NCLEX PN Review - Pharmacology

336. The nurse reinforces instructions to a client taking divalproex sodium (Depakote) to treat absence seizures. Which problem represents the most frequent side effect of this medication? 1. Tinnitus 2. Irritability 3. Blurred vision 4. Nausea and vomiting

Answer 4 Rationale: The most frequent side effects of medication therapy with divalproex sodium are gastrointestinal disturbances such as nausea, vomiting, and indigestion, 'The irems in the other options are not associated side effects. Test-Taking Strategy: Note the strategicword "most" and the subject, frequent side effects of this medicarion. To answer this question correctly, you must be familiar with the side effects of the medication, Remember that divalproex sodium causes gastrointestinal disturbances. Review: divalproex sodium.

362. The nurse is reinforcing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item does the nurse instruct the client to avoid? 1. Grapefruit juice 2. Hamburger patties 3. Broccoli with butter 4. Chicken soup with noodles

Answer: 1 Rationale: A compound present in grapefruit juice inhibits metabolism of cyclosporine. As a result, consuming grapefruit juice can raise cyclosporine levels by 50% to 100%, thereby greatly increasing the risk of toxicity. The foods in options 2, 3, and 4 are acceptable to consume. Test-Taking Strategy: Focus on the subject, the food item to avoid. Use general medication administration guidelines and remember that it is best for a client taking medication to avoid grapefruit juice. Review: client teaching for cyclosporine.

402. Butorphanol tartrate is prescribed for a woman in labor. The nurse should make which statement to the client about the medication? 1. "The medication provides pain relief during labor." 2. "The medication will assist in increasing the contractions. 3. "The medication will help prevent any nausea and vomiting. 4. "The medication prevents respiratory depression in the newborn infant."

Answer: 1 Rationale: Butorphanol tartrate is an opioid analgesic that provides systemic pain relief during labor. It does not increase uterine contractions, relieve nausea, or prevent respiratory depression in the newborn infant. Test-Taking Strategy: Focus on the subject, appropriate medication information. Recalling that butorphanol is an opioid analgesic will assist in directing you to the correct option. Review: opioid analgesics.

386. Allopurinol (Zyloprim) is prescribed for a client. The nurse should reinforce which instruction to the client? 1. Drink an increased amount of fluid daily 2. Take the medication on an empty stomach 3. The effect of the medication will occur immediately 4. A rash may occur, but this is a normal expected response

Answer: 1 Rationale: Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. Allopurinol is to be taken with or immediately after meals. A full therapeutic effect may take 1 or more weeks. A client who develops a rash, irritation of the eyes, or swelling of the lips or mouth should contact the health care provider because this may indicate hypersensitivity. Test-Taking Strategy: Note the subject, appropriate medication instructions. Option 4 can be easily eliminated because it indicates hypersensitivity, which is not a normal expected response. From the remaining options, recalling that this medication is used to treat gout will direct you to the correct option. Review: client teaching for allopurinol.

382. A dient has been started on cyclobenzaprine (Flexeril) for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. The nurse should make which interpretation about these side effects? 1. They are common side effects of this medication. 2. They represent an allergic reaction to the medication. 3. They are related to the problem with the cervical spine. 4. They are dose related; the client should cut the medication dose in half.

Answer: 1 Rationale: Drowsiness, dizziness, and dry mouth are the most common side effects of cyclobenzaprine. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasms that accompany a variety of conditions. Options 2, 3, and 4 are incorrect. Test-Taking Strategy: Focus on the subject, side effects of cyclobenzaprine. Eliminate option 4 first because the client is not told to adjust a medication dosage. Recalling the signs of an allergic reaction will assist in eliminating option 2. From the remaining options, focusing on the subject will direct you to the correct option. Review: cyclobenzaprine.

385. On review of a client's medication history, the nurse notes that the client is taking felodipine (Plendi). The nurse suspects that the client has which disorder? 1. Angina 2. Epilepsy 3. Gastritis 4. Kidney failure

Answer: 1 Rationale: Felodipine is a calcium channel blocker that promotes vasodilation of the coronary and peripheral vessels. It is used to treat angina, dysrhythmias, and hypertension. It is not used to treat the disorders in options 2, 3, or 4. Test-Taking Strategy: Focus on the subject, action and use of felodipine, and name of the medication. Recalling that calcium channel blocker medication names end in the suffix "pine" will direct you to the correct option, the cardiac disorder. Review: telodipine.

379. An older client takes cascara sagrada for ongoing management of chronic constipation. The nurse monitors the client's laboratory results for which primary electrolyte imbalance related to long-term use of this medication? 1. Hypokalemia 2. Hyponatremia 3. Hypercalcemia 4. Hyperphosphatemia

Answer: 1 Rationale: Hypokalemia can result from long-term use of cascara sagrada, a laxative. The medication stimulates peristalsis and alters Auid and electrolyte transport, thus helping fluid to accumulate in the colon. Options 2, 3, and 4 are not specifically associated with the use of this medication. Test-Taking Strategy: Note the subject, laboratory values related to the use of cascara sagrada, and the strategic word "primary." Recalling that this medication is a laxative will direct you to the correct option. Review: cascara sagrada.

387. A client reports frequent use of acetaminophen (Tylenol) for relief of frequent headaches and other discomforts. The nurse should look in the medical record to see if the client has a history of which condition that could increase the client's risk of toxicity? 1. Cirrhosis 2. Hypertension 3. Duodenal ulcer 4. Left heart failure

Answer: 1 Rationale: In adults, overdose of acetaminophen causes liver damage. In addition, clients with liver disorders are at higher risk of experiencing hepatotoxicity with chronic acetaminophen use. The conditions in options 2, 3, and 4 are not a concern. Test-Taking Strategy: Focusing on the subject, the risk of toxicity, and recalling that acetaminophen causes liver damage will direct you to the correct option. Review: acetaminophen.

324. Which data is most important for a client with hypothyroidism who was recently started on levothyroxine (Synthroid)? 1. Measuring the heart rate 2. Checking for pedal edema 3. Checking intake and output 4. Monitoring the potassium level

Answer: 1 Rationale: Levothyroxine is a thyroid medication used to treat hypothyroidism. This medication increases thyroid hormone in the body and can cause adverse effects such as tachycardia, palpitations, and tremors. Therefore, the client's heart rate should be monitored and the client is taught to report adverse eftects to the health care provider immediately. The actions in the remaining options are unrelated to this medication. Test-Taking Strategy: Note the strategic words "most important." Think about the action of this medication and its effect on hypothyroidism. Use of the ABCs--airway, breathing, and circulation--will direct you to the correct option. Review: levothyroxine (Synthroid)

417. The nurse is caring for a client who has recently been prescribed melatonin to aid in sleep. Which priority finding should the nurse report to the health care provider before administering the medication? 1. Possibility of pregnancy 2. History of allergy to sulfa 3. Employment as a secretary 4. Current respiratory infection

Answer: 1 Rationale: Melatonin is an herbal medication that regulates the body's circadian rhythm and regulates sleep patterns. It should not be taken during pregnancy or when breastfeeding. This medication is not classified as a sulfa, and therefore allergy to sulfa is not pertinent to its use. Employment as a secretary and current respiratory infection are also not pertinent pieces of information. Test-Taking Strategy: Note the strategic word "priority." Recalling that this medication should not be taken during pregnancy will assist in directing you to the correct option. Review: herbal substances.

431. A client with a urinary tract infection has been prescribed nalidixic acid (NegGram). The nurse notes that the client also has a prescription for daily warfarin sodium (Coumadin) written by another health care provider. The nurse should take which action? 1. Clarify the medication prescriptions 2. Schedule the doses to be given together 3. Encourage foods that are high in vitamin K 4. Schedule the doses to be given within 5 minutes of each other

Answer: 1 Rationale: Nalidixic acid can intensify the effects of oral anticoagulants by displacing these agents from binding sites on plasma protein. When an oral anticoagulant is combined with nalidixic acid, a reduction in the anticoagulant dosage may be needed. The nurse should clarify the medication prescriptions. Therefore, options 2, 3, and 4 are incorrect. Test-Taking Strategy: Focus on the subject, a medication interaction. Note that options 2 and 4 are comparable or alike and can be eliminated. Noting that a medication has been added to the regimen of a client taking warfarin sodium will direct you to the correct option. Review: warfarin sodium and nalidixic acid.

391. The client with an infected leg wound and purulent drainage has a prescription for sodium hypochlorite (Dakin's solution) to be used for wound care. Which nursing action would be appropriate while using this solution? 1. Rinse off immediately following irrigation 2. Pour onto sterile sponges and pack in the wound 3. Let the solution run freely over normal skin tissue 4. Use each bottle of solution for 7 days before replacing

Answer: 1 Rationale: Sodium hypochlorite is a chlorine solution that is used for irrigating and cleaning either necrotic or purulent wounds. It cannot be used to pack purulent wounds, in that the solution is inactivated by copious pus. It should not come in contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. The solution is unstable and must be prepared fresh for each use. Test-Taking Strategy: Focus on the subject, the use of sodium hypochlorite in a wound. Recalling that Dakin's solution is a chlorine solution will direct you to the correct option. Review: sodium hypochlorite.

421. The nurse is reinforcing instructions to the client who has been prescribed a contraceptive vaginal ring. Which statement, if made by the client, indicates a need for further instruction? 1. "If the ring is dislodged, I will flush it down the toilet. 2. "The ring is kept in place for 3 weeks and removed for 1 week." 3. "The medication is absorbed through mucous membranes of the vagina. 4. "If I decide to become pregnant, I should wait 2 weeks after discontinuation of contraception."

Answer: 1 Rationale: The contraceptive ring, if dislodged, should be wrapped in foil and thrown away, not Aushed down the toilet. The ring is kept in place for 3 weeks and removed for 1 week. The medication is absorbed through the mucous mem- branes of the vagina. If the client decides to become pregnant, she should wait at least 2 weeks after the discontinuation of contraception before conceiving. Test-Taking Strategy: Note the strategic words "need for further instruction." These words indicate a negative event query and the need to select the incorrect option as the answer. Recall that if the ring is dislodged, it should not be Aushed down the toilet. Review: contraceptive vaginal ring.

350. The nurse checks the laboratory result for a serum digoxin (Lanoxin) level that was drawn for a client earlier in the day and notes that the result is 2.4 ng/mL. The nurse should take which action? 1. Notify the health care provider 2. Document the result in the client's record 3. Check the client's previously recorded vital signs 4. Administer the next dose of digoxin (Lanoxin) as scheduled

Answer: 1 Rationale: The normal therapeutic range for digoxin is 0.5 to 2.0 ng/mL. A value of 2.4 ng/mL exceeds the therapeutic range and could be toxic. The nurse should notify the health care provider, who may order further doses of digoxin to be held. Checking the client's previous vital signs may have limited value in this situation. Depending on the time that has elapsed since the last assessment, it may be more useful to do a current assessment of the client's status. Documenting the result is incorrect because the value is not normal. The next dose should not be administered automatically. Test-Taking Strategy: Note the subject, an action that the nurse should take, and focus on the laboratory value. Recalling that the normal therapeutic range for digoxin is 0.5 to 2.0 ng/mL will direct you to the correct option. Review: therapeutic digoxin level.

320. A client with type 2 diabetes mellitus is started on tolbutamide once daily. The nurse reinforces teaching to the client to take the medication at what time of day? 1. At breakfast 2. At dinnertime 3. Before going to bed at night 4. Between breakfast and lunch

Answer: 1 Rationale: Tolbutamide is an oral hypoglycemic agent and is taken in the morning with breakfast to minimize gastric irritation and to enhance diabetic control. It stimulates the pancreas to release insulin. Endogenous insulin must be present for oral hypoglycemics to be effective. Options 2, 3, and 4 are incorrect. Test-Taking Strategy: Focus on the subject, medication administration, and the client's diagnosis. Recalling that this medication is an oral hypoglycemic and that these medications are taken in the morning will direct you to the correct option. Review: oral hypoglycemic agents.

358. A client recently began medication therapy with propranolol (Inderal). The nurse would be concerned if which finding was noted? 1. Wheezing 2. Persistent cough 3. Heart rate of 86 decreased to 78 beats/ min 4. Blood pressure of 136/84 decreased to 130/82 mm Hg

Answer: 1 Rationale: Wheezing could indicate bronchospasm, a serious adverse reaction. A normal decrease in blood pressure and heart rate is expected. Persistent cough is not associated with this medication. Test-Taking Strategy: Remember that medication names ending with the suffix "lol" are beta blockers. Also, use the ABCs- -airway, breathing, and circulation- -to direct you to the correct option. Review: propranolol.

377. Furosemide (Lasix) is prescribed for a client, and the nurse is reinforcing teaching about the medication. Which statements by the client indicate an understanding of the instructions? (Select all that apply.) 1. "I will sit up slowly before standing each morning. 2. "I will take my medication every morning with breakfast." 3. "I need to be sure to avoid any foods that are high in potassium 4. "Some weight gain is expected, and I don't need to be concerned if I gain." 5. "I can expect swelling in my ankles and feet, but it is nothing to worry about."

Answer: 1, 2 Rationale: Furosemide is a potassium-losing diuretic, and the client needs to be sure to include potassium in the diet daily. Sitting up slowly prevents postural hypotension. Taking the medication at the same time each day improves compliance. Because furosemide is a diuretic, morning is the best time to take the medication so as not to interrupt sleep. Notification of the health care provider is appropriate if weight gain occurs; if edema is noticed in the hands, feet, or face; or if the client is short of breath. Furosemide is commonly used to treat heart failure, and these signs are an indication of exacer- bation. Test-Taking Strategy: Note the subject, client understanding of medication instructions, and focus on the medication. Recalling that it is a potassium-losing diuretic will direct you to the correct options. Review: diuretics.

428. The nurse is caring for a hospitalized child who is receiving ribavirin (Virazole) for the treatment of respiratory syncytial virus. Which complications should the nurse monitor for? (Select all that apply.) 1. Apnea 2. Anemia 3. Pneumothorax 4. Bacterial pneumonia 5. Postural hypotension

Answer: 1, 2, 3, 4 Rationale: Ribavirin is an antiviral agent that is used to treat viral infections. Adverse effects include apnea, anemia, pneumothorax, bacterial pneumonia, ventilator dependence, and cardiac arrest. Postural hypotension is not a complication associated with this medication. Test-Taking Strategy: Note the subject, complications associated with this medication. Recall that postural hypotension is not specifically associated with this medication to assist in answering this question. Review: ribavirin.

373. The nurse is caring for a client who is taking procainamide. The nurse monitors for which signs and symptoms that could indicate potential medication toxicity? (Select all that apply.) 1. Confusion 2. Dizziness 3. Drowsiness 4. Bradycardia 5. Decreased urination

Answer: 1, 2, 3, 5 Rationale: Procainamide is classified as an antidysrhythmic medication. Signs and symptoms of medication toxicity include confusion, dizziness, drowsiness, tachydysrhythmias, decreased urination, and nausea and vomiting. Test-Taking Strategy: Note the subject, signs and symptoms indicating medication toxicity. Recalling that, in general, changes in level of consciousness are typically signs of medication toxicity will direct you to options 1, 2, and 3. For the remaining options, it is necessary to be familiar with the signs and symptoms of toxicity to answer this question correctly. Review: procainamide.

375. The nurse is administering diphenoxylate/atropine (Lomotil) to an assigned client. The nurse monitors for adverse effects of this medication. Which findings indicate that an adverse effect may be occurring? (Select all that apply.) 1. Confusion 2. Tachypnea 3. Dry mouth 4. Palpitations 5. Tachycardia 6. Constipation

Answer: 1, 2, 4, 5 Rationale: Adverse effects of diphenoxylate/atropine include confusion; tachypnea; palpitations; tachycardia; hot, dry, fushed skin; absence of bowel sounds; nausea; vomiting; drowsiness; slurred speech; dizziness; and central nervous system stimulation. Dry mouth and constipation are side effects of this medication. Test-Taking Strategy: Note the subject, adverse effects of diphenoxylate/atropine. Note that the adverse effects (correct options) are those that threaten client safety and are most serious. Review: diphenoxylate/atropine (Lomotil).

401. Prednisone is prescribed for a client with adrenal insufficiency. When reinforcing teaching to the client about the medication, the nurse should include which points? (Select all that apply.) 1. Monitor for edema 2. Report rapid weight gain 3. Increase sodium intake 4. Stay away from people with infections 5. Take the medication with a meal or snack 6. Discontinue the medication when symptoms subside

Answer: 1, 2, 4, 5 Rationale: The client taking corticosteroids should be instructed to report edema and weight gain, which can occur from the sodium and water retention. Because corticosteroids cause sodium and water to be retained while causing loss of potassium, the client should limit sodium intake and increase potassium intake. These medications can increase the risk of infection, and the client should avoid contact with persons who are ill. Taking the medication with food will help to prevent gastrointestinal irritation. To prevent acute adrenal insufficiency, corticosteroids should not be abruptly discontinued. Test-Taking Strategy: Focus on the subject, appropriate medication instructions. Use knowledge regarding the administration of corticosteroids and general medication administration guidelines to answer the question. Review: client teaching for corticosteroids.

412. The nurse gathers data from a client who has been taking buspirone hydrochloride for 1 month and determines that the medication is effective if the client reports an absence of which complications? (Select all that apply.) 1. Anxiety 2. Delusions 3. Palpitations 4. Hallucinations 5. Fine hand tremors 6. Paranoid thoughts

Answer: 1, 3 Rationale: Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression. It is not recommended for the treatment of thought disorders (options 2 and 4), drug or alcohol withdrawal (option 5), or schizophrenia (option 6). Test-Taking Strategy: Note the strategic word "effective" and focus on the medication classification. Recalling that this medication is an anxiolytic will direct you to the correct options. Review: buspirone hydrochloride.

426. Atazanavir (Reyataz) has been prescribed for the client with human immunodeficiency virus. Which conditions, if noted in the client's past medical history, would indicate the need for increased monitoring of this client? (Select all that apply.) 1. Hemophilia 2. Hypertension 3. Hyperlipidemia 4. Diabetes mellitus 5. Coronary artery disease

Answer: 1, 3, 4 Rationale: Atazanavir is classified as an antiretroviral agent and acts by inhibiting the activity of reverse transcriptase in viral reproduction. This medication can cause increased bleeding in clients with hemophilia, hyperlipidemia, and hyperglycemia; therefore, clients with a history of these conditions should be monitored closely. Hypertension and coronary artery disease are not associated with cautions or contraindications for this medication and therefore are not indications for increased monitoring relative to its use. Test-Taking Strategy: Note the subject of the question, conditions that indicate the need for increased monitoring relative to atazanavir. Recalling that this medication can cause bleeding, hyperlipidemia, and hyperglycemia will assist in directing you to the correct options. Review: atazanavir.

388. A client with atrial fibrillation has been placed on warfarin (Coumadin). The nurse reinforcing dietary teaching plans to teach the client to limit which foods while taking this medication? (Select all that apply.) 1. Arugula 2. Cherries 3. Potatoes 4. Romaine 5. Spaghetti 6. Brussel sprouts

Answer: 1, 4, 6 Rationale: Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K should be avoided. Vitamin K is found in large amount in green, leafy vegetables such as broccoli; cabbage; turnip greens; spinach; kale; lettuce (romaine, arugula); and Brussel sprouts. The other options listed are foods that are lower in vitamin K. Test-Taking Strategy: Recall the relationship between warfarin and vitamin K. Focus on the subject, food items to avoid. This tells you that the correct options are foods that are high in vitamin K. Review: foods high in vitamin K and warfarin.

