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

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

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

3. A client is receiving heparin sodium by continuous intravenous infusion. The nurse

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

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

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

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

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

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

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

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

11. A client has just been given a prescription for diphenoxylate with atropine
(Lomotil). The nurse teaches the client which of the following about the use of this
medication? *
a. drooling may occur while taking this medication (Lomotil causes dry mouth)
b. irritability may occur while taking this medication (Lomotil causes drowsiness)
c. this medication contains a habit-forming ingredient
d. take the medication with a laxative of choice
(Rationale: Lomotil is an anti-diarrheal medication. Also, it has the risk of becoming
habit-forming.)
12. A nurse is gathering data from client about the client’s medication history and
notes that the client is taking tolterodine tartrate (Detrol LA). The nurse determines
that the client is taking the medication to treat which disorder? *
a. glaucoma (Contraindicated to Detrol LA)
b. renal insufficiency
c. pyloric stenosis
d. urinary frequency and urgency
(Rationale: In urinary frequency and urgency, the overactive urinary bladder is
contracting continuously or in spasms. Tolterodine tartrate (Detrol LA) is an
antispasmodic.

13. A client has an order to receive psyllium (Metamucil) daily. The nurse administers
this medication with: *
a. a multivitamin and mineral supplement
b. a dose of an antacid
c. applesauce
d. eight ounces of liquid
(Rationale: Metamucil is a bulk-forming laxative is best taken with oral fluids to aid the
patient in bowel movement and prevent drug-induced esophagitis.)

14. A nurse is teaching a client taking cyclosporine (Sandimmune) after renal

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

15. A nurse reinforces dietary instruction for the client receiving spironolactone
(Aldactone). Which food would the nurse instruct the client to avoid while taking this
medication? *
a. crackers (Sodium-based food)
POTASSIUM-RICHED FOODS: 9) avocado,
1) Bananas 10) cantaloupe,
2) Legumes 11) strawberries,
3) Potatoes 12) carrots
4) Oranges
b. shrimp (Sodium based food)
c. apricots
d. popcorn (Sodium based food)
(Rationale: Aldactone is a potassium-sparing diuretic. Patients taking Aldactone is in a
low potassium diet.)

16. Oral lactulose (Chronulac) is prescribed for the client with a hepatic disorder and
the nurse provides instructions to the client regarding this medication. Which
statement by the client indicates a need for further instructions? *
a. “I need to take the medication with water’”
b. “ I need to increase fluid intake while taking the medication”
c. “ I need to increase fiber in the diet”
d. “I need to notify the physician of nausea occurs”
(Rationale: Nausea is an expected side effect of Lactulose. Lactulose decreases
ammonia in the body.)

17. A home care nurse provides instructions to a client taking digoxin (Lanoxin) 0.25
mg daily. Which statement by the client indicates a need for further instructions? *
a. “I will take my prescribed antacid if I become nauseated”
b. “It is important to have my blood drawn when prescribed”
c. “I will check my pulse before I take my medication”
d. “I will carry a medication identification card with me”
(Rationale: Antacids is not advisable when nauseated because it neutralizes the
hydrochloric acid in the stomach)

HOME CARE INSTRUCTIONS FOR DIGOXIN ADMINISTRATION:

1) Administer as prescribed
2) Before administration, check apical pulse for one full minute.
3) Administer 1 hour or 2 hours after feedings (empty stomach)
4) Do not mix medication with foods or fluid
5) If a dose is missed (>4 hours), withhold and give next dose at the
scheduled time
6) If a dose is missed (<4 hours), administer the missed dose
7) If a child vomits, do not administer second dose. Follow HCP’s
prescriptions.
8) If more than 2 consecutive doses have been missed, notify HCP.
9) Do not increase or double the dose for missed doses.
10)If child has teeth, give water after medication. After that, if possible, brush
teeth to prevent tooth decay from the sweetened liquid.
11)Monitor for signs of toxicity (poor feeding, vomiting)
12)If child is becoming ill: notify the HCP.
18. A client with anxiety disorder is taking buspirone (BuSpar) and tells the nurse that
it is difficult to swallow the tablets. The nurse tells the client to: *
a. dissolve the tablet in a cup of coffee MEDICATIONS THAT CANNOT BE
b. crush the tablet before taking it CRUSHED:
1) Sustained release (SA)
c. call the physician for a change in
2) Extended release (XR)
medication 3) Enteric coated (EC)
d. mix the tablet uncrushed in custard 4) Long-acting LA)
5) Controlled release (CD)
(Rationale: Buspirone tablets can be crushed.)

