NCLEX Practice Questions — Set 23
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
The nurse instructs a client with pruritus to take an oral antihistamine to relieve the itching. Which of the following should be included in this instruction?
Show answer and rationale
Correct answer: A. "The effects will be best if you take the medication around the clock."
Oral antihistamines have their maximal effect when taken regularly around the clock. Drowsiness is an adverse reaction that is also minimized by this dosing.
The nurse is discharging a client who has second-degree burns on the hands and arms. Treatment includes application of silver sulfadiazine (Silvadene) to the burn area twice a day. Which of the following must be included in wound care instructions for this client?
Show answer and rationale
Correct answer: A. "Wash the area with warm water before the application of Silvadene."
Burn wounds should be cleansed prior to application of Silvadene cream. This helps remove dead tissue and old cream. There is no need to apply salve over the Silvadene. Silvadene provides a protective cover by itself. The client should use a clean technique at home rather than a sterile technique. The treatment must be twice a day, generally in the morning and evening.
A 22-year-old has been diagnosed with acne vulgaris and is to start on tetracycline. Which of the following is a priority question to ask this client before therapy is started?
Show answer and rationale
Correct answer: D. "When was your last menstrual period?"
Because tetracycline is teratogenic, it is a priority to establish that the client is not pregnant before starting the drug. Tetracycline is not the drug of choice for a cystlike type of acne. Scrubbing of the face has no impact on the use of tetracycline systemically. Although asking a client if an oral medication for acne has been taken is appropriate, it is not the priority because of the teratogenic effects of the tetracycline.
The nurse is instructing a client about use of benzoyl peroxide to treat acne. Which of the following should be included?
Show answer and rationale
Correct answer: D. Overuse can cause extreme dryness of the skin
Benzoyl is an effective drying agent that can cause too much drying if overused. Benzoyl peroxide is topical and does not have systemic adverse reactions. Benzoyl peroxide is not associated with the adverse reactions of nausea, vomiting, or a decrease in appetite.
The nurse is providing instruction to a client about use of lindane (Kwell) shampoo for treatment of Pediculus humanus capitis (head lice). Which of the following should be included in the teaching?
Show answer and rationale
Correct answer: C. Apply the shampoo to dry hair and leave on for 4 to 5 minutes
The Kwell shampoo should be applied to dry hair and left on the scalp for 4 to 5 minutes to allow for maximal effect. Treatment should be repeated in a week.
The nurse is instructing the mother of four children on how to treat all of the children for Pediculus humanus capitis (head lice) with Kwell shampoo. The ages of the children are 8 years, 5 years, 2 years, and a premature infant who now weighs 6 pounds. Which one of the following is the priority to include in the instructions given to this mother?
Show answer and rationale
Correct answer: D. Lindane (Kwell) may cause seizures in premature babies
It is a priority to inform the parent that applying Kwell shampoo to premature infants may cause seizures. Purchasing Kwell shampoo for three children may be costly, but it is essential to prevent the spread of Pediculus humanus capitis (head lice). Although an increased incidence of reinfection of the children from one child to another is a minor concern, it is not the priority. Securing help to apply the shampoo may be beneficial, but it is not the priority.
The physician prescribes ketoconazole (Nizoral) to treat systemic candidiasis. The client asks, "What are the main advantages of this drug?" The nurse’s best response is which of the following?
Show answer and rationale
Correct answer: D. "It can be given orally and is safer than amphotericin B."
Ketoconazole (Nizoral) is just as effective to treat systemic candidiasis and not as dangerous as amphotericin B. Amphotericin B is highly toxic and used for progressive and potentially fatal infections. Although expense is a consideration, safety is the most important factor.
When teaching a client about using salicylic acid as a drug to promote shedding of the horny layer of skin, the nurse should explain which of the following about salicylic acid?
Show answer and rationale
Correct answer: D. It is not absorbed through the skin
Salicylic acid has its effect on the keratin layer of the skin. The acid is too mild to burn the skin. It can be used for dandruff. It may also be used to treat acne, because it causes drying and sloughing.
The nurse is caring for a pressure ulcer using a topical debriding agent. Another nurse asks the nurse the type of drug typically used for this purpose. Which of the following is the best response?
Show answer and rationale
Correct answer: B. An enzyme ointment
An enzyme ointment best describes the classification of agents used for debriding pressure ulcers. Corticosteroids do not have debridement properties. Drugs used for psoriasis do not debride. Topical antihistamines are used for itching and inflammation rather than debridement.
The registered nurse is preparing to make out the clinical assignments for the day. Which of the following nursing tasks may the nurse delegate to a licensed practical nurse?
Show answer and rationale
Correct answer: B. Ask the client if stinging occurs when applying topical acyclovir (Zovirax)
A licensed practical nurse may ask a client if stinging occurs when a topical drug is applied. Informing or instructing a client about certain effects of a drug are nursing tasks that should be performed by a registered nurse. Administering a drug intravenously is also a task that belongs to a registered nurse.
The nurse is teaching the client about using tretinoin (Retin-A) for treatment of acne vulgaris. Which of the following indicates that the teaching has been successful?
Show answer and rationale
Correct answer: C. The client limits exposure to sunlight
Tretinoin (Retin-A) is a retinoid that causes sensitivity to sunlight and susceptibility to sunburn, so limiting exposure and using sunscreen of at least 15 SPF are advised. The use of a drying soap assists the client in treating the acne. Although the use of caffeine has no relationship to the medication itself, some clients find that certain foods aggravate their acne and are advised to avoid them or reduce the amount consumed. A stinging sensation is normal for clients with sensitive skin. Avoiding abrasive soaps and keratolytic agents, like benzoyl peroxide and salicylic acid, can reduce this sensation.
After instructing a client on the application of anthralin, the client states, "I want to apply the medication to the nonaffected areas to prevent other lesions from developing." Which of the following responses by the nurse is most appropriate?
Show answer and rationale
Correct answer: A. "The medication can cause chemical burns, so it should be used on the psoriatic lesions only."
Anthralin may be used in the treatment of psoriasis. It inhibits DNA synthesis to suppress the overgrowth of epidermal cells. It is a strong irritant and should be applied only to affected skin. It may be very irritating to unaffected skin. It also stains clothing, skin, and hair.
The client is being treated with haloprogin (Halotex) for tinea pedis (athlete’s foot). Which of the following statements by the client indicates the client understands the teaching about the medication?
Show answer and rationale
Correct answer: A. "I will apply the medication every morning and evening for 2 to 4 weeks."
