1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client?
A. Calcium chloride C. Calcitonin (Miacalcin)
B. Calcium gluconate D. Large doses of vitamin D
2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item?
A. Milk B. Water C. Apple juice D. Orange juice
3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication?
A. Tinnitus B. Diarrhea C. Constipation D. Decreased respirations
4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied:
A. Immediately before swimming C. Immediately before exposure to the sun
B. 15 minutes before exposure to the sun D. At least 30 minutes before exposure to the sun
5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action?
A. Notifying the registered nurse
B. Discontinuing the medication
C. Informing the client that this is normal
D. Applying a thinner film than prescribed to the burn site
6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred?
A.Hyperventilation C.Local pain at the burn site
B.Elevated blood pressure D.Local rash at the burn site
7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?
A. Platelet count C. Complete blood count
B. Triglyceride level D. White blood cell count
8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication?
A. Vitamin A B. Digoxin (Lanoxin) C. Furosemide (Lasix) D. Phenytoin (Dilantin)
9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas?
A. Back B. Axilla C. Soles of the feet D.
Palms of the hands
10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for:
A. Acne B. Eczema C. Hair loss D. Herpes simplex
11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partialthickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing
information to the client about the medication. Which statement made by the client indicates a lack of
understanding about the treatments?
A. "The medication is an antibacterial."
B. "The medication will help heal the burn."
C. "The medication will permanently stain my skin."
D. "The medication should be applied directly to the wound."
12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed.
The nurse should take which appropriate action? A. Notify the registered nurse. B. Administer pain medication to reduce the discomfort.
C. Apply ice and maintain the infusion rate, as prescribed.
D. Elevate the extremity of the IV site, and slow the infusion.
13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?
A. Echocardiography C. Cervical radiography
B. Electrocardiography D. Pulmonary function studies
14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication? A. Clotting time C. Potassium level B. Uric acid level D. Blood glucose level
15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication?
A. Alopecia C. Pulmonary fibrosis
B. Chest pain D. Orthostatic hypotension
16.) The clinic nurse is reviewing a teaching plan for the client receiving an antineoplastic medication.
When implementing the plan, the nurse tells the client:
A. To take aspirin (acetylsalicylic acid) as needed for headache
B. Drink beverages containing alcohol in moderate amounts each evening
C. Consult with health care providers (HCPs) before receiving immunizations
D. That it is not necessary to consult HCPs before receiving a flu vaccine at the local health fair
17.) The client with ovarian cancer is being treated with vincristine (Oncovin). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication? A. Diarrhea
B. Hair loss
C. Chest pain
D. Numbness and tingling in the fingers and toes
18.) The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse consults with the registered nurse regarding the administration of the medication if which of the following is documented in the client's history? A. Pancreatitis
B. Diabetes mellitus
C. Myocardial infarction
D. Chronic obstructive pulmonary disease
19.) Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to: A. Increase DNA and RNA synthesis.
B. Promote the biosynthesis of nucleic acids.
C. Increase estrogen concentration and estrogen response.
D. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.
20.) The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?
A. Glucose level B. Calcium level C. Potassium level D. Prothrombin time
21.) A nurse is assisting with caring for a client with cancer who is receiving cisplatin. Select the adverse effects that the nurse monitors for that are associated with this medication. Select all that apply.
A. Tinnitus D. Hypercalcemia
B. Ototoxicity E. Nephrotoxicity
C. Hyperkalemia F. Hypomagnesemia
22.) A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to:
a. Treat thyroid storm.
b. Prevent cardiac irritability.
c. Treat hypocalcemic tetany.
d. Stimulate the release of parathyroid hormone.
23.) A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which information should the nurse teach when carrying out plans for discharge?
a. Keep insulin vials refrigerated at all times.
b. Rotate the insulin injection sites systematically.
c. Increase the amount of insulin before unusual exercise.
d. Monitor the urine acetone level to determine the insulin dosage.
24.) A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for
A. Withdraws the NPH insulin first
B. Withdraws the regular insulin first
C. Injects air into NPH insulin vial first
D. Injects an amount of air equal to the desired dose of insulin into the vial
25.) A home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin.
The nurse tells the client to:
A. Freeze the insulin. C. Store the insulin in a dark, dry place.
B. Refrigerate the insulin. D. Keep the insulin at room temperature.
26.) Glimepiride (Amaryl) is prescribed for a client with diabetes mellitus. A nurse reinforces instructions for the client and tells the client to avoid which of the following while taking this medication?
