NCLEX Comprehensive Review
The nurse has provided medication instructions to a client with an iron deficiency anemia who will be taking iron supplements. Which statement made by the client indicates an understanding of this medication? A) "I need to increase my fluid intake." B) "I need to eliminate fiber foods from my diet." C) "I need to take the medication with water before a meal." D) "I need to be sure to chew the tablet thoroughly before swallowing it."
A) "I need to increase my fluid intake." Iron preparations can be very irritating to the stomach and are best taken between meals. Because iron supplements may be associated with constipation, the client would increase fluids and fiber in the diet to counteract this side effect of therapy. Iron preparations need to be taken with a substance that is high in vitamin C to increase its absorption. The tablet is swallowed whole and not chewed.
The nurse is providing instructions to a client with seizures who will be taking phenytoin. Which statement, if made by the client, would indicate an understanding of the information about this medication? A) "I need to perform good oral hygiene, including flossing and brushing my teeth." B) "I would try to avoid alcohol, but if I'm not able to, I can drink alcohol in moderation." C) "I need to take my medication before coming to the laboratory to have a blood level drawn." D) "I need to monitor for side effects and adjust my medication dose depending on how severe the side effects are."
A) "I need to perform good oral hygiene, including flossing and brushing my teeth." Phenytoin is an anticonvulsant used to treat seizure disorders. The client needs to see a dentist at regularly scheduled times because gingival hyperplasia is a side effect of this medication. The client needs to perform good oral hygiene, including flossing and brushing the teeth. The client needs to avoid alcohol while taking this medication. The client would also be instructed that follow-up serum blood levels are important and that, on the day of the scheduled laboratory test, the client needs to avoid taking the medication before the specimen is drawn. The client would not adjust medication dosages.
A client is being started on tramadol therapy for pain management after a back injury. When educating this client on tramadol therapy, what is the priority? A) The client cannot drink alcohol while taking tramadol. B) The client cannot smoke cigarettes while taking tramadol. C) The client needs to increase the intake of calcium-rich foods. D) The client needs to avoid additional over-the-counter cough syrups.
A) The client cannot drink alcohol while taking tramadol. Tramadol is similar to an opioid analgesic. The client taking tramadol needs to not consume alcoholic beverages while taking this medication because it further depresses the central nervous system (CNS). Cigarette smoking does not adversely affect tramadol; however, the client would be discouraged from smoking and encouraged to join a smoking-cessation program for general health reasons. The client may need increased calcium, but this is not because of tramadol. The client can take cough syrup with this medication.
The nurse is admitting a client and knows that clients typically share information about herbal supplements or therapies only if they are specifically asked. What are some additional things the nurse needs to do when dealing with this topic with clients? Select all that apply. A) Use open-ended questions. B) Ask clients where they bought the supplements. C) Respond to clients with comments that invite an open-minded discussion. D) Ask the client whether the primary health care provider (PHCP) knows that the client is taking these. E) Document the use of any herbal product(s) or dietary supplements in the client record. F) Create an accepting and nonjudgmental attitude when assessing the use of or interest in herbal products or dietary supplements.
A) Use open-ended questions. C) Respond to clients with comments that invite an open-minded discussion. E) Document the use of any herbal product(s) or dietary supplements in the client record. F) Create an accepting and nonjudgmental attitude when assessing the use of or interest in herbal products or dietary supplements. The nurse's role in assessing a client regarding the use of any herbal supplements or therapies includes the following: using open-ended questions, such as "What types of herbs, vitamins, or supplements do you take?" and "What effects have you noticed from using them?" The nurse would respond to clients with comments that invite an open-minded discussion and would document the use of any herbal products or dietary supplements in the client record. The nurse's role does not include asking the client where they were bought or questioning the client about the PHCP's awareness of this issue.
The nurse is providing a health promotion session to a group of teenagers and is discussing the abuse of barbiturates. The nurse would provide which information to the teenagers? A) Barbiturate use commonly results in a rush of energy. B) Barbiturate abuse is the cause of many drug overdose deaths. C) The primary outcome of barbiturate abuse is psychological dependency. D) A dangerous increase in blood pressure (BP) occurs with barbiturate abuse.
