Question 1: Acetylcysteine
A client with thick mucus and a nonproductive cough is prescribed acetylcysteine. Which question should the nurse ask the client to evaluate the effectiveness of the medication?
- A) “How much phlegm are you coughing up?” (Correct)
- B) “What color is the mucus?”
- C) “Are you still coughing?”
- D) “Are you experiencing any pain when you cough?”
Question 2: Laxative Assessment
The nurse is preparing to administer a laxative to a bedfast client. Which assessment is most important for the nurse to perform before administering the medication?
- A) Determine the frequency and consistency of bowel movements. (Correct)
- B) Evaluate the client’s ability to recognize the urge to defecate.
- C) Assess the client’s strength in moving and turning in the bed.
- D) Observe the skin integrity of the client’s rectal and sacral areas.
Question 3: Rib Fracture Follow-up
A client with multiple rib fractures reports severe pain with breathing and movement. Which assessment findings require follow-up? (Select all that apply)
- A) IV site without redness or swelling
- B) Alert and oriented to person, place, time, and situation
- C) Temperature: 98.8°F (37.1°C)
- D) Heart rate: 92 beats/minute
- E) Blood pressure: 138/82 mm Hg
- F) Respirations: 28 breaths/minute (Correct)
- G) Pain 8 on a 0 to 10 scale (Correct)
- H) Taking shallow breaths (Correct)
Question 4: Pain Management Class
The nurse reviews the client’s medical record. Which medication class is most appropriate to treat the client’s presentation?
- A) Antacids
- B) Antibiotics
- C) Antihypertensives
- D) Bronchodilators
- E) Opioid analgesics (Correct)
Question 5: Morphine Priority Assessment
The nurse is preparing to administer morphine 2 mg IV. Which assessment is most important for the nurse to perform before administering the medication?
- A) Temperature
- B) Heart rate
- C) Respiratory rate (Correct)
- D) Blood pressure
Question 6: Managing Side Effects
Which medications are most appropriate to manage the side effects of morphine sulfate? (Select all that apply)
- A) St. John’s wort
- B) Ondansetron (Correct)
- C) Meperidine
- D) Sildenafil
- E) Docusate sodium (Correct)
- F) Naloxone (Correct)
Question 7: Opioid Education
The nurse is teaching the client about opioid pain medication. Classify the education points as appropriate or not appropriate.
- Increase water and fiber intake: Appropriate
- Use incentive spirometer when pain medication takes effect: Appropriate
- Request pain medication only if pain is severe: Not appropriate
- Expect morphine to take 1 to 2 hours for full effect: Not appropriate
- Ask for assistance when getting out of bed: Appropriate
Question 8: Therapeutic Effects
The nurse evaluates the effectiveness of the interventions. Which findings indicate the therapeutic effect of the medication? (Select all that apply)
- A) Pain level presently 3 on a 0 to 10 scale. (Correct)
- B) Client is able to take deep breaths, achieving 1,000 mL on incentive spirometer. (Correct)
- C) Client reports feeling “sleepy.”
- D) New mild cough noted.
- E) Attempted to get up to the chair, but experienced dizziness with standing.
- F) Repositions in bed with minimal assistance. (Correct)
Question 9: Somatropin Teaching
A client is being discharged with a prescription for somatropin. Which information provided by the client indicates a need for further education?
- A) Store unused vials at room temperature. (Correct)
- B) Rotate injection sites to minimize discomfort.
- C) Administer the medication subcutaneously.
- D) Discard the medication if the solution is cloudy.
Question 10: Nitroglycerin Patch
A client with a transdermal nitroglycerin patch applied 30 minutes ago reports chest pain. What action should the nurse take?
- A) Reassure the client that the patch will begin to take effect within a few minutes.
- B) Obtain another transdermal patch and apply it to a different site.
- C) Withhold further doses of nitroglycerin until the client’s blood pressure is obtained.
- D) Leave the patch in place and administer a PRN dose of sublingual nitroglycerin. (Correct)
Question 11: Adalimumab (Humira)
A client with rheumatoid arthritis is prescribed adalimumab. Which instruction should the nurse provide?
- A) Undergo annual eye examinations.
