Exam Autumn 2018 Questions and Answers PDF

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Exam Autumn 2018, questions and answers
Pharmacology (Arizona State University)
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For the client taking epinephrine, the nurse realizes there is a

possible drug interaction with which drug?
a. albuterol (Proventil)
b. metoprolol (Lopressor)
c. bethanechol (Urecholine)
d. tolterodine tartrate (Detrol)
b. metoprolol (Lopressor)
2.The nurse will monitor the client taking albuterol (Proventil) for
which condition?
a. Palpitations
b. Hypoglycemia
c. Bronchospasm
d. Uterine contractions
a. Palpitations
3.A client is prescribed metoprolol (Lopressor) to treat hyperten-

sion. It is important for the nurse to monitor the client for which
condition?
a. Bradycardia
b. Hypertension
c. Ankle edema
d. Decreased respirations
a. Bradycardia
4.Atenolol (Tenormin) is prescribed for a client. The nurse realizes

that this drug is a beta-adrenergic blocker and that this drug clas-
sification is contraindicated for clients with which condition?
a. Hypothyroidism
b. Angina pectoris
c. Cardiogenic shock
d. Liver dysfunction

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c. Cardiogenic shock
5.The nurse realizes that beta1 receptor stimulation is differenti-

ated from beta2 stimulation in that stimulation of beta1 receptors
leads to which condition?
a. Increased bronchodilation
b. Decreased uterine contractility
c. Increased myocardial contractility
d. Decreased blood flow to skeletal muscles
c. Increased myocardial contractility
6. A client is given epinephrine (Adrenalin), an adrenergic agonist

(sympathomimetic). The nurse should monitor the client for which
condition?
a. Decreased pulse
b. Pupil constriction
c. Bronchial constriction
d. Increased blood pressure
d. Increased blood pressure
7.The nurse is administering atenolol (Tenormin) to a client.

Which concurrent drug does the nurse expect to most likely cause
an interaction?
a. ginseng herb
b. An NSAID, such as aspirin
c. methyldopa (Aldomet)
d. haloperidol (Haldol)
b. An NSAID, such as aspirin
Chapter 19
1. A client is receiving bethanechol (Urecholine). The nurse real-
izes that the action of this drug is to treat:

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a. Glaucoma
b. Urinary retention
c. Delayed gastric emptying
d. Gastroesophageal reflux disease
b. Urinary retention
2. The nurse teaches the client receiving atropine to expect which

side effect?
a. Diarrhea
b. Bradycardia
c. Blurred vision
d. Frequent urination
c. Blurred vision
3. When benztropine (Cogentin) is ordered for a client, the nurse

acknowledges that this drug is an effective treatment for which
condition?
a. Parkinsonism
b. Paralytic ileus
c. Motion sickness
d. Urinary retention
a. Parkinsonism
4. Dicyclomine (Bentyl) is an anticholinergic, which the nurse real-

izes is given to treat which condition?
a. Mydriasis
b. Constipation
c. Urinary retention
d. Irritable bowel syndrome
d. Irritable bowel syndrome

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5. The nurse realizes that cholinergic agonists mimic which

parasympathetic neurotransmitter?
a. dopamine
b. acetylcholine
c. cholinesterase
d. monoamine oxidase
b. acetylcholine
6. The nurse is administering a cholinergic agonist and should

know that the expected cholinergic effects include which of the
following?
a. Increased heart rate
b. Decreased peristalsis
c. Decreased salivation
d. Increased pupil constriction
d. Increased pupil constriction
7. When the client has a cholinergic overdose, the nurse antici-

pates administration of which drug as the antidote?
a. atropine
b. bethanechol
c. ambenonium
d. metoclopramide
a. atropine
Chapter 20
1. When a 12-year-old child is prescribed methylphenidate, which
is most important for the nurse to monitor?
a. The child's temperature
b. The child's respirations
c. The child's intake and output
d. The child's height and weight
d. The child's height and weight

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2. Several children are admitted for diagnosis with possible atten-

tion deficit/hyperactivity disorder. Which is most important for the
nurse to observe?
a. A girl who is lethargic
b. A girl who lacks impulsivity
c. A boy with smooth coordination
d. A boy with an inability to complete tasks
d. A boy with an inability to complete tasks
3. A client is taking benzphetamine. The nurse teaches the client

which information about this drug?
a. That it may cause drowsiness
b. That it may lead to hypotension
c. That it is a respiratory stimulant
d. That it is safe during pregnancy
4. The nurse monitoring a client for methylphenidate withdrawal

should observe the client for which condition?
a. Tremors
b. Insomnia
d. Tachycardia
3= b. That it may lead to hypotension
4= c. Weakness
5. The nurse teaches a client about which common side effect of

analeptics?

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a. Bradycardia
b. Constipation
c. Nervousness
d. Urinary retention
c. Nervousness
6. The nurse who is teaching the client to self-administer medica-

tions explains to the client that which drug treats narcolepsy?
a. modafinil
b. atomoxetine
c. lisdexamfetamine
d. methylphenidate
a. modafinil
7. A newborn client is in respiratory distress. The nurse antici-

pates preparation for which medication to be given?
a. modafinil
b. armodafinil
c. theophylline
d. amphetamine
c. theophylline
Chapter 21
1. It is important for the nurse teaching the client regarding seco-
barbital (Seconal) to include which information about secobarbi-
tal?
a. It is a short-acting drug that may cause one to awaken early in
the morning.
b. It is an intermediate-acting drug that frequently causes REM re-
bound.
c. It is an intermediate-acting drug that frequently causes a hang-
over effect.

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d. It is a long-acting drug that is frequently associated with depen-

dence.
a. It is a short-acting drug that may cause one to awaken early in
the morning.
2. A client taking lorazepam (Ativan) asks the nurse how this drug
works. The nurse should respond by stating that it is a benzodi-
azepine that acts by which mechanism?
a. Depressing the central nervous system (CNS), leading to a loss
of consciousness
b. Depressing the CNS, including the motor and sensory activities
c. Increasing the action of the inhibitory neurotransmitter gamma-
aminobutyric acid (GABA) to GABA receptors
d. Creating an epidural block by placement of the local anesthetic
in the outer covering of the spinal cord
c. Increasing the action of the inhibitory neurotransmitter gamma-
aminobutyric acid (GABA) to GABA receptors
3. A client is taking zolpidem (Ambien) for insomnia. The nurse

prepares a care plan that includes monitoring of the client for side
effects/adverse reactions of this drug. Which is a side effect of
zolpidem?
a. Insomnia
b. Headache
c. Laryngospasm
d. Blood dyscrasias
b. Headache
4. A client received spinal anesthesia. Which is most important for

the nurse to monitor?
a. Loss of consciousness
b. Hangover effects and dependence
c. Hypotension and headaches

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d. Excitement or delirium
c. Hypotension and headaches
5. A nurse is teaching a client about zolpidem. Which is important

for the nurse to include in the teaching of this drug?
a. Maximum dose is 20 mg/d
b. May lead to psychological dependence
c. For older adults, dose is 15 mg at bedtime
d. Should only be used for 21 days or less
b. May lead to psychological dependence
6. A client is taking triazolam (Halcion). Which instructions about

this drug are important for the nurse to include?
a. It may be used as a barbiturate for only 4 weeks.
b. Use as a nonbenzodiazepine to reduce anxiety.
c. This drug does not lead to vivid dreams or nightmares.
d. Avoid alcohol and smoking to prevent rebound insomnia.
d. Avoid alcohol and smoking to prevent rebound insomnia.
7. A client is to receive conscious sedation for a minor surgical

procedure. Which drug administration should the nurse expect?
(Select all that apply.)
a. Propofol (Diprivan) to sustain natural sleep
b. Lidocaine (Xylocaine) to provide local anesthesia
c. Midazolam (Versed) to promote sedation and following of com-
mands
d. Ketamine (Ketalar) for rapid inductionand prolonged duration of
action
a. Propofol (Diprivan) to sustain natural sleep
c. Midazolam (Versed) to promote sedation and following of com-
mands

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Chapter 22
1. The nurse witnesses a client's seizure involving generalized
contraction of the body followed by jerkiness of arms and legs.
The nurse reports that this is which type of seizure?
a. Myoclonic
b. Petit mal
c. Tonic clonic
d. Psychomotor
c. Tonic clonic
2. Phenytoin (Dilantin) has been prescribed for a client with

seizures. The nurse should include which appropriate nursing in-
tervention in the plan of care?
a. Reporting an abnormal phenytoin level of 18 mcg/mL
b. Monitoring CBC levels for early detection of blood dyscrasias
c. Encouraging the client to brush teeth vigorously to prevent
plaque buildup
d. Teaching the client to stop the drug immediately when passing
pinkish-red or reddish-brown urine
b. Monitoring CBC levels for early detection of blood dyscrasias
3. When administering phenytoin (Dilantin), the nurse realizes

more teaching is needed if the client makes which statement?
a. "I must shake the oral suspension very well before pouring in
the dose cup."
b. "I cannot drink alcoholic beverages when taking phenytoin."
c. "I should take phenytoin 1 hour before meals."
d. "I will need to get periodic dental checkups."
c. "I should take phenytoin 1 hour before meals."
4. A client is taking clonazepam (Klonopin) for absence (petit mal)

seizures. Which value(s) should the nurse report as outside the
therapeutic range for clonazepam? (Select all that apply.)

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a. 5 mcg/mL
b. 15 mcg/mL
c. 60 ng/mL
d. 120 ng/mL
a. 5 mcg/mL
b. 15 mcg/mL
d. 120 ng/mL
5. A client is admitted to the emergency department with status

epilepticus. Which drug should the nurse most likely prepare to
administer to this client? (Select all that apply.)
a. diazepam (Valium)
b. midazolam (Versed)
c. gabapentin (Neurontin)
d. levetiracetam (Keppra)
a. diazepam (Valium)
b. midazolam (Versed)
6. The nurse should monitor the client receiving phenytoin (Di-

lantin) for which adverse effect?
a. Psychosis
b. Nosebleeds
c. Hypertension
d. Gum erosion
b. Nosebleeds
7. A client is taking valproic acid (Depakote). The nurse should

monitor the client for a which therapeutic serum range?
a. 10 to 20 mcg/mL
b. 15 to 40 mcg/mL
c. 20 to 80 ng/mL
d. 40 to 100 mcg/mL
d. 40 to 100 mcg/mL

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Chapter 23
1. A client with parkinsonism asks the nurse to explain what
causes this condition. The most accurate response by the nurse
is that parkinsonism is caused by the degeneration of which?
a. Cholinergic neurons
b. Dopaminergic neurons
c. Acetylcholine neurotransmitters
d. Monamine oxidase-B neurotransmitters
b. Dopaminergic neurons
2. A client is receiving carbidopa-levodopa for parkinsonism. What

should the nurse know about this drug?
a. Carbidopa-levodopa may lead to hypertension.
b. Carbidopa-levodopa may lead to excessive saliva.
c. Dopaminergic and anticholinergic therapy may lead to drowsi-
ness and sedation.
d. Dopaminergics and anticholinergics are contraindicated in
clients with glaucoma.
d. Dopaminergics and anticholinergics are contraindicated in
clients with glaucoma.
3. A family member of a client with Alzheimer's disease asks the

nurse what causes this disorder. What does the nurse explain is
the cause of Alzheimer's disease?
a. An excess of acetylcholine
b. Neurofibrillary tangles inside neurons
c. Degeneration of dopaminergic neurons
d. Neuritic plaques that form inside neurons in the cerebellum
b. Neurofibrillary tangles inside neurons

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4. A client is taking rivastigmine (Exelon). The nurse should teach

the client and family which information about rivastigmine?
a. That hepatotoxicity may occur
b. That the initial dose is 6 mg t.i.d
c. That GI distress is a common side effect
d. That weight gain may be a side effect
c. That GI distress is a common side effect
5. Nursing interventions for the client taking carbidopa-levodopa

for parkinsonism include which?
a. Encouraging client to adhere to a high-protein diet
b. Informing client that perspiration may be dark and stain clothing
c. Advising client that glucose levels should be checked through
urine testing
d. Warning client that it may take 4 to 5 days before symptoms
are controlled
b. Informing client that perspiration may be dark and stain clothing
6. What should the client who is taking anticholinergic therapy for

parkinsonism be taught? (Select all that apply.)
a. To avoid alcohol, cigarettes, and caffeine
b. To relieve dry mouth with hard candy or ice chips
c. To use sunglasses to reduce photophobia
d. To urinate 2 hours after taking the drug
e. To receive routine eye examinations
a. To avoid alcohol, cigarettes, and caffeine
b. To relieve dry mouth with hard candy or ice chips
c. To use sunglasses to reduce photophobia
e. To receive routine eye examinations
7. A client is taking tacrine (Cognex) to improve cognitive function.

What should the nurse teach the client? (Select all that apply.)
a. That the client should rise slowly to avoid dizziness

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b. That obstacles should be removed from pathways to avoid in-

jury
c. That the drug dosing schedule should be followed closely
d. That the client should be checked frequently for hypertension
e. That the client should receive regular liver function tests
a. That the client should rise slowly to avoid dizziness
b. That obstacles should be removed from pathways to avoid in-
jury
c. That the drug dosing schedule should be followed closely
e. That the client should receive regular liver function tests
Chapter 24
1. When the nurse explains the pathophysiology of myasthenia
gravis to a client, which is the best explanation?
a. Degeneration of cholinergic neurons and a deficit in acetyl-
choline leads to neuritic plaques and neurofibrillary tangles.
b. Decreased amount of acetylcholine to cholinergic receptors
produces weak muscles and reduced nerve impulses.
c. Myelin sheaths of nerve fibers in brain and spinal cord develop
lesions or plaques.
d. Imbalance of dopamine and acetylcholine leads to degenera-
tion of neurons in midbrain and extrapyramidal motor tracts.
b. Decreased amount of acetylcholine to cholinergic receptors
produces weak muscles and reduced nerve impulses.
2. For the client receiving pyridostigmine administration, the nurse

should monitor for which adverse reaction?
a. Hypertension
b. Bronchospasm
c. Thrombocytopenia
d. Stevens-Johnson syndrome
b. Bronchospasm

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3. A client has spasticity following a spinal cord injury. The nurse

should expect which drug to be prescribed to treat this client's
spasticity?
a. Tacrine
b. Ropinirole
c. Carisoprodol
d. Pyridostigmine
c. Carisoprodol
4. A client with multiple sclerosis is in the chronic progressive

phase. The nurse should expect which drug to be most helpful at
this time?
a. Interferon β-1a (Avonex, Rebif)
b. Glucocorticoids
c. Azathioprine (Imuran)
d. Cyclophosphamide (Cytoxan)
d. Cyclophosphamide (Cytoxan)
5. A client is taking carisoprodol (Soma). Which statement would

the nurse include in teaching the client about this drug?
a. It may cause hypertension.
b. It may lead to bradycardia.
c. It blocks interneuronal activity.
d. Its action is decreased by antihistamines.
c. It blocks interneuronal activity.
6. A client who is prescribed pyridostigmine bromide (Mestinon) is

being taught about the drug. Which statements should the nurse
include in the teaching? (Select all that apply.)
a. The drug must be taken on time.
b. The drug must be taken two times per day.
c. Underdosing can result in cholinergic crisis.
d. Overdosing can result in cholinergic crisis.

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e. The client should report the adverse effects of tachycardia to

the health care provider.
a. The drug must be taken on time.
c. Underdosing can result in cholinergic crisis.
d. Overdosing can result in cholinergic crisis.
7. A client is beginning to take carisoprodol (Soma). Which inter-

ventions should the nurse include in the care of this client? (Se-
lect all that apply.)
a. Ask the client if there is any history of narrow-angle glaucoma.
b. Inform the client that muscular pain is usually relieved within 1
week.
c. Tell the client to report dizziness and double vision to the health
care provider.
d. Advise the client to avoid alcohol and other CNS depressants.
e. Instruct the client that this drug should not be stopped abruptly.
b. Inform the client that muscular pain is usually relieved within 1
week.
c. Tell the client to report dizziness and double vision to the health
care provider.
d. Advise the client to avoid alcohol and other CNS depressants.
e. Instruct the client that this drug should not be stopped abruptly.
Chapter 26
1. The nurse knows that which medication will cause the least
gastrointestinal distress?
a. aspirin
b. ketorolac
c. celecoxib
d. ibuprofen
c. celecoxib

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2. A client states during a medical history that he takes several ac-

etaminophen tablets throughout the day. The nurse teaches the
client that the dosage should not exceed which amount?
a. 1 g/day
b. 2 g/day
c. 4 g/day
d. 6 g/day
c. 4 g/day
3. For the client receiving periodic morphine IV push, which is

most critical for the nurse to monitor?
a. Fever
b. Diarrhea
c. Respirations
d. White blood cell count
c. Respirations
4. A client is admitted to the emergency department in respiratory

depression following self-injection with hydromorphone. The ad-
mitting nurse knows that which drug will reverse respiratory de-
pression caused by opioid overdose?
a. fentanyl
b. naloxone
c. butorphanol
d. sufenta
b. naloxone
5. Assessing a client following IV morphine administration, the

nurse notes cold, clammy skin; a pulse of 40 beats/min; respira-
tions of 10 breaths/min; and constricted pupils. Which medication
will the client likely need next?
a. naloxone (Narcan)
b. meloxicam (Mobic)

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c. pentazocine (Talwin)
d. propoxyphene (Darvon)
a. naloxone (Narcan)
6. For the client who is taking acetaminophen (Tylenol), what

should the nurse do? (Select all that apply.)
a. Monitor routine liver enzyme tests.
b. Encourage the client to check package labels of OTC drugs to
avoid overdosing.
c. Teach the diabetic client taking acetaminophen to check blood
glucose more frequently.
d. Teach the female client that oral contraceptives can increase
the effect of acetaminophen.
e. Teach the client that caffeine decreases the effects of ac-
etaminophen.
a. Monitor routine liver enzyme tests.
b. Encourage the client to check package labels of OTC drugs to
avoid overdosing.
c. Teach the diabetic client taking acetaminophen to check blood
glucose more frequently.
7. For the client who is taking nalbuphine (Nubain), what should

the nurse do? (Select all that apply.)
a. Monitor any changes in respirations.
b. Instruct the client to report bradycardia.
c. Administer IV nalbuphine undiluted.
d. Explain to the client to expect an excessive amount of urine
output.
e. Instruct the client to avoid alcohol when taking nalbuphine to
avoid respiratory depression.
a. Monitor any changes in respirations.
c. Administer IV nalbuphine undiluted.

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e. Instruct the client to avoid alcohol when taking nalbuphine to

avoid respiratory depression.
8. The nurse should know that which drugs are used to treat mi-
graine attacks?
a. Triptans
b. Anticonvulsants
c. Tricyclic antidepressants
d. Beta-adrenergic blockers
a. Triptans
Chapter 27
1. The nurse realizes that facial grimacing, involuntary upward
eye movement, and muscle spasms of the tongue and face are
indicative of which condition?
a. Akathisia
b. Acute dystonia
c. Tardive dyskinesia
d. Pseudoparkinsonism
b. Acute dystonia
2. The nurse understands that antipsychotics act in which way?

a. By blocking actions of dopamine
b. By blocking actions of epinephrine
c. By promoting prostaglandin synthesis
d. By enhancing the action of gamma-aminobutyric acid
a. By blocking actions of dopamine
3. An antipsychotic agent, fluphenazine (Prolixin), is ordered for a

client with psychosis. The nurse knows that this agent can lead to
extrapyramidal symptoms (EPS) that may be treated with which
medication?

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a. quetiapine (Seroquel)
b. aripiprazole (Abilify)
c. benztropine (Cogentin)
d. chlorpromazine (Thorazine)
c. benztropine (Cogentin)
4. An atypical antipsychotic is prescribed for a client with psy-

chosis. The nurse understands that this category of medications
includes which drug?
a. clozapine (Clozaril)
b. loxapine (Loxitane)
c. haloperidol (Haldol)
d. thiothixene (Navane)
a. clozapine (Clozaril)
5. The nurse is aware of which fact regarding lorazepam (Ativan)?

a. It may cause confusion and blurred vision.
b. It has a maximum adult dose of 25 mg/day.
c. When combined with cimetidine, it causes plasma levels to be
decreased.
d. It interferes with the binding of dopamine receptors.
a. It may cause confusion and blurred vision.
6. A client is receiving haloperidol (Haldol). Which nursing inter-

vention(s) should the nurse perform? (Select all that apply.)
a. Monitor vital signs to detect bradycardia.
b. Remain with the client until medication is swallowed.
c. Monitor vital signs to detect orthostatic hypotension.
d. Assess the client for evidence of neuroleptic malignant syn-
drome.
e. Observe the client for acute dystonia, akathisia, and tardive
dyskinesia.
b. Remain with the client until medication is swallowed.

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c. Monitor vital signs to detect orthostatic hypotension.

d. Assess the client for evidence of neuroleptic malignant syn-
drome.
e. Observe the client for acute dystonia, akathisia, and tardive
dyskinesia.
7. A client appears to have had an overdose of phenothiazines.

The nurse is aware that the potential treatment for phenothiazine
overdose includes which intervention(s)? (Select all that apply.)
a. Gastric lavage
b. Adequate hydration
c. Maintaining an airway
d. fluphenazine (Prolixin)
e. risperidone (Risperdal)
f. Activated charcoal administration
a. Gastric lavage
b. Adequate hydration
c. Maintaining an airway
f. Activated charcoal administration
Chapter 28
1. A client is admitted with bipolar affective disorder. The nurse
acknowledges that which medication is used to treat this disorder
for some clients in place of lithium?
a. thiopental
b. gingko biloba
c. fluvoxamine (Luvox)
d. divalproex (Depakote)
d. divalproex (Depakote)
2. The nurse realizes that some herbs interact with selective sero-
tonin reuptake inhibitors (SSRIs). Which herb interaction may
cause serotonin syndrome?

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a. feverfew
b. ma-huang
c. St. John's wort
d. gingko biloba
c. St. John's wort
3. A selective serotonin reuptake inhibitor (SSRI) is prescribed for

a client. The nurse knows that which drug is an SSRI?
a. paroxetine (Paxil)
b. amitriptyline (Elavil)
c. divalproex sodium (Depakote)
d. bupropion HCl (Wellbutrin)
a. paroxetine (Paxil)
4. A client is taking tranylcypromine sulfate (Parnate) for depres-

sion. What advice should the nurse include in the teaching plan
for this medication?
a. Warn of severe hypotension.
b. Avoid beer and cheddar cheese.
c. Encourage ginseng and ephedra.
d. Encourage fruit such as bananas.
b. Avoid beer and cheddar cheese.
5. Which statement is true concerning lithium?

a. The maximum dose is 3.4 g/day.
b. The therapeutic drug range is 2.5 to 3.5 mEq/L.
c. Lithium increases receptor sensitivity to GABA.
d. Concurrent NSAIDs may increase lithium levels.
d. Concurrent NSAIDs may increase lithium levels.
6. When a client is taking an antidepressant, what should the

nurse do? (Select all that apply.)

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a. Monitor the client for suicidal tendencies.

b. Observe the client for orthostatic hypotension.
c. Teach the client to take the drug with food if GI distress occurs.
d. Tell the client that the drug may not have full effectiveness for 1
to 2 weeks.
e. Advise the client to maintain adequate fluid intake of 2 L/day.
a. Monitor the client for suicidal tendencies.
b. Observe the client for orthostatic hypotension.
c. Teach the client to take the drug with food if GI distress occurs.
d. Tell the client that the drug may not have full effectiveness for 1
to 2 weeks.
7. A client is taking lithium. The nurse should be aware of the im-

portance of which nursing intervention(s)? (Select all that apply.)
a. Observe the client for motor tremors.
b. Monitor the client for orthostatic hypotension.
c. Draw lithium blood levels immediately after a dose.
d. Advise the client to drink 750 mL/day of fluid in hot weather.
e. Advise the client to avoid caffeinated foods and beverages,
such as coffee, tea, colas, and chocolate.
f. Teach the client to take lithium with meals to decrease gastric ir-
ritation.
a. Observe the client for motor tremors.
b. Monitor the client for orthostatic hypotension.
e. Advise the client to avoid caffeinated foods and beverages,
such as coffee, tea, colas, and chocolate.
f. Teach the client to take lithium with meals to decrease gastric ir-
ritation.
NCLEX book chapter 59

676. A client has a prescription to take guaifenesin (Mucinex). The
nurse determines that the client understands the proper adminis-
tration of this medication if the client states that he or she will:

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1. Take an extra dose if fever develops.

2. Take the medication with meals only.
3. Take the tablet with a full glass of water.
4. Decrease the amount of daily fluid intake.
677. A nurse is preparing to administer a dose of naloxone hy-

drochloride (Narcan) intravenously to a client with an intravenous
opioid overdose. Which supportive medical equipment would the
nurse plan to have at the client's bedside if needed?
1. Nasogastric tube
2. Paracentesis tray
3. Resuscitation equipment
4. Central line insertion tray
3. Resuscitation equipment
678. A nurse teaches a client about the effects of diphenhy-

dramine (Benadryl), which has been prescribed as a cough sup-
pressant. The nurse determines that the client needs further in-
structions if the client states that he or she will:
1. Take the medication on an empty stomach.
2. Avoid using alcohol while taking this medication.
3. Use sugarless gum, candy, or oral rinses to decrease dry
mouth.
4. Avoid activities requiring mental alertness while taking this
medication.
679. A cromolyn sodium (Intal) inhaler is prescribed for a client

with allergic asthma. A nurse provides instructions regarding the
side effects of this medication. The nurse tells that client that
which undesirable effect is associated with this medication?
1. Insomnia

lOMoARcPSD|3083804
2. Constipation
3. Hypotension
4. Bronchospasm
4. Bronchospasm
680. Terbutaline (Brethine) is prescribed for a client with bronchi-

tis. A nurse understands that this medication should be used with
caution if which of the following medical conditions is present in
the client?
1. Osteoarthritis
2. Hypothyroidism
3. Diabetes mellitus
4. Polycystic disease
681. Zafirlukast (Accolate) is prescribed for a client with bronchial

asthma. Which laboratory test does the nurse expect to be pre-
scribed before the administration of this medication?
1. Platelet count
2. Neutrophil count
3. Liver function tests
4. Complete blood count
682. A client has been taking isoniazid (INH) for 1½ months. The
client complains to a nurse about numbness, paresthesias, and
tingling in the extremities. The nurse interprets that the client is
experiencing:
1. Hypercalcemia
2. Peripheral neuritis
3. Small blood vessel spasm
4. Impaired peripheral circulation

lOMoARcPSD|3083804
683. A client is to begin a 6-month course of therapy with isoniazid

(INH). A nurse plans to teach the client to:
1. Use alcohol in small amounts only.
2. Report yellow eyes or skin immediately.
3. Increase intake of Swiss or aged cheeses.
4. Avoid vitamin supplements during therapy.
684. A client has been started on long-term therapy with rifampin

(Rifadin). A nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is for-gotten
3. Causes orange discoloration of sweat, tears, urine, and feces
4. May be discontinued independently if symptoms are gone in 3
months
685. A nurse has given a client taking ethambutol (Myambutol) in-

formation about the medication. The nurse determines that the
client understands the instructions if the client states to report im-
mediately:
1. Impaired sense of hearing
2. Gastrointestinal side effects
3. Orange-red discoloration of body secretions
4. Difficulty in discriminating the color red from green
4. Difficulty in discriminating the color red from green
686. 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?

lOMoARcPSD|3083804
1. Electrolyte levels
2. Liver enzyme levels
3. Serum creatinine level
4. Coagulation times
687. A nurse has an order to give a client salmeterol (Serevent

Diskus), two puffs, and beclomethasone dipropionate (Qvar), two
puffs, by metered-dose inhaler. The nurse administers the medi-
cation by giving the:
1. Beclomethasone first and then the salmeterol
2. Salmeterol first and then the beclomethasone
3. Alternating a single puff of each, beginning with the salmeterol
4. Alternating a single puff of each, beginning with the be-
clomethasone
2. Salmeterol first and then the beclomethasone
688. The nurse is caring for a client with a diagnosis of influenza

who first began to experience symptoms yesterday. Antiviral ther-
apy is prescribed and the nurse provides instructions to the client
about the therapy. Which statement by the client indicates an un-
derstanding of the instructions?
1. "I must take the medication exactly as prescribed."
2. "Once I start the medication, I will no longer be contagious."
3. "I will not get any colds or infections while taking this medica-
tion."
4. "This medication has minimal side effects and I can return to
normal activities."
1. "I must take the medication exactly as prescribed."
689. A client has begun therapy with theophylline (Theo-24). A

nurse plans to teach the client to limit the intake of which of the
following while taking this medication?

lOMoARcPSD|3083804
1. Coffee, cola, and chocolate

2. Oysters, lobster, and shrimp
3. Melons, oranges, and pineapple
4. Cottage cheese, cream cheese, and dairy creamers
690. The nurse has just administered the first dose of omalizumab
(Xolair) to a client. Which statement by the client would alert the
nurse that the client may be experiencing a life threatening ad-
verse reaction?
1. "I have a severe headache."
2. "My feet are quite swollen."
3. "I am nauseated and may vomit."
4. "My lips and tongue are swollen."
4. "My lips and tongue are swollen."
691. Rifabutin (Mycobutin) is prescribed for a client with active

Mycobacterium avium complex (MAC) disease and tuberculosis.
For which of the following side effects of the medication should
the nurse monitor? Select all that apply.
1. Signs of hepatitis
2. Flu-like syndrome
3. Low neutrophil count
4. Vitamin B6 deficiency
5. Ocular pain or blurred vision
6. Tingling and numbness of the fingers
Chapter 61- cardio

lOMoARcPSD|3083804
717. A client with atrial fibrillation is receiving a continuous heparin

infusion at 1000 units/hr. The nurse would determine that the
client is receiving the therapeutic effect based on which of the fol-
lowing results?
1. Prothrombin time of 12.5 seconds
2. Activated partial thromboplastin time of 60 seconds
4. Activated partial thromboplastin time longer than 120 seconds
718. A nurse provides discharge instructions to a postoperative

client who is taking warfarin sodium (Coumadin). Which state-
ment, 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 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."
719. A client who is receiving digoxin (Lanoxin) daily has a serum

potassium level of 3 mEq/L and is complaining of anorexia. A
physician 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?
1. 0.5 to 2 ng/mL
2. 1.2 to 2.8 ng/mL
3. 3 to 5 ng/mL
4. 3.5 to 5.5 ng/mL
1. 0.5 to 2 ng/mL

lOMoARcPSD|3083804
720. A client is being treated with procainamide (Procanbid) for a

cardiac dysrhythmia. Following intravenous administration of the
medication, the client complains of dizziness. What intervention
should the nurse take first?
1. Administer prescribed nitroglycerin tablets.
2. Measure the heart rate on the rhythm strip.
3. Obtain a 12-lead electrocardiogram immediately.
4. Auscultate the client's apical pulse and obtain a blood pressure.
721. A nurse is monitoring a client who is taking propranolol (In-

deral). Which assessment data would indicate a potential serious
complication associated with propranolol?
1. The development of complaints of insomnia
2. The development of audible expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg followed by a
blood pressure of 138/72 mm Hg after two doses of the medica-
tion
4. A baseline resting heart rate of 88 beats/min followed by a rest-
ing heart rate of 72 beats/min after two doses of the medication
722. A nurse is caring for a client receiving a heparin intravenous

(IV) infusion. The nurse anticipates that which laboratory study
will be prescribed to monitor the therapeutic effect of heparin?
1. Hematocrit
2. Hemoglobin
3. Prothrombin time
4. Activated partial thromboplastin time

lOMoARcPSD|3083804
723. A client is diagnosed with an acute myocardial infarction and

is receiving tissue plasminogen activator, alteplase (Activase,
tPA). Which of the following is a priority nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
3. Monitor for signs of bleeding.
4. Have heparin sodium available.
3. Monitor for signs of bleeding
724. A nurse is planning to administer hydrochlorothiazide (Hy-

droDIURIL) to a client. The nurse understands that which of the
following are concerns related to the administration of this medi-
cation?
1. Hypouricemia, hyperkalemia
2. Increased risk of osteoporosis
3. Hypokalemia, hyperglycemia, sulfa allergy
4. Hyperkalemia, hypoglycemia, penicillin allergy
725. 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 fol-
lowing statements, if made by the client, indicates the need for
further education?
1. "Constipation and bloating might be a problem."
2. "I'll continue to watch my diet and reduce my fats."
3. "Walking a mile each day will help the whole process."
4. "I'll continue my nicotinic acid from the health food store."
726. A client is on nicotinic acid (niacin) for hyperlipidemia and the

nurse provides instructions to the client about the medication.

lOMoARcPSD|3083804
Which statement by the client would indicate an understanding of

the instructions?
1. "It is not necessary to avoid the use of alcohol."
2. "The medication should be taken with meals to decrease flush-
ing."
3. "Clay-colored stools are a common side effect and should not
be of concern."
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid
should decrease the flushing."
727. A 66-year-old client complaining of not feeling well is seen in

a clinic. The client is taking several medications for the control of
heart disease and hypertension. These medications include
atenolol (Tenormin), digoxin (Lanoxin), and chlorothiazide (Diuril).
A tentative diagnosis of digoxin toxicity is made. Which of the fol-
lowing assessment data would support this diagnosis?
1. Dyspnea, edema, and palpitations
2. Chest pain, hypotension, and paresthesia
3. Double vision, loss of appetite, and nausea
4. Constipation, dry mouth, and sleep disorder
728. A client is being treated for acute congestive heart failure

with intravenously administered bumetanide (Bumex). The vital
signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96
beats/min; and respirations, 24 breaths/min. After the initial dose,
which of the following is the priority assessment?
1. Monitoring weight loss
2. Monitoring urine output
3. Monitoring blood pressure
4. Monitoring potassium level

lOMoARcPSD|3083804
729. Intravenous heparin therapy is prescribed for a client. While

implementing this prescription, a nurse ensures that which of the
following medications is available on the nursing unit?
1. Protamine sulfate
2. Potassium chloride
3. Aminocaproic acid (Amicar)
4. Vitamin K (AquaMEPHYTON)
730. A client is receiving thrombolytic therapy with a continuous

infusion of streptokinase (Streptase). The client suddenly be-
comes extremely anxious and complains of itching. A nurse hears
stridor and on examination of the client notes generalized urticaria
and hypotension. Which of the following should be the priority ac-
tion of the nurse?
1. Administer oxygen and protamine sulfate.
2. Stop the infusion and call the physician.
3. Cut the infusion rate in half and sit the client up in bed.
4. Administer diphenhydramine (Benadryl) and continue the infu-
sion.
731. A client is admitted with pulmonary embolism and is to be

treated with streptokinase (Streptase). A nurse would report which
of the following assessments to the physician before initiating this
therapy?
1. Adventitious breath sounds
2. Temperature of 99.4° F orally
3. Blood pressure of 198/110 mm Hg
4. Respiratory rate of 28 breaths/min

lOMoARcPSD|3083804
732. The nurse is monitoring a client who is taking digoxin

(Lanoxin) for adverse effects. Which findings are characteristic of
digoxin toxicity. Select all that apply.
1. Tremors
2. Diarrhea
3. Irritability
4. Blurred vision
5. Nausea and vomiting
2. Diarrhea
4. Blurred vision
chapter 67- neuro

816. Carbidopa-levodopa (Sinemet) is prescribed for the client
with Parkinson's disease. The nurse monitors the client for side
effects to the medication. Which of the following would indicate
that the client is experiencing a side effect?
1. Pruritus
2. Tachycardia
3. Hypertension
4. Impaired voluntary movements
817. The home health nurse visits a client who is taking phenytoin
(Dilantin) for control of seizures. During the assessment, the
nurse notes that the client is taking birth control pills. Which of the
following information should the nurse include in the teaching
plan?
1. Pregnancy should be avoided while taking phenytoin.
2. The client may stop the medication if it is causing severe gas-
trointestinal effects.

lOMoARcPSD|3083804
3. There is the potential of decreased effectiveness of birth control

pills while taking phenytoin.
4. There is the increased risk of thrombophlebitis while taking
phenytoin and birth control pills together.
3. There is the potential of decreased effectiveness of birth control
pills while taking phenytoin.
818. The nurse is caring for a client in the emergency department

diagnosed with Bell's palsy. The client has been taking ac-
etaminophen (Tylenol), and acetaminophen overdose is sus-
pected. The nurse anticipates that the antidote to be prescribed
is:
1. Pentostatin (Nipent)
2. Auranofin (Ridaura)
3. Fludarabine (Fludara)
4. Acetylcysteine (Mucomyst)
819. The client with trigeminal neuralgia tells the nurse that ac-
etaminophen (Tylenol) is taken daily for the relief of generalized
discomfort. Which laboratory value would indicate toxicity associ-
ated with the medication?
1. Sodium level of 140 mEq/L
2. Prothrombin time of 12 seconds
3. Direct bilirubin level of 2 mg/dL
4. Platelet count of 400,000/mm3
3. Direct bilirubin level of 2 mg/dL
820. The client is taking the prescribed dose of phenytoin (Di-

lantin) to control seizures. Results of a phenytoin blood level
study reveal a level of 35 mcg/mL. Which of the following symp-
toms would be expected as a result of this laboratory result?
1. Hypotension

lOMoARcPSD|3083804
2. Tachycardia
3. Slurred speech
4. No symptoms, because this is a normal therapeutic level
3. Slurred speech
821. The client arrives at the emergency department complaining

of back spasms. The client states, "I have been taking two to
three aspirin every 4 hours for the last week, and it hasn't helped
my back." Aspirin intoxication is suspected, and the nurse as-
sesses the client for which of the following?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Photosensitivity
1. Tinnitus
822. A client with trigeminal neuralgia is being treated with carba-

mazepine (Tegretol), 400 mg orally daily. Which of the following
indicates that the client is experiencing a side effect to the medi-
cation?
1. Uric acid level, 5 mg/dL
2. Sodium level, 140 mEq/L
3. Blood urea nitrogen level, 15 mg/dL
4. White blood cell count, 3000/mm3
4. White blood cell count, 3000/mm3
823. The nurse is caring for a client with severe back pain.
Codeine sulfate has been prescribed for the client. Which of the
following does the nurse specifically include in the plan of care
while the client is taking this medication?
1. Monitor fluid balance.
2. Monitor bowel activity.
3. Monitor peripheral pulses.

lOMoARcPSD|3083804
4. Monitor for hypertension.