Haloprogin (Halotex) is an antifungal. Treatment for tinea pedis (athlete’s foot) requires twice-a-day application of Halotex. Soaking the feet in cold water will not improve absorption of the medication.
The client with a rash in the axilla is prescribed amcinonide (Cyclocort) topical. For which of the following adverse reactions should the nurse monitor the client?
Show answer and rationale
Correct answer: B. Thinning of the skin
Amcinonide (Cyclocort) is a topical steroid. Regular use of topical steroids is associated with the adverse effect of thinning of the skin and appearance of "stretch marks."
A female client with herpes genitalis is receiving education about the medication regimen. Which of the following would be most appropriate to include in the teaching?
Show answer and rationale
Correct answer: B. Use topical acyclovir every 4 hours five times a day for 10 days
Acyclovir (Zovirax) is an antiviral used in the treatment of genital herpes. It is used every 4 hours five times a day for 10 days. Terconazole, sulconazole nitrate, and tioconazole are all antifungal drugs.
During the early emergent phase of a burn injury, clients are at risk for infection. Which of the following prescribed drugs would the nurse anticipate administering to prevent infection?
Show answer and rationale
Correct answer: B. Mafenide acetate (Sulfamylon)
Sulfamylon is a topical anti-infective that is used to prevent infections in burn wounds. Lindane (Kwell) is used to treat pediculosis. Acitretin (Soriatane) is a retinoid used in the treatment of psoriasis. Azelaic acid (Azelex) is used in the treatment of acne.
A client with sebhorrheic dermatitis of the face is being treated with topical ketoconazole (Nizoral). Which of the following behaviors by the client indicates that teaching has been effective?
Show answer and rationale
Correct answer: A. Removal of any dry scales prior to application of the cream to aid absorption
Topical ketoconazole (Nizoral) is best absorbed through skin that is free of scales. Gentle washing with soap and water to remove scales will aid in absorption of the topical antifungal. A thin layer that is rubbed in will be more effectively absorbed. The old cream and dead skin must be removed daily. Application of an emollient prior to application of the antifungal will reduce absorption of the antifungal. Moisturizing creams are of no value in treating the fungal infection that caused the dermatitis to begin with.
The nurse explains to the client that which of the following drugs is the drug of choice in Raynaud’s phenomenon?
Show answer and rationale
Correct answer: D. Calcium-channel blockers
The drugs of choice to treat Raynaud’s phenomenon are calcium-channel blockers, such as diltiazem (Cardizem) and nifedipine (Procardia). They are particularly useful in treating acute episodes, but are also used in chronic episodes. They relieve vasospastic attacks by relaxing the smooth muscles of the arterioles.
Allopurinol (Zyloprim) and colchicine have been prescribed for a client with gout and diabetes mellitus. Which of the following instructions should be given to this client?
Show answer and rationale
Correct answer: A. Urine sugar tests may not be valid
Urine sugar tests may indicate false positives when taking gout medications. Blood glucose testing is still accurate. Protein restrictions do not cause diabetic ketoacidosis, and protein is not restricted for diabetic clients.
The nurse should administer which of the following prescribed drugs to a client with rheumatoid arthritis who has severe joint involvement and a positive rheumatoid factor?
Show answer and rationale
Correct answer: B. Methotrexate
Because of the serious adverse reactions, such as hepatotoxicity and bone marrow depression, methotrexate is reserved for severe rheumatoid arthritis with severe systemic involvement and a positive rheumatoid factor. Laboratory monitoring must be obtained periodically throughout treatment. Methotrexate acts by facilitating a rapid anti-inflammatory response within days to weeks.
Which of the following should the nurse consider before administering an opioid analgesic to a child?
Show answer and rationale
Correct answer: C. The child’s age, weight, height, and respiratory status
Age, weight, height, and respiratory status must be considered before administering an opioid analgesic to children. There is no evidence to support that addiction or sedation are increased risks in children.
The nurse instructs a client who has salsalate (Disalcid) prescribed for a sprained ankle. Which of the following statements by the client indicates the client understood the instructions?
Show answer and rationale
Correct answer: B. "It may cause me to have a headache and I should report this to my physician."
Salsalate (Disalcid) is a nonacetylated salicylate prescription drug. All adverse reactions should be reported to the physician. If the client becomes dizzy, lying down is appropriate, but the physician should be notified before resuming normal activities.
The nurse is collecting a medication history for a client who has meloxicam (Mobic) prescribed. Which of the following drugs that the client is taking should the nurse question?
Show answer and rationale
Correct answer: A. Diclofenac potassium (Cataflam)
Diclofenac potassium (Cataflam) is a nonsteroidal anti-inflammatory. Because the client is already taking meloxicam (Mobic), taking two anti-inflammatories at the same time is contraindicated. Taking two antiinflammatory drugs increases the incidence of adverse reactions. Atorvastatin calcium (Lipitor) is an antihyperlipidemic. Alendronate sodium (Fosamax) is a bone growth regulator used in the treatment of osteoporosis. Omeprazole (Prilosec) is a proton pump inhibitor used in the treatment of ulcers and gastroesophageal reflux disease.
A client who has osteoarthritis and is taking acetaminophen (Tylenol) orally and applying capsaicin cream topically to the knees develops a rash. Based on an understanding of the action of the drugs, which of the following is most likely the cause of the rash?
Show answer and rationale
Correct answer: A. A rash is an adverse reaction to both the acetaminophen (Tylenol) and capsaicin
Both acetaminophen (Tylenol) and capsaicin may cause a rash.
The nurse is admitting a client with fibromyalgia and a fractured hip who is taking sertraline (Zoloft) and diazepam (Valium). The physician orders morphine 10 mg IV push for the acute pain. Which of the following adverse reactions is a priority for the nurse to consider before administering the morphine?
Show answer and rationale
Correct answer: A. Sedation
Sedation is an adverse reaction to sertraline (Zoloft), diazepam (Valium), and morphine.
When the first class of drugs prescribed for rheumatoid arthritis fails, the nurse anticipates which category of drugs will be prescribed?
Show answer and rationale
Correct answer: A. Biologic response modulators
Disease-modifying antirheumatic drugs (DMARDs) are the first drugs used to try to reduce joint clinical manifestations in rheumatoid arthritis. Biologic response modulators have a 66% success rate after failure with DMARDs.
