ATI Pharmacology Quiz: Challenge Your Drug Knowledge

1. 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?

Bruising

Fever

Abdominal pain

Rash

A. Bleeding can result if an SSRI is administered with warfarin. however, this is not an indication of serotonin syndrome.
B. CORRECT: Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline.
C. Abdominal pain is not an indication of serotonin syndrome.
D. A localized rash is associated with transdermal preparation. however, it is not an indication of serotonin syndrome.

Explanation

A. Bleeding can result if an SSRI is administered with warfarin. however, this is not an indication of serotonin syndrome.
B. CORRECT: Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline.
C. Abdominal pain is not an indication of serotonin syndrome.
D. A localized rash is associated with transdermal preparation. however, it is not an indication of serotonin syndrome.

2. 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?

Take the medication in the morning to prevent insomnia.

Chew sugarless gum to moisten the mouth.

Use cooling measures to decrease fever.

Take an antacid to relieve nausea.

A. Insomnia is not an anticholinergic effect.
B. CORRECT: Chewing sugarless gum can help the client cope
with dry mouth, a potential anticholinergic effect of uphenazine.
C. Fever is not an anticholinergic effect.
D. Nausea is not an anticholinergic effect.

Explanation

A. Insomnia is not an anticholinergic effect.
B. CORRECT: Chewing sugarless gum can help the client cope
with dry mouth, a potential anticholinergic effect of uphenazine.
C. Fever is not an anticholinergic effect.
D. Nausea is not an anticholinergic effect.

3. 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?

Intestinal ileus

Neutropenia

Delirium

Hyperthermia

A. headache is an adverse effect of nitroprusside, not intestinal ileus.
B. Bradycardia is an adverse effect of nitroprusside, not neutropenia.
C. CORRECT: 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.
D. hypotension is an adverse effect of nitroprusside, not hyperthermia.

Explanation

A. headache is an adverse effect of nitroprusside, not intestinal ileus.
B. Bradycardia is an adverse effect of nitroprusside, not neutropenia.
C. CORRECT: 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.
D. hypotension is an adverse effect of nitroprusside, not hyperthermia.

4. 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?

“Add extra snacks to your diet to prevent weight loss.”

“Notify the provider if you develop breast enlargement.”

“You may begin to have mild seizures while taking this medication.”

“This medication is likely to increase your libido.”

A. Risperidone and other atypical antidepressants cause weight gain and the client should be taught to maintain a lower‐calorie balanced diet.
B. CORRECT: Gynecomastia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider if these manifestations occur.
C. Seizures are not an adverse effect of risperidone.
D. Sexual dysfunction, causing decreased libido and impotence are adverse effects of risperidone.

Explanation

A. Risperidone and other atypical antidepressants cause weight gain and the client should be taught to maintain a lower‐calorie balanced diet.
B. CORRECT: Gynecomastia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider if these manifestations occur.
C. Seizures are not an adverse effect of risperidone.
D. Sexual dysfunction, causing decreased libido and impotence are adverse effects of risperidone.

5. A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include?

“Rinse your mouth after each use of this medication.”

“Limit fluid intake while taking this medication.”

“Increase your intake of vitamin B12 while taking this medication.”

“You can take the medication as needed.”

A. CORRECT: The client should rinse her mouth after each use to reduce the risk of oral fungal infections.
B. A client who has asthma should increase uid intake to liquefy secretions, unless contraindicated by another condition.
C. Glucocorticoids place the client at risk for bone loss. There is no need for the client to increase her intake of vitamin B12. The client should ensure an adequate intake of calcium and vitamin D.
D. Beclomethasone is an inhaled glucocorticoid and is taken on a xed schedule.

Explanation

A. CORRECT: The client should rinse her mouth after each use to reduce the risk of oral fungal infections.
B. A client who has asthma should increase uid intake to liquefy secretions, unless contraindicated by another condition.
C. Glucocorticoids place the client at risk for bone loss. There is no need for the client to increase her intake of vitamin B12. The client should ensure an adequate intake of calcium and vitamin D.
D. Beclomethasone is an inhaled glucocorticoid and is taken on a xed schedule.

6. 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?

Take the albuterol at the same time each day.

Administer the albuterol inhaler prior to using the beclomethasone inhaler.

Use beclomethasone if experiencing an acute episode.

Avoid shaking the beclomethasone before use.

A. Albuterol is a short acting inhaled beta2‐agonist and used for short term relief of bronchospasm. B. CORRECT: 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. C. Beclomethasone is administered on a fixed schedule. It is not used to treat an acute attack. D. The client should shake the metered dose inhaler well before administration.

Explanation

A. Albuterol is a short acting inhaled beta2‐agonist and used for short term relief of bronchospasm. B. CORRECT: 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. C. Beclomethasone is administered on a fixed schedule. It is not used to treat an acute attack. D. The client should shake the metered dose inhaler well before administration.

7. 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?

“Propranolol helps increase blood ow to my thyroid gland.”

“Propranolol is used to prevent excess glucose in my blood.

“Propranolol will decrease my tremors and fast heart beat.”

“Propranolol promotes a decrease of thyroid hormone in my body.”

A. Propranolol lowers blood pressure, but does not increase blood ow to the thyroid gland.
B. Propranolol does not help prevent hyperglycemia.
C. CORRECT: Propranolol is a beta‐adrenergic antagonist that decreases heart rate and controls tremors.
D. Propranolol does not promote a decrease of thyroid hormone.

Explanation

A. Propranolol lowers blood pressure, but does not increase blood ow to the thyroid gland.
B. Propranolol does not help prevent hyperglycemia.
C. CORRECT: Propranolol is a beta‐adrenergic antagonist that decreases heart rate and controls tremors.
D. Propranolol does not promote a decrease of thyroid hormone.

8. 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?

“Notify the provider if you plan to become pregnant.”

“Allow at least 6 hr for sleep when taking zolpidem.”

“To increase the effectiveness of zolpidem, take it with a bedtime snack.”

A. CORRECT: Zolpidem is Pregnancy Risk Category C. The client should notify the provider if she plans to become pregnant.
B. Zolpidem should be taken at bedtime.
C. The client should allow at least 8 hr for sleep when taking zolpidem.
D. Zolpidem is absorbed best on an empty stomach.

Explanation

A. CORRECT: Zolpidem is Pregnancy Risk Category C. The client should notify the provider if she plans to become pregnant.
B. Zolpidem should be taken at bedtime.
C. The client should allow at least 8 hr for sleep when taking zolpidem.
D. Zolpidem is absorbed best on an empty stomach.

9. 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?

Kidney toxicity

Liver damage

Seizure activity

Adrenal insufficiency

A. Atomoxetine can cause urinary retention, but not kidney toxicity.
B. CORRECT: 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.
C. Bupropion increases seizure risk at high dosages. Seizure activity is not an adverse effect of atomoxetine.
D. Atomoxetine can cause suicidal ideation and mood swings. Adrenal insuf ciency is not an adverse effect of atomoxetine.

Explanation

A. Atomoxetine can cause urinary retention, but not kidney toxicity.
B. CORRECT: 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.
C. Bupropion increases seizure risk at high dosages. Seizure activity is not an adverse effect of atomoxetine.
D. Atomoxetine can cause suicidal ideation and mood swings. Adrenal insuf ciency is not an adverse effect of atomoxetine.

10. A nurse is teaching a client who has obsessive‐compulsive disorder and has a new prescription for paroxetine. Which of the following instructions should the nurse include?

“It can take several weeks before you feel like the medication is helping.”

“Take the medication just before bedtime to promote sleep.”

“You should take the medication when needed for obsessive urges.”

“monitor for weight gain while taking this medication.”

A. CORRECT: Paroxetine can take 1 to 4 weeks before the client reaches full therapeutic bene t.
B. Take paroxetine in the morning to prevent insomnia.
C. Take paroxetine on a regular basis rather than an as‐needed basis.
D. Paroxetine can cause decreased appetite and weight loss.

Explanation

A. CORRECT: Paroxetine can take 1 to 4 weeks before the client reaches full therapeutic bene t.
B. Take paroxetine in the morning to prevent insomnia.
C. Take paroxetine on a regular basis rather than an as‐needed basis.
D. Paroxetine can cause decreased appetite and weight loss.

11. 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?

Bilirubin

Protein

Potassium

Calcium

A. Bilirubin can be present in the urine with liver or biliary disorders, but is not monitored during somatropin therapy.
B. Protein can be present in the urine during stress, infection, or glomerular disorders, but is not monitored during somatropin therapy.
C. Potassium is not expected to be present in a urine specimen.
D. CORRECT: 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.

Explanation

A. Bilirubin can be present in the urine with liver or biliary disorders, but is not monitored during somatropin therapy.
B. Protein can be present in the urine during stress, infection, or glomerular disorders, but is not monitored during somatropin therapy.
C. Potassium is not expected to be present in a urine specimen.
D. CORRECT: 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.

12. 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?

Shuffling gait

Neck spasms

Drowsiness

Impotence

A. Shuffling gait is an indication of parkinsonism and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority finding. B. CORRECT: 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. C. Drowsiness is an adverse effect of haloperidol and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority finding. D. Sexual dysfunction is an adverse effect of haloperidol and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority.

Explanation

A. Shuffling gait is an indication of parkinsonism and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority finding. B. CORRECT: 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. C. Drowsiness is an adverse effect of haloperidol and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority finding. D. Sexual dysfunction is an adverse effect of haloperidol and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority.

13. 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?

Perform immediate gastric lavage.

Prepare the client for hemodialysis.

Administer an additional oral dose of lithium.

Request a stat repeat of the laboratory test.

A. CORRECT: 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. B. hemodialysis is appropriate for a client who has a plasma lithium level greater than 2.5 mEq/L. C. Administering an additional dose of lithium will worsen the level of toxicity. D. There is no indication that the client needs another laboratory test, and this action can delay needed treatment.

Explanation

A. CORRECT: 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. B. hemodialysis is appropriate for a client who has a plasma lithium level greater than 2.5 mEq/L. C. Administering an additional dose of lithium will worsen the level of toxicity. D. There is no indication that the client needs another laboratory test, and this action can delay needed treatment.

14. 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 2 to 3 hr after administration?

Insulin glargine

NPh insulin

Regular insulin

Insulin lispro

A. Insulin glargine, a long‐acting insulin, does not have a peak effect time, but is fairly stable in effect after metabolized. B. NPh insulin has a peak effect around 6 to 14 hr following administration. C. CORRECT: Regular insulin has a peak effect around 2 to 3 hr following administration. D. Insulin lispro has a peak effect around 30 min to 2.5 hr following administration.