409. Carboprost (Hemabate) has been prescribed for a woman who is at risk for postpartum bleeding. The nurse preparing to administer the medication checks the client's record for which conditions that are contraindications for the use of this medication? (Select all that apply.) 1. Asthma 2. Renal calculi 3. Diabetes mellitus 4. Sickle cell disease 5. Cardiovascular disease

Answer: 1, 5 Rationale: Carboprost is an oxytocic agent used to prevent or control postpartum hemorrhage by contracting the uterus. It is administered intramuscularly or intramyometrially. I should be used cautiously in women with cardiovascular disease or asthma. It can be used with a client who has the other listed conditions. Test-Taking Strategy: Focus on the subject, contraindications. Use the ABCs-airway, breathing, and circulation--to direct you to the correct options. Review: oxytocic agents.

243. Which medication should the nurse anticipate will be prescribed for the client with herpes simplex type 1? 1. Furosemide (Lasix) 2. Acyclovir (Zovirax) 3. Tazarotene (Tazorac) 4. Clotrimazole (Lotrimin AF)

Answer: 2 Rationale: Acyclovir is an antiviral agent that inhibits DNA replication in the virus. It has activity against herpes simplex types 1 and 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus. Furosemide is a loop diuretic. Tazarotene is used for acne. Clotrimazole is an antifungal. Test-Taking Strategy: Focusing on the subject and recalling that herpes simplex is a virus will direct you to the option that identifies an antiviral medication. Note the suffix "vir" in the name of the medication that is the correct option. Review: antiviral medications,

368. The nurse is preparing a dose of bethanechol (Urecholine) prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available for use if needed? 1. Vitamin K 2. Atropine sulfate 3. Protamine sulfate 4. Acetylcysteine (Mucomyst)

Answer: 2 Rationale: Administration of bethanechol could result in cholinergic overdose. The antidote is atropine (an anti-cholinergic), which should be readily available if overdose occurs. Vitamin K is the antidote for warfarin. Protamine sulfate is the antidote for heparin. Acetylcysteine is the antidote for acetaminophen overdose. Test-Taking Strategy: Focus on the subject, and note that the medication name contains the suffix "chol' (bethanechol) to assist you in determining the action of the medication. Recalling that it is a cholinergic will direct you to the correct option, the anticholinergic. Review: cholinergics and anticholinergics.

427. The nurse is reinforcing instructions to the client who has been prescribed alprostadil injection (Caverject) for the treatment of erectile dysfunction. Which statement, if made by the client, indicates an understanding of the instructions provided? 1. "This medication is taken orally in pill form." 2. "I might experience insomnia while taking this medication." 3. "It is alright to continue taking my nitroglycerin if I need it." 4. "I should notify the health care provider if blurred vision develops."

Answer: 2 Rationale: Alprostadil injection is used to treat erectile dysfunction. Insomnia is a side effect of this medication; therefore the client should be instructed that this may occur. It is injected intracavernously. The administration of alprostadil concurrently with nitroglycerin products is contraindicated because both medications have a vasodilatory effect. Blurred vision is a side effect of this medication and, unless it becomes bothersome or persists, does not indicate the need to notify the health care provider. Test-Taking Strategy: Note the subject of the question, an understanding of instructions related to alprostadil. Recalling that this medication is injected intracavernously, the contraindications, and the effects requiring health care provider notification will direct you to the correct option. Review: medications used to treat erectile dysfunction.

374. The nurse is reviewing the medication list of the client with a history of glaucoma. The nurse should consult with the health care provider if which medication was prescribed for this client? 1. Timolol maleate (Timoptic) 2. Atropine sulfate (Isopto Atropine) 3. Betaxolol hydrochloride (Betoptic) 4. Carteolol hydrochloride (Ocupress)

Answer: 2 Rationale: Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated for use in clients with glaucoma. Mydriatic medications dilate the pupil and can increase intraocular pressure in the eye. The medications in options 1, 3, and 4 are agents used in the treatment of glaucoma. Test-Taking Strategy: Eliminate options 1, 3, and 4 because they are comparable or alike and are beta blocking eye medications. Review: miotic, mydriatic, and cycloplegic medications.

345. The nurse is caring for a client who is being evaluated for possible myasthenia gravis. The health care provider administers a test dose of edrophonium (Enlon). The nurse ensures that which other medication is also available during this test? 1. Droperidol 2. Atropine sulfate 3. Hydroxyzine (Vistaril) 4. Adenosine (Adenocard)

Answer: 2 Rationale: Atropine sulfate should be readily available for the client who is undergoing an edrophonium test. This is the antidote to be used if overmedication occurs. The medications in options 1, 3, and 4 will not be of any use during this test. Test-Taking Strategy: Note the subject of the question, the Enlon test. Recall that atropine sulfate is the antidote to this test in order to direct you to the correct option. Review: edrophonium test.

361. Coal tar has been prescribed for a client with psoriasis, and the nurse reinforces instructions to the client about this treatment. Which statement by the client indicates an understanding of this therapy? 1. "I should report stinging or burning to the health care provider." 2. "This medication has an unpleasant odor and may cause irritation." 3. "This medication should be applied and stay on for a full 24 hours. 4. "I should report staining of the skin and hair to the health care provider."

Answer: 2 Rationale: Coal tar therapy is used in the treatment of psoriasis, and it typically has an unpleasant odor and may cause irritation, stinging, burning, and staining of the skin and hair. These findings are expected, and it is not necessary to report them to the health care provider. This medication is usually left in place for 8 to 10 hours and is then washed off; the area may then be exposed to short-wave ultraviolet radiation. Test-Taking Strategy: Note the subject, client understanding of instructions regarding coal tar therapy. Recalling that stinging, burning, and staining are expected will assist you in eliminating these options. Next, recall that this medication is left in place for 8 to 10 (not 24) hours to assist you in eliminating option 3. Review: coal tar therapy.

408. The nurse is reinforcing teaching to a client about the effects of diphenhydramine (Benadryl), which is an ingredient in a cough suppressant prescribed for the client. The nurse should provide the client with what information while taking this medication? 1. Administer on an empty stomach 2. Avoid activities requiring mental alertness 3. Use alcohol for additional effect in reducing cough 4. Avoid the use of sugarless gum when taking this medication

Answer: 2 Rationale: Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative/hypotonic. Because the medication causes drowsiness, the client should avoid the use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental acuity during use. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth. Test-Taking Strategy: Focus on the subject, medication effects, and name of the medication. Recalling that it is an antihistamine and has a sedative effect will direct you to the correct option. Review: client teaching for antihistamines.

413. The client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse reinforces teaching to the client that which early effect can occur following administration of the medication but subsides in time? 1. Fatigue 2. Diuresis 3. Headache 4. Loss of libido

Answer: 2 Rationale: Diuresis is an early side effect of acetazolamide therapy that usually subsides with continued treatment. This is because the medication is also a weak diuretic, although it is not prescribed for that purpose. Fatigue, headache, and loss of libido are common side effects of therapy, but these may not subside spontaneously. Test-Taking Strategy: Note the strategic word "early" and focus on the name of the medication. Recalling that this medication has a diuretic effect will direct you to the correct option. Review: the action of carbonic anhydrase inhibitors.

403. The nurse determines a need for further teaching related to formoterol (Foradil) inhaler use if which statement is made by the client? 1. "I should avoid smoke-filled rooms." 2. "I should inspire slowly when using the inhaler." 3. "I should rinse my mouth after using the inhaler." 4. "I should wash the inhaler daily in warm water and dry it."

Answer: 2 Rationale: Formoterol is a bronchodilator used in the treatment of asthma and other obstructive respiratory disorders. Inspiration when using dry powder inhalers should be rapid. Options 1, 3, and 4 are correct client statements. Test-Taking Strategy: Note the strategic words "need for further teaching." These words indicate a negative event query and the need to select the incorrect statement. Use of general guidelines related to the use of dry powder inhalers will direct you to the correct option. Review: client teaching for bronchodilators.

337. A client is receiving furosemide (Lasix) 40 mg by mouth once daily for the treatment of Auid overload. The nurse checks the client's laboratory results before administration and determines the need to withhold the medication if which laboratory value is noted? 1. Serum creatinine 0.9 mg/dL 2. Serum potassium 3.2 mEq/L 3. Alanine aminotransferase (ALT) 10 U/L 4. Aspartate aminotransferase (AST) 15 U/L

Answer: 2 Rationale: Furosemide is classified as a loop diuretic and acts by producing diuresis and lowering blood pressure. This medication is used in the treatment of hypertension and fluid overload. It can result in potassium loss, which can lead to life-threatening cardiac dysrhythmias, A potassium level of 3.2 mEq/L is low (normal is 3.5 to 5.0 mEq/L). Therefore, the nurse should withhold the medication and notify the health care provider. A serum creatinine level of 0.9 mg/dI is a normal value. Serum ALT and AST levels are indicative of hepatic function, and the values reported are normal. Test-Taking Strategy: Focus on the subject, administration of furosemide and note that chis medication is a porassium-wasting diuretic. Review: nursing considerations for the administration of furosemide.

284. A client has been given a prescription for gemfibrozil (Lopid). The nurse reinforces instructions to the client to limit which food while taking this medication? 1. Fish 2. Red meat 3. Spicy foods 4. Citrus products

Answer: 2 Rationale: Gemfibrozil is a lipid-lowering agent. It is given as part of a therapeutic regimen that also includes dietary counseling, specifically the limitation of saturated and other fats in the diet. Options 1, 3, and 4 are acceptable food items. Test-Taking Strategy: Focus on the subject, the food item to limit. Recalling that gemfibrozil is a lipid-lowering agent will direct you to the correct option. Review: client teaching for medications that treat high cholesterol (antilipemics).

395. The nurse has reinforced instructions to a client receiving enalapril maleate (Vasotec). Which statement by the client indicates a need for further instruction? 1. "I need to rise slowly from a lying to a sitting position." 2. "I need to notify the health care provider if nausea occurs. 3. "I need to notify the health care provider if a sore throat and fever occur." 4. "I know that several weeks of therapy may be required for the full therapeutic effect."

Answer: 2 Rationale: If nausea occurs, it is not necessary to notify the health care provider. The client should be instructed to consume noncaffeinated carbonated beverages, unsalted crackers, or dry toast to alleviate the nausea. To reduce the hypotensive effect of this medication, the client is instructed to rise slowly from a lying to a sitting position and to permit the legs to dangle from the bed momentarily before standing. The client should report signs of a sore throat or fever to the health care provider, because these may indicate infection. The client should be notified that several weeks may be needed for the full therapeutic effect of blood pressure reduction. Test-Taking Strategy: Note the strategic words "need for further instruction," indicating a negative event query and the need to select the incorrect statement. Knowing that this medication is an antihypertensive will assist in eliminating options 1 and 4. Next, note that option 3 indicates the possibility of infection, requiring the need for health care provider notification. Review: client teaching for angiotensin-converting enzyme (ACE) inhibitors.

406. The nurse is caring for a client who has been prescribed isocarboxazid (Marplan). The nurse notes that this client is also taking carbidopa/levodopa (Sinemet) for the treatment of Parkinson's disease. The nurse notifies the health care provider, understanding that the client may be at risk for which complication? 1. Seizures 2. Hypertensive crisis 3. Vena cava syndrome 4. Orthostatic hypotension

Answer: 2 Rationale: Isocarboxazid is classified as a monoamine oxidase inhibitor (MAOI) and acts by exerting an antidepressant effect. If this medication is taken concurrently with certain substances (carbidopa, methyldopa, nasal decongestant, norepinephrine, riserpine, amphetimines, antidepressants, epinephrine, dopamine, guanethidine, tyramine-containing foods, or vasoconstrictors), the client is at risk for hypertensive crisis. Options 1, 3 and 4 are not associated with MAOIs. Test-Taking Strategy: Note the subject of the question, a potential medication interaction. Recalling that MAOIs cannot be taken concurrently with carbidopa/levodopa because of the risk for hypertensive crisis will direct you to the correct option. Review: medication interactions with monoamine oxidase inhibitors.

400. The nurse is monitoring a child who is receiving ethylenediaminetetraacetic acid (EDTA) for the treatment of lead poisoning. The nurse reviews the laboratory results during treatment and is particularly concerned with monitoring which laboratory test result? 1. Cholesterol level 2. Blood urea nitrogen 3. White blood cell count 4. Hemoglobin and hematocrit

Answer: 2 Rationale: Kidney function tests should be monitored because ethylenediaminetetraacetic acid is nephrotoxic. The calcium level should also be monitored because EDTA enhances the excretion of calcium. Options 1, 3, and 4 are not blood tests that are a primary concern during treatment with EDTA. Test-Taking Strategy: Focus on the subject, laboratory results associated with EDTA. Recalling that this medication is nephrotoxic will direct you to the correct option. Review: ethylenediaminetetraacetic acid.

370. The nurse gives an intramuscular dose of methylergonovine to a client following delivery of her infant. The nurse determines that this medication had the intended effect after noting which finding? 1. Decreased pulse rate 2. Improved uterine tone 3. Increased urine output 4. Increased blood pressure

Answer: 2 Rationale: Methylergonovine is given following delivery to treat postpartum hemorrhage. It acts by vasoconstricting arterioles and directly stimulating uterine muscle contractions. Blood pressure may increase, but this is not the intended therapeutic effect. Options 1 and 3 are unrelated to the effects of this medication. Test-Taking Strategy: Noting the subject, an intended effect, and recalling the action of the medication and its use in the immediate postpartum period will direct you to the correct option. Review: methylergonovine.

244. The client with acromegaly has been started on medication therapy with octreotide acetate (Sandostatin). The nurse should monitor this client for which frequent side effect of this medication? 1. Dyspnea 2. Diarrhea 3. Bradycardia 4. Constipation

Answer: 2 Rationale: Octreotide acetate is used to reduce growth hormone levels in clients with acromegaly. The most common side effects of this medication are diarrhea, nausea, gallstone formation, and abdominal discomfort. Hypertension, although rare, may occur. Dyspnea, bradycardia, and constipation are not associated with use of this medication. Test-Taking Strategy: Focus on the subject, a side effect, and note that options 2 and 4 address opposite conditions, indicating that possibly one of these options is correct. Next, recall that this medication causes diarrhea. Review: octreotide acetate.

356. A client has been taking omeprazole (Prilosec) for 4 weeks. The nurse concludes that the client is receiving the optimal intended effect of the medication if the client reports absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

Answer: 2 Rationale: Omeprazole is a gastric acid pump inhibitor and is classified as an antiulcer agent. Its intended effect is relief of pain from gastric irritation, often referred to as heartburn by clients. It is not used to treat the conditions identified in options 1, 3, and 4. Test-Taking Strategy: Focus on the subject, an intended effect, and note the suffix "zole" in the medication name. Recalling that this medication is a gastric acid pump inhibitor will direct you to the correct option. Review: proton pump inhibitors.

266. The nurse is describing the medication side effects to a client who is taking oxazepam (Serax). The nurse incorporates in the discussion the need for which action? 1. Consume a low-fiber diet 2. Increase Aids and bulk in the diet 3. Rest if the heart begins to beat rapidly 4. Take antidiarrheal agents if continuous diarrhea occurs

Answer: 2 Rationale: Oxazepam is an antianxiety agent and causes constipation, and the client is instructed to increase fluids and bulk (fiber) in the diet. A low-fiber diet may worsen constipation. If the heart begins to beat fast, the health care provider is notified because this could indicate overdose. Additionally, diarrhea could indicate an incomplete intestinal obstruction, and if this occurs, the health care provider is notified. Test-Taking Strategy: Focus on the subject, medication side effects, and determine the medication classification and its action. Recalling that constipation is a side effect will direct you to the correct option. Review: client teaching for antianxiety agents.

367. A client receiving heparin sodium by the subcutaneous route is noted to have persistent nosebleeds. The nurse is concerned that the client is experiencing heparin-related bleeding. After requesting a prescription for a stat partial thromboplastin time (PTT), the nurse checks to see whether which medication is available in the medication cart? 1. Vitamin K 2. Protamine sulfate 3. Enoxaparin (Lovenox) 4. Aminocaproic acid (Amicar)

Answer: 2 Rationale: Persistent nosebleeds are a sign of bleeding, an adverse effect that can occur with heparin therapy. If the results of the next PTT are too high, a dose of protamine sulfate, the antidote for heparin, may be prescribed. Vitamin K is the antidote for warfarin sodium. Enoxaparin is an anticoagulant. Aminocaproic acid is an antithrombinolytic (inhibits clot breakdown). Test-Taking Strategy: Focus on the subject, an antidote. Recalling that the antidote for heparin is protamine sulfate will direct you to the correct option. Review: protamine sulfate and heparin.

288. The client who is human immunodeficiency virus (HIV) seropositive has been taking ritonavir (Norvir). The nurse tells the client that which follow-up laboratory study will be necessary while taking this medication? 1. Platelet count 2. Triglyceride level 3. Prothrombin time (PT) 4. International normalized ratio (INR)

Answer: 2 Rationale: Ritonavir is an antiretroviral (protease inhibitor) used in combination with other antiretroviral medications in the management of HIV infection. It can increase the triglyceride level; therefore the client's triglyceride level should be monitored. The platelet count, PT, and IN are not laboratory tests that would be monitored in the client on this medication. Test-Taking Strategy: Focus on the subject, the side effects of ritonavir. Note that options 1, 3, and 4 are comparable or alike and relate to hematologic function. Remember that ritonavir elevates the triglyceride level. Review: ritonavir.

422. The nurse is collecting data from a client who reports taking kava kava for depression. The nurse collects additional data for which finding to ensure client safety while taking this product? 1. Dizziness 2. Pregnancy 3. Vision changes 4. Gastrointestinal upset

Answer: 2 Rationale: Safety has not been established with the use of kava kava and pregnancy or breastfeeding. The nurse should determine the possibility of pregnancy or breastfeeding in the client who reports taking this medication because the health care provider may discontinue use in this instance. Dizziness, vision changes, and gastrointestinal upset are side effects of this herbal substance. Test-Taking Strategy: Focus on the subject, use of herbal substances. Noting the word "safety" and recalling that the safety of this medication has not been established in pregnancy or breastfeeding mothers will direct you to the correct option. Review: herbal substances.

344. The nurse notes that a client receiving olanzapine (Zyprexa) is moving her mouth, protruding her tongue, and grimacing. The nurse interprets that the client is experiencing which medication complication? 1. Hypertensive crisis 2. Tardive dyskinesia 3. Neuroleptic malignant syndrome 4. A normal reaction to this medication

Answer: 2 Rationale: Tardive dyskinesia is an adverse reaction that can occur with the use of antipsychotic medications; it is characterized by uncontrollable involuntary movements, particularly of the tongue. This is not a normal reaction and needs to be reported to the health care provider. Hypertensive crisis is characterized by a sudden, severe increase in blood pressure. Neuroleptic malignant syndrome is an adverse reaction associated with the use of neuroleptic medications and is characterized by hypertonicity, pallor, dyskinesia, and hyperthermia. Test-Taking Strategy: Focus on the subject, a medication complication, to eliminate option 4. From the remaining options, focus on the symptoms identified in the question and note that the client is receiving an atypical antipsychotic. This will direct you to the correct option. Review: tardive dyskinesia.

415. A dient taking verapamil (Calan SR) has been given information about its side effects. The nurse determines that the client understood the information if the client stated to watch for which common side effect of this medication? 1. Weight loss 2. Constipation 3. Nasal stuffiness 4. Abdominal cramping

Answer: 2 Rationale: The most common complaint with the use of verapamil, an antidysrhythmic and antihypertensive, is constipation. Other frequent side effects are dizziness, facial Aushing, headache, and edema of the hands and feet. Options 1, 3, and 4 are not associated with the use of this medication. Test-Taking Strategy: Note the subject, side effects of antidysrhythmic/antihypertensive medications. Specific knowledge of the side effects of this medication is needed to answer this question. Remember that verapamil causes constipation. Review: side effects of antidysrhythmics and antihypertensives.

