NCLEX Practice Questions — Set 22
How to use this set
Run it as a timed block rather than dipping in and out. 100 items at roughly a minute each is close to the pace the real exam asks for, and pacing is a skill that only improves under a clock. Answer every item before you open a single rationale — checking as you go turns a test into a reading exercise and hides the questions you were unsure about.
These sets are numbered rather than sorted by subject. The questions come from a general NCLEX bank that carries no topic field, and labelling them by eye would put a share of them under the wrong heading, so they are presented as mixed sets — which is how the exam itself arrives.
The 100 questions
When instructing a client to use a metered dose inhaler, it would be essential for the nurse to include which of the following aspects? Instruct the client to
Show answer and rationale
Correct answer: B. activate the canister at the beginning of a slow deep breath.
Proper technique for using a metered dose inhaler is to have the client place the canister either in the mouth or 2 inches in front of an open mouth. The canister must be activated at the beginning of a slow deep inspiratory effort. The inhalation is followed by 5 to 10 seconds of breath holding. Sequence is then repeated if a second puff is ordered.
A client who has asthma asks the nurse why the preferred route of administration for corticosteroids is inhalation. The appropriate response by the nurse is which of the following?
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Correct answer: D. "The systemic adverse reactions are reduced."
The inhaled glucocorticoids are effective on topical administration, and systemic adverse reactions can be reduced when delivered by this route. Instruction is necessary for the client to properly learn the technique of using inhalers. Inhaled steroids should not be stopped suddenly, and oral care is necessary after every treatment to reduce oral candidiasis.
A client with asthma awakens in the middle of the night with an asthma attack. Which of the following inhaler medications should the nurse administer first?
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Correct answer: D. Albuterol (Proventil)
The initial treatment for acute asthma is a bronchodilator. Steroids such as triamcinolone acetonide (Azmacort) and fluticasone propionate (Flovent) may be given after initial bronchospasm is relieved. Cromolyn (Intal) has no immediate effect and is a prophylactic mast cell inhibitor.
After a client diagnosed with pneumonia has an episode of respiratory distress, the client is intubated and placed on a ventilator. The breath sounds are diminished and the chest x-ray shows left lower lobe consolidation. The physician orders respiratory treatments with acetylcysteine (Mucomyst). The nurse should monitor the client for which of the following results from this treatment?
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Correct answer: A. Increased sputum, removed with suctioning
Acetylcysteine (Mucomyst) is a mucolytic agent that breaks down thick secretions and facilitates sputum expectoration. Adverse reactions include nausea and bronchospasm. There is no effect on level of consciousness or vital signs.
The nurse is caring for a client with lung cancer who has an intractable cough and is exhausted from the effort of coughing. Which of the following drugs should the nurse administer to this client?
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Correct answer: C. Codeine
Codeine is a narcotic drug that selectively depresses the cough center in the medulla and inhibits coughing. It is typically used in a dry, nonproductive, intractable cough. It is used with caution in combination with other central nervous system depressants. Rifampin (Rifadin) is a drug used to treat tuberculosis. Acetylcysteine (Mucomyst) is a mucolytic that decreases the viscosity of purulent and nonpurulent secretions and facilitates their removal. Fluticasone (Flovent) is an inhaled corticosteroid used in the treatment of asthma.
Which of the following treatments is the priority for the nurse to administer to a client who has a positive tuberculosis (TB) skin test but has no other evidence of active disease?
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Correct answer: A. Streptomycin for 12 months
A positive skin test with no other evidence of disease indicates exposure to the disease. Isoniazid (INH) therapy for 12 months is the usual protocol. Once a client has a positive skin test, it will always be positive and there is no value in repeating a test. Multidrug therapy is used to treat active disease, and streptomycin or Amikacin is often added in the induction phase of treatment.
The nurse is developing a medication schedule for a client who is receiving isoniazid (INH). To promote the best absorption, this medication would be administered
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Correct answer: B. on an empty stomach.
Isoniazid (INH) should be taken on an empty stomach, either 1 hour before or 2 hours after meals. Avoid antacids with the medication.
Which of the following is the priority for the nurse to monitor in a client who has been on a ventilator and on 70% FIO2 for the past 72�hours?
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Correct answer: B. Pulmonary fibrosis
Clients on an FIO2 of 50% or greater for 24 to 48 hours have a higher incidence of pulmonary fibrosis and oxygen toxicity. Atelectasis can occur but is generally reversible and therefore not the greatest concern. Expense is considered, but treatment requirements for the client take priority. Oxygen dependence is related to pulmonary disease.
The nurse is caring for a client who has chronic obstructive lung disease (COPD) and pneumonia. After being extubated, which of the�following orders should the nurse question?
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Correct answer: C. O2 per nasal cannula at 6 L/min
For a client with chronic obstructive lung disease (COPD), there is an insensitivity to high levels of carbon dioxide and therefore an inspiratory drive that is now triggered by low oxygen levels. Giving higher concentrations of oxygen (greater than 2 to 3 L/min) can decrease the respiratory rate and depth, leading to oxygen-induced hypoventilation, apnea, and respiratory arrest.
The nurse is preparing to teach a class on the appropriate use of nebulizers and metered dose inhalers. Which of the following should the nurse include in the class?
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Correct answer: D. Nebulizers deliver medication through a face mask or mouthpiece
Nebulizers deliver medication through a face mask or mouthpiece, using compressed air or oxygen with a gas flow of 6 to 10 L/min. Metered dose inhalers deliver medication via puffs. Generally, the standard is 2 puffs per administration, a wait of 2 to 5 minutes between puffs, and no more than 12 puffs in 24 hours for most medications. Metered dose inhalers do not require refrigeration.
The nurse is admitting a client who was recently diagnosed with asthma and has been taking a long-acting theophylline (Theo-Dur). After reviewing the client’s history, the nurse discovered that the client has a manic disorder controlled by lithium (Eskalith). Which of the following is a priority for the nurse to include in this client’s treatment plan?
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Correct answer: C. Obtain a serum lithium level
Theophylline may reduce the effects of lithium by increasing its rate of excretion. The client may need to have the dose of lithium increased, but not before the client’s current serum lithium level is known. There is no indication to increase the theophylline dose. Obtaining a serum theophylline level would also be appropriate.
