NCLEX Medical-Surgical Drugs

A client with heart failure is digitalized (given a loading dose of digoxin) and placed on a maintenance dose of digoxin 0.25 mg by mouth daily. What responses does the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved? A. Diuresis and decreased pulse rate B. Increased blood pressure and weight loss C. Regular pulse rhythm and stable fluid balance D. Corrected heart murmur and decreased pulse pressure

A. Diuresis and decreased pulse rate

A client sustains severe burns over 40% of the surface area of the body. The nurse is assigned to care for the client during the first 48 hours after the injury. What clinical finding does the nurse anticipate if the client develops water intoxication? A. Sooty-colored sputum B. Frothy, pink-tinged sputum C. Disorientation with twitching D. Urine output of 25 mL/hr

C. Disorientation with twitching

A client with left ventricular heart failure is taking digoxin 0.25 mg daily. What changes does the nurse expect to find if this medication is therapeutically effective? Select all that apply. A. Diuresis B. Tachycardia C. Decreased edema D. Decreased pulse rate E. Reduced heart murmur F. Jugular vein distention

A. Diuresis C. Decreased edema D. Decreased pulse rate

A client who has just started on a regimen of haloperidol is observed pacing and shifting weight from one foot to the other. What side effect does the nurse document in the client's chart? A. Akathisia B. Parkinsonism C. Tardive dyskinesia D. Acute dystonic reaction

A. Akathisia

Ampicillin 250 mg by mouth every 6 hours is prescribed for a client who is to be discharged. Which statement indicates to the nurse that the client understands the teaching about ampicillin? A. "I should drink a glass of milk with each pill." B. "I should drink at least six glasses of water every day." C. "The medicine should be taken with meals and at bedtime." D. "The medicine should be taken one hour before or two hours after meals."

D. "The medicine should be taken one hour before or two hours after meals."

A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. A. Urinary output B. Deep tendon reflexes C. Last bowel movement D. Arterial blood gas results E. Last serum potassium level F. Patency of the intravenous access

A. Urinary output E. Last serum potassium level F. Patency of the intravenous access

A client with myasthenia gravis improves and is discharged from the hospital. The discharge medications include pyridostigmine bromide 10 mg every 6 hours. The nurse evaluates that the drug regimen is understood when the client makes which statement? A. "I will take the medication on an empty stomach." B. "I need to set an alarm so I take the medication on time." C. "It will be important to check my heart rate before taking the medication." D. "I should monitor for an increase in blood pressure after taking the medication."

B. "I need to set an alarm so I take the medication on time."

The nurse is caring for a client with wound dressings to the burns on 55% of the body. The dressing changes are very painful, and the client rates them 7/10 on the pain scale. The client has morphine 2 mg to be administered by mouth every 2 hours as needed. When planning the client's care, when does the nurse decide to administer the medication? A. 15 minutes before the dressing change B. 60 minutes before the dressing change C. Along with a stool softener each time it is administered D. Only if the client rates pain between 8 and 10 on the pain scale

B. 60 minutes before the dressing change

A client is considered to be in septic shock when what changes are assessed in the client's labwork? A. Blood glucose is 70-100 mg/dL B. An increased serum lactate level C. An increased neutrophil level D. A white blood count of 5000 cells/µL

B. An increased serum lactate level

When a client has gluteal edema, why should the nurse avoid using the gluteus maximus muscle for administration of intramuscular medications? A. Deposition of an injected drug causes pain. B. Blood supply is likely insufficient for adequate absorption. C. Fluid leaks from the site for a long time after the injection. D. Tissue fluid dilutes the drug before it enters the circulation.

B. Blood supply is likely insufficient for adequate absorption.

A nurse identifies that a client's IV site is warm, red, and tender. What does the nurse conclude is the most likely cause of this finding? A. Rapid delivery of the infusion B. Chemical irritation to the tissues C. Allergic response to the infusion D. Catheter infiltration into the tissues

B. Chemical irritation to the tissues

A healthcare provider prescribes selegiline 5 mg twice a day for a client with a diagnosis of Parkinson disease. What is most important for the nurse to teach the client? A. Eat food high in tyramine. B. Ensure that an opioid is not taken currently. C. Take the medication in the morning and evening. D. Monitor for signs of hypoglycemia and hyperglycemia.