A client who had an osteoarthritic knee replacement has been receiving ibuprofen (Motrin) and experiencing excellent pain relief with this drug. Recently the client has been experiencing amblyopia, heartburn, nausea, and diarrhea. Which of the following would be the best nursing action for the nurse to include in this client’s plan of care?
Show answer and rationale
Correct answer: A. Administer the Motrin with prescribed misoprostol (Cytotec)
The most appropriate nursing action for a client who verbalizes effective pain relief from a nonsteroidal anti-inflammatory (NSAID) medication such as ibuprofen (Motrin) for osteoarthritis but is now complaining of gastrointestinal upset is to administer misoprostol (Cytotec) in conjunction with the Motrin. Cytotec is frequently given in conjunction with an NSAID drug that is causing gastrointestinal upset. Cytotec inhibits gastric acid secretion, has mucosal protective properties, and does not interfere with the efficacy of the Motrin. It is given for the duration that the NSAID drug is taken. Amblyopia (blurred vision) has no impact on the gastrointestinal upset. If a client experiences heartburn, nausea, and diarrhea, the NSAID may be administered with food and milk. If no gastrointestinal upset is experienced, the NSAID is given on an empty stomach.
A client with rheumatoid arthritis is being treated with etanercept (Enbrel). Which of the following statements by the nurse indicates the nurse understands the proper handling of this medication?
Show answer and rationale
Correct answer: C. "I will mix the drug by injecting liquid into the vial of powder, swirl it, and inject the drug into the client’s upper arm."
Etanercept (Enbrel) is an immunomodulator used in the treatment of moderate to severe rheumatoid arthritis for clients who have been unsuccessfully treated with one or more antirheumatic drugs. It comes in a vial as a powder. It must be liquefied by adding liquid and swirling to mix. It should not be shaken. It is injected into the upper arm, abdomen, or thigh.
The nurse is caring for a client with systemic scleroderma. The nurse understands that the client is to receive penicillamine (Cuprimine) for which of the following purposes?
Show answer and rationale
Correct answer: D. Causes thinning of the skin
Systemic sclerosis or scleroderma is a connective tissue disorder that results in degenerative, fibrotic, and inflammatory changes of the skin, blood vessels, skeletal muscles, and internal organs. Penicillamine (Cuprimine) is an antirheumatic drug that is investigationally used. It acts by thinning the skin.
Which of the following should the nurse consider before administering anakinra (Kineret) to a client with rheumatoid arthritis?
Show answer and rationale
Correct answer: D. Live vaccines should never be given to this client
Anakinra (Kineret) is a biologic response modifier that acts by inhibiting cytokines. Administering a live vaccine will manifest the disease process. Flu vaccines should be given each year, but not in the live virus form such as FluMist. Currently, there is no oral dosing of these medications. All biologic response modifiers are expensive, but only infliximab (Remicade) is infused through an IV.
The nurse is admitting a client with fibromyalgia who is tearful and states, "I am in so much pain that I can’t sleep. I just don’t know what can be done for me." Which of the following should the nurse include in the instructions given to this client?
Show answer and rationale
Correct answer: A. Treatment will focus on relieving both pain and sleep disturbances
The Food and Drug Administration has approved no drugs specifically for the treatment of fibromyalgia. However, many classes of drugs have proven to be beneficial in relieving pain and sleep disturbances for these clients. Treatment will focus on relieving the pain and facilitating sleep. Anticholinergics are not used to treat clinical manifestations of fibromyalgia.
The nurse is caring for a client with fibromyalgia who is experiencing pain and insomnia. Which of the following prescribed drugs should the nurse administer to relieve pain and insomnia?
Show answer and rationale
Correct answer: B. Cyclobenzaprine (Flexeril)
Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant that is administered to a client with fibromyalgia who is experiencing both pain and insomnia (sleeplessness). Acetaminophen (Tylenol) is a nonopioid analgesic and is administered for pain. Trazodone (Desyrel) is an antidepressant prescribed for depression with or without anxiety. Clonazepam (Klonopin) is a benzodiazepine used in the treatment of depression.
The nurse is caring for a client with a history of chronic gout. The nurse should understand that the client is to receive probenecid (Benemid) for which of the following purposes?
Show answer and rationale
Correct answer: C. Increases uric acid excretion
Probenecid (Benemid) is an antigout drug that acts by inhibiting renal tubular reabsorption of uric acid, promoting uric acid excretion, and decreasing serum urate levels. Allopurinol (Zyloprim) slows uric acid production. Colchicine acts by reducing the pain and inflammation.
The nurse is discharging a client with osteoporosis who is to begin on alendronate (Fosamax). Which of the following should the nurse include in the medication instructions?
Show answer and rationale
Correct answer: B. Avoid taking within 2 hours of eating calcium-rich foods
Alendronate (Fosamax) should not be taken with food or within 2 hours of calcium-rich foods. It is best if it is taken 30 minutes before food. Urinary retention and sedation are not adverse reactions to Fosamax.
The nurse is preparing to delegate clinical assignments to a licensed practical nurse. Which of the following assignments may the nurse delegate?
Show answer and rationale
Correct answer: D. Administer prednisolone (Prelone) with food to a client with rheumatoid arthritis
It is within the job description of a licensed practical nurse to administer prednisolone (Prelone) with food. Instructing a client taking an opioid analgesic on the effects of sedation, monitoring the white blood count and platelets of a client receiving interleukin-1 anakinra (Kineret), and evaluating compliance with drug therapy are all clinical assignments that require the expertise of a registered nurse.
When providing care to a client who is on amoxicillin and potassium clavulanate (Augmentin), the nurse should monitor the client for
Show answer and rationale
Correct answer: C. increased bleeding.
Amoxicillin and potassium clavulanate (Augmentin) is a penicillin anti-infective. Diarrhea, fever, and increased bleeding time are adverse reactions.
Which of the following should the nurse consider before administering glyburide (Micronase) and chlorthalidone (Hygroton) to a client with diabetes mellitus, hypertension, and edema?
Show answer and rationale
Correct answer: B. A thiazide diuretic decreases the action of glyburide
Glyburide (Micronase) is a sulfonylurea (second-generation) oral hypoglycemic agent. Chlorthalidone (Hygroton) is a thiazide diuretic. The thiazide diuretic decreases the action of the oral hypoglycemic agent and should be administered with caution to a client with diabetes mellitus.
The nurse is teaching a class on anti-infectives used to treat urinary tract infections. Which of the following should the nurse include in the class?
