HESI Pharmacology Exam Practice

245 terms by snegash22 

Create a new folder

Advertisement Upgrade to remove ads

NCLEX-PN style study questions

1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D

3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration.

2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice

4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice.

3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations

1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun

4. At least 30 minutes before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site

3. Informing the client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect

6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred?
1.Hyperventilation
2.Elevated blood pressure
3.Local pain at the burn site
4.Local rash at the burn site

1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?
1. Platelet count
2. Triglyceride level
3. Complete blood count
4. White blood cell count

2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment.

8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin)

1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin.

9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands

2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles).

10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for:
1. Acne
2. Eczema
3. Hair loss
4. Herpes simplex

1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect.

11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."

3. "The medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin.

12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion.

1. Notify the registered nurse.
Rationale:
When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider.

13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?
1. Echocardiography
2. Electrocardiography
3. Cervical radiography
4. Pulmonary function studies

4. Pulmonary function studies
Rationale:
Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication?
1. Clotting time
2. Uric acid level
3. Potassium level
4. Blood glucose level

2. Uric acid level
Rationale:
Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication.

15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication?
1. Alopecia
2. Chest pain
3. Pulmonary fibrosis
4. Orthostatic hypotension

4. Orthostatic hypotension
Rationale:
A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client:
1. To take aspirin (acetylsalicylic acid) as needed for headache
2. Drink beverages containing alcohol in moderate amounts each evening
3. Consult with health care providers (HCPs) before receiving immunizations
4. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair

3. Consult with health care providers (HCPs) before receiving immunizations
Rationale:
Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects.

17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication?
1. Diarrhea
2. Hair loss
3. Chest pain
4. Numbness and tingling in the fingers and toes

4. Numbness and tingling in the fingers and toes
Rationale:
A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history?
1. Pancreatitis
2. Diabetes mellitus
3. Myocardial infarction
4. Chronic obstructive pulmonary disease

1. Pancreatitis
Rationale:
Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to:
1. Increase DNA and RNA synthesis.
2. Promote the biosynthesis of nucleic acids.
3. Increase estrogen concentration and estrogen response.
4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.
Rationale:
Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

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

2. Calcium level
Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the 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 of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply.
1. Tinnitus
2. Ototoxicity
3. Hyperkalemia
4. Hypercalcemia
5. Nephrotoxicity
6. Hypomagnesemia

1. Tinnitus
2. Ototoxicity
5. Nephrotoxicity
6. Hypomagnesemia
Rationale:
Cisplatin is an alkylating medication. Alkylating medications are cell cycle phase-nonspecific medications that affect the synthesis of DNA by causing the cross-linking of DNA to inhibit cell reproduction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine (Ethyol) may be administered before cisplatin to reduce the potential for renal toxicity.

22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.

3. Treat hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid glands are accidentally removed or injured during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes or muscle spasms or twitching, the health care provider is notified immediately. Calcium gluconate should be kept at the bedside.

23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.

2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before unusual exercise. If acetone is found in the urine, it may possibly indicate the need for additional insulin. To minimize the discomfort associated with insulin injections, the insulin should be administered at room temperature. Injection sites should be systematically rotated from one area to another. The client should be instructed to give injections in one area, about 1 inch apart, until the whole area has been used and then to change to another site. This prevents dramatic changes in daily insulin absorption.

24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial

1. Withdraws the NPH insulin first
Rationale:
When preparing a mixture of regular insulin with another insulin preparation, the regular insulin is drawn into the syringe first. This sequence will avoid contaminating the vial of regular insulin with insulin of another type. Options 2, 3, and 4 identify the correct actions for preparing NPH and regular insulin.

25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse tells the client to:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.

2. Refrigerate the insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until needed. Vials should not be frozen. When stored unopened under refrigeration, insulin can be used up to the expiration date on the vial. Options 1, 3, and 4 are incorrect.

26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages

1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Alcohol can also potentiate the hypoglycemic effects of the medication. Clients need to be instructed to avoid alcohol consumption while taking this medication. The items in options 2, 3, and 4 do not need to be avoided.

27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history?
1. Neuralgia
2. Insomnia
3. Use of nitroglycerin
4. Use of multivitamins

3. Use of nitroglycerin
Rationale:
Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide in the corpus cavernosum of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. Sildenafil is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication.

28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention?
1. The medication is administered within 60 minutes before the morning and evening meal.
2. The medication is withheld and the HCP is called to question the prescription for the client.
3. The client is monitored for gastrointestinal side effects after administration of the medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.

2. The medication is withheld and the HCP is called to question the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes mellitus only. It is not recommended for clients taking insulin. Hence, the nurse should hold the medication and question the HCP regarding this prescription. Although options 1 and 3 are correct statements about the medication, in this situation the medication should not be administered. The medication is packaged in prefilled pens ready for injection without the need for drawing it up into another syringe.

29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is:
1. 2 to 4 hours after administration
2. 4 to 12 hours after administration
3. 16 to 18 hours after administration
4. 18 to 24 hours after administration

2. 4 to 12 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of action is 1.5 hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
1. Prednisone
2. Phenelzine (Nardil)
3. Atenolol (Tenormin)
4. Allopurinol (Zyloprim)

1. Prednisone
Rationale:
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a monoamine oxidase inhibitor, and option 3, a β-blocker, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary?
1. "I can take aspirin or my antihistamine if I need it."
2. "I need to take the medication every day at the same time."
3. "I need to avoid coffee, tea, cola, and chocolate in my diet."
4. "If I gain more than 5 pounds a week, I will call my doctor."

1. "I can take aspirin or my antihistamine if I need it."
Rationale:
Aspirin and other over-the-counter medications should not be taken unless the client consults with the health care provider (HCP). The client needs to take the medication at the same time every day and should be instructed not to stop the medication. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 lb or more weekly should be reported to the HCP. Caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.