B. Ensure that an opioid is not taken currently.

A client is receiving furosemide. For which sign of hypokalemia should the nurse monitor the client? A. Chvostek sign B. Flabby muscles C. Anxious behavior D. Abdominal cramping

B. Flabby muscles

A nurse is caring for a client during the emergent phase of a severe burn injury. Which parenteral intervention prescribed by the healthcare provider should the nurse question? A. Colloids B. Potassium C. Hypertonic saline D. Lactated Ringer solution

B. Potassium

Potassium chloride effervescent tablets are prescribed for a client who is to be discharged from the emergency department. What information should the nurse include when teaching the client about this medication? A. Chew the tablet completely. B. Take the medication with food. C. Take the medication at bedtime. D. Use warm water to dissolve the tablet.

B. Take the medication with food.

A client is to receive total parenteral nutrition (TPN) via a central venous access device/catheter. What information about this treatment would the nurse recognize as accurate? A. The jugular vein is the most commonly used catheter insertion site. B. The TPN may be administered intermittently rather than continuously. C. The client will experience a moderate amount of pain during the procedure. D. Catheter placement must be confirmed by fluoroscopy before the TPN is initiated.

B. The TPN may be administered intermittently rather than continuously.

A client who takes high-dose aspirin for arthritis has an acute episode of right ventricular heart failure. The healthcare provider prescribes furosemide and lowers the client's usual dosage of aspirin. The client asks the nurse the reason for the lower dose. On what principle does the nurse base a response? A. Aspirin accelerates metabolism of furosemide and decreases the diuretic effect. B. Aspirin in large doses after an acute stress episode increases the bleeding potential. C. Competition for renal excretion sites by the drugs causes increased serum levels of aspirin. D. Use of furosemide and aspirin concomitantly increases formation of uric acid crystals in the nephron.

C. Competition for renal excretion sites by the drugs causes increased serum levels of aspirin.

Twenty minutes after the start of an intravenous (IV) vancomycin infusion, the client appears flushed and complains of palpitations. What action should the nurse take? A. Stop the infusion; the client is having an allergic reaction. B. Continue to monitor the client; this is an expected reaction. C. Contact the primary healthcare provider to obtain a prescription to decrease the infusion rate. D. Contact the primary healthcare provider to obtain a prescription for an antianxiety medication.

C. Contact the primary healthcare provider to obtain a prescription to decrease the infusion rate.

A client with human immunodeficiency virus (HIV)-associated Pneumocystis jiroveci pneumonia is to receive pentamidine isethionate intravenously (IV) once daily. The nurse should monitor the client for what adverse effect? A. Hypertension B. Hypokalemia C. Hypoglycemia D. Hypercalcemia

C. Hypoglycemia

When discussing the therapeutic regimen of vitamin B12 for pernicious anemia with a client, what teaching does the nurse provide? A. Weekly Z-track injections provide needed control. B. Daily intramuscular injections are required for control. C. Intramuscular injections once a month will maintain control. D. Oral vitamin B12 tablets taken daily will provide symptom control.

C. Intramuscular injections once a month will maintain control.

A healthcare provider prescribes ampicillin for a client with an infection. What information should the nurse include in the teaching plan about this medication? A. Take the ampicillin with meals. B. Store the ampicillin in a light-resistant container. C. Notify the healthcare provider if diarrhea develops. D. Continue the drug until a negative culture is obtained.

C. Notify the healthcare provider if diarrhea develops.

Which medication requires the nurse to monitor the client for signs of hyperkalemia? A. Furosemide B. Metolazone C. Spironolactone D. Hydrochlorothiazide

C. Spironolactone

After surgery a client develops a deep vein thrombosis and a pulmonary embolus. Heparin via a continuous drip is prescribed. Several hours later, vancomycin intravenously every 12 hours is prescribed. The client has one intravenous (IV) site: a peripheral line in the left forearm. What action should the nurse take? A. Stop the heparin, flush the line, and administer the vancomycin. B. Use a piggyback setup to administer the vancomycin into the heparin. C. Start another IV line for the vancomycin and continue the heparin as prescribed. D. Hold the vancomycin and tell the healthcare provider that the drug is incompatible with heparin.