824. The nurse has given medication instructions to the client re-
ceiving phenytoin (Dilantin). The nurse determines that the client
has an adequate understanding if the client states that:
1. "Alcohol is not contraindicated while taking this medication."
2. "Good oral hygiene is needed, including brushing and flossing."
3. "The medication dose may be self-adjusted, depending on side
effects."
4. "The morning dose of the medication should be taken before a
serum drug level is drawn."
2. "Good oral hygiene is needed, including brushing and flossing."
825. The client with myasthenia gravis has become increasingly

weaker. The physician prepares to identify whether the client is
reacting to an overdose of the medication (cholinergic crisis) or an
increasing severity of the disease (myasthenic crisis). An injection
of edrophonium (Tensilon) is administered. Which of the following
would indicate that the client is in cholinergic crisis?
1. No change in the condition
2. Complaints of muscle spasms
3. An improvement of the weakness
4. A temporary worsening of the condition
826. Meperidine hydrochloride (Demerol) has been prescribed for

a client to treat pain. Select the side effects of this medication. Se-
lect all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension

lOMoARcPSD|3083804
5. Urinary frequency
6. Increased respiratory rate
2. Tremors
3. Drowsiness
4. Hypotension
chapter 77- psych

944. A client's medication sheet contains a prescription for sertra-
line (Zoloft). To ensure safe administration of the medication, a
nurse would administer the dose:
1. On an empty stomach
2. At the same time each evening
3. Evenly spaced around the clock
4. As needed when the client complains of depression
2. At the same time each evening
945. A client with schizophrenia has been started on medication

therapy with clozapine (Clozaril). A nurse assesses the results of
which laboratory study to monitor for adverse effects from this
medication?
1. Platelet count
2. Blood glucose level
3. White blood cell count
4. Liver function studies
946. A client is scheduled for discharge and will be taking pheno-

barbital (Luminal) for an extended period. A nurse would place
highest priority on teaching the client which of the following points
that directly relates to client safety?
1. Take the medication only with meals.
2. Take the medication at the same time each day.
3. Use a dose container to help prevent missed doses.

lOMoARcPSD|3083804
4. Avoid drinking alcohol while taking this medication.

4. Avoid drinking alcohol while taking this medication.
947. A nurse is describing the medication side effects to a client

who is taking oxazepam (Serax). The nurse incorporates in dis-
cussions with the client the need to:
1. Consume a low-fiber diet.
2. Increase fluids and bulk in the diet.
3. Rest if the heart begins to beat rapidly.
4. Take antidiarrheal agents if diarrhea occurs.
2. Increase fluids and bulk in the diet.
948. A nurse is administering risperidone (Risperdal) to a client

who is scheduled to be discharged. Before discharge, which of
the following should the nurse teach the client?
1. Get adequate sunlight.
2. Avoid foods rich in potassium.
3. Continue driving as usual.
4. Get up slowly when changing positions.
4. Get up slowly when changing positions.
949. A nurse is teaching a client who is being started on

imipramine (Tofranil) about the medication. The nurse informs the
client that the maximum desired effects may:
1. Start during the first week of administration
2. Not occur for 2 to 3 weeks of administration
3. Start during the second week of administration
4. Not occur until after 2 months of administration

lOMoARcPSD|3083804
950. A client receiving tricyclic antidepressants arrives at the men-

tal health clinic. Which observation would indicate that the client is
following the medication plan correctly?
1. Client reports not going to work for this past week.
2. Client arrives at the clinic neat and appropriate in appearance.
3. Client complains of not being able to "do anything" anymore.
4. Client reports sleeping 12 hours per night and 3 to 4 hours dur-
ing the day.
2. Client arrives at the clinic neat and appropriate in appearance.
951. A nurse notes that a client with schizophrenia and receiving

an antipsychotic medication is moving her mouth, protruding her
tongue, and grimacing as she watches television. The nurse de-
termines that the client is experiencing:
1. Parkinsonism
2. Tardive dyskinesia
3. Hypertensive crisis
4. Neuroleptic malignant syndrome
2. Tardive dyskinesia
952. A nurse is performing a follow-up teaching session with a

client discharged 1 month ago. The client is taking fluoxetine
(Prozac). What information would be important for the nurse to
obtain during this client visit regarding the side effects of the med-
ication?
1. Cardiovascular symptoms
2. Gastrointestinal dysfunctions
3. Problems with mouth dryness
4. Problems with excessive sweating
953. A client who has been taking buspirone (BuSpar) for 1 month
returns to the clinic for a follow-up assessment. A nurse deter-

lOMoARcPSD|3083804
mines that the medication is effective if the absence of which

manifestation has occurred?
1. Paranoid thought process
2. Rapid heartbeat or anxiety
3. Alcohol withdrawal symptoms
4. Thought broadcasting or delusions
2. Rapid heartbeat or anxiety
954. A client taking lithium carbonate (Lithobid) reports vomiting,

abdominal pain, diarrhea, blurred vision, tinnitus, and tremors.
The lithium level is 2.5 mEq/L. The nurse interprets this level as:
1. Toxic
2. Normal
3. Slightly above normal
4. Excessively below normal
1. Toxic
955. A home health nurse visits a client. The client gives the nurse
a bottle of clomipramine (Anafranil). The nurse notes that the
medication has not been taken by the client in 2 months. What
behaviors observed in the client would validate noncompliance
with this medication?
1. Complaints of insomnia
2. Complaints of hunger and fatigue
3. A pulse rate less than 60 beats/min
4. Frequent handwashing with hot soapy water
4. Frequent handwashing with hot soapy water
956. A hospitalized client has begun taking bupropion (Wellbutrin)

as an antidepressant agent. A nurse monitors this client for which
side effect indicating that the client is taking an excessive amount
of medication?
1. Constipation

lOMoARcPSD|3083804
2. Seizure activity
3. Increased weight
4. Dizziness when getting upright
2. Seizure activity
957. A hospitalized client is started on phenelzine (Nardil) for the

treatment of depression. A nurse instructs the client to avoid con-
suming which foods while taking this medication? Select all that
apply.
1. Figs
2. Yogurt
3. Crackers
4. Aged cheese
5. Tossed salad
6. Oatmeal cookies
1. Figs
2. Yogurt
4. Aged cheese
-ine
beta-adrenergic agonists (bronchodilate, increase vasc resist)
ex: norepinephrine (Levophed), dopamine (Inotropin)
used cardiac arrest, COPD
adfx: anticholinergic, dysrhythmias
-pam
benzodiazepine
adfx: depression, CNS depression, addictive. d/c slowly
caffeine and nicotine decreases effectiveness
-lol
beta blocker

lOMoARcPSD|3083804
adfx: bronchospasm
antibiotics general
allergic reaction (after 1st time), superinfection, liver kidney toxic
do C&S, encourage fluids, toxic when expired
peak level about an hour after IV, trough just after it's hung
-mycin (micin)
aminoglycosides-inhibit protein synthesis gram neg
adfx:oto and nephrotoxic
check cranial nerve 8 (ear)
ceph (cef)
cephalosporin-tonsillitis, prophylaxis, meningitis-bacterial wall in-
hibitor
adfx: bone marrow depression, GI upset, cross allergy w/pcn, pro-
tein/glucose in urine
do not drink etoh, take with food
-floaxcin
fluoroquinalones- dna inhibitor
anthrax tx, e. coli
adfx: decreased WBC, hct. elevated liver enzymes
don't take with food
-thromycin
macrolide-cell membrane binder
used in pcn allergy. used for dental prophylaxis in valve disorders
adfx: confusion, increases effects of coumadin, theophylline
take without food

lOMoARcPSD|3083804
-cillin
penicillin-inhibits synthesis of cell wall
severe infx-syphillis, lyme disease...
adfx: stomatitis, allergy
take without food
sulf, zulf, bactrim

sulfonamide-antagonizes folic acid synth
UC, crohn's, uri
adfx: peripheral neuropathy, photosensitive, crystalluria, stomatitis
take with food, encourage fluids, mouth care
-cycline
tetracycline-prevents protein synthesis
baby eye drops, acne
adfx: discoloration of primary teeth in utero or in early childhood,
phototoxic, toxic when expired
take without food
uti meds
furadantin-anti-infective adfx: asthma attack, take with food and
cranberry juice
pyridian-urinary tract analgesic adfx: HA, vertigo, turns pee or-
ange, take with meals
anti-impotence drugs adfx: HA, hypotn, priaprism
grapefruit juice interaction

lipitor, viagra, ...

lOMoARcPSD|3083804
anticholinergic
block parasymp nerve
dilate pupil, bronchodilation, decrease secretions, decrease GI
motility and secretions
uses: eye exams, motion sickness
adfx:urinary retention, dry mouth, hypotn and inc HR
probanthine, atropine, -bromide, ium
not with meals or paralytic ileus
-arin
anticoagulant
adfx: bleeding, hematuria
heparin blocks conversion of prothrombin to thrombin, used in PE,
venous thrombosis, after acute MI. PTT: 30-75?
antidote for heparin: protamine sulfate
warfarin interferes with vit k clotting factors. used in PE, vt, pro-
phylaxis after acute MI. adtl adfx: alopecia. takes 5 days for ther-
apy to work PT: 14-35 INR: 2-3 vit c decreases effectiveness
antidote for warfarin: vit k. avoid vit k while taking it.
AVOID GARLIC, GINKO, GINGER w/ anticoags
anticonvulsant
adfx: gingival hypertrophy, resp depression, aplastic anemia
turn urine pink or reddish brown
Dilantin: can cause cardiac arrest if pushed too fast CANNOT BE

MIXED WITH ANOTHER MED
no carbonation with depakote
mARplan, pARnate, nARdil (trade names)

MAOI antidepressant-4 wk to effectiveness

lOMoARcPSD|3083804
adfx: Hypertensive crisis with tyramine foods: aged cheese, liver,

yogurt, beer, wine, pickled foods, herring, bologna, salami, ba-
nanas.
potentiate alcohol, interactions with CNS stimulants or cold meds
-etine, -aline
SSRI antidepressant- 4 weeks for effect
adfx: anxiety, urinary/bowel retention, insomnia at hs, pink urine
suicide risk on upswing
tricyclic antidepressant
used also for sleep apnea
amitryptalin (Elavil), imipramine (Tofranil), desipramine (Norpra-
min)
adfx: postural hypotension, confusion, urinary retention
suicide risk
take at hs
2-6 weeks for effectiveness
wean off
no alcohol, care in sun
heterocyclic antidepressant
Wellbutrin, trazadone
used also for smoking cessation
adfx: wellbutrin- agitation and insomnia. trazadone- sedation
wean slowly, no alcohol
-ase
antidiabetic (also Dymelor) for type II only
adfx: skin reaction, hypoglycemia
take prior to eating- EAT. alcohol, aspirin, sulfonamides, oral birth
control, maois affect action

lOMoARcPSD|3083804
glucagon
used to reverse hypoglycemia
change glycogen to glucose and release it to the body
adfx: hypotn, bronchospasm. may repeat in 15 minutes. once
alert, give longer acting carbohydrates
-ylate
antidiarrheals (also immodium)
adfx: anticholinergic, constipation
cxn in unknown abd pain
antiemetics
trimethobenzamide (Tigan), procorperazine (Compazine),
metoclopramide (Reglan), meclizine (Antivert)
block dopamine, increase GI motility
adfx: anticholinergic, sedation
prophylaxis for chemotherapy as well
may cause Reye's used during viral infx
antifungals
fungizone (Amphotericin), mycostatin (Nystatin)
impair cell membrane
adfx: liver dysfunction, thrombocytopenia, leukopenia, pruritis
take with food
anti-gout
cholsalide (Colchicine), benemid (Probenecid), Zyloprim
(Allopurinol)
decreases uric acid
Probenecid increases action of Cipro

lOMoARcPSD|3083804
Colchicine used only in acute gout syndrome

Probenecid for chronic
adfx: agranulocytosis, renal calculi-flush kidneys at treatment
may take with food/milk/antacids
Antihistamine
chlor-trimeton, diphenhydramine (Benadryl), promethazine
(Phenergan)
adfx: drowsiness, anticholinergic, photosensitivity, bronchospasm
hard candy for dry mouth
-statin
antihyperlipidemia- statins block synthesis of cholesterol and
triglycerides
(sequestrans-Questran-blocks absorption)
adfx: constipation, fat-soluble vitamin deficiency
take hs or at least 30 minutes before meals. assess diet
cannot take with other meds
-pril
antihypertensives
ACE Inhibitors-affect arteries-vasodilation in whole body
use for HTN and CHF
adfx: lethargy initially, orthostatic hypotension
take without food
-lol
antihypertensives
beta adrenergic blockers- decreases excitability of heart, de-
creases oxygen consumption
use: angina, SVT, HTN
adfx: bronchospasm, HR changes

lOMoARcPSD|3083804
take with food, taper off to avoid rebound HTN
-ipine
antihypertensives
also diltiazem, verapamil
calcium channel blocker-inhibit calcium influx across cell mem-
brane to slow conduction and dilate coronary vessels and de-
crease HR
uses: angina, HTN, interstitial cystitis
adfx: hypotn, GI upset
SR-do not chew, crush, open
-artan
antihypertensives
angiotensin II-receptors
uses: HTN, heart failure, MI, neuropathy, stroke prophylaxis
adfx: dizziness, GI distress
SR-do not chew, crush, open
-azosin
antihypertensive
alpha 1-adrenergic blockers in peripheral vasculature
use: HTN, BPH
adfx: orthostatic hypotn, reflex tachycardia, Nasal Congestion, pe-
riph edema
first dose at HS-causes fainting initially
centrally acting alpha-adrenergic

antihypertensive
centrally acting alpha-adrenergic-decrease rate and force of con-
traction
Catapres, Aldomet

lOMoARcPSD|3083804
uses: HTN
adfx: orthostatic hypotn, Sedation
taper off
direct acting vasodilators

minoxidil, hydralazine (Apresoline)-relax smooth muscle
uses: HTN
minoxidil topical is Rogaine
adfx: ortho hypotn, tachycardia (may use with B-blocker to pre-
vent), increased hair
check pulse when taking med
meds for bipolar disorder

lithium, Tegretol, Depakote
block catecholamines
Lithium salt is dangerous: tight therapeutic range. blood drawn 2-
3 weeks. 3000 mL water/day. evaluated q2-3 wk
Tegretol, Depakote: antipsychotic/convulsant watch kidney and
liver
adfx: GI upset, Tremors, polydipsia, polyuria
take with food.
alkylating agents
anti-neoplastic- interferes with rapid DNA replication
used: leukemia, multiple myeloma
Csplatin, busulfan (Mylerin), cyclophosphamide (Cytoxin)
adfx: very hepatotoxic, basic chemo adfx: bone marrow suppres-
sion, decreased WBC, platelets, RBCs, bleeding, GI s/s, alopecia,
lost nails, infertility
check hematopoesis, CBC
antimetabolites

lOMoARcPSD|3083804
anti-neoplastic-inhibit DNA polymerase

fluorouracil (5-FU), Methotrexate
used: ALL, CA of breast, colon, pancreas
adfx: basic- GI-N/V, ulcers, decreased RBC, WBC, plt
CA -mycin (trade name)

anti-tumor antineoplastic-interfere with DNA and RNA synthesis.
ex:Adriamycin
use: CA
adfx: basic chemo: stomatitis, alopecia, bone marrow suppression
hormonal agents
antineoplastic- block hormone input into CA cells
ex: tomoxifen, testosterone
use: hormone-sensitive CA
adfx: leukopenia, bone pain, hypercalcemia, effects of individual
hormone
vin-
Vinca-alkyloid antineoplastic. derived from periwinkle. interferes
with cell division
ex: vinblastine
use: CA- affects every rapid producing cell in body
adfx: CNA Depression, stomatitis, alopecia, bone marrow sup-
pression
check reflexes, give with Zyloprim to reduce uric acid and adfx
risk of extravasation. check IV
-dopa
antiparkinson. essentially replace dopamine
(also parlodil)
adfx: ataxia, anticholinergic, dizziness

lOMoARcPSD|3083804
B6 can reverse effects, avoid CNS depressants
-azine
antipsychotic-block dopamine receptors
adfx: akasthesia, dyskinesia, dystonia, parkinsonian, tardive dysk-
inesia, leukopenia, can stunt growth in kids
avoid etoh and caffeine
-cyclovir
antiviral, inhibits DNA and RNA (includes non -cyclovirs too)
use in herpes, HIV
adfx: HA, dizziness, GI
doesn't cure.
-dronate
biophosphenates- antiosteoporosis inhibit bone resorption
adfx: esophagitis, arthralgia
-tropium, -ol, -phylline

bronchodilators
uses:COPD, asthma (terbutaline for preterm labor)
adfx: tachycardia, dysrhythmias, palpitations, anticholinergic
take bronchodilator first
-zolamide
anti-glaucoma, decreases production of aqueous humor
adfx: blurred vision, lethargy, depression, anorexia, decrease
potassium
-oxin

lOMoARcPSD|3083804
cardiac glycoside-increase force of myocardial contraction, slow

HR
Left heart failure
adfx: bradycardias, N/V, visual disturbance
hold if pulse <60 in adult, <70 in older kids, <90 in infants, young
kids
check K+ levels- low potassium increases risk of toxicity. eat
plenty of potassium
loading doses--- 0.5, then 0.25, then 0.125 for daily dose
antidote: digibind
-fate
cytoprotective agents
form barrier on duodenal ulcers
adfx: constipation, vertigo, flatulance
take without food
-sone
glucocorticoids
uses: asthma, COPD, some leukemias, Addison's, Crohn's
adfx: infxn, mask s/s of infxn, insomnia, hypoglycemia, hy-
pokalemia, psychosis, depression, stunted growth
wean over time
A client with atrial fibrillation is receiving a continuous heparin in-

fusion at 1000 units/hr. The nurse would determine that the client
is receiving the therapeutic effect based on which of the following
results?

lOMoARcPSD|3083804
718. A nurse provides discharge instructions to a postoperative

719. A client who is receiving digoxin (Lanoxin) daily has a serum

potassium level of 3 mEq/L and is complaining of anorexia. A
physician 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?
1. 0.5 to 2 ng/mL
720. A client is being treated with procainamide (Procanbid) for a

cardiac dysrhythmia. Following intravenous administration of the
medication, the client complains of dizziness. What intervention
should the nurse take first?
721. A nurse is monitoring a client who is taking propranolol (In-

deral). Which assessment data would indicate a potential serious
complication associated with propranolol?
722. A nurse is caring for a client receiving a heparin intravenous

(IV) infusion. The nurse anticipates that which laboratory study
will be prescribed to monitor the therapeutic effect of heparin?

lOMoARcPSD|3083804
723. A client is diagnosed with an acute myocardial infarction and

tPA). Which of the following is a priority nursing intervention?
724. A nurse is planning to administer hydrochlorothiazide (Hy-

cation?
725. A home health care nurse is visiting a client with elevated

further education?
726. A client is on nicotinic acid (niacin) for hyperlipidemia and the

the instructions?
727. A 66-year-old client complaining of not feeling well is seen in

a clinic. The client is taking several medications for the control of
heart disease and hypertension. These medications include
atenolol (Tenormin), digoxin (Lanoxin), and chlorothiazide (Diuril).
A tentative diagnosis of digoxin toxicity is made. Which of the fol-
lowing assessment data would support this diagnosis?

lOMoARcPSD|3083804
728. A client is being treated for acute congestive heart failure

with intravenously administered bumetanide (Bumex). The vital
signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96
beats/min; and respirations, 24 breaths/min. After the initial dose,
which of the following is the priority assessment?
729. Intravenous heparin therapy is prescribed for a client. While

730. A client is receiving thrombolytic therapy with a continuous

infusion of streptokinase (Streptase). The client suddenly be-
comes extremely anxious and complains of itching. A nurse hears
stridor and on examination of the client notes generalized urticaria
and hypotension. Which of the following should be the priority ac-
tion of the nurse?
731. A client is admitted with pulmonary embolism and is to be

of the following assessments to the physician before initiating this
therapy?
1. A newly admitted client takes digoxin 0.25 mg/day. The nurse

knows that which is the serum therapeutic range for digoxin?
b.0.5 to 2.0 ng/mL

lOMoARcPSD|3083804
2. The client's serum digoxin level is 3.0 ng/mL. What does the
nurse know about this serum digoxin level?
a.It is in the high (elevated) range
3. The nurse is assessing the client for possible evidence of digi-

talis toxicity. The nurse acknowledges that which is included in the
signs and symptoms for digitalis toxicity?
d.Pulse below 60 beats/min and irregular rate
4. The client is also taking a diuretic that decreases her potassium

level. The nurse expects that a low potassium level (hypokalemia)
could have what effect on the digoxin?
a. The beta blocker should be abruptly stopped when another car-
diac drug is prescribed.
5. When a client first takes a nitrate, the nurse expects which

symptom that often occurs?
b.Headaches
6. The nurse acknowledges that beta blockers are as effective as

antianginals because they do what?
c.Decrease heart rate and decrease myocardial contractility
7. The health care provider is planning to discontinue a client's

beta blocker. What instruction should the nurse give the client re-
garding the beta blocker?
b. The beta blocker should NOT be abruptly stopped; the dose
should be tapered down.

lOMoARcPSD|3083804
8. The beta blocker acebutolol (Sectral) is prescribed for dysrhyth-

mias. The nurse knows that what is the primary purpose of the
drug?
c.To block the beta1-adrenergic receptors in the cardiac tissues
1. A client is taking hydrochlorothiazide 50 mg/day and digoxin

0.25 mg/day. What type of electrolyte imbalance does the nurse
expect to occur?
b.Hypokalemia
2. What would cause the same client's electrolyte imbalance?

c.Hydrochlorothiazide
3. A nurse is teaching a client who has diabetes mellitus and is

taking hydrochlorothiazide 50 mg/day. The teaching should in-
clude the importance of monitoring which levels?
d. Serum glucose (sugar)
4. A client has heart failure and is prescribed Lasix. The nurse is

aware that furosemide (Lasix) is what kind of drug?
c.High-ceiling (loop) diuretic
5. The nurse acknowledges that which condition could occur

when taking furosemide?
a.Hypokalemia
6. For the client taking a diuretic, a combination such as tri-

amterene and hydrochlorothiazide may be prescribed. The nurse
realizes that this combination is ordered for which purpose?
b. To increase the serum potassium level

lOMoARcPSD|3083804
7. The client has been receiving spironolactone (Aldactone) 50

mg/day for heart failure. The nurse should closely monitor the
client for which condition?
b.Hyperkalemia
8. A client who has angina is prescribed nitroglycerin. The nurse

reviews which appropriate nursing interventions for nitroglycerin?
a.Have client lie down when taking a nitroglycerin sublingual
tablet.
b.Teach client to repeat taking a tablet in 5 minutes if chest pain
persists.
e.Warn client against ingesting alcohol while taking nitroglycerin.
1. A client's blood pressure (BP) is 145/90. According to the

guidelines for determining hypertension, the nurse realizes that
the client's BP is at which stage?
c.Stage 1 hypertension
2. The nurse acknowledges that the first-line drug for treating this
client's blood pressure might be which drug?
a. Diuretic
4. The nurse knows that which diuretic is most frequently com-

bined with an antihypertensive drug?
b.hydrochlorothiazide
5. The nurse explains that which beta blocker category is pre-

ferred for treating hypertension?

lOMoARcPSD|3083804
a. Beta1 blocker
6. Captopril (Capoten) has been ordered for a client. The nurse

teaches the client that ACE inhibitors have which common side ef-
fects?
d.Constant, irritating cough
7. A client is prescribed losartan (Cozaar). The nurse teaches the

client that an angiotensin II receptor blocker (ARB) acts by doing
what?
b.Blocking angiotensin II from AT1 receptors
8. During an admission assessment, the client states that she

takes amlodipine (Norvasc). The nurse wishes to determine
whether or not the client has any common side effects of a cal-
cium channel blocker. The nurse asks the client if she has which
signs and symptoms? (Select all that apply.)
b. Dizziness
c. Headache
e. Ankle edema
1. When a newly admitted client is placed on heparin, the nurse

acknowledges that heparin is effective for preventing new clot for-
mation in clients who have which disorder(s)? (Select all that ap-
ply.)
a.Coronary thrombosis
b.Acute myocardial infarction
c.Deep vein thrombosis (DVT)
d.Cerebrovascular accident (CVA) (stroke)
e.Venous disorders

lOMoARcPSD|3083804
2. A client who received heparin begins to bleed, and the physi-

cian calls for the antidote. The nurse knows that which is the anti-
dote for heparin?
a.protamine sulfate
3. A client is prescribed enoxaparin (Lovenox). The nurse knows

that low-molecular-weight heparin (LMWH) has what kind of half-
life?
a.A longer half-life than heparin
4. The nurse is teaching a client about clopidogrel (Plavix). What

is important information to include?
c. Bleeding may increase when taken with aspirin.
5. A client is prescribed dalteparin (Fragmin). LMWH is adminis-

tered via which route?
d.Subcutaneously
6. A client is being changed from an injectable anticoagulant to an

oral anticoagulant. Which anticoagulant does the nurse realize is
administered orally?
b.warfarin (Coumadin)
7. A client is taking warfarin 5 mg/day for atrial fibrillation. The

client's international normalized ratio (INR) is 3.8. The nurse
would consider the INR to be what?
b. Elevated INR range

lOMoARcPSD|3083804
8. Cilostazol (Pletal) is being prescribed for a client with coronary

artery disease. The nurse knows that which is the major purpose
for antiplatelet drug therapy?
d.To suppress platelet aggregation
9. A client is to undergo a coronary angioplasty. The nurse ac-

knowledges that which drug is used primarily for preventing reoc-
clusion of coronary arteries following a coronary angioplasty?
b.abciximab (ReoPro
10. A client is admitted to the emergency department with an

acute myocardial infarction. Which drug category does the nurse
expect to be given to the client early for the prevention of tissue
necrosis following blood clot blockage in a coronary or cerebral
artery?
c. Thrombolytic agent
1. A client has a serum cholesterol level of 265 mg/dL, triglyceride

level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum
levels indicate?
c.Hyperlipidemia
2. The nurse knows that the client's cholesterol level should be

within which range?
a.150 to 200 mg/dL
3. A client's high-density lipoprotein (HDL) is 60 mg/dL. What

does the nurse acknowledge concerning this level?
b.It is the desired level of HDL.

lOMoARcPSD|3083804
4. The nurse realizes that which is the laboratory test ordered to

determine the presence of the amino acid that can contribute to
cardiovascular disease and stroke?
b. homocysteine
5. A client is taking lovastatin (Mevacor). Which serum level is

most important for the nurse to monitor?
d.Liver enzymes
6. The client is taking rosuvastatin (Crestor). What severe skeletal

muscle adverse reaction should the nurse observe for?
b.Rhabdomyolysis
7. When a client is taking ezetimibe (Zetia), she asks the nurse

how it works. The nurse should explain that Zetia does what?
a. Inhibits absorption of dietary cholesterol in the intestines.
8. A client is diagnosed with peripheral arterial disease (PAD). He

is prescribed isoxsuprine (Vasodilan). The nurse acknowledges
that isoxsuprine does what? (Select all that apply.)
a.Relaxes the arterial walls within the skeletal muscles
b.May cause hypotension, chest pain, and palpitations
ending in: ase or plase

Thrombolytic. Clot buster. Side effects include hemorrhage, hy-
potension & cardiac dysrhythmias. Nursing considerations: DO
NOT GIVE IM. Interact with anticoagulant & antiplatelet meds.
ending in: azole

lOMoARcPSD|3083804
Antifungal antimicrobial. Fungicide. Side effects include fever,

chills, shaking, myalgia, arthralgia, weakness, hypotension, in-
somnia, vertigo, ototoxicity, nephrotoxicity, Stevens-Johnson syn-
drome, hepatic necrosis, cardiovascular collapse. Nursing consid-
erations: Risk of cardiac toxicity. Use with caution in renal impair-
ment & severe bone marrow suppression. Take with food to in-
crease absoprtion & decrease n/v. Monitor serum levels. Eat
small frequent meals with increased protein. Interact with antico-
agulants, corticosteriods, nephrotoxic drugs, antidiabetic agents,
antacids, benzodiazepines, oral contraceptives, tetracyclines, ac-
etaminophen, Rifampin, Dilantin, & cyclosporine.
beginning with: cef or ceph

Cephalosporins. Antibiotic (r/t penicillins). Contraindicated if al-
lergy to penicillins. Side effects include lethargy, hallucinations,
anxiety, depression, twitching/convulsions/seizures, coma, colitis,
anemia, increased liver labs, increased bleeding time, alkalosis,
taste alteration, sore mouth, discolored tongue, hives, pruritis,
edema. Nursing considerations: Monitor for toxicities (renal, he-
patic). Monitor BS in diabetics. Refrain from alcohol use during tx.
Interact with loop diuretics, aminoglycosides, anticoagulants,
ethanol, antacids, iron supplements/iron rich foods.
ending in: micin or mycin