32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?
1. Decreased urinary output
2. Decreased blood pressure
3. Decreased peripheral edema
4. Decreased blood glucose level

1. Decreased urinary output
Rationale:
Desmopressin promotes renal conservation of water. The hormone carries out this action by acting on the collecting ducts of the kidney to increase their permeability to water, which results in increased water reabsorption. The therapeutic effect of this medication would be manifested by a decreased urine output. Options 2, 3, and 4 are unrelated to the effects of this medication.

33.) The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply.
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes.
5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.
6. Muscle pain is an expected side effect of metformin and may be treated with acetaminophen (Tylenol).

1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes.
Rationale:
Repaglinide is a rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion that should be taken before meals, and that should be withheld if the client does not eat. Hypoglycemia is a side effect of repaglinide and the client should always be prepared by carrying a simple sugar with her or him at all times. Metformin is an oral hypoglycemic given in combination with repaglinide and works by decreasing hepatic glucose production. A common side effect of metformin is diarrhea. Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants health care provider notification, not the use of acetaminophen.

34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?
1. Monitoring the leukocyte count for 2 days after the infusion
2. Checking the frequency and consistency of bowel movements
3. Checking serum liver enzyme levels before and after the infusion
4. Carrying out a Hematest on gastric fluids after the infusion is completed

2. Checking the frequency and consistency of bowel movements
Rationale:
The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.

35.) The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?
1. Constipation
2. Abdominal pain
3. An episode of diarrhea
4. Hematest-positive nasogastric tube drainage

3. An episode of diarrhea
Rationale:
Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

36.) The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client?
1. Paralytic ileus
2. Incisional pain
3. Urinary retention
4. Nausea and vomiting

4. Nausea and vomiting
Rationale:
Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect.

37.) The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?
1. Weight loss
2. Relief of heartburn
3. Reduction of steatorrhea
4. Absence of abdominal pain

3. Reduction of steatorrhea
Rationale:
Pancrelipase (Pancrease MT) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

38.) An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?
1. Tremors
2. Dizziness
3. Confusion
4. Hallucinations

3. Confusion
Rationale:
Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times?
1. With meals and at bedtime
2. Every 6 hours around the clock
3. One hour after meals and at bedtime
4. One hour before meals and at bedtime

4. One hour before meals and at bedtime
Rationale:
Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which of the following is noted?
1. Resolved diarrhea
2. Relief of epigastric pain
3. Decreased platelet count
4. Decreased white blood cell count

2. Relief of epigastric pain
Rationale:
The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but is not an intended effect. Options 3 and 4 are incorrect.

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

2. Heartburn
Rationale:
Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen?
1. "My ulcer will heal because these medications will kill the bacteria."
2. "These medications are only taken when I have pain from my ulcer."
3. "The medications will kill the bacteria and stop the acid production."
4. "These medications will coat the ulcer and decrease the acid production in my stomach."

3. "The medications will kill the bacteria and stop the acid production."
Rationale:
Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

43.) A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply.
1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
5. Esomeprazole (Nexium)
6. Lansoprazole (Prevacid)

1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
Rationale:
H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors.
H2-receptor antagonists medication names end with -dine.
Proton pump inhibitors medication names end with -zole.

44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use after giving this medication?
1. Ambu bag
2. Intubation tray
3. Nasogastric tube
4. Suction equipment

4. Suction equipment
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 manage to clear the increased volume of liquefied secretions.

45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will:
1. Watch for irritability as a side effect.
2. Take the tablet with a full glass of water.
3. Take an extra dose if the cough is accompanied by fever.
4. Crush the sustained-release tablet if immediate relief is needed.

2. Take the tablet with a full glass of water.
Rationale:
Guaifenesin is an expectorant. It should be taken with a full glass of water to decrease viscosity of secretions. Sustained-release preparations should not be broken open, crushed, or chewed. The medication may occasionally cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache.

46.) A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for:
1. Pupillary changes
2. Scattered lung wheezes
3. Sudden increase in pain
4. Sudden episodes of diarrhea

3. Sudden increase in pain
Rationale:
Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication.

47.) A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing:
1. Hypercalcemia
2. Peripheral neuritis
3. Small blood vessel spasm
4. Impaired peripheral circulation

2. Peripheral neuritis
Rationale:
A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to:
1. Drink alcohol in small amounts only.
2. Report yellow eyes or skin immediately.
3. Increase intake of Swiss or aged cheeses.
4. Avoid vitamin supplements during therapy.

2. Report yellow eyes or skin immediately.
Rationale:
INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of INH therapy for TB.

49.) A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is forgotten
3. Causes orange discoloration of sweat, tears, urine, and feces
4. May be discontinued independently if symptoms are gone in 3 months

3. Causes orange discoloration of sweat, tears, urine, and feces
Rationale:
Rifampin should be taken exactly as directed as part of TB therapy. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. The medication should be administered on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Rifampin causes orange-red discoloration of body secretions and will permanently stain soft contact lenses.

50.) A nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report:
1. Impaired sense of hearing
2. Problems with visual acuity
3. Gastrointestinal (GI) side effects
4. Orange-red discoloration of body secretions

2. Problems with visual acuity
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

51.) Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client-teaching plan regarding this medication?
1. To take the medication before meals
2. To return to the clinic weekly for serum drug-level testing
3. It is not necessary to call the health care provider (HCP) if a skin rash occurs.
4. It is not necessary to restrict alcohol intake with this medication.