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

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

NOTE: If missed more than 2 pills, discontinue the cycle and start it over again.
21. A nurse provides instructions to a client taking clorazepate (Tranxene) for
management of an anxiety disorder. The nurse tells the client that: *
a. drowsiness is a side effect that usually disappears with continued therapy
b. if dizziness occurs, call the physician (It is an expected side effect for which it
depresses CNS levels)
c. smoking increases the effectiveness of the medication (smoking is never beneficial
to the medication, as well as the patient)
d. if gastrointestinal disturbances occur, discontinue the medication (GI disturbance
is a side effect. No need for discontinuation)
(Rationale: Clorazepate (Tranxene) is an anxiolytic and a benzodiazepine which
decreases CNS levels.)

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

23. A nurse in a physician’s office is reviewing the results of a client’s phenytoin

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

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

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

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

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image for a client
who is taking spironolactone (Aldactone). The nurse based this diagnosis on
assessment of which side effect of the medication? *
a. edema
b. weight gain
c. excitability
d. decreased libido
 DRUG CLINICAL ACTION THERAPEUTIC SIDE EFFECTS
EFFECT
Spironolacton  K+ sparing  interferes Na+  diuresis  Hyperkalemia (in
e diuretic reabsorption  lowers BP patients with renal
 Antihypertensive  inhibits action insufficiency,
of taking K+
aldosterone supplements)
 promotes Na+  Dehydration
and water  Hyponatremia
excretion  Lethargy
 increases SEXUAL S/E:
potassium For Males:
retention  Gynecomastia
 Impotence
 Decreased
libido
For Females:
 Menstrual
irregularities
 Breast
tenderness

28. A nurse is caring for the client with a history of mild heart failure who is receiving
diltiazem hydrochloride (Cardizem) for hypertension. The nurse would assess the
client for: *
a. bradycardia
b. wheezing
c. peripheral edema and weight gain
d. apical pulse rate lower than baseline
(Rationale: Diltiazem hydrochloride (Cardizem) is a calcium channel blocker which
blocks the calcium to the blood vessels: inhibiting constriction, causing hypertension;
and the heart: slows contraction, causing decrease cardiac conduction)
29. The wound of a client with an extensive burn injury is being treated with the
application of silver sulfadiazine (Silvadene). Which symptom would indicate to the
nurse that the client is experiencing a side effect related to systemic absorption? *
a. pain at the wound site (Local)
b. burning and itching at the wound site (Local)
c. a localized rash (Local)
d. photosensitivity
(Rationale: Side effect related to systemic absorption of Silver sulfadiazine (Silvadene)
is affecting CNS levels spread throughout.)

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

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

32. A nurse is monitoring a client who is taking fluphenazine decanoate (Prolixin) for
signs of leucopenia. Which finding indicates a sign of this blood dyscrasia? *
a. blurred vision DYSCRASIA:
b. constipation  An abnormal condition of the body and
c. sore throat especially the blood.
d. dry mouth
(Rationale: Leukopenia is an abnormally low leukocytes which can cause infection.)
33. A nurse is administering amphotericin B (Fungizone) to a client intravenously to
treat a fungal infection. The nurse monitors the result of which electrolyte study during
therapy with this medication? *
a. sodium
b. potassium
c. calcium
d. chloride
(Rationale: Amphotericin B (Fungizone) is an antifungal medication which has a high
risk of hyperkalemia. This is prescribed biweekly during therapy)