Aminoglycoside. Antibiotic. Contraindicated in renal disease,
myasthenia gravis, and concurrent use with renal toxic agents.
Side effects include paresthesia, rash, fever, nephrotoxicity, oto-
toxicity, purpura, urticaria, dermatitis, pseudomembranous colitis.
Nursing considerations: Monitor peak/trough levels of drug. Eat
small frequent meals. Interact with penicillins, oral anticoagulants,
and no other meds in the same IV fluid.
ending in: floxacin

lOMoARcPSD|3083804
Flouroquionlone. Antibiotic. Contraindicated in renal impairment or

if hx of seizures. Side effects include dizziness, fatigue/lethargy,
insomnia, depression, restlessness, conflusion, convulsions, oral
candidiasis, dysphagia, pseudomembranous colitis, increased
liver labs, rash, pruritis, urticaria, photosensitivity, flushing, fever,
chills, piloerection, tinnitus, blurred vision. Nursing considerations:
Monitor PT & INR, check for increased bleeding. Eat small fre-
quent meals with increased protein. Report dyspnea, severe h/a,
dizziness or weakness ASAP. Interact with oral antacids,
iron/zinc/sucralfate supplements, glucocorticosteroids, alkaline
foods (dairy, veggies, legumes).
ending in: mycin

Macrolide. Antibiotic. Contraindicated in liver/renal dysfunction, GI
disorders, UC/enteritis, and in infants/elderly. Side effects include
palpitations, chest pain, dizziness, vertigo, lethargy, somnolence,
confusion, hearing loss, stomatitis, hepatotoxicity, ototoxicity,
nephrotoxicity. Nursing considerations: Assess GI function. Ob-
serve for bleeding. Increase protein in diet. Interact with anticoag-
ulants, antihistamines, penicillins.
ending in: cillin

Penicillin. Antibiotic. Contraindicated in anemia, thrombocytope-
nia, & bone marrow depression. Side effects include rash, ur-
ticaria, pruritis, angioedema, colitis, increased liver labs, taste al-
teration, sore mouth, sore/discolored tongue, increased bleeding
time, lethargy, anxiety, depression, hallucinations, twitching/con-
vulsions, coma, metabolic alkalosis, hypo/hyperkalemia. Nursing
considerations: Do not admin with fruit juices, milk or carbonated
beverages. Interact with diuretics, oral contraceptives, aminogly-
cides, tetracyclines, lithium, aspirin, & sulfonamides.
beginning with: sulfa

lOMoARcPSD|3083804
Sulfonamide. Antibiotic. Contraindicated in pregnancy/lactation,

age <2 months, porphyria, renal/hepatic dysfunction, intestinal/uri-
nary blockage, asthma, blood dyscrasias, G6PD deficiency. Side
effects include rash, jaundice, stomatits, insomnia, drowsiness,
depression, psychosis, photosensitivity, crystalluria, peripheral
neuropathy, tinnitus/hearing loss, vertigo, ataxia, convulsions,
heptatitis, pancreatitis, exfoliative dermatitis, Stevens-Johnson
syndrome, serum sickness, drug fever. Nursing considerations:
Baseline assessments of renal/hepatic function and skin. Monitor
for neurotoxicity if ataxia or convulsions develop. Small frequent
meals. Empty bladder frequently (q2h when awake). Interact with
oral anticoagulants, oral antidiabetic agents, iron, some abx, &
phenytoin.
ending in: cycline

Tetracycline. Antibiotic. Contraindicated in renal/hepatic dysfunc-
tion, last 1/2 of pregnancy, 0-8 years old, asthma, hay fever, and
myasthenia gravis. Side effects include dry mouth, dysphagia,
bulky/loose stools, steatorrhea, photosensitivity, increased ICP,
rash, urticaria, exfoliative dermatitis, angioedema, discoloration of
developing teeth, conjuctive pigmentation, lossening of nails, in-
creased liver labs, decreased cholesterol, jaundice, anaphylaxis,
serum sickness, drug fever, retrosternal pain, increased sodium
retention, hepatotoxic, renal toxic, metabolic acidosis, itching, and
wheezing. Nursing considerations: Unstable with age & light ex-
posure, store in tightly covered container in a dry area protected
from light & heat. Practice good oral care/hygeine. Report onset
of severe h/a or visual disturbances. Take oral doses with full
glass of water on an empty stomach to increase absorption. Inter-
act with antacids, antidiarrheals, anticoagulants, oral contracep-
tives, penicillins, , digoxin, dairy & iron supplements.
ending in: zosin

lOMoARcPSD|3083804
Peripherally acting alpha-1 blocker. Antihypertensive. Side effects

include first dose syncope, h/a, drowsiness, hypotension, palpita-
tions, impotence, nasal congestion, tachycardia, anaphylaxis &
arrhythmia. Nursing considerations: May cause syncope within
30-60 min of first dose. DO NOT STOP TAKING ABRUPTLY.
Monitor VS, especially BP & pulse. Monitor for CHF/edema. Moni-
tor diabetic clients for hypoglycemia. Abrupt d/c may worsen
angina or precipitate MI. Change position slowly to prevent dizzi-
ness/falls. Weigh daily, report weight gain >5lbs/week. May take
3-4 weeks for tx response. Interact with oral antidiabetic agents,
digoxin, & beta blockers.
ending in: olol or lol

Beta blocker. Antihypertensive. Contraindicated in symptomatic
bradycardia, greater than first degree heart block, class IV heart
failure & asthma. Side effects include insomnia, fatigue, dizziness,
nervousness, edema, increased airway resistance, muscle/joint
pain, bradycardia, hyptotension, heart failure & bronchospasm.
Nursing considerations: Monitor apical pulse for increased risk of
bradycardia. DO NOT STOP TAKING ABRUPTLY. Interact with
antihypertensives, insulin, & oral antidiabetic agents.
ending in: pril

ACE inhibitor. Antihypertensive. Contraindicated in pregnancy and
with use of potassium supplements or potassium-sparing diuret-
ics. Side effects include anxiety, fatigue, insomnia, nervousness,
hypotension, palpitations, persistent dry non-productive cough,
dyspnea, angioedema, CVA, MI & hypertensive crisis. Nursing
considerations: D/C asap if pregnancy is suspected. Administer
1h before meals to increase absorption. Take BP before dose and
monitor regularly. Diuretics should be d/c 2-3 days before ACE in-
hibitor tx. Report peripheral edema, signs of infection, facial
swelling, loss of taste or dyspnea. Do not skip doses or stop drug

lOMoARcPSD|3083804
abruptly. Notify provider if persistent dry cough develops. Take

antacids 2h before/after ACE inhibitors. Eliminate licorice from
diet. Interact with potassium-sparing diuretics, potassium suppl-
ments. lithium, digoxin, licorice, sodium substitutes, & high fat
foods.
ending in: sartan

Angiotension II antagonists. Antihypertensive. Side effects include
hypotension, dizziness, cough, GI upset, insomnia, nasal conges-
tion, pharyngitis, myalgia/arthralgia, flu-like symptoms, an-
gioedema, tachycardia & bradycardia. Nursing considerations:
D/C asap if pregnancy is suspected. Use with caution in patients
with renal/hepatic disease. Regularly assess renal function. Moni-
tor potassium levels. Monitor BP & apical pulse often. Do not d/c
abruptly. Use non-hormonal birth control options. Interact with
potassium-sparing diuretics, salt subsititutes and red yeast rice.
ending in: dipine

Calcium channel blocker. Antiarrhythmic. Contraindicated in sick
sinus syndrome, second & third degree heart blocks, severe hy-
potension. Side effects include h/a, fatigue, constipation, postural
hypotension, heart block, profound bradycardia, CHF, syncope,
palpitations, fluid overload, dizziness, nervousness, insomnia,
confusion, tremor, gait disturbance, impaired taste, & skin rash.
Nursing considerations: Evaluate BP & ECG before initiation of tx.
Monitor for h/a, analgesic may be required. Hold med if BP is less
than 90/60. May induce hyperglycemia, monitor diabetic patients
closely. Report gradual weight gain & evidence of edema. Take
pulse before each dose. Stop smoking and avoid alcohol con-
sumption. Interact with beta blockers, digoxin, furosemide (incom-
patible in IV solution), grapefruit and grapefruit juice.
beginning or ending in: nitr

lOMoARcPSD|3083804
Nitrate. Contraindicated in hypotension and/or hypovolemia, se-

vere bradycardia/tachycardia, and right ventricular MI. Side ef-
fects include h/a, postural hypotension, flushing, local burning or
tingling sensation, contact dermatitis (topical administration), GI
upset (oral administration), blurred vision, dry mouth, weakness,
dizziness, vertigo, faintness, and fecal & urinary incontinence.
Nursing considerations: Wear gloves when applying NTG paste or
patch. Rotate application sites. Make sure patient is sitting or lying
down when taking NTG to prevent dizziness or fainting. Give one
tablet q5min (no more than 3 tablets total) and notify physician or
emergency services if pain is unrelieved after 3rd dose. Store in a
cool, dry, dark place with lid attached tightly. Patient may
swim/bathe with a NTG patch in place. Take sublingual or spray
NTG before events that cause angina (sex, exercise). Do not mix
with any other meds in the bottle or IV tubing. Interact with Viagra,
antihypertensives, vasodilators, heparin (if NTG is given IV), and
alcohol.
ending in: parin

Heparin or heparinoid. Anticoagulant. Contraindicated in uncon-
trolled bleeding and in patients with pork allergies. Side effects in-
clude hemorrhage, hematuria, epistaxis, bleeding gums, thrombo-
cytopenia, and osteoporosis (with long-term tx). Nursing consider-
ations: Can be given IV or SUBQ. Monitor PTT when on heparin
tx. Should be given via an infusion pump with a dedicated IV line
due to its incompatibility with other drugs. Protamine sulfate is the
antidote for heparin overdose. Monitor for signs of bleeding. Verify
correct dosage with another licensed provider before administra-
tion. Rotate sites for SUBQ administration. Once patient is stabi-
lized, an oral anticoagulant is added for long-term tx. Decrease in-
take of green leafy vegetables if adding warfarin to tx regimen. In-
teract with aspirin, NSAIDS, antiplatelets, and green leafy vegeta-
bles.

lOMoARcPSD|3083804
ending in: vir

Antiviral. Contraindicated in preexisting hepatic/renal dysfunction,
with concurrent use with nephrotoxic drugs, pregnancy & lacta-
tion. Side effects include anemia, h/a, mood changes, depression,
seizures, diarrhea, local irritation/phlebtitis (with IV administra-
tion), inflammation (with topical admnistration), fever, metabolic
acidosis, dysrhythmias, fluid overload, ocular hypertrophy, infertil-
ity, and pancreatitis. Nursing considerations: Administer as soon
as possible to improve effectiveness. Wear gloves when adminis-
tering topically. Preferred central venough access when given IV.
Assess & monitor kidney/liver function. Assess skin and any le-
sions regularly. Hydrate to reduce risk of nephrotoxicity. Frequent,
small meals in high in protein. Interact with nephrotoxic drugs, zi-
dovudine, and probenecid.
beginning or ending with: sal

Salicylate. Nonopioid analgesic. Contraindicated in GI bleeding,
bleeding disorders, younger than 12 years (due to risk of Reye's
syndrome), children/teens with flu-like syndromes, pregnancy/lac-
tation, with vitamin K deficiency, PUD, anemia, renal or hepatic
dysfunction. Side effects include increased bleeding time, drowsi-
ness, dizziness, confusion, h/a, hallucinations, heartburn,
anorexia, rash, urticaria, bruising, tinnitus, seizures, coma, GI
bleeding, hepatitis, and Reye's syndrome. Nursing considera-
tions: Dosage dependent upon age of patient & condition being
treated. GI upset may be decreased by giving with full glass of
water, milk, food or an antacid. Administer at least 30 minutes
prior to PT or planned activity to minimize discomfort. Report any
signs/symptoms of hepatic/renal toxicity Report visual changes,
tinnitus, allergic reactions, and bleeding. Do not exceed recom-
mended dosage. Avoid alcohol to reduce chance of GI bleeding.
Interact with antacids, urinary alkalizers, anticoagulants, alcohol,
corticosteroids, warfarin, insulin, thrombolytic agents, penicillins,

lOMoARcPSD|3083804
phenytoin, valproic acid, oral hypoglycemics, sulfonamides, am-

monium chloride, urinary acidifiers, nizatidine, probenecid,
spironolactone, NSAIDs, beta blockers, ginger, & caffeine.
ending in: zepam or zolam

Benzodiazepine. Sedative-hypnotic, antianxiety. Contraindicated
in pregnancy/lactation, preexisting CNS depression, severe un-
controlled pain, with narrow-angle glaucoma, and hepatic dys-
function. Side effects include decreased mental alertness, drop in
BP (especially when standing), dry mouth, ataxia, dizziness,
drowsiness, n/v, withdrawal symptoms, and overdose (s/s somno-
lence, confusion, coma, diminished reflexes & hypotension).
Nursing considerations: Start at a low dose & gradually increased
until desired results are achieved. Assess degree & manifestation
of anxiet before beginning tx. Monitor BP, HR, & RR and provide
supportive care as indicated. Prolonged tx can lead to depen-
dence. Take exactly as prescribed. Abrupt withdrawal of med may
cause sweating, vomiting, muscle cramps, tremors & convulsions.
Avoid alcohol. Interact with CNS depressants, antacids, TCAs, &
MAOIs.
ending in: statin

HMG-Coenzyme A (HMG-CoA) reductase inhibitors. Lipid lower-
ing agent. Contraindicated in active liver disease and in preg-
nancy/lactation. Side effects include GI upset, dyspepsia, flatu-
lence, pain, myalgias, h/a, rash, dizziness, sinusitis, & altered liver
function tests. Nursing considerations: Usually administered at
night. Not recommended for us in patients less than 20 years old.
Lab monitoring is required is to maintain compliance and assess
client response. Report immediately any unexplained muscle
pain, tenderness, yellowing of skin/eyes, or loss of appetite. Alco-
hol intake should be minimized/avoided. Women of child-bearing
age should use contraception during tx. Interact with immunosup-

lOMoARcPSD|3083804
pressants, antifungals, erythromycin, cholestyramine, and war-

farin.
ending in: prazole

Proton pump inhibitor (PPI). Antiulcer. Contraindicated in children
& nursing mothers. Side effects include h/a, diarrhea, constipa-
tion, flatulence, rash, hyperglycemia, dizziness, pruritis, dry
mouth, pancreatitis, liver necrosis, hepatic failure, toxic epidermal
necrolysis, Stevens-Johnson syndrome, MI, shock, CVA, & GI
hemorrhage. Nursing considerations: May be given with antacids.
Dosage should be reduced in severe liver disease. Monitor he-
patic & renal labs. Increase water intake to 8-10 glasses per day
to prevent constipation. Report diarrhea. Interact with digoxin, iron
preparations, ampicillin, theophylline, diazepam, pheytoin, war-
farin, and benzodiazepines.
ending in: tidine

H2 antagonist. Antiulcer. Contraindicated in impaired renal/hepatic
function. Side effects include somnolence, diaphoresis, rash, h/a,
hypotension, taste disorder, diarrhea, constipation, dry mouth,
cardiac dysrhythmias, impotence (with cimetidine), & anaphylaxis.
Nursing considerations: Should not be given with other drugs via
IV. Avoid antacids within 1h of administration. Reduced dosages
for patients with renal/hepatic dysfunction. Evaluate need for to-
bacco/alcohol cessation. Cigarette smoking reduces drug effec-
tiveness. Interact with beta blockers, lidocaine, benzodiazepines,
TCAs, oral contraceptives, warfarin, iron salts, tetracyclines, di-
azepam, and glipizide.
ending in: sone or lone

beginning with: pred
Corticosteriod. Contraindicated in systemic infections, UC, diverti-
culitis, active or latent PUD, and pregnancy/lactation (safety not

lOMoARcPSD|3083804
established). Side effects include euphoria, h/a, insomnia, psy-

chosis, edema, muscle weakness, delayed wound healing, osteo-
porosis, spontaneous fractures, & hyperglycemia. Nursing consid-
erations: Oral forms should be given with meals. IV form should
be given slowly IVPB to prevent vaginal & anal burning. Establish
baseline & montior BP, I & O, weight & sleep patterns. Measure
2h post-meal blood glucose, potassium & calcium prior to tx &
regularly thereafter. Watch for changes in mood, emotional stabil-
ity, & sleep. Interact with phenytoin, rifampin, amphotericin-B, di-
uretics, vaccines & toxoids.
ending in: phylline

Xanthine bronchodilator. Contraindicated in patients with tach-
yarrhythmias, PUD, GI disorders, cardiovascular disorders (use
with caution), seizure disorders, and hyperthyroidism. Side effects
include anorexia, GERD, sinus tachycardia, extrasystoles, palpita-
tions, ventricular dysrhythmias, hyperglycemia, transient in-
creased urination, tremors, dizziness, hallucinations, restless-
ness, agitation, h/a, insomnia, & chest pain. Nursing considera-
tions: Administer cautiously in elderly due to potential for in-
creased sensitivity. Give to children over 6 months of age with
caution. Dosages should be based on lean body weight as it does
not enter adipose tissue. Start dosage low and titrate up until ther-
apeutic response is achieved. Do not omit or double-up doses,
take exactly as prescribed. Avoid use of caffeine as this can in-
crease CNS stimulation. Increase fluid intake if not contraindi-
cated. Interact with allopurinol, cimetidine, erythromycin, flu vax,
oral contraceptives, sympathomimetics, smoking, barbiturates,
phenobarbital, caffeine, and tobacco.
ending in: terol

Beta-adrenergic bronchodilator. Contraindicated in tachyarrhyth-
mias, severe CAD, cardiovascular disease, & children under 12

lOMoARcPSD|3083804
years old (with the inhaled forms). Side effects include nervous-
ness, tremors, increased heart rate, increased BP, insomnia, rest-
lessness, anorexia, cardiac stimulation, vascular h/a, anginal
pain, hypotension, arrhythmias, paradoxic bronchospasm, urinary
retention, & agitation. Nursing considerations: Monitor elderly
clients closely. Monitor BP & pulse closely. Ensure proper use of
MDIs. Note amount, color & character of sputum. Monitor blood
glucose levels in diabetic patients. Avoid IM injections. Report any
chest pain, palpitations, seizures, h/a, hallucinations or blurred vi-
sion. Teach proper care of nebulizer and/or inhaler. Wait 1-3 min-
utes between inhalations of aerosol meds. Take exactly as or-
dered, do not double-up doses or increase frequency. Increase
fluid intake if not otherwise contraindicated. Interact with MAOIs,
sympathomimetics, beta blockers, potassium-losing diuretics, car-
diac glycosides, other bronchodilators, digoxin, thyroid hormones,
decongestants, & antihistamines.
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?
1. Calcium chloride
2. Calcium gluconate
3. Calcitonin (Miacalcin)
4. Large doses of vitamin D
3. Calcitonin (Miacalcin)
Rationale:
The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is
experiencing hypercalcemia. Calcium gluconate and calcium chlo-
ride are medications used for the treatment of tetany, which oc-
curs as a result of acute hypocalcemia. In hypercalcemia, large
doses of vitamin D need to be avoided. Calcitonin, a thyroid hor-
mone, decreases the plasma calcium level by inhibiting bone re-
sorption and lowering the serum calcium concentration.

lOMoARcPSD|3083804
2.) Oral iron supplements are prescribed for a 6-year-old child

with iron deficiency anemia. The nurse instructs the mother to ad-
minister the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice
4. Orange juice
Rationale:
Vitamin C increases the absorption of iron by the body. The
mother should be instructed to administer the medication with a
citrus fruit or a juice that is high in vitamin C. Milk may affect ab-
sorption of the iron. Water will not assist in absorption. Orange
juice contains a greater amount of vitamin C than apple juice.
3.) Salicylic acid is prescribed for a client with a diagnosis of pso-

riasis. The nurse monitors the client, knowing that which of the fol-
lowing would indicate the presence of systemic toxicity from this
medication?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Decreased respirations
1. Tinnitus
Rationale:
Salicylic acid is absorbed readily through the skin, and systemic
toxicity (salicylism) can result. Symptoms include tinnitus, dizzi-
ness, hyperpnea, and psychological disturbances. Constipation
and diarrhea are not associated with salicylism.

lOMoARcPSD|3083804
4.) The camp nurse asks the children preparing to swim in the
lake if they have applied sunscreen. The nurse reminds the chil-
dren that chemical sunscreens are most effective when applied:
1. Immediately before swimming
2. 15 minutes before exposure to the sun
3. Immediately before exposure to the sun
4. At least 30 minutes before exposure to the sun
4. At least 30 minutes before exposure to the sun
Rationale:
Sunscreens are most effective when applied at least 30 minutes
before exposure to the sun so that they can penetrate the skin. All
sunscreens should be reapplied after swimming or sweating.
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?
1. Notifying the registered nurse
2. Discontinuing the medication
3. Informing the client that this is normal
4. Applying a thinner film than prescribed to the burn site
3. Informing the client that this is normal
Rationale:
Mafenide acetate is bacteriostatic for gram-negative and gram-
positive organisms and is used to treat burns to reduce bacteria
present in avascular tissues. The client should be informed that
the medication will cause local discomfort and burning and that
this is a normal reaction; therefore options 1, 2, and 4 are incor-
rect
6.) The burn client is receiving treatments of topical mafenide ac-

etate (Sulfamylon) to the site of injury. The nurse monitors the

lOMoARcPSD|3083804
client, knowing that which of the following indicates that a sys-

temic effect has occurred?
1.Hyperventilation
2.Elevated blood pressure
3.Local pain at the burn site
4.Local rash at the burn site
1.Hyperventilation
Rationale:
Mafenide acetate is a carbonic anhydrase inhibitor and can sup-
press renal excretion of acid, thereby causing acidosis. Clients re-
ceiving this treatment should be monitored for signs of an acid-
base imbalance (hyperventilation). If this occurs, the medication
should be discontinued for 1 to 2 days. Options 3 and 4 describe
local rather than systemic effects. An elevated blood pressure
may be expected from the pain that occurs with a burn injury.
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?
1. Platelet count
2. Triglyceride level
2. Triglyceride level
Rationale:
Isotretinoin can elevate triglyceride levels. Blood triglyceride lev-
els should be measured before treatment and periodically there-
after until the effect on the triglycerides has been evaluated. Op-
tions 1, 3, and 4 do not need to be monitored specifically during
this treatment.
8.) A client with severe acne is seen in the clinic and the health
care provider (HCP) prescribes isotretinoin. The nurse reviews

lOMoARcPSD|3083804
the client's medication record and would contact the (HCP) if the
client is taking which medication?
1. Vitamin A
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Phenytoin (Dilantin)
1. Vitamin A
Rationale:
Isotretinoin is a metabolite of vitamin A and can produce general-
ized intensification of isotretinoin toxicity. Because of the potential
for increased toxicity, vitamin A supplements should be discontin-
ued before isotretinoin therapy. Options 2, 3, and 4 are not con-
traindicated with the use of isotretinoin.
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 be-
ing applied to which of the following body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands
2. Axilla
Rationale:
Topical corticosteroids can be absorbed into the systemic circula-
tion. Absorption is higher from regions where the skin is especially
permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia),
and lower from regions in which permeability is poor (back, palms,
soles).
10.) The clinic nurse is performing an admission assessment on a

client. The nurse notes that the client is taking azelaic acid

lOMoARcPSD|3083804
(Azelex). Because of the medication prescription, the nurse would

suspect that the client is being treated for:
1. Acne
2. Eczema
3. Hair loss
4. Herpes simplex
1. Acne
Rationale:
Azelaic acid is a topical medication used to treat mild to moderate
acne. The acid appears to work by suppressing the growth of Pro-
pionibacterium acnes and decreasing the proliferation of ker-
atinocytes. Options 2, 3, and 4 are incorrect.
11.) The health care provider has prescribed silver sulfadiazine

(Silvadene) for the client with a partial-thickness burn, which has
cultured positive for gram-negative bacteria. The nurse is reinforc-
ing information to the client about the medication. Which state-
ment made by the client indicates a lack of understanding about
the treatments?
1. "The medication is an antibacterial."
2. "The medication will help heal the burn."
3. "The medication will permanently stain my skin."
4. "The medication should be applied directly to the wound."
3. "The medication will permanently stain my skin."
Rationale:
Silver sulfadiazine (Silvadene) is an antibacterial that has a broad
spectrum of activity against gram-negative bacteria, gram-positive
bacteria, and yeast. It is applied directly to the wound to assist in
healing. It does not stain the skin.
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 inspec-

lOMoARcPSD|3083804
tion 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?
1. Notify the registered nurse.
2. Administer pain medication to reduce the discomfort.
3. Apply ice and maintain the infusion rate, as prescribed.
4. Elevate the extremity of the IV site, and slow the infusion.
Rationale:
When antineoplastic medications (Chemotheraputic Agents) are
administered via IV, great care must be taken to prevent the medi-
cation from escaping into the tissues surrounding the injection
site, because pain, tissue damage, and necrosis can result. The
nurse monitors for signs of extravasation, such as redness or
swelling at the insertion site and a decreased infusion rate. If ex-
travasation occurs, the registered nurse needs to be notified; he
or she will then contact the health care provider.
13.) The client with squamous cell carcinoma of the larynx is re-
ceiving bleomycin intravenously. The nurse caring for the client
anticipates that which diagnostic study will be prescribed?
1. Echocardiography
2. Electrocardiography
3. Cervical radiography
4. Pulmonary function studies
4. Pulmonary function studies
Rationale:
Bleomycin is an antineoplastic medication (Chemotheraputic
Agents) that can cause interstitial pneumonitis, which can
progress to pulmonary fibrosis. Pulmonary function studies along
with hematological, hepatic, and renal function tests need to be
monitored. The nurse needs to monitor lung sounds for dyspnea
and crackles, which indicate pulmonary toxicity. The medication
needs to be discontinued immediately if pulmonary toxicity oc-

lOMoARcPSD|3083804
curs. Options 1, 2, and 3 are unrelated to the specific use of this

medication.
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?
1. Clotting time
2. Uric acid level
3. Potassium level
2. Uric acid level
Rationale:
Busulfan (Myleran) can cause an increase in the uric acid level.
Hyperuricemia can produce uric acid nephropathy, renal stones,
and acute renal failure. Options 1, 3, and 4 are not specifically re-
lated to this medication.
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?
1. Alopecia
2. Chest pain
3. Pulmonary fibrosis
4. Orthostatic hypotension
Rationale:
A side effect specific to etoposide is orthostatic hypotension. The
client's blood pressure is monitored during the infusion. Hair loss
occurs with nearly all the antineoplastic medications. Chest pain
and pulmonary fibrosis are unrelated to this medication.

lOMoARcPSD|3083804
16.) The clinic nurse is reviewing a teaching plan for the client re-
ceiving an antineoplastic medication. When implementing the
plan, the nurse tells the client:
1. To take aspirin (acetylsalicylic acid) as needed for headache
2. Drink beverages containing alcohol in moderate amounts each
evening
3. Consult with health care providers (HCPs) before receiving im-
munizations
4. That it is not necessary to consult HCPs before receiving a flu
vaccine at the local health fair
3. Consult with health care providers (HCPs) before receiving im-
munizations
Rationale:
Because antineoplastic medications lower the resistance of the
body, clients must be informed not to receive immunizations with-
out a HCP's approval. Clients also need to avoid contact with indi-
viduals who have recently received a live virus vaccine. Clients
need to avoid aspirin and aspirin-containing products to minimize
the risk of bleeding, and they need to avoid alcohol to minimize
the risk of toxicity and side effects.
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?
1. Diarrhea
2. Hair loss
3. Chest pain
4. Numbness and tingling in the fingers and toes
4. Numbness and tingling in the fingers and toes
Rationale:
A side effect specific to vincristine is peripheral neuropathy, which
occurs in almost every client. Peripheral neuropathy can be mani-
fested as numbness and tingling in the fingers and toes. Depres-
sion of the Achilles tendon reflex may be the first clinical sign indi-

lOMoARcPSD|3083804
cating peripheral neuropathy. Constipation rather than diarrhea is

most likely to occur with this medication, although diarrhea may
occur occasionally. Hair loss occurs with nearly all the antineo-
plastic medications. Chest pain is unrelated to this medication.
18.) The nurse is reviewing the history and physical examination

of a client who will be receiving asparaginase (Elspar), an anti-
neoplastic agent. The nurse consults with the registered nurse re-
garding the administration of the medication if which of the follow-
ing is documented in the client's history?
1. Pancreatitis
3. Myocardial infarction
4. Chronic obstructive pulmonary disease
1. Pancreatitis
Rationale:
Asparaginase (Elspar) is contraindicated if hypersensitivity exists,
in pancreatitis, or if the client has a history of pancreatitis. The
medication impairs pancreatic function and pancreatic function
tests should be performed before therapy begins and when a
week or more has elapsed between administration of the doses.
The client needs to be monitored for signs of pancreatitis, which
include nausea, vomiting, and abdominal pain. The conditions
noted in options 2, 3, and 4 are not contraindicated with this medi-
cation.
19.) Tamoxifen is prescribed for the client with metastatic breast

carcinoma. The nurse understands that the primary action of this
medication is to:
1. Increase DNA and RNA synthesis.
2. Promote the biosynthesis of nucleic acids.
3. Increase estrogen concentration and estrogen response.

lOMoARcPSD|3083804
4. Compete with estradiol for binding to estrogen in tissues con-

taining high concentrations of receptors.
4. Compete with estradiol for binding to estrogen in tissues con-
taining high concentrations of receptors.
Rationale:
Tamoxifen is an antineoplastic medication that competes with
estradiol for binding to estrogen in tissues containing high con-
centrations of receptors. Tamoxifen is used to treat metastatic
breast carcinoma in women and men. Tamoxifen is also effective
in delaying the recurrence of cancer following mastectomy. Ta-
moxifen reduces DNA synthesis and estrogen response.
20.) The client with metastatic breast cancer is receiving tamox-

ifen. The nurse specifically monitors which laboratory value while
the client is taking this medication?
1. Glucose level
2. Calcium level
3. Potassium level
4. Prothrombin time
2. Calcium level
Rationale:
Tamoxifen may increase calcium, cholesterol, and triglyceride lev-
els. Before the initiation of therapy, a complete blood count,
platelet count, and serum calcium levels should be assessed.
These blood levels, along with cholesterol and triglyceride levels,
should be monitored periodically during therapy. The nurse should
assess for hypercalcemia while the client is taking this medica-
tion. Signs of hypercalcemia include increased urine volume, ex-
cessive thirst, nausea, vomiting, constipation, hypotonicity of mus-
cles, and deep bone and flank pain.
21.) A nurse is assisting with caring for a client with cancer who is
receiving cisplatin. Select the adverse effects that the nurse moni-

lOMoARcPSD|3083804
tors for that are associated with this medication. Select all that ap-
ply.
1. Tinnitus
2. Ototoxicity
3. Hyperkalemia
4. Hypercalcemia
5. Nephrotoxicity
6. Hypomagnesemia
1. Tinnitus
2. Ototoxicity
5. Nephrotoxicity
6. Hypomagnesemia
Rationale:
Cisplatin is an alkylating medication. Alkylating medications are
cell cycle phase-nonspecific medications that affect the synthesis
of DNA by causing the cross-linking of DNA to inhibit cell repro-
duction. Cisplatin may cause ototoxicity, tinnitus, hypokalemia,
hypocalcemia, hypomagnesemia, and nephrotoxicity. Amifostine
(Ethyol) may be administered before cisplatin to reduce the poten-
tial for renal toxicity.
22.) A nurse is caring for a client after thyroidectomy and notes

that calcium gluconate is prescribed for the client. The nurse de-
termines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
3. Treat hypocalcemic tetany.
Rationale:
Hypocalcemia can develop after thyroidectomy if the parathyroid
glands are accidentally removed or injured during surgery. Mani-
festations develop 1 to 7 days after surgery. If the client develops
numbness and tingling around the mouth, fingertips, or toes or

lOMoARcPSD|3083804
muscle spasms or twitching, the health care provider is notified

immediately. Calcium gluconate should be kept at the bedside.
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?
1. Keep insulin vials refrigerated at all times.
2. Rotate the insulin injection sites systematically.
3. Increase the amount of insulin before unusual exercise.
4. Monitor the urine acetone level to determine the insulin dosage.
2. Rotate the insulin injection sites systematically.
Rationale:
Insulin dosages should not be adjusted or increased before un-
usual exercise. If acetone is found in the urine, it may possibly in-
dicate the need for additional insulin. To minimize the discomfort
associated with insulin injections, the insulin should be adminis-
tered at room temperature. Injection sites should be systemati-
cally rotated from one area to another. The client should be in-
structed to give injections in one area, about 1 inch apart, until the
whole area has been used and then to change to another site.
This prevents dramatic changes in daily insulin absorption.
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 further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into
the vial
1. Withdraws the NPH insulin first
Rationale:

lOMoARcPSD|3083804
When preparing a mixture of regular insulin with another insulin

preparation, the regular insulin is drawn into the syringe first. This
sequence will avoid contaminating the vial of regular insulin with
insulin of another type. Options 2, 3, and 4 identify the correct ac-
tions for preparing NPH and regular insulin.
25.) A home care nurse visits a client recently diagnosed with dia-
betes 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:
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.
2. Refrigerate the insulin.
Rationale:
Insulin in unopened vials should be stored under refrigeration until
needed. Vials should not be frozen. When stored unopened under
refrigeration, insulin can be used up to the expiration date on the
vial. Options 1, 3, and 4 are incorrect.
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?
1. Alcohol
2. Organ meats
3. Whole-grain cereals
4. Carbonated beverages
1. Alcohol
Rationale:
When alcohol is combined with glimepiride (Amaryl), a disulfiram-
like reaction may occur. This syndrome includes flushing, palpita-
tions, and nausea. Alcohol can also potentiate the hypoglycemic

lOMoARcPSD|3083804
effects of the medication. Clients need to be instructed to avoid al-

cohol consumption while taking this medication. The items in op-
tions 2, 3, and 4 do not need to be avoided.
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?
1. Neuralgia
2. Insomnia
3. Use of nitroglycerin
4. Use of multivitamins
3. Use of nitroglycerin
Rationale:
Sildenafil (Viagra) enhances the vasodilating effect of nitric oxide
in the corpus cavernosum of the penis, thus sustaining an erec-
tion. Because of the effect of the medication, it is contraindicated
with concurrent use of organic nitrates and nitroglycerin. Sildenafil
is not contraindicated with the use of vitamins. Neuralgia and in-
somnia are side effects of the medication.
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 inter-
vention?
1. The medication is administered within 60 minutes before the
morning and evening meal.
2. The medication is withheld and the HCP is called to question
the prescription for the client.
3. The client is monitored for gastrointestinal side effects after ad-
ministration of the medication.
4. The insulin is withdrawn from the Penlet into an insulin syringe
to prepare for administration.

lOMoARcPSD|3083804
2. The medication is withheld and the HCP is called to question

the prescription for the client.
Rationale:
Exenatide (Byetta) is an incretin mimetic used for type 2 diabetes
mellitus only. It is not recommended for clients taking insulin.
Hence, the nurse should hold the medication and question the
HCP regarding this prescription. Although options 1 and 3 are cor-
rect statements about the medication, in this situation the medica-
tion should not be administered. The medication is packaged in
prefilled pens ready for injection without the need for drawing it up
into another syringe.
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:
1. 2 to 4 hours after administration
Rationale:
Humulin NPH is an intermediate-acting insulin. The onset of ac-
tion is 1.5 hours, it peaks in 4 to 12 hours, and its duration of ac-
tion is 24 hours. Hypoglycemic reactions most likely occur during
peak time.
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?
1. Prednisone
2. Phenelzine (Nardil)

lOMoARcPSD|3083804
3. Atenolol (Tenormin)
4. Allopurinol (Zyloprim)
1. Prednisone
Rationale:
Prednisone may decrease the effect of oral hypoglycemics, in-
sulin, diuretics, and potassium supplements. Option 2, a
monoamine oxidase inhibitor, and option 3, a β-blocker, have their
own intrinsic hypoglycemic activity. Option 4 decreases urinary
excretion of sulfonylurea agents, causing increased levels of the
oral agents, which can lead to hypoglycemia.
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?
1. "I can take aspirin or my antihistamine if I need it."
2. "I need to take the medication every day at the same time."
3. "I need to avoid coffee, tea, cola, and chocolate in my diet."
4. "If I gain more than 5 pounds a week, I will call my doctor."
1. "I can take aspirin or my antihistamine if I need it."
Rationale:
Aspirin and other over-the-counter medications should not be
taken unless the client consults with the health care provider
(HCP). The client needs to take the medication at the same time
every day and should be instructed not to stop the medication. A
slight weight gain as a result of an improved appetite is expected,
but after the dosage is stabilized, a weight gain of 5 lb or more
weekly should be reported to the HCP. Caffeine-containing foods
and fluids need to be avoided because they may contribute to
steroid-ulcer development.