351. The nurse prepares to administer digoxin (Lanoxin) to a newborn with a diagnosis of heart failure and notes that the apical rate is 140 beats/min. Which nursing action is appropriate? 1. Hold the medication 2. Administer the digoxin 3. Notify the health care provider 4. Recheck the apical rate in 1 hour

Answer: 2 Rationale: The normal apical rate for a newborn is 120 to 160 beats/min. Because the apical rate is within the normal range, options 1, 3, and 4 are inappropriate. Test-Taking Strategy: Focus on the subject, guidelines for administering digoxin. Knowing both the normal vital signs for an infant and the schedule for administration of digoxin will direct you to the correct option. Review: digoxin.

376. The nurse is listening to a 52-year-old client's apical heart rate before giving digoxin (Lanoxin) and notes that the heart rate is 58 beats/ min. How should this heart rate be interpreted by the nurse? 1. Expected, because of the client's age 2. Abnormal and requires further assessment 3. Normal, due to the effects of digoxin (Lanoxin) 4. Low and the reason the client is receiving digoxin (Lanoxin)

Answer: 2 Rationale: The normal heart rate is 60 to 100 beats/min in an adult. If the nurse notes a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would report the finding to the health care provider. Options 1, 3, and 4 are incorrect because this heart rate is not normal. Test-Taking Strategy: Knowledge regarding the normal heart rate will direct you to the correct option. Also, note that options 1, 3, and 4 are comparable or alike in that they all indicate that a pulse rate of 58 beats/ min is a normal finding. Review: digoxin.

378. The nurse prepares to administer potassium chloride as prescribed to a client with hypokalemia. Which action is the priority in the nurse's plan regarding the preparation and administration of the potassium chloride? 1. Monitor for diarrhea as a side effect 2. Check renal function and urinary output 3. Give pills one at a time to ease in swallowing 4. Inform the client that the medication can be taken without regard to food

Answer: 2 Rationale: When administering potassium chloride, the nurse should check renal function and urine output because potassium is eliminated through the kidneys. The nurse should monitor for diarrhea, give the oral preparation one at a time to ease in swallowing, and inform the client that the oral preparation can be taken without regard to food, but these actions are not the priority. Test-Taking Strategy: Note the strategic word "priority." Recalling that potassium is excreted via the kidneys will direct you to the correct option. Review: potassium chloride.

411. A hospitalized client with diabetes mellitus received regular insulin at 07:00 hours. The nurse most carefully monitors the client for a hypoglycemic reaction between which hours? 1. 19:00 and 23:00 hours 2. 08:00 and 12:00 hours 3. 10:00 and 11:00 hours 4. 00:00 and 06:00 hours

Answer: 2 Rationale: Regular insulin is short-acting. It peaks in 1 to 5 hours after administration. (Its onset is 30 to 60 minutes, and its duration is 6 to 10 hours.) If the medication was given at 07:00 hours, the nurse would monitor for a hypoglycemic reaction during the peak time of 08:00 and 12:00 hours. Test-Taking Strategy: Note the strategic word "most, the subject, and the peak action time of regular insulin. It is necessary to know that this type of insulin peaks in 1 to 5 hours to answer this question correctly. Review: regular insulin.

425. The nurse is providing information about the side effects and adverse effects of chorionic gonadotropin to the client who has been prescribed it. Which side/adverse effects should the nurse include? (Select all that apply.) 1. Seizures 2. Headache 3. Bloating 4. Risk of birth defects 5. Orthostatic hypotension

Answer: 2, 3, 4, 5 Rationale: Chorionic gonadotropin is a fertility medication. Its side/adverse effects include headache, bloating, risk of multiple births and birth defects, orthostatic hypotension, ovarian overstimulation, irritability, nausea and vomiting, uterine bleeding, ovarian enlargement, gynecomastia, rash, and febrile reactions. Seizures are not associated with this medication. Test-Taking Strategy: Note the subject of the question, side/adverse effects of fertility medications. It is necessary to be familiar with the side/adverse effects of fertility medications to answer this question correctly. Review: fertility medications.

423. The nurse understands that which conditions are contraindications for the use of fertility medications? (Select all that apply.) 1. Hypertension 2. Ovarian cysts 3. Diabetes mellitus 4. Thyroid dysfunction 5. Adrenal dysfunction 6. Ovarian dysfunction

Answer: 2, 4, 5, 6 Rationale: Contraindications for the use of fertility medications include certain conditions including ovarian cysts; thyroid dysfunction; adrenal dysfunction; ovarian dysfunction; pregnancy; or idiopathic uterine bleeding. Hypertension and diabetes mellitus are not contraindications for the use of these medications. Test-Taking Strategy: Note the subject of the question, contraindications for the use of fertility medications. It is necessary to be familiar with these contraindications to answer this question correctly. Review: fertility medications.

390. The nurse is caring for a client who is taking ondansetron (Zofran) for the treatment of nausea and vomiting. The nurse determines that an adverse effect may be occurring if which findings are noted? (Select all that apply.) 1. Temperature 98.6° F 2. Serum creatinine 2.0 mg/dL 3. Pulse rate 86 beats/min 4. Blood pressure 182/100 mm Hg 5. Blood urea nitrogen (BUN) 30 mg/dL 6. Respiratory rate 10 breaths/min

Answer: 2, 4, 5, 6 Rationale: Ondansetron is classified as an antiemetic. Its adverse effects include hypertension, acute kidney injury, gastrointestinal bleeding, respiratory depression, coma, and extrapyramidal effects. A serum creatinine level of 2.0 mg/dL and a BUN level of 30 mg/dL are elevated and indicative of impaired kidney function (normal levels are 0.6 to 1.3 mg/dI and 8 to 25 mg/dL, respectively). A blood pressure of 182/100 mm Hg indicates hypertension. A respiratory rate of 10 breaths/min is indicative of respiratory depression (normal rate is 12 to 20 breaths/min). A pulse rate of 86 beats/min is normal (normal range is 60 to 100 beats/min) and a temperature of 98.6° F is normal. Test-Taking Strategy: Note the subject, adverse effects of this medication. Begin by analyzing each finding in the options. If you did not know the adverse effects of this medication, determine which findings are abnormal; this would assist in directing you to the correct options. Review: ondansetron.

365. Theophylline (Theo-24) tablets are prescribed for a client with chronic airflow limitation. When teaching about the medication, the nurse should provide the client with which pieces of information? Select all that apply. 1. "Wear sunscreen at all times when outdoors." 2. "Periodic blood levels will need to be obtained." 3. "Always take the medication on an empty stomach." 4. "Limit intake of caffeine-containing foods and beverages." 5. "Continue to take the medication even if you are feeling better." 6. "Report any signs of respiratory infection to the health care provider."

Answer: 2, 4, 5, 6 Rationale: Theophylline is a bronchodilator. Caffeine-containing foods are limited to prevent toxicity and periodic blood levels are monitored to ensure a therapeutic medication level. The medication is taken as prescribed and is expected to make the client feel better. Signs of respiratory infection should be reported so that measures can be instituted to prevent respiratory complications. It is not necessary to take the medication on an empty stomach or to wear sunscreen at all times when outdoors. Test-Taking Strategy: Eliminate options 1 and 3 because of the closed-ended words "all" and "always", respectively. Review: client instructions for bronchodilators.

369. The nurse is administering a prescribed dose of dexamethasone to a client following cranial surgery. The nurse should monitor for which adverse effect of this medication? 1. Dehydration 2. Hyperkalemia 3. Delayed wound healing 4. Low blood glucose level

Answer: 3 Rationale: Adverse effects of dexamethasone, a glucocorticoid, include delayed wound healing, hyperglycemia, fluid overload, and hypokalemia, among others. Dehydration, hyperkalemia, and low blood glucose level are not associated adverse effects of this medication. Test-Taking Strategy: Focus on the subject, an adverse effect, and think about the effects of glucocorticoids. Remember that these medications delay healing. Review: dexamethasone.

404. The nurse is caring for a client with leukemia who has been prescribed allopurinol (Zyloprim). The nurse should contact the health care provider if which medication is also noted in the client's medical record? 1. Lisinopril (Zestril) 2. Levothyroxine (Synthroid) 3. Warfarin sodium (Coumadin) 4. Hydrochlorothiazide (Microzide)

Answer: 3 Rationale: Allopurinol can increase the effects of certain medications, including warfarin sodium and oral hypoglycemic agents. The nurse should contact the health care provider if it is noted that these medications are taken concurrently. Lisinopril, levothyroxine, and hydrochlorothiazide are not affected by concurrent use of allopurinol. Test-Taking Strategy: Note the subject, a medication interaction. Begin by eliminating options 1 and 4 because they are comparable or alike and are both used to treat hypertension. From the remaining options, it is necessary to know that a medication interaction can occur with concurrent use of warfarin sodium and allopurinol to answer this question correctly. Review: allopurinol.

383. The client newly diagnosed with gout has been prescribed allopurinol (Zyloprim). The nurse should consult with the health care provider if the dosage for which medication already prescribed has not changed? 1. Digoxin (Lanoxin) 2. Adenosine (Adenocard) 3. Warfarin sodium (Coumadin) 4. Ergotamine tartrate (Ergomar)

Answer: 3 Rationale: Allopurinol is an antigout medication that may increase the effect of oral anticoagulants. Warfarin sodium is an anticoagulant, and if this medication was prescribed for the client, the nurse should verify the prescription. The dosage of warfarin sodium may need to be decreased. Digoxin is a cardiac glycoside. Adenosine is an antidysrhythmic. Ergotamine tartrate is an antimigraine medication. Test-Taking Strategy: Note the subject, a medication interaction, and focus on the action of each medication in the options. Recalling that warfarin sodium is an anticoagulant will direct you to the correct option. Review: antigout agents and anticoagulants.

331. The nurse caring for a client taking amitriptyline hydrochloride receives a laboratory report indicating a serum medication level of 148 ng/mL. The nurse understands that this level is indicative of which result? 1. A low serum medication level 2. A toxic serum medication level 3. A therapeutic serum medication level 4. An ineffective serum medication level

Answer: 3 Rationale: Amitriptyline hydrochloride is classified as an antidepressant. The client taking this medication on a long-term basis should have serum medication levels monitored regularly as prescribed. The normal serum medication level is 120 to 150 ng/mL. A level of 148 ng/mL indicates a therapeutic medication level. Options 1, 2, and 4 are incorrect. Test-Taking Strategy: Note the subject, therapeutic medication level for amitriptyline hydrochloride. Note that options 1 and 4 are comparable or alike and can be eliminated. From the remaining options, it is necessary to know the normal serum level for this medication to answer this question correctly. Review: amitriptyline hydrochloride.

255. An albulterol (AccuNeb) inhaler is prescribed for a client with allergic asthma. The nurse reinforces instructions regarding the adverse effects of this medication. Which is an adverse effect associated with this medication? 1. Diarrhea 2. Headache 3. Tachycardia 4. Throat irritation

Answer: 3 Rationale: An adverse effect associated with this medication is tachycardia when given by the inhalation or nebulization route. Diarrhea, headache, and throat irritation are not adverse effects associated with this medication. Test-Taking Strategy: Note the subject, adverse effects of albuterol. Note that the correct option is a life-threatening condition; this will direct you to this option. Review: albuterol.

381. A client has been placed on warfarin sodium (Coumadin). The nurse is reinforcing discharge dietary teaching and teaches the client to limit foods high in which substance while taking this medication? 1. Protein 2. Vitamin C 3. Vitamin K 4. Carbohydrates

Answer: 3 Rationale: Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are limited in the diet. Vitamin K is primarily found in green, leafy vegetables. The other options listed do not need to be avoided. Test-Taking Strategy: Focus on the subject, the food substance to be avoided. Recalling the method of action of anticoagulants will direct you to the correct option. Review: warfarin sodium.

343. The client with a history of spinal cord injury is beginning medication therapy with baclofen (Lioresal). The nurse should caution the client about which occasional side effect of this medication? 1. Insomnia 2. Muscle pain 3. Low blood pressure 4. Sensitivity to bright light

Answer: 3 Rationale: Baclofen is a centrally acting skeletal muscle relaxant. Side effects include drowsiness, dizziness, weakness, and nausea. Occasional side effects include hypotension, headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, confusion, and nasal congestion. The other options are not associated side effects. Test-Taking Strategy: Focus on the subject, an occasional side effect, and the client's diagnosis. Recalling that baclofen is a skeletal muscle relaxant will direct you to the correct option. Review: baclofen.

342. The nurse is reinforcing discharge instructions to the client who has been prescribed cimetidine (Tagamet). The nurse includes which piece of information with regard to absorption of the medication? 1. Take the medication with food to speed absorption. 2. Take the medication with the prescribed antacid to aid in absorption. 3. Take the medication at least 1 hour apart from the prescribed antacid to ensure absorption. 4. Take the medication with milk to prevent gastrointestinal distress and thereby aid in absorption.

Answer: 3 Rationale: Cimetidine is classified as a histamine-2 (H2) antagonist. To ensure absorption, the nurse should instruct the client to take the medication at least 1 hour apart from the prescribed antacid. Taking cimetidine with food, an antacid, or milk will slow absorption. Test-Taking Strategy: Note the subject, measures to take to aid in absorption of this medication. Recall that food, antacids, and milk affect absorption. Review: cimetidine.

380. A film-coated form of diflunisal (Dolobid) has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the nurse because of difficulty swallowing the tablets. Which initial instruction should the nurse reinforce to the client? 1. Crush the tablet and mix with food 2. Open the tablet and mix the contents with food 3. Swallow the tablet with large amounts of water 4. Notify the health care provider for a medication change

Answer: 3 Rationale: Diflunisal may be given with water, milk, or meals. The tablets should not be crushed or broken open. It is not appropriate at this time to request a medication change. The client should first try to take the medication with large amounts of water. Test-Taking Strategy: Note the strategic word "initial." Eliminate option 4 first as the least likely option. Note the words "film coated" to eliminate options 1 and 2. Additionally, these options are comparable or alike in that they both suggest breaking the tablets. Review: nonsteroidal antinflammatory drugs.

364. A client has a prescription to receive enoxaparin (Lovenox). The nurse prepares to administer this medication by which route? 1. Orally 2. Intranasally 3. Subcutaneously 4. Intramuscularly

Answer: 3 Rationale: Enoxaparin is an anticoagulant that is administered by the subcutaneous route. It is used in preventing thromboembolism in selected clients at risk. It may also be administered by the client at home following hospital discharge with follow-up by a home care nurse. Test-Taking Strategy: Note the subject, the route of administration for this medication. Recalling that enoxaparin is an anticoagulant with properties similar to heparin will direct you to option 3. Review: enoxaparin.

330. The client with kidney failure is receiving epoetin alfa (Epogen). The nurse should monitor this client for which adverse effect of this medication? 1. Bradycardia 2. Depression 3. Hypertension 4. Lack of energy

Answer: 3 Rationale: Epoetin alfa is generally well tolerated, although hypertension can occur and is the most significant adverse effect. Occasionally, tachycardia may also occur. It may also cause an improved sense of well-being. Options 1, 2, and 4 are incorrect. Test-Taking Strategy: Eliminate options 2 and 4 because they are comparable or alike. From the remaining options, recalling the action of the medication will assist in directing you to the correct option. Review: epoetin alfa.

316. The nurse is caring for a client who is taking dantrolene sodium (Dantrium) for the treatment of muscle spasms. The nurse explains to the client that which frequent side effect may occur while taking this medication? 1. Seizures 2. Vomiting 3. Mild diarrhea 4. Respiratory depression

Answer: 3 Rationale: Frequent side effects of dantrolene sodium include mild diarrhea, drowsiness, dizziness, weakness, and general malaise. Seizures, vomiting, and respiratory depression are adverse effects associated with it. Test-Taking Strategy: Note the subject, frequent side effects of dantrolene sodium. Note the relationship between the subject and the word "mild" in the correct option. Review: dantrolene sodium.

307. A client has been diagnosed with Graves' disease. Which medication would most likely be prescribed? 1. Liothyronine (Cytomel) 2. Levodopa (Sinemet) 3. Methimazole (Tapazole) 4. Levothyroxine (Synthroid)

Answer: 3 Rationale: Graves' disease is a hyperthyroid state. Methimazole decreases thyroid hormone production. Options 1 and 4 are thyroid medications used for hypothyroidism. Levodopa is used to treat Parkinson's disease. Test- Taking Strategy: Note the strategic words "most likely," and focus on the client's diagnosis. Eliminate options 1 and 4 because they are hypothyroid medications. From the remaining options, recall that option 2 is used to treat Parkinson's disease. Review: methimazole.

399. The client who has nausea and vomiting has a PRN (as needed) prescription for hydroxyzine (Vistaril) by the intramuscular (IM) route. The nurse anticipates that administration of this medication may cause which effect? 1. Increased alertness 2. Excessive salivation 3. Pain at the injection site 4. Immediate relief of nausea

Answer: 3 Rationale: Hydroxyzine is an antiemetic and sedative/hypnotic. It often is used in conjunction with opioid analgesics for added effect. Medications administered by the IM route generally take 10 to 20 minutes to become effective; relief of nausea is not immediate. Dry mouth and drowsiness are side effects. The medication causes stinging or burning when administered by the IM route. Test-Taking Strategy: Note the subject, expected medication effect. Eliminate option 4, because IM medications do not work immediately. Recalling the action of the medication will eliminate options 1 and 2. Review: hydroxyzine.

349. Before administering an MMR (measles, mumps, and rubella) vaccine to a 15-month-old child, which question should the nurse ask the child's mother? 1. "Has your child had any sore throats?" 2. "Has your child been eating properly?" 3. "Is your child allergic to any antibiotics?" 4. "Has your child been exposed to any infections?"

Answer: 3 Rationale: MMR is used with caution in a child with a history of an allergy to gelatin, eggs, or neomycin, because the live measles vaccine is produced by chick embryo cell culture and MMR also contains a small amount of the antibiotic neomycin. Options 1, 2, and 4 are not questions that relate to contraindications for receiving the MMR vaccine. Test-Taking Strategy: Focus on the subject, the MMR vaccine. When thinking about cautions and contraindications to this vaccine, think about allergic reactions. Review: MMR (measles, mumps, and rubella) vaccine.

392. Mycophenolate mofetil (CellCept) is prescribed for a client for prophylaxis of organ rejection following allogeneic renal transplant. Which instruction should the nurse reinforce to the client regarding this medication? 1. Administer following meals 2. Take the medication with a magnesium-type antacid 3. Contact the health care provider it a sore throat occurs 4. Open the capsule and mix with food before administration

Answer: 3 Rationale: Mycophenolate mofetil should be administered on an empty stomach. Antacids may decrease the absorption of the medication and therefore should not be taken with it. The client should contact the health care provider if unusual bleeding or bruising, sore throat, mouth sores, abdominal pain, or fever occurs; this may be an indication of neutropenia. The capsules should not be opened or crushed. Test-Taking Strategy: Note the subject, appropriate medication instructions. Use of general medication administration guidelines and recalling that neutropenia can occur with the use of this medication will direct you to the correct option. Review: client teaching for mycophenolate mofetil.

357. The nurse is assigned to care for a client with an epidural catheter in place for analgesic administration following cesarean birth. The nurse checks to ensure that which medication is available for use as an antidote if the client develops respiratory depression as an adverse effect of therapy? 1. Betamethasone 2. Morphine sulfate 3. Naloxone (Narcan) 4. Magnesium sulfate

Answer: 3 Rationale: Opioids are used for epidural analgesia. An adverse effect of opioid administration is delayed respiratory depression. Naloxone is an opioid antagonist. It is given if the respiratory rate falls below 6 to 8 breaths/ min. Betamethasone is a corticosteroid administered to enhance fetal lung maturity. Morphine sulfate is an opioid analgesic. Magnesium sulfate is used to control seizure activity in clients with severe preeclampsia. Test-Taking Strategy: Focus on the subject, an antidote for respiratory depression. Think about the classifications of each medication in the options to direct you to the correct option. Review: naloxone.