A. Alcohol C. Whole-grain cereals
B. Organ meats D. Carbonated beverages
27.) Sildenafil (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history?
A. Neuralgia C. Use of nitroglycerin
B. Insomnia D. Use of multivitamins
28.) The health care provider (HCP) prescribes exenatide (Byetta) for a client with type 1 diabetes mellitus who takes insulin. The nurse knows that which of the following is the appropriate intervention?
A. The medication is administered within 60 minutes before the morning and evening meal.
B. The medication is withheld and the HCP is called to question the prescription for the client.
C. The client is monitored for gastrointestinal side effects after administration of the medication.
D. The insulin is withdrawn from the Penlet into an insulin syringe to prepare for administration.
29.) A client is taking Humulin NPH insulin daily every morning. The nurse reinforces instructions for the client and tells the client that the most likely time for a hypoglycemic reaction to occur is:
A. 2 to 4 hours after administration
B. 4 to 12 hours after administration
C. 16 to 18 hours after administration D. 18 to 24 hours after administration
30.) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting blood glucose level has been 180 to 200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?
A. Prednisone B. Phenelzine (Nardil) C. Atenolol (Tenormin) D. Allopurinol (Zyloprim)
31.) A community health nurse visits a client at home. Prednisone 10 mg orally daily has been prescribed for the client and the nurse reinforces teaching for the client about the medication.
Which statement, if made by the client, indicates that further teaching is necessary?
A. "I can take aspirin or my antihistamine if I need it."
B. "I need to take the medication every day at the same time."
C. "I need to avoid coffee, tea, cola, and chocolate in my diet."
D. "If I gain more than 5 pounds a week, I will call my doctor."
32.) Desmopressin acetate (DDAVP) is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response?
A. Decreased urinary output
B. Decreased blood pressure
C. Decreased peripheral edema
D. Decreased blood glucose level
33.) The home health care nurse is visiting a client who was recently diagnosed with type 2 diabetes mellitus. The client is prescribed repaglinide (Prandin) and metformin (Glucophage) and asks the nurse to explain these medications. The nurse should reinforce which instructions to the client? Select all that apply.
A. Diarrhea can occur secondary to the metformin.
B. The repaglinide is not taken if a meal is skipped.
C. The repaglinide is taken 30 minutes before eating.
D. Candy or another simple sugar is carried and used to treat mild hypoglycemia episodes.
E. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide.
F. Muscle pain is an expected side effect of metformin and may be treated with acetaminophen (Tylenol).
34.) A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?
A. Monitoring the leukocyte count for 2 days after the infusion
B. Checking the frequency and consistency of bowel movements
C. Checking serum liver enzyme levels before and after the infusion
D. Carrying out a Hematest on gastric fluids after the infusion is completed
35.) The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?
B. Abdominal pain
C. An episode of diarrhea
D. Hematest-positive nasogastric tube drainage
36.) The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client?
A. Paralytic ileus
B. Incisional pain
C. Urinary retention
D. Nausea and vomiting
37.) The client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?
A. Weight loss C. Reduction of steatorrhea
B. Relief of heartburn D. Absence of abdominal pain
38.) An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication?
A. Tremors C. Confusion
B. Dizziness D. Hallucinations
39.) The client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse schedules the medication for which times?
A. With meals and at bedtime C. One hour after meals and at bedtime
B. Every 6 hours around the clock D. One hour before meals and at bedtime
40.) The client who chronically uses nonsteroidal anti-inflammatory drugs has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which of the following is noted?
A. Resolved diarrhea C. Decreased platelet count
B. Relief of epigastric pain D. Decreased white blood cell count
41.) The client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving optimal intended effect of the medication if the client reports the absence of which symptom?
A. Diarrhea C. Flatulence
B. Heartburn D. Constipation
42.) A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin
esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen?
A. "My ulcer will heal because these medications will kill the bacteria."
B. "These medications are only taken when I have pain from my ulcer."
C. "The medications will kill the bacteria and stop the acid production."
D. "These medications will coat the ulcer and decrease the acid production in my stomach."
43.) A histamine (H2)-receptor will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply.
