1.
A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse’s priority?
Correct Answer
B. Identify the client’s level of consciousness.
Explanation
A. The nurse should prepare to administer flumazenil to reverse the benzodiazepine toxicity. However, there is another action the nurse should take first. B. CORRECT: The first action the nurse should take when using the nursing process is to assess the client. Identifying the client’s level of consciousness is the priority action. C. The nurse should prepare to infuse IV fluids to support the client’s blood pressure. however, there is another action the nurse should take first. D. The nurse should prepare to administer a gastric lavage to reverse the benzodiazepine toxicity. however, there is another action the nurse should take first.
2.
A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching?
Correct Answer
C. “I need to discontinue this medication slowly.”
Explanation
A. The client can take this medication with food for GI distress or without food.
B. The client is at risk for hyponatremia while taking escitalopram.
C. CORRECT: When discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome.
D. The client can crush escitalopram before swallowing.
3.
A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following information should the nurse include?
Correct Answer
D. “This medication has a low risk for dependency.”
Explanation
A. The client can take this medication with food to reduce GI distress. B. Buspirone can take up to 3 to 6 weeks to obtain optimal therapeutic effects C. The client should take buspirone on a regular, not PRN, basis because therapeutic effects occur slowly. D. CORRECT: Buspirone has a low risk for physical or psychological dependence or tolerance.
4.
A nurse is teaching a client who has obsessive‐compulsive disorder and has a new prescription for paroxetine. Which of the following instructions should the nurse include?
Correct Answer
A. “It can take several weeks before you feel like the medication is helping.”
Explanation
A. CORRECT: Paroxetine can take 1 to 4 weeks before the client reaches full therapeutic bene t.
B. Take paroxetine in the morning to prevent insomnia.
C. Take paroxetine on a regular basis rather than an as‐needed basis.
D. Paroxetine can cause decreased appetite and weight loss.
5.
A nurse is caring for a client who takes paroxetine to treat posttraumatic stress disorder and reports that he grinds his teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (Select all that apply.)
Correct Answer(s)
A. Concurrent administration of buspirone
C. Use of a mouth guard
D. Changing to a different class of antidepressant medication
Explanation
A. CORRECT: Concurrent administration of a low dose of buspirone is an effective measure to manage the adverse effects of paroxetine.
B. Other SSRIs also will have bruxism as an adverse effect. This is not an effective measure.
C. CORRECT: Using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism.
D. CORRECT: Changing to different class of antidepressant medication that does not have the adverse effect of bruxism is an effective measure.
E. Increasing the dose of paroxetine can cause the adverse effect of bruxism to worsen. This is not an effective measure.
6.
A nurse is caring for a client who has a new prescription for phenelzine for the treatment of depression. Which of the following indicates that the client has developed an adverse effect of this medication?
Correct Answer
A. Orthostatic hypotension
Explanation
A. CORRECT: Orthostatic hypotension is an adverse of effect of mAOIs, including phenelzine.
B. Phenelzine is more likely to cause blurred vision than hearing loss.
C. Clients taking phenelzine are at risk for multiple adverse effects. however, these do not include GI bleeding.
D. Clients taking phenelzine are at risk for weight gain rather than weight loss.
7.
A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching? (Select all that apply.)
Correct Answer(s)
C. Change positions slowly to minimize dizziness.
E. Chew sugarless gum to prevent dry mouth.
Explanation
A. Therapeutic effects are expected after several weeks of taking amitriptyline.
B. Stopping amitriptyline abruptly can result in relapse.
C. CORRECT: Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect of amitriptyline.
D. Clients should increase dietary ber to prevent constipation, which is an adverse effect of amitriptyline.
E. CORRECT: Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline.
8.
A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine for posttraumatic stress disorder. Which of the following statements should the nurse include in the teaching?
Correct Answer
A. “You may have a decreased desire for intimacy while taking this medication.
Explanation
A. CORRECT: Decreased libido is a potential adverse effect of fluoxetine and other SSRIs.
B. Clients should take fluoxetine in the morning due to CNS stimulation.
C. Clients taking a TCA, rather than fluoxetine, should void prior to taking the medication due to the potential for urinary hesitancy or retention.