B) Barbiturate abuse is the cause of many drug overdose deaths. The abuse of barbiturates, a class of central nervous system (CNS) depressants, is a major cause of fatal drug overdoses. The abuse of barbiturates results in both physical and psychological dependency. Energy rushes and elevated BP result from the use of a CNS stimulant.
A client is receiving zalcitabine. The nurse would monitor the results of which study to determine the effectiveness of this medication? A) Western blot B) CD4+ cell count C) Enzyme-linked immunosorbent assay (ELISA) D) Complete blood cell (CBC) count with differential
B) CD4+ cell count Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Zalcitabine slows the progression of acquired immunodeficiency syndrome (AIDS) by improving the CD4+ cell count. The Western blot and the ELISA are performed to diagnose the infection initially. A CBC count with differential may be done as part of ongoing monitoring of the status of the client with AIDS and to detect adverse effects of other medications.
The clinic nurse is reviewing the record of a client scheduled to be seen in the clinic. The nurse notes that the client is taking selegiline hydrochloride. The nurse suspects that the client has which disorder? A) Diabetes mellitus B) Parkinson's disease C) Alzheimer's disease D) Coronary artery disease
B) Parkinson's disease Selegiline hydrochloride is an antiparkinsonian medication. The medication increases dopaminergic action, assisting in the reduction of tremor, akinesia, and the rigidity of parkinsonism. This medication is not used to treat diabetes mellitus, Alzheimer's disease, or coronary artery disease.
The client delivered a newborn baby 3 hours ago. The assigned nurse is reviewing the electronic health record to determine whether the postnatal client is a candidate for Rh immune globulin administration. Which criteria must be present to determine that the client needs the medication? Select all that apply. A) The sperm must be Rh negative. B) The birth parent must be Rh negative. C) The newborn must be Rh positive. D)The indirect Coombs' test must be negative. E)The newborn must be a second or subsequent child delivered to this parent.
B) The birth parent must be Rh negative. C) The newborn must be Rh positive. D)The indirect Coombs' test must be negative. Following the birth of a first child, if eligible, the postnatal client would receive Rh immune globulin as a protection against the development of Rh isoimmunization in the next child. To be a candidate, the birth parent must be Rh negative, the newborn must be Rh positive, and the sperm must be Rh positive. The indirect Coombs' test needs to be negative and not contain any Rh antibodies.
The nurse provides instructions to a client with hypertension about newly prescribed furosemide. Which information would the nurse use to provide instructions in this teaching session? A) The medication acts on the distal tubule of the nephron. B) The medication acts on the loop of Henle in the nephron. C) The collecting duct of the nephron will be affected by this medication. D) The site of action for furosemide is the proximal tubule of the nephron.
B) The medication acts on the loop of Henle in the nephron. Furosemide works by acting to excrete sodium, potassium, and chloride in the ascending limb of the loop of Henle; therefore, options 1, 3, and 4 are incorrect.
An adolescent has been prescribed an amphetamine to help manage a diagnosis of attention deficit hyperactivity disorder. To best minimize the risk of abuse and/or overdose, the nurse expects that the medication will be administered via which method? A) Sublingual tablets B) Transdermal patch C) Rectal suppository D) Weekly intramuscular injections
B) Transdermal patch The application of a transdermal patch is the method best suited to minimizing the risk of abuse and/or overdose from an amphetamine because it manages the release of the medication without requiring the client's handling of the medication. The remaining options lack that component.
The nurse teaches a client newly diagnosed with type 1 diabetes about storing Humulin N insulin. Which statement indicates to the nurse that the client understood the discharge teaching? A) "I would keep the insulin in the cabinet during the day only." B) "I know I have to keep my insulin in the refrigerator at all times." C) "I can store the open insulin bottle in the kitchen cabinet for 1 month." D) "The best place for my insulin is on the windowsill, but in the cupboard is just as good."
C) "I can store the open insulin bottle in the kitchen cabinet for 1 month." An insulin vial in current use can be kept at room temperature for 1 month without significant loss of activity. Direct sunlight and heat must be avoided. Therefore, options 1, 2, and 4 are incorrect.