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

35. A nurse is caring for a client receiving streptogramin (Synercid) by intravenous

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

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

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

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

39. A client has an order to begin short-term therapy with enoxaparin (Lovenox). The
nurse explains to the client that this medication is being ordered to: *
a. dissolve urinary calculi
b. reduce the risk of deep vein thrombosis
c. relieve migraine headaches
d. stop progression of multiple sclerosis
(Rationale: Enoxaparin (Lovenox) is a low-molecular-weight heparin (LMWH) in
prevention and management of various thromboembolic disorders)
40. Quinidine gluconate (Dura Quin) is prescribed for a client. The nurse reviews the
client’s medical record, knowing that which of the following is a contraindication in the
use of this medication? *
a. complete atrioventricular (AV) block (complete blockage = decrease conduction)
b. muscle weakness
c. asthma
d. infection
(Rationale: In complete AV block, it decreases conduction. If given with Quinidine, it
potentiates even further the decrease of conduction, having a high risk of HF)

ANTIDYSRHYTHMICS
DRUG ACTIONS
CLASS I 1) Quinidine Block fast sodium current
2) Procainamide (hence slow conduction)
3) Disopyramide
4) Lignocaine Indications:
5) Mexiletine Atrial Fibrillation
6) Flocainide Atrial Flutter
7) Propafenone
CLASS II 1) β – adrenoceptor Block effects of
blockers catecholamines
CLASS III 1) Amiodarone Prolong action potential
2) Sotalol and hence refractoriness by
blocking K+ current
CLASS IV 1) Verapamil Block cardiac calcium
2) Diltiazem channel

41. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the
client that this medication should do which of the following? *
a. take away nausea and vomiting
ANTITUSSIVE:
b. calm the persistent cough  Inhibits intensity of cough without
c. decrease anxiety level phlegm.
d. increase comfort level EXPECTORANT:
 Expectorates phlegm
(Rationale: Benzonatate (Tessalon) is
an antitussive)
42. Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the
nurse monitors the client for signs of an adverse effect related to the medication.
Which of the following indicates an adverse effect? *
a. nausea
b. diarrhea
c. anorexia
d. proteinuria
(Rationale: Auranofin (Ridaura) is a gold preparation of antirheumatics. A/E are
decrease Hgb, leukopenia, hematuria, proteinuria, nephrotic syndrome and stomatitis)

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

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

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

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

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

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

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

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

50. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy
precipitate inside the insulin vial. The nurse should: *
a. draw up and administer the dose
b. shake the vial in an attempt to disperse the clumps
c. draw the dose from a new vial
d. warm the bottle under running water to dissolve the clump
(Rationale: Clumpy precipitate signifies loss of potency of the NPH insulin. It must be
discarded and use a new vial.)

51. A client who has been receiving urokinase has a large bloody bowel movement.
Which action would be best for the nurse to take immediately? *
a. Administer vitamin K IM
b. Stop the urokinase
c. Reduce the urokinase and administer heparin
d. Stop the urokinase and call the doctor
(Rationale: Urokinase is a thrombolytic which lyses the clot or thrombus. Any active
bleeding that may observed by the patient is managed by stoppage of thrombolytic
therapy and notifying the physician)

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

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

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

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

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

PRECAUTIONS WITH INTRAVENOUSLY ADMINSTERED POTASSIUM:

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

57. The nurse notes that a post-operative client’s respirations have dropped from 14
to 6 breaths per minute. The nurse administers Narcan (naloxone) per standing order.
Following administration of the medication, the nurse should assess the client for: *
a. Pupillary changes
b. Projectile vomiting
c. Wheezing respirations
d. Sudden, intense pain
(Rationale: Naloxone (Narcan) is an antidote for opioids. In which opioids is to treat
mild-moderate pain, Naloxone subsides the effect, returning the pain)