Show answer and rationale
Correct answer: A. E. coli has developed a resistance to penicillin anti-infectives
There is an increasing resistance to E. coli infections with penicillin anti-infectives. Sulfonamides are effective against aerobic bacteria, except Pseudomonas. Fluoroquinolones are effective broad-spectrum antibiotics used in the treatment of urinary tract infections caused by most organisms. Cephalosporins are chemically similar to penicillin and may result in a cross-sensitivity in clients with a known allergy to penicillin.
Phenazopyridine hydrochloride (Pyridium) is prescribed for a client with acute cystitis. Which of the following should the nurse explain to the client?
Show answer and rationale
Correct answer: C. The urine will turn a reddish-orange color
Phenazopyridine hydrochloride (Pyridium) is a urinary analgesic that exerts a topical analgesic effect on the mucosa lining of the urinary tract. It is normal for the urine to turn a reddishorange color. Gastrointestinal adverse reactions are decreased by taking the drug with food.
The nurse is caring for a client who has sustained a traumatic brain injury and is experiencing a neurogenic bladder. The nurse should understand that the client is to receive which of the following drugs in the treatment of neurogenic bladder?
Show answer and rationale
Correct answer: B. Probanthine bromide (Pro-Banthine)
Probanthine bromide (Pro-Banthine) is an antimuscarinic, also know as an anticholinergic or antispasmodic. It is used to relax the urinary tract smooth muscles by inhibiting acetylcholine in the treatment of bladder spasms or a neurogenic bladder. With a neurogenic bladder, urgency, frequency, incontinence, inability to void, and reflux are common clinical manifestations. Phenazopyridine HCL (Pyridium) is a urinary analgesic used for dysuria. Nalidixic acid (NegGram) and methenamine, phenylsalicylate, atropine, and hyoscyamine (Urised) are urinary anti-infectives used in the treatment of urinary tract infections.
The nurse is caring for a client with congestive heart failure. The nurse should understand that the client is to receive furosemide (Lasix) for which of the following purposes?
Show answer and rationale
Correct answer: D. Inhibits the reabsorption of sodium and chloride in the ascending loop of Henle
Furosemide (Lasix) is a loop diuretic that inhibits the reabsorption of sodium and chloride in the ascending loop of Henle. A carbonic anhydrase inhibitor acts in the renal tubule to decrease water, sodium, and potassium. A thiazide diuretic inhibits sodium and chloride reabsorption in the distal tubule while blocking chloride reabsorption in the ascending loop of Henle. A potassium-sparing diuretic competes with aldosterone in the distal renal tubule, promoting the excretion of water, sodium, chloride, and bicarbonate while sparing potassium.
Tolterodine (Detrol) has been prescribed for an older adult client who has dementia and is experiencing incontinence. The client’s medical history reveals congestive heart failure, edema, and hypertension. Which of the following adverse reactions is a priority to report for this client?
Show answer and rationale
Correct answer: D. Urinary retention
Although dry mouth, restlessness, urinary retention, and nausea are all adverse reactions to tolterodine (Detrol), urinary retention is the priority to report for a client with congestive heart failure and edema. Urinary retention is a potentially serious adverse reaction for a client already experiencing fluid retention with congestive heart failure.
The nurse should administer which of the following prescribed diuretics for the purpose of decreasing the adverse effects of hypokalemia and hyperkalemia?
Show answer and rationale
Correct answer: C. Triameterene and hydrochlorothiazide (Dyazide)
Triameterene and hydrochlorothiazide (Dyazide) is an antihypertensive combination drug used for the purpose of decreasing the effects of both hypokalemia and hyperkalemia. Quinethazone (Hydromox) is a thiazide diuretic, ethacrynic acid (Edecrin) is a loop diuretic, and acetazolamide (Diamox) is a carbonic anhydrase inhibitor. All of these diuretics cause hypokalemia.
Which of the following questions is a priority for the nurse to ask a client before administering ceftriaxone (Rocephin)?
Show answer and rationale
Correct answer: D. "Do you have an allergy to penicillin?"
Ceftriaxone (Rocephin) is a cephalosporin that is chemically and pharmacologically related to penicillin. Because of this chemical similarity, there may be a cross-sensitivity in clients with a known allergy to penicillin.
The nurse is developing a medication schedule for a client who is to receive cefadroxil (Duricef) orally. Based on an understanding of the drug, which of the following administration methods would promote the best absorption?
Show answer and rationale
Correct answer: B. With food
Cefadroxil (Duricef) is a cephalosporin given in the treatment of acute urinary tract infections. The usual oral dose is 1-2 grams twice a day. Oral absorption is increased when taken with food.
Which of the following is a priority to include in the plan of care for starting antimicrobial therapy?
Show answer and rationale
Correct answer: D. Stay with the client for 30 minutes after the initial dose
It is a priority to stay with the client for the first 30 minutes when initiating antimicrobial therapy to monitor the client for a severe reaction, such as anaphylactoid reaction. Encouraging an increased fluid intake, monitoring the liver and blood studies, and maintaining an accurate intake and output are all appropriate interventions, but not the priority.
The registered nurse making out clinical assignments for the day may delegate which of the following nursing skills to a licensed practical nurse?
Show answer and rationale
Correct answer: B. Maintain an accurate intake and output in a client taking spironolactone (Aldactone)
Nursing skills that involve assessment, monitoring, or notifying are skills that must be performed by a registered nurse. A licensed practical nurse does have the skill to maintain an accurate intake and output.
The nurse is reviewing the medical history of a client taking dichlorphenamide (Daranide). For which of the following conditions is Daranide contraindicated or to be used with extreme caution?
Show answer and rationale
Correct answer: B. Hyperkalemia
Dichlorphenamide (Daranide) is a potassiumsparing diuretic that is contraindicated or should be used only with extreme caution for a client with renal disease or with an electrolyte imbalance such as hyperkalemia.
Based on an understanding of the drug interactions for a client taking a loop diuretic and an aminoglyceride, for which of the following should the nurse monitor the client?
Show answer and rationale
Correct answer: C. Ototoxicity
There is a drug interaction between a loop diuretic and an aminoglyceride that may result in ototoxicity. If it is a medical necessity to have the client on both, it is essential that the client be monitored for manifestations of ototoxicity. A loop diuretic and corticosteroid interaction may result in hypokalemia. A drug interaction between a loop diuretic and an opiate may result in orthostatic hypotension. A drug interaction between a loop diuretic and a salicylate may decrease the diuretic effects.
Which of the following is a priority for the nurse to include in the instructions for a client starting estrogen hormone replacement therapy for menopause?