398. The nurse is reinforcing instructions to an adolescent who is taking phenytoin (Dilantin) for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication? 1. "The medication may cause oily skin. 2. "Drinking alcohol may affect the medication." 3. "If my gums become sore, I need to stop the medication." 4. "Birth control pills may not be effective when I take this medication.

Answer: 3 Rationale: The adolescent should not stop taking the medication without discussing it with the health care provider or nurse because of the risk of recurring seizures. Acne or oily skin may be a problem for the adolescent, and the client is advised to call a health care provider for skin problems. Alcohol will lower the seizure threshold, and it is best to avoid its use. Birth control pills may be less effective when the client is taking anticonvulsant medication. Test-Taking Strategy: Note the strategic words "need for further teaching." These words indicate a negative event query and the need to select the incorrect statement. Use of general principles related to the administration of medication will direct you to the correct option. Review: teaching points for anticonvulsants.

384. The client who has sustained an eye injury has been prescribed prednisolone (Inflamase). The nurse should most carefully monitor for side effects of this medication if the client has which health problem listed on the medical record? 1. Cirrhosis 2. Hypertension 3. Diabetes mellitus 4. Chronic constipation

Answer: 3 Rationale: The client with diabetes mellitus is especially at risk for side effects when taking this medication, which is a glucocorticoid. The client with diabetes mellitus may experience elevations in blood glucose, which should be monitored routinely. The other options are incorrect. Test-Taking Strategy: Note the strategic word "most" and focus on the subject, a medication interaction, side effects of prednisolone. Recalling that glucocorticoids increase the blood glucose level will direct you to the correct option. Review: prednisolone.

363. The nurse is administering a dose of prochlorperazine (Compazine) to a client for nausea and vomiting. The nurse should monitor the client for which frequent side effect of this medication? 1. Diarrhea 2. Drooling 3. Blurred vision 4. Excessive lacrimation

Answer: 3 Rationale: The nurse should assess the client for blurred vision as a frequent side effect of prochlorperazine. Other frequent side effects of this phenothiazine-type antiemetic and antipsychotic are dry eyes, dry mouth, and constipation. Test-Taking Strategy: Focus on the subject, a frequent side effect. Recalling that this medication is a phenothiazine-type antiemetic and knowing the side effects of these medications will direct you to the correct option. Review: prochlorperazine.

340. A client who has undergone renal transplant is receiving ongoing therapy with cyclosporine (Sandimmune). The nurse would be sure to immediately report the results of periodic laboratory work that indicated which finding? 1. Hematocrit 45% 2. Hemoglobin 13.8 g/dL 3. Blood urea nitrogen (BUN) 27 mg/dL 4. White blood cell count 6000 cells/mm3

Answer: 3 Rationale: The use of cyclosporine can cause nephrotoxicity. This complication is detected by assessing for elevated levels of BUN (normal 8 to 25 mg/dL) and serum creatinine. Options 1, 2, and 4 are incorrect and are not complications of cyclosporine therapy. Test-Taking Strategy: Note the strategic word "immediately." Eliminate options 1, 2, and 4 first because they are comparable or alike, are components of a complete blood cell count, and are unrelated to renal function. Also note that the correct option indicates an elevated value to assist in directing you to this option. Review: cyclosporine.

405. The preoperative medication sheet identifies that tropicamide (MiydriacyI) is prescribed for a client before undergoing cataract surgery. The client asks the nurse administering the medication what the eyedrops are for. The nurse formulates a response based on the understanding of which action of the medication? 1. Lubricates the affected eye 2. Promotes miosis of the affected eye 3. Dilates the pupil of the affected eye 4. Constricts the pupil of the affected eye

Answer: 3 Rationale: Tropicamide is used for preoperative mydriasis. It is a rapidly acting mydriatic and cycloplegic medica- tion. Options 1, 2, and 4 are not actions of this medication. Test-Taking Strategy: Eliminate options 2 and 4 because they are comparable or alike and relate to pupillary constriction. Next, noting the word "preoperative" will direct you to the correct option. Review: tropicamide.

420. The nurse caring for a client who is taking valerian root for induction of sleep notes that the client has recently begun to have difficulty walking. Which action by the nurse is most appropriate at this time? 1. Continue to monitor the client 2. Measure the client's vital signs 3. Notify the health care provider 4. Check the client's mental status

Answer: 3 Rationale: Valerian root is an herbal substance that produces a sedative effect. Ataxia (difficulty walking), hypothermia, increased muscle relaxation, excitability, and insomnia are adverse effects of this substance, warranting health care provider notification. Continuing to monitor the client, measuring the client's vital signs, and assessing the client's mental status do not address the fact that an adverse effect is occurring. Test-Taking Strategy: Note the strategic words "most appropriate." Noting that difficulty walking indicates an adverse effect is occurring will direct you to the correct option. Review: herbal substances.

339. A client has begun medication therapy with pancrelipase (Pancrease MT). The nurse concludes that the medication is having the optimal intended benefit if which effects are observed? (Select all that apply.) 1. Weight loss 2. Relief of heartburn 3. Reduction of fatty stools 4. Improved nutritional status 5. Absence of abdominal pain

Answer: 3, 4 Rationale: Pancrelipase is a pancreatic enzyme used as a digestive aid in clients with pancreatitis. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It could result in weight gain, but should not result in weight loss if it is aiding in digestion. It is not used to treat heartburn or abdominal pain. Test-Taking Strategy: Focus on the subject, intended benefits, and the name of the medication. Use knowledge of physiology of the pancreas to assist in directing you to the correct options. Review: pancrelipase.

338. A client taking a monoamine oxidase inhibitor (MAI) is being monitored by the nurse for hypertensive crisis. Which findings would indicate the presence of this adverse effect? (Select all that apply.) 1. Insomnia 2. Dizziness 3. Dilated pupils 4. Nausea and vomiting 5. Neck stiffness and soreness 6. Occipital headache radiating frontally

Answer: 3, 4, 5, 6 Rationale: Signs and symptoms of hypertensive crisis include dilated pupils; nausea and vomiting; neck stiffness and soreness; occipital headache radiating frontally; hypertension; sweating; fever and chills; clammy skin; palpitations, tachycardia, or bradycardia; and constricting chest pain. Insomnia and dizziness are side effects of this medication but are not indicative of hypertensive crisis. Test-Taking Strategy: Note the subject, signs and symptoms of hypertensive crisis. Recalling that insomnia and dizziness are common side effects, not adverse effects, will assist you in eliminating these options. Review: monoamine oxidase inhibitors.

372. A client is scheduled to receive acetylcysteine (Mucomyst) 20% solution diluted in 0.9% normal saline by nebulizer. The nurse checks the client's room to ensure that which equipment is available for use as needed following administration of this medication? 1. Ambu bag 2. Intubation tray 3. Nasogastric tube 4. Suction equipment

Answer: 4 Rationale: Acetylcysteine can be given orally or by nasogastric tube to treat acetaminophen overdose, or it may be given by inhalation for use as a mucolytic. The nurse administering this medication as a mucolytic should have suction equipment available in case the client cannot clear the increased volume of liquefied secretions. The Ambu bag, intubation tray, and nasogastric tube are not necessary. Test-Taking Strategy: Focus on the subject, nursing considerations for administering acetylcysteine. Options 1 and 2 can be eliminated because the client does not need resuscitation. Option 3 is eliminated because the medication is being given via nebulizer; a nasogastric tube is not necessary. Review: acetylcysteine.

348. The nurse is reading the laboratory results for a client being treated with carbamazepine (Tegretol). The nurse interprets that which value indicates an adverse effect of this medication? 1. Sodium 136 mEg/L 2. Platelet count 350,000 cells/mm3 3. Blood urea nitrogen 19 mg/dI 4. White blood cell count 3200 cells/mm?

Answer: 4 Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Other adverse effects include cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Test-Taking Strategy: Note the subject, adverse effects associated with this medication. If you are familiar with normal laboratory values, you will note that the only option that indicates an abnormal value is the correct option. Review: carbamazepine.

424. The nurse is caring for a client who is taking alprazolam for the treatment of anxiety. Which finding warrants immediate notification of the health care provider? 1. Confusion 2. Slurred speech 3. Lightheadedness 4. Pronounced restlessness

Answer: 4 Rationale: Alprazolam is classified as a benzodiazepine and acts by producing an anxiolytic effect due to central nervous system depressant action. Adverse effects include pronounced restlessness; irritability; insomnia; hand tremors; abdominal/ muscle cramps; diaphoresis; vomiting; and seizures. Blood dyscrasias are noted rarely. Confusion, slurred speech, and lightheadedness are side effects of this medication. Test-Taking Strategy: Note the strategic word "immediate." Additionally, note the word "pronounced." This will assist in directing you to this option. Review: benzodiazepines.

410. A dlient is being discharged to home with a prescription for a daily dose of amlodipine (Norvasc), and the nurse is reinforcing medication instructions. The nurse determines that the client needs additional instruction if the client states to take the medication in which way? 1. In the morning 2. With breakfast 3. With a glass of milk 4. With grapefruit juice

Answer: 4 Rationale: Amlodipine is an antianginal medication. Grapefruit juice is avoided with this medication because it may increase the medication concentration. Amlodipine may be given without regard to food, and it is best to administer in the morning. Test-Taking Strategy: Note the strategic words "needs additional instruction." These words indicate a negative event query and the need to select the incorrect way to take the medication. Remember that grapefruit juice is avoided with the administration of most medications. Review: guidelines for administering antihypertensives.

389. The nurse notes that the client is receiving cyclobenzaprine hydrochloride (Flexeril) for the treatment of muscle spasms. The nurse questions the prescription if which disorder is noted in the admission history? 1. Hypothyroidism 2. Chronic bronchitis 3. Recurrent pneumonia 4. Angle-closure glaucoma

Answer: 4 Rationale: Because cyclobenzaprine hydrochloride has anticholinergic effects, it should be used cautiously in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Options 1, 2, and 3 are not contraindications for its use. Test-Taking Strategy: Eliminate options 2 and 3 because they are comparable or alike and both relate to a respiratory disorder. Recalling that this medication has anticholinergic effects will direct you to the correct option. Review: skeletal muscle relaxants.

393. The nurse has administered bisacodyl (Dulcolax) to an assigned client by the rectal route. The nurse should expect this medication to begin to take effect in how long? 1. 1.5 to 2 hours 2. 2.5 to 3 hours 3. 3.5 to 4 hours 4. 15 minutes to 1 hour

Answer: 4 Rationale: Bisacodyl begins to take effect in 15 minutes to 1 hour if given by the rectal route. The time frames in options 1, 2, and 3 are incorrect. Test-Taking Strategy: Note the subject, onset of bisacodyl administered rectally. Noting the route of administration will assist in directing you to the correct option. Review: bisacodyl.

355. The nurse is assisting in monitoring a client with leukemia who is receiving doxorubicin (Adriamycin) by intravenous infusion. The nurse should monitor for which finding that indicates medication toxicity? 1. Elevated creatinine 2. Decreased uric acid 3. Elevated blood urea nitrogen 4. Electrocardiographic (ECG) changes

Answer: 4 Rationale: Cardiotoxicity can occur with the use of doxorubicin. The medication can produce irreversible toxicity to the heart including ECG changes and heart failure. Elevated renal function tests (options 1 and 3) are not associated with the use of this medication. Uric acid is typically increased with doxorubicin and may be treated with additional medication. Test-Taking Strategy: Eliminate options 1, 2, and 3 because they are comparable or alike in that they all address the renal system. Review: doxorubicin.

346. A client with persistent hiccoughs has been prescribed chlorpromazine. The client calls the mental health clinic and tells the nurse that her urine has become dark but that she has no other urinary symptoms. What should the nurse tell the client? 1. That this indicates medication toxicity 2. To seek treatment for a urinary tract infection 3. To increase the intake of acid-ash foods and liquid 4. That this is an expected side effect of the medication

Answer: 4 Rationale: Chlorpromazine is an antipsychotic medication. A side effect of this medication is that the urine may darken in color. The client should be aware that this is harmless. The other options are incorrect. Test-Taking Strategy: Note the subject, side effects of chlorpromazine. Eliminate options 2 and 3 first because the question states that the client reports no other urinary symptoms. From the remaining options, it is necessary to know the side effects of this medication. Review: chlorpromazine.

371. A client with tuberculosis is being treated with isoniazid and rifampin (Rifadin). The nurse should provide the client with what information about these medications? 1. "You must take the medication with meals." 2. "You must discontinue the medication if gastrointestinal (G) irritation occurs." 3. "Fluids must be increased while taking this medication to prevent kidney failure." 4. "You may notice that your urine, sweat, saliva, and tears take on a red-orange color."

Answer: 4 Rationale: Clients taking rifampin need to be instructed that their body fluids may change color so that they are not alarmed or stop taking their medications if this harmless side effect is noted. It is preferable to take the medications 1 hour before or 2 hours after meals. If Gl irritation occurs, the medication should not be discontinued; instead a small amount of food may be eaten to reduce the irritation. It is not necessary to increase fluids during this medication therapy, although fluids are generally healthy. Test-Taking Strategy: Note that options 1, 2, and 3 contain the closed-ended word "must." Review: antitubercular medications.

418. The nurse is caring for a client who is taking cyclobenzaprine (Flexeril) for the treatment of muscle spasms related to a back injury. Which finding warrants immediate notification of the health care provider? 1. Dry mouth 2. Drowsiness 3. Blurred vision 4. Muscle rigidity

Answer: 4 Rationale: Cyclobenzaprine is classified as a skeletal muscle relaxant and acts by relieving local skeletal muscle spasm. Adverse effects of this medication include muscle rigidity, visual hallucinations, hyperactive reflexes, vomiting, and hyperpyrexia. Dry mouth, drowsiness, and blurred vision are side effects of this medication. Test-Taking Strategy: Note the strategic word "immediate." Recalling the action of this medication will assist in directing you to muscle rigidity as the correct option. Review: skeletal muscle relaxants

397. The nurse is admitting a child who arrived from the emergency department after treatment for lead poisoning. The nurse reviews the child's record and expects to note that the child received which medication for the lead poisoning? 1. Acetylcysteine 2. Protamine sulfate 3. Epoetin alta (Epogen) 4. Ethylenediaminetetraacetic acid (EDTA)

Answer: 4 Rationale: Ethylenediaminetetraacetic acid is used in the treatment of lead poisoning. Protamine sulfate is the antidote for heparin. Epoetin alfa induces erythropoiesis and is used in the treatment of anemia. Acetylcysteine is the antidote for acetaminophen overdose. Test-Taking Strategy: Focusing on the subject, the medication to treat lead poisoning, and recalling the antidote for lead poisoning will direct you to the correct option. Remember that EDTA is the antidote for lead poisoning. Review: ethylenediaminetetraacetic acid.

332. The nurse has reinforced instructions to a client receiving the first administration of the vaccine Gardasil for human papillomavirus (HPV). Which statement by the client indicates an understanding of the instructions? 1. "This will always protect me from contracting genital warts. 2. "I am relieved that my HPV is never going to cause cervical cancer for me." 3. "I will be protected from contracting all types of HPV after the vaccine series." 4. "I would like to make appointments for my other two vaccine administrations."

Answer: 4 Rationale: Gardasil guards against diseases that are caused by HPV types 6, 11, 16, and 18, such as cervical cancer, cervical abnormalities that can lead to cervical cancer, and genital warts. The vaccine will not protect 100% from contracting genital warts. The vaccine is administered as three injections over 6 months. Test-Taking Strategy: Eliminate options 1, 2, and 3 because of the closed-ended words "always", "never", and "all" in these options. Review: teaching points for immunizations.

341. The nurse reinforces teaching to a client taking metoclopramide (Reglan) on a long-term basis to withhold the medication immediately and call the health care provider if which adverse effect occurs? 1. Dry mouth 2. Feelings of irritability 3. Feelings of excitability 4. Uncontrollable movements of the arms

Answer: 4 Rationale: If the client experiences tardive dyskinesia (rhythmic movements of the face or limbs), the client should stop the medication and call the health care provider. This adverse effect may be irreversible. Excitability is not associated with this medication. Dry mouth and irritability are side effects that are not as harmful to the client. Test-Taking Strategy: Note the strategic word "immediately" and focus on the subject, an adverse effect. Select option 4 because, from the options provided, this effect is most harmful to the client. Review: metoclopramide.

352. A client is receiving scheduled doses of lovastatin (Mevacor). The nurse evaluates that the medication is having the intended effect if the nurse notes which client data? 1. Weight loss of 15 pounds 2. Pulse rate increased from 82 to 88 beats/min 3. Blood pressure decreased from 145/95 to 132/86 mm Hg 4. Cholesterol level decreased from 255 mg/dL to 187 mg/dI

Answer: 4 Rationale: Lovastatin is an HMG-CoA reductase inhibitor used to lower blood cholesterol levels. It does not induce weight loss, does not affect heart rate, and is not an antihypertensive. Test-Taking Strategy: Note the subject, an intended medication effect, and the name of the medication. Remember that medications with names that end with the suffix "statin" lower cholesterol levels. Review: lovastatin.

414. The client who has just been diagnosed with glaucoma has been given a prescription for a miotic medication. When reinforc- ing teaching to the client, the nurse should tell the client about which medication effect? 1. Reshapes the lens to eliminate blurred vision 2. Dilates the pupil to reduce intraocular pressure 3. Interrupts the drainage of aqueous humor from the eye 4. Lowers intraocular pressure and enhances blood flow to the retina

Answer: 4 Rationale: Miotics are used to lower intraocular pressure, which then increases blood flow to the retina. This in turn decreases retinal damage and loss of vision. Miotics cause a contraction or constriction of the ciliary muscle and widen the trabecular meshwork. The other options are incorrect. Test-Taking Strategy: Note the subject, the effect of a miotic, and the client's diagnosis. Knowing that the goal of treatment for glaucoma is to reduce intraocular pressure will direct you to the correct option. Review: miotics.

354. The nurse is caring for a client who has been prescribed psyllium (Metamucil). The nurse understands that this medication is classified as which type of laxative? 1. Osmotic 2. Stimulant 3. Surfactant 4. Bulk-forming

Answer: 4 Rationale: Psyllium is classified as a bulk-forming laxative and absorbs water into the feces and increases bulk to produce large and soft stools. Options 1, 2, and 3 are incorrect. Osmotics attract water into the large intestine to produce bulk and stimulate peristalsis. Stimulants stimulate motility of the large intestines. Surfactants inhibit absorption of water so fecal mass remains large and soft. Test-Taking Strategy: Note the subject, the type of laxative. Think about the action of psyllium to assist in answering correctly. Review: psyllium.

396. A client has been prescribed scopolamine (Transderm Scop). The nurse notifies the health care provider if which condition is noted in the health history? 1. Epilepsy 2. Diabetes mellitus 3. Rheumatoid arthritis 4. Angle-closure glaucoma

Answer: 4 Rationale: Scopolamine is classified as an antiemetic. This medication is contraindicated in angle-closure glaucoma, gastrointestinal/genitourinary obstruction, myasthenia gravis, paralytic ileus, tachycardia, and thyrotoxicosis. The disorders in options 1, 2, and 3 are not contraindications associated with this medication. Test-Taking Strategy: Note the subject, contraindications associated with this medication. It is necessary to know which disorders are contraindicated in the use of this medication to answer this question correctly. Think about the action of the medication and the pathophysiology of each condition to assist in answering correctly. Review: scopolamine.

366. The nurse is administering a first dose of an adrenergic bronchodilator to a client. The nurse should monitor the client carefully for which side effect of this medication? 1. Drowsiness 2. Hyperkalemia 3. Hyperglycemia 4. Increased pulse rate

Answer: 4 Rationale: Side effects of an adrenergic bronchodilator can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The items in the other options are not side effects of this medication. Test-Taking Strategy: Focus on the subject, a side effect, and the medication classification, and recall that it has cardiovascular effects to direct you to the correct option. Review: adrenergic bronchodilator.