- B) Have a chest x-ray prior to your first dose. (Correct)
- C) Obtain routine vaccinations as scheduled.
- D) Avoid crowds and people who are sick.
Question 12: Pyridostigmine Timing
A client with Myasthenia Gravis is prescribed pyridostigmine. What information should the nurse obtain prior to administration?
- A) Unexplained weight loss
- B) Difficulty with urination
- C) Trouble sleeping
- D) Recent oral intake (Correct)
Question 13: Albuterol Overuse
A client presents with dizziness, lightheadedness, and palpitations after using multiple doses of albuterol.
- Potential Condition: Tachydysrhythmia
- Actions to Take: Take baseline vital signs; Place on cardiorespiratory monitor.
- Parameters to Monitor: Heart rate and rhythm; Breath sounds.
Question 14: Rosuvastatin Effectiveness
The nurse is evaluating the effectiveness of a rosuvastatin prescription. Which action should be implemented?
- A) Evaluate the client’s serum cholesterol level results. (Correct)
- B) Obtain the client’s heart rate and blood pressure.
- C) Review the client’s daily food and weight log.
- D) Measure skin folds for body mass index (BMI) calculations.
Question 15: Tetracycline Administration
A client is prescribed tetracycline for an infection. The nurse should instruct the client to take the medication with which food?
- A) Cheese and crackers
- B) Toasted wheat bread and jelly (Correct)
- C) Cold cereal with skim milk
- D) Fruit-flavored yogurt
Question 16: Digoxin Pre-administration
The nurse is preparing to administer digoxin. What action should the nurse take prior to administration?
- A) Check the client for signs of orthostatic hypotension.
- B) Listen to the heart at the left 5th intercostal space. (Correct)
- C) Verify that the urine output exceeds 30 mL per hour.
- D) Obtain a left radial pulse rate for a full 30 seconds.
Question 17: Oxybutynin and Exercise
A client taking oxybutynin is training for a half marathon. Which instruction should the nurse emphasize?
- A) Keep skin and eyes covered to protect from sun injury.
- B) Avoid crowds to help prevent acquiring infections.
- C) Take measures to avoid dehydration and overheating. (Correct)
- D) Wear padding to protect from bruising if a fall occurs.
Question 18: Glaucoma Drops
The nurse is teaching a client about eye drops for open-angle glaucoma. What is the purpose of the medication?
- A) For long term control of pain and swelling.
- B) Until the excess pressure is reduced.
- C) Until a smaller angle can be restored.
- D) For long term control of normal eye pressure. (Correct)
Question 19: Insulin Glargine Peak
A client is prescribed insulin glargine at 2100. When is the client at the highest risk for hypoglycemia?
- A) Midmorning
- B) Midafternoon
- C) Shortly after midnight
- D) No peak occurs. (Correct)
Question 20: HIV and Antiretrovirals
A client with HIV is starting antiretroviral therapy (ART). Which statement requires additional instruction?
- A) Antiretroviral medication prevents the transmission of the virus. (Correct)
- B) The medications can decrease AIDS-related complications.
- C) HIV infection is not cured by the antiretroviral regimen.
- D) The viral load can be decreased to an undetectable level.
Question 21: Sucralfate Timing
The nurse is providing discharge education for a client prescribed sucralfate. What instruction should be provided?
- A) Continue with normal dose schedule after missing a dose.
- B) Schedule doses with each meal and at bedtime.
- C) Take on an empty stomach at least 1 hour before meals. (Correct)
- D) Administer an additional dose if a dose is missed.
It looks like you’re ready to continue with the next set of questions from your pharmacology exam. I’ll continue the transcription and analysis starting from Question 22.
Question 22: Phenytoin (Dilantin) Teaching
A client is being discharged with a new prescription for phenytoin to control seizures. Which instruction should the nurse include in the discharge teaching?
- A) “You can stop taking the medication once you have been seizure-free for a month.”
- B) “Brush and floss your teeth after every meal and visit your dentist regularly.” (Correct)
- C) “Take an extra dose if you feel a seizure coming on.”
- D) “Expect your urine to turn a bright orange color while taking this drug.”
Rationale: Phenytoin commonly causes gingival hyperplasia (overgrowth of gum tissue). Meticulous oral hygiene and dental follow-up are essential to manage this side effect.