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32.) Desmopressin acetate (DDAVP) is prescribed for the treat-

ment of diabetes insipidus. The nurse monitors the client after
medication administration for which therapeutic response?
1. Decreased urinary output
2. Decreased blood pressure
3. Decreased peripheral edema
4. Decreased blood glucose level
1. Decreased urinary output
Rationale:
Desmopressin promotes renal conservation of water. The hor-
mone carries out this action by acting on the collecting ducts of
the kidney to increase their permeability to water, which results in
increased water reabsorption. The therapeutic effect of this medi-
cation would be manifested by a decreased urine output. Options
2, 3, and 4 are unrelated to the effects of this medication.
33.) The home health care nurse is visiting a client who was re-
cently diagnosed with type 2 diabetes mellitus. The client is pre-
scribed repaglinide (Prandin) and metformin (Glucophage) and
asks the nurse to explain these medications. The nurse should re-
inforce which instructions to the client? Select all that apply.
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.
4. Candy or another simple sugar is carried and used to treat mild
hypoglycemia episodes.
5. Metformin increases hepatic glucose production to prevent hy-
poglycemia associated with repaglinide.
6. Muscle pain is an expected side effect of metformin and may
be treated with acetaminophen (Tylenol).
1. Diarrhea can occur secondary to the metformin.
2. The repaglinide is not taken if a meal is skipped.
3. The repaglinide is taken 30 minutes before eating.

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4. Candy or another simple sugar is carried and used to treat mild

hypoglycemia episodes.
Rationale:
Repaglinide is a rapid-acting oral hypoglycemic agent that stimu-
lates pancreatic insulin secretion that should be taken before
meals, and that should be withheld if the client does not eat. Hy-
poglycemia is a side effect of repaglinide and the client should al-
ways be prepared by carrying a simple sugar with her or him at all
times. Metformin is an oral hypoglycemic given in combination
with repaglinide and works by decreasing hepatic glucose produc-
tion. A common side effect of metformin is diarrhea. Muscle pain
may occur as an adverse effect from metformin but it might signify
a more serious condition that warrants health care provider notifi-
cation, not the use of acetaminophen.
34.) A client with Crohn's disease is scheduled to receive an infu-

sion of infliximab (Remicade). The nurse assisting in caring for the
client should take which action to monitor the effectiveness of
treatment?
1. Monitoring the leukocyte count for 2 days after the infusion
2. Checking the frequency and consistency of bowel movements
3. Checking serum liver enzyme levels before and after the infu-
sion
4. Carrying out a Hematest on gastric fluids after the infusion is
completed
2. Checking the frequency and consistency of bowel movements
Rationale:
The principal manifestations of Crohn's disease are diarrhea and
abdominal pain. Infliximab (Remicade) is an immunomodulator
that reduces the degree of inflammation in the colon, thereby re-
ducing the diarrhea. Options 1, 3, and 4 are unrelated to this med-
ication.

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35.) The client has a PRN prescription for loperamide hydrochlo-

ride (Imodium). The nurse understands that this medication is
used for which condition?
1. Constipation
2. Abdominal pain
3. An episode of diarrhea
4. Hematest-positive nasogastric tube drainage
3. An episode of diarrhea
Rationale:
Loperamide is an antidiarrheal agent. It is used to manage acute
and also chronic diarrhea in conditions such as inflammatory
bowel disease. Loperamide also can be used to reduce the vol-
ume of drainage from an ileostomy. It is not used for the condi-
tions in options 1, 2, and 4.
36.) The client has a PRN prescription for ondansetron (Zofran).

For which condition should this medication be administered to the
postoperative client?
1. Paralytic ileus
2. Incisional pain
3. Urinary retention
Rationale:
Ondansetron is an antiemetic used to treat postoperative nausea
and vomiting, as well as nausea and vomiting associated with
chemotherapy. The other options are incorrect.
37.) The client has begun medication therapy with pancrelipase

(Pancrease MT). The nurse evaluates that the medication is hav-
ing the optimal intended benefit if which effect is observed?
1. Weight loss
2. Relief of heartburn

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3. Reduction of steatorrhea
4. Absence of abdominal pain
3. Reduction of steatorrhea
Rationale:
Pancrelipase (Pancrease MT) is a pancreatic enzyme used in
clients with pancreatitis as a digestive aid. The medication should
reduce the amount of fatty stools (steatorrhea). Another intended
effect could be improved nutritional status. It is not used to treat
abdominal pain or heartburn. Its use could result in weight gain
but should not result in weight loss if it is aiding in digestion.
38.) An older client recently has been taking cimetidine (Tagamet).

The nurse monitors the client for which most frequent central ner-
vous system side effect of this medication?
1. Tremors
2. Dizziness
3. Confusion
4. Hallucinations
3. Confusion
Rationale:
Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients
are especially susceptible to central nervous system side effects
of cimetidine. The most frequent of these is confusion. Less com-
mon central nervous system side effects include headache, dizzi-
ness, drowsiness, and 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?
1. With meals and at bedtime
2. Every 6 hours around the clock
3. One hour after meals and at bedtime
4. One hour before meals and at bedtime

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4. One hour before meals and at bedtime

Rationale:
Sucralfate is a gastric protectant. The medication should be
scheduled for administration 1 hour before meals and at bedtime.
The medication is timed to allow it to form a protective coating
over the ulcer before food intake stimulates gastric acid produc-
tion and mechanical irritation. The other options are incorrect.
40.) The client who chronically uses nonsteroidal anti-inflamma-

tory drugs has been taking misoprostol (Cytotec). The nurse de-
termines that the medication is having the intended therapeutic ef-
fect if which of the following is noted?
1. Resolved diarrhea
2. Relief of epigastric pain
3. Decreased platelet count
4. Decreased white blood cell count
2. Relief of epigastric pain
Rationale:
The client who chronically uses nonsteroidal anti-inflammatory
drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is
a gastric protectant and is given specifically to prevent this occur-
rence. Diarrhea can be a side effect of the medication, but is not
an intended effect. Options 3 and 4 are incorrect.
41.) The client has been taking omeprazole (Prilosec) for 4

weeks. The ambulatory care nurse evaluates that the client is re-
ceiving optimal intended effect of the medication if the client re-
ports the absence of which symptom?
1. Diarrhea
2. Heartburn
3. Flatulence
4. Constipation
2. Heartburn

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Rationale:
Omeprazole is a proton pump inhibitor classified as an antiulcer
agent. The intended effect of the medication is relief of pain from
gastric irritation, often called heartburn by clients. Omeprazole is
not used to treat the conditions identified in options 1, 3, and 4.
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 (Bi-
axin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which
statement by the client indicates the best understanding of the
medication regimen?
1. "My ulcer will heal because these medications will kill the bac-
teria."
2. "These medications are only taken when I have pain from my
ulcer."
3. "The medications will kill the bacteria and stop the acid produc-
tion."
4. "These medications will coat the ulcer and decrease the acid
production in my stomach."
3. "The medications will kill the bacteria and stop the acid produc-
tion."
Rationale:
Triple therapy for Helicobacter pylori infection usually includes two
antibacterial drugs and a proton pump inhibitor. Clarithromycin
and amoxicillin are antibacterials. Esomeprazole is a proton pump
inhibitor. These medications will kill the bacteria and decrease
acid production.
43.) A histamine (H2)-receptor antagonist will be prescribed for a

client. The nurse understands that which medications are H2-re-
ceptor antagonists? Select all that apply.
1. Nizatidine (Axid)

lOMoARcPSD|3083804
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
5. Esomeprazole (Nexium)
6. Lansoprazole (Prevacid)
1. Nizatidine (Axid)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
Rationale:
H2-receptor antagonists suppress secretion of gastric acid, allevi-
ate symptoms of heartburn, and assist in preventing complica-
tions of peptic ulcer disease. These medications also suppress
gastric acid secretions and are used in active ulcer disease, ero-
sive esophagitis, and pathological hypersecretory conditions. The
other medications listed are proton pump inhibitors.
H2-receptor antagonists medication names end with -dine.
Proton pump inhibitors medication names end with -zole.
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?
1. Ambu bag
2. Intubation tray
3. Nasogastric tube
4. Suction equipment
4. Suction equipment
Rationale:
Acetylcysteine can be given orally or by nasogastric tube to treat
acetaminophen overdose, or it may be given by inhalation for use
as a mucolytic. The nurse administering this medication as a mu-
colytic should have suction equipment available in case the client
cannot manage to clear the increased volume of liquefied secre-
tions.

lOMoARcPSD|3083804
45.) A client has a prescription to take guaifenesin (Humibid) ev-

ery 4 hours, as needed. The nurse determines that the client un-
derstands the most effective use of this medication if the client
states that he or she will:
1. Watch for irritability as a side effect.
3. Take an extra dose if the cough is accompanied by fever.
4. Crush the sustained-release tablet if immediate relief is
needed.
Rationale:
Guaifenesin is an expectorant. It should be taken with a full glass
of water to decrease viscosity of secretions. Sustained-release
preparations should not be broken open, crushed, or chewed. The
medication may occasionally cause dizziness, headache, or
drowsiness as side effects. The client should contact the health
care provider if the cough lasts longer than 1 week or is accompa-
nied by fever, rash, sore throat, or persistent headache.
46.) A postoperative client has received a dose of naloxone hy-

drochloride for respiratory depression shortly after transfer to the
nursing unit from the postanesthesia care unit. After administra-
tion of the medication, the nurse checks the client for:
1. Pupillary changes
2. Scattered lung wheezes
3. Sudden increase in pain
4. Sudden episodes of diarrhea
3. Sudden increase in pain
Rationale:
Naloxone hydrochloride is an antidote to opioids and may also be
given to the postoperative client to treat respiratory depression.
When given to the postoperative client for respiratory depression,

lOMoARcPSD|3083804
it may also reverse the effects of analgesics. Therefore, the nurse

must check the client for a sudden increase in the level of pain ex-
perienced. Options 1, 2, and 4 are not associated with this medi-
cation.
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:
1. Hypercalcemia
3. Small blood vessel spasm
4. Impaired peripheral circulation
Rationale:
A common side effect of the TB drug INH is peripheral neuritis.
This is manifested by numbness, tingling, and paresthesias in the
extremities. This side effect can be minimized by pyridoxine (vita-
min B6) intake. Options 1, 3, and 4 are incorrect.
48.) A client is to begin a 6-month course of therapy with isoniazid

(INH). A nurse plans to teach the client to:
1. Drink alcohol in small amounts only.
3. Increase intake of Swiss or aged cheeses.
4. Avoid vitamin supplements during therapy.
Rationale:
INH is hepatotoxic, and therefore the client is taught to report
signs and symptoms of hepatitis immediately (which include yel-
low skin and sclera). For the same reason, alcohol should be
avoided during therapy. The client should avoid intake of Swiss
cheese, fish such as tuna, and foods containing tyramine because

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they may cause a reaction characterized by redness and itching

of the skin, flushing, sweating, tachycardia, headache, or light-
headedness. The client can avoid developing peripheral neuritis
by increasing the intake of pyridoxine (vitamin B6) during the
course of INH therapy for TB.
49.) A client has been started on long-term therapy with rifampin

(Rifadin). A nurse teaches the client that the medication:
1. Should always be taken with food or antacids
2. Should be double-dosed if one dose is forgotten
4. May be discontinued independently if symptoms are gone in 3
months
Rationale:
Rifampin should be taken exactly as directed as part of TB ther-
apy. Doses should not be doubled or skipped. The client should
not stop therapy until directed to do so by a health care provider.
The medication should be administered on an empty stomach un-
less it causes gastrointestinal upset, and then it may be taken
with food. Antacids, if prescribed, should be taken at least 1 hour
before the medication. Rifampin causes orange-red discoloration
of body secretions and will permanently stain soft contact lenses.
50.) A nurse has given a client taking ethambutol (Myambutol) in-

formation about the medication. The nurse determines that the
client understands the instructions if the client states that he or
she will immediately report:
2. Problems with visual acuity
3. Gastrointestinal (GI) side effects
2. Problems with visual acuity

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Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity
and the ability to discriminate between the colors red and green.
This poses a potential safety hazard when a client is driving a mo-
tor vehicle. The client is taught to report this symptom immedi-
ately. The client is also taught to take the medication with food if
GI upset occurs. Impaired hearing results from antitubercular ther-
apy with streptomycin. Orange-red discoloration of secretions oc-
curs with rifampin (Rifadin).
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 medica-
tion?
1. To take the medication before meals
2. To return to the clinic weekly for serum drug-level testing
3. It is not necessary to call the health care provider (HCP) if a
skin rash occurs.
4. It is not necessary to restrict alcohol intake with this medication.
2. To return to the clinic weekly for serum drug-level testing
Rationale:
Cycloserine (Seromycin) is an antitubercular medication that re-
quires weekly serum drug level determinations to monitor for the
potential of neurotoxicity. Serum drug levels lower than 30
mcg/mL reduce the incidence of neurotoxicity. The medication
must be taken after meals to prevent gastrointestinal irritation.
The client must be instructed to notify the HCP if a skin rash or
signs of central nervous system toxicity are noted. Alcohol must
be avoided because it increases the risk of seizure activity.
52.) A client with tuberculosis is being started on antituberculosis

therapy with isoniazid (INH). Before giving the client the first dose,

lOMoARcPSD|3083804
a nurse ensures that which of the following baseline studies has

been completed?
1. Electrolyte levels
2. Coagulation times
4. Serum creatinine level
Rationale:
INH therapy can cause an elevation of hepatic enzyme levels and
hepatitis. Therefore, liver enzyme levels are monitored when ther-
apy is initiated and during the first 3 months of therapy. They may
be monitored longer in the client who is greater than age 50 or
abuses alcohol.
53.) Rifabutin (Mycobutin) is prescribed for a client with active My-

cobacterium avium complex (MAC) disease and tuberculosis. The
nurse monitors for which side effects of the medication? Select all
that apply.
4. Vitamin B6 deficiency
6. Tingling and numbness of the fingers
Rationale:
Rifabutin (Mycobutin) may be prescribed for a client with active
MAC disease and tuberculosis. It inhibits mycobacterial DNA-de-
pendent RNA polymerase and suppresses protein synthesis. Side
effects include rash, gastrointestinal disturbances, neutropenia
(low neutrophil count), red-orange body secretions, uveitis

lOMoARcPSD|3083804
(blurred vision and eye pain), myositis, arthralgia, hepatitis, chest

pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency
and numbness and tingling in the extremities are associated with
the use of isoniazid (INH). Ethambutol (Myambutol) also causes
peripheral neuritis.
54.) A nurse reinforces discharge instructions to a postoperative

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."
Rationale:
Ecotrin is an aspirin-containing product and should be avoided.
Alcohol consumption should be avoided by a client taking warfarin
sodium. Taking prescribed medication at the same time each day
increases client compliance. The Medic-Alert bracelet provides
health care personnel emergency information.
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 fol-
lowing is the therapeutic serum level (range) for digoxin?
1. 3 to 5 ng/mL
2. 0.5 to 2 ng/mL
3. 1.2 to 2.8 ng/mL
4. 3.5 to 5.5 ng/mL

lOMoARcPSD|3083804
2.) 0.5 to 2 ng/mL

Rationale:
Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. There-
fore, options 1, 3, and 4 are incorrect.
56.) Heparin sodium is prescribed for the client. The nurse ex-
pects that the health care provider will prescribe which of the fol-
lowing to monitor for a therapeutic effect of the medication?
1. Hematocrit level
2. Hemoglobin level
3. Prothrombin time (PT)
4. Activated partial thromboplastin time (aPTT)
4. Activated partial thromboplastin time (aPTT)
Rationale:
The PT will assess for the therapeutic effect of warfarin sodium
(Coumadin) and the aPTT will assess the therapeutic effect of
heparin sodium. Heparin sodium doses are determined based on
these laboratory results. The hemoglobin and hematocrit values
assess red blood cell concentrations.
57.) A nurse is monitoring a client who is taking propranolol (In-

deral LA). Which data collection finding would indicate a potential
serious complication associated with propranolol?
1. The development of complaints of insomnia
3. A baseline blood pressure of 150/80 mm Hg followed by a
blood pressure of 138/72 mm Hg after two doses of the medica-
tion
4. A baseline resting heart rate of 88 beats/min followed by a rest-
ing heart rate of 72 beats/min after two doses of the medication
Rationale:

lOMoARcPSD|3083804
Audible expiratory wheezes may indicate a serious adverse reac-

tion, bronchospasm. β-Blockers may induce this reaction, particu-
larly in clients with chronic obstructive pulmonary disease or
asthma. Normal decreases in blood pressure and heart rate are
expected. Insomnia is a frequent mild side effect and should be
monitored.
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:
1. Cut the dose in half.
2. Discontinue the medication.
3. Take the medication with food.
4. Contact the health care provider (HCP).
Rationale:
Isosorbide mononitrate is an antianginal medication. Headache is
a frequent side effect of isosorbide mononitrate and usually disap-
pears during continued therapy. If a headache occurs during ther-
apy, the client should be instructed to take the medication with
food or meals. It is not necessary to contact the HCP unless the
headaches persist with therapy. It is not appropriate to instruct the
client to discontinue therapy or adjust the dosages.
59.) A client is diagnosed with an acute myocardial infarction and

tPA). Which action is a priority nursing intervention?
1. Monitor for renal failure.
2. Monitor psychosocial status.
4. Have heparin sodium available.

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Rationale:
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a
complication of any type of thrombolytic medication. The client is
monitored for bleeding. Monitoring for renal failure and monitoring
the client's psychosocial status are important but are not the most
critical interventions. Heparin is given after thrombolytic therapy,
but the question is not asking about follow-up medications.
60.) A nurse is planning to administer hydrochlorothiazide (Hy-

cation?
1. Hypouricemia, hyperkalemia
2. Increased risk of osteoporosis
4. Hyperkalemia, hypoglycemia, penicillin allergy
Rationale:
Thiazide diuretics such as hydrochlorothiazide are sulfa-based
medications, and a client with a sulfa allergy is at risk for an aller-
gic reaction. Also, clients are at risk for hypokalemia, hyper-
glycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.
61.) A home health care nurse is visiting a client with elevated

further education?
1. "Constipation and bloating might be a problem."
2. "I'll continue to watch my diet and reduce my fats."
3. "Walking a mile each day will help the whole process."

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Rationale:
Nicotinic acid, even an over-the-counter form, should be avoided
because it may lead to liver abnormalities. All lipid-lowering medi-
cations also can cause liver abnormalities, so a combination of
nicotinic acid and cholestyramine resin is to be avoided. Constipa-
tion and bloating are the two most common side effects. Walking
and the reduction of fats in the diet are therapeutic measures to
reduce cholesterol and triglyceride levels.
62.) A client is on nicotinic acid (niacin) for hyperlipidemia and the

the instructions?
1. "It is not necessary to avoid the use of alcohol."
2. "The medication should be taken with meals to decrease flush-
ing."
3. "Clay-colored stools are a common side effect and should not
be of concern."
Rationale:
Flushing is a side effect of this medication. Aspirin or a nons-
teroidal anti-inflammatory drug can be taken 30 minutes before
taking the medication to decrease flushing. Alcohol consumption
needs to be avoided because it will enhance this side effect. The
medication should be taken with meals, this will decrease gas-
trointestinal upset. Taking the medication with meals has no effect
on the flushing. Clay-colored stools are a sign of hepatic dysfunc-
tion and should be immediately reported to the health care
provider (HCP).

lOMoARcPSD|3083804
63.) A client with coronary artery disease complains of substernal

chest pain. After checking the client's heart rate and blood pres-
sure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After
5 minutes, the client states, "My chest still hurts." Select the ap-
propriate actions that the nurse should take. Select all that apply.
1. Call a code blue.
2. Contact the registered nurse.
3. Contact the client's family.
4. Assess the client's pain level.
5. Check the client's blood pressure.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.
2. Contact the registered nurse.
4. Assess the client's pain level.
6. Administer a second nitroglycerin, 0.4 mg, sublingually.
Rationale:
The usual guideline for administering nitroglycerin tablets for a
hospitalized client with chest pain is to administer one tablet every
5 minutes PRN for chest pain, for a total dose of three tablets.
The registered nurse should be notified of the client's condition,
who will then notify the health care provider as appropriate. Be-
cause the client is still complaining of chest pain, the nurse would
administer a second nitroglycerin tablet. The nurse would assess
the client's pain level and check the client's blood pressure before
administering each nitroglycerin dose. There are no data in the
question that indicate the need to call a code blue. In addition, it is
not necessary to contact the client's family unless the client has
requested this.
64.) Nalidixic acid (NegGram) is prescribed for a client with a uri-

nary tract infection. On review of the client's record, the nurse
notes that the client is taking warfarin sodium (Coumadin) daily.
Which prescription should the nurse anticipate for this client?
1. Discontinuation of warfarin sodium (Coumadin)

lOMoARcPSD|3083804
2. A decrease in the warfarin sodium (Coumadin) dosage

3. An increase in the warfarin sodium (Coumadin) dosage
4. A decrease in the usual dose of nalidixic acid (NegGram)
2. A decrease in the warfarin sodium (Coumadin) dosage
Rationale:
Nalidixic acid can intensify the effects of oral anticoagulants by
displacing these agents from binding sites on plasma protein.
When an oral anticoagulant is combined with nalidixic acid, a de-
crease in the anticoagulant dosage may be needed.
65.) A nurse is reinforcing discharge instructions to a client receiv-

ing sulfisoxazole. Which of the following should be included in the
list of instructions?
1. Restrict fluid intake.
2. Maintain a high fluid intake.
3. If the urine turns dark brown, call the health care provider
(HCP) immediately.
4. Decrease the dosage when symptoms are improving to prevent
an allergic response.
Rationale:
Each dose of sulfisoxazole should be administered with a full
glass of water, and the client should maintain a high fluid intake.
The medication is more soluble in alkaline urine. The client should
not be instructed to taper or discontinue the dose. Some forms of
sulfisoxazole cause urine to turn dark brown or red. This does not
indicate the need to notify the HCP.
66.) Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for

a client. A nurse should instruct the client to report which symptom
if it developed during the course of this medication therapy?
1. Nausea
2. Diarrhea

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3. Headache
4. Sore throat
4. Sore throat
Rationale:
Clients taking trimethoprim-sulfamethoxazole (TMP-SMZ) should
be informed about early signs of blood disorders that can occur
from this medication. These include sore throat, fever, and pallor,
and the client should be instructed to notify the health care
provider if these symptoms occur. The other options do not re-
quire health care provider notification.
67.) Phenazopyridine hydrochloride (Pyridium) is prescribed for a

client for symptomatic relief of pain resulting from a lower urinary
tract infection. The nurse reinforces to the client:
1. To take the medication at bedtime
2. To take the medication before meals
3. To discontinue the medication if a headache occurs
4. That a reddish orange discoloration of the urine may occur
4. That a reddish orange discoloration of the urine may occur
Rationale:
The nurse should instruct the client that a reddish-orange discol-
oration of urine may occur. The nurse also should instruct the
client that this discoloration can stain fabric. The medication
should be taken after meals to reduce the possibility of gastroin-
testinal upset. A headache is an occasional side effect of the med-
ication and does not warrant discontinuation of the medication.
68.) Bethanechol chloride (Urecholine) is prescribed for a client

with urinary retention. Which disorder would be a contraindication
to the administration of this medication?
1. Gastric atony
2. Urinary strictures
3. Neurogenic atony

lOMoARcPSD|3083804
4. Gastroesophageal reflux
2. Urinary strictures
Rationale:
Bethanechol chloride (Urecholine) can be harmful to clients with
urinary tract obstruction or weakness of the bladder wall. The
medication has the ability to contract the bladder and thereby in-
crease pressure within the urinary tract. Elevation of pressure
within the urinary tract could rupture the bladder in clients with
these conditions.
69.) A nurse who is administering bethanechol chloride (Ure-

choline) is monitoring for acute toxicity associated with the medi-
cation. The nurse checks the client for which sign of toxicity?
1. Dry skin
2. Dry mouth
3. Bradycardia
4. Signs of dehydration
3. Bradycardia
Rationale:
Toxicity (overdose) produces manifestations of excessive mus-
carinic stimulation such as salivation, sweating, involuntary urina-
tion and defecation, bradycardia, and severe hypotension. Treat-
ment includes supportive measures and the administration of at-
ropine sulfate subcutaneously or intravenously.
70.) Oxybutynin chloride (Ditropan XL) is prescribed for a client

with neurogenic bladder. Which sign would indicate a possible
toxic effect related to this medication?
1. Pallor
2. Drowsiness
3. Bradycardia
4. Restlessness
4. Restlessness

lOMoARcPSD|3083804
Rationale:
Toxicity (overdosage) of this medication produces central nervous
system excitation, such as nervousness, restlessness, hallucina-
tions, and irritability. Other signs of toxicity include hypotension or
hypertension, confusion, tachycardia, flushed or red face, and
signs of respiratory depression. Drowsiness is a frequent side ef-
fect of the medication but does not indicate overdosage.
71.) After kidney transplantation, cyclosporine (Sand immune) is

prescribed for a client. Which laboratory result would indicate an
adverse effect from the use of this medication?
1. Decreased creatinine level
2. Decreased hemoglobin level
3. Elevated blood urea nitrogen level
4. Decreased white blood cell count
3. Elevated blood urea nitrogen level
Rationale:
Nephrotoxicity can occur from the use of cyclosporine (Sandim-
mune). Nephrotoxicity is evaluated by monitoring for elevated
blood urea nitrogen (BUN) and serum creatinine levels. Cy-
closporine is an immunosuppressant but does not depress the
bone marrow.
72.) Cinoxacin (Cinobac), a urinary antiseptic, is prescribed for

the client. The nurse reviews the client's medical record and
should contact the health care provider (HCP) regarding which
documented finding to verify the prescription? Refer to chart.
1. Renal insufficiency
2. Chest x-ray: normal
3. Blood glucose, 102 mg/dL
4. Folic acid (vitamin B6) 0.5 mg, orally daily
1. Renal insufficiency
Rationale:

lOMoARcPSD|3083804
Cinoxacin should be administered with caution in clients with re-

nal impairment. The dosage should be reduced, and failure to do
so could result in accumulation of cinoxacin to toxic levels. There-
fore the nurse would verify the prescription if the client had a doc-
umented history of renal insufficiency. The laboratory and diag-
nostic test results are normal findings. Folic acid (vitamin B6) may
be prescribed for a client with renal insufficiency to prevent ane-
mia.
73.) A client with myasthenia gravis is suspected of having cholin-

ergic crisis. Which of the following indicate that this crisis exists?
1. Ataxia
2. Mouth sores
3. Hypotension
4. Hypertension
4. Hypertension
Rationale:
Cholinergic crisis occurs as a result of an overdose of medication.
Indications of cholinergic crisis include gastrointestinal distur-
bances, nausea, vomiting, diarrhea, abdominal cramps, increased
salivation and tearing, miosis, hypertension, sweating, and in-
creased bronchial secretions.
74.) A client with myasthenia gravis is receiving pyridostigmine

(Mestinon). The nurse monitors for signs and symptoms of cholin-
ergic crisis caused by overdose of the medication. The nurse
checks the medication supply to ensure that which medication is
available for administration if a cholinergic crisis occurs?
1. Vitamin K
2. Atropine sulfate
2. Atropine sulfate

lOMoARcPSD|3083804
Rationale:
The antidote for cholinergic crisis is atropine sulfate. Vitamin K is
the antidote for warfarin (Coumadin). Protamine sulfate is the anti-
dote for heparin, and acetylcysteine (Mucomyst) is the antidote for
acetaminophen (Tylenol).
75.) A client with myasthenia gravis becomes increasingly weak.

