratory depression can occur in clients taking gentamicin as a result
of neuromuscular blockade
E. Vertigo, ataxia, and hearing loss are indications of ototoxicity that can occur in clients taking
gentamicin)
A nurse is caring for a client who has Subacute Bacterial Endocarditis and is receiving several
antibiotics, including Streptomycin I’m. For which of the following manifestations should the
nurse monitor as an adverse effect of this medication?
A. Extremity paresthesias
B. Urinary retention
C. Severe constipation
D. Complex partial seizures
Answer: A. Extremity paresthesias
Rationale:
(Paresthesias of the hands and feet are a common adverse effect of streptomycin. This
medication treats infections in combination with other antibiotics or to treat severe infections
when other antibiotics failed)

A nurse is caring for a client who is undergoing preparation for extensive colorectal surgery.
Which of the following oral antibiotics should the nurse expect to administer specifically to
suppress normal flora in the GI tract?
A. Kanamycin
B. Gentamicin
C. Neomycin
D. Tobramycin
Answer: C. Neomycin
Rationale:
(The nurse should expect to administer neomycin, an aminoglycoside antibiotic, orally prior to
GI surgery to rid the large intestine of normal flora)
A nurse reviewing a client's medication history notes an allergy to Sulphonamides. This allergy is
a contraindication for taking which of the following medications? (Select all that apply.)
A. Hydrochlorothiazide
B. Metoprolol
C. Acetaminophen
D. Glipizide
E. Furosemide
Answer: A. Hydrochlorothiazide
D. Glipizide
E. Furosemide
Rationale:
(A. A sulphonamide allergy is a contraindication for taking hydrochlorothiazide. hypersensitivity,
including Stevens-Johnson syndrome, can result from taking hydrochlorothiazide and a
sulphonamide concurrently.
D. A sulphonamide allergy is a contraindication for taking some oral antidiabetic medications,
including glipizide and glyburide. hypersensitivity, including Stevens-Johnson syndrome, can
result from taking glipizide and a sulphonamide concurrently.
E. A sulphonamide allergy is a contraindication for taking loop diuretics, such as furosemide.

hypersensitivity, including Stevens-Johnson syndrome, can result from taking furosemide and a
sulphonamide concurrently)
A nurse is teaching a client who has a new prescription for Nitrofurantoin. Which of the
following information should the nurse include? (Select all that apply.)
A. Observe for bruising on the skin.
B. Take the medication with milk or meals.
C. Expect brown discoloration of urine.
D. Crush the medication if it is difficult to swallow.
E. Expect insomnia when taking it
Answer: A. Observe for bruising on the skin.
B. Take the medication with milk or meals.
C. Expect brown discoloration of urine.
Rationale:
(A. Bruising can indicate a blood dyscrasia, and the client should notify the provider if this
occurs.
B. Taking the medication with milk or meals minimizes GI discomfort from nausea, vomiting,
anorexia, and diarrhoea.
C. A brown discoloration of urine is a common adverse effect of nitrofurantoin.)
A nurse is teaching a female client who has a severe UTI about ciprofloxacin. Which of the
following information about adverse reactions should the nurse include? (Select all that apply.)
A. Observe for pain and swelling of the Achilles tendon.
B. Watch for a vaginal yeast infection.
C. Expect excessive nighttime perspiration.
D. Inspect the mouth for cottage cheese-like lesions.
E. Take the medication with a dairy product
Answer: A. Observe for pain and swelling of the Achilles tendon.
B. Watch for a vaginal yeast infection.
D. Inspect the mouth for cottage cheese-like lesions.
Rationale:

(A. Pain and swelling of the Achilles tendon indicate an adverse effect of ciprofloxacin to report
to the provider.
B. A vaginal yeast infection is an overgrowth of Candida albicans, which commonly occurs when
taking ciprofloxacin.
D. Cottage cheese-like lesions in the mouth indicate an overgrowth of Candida albicans, a
common adverse effect when taking ciprofloxacin)
A nurse is planning discharge teaching for a female client who has a new prescription for
Trimethoprim-sulfamethoxazole. Which of the following information should the nurse include?
A. Take the medication even if pregnant.
B. Maintain a fluid restriction while taking it.
C. Take it on an empty stomach.
D. Stop taking it when manifestations subside
Answer: C. Take it on an empty stomach.
Rationale:
(The nurse should inform the client that she may take the medication with or without food.)
A nurse is planning to administer Ciprofloxacin IV to a client who has cystitis. Which of the
following actions should the nurse take?
A. Administer a concentrated solution.
B. Infuse the medication over 60 min.
C. Infuse the solution through the primary IV fluid's tubing.
D. Choose a small peripheral vein for administration.
Answer: B. Infuse the medication over 60 min.
Rationale:
(The nurse should administer ciprofloxacin IV over 60 min to minimize irritation of the vein)
A nurse is caring for a client who has Diabetes Mellitus, Pulmonary Tuberculosis, and a new
prescription for Isoniazid. Which of the following supplements should the nurse expect to
administer to prevent an adverse effect of INH?
A. Ascorbic acid

B. Pyridoxine
C. Folic acid
D. Cyanocobalami
Answer: B. Pyridoxine
Rationale:
(Pyridoxine is frequently prescribed along with INh to prevent peripheral neuropathy for clients
who have increased risk factors, such as diabetes mellitus or alcohol use disorder)
A nurse is infusing IV Amphotericin B to a client who has a systemic fungal infection. The nurse
should monitor the client for which of the following adverse effects of this medication?
A. Hypoglycaemia
B. Constipation
C. Fever
D. Hyperkalemia
Answer: C. Fever
Rationale:
(Amphotericin B can cause fever, chills, and nausea during the infusion. Pretreatment with
diphenhydramine and acetaminophen can reduce these effects.)
A nurse is administering IV Amphotericin B to a client who has a systemic fungal infection. The
nurse should monitor which of the following laboratory values? (Select all that apply.)
A. Serum calcium
B. Serum amylase
C. Serum potassium
D. Hematocrit
E. Serum creatinine
Answer: C. Serum potassium
D. Hematocrit
E. Serum creatinine
Rationale:

(C. hypokalemia is a serious adverse effect of amphotericin B. The nurse should monitor serum
potassium values for hypokalaemia.
D. Amphotericin B can cause bone marrow suppression. The nurse should monitor CBC and
platelet count periodically.
E. Amphotericin B can cause nephrotoxicity. The nurse should monitor kidney function (with
serum creatinine, BUN, and creatinine clearance))
A nurse is teaching a client who is beginning a course of Metronidazole to treat an infection. For
which of the following adverse effects should the nurse instruct the client to stop taking
Metronidazole and notify the provider?
A. Metallic taste
B. Nausea
C. Ataxia
D. Dark-colored urine
Answer: C. Ataxia
Rationale:
(Ataxia , tremors, paresthesias of the extremities, and seizures are manifestations of CNS
toxicity. The client should stop taking the medication and notify the provider if any of these
effects occur.)
A nurse is teaching a client who has active tuberculosis about his treatment regimen. The client
asks why he must take four different medications. Which of the following responses should the
nurse make?
A. "Four medications decrease the risk for a severe allergic reaction"
B. "Four medications reduce the chance that the bacteria will become resistant.
C. "Four medications reduce the risk for adverse reactions"
D. "Four medications decrease the chance of having a positive tuberculin skin test.
Answer: B. "Four medications reduce the chance that the bacteria will become resistant.
Rationale:
(If the client took only one medication to treat active tuberculosis, resistance to the medication
would occur quickly. Taking three or four medications decreases the possibility of resistance.)

A nurse is teaching a client who has a new prescription for combination oral NRTIs (abacavir,
lamivudine, and zidovudine) for treatment of HIV. Which of the following statements should the
nurse include?
A. "These medications work by blocking HIV entry into cells."
B. "These medications work by weakening the cell wall of the HIV virus."
C. "These medications work by inhibiting enzymes to prevent HIV replication."
D. "These medications work by preventing protein synthesis within the HIV cell."
Answer: C. "These medications work by inhibiting enzymes to prevent HIV replication."
Rationale:
(The NRTI antiretroviral medications this client takes work by inhibiting the enzyme reverse
transcriptase and preventing HIV replication)
A nurse is caring for a client who takes several antiretroviral medications, including the NRTI
Zidovudine, to treat hIV infection. The nurse should monitor for which of the following adverse
effects of Zidovudine? (Select all that apply.)
A. Fatigue
B. Blurred vision
C. Ataxia
D. Hyperventilation
E. Vomiting
Answer: A. Fatigue
D. Hyperventilation
E. Vomiting
Rationale:
(A. Fatigue is a manifestation of anemia, an adverse effect of zidovudine. Neutropenia can also
occur, causing a high risk for infection
D. hyperventilation is a finding that can occur if the client develops lactic acidosis, a serious
adverse effect of zidovudine.
E. Vomiting and other GI effects are adverse effects of zidovudine)

A nurse is caring for a client who is taking Ritonavir, a protease inhibitor, to treat HIV infection.
The nurse should monitor for which of the following adverse effects of this medication?
A. Increased TSH level
B. Decreased ALT level
C. Hypoglycaemia
D. Hyperlipidaemia
Answer: D. Hyperlipidaemia
Rationale:
(Hyperlipidaemia with increased cholesterol and triglyceride levels can occur as an adverse
effect of ritonavir)
A nurse is caring for a client who has a new prescription for Enfuvirtide to treat HIV infection.
The nurse should monitor the client for which of the adverse reactions of this medication?
(Select all that apply.)
A. Bleeding
B. Pneumonia
C. Cerebral edema
D. Localized erythema
E. Hypotension
Answer: B. Pneumonia
D. Localized erythema
E. Hypotension
Rationale:
(B. Bacterial pneumonia with fever, cough, and difficulty breathing are manifestations of an
adverse reaction to enfuvirtide. The nurse should assess breath sounds regularly
D. Enfuvirtide is administered subcutaneously. Injection-site reactions, such as pain, redness,
itching, and bruising, are common.
E. A systemic allergic reaction can occur when taking enfuvirtide. manifestations of
hypersensitivity include rash, hypotension, fever, and chills)

A nurse is administering IV Acyclovir to a client who has Varicella. Which of the following
actions should the nurse take?
A. Administer a stool softener
B. Decrease fluid intake following infusion.
C. Infuse Acyclovir over 1 hr
D. Monitor for a for hypotension
Answer: C. Infuse Acyclovir over 1 hr
Rationale:
(The nurse should administer IV acyclovir slowly, over at least 1 hr, to prevent nephrotoxicity)
A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for
HIV infection about ways to prevent medication resistance. Which of the following information
should the nurse teach the client about resistance?
A. Taking low dosages of antiretroviral medication minimizes resistance.
B. Taking one antiretroviral medication at a time minimizes resistance.
C. Taking medication at the same times daily without missing doses minimizes resistance.
D. Changing the medication regimen when adverse effects occur minimizes resistance
Answer: C. Taking medication at the same times daily without missing doses minimizes
resistance.
Rationale:
(The nurse should emphasize the importance of taking each dose of medication exactly as
prescribed. missing even a few doses of antiretroviral medication can promote medication
resistance, which can cause treatment failure)