Explanation

A. Insulin glargine, a long‐acting insulin, does not have a peak effect time, but is fairly stable in effect after metabolized. B. NPh insulin has a peak effect around 6 to 14 hr following administration. C. CORRECT: Regular insulin has a peak effect around 2 to 3 hr following administration. D. Insulin lispro has a peak effect around 30 min to 2.5 hr following administration.

15. 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?

Light yellow urine

Report of tinnitus

Productive cough

Blue‐gray skin discoloration

A. Light yellow urine is an expected nding and does not indicate toxicity.
B. Ototoxicity can occur with aminoglycoside antibiotics, but does not indicate amiodarone toxicity.
C. CORRECT: Productive cough can indicate pulmonary toxicity or heart failure. The nurse should assess for cough, chest pain, and shortness of breath.
D. A blue‐gray skin discoloration can occur in clients who are taking amiodarone with sun exposure and should resolve.

Explanation

A. Light yellow urine is an expected nding and does not indicate toxicity.
B. Ototoxicity can occur with aminoglycoside antibiotics, but does not indicate amiodarone toxicity.
C. CORRECT: Productive cough can indicate pulmonary toxicity or heart failure. The nurse should assess for cough, chest pain, and shortness of breath.
D. A blue‐gray skin discoloration can occur in clients who are taking amiodarone with sun exposure and should resolve.

16. 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?

Calcium gluconate

Sodium bicarbonate

Potassium chloride

Magnesium sulfate

A. CORRECT: 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 uid therapy and placing the client in a modi ed Trendelenburg position.
B. IV sodium bicarbonate is used to treat metabolic acidosis. It is not used to increase blood pressure in clients who have received verapamil.
C. IV potassium chloride is used to treat hypokalemia. It is not used to increase blood pressure in clients who have received verapamil.
D. IV magnesium sulfate is used to treat ventricular dysrhythmias, such as torsades de pointe. It is not used to increase blood pressure in clients who have received verapamil.

Explanation

A. CORRECT: 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 uid therapy and placing the client in a modi ed Trendelenburg position.
B. IV sodium bicarbonate is used to treat metabolic acidosis. It is not used to increase blood pressure in clients who have received verapamil.
C. IV potassium chloride is used to treat hypokalemia. It is not used to increase blood pressure in clients who have received verapamil.
D. IV magnesium sulfate is used to treat ventricular dysrhythmias, such as torsades de pointe. It is not used to increase blood pressure in clients who have received verapamil.

17. 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?

The client will start at a high dose, and the dose will be tapered as needed.

The client will remain on the initial dosage during the course of treatment.

The client’s dosage will be adjusted daily based on blood levels.

The client will start on a low dose, which will be gradually increased.

A. The nurse should not expect that the levothyroxine will be started at a high dose.
B. The nurse should not expect that the client’s dosage will remain the same throughout treatment.
C. The nurse should not expect that the client’s dosage will be adjusted daily based on blood levels.
D. CORRECT: 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.

Explanation

A. The nurse should not expect that the levothyroxine will be started at a high dose.
B. The nurse should not expect that the client’s dosage will remain the same throughout treatment.
C. The nurse should not expect that the client’s dosage will be adjusted daily based on blood levels.
D. CORRECT: 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.

18. 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?

Increase the amount of dietary fiber in the diet.

Drink grapefruit juice daily to increase vitamin C intake.

Decrease the amount of calcium in the diet.

Withhold food for 1 hr after the medication is taken.

A. CORRECT: Increasing dietary fiber intake can help prevent constipation, an adverse effect of verapamil.
B. Clients should be taught to avoid drinking grapefruit juice when taking verapamil because concurrent use can lead to toxicity. In addition, it is not necessary to take extra vitamin C when taking verapamil.
C. There is no restriction on dietary calcium intake for clients taking verapamil.
D. There is no restriction regarding food when taking verapamil. Clients can take verapamil with food to prevent GI upset.

Explanation

A. CORRECT: Increasing dietary fiber intake can help prevent constipation, an adverse effect of verapamil.
B. Clients should be taught to avoid drinking grapefruit juice when taking verapamil because concurrent use can lead to toxicity. In addition, it is not necessary to take extra vitamin C when taking verapamil.
C. There is no restriction on dietary calcium intake for clients taking verapamil.
D. There is no restriction regarding food when taking verapamil. Clients can take verapamil with food to prevent GI upset.

19. A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine for posttraumatic stress disorder. Which of the following statements should the nurse include in the teaching?

“You may have a decreased desire for intimacy while taking this medication.

“You should take this medication at bedtime to help promote sleep.”

“You will have fewer urinary adverse effects if you urinate just before taking this medication.”

“You’ll need to wear sunglasses when outdoors due to the light sensitivity caused by this medication.”

A. CORRECT: Decreased libido is a potential adverse effect of fluoxetine and other SSRIs.
B. Clients should take fluoxetine in the morning due to CNS stimulation.
C. Clients taking a TCA, rather than fluoxetine, should void prior to taking the medication due to the potential for urinary hesitancy or retention.
D. Clients taking a TCA, rather than fluoxetine, should wear sunglasses when outdoors due to the potential for photophobia.

Explanation

A. CORRECT: Decreased libido is a potential adverse effect of fluoxetine and other SSRIs.
B. Clients should take fluoxetine in the morning due to CNS stimulation.
C. Clients taking a TCA, rather than fluoxetine, should void prior to taking the medication due to the potential for urinary hesitancy or retention.
D. Clients taking a TCA, rather than fluoxetine, should wear sunglasses when outdoors due to the potential for photophobia.

20. A nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include?

Remove the patch each evening.

Cut each patch in half if angina attacks are under control.

Take off the nitroglycerin patch for 30 min if a headache occurs.

Apply a new patch every 48 hr.

A. CORRECT: In order to prevent tolerance to nitroglycerin, the client should remove the patch for 10 to 12 hr during each 24‐hr period.
B. The client should always apply a whole patch to ensure he receives the prescribed dosage. The patches are available in many dosages.
C. The nurse should not instruct the client to remove patches for a 30‐min period if a headache occurs. The client should notify the provider if headaches do not resolve because
the dose of nitroglycerin might need to be decreased.
D. The client should apply a new patch every 24 hr.

Explanation

A. CORRECT: In order to prevent tolerance to nitroglycerin, the client should remove the patch for 10 to 12 hr during each 24‐hr period.
B. The client should always apply a whole patch to ensure he receives the prescribed dosage. The patches are available in many dosages.
C. The nurse should not instruct the client to remove patches for a 30‐min period if a headache occurs. The client should notify the provider if headaches do not resolve because
the dose of nitroglycerin might need to be decreased.
D. The client should apply a new patch every 24 hr.

21. 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?

Avoid the use of acetaminophen for headaches

Restrict intake of foods rich in sodium.

Decrease fluid intake to less than 1,500 mL daily

Limit aerobic activity in hot weather or hydrate very well by doing so.

A. The client should use acetaminophen, rather than NSAIDs such as ibuprofen, for headaches because NSAIDs interact with lithium and can cause increased blood levels of lithium. B. The client should increase, rather than decrease, sodium intake to reduce the risk for toxicity. C. The client should increase, rather than decrease, uid intake to reduce the risk for toxicity. D. CORRECT: The client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity.

Explanation

A. The client should use acetaminophen, rather than NSAIDs such as ibuprofen, for headaches because NSAIDs interact with lithium and can cause increased blood levels of lithium. B. The client should increase, rather than decrease, sodium intake to reduce the risk for toxicity. C. The client should increase, rather than decrease, uid intake to reduce the risk for toxicity. D. CORRECT: The client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity.

22. A nurse is teaching a client about preventing otitis externa. Which of the following instructions should the nurse include?

Clean the ear with a cotton‐tipped swab daily.

Place earplugs in the ears when sleeping at night.

Use a cool water irrigation solution to remove earwax.

Tip the head to the side to remove water from the ears after showering

A. The client should not insert anything in the ear because this can push cerumen into the eardrum, damage
the epithelium, or puncture the eardrum.
B. The client should wear earplugs only when swimming to reduce the risk for otitis externa.
C. The client should not use cool water irrigation solution to remove cerumen. Cool uid can cause vertigo, dizziness, and nausea. The client should not remove cerumen
from the ear to reduce the risk for otitis externa.
D. CORRECT: The client should remove water from the ear after showering or swimming to reduce the risk for otitis externa.

Explanation

A. The client should not insert anything in the ear because this can push cerumen into the eardrum, damage
the epithelium, or puncture the eardrum.
B. The client should wear earplugs only when swimming to reduce the risk for otitis externa.
C. The client should not use cool water irrigation solution to remove cerumen. Cool uid can cause vertigo, dizziness, and nausea. The client should not remove cerumen
from the ear to reduce the risk for otitis externa.
D. CORRECT: The client should remove water from the ear after showering or swimming to reduce the risk for otitis externa.

23. A nurse is caring for a client who is receiving moderate sedation with diazepam IV. The client is oversedated. Which of the following medications should the nurse anticipate administering to this client?

Ketamine

Naltrexone

Flumazenil

Fluvoxamine

A. ketamine is an anesthetic agent. B. Naltrexone is an opioid antagonist used to treat opioid overdose and alcohol use disorders. C. CORRECT: Although rarely used, Flumazenil is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzodiazepines. D. Fluvoxamine is a selective serotonin reuptake inhibitor used to treat depression.

Explanation

A. ketamine is an anesthetic agent. B. Naltrexone is an opioid antagonist used to treat opioid overdose and alcohol use disorders. C. CORRECT: Although rarely used, Flumazenil is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzodiazepines. D. Fluvoxamine is a selective serotonin reuptake inhibitor used to treat depression.

24. 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?

“Expect this medication to suppress your cough.”

”Expect this medication to smell like rotten eggs.”

“Expect this medication to cause euphoria.”

“Expect this medication to turn your urine orange.”

A. Acetylcysteine can stimulate a cough. Dextromethorphan suppresses a cough.
B. CORRECT: Acetylcysteine has a sulfur content that causes a rotten‐egg odor.
C. Dextromethorphan can cause euphoria at high doses. Acetylcysteine can cause drowsiness.
D. Discoloration of urine is an adverse effect of COmT inhibitors. Acetylcysteine can cause diarrhea.

Explanation

A. Acetylcysteine can stimulate a cough. Dextromethorphan suppresses a cough.
B. CORRECT: Acetylcysteine has a sulfur content that causes a rotten‐egg odor.
C. Dextromethorphan can cause euphoria at high doses. Acetylcysteine can cause drowsiness.
D. Discoloration of urine is an adverse effect of COmT inhibitors. Acetylcysteine can cause diarrhea.