2. To return to the clinic weekly for serum drug-level testing
Rationale:
Cycloserine (Seromycin) is an antitubercular medication that requires weekly serum drug level determinations to monitor for the potential of neurotoxicity. Serum drug levels lower than 30 mcg/mL reduce the incidence of neurotoxicity. The medication must be taken after meals to prevent gastrointestinal irritation. The client must be instructed to notify the HCP if a skin rash or signs of central nervous system toxicity are noted. Alcohol must be avoided because it increases the risk of seizure activity.

52.) A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed?
1. Electrolyte levels
2. Coagulation times
3. Liver enzyme levels
4. Serum creatinine level

3. Liver enzyme levels
Rationale:
INH therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is greater than age 50 or abuses alcohol.

53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select all that apply.
1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
4. Vitamin B6 deficiency
5. Ocular pain or blurred vision
6. Tingling and numbness of the fingers

1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
5. Ocular pain or blurred vision
Rationale:
Rifabutin (Mycobutin) may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid (INH). Ethambutol (Myambutol) also causes peripheral neuritis.

54.) A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?
1. "I will take my pills every day at the same time."
2. "I will be certain to avoid alcohol consumption."
3. "I have already called my family to pick up a Medic-Alert bracelet."
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
Rationale:
Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin?
1. 3 to 5 ng/mL
2. 0.5 to 2 ng/mL
3. 1.2 to 2.8 ng/mL
4. 3.5 to 5.5 ng/mL

2.) 0.5 to 2 ng/mL
Rationale:
Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. Therefore, options 1, 3, and 4 are incorrect.

56.) Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication?
1. Hematocrit level
2. Hemoglobin level
3. Prothrombin time (PT)
4. Activated partial thromboplastin time (aPTT)

4. Activated partial thromboplastin time (aPTT)
Rationale:
The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations.

57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol?
1. The development of complaints of insomnia
2. The development of audible expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication
4. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication

2. The development of audible expiratory wheezes
Rationale:
Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client:
1. Cut the dose in half.
2. Discontinue the medication.
3. Take the medication with food.
4. Contact the health care provider (HCP).

3. Take the medication with food.
Rationale:
Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the HCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.

59.) A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
3. Monitor for signs of bleeding.
4. Have heparin sodium available.

3. Monitor for signs of bleeding.
Rationale:
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.

60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication?
1. Hypouricemia, hyperkalemia
2. Increased risk of osteoporosis
3. Hypokalemia, hyperglycemia, sulfa allergy
4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hyperglycemia, sulfa allergy
Rationale:
Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

61.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education?
1. "Constipation and bloating might be a problem."
2. "I'll continue to watch my diet and reduce my fats."
3. "Walking a mile each day will help the whole process."
4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store."
Rationale:
Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions?
1. "It is not necessary to avoid the use of alcohol."
2. "The medication should be taken with meals to decrease flushing."
3. "Clay-colored stools are a common side effect and should not be of concern."
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
Rationale:
Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals, this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

63.) A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Select the appropriate actions that the nurse should take. Select all that apply.
1. Call a code blue.
2. Contact the registered nurse.
3. Contact the client's family.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.

2. Contact the registered nurse.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.
Rationale:
The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider as appropriate. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.

64.) Nalidixic acid (NegGram) is prescribed for a client with a urinary tract infection. On review of the client's record, the nurse notes that the client is taking warfarin sodium (Coumadin) daily. Which prescription should the nurse anticipate for this client?
1. Discontinuation of warfarin sodium (Coumadin)
2. A decrease in the warfarin sodium (Coumadin) dosage
3. An increase in the warfarin sodium (Coumadin) dosage
4. A decrease in the usual dose of nalidixic acid (NegGram)

2. A decrease in the warfarin sodium (Coumadin) dosage
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 decrease in the anticoagulant dosage may be needed.

65.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions?
1. Restrict fluid intake.
2. Maintain a high fluid intake.
3. If the urine turns dark brown, call the health care provider (HCP) immediately.
4. Decrease the dosage when symptoms are improving to prevent an allergic response.

2. Maintain a high fluid intake.
Rationale:
Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for a client. A nurse should instruct the client to report which symptom if it developed during the course of this medication therapy?
1. Nausea
2. Diarrhea
3. Headache
4. Sore throat

4. Sore throat
Rationale:
Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider if these symptoms occur. The other options do not require health care provider notification.

67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client:
1. To take the medication at bedtime
2. To take the medication before meals
3. To discontinue the medication if a headache occurs
4. That a reddish orange discoloration of the urine may occur

4. That a reddish orange discoloration of the urine may occur
Rationale:
The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

68.) Bethanechol chloride (Urecholine) is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication?
1. Gastric atony
2. Urinary strictures
3. Neurogenic atony
4. Gastroesophageal reflux

2. Urinary strictures
Rationale:
Bethanechol chloride (Urecholine) can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

69.) A nurse who is administering bethanechol chloride (Urecholine) is monitoring for acute toxicity associated with the medication. The nurse checks the client for which sign of toxicity?
1. Dry skin
2. Dry mouth
3. Bradycardia
4. Signs of dehydration

3. Bradycardia
Rationale:
Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication?
1. Pallor
2. Drowsiness
3. Bradycardia
4. Restlessness

4. Restlessness
Rationale:
Toxicity (overdosage) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

71.) After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication?
1. Decreased creatinine level
2. Decreased hemoglobin level
3. Elevated blood urea nitrogen level
4. Decreased white blood cell count

3. Elevated blood urea nitrogen level
Rationale:
Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosuppressant but does not depress the bone marrow.