Question 23: Spironolactone (Aldactone) and Diet
A client with heart failure is taking spironolactone. Which food choice indicates the client understands the dietary restrictions associated with this medication?
- A) A large banana with breakfast.
- B) A baked potato with the skin.
- C) An apple or a bowl of blueberries. (Correct)
- D) Spinach salad with a salt substitute.
Rationale: Spironolactone is a potassium-sparing diuretic. Clients must avoid high-potassium foods (bananas, potatoes, spinach) and salt substitutes (which contain potassium chloride) to prevent life-threatening hyperkalemia.
Question 24: Warfarin (Coumadin) and Lab Monitoring
The nurse is reviewing lab results for a client taking warfarin. Which laboratory value should the nurse monitor to determine if the dose is therapeutic?
- A) Partial Thromboplastin Time (PTT).
- B) International Normalized Ratio (INR). (Correct)
- C) Platelet count.
- D) Hemoglobin and Hematocrit.
Rationale: The INR is the standardized system for reporting PT (prothrombin time) results and is used to monitor the effectiveness of warfarin therapy. The typical target range for most conditions is $2.0$ to $3.0$.
Question 25: Alendronate (Fosamax) Administration
Which instruction is most important for the nurse to provide a client prescribed alendronate for osteoporosis?
- A) “Sit upright for at least 30 minutes after taking the medication.” (Correct)
- B) “Take the medication right before you go to sleep.”
- C) “Take the medication with a full glass of milk or orange juice.”
- D) “Chew the tablet thoroughly before swallowing.”
Rationale: Alendronate can cause severe esophageal erosion. To prevent this, the client must take it with plain water only and remain upright to ensure the tablet passes completely into the stomach.
Question 26: Levothyroxine (Synthroid) Evaluation
The nurse evaluates a client’s response to levothyroxine. Which finding indicates that the medication dose is effective?
- A) The client reports an increased appetite and weight loss.
- B) The client’s Thyroid Stimulating Hormone (TSH) level has decreased. (Correct)
- C) The client experiences a decrease in heart rate.
- D) The client reports feeling more tired than usual.
Rationale: Levothyroxine is a synthetic thyroid hormone used for hypothyroidism. Effectiveness is measured by the normalization of TSH levels (TSH levels drop as thyroid hormone levels rise).
Question 27: Furosemide (Lasix) and Ototoxicity
A client is receiving high-dose intravenous furosemide. The nurse should monitor the client for which adverse effect?
- A) Visual disturbances like “halos” around lights.
- B) Severe dry cough.
- C) Tinnitus or hearing loss. (Correct)
- D) Gum hyperplasia.
Rationale: Furosemide is a loop diuretic that can cause ototoxicity (damage to the ear), especially when administered too rapidly via IV bolus.
Question 28: Nitroglycerin Storage
The nurse is teaching a client how to store their sublingual nitroglycerin tablets. Which statement by the client indicates understanding?
- A) “I should keep the bottle on my windowsill so I can find it easily.”
- B) “I can move the tablets into a smaller, clear plastic container for my purse.”
- C) “I must keep the tablets in the original dark glass bottle, tightly closed.” (Correct)
- D) “The tablets are good for up to two years after opening the bottle.”
Rationale: Nitroglycerin is highly unstable and decomposes when exposed to light, heat, or moisture. It must be kept in its original amber glass container.
Question 29: Rifampin Side Effects
A client being treated for tuberculosis is prescribed rifampin. Which side effect should the nurse tell the client to expect?
- A) “Your vision may become blurry or you may have trouble seeing colors.”
- B) “You will likely develop a persistent, dry, hacking cough.”
- C) “Your urine, sweat, and tears may turn a harmless orange-red color.” (Correct)
- D) “You may experience severe muscle pain and weakness.”
Question 30: Lisinopril Adverse Effects
A client taking lisinopril for hypertension contacts the clinic. Which symptom should the nurse prioritize as a reason to stop the medication and seek immediate care?
- A) A frequent, dry, non-productive cough.
- B) Feeling slightly dizzy when standing up too fast.
- C) Swelling of the lips, tongue, or throat. (Correct)
- D) A metallic taste in the mouth.