25. 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?

Constipation

Suicidal thoughts

Photophobia

Dry mouth

A. The client is at risk for constipation because of the anticholinergic effects of desipramine. The client should increase uid intake to reduce the risk of constipation. however, another adverse effect is the priority.
B. CORRECT: The greatest risk to this client is injury from a suicide attempt; therefore, this is the priority. Desipramine can cause suicidal thoughts and behaviors which puts the client at risk. The parents should monitor and report any indication of increased depression or thoughts of suicidal behavior.
C. The client is at risk for photophobia, because of the anticholinergic effects of desipramine. The client should wear sun glasses when exposed to sunlight. however, another adverse effect is the priority.
D. The client is at risk for dry mouth because of the anticholinergic effects of desipramine. The client should increase uids and use hard candy to reduce dry mouth. however, another adverse effect is the priority.

Explanation

A. The client is at risk for constipation because of the anticholinergic effects of desipramine. The client should increase uid intake to reduce the risk of constipation. however, another adverse effect is the priority.
B. CORRECT: The greatest risk to this client is injury from a suicide attempt; therefore, this is the priority. Desipramine can cause suicidal thoughts and behaviors which puts the client at risk. The parents should monitor and report any indication of increased depression or thoughts of suicidal behavior.
C. The client is at risk for photophobia, because of the anticholinergic effects of desipramine. The client should wear sun glasses when exposed to sunlight. however, another adverse effect is the priority.
D. The client is at risk for dry mouth because of the anticholinergic effects of desipramine. The client should increase uids and use hard candy to reduce dry mouth. however, another adverse effect is the priority.

26. A nurse is teaching the parents of a school‐age child about transdermal methylphenidate. Which of the following instructions should the nurse include?

Apply one patch twice per day.

Leave the patch on for 9 hr.

Apply the patch to the child’s waist.

Use opened tray within 6 months.

A. Transdermal methylphenidate is administered once per day.
B. CORRECT: Transdermal methylphenidate is administered for 9 hr/day.
C. Transdermal methylphenidate is applied to the child’s hip.
D. Use the opened tray of transdermal methylphenidate within 2 months.

Explanation

A. Transdermal methylphenidate is administered once per day.
B. CORRECT: Transdermal methylphenidate is administered for 9 hr/day.
C. Transdermal methylphenidate is applied to the child’s hip.
D. Use the opened tray of transdermal methylphenidate within 2 months.

27. 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?

Increases the risk for seizure activity

Provides a form of aversion therapy

Decreases cravings

Results in mild hypertension

A. Seizure activity is a potential effect of alcohol withdrawal. however, propranolol does not increase this risk.
B. Disul ram, rather than propranolol, provides a form of aversion therapy.
C. CORRECT: Propranolol is an adjunct medication used during withdrawal to decrease the client’s craving for alcohol.
D. Propranolol is an antihypertensive medication that can result in hypotension rather than hypertension.

Explanation

A. Seizure activity is a potential effect of alcohol withdrawal. however, propranolol does not increase this risk.
B. Disul ram, rather than propranolol, provides a form of aversion therapy.
C. CORRECT: Propranolol is an adjunct medication used during withdrawal to decrease the client’s craving for alcohol.
D. Propranolol is an antihypertensive medication that can result in hypotension rather than hypertension.

28. 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?

Hold propranolol for an apical pulse greater than 100/min.

Administer propranolol to increase the client’s blood pressure.

Assist the client when she sits up or stands after taking this medication.

Check for hypokalemia frequently due to the risk for propranolol toxicity.

A. Propranolol is a beta‐adrenergic blocker that is used
to slow tachydysrhythmias. The nurse should not hold the medication for a pulse greater than 100/min, but should hold it for a very low pulse rate, such as less than 50/min.
B. Propranolol is used to treat hypertension and is not administered to increase the client’s blood pressure.
C. CORRECT: Propranolol can cause orthostatic hypotension, so it is important assess for dizziness during ambulation or when moving to a sitting position.
D. Propranolol can increase potassium level. The client is at risk for toxicity with digoxin, rather than

Explanation

A. Propranolol is a beta‐adrenergic blocker that is used
to slow tachydysrhythmias. The nurse should not hold the medication for a pulse greater than 100/min, but should hold it for a very low pulse rate, such as less than 50/min.
B. Propranolol is used to treat hypertension and is not administered to increase the client’s blood pressure.
C. CORRECT: Propranolol can cause orthostatic hypotension, so it is important assess for dizziness during ambulation or when moving to a sitting position.
D. Propranolol can increase potassium level. The client is at risk for toxicity with digoxin, rather than

29. 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?

Orthostatic hypotension

Hearing loss

Gastrointestinal bleeding

Weight loss

A. CORRECT: Orthostatic hypotension is an adverse of effect of mAOIs, including phenelzine.
B. Phenelzine is more likely to cause blurred vision than hearing loss.
C. Clients taking phenelzine are at risk for multiple adverse effects. however, these do not include GI bleeding.
D. Clients taking phenelzine are at risk for weight gain rather than weight loss.

Explanation

A. CORRECT: Orthostatic hypotension is an adverse of effect of mAOIs, including phenelzine.
B. Phenelzine is more likely to cause blurred vision than hearing loss.
C. Clients taking phenelzine are at risk for multiple adverse effects. however, these do not include GI bleeding.
D. Clients taking phenelzine are at risk for weight gain rather than weight loss.

30. 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?

“I should avoid eating right before I chew a piece of nicotine gum.”

“I will need to stop using the nicotine gum after 1 year.”

“I know that nicotine gum is a safe alternative to smoking if I become pregnant.”

“I must chew the nicotine gum quickly for about 15 minutes.”

A. CORRECT: The client should avoid eating or drinking 15 min prior to and while chewing the nicotine gum.
B. The client should not use nicotine gum for longer than 6 months.
C. The client should avoid all nicotine products, including nicotine gum, while pregnant or breastfeeding.
D. The client should chew the nicotine gum slowly and intermittently over 30 min.

Explanation

A. CORRECT: The client should avoid eating or drinking 15 min prior to and while chewing the nicotine gum.
B. The client should not use nicotine gum for longer than 6 months.
C. The client should avoid all nicotine products, including nicotine gum, while pregnant or breastfeeding.
D. The client should chew the nicotine gum slowly and intermittently over 30 min.

31. 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?

Baked potato

Fried chicken

Whole‐grain bread

Citrus fruits

A. A baked potato does not affect absorption of ramelteon.
B. CORRECT: high‐fat foods, such as fried chicken prolong the absorption of ramelteon and should be avoided.
C. Whole‐grain breads do not affect the absorption of ramelteon.
D. Citrus fruits do not affect the absorption of ramelteon.

Explanation

A. A baked potato does not affect absorption of ramelteon.
B. CORRECT: high‐fat foods, such as fried chicken prolong the absorption of ramelteon and should be avoided.
C. Whole‐grain breads do not affect the absorption of ramelteon.
D. Citrus fruits do not affect the absorption of ramelteon.

32. 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.)

Lorazepam

Diazepam

Disulfiram

Naltrexone

Acamprosate

A. CORRECT: Lorazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. B. CORRECT: Diazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. C. Disulfiram is administered to assist the client in maintaining abstinence from alcohol following withdrawal. D. Naltrexone is administered to assist the client in maintaining abstinence from alcohol following withdrawal. E. Acamprosate decreases unpleasant effects, such as anxiety or restlessness, resulting from abstinence. However, it is not used during acute withdrawal.

Explanation

A. CORRECT: Lorazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. B. CORRECT: Diazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. C. Disulfiram is administered to assist the client in maintaining abstinence from alcohol following withdrawal. D. Naltrexone is administered to assist the client in maintaining abstinence from alcohol following withdrawal. E. Acamprosate decreases unpleasant effects, such as anxiety or restlessness, resulting from abstinence. However, it is not used during acute withdrawal.

Submit

33. 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?

“This medication can stain your contacts.”

”This medication can cause your pupils to constrict.”

This medication can absorb into your contacts.”

“This medication can slow your heart rate.”

A. Rifampin can stain soft contact lenses. Brimonidine does not stain contacts.
B. Brimonidine can cause mydriasis or dilated pupils.
C. CORRECT: Brimonidine can absorb into soft contact lenses. The client should remove his contacts then instill the medication and wait at least 15 min before putting in his contacts back in.
D. Beta‐adrenergic blockers, such as timolol, can slow the heart rate. Brimonidine can cause hypertension or hypotension.

Explanation

A. Rifampin can stain soft contact lenses. Brimonidine does not stain contacts.
B. Brimonidine can cause mydriasis or dilated pupils.
C. CORRECT: Brimonidine can absorb into soft contact lenses. The client should remove his contacts then instill the medication and wait at least 15 min before putting in his contacts back in.
D. Beta‐adrenergic blockers, such as timolol, can slow the heart rate. Brimonidine can cause hypertension or hypotension.

34. 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?

“You should have a high carbohydrate snack between meals and at bedtime.”

“You are likely to develop hand tremors if you take this medication for a long period of time.”

'You may experience temporary numbness of your mouth after each dose.”

“You should have your white blood cell count monitored every week.”

A. Clozapine increases the client’s risk of developing diabetes mellitus and weight gain. It is not appropriate to increase carbohydrate intake. B. Clozapine has a low risk of EPS such as hand tremors. C. Asenapine, rather than clozapine, causes temporary numbing of the mouth. D. CORRECT: Due to the risk for fatal agranulocytosis weekly monitoring of the client’s WBC count is recommended while taking clozapine.

Explanation

A. Clozapine increases the client’s risk of developing diabetes mellitus and weight gain. It is not appropriate to increase carbohydrate intake. B. Clozapine has a low risk of EPS such as hand tremors. C. Asenapine, rather than clozapine, causes temporary numbing of the mouth. D. CORRECT: Due to the risk for fatal agranulocytosis weekly monitoring of the client’s WBC count is recommended while taking clozapine.

35. 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 after three rounds of nitroglycerin?" Which of the following responses should the nurse make?

“Take two more sublingual tablets at the same time.”

“Call the emergency response team.”

“Take a sustained‐release nitroglycerin capsule."

“Wait another 5 minutes then take a second sublingual tablet.”

A. The client should not take two sublingual doses at once. B. CORRECT: The next step is to call 911 and then take a second sublingual tablet. If the rst 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. C. Taking an oral sustained‐release capsule is not indicated to treat an acute anginal attack. D. The client should not wait an additional 5 minutes before taking a second tablet. The client should call 911 because he might be having a myocardial infarction.