A client questions a prescription for pyridoxine (B6) after being started on the triple-drug therapy for tuberculosis (ethambutol, rifampin, and isoniazid). The nurse explains that pyridoxine will
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Correct answer: D. counter the peripheral neuritis of the isoniazid.
Pyridoxine (B6) helps counter the peripheral neuritis associated with isoniazid therapy. Skin rash is a possible adverse reaction of ethambutol, and clients on streptomycin should be monitored for hearing loss, particularly those with renal insufficiency. The duration of therapy is not shortened by pyridoxine.
The nurse is collecting a medication history on a client admitted with asthma who has been taking theophylline. Which of the following drugs is a priority for the nurse to notify the physician that the client has also been taking for a urinary tract infection?
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Correct answer: A. Ciprofloxacin (Cipro)
Ciprofloxacin (Cipro) causes a decrease in theophylline clearance and can elevate serum drug levels, causing theophylline toxicity.
A client arrives at the emergency room in status asthmaticus. Which of the following is the priority nursing action?
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Correct answer: A. Administer inhaled bronchodilator therapy as ordered
Administering aminophylline intravenously, monitoring the respiratory status and for signs of hypoxia, and providing emotional support are all appropriate interventions, but the initial action should be focused on improving oxygenation (airway, breathing, circulation). An inhalation bronchodilator will act quickly and should be followed by intravenous medications.
The nurse evaluates which of the following as the appropriate method of improving oxygenation in a client with chronic airway limitation (CAL) who is lethargic, sleeps with the mouth open, is receiving 2 L/minute of oxygen per nasal cannula, and has a pulse oximetry check of 88%?
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Correct answer: B. Obtain an order for a face mask and use nasal cannula during meals
Clients who are mouth breathers may not get the full benefit from nasal cannula administration of oxygen. A face mask may be more effective. Face masks are removed for meals and a nasal cannula would be appropriate at that time. The client’s oxygenation may improve when awake, but one cannot be kept awake all the time. Clients with chronic airway limitation (CAL) should not receive oxygen greater than 2 to 3 L/minute because greater oxygen administration may suppress the respiratory drive.
The nurse is preparing to delegate the nursing tasks for the day. Which of the following tasks should the nurse delegate to a licensed practical nurse?
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Correct answer: D. Administer a nasal spray to a client with rhinitis
A licensed practical nurse cannot monitor a drug for its effectiveness or develop a teaching plan. These are job functions reserved for a registered nurse. Neither a registered nurse nor a licensed practical nurse can increase the oxygen flow rate to a client without a physician’s order. Once a physician’s order is obtained, a registered nurse should increase the flow rate.
Which of the following is the priority for the nurse to assess before administering digoxin (Lanoxin)?
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Correct answer: D. Auscultate the apical pulse for 1 full minute
A long-standing hallmark in the nursing interventions of the plan of care for a client taking digoxin (Lanoxin) is to take the apical pulse for a full minute. This is the priority nursing action. Bradycardia, in which the pulse is less than 60 beats per minute for 1 full minute, is one potential sign of digoxin toxicity. Although monitoring the renal function tests and serum potassium are appropriate interventions in the plan of care for a client taking Lanoxin, they are not the priority.
Upon finding a client in cardiac arrest, the nurse should administer which of the following drugs first?
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Correct answer: C. Epinephrine
Epinephrine is the initial drug administered for cardiac arrest using the advanced cardiac life support (ACLS) algorithm. Atropine is used to restore cardiac rate in a client experiencing symptomatic sinus bradycardia. Lidocaine is used in the treatment of arrhythmias. Atenolol (Tenormin) is a beta-adrenergic blocking drug used for hypertension.
After medication teaching on atenolol (Tenormin), which of the following statements by a client with diabetes mellitus demonstrates an understanding of the atenolol?
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Correct answer: C. "It may mask an early indication of hypoglycemia."
Beta blockers, such as atenolol (Tenormin), depress the heart rate and prevent tachycardia, one of the early indications of hypoglycemia.
The nurse is caring for a client with hypertension. Which of the following drugs should the nurse administer?
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Correct answer: A. Triamterene and hydrochlorothiazide (Dyazide)
Dyazide contains a combination of potassiumsparing diuretic and thiazide diuretic, triamterene and hydrochlorothiazide, to induce antihypertension by diminishing blood volume. Mexiletine (Mexitil) is an antiarrhythmic used in the treatment of ventricular arrhythmias. Digoxin (Lanoxin) is a cardiac glycoside used in the treatment of congestive heart failure and to slow the heart rate in a client with sinus tachycardia. Warfarin (Coumadin) is an anticoagulant.
Based on an understanding of nitroglycerin, the nurse administers it for which of the following reasons to a client with angina?
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Correct answer: A. Dilate the veins
Nitroglycerin is a coronary vasodilator used in the treatment of angina. The venodilation decreases preload by decreasing blood return to the heart. Decreased preload diminishes the work of the heart, which reduces the oxygen needs and diminishes the anginal pain.
The nurse is caring for a client with atrial fibrillation who is being treated with a variety of drugs. The nurse administers which of the following drugs in combination with quinidine that may result in an increased level of the drug?
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Correct answer: C. Digoxin (Lanoxin)
Quinidine is an antiarrhythmic used in combination with digoxin and may potentially double digoxin levels. Furosemide (Lasix) is a loop diuretic. Digoxin (Lanoxin) is a cardiac glycoside used to control the rapid ventricular contraction rate in atrial fibrillation or atrial flutter, slow the heart rate in sinus tachycardia, and in the treatment of recurrent paroxysmal atrial tachycardia with paroxysmal AV junctional rhythm. Propranolol (Inderal) is a beta-adrenergic blocking drug used in the treatment of hypertension. Triamterene and hydrochlorothiazide (Dyazide) is a combination antihypertensive drug.
The nurse should administer amiodarone (Cordarone) to treat which of the following arrhythmias?
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Correct answer: B. Ventricular tachycardia
Amiodarone (Cordarone) is an antiarrhythmic that prolongs the duration of the action potential and refractory period, thus preventing life-threatening ventricular arrhythmias such as ventricular tachycardia by decreasing the sinus rate. Sinus bradycardia, bundle branch block, and junctional rhythm are all arrhythmias in which there is a slow heart rate.
Which of the following is the priority nursing intervention for a client who is receiving adenosine (Adenocard) for supraventricular tachycardia (SVT)?