A client received 20 units of Humulin N insulin subcutaneously at 08:00. At what time would the nurse plan to assess the client for a hypoglycemic reaction? A) 10:00 B) 11:00 C) 17:00 D) 24:00
C) 17:00 Humulin N is an intermediate-acting insulin. The onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours. Hypoglycemic reactions most likely occur during peak time.
The nurse is caring for a client with heart failure who was prescribed furosemide. The nurse would monitor the client for damage of which kidney structure? A) Pelvis B) Calyx C) Nephron D) Renal artery
C) Nephron The nephron is the functional unit of the kidney that is responsible for clearance of excess fluid and waste products of metabolism. The renal pelvis and calices collect urine to send to the ureter. The renal artery brings blood to the kidney for filtering by the nephron.
The nurse has administered a dose of meperidine hydrochloride to a client with renal calculi as treatment for pain. The nurse carefully monitors this client for which side and adverse effect of this medication? A) Bradycardia B) Hypertension C) Urinary retention D) Increased respirations
C) Urinary retention Meperidine hydrochloride is an opioid analgesic. Side effects of meperidine hydrochloride include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.
A 56-year-old adult client with heart failure is receiving digoxin. The nurse is auscultating the apical heart rate before giving digoxin and notes that the heart rate is 48 beats/minute. Which action would the nurse take? A) Withhold the digoxin, and reevaluate the heart rate in 4 hours. B) Administer half of the prescribed dose to avoid a further decrease in heart rate. C) Withhold the digoxin, and assess for signs of decreased cardiac output and digoxin toxicity. D) Administer the digoxin; the heart rate would be considered normal because of the client's age.
C) Withhold the digoxin, and assess for signs of decreased cardiac output and digoxin toxicity. The normal heart rate is 60 to 100 beats/minute in an adult. If the nurse notes a heart rate that is less than 60 beats/minute, the nurse would not administer the digoxin and would further evaluate the client for signs and symptoms of digoxin toxicity. When clients are bradycardic, they may have symptoms of decreased cardiac output, so this would also be assessed.
The nurse is assisting in administering immunizations as well as providing education to the clients who receive them at a health care clinic. Which statement by a client indicates that teaching was successful? A) "Immunizations protect against all diseases." B) "Immunizations can provide natural immunity." C) "Immunizations can provide innate immunity." D) "Immunizations are a way to acquire immunity to a specific disease."
D) "Immunizations are a way to acquire immunity to a specific disease." Acquired immunity is immunity that can occur by receiving an immunization that causes antibodies to a specific pathogen to form. No immunization protects the client from all diseases. Natural (innate) immunity is present at birth.
Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care would the nurse review with the client's primary health care provider? A) A decreased dosage of levothyroxine B) An increased dosage of levothyroxine C) A decreased dosage of warfarin sodium D) An increased dosage of warfarin sodium
D) A decreased dosage of warfarin sodium Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin would be reduced.
A client arrives at the clinic complaining of fatigue, lack of energy, constipation, and depression. Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication? A) Alleviates depression B) Increases energy levels C) Increases blood glucose levels D) Achieves normal thyroid hormone levels
D) Achieves normal thyroid hormone levels Laboratory determinations of the serum thyroid-stimulating hormone (TSH) level are an important means of evaluation. Successful therapy causes elevated TSH levels to decline. These levels begin their decline within hours of the onset of therapy and continue to decrease as plasma levels of thyroid hormone build up. If an adequate dosage is administered, TSH levels remain suppressed for the duration of therapy. Although energy levels may increase and the client's mood may improve following effective treatment, these are not noted until normal thyroid hormone levels are achieved with medication therapy. An increase in the blood glucose level is not associated with this condition.
A client with acquired immunodeficiency syndrome (AIDS) has been started on therapy with zidovudine. The nurse would monitor the results of which laboratory blood study for adverse effects of therapy? A) Creatinine level B) Potassium concentration C) Blood urea nitrogen (BUN) level D) Complete blood cell (CBC) count
D) Complete blood cell (CBC) count Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Common adverse effects of zidovudine are granulocytopenia and anemia. The nurse would monitor the CBC count for these changes. Creatinine, potassium, and BUN are unrelated to this medication.
Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse would include in the client's teaching plan? A) Weight gain B) Hypoglycemia C) Flushing and palpitations D) Gastrointestinal disturbances
D) Gastrointestinal disturbances The most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea. These generally subside over time. This medication does not cause weight gain; clients lose an average of 7 to 8 lb (3.2 to 3.6 kg) because the medication causes nausea and decreased appetite. Although hypoglycemia can occur, it is not the most common side effect. Flushing and palpitations are not specifically associated with this medication.
The nurse is administering a dose of triamterene to a client with heart failure. What is the most significant adverse effect of this medication for which the client would be monitored? A) Edema B) Bradycardia C) Hypertension D) Hyperkalemia
D) Hyperkalemia Hyperkalemia is the most significant adverse effect of triamterene, especially when it is used alone. Edema, bradycardia, and hypertension are not adverse effects of this medication. Triamterene is a potassium-retaining diuretic, so the nurse needs to monitor the client for hyperkalemia. Triamterene would never be used in conjunction with another potassium-retaining diuretic or with potassium supplements or salt substitutes. In addition, caution is needed if the medication is combined with an angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker, or direct renin inhibitor. Common side effects include nausea, vomiting, leg cramps, and dizziness.
A client who has been receiving pentamidine intravenously now has a fever with a temperature of 102° F (38.9° C). Keeping in mind that the client has a diagnosis of acquired immunodeficiency syndrome (AIDS) and Pneumocystis jiroveci pneumonia, the nurse would interpret that this fever is most associated with which condition? A) Inadequate thermoregulation B) Insufficient medication dosing C) Toxic nervous system effects from the medication D) Infection caused by leukopenic effects of the medication
D) Infection caused by leukopenic effects of the medication Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. Adverse effects of pentamidine include leukopenia, thrombocytopenia, and anemia. The client needs to be routinely assessed for signs and symptoms of infection. The remaining options are inaccurate interpretations.
A client who has been taking high doses of acetylsalicylic acid to relieve pain from osteoarthritis now has more generalized joint pain and an elevated temperature. The nurse would assess for which complication to determine whether the client has other signs of aspirin toxicity? A) Diarrhea B) Constipation C) Double vision D) Ringing in the ears
D) Ringing in the ears Mild intoxication with acetylsalicylic acid, called salicylism, commonly occurs when the daily dosage is more than 4 g. Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. Hyperventilation also may occur because a salicylate stimulates the respiratory center. Fever may result because a salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production. The remaining options are not signs of aspirin toxicity.
Pancreatin is prescribed for a client with postgastrectomy syndrome. Which assessment finding would indicate a therapeutic effect of this medication? A) The client's appetite improves. B) The client experiences weight loss. C) Vitamin B12 deficiency is controlled. D) The stool is less fatty and decreases in frequency.
D) The stool is less fatty and decreases in frequency. Pancreatin aids in the digestion of protein, carbohydrate, and fat in the gastrointestinal tract. It is used to treat steatorrhea associated with postgastrectomy syndrome after bowel resection. The nurse needs to record the number of stools per day and the stool consistency to monitor the effectiveness of this enzyme therapy. If it is effective, the stools would become less frequent and less fatty. The remaining options are not indications of a therapeutic effect of the medication.
Before giving the client the initial dose of disulfiram, what would the psychiatric home health nurse determine? A) If there is a history of hyperthyroidism B) When the last full meal was consumed C) If there is a history of diabetes insipidus D) When the last alcoholic drink was consumed
D) When the last alcoholic drink was consumed Disulfiram is an adjunctive treatment for some clients with chronic alcoholism to assist in maintaining enforced sobriety. Because clients must abstain from alcohol for at least 12 hours before the initial dose, the most important assessment is when the last alcoholic drink was consumed. The medication would be used cautiously in clients with hypothyroidism, diabetes mellitus, epilepsy, cerebral damage, nephritis, and hepatic disease. It is contraindicated in persons with severe heart disease, psychosis, or hypersensitivity to the medication. Food is not a consideration with this medication.