72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for the client. The nurse reviews the client's medical record and should contact the health care provider (HCP) regarding which documented finding to verify the prescription? Refer to chart.
1. Renal insufficiency
2. Chest x-ray: normal
3. Blood glucose, 102 mg/dL
4. Folic acid (vitamin B6) 0.5 mg, orally daily

1. Renal insufficiency
Rationale:
Cinoxacin should be administered with caution in clients with renal impairment. The dosage should be reduced, and failure to do so could result in accumulation of cinoxacin to toxic levels. Therefore the nurse would verify the prescription if the client had a documented history of renal insufficiency. The laboratory and diagnostic test results are normal findings. Folic acid (vitamin B6) may be prescribed for a client with renal insufficiency to prevent anemia.

73.) A client with myasthenia gravis is suspected of having cholinergic crisis. Which of the following indicate that this crisis exists?
1. Ataxia
2. Mouth sores
3. Hypotension
4. Hypertension

4. Hypertension
Rationale:
Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.

74.) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs?
1. Vitamin K
2. Atropine sulfate
3. Protamine sulfate
4. Acetylcysteine (Mucomyst)

2. Atropine sulfate
Rationale:
The antidote for cholinergic crisis is atropine sulfate. Vitamin K is the antidote for warfarin (Coumadin). Protamine sulfate is the antidote for heparin, and acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol).

75.) A client with myasthenia gravis becomes increasingly weak. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Enlon) is administered. Which of the following indicates that the client is in cholinergic crisis?
1. No change in the condition
2. Complaints of muscle spasms
3. An improvement of the weakness
4. A temporary worsening of the condition

4. A temporary worsening of the condition
Rationale:
An edrophonium (Enlon) injection, a cholinergic drug, makes the client in cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Options 1 and 2 would not occur in either crisis.

76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction?
1. Pruritus
2. Tachycardia
3. Hypertension
4. Impaired voluntary movements

4. Impaired voluntary movements
Rationale:
Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

77.) Phenytoin (Dilantin), 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions?
1. "I will use a soft toothbrush to brush my teeth."
2. "It's all right to break the capsules to make it easier for me to swallow them."
3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose."
4. "If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."

1. "I will use a soft toothbrush to brush my teeth."
Rationale:
Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses, because this could precipitate a seizure. Capsules should not be chewed or broken and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity.

78.) A client is taking phenytoin (Dilantin) for seizure control and a sample for a serum drug level is drawn. Which of the following indicates a therapeutic serum drug range?
1. 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL

2. 10 to 20 mcg/mL
Rationale:
The therapeutic serum drug level range for phenytoin (Dilantin) is 10 to 20 mcg/mL.
* A helpful hint may be to remember that the theophylline therapeutic range and the acetaminophen (Tylenol) therapeutic range are the same as the phenytoin (Dilantin) therapeutic range.*

79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication:
1. With 8 oz of milk
2. In the morning after arising
3. 60 minutes before breakfast
4. At bedtime on an empty stomach

1. With 8 oz of milk
Rationale:
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.

80.) A nurse is caring for a client who is taking phenytoin (Dilantin) for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse provide to the client?
1. Pregnancy should be avoided while taking phenytoin (Dilantin).
2. The client may stop taking the phenytoin (Dilantin) if it is causing severe gastrointestinal effects.
3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin).
4. The increased risk of thrombophlebitis exists while taking phenytoin (Dilantin) and birth control pills together.

3. The potential for decreased effectiveness of the birth control pills exists while taking phenytoin (Dilantin).
Rationale:
Phenytoin (Dilantin) enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not accurate.

81.) A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol). Which laboratory result would indicate that the client is experiencing an adverse reaction to the medication?
1. Sodium level, 140 mEq/L
2. Uric acid level, 5.0 mg/dL
3. White blood cell count, 3000 cells/mm3
4. Blood urea nitrogen (BUN) level, 15 mg/dL

3. White blood cell count, 3000 cells/mm3
Rationale:
Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values.

82.) A client is receiving meperidine hydrochloride (Demerol) for pain. Which of the following are side effects of this medication. Select all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory rate

2. Tremors
3. Drowsiness
4. Hypotension
Rationale:
Meperidine hydrochloride is an opioid analgesic. Side effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

83.) The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to check:
1. The injection site for itching and edema
2. The white blood cell counts and platelet counts
3. Whether the client is experiencing fatigue and joint pain
4. A metallic taste in the mouth, with a loss of appetite

2. The white blood cell counts and platelet counts
Rationale:
Infection and pancytopenia are side effects of etanercept (Enbrel). Laboratory studies are performed before and during drug treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching is a common occurrence following administration. A metallic taste with loss of appetite are not common signs of side effects of this medication.

84.) Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, knowing that the primary therapeutic effect of this medication is which of the following?
1. Increased muscle tone
2. Decreased muscle spasms
3. Increased range of motion
4. Decreased local pain and tenderness

2. Decreased muscle spasms
Rationale:
Baclofen is a skeletal muscle relaxant and central nervous system depressant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients with multiple sclerosis. Options 1, 3, and 4 are incorrect.

85.) A nurse is monitoring a client receiving baclofen (Lioresal) for side effects related to the medication. Which of the following would indicate that the client is experiencing a side effect?
1. Polyuria
2. Diarrhea
3. Drowsiness
4. Muscular excitability

3. Drowsiness
Rationale:
Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

86.) A nurse is reinforcing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would the nurse include in the instructions?
1. Restrict fluid intake.
2. Avoid the use of alcohol.
3. Stop the medication if diarrhea occurs.
4. Notify the health care provider if fatigue occurs.

2. Avoid the use of alcohol.
Rationale:
Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants, because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs.

87.) A client with acute muscle spasms has been taking baclofen (Lioresal). The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client?
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 okay 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."

4. "Weakness and fatigue commonly occur and will diminish with continued medication use."
Rationale:
The client 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 withdraw or stop the medication abruptly, 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 the use of the medication.

