1. A client with myasthenia gravis reports the occurrence of difficulty chewing.

The physician
prescribes pyridostigmine bromide (Mestinon) to increase muscle strength for this activity. The
nurse instructs the client to take the medication at what time, in relation to meals?
a. after dinner daily when most fatigued
b. before breakfast daily
c. as soon as arising in the morning
d. thirty minutes before each meal
(Rationale: the client will have more energy to eat during meals and avoid aspiration )

2. A client is advised to take senna (Senokot) for the treatment of constipation asks the nurse
how this medication works. The nurse responds knowing that it:
a. accumulates water in the stool and increases peristalsis
b. stimulates the vagus nerve
c. coats the bowel wall (Emollients/Stool softeners)
d. adds fiber and bulk to the stool (Bulk-forming laxatives)
(Rationale: Senna is a stimulant laxative which stimulates motility of large intestines )

3. A client is receiving heparin sodium by continuous intravenous infusion. The nurse monitors
the client for which adverse effect of this therapy?
a. decreased blood pressure
b. increased pulse rate
c. ecchymoses
d. tinnitus
(Rationale: Heparin is an anticoagulant where it has a risk for bleeding. S/sx of bleeding are:
melena, bleeding gums, ecchymosis, hematochezia, hematuria, hematoma, etc. )

4. A client is being treated for acute congestive heart failure (CHF) and the client’s vital signs
are as follows: BP 85/50 mm Hg; pulse, 96 bpm; respirations, 26 cpm. The physician prescribes
digoxin (Lanoxin). To evaluate a therapeutic effectiveness of this medication, the nurse would
expect which of the following changes in the client’s vital signs? *
a. BP 85/50 mm Hg, pulse 60 bpm, respirations 26 cpm
b. BP 98/60 mm Hg, pulse 80 bpm, respirations 24 cpm
c. BP 130/70 mm Hg, pulse 104 bpm, respirations 20 cpm
d. BP 110/40 mm Hg, 110 bpm, respirations 20 cpm
(Rationale: digoxin has a positive inotrtopic effect: increases myocardial contraction; and
negative chronotropic effect: decreases heart rate.)

5. Diazepam (Valium) is prescribed for a client with anxiety. The nurse instructs the client to
expect which side effect? *
a. incoordination
b. cough
c. tinnitus
d. hypertension
(Rationale: Diazepam depresses the CNS levels which affects the signaling impulses
throughout the body)

6. A client receives oxytocin (Pitocin) to induce labor. During the administration of the oxytocin,
it is most important for the nurse to monitor: *
a. urinary output
b. fetal heart rate
c. central venous pressure
d. maternal blood glucose
(Rationale: Oxytocin increases uterine contractions which causes decrease placental blood
flow affecting the fetal heart rate)

7. A clinic nurse is performing assessment on a client who is being seen in the clinic for the first
time. When asking about the client’s medication history, the client tells the nurse that he takes
nateglinide (Starlix). The nurse then questions the client about the presence of which disorder
that is treated with this medication? *
a. hypothyroidism
b. insomnia
c. type 2 diabetes mellitus
d. renal failure
(Rationale: Nateglinide (Starlix) is an oral hypoglycemic agent in treating type 2 DM. it
stimulates the release of beta cells in the pancreas)

8. A client who is taking rifampin (Rifadin) as part of the medication regimen for the treatment
of tuberculosis calls the clinic nurse and reports that her urine is a red-orange color. The nurse
tells the client to: *
a. come to the clinic to provide a urine sample
b. stop the medication until further instructions are given by the physician
c. take the medication dose with an antacid to prevent this adverse effect
d. expect a red-orange color in urine, feces, sweat, sputum, and tears as a harmless side
effect
(Rationale: Rifampicin S/E consists of reddish orange secretion and hepatotoxic)

9. A nurse is caring for a client with a tracheostomy that has been diagnosed with a respiratory
infection. The client is receiving vancomycin hydrochloride (Vancocin) 500 mg intravenously
every 12 hours. Which of the following would indicate to the nurse that the client is experiencing
an adverse effect of the medication? *
a. decreased hearing acuity
b. photophobia
c. hypotension
d. bradycardia
(Rationale: Vancomycin S/E are ototoxic and nephrotoxic)

10. A nurse is caring for a client with a diagnosis of metastatic breast carcinoma who is receiving
tamoxifen citrate (Nolvadex) 10 mg orally twice daily. Which of the following would indicate
to the nurse that the client is experiencing a side effect related to the medication? *
a. hypetension
b. diarrhea
c. nose bleeds
d. vaginal bleeding
(Rationale: Breast cancer increases estrogen levels which causes early menarche and late
menopause. Tamoxifen is an anti-estrogen drug which has a side effect of menstrual-like
symptoms: hot flashes, vaginal bleeding, nausea & vomiting, pruritus)

11. A client has just been given a prescription for diphenoxylate with atropine (Lomotil). The
nurse teaches the client which of the following about the use of this medication? *
a. drooling may occur while taking this medication (Lomotil causes dry mouth)
b. irritability may occur while taking this medication (Lomotil causes drowsiness)
c. this medication contains a habit-forming ingredient
d. take the medication with a laxative of choice
(Rationale: Lomotil is an anti-diarrheal medication. Also, it has the risk of becoming habit-
forming.)

12. A nurse is gathering data from client about the client’s medication history and notes that the
client is taking tolterodine tartrate (Detrol LA). The nurse determines that the client is taking the
medication to treat which disorder? *
a. glaucoma (Contraindicated to Detrol LA)
b. renal insufficiency
c. pyloric stenosis
d. urinary frequency and urgency
(Rationale: In urinary frequency and urgency, the overactive urinary bladder is contracting
continuously or in spasms. Tolterodine tartrate (Detrol LA) is an antispasmodic.
13. A client has an order to receive psyllium (Metamucil) daily. The nurse administers this
medication with: *
a. a multivitamin and mineral supplement
b. a dose of an antacid
c. applesauce
d. eight ounces of liquid
(Rationale: Metamucil is a bulk-forming laxative is best taken with oral fluids to aid the patient
in bowel movement and prevent drug-induced esophagitis.)