The health care provider prepares to identify whether the client is
reacting to an overdose of the medication (cholinergic crisis) or in-
creasing severity of the disease (myasthenic crisis). An injection
of edrophonium (Enlon) is administered. Which of the following in-
dicates that the client is in cholinergic crisis?
2. Complaints of muscle spasms
3. An improvement of the weakness
Rationale:
An edrophonium (Enlon) injection, a cholinergic drug, makes the
client in cholinergic crisis temporarily worse. This is known as a
negative test. An improvement of weakness would occur if the
client were experiencing myasthenia gravis. Options 1 and 2
would not occur in either crisis.
76.) Carbidopa-levodopa (Sinemet) is prescribed for a client with

Parkinson's disease, and the nurse monitors the client for adverse
reactions to the medication. Which of the following indicates that
the client is experiencing an adverse reaction?
1. Pruritus
2. Tachycardia
3. Hypertension

lOMoARcPSD|3083804
Rationale:
Dyskinesia and impaired voluntary movement may occur with
high levodopa dosages. Nausea, anorexia, dizziness, orthostatic
hypotension, bradycardia, and akinesia (the temporary muscle
weakness that lasts 1 minute to 1 hour, also known as the "on-off
phenomenon") are frequent side effects of the medication.
77.) Phenytoin (Dilantin), 100 mg orally three times daily, has

been prescribed for a client for seizure control. The nurse rein-
forces instructions regarding the medication to the client. Which
statement by the client indicates an understanding of the instruc-
tions?
1. "I will use a soft toothbrush to brush my teeth."
2. "It's all right to break the capsules to make it easier for me to
swallow them."
3. "If I forget to take my medication, I can wait until the next dose
and eliminate that dose."
4. "If my throat becomes sore, it's a normal effect of the medica-
tion and it's nothing to be concerned about."
1. "I will use a soft toothbrush to brush my teeth."
Rationale:
Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperplasia,
bleeding, swelling, and tenderness of the gums can occur with the
use of this medication. The client needs to be taught good oral hy-
giene, gum massage, and the need for regular dentist visits. The
client should not skip medication doses, because this could pre-
cipitate a seizure. Capsules should not be chewed or broken and
they must be swallowed. The client needs to be instructed to re-
port a sore throat, fever, glandular swelling, or any skin reaction,
because this indicates hematological toxicity.

lOMoARcPSD|3083804
78.) A client is taking phenytoin (Dilantin) for seizure control and a

sample for a serum drug level is drawn. Which of the following in-
dicates a therapeutic serum drug range?
1. 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL
2. 10 to 20 mcg/mL
Rationale:
The therapeutic serum drug level range for phenytoin (Dilantin) is
10 to 20 mcg/mL.
* A helpful hint may be to remember that the theophylline
therapeutic range and the acetaminophen (Tylenol) therapeu-
tic range are the same as the phenytoin (Dilantin) therapeutic
range.*
79.) Ibuprofen (Advil) is prescribed for a client. The nurse tells the
client to take the medication:
1. With 8 oz of milk
2. In the morning after arising
3. 60 minutes before breakfast
4. At bedtime on an empty stomach
1. With 8 oz of milk
Rationale:
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID).
NSAIDs should be given with milk or food to prevent gastrointesti-
nal irritation. Options 2, 3, and 4 are incorrect.
80.) A nurse is caring for a client who is taking phenytoin (Dilantin)

for control of seizures. During data collection, the nurse notes that
the client is taking birth control pills. Which of the following infor-
mation should the nurse provide to the client?
1. Pregnancy should be avoided while taking phenytoin (Dilantin).

lOMoARcPSD|3083804
2. The client may stop taking the phenytoin (Dilantin) if it is caus-

ing severe gastrointestinal effects.
3. The potential for decreased effectiveness of the birth control
pills exists while taking phenytoin (Dilantin).
4. The increased risk of thrombophlebitis exists while taking
phenytoin (Dilantin) and birth control pills together.
3. The potential for decreased effectiveness of the birth control
pills exists while taking phenytoin (Dilantin).
Rationale:
Phenytoin (Dilantin) enhances the rate of estrogen metabolism,
which can decrease the effectiveness of some birth control pills.
Options 1, 2, are 4 are not accurate.
81.) A client with trigeminal neuralgia is being treated with carba-

mazepine (Tegretol). Which laboratory result would indicate that
the client is experiencing an adverse reaction to the medication?
1. Sodium level, 140 mEq/L
2. Uric acid level, 5.0 mg/dL
3. White blood cell count, 3000 cells/mm3
4. Blood urea nitrogen (BUN) level, 15 mg/dL
3. White blood cell count, 3000 cells/mm3
Rationale:
Adverse effects of carbamazepine (Tegretol) appear as blood
dyscrasias, including aplastic anemia, agranulocytosis, thrombo-
cytopenia, leukopenia, cardiovascular disturbances, throm-
bophlebitis, dysrhythmias, and dermatological effects. Options 1,
2, and 4 identify normal laboratory values.
82.) A client is receiving meperidine hydrochloride (Demerol) for

pain. Which of the following are side effects of this medication.
Select all that apply.
1. Diarrhea
2. Tremors

lOMoARcPSD|3083804
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory rate
2. Tremors
3. Drowsiness
4. Hypotension
Rationale:
Meperidine hydrochloride is an opioid analgesic. Side effects in-
clude respiratory depression, drowsiness, hypotension, constipa-
tion, urinary retention, nausea, vomiting, and tremors.
83.) The client has been on treatment for rheumatoid arthritis for 3
weeks. During the administration of etanercept (Enbrel), it is most
important for the nurse to check:
1. The injection site for itching and edema
2. The white blood cell counts and platelet counts
3. Whether the client is experiencing fatigue and joint pain
4. A metallic taste in the mouth, with a loss of appetite
Rationale:
Infection and pancytopenia are side effects of etanercept (Enbrel).
Laboratory studies are performed before and during drug treat-
ment. The appearance of abnormal white blood cell counts and
abnormal platelet counts can alert the nurse to a potentially life-
threatening infection. Injection site itching is a common occur-
rence following administration. A metallic taste with loss of ap-
petite are not common signs of side effects of this medication.
84.) Baclofen (Lioresal) is prescribed for the client with multiple

sclerosis. The nurse assists in planning care, knowing that the pri-
mary therapeutic effect of this medication is which of the follow-
ing?

lOMoARcPSD|3083804
1. Increased muscle tone

2. Decreased muscle spasms
3. Increased range of motion
4. Decreased local pain and tenderness
2. Decreased muscle spasms
Rationale:
Baclofen is a skeletal muscle relaxant and central nervous system
depressant and acts at the spinal cord level to decrease the fre-
quency and amplitude of muscle spasms in clients with spinal
cord injuries or diseases and in clients with multiple sclerosis. Op-
tions 1, 3, and 4 are incorrect.
85.) A nurse is monitoring a client receiving baclofen (Lioresal) for

side effects related to the medication. Which of the following
would indicate that the client is experiencing a side effect?
1. Polyuria
2. Diarrhea
3. Drowsiness
4. Muscular excitability
3. Drowsiness
Rationale:
Baclofen is a central nervous system (CNS) depressant and fre-
quently causes drowsiness, dizziness, weakness, and fatigue. It
can also cause nausea, constipation, and urinary retention.
Clients should be warned about the possible reactions. Options 1,
2, and 4 are not side effects.
86.) A nurse is reinforcing discharge instructions to a client receiv-

ing baclofen (Lioresal). Which of the following would the nurse in-
clude in the instructions?
2. Avoid the use of alcohol.
3. Stop the medication if diarrhea occurs.

lOMoARcPSD|3083804
4. Notify the health care provider if fatigue occurs.

2. Avoid the use of alcohol.
Rationale:
Baclofen is a central nervous system (CNS) depressant. The
client should be cautioned against the use of alcohol and other
CNS depressants, because baclofen potentiates the depressant
activity of these agents. Constipation rather than diarrhea is an
adverse effect of baclofen. It is not necessary to restrict fluids, but
the client should be warned that urinary retention can occur. Fa-
tigue is related to a CNS effect that is most intense during the
early phase of therapy and diminishes with continued medication
use. It is not necessary that the client notify the health care
provider if fatigue occurs.
87.) A client with acute muscle spasms has been taking baclofen
(Lioresal). The client calls the clinic nurse because of continuous
feelings of weakness and fatigue and asks the nurse about dis-
continuing the medication. The nurse should make which appro-
priate response to the client?
1. "You should never stop the medication."
2. "It is best that you taper the dose if you intend to stop the medi-
cation."
3. "It is okay to stop the medication if you think that you can toler-
ate the muscle spasms."
4. "Weakness and fatigue commonly occur and will diminish with
continued medication use."
4. "Weakness and fatigue commonly occur and will diminish with
continued medication use."
Rationale:
The client should be instructed that symptoms such as drowsi-
ness, weakness, and fatigue are more intense in the early phase
of therapy and diminish with continued medication use. The client
should be instructed never to withdraw or stop the medication
abruptly, because abrupt withdrawal can cause visual hallucina-

lOMoARcPSD|3083804
tions, paranoid ideation, and seizures. It is best for the nurse to in-
form the client that these symptoms will subside and encourage
the client to continue the use of the medication.
88.) Dantrolene sodium (Dantrium) is prescribed for a client expe-

riencing flexor spasms, and the client asks the nurse about the
action of the medication. The nurse responds, knowing that the
therapeutic action of this medication is which of the following?
1. Depresses spinal reflexes
2. Acts directly on the skeletal muscle to relieve spasticity
3. Acts within the spinal cord to suppress hyperactive reflexes
4. Acts on the central nervous system (CNS) to suppress spasms
2. Acts directly on the skeletal muscle to relieve spasticity
Rationale:
Dantrium acts directly on skeletal muscle to relieve muscle spas-
ticity. The primary action is the suppression of calcium release
from the sarcoplasmic reticulum. This in turn decreases the ability
of the skeletal muscle to contract.
*Options 1, 3, and 4 are all comparable or alike in that they
address CNS suppression and the depression of reflexes.
Therefore, eliminate these options.*
89.) A nurse is reviewing the laboratory studies on a client receiv-

ing dantrolene sodium (Dantrium). Which laboratory test would
identify an adverse effect associated with the administration of
this medication?
1. Creatinine
3. Blood urea nitrogen
4. Hematological function tests
Rationale:

lOMoARcPSD|3083804
Dose-related liver damage is the most serious adverse effect of

dantrolene. To reduce the risk of liver damage, liver function tests
should be performed before treatment and periodically throughout
the treatment course. It is administered in the lowest effective
dosage for the shortest time necessary.
*Eliminate options 1 and 3 because these tests both assess
kidney function.*
90.) A nurse is reviewing the record of a client who has been pre-
scribed baclofen (Lioresal). Which of the following disorders, if
noted in the client's history, would alert the nurse to contact the
health care provider?
1. Seizure disorders
2. Hyperthyroidism
4. Coronary artery disease
1. Seizure disorders
Rationale:
Clients with seizure disorders may have a lowered seizure thresh-
old when baclofen is administered. Concurrent therapy may re-
quire an increase in the anticonvulsive medication. The disorders
in options 2, 3, and 4 are not a concern when the client is taking
baclofen.
91.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat

muscle spasms, and the nurse is reviewing the client's record.
Which of the following disorders, if noted in the client's record,
would indicate a need to contact the health care provider regard-
ing the administration of this medication?
1. Glaucoma
2. Emphysema
3. Hyperthyroidism

lOMoARcPSD|3083804
1. Glaucoma
Rationale:
Because this medication has anticholinergic effects, it should be
used with caution in clients with a history of urinary retention, an-
gle-closure glaucoma, and increased intraocular pressure. Cy-
clobenzaprine hydrochloride should be used only for short-term 2-
to 3-week therapy.
92.) In monitoring a client's response to disease-modifying an-

tirheumatic drugs (DMARDs), which findings would the nurse in-
terpret as acceptable responses? Select all that apply.
1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degen-
eration
4. An increased range of motion in the affected joints 3 months
into therapy
5. Inflammation and irritation at the injection site 3 days after in-
jection is given
6. A low-grade temperature upon rising in the morning that re-
mains throughout the day
1. Symptom control during periods of emotional stress
2. Normal white blood cell counts, platelet, and neutrophil counts
3. Radiological findings that show nonprogression of joint degen-
eration
4. An increased range of motion in the affected joints 3 months
into therapy
Rationale:
Because emotional stress frequently exacerbates the symptoms
of rheumatoid arthritis, the absence of symptoms is a positive
finding. DMARDs are given to slow progression of joint degenera-
tion. In addition, the improvement in the range of motion after 3
months of therapy with normal blood work is a positive finding.

lOMoARcPSD|3083804
Temperature elevation and inflammation and irritation at the medi-

cation injection site could indicate signs of infection.
93.) The client who is human immunodeficiency virus seropositive

has been taking stavudine (d4t, Zerit). The nurse monitors which
of the following most closely while the client is taking this medica-
tion?
1. Gait
2. Appetite
3. Level of consciousness
4. Hemoglobin and hematocrit blood levels
1. Gait
Rationale:
Stavudine (d4t, Zerit) is an antiretroviral used to manage human
immunodeficiency virus infection in clients who do not respond to
or who cannot tolerate conventional therapy. The medication can
cause peripheral neuropathy, and the nurse should monitor the
client's gait closely and ask the client about paresthesia. Options
2, 3, and 4 are unrelated to the use of the medication.
94.) The client with acquired immunodeficiency syndrome has be-

gun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV).
The nurse carefully monitors which of the following laboratory re-
sults during treatment with this medication?
1. Blood culture
Rationale:
A common side effect of therapy with zidovudine is leukopenia
and anemia. The nurse monitors the complete blood count results

lOMoARcPSD|3083804
for these changes. Options 1, 2, and 3 are unrelated to the use of

this medication.
95.) The nurse is reviewing the results of serum laboratory studies

drawn on a client with acquired immunodeficiency syndrome who
is receiving didanosine (Videx). The nurse interprets that the
client may have the medication discontinued by the health care
provider if which of the following significantly elevated results is
noted?
1. Serum protein
2. Blood glucose
3. Serum amylase
4. Serum creatinine
3. Serum amylase
Rationale:
Didanosine (Videx) can cause pancreatitis. A serum amylase level
that is increased 1.5 to 2 times normal may signify pancreatitis in
the client with acquired immunodeficiency syndrome and is poten-
tially fatal. The medication may have to be discontinued. The
medication is also hepatotoxic and can result in liver failure.
96.) The nurse is caring for a postrenal transplant client taking cy-
closporine (Sandimmune, Gengraf, Neoral). The nurse notes an
increase in one of the client's vital signs, and the client is com-
plaining of a headache. What is the vital sign that is most likely in-
creased?
1. Pulse
2. Respirations
3. Blood pressure
4. Pulse oximetry
3. Blood pressure
Rationale:

lOMoARcPSD|3083804
Hypertension can occur in a client taking cyclosporine (Sandim-

mune, Gengraf, Neoral), and because this client is also complain-
ing of a headache, the blood pressure is the vital sign to be moni-
toring most closely. Other adverse effects include infection,
nephrotoxicity, and hirsutism. Options 1, 2, and 4 are unrelated to
the use of this medication.
97.) Amikacin (Amikin) is prescribed for a client with a bacterial in-

fection. The client is instructed to contact the health care provider
(HCP) immediately if which of the following occurs?
1. Nausea
2. Lethargy
3. Hearing loss
4. Muscle aches
3. Hearing loss
Rationale:
Amikacin (Amikin) is an aminoglycoside. Adverse effects of
aminoglycosides include ototoxicity (hearing problems), confu-
sion, disorientation, gastrointestinal irritation, palpitations, blood
pressure changes, nephrotoxicity, and hypersensitivity. The nurse
instructs the client to report hearing loss to the HCP immediately.
Lethargy and muscle aches are not associated with the use of this
medication. It is not necessary to contact the HCP immediately if
nausea occurs. If nausea persists or results in vomiting, the HCP
should be notified.
*(most aminoglycoside medication names end in the letters
-cin)*
98.) The nurse is assigned to care for a client with cy-

tomegalovirus retinitis and acquired immunodeficiency syndrome
who is receiving foscarnet. The nurse should check the latest re-
sults of which of the following laboratory studies while the client is
taking this medication?

lOMoARcPSD|3083804
1. CD4 cell count

2. Serum albumin
3. Serum creatinine
4. Lymphocyte count
3. Serum creatinine
Rationale:
Foscarnet is toxic to the kidneys. Serum creatinine is monitored
before therapy, two to three times per week during induction ther-
apy, and at least weekly during maintenance therapy. Foscarnet
may also cause decreased levels of calcium, magnesium, phos-
phorus, and potassium. Thus these levels are also measured with
the same frequency.
99.) The client with acquired immunodeficiency syndrome and

Pneumocystis jiroveci infection has been receiving pentamidine
isethionate (Pentam 300). The client develops a temperature of
101° F. The nurse does further monitoring of the client, knowing
that this sign would most likely indicate:
1. The dose of the medication is too low.
2. The client is experiencing toxic effects of the medication.
3. The client has developed inadequacy of thermoregulation.
4. The result of another infection caused by leukopenic effects of
the medication.
4. The result of another infection caused by leukopenic effects of
the medication.
Rationale:
Frequent side effects of this medication include leukopenia,
thrombocytopenia, and anemia. The client should be monitored
routinely for signs and symptoms of infection. Options 1, 2, and 3
are inaccurate interpretations.

lOMoARcPSD|3083804
100.) Saquinavir (Invirase) is prescribed for the client who is hu-

man immunodeficiency virus seropositive. The nurse reinforces
medication instructions and tells the client to:
1. Avoid sun exposure.
2. Eat low-calorie foods.
3. Eat foods that are low in fat.
1. Avoid sun exposure.
Rationale:
Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used
with other antiretroviral medications to manage human immunod-
eficiency virus infection. Saquinavir is administered with meals
and is best absorbed if the client consumes high-calorie, high-fat
meals. Saquinavir can cause photosensitivity, and the nurse
should instruct the client to avoid sun exposure.
101.) Ketoconazole is prescribed for a client with a diagnosis of

candidiasis. Select the interventions that the nurse includes when
administering this medication. Select all that apply.
2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
4. Administer the medication with an antacid.
5. Instruct the client to avoid exposure to the sun.
6. Administer the medication on an empty stomach.
2. Instruct the client to avoid alcohol.
3. Monitor hepatic and liver function studies.
5. Instruct the client to avoid exposure to the sun.
Rationale:
Ketoconazole is an antifungal medication. It is administered with
food (not on an empty stomach) and antacids are avoided for 2
hours after taking the medication to ensure absorption. The medi-
cation is hepatotoxic and the nurse monitors liver function studies.
The client is instructed to avoid exposure to the sun because the

lOMoARcPSD|3083804
medication increases photosensitivity. The client is also instructed

to avoid alcohol. There is no reason for the client to restrict fluid
intake. In fact, this could be harmful to the client.
102.) A client with human immunodeficiency virus is taking nevi-

rapine (Viramune). The nurse should monitor for which adverse
effects of the medication? Select all that apply.
1. Rash
2. Hepatotoxicity
3. Hyperglycemia
4. Peripheral neuropathy
5. Reduced bone mineral density
1. Rash
2. Hepatotoxicity
Rationale:
Nevirapine (Viramune) is a non-nucleoside reverse transcriptase
inhibitors (NRTI) that is used to treat HIV infection. It is used in
combination with other antiretroviral medications to treat HIV. Ad-
verse effects include rash, Stevens-Johnson syndrome, hepatitis,
and increased transaminase levels. Hyperglycemia, peripheral
neuropathy, and reduced bone density are not adverse effects of
this medication.
103.) A nurse is caring for a hospitalized client who has been tak-
ing clozapine (Clozaril) for the treatment of a schizophrenic disor-
der. Which laboratory study prescribed for the client will the nurse
specifically review to monitor for an adverse effect associated with
the use of this medication?
1. Platelet count
2. Cholesterol level
4. Blood urea nitrogen level

lOMoARcPSD|3083804
Rationale:
Hematological reactions can occur in the client taking clozapine
and include agranulocytosis and mild leukopenia. The white blood
cell count should be checked before initiating treatment and
should be monitored closely during the use of this medication.
The client should also be monitored for signs indicating agranulo-
cytosis, which may include sore throat, malaise, and fever. Op-
tions 1, 2, and 4 are unrelated to this medication.
104.) Disulfiram (Antabuse) is prescribed for a client who is seen

in the psychiatric health care clinic. The nurse is collecting data
on the client and is providing instructions regarding the use of this
medication. Which is most important for the nurse to determine
before administration of this medication?
1. A history of hyperthyroidism
2. A history of diabetes insipidus
3. When the last full meal was consumed
4. When the last alcoholic drink was consumed
4. When the last alcoholic drink was consumed
Rationale:
Disulfiram is used as an adjunct treatment for selected clients with
chronic alcoholism who want to remain in a state of enforced so-
briety. Clients must abstain from alcohol intake for at least 12
hours before the initial dose of the medication is administered.
The most important data are to determine when the last alcoholic
drink was consumed. The medication is used with caution in
clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral
damage, nephritis, and hepatic disease. It is also contraindicated
in severe heart disease, psychosis, or hypersensitivity related to
the medication.
105.) A nurse is collecting data from a client and the client's

spouse reports that the client is taking donepezil hydrochloride

lOMoARcPSD|3083804
(Aricept). Which disorder would the nurse suspect that this client
may have based on the use of this medication?
1. Dementia
2. Schizophrenia
3. Seizure disorder
4. Obsessive-compulsive disorder
1. Dementia
Rationale:
Donepezil hydrochloride is a cholinergic agent used in the treat-
ment of mild to moderate dementia of the Alzheimer type. It en-
hances cholinergic functions by increasing the concentration of
acetylcholine. It slows the progression of Alzheimer's disease.
Options 2, 3, and 4 are incorrect.
106.) Fluoxetine (Prozac) is prescribed for the client. The nurse

reinforces instructions to the client regarding the administration of
the medication. Which statement by the client indicates an under-
standing about administration of the medication?
1. "I should take the medication with my evening meal."
2. "I should take the medication at noon with an antacid."
3. "I should take the medication in the morning when I first arise."
4. "I should take the medication right before bedtime with a
snack."
3. "I should take the medication in the morning when I first arise."
Rationale:
Fluoxetine hydrochloride is administered in the early morning
without consideration to meals.
*Eliminate options 1, 2, and 4 because they are comparable
or alike and indicate taking the medication with an antacid or
food.*

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107.) A client receiving a tricyclic antidepressant arrives at the

mental health clinic. Which observation indicates that the client is
correctly following the medication plan?
1. Reports not going to work for this past week
2. Complains of not being able to "do anything" anymore
3. Arrives at the clinic neat and appropriate in appearance
4. Reports sleeping 12 hours per night and 3 to 4 hours during the
day
3. Arrives at the clinic neat and appropriate in appearance
Rationale:
Depressed individuals will sleep for long periods, are not able to
go to work, and feel as if they cannot "do anything." Once they
have had some therapeutic effect from their medication, they will
report resolution of many of these complaints as well as demon-
strate an improvement in their appearance.
108.) A nurse is performing a follow-up teaching session with a

client discharged 1 month ago who is taking fluoxetine (Prozac).
What information would be important for the nurse to gather re-
garding the adverse effects related to the medication?
1. Cardiovascular symptoms
3. Problems with mouth dryness
4. Problems with excessive sweating
Rationale:
The most common adverse effects related to fluoxetine include
central nervous system (CNS) and gastrointestinal (GI) system
dysfunction. This medication affects the GI system by causing
nausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4
are not adverse effects of this medication.

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109.) A client taking buspirone (BuSpar) for 1 month returns to the

clinic for a follow-up visit. Which of the following would indicate
medication effectiveness?
1. No rapid heartbeats or anxiety
2. No paranoid thought processes
3. No thought broadcasting or delusions
4. No reports of alcohol withdrawal symptoms
1. No rapid heartbeats or anxiety
Rationale:
Buspirone hydrochloride is not recommended for the treatment of
drug or alcohol withdrawal, paranoid thought disorders, or
schizophrenia (thought broadcasting or delusions). Buspirone hy-
drochloride is most often indicated for the treatment of anxiety
and aggression.
110.) A client taking lithium carbonate (Lithobid) reports vomiting,

abdominal pain, diarrhea, blurred vision, tinnitus, and tremors.
The lithium level is checked as a part of the routine follow-up and
the level is 3.0 mEq/L. The nurse knows that this level is:
1. Toxic
2. Normal
3. Slightly above normal
4. Excessively below normal
1. Toxic
Rationale:
The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level
of 3 mEq/L indicates toxicity.
111.) A client arrives at the health care clinic and tells the nurse
that he has been doubling his daily dosage of bupropion hy-
drochloride (Wellbutrin) to help him get better faster. The nurse
understands that the client is now at risk for which of the follow-
ing?

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1. Insomnia
2. Weight gain
3. Seizure activity
3. Seizure activity
Rationale:
Bupropion does not cause significant orthostatic blood pressure
changes. Seizure activity is common in dosages greater than 450
mg daily. Bupropion frequently causes a drop in body weight. In-
somnia is a side effect, but seizure activity causes a greater client
risk.
112.) A hospitalized client is started on phenelzine sulfate (Nardil)

for the treatment of depression. The nurse instructs the client to
avoid consuming which foods while taking this medication? Select
all that apply.
1. Figs
2. Yogurt
3. Crackers
4. Aged cheese
5 Tossed salad
6. Oatmeal cookies
1. Figs
2. Yogurt
4. Aged cheese
Rationale:
Phenelzine sulfate (Nardil) is a monoamine oxidase
inhibitor(MAOI). The client should avoid taking in foods that are
high in tyramine. Use of these foods could trigger a potentially fa-
tal hypertensive crisis. Some foods to avoid include yogurt, aged
cheeses, smoked or processed meats, red wines, and fruits such
as avocados, raisins, and figs.

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113.) A nurse is reinforcing discharge instructions to a client re-

ceiving sulfisoxazole. Which of the following would be included in
the plan of care for instructions?
2. Discontinue the medication when feeling better.
3. If the urine turns dark brown, call the health care provider im-
mediately.
4. Decrease the dosage when symptoms are improving to prevent
an allergic response.
Rationale:
Each dose of sulfisoxazole should be administered with a full
glass of water, and the client should maintain a high fluid intake.
The medication is more soluble in alkaline urine. The client should
not be instructed to taper or discontinue the dose. Some forms of
sulfisoxazole cause the urine to turn dark brown or red. This does
not indicate the need to notify the health care provider.
114.) A postoperative client requests medication for flatulence

(gas pains). Which medication from the following PRN list should
the nurse administer to this client?
1. Ondansetron (Zofran)
2. Simethicone (Mylicon)
3. Acetaminophen (Tylenol)
4. Magnesium hydroxide (milk of magnesia, MOM)
2. Simethicone (Mylicon)
Rationale:
Simethicone is an antiflatulent used in the relief of pain caused by
excessive gas in the gastrointestinal tract. Ondansetron is used to
treat postoperative nausea and vomiting. Acetaminophen is a
nonopioid analgesic. Magnesium hydroxide is an antacid and lax-
ative.

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115.) A client received 20 units of NPH insulin subcutaneously at

8:00 AM. The nurse should check the client for a potential hypo-
glycemic reaction at what time?
1. 5:00 PM
2. 10:00 AM
3. 11:00 AM
4. 11:00 PM
1. 5:00 PM
Rationale:
NPH is intermediate-acting insulin. Its onset of action is 1 to 2½
hours, it peaks in 4 to 12 hours, and its duration of action is 24
hours. Hypoglycemic reactions most likely occur during peak time.
116.) A nurse administers a dose of scopolamine (Transderm-

Scop) to a postoperative client. The nurse tells the client to expect
which of the following side effects of this medication?
1. Dry mouth
2. Diaphoresis
3. Excessive urination
4. Pupillary constriction
1. Dry mouth
Rationale:
Scopolamine is an anticholinergic medication for the prevention of
nausea and vomiting that causes the frequent side effects of dry
mouth, urinary retention, decreased sweating, and dilation of the
pupils. The other options describe the opposite effects of choliner-
gic-blocking agents and therefore are incorrect.
117.) A nurse has given the client taking ethambutol (Myambutol)

information about the medication. The nurse determines that the
client understands the instructions if the client immediately re-
ports:

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2. Distressing gastrointestinal side effects

4. Difficulty discriminating the color red from green
4. Difficulty discriminating the color red from green
Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity
and the ability to discriminate between the colors red and green.
This poses a potential safety hazard when driving a motor vehicle.
The client is taught to report this symptom immediately. The client
is also taught to take the medication with food if gastrointestinal
upset occurs. Impaired hearing results from antitubercular therapy
with streptomycin. Orange-red discoloration of secretions occurs
with rifampin (Rifadin).
118.) A nurse is caring for an older client with a diagnosis of

myasthenia gravis and has reinforced self-care instructions.
Which statement by the client indicates that further teaching is
necessary?
1. "I rest each afternoon after my walk."
2. "I cough and deep breathe many times during the day."
3. "If I get abdominal cramps and diarrhea, I should call my doc-
tor."
4. "I can change the time of my medication on the mornings that I
feel strong."
4. "I can change the time of my medication on the mornings that I
feel strong."
Rationale:
The client with myasthenia gravis should be taught that timing of
anticholinesterase medication is critical. It is important to instruct
the client to administer the medication on time to maintain a
chemical balance at the neuromuscular junction. If not given on
time, the client may become too weak to swallow. Options 1, 2,
and 3 include the necessary information that the client needs to

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understand to maintain health with this neurological degenerative

disease.
119.) A client with diabetes mellitus who has been controlled with
daily insulin has been placed on atenolol (Tenormin) for the con-
trol of angina pectoris. Because of the effects of atenolol, the
nurse determines that which of the following is the most reliable
indicator of hypoglycemia?
1. Sweating
2. Tachycardia
3. Nervousness
4. Low blood glucose level
4. Low blood glucose level
Rationale:
β-Adrenergic blocking agents, such as atenolol, inhibit the ap-
pearance of signs and symptoms of acute hypoglycemia, which
would include nervousness, increased heart rate, and sweating.
Therefore, the client receiving this medication should adhere to
the therapeutic regimen and monitor blood glucose levels care-
fully. Option 4 is the most reliable indicator of hypoglycemia.
120.) A client is taking lansoprazole (Prevacid) for the chronic

management of Zollinger-Ellison syndrome. The nurse advises
the client to take which of the following products if needed for a
headache?
1. Naprosyn (Aleve)
2. Ibuprofen (Advil)
4. Acetylsalicylic acid (aspirin)
Rationale:
Zollinger-Ellison syndrome is a hypersecretory condition of the
stomach. The client should avoid taking medications that are irri-

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tating to the stomach lining. Irritants would include aspirin and

nonsteroidal antiinflammatory drugs (ibuprofen). The client should
be advised to take acetaminophen for headache.
*Remember that options that are comparable or alike are not
likely to be correct. With this in mind, eliminate options 1 and
2 first.*
121.) A client who is taking hydrochlorothiazide (HydroDIURIL,

HCTZ) has been started on triamterene (Dyrenium) as well. The
client asks the nurse why both medications are required. The
nurse formulates a response, based on the understanding that:
1. Both are weak potassium-losing diuretics.
2. The combination of these medications prevents renal toxicity.
3. Hydrochlorothiazide is an expensive medication, so using a
combination of diuretics is cost-effective.
4. Triamterene is a potassium-sparing diuretic, whereas hy-
drochlorothiazide is a potassium-losing diuretic.
4. Triamterene is a potassium-sparing diuretic, whereas hy-
drochlorothiazide is a potassium-losing diuretic.
Rationale:
Potassium-sparing diuretics include amiloride (Midamor), spirono-
lactone (Aldactone), and triamterene (Dyrenium). They are weak
diuretics that are used in combination with potassium-losing di-
uretics. This combination is useful when medication and dietary
supplement of potassium is not appropriate. The use of two differ-
ent diuretics does not prevent renal toxicity. Hydrochlorothiazide
is an effective and inexpensive generic form of the thiazide classi-
fication of diuretics.
*It is especially helpful to remember that hydrochlorothiazide
is a potassium-losing diuretic and triamterene is a potas-
sium-sparing diuretic*

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122.) A client who has begun taking fosinopril (Monopril) is very

distressed, telling the nurse that he cannot taste food normally
since beginning the medication 2 weeks ago. The nurse provides
the best support to the client by:
1. Telling the client not to take the medication with food
2. Suggesting that the client taper the dose until taste returns to
normal
3. Informing the client that impaired taste is expected and gener-
ally disappears in 2 to 3 months
4. Requesting that the health care provider (HCP) change the pre-
scription to another brand of angiotensin-converting enzyme
(ACE) inhibitor
3. Informing the client that impaired taste is expected and gener-
ally disappears in 2 to 3 months
Rationale:
ACE inhibitors, such as fosinopril, cause temporary impairment of
taste (dysgeusia). The nurse can tell the client that this effect usu-
ally disappears in 2 to 3 months, even with continued therapy, and
provide nutritional counseling if appropriate to avoid weight loss.
Options 1, 2, and 4 are inappropriate actions. Taking this medica-
tion with or without food does not affect absorption and action.
The dosage should never be tapered without HCP approval and
the medication should never be stopped abruptly.
123.) A nurse is planning to administer amlodipine (Norvasc) to a

client. The nurse plans to check which of the following before giv-
ing the medication?
1. Respiratory rate
2. Blood pressure and heart rate
3. Heart rate and respiratory rate
4. Level of consciousness and blood pressure
2. Blood pressure and heart rate
Rationale:

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Amlodipine is a calcium channel blocker. This medication de-

creases the rate and force of cardiac contraction. Before adminis-
tering a calcium channel blocking agent, the nurse should check
the blood pressure and heart rate, which could both decrease in
response to the action of this medication. This action will help to
prevent or identify early problems related to decreased cardiac
contractility, heart rate, and conduction.
*amlodipine is a calcium channel blocker, and this group of
medications decreases the rate and force of cardiac contrac-
tion. This in turn lowers the pulse rate and blood pressure.*
124.) A client with chronic renal failure is receiving ferrous sulfate

(Feosol). The nurse monitors the client for which common side ef-
fect associated with this medication?
1. Diarrhea
2. Weakness
3. Headache
4. Constipation
4. Constipation
Rationale:
Feosol is an iron supplement used to treat anemia. Constipation
is a frequent and uncomfortable side effect associated with the
administration of oral iron supplements. Stool softeners are often
prescribed to prevent constipation.
*Focus on the name of the medication. Recalling that oral
iron can cause constipation will easily direct you to the cor-
rect option.*
125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125

mg orally, to a client with heart failure. Which vital sign is most im-
portant for the nurse to check before administering the medica-
tion?
1. Heart rate

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2. Temperature
3. Respirations
4. Blood pressure
1. Heart rate
Rationale:
Digoxin is a cardiac glycoside that is used to treat heart failure
and acts by increasing the force of myocardial contraction. Be-
cause bradycardia may be a clinical sign of toxicity, the nurse
counts the apical heart rate for 1 full minute before administering
the medication. If the pulse rate is less than 60 beats/minute in an
adult client, the nurse would withhold the medication and report
the pulse rate to the registered nurse, who would then contact the
health care provider.
126.) A nurse is caring for a client who has been prescribed

furosemide (Lasix) and is monitoring for adverse effects associ-
ated with this medication. Which of the following should the nurse
recognize as a potential adverse effect Select all that apply.
1. Nausea
2. Tinnitus
3. Hypotension
4. Hypokalemia
5. Photosensitivity
6. Increased urinary frequency
2. Tinnitus
3. Hypotension
4. Hypokalemia
Rationale:
Furosemide is a loop diuretic; therefore, an expected effect is in-
creased urinary frequency. Nausea is a frequent side effect, not
an adverse effect. Photosensitivity is an occasional side effect.
Adverse effects include tinnitus (ototoxicity), hypotension, and hy-
pokalemia and occur as a result of sudden volume depletion.