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Correct answer: C. Assure a patent IV in the antecubital vein
Adenosine (Adenocard) is an antiarrhythmic that must be given in a large vessel, closest to the heart, due to its extremely short half-life. Documenting the presence of peripheral pulses, monitoring the pulse oximetry, and preparing for emergency defibrillation are all appropriate interventions, but the drug cannot be administered without IV access, so this is the priority.
A client has been taking Viagra and is now experiencing angina. The physician has prescribed nitroglycerin p.r.n. for the angina. Which of the following should the nurse include in the discharge instructions?
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Correct answer: B. Viagra should not be used within 24 hours of taking nitroglycerin
When used in combination, Viagra and nitroglycerin may cause life-threatening hypotension. The manufacturer’s recommendations state that Viagra should not be used within 24 hours of taking nitroglycerin.
Which of the following adverse reactions should the nurse assess in a 70-year-old adult who is receiving a continuous infusion of lidocaine?
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Correct answer: A. Confusion
Lidocaine is an antiarrhythmic used in the treatment of ventricular arrhythmias. Confusion is a potential adverse reaction of a lidocaine infusion and is more common in the older adult.
Based on an understanding of beta blockers used for unstable angina, the nurse administers a beta blocker because of which of the following actions?
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Correct answer: C. To decrease heart rate
Beta blockers decrease the heart rate, diminishing the work of the heart and the oxygen needs, which results in a decrease in the anginal pain.
A client’s family member asks the nurse how to know if the client is improving while receiving furosemide (Lasix) for congestive heart failure. The nurse’s response should be based on the understanding that improvement in the client’s condition is characterized by
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Correct answer: B. diminishing oxygen needs.
With congestive heart failure (CHF), fluid accumulates in the lung tissue due to ineffective pump action by the heart. As a diuretic, furosemide (Lasix) works to remove excess bodily fluids via the kidneys. The fluid shifts out of the lung tissue and therefore diminishes oxygen needs.
A client with congestive heart disease returns to the clinic with muscle aching. The physician orders a potassium level, which shows hypokalemia. The drug regimen includes furosemide (Lasix) 80 mg b.i.d. In addition to treatment with a potassium supplement, the nurse administers which of the following prescribed drugs?
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Correct answer: B. Spironolactone (Aldactone)
Spironolactone (Aldactone) is a potassiumsparing diuretic. Its diuretic action is scant and it works to retain potassium. It is very often used in combination with the more powerful loop diuretics, such as furosemide (Lasix), to counteract their potassium-wasting effects. Bumetanide (Bumex) and torsemide (Demadex) are loop diuretics, which deplete the body of potassium. Clonidine (Catapres) is an antihypertensive.
The nurse is caring for a client on a heparin infusion when the client expresses concern over a progressively painful headache. Which of the following is the priority nursing action?
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Correct answer: B. Notify the physician
The priority nursing action is to notify the physician. Headache, although rare, is an adverse reaction to a heparin hypersensitivity. The nurse may anticipate stopping the heparin infusion or administering protamine sulfate, a heparin antagonist, but the priority intervention is to notify the physician of a potential hypersensitivity.
A client has been taking warfarin sodium (Coumadin) for the prevention of deep vein thrombosis. When the home care nurse arrives for a weekly visit, the client reports having been using aspirin (acetylsalicylic acid) daily for arthritic pain since hearing a commercial on television bolstering its benefits. Which of the following is the most appropriate response by the nurse, based on an understanding of the effect of combining Coumadin with aspirin?
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Correct answer: C. "Coumadin and aspirin used in combination increases the potential for bleeding."
Aspirin inhibits platelet aggregation, diminishing the potential for clot formation. Warfarin (Coumadin) is an anticoagulant that interferes with blood clot formation by interfering with the synthesis of vitamin K clotting factors, resulting in depletion of the clotting factors. The combination of Coumadin and aspirin increases the potential for bleeding.
The nurse is instructing a client on clopidogrel bisulfate (Plavix). Which of the following statements by the client indicates an understanding of the effect of this drug?
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Correct answer: B. "I should use caution taking other drugs that cause bleeding."
Clopidogrel bisulfate (Plavix) is an antiplatelet drug that inhibits platelet aggregation, diminishing the potential for clot formation. Caution should be used when taking other drugs that may increase bleeding. Plavix may cause the adverse reactions of hypertension and diarrhea.
The nurse should monitor a client with an acute myocardial infarction who is receiving intravenous streptokinase (Streptase) for which of the following serious adverse reactions?
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Correct answer: B. Intracranial hemorrhage
Streptokinase (Streptase) is a thrombolytic enzyme used in the treatment of deep vein thrombosis, arterial thrombosis, acute evolving myocardial infarction, and pulmonary embolism, and to clear an occluded arteriovenous and IV�cannula. It is a priority that the client is monitored for an intracranial hemorrhage that could potentially lead to coma and death.
The nurse is caring for a client taking atorvastatin (Lipitor). The client admits to consuming 6 to 12 beers daily. The nurse should monitor the client for what potentially serious adverse reaction to Lipitor?
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Correct answer: A. Hepatotoxicity
Atorvastatin (Lipitor) is an antihyperlipidemic and HMG-CoA reduction inhibitor. The risk for hepatotoxicity while using Lipitor is increased by excessive alcohol ingestion.
The nurse is developing a medication schedule for a client receiving simvastatin (Zocor).To promote maximal effectiveness, the nurse should administer the drug
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Correct answer: B. at bedtime.
Simvastatin (Zocor) is an antihyperlipidemic. Because cholesterol synthesis normally increases during the night, statins such as Zocor are most effective when given in the evening.
The nurse is caring for a client admitted with severe rectal bleeding who is receiving warfarin (Coumadin) therapy. Which of the following interventions should have priority in the plan of care?
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Correct answer: B. Assure a patent 18-gauge IV
Although maintaining an accurate intake and output, discontinuing the Coumadin, and administering vitamin K may be anticipated, the priority intervention is to assure an 18-gauge IV needed for potential transfusion of blood, if bleeding causes hypovolemia and low hemoglobin.
The registered nurse is preparing to delegate assignments for the day. Which of the following assignments would be appropriate to delegate to a licensed practical nurse?