D. Clients taking a TCA, rather than fluoxetine, should wear sunglasses when outdoors due to the potential for photophobia.
9.
A nurse is caring for a client who has depression and a new prescription for venlafaxine. For which of the following adverse effects should the nurse monitor this client? (Select all that apply)
Correct Answer(s)
A. Hypertension
B. Vision Changes
C. Decreased libido
Explanation
A. CORRECT Hypertension (high blood pressure) is also important when a client is taking venlafaxine. Venlafaxine can lead to an increase in blood pressure in some individuals. B. CORRECT: Dizziness is a common adverse effect of venlafaxine. C. CORRECT: Sexual dysfunction, such as decreased libido, decreased orgasm, impotence, and menstrual changes are adverse effects of venlafaxine. D. Alopecia is not an adverse effect of venlafaxine. E. hypertension and tachycardia are adverse effects of venlafaxine.
10.
A nurse is caring for a client who has been taking sertraline for the past 2 days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome?
Correct Answer
B. Fever
Explanation
A. Bleeding can result if an SSRI is administered with warfarin. however, this is not an indication of serotonin syndrome.
B. CORRECT: Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline.
C. Abdominal pain is not an indication of serotonin syndrome.
D. A localized rash is associated with transdermal preparation. however, it is not an indication of serotonin syndrome.
11.
A nurse is providing instructions to a client who has been experiencing insomnia and has a new prescription for temazepam. The nurse should inform the client that which of the following manifestations are adverse effects of temazepam? (Select all that apply.)
Correct Answer(s)
A. Incoordination
D. Sleep driving
E. Amnesia
Explanation
A. CORRECT: Due to CNS depression, incoordination is an adverse effect of temazepam.
B. hypotension is an adverse effect of temazepam.
C. Pruritus is not an adverse effect of temazepam.
D. CORRECT: Sleep driving (driving after taking the medication without memory of doing so) is an adverse effect of temazepam.
E. CORRECT: Retrograde amnesia, the inability to remember the events that occurred after taking the medication,
can occur as an adverse effect of temazepam.
12.
A nurse is caring for a client who is receiving moderate sedation with diazepam IV. The client is oversedated. Which of the following medications should the nurse anticipate administering to this client?
Correct Answer
C. Flumazenil
Explanation
A. ketamine is an anesthetic agent. B. Naltrexone is an opioid antagonist used to treat opioid overdose and alcohol use disorders. C. CORRECT: Although rarely used, Flumazenil is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzodiazepines. D. Fluvoxamine is a selective serotonin reuptake inhibitor used to treat depression.
13.
A nurse is teaching a client who has a new prescription for ramelteon. The nurse should instruct the client to avoid which of the following foods while taking this medication?
Correct Answer
B. Fried chicken
Explanation
A. A baked potato does not affect absorption of ramelteon.
B. CORRECT: high‐fat foods, such as fried chicken prolong the absorption of ramelteon and should be avoided.
C. Whole‐grain breads do not affect the absorption of ramelteon.
D. Citrus fruits do not affect the absorption of ramelteon.
14.
A nurse is caring for a client who is admitted to undergo a surgical procedure. Which of the following preexisting conditions can be a contraindication for the use of ketamine as an intravenous anesthetic?
Correct Answer
D. SchizopHrenia
Explanation
A. Peptic ulcer disease is not a contraindication for the use of ketamine.
B. Breast cancer is not a contraindication for the use of ketamine.
C. Diabetes mellitus is not a contraindication for the use of ketamine.
D. CORRECT: ketamine can produce psychological effects, such as hallucinations. Therefore, schizophrenia can be a contraindication for the use of ketamine.
15.
A nurse is providing instructions to a female client who has a new prescription for zolpidem. Which of the following instructions should the nurse include?
Correct Answer
A. “Notify the provider if you plan to become pregnant.”
Explanation
A. CORRECT: Zolpidem is Pregnancy Risk Category C. The client should notify the provider if she plans to become pregnant.