Rationale: While a cough is a common side effect of ACE inhibitors, angioedema (swelling of the airway) is a life-threatening emergency.
Moving forward with the transcription and analysis of your pharmacology exam questions, focusing on accuracy and high-yield rationales.
Question 31: Metformin and Contrast Media
A client taking metformin is scheduled for a CT scan with intravenous contrast dye. Which instruction is most important for the nurse to provide?
- A) “Take an extra dose of metformin the morning of the procedure.”
- B) “Hold the metformin for 48 hours after the procedure.” (Correct)
- C) “Drink plenty of orange juice after the scan to flush the dye.”
- D) “Expect your blood sugar to drop significantly after the contrast is given.”
Rationale: Both metformin and contrast dye are cleared by the kidneys. Using them together increases the risk of contrast-induced nephropathy and life-threatening lactic acidosis. Metformin is typically held the day of and for 48 hours after contrast administration, until renal function is confirmed as normal.
Question 32: Beclomethasone (QVAR) Education
The nurse is teaching a client about the use of a beclomethasone inhaler for asthma. What should the nurse instruct the client to do after each use?
- A) “Check your pulse for one full minute.”
- B) “Drink a full glass of water immediately.”
- C) “Rinse your mouth out with water and spit.” (Correct)
- D) “Use your albuterol inhaler to clear the medication.”
Rationale: Beclomethasone is an inhaled corticosteroid. Rinsing the mouth prevents local immunosuppression that leads to oral candidiasis (thrush).
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Question 33: Vancomycin Infusion Rate
A client is receiving intravenous vancomycin. The nurse notes the client’s upper body and face have become bright red and flushed. What is the nurse’s priority action?
- A) Administer an immediate dose of epinephrine.
- B) Stop the infusion and notify the healthcare provider of an allergy.
- C) Slow the rate of the infusion. (Correct)
- D) Apply cold compresses to the flushed areas.
Rationale: This is “Red Man Syndrome,” a common infusion-related reaction (not a true allergy) caused by rapid administration. The priority is to slow the infusion rate.
Question 34: Folic Acid and Pregnancy
A female client of childbearing age is prescribed folic acid. The nurse explains that this supplement is primarily given to prevent which condition?
- A) Iron-deficiency anemia.
- B) Gestational diabetes.
- C) Neural tube defects in the fetus. (Correct)
- D) Pregnancy-induced hypertension.
Rationale: Folic acid is essential during early pregnancy for the proper closure of the fetal spinal cord.
Question 35: Amiodarone (Cordarone) Monitoring
A client is prescribed amiodarone for a ventricular dysrhythmia. Which diagnostic test should the nurse expect the client to undergo periodically while on this medication?
- A) Weekly hearing tests.
- B) Bone density scans.
- C) Pulmonary function tests. (Correct)
- D) Daily blood glucose monitoring.
Rationale: Amiodarone can cause serious pulmonary toxicity (lung fibrosis). Baseline and periodic PFTs are required to monitor for this potentially fatal side effect.
Question 36: Haloperidol (Haldol) Adverse Effects
A client taking haloperidol begins to experience tremors, shuffling gait, and drooling. Which medication should the nurse expect to administer?
- A) Lorazepam (Ativan)
- B) Benztropine (Cogentin) (Correct)
- C) Risperidone (Risperdal)
- D) Fluoxetine (Prozac)
Rationale: These symptoms represent Extrapyramidal Symptoms (EPS), specifically pseudoparkinsonism. Benztropine is an anticholinergic used to reverse these effects.
Question 37: Enoxaparin (Lovenox) Administration
When administering enoxaparin subcutaneously, which action should the nurse take?
- A) Aspirate for blood return before injecting.
- B) Administer the injection in the abdomen, at least 2 inches from the umbilicus. (Correct)
- C) Rub the site vigorously after injection to aid absorption.
- D) Expel the nitrogen air bubble from the prefilled syringe before use.
Rationale: The abdomen is the preferred site for absorption. Aspiration and rubbing are avoided as they increase bruising and hematoma formation. The air bubble should not be expelled as it helps “seal” the medication into the tissue.
Question 38: Clopidogrel (Plavix) Assessment
A client is taking clopidogrel after a coronary stent placement. Which finding is most concerning to the nurse?
