NCLEX Medical-Surgical drugs

A nurse is preparing to administer insulin to a client with diabetes. In which order should the nurse perform the actions associated with insulin administration? 1. Wipe the top of the insulin vial with an alcohol swab. 2. Wash hands with soap and water. 3. Rotate the vial of insulin between the palms of the hands. 4. Withdraw the correct amount of insulin from the inverted vial. 5. Instill air into the vial of insulin equal to the desired dose.

2. Wash hands with soap and water. 3. Rotate the vial of insulin between the palms of the hands. 1. Wipe the top of the insulin vial with an alcohol swab. 5. Instill air into the vial of insulin equal to the desired dose. 4. Withdraw the correct amount of insulin from the inverted vial.

Which assessment should the nurse obtain before administering digoxin to a client? A. Apical heart rate B. Radial pulse on the left side C. Radial pulse in both right and left arms D. Difference between apical and radial pulses

A. Apical heart rate

A client with Hodgkin disease enters a remission period and remains symptom free for 6 months before a relapse occurs. The client is diagnosed at stage IV. What therapy option does the nurse expect to be implemented? A. Radiation therapy B. Combination chemotherapy C. Radiation with chemotherapy D. Surgical removal of the affected nodes

B. Combination chemotherapy

A health care provider prescribes psyllium 3.5 g twice a day for constipation. What is most important for the nurse to teach this client? A. Urine may be discolored. B. Each dose should be taken with a full glass of water. C. Use only when necessary because it can cause dependence. D. Daily use may inhibit the absorption of some fat-soluble vitamins.

B. Each dose should be taken with a full glass of water.

A nurse is caring for a client who is receiving serum albumin. What indicates that the albumin is effective? A. Improved clotting of blood B. Formation of red blood cells C. Activation of white blood cells (WBCs) D. Effective cardiac output

D. Effective cardiac output

A client who weighs 176 pounds (80 kg) is being immunosuppressed by daily maintenance doses of cyclosporine to prevent organ transplant rejection. The dose prescribed is 8 mg/kg each day. How many milligrams should the nurse plan to administer each day? Record your answer using a whole number. ___ mg

640

A client has an anaphylactic reaction after receiving intravenous penicillin. What does the nurse conclude is the cause of this reaction? A. An acquired atopic sensitization occurred. B. There was passive immunity to the penicillin allergen. C. Antibodies to penicillin developed after a previous exposure. D. Potent antibodies were produced when the infusion was instituted.

C. Antibodies to penicillin developed after a previous exposure.

A client is scheduled to receive an intravenous (IV) solution of lactated Ringer to run at 150 mL/hr. To deliver the solution, the nurse plans to use an administration set that delivers 15 gtt/mL. At how many drops per minute should the nurse set the IV to administer the prescribed amount of fluid? Record your answer using a whole number. ___ gtt/min.

38

An intravenous piggyback (IVPB) of cefazolin 500 mg in 50 mL of 5% dextrose in water is to be administered over a 20-minute period. The tubing has a drop factor of 15 drops/mL. At what rate per minute should the nurse regulate the infusion to run? Record your answer using a whole number. Do not include units in your answer. ______ gtt/min

38

Ten minutes after the initiation of a blood transfusion, a client reports lumbar pain. What is the next nursing action? A. Stop the transfusion. B. Obtain the vital signs. C. Assess the pain further. D. Increase the flow of normal saline.

A. Stop the transfusion.

A client with arthritis is taking large doses of aspirin. What symptom does the nurse include when teaching the client about the clinical manifestations of aspirin toxicity? A. Feelings of drowsiness B. Disturbances in hearing C. Intermittent constipation D. Metallic taste in the mouth

B. Disturbances in hearing

A client reports frequently taking calcium carbonate. What effect should the nurse advise the client that this can have? A. Diarrhea B. Water retention C. Rebound hyperacidity D. Bone demineralization

C. Rebound hyperacidity

A nurse teaches a client about warfarin. Which information is essential for the nurse to include in the education plan? A. Periodic blood testing is necessary. B. Foods do not affect the medication. C. Physical activities should be limited. D. Daily doses should not be interrupted.