B. Zolpidem should be taken at bedtime.
C. The client should allow at least 8 hr for sleep when taking zolpidem.
D. Zolpidem is absorbed best on an empty stomach.
16.
A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects?
Correct Answer
B. Chew sugarless gum to moisten the mouth.
Explanation
A. Insomnia is not an anticholinergic effect.
B. CORRECT: Chewing sugarless gum can help the client cope
with dry mouth, a potential anticholinergic effect of uphenazine.
C. Fever is not an anticholinergic effect.
D. Nausea is not an anticholinergic effect.
17.
A nurse is assessing a male client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider?
Correct Answer
B. Neck spasms
Explanation
A. Shuffling gait is an indication of parkinsonism and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority finding. B. CORRECT: Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid treatment. This is the greatest risk to the client and is therefore the priority finding. C. Drowsiness is an adverse effect of haloperidol and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority finding. D. Sexual dysfunction is an adverse effect of haloperidol and should be reported to the provider. however, this is not the greatest risk to the client and is therefore not the priority.
18.
A nurse is providing discharge teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching?
Correct Answer
D. “You should have your white blood cell count monitored every week.”
Explanation
A. Clozapine increases the client’s risk of developing diabetes mellitus and weight gain. It is not appropriate to increase carbohydrate intake. B. Clozapine has a low risk of EPS such as hand tremors. C. Asenapine, rather than clozapine, causes temporary numbing of the mouth. D. CORRECT: Due to the risk for fatal agranulocytosis weekly monitoring of the client’s WBC count is recommended while taking clozapine.
19.
A nurse is providing teaching for a male client who has schizophrenia and is taking risperidone. Which of the following instructions should the nurse include in the teaching?
Correct Answer
B. “Notify the provider if you develop breast enlargement.”
Explanation
A. Risperidone and other atypical antidepressants cause weight gain and the client should be taught to maintain a lower‐calorie balanced diet.
B. CORRECT: Gynecomastia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider if these manifestations occur.
C. Seizures are not an adverse effect of risperidone.
D. Sexual dysfunction, causing decreased libido and impotence are adverse effects of risperidone.
20.
A nurse is preparing to perform a follow‐up assessment on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? (Select all that apply.)
Correct Answer(s)
A. Disorganized speech
B. Bizarre behavior
D. Hallucinations
Explanation
A. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech.
B. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior.
C. Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as impaired social interactions.
D. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations.
E. Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as decreased motivation.
21.
A nurse is reviewing laboratory findings and notes that a client’s plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse?
Correct Answer
A. Perform immediate gastric lavage.
Explanation
A. CORRECT: Gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma lithium level of 2.1 mEq/L. This action will lower the client’s lithium level. B. hemodialysis is appropriate for a client who has a plasma lithium level greater than 2.5 mEq/L. C. Administering an additional dose of lithium will worsen the level of toxicity. D. There is no indication that the client needs another laboratory test, and this action can delay needed treatment.
22.
A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following?
Correct Answer
D. Limit aerobic activity in hot weather or hydrate very well by doing so.
Explanation
A. The client should use acetaminophen, rather than NSAIDs such as ibuprofen, for headaches because NSAIDs interact with lithium and can cause increased blood levels of lithium. B. The client should increase, rather than decrease, sodium intake to reduce the risk for toxicity. C. The client should increase, rather than decrease, uid intake to reduce the risk for toxicity. D. CORRECT: The client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity.
23.
A nurse is assessing a client who takes lithium carbonate for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity to this medication?
Correct Answer
B. Coarse tremors
Explanation
A. Severe hypotension, rather than hypertension, is an indication of toxicity.
B. CORRECT: Coarse tremors are an indication of toxicity.
C. Diarrhea, rather than constipation, is an indication of toxicity.
D. muscle weakness, rather than muscle spasm, is an indication of lithium toxicity.
24.
A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client that while taking this medication he will need to have which of the following laboratory tests completed periodically? (Select all that apply.)