88.) Dantrolene sodium (Dantrium) is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following?
1. Depresses spinal reflexes
2. Acts directly on the skeletal muscle to relieve spasticity
3. Acts within the spinal cord to suppress hyperactive reflexes
4. Acts on the central nervous system (CNS) to suppress spasms

2. Acts directly on the skeletal muscle to relieve spasticity
Rationale:
Dantrium acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract.
*Options 1, 3, and 4 are all comparable or alike in that they address CNS suppression and the depression of reflexes. Therefore, eliminate these options.*

89.) A nurse is reviewing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which laboratory test would identify an adverse effect associated with the administration of this medication?
1. Creatinine
2. Liver function tests
3. Blood urea nitrogen
4. Hematological function tests

2. Liver function tests
Rationale:
Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary.
*Eliminate options 1 and 3 because these tests both assess kidney function.*

90.) A nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of the following disorders, if noted in the client's history, would alert the nurse to contact the health care provider?
1. Seizure disorders
2. Hyperthyroidism
3. Diabetes mellitus
4. Coronary artery disease

1. Seizure disorders
Rationale:
Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which of the following disorders, if noted in the client's record, would indicate a need to contact the health care provider regarding the administration of this medication?
1. Glaucoma
2. Emphysema
3. Hyperthyroidism
4. Diabetes mellitus

1. Glaucoma
Rationale:
Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.

92.) In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply.
1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degeneration
4. An increased range of motion in the affected joints 3 months into therapy
5. Inflammation and irritation at the injection site 3 days after injection is given
6. A low-grade temperature upon rising in the morning that remains throughout the day

1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degeneration
4. An increased range of motion in the affected joints 3 months into therapy
Rationale:
Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

93.) The client who is human immunodeficiency virus seropositive has been taking stavudine (d4t, Zerit). The nurse monitors which of the following most closely while the client is taking this medication?
1. Gait
2. Appetite
3. Level of consciousness
4. Hemoglobin and hematocrit blood levels

1. Gait
Rationale:
Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus infection in clients who do not respond to or who cannot tolerate conventional therapy. The medication can cause peripheral neuropathy, and the nurse should monitor the client's gait closely and ask the client about paresthesia. Options 2, 3, and 4 are unrelated to the use of the medication.

94.) The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors which of the following laboratory results during treatment with this medication?
1. Blood culture
2. Blood glucose level
3. Blood urea nitrogen
4. Complete blood count

4. Complete blood count
Rationale:
A common side effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.

95.) The nurse is reviewing the results of serum laboratory studies drawn on a client with acquired immunodeficiency syndrome who is receiving didanosine (Videx). The nurse interprets that the client may have the medication discontinued by the health care provider if which of the following significantly elevated results is noted?
1. Serum protein
2. Blood glucose
3. Serum amylase
4. Serum creatinine

3. Serum amylase
Rationale:
Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased 1.5 to 2 times normal may signify pancreatitis in the client with acquired immunodeficiency syndrome and is potentially fatal. The medication may have to be discontinued. The medication is also hepatotoxic and can result in liver failure.

96.) The nurse is caring for a postrenal transplant client taking cyclosporine (Sandimmune, Gengraf, Neoral). The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What is the vital sign that is most likely increased?
1. Pulse
2. Respirations
3. Blood pressure
4. Pulse oximetry

3. Blood pressure
Rationale:
Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral), and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to the use of this medication.

97.) Amikacin (Amikin) is prescribed for a client with a bacterial infection. The client is instructed to contact the health care provider (HCP) immediately if which of the following occurs?
1. Nausea
2. Lethargy
3. Hearing loss
4. Muscle aches

3. Hearing loss
Rationale:
Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include ototoxicity (hearing problems), confusion, disorientation, gastrointestinal irritation, palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity. The nurse instructs the client to report hearing loss to the HCP immediately. Lethargy and muscle aches are not associated with the use of this medication. It is not necessary to contact the HCP immediately if nausea occurs. If nausea persists or results in vomiting, the HCP should be notified.
*(most aminoglycoside medication names end in the letters -cin)*

98.) The nurse is assigned to care for a client with cytomegalovirus retinitis and acquired immunodeficiency syndrome who is receiving foscarnet. The nurse should check the latest results of which of the following laboratory studies while the client is taking this medication?
1. CD4 cell count
2. Serum albumin
3. Serum creatinine
4. Lymphocyte count

3. Serum creatinine
Rationale:
Foscarnet is 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. Foscarnet may also cause decreased levels of calcium, magnesium, phosphorus, and potassium. Thus these levels are also measured with the same frequency.

99.) The client with acquired immunodeficiency syndrome and Pneumocystis jiroveci infection has been receiving pentamidine isethionate (Pentam 300). The client develops a temperature of 101° F. The nurse does further monitoring of the client, knowing that this sign would most likely indicate:
1. The dose of the medication is too low.
2. The client is experiencing toxic effects of the medication.
3. The client has developed inadequacy of thermoregulation.
4. The result of another infection caused by leukopenic effects of the medication.

4. The result of another infection caused by leukopenic effects of the medication.
Rationale:
Frequent side effects of this medication include leukopenia, thrombocytopenia, and anemia. The client should be monitored routinely for signs and symptoms of infection. Options 1, 2, and 3 are inaccurate interpretations.

100.) Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virus seropositive. The nurse reinforces medication instructions and tells the client to:
1. Avoid sun exposure.
2. Eat low-calorie foods.
3. Eat foods that are low in fat.
4. Take the medication on an empty stomach.

1. Avoid sun exposure.
Rationale:
Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral medications to manage human immunodeficiency virus infection. Saquinavir is administered with meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.

101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select the interventions that the nurse includes when administering this medication. Select all that apply.
1. Restrict fluid intake.
2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
4. Administer the medication with an antacid.
5. Instruct the client to avoid exposure to the sun.
6. Administer the medication on an empty stomach.