- A) A mild headache in the afternoon.
- B) A small bruise at the site of a recent blood draw.
- C) Black, tarry stools. (Correct)
- D) Fatigue after exercise.
Rationale: Clopidogrel is an antiplatelet. Black, tarry stools (melena) indicate gastrointestinal bleeding, a major risk of this therapy.
Question 39: Prednisone Tapering
The nurse is teaching a client about a new prescription for prednisone. Why is it essential to taper the dose rather than stopping abruptly?
- A) To prevent the return of original symptoms.
- B) To avoid developing a tolerance to the drug.
- C) To prevent acute adrenal insufficiency. (Correct)
- D) To minimize the risk of weight gain.
Rationale: Exogenous steroids suppress the body’s natural cortisol production by the adrenal glands. Abrupt withdrawal doesn’t give the adrenals time to “wake up,” leading to a life-threatening adrenal crisis.
Question 40: Digoxin Toxicity
A client taking digoxin reports seeing “yellow-green halos” around lights and is experiencing nausea. What should the nurse do first?
- A) Administer an antiemetic for the nausea.
- B) Check the client’s blood pressure.
- C) Obtain a serum digoxin level and electrolytes. (Correct)
- D) Encourage the client to eat a banana.
Rationale: These are classic signs of digoxin toxicity. Hypokalemia (low potassium) often precipitates this toxicity, so checking both the drug level and electrolyte levels is the priority.
Question 41: Spironolactone (Aldactone) Adverse Effects
The nurse is monitoring a male client taking spironolactone for heart failure. Which finding should the nurse report to the healthcare provider?
- A) Increased urinary output.
- B) Excessive growth of breast tissue (gynecomastia). (Correct)
- C) A serum potassium level of 4.2 mEq/L.
- D) Decreased blood pressure.
Rationale: Spironolactone is a potassium-sparing diuretic that also has anti-androgenic effects. It can cause gynecomastia in men and menstrual irregularities in women. Increased urine and lower BP are expected therapeutic effects.
Question 42: Lithium Carbonate and Sodium Intake
A client with bipolar disorder is starting lithium carbonate. Which dietary instruction is most important?
- A) “Restrict your total fluid intake to less than one liter per day.”
- B) “Follow a strictly low-sodium diet.”
- C) “Maintain a consistent intake of salt and fluids.” (Correct)
- D) “Take the medication only when you feel a manic episode starting.”
Rationale: The kidneys handle lithium and sodium similarly. If sodium levels drop (due to a low-salt diet or dehydration), the kidneys reabsorb lithium instead, leading to lithium toxicity.
Question 43: Nifedipine (Procardia) Assessment
A nurse is preparing to administer nifedipine to a client. Which assessment finding would require the nurse to withhold the medication?
- A) Peripheral edema 1+ in the ankles.
- B) A respiratory rate of 16 breaths/minute.
- C) A blood pressure of 88/52 mm Hg. (Correct)
- D) A heart rate of 72 beats/minute.
Rationale: Nifedipine is a calcium channel blocker used for hypertension and angina. Its primary action is vasodilation, which lowers blood pressure. Administering it to a client who is already hypotensive (BP < 90/60) could lead to severe complications.
Question 44: Gentamicin (Garamycin) Lab Monitoring
A client is receiving intravenous gentamicin every 8 hours. The nurse is preparing to draw a trough level. When should the blood be collected?
- A) 30 minutes after the infusion is complete.
- B) Exactly halfway between the two doses.
- C) Immediately (within 30 minutes) before the next dose. (Correct)
- D) Two hours after the morning dose.
Rationale: Trough levels represent the lowest concentration of the drug in the blood. They are drawn just before the next dose to ensure the drug is being cleared effectively, minimizing the risk of nephrotoxicity and ototoxicity.
Question 45: Epinephrine in Anaphylaxis
The nurse administers epinephrine to a client experiencing an anaphylactic reaction. Which finding indicates the medication was effective?
- B) Unlabored respirations and decreased wheezing. (Correct)
- A) Increased heart rate and palpitations.
- C) Decreased blood pressure.
- D) Increased swelling of the lips.