Correct Answer(s)
A. Thrombocyte count
C. Valproate level
D. Liver function tests
Explanation
A. CORRECT: Treatment with valproic acid can result in thrombocytopenia. The client’s thrombocyte count should be monitored periodically. B. Treatment with valproic acid is not known to have an effect on a client’s hematocrit. C. CORRECT: Treatment with valproic acid can result in pancreatitis. The client’s amylase should be monitored periodically. D. CORRECT: Treatment with valproic acid can result in hepatotoxicity. The client’s liver function should be monitored periodically. E. Treatment with valproic acid is not known to have an effect on a client’s potassium.
25.
A nurse is preparing a teaching plan for a female client who has bipolar disorder and a new prescription for carbamazepine. Which of the following instructions should the nurse include in the teaching?
Correct Answer(s)
B. “Eliminate grapefruit juice from your diet."
C. “You will need to have a complete blood count and carbamazepine levels drawn periodically.”
D. “Notify your provider if you develop a rash.”
E. “Avoid driving for the first few days after starting this medication.”
Explanation
A. Carbamazepine is a Pregnancy Category Risk D medication. The client should be instructed to avoid pregnancy while taking carbamazepine. B. CORRECT: Grapefruit juice affects carbamazepine metabolism and should be avoided. C. CORRECT: Carbamazepine blood levels and the CBC should be monitored during therapy. The client is at risk for bone marrow depression while taking carbamazepine and should notify the provider for a sore throat or other manifestations of an infection. D. CORRECT: Carbamazepine can cause Stevens‐Johnson syndrome, which can be fatal. The client should notify the provider promptly if a rash occurs. E. CORRECT: CNS effects such as drowsiness or dizziness can occur early in treatment with carbamazepine and the client should avoid activities requiring alertness until these effects subside.
26.
A nurse is teaching the parents of a child who has a new prescription for desipramine. The nurse should instruct the parents that which of the following adverse effects is the priority to report to the provider?
Correct Answer
B. Suicidal thoughts
Explanation
A. The client is at risk for constipation because of the anticholinergic effects of desipramine. The client should increase uid intake to reduce the risk of constipation. however, another adverse effect is the priority.
B. CORRECT: The greatest risk to this client is injury from a suicide attempt; therefore, this is the priority. Desipramine can cause suicidal thoughts and behaviors which puts the client at risk. The parents should monitor and report any indication of increased depression or thoughts of suicidal behavior.
C. The client is at risk for photophobia, because of the anticholinergic effects of desipramine. The client should wear sun glasses when exposed to sunlight. however, another adverse effect is the priority.
D. The client is at risk for dry mouth because of the anticholinergic effects of desipramine. The client should increase uids and use hard candy to reduce dry mouth. however, another adverse effect is the priority.
27.
A nurse is teaching an adolescent client who has a new prescription for clomipramine for OCD. Which of the following instructions should the nurse include to minimize an adverse effect of his medication?
Correct Answer
A. Wear sunglasses when outdoors.
Explanation
A. CORRECT: Wearing sunglasses when outdoors will decrease photophobia, an anticholinergic effect associated with TCA use.
B. Checking the client’s temperature daily is not necessary while taking a TCA.
C. The client should take this medication at bedtime rather than in the morning to prevent daytime sleepiness.
D. Following a low‐calorie diet plan will help prevent weight gain, an adverse effect of TCAs.
28.
A nurse is caring for a school‐age child who has a new prescription for atomoxetine. The nurse should monitor the client for which of the following adverse effects of this medication?
Correct Answer
B. Liver damage
Explanation
A. Atomoxetine can cause urinary retention, but not kidney toxicity.
B. CORRECT: Liver damage is an adverse effect of atomoxetine. The nurse should monitor for manifestations such as jaundice, upper abdominal tenderness, darkening of urine, and elevated liver enzymes.
C. Bupropion increases seizure risk at high dosages. Seizure activity is not an adverse effect of atomoxetine.
D. Atomoxetine can cause suicidal ideation and mood swings. Adrenal insuf ciency is not an adverse effect of atomoxetine.
29.
A nurse is teaching the parents of a school‐age child about transdermal methylphenidate. Which of the following instructions should the nurse include?