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127.) The nurse provides medication instructions to an older hy-

pertensive client who is taking 20 mg of lisinopril (Prinivil, Zestril)
orally daily. The nurse evaluates the need for further teaching
when the client states which of the following?
1. "I can skip a dose once a week."
2. "I need to change my position slowly."
3. "I take the pill after breakfast each day."
4. "If I get a bad headache, I should call my doctor immediately."
1. "I can skip a dose once a week."
Rationale:
Lisinopril is an antihypertensive angiotensin-converting enzyme
(ACE) inhibitor. The usual dosage range is 20 to 40 mg per day.
Adverse effects include headache, dizziness, fatigue, orthostatic
hypotension, tachycardia, and angioedema. Specific client teach-
ing points include taking one pill a day, not stopping the medica-
tion without consulting the health care provider (HCP), and moni-
toring for side effects and adverse reactions. The client should no-
tify the HCP if side effects occur.
128.) A nurse is providing instructions to an adolescent who has a

history of seizures and is taking an anticonvulsant medication.
Which of the following statements indicates that the client under-
stands the instructions?
1. "I will never be able to drive a car."
2. "My anticonvulsant medication will clear up my skin."
3. "I can't drink alcohol while I am taking my medication."
4. "If I forget my morning medication, I can take two pills at bed-
time."
3. "I can't drink alcohol while I am taking my medication."
Rationale:
Alcohol will lower the seizure threshold and should be avoided.
Adolescents can obtain a driver's license in most states when
they have been seizure free for 1 year. Anticonvulsants cause

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acne and oily skin; therefore a dermatologist may need to be con-

sulted. If an anticonvulsant medication is missed, the health care
provider should be notified.
129.) Megestrol acetate (Megace), an antineoplastic medication,

is prescribed for the client with metastatic endometrial carcinoma.
The nurse reviews the client's history and contacts the registered
nurse if which diagnosis is documented in the client's history?
1. Gout
2. Asthma
3. Thrombophlebitis
4. Myocardial infarction
3. Thrombophlebitis
Rationale:
Megestrol acetate (Megace) suppresses the release of luteinizing
hormone from the anterior pituitary by inhibiting pituitary function
and regressing tumor size. Megestrol is used with caution if the
client has a history of thrombophlebitis.
*megestrol acetate is a hormonal antagonist enzyme and that
a side effect is thrombotic disorders*
130.) The nurse is analyzing the laboratory results of a client with

leukemia who has received a regimen of chemotherapy. Which
laboratory value would the nurse specifically note as a result of
the massive cell destruction that occurred from the chemother-
apy?
1. Anemia
2. Decreased platelets
3. Increased uric acid level
4. Decreased leukocyte count
3. Increased uric acid level
Rationale:

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Hyperuricemia is especially common following treatment for

leukemias and lymphomas because chemotherapy results in a
massive cell kill. Although options 1, 2, and 4 also may be noted,
an increased uric acid level is related specifically to cell destruc-
tion.
131.) The nurse is reinforcing medication instructions to a client

with breast cancer who is receiving cyclophosphamide (Neosar).
The nurse tells the client to:
2. Increase fluid intake to 2000 to 3000 mL daily.
3. Decrease sodium intake while taking the medication.
4. Increase potassium intake while taking the medication.
2. Increase fluid intake to 2000 to 3000 mL daily.
Rationale:
Hemorrhagic cystitis is a toxic effect that can occur with the use of
cyclophosphamide. The client needs to be instructed to drink co-
pious amounts of fluid during the administration of this medica-
tion. Clients also should monitor urine output for hematuria. The
medication should be taken on an empty stomach, unless gas-
trointestinal (GI) upset occurs. Hyperkalemia can result from the
use of the medication; therefore the client would not be told to in-
crease potassium intake. The client would not be instructed to al-
ter sodium intake.
132.) The client with non-Hodgkin's lymphoma is receiving

daunorubicin (DaunoXome). Which of the following would indicate
to the nurse that the client is experiencing a toxic effect related to
the medication?
1. Fever
2. Diarrhea
3. Complaints of nausea and vomiting
4. Crackles on auscultation of the lungs

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4. Crackles on auscultation of the lungs

Rationale:
Cardiotoxicity noted by abnormal electrocardiographic findings or
cardiomyopathy manifested as congestive heart failure is a toxic
effect of daunorubicin. Bone marrow depression is also a toxic ef-
fect. Nausea and vomiting are frequent side effects associated
with the medication that begins a few hours after administration
and lasts 24 to 48 hours. Fever is a frequent side effect, and diar-
rhea can occur occasionally. The other options, however, are not
toxic effects.
*keep in mind that the question is asking about a toxic effect
and think: ABCs—airway, breathing, and circulation*
133.) A nurse is monitoring a client receiving desmopressin ac-

etate (DDAVP) for adverse effects to the medication. Which of the
following indicates the presence of an adverse effect?
1. Insomnia
2. Drowsiness
3. Weight loss
4. Increased urination
2. Drowsiness
Rationale:
Water intoxication (overhydration) or hyponatremia is an adverse
effect to desmopressin. Early signs include drowsiness, listless-
ness, and headache. Decreased urination, rapid weight gain, con-
fusion, seizures, and coma also may occur in overhydration.
*Recall that this medication is used to treat diabetes in-
sipidus to eliminate weight loss and increased urination.*
134.) A nurse reinforces instructions to a client who is taking

levothyroxine (Synthroid). The nurse tells the client to take the
medication:
1. With food

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2. At lunchtime
3. On an empty stomach
4. At bedtime with a snack
Rationale:
Oral doses of levothyroxine (Synthroid) should be taken on an
empty stomach to enhance absorption. Dosing should be done in
the morning before breakfast.
*Note that options 1, 2, and 4 are comparable or alike in that
these options address administering the medication with
food.*
135.) A nurse reinforces medication instructions to a client who is

taking levothyroxine (Synthroid). The nurse instructs the client to
notify the health care provider (HCP) if which of the following oc-
curs?
1. Fatigue
2. Tremors
3. Cold intolerance
4. Excessively dry skin
2. Tremors
Rationale:
Excessive doses of levothyroxine (Synthroid) can produce signs
and symptoms of hyperthyroidism. These include tachycardia,
chest pain, tremors, nervousness, insomnia, hyperthermia, heat
intolerance, and sweating. The client should be instructed to notify
the HCP if these occur. Options 1, 3, and 4 are signs of hypothy-
roidism.
136.) A nurse performs an admission assessment on a client who

visits a health care clinic for the first time. The client tells the
nurse that propylthiouracil (PTU) is taken daily. The nurse contin-
ues to collect data from the client, suspecting that the client has a
history of:

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1. Myxedema
2. Graves' disease
3. Addison's disease
4. Cushing's syndrome
2. Graves' disease
Rationale:
PTU inhibits thyroid hormone synthesis and is used to treat hyper-
thyroidism, or Graves' disease. Myxedema indicates hypothy-
roidism.
Cushing's syndrome and Addison's disease are disorders related
to adrenal function.
137.) A nurse is reinforcing instructions for a client regarding in-

tranasal desmopressin acetate (DDAVP). The nurse tells the
client that which of the following is a side effect of the medication?
1. Headache
2. Vulval pain
3. Runny nose
4. Flushed skin
3. Runny nose
Rationale:
Desmopressin administered by the intranasal route can cause a
runny or stuffy nose. Headache, vulval pain, and flushed skin are
side effects if the medication is administered by the intravenous
(IV) route.
138.) A daily dose of prednisone is prescribed for a client. A nurse

reinforces instructions to the client regarding administration of the
medication and instructs the client that the best time to take this
medication is:
1. At noon
2. At bedtime
3. Early morning

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4. Anytime, at the same time, each day

3. Early morning
Rationale:
Corticosteroids (glucocorticoids) should be administered before
9:00 AM. Administration at this time helps minimize adrenal insuf-
ficiency and mimics the burst of glucocorticoids released naturally
by the adrenal glands each morning.
*Note the suffix "-sone," and recall that medication names
that end with these letters are corticosteroids.*
139.) Prednisone is prescribed for a client with diabetes mellitus

who is taking Humulin neutral protamine Hagedorn (NPH) insulin
daily. Which of the following prescription changes does the nurse
anticipate during therapy with the prednisone?
1. An additional dose of prednisone daily
2. A decreased amount of daily Humulin NPH insulin
3. An increased amount of daily Humulin NPH insulin
4. The addition of an oral hypoglycemic medication daily
3. An increased amount of daily Humulin NPH insulin
Rationale:
Glucocorticoids can elevate blood glucose levels. Clients with dia-
betes mellitus may need their dosages of insulin or oral hypo-
glycemic medications increased during glucocorticoid therapy.
Therefore the other options are incorrect.
140.) The client has a new prescription for metoclopramide

(Reglan). On review of the chart, the nurse identifies that this
medication can be safely administered with which condition?
1. Intestinal obstruction
2. Peptic ulcer with melena
3. Diverticulitis with perforation
4. Vomiting following cancer chemotherapy
4. Vomiting following cancer chemotherapy

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Rationale:
Metoclopramide is a gastrointestinal (GI) stimulant and
antiemetic. Because it is a GI stimulant, it is contraindicated with
GI obstruction, hemorrhage, or perforation. It is used in the treat-
ment of emesis after surgery, chemotherapy, and radiation.
141.) The nurse has reinforced instructions to a client who has

been prescribed cholestyramine (Questran). Which statement by
the client indicates a need for further instructions?
1. "I will continue taking vitamin supplements."
2. "This medication will help lower my cholesterol."
3. "This medication should only be taken with water."
4. "A high-fiber diet is important while taking this medication."
3. "This medication should only be taken with water."
Rationale:
Cholestyramine (Questran) is a bile acid sequestrant used to
lower the cholesterol level, and client compliance is a problem be-
cause of its taste and palatability. The use of flavored products or
fruit juices can improve the taste. Some side effects of bile acid
sequestrants include constipation and decreased vitamin absorp-
tion.
*Note the closed-ended word "only" in option 3*
142.) A health care provider has written a prescription for raniti-

dine (Zantac), once daily. The nurse should schedule the medica-
tion for which of the following times?
1. At bedtime
2. After lunch
3. With supper
4. Before breakfast
1. At bedtime
Rationale:

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A single daily dose of ranitidine is usually scheduled to be given at

bedtime. This allows for a prolonged effect, and the greatest pro-
tection of the gastric mucosa.
*recall that ranitidine suppresses secretions of gastric acids*
143.) A client has just taken a dose of trimethobenzamide (Tigan).

The nurse plans to monitor this client for relief of:
1. Heartburn
2. Constipation
3. Abdominal pain
Rationale:
Trimethobenzamide is an antiemetic agent used in the treatment
of nausea and vomiting. The other options are incorrect.
144.) A client is taking docusate sodium (Colace). The nurse mon-

itors which of the following to determine whether the client is hav-
ing a therapeutic effect from this medication?
1. Abdominal pain
2. Reduction in steatorrhea
3. Hematest-negative stools
4. Regular bowel movements
4. Regular bowel movements
Rationale:
Docusate sodium is a stool softener that promotes the absorption
of water into the stool, producing a softer consistency of stool.
The intended effect is relief or prevention of constipation. The
medication does not relieve abdominal pain, stop gastrointestinal
(GI) bleeding, or decrease the amount of fat in the stools.
145.) A nurse has a prescription to give a client albuterol (Proven-

til HFA) (two puffs) and beclomethasone dipropionate (Qvar)

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(nasal inhalation, two puffs), by metered-dose inhaler. The nurse

administers the medication by giving the:
1. Albuterol first and then the beclomethasone dipropionate
2. Beclomethasone dipropionate first and then the albuterol
3. Alternating a single puff of each, beginning with the albuterol
4. Alternating a single puff of each, beginning with the be-
clomethasone dipropionate
1. Albuterol first and then the beclomethasone dipropionate
Rationale:
Albuterol is a bronchodilator. Beclomethasone dipropionate is a
glucocorticoid. Bronchodilators are always administered before
glucocorticoids when both are to be given on the same time
schedule. This allows for widening of the air passages by the
bronchodilator, which then makes the glucocorticoid more effec-
tive.
146.) A client has begun therapy with theophylline (Theo-24). The

nurse tells the client to limit the intake of which of the following
while taking this medication?
1. Oranges and pineapple
3. Oysters, lobster, and shrimp
4. Cottage cheese, cream cheese, and dairy creamers
Rationale:
Theophylline is a xanthine bronchodilator. The nurse teaches the
client to limit the intake of xanthine-containing foods while taking
this medication. These include coffee, cola, and chocolate.
147.) A client with a prescription to take theophylline (Theo-24)

daily has been given medication instructions by the nurse. The
nurse determines that the client needs further information about
the medication if the client states that he or she will:

lOMoARcPSD|3083804
1. Drink at least 2 L of fluid per day.

2. Take the daily dose at bedtime.
3. Avoid changing brands of the medication without health care
provider (HCP) approval.
4. Avoid over-the-counter (OTC) cough and cold medications un-
less approved by the HCP.
2. Take the daily dose at bedtime.
Rationale:
The client taking a single daily dose of theophylline, a xanthine
bronchodilator, should take the medication early in the morning.
This enables the client to have maximal benefit from the medica-
tion during daytime activities. In addition, this medication causes
insomnia. The client should take in at least 2 L of fluid per day to
decrease viscosity of secretions. The client should check with the
physician before changing brands of the medication. The client
also checks with the HCP before taking OTC cough, cold, or other
respiratory preparations because they could cause interactive ef-
fects, increasing the side effects of theophylline and causing dys-
rhythmias.
148.) A client is taking cetirizine hydrochloride (Zyrtec). The nurse

checks for which of the following side effects of this medication?
1. Diarrhea
2. Excitability
3. Drowsiness
4. Excess salivation
3. Drowsiness
Rationale:
A frequent side effect of cetirizine hydrochloride (Zyrtec), an anti-
histamine, is drowsiness or sedation. Others include blurred vi-
sion, hypertension (and sometimes hypotension), dry mouth, con-
stipation, urinary retention, and sweating.

lOMoARcPSD|3083804
149.) A client taking fexofenadine (Allegra) is scheduled for allergy

skin testing and tells the nurse in the health care provider's office
that a dose was taken this morning. The nurse determines that:
1. The client should reschedule the appointment.
2. A lower dose of allergen will need to be injected.
3. A higher dose of allergen will need to be injected.
4. The client should have the skin test read a day later than usual.
1. The client should reschedule the appointment.
Rationale:
Fexofenadine is an antihistamine, which provides relief of symp-
toms caused by allergy. Antihistamines should be discontinued for
at least 3 days (72 hours) before allergy skin testing to avoid
false-negative readings. This client should have the appointment
rescheduled for 3 days after discontinuing the medication.
150.) A client complaining of not feeling well is seen in a clinic.

The client is taking several medications for the control of heart
disease and hypertension. These medications include a β-blocker,
digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin
toxicity is made. Which of the following assessment data would
support this diagnosis?
1. Dyspnea, edema, and palpitations
2. Chest pain, hypotension, and paresthesia
4. Constipation, dry mouth, and sleep disorder
Rationale:
Double vision, loss of appetite, and nausea are signs of digoxin
toxicity. Additional signs of digoxin toxicity include bradycardia,
difficulty reading, visual alterations such as green and yellow vi-
sion or seeing spots or halos, confusion, vomiting, diarrhea, de-
creased libido, and impotence.
*gastrointestinal (GI) and visual disturbances occur with
digoxin toxicity*

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151.) A client is being treated for acute congestive heart failure

with intravenously administered bumetanide. The vital signs are
as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min;
and respirations, 24 breaths/min. After the initial dose, which of
the following is the priority assessment?
1. Monitoring weight loss
2. Monitoring temperature
4. Monitoring potassium level
Rationale:
Bumetanide is a loop diuretic. Hypotension is a common side ef-
fect associated with the use of this medication. The other options
also require assessment but are not the priority.
*priority ABCs—airway, breathing, and circulation*
152.) Intravenous heparin therapy is prescribed for a client. While

2. Potassium chloride
3. Phytonadione (vitamin K )
4. Aminocaproic acid (Amicar)
Rationale:
The antidote to heparin is protamine sulfate; it should be readily
available for use if excessive bleeding or hemorrhage occurs.
Potassium chloride is administered for a potassium deficit. Vita-
min K is an antidote for warfarin sodium. Aminocaproic acid is the
antidote for thrombolytic therapy.

lOMoARcPSD|3083804
153.) A client is diagnosed with pulmonary embolism and is to be

priority data collection finding to the registered nurse before initiat-
ing this therapy?
1. Adventitious breath sounds
2. Temperature of 99.4° F orally
4. Respiratory rate of 28 breaths/min
Rationale:
Thrombolytic therapy is contraindicated in a number of preexisting
conditions in which there is a risk of uncontrolled bleeding, similar
to the case in anticoagulant therapy. Thrombolytic therapy also is
contraindicated in severe uncontrolled hypertension because of
the risk of cerebral hemorrhage. Therefore the nurse would report
the results of the blood pressure to the registered nurse before
initiating therapy. The findings in options 1, 2, and 4 may be
present in the client with pulmonary embolism.
154.) A nurse is reinforcing dietary instructions to a client who has

been prescribed cyclosporine (Sandimmune). Which food item
would the nurse instruct the client to avoid?
1. Red meats
2. Orange juice
3. Grapefruit juice
4. Green, leafy vegetables
3. Grapefruit juice
Rationale:
A compound present in grapefruit juice inhibits metabolism of cy-
closporine. As a result, the consumption of grapefruit juice can
raise cyclosporine levels by 50% to 100%, thereby greatly in-
creasing the risk of toxicity. Grapefruit juice needs to be avoided.
Red meats, orange juice, and green leafy vegetables are accept-
able to consume.

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155.) Mycophenolate mofetil (CellCept) is prescribed for a client

as prophylaxis for organ rejection following an allogeneic renal
transplant. Which of the following instructions does the nurse rein-
force regarding administration of this medication?
1. Administer following meals.
2. Take the medication with a magnesium-type antacid.
3. Open the capsule and mix with food for administration.
4. Contact the health care provider (HCP) if a sore throat occurs.
4. Contact the health care provider (HCP) if a sore throat occurs.
Rationale:
Mycophenolate mofetil should be administered on an empty stom-
ach. The capsules should not be opened or crushed. The client
should contact the HCP if unusual bleeding or bruising, sore
throat, mouth sores, abdominal pain, or fever occurs because
these are adverse effects of the medication. Antacids containing
magnesium and aluminum may decrease the absorption of the
medication and therefore should not be taken with the medication.
The medication may be given in combination with corticosteroids
and cyclosporine.
*neutropenia can occur with this medication*
156.) A nurse is reviewing the laboratory results for a client receiv-

ing tacrolimus (Prograf). Which laboratory result would indicate to
the nurse that the client is experiencing an adverse effect of the
medication?
1. Blood glucose of 200 mg/dL
2. Potassium level of 3.8 mEq/L
3. Platelet count of 300,000 cells/mm3
4. White blood cell count of 6000 cells/mm3
1. Blood glucose of 200 mg/dL
Rationale:

lOMoARcPSD|3083804
A blood glucose level of 200 mg/dL is elevated above the normal

range of 70 to 110 mg/dL and suggests an adverse effect. Other
adverse effects include neurotoxicity evidenced by headache,
tremor, insomnia; gastrointestinal (GI) effects such as diarrhea,
nausea, and vomiting; hypertension; and hyperkalemia.
157.) A client receiving nitrofurantoin (Macrodantin) calls the

health care provider's office complaining of side effects related to
the medication. Which side effect indicates the need to stop treat-
ment with this medication?
1. Nausea
2. Diarrhea
3. Anorexia
4. Cough and chest pain
4. Cough and chest pain
Rationale:
Gastrointestinal (GI) effects are the most frequent adverse reac-
tions to this medication and can be minimized by administering
the medication with milk or meals. Pulmonary reactions, mani-
fested as dyspnea, chest pain, chills, fever, cough, and the pres-
ence of alveolar infiltrates on the x-ray, would indicate the need to
stop the treatment. These symptoms resolve in 2 to 4 days follow-
ing discontinuation of this medication.
*Eliminate options 1, 2, and 3 because they are similar GI-re-
lated side effects. Also, use the ABCs— airway, breathing,
and circulation*
158.) A client with chronic renal failure is receiving epoetin alfa

(Epogen, Procrit). Which laboratory result would indicate a thera-
peutic effect of the medication?
1. Hematocrit of 32%
3. White blood cell count of 6000 cells/mm3

lOMoARcPSD|3083804
4. Blood urea nitrogen (BUN) level of 15 mg/dL

1. Hematocrit of 32%
Rationale:
Epoetin alfa is used to reverse anemia associated with chronic re-
nal failure. A therapeutic effect is seen when the hematocrit is be-
tween 30% and 33%. The laboratory tests noted in the other op-
tions are unrelated to the use of this medication.
159.) A nurse is caring for a client receiving morphine sulfate sub-

cutaneously for pain. Because morphine sulfate has been pre-
scribed for this client, which nursing action would be included in
the plan of care?
1. Encourage fluid intake.
2. Monitor the client's temperature.
3. Maintain the client in a supine position.
4. Encourage the client to cough and deep breathe.
4. Encourage the client to cough and deep breathe.
Rationale:
Morphine sulfate suppresses the cough reflex. Clients need to be
encouraged to cough and deep breathe to prevent pneumonia.
*ABCs—airway, breathing, and circulation*
160.) Meperidine hydrochloride (Demerol) is prescribed for the

client with pain. Which of the following would the nurse monitor for
as a side effect of this medication?
1. Diarrhea
2. Bradycardia
3. Hypertension
Rationale:
Meperidine hydrochloride (Demerol) is an opioid analgesic. Side
effects of this medication include respiratory depression, ortho-

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static hypotension, tachycardia, drowsiness and mental clouding,

constipation, and urinary retention.
161.) A nurse is caring for a client with severe back pain, and
codeine sulfate has been prescribed for the client. Which of the
following would the nurse include in the plan of care while the
client is taking this medication?
3. Monitor for hypertension.
4. Monitor peripheral pulses.
Rationale:
While the client is taking codeine sulfate, an opioid analgesic, the
nurse would monitor vital signs and monitor for hypotension. The
nurse should also increase fluid intake, palpate the bladder for uri-
nary retention, auscultate bowel sounds, and monitor the pattern
of daily bowel activity and stool consistency (codeine can cause
constipation). The nurse should monitor respiratory status and ini-
tiate breathing and coughing exercises. In addition, the nurse
monitors the effectiveness of the pain medication.
162.) Carbamazepine (Tegretol) is prescribed for a client with a di-

agnosis of psychomotor seizures. The nurse reviews the client's
health history, knowing that this medication is contraindicated if
which of the following disorders is present?
1. Headaches
2. Liver disease
3. Hypothyroidism
2. Liver disease
Rationale:

lOMoARcPSD|3083804
Carbamazepine (Tegretol) is contraindicated in liver disease, and

liver function tests are routinely prescribed for baseline purposes
and are monitored during therapy. It is also contraindicated if the
client has a history of blood dyscrasias. It is not contraindicated in
the conditions noted in the incorrect options.
163.) A client with trigeminal neuralgia tells the nurse that ac-
etaminophen (Tylenol) is taken on a frequent daily basis for relief
of generalized discomfort. The nurse reviews the client's labora-
tory results and determines that which of the following indicates
toxicity associated with the medication?
1. Sodium of 140 mEq/L
2. Prothrombin time of 12 seconds
4. A direct bilirubin level of 2 mg/dL
4. A direct bilirubin level of 2 mg/dL
Rationale:
In adults, overdose of acetaminophen (Tylenol) causes liver dam-
age. Option 4 is an indicator of liver function and is the only option
that indicates an abnormal laboratory value. The normal direct
bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to
400,000 cells/mm3. The normal prothrombin time is 10 to 13 sec-
onds. The normal sodium level is 135 to 145 mEq/L.
164.) A client receives a prescription for methocarbamol

(Robaxin), and the nurse reinforces instructions to the client re-
garding the medication. Which client statement would indicate a
need for further instructions?
1. "My urine may turn brown or green."
2. "This medication is prescribed to help relieve my muscle
spasms."
3. "If my vision becomes blurred, I don't need to be concerned
about it."

lOMoARcPSD|3083804
4. "I need to call my doctor if I experience nasal congestion from

this medication."
3. "If my vision becomes blurred, I don't need to be concerned
about it."
Rationale:
The client needs to be told that the urine may turn brown, black,
or green. Other adverse effects include blurred vision, nasal con-
gestion, urticaria, and rash. The client needs to be instructed that,
if these adverse effects occur, the health care provider needs to
be notified. The medication is used to relieve muscle spasms.
165.) The client has been on treatment for rheumatoid arthritis for
3 weeks. During the administration of etanercept (Enbrel), it is
most important for the nurse to assess:
1. The injection site for itching and edema
3. Whether the client is experiencing fatigue and joint pain
4. A metallic taste in the mouth and a loss of appetite
Rationale:
Infection and pancytopenia are adverse effects of etanercept (En-
brel). Laboratory studies are performed before and during treat-
ment. The appearance of abnormal white blood cell counts and
abnormal platelet counts can alert the nurse to a potential life-
threatening infection. Injection site itching is a common occur-
rence following administration of the medication. In early treat-
ment, residual fatigue and joint pain may still be apparent. A
metallic taste and loss of appetite are not common signs of side
effects of this medication.
166.) Alendronate (Fosamax) is prescribed for a client with osteo-

porosis. The client taking this medication is instructed to:
1. Take the medication at bedtime.

lOMoARcPSD|3083804
2. Take the medication in the morning with breakfast.

3. Lie down for 30 minutes after taking the medication.
4. Take the medication with a full glass of water after rising in the
morning.
4. Take the medication with a full glass of water after rising in the
morning.
Rationale:
Precautions need to be taken with administration of alendronate
to prevent gastrointestinal side effects (especially esophageal irri-
tation) and to increase absorption of the medication. The medica-
tion needs to be taken with a full glass of water after rising in the
morning. The client should not eat or drink anything for 30 min-
utes following administration and should not lie down after taking
the medication.
167.) A nurse prepares to reinforce instructions to a client who is

taking allopurinol (Zyloprim). The nurse plans to include which of
the following in the instructions?
1. Instruct the client to drink 3000 mL of fluid per day.
2. Instruct the client to take the medication on an empty stomach.
3. Inform the client that the effect of the medication will occur im-
mediately.
4. Instruct the client that, if swelling of the lips occurs, this is a
normal expected response.
1. Instruct the client to drink 3000 mL of fluid per day.
Rationale:
Allopurinol (Zyloprim) is an antigout medication used to decrease
uric acid levels. Clients taking allopurinol are encouraged to drink
3000 mL of fluid a day. A full therapeutic effect may take 1 week
or longer. Allopurinol is to be given with or immediately following
meals or milk to prevent gastrointestinal irritation. If the client de-
velops a rash, irritation of the eyes, or swelling of the lips or
mouth, he or she should contact the health care provider because
this may indicate hypersensitivity.

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168.) Colcrys (colchicine) is prescribed for a client with a diagno-

sis of gout. The nurse reviews the client's medical history in the
health record, knowing that the medication would be contraindi-
cated in which disorder?
1. Myxedema
2. Renal failure
3. Hypothyroidism
2. Renal failure
Rationale:
Colchicine is contraindicated in clients with severe gastrointesti-
nal, renal, hepatic or cardiac disorders, or with blood dyscrasias.
Clients with impaired renal function may exhibit myopathy and
neuropathy manifested as generalized weakness. This medication
should be used with caution in clients with impaired hepatic func-
tion, older clients, and debilitated clients.
*Note that options 1, 3, and 4 are all endocrine-related disor-
ders: Myxedema=Hypothyroidism*
169.) Insulin glargine (Lantus) is prescribed for a client with dia-

betes mellitus. The nurse tells the client that it is best to take the
insulin:
1. 1 hour after each meal
2. Once daily, at the same time each day
3. 15 minutes before breakfast, lunch, and dinner
4. Before each meal, on the basis of the blood glucose level
2. Once daily, at the same time each day
Rationale:
Insulin glargine is a long-acting recombinant DNA human insulin
used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour
duration of action and is administered once a day, at the same
time each day.

lOMoARcPSD|3083804
170.) Atenolol hydrochloride (Tenormin) is prescribed for a hospi-

talized client. The nurse should perform which of the following as
a priority action before administering the medication?
1. Listen to the client's lung sounds.
3. Check the recent electrolyte levels.
4. Assess the client for muscle weakness.
Rationale:
Atenolol hydrochloride is a beta-blocker used to treat hyperten-
sion. Therefore the priority nursing action before administration of
the medication is to check the client's blood pressure. The nurse
also checks the client's apical heart rate. If the systolic blood
pressure is below 90 mm Hg or the apical pulse is 60 beats per
minute or lower, the medication is withheld and the registered
nurse and/or health care provider is notified. The nurse would
check baseline renal and liver function tests. The medication may
cause weakness, and the nurse would assist the client with activi-
ties if weakness occurs.
*Beta-blockers have "-lol" at the end of the medication name*
171.) A nurse is preparing to administer furosemide (Lasix) to a

client with a diagnosis of heart failure. The most important labora-
tory test result for the nurse to check before administering this
medication is:
1. Potassium level
2. Creatinine level
3. Cholesterol level
1. Potassium level
Rationale:

lOMoARcPSD|3083804
Furosemide is a loop diuretic. The medication causes a decrease

in the client's electrolytes, especially potassium, sodium, and
chloride. Administering furosemide to a client with low electrolyte
levels could precipitate ventricular dysrhythmias. Options 2 and 4
reflect renal function. The cholesterol level is unrelated to the ad-
ministration of this medication.
172.) A nurse provides dietary instructions to a client who will be

taking warfarin sodium (Coumadin). The nurse tells the client to
avoid which food item?
1. Grapes
2. Spinach
3. Watermelon
4. Cottage cheese
2. Spinach
Rationale:
Warfarin sodium is an anticoagulant. Anticoagulant medications
act by antagonizing the action of vitamin K, which is needed for
clotting. When a client is taking an anticoagulant, foods high in vi-
tamin K often are omitted from the diet. Vitamin K-rich foods in-
clude green, leafy vegetables, fish, liver, coffee, and tea.
173.) A nurse reviews the medication history of a client admitted

to the hospital and notes that the client is taking leflunomide (Ar-
ava). During data collection, the nurse asks which question to de-
termine medication effectiveness?
1. "Do you have any joint pain?"
2. "Are you having any diarrhea?"
3. "Do you have frequent headaches?"
4. "Are you experiencing heartburn?"
1. "Do you have any joint pain?"
Rationale:

lOMoARcPSD|3083804
Leflunomide is an immunosuppressive agent and has an anti-in-

flammatory action. The medication provides symptomatic relief of
rheumatoid arthritis. Diarrhea can occur as a side effect of the
medication. The other options are unrelated to medication effec-
tiveness.
174.) A client with portosystemic encephalopathy is receiving oral

lactulose (Chronulac) daily. The nurse assesses which of the fol-
lowing to determine medication effectiveness?
1. Lung sounds
2. Blood pressure
3. Blood ammonia level
4. Serum potassium level
3. Blood ammonia level
Rationale:
Lactulose is a hyperosmotic laxative and ammonia detoxicant. It
is used to prevent or treat portosystemic encephalopathy, includ-
ing hepatic precoma and coma. It also is used to treat constipa-
tion. The medication retains ammonia in the colon (decreases the
blood ammonia concentration), producing an osmotic effect. It
promotes increased peristalsis and bowel evacuation, expelling
ammonia from the colon.
175.) A nurse notes that a client is receiving lamivudine (Epivir).

The nurse determines that this medication has been prescribed to
treat which of the following?
1. Pancreatitis
2. Pharyngitis
3. Tonic-clonic seizures
4. Human immunodeficiency virus (HIV) infection
4. Human immunodeficiency virus (HIV) infection
Rationale:

lOMoARcPSD|3083804
Lamivudine is a nucleoside reverse transcriptase inhibitor and an-

tiviral medication. It slows HIV replication and reduces the pro-
gression of HIV infection. It also is used to treat chronic hepatitis
B and is used for prophylaxis in health care workers at risk of ac-
quiring HIV after occupational exposure to the virus.
*Note the letters "-vir" in the trade name for this medication*
176.) A nurse notes that a client is taking lansoprazole (Prevacid).