14. A nurse is teaching a client taking cyclosporine (Sandimmune) after renal transplant about
medication information. The nurse tells the client to be especially alert for: *
a. signs of infection
b. hypotension
c. weight loss
d. hair loss
(Rationale: Cyclosporine is an immunosuppressant and it is taken for post renal transplant
patients. The immune system is depressed which is likely to have a risk of an infection.)

15. A nurse reinforces dietary instruction for the client receiving spironolactone (Aldactone).
Which food would the nurse instruct the client to avoid while taking this medication? *
a. crackers (Sodium-based food)
POTASSIUM-RICHED FOODS: 9) avocado,
b. shrimp (Sodium based food)
c. apricots 1) Bananas 10) cantaloupe,
d. popcorn (Sodium based food) 2) Legumes 11) strawberries,
3) Potatoes 12) carrots
(Rationale: Aldactone is a potassium-sparing 4) Oranges
diuretic. Patients taking Aldactone is in a low 5) Apricots
potassium diet.)
6) Spinach
16. Oral lactulose (Chronulac) is prescribed 7) Tomatoes
8) Raisins
for the client with a hepatic disorder and the
nurse provides instructions to the client
regarding this medication. Which statement by the client indicates a need for further
instructions? *
a. “I need to take the medication with water’”
b. “ I need to increase fluid intake while taking the medication”
c. “ I need to increase fiber in the diet”
d. “I need to notify the physician of nausea occurs”
(Rationale: Nausea is an expected side effect of Lactulose. Lactulose decreases ammonia in the
body.)
17. A home care nurse provides instructions to a client taking digoxin (Lanoxin) 0.25 mg daily.
Which statement by the client indicates a need for further instructions? *
a. “I will take my prescribed antacid if I become nauseated”
b. “It is important to have my blood drawn when prescribed”
c. “I will check my pulse before I take my medication”
d. “I will carry a medication identification card with me”
(Rationale: Antacids is not advisable when nauseated because it neutralizes the hydrochloric
acid in the stomach)

HOME CARE INSTRUCTIONS FOR DIGOXIN ADMINISTRATION:

1) Administer as prescribed
2) Before administration, check apical pulse for MEDICATIONS
one full minute. THAT CANNOT BE
CRUSHED:
3) Administer 1 hour or 2 hours after feedings (empty stomach)
1) Sustained release (SA)
4) Do not mix medication with foods or fluid 2) Extended release (XR)
5) If a dose is missed (>4 hours), withhold and give 3)
nextEnteric
dose atcoated (EC)
the scheduled time
6) 4) Long-acting
If a dose is missed (<4 hours), administer the missed dose LA)
5) Controlled release (CD)
7) If a child vomits, do not administer second dose. Follow HCP’s prescriptions.
8) If more than 2 consecutive doses have been missed, notify HCP.
9) Do not increase or double the dose for missed doses.
10) If child has teeth, give water after medication. After that, if possible, brush teeth to
prevent tooth decay from the sweetened liquid.
11) Monitor for signs of toxicity (poor feeding, vomiting)
12) If child is becoming ill: notify the HCP.
13) Keep medication in a locked cabinet.

18. A client with anxiety disorder is taking buspirone (BuSpar) and tells the nurse that it is
difficult to swallow the tablets. The nurse tells the client to: *
a. dissolve the tablet in a cup of coffee
b. crush the tablet before taking it
c. call the physician for a change in medication
d. mix the tablet uncrushed in custard
(Rationale: Buspirone tablets can be crushed.)

19. A nurse is caring for a child with CHF provides instructions to the parents regarding the
administration of digoxin (Lanoxin). Which statement by the mother indicates a need for
further instructions? *
a. “If my child vomits after I give the medication, I will not repeat the dose” (We never know
how many amount of medication has been absorbed)
b. “I will check my child’s pulse before giving the medication”
c. “I will check the dose of the medication with my husband before I give the medication”
d. “I will mix the medication with food”
(Rationale: Digoxin is not advisable to be mixed with other foods.)

20. A nurse provides instructions to a client who will begin an oral contraceptives. Which
statement by the client indicates the need for further instructions? *
a. “I will take one pill daily at the same time every day” (To maintain the drug level in the body)
b. “I will not need to use an additional birth control method once I start these pills”
c. “If I miss a pill I need to take it as soon as I remember”
d. “If I miss two pills I will take them both as soon as I remember and I will take two pills the
next day also”
(Rationale: You still need to use additional birth control to maintain the first menstrual cycle’s
increase of hormonal stability. It needs to finish the one cycle first.)

NOTE: If missed more than 2 pills, discontinue the cycle and start it over again.

21. A nurse provides instructions to a client taking clorazepate (Tranxene) for management of
an anxiety disorder. The nurse tells the client that: *
a. drowsiness is a side effect that usually disappears with continued therapy
b. if dizziness occurs, call the physician (It is an expected side effect for which it depresses
CNS levels)
c. smoking increases the effectiveness of the medication (smoking is never beneficial to the
medication, as well as the patient)
d. if gastrointestinal disturbances occur, discontinue the medication (GI disturbance is a side
effect. No need for discontinuation)
(Rationale: Clorazepate (Tranxene) is an anxiolytic and a benzodiazepine which decreases
CNS levels.)