A. Nizatidine (Axid) D. Cimetidine (Tagamet)
B. Ranitidine (Zantac) E. Esomeprazole (Nexium)
C. Famotidine (Pepcid) F. Lansoprazole (Prevacid)
44.) A client is receiving acetylcysteine (Mucomyst), 20% solution diluted in 0.9% normal saline by nebulizer. The nurse should have which item available for possible use after giving this medication?
a. Ambu bag c. Nasogastric tube
b. Intubation tray d. Suction equipment
45.) A client has a prescription to take guaifenesin (Humibid) every 4 hours, as needed. The nurse determines that the client understands the most effective use of this medication if the client states that he or she will:
a. Watch for irritability as a side effect.
b. Take the tablet with a full glass of water.
c. Take an extra dose if the cough is accompanied by fever.
d. Crush the sustained-release tablet if immediate relief is needed.
46.) A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the
medication, the nurse checks the client for:
A. Pupillary changes
B. Scattered lung wheezes
C. Sudden increase in pain
D. Sudden episodes of diarrhea
47.) A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing:
A. Hypercalcemia C. Small blood vessel spasm
B. Peripheral neuritis D. Impaired peripheral circulation
48.) A client is to begin a 6-month course of therapy with isoniazid (INH). A nurse plans to teach the client to:
A. Drink alcohol in small amounts only.
B. Report yellow eyes or skin immediately.
C. Increase intake of Swiss or aged cheeses.
D. Avoid vitamin supplements during therapy.
49.) A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:
A. Should always be taken with food or antacids
B. Should be double-dosed if one dose is forgotten
C. Causes orange discoloration of sweat, tears, urine, and feces D. May be discontinued independently if symptoms are gone in 3 months
50.) A nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report:
a. Impaired sense of hearing
b. Problems with visual acuity
c. Gastrointestinal (GI) side effects
d. Orange-red discoloration of body secretions
51.) Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which of the following would the nurse include in the client teaching plan regarding this medication?
A. To take the medication before meals
B. To return to the clinic weekly for serum drug-level testing
C. It is not necessary to call the health care provider (HCP) if a skin rash occurs.
D. It is not necessary to restrict alcohol intake with this medication.
52.) A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed?
A. Electrolyte levels C. Liver enzyme levels
B. Coagulation times D. Serum creatinine level
53.) Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium Avium Complex (MAC) disease and tuberculosis. The nurse monitors for which side effects of the medication? Select all that apply.
a. Signs of hepatitis
b. Flu-like syndrome
c. Low neutrophil count
d. Vitamin B6 deficiency
e. Ocular pain or blurred vision
f. Tingling and numbness of the fingers
54.) A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?
1. "I will take my pills every day at the same time."
2. "I will be certain to avoid alcohol consumption."
3. "I have already called my family to pick up a Medic- Alert bracelet."
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
55.) A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. A health care provider prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin?
A. 3 to 5 ng/mL C. 1.2 to 2.8 ng/mL
B. 0.5 to 2 ng/mL D. 3.5 to 5.5 ng/mL
56.) Heparin sodium is prescribed for the client. The nurse expects that the health care provider will prescribe which of the following to monitor for a therapeutic effect of the medication?
A. Hematocrit level C. Prothrombin time (PT)
B. Hemoglobin level D. Activated partial thromboplastin time (APTT)
57.) A nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol?
A. The development of complaints of insomnia
B. The development of audible expiratory wheezes
C. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication
D. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 72 beats/min after two doses of the medication
58.) Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client:
A. Cut the dose in half.
B. Discontinue the medication.
C. Take the medication with food.
D. Contact the health care provider (HCP).
59.) A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? a. Monitor for renal failure.
b. Monitor psychosocial status.
c. Monitor for signs of bleeding.
d. Have heparin sodium available.
60.) A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication?
a. Hypouricemia, hyperkalemia
b. Increased risk of osteoporosis
c. Hypokalemia, hyperglycemia, sulfa allergy
d. Hyperkalemia, hypoglycemia, penicillin Allergy
61.) A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education?
a. "Constipation and bloating might be a problem."
b. "I'll continue to watch my diet and reduce my fats."
c. "Walking a mile each day will help the whole process."
d. "I'll continue my nicotinic acid from the health food store."
When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don't remember me nor I them. But I do know that I gave a little piece of myself to each of them and they to me and those threads make up the beautiful tapestry in my mind that is my career in nursing. ~Donna Wilk Cardillo, A Daybook for Beginning Nurses
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