Explanation

A. The client should not take two sublingual doses at once. B. CORRECT: The next step is to call 911 and then take a second sublingual tablet. If the rst 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. C. Taking an oral sustained‐release capsule is not indicated to treat an acute anginal attack. D. The client should not wait an additional 5 minutes before taking a second tablet. The client should call 911 because he might be having a myocardial infarction.

36. 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?

“You can take this medication to abort an acute asthma attack.”

“Tremors are an adverse effect of this medication.”

“Prolonged use of this medication can cause hyperglycemia.”

“This medication can slow skeletal growth rate.”

A. Inhaled albuterol is used to abort an acute asthma episode.
B. CORRECT: Tremors can occur due to excessive
stimulation of beta2 receptors of skeletal muscles.
C. Prolonged use of glucocorticoids can cause hyperglycemia.
D. Glucocorticoids slow skeletal growth rate in children and adolesc

Explanation

A. Inhaled albuterol is used to abort an acute asthma episode.
B. CORRECT: Tremors can occur due to excessive
stimulation of beta2 receptors of skeletal muscles.
C. Prolonged use of glucocorticoids can cause hyperglycemia.
D. Glucocorticoids slow skeletal growth rate in children and adolesc

37. A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instructions?

“Remove the prior dose before applying a new dose.

“Rub the ointment directly into your skin until it is no longer visible.”

“Cover the applied ointment with a clean gauze pad.”

“Apply the ointment to the same skin area each time.”

A. CORRECT: The client should remove the prior dose before applying a new dose to prevent toxicity.
B. The ointment should not be rubbed directly onto the skin. It is also important to tell the client not to touch the ointment with the ngers. The client should use the applicator that comes with the ointment to measure the correct dose and then spread the ointment onto the pre‐marked paper, before applying the ointment‐covered paper to the skin.
C. The client should cover the applied ointment with a transparent dressing and tape securely to the skin. Do not cover the medication with gauze.
D. The client should rotate application sites each time the ointment is applied. The client should select a clean, hairless area of the body.

Explanation

A. CORRECT: The client should remove the prior dose before applying a new dose to prevent toxicity.
B. The ointment should not be rubbed directly onto the skin. It is also important to tell the client not to touch the ointment with the ngers. The client should use the applicator that comes with the ointment to measure the correct dose and then spread the ointment onto the pre‐marked paper, before applying the ointment‐covered paper to the skin.
C. The client should cover the applied ointment with a transparent dressing and tape securely to the skin. Do not cover the medication with gauze.
D. The client should rotate application sites each time the ointment is applied. The client should select a clean, hairless area of the body.

38. 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?

Severe hypertension

Coarse tremors

Constipation

Muscle spasms

A. Severe hypotension, rather than hypertension, is an indication of toxicity.
B. CORRECT: Coarse tremors are an indication of toxicity.
C. Diarrhea, rather than constipation, is an indication of toxicity.
D. muscle weakness, rather than muscle spasm, is an indication of lithium toxicity.

Explanation

A. Severe hypotension, rather than hypertension, is an indication of toxicity.
B. CORRECT: Coarse tremors are an indication of toxicity.
C. Diarrhea, rather than constipation, is an indication of toxicity.
D. muscle weakness, rather than muscle spasm, is an indication of lithium toxicity.

39. A nurse is caring for a client who takes paroxetine to treat posttraumatic stress disorder 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.)

Concurrent administration of buspirone

Administration of a different SSRI

Use of a mouth guard

Changing to a different class of antidepressant medication

Increasing the dose of paroxetine

A. CORRECT: Concurrent administration of a low dose of buspirone is an effective measure to manage the adverse effects of paroxetine.
B. Other SSRIs also will have bruxism as an adverse effect. This is not an effective measure.
C. CORRECT: Using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism.
D. CORRECT: Changing to different class of antidepressant medication that does not have the adverse effect of bruxism is an effective measure.
E. Increasing the dose of paroxetine can cause the adverse effect of bruxism to worsen. This is not an effective measure.

Explanation

A. CORRECT: Concurrent administration of a low dose of buspirone is an effective measure to manage the adverse effects of paroxetine.
B. Other SSRIs also will have bruxism as an adverse effect. This is not an effective measure.
C. CORRECT: Using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism.
D. CORRECT: Changing to different class of antidepressant medication that does not have the adverse effect of bruxism is an effective measure.
E. Increasing the dose of paroxetine can cause the adverse effect of bruxism to worsen. This is not an effective measure.

Submit

40. 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?

Insidious onset of painless loss of vision

Gradual reduction in peripheral vision

Severe pain around eyes

Intraocular pressure 12 mm hg

A. Acute‐angle glaucoma is painful and has a sudden onset. B. Gradual loss of peripheral vision is a manifestation
of primary open‐angle glaucoma.
C. CORRECT: Severe pain around eyes that radiates over the face is a manifestation of acute angle‐closure glaucoma.
D. An IOP of 12 mm hg is within the expected reference range. Elevated IOP is a manifestation of angle‐closure glaucoma.

Explanation

A. Acute‐angle glaucoma is painful and has a sudden onset. B. Gradual loss of peripheral vision is a manifestation
of primary open‐angle glaucoma.
C. CORRECT: Severe pain around eyes that radiates over the face is a manifestation of acute angle‐closure glaucoma.
D. An IOP of 12 mm hg is within the expected reference range. Elevated IOP is a manifestation of angle‐closure glaucoma.

41. 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?

Sedation

Nasal congestion

Productive cough

Constipation

A. Insomnia, rather than sedation, is an adverse effect of this medication.
B. CORRECT: When used for over 5 days, rebound nasal congestion can occur when taking nasal sympathomimetic medications, such as phenylephrine.
C. Phenylephrine can cause a headache, but productive cough is not an adverse effect of this medication.
D. Constipation is an adverse effect of rst generation antihistamines, but is not caused by sympathomimetic medications such as phenylephrine.

Explanation

A. Insomnia, rather than sedation, is an adverse effect of this medication.
B. CORRECT: When used for over 5 days, rebound nasal congestion can occur when taking nasal sympathomimetic medications, such as phenylephrine.
C. Phenylephrine can cause a headache, but productive cough is not an adverse effect of this medication.
D. Constipation is an adverse effect of rst generation antihistamines, but is not caused by sympathomimetic medications such as phenylephrine.

42. 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?

Diarrhea

Anxiety

Sedation

Palpitations

A. Dextromethorphan can cause nausea.
B. Phenylephrine can cause anxiety and irritability.
C. CORRECT: Dextromethorphan can cause sedation. Advise the client to avoid activities that require alertness.
D. Phenylephrine can cause tachycardia and palpitations.

Explanation

A. Dextromethorphan can cause nausea.
B. Phenylephrine can cause anxiety and irritability.
C. CORRECT: Dextromethorphan can cause sedation. Advise the client to avoid activities that require alertness.
D. Phenylephrine can cause tachycardia and palpitations.

43. 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?

Wear sunglasses when outdoors.

Check your temperature daily.

Take this medication in the morning.

Add extra calories to your diet.

A. CORRECT: Wearing sunglasses when outdoors will decrease photophobia, an anticholinergic effect associated with TCA use.
B. Checking the client’s temperature daily is not necessary while taking a TCA.
C. The client should take this medication at bedtime rather than in the morning to prevent daytime sleepiness.
D. Following a low‐calorie diet plan will help prevent weight gain, an adverse effect of TCAs.

Explanation

A. CORRECT: Wearing sunglasses when outdoors will decrease photophobia, an anticholinergic effect associated with TCA use.
B. Checking the client’s temperature daily is not necessary while taking a TCA.
C. The client should take this medication at bedtime rather than in the morning to prevent daytime sleepiness.
D. Following a low‐calorie diet plan will help prevent weight gain, an adverse effect of TCAs.

44. 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?

“I should take the medication on an empty stomach.”

“I will follow a low‐sodium diet while taking this medication.”

“I need to discontinue this medication slowly.”

“I should not crush this medication before swallowing.”

A. The client can take this medication with food for GI distress or without food.
B. The client is at risk for hyponatremia while taking escitalopram.
C. CORRECT: When discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome.
D. The client can crush escitalopram before swallowing.

Explanation

A. The client can take this medication with food for GI distress or without food.
B. The client is at risk for hyponatremia while taking escitalopram.
C. CORRECT: When discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome.
D. The client can crush escitalopram before swallowing.

45. 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?

“Take this medication on an empty stomach“

“Expect optimal therapeutic effects within 24 hr.”

“Take this medication when needed for psychosis”

“This medication has a low risk for dependency.”

A. The client can take this medication with food to reduce GI distress. B. Buspirone can take up to 3 to 6 weeks to obtain optimal therapeutic effects C. The client should take buspirone on a regular, not PRN, basis because therapeutic effects occur slowly. D. CORRECT: Buspirone has a low risk for physical or psychological dependence or tolerance.

Explanation

A. The client can take this medication with food to reduce GI distress. B. Buspirone can take up to 3 to 6 weeks to obtain optimal therapeutic effects C. The client should take buspirone on a regular, not PRN, basis because therapeutic effects occur slowly. D. CORRECT: Buspirone has a low risk for physical or psychological dependence or tolerance.

46. 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.)

Dry mouth

Nonproductive cough

Skin rash

Drowsiness

Urinary hesitation

A. CORRECT: Dry mouth is an anticholinergic manifestation that can occur when a client takes diphenhydramine.
B. Cough is not an adverse reaction to this medication. Diphenhydramine is prescribed to treat nonproductive cough.
C. Skin rash is not an adverse reaction to this medication. Diphenhydramine is sometimes prescribed for skin rash caused by allergies.
D. CORRECT: Drowsiness is an adverse reaction of this medication. Diphenhydramine is administered to treat insomnia.
E. CORRECT: Urinary retention is an anticholinergic manifestation that can occur when a client takes diphenhydramine.

Explanation

A. CORRECT: Dry mouth is an anticholinergic manifestation that can occur when a client takes diphenhydramine.
B. Cough is not an adverse reaction to this medication. Diphenhydramine is prescribed to treat nonproductive cough.
C. Skin rash is not an adverse reaction to this medication. Diphenhydramine is sometimes prescribed for skin rash caused by allergies.
D. CORRECT: Drowsiness is an adverse reaction of this medication. Diphenhydramine is administered to treat insomnia.
E. CORRECT: Urinary retention is an anticholinergic manifestation that can occur when a client takes diphenhydramine.