22. A client with Parkinson’s disease has begun therapy with levodopa (L-dopa). The nurse
determines that the client understands the action of the medication if the client verbalizes that
results may not be apparent for: *
a. 24 hours
b. Two to three days
c. One week
d. Two to three weeks
(Rationale: Levodopa has a long therapeutic effect which takes about 2-3 weeks)

23. A nurse in a physician’s office is reviewing the results of a client’s phenytoin (Dilantin) level
drawn that morning. The nurse determines that the client has a therapeutic drug level if the
client’s result was: *
a. 3 mcg/ml
b. 8 mcg/ml
c. 15 mcg/ml
d. 24mcg/ml
(Rationale: Phenytoin’s (Dilantin) normal levels are 10-20 mcg/mL.)

24. A nurse is caring for a client with a genitourinary tract infection receiving amoxicillin
(Augmentin) 500 mg every 8 hours. Which of the following would indicate to the nurse that the
client is experiencing an adverse effect related to the medication? *
a. hypertension
b. nausea
c. headache
d. watery diarrhea
(Rationale: Amoxicillin is a broad-spectrum antibiotic. Adverse effect of broad-spectrum
antibiotics is superinfection/Antibiotic-induced colitis which is observed with diarrhea,
constipation and other GI-related symptoms)

25. A nurse is caring for a client with glaucoma who receives a daily dose of acetazolamide
(Diamox). Which of the following would indicate to the nurse that the client is experiencing an
adverse effect of the medication? *
a. constipation
b. difficulty swallowing
c. dark-colored urine and stools
d. irritability
(Rationale: Acetalazomide (Diamox) is a carbonic anhydrase inhibitor which decreases
formation of aqueous humor in eye. A/E of this drug is nephrotoxic and hepatotoxic.)

26. A nurse is caring for a client with a diagnosis of meningitis who is receiving amphotericin B
(Fungizone) intravenously. Which of the following would indicate to the nurse that the client is
experiencing an adverse effect related to the medication? *
a. nausea
b. decreased urinary output
 c. muscle weakness
d. confusion
(Rationale: Amphotericin B (Fungizone) is an antifungal for first line systemic fungal infection.
A/E of this drug is nephrotoxic)

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image for a client who is
taking spironolactone (Aldactone). The nurse based this diagnosis on assessment of which side
effect of the medication? *
a. edema
b. weight gain
c. excitability
d. decreased libido

DRUG CLINICAL ACTION THERAPEUTIC SIDE EFFECTS

EFFECT
Spironolactone  K+ sparing  interferes Na+  diuresis  Hyperkalemia (in
diuretic reabsorption  lowers BP patients with renal
 Antihypertensive  inhibits action insufficiency, taking
of aldosterone K+ supplements)
 promotes Na+  Dehydration
and water  Hyponatremia
excretion  Lethargy
 increases SEXUAL S/E:
potassium For Males:
retention  Gynecomastia
 Impotence
 Decreased libido
For Females:
 Menstrual
irregularities
 Breast tenderness

28. A nurse is caring for the client with a history of mild heart failure who is receiving diltiazem
hydrochloride (Cardizem) for hypertension. The nurse would assess the client for: *
a. bradycardia
b. wheezing
c. peripheral edema and weight gain
d. apical pulse rate lower than baseline
(Rationale: Diltiazem hydrochloride (Cardizem) is a calcium channel blocker which blocks the
calcium to the blood vessels: inhibiting constriction, causing hypertension; and the heart: slows
contraction, causing decrease cardiac conduction)

29. The wound of a client with an extensive burn injury is being treated with the application of
silver sulfadiazine (Silvadene). Which symptom would indicate to the nurse that the client is
experiencing a side effect related to systemic absorption? *
a. pain at the wound site (Local)
b. burning and itching at the wound site (Local)
c. a localized rash (Local)
d. photosensitivity
(Rationale: Side effect related to systemic absorption of Silver sulfadiazine (Silvadene) is
affecting CNS levels spread throughout.)

30. A nurse is caring for a client with a diagnosis of rheumatoid arthritis who is receiving
sulindac (Clinoril) 150 mg po twice daily. Which finding would indicate to the nurse that the
client is experiencing a side effect related to the medication? *
a. diarrhea
b. photophobia
c. fever
d. tingling in the extremities
(Rationale: Sulindac (Clinoril) is a non-steroidal anti-inflammatory drug (NSAID) which is
taken with food to prevent irritation of the GI lining)

31. The nurse notes that the client is receiving filgrastim (Neupogen). The nurse checks which
of the following to determine medication effectiveness? *
a. neutrophil count
b. platelet count
c. blood urea nitrogen
d. creatinine level
(Rationale: Filgrastim (Neupogen) is a biologic modifier that stimulates production and
maturation of neutrophils)

32. A nurse is monitoring a client who is taking fluphenazine decanoate (Prolixin) for signs of
leucopenia. Which finding indicates a sign of this blood dyscrasia? *
a. blurred vision
DYSCRASIA:
b. constipation
c. sore throat  An abnormal condition of the body and
especially the blood.
d. dry mouth
(Rationale: Leukopenia is an abnormally low leukocytes which can cause infection.)

33. A nurse is administering amphotericin B (Fungizone) to a client intravenously to treat a

fungal infection. The nurse monitors the result of which electrolyte study during therapy with
this medication? *
a. sodium
b. potassium
c. calcium
d. chloride
(Rationale: Amphotericin B (Fungizone) is an antifungal medication which has a high risk of
hyperkalemia. This is prescribed biweekly during therapy)

34. A clinic nurse asks a client with diabetes mellitus being seen in the clinic for the first time
to list the medications that she is taking. Which combination of medications taken by the client
should the nurse report to the physician? *
a. Acetohexamide (Dymelor) and trimethoprim-sulfamethoxazole (Bactrim)
b. Chlorpropamide (Diabenase) and amitriptyline (Elavil)
c. Glyburide (DiaBeta) and Lanoxin (Digoxin)
d. Tolbutamide (Orinase) and amoxicillin (Amoxil)
(Rationale: Antidiabetics is not advisable to be taken with sulfonylureas because sulfonamides
potentiate the blood sugar lowering activity which has a high risk of hypoglycemia)