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Correct answer: C. Take the blood pressure before administering a dose of verapamil (Calan)
Contacting a client’s physician, monitoring the�heparin level, and questioning the administration of a drug are all nursing tasks that should be performed by a registered nurse. A licensed practical nurse (LPN) may take a blood pressure before administering a drug. LPNs are trained to take the blood pressure; if the blood pressure is too low or too high, it becomes the responsibility of the registered nurse to notify the physician.
The nurse evaluates that medication teaching has been effective when the client states that ranitidine (Zantac)
Show answer and rationale
Correct answer: C. decreases gastric acid levels.
Ranitidine (Zantac) is a histamine 2-receptor antagonist, which suppresses gastric acid secretion. Changing hormonal levels is not a primary action of ranitidine. Cimetidine (Tagamet) suppresses pepsin production. Zantac also reduces hydrogen ion concentration, which will increase pH levels.
Which of the following should the nurse include in the teaching plan the nurse is preparing for a client taking sucralfate (Carafate)?
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Correct answer: A. Separate administration of sucralfate with other drugs by 2 hours
The administration of sucralfate (Carafate) should be separated from other drug administration by 2 hours to protect those drugs from binding to the protective adhesive that forms. Sucralfate is an antipeptic/ cytoprotective gastrointestinal drug used to protect eroded ulcer sites from further acidic damage. Sucralfate should be administered 1 hour before meals. Antibiotics are used in peptic ulcer disease to fight against H. pylori.
Which of the following is a priority for the nurse to administer to a client with gastroesophageal reflux disease (GERD)?
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Correct answer: D. Proton pump inhibitors
Drugs used to promote healing the tissues damaged by acid reflux include antacids and antisecretory drugs, such as proton pump inhibitors and histamine 2-receptor antagonists. Cytoprotective/antipeptics and antibiotics (and anticholinergics) are primarily used for peptic ulcer disease. Cholinergics are used on rare occasion for gastroesophageal reflux to increase the rate of gastric emptying.
The nurse should assess which of the following body systems while administering intravenous cimetidine (Tagamet) to a client?
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Correct answer: A. Cardiovascular
Cimetidine (Tagamet) is a histamine 2-receptor blocking drug used in the treatment of ulcers and gastroesophageal reflux disease. The cardiovascular system needs to be assessed. Intravenous cimetidine (Tagamet) can cause dysrhythmias and hypotension. Other body systems that need to be assessed include the gastrointestinal, hematologic, metabolic, central nervous system, and genital systems. Tagamet does not affect the urinary, immune, or respiratory systems.
A client is experiencing peptic ulcer disease caused by H. pylori. The nurse should plan to administer which of the following oral drug combinations? Clarithromycin (Biaxin) with
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Correct answer: C. amoxicillin (Amoxil) and omeprazole (Prilosec).
Clarithromycin (Biaxin) is used in combination with amoxicillin (Amoxil) and omeprazole (Prilosec) as an effective combination to combat H. pylori.
The nurse should instruct which of the following clients that taking which antacid may result in constipation? A client taking
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Correct answer: A. aluminum carbonate (Basaljel).
Most antacids affect the bowel. Some promote constipation, such as aluminum carbonate (Basaljel), and others promote diarrhea, such as magnesium. Effects can be minimized by combining aluminum and magnesium.
The nurse is caring for a client who admits to a 15-year history of gastric ulcers. The nurse instructs this client to take which of the following drugs for minor aches and pains?
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Correct answer: D. Acetaminophen (Tylenol)
Acetaminophen (Tylenol) has no adverse effect on the gastric mucosa and produces no ulcerative effects when administered for pain. Buffered aspirin does not reduce the incidence of gastric ulcers, although enteric-coated aspirin dissolves in the intestine rather than the stomach. Plain aspirin is associated with development of gastric ulcers. Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin), may cause gastric ulceration.
Which of the following antacids should the nurse question administering to the client with a gastric ulcer and congestive heart failure?
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Correct answer: B. Sodium bicarbonate (baking soda)
Sodium bicarbonate has higher sodium levels than other antacids and is contraindicated for clients with ulcerative disease and heart failure. Magnesium-based and calcium-based antacids, such as magaldrate (Riopan), calcium carbonate (Tums), and magnesium hydroxide (Milk of Magnesia), are often chosen for clients with heart failure because of their low sodium content.
After obtaining a medication history from a client who informs the nurse of her early pregnancy, which of the following drugs is a priority for the nurse to obtain an order to discontinue?
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Correct answer: D. Misoprostol (Cytotec)
Although all drug use needs to be questioned in the first trimester of pregnancy, misoprostol (Cytotec), which may be used in peptic ulcer prevention as a prostaglandin and cytoprotective agent, is known to cause miscarriages. Docusate (Surfak) is a mild surfactant laxative, which has no adverse effects. Magnesium hydroxide (Milk of Magnesia) and bismuth subsalicylate are mild antacids with no teratogenic effects.
The client is to begin taking methylcellulose (Citrucel) daily. The nurse will include which of the following instructions in the teaching plan?
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Correct answer: A. Administer with at least 8 ounces of liquid
Methylcellulose is a bulk laxative. Bulk laxatives must be given with at least 8 ounces of liquid to provide enough water to increase the size of the stool mass and stretch the intestinal wall, promoting peristalsis. Bulk laxatives should be taken when the client is most active. The therapeutic effect occurs within 2 to 3 days. Stool softeners are not contraindicated with bulk laxative use.
The nurse informs a student nurse that the loperamide (Imodium) prescribed for a client who is experiencing diarrhea has which of the following actions?
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Correct answer: C. Inhibits the peristaltic activity of intestinal muscles
Loperamide (Imodium) directly inhibits peristaltic activity of the intestinal muscles, which results in decreased gastrointestinal motility. Consolidating stool in the intestine describes pectin, which is a component of the antidiarrheal Kaopectate. Lowering the surface tension allows more water into the stool, which describes surfactant laxatives or stool softeners. Distending the intestine by osmotic retention of fluid describes the action of saline or osmotic laxatives.
Which of the following is a priority for the nurse to include in the plan of care for a client taking ondansetron (Zofran) for chemotherapy?