On data collection, the nurse asks which question to determine
medication effectiveness?
1. "Has your appetite increased?"
2. "Are you experiencing any heartburn?"
3. "Do you have any problems with vision?"
4. "Do you experience any leg pain when walking?"
2. "Are you experiencing any heartburn?"
Rationale:
Lansoprazole is a gastric acid pump inhibitor used to treat gastric
and duodenal ulcers, erosive esophagitis, and hypersecretory
conditions. It also is used to treat gastroesophageal reflux disease
(GERD). It is not used to treat visual problems, problems with ap-
petite, or leg pain.
*NOTE: "-zole" refers to gastric acid pump inhibitors*
177.) A nurse is assisting in caring for a pregnant client who is re-

ceiving intravenous magnesium sulfate for the management of
preeclampsia and notes that the client's deep tendon reflexes are
absent. On the basis of this data, the nurse reports the finding
and makes which determination?
1. The magnesium sulfate is effective.
2. The infusion rate needs to be increased.
3. The client is experiencing cerebral edema.
4. The client is experiencing magnesium toxicity.
4. The client is experiencing magnesium toxicity.

lOMoARcPSD|3083804
Rationale:
Magnesium toxicity can occur as a result of magnesium sulfate
therapy. Signs of magnesium sulfate toxicity relate to the central
nervous system depressant effects of the medication and include
respiratory depression; loss of deep tendon reflexes; sudden de-
crease in fetal heart rate or maternal heart rate, or both; and sud-
den drop in blood pressure. Hyperreflexia indicates increased
cerebral edema. An absence of reflexes indicates magnesium tox-
icity. The therapeutic serum level of magnesium for a client re-
ceiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8
mg/dL).
178.) Methylergonovine (Methergine) is prescribed for a client

with postpartum hemorrhage caused by uterine atony. Before ad-
ministering the medication, the nurse checks which of the follow-
ing as the important client parameter?
1. Temperature
2. Lochial flow
3. Urine output
4. Blood pressure
4. Blood pressure
Rationale:
Methylergonovine is an ergot alkaloid used for postpartum hemor-
rhage. It stimulates contraction of the uterus and causes arterial
vasoconstriction. Ergot alkaloids are avoided in clients with signifi-
cant cardiovascular disease, peripheral disease, hypertension,
eclampsia, or preeclampsia. These conditions are worsened by
the vasoconstrictive effects of the ergot alkaloids. The nurse
would check the client's blood pressure before administering the
medication and would follow agency protocols regarding withhold-
ing of the medication. Options 1, 2, and 3 are items that are
checked in the postpartum period, but they are unrelated to the
use of this medication.

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179.) A nurse provides medication instructions to a client who had

a kidney transplant about therapy with cyclosporine (Sandim-
mune). Which statement by the client indicates a need for further
instruction?
1. "I need to obtain a yearly influenza vaccine."
2. "I need to have dental checkups every 3 months."
3. "I need to self-monitor my blood pressure at home."
4. "I need to call the health care provider (HCP) if my urine vol-
ume decreases or my urine becomes cloudy."
1. "I need to obtain a yearly influenza vaccine."
Rationale:
Cyclosporine is an immunosuppressant medication. Because of
the medication's effects, the client should not receive any vaccina-
tions without first consulting the HCP. The client should report de-
creased urine output or cloudy urine, which could indicate kidney
rejection or infection, respectively. The client must be able to self-
monitor blood pressure to check for the side effect of hyperten-
sion. The client needs meticulous oral care and dental cleaning
every 3 months to help prevent gingival hyperplasia.
180.) A health care provider (HCP) writes a prescription for

digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client
about the medication and tells the client that it is important to:
1. Count the radial and carotid pulses every morning.
2. Check the blood pressure every morning and evening.
3. Stop taking the medication if the pulse is higher than 100 beats
per minute.
4. Withhold the medication and call the HCP if the pulse is less
than 60 beats per minute.
4. Withhold the medication and call the HCP if the pulse is less
than 60 beats per minute.
Rationale:

lOMoARcPSD|3083804
An important component of taking this medication is monitoring

the pulse rate; however, it is not necessary for the client to take
both the radial and carotid pulses. It is not necessary for the client
to check the blood pressure every morning and evening because
the medication does not directly affect blood pressure. It is most
important for the client to know the guidelines related to withhold-
ing the medication and calling the HCP. The client should not stop
taking a medication.
181.) A client is taking ticlopidine hydrochloride (Ticlid). The nurse

tells the client to avoid which of the following while taking this
medication?
1. Vitamin C
2. Vitamin D
Rationale:
Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is
used to decrease the risk of thrombotic strokes in clients with pre-
cursor symptoms. Because it is an antiplatelet agent, other medi-
cations that precipitate or aggravate bleeding should be avoided
during its use. Therefore, aspirin or any aspirin-containing product
should be avoided.
182.) A client with angina pectoris is experiencing chest pain that

radiates down the left arm. The nurse administers a sublingual ni-
troglycerin tablet to the client. The client's pain is unrelieved, and
the nurse determines that the client needs another nitroglycerin
tablet. Which of the following vital signs is most important for the
nurse to check before administering the medication?
1. Temperature
2. Respirations

lOMoARcPSD|3083804
3. Blood pressure
4. Radial pulse rate
Rationale:
Nitroglycerin acts directly on the smooth muscle of the blood ves-
sels, causing relaxation and dilation. As a result, hypotension can
occur. The nurse would check the client's blood pressure before
administering the second nitroglycerin tablet. Although the respi-
rations and apical pulse may be checked, these vital signs are not
affected as a result of this medication. The temperature also is not
associated with the administration of this medication.
183.) A client who received a kidney transplant is taking azathio-

prine (Imuran), and the nurse provides instructions about the
medication. Which statement by the client indicates a need for fur-
ther instructions?
1. "I need to watch for signs of infection."
2. "I need to discontinue the medication after 14 days of use."
3. "I can take the medication with meals to minimize nausea."
4. "I need to call the health care provider (HCP) if more than one
dose is missed."
2. "I need to discontinue the medication after 14 days of use."
Rationale:
Azathioprine is an immunosuppressant medication that is taken
for life. Because of the effects of the medication, the client must
watch for signs of infection, which are reported immediately to the
HCP. The client should also call the HCP if more than one dose is
missed. The medication may be taken with meals to minimize
nausea.
184.) A nurse preparing a client for surgery reviews the client's

medication record. The client is to be nothing per mouth (NPO) af-
ter midnight. Which of the following medications, if noted on the
client's record, should the nurse question?

lOMoARcPSD|3083804
1. Cyclobenzaprine (Flexeril)
2. Alendronate (Fosamax)
3. Allopurinol (Zyloprim)
4. Prednisone
4. Prednisone
Rationale:
Prednisone is a corticosteroid that can cause adrenal atrophy,
which reduces the body's ability to withstand stress. Before and
during surgery, dosages may be temporarily increased. Cycloben-
zaprine is a skeletal muscle relaxant. Alendronate is a bone-re-
sorption inhibitor. Allopurinol is an antigout medication.
185.) Which of the following herbal therapies would be prescribed

for its use as an antispasmodic? Select all that apply.
1.Aloe
2.Kava
3.Ginger
4.Chamomile
5.Peppermint oil
4.Chamomile
5.Peppermint oil
Rationale:
Chamomile has a mild sedative effect and acts as an antispas-
modic and anti-inflammatory. Peppermint oil acts as an antispas-
modic and is used for irritable bowel syndrome. Topical aloe pro-
motes wound healing. Aloe taken orally acts as a laxative. Kava
has an anxiolytic, sedative, and analgesic effect. Ginger is effec-
tive in relieving nausea.
186.) A nurse prepares to administer sodium polystyrene sul-

fonate (Kayexalate) to a client. Before administering the medica-
tion, the nurse reviews the action of the medication and under-
stands that it:

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1. Releases bicarbonate in exchange for primarily sodium ions

2. Releases sodium ions in exchange for primarily potassium ions
3. Releases potassium ions in exchange for primarily sodium ions
4. Releases sodium ions in exchange for primarily bicarbonate
ions
2. Releases sodium ions in exchange for primarily potassium ions
Rationale:
Sodium polystyrene sulfonate is a cation exchange resin used in
the treatment of hyperkalemia. The resin either passes through
the intestine or is retained in the colon. It releases sodium ions in
exchange for primarily potassium ions. The therapeutic effect oc-
curs 2 to 12 hours after oral administration and longer after rectal
administration.
187.) A clinic nurse prepares to administer an MMR (measles,

mumps, rubella) vaccine to a child. How is this vaccine best ad-
ministered?
1. Intramuscularly in the deltoid muscle
2. Subcutaneously in the gluteal muscle
3. Subcutaneously in the outer aspect of the upper arm
4. Intramuscularly in the anterolateral aspect of the thigh
Rationale:
The MMR vaccine is administered subcutaneously in the outer as-
pect of the upper arm. The gluteal muscle is most often used for
intramuscular injections. The MMR vaccine is not administered by
the intramuscular route.
188.) The nurse should anticipate that the most likely medication
to be prescribed prophylactically for a child with spina bifida
(myelomeningocele) who has a neurogenic bladder would be:
1. Prednisone
2. Sulfisoxazole

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4. Intravenous immune globulin (IVIG)
2. Sulfisoxazole
Rationale:
A neurogenic bladder prevents the bladder from completely emp-
tying because of the decrease in muscle tone. The most likely
medication to be prescribed to prevent urinary tract infection
would be an antibiotic. A common prescribed medication is sul-
fisoxazole. Prednisone relieves allergic reactions and inflamma-
tion rather than preventing infection. Furosemide promotes diure-
sis and decreases edema caused by congestive heart failure.
IVIG assists with antibody production in immunocompromised
clients.
189.) Prostaglandin E1 is prescribed for a child with transposition

of the great arteries. The mother of the child asks the nurse why
the child needs the medication. The nurse tells the mother that
the medication:
1. Prevents hypercyanotic (blue or tet) spells
2. Maintains an adequate hormone level
3. Maintains the position of the great arteries
4. Provides adequate oxygen saturation and maintains cardiac
output
4. Provides adequate oxygen saturation and maintains cardiac
output
Rationale:
A child with transposition of the great arteries may receive
prostaglandin E1 temporarily to increase blood mixing if systemic
and pulmonary mixing are inadequate to maintain adequate car-
diac output. Options 1, 2, and 3 are incorrect. In addition, hyper-
cyanotic spells occur in tetralogy of Fallot.
*Use the ABCs—airway, breathing, and circulation—to an-
swer the question. The correct option addresses circulation*

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190.) A child is hospitalized with a diagnosis of lead poisoning.

The nurse assisting in caring for the child would prepare to assist
in administering which of the following medications?
1. Activated charcoal
2. Sodium bicarbonate
3. Syrup of ipecac syrup
4. Dimercaprol (BAL in Oil)
4. Dimercaprol (BAL in Oil)
Rationale:
Dimercaprol is a chelating agent that is administered to remove
lead from the circulating blood and from some tissues and organs
for excretion in the urine. Sodium bicarbonate may be used in sal-
icylate poisoning. Syrup of ipecac is used in the hospital setting in
poisonings to induce vomiting. Activated charcoal is used to de-
crease absorption in certain poisoning situations. Note that dimer-
caprol is prepared with peanut oil, and hence should be avoided
by clients with known or suspected peanut allergy.
191.) A child is brought to the emergency department for treat-

ment of an acute asthma attack. The nurse prepares to administer
which of the following medications first?
1. Oral corticosteroids
2. A leukotriene modifier
3. A β2 agonist
4. A nonsteroidal anti-inflammatory
3. A β2 agonist
Rationale:
In treating an acute asthma attack, a short acting β2 agonist such
as albuterol (Proventil HFA) will be given to produce bronchodila-
tion. Options 1, 2, and 4 are long-term control (preventive) medi-
cations.

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192.) A nurse is collecting medication information from a client,

and the client states that she is taking garlic as an herbal supple-
ment. The nurse understands that the client is most likely treating
which of the following conditions?
1. Eczema
2. Insomnia
3. Migraines
4. Hyperlipidemia
4. Hyperlipidemia
Rationale:
Garlic is an herbal supplement that is used to treat hyperlipidemia
and hypertension. An herbal supplement that may be used to treat
eczema is evening primrose. Insomnia has been treated with both
valerian root and chamomile. Migraines have been treated with
feverfew.
193.) Sodium hypochlorite (Dakin's solution) is prescribed for a

client with a leg wound containing purulent drainage. The nurse is
assisting in developing a plan of care for the client and includes
which of the following in the plan?
1. Ensure that the solution is freshly prepared before use.
2. Soak a sterile dressing with solution and pack into the wound.
3. Allow the solution to remain in the wound following irrigation.
4. Apply the solution to the wound and on normal skin tissue sur-
rounding the wound.
1. Ensure that the solution is freshly prepared before use.
Rationale:
Dakin solution is a chloride solution that is used for irrigating and
cleaning necrotic or purulent wounds. It can be used for packing
necrotic wounds. It cannot be used to pack purulent wounds be-
cause the solution is inactivated by copious pus. It should not
come into contact with healing or normal tissue, and it should be
rinsed off immediately if used for irrigation. Solutions are unstable

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and the nurse must ensure that the solution has been prepared
fresh before use.
*Eliminate options 2 and 3 first because they are comparable
or alike. It makes sense to ensure that the solution is freshly
prepared; therefore, select option 1*
194.) A nurse provides instructions to a client regarding the use of

tretinoin (Retin-A). Which statement by the client indicates the
need for further instructions?
1. "Optimal results will be seen after 6 weeks."
2. "I should apply a very thin layer to my skin."
3. "I should wash my hands thoroughly after applying the medica-
tion."
4. "I should cleanse my skin thoroughly before applying the medi-
cation."
2. "I should apply a very thin layer to my skin."
Rationale:
Tretinoin is applied liberally to the skin. The hands are washed
thoroughly immediately after applying. Therapeutic results should
be seen after 2 to 3 weeks but may not be optimal until after 6
weeks. The skin needs to be cleansed thoroughly before applying
the medication.
195.) A nurse is caring for a client who is taking metoprolol (Lo-

pressor). The nurse measures the client's blood pressure (BP)
and apical pulse (AP) immediately before administration. The
client's BP is 122/78 mm/Hg and the AP is 58 beats/min. Based
on this data, which of the following is the appropriate action?
1. Withhold the medication.
2. Notify the registered nurse immediately.
3. Administer the medication as prescribed.
4. Administer half of the prescribed medication.
1. Withhold the medication.

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Rationale:
Metoprolol (Lopressor) is classified as a beta-adrenergic blocker
and is used in the treatment of hypertension, angina, and myocar-
dial infarction. Baseline nursing assessments include measure-
ment of BP and AP immediately before administration. If the sys-
tolic BP is below 90 mm/Hg and the AP is below 60 beats/min, the
nurse should withhold the medication and document this action.
Although the registered nurse should be informed of the client's
vital signs, it is not necessary to do so immediately. The medica-
tion should not be administered because the data is outside of the
prescribed parameters for this medication. The nurse should not
administer half of the medication, or alter any dosages at any
point in time.
196.) A client has been prescribed amikacin (Amikin). Which of

the following priority baseline functions should be monitored?
1. Apical pulse
2. Liver function
3. Blood pressure
4. Hearing acuity
4. Hearing acuity
Rationale:
Amikacin (Amikin) is an antibiotic. This medication can cause oto-
toxicity and nephrotoxicity; therefore, hearing acuity tests and kid-
ney function studies should be performed before the initiation of
therapy. Apical pulse, liver function studies, and blood pressure
are not specifically related to the use of this medication.
197.) Collagenase (Santyl) is prescribed for a client with a severe

burn to the hand. The nurse provides instructions to the client re-
garding the use of the medication. Which statement by the client
indicates an accurate understanding of the use of this medica-
tion?

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1. "I will apply the ointment once a day and leave it open to the
air."
2. "I will apply the ointment twice a day and leave it open to the
air."
3. "I will apply the ointment once a day and cover it with a sterile
dressing."
4. "I will apply the ointment at bedtime and in the morning and
cover it with a sterile dressing."
3. "I will apply the ointment once a day and cover it with a sterile
dressing."
Rationale:
Collagenase is used to promote debridement of dermal lesions
and severe burns. It is usually applied once daily and covered
with a sterile dressing.
198.) Coal tar has been prescribed for a client with a diagnosis of
psoriasis, and the nurse provides instructions to the client about
the medication. Which statement by the client indicates a need for
further instructions?
1. "The medication can cause phototoxicity."
2. "The medication has an unpleasant odor."
3. "The medication can stain the skin and hair."
4. "The medication can cause systemic effects."
4. "The medication can cause systemic effects."
Rationale:
Coal tar is used to treat psoriasis and other chronic disorders of
the skin. It suppresses DNA synthesis, mitotic activity, and cell
proliferation. It has an unpleasant odor, can frequently stain the
skin and hair, and can cause phototoxicity. Systemic toxicity does
not occur.
*The name of the medication will assist in eliminating options
2 and 3*

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199.) A nurse is applying a topical glucocorticoid to a client with

eczema. The nurse monitors for systemic absorption of the medi-
cation if the medication is being applied to which of the following
body areas?
1. Back
2. Axilla
3. Soles of the feet
4. Palms of the hands
2. Axilla
Rationale:
Topical glucocorticoids can be absorbed into the systemic circula-
tion. Absorption is higher from regions where the skin is especially
permeable (scalp, axillae, face, eyelids, neck, perineum, geni-
talia), and lower from regions where penetrability is poor (back,
palms, soles).
*Eliminate options 3 and 4 because these body areas are
similar in terms of skin characteristics*
200.) A client is seen in the clinic for complaints of skin itchiness

that has been persistent over the past several weeks. Following
data collection, it has been determined that the client has scabies.
Lindane is prescribed, and the nurse is asked to provide instruc-
tions to the client regarding the use of the medication. The nurse
tells the client to:
1. Apply a thick layer of cream to the entire body.
2. Apply the cream as prescribed for 2 days in a row.
3. Apply to the entire body and scalp, excluding the face.
4. Leave the cream on for 8 to 12 hours and then remove by
washing.
4. Leave the cream on for 8 to 12 hours and then remove by
washing.
Rationale:
Lindane is applied in a thin layer to the entire body below the
head. No more than 30 g (1 oz) should be used. The medication

lOMoARcPSD|3083804
is removed by washing 8 to 12 hours later. Usually, only one ap-

plication is required.
201.) A nurse is preparing to administer eardrops to an infant. The

nurse plans to:
1. Pull up and back on the ear and direct the solution onto the
eardrum.
2. Pull down and back on the ear and direct the solution onto the
eardrum.
3. Pull down and back on the ear and direct the solution toward
the wall of the canal.
4. Pull up and back on the ear lobe and direct the solution toward
3. Pull down and back on the ear and direct the solution toward
Rationale:
When administering eardrops to an infant, the nurse pulls the ear
down and straight back. In the adult or a child older than 3 years,
the ear is pulled up and back to straighten the auditory canal. The
medication is administered by aiming it at the wall of the canal
rather than directly onto the eardrum.
202.) A nurse is collecting data from a client about medications

being taken, and the client tells the nurse that he is taking herbal
supplements for the treatment of varicose veins. The nurse under-
stands that the client is most likely taking which of the following?
1. Bilberry
2. Ginseng
3. Feverfew
4. Evening primrose
1. Bilberry
Rationale:

lOMoARcPSD|3083804
Bilberry is an herbal supplement that has been used to treat vari-

cose veins. This supplement has also been used to treat
cataracts, retinopathy, diabetes mellitus, and peripheral vascular
disease. Ginseng has been used to improve memory perfor-
mance and decrease blood glucose levels in type 2 diabetes mel-
litus. Feverfew is used to prevent migraine headaches and to treat
rheumatoid arthritis. Evening primrose is used to treat eczema
and skin irritation.
203.) A nurse is preparing to give the postcraniotomy client medi-

cation for incisional pain. The family asks the nurse why the client
is receiving codeine sulfate and not "something stronger." In for-
mulating a response, the nurse incorporates the understanding
that codeine:
1. Is one of the strongest opioid analgesics available
2. Cannot lead to physical or psychological dependence
3. Does not cause gastrointestinal upset or constipation as do
other opioids
4. Does not alter respirations or mask neurological signs as do
other opioids
4. Does not alter respirations or mask neurological signs as do
other opioids
Rationale:
Codeine sulfate is the opioid analgesic often used for clients after
craniotomy. It is frequently combined with a nonopioid analgesic
such as acetaminophen for added effect. It does not alter the res-
piratory rate or mask neurological signs as do other opioids. Side
effects of codeine include gastrointestinal upset and constipation.
The medication can lead to physical and psychological depen-
dence with chronic use. It is not the strongest opioid analgesic
available.

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204.) A client receives a dose of edrophonium (Enlon). The client

shows improvement in muscle strength for a period of time follow-
ing the injection. The nurse interprets that this finding is compati-
ble with:
1. Multiple sclerosis
2. Myasthenia gravis
3. Muscular dystrophy
4. Amyotrophic lateral sclerosis
2. Myasthenia gravis
Rationale:
Myasthenia gravis can often be diagnosed based on clinical signs
and symptoms. The diagnosis can be confirmed by injecting the
client with a dose of edrophonium . This medication inhibits the
breakdown of an enzyme in the neuromuscular junction, so more
acetylcholine binds to receptors. If the muscle is strengthened for
3 to 5 minutes after this injection, it confirms a diagnosis of myas-
thenia gravis. Another medication, neostigmine (Prostigmin), also
may be used because its effect lasts for 1 to 2 hours, providing a
better analysis. For either medication, atropine sulfate should be
available as the antidote.
205.) A nurse is assisting in preparing to administer acetylcysteine

(Mucomyst) to a client with an overdose of acetaminophen
(Tylenol). The nurse prepares to administer the medication by:
1. Administering the medication subcutaneously in the deltoid
muscle
2. Administering the medication by the intramuscular route in the
gluteal muscle
3. Administering the medication by the intramuscular route, mixed
in 10 mL of normal saline
4. Mixing the medication in a flavored ice drink and allowing the
client to drink the medication through a straw
4. Mixing the medication in a flavored ice drink and allowing the
client to drink the medication through a straw

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Rationale:
Because acetylcysteine has a pervasive odor of rotten eggs, it
must be disguised in a flavored ice drink. It is consumed prefer-
ably through a straw to minimize contact with the mouth. It is not
administered by the intramuscular or subcutaneous route.
*Knowing that the medication is a solution that is also used
for nebulization treatments will assist you to select the op-
tion that indicates an oral route*
206.) A client is receiving baclofen (Lioresal) for muscle spasms

caused by a spinal cord injury. The nurse monitors the client,
knowing that which of the following is a side effect of this medica-
tion?
1. Muscle pain
2. Hypertension
3. Slurred speech
4. Photosensitivity
Rationale:
Side effects of baclofen include drowsiness, dizziness, weakness,
and nausea. Occasional side effects include headache, paresthe-
sia of the hands and feet, constipation or diarrhea, anorexia, hy-
potension, confusion, and nasal congestion. Paradoxical central
nervous system excitement and restlessness can occur, along
with slurred speech, tremor, dry mouth, nocturia, and impotence.
*Option 3 is most closely associated with a neurological dis-
order*
207.) A client is suspected of having myasthenia gravis, and the

health care provider administers edrophonium (Enlon) to deter-
mine the diagnosis. After administration of this medication, which
of the following would indicate the presence of myasthenia
gravis?
1. Joint pain

lOMoARcPSD|3083804
2. A decrease in muscle strength

3. An increase in muscle strength
4. Feelings of faintness, dizziness, hypotension, and signs of
flushing in the client
3. An increase in muscle strength
Rationale:
Edrophonium is a short-acting acetylcholinesterase inhibitor used
as a diagnostic agent. When a client with suspected myasthenia
gravis is given the medication intravenously, an increase in mus-
cle strength would be seen in 1 to 3 minutes. If no response oc-
curs, another dose is given over the next 2 minutes, and muscle
strength is again tested. If no increase in muscle strength occurs
with this higher dose, the muscle weakness is not caused by
myasthenia gravis. Clients receiving injections of this medication
commonly demonstrate a drop of blood pressure, feel faint and
dizzy, and are flushed.
208.) A client with myasthenia gravis verbalizes complaints of

feeling much weaker than normal. The health care provider plans
to implement a diagnostic test to determine if the client is experi-
encing a myasthenic crisis and administers edrophonium (Enlon).
Which of the following would indicate that the client is experienc-
ing a myasthenic crisis?
1. Increasing weakness
3. An increase in muscle spasms
4. A temporary improvement in the condition
auto-define "A client with myasthen..."
Rationale:
Edrophonium (Enlon) is administered to determine whether the
client is reacting to an overdose of a medication (cholinergic cri-
sis) or to an increasing severity of the disease (myasthenic crisis).
When the edrophonium (Enlon) injection is given and the condi-
tion improves temporarily, the client is in myasthenic crisis. This is

lOMoARcPSD|3083804
known as a positive test. Increasing weakness would occur in

cholinergic crisis. Options 2 and 3 would not occur in either crisis.
209.) A client with multiple sclerosis is receiving diazepam (Val-

ium), a centrally acting skeletal muscle relaxant. Which of the fol-
lowing would indicate that the client is experiencing a side effect
related to this medication?
1. Headache
2. Drowsiness
4. Increased salivation
2. Drowsiness
Rationale:
Incoordination and drowsiness are common side effects resulting
from this medication. Options 1, 3, and 4 are incorrect.
210.) Dantrolene (Dantrium) is prescribed for a client with a spinal

cord injury for discomfort resulting from spasticity. The nurse tells
the client about the importance of follow-up and the need for
which blood study?
1. Creatinine level
2. Sedimentation rate
Rationale:
Dantrolene can cause liver damage, and the nurse should monitor
liver function studies. Baseline liver function studies are done be-
fore therapy starts, and regular liver function studies are per-
formed throughout therapy. Dantrolene is discontinued if no relief
of spasticity is achieved in 6 weeks.

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211.) A client with epilepsy is taking the prescribed dose of pheny-

toin (Dilantin) to control seizures. A phenytoin blood level is
drawn, and the results reveal a level of 35 mcg/ml. Which of the
following symptoms would be expected as a result of this labora-
tory result?
1. Nystagmus
2. Tachycardia
3. Slurred speech
4. No symptoms, because this is a normal therapeutic level
3. Slurred speech
Rationale:
The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level
higher than 20 mcg/mL, involuntary movements of the eyeballs
(nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and
slurred speech occur.
212.) Mannitol (Osmitrol) is being administered to a client with in-

creased intracranial pressure following a head injury. The nurse
assisting in caring for the client knows that which of the following
indicates the therapeutic action of this medication?
1. Prevents the filtration of sodium and water through the kidneys
2. Prevents the filtration of sodium and potassium through the kid-
neys
3. Decreases water loss by promoting the reabsorption of sodium
and water in the loop of Henle
4. Induces diuresis by raising the osmotic pressure of glomerular
filtrate, thereby inhibiting tubular reabsorption of water and solutes
4. Induces diuresis by raising the osmotic pressure of glomerular
filtrate, thereby inhibiting tubular reabsorption of water and solutes
Rationale:
Mannitol is an osmotic diuretic that induces diuresis by raising the
osmotic pressure of glomerular filtrate, thereby inhibiting tubular
reabsorption of water and solutes. It is used to reduce intracranial
pressure in the client with head trauma.

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213.) A client is admitted to the hospital with complaints of back

spasms. The client states, "I have been taking two or three aspirin
every 4 hours for the past week and it hasn't helped my back." As-
pirin intoxication is suspected. Which of the following complaints
would indicate aspirin intoxication?
1. Tinnitus
2. Constipation
3. Photosensitivity
4. Abdominal cramps
1. Tinnitus
Rationale:
Mild intoxication with acetylsalicylic acid (aspirin) is called sali-
cylism and is commonly experienced when the daily dosage is
higher than 4 g. Tinnitus (ringing in the ears) is the most fre-
quently occurring effect noted with intoxication. Hyperventilation
may occur because salicylate stimulates the respiratory center.
Fever may result because salicylate interferes with the metabolic
pathways involved with oxygen consumption and heat production.
Options 2, 3, and 4 are incorrect.
214.) A health care provider initiates carbidopa/levodopa

(Sinemet) therapy for the client with Parkinson's disease. A few
days after the client starts the medication, the client complains of
nausea and vomiting. The nurse tells the client that:
1. Taking an antiemetic is the best measure to prevent the nau-
sea.
2. Taking the medication with food will help to prevent the nausea.
3. This is an expected side effect of the medication and will de-
crease over time.
4. The nausea and vomiting will decrease when the dose of lev-
odopa is stabilized.
2. Taking the medication with food will help to prevent the nausea.

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Rationale:
If carbidopa/levodopa is causing nausea and vomiting, the nurse
would tell the client that taking the medication with food will pre-
vent the nausea. Additionally, the client should be instructed not to
take the medication with a high-protein meal because the high-
protein will affect absorption. Antiemetics from the phenothiazine
class should not be used because they block the therapeutic ac-
tion of dopamine.
*eliminate options 3 and 4 because they are comparable or
alike*
215.) A client with rheumatoid arthritis is taking acetylsalicylic acid

(aspirin) on a daily basis. Which medication dose should the
nurse expect the client to be taking?
1. 1 g daily
2. 4 g daily
3. 325 mg daily
4. 1000 mg daily
2. 4 g daily
Rationale:
Aspirin may be used to treat the client with rheumatoid arthritis. It
may also be used to reduce the risk of recurrent transient is-
chemic attack (TIA) or brain attack (stroke) or reduce the risk of
myocardial infarction (MI) in clients with unstable angina or a his-
tory of a previous MI. The normal dose for clients being treated
with aspirin to decrease thrombosis and MI is 300 to 325 mg/day.
Clients being treated to prevent TIAs are usually prescribed 1.3
g/day in two to four divided doses. Clients with rheumatoid arthri-
tis are treated with 3.6 to 5.4 g/day in divided doses.
*Eliminate options 1 and 4 because they are alike*
216.) A nurse is caring for a client with gout who is taking Colcrys
(colchicine). The client has been instructed to restrict the diet to

lOMoARcPSD|3083804
low-purine foods. Which of the following foods should the nurse

instruct the client to avoid while taking this medication?
1. Spinach
2. Scallops
3. Potatoes
4. Ice cream
2. Scallops
Rationale:
Colchicine is a medication used for clients with gout to inhibit the
reabsorption of uric acid by the kidney and promote excretion of
uric acid in the urine. Uric acid is produced when purine is catabo-
lized. Clients are instructed to modify their diet and limit excessive
purine intake. High-purine foods to avoid or limit include organ
meats, roe, sardines, scallops, anchovies, broth, mincemeat, her-
ring, shrimp, mackerel, gravy, and yeast.
217.) A health care provider prescribes auranofin (Ridaura) for a

client with rheumatoid arthritis. Which of the following would indi-
cate to the nurse that the client is experiencing toxicity related to
the medication?
1. Joint pain
2. Constipation
3. Ringing in the ears
4. Complaints of a metallic taste in the mouth
4. Complaints of a metallic taste in the mouth
Rationale:
Ridaura is the one gold preparation that is given orally rather than
by injection. Gastrointestinal reactions including diarrhea, abdomi-
nal pain, nausea, and loss of appetite are common early in ther-
apy, but these usually subside in the first 3 months of therapy.
Early symptoms of toxicity include a rash, purple blotches, pruri-
tus, mouth lesions, and a metallic taste in the mouth.