Show answer and rationale
Correct answer: B. Remember to do a breast self-examination every month
Menopausal women who take estrogen hormone replacement therapy (HRT) are at risk for developing breast cancer; thus, monthly breast self-examinations are very important. It is normal for women who start HRT to gain weight. Menopausal women who do not start HRT will be at risk for osteoporosis and prone to fractures and will have greater frequency and urgency in urination.
After receiving instructions from the nurse regarding the drug alendronate (Fosamax), which of the following statements from a postmenopausal client indicates an understanding of the purpose of the drug?
Show answer and rationale
Correct answer: C. "This drug should make my bones stronger."
Alendronate (Fosamax) is a drug that decreases the rate of bone resorption and is used to prevent or treat osteoporosis in postmenopausal women. Fosamax is not helpful for other clinical manifestations of menopause, which include mood swings, stress incontinence, and hot flashes.
The nurse instructs the perimenopausal client that it is a priority to stop taking the prescribed estrogen if which of the following occurs?
Show answer and rationale
Correct answer: A. Nausea and vomiting
Hormone replacement therapy (HRT) should not be taken if one is pregnant; if a woman begins to experience nausea and vomiting, it could indicate morning sickness accompanying a pregnancy. Spotting between menstrual periods and breast tenderness are adverse reactions to HRT. Painful intercourse may be due to vaginal dryness, which commonly occurs in menopause with the absence of estrogen.
Which of the following should the nurse include in the administration instructions for a client using estrogen vaginal cream?
Show answer and rationale
Correct answer: C. Remain in bed for 30 minutes after inserting the drug
For proper absorption of the vaginal cream, the client should remain in bed for 30 minutes after insertion. A tampon would absorb the cream and reduce its effectiveness. Application schedules vary, but the cream should be applied at least one to three times per week. The applicator should be cleaned with soap and water after use.
Based on an understanding of drugs, the nurse plans to instruct a client with amenorrhea to use which of the following drugs?
Show answer and rationale
Correct answer: C. Estrogen (Premarin)
Amenorrhea is treated with drugs such as estrogen (Premarin) to stimulate ovulation. Danazol (Danocrine) is used to suppress ovulation. Progesterone (Progestin) causes the uterine lining to shed with menses. Naproxen (Naprosyn) is a nonsteroidal anti-inflammatory drug used in the treatment of dysmenorrhea.
Which of the following should the nurse include in the instructions to a client receiving a nonsteroidal anti-inflammatory drug?
Show answer and rationale
Correct answer: A. Do not take with the drug lithium
Nonsteroidal anti-inflammatory drugs (NSAIDs) interact with lithium to increase lithium toxicity. Caffeine is not contraindicated with the use of NSAIDs. NSAIDs are not hormones and would not affect pregnancy. NSAIDs should be taken with food or milk to minimize gastric irritation.
Which of the following allergies should the nurse assess for a client who is taking naproxen (Naprosyn) for the treatment of dysmenorrhea?
Show answer and rationale
Correct answer: B. Aspirin
Naproxen (Naprosyn) and acetylsalicylic acid (aspirin) are both nonsteroidal antiinflammatory drugs (NSAIDs), and a hypersensitivity to any NSAID creates a hypersensitivity to all of the others in the group. Allergies to morphine and penicillin would not affect the use of NSAIDs. Tylenol is a nonnarcotic analgesic that does not cause the same bleeding tendencies as aspirin and is often used as a substitute for aspirin when aspirin is contraindicated.
Which of the following assessment findings is expected in a client with premenstrual syndrome (PMS) who is receiving danazol (Danocrine)?
Show answer and rationale
Correct answer: B. Amenorrhea
Danazol (Danocrine) is an ovulatory suppression drug used to create anovulation and amenorrhea in the treatment of premenstrual syndrome (PMS). It does not cause breast tenderness or hirsutism. Danazol is�known to decrease libido rather than increase�it.
T he nurse should instruct a client who is prescribed danazol (Danocrine) for the treatment of premenstrual syndrome (PMS) to take the first dose
Show answer and rationale
Correct answer: C. during the next menstrual period.
Danazol (Danocrine) is started during the menses to ensure that the client is not pregnant. The client could be pregnant 2 weeks after her menstrual period and 1 week prior to the start of the next menses. Thick mucus discharge could indicate that the client has ovulated and possibly conceived.
The nurse instructs the client taking miconazole nitrate (Monistat) to avoid which of the following drugs?
Show answer and rationale
Correct answer: D. Isoniazid (Nydrazid)
Isoniazid (Nydrazid) is an antitubercular drug that decreases the effectiveness and blood levels of the antifungal drug miconazole nitrate (Monistat). Coumadin, probenecid (Benemid), and hydrochlorothiazide (Hydrodiuril) are not contraindicated when Monistat is prescribed.
Which of the following should the nurse include in the medication instructions for a client with gonorrhea who is prescribed tetracycline hydrochloride (Achromycin V)?
Show answer and rationale
Correct answer: C. Use sun protection and cover your body if going outdoors
A major adverse reaction of most antibiotics, including tetracycline hydrochloride (Achromycin V), is photosensitivity; thus, clients should use sun protection and cover their bodies when going outdoors. Clients taking Achromycin V should use a nonhormonal type�of contraceptive, as there is decreased effectiveness of hormonal contraceptives and a possibility of breakthrough bleeding. This drug should be taken around the clock to maintain blood levels. The first dose of any antibiotic can be started after the specimen for culture and sensitivity has been obtained but before the results are known.
T he nurse should notify the physician if which of the following occurs when treating a client receiving antibiotics for gonorrhea?
Show answer and rationale
Correct answer: D. A black furry growth appears on the tongue
A black furry growth that appears on the tongue is an indication of the presence of a superinfection. Herpesvirus type 2 has lesions on the perineal area but gonorrhea does not. Clients with gonorrhea may have painful sexual intercourse and spotting between periods as part of the disease process.
The nurse is creating a medication schedule for erythromycin prescribed for a client with pelvic inflammatory disease. Which of the following times for administration should the nurse include in the schedule? Administer with
Show answer and rationale
Correct answer: B. a full glass of water between meals.
Erythromycin is an antibiotic used in the treatment of pelvic inflammatory disease. It should be taken with a full glass of water 1�hour before or 2 hours after a meal. It should not be taken with fruit juices. It is not necessary to take it with an antacid, and taking it 30 minutes prior to a meal would interfere with absorption. Erythromycin should be taken on an empty stomach; milk and meals would both interfere with absorption.