35. A nurse is caring for a client receiving streptogramin (Synercid) by intravenous intermittent
infusion for the treatment of a bone infection develops diarrhea. Which nursing action would the
nurse implement? *
a. administer an antidiarrheal agent
b. notify the physician
c. discontinue the medication
d. monitor the client’s temperature
(Rationale: Streptogramin (Synercid) is a broad-spectrum antibiotic. Adverse effect of broad-
spectrum antibiotics is superinfection/Antibiotic-induced colitis which is observed with
diarrhea, constipation and other GI-related symptoms)

36. A client has been taking fosinopril (Monopril) for 2 months. The nurse determines that the
client is having the intended effects of therapy if the nurse notes which of the following? *
a. lowered BP
b. lowered pulse rate
c. increased WBC
d. increased monocyte count
(Rationale: Fosinopril (Monopril) is an ACE inhibitor and an antihypertensive which lowers
BP)

37. A client is taking labetalol (Normodyne). The nurse monitors the client for which frequent
side effect of the medication? *
a. tachycardia (Beta blockers causes bradycardia)
b. impotence
c. increased energy level (Beta blockers lower energy levels)
d. night blindness (Not related to beta blockers)
(Rationale: Labetalol (Normodyne) is a beta blocker which inhibit the release the
catecholamines (epinephrine & norepinephrine)

38. An older client has been using cascara sagrada on a long-term basis. The nurse determines
that which laboratory result is a result of the side effects of this medication? *
a. Sodium 135 mEq/L (Normal)
(N) Sodium: 135-145 mEq/L
b. Sodium 145 mEq/L (Normal)
c. Potassium 3.1 mEq/L (Low – Hypokalemia) (N) Potassium: 3.5-5.1 mEq/L
d. Potassium 5.0 mEq/L (Normal)
(Rationale: Cascara sagrada is an herbal laxative that treats constipation which in a long
term use can cause hypokalemia.)

39. A client has an order to begin short-term therapy with enoxaparin (Lovenox). The nurse
explains to the client that this medication is being ordered to: *
a. dissolve urinary calculi
b. reduce the risk of deep vein thrombosis
c. relieve migraine headaches
d. stop progression of multiple sclerosis
(Rationale: Enoxaparin (Lovenox) is a low-molecular-weight heparin (LMWH) in prevention
and management of various thromboembolic disorders)

40. Quinidine gluconate (Dura Quin) is prescribed for a client. The nurse reviews the client’s
medical record, knowing that which of the following is a contraindication in the use of this
medication? *
a. complete atrioventricular (AV) block (complete blockage = decrease conduction)
b. muscle weakness
c. asthma
d. infection
(Rationale: In complete AV block, it decreases conduction. If given with Quinidine, it
potentiates even further the decrease of conduction, having a high risk of HF)
ANTIDYSRHYTHMICS
DRUG ACTIONS
CLASS I 1) Quinidine Block fast sodium current
2) Procainamide (hence slow conduction)
3) Disopyramide
4) Lignocaine Indications:
5) Mexiletine Atrial Fibrillation
6) Flocainide Atrial Flutter
7) Propafenone
CLASS II 1) β – adrenoceptor Block effects of
blockers catecholamines
CLASS III 1) Amiodarone Prolong action potential and
2) Sotalol hence refractoriness by
blocking K+ current
CLASS IV 1) Verapamil Block cardiac calcium
2) Diltiazem channel

41. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client that
this medication should do which of the following? *
a. take away nausea and vomiting
ANTITUSSIVE:
b. calm the persistent cough
c. decrease anxiety level  Inhibits intensity of cough without
d. increase comfort level phlegm.
EXPECTORANT:
(Rationale: Benzonatate (Tessalon) is an  Expectorates phlegm
antitussive)

42. Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the nurse
monitors the client for signs of an adverse effect related to the medication. Which of the
following indicates an adverse effect? *
a. nausea
b. diarrhea
c. anorexia
d. proteinuria
(Rationale: Auranofin (Ridaura) is a gold preparation of antirheumatics. A/E are decrease
Hgb, leukopenia, hematuria, proteinuria, nephrotic syndrome and stomatitis)

43. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril).

The nurse tells the client: *
a. to take the medication with food only
b. to rise slowly from a lying to a sitting position
c. to discontinue the medication if nausea occurs
d. that a therapeutic effect will be noted immediately
(Rationale: Quinapril hydrochloride (Accupril) is an ACE inhibitor ant an antihypertensive.
Common S/E is orthostatic hypotension and the patient should be advised to rise slowly from
lying to sitting position.)

44. A female client tells the clinic nurse that her skin is very dry and irritated. Which product
would the nurse suggest that the client apply to the dry skin? *
a. glycerin emollient
b. aspercreame (for muscle aches)
c. myoflex (for muscle aches)
d. acetic acid solution (this is for cleaning wound infection by P. aureginosa)
(Rationale: Glycerin emollient is used as moisturizer to treat or prevent dry, rough, scaly, itchy
skin and minor skin irritations)

45. A client with advanced cirrhosis of the liver is not tolerating protein well, as evidenced by
abnormal laboratory values. The nurse anticipates that which of the following medications will
be prescribed for the client? *
a. lactulose (Chronulac)
b. ethacrynic acid (Edecrin)
c. folic acid (Folvite)
d. thiamine (Vitamin B1)
(Rationale: Lactulose decreases levels of ammonia in the body. Hepatic disorders do not
process ammonia properly; making ammonia cannot be converted to urea to be cleared out of
the body)

46. A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The
nurse plans to include which of the following in a list of foods those are acceptable? *
a. baked potato
b. bananas
c. oranges
d. pears canned in water
(Rationale: Triameterene (Dyrenium) is a K+ sparing diuretic. The diet needs to be a low -
potassium diet. Pears canned in water is acceptable because potassium in water is dissolved
(water-soluble)