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Correct answer: A. Monitor the client for fluid and electrolyte imbalance
Ondansetron (Zofran) is a serotonin receptor antagonist, which suppresses the vomiting reflex and chemotherapy-induced emesis. Because diarrhea is the most common adverse reaction of Zofran and the client may be experiencing vomiting from the chemotherapy, the client may become dehydrated. The client should be monitored for fluid and electrolyte imbalances. Although it is appropriate to tell the client to take the Zofran 30 minutes before the chemotherapy, to avoid activities that may cause drowsiness, and to take an analgesic if a headache occurs, they are not the priority interventions.
Which of the following is the priority for the nurse to include in the plan of care for a client receiving metoclopramide (Reglan) with chemotherapy in a clinic?
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Correct answer: C. Instruct the client to avoid driving home
Although it is appropriate to offer a client receiving metoclopramide (Reglan) gum or hard candy, administer the Reglan � to 1 hour before the chemotherapy, and assess the client for extrapyramidal clinical manifestations, the priority nursing intervention is to instruct the client to avoid driving home.
The nurse should question which of the following medication administration orders?
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Correct answer: C. Cimetidine (Tagamet) 300 mg orally four times a day to an 86-year-old client with gastroesophageal reflux disease
Cimetidine (Tagamet), a histamine 2-receptor blocking agent, should be avoided in the older adult because it causes confusion.
The nurse selects the ideal antacid for a client because of which of the following characteristics?
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Correct answer: C. Decreases acidity without constipating or cathartic properties
The ideal antacid would decrease the acidity of the gastric secretions without either constipating or cathartic effects.
After administering ursodiol (Actigall) to the client with gallbladder disease, the nurse evaluates the priority outcome to be
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Correct answer: D. reduced stone formation.
Gallstone dissolvers, such as ursodiol, are bile acids that reduce the cholesterol content in bile and allow for the dissolution of cholesteroltype gallstones. Decreased vomiting may result from a decrease in pain, which more likely will occur with analgesic use. Increased comfort will primarily occur with analgesic use and may be a secondary effect of stone dissolution. Ursodiol reduces the cholesterol content of bile, but hepatic production of bile is not affected.
The nurse is collecting a nursing history from a client admitted on pancreatin. Which of the following diseases should the nurse question in the client’s medical history?
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Correct answer: A. Cystic fibrosis
Pancreatin is a pancreatic enzyme used to replace enzyme deficiencies caused by disorders such as cystic fibrosis. Hepatitis and cirrhosis may cause vitamin and other hepatic deficiencies, but not pancreatic enzyme deficiencies. Enzyme replacement is generally not indicated for gallbladder cancer.
The nurse has instructed the client about sulfasalazine (Azulfidine), which was prescribed for her ulcerative colitis. The nurse evaluates which of the following statements by the client to indicate that the client understood the instructions?
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Correct answer: D. "Nausea, vomiting, and abdominal pain are adverse reactions of Azulfidine."
Sulfasalazine (Azulfidine) is an antiinflammatory agent and sulfonamide, which�reduces gastrointestinal motility, inflammation,�and microbial flora such as E.�coli. Nausea, vomiting, and abdominal pain�are adverse reactions. Decreasing gas formation�is the action of simethicone. The�tablets are not chewed, and Azulfidine should�be administered with a full glass of�water. The�skin and urine may turn yellow-orange.
The client was recently diagnosed with chronic hepatitis C. The nurse plans to instruct the client about which of the following drugs that is used in combination with oral ribavirin?
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Correct answer: C. Interferon alfa
In clients with chronic hepatitis C, modest responses have occurred with combining ribavirin with interferon alfa. All interferons of the alfa class are used to treat hepatitis. Lamivudine is used only in the treatment of hepatitis B virus. Interferons of the gamma class are not utilized for hepatitis. Ganciclovir is utilized to treat herpes viruses.
The nurse is preparing to delegate which of the following nursing tasks to a licensed practical nurse?
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Correct answer: D. Administer trimethobenzamide (Tigan) Z-track to a client prior to chemotherapy
A licensed practical nurse may administer a drug by Z-track. Administering a drug IV, instructing a client on the adverse reactions of a drug, and developing a medication schedule for a client taking an antacid and several other drugs are nursing tasks reserved for a registered nurse.
Which of the following should the nurse include in the instructions given to a client receiving somatropin (Humatrope)?
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Correct answer: A. Get an annual bone age assessment
Somatropin (growth hormone) is given when there is growth failure prior to epiphyseal closure. Annual bone assessment is necessary to make certain that epiphyseal closure has not occurred. Growth hormone increases the glucose level in the blood, so that those with a family history of diabetes are likely to develop diabetes mellitus. Fasting blood sugars should be done more frequently than once a year to detect development of diabetes mellitus. Linear growth of 7 to 20 cm in the first year is normal and not necessary to report. Growth hormone does not affect urinary output.
Which of the following assessment findings is an anticipated outcome for a client with diabetes insipidus who is receiving vasopressin (Pitressin) injections?
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Correct answer: D. Urine output of 2500 ml/day
The client with diabetes insipidus who is receiving vasopressin injections should have an improvement in the clinical manifestations of diabetes insipidus (polyuria and polydipsia). The client should notice an increase in weight and a decrease in urine output. The urine output of 2500 ml is in the normal range. Urine specific gravity of 1.005 and an oral intake of 4500 ml/day are characteristic of untreated diabetes insipidus.
The client starting on vasopressin asks the nurse, "Why did the physician say to avoid drinking alcohol while taking this medication?" Which of the following responses by the nurse is appropriate? "Alcohol will
Show answer and rationale
Correct answer: A. decrease the antidiuretic effect."
Alcohol causes vasodilatation, not vasoconstriction, in a client taking vasopressin. Alcohol does decrease the antidiuretic effect of vasopressin from its action on the kidneys. Vasopressin is injected and absorbed intramuscularly. Hypersensitivity reactions occur with vasopressin, but are not related to the ingestion of alcohol.
Prior to discharge, the nurse instructs a client who is receiving liothyronine (Cytomel) to notify the physician if which of the following occurs?
Show answer and rationale
Correct answer: D. A pulse rate of more than 100 beats per minute
Liothyronine (Cytomel) is a thyroid drug used in the treatment of hypothyroidism. It increases the metabolic rate, but a rate of more than 100 beats per minute is an indication that the dosage needs to be decreased. Weight loss and diuresis would be expected therapy outcomes. A client with hypothyroidism would be very lethargic and sleep most of the day. The activity level should increase as a response to the drug, and a nap during the day would improve the condition.