The nurse informs a client with bacterial vaginosis who has been taking metronidazole (Flagyl) that which of the following would indicate an expected response to the drug?
Show answer and rationale
Correct answer: B. Reddish-brown urine
Metronidazole (Flagyl) is an antifungal drug used to treat bacterial vaginosis. It may cause reddish-brown urine, which is of no clinical significance. Weight gain, a metallic taste, and diarrhea are adverse reactions that are not considered to be normal.
The nurse instructs a client who has trichomoniasis to avoid which of the following while taking metronidazole (Flagyl)?
Show answer and rationale
Correct answer: B. Alcohol
A disulfiram-like reaction may occur when alcohol is ingested while one is taking metronidazole (Flagyl). Lithium, caffeine, and diazepam are not known to be contraindicated with Flagyl.
Which of the following is correct to include in the procedure for a client with herpesvirus type 2 who is being treated with acyclovir (Zovirax)?
Show answer and rationale
Correct answer: A. Apply ointment to the lesions with a nonsterile glove
Acyclovir (Zovirax) is supplied as an ointment, which is applied topically to the lesions of a client with herpesvirus type 2. A nonsterile glove or finger cot should be used in applying the ointment to prevent cross-contamination. Liquid soap should be used rather than bar soap, as the bar soap would become contaminated for use by others. Acyclovir is not supplied as a transdermal patch and the lesions should be left open to air.
Which of the following laboratory tests would be most important for the nurse to monitor in a client with herpesvirus type 2 who has been taking acyclovir (Zovirax)?
Show answer and rationale
Correct answer: D. Serum creatinine
Acyclovir (Zovirax) is an antiviral used in the treatment of herpes. Clients receiving acyclovir (Zovirax) for herpesvirus type 2 need to be assessed frequently to detect changes in renal function, as the drug can be nephrotoxic. Serum creatinine is a good laboratory test to monitor renal function. Zovirax is not known to affect liver function, white cell count, or bleeding and clotting time.
The nurse instructs a client with a history of herpesvirus type 2 to take the prescribed acyclovir (Zovirax)
Show answer and rationale
Correct answer: C. at the first sign of clinical manifestations returning.
Acyclovir (Zovirax) should be taken as soon as the client notices the clinical manifestations are reappearing. Acyclovir is not recommended to be taken for longer than a 6-month period. Over-the-counter ointment and creams should not be used, as they may delay healing and spread infection. Acyclovir should not be taken before clinical manifestations appear, and it does not prevent reinfection.
A client who is prescribed danazol (Danocrine) for endometriosis asks the nurse, "What happens when I stop taking this drug?" The best response of the nurse would be
Show answer and rationale
Correct answer: D. "You will ovulate and start menstruating in 2 to 3 months."
Danazol (Danocrine) is a synthetic androgen that is used to cause atrophy of the endometrium, resulting in amenorrhea. When the drug is stopped, the reactions are reversible and ovulation and menses will return in 2 to 3�months. These drugs do not cure endometriosis, but alleviate the clinical manifestations during drug therapy. A client taking this drug may still have some endometrial cells, which are stimulated by estrogen, so the dysmenorrhea may return. Danazol does not affect the regularity of menstrual periods.
The nurse should inform a client taking oral contraceptives for birth control that which of the following is a priority to immediately report?
Show answer and rationale
Correct answer: D. Calf pain with dorsiflexion of the foot
Clients taking oral contraceptives are at risk for developing thrombophlebitis as evidenced by calf pain with dorsiflexion of the foot. Spotting between periods, breast enlargement, and an increase in growth of body hair are adverse reactions that occur with the use of oral contraceptives.
The nurse instructs a client who is prescribed a progestin-only contraceptive for birth control to
Show answer and rationale
Correct answer: D. wait 3 months to get pregnant after she stops taking the drug.
Clients taking progestin-only drugs for birth control are instructed to wait 3�months to get pregnant once the drug is stopped, to avoid the risk of birth defects to the fetus. Progestin-only drugs are taken daily throughout the month. A barrier method of contraception is needed only for the first 3 weeks after starting the drug. Progestin-only contraceptives inhibit ovulation, but the menstrual cycle is not usually disrupted.
Which of the following nursing tasks may the registered nurse safely delegate to a licensed practical nurse?
Show answer and rationale
Correct answer: B. Question a client taking a non steroidal anti-inflammatory drug about the presence of dark, tarry stools or a coffee-ground emesis.
It is not appropriate for either a licensed practical nurse or a registered nurse to inform a client on the pros and cons of hormone replacement therapy. This is the responsibility of the physician. Giving a client information or instruction on how to take a drug is a nursing task reserved for the registered nurse. Instructing a client on the purpose of a drug is a responsibility of the physician that may be reinforced by the registered nurse. A licensed practical nurse may question a client taking a non steroidal anti inflammatory drug about experiencing dark, tarry stools or coffee-ground emesis. The licensed practical nurse should in turn notify the registered nurse if they are present. The registered nurse in turn notifies the physician.
A client asks the nurse if the chemotherapy will only affect the cancer cells in the body. Which of the following is the appropriate response by the nurse?
Show answer and rationale
Correct answer: B. "The chemotherapy affects both the normal as well as the cancer cells."
Chemotherapy is a systemic treatment that affects normal as well as cancer cells. Cells of any tissue that are actively dividing will be more susceptible to its effects. Although the adverse reactions experienced by any one client may vary somewhat, cancer cells and normal cells are still both affected by the treatment.
The nurse evaluates chemotherapy to be most effective in which of the following clients?
Show answer and rationale
Correct answer: C. A client who is well nourished
Chemotherapy is equally effective in both men and women. The type of cancer a client has does not affect the potential of the chemotherapy. Chemotherapy may actually be somewhat less effective in those who have been exposed to chemotherapy previously, due to cancer cell resistance. Clients who are overall in better health will be able to tolerate the prescribed dose and regimen of chemotherapy better than those who are not, rendering it as effective as possible. Age does not directly affect the chemotherapy or type of cancer. Age directly relates to the client’s overall condition of health.
A client asks the nurse what was meant when the physician stated, "There has been a partial remission of the cancer." Which of the following is the appropriate response by the nurse?
Show answer and rationale
Correct answer: A. "The cancer has regressed 50% or more."
A partial remission of a client’s cancer indicates that it is not spreading further to the lymph nodes or growing (progressing), but rather that it has regressed (decreased) 50% or more. A complete remission would be characterized as the cancer appearing to have disappeared.