A. Periodic blood testing is necessary.

A nurse is administering a histamine H2 antagonist to a client who has extensive burns. The nurse explains to the client that this drug is given prophylactically during the first few weeks after extensive burns. What complication of burns will it prevent? A. Colitis B. Gastritis C. Stress ulcer D. Metabolic acidosis

C. Stress ulcer

A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. A. Fever B. Diarrhea C. Headache D. Hematuria E. Ecchymosis

C. Headache D. Hematuria E. Ecchymosis

When obtaining a health history, the nurse is informed that a client has been taking digoxin. What therapeutic effect of digoxin does the nurse expect? A. Decreased cardiac output B. Decreased stroke volume of the heart C. Increased contractile force of the myocardium D. Increased electrical conduction through the atrioventricular (AV) node

C. Increased contractile force of the myocardium

A health care provider prescribes famotidine for a client with dyspepsia. What is important to include about this medication in a teaching program for this client? A. Lowers the stress level B. Neutralizes gastric acidity C. Reduces gastrointestinal peristalsis D. Decreases secretions in the stomach

D. Decreases secretions in the stomach

The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. What is an action of PTU that the nurse will include in teaching? A. Increases the uptake of iodine B. Causes the thyroid gland to atrophy C. Interferes with the synthesis of thyroid hormone D. Decreases the secretion of thyroid-stimulating hormone (TSH)

C. Interferes with the synthesis of thyroid hormone

A client with terminal cancer is to receive 4 mg of hydromorphone intravenously (IV) every 4 hours as needed for severe breakthrough pain. It is supplied at 10 mg/mL. When the client complains of severe pain, how much solution of hydromorphone should the nurse administer? Record your answer using one decimal place and leading zero if applicable. ___ mL

0.4

A client with postradiation enteritis is to continue receiving total parenteral nutrition (TPN) at home after discharge. What information should the nurse include in the client's teaching plan? A. Showing how to mix the nutritional solutions B. Demonstrating how to test capillary glucose levels C. Identifying the types of infusion pumps that can be used D. Checking for catheter placement by palpating the insertion site

B. Demonstrating how to test capillary glucose levels

What should the nurse monitor when a client is receiving a platelet aggregation inhibitor such as clopidogrel? A. Nausea B. Epistaxis C. Chest pain D. Elevated temperature

B. Epistaxis

The nurse is caring for a client with type 1 diabetes. For which signs or symptoms of insulin-induced hypoglycemia should the nurse particularly be observant? Select all that apply. A. Excessive hunger B. Headache C. Diaphoresis D. Excessive thirst E. Deep respirations

B. Headache C. Diaphoresis

A nurse is assessing the adequacy of a client's intravenous fluid replacement therapy during the first 2 to 3 days after sustaining full-thickness burns to the trunk and right thigh. What assessment will provide the nurse with the most significant data? A. Weights every day B. Urinary output every hour C. Blood pressure every 15 minutes D. Extent of peripheral edema every 4 hours

B. Urinary output every hour

A client is scheduled to begin chemotherapy 2 weeks after surgery for colon cancer. What explanation does the nurse give to explain the delay following surgery? A. Chemotherapy interferes with cell growth and delays wound healing. B. Because chemotherapy causes vomiting, it endangers the integrity of the incisional area. C. Chemotherapy decreases red blood cell production, and the resultant anemia will add to postoperative fatigue. D. Chemotherapy increases edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes.

A. Chemotherapy interferes with cell growth and delays wound healing.

A client with bleeding esophageal varices is to be treated via infusion of medication through an intravenous line. Which medication should the nurse anticipate will be prescribed? A. Vasopressin B. Neostigmine C. Lansoprazole D. Phytonadione

A. Vasopressin

A client is waiting for a kidney transplant. What explanation should the nurse include when teaching the client about the transplant? A. "Production of urine will be delayed after surgery." B. "You will require immunosuppressive drugs daily for the rest of your life." C. "Symptoms of rejection include a decrease in temperature and blood pressure." D. "You will need to modify your program of work and recreation, including sports."