Submit

47. 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?

Asthma

Glaucoma

Hypertension

Tachycardia

A. CORRECT: 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.
B. Propranolol is not contraindicated in clients who have glaucoma.
C. Propranolol is prescribed to treat hypertension. It is not contraindicated for clients who have this disorder.
D. Propranolol is prescribed to treat tachydysrhythmias, such as tachycardia. It is contraindicated in clients

Explanation

A. CORRECT: 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.
B. Propranolol is not contraindicated in clients who have glaucoma.
C. Propranolol is prescribed to treat hypertension. It is not contraindicated for clients who have this disorder.
D. Propranolol is prescribed to treat tachydysrhythmias, such as tachycardia. It is contraindicated in clients

48. 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?

Administer the clonidine on the prescribed schedule.

Provide ice chips at the client’s bedside.

Educate the client on the effects of clonidine.

Obtain baseline vital signs.

A. Administering clonidine as prescribed is an important nursing action. however, it is not the priority action.
B. Providing ice chips is an important nursing action. however, it is not the priority action.
C. Educating the client about the medication is an important nursing action. however, it is not the priority action.
D. CORRECT: Assessment is the initial step of the nursing process. Obtaining the client’s baseline vital signs is the priority nursing action.

Explanation

A. Administering clonidine as prescribed is an important nursing action. however, it is not the priority action.
B. Providing ice chips is an important nursing action. however, it is not the priority action.
C. Educating the client about the medication is an important nursing action. however, it is not the priority action.
D. CORRECT: Assessment is the initial step of the nursing process. Obtaining the client’s baseline vital signs is the priority nursing action.

49. A nurse is instructing a client who has a new prescription for timolol how to insert eye drops. The nurse should instruct theclient to press on which of the following areas to prevent systemic absorption of the medication?

Bony orbit

Nasolacrimal duct

Conjunctival sac

Outer canthus

A. Pressing on the bony orbit will not prevent systemic absorption of the medication.
B. CORRECT: Pressing on the nasolacrimal duct blocks the lacrimal punctum and prevents systemic absorption of the medication.
C. Pressing on the conjunctival sac will not prevent systemic absorption of the medication.
D. Pressing on the outer canthus will not prevent systemic absorption of the medication.

Explanation

A. Pressing on the bony orbit will not prevent systemic absorption of the medication.
B. CORRECT: Pressing on the nasolacrimal duct blocks the lacrimal punctum and prevents systemic absorption of the medication.
C. Pressing on the conjunctival sac will not prevent systemic absorption of the medication.
D. Pressing on the outer canthus will not prevent systemic absorption of the medication.

50. A nurse is assessing a client who takes desmopressin for diabetes insipidus. For which of the following adverse effects should the nurse monitor?

Hypovolemia

Hypercalcemia

Agitation

Headache

A. Edema and hypervolemia, rather than hypovolemia, are adverse effects of desmopressin.
B. Calcium imbalance is not an adverse effect of desmopressin.
C. Sleepiness, rather than agitation, is an adverse effect of desmopressin, which can indicate water intoxication.
D. CORRECT: headache during desmopressin therapy is an indication of water intoxication.

Explanation

A. Edema and hypervolemia, rather than hypovolemia, are adverse effects of desmopressin.
B. Calcium imbalance is not an adverse effect of desmopressin.
C. Sleepiness, rather than agitation, is an adverse effect of desmopressin, which can indicate water intoxication.
D. CORRECT: headache during desmopressin therapy is an indication of water intoxication.

51. 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?

Administering a supplemental dose of hydrocortisone

Instructing the client about coughing and deep breathing

Collecting additional information from the client about his history of Addison’s disease

Inserting an indwelling urinary catheter

A. CORRECT: Acute adrenal insuf ciency (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 insuf ciency, supplemental doses are administered during times of increased stress.
B. Instruction on coughing and deep breathing is important, but is not the nurse’s priority for this client.
C. Obtaining additional data from the client about past medical history is important, but is not the nurse’s priority for this client.
D. Inserting an indwelling urinary catheter is important, but is not the nurse’s priority for this client.

Explanation

A. CORRECT: Acute adrenal insuf ciency (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 insuf ciency, supplemental doses are administered during times of increased stress.
B. Instruction on coughing and deep breathing is important, but is not the nurse’s priority for this client.
C. Obtaining additional data from the client about past medical history is important, but is not the nurse’s priority for this client.
D. Inserting an indwelling urinary catheter is important, but is not the nurse’s priority for this client.

52. 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?

Bruising

Report of metallic taste

Muscle pain

Report of anorexia

A. Bruising is an adverse effect of anticoagulants and antiplatelet medications.
B. metallic taste is an adverse effect of captopril and certain antibiotics. C. Weakness is a manifestation of digoxin toxicity, not muscle pain.
D. CORRECT: Anorexia, blurred vision, stomach pain, and diarrhea are manifestations of digoxin toxicity.

Explanation

A. Bruising is an adverse effect of anticoagulants and antiplatelet medications.
B. metallic taste is an adverse effect of captopril and certain antibiotics. C. Weakness is a manifestation of digoxin toxicity, not muscle pain.
D. CORRECT: Anorexia, blurred vision, stomach pain, and diarrhea are manifestations of digoxin toxicity.

53. 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?

“I should use the spray every 4 hours while I am awake.”

“It can take as long as 3 weeks before the medication takes a maximum effect.”

“This medication can also be used to treat motion sickness.”

“I can use this medication when my nasal passages are blocked.”

A. The client should use the medication once a day.
B. CORRECT: The client can see some benefits of the medication
within a few hours, but the maximum benefits can take up to 3 weeks.
C. Diphenhydramine is used to treat motion sickness.
D. The client should blow his nose to clear the nasal passages or use a topical decongestant, prior to use of the medication.

Explanation

A. The client should use the medication once a day.
B. CORRECT: The client can see some benefits of the medication
within a few hours, but the maximum benefits can take up to 3 weeks.
C. Diphenhydramine is used to treat motion sickness.
D. The client should blow his nose to clear the nasal passages or use a topical decongestant, prior to use of the medication.

54. 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.)

An adverse effect of this medication is CNS stimulation.

Administer the medication before bedtime.

Monitor blood pressure while taking this medication.

Therapeutic effects of this medication will take 1 to 3 weeks to fully develop.

This medication raises the levels of dopamine in the brain.

A. CORRECT: An adverse effect of lisdexamfetamine is CNS stimulation such as insomnia and restlessness.
B. Administer lisdexamfetamine daily in the morning to reduce insomnia.
C. CORRECT: The nurse should instruct the client to monitor his blood pressure due to potential cardiovascular effects of lisdexamfetamine.
D. Therapeutic effects of lisdexamfetamine begin immediately and last 10 to 12 hrs.
E. CORRECT: Lisdexamfetamine, a CNS stimulant, works by raising the levels of norepinephrine and dopamine in the CNS.

Explanation

A. CORRECT: An adverse effect of lisdexamfetamine is CNS stimulation such as insomnia and restlessness.
B. Administer lisdexamfetamine daily in the morning to reduce insomnia.
C. CORRECT: The nurse should instruct the client to monitor his blood pressure due to potential cardiovascular effects of lisdexamfetamine.
D. Therapeutic effects of lisdexamfetamine begin immediately and last 10 to 12 hrs.
E. CORRECT: Lisdexamfetamine, a CNS stimulant, works by raising the levels of norepinephrine and dopamine in the CNS.

Submit

55. 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.)

Disorganized speech

Bizarre behavior

Impaired social interactions

Hallucinations

Decreased motivation

A. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech.
B. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior.
C. Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as impaired social interactions.
D. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations.
E. Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as decreased motivation.

Explanation

A. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech.
B. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior.
C. Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as impaired social interactions.
D. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations.
E. Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as decreased motivation.

Submit

56. 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?

Bursitis

Sinusitis

Depression

Glaucoma

A. Oxybutynin is contraindicated in clients who have unstable cardiovascular disease, not bursitis.
B. Oxybutynin is contraindicated in clients who have urinary retention, not sinusitis.
C. Oxybutynin is contraindicated in clients who have myasthenia gravis, not depression.
D. CORRECT: Oxybutynin is an anticholinergic and can increase intraocular pressure. It is contraindicated for clients who have glaucoma.

Explanation

A. Oxybutynin is contraindicated in clients who have unstable cardiovascular disease, not bursitis.
B. Oxybutynin is contraindicated in clients who have urinary retention, not sinusitis.
C. Oxybutynin is contraindicated in clients who have myasthenia gravis, not depression.
D. CORRECT: Oxybutynin is an anticholinergic and can increase intraocular pressure. It is contraindicated for clients who have glaucoma.

57. 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?

Hypokalemia

Hypernatremia

Neutropenia

Bradycardia

A. hyperkalemia, rather than hypokalemia, is a risk for clients taking ACE inhibitors.
B. ACE inhibitors cause excretion of sodium and water. hypernatremia is not a risk for the client taking an ACE inhibitor.
C. CORRECT: 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.
D. Tachycardia is an adverse effect of ACE inhibitors.

Explanation

A. hyperkalemia, rather than hypokalemia, is a risk for clients taking ACE inhibitors.
B. ACE inhibitors cause excretion of sodium and water. hypernatremia is not a risk for the client taking an ACE inhibitor.
C. CORRECT: 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.
D. Tachycardia is an adverse effect of ACE inhibitors.

58. 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?

Furosemide

Captopril

Ranolazine

Metoprolol

A. Furosemide, a loop diuretic, treats hypertension and edema associated with heart failure. It is not used to treat tachycardia.
B. Captopril, an ACE inhibitor, treats hypertension or heart failure. It is not used to treat tachycardia.
C. Ranolazine, an antianginal medication, treats stable angina pectoris. It is not used to treat tachycardia.
D. CORRECT: 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.

Explanation

A. Furosemide, a loop diuretic, treats hypertension and edema associated with heart failure. It is not used to treat tachycardia.
B. Captopril, an ACE inhibitor, treats hypertension or heart failure. It is not used to treat tachycardia.
C. Ranolazine, an antianginal medication, treats stable angina pectoris. It is not used to treat tachycardia.
D. CORRECT: 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.

59. A nurse in a provider's of ce 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.)

“Place the child on his unaffected side when you are ready to administer

“Warm the medication by gently rolling it between your hands for a few minutes.”

“Gently shake medication that is in suspension form.”

“keep the child on his side for 5 minutes after instillation of the ear drops.”

“Tightly pack the ear with cotton after instillation of the ear drops.”