47. A client is taking famotidine (Pepcid) asks the home care nurse what would be the best
medication to take for a headache. The nurse tells the client that it would be best to take: *
a. aspirin (acetylsalicylic acid, ASA) (NSAID and antiplatelet: high risk of bleeding)
b. ibuprofen (Motrin) (NSAID)
c. acetaminophen (Tylenol)
d. naproxen (Naprosyn) (NSAID)
(Rationale: Famotidine (Pepcid) is a histamine 2 (H2) Antagonist which decreases HCl. It is
contraindicated with patients taking NSAIDs)

48. A nurse has taught a client taking a xanthine bronchodilator about beverages to avoid. The
nurse determines that the client understands the information if the client chooses which of the
following beverages from the dietary menu? *
a. chocolate milk
b. cranberry juice
c. coffee
d. cola
(Rationale: Taking xanthine bronchodilators (-phylline drugs) with caffeinated beverages is
not advisable because it can cause unwanted side effects)

49. A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the
client to do which of the following while taking this medication? *
a. take the medication on an empty stomach ANTIFUNGALS:
b. take the medication with an antacid  Taken with food
c. avoid exposure to sunlight  AVOID antacids
d. limit alcohol to 2 ounces per day  AVOID alcohol
(Rationale: Ketoconazole (Nizoral) is an antifungal  Photosensitive
medication which is photosensitive and the patient must
avoid exposure to sunlight.)

50. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy precipitate
inside the insulin vial. The nurse should: *
a. draw up and administer the dose
b. shake the vial in an attempt to disperse the clumps
c. draw the dose from a new vial
d. warm the bottle under running water to dissolve the clump
(Rationale: Clumpy precipitate signifies loss of potency of the NPH insulin. It must be
discarded and use a new vial.)
51. A client who has been receiving urokinase has a large bloody bowel movement. Which action
would be best for the nurse to take immediately? *
a. Administer vitamin K IM
b. Stop the urokinase
c. Reduce the urokinase and administer heparin
d. Stop the urokinase and call the doctor
(Rationale: Urokinase is a thrombolytic which lyses the clot or thrombus. Any active bleeding
that may observed by the patient is managed by stoppage of thrombolytic therapy and notifying
the physician)

52. The physician has ordered Basalgel (aluminum carbonate gel) for a client with recurrent
indigestion. The nurse should teach the client common side effects of the medication, which
include: *
a. Constipation
b. Urinary retention
c. Diarrhea (Magnesium compounds cause diarrhea)
d. Confusion
(Rationale: Basalgel is an antacid which has aluminum and calcium compounds that can cause
constipation)

53. A client with congestive heart failure has been receiving digoxin (Lanoxin). Which finding
indicates that the medication is having a desired effect? *
a. Increased urinary output
b. Stabilized weight
c. Improved appetite
d. Increased pedal edema
(Rationale: Digoxin (Lanoxin) promotes increase cardiac output, interrelated with an increase
of urine output because the reduction of cardiac output affects the renal function of the kidneys)

54. A client has been receiving Rheumatrex (methotrexate) for severe rheumatoid arthritis. The
nurse should tell the client to avoid taking: *
a. Aspirin
b. Multivitamins
c. Omega 3 fish oils
d. Acetaminophen
(Rationale: Methotrexate is a folic acid antagonist. Taking multivitamins inhibits the action of
the methotrexate)

55. Which vitamin should be administered with INH (isoniazid) in order to prevent possible
nervous system side effects? *
a. Thiamine
b. Niacin
c. Pyridoxine
d. Riboflavin
(Rationale: INH (isoniazid) is best taken with Vitamin B6 (Pyridoxine) to prevent CNS S/E.)

56. The physician has ordered 50mEq of potassium chloride for a client with a potassium level
of 2.5mEq. The nurse should administer the medication: *
a. Slow, continuous IV push over 10 minutes
b. Continuous infusion over 30 minutes
c. Controlled infusion over 5 hours
d. Continuous infusion over 24 hours
(Rationale: Potassium chloride must be administered via IV with an infusion pump)

PRECAUTIONS WITH INTRAVENOUSLY ADMINSTERED POTASSIUM:

1) K+ is never given by IV push, IM, or SC route.
2) Dilution: 1mEq/10 mL (1mmol/10 mL) of solution is recommended,
3) Before administering and frequently during infusion of IV solution, rotate and invert bag
to ensure potassium is distributed evenly through the IV solution.
4) Ensure IV bag of K+ is properly labeled.
5) Maximum recommended infusion rate: 5-10mEq/hour (5-10mmol/hour)
6) Never exceed to 20mEq/hour (20mmol/hour).
7) Client receiving more than 10mEq/hour (10mmol/hour): placed in a cardiac monitor for
cardiac changes. Infusion should be controlled with an infusion device.
8) K+ infusion can cause phlebitis. Nurse must assess IV site frequently for signs of phlebitis
and infiltration. If either of them occurs, STOP infusion immediately,
9) Nurse must assess renal function before administering K+. Monitor I&O during
administration.

57. The nurse notes that a post-operative client’s respirations have dropped from 14 to 6 breaths
per minute. The nurse administers Narcan (naloxone) per standing order. Following
administration of the medication, the nurse should assess the client for: *
a. Pupillary changes
b. Projectile vomiting
c. Wheezing respirations
d. Sudden, intense pain
(Rationale: Naloxone (Narcan) is an antidote for opioids. In which opioids is to treat mild-
moderate pain, Naloxone subsides the effect, returning the pain)
58. The physician has ordered Dilantin (phenytoin) 100mg intravenously for a client with
generalized tonic clonic seizures. The nurse should administer the medication: *
a. Rapidly with an IV push
b. With IV dextrose (It has the possibility of crystallization)
c. Slowly over 2–3 minutes
d. Through a small vein (tendency to develop purple glove syndrome)
(Rationale: Phenytoin (Dilantin) is an anticonvulsant or antiepileptic and must be administered
via IV in a slow, no more than 50 mg/hour)

59. In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia, the nurse
should expect: *
a. A rapid delivery
b. Cervical effacement (Caused by pressure of presenting head of baby)
c. Infrequent contractions
d. Progressive cervical dilation
(Rationale: IV Pitocin stimulates contraction and cervical dilation.)