A client asks, "Why will I lose my hair from chemotherapy?" The appropriate response by the nurse is based on which of the following?
Show answer and rationale
Correct answer: D. Chemotherapy affects normal cells that divide often
Chemotherapy drugs affect all cells of the body that divide often, such as the hair follicle cells, thus causing hair loss. Many chemotherapy drugs cause total alopecia, but some do not. There is no known, accepted method of preventing chemotherapy-related alopecia.
The nurse is planning to care for the adverse reactions in a client receiving chemotherapy. Which adverse reaction should take priority in this plan of care?
Show answer and rationale
Correct answer: B. Fatigue
Fatigue is the most common adverse reaction to chemotherapy. Clients receiving chemotherapy may experience depression and headache, but these are very individual to the client. Rash is more associated with an allergic reaction, a skin reaction to immunosuppression, or to specific types of chemotherapy, but is not common overall.
A client’s family asks the nurse, "Why can’t the chemotherapy be given once instead of in multiple cycles?" The nurse’s response is based on which of the following?
Show answer and rationale
Correct answer: C. Certain chemotherapy works best during certain phases of the cell cycle
Chemotherapy is given in multiple cycles to allow for recuperation of normal cells between doses and to catch cancer cells in various phases of the cell cycle when the chemotherapy would have the most effect. It is true that giving too large a dose of chemotherapy could be lethal to a client, but this is not the primary reason that chemotherapy is administered in cycles. The number of cycles has been established through clinical trials and is not dependent on insurance payment.
The nurse is teaching a class on the various types of chemotherapy agents. Which of the following examples of chemotherapy agents should the nurse include in the cell-cycle-specific group?
Show answer and rationale
Correct answer: C. Methotrexate
Methotrexate is an antimetabolite and a cellcycle-specific drug. Cyclophosphamide (Cytoxan), doxorubicin (Doxil), and nitrogen mustard are cell-cycle-nonspecific drugs.
The nurse should administer which of the following cell-cycle-nonspecific chemotherapy agents to a client?
Show answer and rationale
Correct answer: C. Cisplatin (Platinol)
Cisplatin (Platinol) is an alkylating agent and a cell-cycle-nonspecific chemotherapy drug. Paclitaxel (Taxol), 5-fluorouracil (Adrucil), and vincristine (Oncovin) are all cell-cycle-specific chemotherapy drugs.
Which of the following should the nurse consider before preparing to administer chemotherapy to a client?
Show answer and rationale
Correct answer: B. Wear disposable gown, mask, and gloves
Nurses should always wear protective clothing such as a disposable gown, mask, and gloves when administering chemotherapy. Chemotherapy drugs are usually prepared by a pharmacist or the nurse under a vented, laminar-flow cabinet. Pregnant nurses may administer chemotherapy using the usual precautions. The IV tubing should not be primed with the chemotherapy agent.
The nurse should include which of the following when preparing to select the client’s IV site for chemotherapy administration? Choose an IV site
Show answer and rationale
Correct answer: A. between the antecubital space and wrist.
The appropriate site for chemotherapy administration is between the antecubital space and wrist, proximal to any recent venipuncture site. Chemotherapy should be administered to a site with excellent blood return to assure the vessel is competent to receive chemotherapy without leakage. Leakage of the chemotherapy agent through the vein can occur if it is administered distal to a recent venipuncture site. Chemotherapy is usually not administered on the arm associated with the cancer surgery, if applicable (e.g., given right mastectomy, chemotherapy will be administered to the left arm).
Prior to initiating chemotherapy administration for a client, the nurse should consider which of the following principles?
Show answer and rationale
Correct answer: B. Vesicant drugs should be infused before nonvesicant drugs
Vesicant chemotherapy agents should be administered before nonvesicant drugs if two such drugs are ordered in combination. This is due to the fact that the best blood flow, condition of vein, and site are desired for administration of a potentially tissue-damaging drug (vesicant). Because these factors could deteriorate during drug administration, the nurse should start with the vesicant. Some chemotherapy agents should be administered with an infusion pump, but others should not. The client’s arm should be in a natural, relaxed position during administration. The IV line should be flushed with approximately 10 ml of normal saline between administrations of chemotherapy drugs.
Which of the following is the priority nursing action when a client states, "My IV site hurts!" during chemotherapy administration?
Show answer and rationale
Correct answer: B. Stop the infusion
The priority nursing action that should be taken by the nurse if the client complains of a painful IV site during chemotherapy administration is to stop the infusion. The nurse would then assess the situation to determine the cause of the pain. Caution should be used regarding repositioning of the needle so as not to damage the vein. If extravasation is suspected, the needle should be left in place, and the physician notified. Applying heat or cold to the IV site may be ordered, based on the chemotherapy being administered. All of these interventions are performed only after stopping the infusion.
The nurse suspects that the vesicant IV chemotherapy being administered to the client has extravasated. Based on this assessment, which of the following is the priority intervention?
Show answer and rationale
Correct answer: D. Stop the infusion and notify the physician
The first action taken when extravasation is suspected is to stop the infusion and notify the physician. The nurse should not wait to stop the IV until confirmation of extravasation by the physician. The needle should not be removed, as it will be used to aspirate drug from the site to treat the extravasation. The drug should not be restarted until the extravasation has been properly treated according to the physician’s orders.
Which of the following client assignments is an appropriate assignment for a licensed practical nurse?
Show answer and rationale
Correct answer: B. Assist a client receiving ifosfamide (Ifex) to mark a bland diet
Only specially trained registered nurses may administer chemotherapy drugs, regardless of the route. Developing a plan of care is a job task reserved for the registered nurse. A licensed practical nurse may assist a client receiving chemotherapy to mark a bland diet after the initial instruction has taken place.
The nurse should administer which of the following prescribed drugs to a client receiving chemotherapy who has developed neutropenia?
Show answer and rationale
Correct answer: B. Filgrastim (Neupogen)
Filgrastim (Neupogen) is a colony-stimulating factor used in the treatment of neutropenia for a client receiving chemotherapy. Leuprolide acetate (Lupron) is an antineoplastic hormone used in the treatment of prostate cancer. Tamoxifen (Tamofen) is an antiestrogen used in breast cancer. Trastuzumab (Herceptin) is an antineoplastic used in the treatment of breast cancer.
The nurse is caring for a 30-year-old female with ovarian cancer who is receiving cisplatin (Platinol). Which of the following is a priority to include in this client’s plan of care?