A. CORRECT: 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. CORRECT: The parent should warm the medication by rolling it between his hands. Administering
the medication cold can cause dizziness.
C. CORRECT: The parent should gently shake medication that is in suspension form to evenly‐ disperse the medication.
D. CORRECT: The parent should keep the child on his side to promote drainage of the medication by gravity into the ear.
E. The parent should loosely pack the child’s ear with cotton.

Explanation

A. CORRECT: 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. CORRECT: The parent should warm the medication by rolling it between his hands. Administering
the medication cold can cause dizziness.
C. CORRECT: The parent should gently shake medication that is in suspension form to evenly‐ disperse the medication.
D. CORRECT: The parent should keep the child on his side to promote drainage of the medication by gravity into the ear.
E. The parent should loosely pack the child’s ear with cotton.

Submit

60. 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?

Neostigmine

Naloxone

Dantrolene

Vecuronium

A. Neostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers. It can delay inactivation of succinylcholine, a depolarizing neuromuscular blocker.
B. Naloxone is used to reverse the effects of opioids. It is not used to treat malignant hyperthermia.
C. CORRECT: 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.
D. Vecuronium is an intermediate‐acting nondepolarizing neuromuscular blocker. It is not useful in treating malignant hyperthermia.

Explanation

A. Neostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers. It can delay inactivation of succinylcholine, a depolarizing neuromuscular blocker.
B. Naloxone is used to reverse the effects of opioids. It is not used to treat malignant hyperthermia.
C. CORRECT: 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.
D. Vecuronium is an intermediate‐acting nondepolarizing neuromuscular blocker. It is not useful in treating malignant hyperthermia.

61. 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 anesthetic?

Peptic ulcer disease

Breast cancer

Diabetes mellitus

Schizophrenia

A. Peptic ulcer disease is not a contraindication for the use of ketamine.
B. Breast cancer is not a contraindication for the use of ketamine.
C. Diabetes mellitus is not a contraindication for the use of ketamine.
D. CORRECT: ketamine can produce psychological effects, such as hallucinations. Therefore, schizophrenia can be a contraindication for the use of ketamine.

Explanation

A. Peptic ulcer disease is not a contraindication for the use of ketamine.
B. Breast cancer is not a contraindication for the use of ketamine.
C. Diabetes mellitus is not a contraindication for the use of ketamine.
D. CORRECT: ketamine can produce psychological effects, such as hallucinations. Therefore, schizophrenia can be a contraindication for the use of ketamine.

62. 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?

Diarrhea

Dry mouth

Insomnia

Hypertension

A. Constipation, rather than diarrhea, is a common adverse effect associated with clonidine use.
B. CORRECT: Dry mouth is a common adverse effect associated with clonidine use.
C. Sedation, rather than insomnia, is a common adverse effect associated with clonidine use.
D. Clonidine is more likely to cause hypotension than hypertension.

Explanation

A. Constipation, rather than diarrhea, is a common adverse effect associated with clonidine use.
B. CORRECT: Dry mouth is a common adverse effect associated with clonidine use.
C. Sedation, rather than insomnia, is a common adverse effect associated with clonidine use.
D. Clonidine is more likely to cause hypotension than hypertension.

63. 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?

Weight gain

Nervousness

Bradycardia

Constipation

A. CORRECT: Weight gain and uid retention are adverse effects of oral prednisone due to the effect of sodium and water retention.
B. Nervousness and insomnia are adverse effects of beta agonists, not glucocorticoids.
C. Tachycardia are adverse effects of prednisone and beta agonists.
D. Diarrhea is an adverse effect of prednisone. Constipation is an adverse effect of tiotropium.

Explanation

A. CORRECT: Weight gain and uid retention are adverse effects of oral prednisone due to the effect of sodium and water retention.
B. Nervousness and insomnia are adverse effects of beta agonists, not glucocorticoids.
C. Tachycardia are adverse effects of prednisone and beta agonists.
D. Diarrhea is an adverse effect of prednisone. Constipation is an adverse effect of tiotropium.

64. 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?

WBC

Serum potassium

Platelet count

Liver function tests

A. Infection is not an adverse effect of acarbose. It is not necessary to monitor WBC while the client is taking this medication.
B. Acarbose does not affect potassium levels. It is not necessary to monitor serum potassium while the client is taking this medication.
C. Acarbose does not affect the platelet levels. It is not necessary to monitor the platelet count while the client is taking this medication.
D. CORRECT: Acarbose can cause liver toxicity when taken long‐term. Liver function tests should be monitored periodically while the client takes this medication.

Explanation

A. Infection is not an adverse effect of acarbose. It is not necessary to monitor WBC while the client is taking this medication.
B. Acarbose does not affect potassium levels. It is not necessary to monitor serum potassium while the client is taking this medication.
C. Acarbose does not affect the platelet levels. It is not necessary to monitor the platelet count while the client is taking this medication.
D. CORRECT: Acarbose can cause liver toxicity when taken long‐term. Liver function tests should be monitored periodically while the client takes this medication.

65. 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?

Mental status changes

Tremor

Jaundice

Pneumonia

A. mental status changes do not occur as adverse effects of gemfibrozil.
B. Tremor does not occur as an adverse effect of gemfibrozil.
C. CORRECT: Jaundice, anorexia, and upper abdominal discomfort can be findings in liver impairment, which can occur in clients taking gemfibrozil.
D. Pneumonia is not an adverse effect of gemfibrozil.

Explanation

A. mental status changes do not occur as adverse effects of gemfibrozil.
B. Tremor does not occur as an adverse effect of gemfibrozil.
C. CORRECT: Jaundice, anorexia, and upper abdominal discomfort can be findings in liver impairment, which can occur in clients taking gemfibrozil.
D. Pneumonia is not an adverse effect of gemfibrozil.

66. 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?

History of severe constipation

History of hypertension

Active hepatitis C

Type 2 diabetes mellitus

A. Unlike the bile‐acid sequestrants, ezetimibe does not cause constipation and is not contraindicated
in clients who have a history of constipation.
B. A history of hypertension is not a contraindication to taking ezetimibe along with simvastatin.
C. CORRECT: 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.
D. Type 2 diabetes mellitus is not a contraindication to taking ezetimibe along with simvastatin.

Explanation

A. Unlike the bile‐acid sequestrants, ezetimibe does not cause constipation and is not contraindicated
in clients who have a history of constipation.
B. A history of hypertension is not a contraindication to taking ezetimibe along with simvastatin.
C. CORRECT: 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.
D. Type 2 diabetes mellitus is not a contraindication to taking ezetimibe along with simvastatin.

67. 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)

Hypertension

Vision Changes

Decreased libido

Alopecia

Hypotension

A. CORRECT Hypertension (high blood pressure) is also important when a client is taking venlafaxine. Venlafaxine can lead to an increase in blood pressure in some individuals. B. CORRECT: Dizziness is a common adverse effect of venlafaxine. C. CORRECT: Sexual dysfunction, such as decreased libido, decreased orgasm, impotence, and menstrual changes are adverse effects of venlafaxine. D. Alopecia is not an adverse effect of venlafaxine. E. hypertension and tachycardia are adverse effects of venlafaxine.

Explanation

A. CORRECT Hypertension (high blood pressure) is also important when a client is taking venlafaxine. Venlafaxine can lead to an increase in blood pressure in some individuals. B. CORRECT: Dizziness is a common adverse effect of venlafaxine. C. CORRECT: Sexual dysfunction, such as decreased libido, decreased orgasm, impotence, and menstrual changes are adverse effects of venlafaxine. D. Alopecia is not an adverse effect of venlafaxine. E. hypertension and tachycardia are adverse effects of venlafaxine.

Submit

68. 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?

“I’ll take this medicine with my meals.”

“I’ll take this medicine 30 minutes before I eat.”

“I’ll take this medicine just before I go to bed.”

“I’ll take this medicine as soon as I wake up in the morning.”

A. Repaglinide should not be taken with a meal.
B. CORRECT: 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.
C. Repaglinide should not be taken just before bedtime.
D. Repaglinide is not taken upon awakening in the morning.

Explanation

A. Repaglinide should not be taken with a meal.
B. CORRECT: 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.
C. Repaglinide should not be taken just before bedtime.
D. Repaglinide is not taken upon awakening in the morning.

69. A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching?

Take this medication in the evening.

Change position slowly when rising from a chair.

Maintain a steady intake of green leafy vegetables.

Consume no more than 1 L/day of uid.

A. CORRECT: 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.
B. Changing position slowly might be necessary when taking an antihypertensive medication, but it is not necessary after taking simvastatin.
C. Consuming a steady intake of green vegetables is important for clients taking warfarin, but does not help lower cholesterol when taking simvastatin.
D. There is no indication for taking less than 1 L/day of uid when taking simvastatin.

Explanation

A. CORRECT: 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.
B. Changing position slowly might be necessary when taking an antihypertensive medication, but it is not necessary after taking simvastatin.
C. Consuming a steady intake of green vegetables is important for clients taking warfarin, but does not help lower cholesterol when taking simvastatin.
D. There is no indication for taking less than 1 L/day of uid when taking simvastatin.

70. 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?

Somnolence

Constipation

Fluid retention

Weight gain

A. CORRECT: 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.
B. Diarrhea is an adverse effect of metformin.
C. Fluid retention is not an adverse effect caused by metformin. D. Anorexia and weight loss are adverse effects of metformin.

Explanation

A. CORRECT: 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.
B. Diarrhea is an adverse effect of metformin.
C. Fluid retention is not an adverse effect caused by metformin. D. Anorexia and weight loss are adverse effects of metformin.

71. 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?

Dry mouth

Hypertension

Excessive perspiration

Fecal impaction

A. Increased salivation is a manifestation of muscarinic stimulation. B. hypotension is a manifestation of muscarinic stimulation.
C. CORRECT: Bethanechol is a muscarinic agonist. muscarinic stimulation can result in sweating.
D. Diarrhea is an adverse effect of bethanechol.

Explanation

A. Increased salivation is a manifestation of muscarinic stimulation. B. hypotension is a manifestation of muscarinic stimulation.
C. CORRECT: Bethanechol is a muscarinic agonist. muscarinic stimulation can result in sweating.
D. Diarrhea is an adverse effect of bethanechol.

72. 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?

Irregular heart beat

Abnormal uterine bleeding

Yellow sclera or dark‐colored urine.

Difficulty swallowing

A. An irregular heart beat is not an adverse effect of tamoxifen.
B. CORRECT: 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.
C. Liver dysfunction, which can be manifested by yellow sclera or dark urine, is not an adverse effect of taking tamoxifen.
D. Dif culty swallowing is not an adverse effect of tamoxifen.