C. Start another IV line for the vancomycin and continue the heparin as prescribed.

A client says, "I take baking soda in water when I get heartburn." The nurse suggests an antacid containing aluminum and magnesium hydroxide instead of baking soda. What is the advantage these antacids have over baking soda? A. They contain little, if any, sodium. B. Absorption by the stomach mucosa is markedly enhanced. C. There is no direct effect on the systemic acid-base balance when taken as directed. D. Fewer side effects, such as diarrhea or constipation, are experienced when they are used properly.

C. There is no direct effect on the systemic acid-base balance when taken as directed.

A client on prolonged cortisone therapy for adrenal insufficiency is being discharged. Which side effects should the nurse teach the client and family to expect? Select all that apply. A. Oliguria B. Anorexia C. Weakness D. Moon face E. Weight gain F. Nervousness

C. Weakness D. Moon face E. Weight gain

The healthcare provider prescribes an intravenous medication for a client who has been admitted for a chronic obstructive pulmonary disease exacerbation. When preparing to initiate an intravenous line, the nurse applies the tourniquet to select the site. When should the nurse release the tourniquet? A. After cleaning the insertion site B. As soon as the needle pierces the skin C. When the needle enters the vein D. After the device is secured with tape

C. When the needle enters the vein

An obese client must self-administer insulin at home. The nurse will teach the client to inject insulin at which angle? A. 30-degree angle B. 60-degree angle C. 45-degree angle D. 90-degree angle

D. 90-degree angle

An older adult with cerebral arteriosclerosis is admitted with atrial fibrillation and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective? A. A reduction of confusion B. An absence of ecchymotic areas C. A decreased viscosity of the blood D. An activated partial thromboplastin twice the usual value

D. An activated partial thromboplastin twice the usual value

A healthcare provider prescribes tolterodine for a client with an overactive bladder. What is most important for the nurse to teach the client to do? A. Maintain a strict record of fluid intake and urinary output. B. Chew the extended-release capsule thoroughly before swallowing. C. Report episodes of diarrhea or any increase in respiratory secretions. D. Avoid activities requiring alertness until the response to medication is known.

D. Avoid activities requiring alertness until the response to medication is known.

A client with hyperthyroidism is to receive potassium iodide solution before a subtotal thyroidectomy is performed. What action does the nurse include when providing teaching about this drug? A. Decreases the total basal metabolic rate B. Maintains the function of the parathyroids C. Blocks the formation of thyroxine by the thyroid gland D. Decreases the size and vascularity of the thyroid gland

D. Decreases the size and vascularity of the thyroid gland

A healthcare provider has prescribed isoniazid for a client. Which instruction should be a priority for the nurse to give the client about this medication? A. Prolonged use can cause dark, concentrated urine. Incorrect B. The medication is best absorbed when taken on an empty stomach. C. Take the medication with aluminum hydroxide to minimize gastrointestinal (GI) upset. D. Drinking alcohol daily can cause drug-induced hepatitis.

D. Drinking alcohol daily can cause drug-induced hepatitis.

A nurse is instructing a group of volunteer nurses on the technique of administering the smallpox vaccine. What injection method should the nurse teach? A. Z-track B. Intravenous C. Subcutaneous D. Intradermal scratch

D. Intradermal scratch

The nurse is caring for a client hospitalized with a myocardial infarction. Which analgesic is the drug of choice for this client? A. Diazepam B. Meperidine C. Flurazepam D. Morphine sulfate

D. Morphine sulfate

A client, admitted to the cardiac care unit with a myocardial infarction, complains of chest pain. What intervention will be most effective in relieving the client's pain? A. Nitroglycerin sublingually B. Oxygen per nasal cannula C. Lidocaine hydrochloride 50 mg IV bolus D. Morphine sulfate 2 mg intravenously (IV)

D. Morphine sulfate 2 mg intravenously (IV)

A client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery? A. Vasopressin B. Levothyroxine C. Propylthiouracil D. Potassium iodide

D. Potassium iodide

A healthcare provider prescribes a medication to be administered via a metered-dose inhaler (MDI) for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using the inhaler. 1. Hold the inhaler upright in the mouth. 2. Shake the inhaler for 30 seconds. 3. Start breathing in and press down on the inhaler once. 4. Exhale slowly and deeply to empty the air from the lungs.