B. "You will require immunosuppressive drugs daily for the rest of your life."

A client is admitted to the hospital with a diagnosis of an exacerbation of asthma. What should the nurse plan to do to best help this client? A. Determine the client's emotional state. B. Give prescribed drugs to promote bronchiolar dilation. C. Provide education about the impact of a family history. D. Encourage the client to use an incentive spirometer routinely.

B. Give prescribed drugs to promote bronchiolar dilation.

A healthcare provider informs a client that midazolam will be administered preoperatively. Later, the client asks the nurse why this medication is given. What primary reason should the nurse consider when formulating a response? A. Reduces pain B. Induces sedation C. Produces amnesia D. Limits oral secretions

B. Induces sedation

A nurse teaches a client about the dangers of using sodium bicarbonate regularly. What effect of sodium bicarbonate is the nurse trying to prevent? A. Gastric distention B. Metabolic alkalosis C. Chronic constipation D. Cardiac dysrhythmias

B. Metabolic alkalosis

What are the desired outcomes that the nurse expects when administering ibuprofen? Select all that apply A. Diuresis B. Pain relief C. Antipyresis D. Bronchodilation E. Anticoagulation F. Reduced inflammation

B. Pain relief C. Antipyresis F. Reduced inflammation

Dexamethasone has been prescribed for a client after a craniotomy for a brain tumor. When evaluating the effectiveness of the medication, the nurse expects what physiologic response? A. Reduced cell growth B. Reduced cerebral edema C. Increased renal reabsorption D. Increased response to sedation

B. Reduced cerebral edema

What should the nurse include in a teaching plan for a client taking calcium channel blockers such as nifedipine? Select all that apply. A. Reduce calcium intake. B. Report peripheral edema. C. Expect temporary hair loss. D. Avoid drinking grapefruit juice. E. Change to a standing position slowly.

B. Report peripheral edema. D. Avoid drinking grapefruit juice. E. Change to a standing position slowly.

A client who has been taking ibuprofen for rheumatoid arthritis asks the nurse if acetaminophen can be substituted instead. What is the appropriate nursing response? A. "Acetaminophen is the preferred treatment for rheumatoid arthritis." B. "Acetaminophen irritates the stomach more than ibuprofen does." C. "Ibuprofen has antiinflammatory properties and acetaminophen does not." D. "Yes, both are antipyretics and have the same effect."

C. "Ibuprofen has antiinflammatory properties and acetaminophen does not."

A client is scheduled to receive phenytoin 100 mg orally at 6 PM but is having difficulty swallowing capsules. What method should the nurse use to help the client take the medication? A. Sprinkle the powder from the capsule into a cup of water. B. Insert a rectal suppository containing 100 mg of phenytoin. C. Administer 4 mL of phenytoin suspension containing 125 mg/5 mL. D. Obtain a change in the administration route to allow an intramuscular injection.

C. Administer 4 mL of phenytoin suspension containing 125 mg/5 mL.

The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. What does the nurse explain to the client regarding the purpose of the albumin? A. It provides nutrients. B. It increases protein stores. C. Albumin elevates the circulating blood volume. D. Albumin temporarily diverts blood flow away from the liver.