Correct Answer
B. Leave the patch on for 9 hr.
Explanation
A. Transdermal methylphenidate is administered once per day.
B. CORRECT: Transdermal methylphenidate is administered for 9 hr/day.
C. Transdermal methylphenidate is applied to the child’s hip.
D. Use the opened tray of transdermal methylphenidate within 2 months.
30.
A nurse is teaching a school‐age child and his parents about a new prescription for lisdexamfetamine. Which of the following information should the nurse include in the teaching? (Select all that apply.)
Correct Answer(s)
A. An adverse effect of this medication is CNS stimulation.
C. Monitor blood pressure while taking this medication.
E. This medication raises the levels of dopamine in the brain.
Explanation
A. CORRECT: An adverse effect of lisdexamfetamine is CNS stimulation such as insomnia and restlessness.
B. Administer lisdexamfetamine daily in the morning to reduce insomnia.
C. CORRECT: The nurse should instruct the client to monitor his blood pressure due to potential cardiovascular effects of lisdexamfetamine.
D. Therapeutic effects of lisdexamfetamine begin immediately and last 10 to 12 hrs.
E. CORRECT: Lisdexamfetamine, a CNS stimulant, works by raising the levels of norepinephrine and dopamine in the CNS.
31.
A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for propranolol. Which of the following information should the nurse to include in the teaching?
Correct Answer
C. Decreases cravings
Explanation
A. Seizure activity is a potential effect of alcohol withdrawal. however, propranolol does not increase this risk.
B. Disul ram, rather than propranolol, provides a form of aversion therapy.
C. CORRECT: Propranolol is an adjunct medication used during withdrawal to decrease the client’s craving for alcohol.
D. Propranolol is an antihypertensive medication that can result in hypotension rather than hypertension.
32.
A charge nurse is planning a staff education session to discuss medications used during the care of a client experiencing alcohol withdrawal. Which of the following medications should the charge nurse include in the discussion? (Select all that apply.)
Correct Answer(s)
A. Lorazepam
B. Diazepam
Explanation
A. CORRECT: Lorazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. B. CORRECT: Diazepam is a benzodiazepine used during alcohol withdrawal to decrease anxiety and reduce the risk for seizures. C. Disulfiram is administered to assist the client in maintaining abstinence from alcohol following withdrawal. D. Naltrexone is administered to assist the client in maintaining abstinence from alcohol following withdrawal. E. Acamprosate decreases unpleasant effects, such as anxiety or restlessness, resulting from abstinence. However, it is not used during acute withdrawal.
33.
A nurse is providing teaching to a client who has a new prescription for clonidine to assist with maintenance of abstinence from opioids. The nurse should instruct the client to monitor for which of the following adverse effects?
Correct Answer
B. Dry mouth
Explanation
A. Constipation, rather than diarrhea, is a common adverse effect associated with clonidine use.
B. CORRECT: Dry mouth is a common adverse effect associated with clonidine use.
C. Sedation, rather than insomnia, is a common adverse effect associated with clonidine use.
D. Clonidine is more likely to cause hypotension than hypertension.
34.
A nurse is teaching a female client who has tobacco use disorder about nicotine replacement therapy. Which of the following statements by the client indicates understanding of the teaching?
Correct Answer
A. “I should avoid eating right before I chew a piece of nicotine gum.”
Explanation
A. CORRECT: The client should avoid eating or drinking 15 min prior to and while chewing the nicotine gum.
B. The client should not use nicotine gum for longer than 6 months.
C. The client should avoid all nicotine products, including nicotine gum, while pregnant or breastfeeding.
D. The client should chew the nicotine gum slowly and intermittently over 30 min.
35.
A nurse in an acute mental health facility is caring for a client who is experiencing withdrawal from opioid use and has a new prescription for clonidine. Which of the following actions should the nurse identify as the priority?
Correct Answer
D. Obtain baseline vital signs.
Explanation
A. Administering clonidine as prescribed is an important nursing action. however, it is not the priority action.
B. Providing ice chips is an important nursing action. however, it is not the priority action.
C. Educating the client about the medication is an important nursing action. however, it is not the priority action.
D. CORRECT: Assessment is the initial step of the nursing process. Obtaining the client’s baseline vital signs is the priority nursing action.