The nurse instructs a client who is started on levothyroxine sodium (Synthroid) that the best time to take the medication is
Show answer and rationale
Correct answer: B. 30 minutes before breakfast.
Food interferes with the absorption of levothyroxine (Synthroid). The client should take the drug at the same time of day, preferably before breakfast.
Which of the following is essential that the nurse include in the assessment of a client receiving methimazole (Tapazole)?
Show answer and rationale
Correct answer: B. White blood cell count and differential
A serious adverse reaction to antithyroid drugs is agranulocytosis, a severe reduction in the number of granulocytes (basophils, eosinophils, and neutrophils). Antithyroid drugs do not affect serum sodium and lipid levels or platelet count.
The nurse instructs a client who has been prescribed Lugol’s solution to notify the physician if which of the following occurs?
Show answer and rationale
Correct answer: A. Brassy taste in mouth
Clients receiving iodine preparations, such as Lugol’s solution, are advised to notify the physician if they experience a brassy taste in the mouth, which may be significant for iodism (excessive amounts of iodine in the body). Blurred vision, weight gain, and increased urinary output are clinical manifestations of endocrine disorders, but are not attributed to iodine preparations.
When a client experiencing thyrotoxicosis arrives at the emergency room, the nurse should administer which of the following drugs intravenously?
Show answer and rationale
Correct answer: B. Saturated solution of potassium iodide
The client with thyrotoxicosis (thyroid storm) is experiencing severe hyperthyroidism. Saturated solution of potassium iodide is given IV, because it acts quickly to reduce the metabolic rate. Dextrose 50% is an emergency drug for the treatment of hypoglycemia. Calcium gluconate is used for hypoparathyroidism in clients who are experiencing tetany. Theophylline is an emergency drug for clients experiencing breathing difficulties.
The nurse is caring for a client who developed tetany postoperatively. The client is to receive aluminum hydroxide gel (Gelusil) and calcium gluconate (Kalcinate). The nurse should understand that the client is to receive aluminum hydroxide gel (Gelusil) for which of the following purposes?
Show answer and rationale
Correct answer: C. To bind dietary phosphorus and promote the elimination of insoluble aluminum phosphate by the GI tract
Aluminum hydroxide gel (Gelusil) is given in conjunction with calcium gluconate to bind dietary phosphorus and promote the elimination of insoluble aluminum phosphate in the feces in a client who is experiencing tetany. The client with tetany has decreased serum calcium and an increase in serum phosphate levels. The neutralization of hydrochloric acid in the stomach does not affect the absorption of calcium. Calcium gluconate is not irritating to the mucosa of the esophagus and stomach. Aluminum hydroxide gel decreases, rather than increases, the rate of gastric emptying.
The nurse is collecting a health history from a client who is to begin taking calcium lactate. Which of the following questions should the nurse ask to determine the safety of taking calcium supplements?
Show answer and rationale
Correct answer: C. "Have you had any kidney stones within the past year?"
Calcium salts cause an increase in serum calcium, which can lead to calcium deposits in the kidneys; therefore, calcium salts are contraindicated for the client with a history of renal calculi. A history of hypertension and myocardial infarction are not cardiovascular changes that would be contraindications. Calcium salts may cause constipation.
A client with Addison’s disease is scheduled for hernia surgery in the morning. Which of the following drugs should the nurse expect to give with a sip of water the morning of surgery?
Show answer and rationale
Correct answer: C. Prednisone
The client with Addison’s disease has a deficiency in glucocorticoids and mineralocorticoids. The treatment is lifelong replacement therapy with prednisone. Glucocorticoids must never be withdrawn abruptly and are therefore given the morning of surgery. A client receiving Micronase would have type 2 diabetes mellitus and the drug could be administered later in the day. A client receiving Synthroid for the treatment of hypothyroidism could also miss the morning dose without consequence. Furosemide (Lasix), a loop diuretic, would not be given to a client with Addison’s disease because clients with Addison’s disease have low sodium levels.
The nurse is caring for a client taking prednisone. The nurse should instruct the client that the best time to take the drug to promote absorption is
Show answer and rationale
Correct answer: B. in the morning with breakfast.
Prednisone is irritating to the gastric mucosa and should be given with food or fluid in the morning with breakfast. The client needs the higher cortisol levels in the daytime, when one is more active. It should not be given on an empty stomach or 2 hours after a meal.
The nurse should monitor which of the following laboratory reports for a client receiving long-term corticosteroid therapy?
Show answer and rationale
Correct answer: B. Glucose and potassium
Corticosteroids increase glucose metabolism (effect of glucocorticoids) and the absorption of sodium and elimination of potassium (effect of mineralocorticoids). Thus, clients receiving long-term corticosteroid therapy need to be monitored for increased blood glucose levels and low serum potassium. Corticosteroids do not affect calcium, magnesium, cholesterol levels, or hemoglobin and hematocrit levels.
The nurse should monitor a client who has been taking fludrocortisone acetate for several months for which of the following adverse reactions of this drug?
Show answer and rationale
Correct answer: D. Pedal edema
Fludrocortisone acetate, a mineralocorticoid, promotes sodium ion absorption and potassium ion excretion by the kidneys. A major side effect of the drug is sodium retention, which would contribute to the development of pedal edema. Other adverse reactions are hypokalemia, hyperglycemia, and weight gain.
The nurse should instruct a female client who has been prescribed testosterone to notify the physician if which of the following is experienced?
Show answer and rationale
Correct answer: A. Low-pitched voice
Females receiving testosterone should notify the physician if any signs of virilism appear. Testosterone antagonizes the effects of estrogen on the endometrium, so that it is expected that menstruation will become irregular. It is also expected that libido will decrease. Testosterone is given to treat engorged breasts.
The nurse should assess a client who received Humulin N insulin at 0730 for hypoglycemia at
Show answer and rationale
Correct answer: A. 1600 hours.
Hypoglycemia occurs during the peak action time of specific insulin. Humulin N insulin peaks in 4 to 12 hours after administration. The peak time is too early at 1000 hours and too late at 2000 hours and 2400 hours.
Which of the following should the nurse include in the medication instructions for a client taking chlorpropamide (Diabinese)?