Rationale: Epinephrine acts as a bronchodilator and vasoconstrictor. In anaphylaxis, the therapeutic goal is to open the airway and support blood pressure. While it does increase heart rate (a side effect), the therapeutic effect is the resolution of respiratory distress.
Question 46: Montelukast (Singulair) Timing
The nurse is teaching a client about montelukast for the management of asthma. When should the nurse instruct the client to take this medication?
- A) Only when an asthma attack begins.
- B) 30 minutes before using a rescue inhaler.
- C) Once daily in the evening. (Correct)
- D) Twice daily, once in the morning and once at bedtime.
Rationale: Montelukast is a leukotriene receptor antagonist used for long-term prophylaxis, not acute attacks. It is typically taken in the evening because asthma symptoms often worsen at night or in the early morning.
Question 47: Allopurinol (Zyloprim) Education
A client is prescribed allopurinol for the treatment of gout. Which instruction should the nurse provide?
- A) “Take the medication with a large glass of grapefruit juice.”
- B) “Increase your fluid intake to 2 to 3 liters per day.” (Correct)
- C) “Expect the pain to worsen for the first few months of therapy.”
- D) “Limit your intake of dairy products while on this drug.”
Rationale: Allopurinol lowers uric acid levels. Increasing fluids helps the kidneys excrete uric acid and prevents the formation of uric acid kidney stones.
Question 48: Atorvastatin (Lipitor) and Muscle Pain
A client taking atorvastatin reports new onset of muscle aches and weakness. What is the nurse’s priority action?
- A) Advise the client to increase their intake of potassium.
- B) Tell the client this is a normal side effect that will go away.
- C) Instruct the client to stop the drug and notify the provider. (Correct)
- D) Schedule the client for a routine cholesterol check.
Rationale: Muscle pain/weakness in a client taking a statin can indicate rhabdomyolysis (breakdown of muscle tissue), which can lead to acute renal failure. This requires immediate evaluation of Creatine Kinase (CK) levels.
Question 49: Iron Supplementation (Ferrous Sulfate)
The nurse is teaching a client about taking oral iron supplements. Which statement by the client indicates understanding?
- A) “I will take my iron pill with my morning coffee.”
- B) “I will take the medication with orange juice to help it absorb.” (Correct)
- C) “I should be concerned if my stools turn a dark green or black color.”
- D) “I will take an antacid right before my iron to prevent stomach upset.”
Rationale: Vitamin C (ascorbic acid) enhances the absorption of iron. Calcium (dairy/antacids) and tannins (tea/coffee) inhibit it. Dark green/black stools are a harmless, expected side effect.
Question 50: Glucagon Emergency Use
A family member of a client with Type 1 diabetes is being taught how to use a glucagon emergency kit. In which situation should it be used?
- A) When the client’s blood sugar is over 300 mg/dL.
- B) If the client is awake but feeling shaky and sweaty.
- C) When the client is unconscious and unable to swallow. (Correct)
- D) If the client forgets to take their morning insulin dose.
Rationale: Glucagon is used for severe hypoglycemia when the client cannot safely take oral glucose (carbohydrates) due to a decreased level of consciousness.
Question 51: Isotretinoin (Accutane) Safety
A female client is prescribed isotretinoin for severe acne. Which intervention is most essential for the nurse to implement?
- A) Monitor the client for increased hair growth.
- B) Instruct the client to take Vitamin A supplements.
- C) Verify that the client is using two forms of effective contraception. (Correct)
- D) Advise the client to use a tanning bed to help dry out the acne.
Rationale: Isotretinoin is highly teratogenic (causes severe birth defects). Under the iPLEDGE program, female clients of childbearing age must commit to using two forms of birth control and have regular pregnancy tests.
Question 52: Digoxin and Hypokalemia
The nurse is reviewing the lab results of a client taking digoxin and furosemide. Which lab value increases the client’s risk for digoxin toxicity?
- A) Sodium 138 mEq/L
- B) Potassium 3.2 mEq/L (Correct)
- C) Calcium 9.5 mg/dL
- D) Magnesium 2.0 mEq/L
Rationale: Low potassium (hypokalemia) increases the susceptibility of the heart to digoxin, significantly increasing the risk of toxicity even if the digoxin level itself is within a normal range.