60. A client with benign prostatic hypertrophy has been started on Proscar (finasteride). The
nurse’s discharge teaching should include: *
a. Telling the client’s wife not to touch the tablets
b. Explaining that the medication should be taken with meals
c. Telling the client that symptoms will improve in 1–2 weeks (therapeutic effect takes around
6 months)
d. Instructing the client to take the medication at bedtime, to prevent nocturia (not related on
the medication)
(Rationale: Finasteride (Proscar) is an androgen inhibitor. Pregnant women is not advised to
take this medication for it can cause NTDs)

61. A client is to receive Dilantin (phenytoin) via a nasogastric (NG) tube. When giving the
medication, the nurse should: *
a. Flush the NG tube with 2–4mL of water before giving the medication (too little amount)
b. Administer the medication, flush with 5mL of water, and clamp the NG tube
c. Flush the NG tube with 5mL of normal saline and administer the medication
d. Flush the NG tube with 2–4oz of water before and after giving the medication
(Rationale: Flushing the NG tube of 30 mL of water before and after medication is advised)

62. The physician has prescribed Gantrisin (sulfasoxazole) 1g in divided doses for a client with
a urinary tract infection. The nurse should administer the medication *
A. With meals or a snack
B. 30 minutes before meals
C. 30 minutes after meals
D. at bedtime
(Rationale: Sulfasoxazole (Gantrisin) is a sulfonamide medication and it is best taken on an
empty stomach)

63. A client in labor has been given epidural anesthesia with Marcaine (bupivacaine). To reverse
the hypotension associated with epidural anesthesia, the nurse should have which medication
available? *
a. Narcan (naloxone) (Antidote for opioids)
b. Dobutrex (dobutamine) (Decreases cardiac output)
c. Romazicon (flumazenil) (Benzodiazepine antagonist)
d. Adrenalin (epinephrine)
(Rationale: To reverse the hypotension, epinephrine is administered to promote
vasoconstriction, resulting increase BP)

64. The physician has prescribed a Becloforte (beclomethasone) inhaler two puffs twice a day
for a client with asthma. The nurse should tell the client to report: *
a. Increased weight
b. A sore throat
c. Difficulty in sleeping
d. Changes in mood
(Rationale: Beclomethasone (Becloforte) is a corticosteroid which decreases immune response,
increasing the risk of infection)

65. A client with schizophrenia has been taking Clozaril (clozapine) for the past 6 months. This
morning the client’s temperature was elevated to 102°F. The nurse should give priority to: *
a. Placing a note in the chart for the doctor
b. Rechecking the temperature in 4 hours
c. Notifying the physician immediately
d. Asking the client if he has been feeling sick
(Rationale: Clozapine (Clozaril) is an antipsychotic which has an adverse effect of
agranulocytosis - decrease WBCs. If so, report to physician immediately)

66. A client with bipolar disorder is discharged with a prescription for Depakote (divalproex
sodium). The nurse should remind the client of the need for: *
a. Frequent dental visits (phenytoin (Dilantin) causes gingival hyperplasia)
b. Frequent lab work
c. Additional fluids
d. Additional sodium
(Rationale: Divalproex sodium (Depakote) is an antipsychotic medication. Lab works must be
carefully looked for because this medication can cause leukopenia, thrombocytosis, bleeding
tendencies, depressed bone marrow and hepatotoxicity)

67. The physician has ordered Coumadin (sodium war farin) for a client with a history of clots.
The nurse should tell the client to avoid which of the following vegetables? *
a. Lettuce
VITAMIN K-rich foods:
b. Cauliflower
c. Beets  Cauliflower
d. Carrots  Spinach
 Cabbage
(Rationale: Warfarin (Coumadin) is not advisable to be  Turnips
taken with Vitamin K in order not to antagonize the  Other green leafy
warfarin’s intended action.) vegetables

68. Which medication is used to treat iron toxicity? *

a. Narcan (naloxone) (Antidote for opioids)
b. Digibind (digoxin immune Fab) (antidote for digoxin)
c. Desferal (deferoxamine)
d. Zinecard (dexrazoxane) (Antidote for doxorubicin)
(Rationale: Antidote for iron toxicity is deferoxamine)

69. The client has a prescription for a calcium carbonate compound to neutralize stomach acid.
The nurse should assess the client for: *
a. Constipation
b. Hyperphosphatemia
c. Hypomagnesemia
d. Diarrhea
(Rationale: Laxatives with aluminum and calcium compounds can cause constipation)

70. Heparin has been ordered for a client with pulmonary emboli. Which statement, if made by
the graduate nurse, indicates a lack of understanding of the medication? *
a. “I will administer the medication 1-2 inches away from the umbilicus.”
b. “I will administer the medication in the abdomen.”
c. “I will check the PTT before administering the medication.”
d. “I will need to aspirate when I give Heparin.”
(Rationale: Heparin SC route does not need to be aspirated)
71. The nurse is teaching the client regarding use of sodium warfarin. Which statement made by
the client would require further teaching? *
a. “I will have blood drawn every month.”
b. “I will assess my skin for a rash.”
c. “I take aspirin for a headache.”
d. “I will use an electric razor to shave.” (One of the bleeding precautions)
(Rationale: Aspirin increases risk of bleeding)

72. The client who is admitted with thrombophlebitis has an order for heparin. The medication
should be administered using a/an: *
a. Buretrol
b. Infusion controller
c. Intravenous filter
d. Three-way stop-cock
(Rationale: For accurate dosage, it is best to use an infusion pump or an infusion controller.)