Show answer and rationale
Correct answer: B. Avoid drinking alcohol
When clients take chlorpropamide (Diabinese), an antidiabetic agent, there is an additional adverse reaction, which is an Antabuse-type reaction, when alcohol is ingested. To prevent gastrointestinal adverse reactions, the drug should be taken with breakfast. Antidiabetic agents are given daily each morning and aspartame is not contraindicated for this category of antidiabetic drugs.
Which of the following should the nurse include in the insulin administration instructions for a client being discharged on insulin?
Show answer and rationale
Correct answer: D. Sites should be rotated systematically and not used again for 2 to 3 weeks
The client needs to develop a systematic plan for rotating injection sites. Once a site is injected, it should not be used again for 2 to 3 weeks. If an injection were to be given into an extremity to be exercised, it would cause rapid absorption of the insulin and cause hypoglycemia. Insulin injections are given into subcutaneous tissue, not into muscles. It is not recommended that clients aspirate prior to injecting insulin.
After administering 5 units of regular insulin per minute to a client in diabetic ketoacidosis, the nurse should add dextrose to the intravenous fluids when the blood glucose reaches which of the following levels?
Show answer and rationale
Correct answer: A. 300 mg/dl
Dextrose is added to the intravenous fluids when the blood glucose level reaches 250 to 300 mg/dl, so that the blood sugar doesn’t drop too rapidly and put the client at risk for hypoglycemia. The values of 350 mg/dl, 400 mg/dl, and 450 mg/dl are not low enough to add dextrose.
After receiving blood glucose monitoring instructions from the nurse, which of the following client statements indicates an understanding of when more frequent monitoring is necessary?
Show answer and rationale
Correct answer: D. "I should monitor my glucose more often when I am under stress."
Stressful situations, whether they be physiological or emotional, precipitate the release of hormones, which elevate the blood sugar levels and alter the body’s need for insulin. Exercising should be part of the daily routine and would not be an indication for more frequent blood glucose monitoring. A dental examination would not normally cause a significant rise in blood glucose level. Vacationing should not impact the blood sugar level, unless the daily routines of insulin injections or oral antidiabetic agents, nutrition, and exercise were changed substantially.
The nurse instructs a type 1 diabetic client to avoid which of the following while taking insulin?
Show answer and rationale
Correct answer: C. Furosemide (Lasix)
Furosemide (Lasix), a loop diuretic, is one of several drugs that increases serum glucose levels and is therefore contraindicated if one is taking insulin. Dicumarol, an anticoagulant; reserpine, an antihypertensive agent; and cimetidine, an H2-receptor antagonist, do not affect blood sugar levels.
The nurse should instruct the family of a diabetic client to administer glucagon by which of the following routes?
Show answer and rationale
Correct answer: A. Subcutaneously
Family members are taught to give glucagon either subcutaneously or intramuscularly to clients in hypoglycemia who are unresponsive. It is only available in injectable form, so it cannot be given sublingually or rectally. Family members would not routinely be taught to administer a drug intravenously.
The nurse instructs the family that after the administration of the drug glucagon, the client’s blood sugar should begin to rise and the client should regain consciousness. The nurse should tell the family members to wait for how long for the client to respond before summoning emergency assistance?
Show answer and rationale
Correct answer: D. 20 minutes
The blood glucose level should begin to rise in approximately 5 to 20 minutes after an injection of glucagon. It would take more than 4 minutes for the client to respond. If the client doesn’t respond in 20 to 30 minutes, emergency personnel need to be summoned to administer dextrose intravenously.
The registered nurse is preparing to delegate the nursing tasks for the day. Which of the following nursing tasks should the nurse delegate to a licensed practical nurse?
Show answer and rationale
Correct answer: A. Administer an oral calcium supplement 1 hour after meals
A licensed practical nurse may administer a�calcium supplement 1 hour after meals. Developing a medication schedule, administering intravenous insulin, and assessing a client taking iodine for signs of iodine poisoning are tasks that should be performed by a registered nurse.
The nurse should monitor a client receiving pyridostigmine (Mestinon) for which of the following adverse reactions?
Show answer and rationale
Correct answer: B. Decreased heart rate
Pyridostigmine (Mestinon) is a cholinergic drug used in the treatment of myasthenia gravis. Adverse reactions include bradycardia, diarrhea, and hypotension.
The nurse should assess for which of the following after slowly administering lorazepam (Ativan) intravenously to a client who has been experiencing seizures in rapid succession?
Show answer and rationale
Correct answer: B. Respiratory depression
Lorazepam (Ativan) is given intravenously in the treatment of status epilepticus. A client receiving Ativan for status epilepticus must be closely monitored for respiratory depression.
A client is taking phenytoin (Dilantin) 200 mg daily. The nurse monitors the client for which of the following adverse reactions?
Show answer and rationale
Correct answer: D. Sedation
Phenytoin (Dilantin) is an anticonvulsant used in the treatment of seizures. Adverse reactions include sedation, hypotension, and constipation.
The nurse infuses phenytoin (Dilantin) with which of the following solutions to control seizures?
Show answer and rationale
Correct answer: D. Normal saline
Phenytoin (Dilantin) should not be used intravenously with dextrose because it forms a precipitate. Dilantin should only be infused intravenously with normal saline.
Phenytoin (Dilantin) has been prescribed for a client. Based on an understanding of medication, the nurse caring for the client should
Show answer and rationale
Correct answer: C. administer good oral hygiene.
Gingival hyperplasia is an adverse reaction to phenytoin (Dilantin). Administering good oral hygiene is the appropriate intervention. The normal therapeutic Dilantin level is 7.5 to 20 ?g/ml. Dilantin should not be administered with dextrose because it forms precipitates. It should only be infused with normal saline. Dilantin is not administered intramuscularly
The nurse obtains a subtherapeutic serum level for a client who is receiving phenytoin (Dilantin) with seizure activity under control. Based on the results of the Dilantin level, the appropriate nursing action is to
Show answer and rationale
Correct answer: D. continue the phenytoin (Dilantin) as ordered.
Therapeutic ranges for drugs serve only as a guide. The therapeutic drug range excludes a serum level lower than where the client continues to have seizures and higher than where the client experiences toxic effects. If a client’s seizures are well controlled at a subtherapeutic level, the dose does not need to be increased because it appears to be stabilizing the client’s seizures, which is the goal of therapy.
The nurse is caring for a client who has cerebral edema following a cerebrovascular accident. The nurse should understand that the client is to receive mannitol IV for which of the following purposes?