2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
5. Instruct the client to avoid exposure to the sun.
Rationale:
Ketoconazole is an antifungal medication. It is administered with food (not on an empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption. The medication is hepatotoxic and the nurse monitors liver function studies. The client is instructed to avoid exposure to the sun because the medication increases photosensitivity. The client is also instructed to avoid alcohol. There is no reason for the client to restrict fluid intake. In fact, this could be harmful to the client.

102.) A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which adverse effects of the medication? Select all that apply.
1. Rash
2. Hepatotoxicity
3. Hyperglycemia
4. Peripheral neuropathy
5. Reduced bone mineral density

1. Rash
2. Hepatotoxicity
Rationale:
Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not adverse effects of this medication.

103.) A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication?
1. Platelet count
2. Cholesterol level
3. White blood cell count
4. Blood urea nitrogen level

3. White blood cell count
Rationale:
Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.

104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication?
1. A history of hyperthyroidism
2. A history of diabetes insipidus
3. When the last full meal was consumed
4. When the last alcoholic drink was consumed

4. When the last alcoholic drink was consumed
Rationale:
Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

105.) A nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication?
1. Dementia
2. Schizophrenia
3. Seizure disorder
4. Obsessive-compulsive disorder

1. Dementia
Rationale:
Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease. Options 2, 3, and 4 are incorrect.

106.) Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication?
1. "I should take the medication with my evening meal."
2. "I should take the medication at noon with an antacid."
3. "I should take the medication in the morning when I first arise."
4. "I should take the medication right before bedtime with a snack."

3. "I should take the medication in the morning when I first arise."
Rationale:
Fluoxetine hydrochloride is administered in the early morning without consideration to meals.
*Eliminate options 1, 2, and 4 because they are comparable or alike and indicate taking the medication with an antacid or food.*

107.) A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan?
1. Reports not going to work for this past week
2. Complains of not being able to "do anything" anymore
3. Arrives at the clinic neat and appropriate in appearance
4. Reports sleeping 12 hours per night and 3 to 4 hours during the day

3. Arrives at the clinic neat and appropriate in appearance
Rationale:
Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints as well as demonstrate an improvement in their appearance.

108.) A 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 gather regarding the adverse effects related to the medication?
1. Cardiovascular symptoms
2. Gastrointestinal dysfunctions
3. Problems with mouth dryness
4. Problems with excessive sweating

2. Gastrointestinal dysfunctions
Rationale:
The most common adverse effects related to fluoxetine include central nervous system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4 are not adverse effects of this medication.

109.) A client taking buspirone (BuSpar) for 1 month returns to the clinic for a follow-up visit. Which of the following would indicate medication effectiveness?
1. No rapid heartbeats or anxiety
2. No paranoid thought processes
3. No thought broadcasting or delusions
4. No reports of alcohol withdrawal symptoms

1. No rapid heartbeats or anxiety
Rationale:
Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression.

110.) A client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up and the level is 3.0 mEq/L. The nurse knows that this level is:
1. Toxic
2. Normal
3. Slightly above normal
4. Excessively below normal

1. Toxic
Rationale:
The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity.

111.) A client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of bupropion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following?
1. Insomnia
2. Weight gain
3. Seizure activity
4. Orthostatic hypotension

3. Seizure activity
Rationale:
Bupropion does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect, but seizure activity causes a greater client risk.

112.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. The nurse instructs the client to avoid consuming which foods while taking this medication? Select all that apply.
1. Figs
2. Yogurt
3. Crackers
4. Aged cheese
5 Tossed salad
6. Oatmeal cookies

1. Figs
2. Yogurt
4. Aged cheese
Rationale:
Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The client should avoid taking in foods that are high in tyramine. Use of these foods could trigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, and figs.

113.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following would be included in the plan of care for instructions?
1. Maintain a high fluid intake.
2. Discontinue the medication when feeling better.
3. If the urine turns dark brown, call the health care provider immediately.
4. Decrease the dosage when symptoms are improving to prevent an allergic response.

1. Maintain a high fluid intake.
Rationale:
Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause the urine to turn dark brown or red. This does not indicate the need to notify the health care provider.

114.) A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client?
1. Ondansetron (Zofran)
2. Simethicone (Mylicon)
3. Acetaminophen (Tylenol)
4. Magnesium hydroxide (milk of magnesia, MOM)

2. Simethicone (Mylicon)
Rationale:
Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Ondansetron is used to treat postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.

115.) A client received 20 units of NPH insulin subcutaneously at 8:00 AM. The nurse should check the client for a potential hypoglycemic reaction at what time?
1. 5:00 PM
2. 10:00 AM
3. 11:00 AM
4. 11:00 PM

1. 5:00 PM
Rationale:
NPH is intermediate-acting insulin. Its onset of action is 1 to 2½ hours, it peaks in 4 to 12 hours, and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.

116.) A nurse administers a dose of scopolamine (Transderm-Scop) to a postoperative client. The nurse tells the client to expect which of the following side effects of this medication?
1. Dry mouth
2. Diaphoresis
3. Excessive urination
4. Pupillary constriction

1. Dry mouth
Rationale:
Scopolamine is an anticholinergic medication for the prevention of nausea and vomiting that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options describe the opposite effects of cholinergic-blocking agents and therefore are incorrect.

117.) A nurse has given the client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client immediately reports:
1. Impaired sense of hearing
2. Distressing gastrointestinal side effects
3. Orange-red discoloration of body secretions
4. Difficulty discriminating the color red from green

4. Difficulty discriminating the color red from green
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

118.) A nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates that further teaching is necessary?
1. "I rest each afternoon after my walk."
2. "I cough and deep breathe many times during the day."
3. "If I get abdominal cramps and diarrhea, I should call my doctor."
4. "I can change the time of my medication on the mornings that I feel strong."