Show answer and rationale
Correct answer: B. Instruct the client to use a reliable method of birth control
It is a priority to instruct a client who is of childbearing age and receiving cisplatin (Platinol) to use a reliable method of birth control. Monitoring the BUN and creatinine, maintaining IV hydration, and instructing the client to report tinnitus are all appropriate interventions but not the priority intervention.
Which of the following is a priority for the nurse to monitor for a client receiving ifosfamide (Ifex) for testicular cancer?
Show answer and rationale
Correct answer: D. Hemorrhagic cystitis
Ifosfamide (Ifex) is an alkylating antineoplastic drug used in the treatment of testicular cancer, generally as a third-line therapy. It must always be administered with mesna (Mesnex), the antidote for ifosfamide toxicity. Ifex is metabolized to products that cause hemorrhagic cystitis. At least 2 liters of oral or IV fluids should be given with mesna (Mesnex) to prevent bladder toxicity. Other less serious adverse reactions include alopecia, phlebitis, and liver dysfunction.
Which of the following is a priority for the nurse to monitor in a client who is receiving mitoxantrone (Novantrone) for leukemia?
Show answer and rationale
Correct answer: B. Congestive heart failure
Mitoxantrone (Novantrone) is an antineoplastic used in the treatment of leukemia. It can cause a potentially fatal congestive heart failure. Other less serious adverse reactions include amenorrhea, mucositis, and pneumonia.
The nurse caring for a client administers sertraline (Zoloft) for which of the following disorders?
Show answer and rationale
Correct answer: A. Major depressive disorder
Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used in the treatment of major depression, obsessivecompulsive disorder, posttraumatic stress disorder, and panic disorders.
The client is instructed to take mirtazapine (Remeron) for depression. Which of the following would best indicate that the client is complying with the prescribed regimen? The client
Show answer and rationale
Correct answer: C. places the tablet on the tongue and waits 30 seconds for it to dissolve.
Mirtazapine (Remeron) is a tetracyclic antidepressant used in the treatment of depression. The tablets come as oral disintegrating tablets and should be administered initially in the evening, before sleep, until the drug effects are known. The tablet should be placed on the tongue for 30 seconds until dissolved. The client should not engage in activities that require mental alertness until the drug effects are known. Although nausea and vomiting may occur, there are no food restrictions. Fluids may be encouraged for the adverse reaction to constipation.
Which of the following is a priority to include in the plan of care for a client taking fluoxetine (Prozac)?
Show answer and rationale
Correct answer: D. Wait 14 days after taking a monoamine oxidase inhibitor before starting Prozac
Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. The client should be monitored for orthostatichypotension and instructed to change positions with caution. Prozac may be administered with food to decrease gastrointestinal upset. It is a priority to wait 14 days after discontinuing a monoamine oxidase inhibitor (MAOI) and administering Prozac. Five weeks should pass between stopping Prozac and starting a MAOI. Prozac should not be administered with Mellaril.
A client complains of having a dry mouth. Which of the following instructions should the nurse give to the client?
Show answer and rationale
Correct answer: D. "Try chewing sugar-free gum and drinking cool, sugar-free sodas."
Clients who take antidepressants and antipsychotic drugs may experience dry mouth as an adverse reaction. The client should avoid high-calorie fluids, which may promote weight gain. Drinking low-calorie fluids and chewing sugarless gum are encouraged to avoid gaining weight.
The nurse should question an order for bupropion (Wellbutrin) for which of the following clients?
Show answer and rationale
Correct answer: A. A client with a closed head injury
Bupropion (Wellbutrin) is an antidepressant that is known to lower the seizure threshold and is contraindicated for clients with known seizure disorders or closed head injuries.
The priority nursing action for the nurse administering an antidepressant drug to a client is which of the following?
Show answer and rationale
Correct answer: B. Check the client’s mouth for possible hoarding of the drug
Clients who are suicidal may attempt to hoard their drugs by "cheeking" them to be used later for a suicide attempt. Extreme caution should be used with suicidal clients.
A nurse is instructing a client about getting blood drawn the following day for a lithium carbonate (Eskalith) level. Which of the following instructions is important?
Show answer and rationale
Correct answer: D. "Do not eat anything in the morning before having your blood drawn."
Lithium carbonate (Eskalith) is an antimanic drug used in the treatment of bipolar disorders (manic phase) and in the prevention of bipolar manic-depressive psychosis. The lithium blood level is most accurate if the blood is drawn 12 hours after the last dose of drug. The client should avoid eating prior to having a lithium level drawn to avoid a food-lithium interaction and an inaccurate result.
The nurse evaluates which of the following lab results as within the normal range for a client who is receiving lithium carbonate (Eskalith)?
Show answer and rationale
Correct answer: C. 0.6 to 1.2 mEq/L
Lithium carbonate (Eskalith) is an antimanic drug. The client’s lithium carbonate level should be monitored. The normal range is 0.6 to 1.2 mEq/L.
The nurse is caring for a client with a psychotic disorder who is receiving thioridazine (Mellaril). The nurse should monitor this client for which of the following abnormal laboratory results?
Show answer and rationale
Correct answer: B. Agranulocytosis
Thioridazine (Mellaril) is an antipsychotic and atypical neuroleptic used in the treatment of psychotic disorders, schizophrenia, major depressive disorders, and organic brain syndrome. Mellaril may cause agranulocytosis (reduction in the number of white blood cells).
A client has been treated for depression with phenelzine (Nardil). The nurse recognizes that the drug was difficult to take for which of the following reasons?
Show answer and rationale
Correct answer: D. It requires adherence to a strict diet
Monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil), interact with the tyramine found in many foods, thus requiring the individuals using these drugs to follow a strict diet. Compliance becomes an issue. Foods high in tyramine include aged cheese, salami, sauerkraut, avocados, chocolate, coffee, fava beans, and beer and wine containing yeast.
The nurse is discharging a client taking flurazepam (Dalmane). Which of the following instructions should be given?
Show answer and rationale
Correct answer: D. A "hangover effect" may be experienced in the morning
Flurazepam (Dalmane) is a sedative and hypnotic that is used for insomnia. Clients are advised to avoid alcohol because alcohol taken in combination with hypnotics can have a lethal effect. Clients should not drive after taking hypnotics for safety reasons. Their reflexes would be dulled. Low-calorie fluids are not necessary because dry mouth is not an adverse reaction and Dalmane has no effect on appetite.
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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