2. Shake the inhaler for 30 seconds. 4. Exhale slowly and deeply to empty the air from the lungs. 1. Hold the inhaler upright in the mouth. 3. Start breathing in and press down on the inhaler once.

The nurse is providing postoperative care for a client who has received a prescription for nalbuphine for pain. What side effects or adverse reactions does the nurse anticipate after administering this medication? Select all that apply. A. Nausea B. Oliguria C. Sedation D. Dry mouth E. Flushed skin F. Orthostatic hypotension

A. Nausea C. Sedation D. Dry mouth F. Orthostatic hypotension

The nurse is preparing to administer ear drops to a client who has impacted cerumen. Before administering the drops, the nurse will assess the client for which contraindications? Select all that apply. A. Allergy to the medication B. Itching in the ear canal C. Drainage from the ear canal D. Tympanic membrane rupture E. Partial hearing loss in the affected ear

A. Allergy to the medication C. Drainage from the ear canal D. Tympanic membrane rupture

A client's cardiac monitor indicates ventricular tachycardia. The nurse assesses the client and identifies an increase in apical pulse rate from 100 to 150 beats per minute. What is an appropriate treatment plan? A. Amiodarone bolus B. Intracardiac epinephrine C. Insertion of a pacemaker D. Cardiopulmonary resuscitation (CPR)

A. Amiodarone bolus

Which medications are associated commonly with upper gastrointestinal (GI) bleeding? Select all that apply. A. Aspirin B. Ibuprofen C. Ciprofloxacin D. Acetaminophen E. Methylprednisolone

A. Aspirin B. Ibuprofen E. Methylprednisolone

A nurse is teaching a client who is taking a loop diuretic about foods that are high in potassium. Which foods should the nurse emphasize? Select all that apply. A. Bananas B. Apricots C. Roasted chicken D. Macaroni and cheese E. Baked potatoes with skins

A. Bananas B. Apricots E. Baked potatoes with skins

For which side effects should a nurse assess a client with cancer who is being treated with chemotherapeutic agents? Select all that apply. A. Diarrhea B. Leukocytosis C. Bleeding tendencies D. Lowered sedimentation rate E. Increased hemoglobin levels

A. Diarrhea C. Bleeding tendencies

A healthcare provider prescribes two units of blood for a client who is bleeding. Which nursing interventions are necessary before the blood transfusion is administered? Select all that apply. A. Obtain the client's vital signs. B. Monitor hemoglobin and hematocrit levels. C. Allow the blood to reach room temperature. D. Determine typing and crossmatching of blood. E. Use a Y-type infusion set to initiate 0.9% normal saline.

A. Obtain the client's vital signs. D. Determine typing and crossmatching of blood. E. Use a Y-type infusion set to initiate 0.9% normal saline.

What dietary choices should the nurse instruct the client taking spironolactone to avoid increasing? Select all that apply. A. Potatoes B. Red meat C. Cantaloupe D. Wheat bread E. Flavored yogurt

A. Potatoes C. Cantaloupe

The nurse is caring for a client with a 30% total body surface area burn. Which assessment finding indicates to the nurse that the client's fluid replacement is adequate? A. Increasing hematocrit level B. Urinary output of 15 to 20 mL/hr C. Slowing of a previously rapid pulse rate D. Central venous pressure progressing from 5 to 1 mm Hg

C. Slowing of a previously rapid pulse rate

A client is receiving penicillin G and probenecid for syphilis. What rationale should the nurse give for the need to take these two drugs? A. Each drug attacks the organism during different stages of cell multiplication. B. The penicillin treats the syphilis, whereas the probenecid relieves the severe urethritis. C. Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods. D. Probenecid decreases the potential for an allergic reaction to penicillin, which treats the syphilis.

C. Probenecid delays excretion of penicillin, thus maintaining blood levels for longer periods.

A client who is hospitalized after a myocardial infarction asks the nurse why morphine was prescribed. What will the nurse include in the reply? A. Decreases anxiety and promotes sleep B. Helps prevent development of atrial fibrillation C. Relieves pain and reduces cardiac oxygen demand D. Dilates coronary blood vessels to increase oxygen supply

C. Relieves pain and reduces cardiac oxygen demand

The healthcare provider prescribes finasteride for a client with benign prostatic hyperplasia. What information does the nurse provide to the client? A. Male pattern baldness can occur. B. Results can be expected in 4 to 6 weeks. C. The medication relaxes the muscles in the bladder neck, making it easier to urinate. D. Protection should be worn during intercourse with a pregnant female.