4. "I can change the time of my medication on the mornings that I feel strong."
Rationale:
The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If not given on time, the client may become too weak to swallow. Options 1, 2, and 3 include the necessary information that the client needs to understand to maintain health with this neurological degenerative disease.

119.) A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which of the following is the most reliable indicator of hypoglycemia?
1. Sweating
2. Tachycardia
3. Nervousness
4. Low blood glucose level

4. Low blood glucose level
Rationale:
β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.

120.) A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. The nurse advises the client to take which of the following products if needed for a headache?
1. Naprosyn (Aleve)
2. Ibuprofen (Advil)
3. Acetaminophen (Tylenol)
4. Acetylsalicylic acid (aspirin)

3. Acetaminophen (Tylenol)
Rationale:
Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory drugs (ibuprofen). The client should be advised to take acetaminophen for headache.
*Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate options 1 and 2 first.*

121.) A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. The nurse formulates a response, based on the understanding that:
1. Both are weak potassium-losing diuretics.
2. The combination of these medications prevents renal toxicity.
3. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective.
4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.

4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.
Rationale:
Potassium-sparing diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-losing diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics.
*It is especially helpful to remember that hydrochlorothiazide is a potassium-losing diuretic and triamterene is a potassium-sparing diuretic*

122.) A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. The nurse provides the best support to the client by:
1. Telling the client not to take the medication with food
2. Suggesting that the client taper the dose until taste returns to normal
3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months
4. Requesting that the health care provider (HCP) change the prescription to another brand of angiotensin-converting enzyme (ACE) inhibitor

3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months
Rationale:
ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without HCP approval and the medication should never be stopped abruptly.

123.) A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse plans to check which of the following before giving the medication?
1. Respiratory rate
2. Blood pressure and heart rate
3. Heart rate and respiratory rate
4. Level of consciousness and blood pressure

2. Blood pressure and heart rate
Rationale:
Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction.
*amlodipine is a calcium channel blocker, and this group of medications decreases the rate and force of cardiac contraction. This in turn lowers the pulse rate and blood pressure.*

124.) A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitors the client for which common side effect associated with this medication?
1. Diarrhea
2. Weakness
3. Headache
4. Constipation

4. Constipation
Rationale:
Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipation.
*Focus on the name of the medication. Recalling that oral iron can cause constipation will easily direct you to the correct option.*

125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication?
1. Heart rate
2. Temperature
3. Respirations
4. Blood pressure

1. Heart rate
Rationale:
Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the registered nurse, who would then contact the health care provider.

126.) A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply.
1. Nausea
2. Tinnitus
3. Hypotension
4. Hypokalemia
5. Photosensitivity
6. Increased urinary frequency

2. Tinnitus
3. Hypotension
4. Hypokalemia
Rationale:
Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

127.) The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teaching when the client states which of the following?
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."

1. "I can skip a dose once a week."
Rationale:
Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific client teaching points include taking one pill a day, not stopping the medication without consulting the health care provider (HCP), and monitoring for side effects and adverse reactions. The client should notify the HCP if side effects occur.

128.) A nurse is providing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which of the following statements indicates that the client understands the instructions?
1. "I will never be able to drive a car."
2. "My anticonvulsant medication will clear up my skin."
3. "I can't drink alcohol while I am taking my medication."
4. "If I forget my morning medication, I can take two pills at bedtime."

3. "I can't drink alcohol while I am taking my medication."
Rationale:
Alcohol will lower the seizure threshold and should be avoided. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants cause acne and oily skin; therefore a dermatologist may need to be consulted. If an anticonvulsant medication is missed, the health care provider should be notified.

129.) Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the registered nurse if which diagnosis is documented in the client's history?
1. Gout
2. Asthma
3. Thrombophlebitis
4. Myocardial infarction

3. Thrombophlebitis
Rationale:
Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis.
*megestrol acetate is a hormonal antagonist enzyme and that a side effect is thrombotic disorders*

130.) The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy?
1. Anemia
2. Decreased platelets
3. Increased uric acid level
4. Decreased leukocyte count

3. Increased uric acid level
Rationale:
Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in a massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

131.) The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Neosar). The nurse tells the client to:
1. Take the medication with food.
2. Increase fluid intake to 2000 to 3000 mL daily.
3. Decrease sodium intake while taking the medication.
4. Increase potassium intake while taking the medication.

2. Increase fluid intake to 2000 to 3000 mL daily.
Rationale:
Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

132.) The client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which of the following would indicate to the nurse that the client is experiencing a toxic effect related to the medication?
1. Fever
2. Diarrhea
3. Complaints of nausea and vomiting
4. Crackles on auscultation of the lungs

4. Crackles on auscultation of the lungs
Rationale:
Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting are frequent side effects associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect, and diarrhea can occur occasionally. The other options, however, are not toxic effects.
*keep in mind that the question is asking about a toxic effect and think: ABCs—airway, breathing, and circulation*

133.) A nurse is monitoring a client receiving desmopressin acetate (DDAVP) for adverse effects to the medication. Which of the following indicates the presence of an adverse effect?
1. Insomnia
2. Drowsiness
3. Weight loss
4. Increased urination

2. Drowsiness
Rationale:
Water intoxication (overhydration) or hyponatremia is an adverse effect to desmopressin. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma also may occur in overhydration.
*Recall that this medication is used to treat diabetes insipidus to eliminate weight loss and increased urination.*

134.) A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication:
1. With food
2. At lunchtime
3. On an empty stomach
4. At bedtime with a snack

Rationale:
Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.
*Note that options 1, 2, and 4 are comparable or alike in that these options address administering the medication with food.*

135.) A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs?
1. Fatigue
2. Tremors
3. Cold intolerance
4. Excessively dry skin

2. Tremors
Rationale:
Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

136.) A nurse performs an admission assessment on a client who visits a health care clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of:
1. Myxedema
2. Graves' disease
3. Addison's disease
4. Cushing's syndrome

2. Graves' disease
Rationale:
PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves' disease. Myxedema indicates hypothyroidism.
Cushing's syndrome and Addison's disease are disorders related to adrenal function.