Explanation

A. An irregular heart beat is not an adverse effect of tamoxifen.
B. CORRECT: 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.
C. Liver dysfunction, which can be manifested by yellow sclera or dark urine, is not an adverse effect of taking tamoxifen.
D. Dif culty swallowing is not an adverse effect of tamoxifen.

73. 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.)

Expect therapeutic effects in 24 to 48 hr.

Discontinue the medication after a week of improved mood.

Change positions slowly to minimize dizziness.

Decrease dietary ber intake to control diarrhea.

Chew sugarless gum to prevent dry mouth.

A. Therapeutic effects are expected after several weeks of taking amitriptyline.
B. Stopping amitriptyline abruptly can result in relapse.
C. CORRECT: Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect of amitriptyline.
D. Clients should increase dietary ber to prevent constipation, which is an adverse effect of amitriptyline.
E. CORRECT: Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline.

Explanation

A. Therapeutic effects are expected after several weeks of taking amitriptyline.
B. Stopping amitriptyline abruptly can result in relapse.
C. CORRECT: Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect of amitriptyline.
D. Clients should increase dietary ber to prevent constipation, which is an adverse effect of amitriptyline.
E. CORRECT: Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline.

Submit

74. 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?

“Take digoxin with your morning dose of colesevelam.”

"Your sodium and potassium levels will be monitored periodically while taking colesevelam.”

“Watch for bleeding or bruising while taking colesevelam.”

“Take colesevelam with food and at least one glass of water.”

A. many medications, including digoxin, should be taken 4 hr before colesevelam to prevent decreased absorption of the other medications.
B. Serum electrolytes are not checked periodically while taking colesevelam. however, total cholesterol, LDL, hDL, and triglycerides are checked, as well as blood glucose and hbA1C levels for clients who have diabetes mellitus.
C. Bleeding and bruising are not expected effects caused by colesevelam.
D. CORRECT: Colesevelam should be taken with food and at least 8 oz of water.

Explanation

A. many medications, including digoxin, should be taken 4 hr before colesevelam to prevent decreased absorption of the other medications.
B. Serum electrolytes are not checked periodically while taking colesevelam. however, total cholesterol, LDL, hDL, and triglycerides are checked, as well as blood glucose and hbA1C levels for clients who have diabetes mellitus.
C. Bleeding and bruising are not expected effects caused by colesevelam.
D. CORRECT: Colesevelam should be taken with food and at least 8 oz of water.

75. 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.)

Incoordination

Hypertension

Pruritus

Sleep driving

Amnesia

A. CORRECT: Due to CNS depression, incoordination is an adverse effect of temazepam.
B. hypotension is an adverse effect of temazepam.
C. Pruritus is not an adverse effect of temazepam.
D. CORRECT: Sleep driving (driving after taking the medication without memory of doing so) is an adverse effect of temazepam.
E. CORRECT: Retrograde amnesia, the inability to remember the events that occurred after taking the medication,
can occur as an adverse effect of temazepam.

Explanation

A. CORRECT: Due to CNS depression, incoordination is an adverse effect of temazepam.
B. hypotension is an adverse effect of temazepam.
C. Pruritus is not an adverse effect of temazepam.
D. CORRECT: Sleep driving (driving after taking the medication without memory of doing so) is an adverse effect of temazepam.
E. CORRECT: Retrograde amnesia, the inability to remember the events that occurred after taking the medication,
can occur as an adverse effect of temazepam.

Submit

76. 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.)

Thrombocyte count

Hematocrit

Valproate level

Liver function tests

Potassium

A. CORRECT: Treatment with valproic acid can result in thrombocytopenia. The client’s thrombocyte count should be monitored periodically. B. Treatment with valproic acid is not known to have an effect on a client’s hematocrit. C. CORRECT: Treatment with valproic acid can result in pancreatitis. The client’s amylase should be monitored periodically. D. CORRECT: Treatment with valproic acid can result in hepatotoxicity. The client’s liver function should be monitored periodically. E. Treatment with valproic acid is not known to have an effect on a client’s potassium.

Explanation

A. CORRECT: Treatment with valproic acid can result in thrombocytopenia. The client’s thrombocyte count should be monitored periodically. B. Treatment with valproic acid is not known to have an effect on a client’s hematocrit. C. CORRECT: Treatment with valproic acid can result in pancreatitis. The client’s amylase should be monitored periodically. D. CORRECT: Treatment with valproic acid can result in hepatotoxicity. The client’s liver function should be monitored periodically. E. Treatment with valproic acid is not known to have an effect on a client’s potassium.

Submit

77. 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?

Bradycardia

Insomnia

Heat intolerance

Weight loss

A. CORRECT: Bradycardia is an adverse effect of propylthiouracil. The nurse should monitor for bradycardia.
B. Drowsiness, rather than insomnia, is an adverse effect of propylthiouracil.
C. Cold intolerance rather than heat intolerance is an adverse effect of propylthiouracil.
D. Weight gain, rather than weight loss, is an adverse effect of propylthiouracil.

Explanation

A. CORRECT: Bradycardia is an adverse effect of propylthiouracil. The nurse should monitor for bradycardia.
B. Drowsiness, rather than insomnia, is an adverse effect of propylthiouracil.
C. Cold intolerance rather than heat intolerance is an adverse effect of propylthiouracil.
D. Weight gain, rather than weight loss, is an adverse effect of propylthiouracil.

78. 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.)

Hypertension

Widened QRS complex

Narrowed QT interval

Easy bruising

Swollen joints

A. hypotension, rather than hypertension, is an adverse effect of procainamide.
B. CORRECT: 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.
C. On the ECG, procainamide can cause a prolonged QT interval, a manifestation of cardiotoxicity.
D. CORRECT: Procainamide can cause bone marrow depression, with neutropenia (infection) and thrombocytopenia (easy bruising, bleeding).
E. CORRECT: 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.

Explanation

A. hypotension, rather than hypertension, is an adverse effect of procainamide.
B. CORRECT: 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.
C. On the ECG, procainamide can cause a prolonged QT interval, a manifestation of cardiotoxicity.
D. CORRECT: Procainamide can cause bone marrow depression, with neutropenia (infection) and thrombocytopenia (easy bruising, bleeding).
E. CORRECT: 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.

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79. 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.)

Simvastatin

Hydrochlorothiazide

Phenytoin

Clonidine

Aliskiren

A. Simvastatin, an antilipemic medication that lowers cholesterol, does not interact with captopril and does not intensify first‐dose hypotension. B. CORRECT: 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. C. Phenytoin, an antiseizure medication, does not interact with captopril and does not intensify first dose hypotension. D. CORRECT: Clonidine, a centrally acting alpha2 agonist, is an antihypertensive medication that can interact with captopril to intensify rst‐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. CORRECT: Aliskiren, a direct renin inhibitor, is an antihypertensive medication that can interact with captopril to intensify its rst‐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.

Explanation

A. Simvastatin, an antilipemic medication that lowers cholesterol, does not interact with captopril and does not intensify first‐dose hypotension. B. CORRECT: 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. C. Phenytoin, an antiseizure medication, does not interact with captopril and does not intensify first dose hypotension. D. CORRECT: Clonidine, a centrally acting alpha2 agonist, is an antihypertensive medication that can interact with captopril to intensify rst‐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. CORRECT: Aliskiren, a direct renin inhibitor, is an antihypertensive medication that can interact with captopril to intensify its rst‐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.

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80. 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?

“Leucovorin reduces the risk of a transfusion reaction

“Leucovorin increases platelet production and prevents bleeding.”

“Leucovorin potentiates the cytotoxic effects of methotrexate.”

“Leucovorin protects healthy cells from methotrexate’s toxic effect.”

A. Leucovorin does not reduce the risk of a transfusion reaction from methotrexate.
B. Leucovorin does not increase platelet production.
C. Leucovorin does not potentiate the effects of methotrexate.
D. CORRECT: 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.

Explanation

A. Leucovorin does not reduce the risk of a transfusion reaction from methotrexate.
B. Leucovorin does not increase platelet production.
C. Leucovorin does not potentiate the effects of methotrexate.
D. CORRECT: 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.

81. A nurse in the post‐anesthesia 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.)

Place a cooling blanket on the client.

Administer oxygen at 100%.

Administer iced 0.9% sodium chloride.

Administer potassium chloride IV.

Monitor core body temperature.

A. CORRECT: The nurse should apply a cooling blanket and apply ice to the axilla and groin.
B. CORRECT: The nurse should administer oxygen at 100% to treat decreased oxygen saturation.
C. CORRECT: The nurse should take action to decrease the client’s body temperature by administering iced IV uids.
D. A client who has malignant hyperthermia is at risk for hyperkalemia.
E. CORRECT: The nurse should monitor core body temperature to prevent hypothermia and to determine progress with treatment measures.

Explanation

A. CORRECT: The nurse should apply a cooling blanket and apply ice to the axilla and groin.
B. CORRECT: The nurse should administer oxygen at 100% to treat decreased oxygen saturation.
C. CORRECT: The nurse should take action to decrease the client’s body temperature by administering iced IV uids.
D. A client who has malignant hyperthermia is at risk for hyperkalemia.
E. CORRECT: The nurse should monitor core body temperature to prevent hypothermia and to determine progress with treatment measures.

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82. 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?

Administer flumazenil.

Identify the client’s level of consciousness.

Infuse IV fluids.

Prepare the client for gastric lavage.

A. The nurse should prepare to administer flumazenil to reverse the benzodiazepine toxicity. However, there is another action the nurse should take first. B. CORRECT: The first action the nurse should take when using the nursing process is to assess the client. Identifying the client’s level of consciousness is the priority action. C. The nurse should prepare to infuse IV fluids to support the client’s blood pressure. however, there is another action the nurse should take first. D. The nurse should prepare to administer a gastric lavage to reverse the benzodiazepine toxicity. however, there is another action the nurse should take first.

Explanation

A. The nurse should prepare to administer flumazenil to reverse the benzodiazepine toxicity. However, there is another action the nurse should take first. B. CORRECT: The first action the nurse should take when using the nursing process is to assess the client. Identifying the client’s level of consciousness is the priority action. C. The nurse should prepare to infuse IV fluids to support the client’s blood pressure. however, there is another action the nurse should take first. D. The nurse should prepare to administer a gastric lavage to reverse the benzodiazepine toxicity. however, there is another action the nurse should take first.

83. 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.)