D. Protection should be worn during intercourse with a pregnant female.

Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking this medication? A. Prevents an infection B. Limits abdominal distention C. Minimizes intestinal edema D. Reduces the blood ammonia level

D. Reduces the blood ammonia level

One week after being hospitalized for an acute myocardial infarction, a client reports loss of appetite and feeling nauseated. Which of the client's prescribed medications should be withheld and the healthcare provider notified? A. Digoxin B. Propranolol C. Furosemide D. Spironolactone

A. Digoxin

After a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension, a client is discharged on a regimen that includes chlorothiazide. What will the nurse instruct the client to do regarding nutrition? Select all that apply. A. Eat more dark green leafy vegetables such as spinach. B. Eat more vitamin-enriched products. C. Return to previous eating habits. D. Increase intake of dairy products. E. Increase intake of beans.

A. Eat more dark green leafy vegetables such as spinach. E. Increase intake of beans.

A client is prescribed epoetin injections. To ensure the client's safety, which lab value should the nurse assess before administration? A. Hemoglobin B. Platelet count C. Prothrombin time D. Partial thromboplastin time

A. Hemoglobin

A client who is receiving hydrochlorothiazide asks what this drug actually does. What information about the drug's therapeutic action will the nurse consider when formulating a response? A. Increases the excretion of sodium B. Increases the glomerular filtration rate C. Decreases the reabsorption of potassium D. Decreases the amount of fluid reabsorption in the loop of Henle

A. Increases the excretion of sodium

A client with arthritis increases the dose of ibuprofen to abate joint discomfort. After several weeks the client becomes increasingly weak. The client is admitted to the hospital and is diagnosed with severe anemia. What findings does the nurse expect to identify when performing an admission assessment? Select all that apply. A. Melena B. Tachycardia C. Constipation D. Clay-colored stools E. Painful bowel movements

A. Melena (blood in the stool) B. Tachycardia

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin. Which clinical adverse effect should the nurse identify as a reason for the client to seek medical consultation? Select all that apply. A. Presence of blood in urine (hematuria). B. Bruising noted at various stages of healing. C. Delayed clotting from minor cuts and scrapes. D. Bleeding from gums when brushing teeth. E. Vomiting coffee-ground emesis.

A. Presence of blood in urine (hematuria). E. Vomiting coffee-ground emesis.

A hospitalized client is receiving pyridostigmine for control of myasthenia gravis. In the middle of the night, the nurse finds the client weak and barely able to move. Which additional clinical findings support the conclusion that these responses are related to pyridostigmine? Select all that apply. A. Respiratory depression B. Distention of the bladder C. Decreased blood pressure D. Fine tremor of the fingers E. High-pitched gurgling bowel sounds

A. Respiratory depression C. Decreased blood pressure E. High-pitched gurgling bowel sounds

A client is scheduled for a craniotomy to remove a brain tumor. To prevent the development of cerebral edema after surgery, the nurse anticipates the use of drugs from which class? A. Steroids B. Diuretics C. Anticonvulsants D. Antihypertensives

A. Steroids

How should a nurse prepare an intravenous piggyback (IVPB) medication for administration to a client receiving an IV infusion? Select all that apply. A. Wear clean gloves to check the IV site. B. Rotate the bag after adding the medication to mix. C. Use 100 mL of fluid to mix the medication. D. Flush the IV insertion site with 2 mL saline. E. Place the IVPB at a lower level than the existing IV. F. Use a sterile technique when preparing the medication.

A. Wear clean gloves to check the IV site. B. Rotate the bag after adding the medication to mix. F. Use a sterile technique when preparing the medication.

A client is receiving furosemide to relieve edema. The nurse will monitor the client for which responses? Select all that apply. A. Weight loss B. Negative nitrogen balance C. Increased urine specific gravity D. Excessive loss of potassium ions E. Pronounced retention of sodium ions

A. Weight loss D. Excessive loss of potassium ions