36.
A nurse is teaching clients in an outpatient facility about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 2 to 3 hr after administration?
Correct Answer
C. Regular insulin
Explanation
A. Insulin glargine, a long‐acting insulin, does not have a peak effect time, but is fairly stable in effect after metabolized. B. NPh insulin has a peak effect around 6 to 14 hr following administration. C. CORRECT: Regular insulin has a peak effect around 2 to 3 hr following administration. D. Insulin lispro has a peak effect around 30 min to 2.5 hr following administration.
37.
A nurse is caring for a client in an outpatient facility who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor?
Correct Answer
D. Liver function tests
Explanation
A. Infection is not an adverse effect of acarbose. It is not necessary to monitor WBC while the client is taking this medication.
B. Acarbose does not affect potassium levels. It is not necessary to monitor serum potassium while the client is taking this medication.
C. Acarbose does not affect the platelet levels. It is not necessary to monitor the platelet count while the client is taking this medication.
D. CORRECT: Acarbose can cause liver toxicity when taken long‐term. Liver function tests should be monitored periodically while the client takes this medication.
38.
A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication?
Correct Answer
B. “I’ll take this medicine 30 minutes before I eat.”
Explanation
A. Repaglinide should not be taken with a meal.
B. CORRECT: Repaglinide causes a rapid, short‐lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is digested.
C. Repaglinide should not be taken just before bedtime.
D. Repaglinide is not taken upon awakening in the morning.
39.
A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to report to the provider?
Correct Answer
A. Somnolence
Explanation
A. CORRECT: Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider.
B. Diarrhea is an adverse effect of metformin.
C. Fluid retention is not an adverse effect caused by metformin. D. Anorexia and weight loss are adverse effects of metformin.
40.
A nurse is providing teaching to a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.)
Correct Answer(s)
D. “Inject pramlintide just before a meal.”
E. “Discard open vials after 28 days.”
Explanation
A. Pramlintide delays oral medication absorption, so oral medications should be taken 1 to 2 hr after pramlintide injection.
B. The thigh or abdomen, rather than the upper arms, are preferred sites for pramlintide injection.
C. Pramlintide should not be mixed in a syringe with any type of insulin.
D. CORRECT: Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important
to eat a meal after injecting this medication.
E. CORRECT: Unused medication in the open pramlintide vial should be discarded after 28 days.
41.
A nurse is caring for a client who is taking propylthiouracil. For which of the following adverse effects of this medication should the nurse monitor?
Correct Answer
A. Bradycardia
Explanation
A. CORRECT: Bradycardia is an adverse effect of propylthiouracil. The nurse should monitor for bradycardia.
B. Drowsiness, rather than insomnia, is an adverse effect of propylthiouracil.
C. Cold intolerance rather than heat intolerance is an adverse effect of propylthiouracil.
D. Weight gain, rather than weight loss, is an adverse effect of propylthiouracil.
42.
A nurse is teaching a client who has Graves’ disease about her prescribed medications. Which of the following statements by the client indicates an understanding of the use of propranolol in the treatment of Graves’ disease?
Correct Answer
C. “Propranolol will decrease my tremors and fast heart beat.”
Explanation
A. Propranolol lowers blood pressure, but does not increase blood ow to the thyroid gland.
B. Propranolol does not help prevent hyperglycemia.
C. CORRECT: Propranolol is a beta‐adrenergic antagonist that decreases heart rate and controls tremors.
D. Propranolol does not promote a decrease of thyroid hormone.
43.
A nurse is caring for an older adult client in a long‐term care facility who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client?
Correct Answer
D. The client will start on a low dose, which will be gradually increased.
Explanation
A. The nurse should not expect that the levothyroxine will be started at a high dose.
B. The nurse should not expect that the client’s dosage will remain the same throughout treatment.
C. The nurse should not expect that the client’s dosage will be adjusted daily based on blood levels.
D. CORRECT: The nurse should expect that levothyroxine will be started at a low dose and gradually increased over several weeks. This is especially important in older adult clients to prevent toxicity.