137.) A nurse is reinforcing instructions for a client regarding intranasal desmopressin acetate (DDAVP). The nurse tells the client that which of the following is a side effect of the medication?
1. Headache
2. Vulval pain
3. Runny nose
4. Flushed skin

3. Runny nose
Rationale:
Desmopressin administered by the intranasal route can cause a runny or stuffy nose. Headache, vulval pain, and flushed skin are side effects if the medication is administered by the intravenous (IV) route.

138.) A daily dose of prednisone is prescribed for a client. A nurse reinforces instructions to the client regarding administration of the medication and instructs the client that the best time to take this medication is:
1. At noon
2. At bedtime
3. Early morning
4. Anytime, at the same time, each day

3. Early morning
Rationale:
Corticosteroids (glucocorticoids) should be administered before 9:00 AM. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.
*Note the suffix "-sone," and recall that medication names that end with these letters are corticosteroids.*

139.) Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone?
1. An additional dose of prednisone daily
2. A decreased amount of daily Humulin NPH insulin
3. An increased amount of daily Humulin NPH insulin
4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily Humulin NPH insulin
Rationale:
Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore the other options are incorrect.

140.) The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition?
1. Intestinal obstruction
2. Peptic ulcer with melena
3. Diverticulitis with perforation
4. Vomiting following cancer chemotherapy

4. Vomiting following cancer chemotherapy
Rationale:
Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

141.) The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions?
1. "I will continue taking vitamin supplements."
2. "This medication will help lower my cholesterol."
3. "This medication should only be taken with water."
4. "A high-fiber diet is important while taking this medication."

3. "This medication should only be taken with water."
Rationale:
Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.
*Note the closed-ended word "only" in option 3*

142.) A health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which of the following times?
1. At bedtime
2. After lunch
3. With supper
4. Before breakfast

1. At bedtime
Rationale:
A single daily dose of ranitidine is usually scheduled to be given at bedtime. This allows for a prolonged effect, and the greatest protection of the gastric mucosa.
*recall that ranitidine suppresses secretions of gastric acids*

143.) A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of:
1. Heartburn
2. Constipation
3. Abdominal pain
4. Nausea and vomiting

4. Nausea and vomiting
Rationale:
Trimethobenzamide is an antiemetic agent used in the treatment of nausea and vomiting. The other options are incorrect.

144.) A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication?
1. Abdominal pain
2. Reduction in steatorrhea
3. Hematest-negative stools
4. Regular bowel movements

4. Regular bowel movements
Rationale:
Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not relieve abdominal pain, stop gastrointestinal (GI) bleeding, or decrease the amount of fat in the stools.

145.) A nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (nasal inhalation, two puffs), by metered-dose inhaler. The nurse administers the medication by giving the:
1. Albuterol first and then the beclomethasone dipropionate
2. Beclomethasone dipropionate first and then the albuterol
3. Alternating a single puff of each, beginning with the albuterol
4. Alternating a single puff of each, beginning with the beclomethasone dipropionate

1. Albuterol first and then the beclomethasone dipropionate
Rationale:
Albuterol is a bronchodilator. Beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

146.) A client has begun therapy with theophylline (Theo-24). The nurse tells the client to limit the intake of which of the following while taking this medication?
1. Oranges and pineapple
2. Coffee, cola, and chocolate
3. Oysters, lobster, and shrimp
4. Cottage cheese, cream cheese, and dairy creamers

2. Coffee, cola, and chocolate
Rationale:
Theophylline is a xanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These include coffee, cola, and chocolate.

147.) A client with a prescription to take theophylline (Theo-24) daily has been given medication instructions by the nurse. The nurse determines that the client needs further information about the medication if the client states that he or she will:
1. Drink at least 2 L of fluid per day.
2. Take the daily dose at bedtime.
3. Avoid changing brands of the medication without health care provider (HCP) approval.
4. Avoid over-the-counter (OTC) cough and cold medications unless approved by the HCP.

2. Take the daily dose at bedtime.
Rationale:
The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the physician before changing brands of the medication. The client also checks with the HCP before taking OTC cough, cold, or other respiratory preparations because they could cause interactive effects, increasing the side effects of theophylline and causing dysrhythmias.

148.) A client is taking cetirizine hydrochloride (Zyrtec). The nurse checks for which of the following side effects of this medication?
1. Diarrhea
2. Excitability
3. Drowsiness
4. Excess salivation

3. Drowsiness
Rationale:
A frequent side effect of cetirizine hydrochloride (Zyrtec), an antihistamine, is drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating.

149.) A client taking fexofenadine (Allegra) is scheduled for allergy skin testing and tells the nurse in the health care provider's office that a dose was taken this morning. The nurse determines that:
1. The client should reschedule the appointment.
2. A lower dose of allergen will need to be injected.
3. A higher dose of allergen will need to be injected.
4. The client should have the skin test read a day later than usual.

1. The client should reschedule the appointment.
Rationale:
Fexofenadine is an antihistamine, which provides relief of symptoms caused by allergy. Antihistamines should be discontinued for at least 3 days (72 hours) before allergy skin testing to avoid false-negative readings. This client should have the appointment rescheduled for 3 days after discontinuing the medication.

See More

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set