Show answer and rationale
Correct answer: D. Decrease intracranial pressure
Mannitol is an osmotic diuretic used to promote systemic diuresis in cerebral edema and to decrease intracranial pressure.
Which of the following would the nurse recognize as the appropriate rationale for the administration of the drug levodopa (L-dopa) to a client with Parkinson’s disease?
Show answer and rationale
Correct answer: D. The drug provides the precursor of dopamine
Levodopa (L-dopa) is an antiparkinsonian drug. When L-dopa enters the bloodstream, it is converted to dopamine by the enzyme dopadecarboxylase and increases the dopamine available to the brain.
The nurse is caring for a client who has tetanus and is experiencing seizures unrelieved by sedation. Which of the following drugs should the nurse administer?
Show answer and rationale
Correct answer: C. D-tubocurarine (Curate)
When seizures are not controlled by sedation, d-tubocurarine (Curate) is a skeletal-muscleparalyzing drug that is used.
The nurse is caring for a client who is experiencing an overdose of atropine. The nurse should prepare to administer which of the following drugs?
Show answer and rationale
Correct answer: B. Physostigmine salicylate (Antilirium)
Physostigmine salicylate (Antilirium) is a specific antidote for atropine overdose. A client exhibiting an atropine overdose would present with flushing, warm and dry skin, decreased salivation, tachycardia, and urinary retention.
Benztropine (Cogentin) has been prescribed for a client. Based on an understanding of the adverse reactions, the nurse caring for the client should do which of the following?
Show answer and rationale
Correct answer: A. Monitor the client for urinary retention
Urinary retention is a common adverse reaction to benztropine (Cogentin), which is an anticholinergic drug used in the treatment of Parkinson’s disease. Other common adverse reactions include constipation, dry mouth, blurry vision, and tachycardia. The client should be instructed to avoid driving or operating heavy machinery.
The nurse is caring for a client with myasthenia gravis who has become progressively weaker. Edrophonium (Tensilon) has been prescribed for which of the following purposes?
Show answer and rationale
Correct answer: B. Differentiate between a cholinergic crisis and myasthenic crisis
Edrophonium (Tensilon) is used to differentiate between a cholinergic crisis and a myasthenic crisis. If a client is experiencing a cholinergic crisis, edrophonium (Tensilon) will result in an increase in the muscle weakness. If a client is experiencing a myasthenic crisis, edrophonium (Tensilon) will result in an improvement of the client’s clinical manifestations.
The nurse should monitor which of the following laboratory tests in a client receiving ethosuximide (Zarontin)?
Show answer and rationale
Correct answer: D. Complete blood count and liver function studies
Ethosuximide (Zarontin) is an anticonvulsant drug used to treat absence seizures. Complete blood count and liver function studies should be monitored. Anticonvulsants are contraindicated in hepatic dysfunction and bleeding disorders.
The nurse is teaching a class on drugs used in the treatment of neurological disorders. Which of the following should the nurse include in the class?
Show answer and rationale
Correct answer: A. Narrow-angle glaucoma is a contraindication in the use of antiparkinsonian drugs
Narrow-angle glaucoma is a contraindication in the use of antiparkinsonian drugs. Allergic reactions, hepatitis, and bone marrow depression are uncommon adverse reactions to anticonvulsants. Common adverse reactions include central nervous system effects such as drowsiness, nervousness, ataxia, and dizziness. Common gastrointestinal adverse reactions include gingival hyperplasia, nausea, vomiting, and epigastric discomfort. Antihistamines and antipsychotic drugs increase the effects of antiparkinsonian drugs. Clinical manifestations of Cushing’s syndrome include buffalo hump, moon face, abdominal distention, ecchymosis, hypertension, weakness, osteoporosis, amenorrhea, and impotence, and are the result of long-term corticosteroid use.
Methysergide maleate (Sansert) has been prescribed for a client experiencing cluster headaches. Which of the following should the nurse include in the medication instructions?
Show answer and rationale
Correct answer: A. Discontinue the medication for 1 month after every 4 months
Methysergide maleate (Sansert) is a synthetic ergot derivative used to prevent but not manage acute migraine attacks because of the serious adverse reactions. It is recommended to discontinue Sansert for 1 month after every 4 to 6 months. This too is part of the prescription protocol to prevent serious adverse reactions. The client should never take an additional tablet if the first does not provide relief. This is likely an indication that the drug is not effective for this client. Sansert is taken orally, not sublingually. Ergotamine tartrate (Ergomar) is administered sublingually in the treatment of vascular headaches.
The nurse questions an order to administer rizatriptan (Maxalt) to which of the following clients? A client with
Show answer and rationale
Correct answer: D. hypertension.
Rizatriptan (Maxalt) is used in the treatment of migraine headaches. It is contraindicated for a client with hypertension because hypertension is also an adverse reaction to the drug.
The registered nurse is preparing to delegate nursing tasks for the day. Which of the following tasks should the nurse delegate to a licensed practical nurse?
Show answer and rationale
Correct answer: B. Offer a client taking trihexyphenidyl (Artane) increased fluids
It would be appropriate to delegate increasing fluids to a client taking trihexyphenidyl (Artane) to a licensed practical nurse. Artane is an anticholinergic drug that causes constipation. A licensed practical nurse may not administer intravenous drugs, develop a nutritional plan, or monitor a client for adverse reactions.
The nurse should monitor a client carefully and use extreme caution when administering phenobarbital with what additional drug?
Show answer and rationale
Correct answer: C. Valproic acid (Depakene)
The combination of phenobarbital and valproic acid (Depakene) may increase the risk of phenobarbital toxicity.
The nurse should instruct a client taking an oral retinoid to avoid which of the following?
Show answer and rationale
Correct answer: B. Vitamin A supplements
Oral retinoids are derived from vitamin A; hence, taking supplemental vitamin A could cause an overdose of this fat-soluble vitamin.
What to do with your score
Score the set, then spend longer on the review than you did on the questions. For every item you missed, decide which of three things went wrong: you did not know the fact, you misread what the item was asking, or you knew the fact and still chose second-best. Those need three different fixes — content review, slower reading, and priority-framework practice — and lumping them together is why question banks stop working for people.
Read the rationale on the items you got right as well. Arriving at the correct option for the wrong reason is common, and it does not survive a harder version of the same question.
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