73. The physician has ordered atropine sulfate 0.4mg IM before surgery. The medication is
supplied in 0.8mg per milliliter. The nurse should administer how many milliliters of the
medication? *
a. 0.25mL
b. 0.5mL
c. 1.0mL
d. 1.25mL
(Rationale: 0.4/0.8 = 0.5 mL)

74. The doctor has ordered 80mg of furosemide (Lasix) two times per day. The nurse notes the
patient’s potassium level to be 2.5meq/L. The nurse should: *
a. Administer the Lasix as ordered
b. Administer half the dose
c. Offer the patient a potassium-rich food
d. Withhold the drug and call the doctor
(Rationale: furosemide (Lasix) desired effect is to remove excess potassium. In hypokalemia,
furosemide potentiates the condition, which is fatal to the patient)

75. Which of the following lab studies should be done periodically if the client is taking warfarin
sodium (Coumadin)? *
a. Stool specimen for occult blood
b. White blood cell count
c. Blood glucose
d. Erythrocyte count
(Rationale: Fecal occult blood test (FOBT) screening detects bleeding from warfarin users)

76. The client has an order for heparin to prevent post-surgical thrombi. Immediately following
a heparin injection, the nurse should: *
a. Aspirate for blood
b. Check the pulse rate
c. Massage the site
d. Check the site for bleeding
(Rationale: Assess s/sx of bleeding in which heparin increases the risk for bleeding)

77. The client with AIDS tells the nurse that he has been using acupuncture to help with his pain.
The nurse should question the client regarding this treatment because acupuncture uses: *
a. Pressure from the fingers and hands to stimulate the energy points in the body (acupressure)
b. Oils extracted from plants and herbs (massage)
c. Needles to stimulate certain points on the body to treat pain
d. Manipulation of the skeletal muscles to relieve stress and pain (massage)
(Rationale: Needles used can potentiate the risk of infection to an AIDS patient)

78. The 84-year-old male has returned from the recovery room following a total hip repair. He
complains of pain and is medicated with morphine sulfate and promethazine. Which medication
should be kept available for the client being treated with opioid analgesics? *
a. Naloxone (Narcan)
b. Ketorolac (Toradol)
c. Acetylsalicylic acid (aspirin)
d. Atropine sulfate (Atropine)
(Rationale: Antidote for opioid toxicity is naloxone (Narcan))

79. The doctor has ordered a patient-controlled analgesia (PCA) pump for the client with chronic
pain. The client asks the nurse if he can become overdosed with pain medication using this
machine. The nurse demonstrates understanding of the PCA if she states: *
a. “The machine will administer only the amount that you need to control your pain without any
action from you.”
b. “The machine has a locking device that prevents overdosing.”
c. “The machine will administer one large dose every 4 hours to relieve your pain.”
d. “The machine is set to deliver medication only if you need it.”
(Rationale: PCA pumps have built-in safety mechanisms such as lock-out times and limitations
of the total amount of drug delivered)

80. The nurse is caring for a client with epilepsy who is being treated with carbamazepine
(Tegretol). Which laboratory value might indicate a serious side effect of this drug? *
a. Uric acid of 5mg/dL (Normal)
b. Hematocrit of 33% (Normal)
c. WBC 2000 per cubic millimeter
d. Platelets 150,000 per cubic millimeter (Normal)
(Rationale: Carbamazepine (Tegretol) suppresses bone marrow including WBCs)

81. The nurse is visiting a home health client with osteoporosis. The client has a new prescription
for alendronate (Fosamax). Which instruction should be given to the client? *
A. Rest in bed after taking the medication for at least 30 minutes (Remain upright at least 30
mintues)
B. Avoid rapid movements after taking the medication
C. takes the medication with water only
D. allows at least 1 hour between taking the medicine and taking other medications
(Rationale: Alendronate (Fosamax) is best taken with water only)

82. Which is true regarding the administration of antacids? *

a. Antacids should be administered without regard to mealtimes.
b. Antacids should be administered with each meal and snack of the day.
c. Antacids should not be administered with other medications.
d. Antacids should be administered with all other medications, for maximal absorption.
(Rationale: Antacids shout not be taken together with other medications in order not to disrupt
the drug’s action)

83. A client being treated with sodium warfarin has an INR of 8.0. Which intervention would be
most important to include in the nursing care plan? *
a. Assess for signs of abnormal bleeding
b. Anticipate an increase in the Coumadin dosage
c. Instruct the client regarding the drug therapy
d. Increase the frequency of neurological assessments
(Rationale: Warfarin increases risk of bleeding)

84. The client with preeclampsia is admitted to the unit with an order for magnesium sulfate IV.
Which action by the nurse indicates a lack of understanding of magnesium sulfate? *
a. The nurse places a sign over the bed not to check blood pressures in the left arm.
b. The nurse obtains an IV controller.
c. The nurse inserts a Foley catheter. (to assess urine output accurately)
d. The nurse darkens the room. (to prevent seizures)
(Rationale: Not to check BP in the left arm is not related to administration of MgSO4. It is
indicated for patients having mastectomy in the left breast or having an AVF at (L) arm)
85. The nurse is assisting in the assessment of the patient admitted with “extreme abdominal
pain.” The nurse asks the client about the medication that he has been taking because: *
a. Interactions between medications will cause abdominal pain.
b. Various medications taken by mouth can affect the alimentary tract.
c. This will provide an opportunity to educate the patient regarding the medications used. (not
the right time to educate for patient is having extreme abdominal pain)
d. The types of medications might be attributable to an abdominal pathology not already
identified.
(Rationale: Many medications can irritate the stomach and contribute to abdominal pain.)