44.
A nurse is caring for a client who is taking for somatropin to stimulate growth. The nurse should plan to monitor the client’s urine for which of the following?
Correct Answer
D. Calcium
Explanation
A. Bilirubin can be present in the urine with liver or biliary disorders, but is not monitored during somatropin therapy.
B. Protein can be present in the urine during stress, infection, or glomerular disorders, but is not monitored during somatropin therapy.
C. Potassium is not expected to be present in a urine specimen.
D. CORRECT: A large amount of calcium can be present in the urine of a client who takes somatropin. This puts the client at risk for renal calculi.
45.
A nurse is assessing a client who takes desmopressin for diabetes insipidus. For which of the following adverse effects should the nurse monitor?
Correct Answer
D. Headache
Explanation
A. Edema and hypervolemia, rather than hypovolemia, are adverse effects of desmopressin.
B. Calcium imbalance is not an adverse effect of desmopressin.
C. Sleepiness, rather than agitation, is an adverse effect of desmopressin, which can indicate water intoxication.
D. CORRECT: headache during desmopressin therapy is an indication of water intoxication.
46.
A nurse is admitting a client to an acute care facility for a total hip arthroplasty. The client takes hydrocortisone for Addison’s disease. Which of the following actions is the nurse’s priority?
Correct Answer
A. Administering a supplemental dose of hydrocortisone
Explanation
A. CORRECT: Acute adrenal insuf ciency (adrenal crisis) is the greatest risk to a client who has Addison’s disease, is taking a glucocorticoid, and is undergoing surgery. To prevent acute adrenal insuf ciency, supplemental doses are administered during times of increased stress.
B. Instruction on coughing and deep breathing is important, but is not the nurse’s priority for this client.
C. Obtaining additional data from the client about past medical history is important, but is not the nurse’s priority for this client.
D. Inserting an indwelling urinary catheter is important, but is not the nurse’s priority for this client.
47.
A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include?
Correct Answer
A. “Rinse your mouth after each use of this medication.”
Explanation
A. CORRECT: The client should rinse her mouth after each use to reduce the risk of oral fungal infections.
B. A client who has asthma should increase uid intake to liquefy secretions, unless contraindicated by another condition.
C. Glucocorticoids place the client at risk for bone loss. There is no need for the client to increase her intake of vitamin B12. The client should ensure an adequate intake of calcium and vitamin D.
D. Beclomethasone is an inhaled glucocorticoid and is taken on a xed schedule.
48.
A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?
Correct Answer
B. Administer the albuterol inhaler prior to using the beclomethasone inhaler.
Explanation
A. Albuterol is a short acting inhaled beta2‐agonist and used for short term relief of bronchospasm. B. CORRECT: When a client is prescribed an inhaled beta2‐agonist (such as albuterol) and an inhaled glucocorticoid (such as beclomethasone), the client should take the beta2‐agonist first. The beta2‐agonist promotes bronchodilation and enhances absorption of the glucocorticoid. C. Beclomethasone is administered on a fixed schedule. It is not used to treat an acute attack. D. The client should shake the metered dose inhaler well before administration.
49.
A nurse is providing instructions to the parent of an adolescent client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse include?
Correct Answer
B. “Tremors are an adverse effect of this medication.”
Explanation
A. Inhaled albuterol is used to abort an acute asthma episode.
B. CORRECT: Tremors can occur due to excessive
stimulation of beta2 receptors of skeletal muscles.
C. Prolonged use of glucocorticoids can cause hyperglycemia.
D. Glucocorticoids slow skeletal growth rate in children and adolesc
50.
A nurse is teaching a client who has a prescription for long‐term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?
Correct Answer
A. Weight gain
Explanation
A. CORRECT: Weight gain and uid retention are adverse effects of oral prednisone due to the effect of sodium and water retention.
B. Nervousness and insomnia are adverse effects of beta agonists, not glucocorticoids.
C. Tachycardia are adverse effects of prednisone and beta agonists.
D. Diarrhea is an adverse effect of prednisone. Constipation is an adverse effect of tiotropium.