430. A client is receiving heparin sodium as a continuous infusion at 600 units/hour. The nurse should check which laboratory study to determine the therapeutic effect of heparin? 1. Bleeding time 2. Prothrombin time (PT) 3. International normalized ratio (INR) 4. Activated partial thromboplastin time (aPTT)

Answer: 4 Rationale: The aPTT will assess the therapeutic effect of heparin, whereas the PT and INR will assess the therapeutic effect of warfarin. Bleeding time is another hematologic study that may be prescribed by the hematologist for clients with coagulopathy or other disorders. Test-Taking Strategy: Note the subject, laboratory values associated with heparin therapy. Eliminate option 1 because it is not commonly prescribed during anticoagulant therapy. Choose between the remaining options, knowing the differences between the value measured for heparin and those measured for warfarin. Review: anticoagulants and associated laboratory values.

335. A client has been started on medication therapy with alprazolam. When the nurse explains to the client that the medication should not be discontinued abruptly, the client asks why. The nurse should incorporate which information when formulating a reply? 1. The client is likely to become resistant to medication effects. 2. The client is likely to suffer irreversible damage to the kidneys. 3. It will make the medication much less effective if it must be restarted. 4. Rebound central nervous system (CNS) excitation could occur and cause feelings of restlessness and irritability.

Answer: 4 Rationale: The abrupt withdrawal of alprazolam could result in rebound CNS excitation. All clients receiving this medication should be warned of this danger. The other options are incorrect. Test-Taking Strategy: Eliminate options I and 3 first because they are comparable or alike. From the remaining options, recalling the adverse effects will direct you to the correct option. Review: client instructions for benzodiazepines.

360. The nurse is caring for a client who is receiving codeine sulfate for pain. The nurse should monitor for which finding to detect adverse effects of this medication? 1. Fluid volume excess 2. Onset of hypertension 3. Strength of peripheral pulses 4. Decreased level of consciousness

Answer: 4 Rationale: The client taking codeine sulfate is at risk for overdose; decreased level of consciousness is a sign of toxicity. Thus the nurse monitors for changes in level of consciousness. The nurse also monitors for hypotension, decreased respirations, and urinary retention. Options 1, 2, and 3 are not related to this medication. Test-Taking Strategy: Focus on the subject, adverse effects, and name of the medication. Remember that codeine is an opioid analgesic and can result in overdose. Review: codeine sulfate.

*419. The nurse is reinforcing instructions to the client who has been prescribed a contraceptive patch. Which statement, if made by the client, indicates a need for further instruction? 1. "If the patch falls off, I can reapply it if it is still sticky." 2. "'The patch should be worn for 3 weeks and removed for 1 week." 3. "I should apply the patch to the buttocks, abdomen, upper outer arm, or upper torso." 4. "I will change the patch weekly, using the same location every time I change the patch."

Answer: 4 Rationale: The contraceptive patch is a form of birth control and is changed on a weekly basis, using a different location every time the patch is changed. If the patch falls off, it can be reapplied if it is still sticky; otherwise, a new patch can be applied. The patch should be worn for 3 weeks and removed for I week. It should be applied to the buttocks, abdomen, upper outer arm, or upper torso. Test-Taking Strategy: Note the strategic words "need for further instruction." These words indicate a negative event query and the need to select the incorrect client statement as the answer. Recall that sites should be rotated to ensure maximal absorption. Review: contraception.

353. A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. Which response to the client is appropriate? 1. "You should never stop the medication." 2. "It is best that you taper the dose if you intend to stop the medication." 3. "It is all right to stop the medication if you think that you can tolerate the muscle spasms." 4. "Weakness and fatigue commonly occur and will diminish with continued medication use."

Answer: 4 Rationale: The dient should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to abruptly withdraw or stop the medication because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue use of the medication. Test-Taking Strategy: Eliminate option 1 first because of the closed-ended word "never." Next, eliminate options 2 and 3 because these responses are not within the scope of nursing practice. Review: skeletal muscle relaxants.

347. The nurse is reinforcing teaching to a client who is being started on imipramine hydrochloride (Tofranil). The nurse should provide the client with which information about the maximum desired effects? 1. They start during the first week of administration. 2. They start during the second week of administration. 3. They may not occur until 2 months after the start of administration. 4. They may not occur for 2 to 3 weeks after the start of administration.

Answer: 4 Rationale: The maximum therapeutic effects of imipramine hydrochloride may not occur for 2 to 3 weeks after therapy has been initiated. Options 1, 2, and 3 are incorrect. Test-Taking Strategy: Note the subject, the time frame for a therapeutic effect. Recalling that it takes 2 to 3 weeks for a maximum therapeutic effect to occur with most antidepressants will direct you to the correct option. Review: effects of antidepressants.

429. A health care provider prescribes intravenous (IV) potassium for a child with hypertonic dehydration. The nurse prioritizes data collection on which finding before the prescription is implemented? 1. Obtaining the weight 2. Taking the temperature 3. Taking the blood pressure 4. Checking the amount of urine output

Answer: 4 Rationale: The priority assessment before administering IV potassium is to assess urine output. Potassium should never be administered in the presence of oliguria or anuria. Although options 1, 2, and 3 are appropriate assessments for the child with dehydration, they are not specifically related to the administration of IV potassium. Test-Taking Strategy: Note the strategic word "prioritizes." Recalling that the kidneys play a key role in the excretion and reabsorption of potassium will direct you to the correct option. Review: hypertonic dehydration and administration of intravenous potassium.

359. The nurse has a prescription to give a first dose of hydrochlorothiazide (Microzide) to a client. The nurse should question the prescription if the client has a history of allergy to which item? 1. Iodine 2. Shellfish 3. Scallops 4. Sulfa drugs

Answer: 4 Rationale: Thiazide diuretics are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. The items in options 1, 2, and 3 are not associated with this medication. Test-Taking Strategy: Focus on the subject, allergy history. Next, eliminate options 1, 2, and 3 because they are comparable or alike. Recalling that thiazide diuretics carry a sulfa ring in their chemical composition will direct you to the correct option. Review: thiazide diuretics.

394. The nurse is told that the serum carbamazepine level is 10 mcg/mL for a child who is receiving carbamazepine (Tegretol) for the control of seizures. Based on this laboratory result, the nurse anticipates which health care provider prescription? 1. Discontinuation of the medication 2. A decrease of the dose of the medication 3. An increase of the dose of the medication 4. Continuation of the current dosage

Answer: 4 Rationale: When carbamazepine is administered, blood levels need to be checked periodically to monitor absorp- tion. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 4 to 12 mcg/mL. The nurse would anticipate that the health care provider will continue the current dosage. Test-Taking Strategy: Note the subject, a serum carbamazepine level of 10 mcg/mL. Recalling the therapeutic serum drug level will direct you to the correct option. Review: carbamazepine.

416. The nurse is caring for a client who has been prescribed zolpidem tartrate (Ambien). Which nursing intervention is the priority for this client? 1. Lower the lighting in the client's room and in the hallway 2. Give the client a back massage and ensure a quiet environment 3. Control the temperature in the room and decrease stimulation 4. Ensure that the bed is in the low position and place the call light within reach

Answer: 4 Rationale: Zolpidem tartrate is classified as a sedative hypnotic and acts by inducing sleep and improving sleep quality. The nurse needs to ensure that the bed is in the low position and that the call light is within reach to ensure client safety. Options 1, 2, and 3 provide comfort but do not ensure client safety. Test-Taking Strategy: Note the strategic word "priority." Use Maslow's Hierarchy of Needs theory, and recall that safety needs are a priority after physiologic needs. Review: sedative-hypnotics.

407. The nurse is interviewing a client who has been taking clomipramine hydrochloride (Anafranil). The nurse interprets that the client may be noncompliant with therapy if the client exhibits which finding during the interaction with the nurse? 1. Tired, fatigued appearance 2. Complaints of hunger and fatigue 3. Slight dizziness when standing up quickly 4. Frequently checking her purse for her keys

Answer: 4 Rationale: Clomipramine hydrochloride is commonly used in the treatment of obsessive-compulsive disorder (OCD). Frequently checking the purse for keys is a nonproductive repetitive activity that is characteristic of that disorder. Reappearance of symptoms may indicate noncompliance with medication therapy. The incorrect options are common side effects of the medication. Test-Taking Strategy: Focus on the subject, noncompliance, and recalling that the medication is used in the treatment of OCD will direct you to the correct option. Review: clomipramine hydrochloride

334. The nurse is caring for a client who has just been prescribed haloperidol for the treatment of schizophrenia. The nurse should expect to note which findings in this client related to schizophrenia? (Select all that apply.) 1. Alogia 2. Apathy 3. Avolition 4. Delusions 5. Aggression 6. Hallucinations

Answer: 4, 5, 6 Rationale: Haloperidol is classified as a typical antipsychotic and is commonly used in the treatment of schizophrenia. Typical antipsychotics are used to treat the positive symptoms of schizophrenia, including delusions, aggression, and hallucinations. Atypical antipsychotics are used to treat the negative symptoms of schizophrenia, including alogia, apathy, and avolition. Test-Taking Strategy: Focus on the subject, use of haloperidol to treat schizophrenia. Begin to answer this question by determining the classification of this medication. Recalling that typical antipsychotics are used to treat the positive symptoms of schizophrenia will direct you to the correct options. Review: haloperidol.

312. The nurse caring for a client taking rabeprazole understands that this medication is associated with which action? 1. Suppresses gastric acid secretion 2. Increases the rate of gastric emptying 3. Absorbs and secretes intestinal bile salts 4. Stimulates motility of the gastrointestinal tract

Answer: 1 Rationale: Rabeprazole is classified as a proton pump inhibitor (PPT) and acts by suppressing gastric acid secretion. Prokinetic agents increase the rate of gastric emptying and stimulate the motility of the gastrointestinal tract. Bile acid sequestrants absorb and secrete intestinal bile salts. Test-Taking Strategy: Note the subject, action of rabeprazole. Note the name of the medication--rabeprazole--and recall that the suffix "ole" indicates the PPI classification to direct you to the correct option. Review: rabeprazole (Aciphex).

231. Which finding indicates the presence of systemic toxicity from topical salicylic acid? 1. Tinnitus 2. Vomiting 3. Constipation 4. Decreased respirations

Answer: 1 Rationale: Salicylic acid is readily absorbed through the skin, and systemic toxicity (salicylism) can result. Symp- toms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Vomiting and constipation are not associated with salicylism. Test-Taking Strategy: Focus on the subject, toxicity. Remember that tinnitus indicates toxicity from salicylic acid. Review: salicylic acid.

242. The health care provider has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse tells the client to take measures to prevent which frequent side effect of this medication? 1. Constipation 2. Increased salivation 3. Abdominal discomfort 4. Difficulty swallowing

Answer: 1 Rationale: A frequent side effect of codeine sulfate is constipation. Additional side effects include drowsiness, nausea, and vomiting. Options 2, 3, and 4 are unrelated to the administration of this medication. Test-Taking Strategy: Focus on the subject, a frequent side effect. Recalling that this medication is an opioid analgesic will direct you to the correct option. Remember that codeine sulfate can cause constipation. Review: side effects of opioid analgesics.

272. A client who is receiving an antipsychotic medication complains that he feels very faint when trying to get out of bed in the morning. The nurse recognizes this complaint as a symptom of which side effect? 1. Postural hypotension 2. Cardiac dysrhythmias 3. Respiratory insufficiency 4. Psychosomatic symptoms

Answer: 1 Rationale: An antipsychotic can cause postural hypotension. The client needs to be taught to get out of bed slowly and to rise from a sitting position slowly because of this medication-related side effect. Options 2, 3, and 4 are not related to this medication. Test-Taking Strategy: Focus on the subject, a side effect of antipsychotic medications. Note the words "feels very faint." This should direct you to the correct option. Review: side effects of antipsychotic medications.

246. Vasopressin (Pitressin) is prescribed for a client who has developed diabetes insipidus as a complication of cranial surgery. The diet's history reveals that the client has chronic bronchitis and has undergone bypass grafting of three coronary arteries. The nurse should monitor this client carefully for which adverse effect related to use of this medication? 1. Chest pain 2. Depression 3. Joint stiffness 4. Nagging cough

Answer: 1 Rationale: Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if administered to clients with coronary artery disease. In addition, vasopressin may cause gangrene by decreasing blood flow in the periphery. The other options are incorrect. Test-Taking Strategy: Focus on the subject, adverse effects of this medication. The name "vasopressin" implies an effect on blood vessels. Correlate this name with an option that represents a cardiovascular problem. Review: vasopressin.

302. The nurse is assigned to care for a client with lymphoma who is receiving bleomycin sulfate. Which intervention would be the priority for this client? 1. Checking lung sounds 2. Monitoring urine output 3. Monitoring for weight gain 4. Checking for peripheral edema

Answer: 1 Rationale: Bleomycin sulfate is an antitumor antibiotic chemotherapeutic agent. The priority concern for the client receiving bleomycin sulfate is pulmonary toxicity. Therefore, the priority intervention is to check the client's lung sounds and monitor for adventitious sounds, such as crackles. Although monitoring urine output, monitoring for weight gain, and checking for peripheral edema are also important interventions, checking lung sounds is the priority. Test-Taking Strategy: Note the strategic word "priority." Use the ABCs--airway, breathing, and circulation--to direct you to the correct option. Review: bleomycin.

293. Dapsone (Avlosulfon) is prescribed for the treatment of toxoplasmosis in a client with acquired immunodeficiency syndrome. The nurse reinforces medication instructions and tells the client to perform which action? 1. Report a sore throat to the health care provider (HCP) 2. Discontinue the medication if nausea develops 3. Take the medication every 4 hours around the clock 4. Expect that abdominal pain and jaundice will occur as a normal side effect

Answer: 1 Rationale: Dapsone may be prescribed to treat toxoplasmosis. The medication is taken orally on a daily basis. The medication suppresses bone marrow activity, and the complete blood count is monitored closely. If the client develops fever, sore throat, purpura, or jaundice, the HCP is notified. Medications are available to treat nausea and vomiting; the client should not discontinue the medication if these symptoms occur, but should contact the HCP This medication is administered once daily. Test-Taking Strategy: Focus on the subject, appropriate medication instructions. Eliminate option 2 first, because the nurse would not tell the client to discontinue the medication. Next, eliminate options 3 and 4, knowing that the medication is administered on a daily basis and that jaundice needs to be reported to the HCP. Review: client teaching for antiviral agents.

290. The nurse is reinforcing discharge instructions to a client who has been prescribed desipramine (Norpramin). Which statement, if made by the client, indicates a need for further instruction? 1. "I should limit my alcohol intake while taking this medication." 2. "Sedation is expected in early therapy and will go away with time." 3. "I should not expose myself to sunlight while taking this medication." 4. "If I develop a cold, I will notify my health care provider before buying any remedies."

Answer: 1 Rationale: Desipramine is classified as a tricyclic antidepressant. The client taking this medication should be instructed to avoid alcohol entirely because adverse medication interactions can occur. The client should also be informed that sedation is expected in early therapy and will subside with time; therefore, operation of motor vehicles or machinery should be avoided until this effect has been determined. The client should also avoid sunlight because of photosensitivity. If the client develops a cold, he or she should notify the health care provider before purchasing any over-the-counter medications because of the risk of interaction. Test-Taking Strategy: Note the strategic words "need for further instruction." These words indicate a negative event query and the need to select the incorrect client statement as the answer. Recall that alcohol intake is not advisable for the client taking tricyclic antidepressants or other medications. Review: desipramine.

260. A client is receiving a phenothiazine antipsychotic medication on a daily basis. The nurse should reinforce teaching the client to implement which measure to minimize common side effects of this medication? 1. Rinse the mouth with water frequently 2. Monitor the temperature on a daily basis 3. Eat snacks at midmorning and at bedtime 4. Check the blood pressure once a week

Answer: 1 Rationale: Dry mouth is a common side effect of phenothiazine antipsychotics. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate it. Mild leukopenia may occur, but the temperature does not need to be taken daily. Weight gain is a common side effect, and frequent snacks will worsen the problem. Hypotension and hypertension are rare side effects. Test-Taking Strategy: Note the subject, side effects of phenothiazine antipsychotics. Eliminate options 2 and 4 because they are assessments rather than interventions; as such, they cannot minimize a side effect. From the remaining options, it is necessary to recall that dry mouth is a side effect. Review: client teaching for phenothiazine antipsychotics.

319. A hospitalized client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure (BP) and administers nitroglycerin 0.04 mg sublingually. Five minutes later, the client is still experiencing chest pain. If the BP is still stable, the nurse should take which action next? 1. Administer another nitroglycerin tablet 2. Apply 10 L of oxygen via nasal cannula 3. Call for a 12-lead electrocardiogram (ECG) to be performed 4. Wait an additional 5 minutes, and then give a second nitroglycerin tablet

Answer: 1 Rationale: For the hospitalized client, nitroglycerin tablets are usually prescribed one every 5 minutes as needed for chest pain up to a total dose of three tablets. The nurse should administer the second tablet. The client with known angina pectoris should have low-flow oxygen at a rate of 1 to 3 L/min via nasal cannula. A 12-lead ECG would be done if prescribed by standing protocol or by individual health care provider prescription. • Test-Taking Strategy: Note the strategic word "next. Options 2 and 4 are not part of standard practice and should be eliminated first. From the remaining options, noting that the BP is stable will direct you to the correct option. Review: nitroglycerin.

294. The nurse is reviewing the laboratory results for a client who is receiving tacrolimus (Prograf). Which finding indicates to the nurse that the client is experiencing an adverse effect of the medication? 1. Blood glucose 200 mg/dL 2. Potassium level 3.8 mEq/L 3. Platelet count 300,000 cells/mm? 4. White blood cell count 6000 cells/mm3

Answer: 1 Rationale: Hyperglycemia is an adverse effect associated with this medication. Nephrotoxicity is also a concern. Other common reactions include neurotoxicity evidenced by headache, tremor, and insomnia and gastrointestinal effects such as diarrhea, nausea and vomiting, hypertension, and hyperkalemia. Test-Taking Strategy: Note that options 2, 3, and 4 are comparable or alike and represent normal values. Option 1 is the only abnormal value, reflecting an elevation. Review: tacrollimus.

295. Ketoconazole is prescribed for an assigned client. How should the nurse administer the medication? 1. With food 2. With an antacid 3. With 8 ounces of water 4. On an empty stomach

Answer: 1 Rationale: Ketoconazole should be administered with food to minimize gastrointestinal irritation. Options 2, 3, and 4 are incorrect. The medication requires acidity for absorption and effectiveness and should be administered at least 2 hours apart from an antacid. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike. Recalling that most medications are not administered with antacids will assist in eliminating option 2. Review: ketoconazole.

275. The nurse provides medication instructions to a client who is taking lisinopril (Prinivil). Which statement by the client indicates that further teaching is necessary? 1. "I can skip a dose once a week." 2. "I need to change my position slowly." 3. "I take the pill after breakfast each day. 4. "If I get a bad headache, I should call my doctor immediately.

Answer: 1 Rationale: Lisinopril is an antihypertensive that belongs to the angiotensin-converting enzyme inhibitor class. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. The client should not stop taking the medication. The client should notify the health care provider if adverse effects occur. Test-Taking Strategy: Note the strategic words "further teaching is necessary. These words indicate a negative event query and the need to select the incorrect statement. Basic principles related to the administration of prescribed medications will direct you to the correct option. Review: client teaching for angiotensin-converting enzyme inhibitors.

265. The client who is currently taking levothyroxine sodium (Synthroid) complains of cold intolerance, constipation, dry skin, weight gain, and puffy eyes. On the basis of these findings, the nurse anticipates which prescription? 1. Increase levothyroxine sodium dosage after checking the T4 level 2. Decrease levothyroxine sodium dosage after checking the T4 level 3. Discontinue levothyroxine sodium because the client is having an adverse reaction 4. No change in medication because these are common side effects that will diminish with time

Answer: 1 Rationale: Manifestations of hypothyroidism include cold intolerance; constipation; loss of initiative; thick, dry skin; weight gain; a notably puffy appearance of the skin around the eyes; slowed intellectual function, including slowed speech and apathy; and low metabolic rate. The current dosage of levothyroxine sodium is not therapeutic and needs to be increased. Test-Taking Strategy: Focus on the subject, the manifestations of hypothyroidism, and note that the signs presented in the question relate to these manifestations. This will direct you to the correct option. Review: levothyroxine sodium.