C. Albumin elevates the circulating blood volume.

A client is admitted to the cardiac care unit with a myocardial infarction. The cardiac monitor reveals several runs of ventricular tachycardia. The nurse anticipates that the client will be receiving a prescription for which drug? A. Atropine B. Epinephrine C. Amiodarone D. Sodium bicarbonate

C. Amiodarone

A client who has been taking digoxin for 20 years is hospitalized. The client exhibits signs of dehydration, and laboratory results identify the presence of hypokalemia. The nurse should monitor the client for which clinical finding indicating digoxin toxicity? A. Constipation B. Decreased urination C. Cardiac dysrhythmias D. Metallic taste in the mouth

C. Cardiac dysrhythmias

While on a hike, a rusty nail pierces the sole of a client's foot and he is brought to the emergency department of a local hospital. Tetanus immune globulin is prescribed because the client does not know when the last tetanus immunization was received. What information will the nurse include when teaching the client about this drug? A. It will take about a week to become effective. B. Immune globulin provides lifelong passive immunity. C. It provides immediate, passive, short-term immunity. D. Immune globulins stimulate the production of antibodies.

C. It provides immediate, passive, short-term immunity.

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which drug does the nurse expect the health care provider to prescribe? A. Psyllium B. Bisacodyl C. Loperamide D. Docusate sodium

C. Loperamide

A nurse prepares to administer intravenous (IV) albumin to a client with ascites. What effect does the nurse anticipate? A. Ascites and blood ammonia levels will decrease. B. Decreased capillary perfusion and blood pressure. C. Venous stasis and blood urea nitrogen level will increase. D. As extravascular fluid decreases, the hematocrit will decrease.

D. As extravascular fluid decreases, the hematocrit will decrease.

A healthcare provider prescribes simvastatin 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which is most important for the nurse to teach when the client initially takes the medication? A. Take the medication with breakfast. B. Have liver function tests every 6 months. C. Wear sunscreen to prevent photosensitivity reactions. D. Inform the healthcare provider if the client wishes to become pregnant.

D. Inform the healthcare provider if the client wishes to become pregnant.

A client using fentanyl transdermal patches for pain management in late-stage cancer dies. What should the hospice nurse who is caring for this client do about the patch? A. Tell the family to remove and dispose of the patch. B. Leave the patch in place for the mortician to remove. C. Have the family return the patch to the pharmacy for disposal. D. Remove and dispose of the patch in an appropriate receptacle.

D. Remove and dispose of the patch in an appropriate receptacle.

What will the nurse include when developing a teaching plan for a client receiving digoxin for left ventricular failure? A. Sleep flat in bed B. Follow a low-potassium diet C. Take the pulse three times a day D. Rest periodically throughout the day

D. Rest periodically throughout the day

A client with esophageal cancer is to receive total parenteral nutrition. A right subclavian catheter is inserted. What is the primary reason total parenteral nutrition is infused through a central line rather than a peripheral line? A. It prevents the development of infection. B. There is less chance of this infusion infiltrating. C. It is more convenient so clients can use their hands. D. The large amount of blood helps dilute the concentrated solution.

D. The large amount of blood helps dilute the concentrated solution.

The nurse is caring for a client who is scheduled for an electrophysiology study (EPS) because of persistent ventricular tachycardia. Before the procedure the client is to receive a beta-blocker. What client's response during the procedure best indicates that the beta-blocker is working effectively? A. Decreased anxiety B. Reduced chest pain C. Decreased heart rate D. Increased blood pressure

C. Decreased heart rate

A client with Addison disease is receiving cortisone therapy. What complications does the nurse expect if the client abruptly stops the medication? Select all that apply. A. Diplopia B. Dysphagia C. Tachypnea D. Bradycardia E. Hypotension

C. Tachypnea E. Hypotension

A nurse in the surgical intensive care unit is caring for a client with a large surgical incision. The nurse reviews a list of vitamins and expects that which medication may be prescribed because of its major role in wound healing? A. Vitamin A (retinol) B. Vitamin K (phytonadione) C. Vitamin C (ascorbic acid) D. Vitamin B12 (cyanocobalamin)

C. Vitamin C (ascorbic acid)

Levofloxacin 750 mg intravenous piggyback (IVPB) is prescribed for a client with pneumonia. The dose is available in 150 mL of 5% dextrose and is to infuse over 90 minutes. The administration set has a drop factor of 15 drops per mL. At how many drops per minute should the nurse regulate the IVPB to infuse? Record your answer using a whole number. ___ gtt/minute