86. The client has an order for gentamycin to be administered. Which lab results should be
reported to the doctor before beginning the medication? *
a. Hematocrit
b. Creatinine
c. White blood cell count
d. Erythrocyte count
(Rationale: Gentamycin is an antibiotic which can cause nephrotoxicity and ototoxicity.
Laboratory values to be checked is to check its creatinine count)

87. The physician has prescribed Chloromycetin (chloramphenicol) for a client with bacterial
meningitis. Which lab report should the nurse monitor most carefully? *
a. Serum creatinine
b. Urine specific gravity
c. Complete blood count
d. Serum sodium
(Rationale: Chloramphenicol (Chloromycetin) adverse effect is aplastic anemia – lowers Hgb,
WBC)

88. The client has an order for FeSO4 liquid. Which method of administration would be best? *
a. Administer the medication with milk
b. Administer the medication with a meal
c. Administer the medication with orange juice
d. Administer the medication undiluted
(Rationale: Iron is best absorbed when given Vitamin C rich foods or beverages)

89. Before administering Methyltrexate orally to the client with cancer, the nurse should check
the: *
a. IV site (Methyltrexate is taken orally)
b. Electrolytes
c. Blood gases
d. Vital signs
(Rationale: Methyltrexate depresses bone marrow, resulting low WBCs.)

90. A 4-year-old with cystic fibrosis has a prescription for Viokase pancreatic enzymes to
prevent malabsorption. The correct time to give pancreatic enzyme is: *
a. 1 hour before meals (Empty)
b. 2 hours after meals (Empty)
c. With each meal and snack
d. On an empty stomach (empty)
(Rationale: Viokase pancreatic enzymes are used to facilitate digestion. It should be given with
meals and snacks,)

91. A client with osteomylitis has an order for a trough level (lowest blood level) to be done
because he is taking Gentamycin. When should the nurse call the lab to obtain the trough level? *
a. Before the first dose
b. 30 minutes before the fourth dose
c. 30 minutes after the first dose
d. 30 minutes before the first dose
(Rationale: Gentamycin is advised to be taken before the 3rd or 4th dose)

92. A new diabetic is learning to administer his insulin. He receives 10U of NPH and 12U of
regular insulin each morning. Which of the following statements reflects understanding of the
nurse’s teaching? *
a. “When drawing up my insulin, I should draw up the regular insulin first.”
b. “When drawing up my insulin, I should draw up the NPH insulin first.”
c. “It doesn’t matter which insulin I draw up first.”
d. “I cannot mix the insulin, so I will need two shots.”
(Rationale: drawing first the regular insulin followed by the NPH is advised in order to prevent
contamination of (CLEAR) regular insulin from the (CLOUDY) NPH insulin)

93. The client with a recent liver transplant asks the nurse how long he will have to take an
immunosuppressant. Which response would be correct? *
a. 1 year
b. 5 years
c. 10 years
d. The rest of his life
(Rationale: Patients who have organ transplants are advised to take the immunosuppressant for
the rest of his life to prevent organ rejection)
94. The client is admitted from the emergency room with multiple injuries sustained from an
auto accident. His doctor prescribes a histamine blocker. The nurse is aware that the reason for
this order is to: *
a. Treat general discomfort
b. Correct electrolyte imbalances
c. Prevent stress ulcers
d. Treat nausea
(Rationale: Histamine blocker decreases hydrochloric acid and also it is used for prolonged
periods for patients who are in a stressful situation. Stress increases the production of HCl which
can lead to ulcer.)

95. The physician prescribes regular insulin, 5 units subcutaneous. Regular insulin begins to
exert an effect: *
a. In 5–10 minutes
b. In 10–20 minutes
c. In 30–60 minutes
d. In 60–120 minutes
(Rationale: The time of onset for regular insulin is 30-60 minutes)

96. A 60-year-old diabetic is taking glyburide (Diabeta) 1.25mg daily to treat Type II diabetes
mellitus. Which statement indicates the need for further teaching? *
a. “I will keep candy with me just in case my blood sugar drops.”
b. “I need to stay out of the sun as much as possible.”
c. “I often skip dinner because I don’t feel hungry.”
d. “I always wear my medical identification.”
(Rationale: Skipping dinner is not advisable to DM patients for it increased risk for hypoglycemia
or worse, coma)

97. A 5-year-old is a family contact to the client with tuberculosis. Isoniazid (INH) has been
prescribed for the client. The nurse is aware that the length of time that the medication will be
taken is: *
a. 6 months
b. 3 months
c. 1 year
d. 2 years
(Rationale: Isoniazid must be taken about 6 months for prophylaxis)

98. A 20-year-old female has a prescription for tetracycline. While teaching the client how to
take her medicine, the nurse learns that the client is also taking Ortho-Novum oral contraceptive
pills. Which instructions should be included in the teaching plan? *
a. The oral contraceptives will decrease the effectiveness of the tetracycline.
b. Nausea often results from taking oral contraceptives and antibiotics.
c. Toxicity can result when taking these two medications together.
d. Antibiotics can decrease the effectiveness of oral contraceptives, so the client should use
an alternate method of birth control.
(Rationale: Antibiotics with oral contraceptives decreases the effectiveness of contraceptives.)

99. The client is taking prednisone 7.5mg po each morning to treat his systemic lupus
erythematosis. Which statement best explains the reason for taking the prednisone in the
morning? *
a. There is less chance of forgetting the medication if taken in the morning.
b. There will be less fluid retention if taken in the morning.
c. Prednisone is absorbed best with the breakfast meal.
d. Morning administration mimics the body’s natural secretion of corticosteroid
(Rationale: Prednisone is a corticosteroid which is best taken in the morning because it mimics
the circadian rhythm or the body’s natural secretion of the corticosteroid)

100. The client is taking rifampin 600mg po daily to treat his tuberculosis. Which action by the
nurse indicates understanding of the medication? *
A. Telling the client that the medication will need to be taken with juice.
B. Telling the client that the medication will change the color of the urine.
C. Telling the client that the medication before going to bed at night.
D. Telling the client that the medication if night sweats occur
(Rationale: Rifampicin common S/E is discoloration of urine to a yellowish to brownish color.)