240. Metoprolol succinate (Lopressor) has been prescribed for a client for the treatment of tachydysrhythmias. The nurse ensures that which baseline data are collected before administration of this medication? 1. Intake and output 2. Hematologic studies 3. Hepatic function studies 4. Basic metabolic panel results

Answer: 1 Rationale: Metoprolol succinate is classified as a beta blocker and helps to correct certain cardiac dysrhythmias, such as sinus tachycardia. Baseline assessments that should be completed include intake and output; skin turgor and mucous membranes to assess hydration status; blood pressure, pulse, and temperature; bowel sounds for peristalsis; bladder palpation for urinary retention; and bowel movements for stool type and consistency. This medication can be given without waiting for laboratory results; therefore, options 2, 3, and 4 are incorrect. Test-Taking Strategy: Focus on the subject, data collection associated with this medication. Note that options 2, 3, and 4 are comparable or alike and are all laboratory assessments. Therefore, eliminate these options. Review: metoprolol succinate.

238. The nurse caring for the client who has been prescribed tamoxifen (Nolvadex) for off-label use understands that which condition may be present? 1. Gynecomastia 2. Breast cancer 3. Uterine cancer 4. Ductal carcinoma

Answer: 1 Rationale: Of-label uses of tamoxifen include melanoma, induction of ovulation, gynecomastia, pancreatic tumors, and precocious puberty in females. Breast cancer, uterine cancer, and ductal carcinoma are therapeutic (not off-label) uses. Test-Taking Strategy: Focus on the subject, an off-label use of the medication. Noting that options 2 and 4 are comparable or alike in that they are both forms of breast cancer will assist in eliminating these options. From the remaining options, recall that this medication is indicated for uterine cancer to assist in eliminating this option. Review: tamoxifen.

329. The nurse has a prescription to administer a dose of iron by the intramuscular route to an assigned client. Which action should the nurse take to decrease tissue irritation from the injection? 1. Use the Z-track method 2. Push any air out of the syringe after drawing up the medication 3. Massage the injection site well after injection to hasten absorption 4. Wipe off the needle with alcohol after drawing up the medication and before injection

Answer: 1 Rationale: Parenteral iron may be given by the intramuscular route. Using the Z-track technique decreases pain and tracking of the medication during needle withdrawal. An air lock and Z-track technique should both be used. The site should not be massaged after injection because massaging could cause staining of the skin. Proper technique includes changing the needle after drawing up the medication and before giving it to prevent staining of skin. Test-Taking Strategy: Focus on the subject, "decreasing the pain of the injection." This tells you that the correct answer relates to injection technique that reduces pain and will direct you to the correct option. Review: intramuscular administration of iron.

281. A preoperative client has health care provider prescriptions that state the client must be NPO after midnight. In reviewing the client's medications, the nurse should question the prescription to withhold which medication and determine whether it should be-administered parenterally? 1. Prednisone 2. Desyrel (Trazodone) 3. Sucralfate (Carafate) 4. Cyclobenzaprine (Flexeril)

Answer: 1 Rationale: Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the body's ability to withstand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery, dosages may be temporarily increased and should not be withheld. An alternate route should be considered if possible. Sucralfate is used to treat gastric ulcers and is administered before meals. Desyrel is an antidepressant. Cyclobenzaprine is a skeletal muscle relaxant. These medications can be safely withheld before surgery. Test-Taking Strategy: Focus on the subject, the medication that should be administered before surgery. Remember that when stress is severe, such as from surgery, corticosteroids are essential to life. Review: corticosteroids.

249. The nurse administered a dose of prochlorperazine to a client by the intramuscular route at 09:00 hours. The nurse is monitoring for therapeutic effects of this medication, which should occur during which time period? 1. 09:10 to 09:20 hours 2. 10:00 to 10:30 hours 3. 11:00 to 11:15 hours 4. 12:00 to 12:30 hours

Answer: 1 Rationale: Prochlorperazine, an antipsychotic, administered by the intramuscular route has an onset time of 10 to 20 minutes; therefore, if the medication was given at 09:00 hours, its onset would begin at 09:10 to 09:20 hours. The duration of this medication is 3 to 4 hours. Options 2, 3, and 4 are incorrect. Test-Taking Strategy: Note the subject, onset of this medication. Note that the medication is being administered by the intramuscular route in order to direct you to the correct option. Review: prochlorperazine.

250. The nurse is caring for a client who reports taking St. John's wort for the treatment of depression. The nurse determines that a potential medication interaction can occur if the client is also taking which medication? 1. Lisinopril (Zestril) 2. Sucralfate (Carafate) 3. Memantine (Namenda) 4. Spironolactone (Aldactone)

Answer: 1 Rationale: St. John's wort is an herbal substance that is used to relieve depression. This herbal substance can cause interactions with certain medications, including angiotensin-converting enzyme (ACE) inhibitors. Other medications that can result in interaction if taken concurrently with St. John's wort include indinavir, digoxin, other antidepressants, and cyclosporine. The medications in options 2, 3, and 4 are not known to cause an interaction with this herbal substance. Test-Taking Strategy: Note the subject, a medication interaction with St. John's wort. Recall that the suffix "pril" indicates that the medication belongs to the ACE inhibitor class. Also, recall that if taken concurrently with ACE inhibitors, this herbal substance can result in hypertension. Review: St. John's wort.

262. Tacrolimus (Prograf) is prescribed for a client. Which disorder, if noted in the client's record, indicates that the medication needs to be administered with caution? 1. Pancreatitis 2. Ulcerative colitis 3. Diabetes insipidus 4. Coronary artery disease

Answer: 1 Rationale: Tacrolimus is used with caution in immunosuppressed clients and in clients with renal, hepatic, or pancreatic function impairment. It is contraindicated in clients with hypersensitivity to this medication or hypersensitivity to cyclosporine. It is not contraindicated in ulcerative colitis, diabetes insipidus, or coronary artery disease. Test-Taking Strategy: Focus on the subject, disorders indicating that this medication should be administered with caution. Many medications affect renal, hepatic, and pancreatic function. If you had to select an option and were unsure, select the option that addresses these body systems. Review: tacrolimus.

278. A daily dose of prednisone has been prescribed for a client, and the nurse is reinforcing client teaching about the medication. Which statements by the client indicate that further teaching is necessary? (Select all that apply.) 1. "I can take aspirin or my antihistamine if I need it." 2. "Muscle weakness is expected and is not a concern." 3. "I need to avoid caffeinated food and fluids in my diet." 4. "I need to take the medication every day at the same time. 5. "If I gain more than 5 pounds in 1 week, I'll call my doctor.

Answer: 1, 2 Rationale: Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider. Muscle weakness could be a sign of hypokalemia, an adverse effect of the medication, and needs to be reported. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 pounds or more weekly should be reported to the health care provider because this indicates fluid retention. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid ulcer development. The client needs to take the medication at the same time every day and should be instructed not to stop it. Test-Taking Strategy: Note the strategic words "further teaching is necessary." This indicates a negative event query and the need to select the incorrect statements. Use general medication guidelines and knowledge of the side effects and adverse effects of the medication to answer correctly. Review: teaching points for prednisone.

328. The health care provider prescribes etanercept (Enbrel) for a client with rheumatoid arthritis. Which findings indicate to the nurse that the client is experiencing an injection site reaction to the medication? (Select all that apply.) 1. Pain 2. Itching 3. Swelling 4. Erythema 5. Papular diffuse rash 6. Sensory impairment distal to site

Answer: 1, 2, 3, 4 Rationale: Injection site reactions include pain, itching, swelling, and erythema. Other mild but less common reactions include headache, rhinitis, cough, and abdominal pain. A papular rash or sensory impairment distal to the site are not indications of an injection site reaction. Test-Taking Strategy: Focus on the subject, an injection site reaction. Eliminate options 5 and 6 because they are systemic rather than local manifestations. Review: etanercept.

253. The nurse is caring for a client who has been prescribed albuterol (Proventil HFA). The nurse understands that this medication is used with caution in which conditions? (Select all that apply.) 1. Hypertension 2. Hyperthyroidism 3. Diabetes mellitus 4. Rheumatoid arthritis 5. Cardiovascular disease 6. Chronic obstructive pulmonary disease

Answer: 1, 2, 3, 5 Rationale: Albuterol is classified as a beta-adrenergic agonist. This medication should be used with caution in certain conditions, including hypertension, hyperthyroidism, diabetes mellitus, and cardiovascular disease. It can be used safely with rheumatoid arthritis. Chronic obstructive pulmonary disease is an indication for the use of this medication. Test-Taking Strategy: Note the subject, conditions warranting caution for albuterol. Recall the action of this medication and that this medication is indicated in chronic obstructive pulmonary disease. In addition, note that rheumatoid arthritis is a musculoskeletal disorder and is not affected by this medication. Review: albuterol.

236. A client has begun therapy with theophylline (Theo-24). The nurse plans to teach the client to limit the intake of which items while taking this medication? (Select all that apply.) 1. Tea 2. Cola 3. Milk 4. Chocolate 5. Orange juice

Answer: 1, 2, 4 Rationale: Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include tea, coffee, cola, and chocolate. Test-Taking Strategy: Recall that theophylline is a methylxanthine bronchodilator and the foods that are naturally high in xanthines. Note that the correct options are comparable or alike and contain caffeine. Review: teaching points for methylxanthine bronchodilators.

280. Cytarabine (Cytosar-U) has been prescribed for a client with acute lymphocytic leukemia. The nurse understands that this medication can cause which adverse effects? (Select all that apply.) 1. Alopecia 2. Stomatitis 3. Ototoxicity 4. Hyperuricemia 5. Hepatotoxicity 6. Nephrotoxicity

Answer: 1, 2, 4, 5 Rationale: Effects of cytarabine include alopecia, stomatitis, hyperuricemia, and hepatotoxicity. Ototoxicity and nephrotoxicity are not specifically associated with this medication. Test-Taking Strategy: Note the subject, adverse effects of cytarabine. It is necessary to be familiar with the effects this medication can cause in order to answer this question correctly. Review: cytarabine.

322. The nurse is caring for a client who has been prescribed sucralfate (Carafate). The nurse checks the client's medication history because the absorption of which medications can be affected if taken concurrently? (Select all that apply.) 1. Theophylline 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin) 5. Warfarin sodium (Coumadin)

Answer: 1, 2, 4, 5 Rationale: Sucralfate can affect absorption of theophylline, digoxin, phenytoin, warfarin sodium, thyroid medications, and certain antibiotics. Absorption of furosemide is not affected by this medication. Test-Taking Strategy: Note the subject, medication interactions. Think about the action and use of sucralfate to assist in answering correctly. Recalling that furosemide is not affected by this medication will assist you in eliminating this option. Review: sucralfate.

300. The nurse is caring for a client who has been prescribed cisplatin. The nurse monitors the client for adverse effects of this medication, understanding that which findings may indicate an adverse effect? (Select all that apply.) 1. Ringing in the ears 2. Visual disturbances 3. Cardiac disturbances 4. Abnormal renal function studies 5. Abnormal hepatic function studies

Answer: 1, 3, 4 Rationale: Adverse effects associated with cisplatin include ototoxicity (as evidenced by tinnitus, or ringing in the ears); hypokalemia, hypocalcemia, and hypomagnesemia (which could result in cardiac disturbances); and nephrotoxicity (which could result in abnormal renal function study results). Visual disturbances and abnormal hepatic function studies are not specifically associated with this medication. Test-Taking Strategy: Note the subject of the question, assessment findings indicative of adverse effects of this medication. Recalling that ototoxicity and nephrotoxicity can occur will direct you to options 1 and 4. From the remaining options, recall that this medication can cause electrolyte disturbances resulting in cardiac disturbances. Review: cisplatin.

303. The nurse is caring for a client who has been prescribed silver sulfadiazine (Silvadene) for the treatment of burn injuries. Which baseline studies should be completed before initiation of medication therapy? (Select all that apply.) 1. Urinalysis 2. Lipid panel 3. Renal function studies 4. Hepatic function studies 5. Complete blood count (CBC)

Answer: 1, 3, 4, 5 Rationale: Baseline studies that should be completed before the initiation of therapy with silver sulfadiazine include urinalysis, renal function studies, hepatic function studies, and CBC. Electrolytes are also checked. A lipid panel is not usually obtained with this medication. Test-Taking Strategy: Note the subject, baseline studies for silver sulfadiazine. Recall that these studies include urinalysis, renal function studies, hepatic function studies, and CBC due to the potential effects this medication can have on these body systems. Review: silver sulfadiazine.

233. The nurse determines that learning about levodopa/carbidopa (Sinemet) is evident if the client makes which statements? (Select all that apply.) 1. "I'll change my position slowly." 2. "If I miss a dose, I should double the next dose." 3. "I'll increase the amount of chicken and fish in my diet." 4. "I need to always take the medication on an empty stomach." 5. "My urine and sweat may darken, but I shouldn't be alarmed." 6. "Hard candy or gum may help lessen the side effect of dry mouth.

Answer: 1, 5, 6 Rationale: Levodopa/carbidopa is used in the management of symptoms of Parkinson's disease. Side effects include orthostatic hypotension, darkening of body fluids, gastrointestinal symptoms, and dry mouth. The client should be in- structed to change positions slowly. The client should never take a double dose to make up for a missed dose, but missed doses can be taken as soon as remembered up to 2 hours before the next dose. Dietary protein should be limited because it impairs medication absorption. Because the medication can cause gastrointestinal side effects, it should be taken with or after meals. Test-Taking Strategy: Use of general medication administration guidelines and knowledge about this medication will assist in answering this question. Eliminate option 4 because of the closed-ended word "always". Review: client teaching for antiparkinsonian medications.

241. A client is scheduled to receive chemotherapy with asparaginase (Elspar). The nurse anticipates that this medication will be discontinued from the regimen after noting which disorder in the client's medical record? 1. Heart failure 2. Hypersensitivity 3. Hypothyroidism 4. Chronic airflow limitation

Answer: 2 Rationale: Asparaginase is contraindicated if the client has shown hypersensitivity or has pancreatitis or a history of the same. Because this medication impairs pancreatic function, tests to monitor pancreatic function should be performed before initiating therapy and when 1 week or more has elapsed between doses. The client is also monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. Options 1, 3, and 4 are not contraindications for the use of this medication. Test-Taking Strategy: Focus on the subject, a contraindication. Remember that asparaginase is contraindicated in hypersensitivity and pancreatitis. Review: asparaginase.

310. The nurse is caring for a client who has been prescribed bupropion (Wellbutrin) for the treatment of depression. The nurse most appropriately reinforces instructions to the client to take this medication at which time? 1. At lunchtime 2. Early in the day 3. Before bedtime 4. Any time, at the same time each day

Answer: 2 Rationale: Bupropion is classified as an antidepressant. The nurse should instruct the client to take this medication early in the day in order to prevent interference with sleep. Options 1, 3, and 4 are incorrect instructions. Test-Taking Strategy: Note the strategic words "most appropriately. Recalling that antidepressant medications are typically given early in the day to promote energy during the day (thereby preventing sleep interference) will direct you to the cor- rect option. Review: bupropion.

239. A client with allergic dermatitis has been given a prescription for a tube of diphenhydramine (Benadryl) to use as a topical agent. The nurse evaluates on a follow-up visit that the medication was effective if which effect was noted? 1. Nighttime sedation 2. Decrease in urticaria 3. Absence of ecchymoses 4. Healing of irritated skin

Answer: 2 Rationale: Diphenhydramine reduces the symptoms of allergic reaction, such as itching or urticaria, when used as a topical agent on the skin. The medication also has many other uses, such as to provide mild nighttime sedation when given in the oral form. It is not used to heal irritated skin or ecchymoses. Test-Taking Strategy: Note the strategic word "effective" and the client's diagnosis, "allergic dermatitis." This tells you that the correct option is one that indicates relief of an allergic skin condition, which will direct you to the correct option. Review: uses of antihistamines.

327. The nurse is reinforcing medication information to a client who is beginning therapy with enalapril (Vasotec). The nurse tells the dient that which finding is an anticipated although unpleasant side effect of this medication? 1. Rapid pulse 2. Persistent cough 3. Metal taste in the mouth 4. Increased blood pressure

Answer: 2 Rationale: Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. Side effects of ACE inhibitors are persistent cough, first-dose hypotension, and hyperkalemia. Options 1, 3, and 4 are not side effects of this medication. Test-Taking Strategy: Note the subject, a side effect of an ACE inhibitor. Eliminate options 1 and 4 first because of the word "'unpleasant" in the question. Remember that ACE inhibitors cause a persistent cough. Review: angiotensin-converting enzyme (ACE) inhibitors.

270. The nurse is caring for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet (Foscavir). The nurse reviews the laboratory test results and determines the presence of an adverse effect if which finding is noted? 1. Serum albumin 3.5 g/dL 2. Serum creatinine 2.0 mg/dL 3. CD4 cell count 1000 cells/L 4. Lymphocyte count 2000 cells/mm3

Answer: 2 Rationale: Foscarnet is very toxic to the kidneys. Serum creatinine is monitored before therapy, two to three times per week during induction therapy, and at least weekly during maintenance therapy. It also may cause decreased levels of calcium, magnesium, phosphorus, and potassium in the bloodstream. Thus these levels also are measured with the same frequency. Options 1, 3, and 4 are not associated with adverse effects of this medication. Test-Taking Strategy: Focus on the subject, an adverse effect. Recalling that foscarnet is nephrotoxic will direct you to the correct option. Review: foscarnet.

309. The nurse is caring for a client with multiple sclerosis who is receiving an intravenous (IV) dose of methocarbamol (Robaxin). While caring for this client, the nurse should carefully monitor for which finding? 1. Palpitations 2. Bradycardia 3. Tachycardia 4. Hypertension

Answer: 2 Rationale: IV administration of methocarbamol, a muscle relaxant, can cause hypotension and bradycardia. The nurse needs to monitor carefully for these effects by taking vital signs every 15 minutes during the infusion. The medication also should be given via a controlled infusion device. Options 1, 3, and 4 are not associated with this medication. Test-Taking Strategy: Eliminate options 1 and 3 first, because they are comparable or alike. From the remaining options, think about the action of the medication to direct you to the correct option. Review: methocarbamol.

245. The nurse is caring for a client who is taking imipramine (Tofranil). Which condition, if noted in the client's medical record, should the nurse consider the priority? 1. History of anxiety 2. History of seizures 3. Chronic constipation 4. History of urinary retention

Answer: 2 Rationale: Imipramine is classified as a tricyclic antidepressant. This medication can lower the seizure threshold; therefore, a client with a history of seizures should be monitored closely for this adverse effect. Measures should be taken to prevent constipation because this medication can potentiate it; however, this is not the priority. The client should also be monitored for urinary retention, but this is also not the priority. A history of anxiety is not a contraindication for this medication. Test-Taking Strategy: Note the strategic word "priority." This word indicates that all options may be correct, but you must determine which is most important. Recall that this medication reduces the seizure threshold. Review: imipramine.

235. The nurse is caring for a client who has been prescribed sucralfate (Carafate). The nurse notifies the health care provider if which other medication is noted in the medical record? 1. Bumetanide 2. Digoxin (Lanoxin) 3. Cyclobenzaprine (Flexeril) 4. Spironolactone (Aldactone)

Answer: 2 Rationale: Medication interactions can occur if the client is taking sucralfate (Carafate) concurrently with digoxin (Lanoxin), phenytoin (Dilantin), theophylline, warfarin sodium (Coumadin), and certain antibiotics. Medication interactions do not occur with the medications noted in options 1, 3, or 4. Test-Taking Strategy: Note the subject, a medication interaction. Note that options 1 and 4 are comparable or alike in that they are both diuretics; therefore, these options can be eliminated. From the remaining options, it is necessary to know which medications can result in an interaction. Review: sucralfate.