25

The nurse is monitoring a client who is having a third transfusion of packed red blood cells. Which of these may be evident if the client is experiencing a febrile transfusion reaction? Select all that apply. A. Chills B. Urticaria C. Hypotension D. Tachycardia E. Bronchospasm F. Sense of impending doom

A. Chills C. Hypotension D. Tachycardia

A client is diagnosed with acute kidney failure secondary to dehydration. An intravenous (IV) infusion of 50% glucose with regular insulin is prescribed. What does the nurse recognize as the primary purpose of the IV insulin for this client? A. Correct hyperkalemia B. Increase urinary output C. Prevent respiratory acidosis D. Increase serum calcium levels

A. Correct hyperkalemia

A client with anorexia nervosa is admitted to the critical care unit following a period of prolonged starvation. What signs or symptoms indicate to the nurse that the client may have hypokalemia? Select all that apply. A. Muscle weakness B. Metabolic alkalosis C. Cardiac dysrhythmias D. Respiratory rate of 24 or higher E. Serum potassium of 5.5 mEq/L (5.5 mmol/L)

A. Muscle weakness C. Cardiac dysrhythmias

A client with type 1 diabetes self-administers NPH insulin every morning at 8 am. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? A. Noon to 8 pm B. 8 pm to noon C. 9 am to 10 am D. 10 am to 11 am

A. Noon to 8 pm

A client who has a long leg cast for a fractured bone is to be discharged from the emergency department. When discussing pain management, when does the nurse advise the client to take the prescribed as-needed oxycodone? A. Just as a last resort B. Before going to sleep C. As the pain becomes intense D. When the discomfort begins

D. When the discomfort begins

A client diagnosed with asthma has received a prescription for an inhaler. The nurse teaches the client how to determine when the inhaler is empty, instructing the client to do what? A. Count the number of doses taken. B. Taste the medication when sprayed into the air. C. Shake the canister. D. Place the canister in water to see if it floats.

A. Count the number of doses taken.

A client steps on a rusty nail, and the puncture site becomes swollen and painful. Tetanus immune globulin is prescribed. What does the nurse identify as an action of this drug? A. Provides antibodies B. Stimulates plasma cells C. Produces active immunity D. Facilitates long-lasting immunity

A. Provides antibodies

A client is admitted to the emergency department in the midst of persistent tonic-clonic seizures (status epilepticus). Diazepam is to be administered immediately. In addition to decreasing central neuronal activity, what other effect does the nurse anticipate? A. Relaxing peripheral muscles B. Slowing cardiac contractions C. Dilating tracheobronchial structures D. Providing amnesia of the convulsive episode

A. Relaxing peripheral muscles

Hydrocortisone is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug? A. Supports a better response to stress B. Promotes a decrease in blood pressure C. Decreases episodes of shortness of breath D. Controls an excessive loss of potassium from the body

A. Supports a better response to stress

A client is admitted to the hospital for medical management of acute pancreatitis. Which nursing action is most likely to reduce the pancreatic and gastric secretions of a client with pancreatitis? A. Encouraging clear liquids B. Obtaining a prescription for morphine C. Assisting the client into a semi-Fowler position D. Administering prescribed anticholinergic medication

D. Administering prescribed anticholinergic medication

The nurse is caring for a client who is experiencing side effects from high doses of methotrexate. Leucovorin calcium is prescribed and is to be administered immediately after the infusion of methotrexate. What is the best indicator that leucovorin calcium is effective? A. Increased energy B. Decreased nausea C. Decreased white blood cell (WBC) level D. Methotrexate level less than 0.05 micromole

D. Methotrexate level less than 0.05 micromole

A client has increased intracranial pressure resulting from a traumatic brain injury. Assessment findings indicate that the client is unconscious with vital signs of pulse 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription? A. Mannitol B. Dexamethasone C. Chlorpromazine D. Morphine

D. Morphine