Digoxin

Simvastatin

Verapamil

Amlodipine

Nitroglycerin transdermal patch

A. CORRECT: Concurrent use with ranolazine increases serum levels of digoxin, so digoxin toxicity can result.
B. CORRECT: Concurrent use with ranolazine increases serum levels of simvastatin, so liver toxicity can result.
C. CORRECT: Verapamil is an inhibitor of CYP3A4, which can increase levels of ranolazine and lead to the dysrhythmia torsades de pointes.
D. Amlodipine, a calcium channel blocker, is used for hypertension and stable angina. It is prescribed along with ranolazine to treat angina.
E. Nitroglycerin transdermal patches are prescribed along with ranolazine to treat angina.

Explanation

A. CORRECT: Concurrent use with ranolazine increases serum levels of digoxin, so digoxin toxicity can result.
B. CORRECT: Concurrent use with ranolazine increases serum levels of simvastatin, so liver toxicity can result.
C. CORRECT: Verapamil is an inhibitor of CYP3A4, which can increase levels of ranolazine and lead to the dysrhythmia torsades de pointes.
D. Amlodipine, a calcium channel blocker, is used for hypertension and stable angina. It is prescribed along with ranolazine to treat angina.
E. Nitroglycerin transdermal patches are prescribed along with ranolazine to treat angina.

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84. 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.)

“I will stop taking this medication right away if I develop dizziness.”

“I know the doctor will gradually increase my dose of this medication for a while.”

“I should increase ber to prevent constipation from this medication.”

“I won’t be able to drink alcohol while I’m taking this medication.”

“I should take this medication on an empty stomach each morning.”

A. Abrupt withdrawal from baclofen can result in a number of adverse effects, including visual hallucinations and seizures. B. CORRECT: The provider starts the client on a low dose, and the dose is increased gradually to prevent CNS depression. C. CORRECT: The client should increase fluids and fiber to reduce the risk for constipation. D. CORRECT: 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. E. The client should take baclofen with meals to reduce gastric upset.

Explanation

A. Abrupt withdrawal from baclofen can result in a number of adverse effects, including visual hallucinations and seizures. B. CORRECT: The provider starts the client on a low dose, and the dose is increased gradually to prevent CNS depression. C. CORRECT: The client should increase fluids and fiber to reduce the risk for constipation. D. CORRECT: 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. E. The client should take baclofen with meals to reduce gastric upset.

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85. 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?

“This medication can safely be taken during pregnancy.”

“Eliminate grapefruit juice from your diet."

“You will need to have a complete blood count and carbamazepine levels drawn periodically.”

“Notify your provider if you develop a rash.”

“Avoid driving for the first few days after starting this medication.”

A. Carbamazepine is a Pregnancy Category Risk D medication. The client should be instructed to avoid pregnancy while taking carbamazepine. B. CORRECT: Grapefruit juice affects carbamazepine metabolism and should be avoided. C. CORRECT: 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. CORRECT: Carbamazepine can cause Stevens‐Johnson syndrome, which can be fatal. The client should notify the provider promptly if a rash occurs. E. CORRECT: 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.

Explanation

A. Carbamazepine is a Pregnancy Category Risk D medication. The client should be instructed to avoid pregnancy while taking carbamazepine. B. CORRECT: Grapefruit juice affects carbamazepine metabolism and should be avoided. C. CORRECT: 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. CORRECT: Carbamazepine can cause Stevens‐Johnson syndrome, which can be fatal. The client should notify the provider promptly if a rash occurs. E. CORRECT: 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.

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86. A nurse is caring for a client who receives rituximab to treat non‐Hodgkin's leukemia and who asks the nurse how rituximab works. Which of the following should the nurse include?

Blocks hormone receptors

Increases immune response

Binds with specific antigens on tumor cells

Stops DNA replication during cell division

A. medications like tamoxifen, an estrogen‐receptor modifier, work by blocking hormone receptors. Rituximab does not work in this way.
B. Interferon alfa‐2b is an example of a medication that works by stimulating the client’s own immune system. Rituximab does not work in this way.
C. CORRECT: Rituximab is a monoclonal antibody that binds to specific antigens on B‐lymphocytes and then destroying cancer cells.
D. Fluorouracil is an example of a cytotoxic medication that kills cells as they divide. Rituximab does not work in this way.

Explanation

A. medications like tamoxifen, an estrogen‐receptor modifier, work by blocking hormone receptors. Rituximab does not work in this way.
B. Interferon alfa‐2b is an example of a medication that works by stimulating the client’s own immune system. Rituximab does not work in this way.
C. CORRECT: Rituximab is a monoclonal antibody that binds to specific antigens on B‐lymphocytes and then destroying cancer cells.
D. Fluorouracil is an example of a cytotoxic medication that kills cells as they divide. Rituximab does not work in this way.

87. A nurse is preparing to administer cyclophosphamide IV to a client who has Hodgkin's disease. Which of the following medicationsshould the nurse expect to administer concurrently with the chemotherapy to prevent an adverse effect of cyclophosphamide?

Uroprotectant agent, such as mesna

Opioid, such as morphine

Loop diuretic, such as furosemide

H1 receptor antagonist, such as diphenhydramine

A. CORRECT: mesna is a uroprotectant agent that can help prevent hemorrhagic cystitis when administered IV with a nitrogen mustard chemotherapy medication.
B. An opioid is not administered concurrently with cyclophosphamide to prevent an adverse effect.
C. A loop diuretic is not administered concurrently with cyclophosphamide to prevent an adverse effect.
D. An h1 receptor antagonist is not administered concurrently with cyclophosphamide to prevent an adverse effect.

Explanation

A. CORRECT: mesna is a uroprotectant agent that can help prevent hemorrhagic cystitis when administered IV with a nitrogen mustard chemotherapy medication.
B. An opioid is not administered concurrently with cyclophosphamide to prevent an adverse effect.
C. A loop diuretic is not administered concurrently with cyclophosphamide to prevent an adverse effect.
D. An h1 receptor antagonist is not administered concurrently with cyclophosphamide to prevent an adverse effect.

88. 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.)

“Take oral medications 1 hr before injection.”“Take oral medications 1 hr before injection.” “Take oral medications 1 hr before injection.”

“Use upper arms as preferred injection sites.”

“mix pramlintide with breakfast dose of insulin.

“Inject pramlintide just before a meal.”

“Discard open vials after 28 days.”

A. Pramlintide delays oral medication absorption, so oral medications should be taken 1 to 2 hr after pramlintide injection.
B. The thigh or abdomen, rather than the upper arms, are preferred sites for pramlintide injection.
C. Pramlintide should not be mixed in a syringe with any type of insulin.
D. CORRECT: Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important
to eat a meal after injecting this medication.
E. CORRECT: Unused medication in the open pramlintide vial should be discarded after 28 days.

Explanation

A. Pramlintide delays oral medication absorption, so oral medications should be taken 1 to 2 hr after pramlintide injection.
B. The thigh or abdomen, rather than the upper arms, are preferred sites for pramlintide injection.
C. Pramlintide should not be mixed in a syringe with any type of insulin.
D. CORRECT: Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important
to eat a meal after injecting this medication.
E. CORRECT: Unused medication in the open pramlintide vial should be discarded after 28 days.

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89. 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.)

Muscle aches

Hyperglycemia

Hearing loss

Flushing of the skin

Jaundice

A. myopathy (muscles aches) can occur with statins and other antilipemic medications, but this is not an adverse effect of niacin.
B. CORRECT: hyperglycemia can occur as an adverse effect of niacin. The nurse should plan to monitor blood glucose periodically.
C. hearing loss is not an adverse effect of taking niacin.
D. CORRECT: 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. CORRECT: Niacin can cause liver disorders, so the nurse should monitor for jaundice, abdominal pain, and anorexia.

Explanation

A. myopathy (muscles aches) can occur with statins and other antilipemic medications, but this is not an adverse effect of niacin.
B. CORRECT: hyperglycemia can occur as an adverse effect of niacin. The nurse should plan to monitor blood glucose periodically.
C. hearing loss is not an adverse effect of taking niacin.
D. CORRECT: 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. CORRECT: Niacin can cause liver disorders, so the nurse should monitor for jaundice, abdominal pain, and anorexia.

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90. 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.)

Decrease medication resistance

Attack cancer cells at different stages of cell growth

Block chemotherapy agent from entering healthy cells

Stimulate immune system

Decrease injury to normal body cells

A. CORRECT: medication resistance is decreased with combination therapy because the chance of developing resistance to
several medication is less than to only one medication.
B. CORRECT: Each medication kills cancer cells at a different stage of growth. A combination of medications can kill more cancer cells than only one medication.
C. Chemotherapy agents are not blocked from entering healthy cells during combination therapy.
D. Cancer chemotherapy with a combination of cytotoxic agents often causes infection rather than stimulating the immune system.
E. CORRECT: Injury to normal body cells can be decreased by combination therapy because the medications used have different toxicities.

Explanation

A. CORRECT: medication resistance is decreased with combination therapy because the chance of developing resistance to
several medication is less than to only one medication.
B. CORRECT: Each medication kills cancer cells at a different stage of growth. A combination of medications can kill more cancer cells than only one medication.
C. Chemotherapy agents are not blocked from entering healthy cells during combination therapy.
D. Cancer chemotherapy with a combination of cytotoxic agents often causes infection rather than stimulating the immune system.
E. CORRECT: Injury to normal body cells can be decreased by combination therapy because the medications used have different toxicities.

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91. 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.)

Tinnitus

Muscle aches

Peripheral neuropathy

Bone loss

Depression

A. Tinnitus is not an adverse effect of interferon alfa‐2b.
B. CORRECT: muscle aches and other u‐like manifestations are common adverse effects of interferon alfa‐2b. Acetaminophen may be prescribed to relieve these manifestations.
C. CORRECT: 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.
D. Bone loss can occur from treatment with gonadotropin‐releasing hormone agonists, such as leuprolide. Bone loss does
not occur with interferon alfa‐2b treatment.
E. CORRECT: Depression and mental status changes can occur with interferon alfa‐2b treatment. The nurse should assess the client for suicidal thoughts.

Explanation

A. Tinnitus is not an adverse effect of interferon alfa‐2b.
B. CORRECT: muscle aches and other u‐like manifestations are common adverse effects of interferon alfa‐2b. Acetaminophen may be prescribed to relieve these manifestations.
C. CORRECT: 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.
D. Bone loss can occur from treatment with gonadotropin‐releasing hormone agonists, such as leuprolide. Bone loss does
not occur with interferon alfa‐2b treatment.
E. CORRECT: Depression and mental status changes can occur with interferon alfa‐2b treatment. The nurse should assess the client for suicidal thoughts.

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