237. A client who is human immunodeficiency virus (HIV) seropositive has been taking stavudine (Zerit). The nurse should monitor which item closely while the client is taking this medication? 1. Appetite 2. Presence of paresthesias 3. Gastrointestinal function 4. Level of consciousness

Answer: 2 Rationale: Stavudine is an antiretroviral (protease inhibitor) used in the management of HIV infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy; the nurse should closely monitor the client's gait and ask the client about paresthesia. Options 1, 3, and 4 are not directly associated with the use of this medication. Test-Taking Strategy: Focus on the subject, side effects of this medication. Knowledge regarding the specific side effects of this medication is needed to answer this question. Remember that stavudine causes peripheral neuropathy. Review: stavudine.

247. A client with metastatic breast cancer is receiving tamoxifen (Nolvadex). The nurse should specifically monitor which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

Answer: 2 Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone or flank pain. Test-Taking Strategy: Focus on the subject, an indication of an adverse effect of tamoxifen, and the name of the medication. It is necessary to know the adverse effects of this medication to answer correctly. Remember that this medication causes hypercalcemia. Review: tamoxifen.

256. The nurse is caring for a client who is taking acetylsalicylic acid (aspirin, ASA). The nurse determines that the client is experiencing metabolic effects of this medication if which findings are noted? (Select all that apply.) 1. Oliguria 2. Diaphoresis 3. Dehydration 4. Hyponatremia 5. Bleeding tendencies

Answer: 2, 3, 4 Rationale: Metabolic effects of this medication include fever, diaphoresis, dehydration, hyponatremia, hypokalemia, hypoglycemia, and metabolic acidosis. Oliguria is a renal effect of this medication, and bleeding tendencies are a hematologic effect. Test-Taking Strategy: Focus on the subject, effects of acetylsalicylic acid. Note the words "metabolic effects." Recognizing that oliguria is a renal effect and bleeding tendencies are a hematologic effect will assist you in eliminating these options. Review: metabolic effects of acetylsalicylic acid on the body.

289. The nurse caring for a client taking somatropin (Humatrope) prepares to monitor which laboratory studies specifically related to this medication? (Select all that apply.) 1. Potassium level 2. Blood glucose level 3. Liver function studies 4. Thyroid function tests 5. Renal function studies

Answer: 2, 3, 4 Rationale: Somatropin is a pituitary medication and is classified as a growth hormone. Laboratory studies that should be monitored while taking this medication include the blood glucose level, liver function studies, and thyroid function tests. The potassium level and renal function studies are not specifically related to this medication. Test-Taking Strategy: Note the subject of the question, laboratory studies specifically related to this medication. Noting the action of this medication and recalling that hyperglycemia and liver and thyroid function impairment can occur will assist in directing you to the correct option. Review: somatropin.

274. The nurse monitors a client with a history of opioid abuse for which signs and symptoms associated with opioid withdrawal? (Select all that apply.) 1. Lethargy 2. Diaphoresis 3. Tachycardia 4. Hypertension 5. Frequent sneezing 6. Abdominal cramps

Answer: 2, 3, 4, 5, 6 Rationale: The client who is experiencing opioid withdrawal may experience diaphoresis, increased heart rate, increased blood pressure, sneezing, abdominal cramping, dysphoric mood, nausea, vomiting, diarrhea, muscle aches, piloerection, runny eyes (lacrimation) and nose (rhinorrhea), yawning, fever, and insomnia. Test-Taking Strategy: Think about the subject, the effects of opioids on the body. This will assist you in determining the manifestations that the client would exhibit in withdrawal. Review: opioid withdrawal.

258. The nurse is administering enoxaparin (Lovenox) subcutaneously to a client. The nurse is monitoring for adverse effects related to this medication and understands that an adverse effect may be occurring if which finding is noted? 1. Diarrhea 2. Insomnia 3. Thrombocytopenia 4. Erythema at the injection site

Answer: 3 Rationale: Adverse effects related to the use of enoxaparin include bacterial pneumonia, hypersensitivity, thrombocytopenia, neutropenia, and renal insufficiency or failure. Diarrhea, insomnia, and erythema at the injection site are side effects related to this medication. Test-Taking Strategy: Note the subject, monitoring for an adverse reaction. Recalling the action of this medication (anticoagulant) will assist in directing you to the correct option. Review: enoxaparin.

323. The nurse is reinforcing instructions to the client who has been prescribed bupropion (Wellbutrin). The nurse determines that the client needs further instruction if which is stated? 1. "This medication should not be stopped abruptly. 2. "I should change my position slowly while taking this medication." 3. "I know that a common and harmless side effect is a painful erection that lasts a long time." 4. "I should avoid taking over-the-counter medications without first consulting my health care provider.

Answer: 3 Rationale: Bupropion is a selective serotonin reuptake inhibitor and acts by eliciting an antidepressant response. In providing discharge instructions, the nurse should inform the client that if priapism (prolonged, painful erection) occurs, the medication should be withheld and the health care provider notified. This medication should not be discontinued abruptly because of the risk of serotonin syndrome. The client should be instructed to change positions slowly because of the hypotensive effect associated with this medication. Over-the-counter medication increases the likelihood of serotonin syndrome and should be avoided while taking this medication. Test-Taking Strategy: Note the strategic words "needs further instruction." These words indicate a negative event query and the need to select the incorrect client statement as the answer. Recall that priapism (prolonged, painful erection) is a medical emergency. Review: bupropion.

297. A health care provider has prescribed calcipotriene (Dovonex) for a client with psoriasis. The nurse should reinforce which teaching point to the client about this medication? 1. Systemic toxicity may occur 2. Thinning of the skin may occur 3. Improvement may take 1 to 2 months 4. The medication has an unpleasant odor

Answer: 3 Rationale: Improvement in the client's condition may take 1 to 2 months. Systemic toxicity does not occur at normal doses. Thinning of the skin does not occur. The medication does not have an odor. Test-Taking Strategy: Focus on the subject, medication instructions, and the client's diagnosis. Recalling that medications used to treat chronic conditions take time to work will direct you to the correct option. Review: medications used to treat psoriasis.

286. The nurse is preparing to administer pentamidine isethionate (Pentam 300) to an assigned client. The nurse plans to monitor which client parameter closely after administering this medication? 1. Capillary refill 2. Peripheral pulses 3. Blood pressure (BP) 4. Level of consciousness

Answer: 3 Rationale: Life-threatening and fatal hypotension can occur following the administration of this medication. The client must be in a supine position with frequent BP checks following administration. Options 1, 2, and 4 are not associated with the administration of this medication. Test-Taking Strategy: Focus on the subject, adverse effects associated with this medication. It is necessary to know that hypotension is an adverse effect of this medication. Review: pentamidine isethionate (Pentam 300).

232. The nurse is caring for a client who is receiving antibiotics and has been experiencing bouts of diarrhea. The health care provider has prescribed loperamide (Imodium). Which condition, if noted in the client's medical record, warrants notification of the health care provider before administering the medication? 1. Stomatitis 2. Crohn's disease 3. Acute ulcerative colitis 4. Gastroesophageal reflux disease

Answer: 3 Rationale: Loperamide is classified as an antidiarrheal. Use of this medication is contraindicated in acute ulcerative colitis and diarrhea caused by pseudomembranous enterocolitis due to broad-spectrum antibiotics. Options 1, 2, and 4 are not contraindications to the use of this medication. Test-Taking Strategy: Note the subject, contraindications associated with loperamide. Note the word "acute" to assist in directing you to this option. Review: loperamide.

283. Megestrol acetate (Megace) is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the health care provider if which condition is documented in the client's history? 1. Gout 2. Asthma 3. Thrombophlebitis 4. Myocardial infarction

Answer: 3 Rationale: Megestrol acetate suppresses the release of luteinizing hormone from the anterior pituitary gland by inhibiting pituitary function and reducing tumor size. It is used with caution if the client has a history of thrombophlebitis. Test-Taking Strategy: Note the subject, cautions associated with the use of megestrol acetate. Recalling that megestrol acetate is a hormonal antagonist enzyme and that an adverse effect is thrombolytic disorders will direct you to the correct option. Review: megestrol acetate.

259. The nurse is caring for a client who has been prescribed salmeterol (Serevent Diskus) and is monitoring the client for adverse effects of this medication. Which finding would indicate potential development of an adverse effect? 1. Dry mouth 2. Sleepiness 3. Tachycardia 4. Significant rise in blood pressure

Answer: 3 Rationale: Signs of adverse effects associated with this medication include diaphoresis, tachycardia, a slight increase in blood pressure followed by a substantial decrease, chills, restlessness, palpitations, and chest pain. Dry mouth is a side effect associated with this medication. Test-Taking Strategy: Note the subject, adverse effects associated with this medication. Recalling that restlessness (not sleepiness) and a significant decrease (not increase) in blood pressure are indicative of an adverse effect will assist you in eliminating options 2 and 4. From the remaining options, recall that dry mouth is a side effect to direct you to the correct option. Review: salmeterol.

285. Somatropin (Humatrope) is administered to a client with pituitary dwarfism. The nurse monitors the client, knowing that the expected therapeutic effect of this medication is which result? 1. Promotes weight gain 2. Increases bone density 3. Stimulates linear growth 4. Decreases the mobilization of fats

Answer: 3 Rationale: Somatropin is a growth stimulator used in the long-term treatment of growth failure resulting from endogenous growth hormone deficiency. It stimulates linear growth and increases the number and size of muscle cells and red cell mass. It affects carbohydrate metabolism by antagonizing the action of insulin, increases mobilization of fats, and increases cellular protein synthesis. Options 1, 2, and 4 are not actions of this medication. Test-Taking Strategy: Focus on the subject, the expected therapeutic effect of somatropin. Also, focus on the client's diagnosis. Note the relationship between "dwarfism" in the question and "growth" in the correct option. Review: somatropin.

261. The nurse is caring for a client who has been prescribed tacrolimus (Prograf) to prevent organ rejection. The nurse most appropriately administers this medication by which method? 1. With meals 2. With an antacid 3. On an empty stomach 4. With a full glass of milk

Answer: 3 Rationale: Tacrolimus should be given on an empty stomach to ensure proper absorption. Options 1, 2, and 4 are incorrect administration methods. Test-Taking Strategy: Note the strategic words "most appropriately." Note that options 1, 2, and 4 are comparable or alike and indicate that the medication be given with another substance. Recall that this medication should be given on an empty stomach. Review: tacrolimus.

229. The nurse is caring for a client with metastatic breast cancer who is taking tamoxifen citrate (Nolvadex). The nurse plans to monitor for which trend in laboratory values for this client? 1. Prolonged bleeding time 2. Decreasing sodium level 3. Rising serum calcium level 4. Increasing blood glucose level

Answer: 3 Rationale: Tamoxifen citrate may increase calcium, cholesterol, and triglyceride levels. Before initiation of therapy, a complete blood count, platelet count, and serum calcium level should be obtained. These blood levels should continue to be monitored periodically during therapy. Options 1, 2, and 4 are not a concern with this medication. Test-Taking Strategy: Focus on the subject, laboratory values related to tamoxifen. Knowledge about the effects of tamoxifen citrate is required to answer this question. Remember that this medication affects the calcium level. Review: tamoxifen

301. A client has been taking hydrochlorothiazide (Microzide) for several weeks. The health care provider indicates that the client's glomerular filtration rate (GFR) is 40 mL/min. What would the nurse need to discuss with the health care provider? 1. That the client's weight has been stable 2. The need to add a second thiazide diuretic 3. That the client is on hydrochlorothiazide, which is not effective with low GFR 4. The need to change the medication to furosemide (Lasix) immediately to save the kidney

Answer: 3 Rationale: The normal GFR is 90 to 120 mL/min. Older people will have lower GFR levels because GFR decreases with age. Additionally, low levels may indicate kidney disease. Hydrochlorothiazide is a thiazide diuretic, and thiazides are not effective when there is decreased renal function. Options 1, 2, and 4 are incorrect in this situation. Test-Taking Strategy: Focus on the subject, a low GFR level. Note the relationship of the data in the question (the medication and the GFR) and the correct option. Review: hydrochlorothiazide.

234. The nurse is caring for a client who shows signs of benzodiazepine withdrawal. The nurse should ask the client about abruptly discontinuing which medication? 1. Prednisone 2. Sertraline (Zoloft) 3. Diazepam (Valium) 4. Fluoxetine (Prozac)

Answer: 3 Rationale: The only benzodiazepine presented in the options is diazepam (Valium). Short-acting benzodiazepines can produce withdrawal symptoms within 1 to 2 days, whereas the long-acting ones take 5 to 10 days for withdrawal symptoms to occur following discontinuation. Manifestations include insomnia, agitation, anxiety, irritability, nausea, and diaphoresis. The other options are a corticosteroid (option 1) and antidepressants (options 2 and 4). Test-Taking Strategy: Note the subject, a benzodiazepine. Recalling the medication classifications will direct you to the correct option. Review: benzodiazepine withdrawal.

252. A client with severe preeclampsia is receiving intravenous magnesium sulfate. The nurse is reviewing the laboratory results and determines that which magnesium level is within the therapeutic range? 1. 1 mg/dL 2. 3 mg/dL 3. 5 mg/dI 4. 10 mg/dI

Answer: 3 Rationale: The therapeutic range for magnesium sulfate is 4 to 7 mg/dL. Options 1 and 2 are low values. Option 4 is an elevated value. Test-Taking Strategy: Note the subject, therapeutic magnesium level. Knowledge about the therapeutic magnesium level for a client receiving magnesium sulfate will direct you to the correct option. Review: normal laboratory values.

279. Cyclosporine (Sandimmune) is prescribed for a client following an allogenic kidney transplant. The nurse reinforces instructions to the client regarding the medication and gives the client which information? 1. There are no known adverse effects of the medication. 2. The medication will need to be taken for a period of 6 months. 3. Blood levels of the medication will need to be measured periodically. 4. The medication is administered by the intravenous route on a monthly basis.

Answer: 3 Rationale: To avoid toxicity from high medication levels and to avoid organ rejection from low medication levels, blood levels of cyclosporine should be measured periodically. In the organ transplant client, an immunosuppressant will need to be taken for life. Oral administration is the route of choice; intravenous administration is reserved for clients who cannot take the medication orally. The most serious adverse effects are nephrotoxicity and infection. Test-Taking Strategy: Focus on the subject, client instructions, and the medication classification, and recall that this medication is an immunosuppressant. Recalling that toxicity can occur with this medication will direct you to the correct option. Review: cyclosporine.

291. The nurse is caring for a client taking vasopressin (Pitressin) for the treatment of diabetes insipidus. Which finding indicates a potential complication and warrants health care provider (HCP) notification? 1. Potassium level 4.2 mEq/L 2. Blood pressure 112/84 mm Hg 3. Respiratory rate 25 breaths/min 4. Weight gain of 0.5 pound since the previous shift

Answer: 3 Rationale: Vasopressin is classified as an antidiuretic hormone and is used in the treatment of diabetes insipidus. Potential complications associated with it include dehydration and water intoxication. Shortness of breath or an increased respiratory rate is a sign of water intoxication. A potassium level of 4.2 mEq/L is a normal finding. A blood pressure of 112/84 mm Hg is also a normal finding. A weight gain of 0.5 pound since the previous shift is insignificant. Additional signs of water intoxication include drowsiness, listlessness, and headache, and they indicate the need to increase the medication dosage. Test-Taking Strategy: Note the subject, findings related to this medication that indicate the need to notify the HCP. Use knowledge of normal findings to direct you to the correct option. Review: vasopressin.

230. A client is admitted to the emergency department with a massive pulmonary thromboembolism and is to be treated with alteplase (Activase, a tissue plasminogen activator). The nurse should report which finding to the health care provider before this therapy is initiated? 1. Adventitious breath sounds 2. Temperature of 99.4° F orally 3. Blood pressure (BP) of 198/110 mm Hg 4. Respiratory rate of 28 breaths/min

Answer: 3 Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. It is also contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore, the nurse would report the client's BP to the health care provider before initiating therapy. Options 1, 2, and 4 are not contraindications for using this medication. Test-Taking Strategy: Focus on the subject, the client's diagnosis, and the medication prescribed. Options 1, 2, and 4 may be present in the client with pulmonary thromboembolism and are not necessarily signs that warrant reporting before initiating this therapy. Review: thrombolytic medications.

273. The nurse is caring for a client who sustained a burn injury and is being treated with mafenide (Sulfamylon). The nurse determines that the client may be experiencing systemic effects associated with this medication if which problems are noted in the medical record? (Select all that apply.) 1. Local pain 2. Local rash 3. Hemolytic anemia 4. Metabolic acidosis 5. Bone marrow depression

Answer: 3, 4, 5 Rationale: Systemic effects of mafenide include hemolytic anemia, metabolic acidosis, and bone marrow depression. Local pain and rash are local reactions associated with this medication. Test-Taking Strategy: Note the subject, systemic effects of mafenide. Note the word "local" in the incorrect options to assist you in eliminating these options. Review: mafenide.

321. The client with heart disease who is taking digoxin (Lanoxin) complains of having no apperite. The nurse notes that the client also has a low serum potassium (K*) level. The nurse then checks the results of the digoxin level drawn that morning, anticipating that the result is likely to be which value? 1. 0.2 ng/mL 2. 0.4 ng/mL 3. 1.0 ng/mL 4. 2.5 ng/mL

Answer: 4 Rationale: A high digoxin level would indicate digoxin toxicity, which is compatible with the client's complaint of anorexia and the low serum K+ level (which can precipitate digoxin toxicity). The normal serum digoxin level is 0.5 to 2 ng/mL; therefore option 4 is correct. Options 1 and 2 indicate low values. Option 3 indicates a therapeutic level. After drawing this initial conclusion, the nurse's next step is to notify the health care provider for further action. Test-Taking Strategy: Focus on the subject of the question, digoxin toxicity. Recalling the relationship between digoxin toxicity and the client's clinical picture will direct you to the correct option. Review: digoxin.

325. The nurse is caring for a client with a history of heart failure who has been prescribed bumetanide. The nurse determines that an adverse effect may be occurring if which finding is noted? 1. Phosphorus level 3.0 mg/dI 2. Calcium level 9.2 mg/dL 3. Sodium level 137 mEq/L 4. Potassium level 3.2 mEq/L

Answer: 4 Rationale: Adverse effects of this medication include dehydration and electrolyte disturbances. Ototoxicity and blood dyscrasias can also occur. A potassium level of 3.2 mEq/L indicates hypokalemia (normal is 3.5 to 5.0 mFq/L) and is an adverse effect associated with this medication. The results in options 1, 2, and 3 are normal. Test-Taking Strategy: Note the subject, adverse effects of bumetanide. Recall that this medication is a diuretic. Also, if you are able to identify the abnormal laboratory value in the options, you will be directed to the correct answer. Review: bumetanide.

315. Allopurinol (Zyloprim) has been prescribed for a client. The nurse prepares to administer this medication, knowing that which information is accurate regarding it? 1. It is used for the lysis of thrombi obstructing coronary arteries. 2. It decreases sympathetic outflow from the central nervous system. 3. It prevents calcium ion entry across cell membranes of the cardiac smooth muscle. 4. It decreases uric acid production and reduces uric acid concentrations in serum and urine.

Answer: 4 Rationale: Allopurinol is an antigout medication. It decreases uric acid production by inhibiting xanthine oxidase, an enzyme, and reduces uric acid concentrations in both serum and urine. Options 1, 2, and 3 are incorrect actions. Test-Taking Strategy: Note that options 1 and 3 are comparable or alike in that they both address a cardiac situation. Knowledge that this medication is in the antigout classification will assist in directing you to the correct option. Review: allopurinol.