Question 53: Ciprofloxacin (Cipro) Adverse Effects
A client taking ciprofloxacin for a urinary tract infection reports pain and swelling in the back of the ankle. What is the nurse’s priority action?
- A) Apply a heating pad to the area.
- B) Instruct the client to perform stretching exercises.
- C) Advise the client to stop the medication and avoid weight-bearing. (Correct)
- D) Tell the client to take ibuprofen for the inflammation.
Rationale: Fluoroquinolones like ciprofloxacin carry a black box warning for tendon rupture, most commonly the Achilles tendon. The drug must be stopped immediately to prevent a complete tear.
Question 54: Nitroglycerin Side Effects
The nurse administers a sublingual nitroglycerin tablet to a client with chest pain. Which common side effect should the nurse warn the client about?
- A) A throbbing headache. (Correct)
- B) Numbness in the fingers.
- C) A dry, persistent cough.
- D) Orange-colored urine.
Rationale: Nitroglycerin is a potent vasodilator. Vasodilation of the cerebral blood vessels frequently causes a headache, which can often be treated with acetaminophen.
Question 55: Grapefruit Juice Interactions
The nurse is providing discharge teaching for a client prescribed simvastatin and nifedipine. Which beverage should the nurse instruct the client to avoid?
- A) Apple juice
- B) Skim milk
- C) Grapefruit juice (Correct)
- D) Iced tea
Rationale: Grapefruit juice inhibits the CYP3A4 enzyme in the liver, which is responsible for breaking down many drugs, including statins and calcium channel blockers. This can lead to dangerously high drug levels and toxicity.
Question 56: Tamoxifen (Soltamox) Risks
A client with breast cancer is prescribed tamoxifen. The nurse should monitor the client for which serious adverse effect?
- A) Prolonged diarrhea.
- B) Severe facial acne.
- C) Increased risk of endometrial cancer and blood clots. (Correct)
- D) Permanent hearing loss.
Rationale: While tamoxifen blocks estrogen in the breast, it acts like estrogen in the uterus, increasing the risk of endometrial hyperplasia. It also increases the risk of DVT and pulmonary embolism.
Question 57: Pancrelipase (Creon) Administration
The nurse is teaching a client with cystic fibrosis how to take pancrelipase. When should the medication be administered?
- A) First thing in the morning upon awakening.
- B) Exactly two hours after every meal.
- C) With every meal and snack. (Correct)
- D) Only when the client experiences abdominal pain.
Rationale: Pancrelipase provides the digestive enzymes the client’s pancreas cannot produce. It must be present in the GI tract at the same time as food to break down fats, proteins, and starches.
Question 58: Naloxone (Narcan) Duration
A nurse administers naloxone to a client with respiratory depression from a heroin overdose. Why must the nurse continue to monitor the client closely?
- A) The client may become violently aggressive.
- B) Naloxone can cause severe hypertension.
- C) The half-life of naloxone is shorter than most opioids. (Correct)
- D) The client may develop a tolerance to naloxone.
Rationale: Naloxone wears off in about 30 to 90 minutes, which is often much shorter than the opioid it is reversing. Once the naloxone wears off, the client can sink back into fatal respiratory depression.
Question 59: Hydrochlorothiazide (HCTZ) and Gout
A client with a history of gout is started on hydrochlorothiazide for hypertension. What should the nurse monitor for?
- A) Decreased blood glucose levels.
- B) Excessive hair growth.
- C) Increased uric acid levels and gout attacks. (Correct)
- D) Overhydration and edema.
Rationale: Thiazide diuretics can decrease the excretion of uric acid by the kidneys, which may lead to hyperuricemia and trigger an acute gout flare-up.
Question 60: Vancomycin Trough and Nephrotoxicity
A nurse receives a trough level of 25 mcg/mL (normal range 10–20 mcg/mL) for a client receiving IV vancomycin. Which lab value is most important for the nurse to check?
- A) White blood cell count.
- B) Creatinine and BUN. (Correct)
- C) Serum glucose.
- D) Hemoglobin.
Rationale: A high vancomycin trough level indicates a high risk for nephrotoxicity. The nurse must assess renal function (Creatinine and BUN) before the next dose is even considered.