58. The physician has ordered Dilantin (phenytoin) 100mg intravenously for a client
with generalized tonic clonic seizures. The nurse should administer the medication: *
a. Rapidly with an IV push
b. With IV dextrose (It has the possibility of crystallization)
c. Slowly over 2–3 minutes
d. Through a small vein (tendency to develop purple glove syndrome)
(Rationale: Phenytoin (Dilantin) is an anticonvulsant or antiepileptic and must be
administered via IV in a slow, no more than 50 mg/hour)
59. In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia,
the nurse should expect: *
a. A rapid delivery
b. Cervical effacement (Caused by pressure of presenting head of baby)
c. Infrequent contractions
d. Progressive cervical dilation
(Rationale: IV Pitocin stimulates contraction and cervical dilation.)

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

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

62. The physician has prescribed Gantrisin (sulfasoxazole) 1g in divided doses for a
client with a urinary tract infection. The nurse should administer the medication *
A. With meals or a snack
B. 30 minutes before meals
C. 30 minutes after meals
D. at bedtime
(Rationale: Sulfasoxazole (Gantrisin) is a sulfonamide medication and it is best taken
on an empty stomach)
63. A client in labor has been given epidural anesthesia with Marcaine (bupivacaine).
To reverse the hypotension associated with epidural anesthesia, the nurse should
have which medication available? *
a. Narcan (naloxone) (Antidote for opioids)
b. Dobutrex (dobutamine) (Decreases cardiac output)
c. Romazicon (flumazenil) (Benzodiazepine antagonist)
d. Adrenalin (epinephrine)
(Rationale: To reverse the hypotension, epinephrine is administered to promote
vasoconstriction, resulting increase BP)

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

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

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

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

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

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

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

70. Heparin has been ordered for a client with pulmonary emboli. Which statement, if
made by the graduate nurse, indicates a lack of understanding of the medication? *
a. “I will administer the medication 1-2 inches away from the umbilicus.”
b. “I will administer the medication in the abdomen.”
c. “I will check the PTT before administering the medication.”
d. “I will need to aspirate when I give Heparin.”
(Rationale: Heparin SC route does not need to be aspirated)

71. The nurse is teaching the client regarding use of sodium warfarin. Which
statement made by the client would require further teaching? *
a. “I will have blood drawn every month.”
b. “I will assess my skin for a rash.”
c. “I take aspirin for a headache.”
d. “I will use an electric razor to shave.” (One of the bleeding precautions)
(Rationale: Aspirin increases risk of bleeding)

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

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

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

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

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

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

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

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

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

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

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

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

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

84. The client with preeclampsia is admitted to the unit with an order for magnesium
sulfate IV. Which action by the nurse indicates a lack of understanding of magnesium
sulfate? *
a. The nurse places a sign over the bed not to check blood pressures in the left arm .
b. The nurse obtains an IV controller.
c. The nurse inserts a Foley catheter. (to assess urine output accurately)
d. The nurse darkens the room. (to prevent seizures)
(Rationale: Not to check BP in the left arm is not related to administration of MgSO4. It
is indicated for patients having mastectomy in the left breast or having an AVF at (L)
arm)

85. The nurse is assisting in the assessment of the patient admitted with “extreme
abdominal pain.” The nurse asks the client about the medication that he has been
taking because: *
a. Interactions between medications will cause abdominal pain.
b. Various medications taken by mouth can affect the alimentary tract.
c. This will provide an opportunity to educate the patient regarding the medications
used. (not the right time to educate for patient is having extreme abdominal pain)
d. The types of medications might be attributable to an abdominal pathology not
already identified.
(Rationale: Many medications can irritate the stomach and contribute to abdominal pain.)
86. The client has an order for gentamycin to be administered. Which lab results
should be reported to the doctor before beginning the medication? *
a. Hematocrit
b. Creatinine
c. White blood cell count
d. Erythrocyte count
(Rationale: Gentamycin is an antibiotic which can cause nephrotoxicity and ototoxicity.
Laboratory values to be checked is to check its creatinine count)

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

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

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

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

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

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

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

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

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

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

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

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

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