306. A client with myocardial infarction is a candidate for alteplase (Activase) therapy. The nurse caring for the client is aware that it will be necessary to monitor for which adverse effect if the client receives this treatment? 1. Infection 2. Allergic reaction 3. Muscle weakness 4. Superficial bleeding

Answer: 4 Rationale: Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots. Because of its action, an adverse effect is bleeding. Local or systemic infection could occur with poor aseptic technique during medication administration, but it is rare. Allergic reaction is not a frequent occurrence. Muscle weakness is not an adverse effect or side eftect of this medication. Test-Taking Strategy: Focus on the subject, an adverse effect, and the medication class, and recall that it is a thrombolytic medication. This will direct you to the correct option. Review: alteplase.

268. The nurse is caring for a client who has been prescribed amitriptyline hydrochloride for the treatment of depression. The nurse should notify the health care provider if which condition is noted in the client's recent medical history? 1. Pancreatitis 2. Bipolar disorder 3. Urinary tract infection 4. Myocardial infarction

Answer: 4 Rationale: Amitriptyline hydrochloride is used in the treatment of depression. This medication is contraindicated in the acute recovery period following myocardial infarction. The nurse should notify the health care provider if this is noted in the client's recent medical history. The conditions in the other options are not contraindications for use of this medication. Test-Taking Strategy: Focus on the subject, contraindications associated with this medication. Note the word "recent" in the correct option. Review: amitriptyline hydrochloride.

267. The client with acquired immunodeficiency syndrome has been started on therapy with zidovudine (Retrovir). The nurse monitors the results of the prescribed laboratory tests and determines that an adverse effect may be occurring if which find- ing is noted? 1. Negative blood culture 2. Blood glucose level 90 mg/dL 3. Blood urea nitrogen 12 mg/dL 4. White blood cell count 12,000 cells/mm3

Answer: 4 Rationale: An adverse effect of zidovudine is agranulocytopenia and anemia. The nurse carefully monitors the complete blood cell count results for these changes. Options 1, 2, and 3 are not associated with an adverse effect of this medication. Test-Taking Strategy: Focus on the subject, the adverse effects of zidovudine. Note that the only abnormal value is the one noted in the correct option. Remember that this medication causes agranulocytopenia. Review: zidovudine.

287. The nurse reinforces teaching to a client receiving an antineoplastic medication to perform which action? 1. Be sure to receive the Flu and pneumonia vaccines 2. Drink beverages containing alcohol in moderate amounts only 3. Take aspirin (acetylsalicylic acid, ASA) as needed for headache 4. Consult with the health care provider before receiving immunizations

Answer: 4 Rationale: Because antineoplastic medications lower the body's resistance, clients need to be instructed not to receive immunizations without a health care provider's approval. Alcohol needs to be avoided to minimize the risk of toxicity. Aspirin and aspirin-containing products need to be avoided to minimize the risk of bleeding. Test-Taking Strategy: Focusing on the subject, the effects of an antineoplastic, and recalling that antineoplastic medications lower the body's resistance will direct you to the correct option. Review: client instructions for antineoplastics.

251. Tetracycline hydrochloride has been prescribed for a child. The nurse should reinforce to the mother which medication administration instruction? 1. Give the medication with milk 2. Give the medication with ice cream 3. Mix the medication in a small amount of a protein shake 4. Help the child rinse his/her mouth after taking the medication

Answer: 4 Rationale: Because tetracycline hydrochloride can cause staining of the teeth, straws should be used and the mouth should be rinsed after administration. The medication should be administered 1 hour before or 2 hours after drinking milk. Options 1, 2, and 3 are unnecessary. Test-Taking Strategy: Eliminate options 1 and 2 first because they are comparable or alike; both involve milk products. From the remaining options, recalling that tetracycline can cause teeth staining will direct you to the correct option. Review: administration of antibiotics to a child.

305. A dient with elevated triglycerides and a serum cholesterol of 398 mg/dL is taking cholestyramine resin (Questran). Which statement by the client indicates the need for further teaching? 1. "Constipation and bloating might be a problem." 2. "TIl continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "TIl continue taking my nicotinic acid from the health food store."

Answer: 4 Rationale: Cholestyramine resin is a lipid-lowering medication. Nicotinic acid, also known as niacin, is an over-the-counter medication used to lower cholesterol levels. Lipid-lowering medications can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are common side effects. Both walking and reducing fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels. Test-Taking Strategy: Note the strategic words "need for further teaching." These words indicate a negative event query and the need to select the incorrect statement. Remembering that over-the-counter medications should be avoided when a client is taking a prescription medication will direct you to the correct option. Review: client teaching for antilipemic medications.

298. The nurse collects data on a client with a history of renal transplantation expecting to note that which medication will be most likely prescribed to prevent organ rejection? 1. Probenecid 2. Prednisone 3. Indomethacin (Indocin) 4. Cyclosporine (Sandimmune)

Answer: 4 Rationale: Cyclosporine is a powerful immunosuppressant and is the medication of choice for preventing organ rejection following allogenic transplants. Prednisone is a glucocorticoid and may or may not be administered concurrently with the cyclosporine. Probenecid is a uricosuric agent used to treat hyperuricemia. Indomethacin is a nonsteroidal antiinflammatory agent. Test-Taking Strategy: Note the subject, the client's renal transplant, and the strategic words "most likely." Recalling that cyclosporine is an immunosuppressant will direct you to the correct option. Review: cyclosporine.

271. Diclofenac is prescribed for a client with osteoarthritis. Which medication, if noted on the client's record, would alert the nurse to consult with the health care provider? 1. Primidone 2. Pyrimethamine (Daraprim) 3. Calcium citrate (Citracal) 4. Warfarin sodium (Coumadin)

Answer: 4 Rationale: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Interactions may occur with the use of anticoagulants, such as warfarin sodium. The nurse should consult with the health care provider about a potential medication interaction. Options 1, 2, and 3 are not contraindications. Test-Taking Strategy: Focus on the subject, a contraindication, and recall that diclofenac is an NSAID. Recalling the effects of an NSAID will direct you to the correct option. Review: diclofenac.

276. The client has received a dose of dimenhydrinate (Dramamine). The nurse assesses for the effectiveness of the medication by asking the client about relief of which condition? 1. Fever 2. Headache 3. Muscle aches 4. Nausea and vomiting

Answer: 4 Rationale: Dimenhydrinate is used to treat motion sickness and the symptoms that accompany it, such as dizziness, vertigo, nausea, and vomiting. The other options are incorrect. Test-Taking Strategy: Note the strategic word "effectiveness." Focus on the name of the medication, and recall that it is used to treat nausea and vomiting. This will direct you to the correct option. Review: dimenhydrinate.

304. The nurse is reviewing laboratory results for a client taking dantrolene sodium (Dantrium). The nurse should notify the health care provider if which finding was noted on the laboratory report? 1. Creatinine 0.6 mg/dL 2. Platelet count 290,000 mm' 3. Blood urea nitrogen 9 mg/dI 4. Aspartate aminotransferase (AST) 40 U/L

Answer: 4 Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, tests of liver function should be performed before and throughout the treatment interval. It is administered in the lowest effective dosage for the shortest time necessary. The AST level reported in option 4 is high (normal is 10 to 30 U/L); the other options indicate normal laboratory results. Test-Taking Strategy: Eliminate options 1, 2, and 3 because they are comparable or alike and are normal laboratory values. Review: dantrolene sodium.

269. A health care provider has prescribed etanercept (Enbrel) for a client with a diagnosis of rheumatoid arthritis. The nurse explains to the client in layperson terms that this medication is classified as which type of medication? 1. Glucocorticoid 2. Antimetabolite 3. Ibuprofen analgesic 4. Biological response modifier

Answer: 4 Rationale: Etanercept is a biological response modifier that neutralizes the tumor necrosis factor. It is not a glucocorticoid, antimetabolite, or ibuprofen analgesic. Test-Taking Strategy: Noting the subject, medication classification, and the name of the medication and the client's diagnosis will direct you to the correct option. Review: biological response modifiers.

314. The nurse reinforces instructions to a client taking fludrocortisone acetate (Florinef). The nurse instructs the client to notify the health care provider if which occurs? 1. Nausea 2. Fatigue 3. Weight loss 4. Swelling of the feet

Answer: 4 Rationale: Excessive doses of fudrocortisone acetate cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. Options 1, 2, and 3 are not a concern with this medication. Test-Taking Strategy: Focus on the subject, signs of an adverse medication effect, and the name of the medication. Note the suffix "sone" in its name; this indicates that the medication is a corticosteroid (mineralocorticoid). Next, recall the side and adverse effects and that corticosteroids can cause water retention. Review: side effects and adverse effects of corticosteroids.

311. Which action by the nurse demonstrates safe administration of subcutaneous enoxaparin (Lovenox)? 1. Expels air bubble from the syringe before use 2. Administers the injection while the client is in the chair 3. Applies pressure to the site for 10 minutes following the injection 4. Administers the medication in the right anterolateral abdominal wall

Answer: 4 Rationale: Locations for subcutaneous injection of enoxaparin include the right and left anterolateral abdomen and the right and left posterolateral abdomen. The bubble in the syringe serves as an air lock. The injection should be administered while the client is in the recumbent position. Pressure should be applied to the site for 1 minute after injection. Test-Taking Strategy: Focus on the subject, safe administration, and visualize the procedure for administering an anticoagulant. This will direct you to the correct and safe action. Review: anticoagulant administration.

263. Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse should contact the health care provider who prescribed the medication if which condition is documented in the client's medical history? 1. Hypotension 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease

Answer: 4 Rationale: Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. Ergot alkaloids are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, preeclampsia, or eclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. Options 1, 2, and 3 are not contraindications. Test-Taking Strategy: Focus on the subject, the medication and its classification. Recalling that ergot alkaloids produce vasoconstriction will direct you to the correct option. Review: ergot alkaloids.

282. Blood work has been drawn on a client who has been taking cyclosporine (Sandimmune) following an allogenic liver transplant. The nurse checks the results of the laboratory tests and determines the presence of an adverse effect related to this medication if which result is noted? 1. Hematocrit level 45% 2. Hemoglobin level 14 g/dI 3. Cholesterol level 174 mg/dI 4. Serum creatinine 2.2 mg/dL

Answer: 4 Rationale: Nephrotoxicity is an adverse effect of cyclosporine, an immunosuppressant. Nephrotoxicity is evaluated by monitoring the blood urea nitrogen and creatinine levels. Options 1, 2, and 3 are unrelated to the adverse effects associated with the administration of this medication. Test-Taking Strategy: Eliminate options 1 and 2 first because they are comparable or alike. For the remaining options, recall that nephrotoxicity is an adverse effect and that nephrotoxicity is evaluated by monitoring the creatinine level. Review: cyclosporine.

317. An older client has been given a prescription to begin taking cimetidine (Tagamet). The nurse should be certain to question the prescription if the client already has a history of which problem? 1. Fatigue 2. Tremors 3. Stiff joints 4. Confusion

Answer: 4 Rationale: Older clients are especially susceptible to the central nervous system side effects of cimetidine; the most frequent of these is confusion. Fatigue, tremors, and stiff joints are not associated with this medication. Test-Taking Strategy: Focus on the subject, medication cautions, and note the words "be certain to question." Use knowledge that this is an older client and the side effects of this medication to direct you to the correct option. Review: Histamine, (H2)-receptor antagonists.

308. The nurse reinforcing instructions to a client who is taking levothyroxine (Synthroid) should tell the client to take the medication in which way? 1. With a high-fat food 2. At lunchtime with at least one slice of bread 3. Ar bedtime with a high-carbohydrate food item 4. In the morning at least 1 hour before breakfast

Answer: 4 Rationale: Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Therefore options 1, 2, and 3 are incorrect. Test-Taking Strategy: Note that options 1, 2, and 3 are comparable or alike in that these options all address administering the medication with food. Review: administration procedures for levothyroxine.

299. The nurse is speaking with a client taking phenytoin (Dilantin) for seizure control. The client states that she has started using birth control pills to prevent pregnancy. The nurse becomes concerned, knowing that this combination of medications could have which effect? 1. Increased risk of thrombophlebitis 2. Severe gastrointestinal side effects 3. Decreased effectiveness of phenytoin 4. Decreased effectiveness of birth control pills

Answer: 4 Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. The nurse should tell the client to alert the health care provider, so that counseling may be done about alternative birth control methods. The other options are incorrect. Test-Taking Strategy: Focus on the subject, medication interactions. Knowledge about medications that interact with phenytoin is required to answer the question. Remember that phenytoin decreases the effectiveness of some birth control pills. Review: client teaching for anticonvulsants.

296. Sumatriptan succinate (Imitrex) is prescribed for a client with migraine headaches, and the nurse is reinforcing medication instructions. The nurse determines that the client understands the instructions if the client makes which statement? 1. "Skipped heartbeats is an expected effect of the medication. 2. "I am happy I will be able to prevent all of my future headaches." 3. "This medication is made for me since I can take it as much as I need to." 4. "I can only take a certain amount of medication in a 24-hour period.

Answer: 4 Rationale: Sumatriptan succinate is an antimigraine medication. One adverse effect associated with its use is skipped heartbeats, and the health care provider should be notified if they occur. It cannot prevent all future headaches. The maximum amount of medication that can be taken in a 24-hour period is 200 mg. Test-Taking Strategy: Focus on the subject, client understanding of medication instructions. Read each option carefully. Use of general medication administration guidelines will direct you to the correct option. Review: client teaching for sumatriptan succinate.

254. Phenazopyridine (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse should reinforce which instruction to the client? 1. To take the medication 1 hour before meals 2. To take the medication at bedtime without food 3. To discontinue the medication if headache occurs 4. That a reddish-orange discoloration of the urine may occur

Answer: 4 Rationale: The client should be instructed that a reddish-orange discoloration of urine may occur. The medication should be taken after meals (not at bedtime or 1 hour before meals) to reduce the possibility of gastrointestinal upset. Headache is an occasional side effect and does not warrant discontinuation. Test-Taking Strategy: Eliminate options 1 and 2 first because they are comparable or alike in that they both address time schedules for administration of the medication on an empty stomach. From the remaining options, eliminate option 3 because the nurse would not advise the client to discontinue medication. Review: urinary tract analgesics.

318. The nurse is caring for a client who is taking thyroid hormones concurrently with aluminum hydroxide tablets. The nurse reinforces instructions to this client to take these medications at least how much time apart? 1. 15 minutes 2. 30 minutes 3. 45 minutes 4. 4 hours

Answer: 4 Rationale: The client taking thyroid hormones who is also taking aluminum hydroxide tablets should take these medications at least 4 hours apart to ensure adequate absorption. Options 1, 2, and 3 are too short and would not ensure adequate absorption of the medications. Test-Taking Strategy: Note the subject, appropriate medication administration. Recalling that absorption can be affected by administration of an antacid will assist in directing you to the correct option. Review: aluminum hydroxide and thyroid hormones.

277. The nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client session about the side effects related to the medication? 1. Mouth dryness 2. Excessive sweating 3. Cardiovascular symptoms 4. Gastrointestinal (GI) dysfunction

Answer: 4 Rationale: The most common side effects related to this medication include central nervous system and Gl system dysfunction. Fluoxetine affects the Gl system by causing nausea and vomiting, cramping, and diarrhea. Dry mouth, excessive sweating, and cardiovascular symptoms are not side effects associated with this medication. Test-Taking Strategy: Focus on the subject, side effects, and on the name of the medication. Recalling that this medication causes Gl problems will direct you to the correct option. Review: fluoxetine.

264. A client receiving long-term therapy with lithium carbonate (Lithobid) exhibits polyuria and prolonged vomiting and diarrhea. The nurse anticipates that the results of the most recent serum lithium level will be between which levels? 1. 0 and 0.5 mEg/L 2. 0.6 and 1 mEq/L 3. 1 and 1.3 mEq/L 4. 1.5 and 2 mEq/L

Answer: 4 Rationale: The therapeutic serum lithium carbonate level is 1 to 1.4 mEq/L for clients with acute mania and 0.5 to 1.3 mEg/L for maintenance levels. Serum lithium concentrations of 1.5 to 2.0 mE/L may produce a variety of symptoms, including polyuria, prolonged vomiting and diarrhea, drowsiness, incoordination, coarse hand tremors, muscle twitching, and mental confusion. Test-Taking Strategy: Focus on the subject, the serum lithium level, and the data presented in the question to assist in directing you to the correct option. Also, recalling the therapeutic serum lithium level will direct you to the correct option. Review: lithium carbonate.

292. The nurse is caring for a client taking levothyroxine sodium (Synthroid) who has been prescribed aluminum hydroxide tablets. The nurse should schedule the new medication to be taken at what time? 1. Concurrently with levothyroxine sodium 2. One hour apart from levothyroxine sodium 3. Two hours apart from levothyroxine sodium 4. Four hours apart from levothyroxine sodium

Answer: 4 Rationale: Thyroid hormones should be given at least 4 hours apart from certain medications such as multivitamins, aluminum hydroxide and magnesium hydroxide, simethicone, calcium carbonate, bile acid sequestrants, iron, and sucralfate because they decrease the absorption of thyroid replacement hormones. Test-Taking Strategy: Focus on the subject, the timing of medication administration. Note the time frames in each option. Recall that absorption of thyroid preparations is very important and that they should be taken at least 1 hour before meals and at least 4 hours apart from certain other medications. This knowledge will direct you to the correct option. Review: thyroid hormones.

248. A client is beginning to take trimethoprim-sulfamethoxazole (Bactrim) for a recurrent urinary tract infection (UTI). The nurse should reinforce which instruction regarding this medication? 1. Discontinue the medication once symptoms subside 2. Expect rashes or skin changes as a result of therapy 3. Take most doses early in the day when fluid intake is highest 4. Take each dose with 8 ounces of water and drink extra water each day

Answer: 4 Rationale: Trimethoprim-sulfamethoxazole is an antibacterial and antinfective. The client takes each dose with 8 ounces of water and drinks several extra glasses of water each day. The client should space doses evenly around the clock for stable blood levels and should take the medication for the full course of therapy. The client should report rashes or other skin changes, which could indicate an allergy to sulfa. Test-Taking Strategy: Focus on the subject, appropriate medication instructions. Recalling the general principles related to antibiotic therapy will assist in eliminating options 1 and 3. From the remaining options, recall either that extra fluids are needed during treatment of UTI or that this medication contains sulfa. Review: client teaching for sulfa medications.

257. Calcitriol is administered to a client. Which findings should the nurse expect to note regarding this medication? (Select all that apply.) 1. Relief of pain 2. Resolution of anemia 3. Normal red blood cell levels 4. Normal serum calcium levels 5. Normal serum phosphorus levels

Answer: 4, 5 Rationale: Calcitriol is vitamin D therapy for hypoparathyroidism and hypocalcemia with chronic renal dialysis clients. Therefore, achievement of normal serum calcium and phosphorus levels is primarily expected. The medication does not relieve pain or resolve anemia. Calcitriol does not affect red blood cells. Test-Taking Strategy: Focus on the subject, intended medication effects. Note the relationship between the name of the medication and the word "calcium" in option 4. Recalling the use and purpose of this medication will assist in selecting option 5. Review: purpose and use of calcitriol.

313. The dient has been tentatively diagnosed with gout. The nurse determines that which condition indicates a potential contraindication for therapy with colchicine? 1. Cirrhosis 2. Hyperthyroidism 3. Adrenal insufficiency 4. Diabetes mellitus type 2

Answer: I Rationale: Colchicine is contraindicated in severe gastrointestinal, renal, hepatic, or cardiac disorders, and in clients with blood dyscrasias. Options 2, 3, and 4 are not contraindications for its use. Test-Taking Strategy: Eliminate options 2, 3, and 4 because they are comparable or alike and are endocrine-related disorders. Review: colchicine.