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218.) A film-coated form of diflunisal has been prescribed for a

client for the treatment of chronic rheumatoid arthritis. The client
calls the clinic nurse because of difficulty swallowing the tablets.
Which initial instruction should the nurse provide to the client?
1. "Crush the tablets and mix them with food."
2. "Notify the health care provider for a medication change."
3. "Open the tablet and mix the contents with food."
4. "Swallow the tablets with large amounts of water or milk."
4. "Swallow the tablets with large amounts of water or milk."
Rationale:
Diflunisal may be given with water, milk, or meals. The tablets
should not be crushed or broken open. Taking the medication with
a large amount of water or milk should be tried before contacting
the health care provider.
219.) A health care provider instructs a client with rheumatoid

arthritis to take ibuprofen (Motrin). The nurse reinforces the in-
structions, knowing that the normal adult dose for this client is
which of the following?
1. 100 mg orally twice a day
2. 200 mg orally twice a day
3. 400 mg orally three times a day
4. 1000 mg orally four times a day
3. 400 mg orally three times a day
Rationale:
For acute or chronic rheumatoid arthritis or osteoarthritis, the nor-
mal oral adult dose is 400 to 800 mg three or four times daily.
220.) A adult client with muscle spasms is taking an oral mainte-

nance dose of baclofen (Lioresal). The nurse reviews the medica-
tion record, expecting that which dose should be prescribed?
1. 15 mg four times a day

lOMoARcPSD|3083804

Rationale:
Baclofen is dispensed in 10- and 20-mg tablets for oral use.
Dosages are low initially and then gradually increased. Mainte-
nance doses range from 15 to 20 mg administered three or four
times a day.
221.) A nurse is reviewing the health care provider's prescriptions

for an adult client who has been admitted to the hospital following
a back injury. Carisoprodol (Soma) is prescribed for the client to
relieve the muscle spasms; the health care provider has pre-
scribed 350 mg to be administered four times a day. When pre-
paring to give this medication, the nurse determines that this
dosage is:
1. The normal adult dosage
2. A lower than normal dosage
3. A higher than normal dosage
4. A dosage requiring further clarification
1. The normal adult dosage
Rationale:
The normal adult dosage for carisoprodol is 350 mg orally three or
four times daily.
222.) A nurse has administered a dose of diazepam (Valium) to a

client. The nurse would take which important action before leaving
the client's room?
1. Giving the client a bedpan
2. Drawing the shades or blinds closed
3. Turning down the volume on the television
4. Per agency policy, putting up the side rails on the bed
4. Per agency policy, putting up the side rails on the bed

lOMoARcPSD|3083804
Rationale:
Diazepam is a sedative-hypnotic with anticonvulsant and skeletal
muscle relaxant properties. The nurse should institute safety mea-
sures before leaving the client's room to ensure that the client
does not injure herself or himself. The most frequent side effects
of this medication are dizziness, drowsiness, and lethargy. For
this reason, the nurse puts the side rails up on the bed before
leaving the room to prevent falls. Options 1, 2, and 3 may be help-
ful measures that provide a comfortable, restful environment, but
option 4 is the one that provides for the client's safety needs.
223.) A client with a psychotic disorder is being treated with

haloperidol (Haldol). Which of the following would indicate the
presence of a toxic effect of this medication?
1. Nausea
2. Hypotension
3. Blurred vision
4. Excessive salivation
4. Excessive salivation
Rationale:
Toxic effects include extrapyramidal symptoms (EPS) noted as
marked drowsiness and lethargy, excessive salivation, and a fixed
stare. Akathisia, acute dystonias, and tardive dyskinesia are also
signs of toxicity. Hypotension, nausea, and blurred vision are oc-
casional side effects.
224.) Neuroleptic malignant syndrome is suspected in a client

who is taking chlorpromazine. Which medication would the nurse
prepare in anticipation of being prescribed to treat this adverse ef-
fect related to the use of chlorpromazine?
2. Bromocriptine (Parlodel)
3. Phytonadione (vitamin K)

lOMoARcPSD|3083804
4. Enalapril maleate (Vasotec)

2. Bromocriptine (Parlodel)
Rationale:
Bromocriptine is an antiparkinsonian prolactin inhibitor used in the
treatment of neuroleptic malignant syndrome. Vitamin K is the an-
tidote for warfarin (Coumadin) overdose. Protamine sulfate is the
antidote for heparin overdose. Enalapril maleate is an antihyper-
tensive used in the treatment of hypertension.
225.) A nursing student is assigned to care for a client with a diag-

nosis of schizophrenia. Haloperidol (Haldol) is prescribed for the
client, and the nursing instructor asks the student to describe the
action of the medication. Which statement by the nursing student
indicates an understanding of the action of this medication?
1. It is a serotonin reuptake blocker.
2. It inhibits the breakdown of released acetylcholine.
3. It blocks the uptake of norepinephrine and serotonin.
4. It blocks the binding of dopamine to the postsynaptic dopamine
receptors in the brain.
4. It blocks the binding of dopamine to the postsynaptic dopamine
receptors in the brain.
Rationale:
Haloperidol acts by blocking the binding of dopamine to the post-
synaptic dopamine receptors in the brain. Imipramine hydrochlo-
ride (Tofranil) blocks the reuptake of norepinephrine and sero-
tonin. Donepezil hydrochloride (Aricept) inhibits the breakdown of
released acetylcholine. Fluoxetine hydrochloride (Prozac) is a po-
tent serotonin reuptake blocker.
226.) A client receiving lithium carbonate (Lithobid) complains of

loose, watery stools and difficulty walking. The nurse would ex-
pect the serum lithium level to be which of the following?
1. 0.7 mEq/L

lOMoARcPSD|3083804
2. 1.0 mEq/L
3. 1.2 mEq/L
4. 1.7 mEq/L
4. 1.7 mEq/L
Rationale:
The therapeutic serum level of lithium ranges from 0.6 to 1.2
mEq/L. Serum lithium levels above the therapeutic level will pro-
duce signs of toxicity.
227.) When teaching a client who is being started on imipramine

hydrochloride (Tofranil), the nurse would inform the client that the
desired effects of the medication may:
1. Start during the first week of administration
3. Start during the second week of administration
4. Not occur until after a month of administration
Rationale:
The therapeutic effects of administration of imipramine hydrochlo-
ride may not occur for 2 to 3 weeks after the antidepressant ther-
apy has been initiated. Therefore options 1, 3, and 4 are incorrect.
228.) A client receiving an anxiolytic medication complains that he

feels very "faint" when he tries to get out of bed in the morning.
The nurse recognizes this complaint as a symptom of:
1. Cardiac dysrhythmias
2. Postural hypotension
3. Psychosomatic symptoms
4. Respiratory insufficiency
2. Postural hypotension
Rationale:
Anxiolytic medications can cause postural hypotension. The client
needs to be taught to rise to a sitting position and get out of bed

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slowly because of this adverse effect related to the medication.

Options 1, 3, and 4 are unrelated to the use of this medication.
229.) A client who is taking lithium carbonate (Lithobid) is sched-

uled for surgery. The nurse informs the client that:
1. The medication will be discontinued a week before the surgery
and resumed 1 week postoperatively.
2. The medication is to be taken until the day of surgery and re-
sumed by injection immediately postoperatively.
3. The medication will be discontinued 1 to 2 days before the
surgery and resumed as soon as full oral intake is allowed.
4. The medication will be discontinued several days before
surgery and resumed by injection in the immediate postoperative
period.
3. The medication will be discontinued 1 to 2 days before the
surgery and resumed as soon as full oral intake is allowed.
Rationale:
The client who is on lithium carbonate must be off the medication
for 1 to 2 days before a scheduled surgical procedure and can re-
sume the medication when full oral intake is prescribed after the
surgery.
*lithium carbonate is an oral medication and is not given as
an injection*
230.) A client is placed on chloral hydrate (Somnote) for short-

term treatment. Which nursing action indicates an understanding
of the major side effect of this medication?
1. Monitoring neurological signs every 2 hours
2. Monitoring the blood pressure every 4 hours
3. Instructing the client to call for ambulation assistance
4. Lowering the bed and clearing a path to the bathroom at bed-
time
3. Instructing the client to call for ambulation assistance

lOMoARcPSD|3083804
Rationale:
Chloral hydrate (a sedative-hypnotic) causes sedation and impair-
ment of motor coordination; therefore, safety measures need to
be implemented. The client is instructed to call for assistance with
ambulation. Options 1 and 2 are not specifically associated with
the use of this medication. Although option 4 is an appropriate
nursing intervention, it is most important to instruct the client to
call for assistance with ambulation.
231.) A client admitted to the hospital gives the nurse a bottle of

clomipramine (Anafranil). The nurse notes that the medication has
not been taken by the client in 2 months. What behaviors ob-
served in the client would validate noncompliance with this medi-
cation?
1. Complaints of hunger
2. Complaints of insomnia
3. A pulse rate less than 60 beats per minute
4. Frequent handwashing with hot, soapy water
4. Frequent handwashing with hot, soapy water
Rationale:
Clomipramine is commonly used in the treatment of obsessive-
compulsive disorder. Handwashing is a common obsessive-com-
pulsive behavior. Weight gain is a common side effect of this
medication. Tachycardia and sedation are side effects. Insomnia
may occur but is seldom a side effect.
232.) A client in the mental health unit is administered haloperidol

(Haldol). The nurse would check which of the following to deter-
mine medication effectiveness?
1. The client's vital signs
2. The client's nutritional intake
3. The physical safety of other unit clients
4. The client's orientation and delusional status

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4. The client's orientation and delusional status

Rationale:
Haloperidol is used to treat clients exhibiting psychotic features.
Therefore, to determine medication effectiveness, the nurse
would check the client's orientation and delusional status. Vital
signs are routine and not specific to this situation. The physical
safety of other clients is not a direct assessment of this client.
Monitoring nutritional intake is not related to this situation.
233.) Diphenhydramine hydrochloride (Benadryl) is used in the

treatment of allergic rhinitis for a hospitalized client with a chronic
psychotic disorder. The client asks the nurse why the medication
is being discontinued before hospital discharge. The nurse re-
sponds, knowing that:
1. Allergic symptoms are short in duration.
2. This medication promotes long-term extrapyramidal symptoms.
3. Addictive properties are enhanced in the presence of psy-
chotropic medications.
4. Poor compliance causes this medication to fail to reach its ther-
apeutic blood level.
3. Addictive properties are enhanced in the presence of psy-
chotropic medications.
Rationale:
The addictive properties of diphenhydramine hydrochloride are
enhanced when used with psychotropic medications. Allergic
symptoms may not be short term and will occur if allergens are
present in the environment. Poor compliance may be a problem
with psychotic clients but is not the subject of the question.
Diphenhydramine hydrochloride may be used for extrapyramidal
symptoms and mild medication-induced movement disorders.

lOMoARcPSD|3083804
234.) A hospitalized client is started on phenelzine sulfate (Nardil)

for the treatment of depression. At lunchtime, a tray is delivered to
the client. Which food item on the tray will the nurse remove?
1. Yogurt
2. Crackers
3. Tossed salad
4. Oatmeal cookies
1. Yogurt
Rationale:
Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The
client should avoid taking in foods that are high in tyramine.
These foods could trigger a potentially fatal hypertensive crisis.
Foods to avoid include yogurt, aged cheeses, smoked or pro-
cessed meats, red wines, and fruits such as avocados, raisins, or
figs.
235.) A tricyclic antidepressant is administered to a client daily.

The nurse plans to monitor for the common side effects of the
medication and includes which of the following in the plan of
care?
1. Offer hard candy or gum periodically.
2. Offer a nutritious snack between meals.
3. Monitor the blood pressure every 2 hours.
4. Review the white blood cell (WBC) count results daily.
1. Offer hard candy or gum periodically.
Rationale:
Dry mouth is a common side effect of tricyclic antidepressants.
Frequent mouth rinsing with water, sucking on hard candy, and
chewing gum will alleviate this common side effect. It is not nec-
essary to monitor the blood pressure every 2 hours. In addition, it
is not necessary to check the WBC daily. Weight gain is a com-
mon side effect and frequent snacks will aggravate this problem.

lOMoARcPSD|3083804
236.) A client is being treated for depression with amitriptyline hy-

drochloride. During the initial phases of treatment, the most im-
portant nursing intervention is:
1. Prescribing the client a tyramine-free diet
2. Checking the client for anticholinergic effects
3. Monitoring blood levels frequently because there is a narrow
range between therapeutic and toxic blood levels of this medica-
tion
4. Getting baseline postural blood pressures before administering
the medication and each time the medication is administered
4. Getting baseline postural blood pressures before administering
the medication and each time the medication is administered
Rationale:
Amitriptyline hydrochloride is a tricyclic antidepressant often used
to treat depression. It causes orthostatic changes and can pro-
duce hypotension and tachycardia. This can be frightening to the
client and dangerous because it can result in dizziness and client
falls. The client must be instructed to move slowly from a lying to
a sitting to a standing position to avoid injury if these effects are
experienced. The client may also experience sedation, dry mouth,
constipation, blurred vision, and other anticholinergic effects, but
these are transient and will diminish with time.
237.) A client who is on lithium carbonate (Lithobid) will be dis-

charged at the end of the week. In formulating a discharge teach-
ing plan, the nurse will instruct the client that it is most important
to:
1. Avoid soy sauce, wine, and aged cheese.
2. Have the lithium level checked every week.
3. Take medication only as prescribed because it can become ad-
dicting.
4. Check with the psychiatrist before using any over-the-counter
(OTC) medications or prescription medications.

lOMoARcPSD|3083804
4. Check with the psychiatrist before using any over-the-counter

(OTC) medications or prescription medications.
Rationale:
Lithium is the medication of choice to treat manic-depressive ill-
ness. Many OTC medications interact with lithium, and the client
is instructed to avoid OTC medications while taking lithium.
Lithium is not addicting, and, although serum lithium levels need
to be monitored, it is not necessary to check these levels every
week. A tyramine-free diet is associated with monoamine oxidase
inhibitors.
238.) Ribavirin (Virazole) is prescribed for the hospitalized child

with respiratory syncytial virus (RSV). The nurse prepares to ad-
minister this medication via which of the following routes?
1. Orally
2. Via face mask
3. Intravenously
4. Intramuscularly
2. Via face mask
Rationale:
Ribavirin is an antiviral respiratory medication used mainly in hos-
pitalized children with severe RSV and in high-risk children. Ad-
ministration is via hood, face mask, or oxygen tent. The medica-
tion is most effective if administered within the first 3 days of the
infection.
239.) Which of the following precautions will the nurse specifically

take during the administration of ribavirin (Virazole) to a child with
respiratory syncytial virus (RSV)?
1. Wearing goggles
2. Wearing a gown
3. Wearing a gown and a mask
4. Handwashing before administration

lOMoARcPSD|3083804
1. Wearing goggles
Rationale:
Some caregivers experience headaches, burning nasal passages
and eyes, and crystallization of soft contact lenses as a result of
administration of ribavirin. Specific to this medication is the use of
goggles. A gown is not necessary. A mask may be worn. Hand-
washing is to be performed before and after any child contact.
240.) A client with Parkinson's disease has been prescribed ben-

ztropine (Cogentin). The nurse monitors for which gastrointestinal
(GI) side effect of this medication?
1. Diarrhea
2. Dry mouth
3. Increased appetite
4. Hyperactive bowel sounds
2. Dry mouth
Rationale:
Common GI side effects of benztropine therapy include constipa-
tion and dry mouth. Other GI side effects include nausea and
ileus. These effects are the result of the anticholinergic properties
of the medication.
*Eliminate options 1 and 4 because they are comparable or
alike. Recall that the medication is an anticholinergic, which
causes dry mouth*
241.) A client with a history of simple partial seizures is taking clo-

razepate (Tranxene), and asks the nurse if there is a risk of addic-
tion. The nurse's response is based on the understanding that clo-
razepate:
1. Is not habit forming, either physically or psychologically
2. Leads to physical tolerance, but only after 10 or more years of
therapy

lOMoARcPSD|3083804
3. Leads to physical and psychological dependence with pro-

longed high-dose therapy
4. Can result in psychological dependence only, because of the
nature of the medication
3. Leads to physical and psychological dependence with pro-
longed high-dose therapy
Rationale:
Clorazepate is classified as an anticonvulsant, antianxiety agent,
and sedative-hypnotic (benzodiazepine). One of the concerns
with clorazepate therapy is that the medication can lead to physi-
cal or psychological dependence with prolonged therapy at high
doses. For this reason, the amount of medication that is readily
available to the client at any one time is restricted.
*Eliminate options 2 and 4 first because of the closed-ended
word "only"*
242.) A client who was started on anticonvulsant therapy with

clonazepam (Klonopin) tells the nurse of increasing clumsiness
and unsteadiness since starting the medication. The client is visi-
bly upset by these manifestations and asks the nurse what to do.
The nurse's response is based on the understanding that these
symptoms:
1. Usually occur if the client takes the medication with food
2. Are probably the result of an interaction with another medica-
tion
3. Indicate that the client is experiencing a severe untoward reac-
tion to the medication
4. Are worse during initial therapy and decrease or disappear with
long-term use
4. Are worse during initial therapy and decrease or disappear with
long-term use
Rationale:
Drowsiness, unsteadiness, and clumsiness are expected effects
of the medication during early therapy. They are dose related and

lOMoARcPSD|3083804
usually diminish or disappear altogether with continued use of the

medication. It does not indicate that a severe side effect is occur-
ring. It is also unrelated to interaction with another medication.
The client is encouraged to take this medication with food to mini-
mize gastrointestinal upset.
or alike and because of the word "severe" in option 3*
243.) A hospitalized client is having the dosage of clonazepam

(Klonopin) adjusted. The nurse should plan to:
1. Weigh the client daily.
2. Observe for ecchymosis.
3. Institute seizure precautions.
4. Monitor blood glucose levels.
3. Institute seizure precautions.
Rationale:
Clonazepam is a benzodiazepine used as an anticonvulsant. Dur-
ing initial therapy and during periods of dosage adjustment, the
nurse should initiate seizure precautions for the client. Options 1,
2, and 4 are not associated with the use of this medication.
244.) A client has a prescription for valproic acid (Depakene)

orally once daily. The nurse plans to:
1. Administer the medication with an antacid.
2. Administer the medication with a carbonated beverage.
3. Ensure that the medication is administered at the same time
each day.
4. Ensure that the medication is administered 2 hours before
breakfast only, when the client's stomach is empty.
3. Ensure that the medication is administered at the same time
each day.
Rationale:

lOMoARcPSD|3083804
Valproic acid is an anticonvulsant, antimanic, and antimigraine

medication. It may be administered with or without food. It should
not be taken with an antacid or carbonated beverage because
these products will affect medication absorption. The medication
is administered at the same time each day to maintain therapeutic
serum levels.
*Use general pharmacology guidelines to assist in eliminat-
ing options 1 and 2. Eliminate option 4 because of the
closed-ended word "only."*
245.) A client taking carbamazepine (Tegretol) asks the nurse

what to do if he misses one dose. The nurse responds that the
carbamazepine should be:
1. Withheld until the next scheduled dose
2. Withheld and the health care provider is notified immediately
3. Taken as long as it is not immediately before the next dose
4. Withheld until the next scheduled dose, which should then be
doubled
3. Taken as long as it is not immediately before the next dose
Rationale:
Carbamazepine is an anticonvulsant that should be taken around
the clock, precisely as directed. If a dose is omitted, the client
should take the dose as soon as it is remembered, as long as it is
not immediately before the next dose. The medication should not
be double dosed. If more than one dose is omitted, the client
should call the health care provider.
A nurse has given medication instructions to a client beginning

anticonvulsant therapy with carbamazepine (Tegretol). The nurse
determines that the client understands the use of the medication if
the client knows to:
1. Drive as long as it is not at night.
2. Use sunscreen when outsides.

lOMoARcPSD|3083804
3. Discontinue the medication if fever or sore throat occurs.

4. Keep tissues handy because of excess salivation that may oc-
cur.
2. Use sunscreen when outsides.
Rationale:
Carbamazepine acts by depressing synaptic transmission in the
central nervous system (CNS). Because of this, the client should
avoid driving or doing other activities that require mental alertness
until the effect on the client is known. The client should use pro-
tective clothing and sunscreen to avoid photosensitivity reactions.
The medication may cause dry mouth (not excessive salivation),
and the client should be instructed to provide good oral hygiene
and use sugarless candy or gum as needed. The medication
should not be abruptly discontinued because it could cause return
of seizures or status epilepticus. Fever and sore throat (leukope-
nia) should be reported to the health care provider (HCP).
A client with vascular headaches is taking ergotamine (Ergomar).

The nurse would monitor the client for:
1. Constipation
2. Hypotension
3. Dependent edema
4. Cool, numb fingers and toes
4. Cool, numb fingers and toes
Rationale:
Ergotamine produces vasoconstriction, which suppresses vascu-
lar headaches when given at a therapeutic dose range. The nurse
monitors for hypertension; cool, numb fingers and toes; muscle
pain; and nausea and vomiting.
*first recall that vascular headaches are caused by vasodi-
latation of the blood vessels in the head. Following this train
of thought, you then recall that this medication must cause
vasoconstriction. The only side effect consistent with vaso-
constriction is option 4, the cool, numb fingers and toes.*

lOMoARcPSD|3083804
A nurse is caring for a client with myasthenia gravis who has re-
ceived edrophonium (Enlon) intravenously to test for myasthenic
crisis. The client asks the nurse how long the improvement in
muscle strength will last. The nurse's response is based on the
understanding that the effects have a duration of approximately:
1. 5 minutes
2. 15 minutes
3. 30 minutes
4. 60 minutes
3. 30 minutes
Rationale:
Edrophonium may be given to test for myasthenic crisis. If the
client is in myasthenic crisis, muscle strength improves after ad-
ministration of the medication and lasts for about 30 minutes.
A client with narcolepsy has been prescribed dextroamphetamine

(Dexedrine). The client complains to the nurse that he cannot
sleep well anymore at night and does not want to take the medi-
cation any longer. Before making any specific comment, the nurse
plans to investigate whether the client takes the medication at
which of the following proper time schedules?
1. After dinner each day
2. Just before going to bed
3. Two hours before bedtime
4. At least 6 hours before bedtime
Rationale:
Dextroamphetamine is a central nervous system (CNS) stimulant,
which acts by releasing norepinephrine from nerve endings. The
client should take the medication at least 6 hours before going to
bed at night to prevent disturbances with sleep. Taking the medi-
cation at the time frames indicated in options 1, 2, and 3 will pre-

lOMoARcPSD|3083804
vent the client from sleeping because of the stimulant properties

of the medication.
A client on the nursing unit has a prescription for dextroam-

phetamine (Dexedrine) orally daily. The nurse collaborates with
the dietitian to limit the amount of which of the following items on
the client's dietary trays?
1. Fat
2. Protein
3. Starch
4. Caffeine
4. Caffeine
Rationale:
Dextroamphetamine is a central nervous system (CNS) stimulant.
Caffeine is a stimulant also and should be limited in the client tak-
ing this medication. The client should be taught to limit caffeine in-
take as well.
A client with Parkinson's disease has begun therapy with car-

bidopa/levodopa (Sinemet). The nurse determines that the client
understands the action of the medication if the client verbalizes
that results may not be apparent for:
1. 24 hours
2. 1 week
3. 2 to 3 days
4. 2 to 3 weeks
4. 2 to 3 weeks
Rationale:
Signs and symptoms of Parkinson's disease usually begin to re-
solve within 2 to 3 weeks of starting therapy, although in some
clients marked improvement may not be seen for up to 6 months.
Clients need to understand this concept to aid in compliance with

lOMoARcPSD|3083804
medication therapy. Options 1, 2, and 3 are incorrect because of

the short time frames.
A client is taking trihexyphenidyl for the treatment of Parkinson's

disease. The nurse would monitor for which adverse effect of this
medication?
1. Diarrhea
3. Urinary incontinence
4. Excessive perspiration
Rationale:
Trihexyphenidyl is an anticholinergic medication. Because of this,
it can cause urinary hesitancy and retention, constipation, dry
mouth, and decreased sweating as side effects.
A client receiving therapy with carbidopa/levodopa (Sinemet) is

upset and tells the nurse that his urine has turned a darker color
since he began to take the medication. The client wants to discon-
tinue its use. In formulating a response to the client's concerns,
the nurse interprets that this change is:
1. Indicative of developing toxicity
2. A harmless side effect of the medication
3. A result of taking the medication with milk
4. A sign of interaction with another medication
2. A harmless side effect of the medication
Rationale:
With carbidopa/levodopa therapy, a darkening of the urine or
sweat may occur. The client should be reassured that this is a
harmless effect of the medication, and its use should be contin-
ued.
or alike.*

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A client began taking amantadine (Symmetrel) approximately 2

weeks ago. The nurse would evaluate that the medication was
having a therapeutic effect if the client exhibited decreased:
1. Voiding
2. Blood pressure
3. Rigidity and akinesia
3. Rigidity and akinesia
Rationale:
Amantadine is an antiparkinson agent that potentiates the action
of dopamine in the central nervous system. The expected effect of
therapy is a decrease in akinesia and rigidity. Leukopenia, urinary
retention, and hypotension are all adverse effects of the medica-
tion.
A client is receiving anticonvulsant therapy with phenytoin (Di-

lantin). The nurse plans to monitor the results of which laboratory
test closely?
1. Serum sodium
2. Serum potassium
4. Complete blood cell count
4. Complete blood cell count
Rationale:
The nurse would monitor the client's complete blood cell counts
because hematological side effects of this therapy include aplastic
anemia, agranulocytosis, leukopenia, and thrombocytopenia.
Other values that warrant monitoring include serum calcium levels
and the results of urinalysis, hepatic, and thyroid function tests.
A client has been prescribed cyclobenzaprine (Flexeril) in the

treatment of painful muscle spasms accompanying a herniated in-

lOMoARcPSD|3083804
tervertebral disk. The nurse would withhold the medication and

question the prescription if the client had concurrent prescriptions
to take:
1. Ibuprofen (Advil)
3. Valproic acid (Depakene)
4. Tranylcypromine (Parnate)
4. Tranylcypromine (Parnate)
Rationale:
The client should not receive cyclobenzaprine if the client has
taken monoamine oxidase inhibitors (MAOIs) such as tranyl-
cypromine (Parnate) or phenelzine (Nardil) within the past 14
days. Otherwise, the client could experience hyperpyretic crisis,
seizures, or death.
A nurse prepares to administer digoxin (Lanoxin) to a 3-year-old

with a diagnosis of congestive heart failure and notes that the api-
cal heart rate is 120 beats per minute. Which nursing action is ap-
propriate?
1. Administer the digoxin.
2. Recheck the apical heart rate in 15 minutes.
4. Hold the medication.
1. Administer the digoxin.
Rationale:
The normal apical heart rate for a 3-year-old is 80 to 125 beats
per minute. Because the apical heart rate is within normal range,
options 2, 3, and 4 are inappropriate.
A nurse is caring for a hospitalized child with a history of seizures

who is receiving oral phenytoin sodium (Dilantin). Which of the fol-
lowing should be included in the plan of care for this child?
1. Monitoring intake and output

lOMoARcPSD|3083804
2. Checking the heart rate before administering the phenytoin

3. Providing oral hygiene especially care of the gums
4. Administering medications 1 hour before food intake
3. Providing oral hygiene especially care of the gums
Rationale:
Phenytoin sodium causes gum bleeding and hypertrophy, and
therefore oral hygiene is important. Soft toothbrushes and gum
massage should be instituted to reduce the risk of complications
and prevent further trauma. Options 1 and 2 are incorrect be-
cause the intake and output as well as heart rate are not affected
by this medication. Option 4 is incorrect because directions for ad-
ministration of this medication include administering with food to
minimize gastrointestinal upset.
A nurse is caring for a child receiving carbamazepine (Tegretol)

who has a carbamazepine level drawn. Which of the following re-
sults indicates a therapeutic level?
1. 1 mcg/mL
2. 3 mcg/mL
3. 6 mcg/mL
4. 15 mcg/mL
3. 6 mcg/mL
Rationale:
When carbamazepine is administered, blood levels need to be
drawn periodically to check for the child's absorption of the medi-
cation. The amount of the medication prescribed is based on the
blood level achieved. The therapeutic serum level for this medica-
tion is 4 to 12 mcg/mL.
A 6-month-old infant receives a diphtheria, tetanus, and pertussis

(DTaP) immunization at the well-baby clinic. The mother returns
home and calls the clinic to report that the infant has developed

lOMoARcPSD|3083804
swelling and redness at the site of injection. The appropriate sug-

gestion to the mother should be to:
1. Apply a warm pack to the injection site.
2. Bring the infant back to the clinic.
3. Apply an ice pack to the injection site.
4. Monitor the infant for a fever.
3. Apply an ice pack to the injection site.
Rationale:
Occasionally, tenderness, redness, or swelling may occur at the
site of the injection. This can be relieved with ice packs for the
first 24 hours followed by warm compresses if the inflammation
persists. It is not necessary to bring the infant back to the clinic.
Option 4 may be an appropriate intervention but is not specific to
the subject of the question.
A child is hospitalized with Rocky Mountain spotted fever (RMSF).

The health record reveals documentation that the child was bitten
by a tick 2 weeks ago. The child presents with complaints of
headache, fever, and anorexia, and the nurse notes a rash on the
palms of the hands and soles of the feet. The nurse reviews the
health care provider's prescriptions and anticipates that which of
the following will be prescribed?
1. Doxycycline (Vibramycin)
2. Amphotericin B
3. Ganciclovir (Cytovene)
4. Amantadine (Symmetrel)
1. Doxycycline (Vibramycin)
Rationale:
The care of a child with RMSF caused by the bacterium Rickettsia
rickettsii will include the administration of the antibacterial, doxy-
cycline. Amphotericin B is used for fungal infections. Ganciclovir is
used to treat cytomegalovirus. Amantadine is used to treat in-
fluenza A virus.

lOMoARcPSD|3083804
A nurse prepares to administer a measles, mumps, and rubella

(MMR) vaccine to a 5-year-old child. The nurse plans to adminis-
ter this vaccine:
1. Intramuscularly in the anterolateral aspect of the thigh
2. Intramuscularly in the deltoid muscle
4. Subcutaneously in the gluteal muscle
Rationale:
MMR is administered subcutaneously in the outer aspect of the
upper arm. Each child should receive two vaccinations, the first
between 12 and 15 months of age and the second between 4 and
6 years or 11 and 12 years.
*Knowledge that MMR is administered subcutaneously will
assist in eliminating options 1 and 2. Knowing that the
gluteal muscle is not incorporated in the subcutaneous tis-
sue will eliminate option 4.*
A client with a history of spinal cord injury is receiving baclofen

(Lioresal) for muscle spasms. The nurse determines that the
client is experiencing a side effect of this medication if the client
experiences:
1. Photosensitivity
2. Drowsiness
3. Hypertension
4. Muscle pain
2. Drowsiness
Rationale:
Baclofen is a centrally acting skeletal muscle relaxant. Side ef-
fects of baclofen include drowsiness, dizziness, weakness, and
nausea. Occasional side effects include headache, paresthesias
of the hands and feet, constipation or diarrhea, anorexia, hypoten-
sion, confusion, and nasal congestion. Options 1, 3, and 4 are in-
correct.

lOMoARcPSD|3083804
A client is receiving diazepam (Valium) for its skeletal muscle re-

laxant effects. The nurse should monitor this client for which side
effect of this medication?
2. Headache
3. Incoordination
4. Increased salivation
3. Incoordination
Rationale:
Diazepam is a centrally acting skeletal muscle relaxant. Incoordi-
nation and drowsiness are common side effects resulting from
this medication. The other options are incorrect.
A client with multiple sclerosis is receiving dantrolene (Dantrium)

for relief of muscle spasticity. The nurse checks the results of
which laboratory value periodically prescribed while the client is
taking this medication?
2. Creatinine
4. Hematocrit level
1. Liver function studies (LFT's)
Rationale:
Dantrolene can cause liver damage, and the nurse should monitor
the results of liver function studies. Baseline liver function studies
are done before therapy starts, and regular liver function studies
are performed throughout therapy. Dantrolene is discontinued if
no relief of spasticity is achieved in 6 weeks.
A nurse has provided instructions to a client regarding the method

for instilling eye drops into the left eye. The nurse determines that

lOMoARcPSD|3083804
the client needs further instruction if the client does which of the
following during a return demonstration?
1. Lies with the head to one side, puts the drop in the inner can-
thus, and slowly turns to the other side while blinking
2. Lies supine, pulls down on the lower lid, and puts the drop in
the lower lid
3. Lies supine, pulls up on the upper lid, and puts the drop in the
upper lid
4. Tilts the head back, pulls down on the lower lid, and puts the
drop in the lower lid
3. Lies supine, pulls up on the upper lid, and puts the drop in the
upper lid
Rationale:
It is correct procedure for the client to either lie down or sit with
the head tilted back. The thumb or finger is used to pull down on
the lower lid. The client holds the bottle like a pencil (tip facing
downward) and squeezes the bottle so that the drop falls into the
sac. The client then gently closes the eye. An alternative method
for clients who blink very easily is to place the client in the supine
position with the head turned to one side. The eye to be used is
uppermost. The client squeezes the drop onto the inner canthus.
The client turns from this side to the other while blinking. Surface
tension and gravity then cause the drop to move into the conjunc-
tival sac.
A transcutaneous electrical nerve stimulation (TENS) is pre-

scribed for a client with pain, and the nurse provides information
to the client about TENS unit. Which statement by the client indi-
cates the need for further information?
1. "Electrodes are attached to the skin."
2. "The unit relieves pain."
3. "The unit will reduce the needs for analgesics."
4. "Needles are inserted in the subcutaneous tissue to stimulate
the nerve."

lOMoARcPSD|3083804
4. "Needles are inserted in the subcutaneous tissue to stimulate

the nerve."
Rationale:
The TENS unit is a portable unit, and the client controls the sys-
tem for relieving pain and reducing the need for analgesics. It is
attached to the skin of the body by electrodes. Needles are not
used.
A client is receiving a maintenance dose of oral dantrolene

sodium (Dantrium) for the treatment of spasticity. The nurse re-
views the medication record, expecting that which of the following
doses would be prescribed?
1. 50 mg daily
2. 100 mg daily
3. 100 mg twice daily
4. 200 mg four times daily
3. 100 mg twice daily
Rationale:
For treatment of spasticity, dantrolene is administered orally. The
initial dosage in adults is 25 mg once daily. The usual mainte-
nance dosage is 100 mg two to four times daily. If beneficial ef-
fects do not develop within 45 days, dantrolene therapy should be
discontinued.
A health care provider is planning to administer a skeletal muscle

relaxant to a client with a spinal cord injury. The medication is go-
ing to be administered intrathecally. Which of the following medi-
cations should the nurse expect to be prescribed and adminis-
tered by this route?
1. Cyclobenzaprine hydrochloride (Flexeril)
2. Chlorzoxazone (Paraflex)
3. Dantrolene sodium (Dantrium)
4. Baclofen (Lioresal)

lOMoARcPSD|3083804
4. Baclofen (Lioresal)
Rationale:
Baclofen is the only skeletal muscle relaxant that can be adminis-
tered intrathecally. Therefore options 1, 2, and 3 are incorrect.
A client with diabetes mellitus has a foot infection and is to be

started on antibiotic therapy with an aminoglycoside. The nurse
collects data from the client and notes that the client has a hear-
ing loss. The nurse should take which of the following actions
next?
1. Suggest a peak and trough to ensure safe medication adminis-
tration.
2. Have the client drink extra water to avoid toxic side effects.
3. Inform the registered nurse (RN) about the hearing loss.
4. Give the medication but at half the prescribed dose.
3. Inform the registered nurse (RN) about the hearing loss.
Rationale:
A preexisting hearing loss is a contraindication for the administra-
tion of aminoglycosides because these medications can cause
ototoxicity and irreversible hearing loss. The nurse should report
the findings to the RN to protect the client's safety. The RN will in
turn notify the health care provider. Options 1 and 2 are not bene-
ficial because hearing loss has already occurred in this client.
Nurses do not change medication prescriptions independently.
A nurse notes that a client in a long-term care facility is receiving

a daily dose of furosemide (Lasix). The nurse writes in the care
plan to monitor which of the following parameters on a daily ba-
sis?
1. Weight
2. Radial pulse
3. Hemoglobin
4. Serum creatinine clearance

lOMoARcPSD|3083804
1. Weight
Rationale:
Daily weight should be monitored because this reflects the fluid
status of the client who is receiving a diuretic. Option 2 is a gen-
eral assessment and does not relate directly to fluid balance. Op-
tions 3 and 4 are laboratory measurements that are not pre-
scribed routinely by the nurse and would not be done on a daily
basis in a long-term care facility.
A nurse is reviewing medications with the client receiving

colchicine for the treatment of gout. The nurse determines that the
medication is effective if the client reports a decrease in:
1. Blood glucose
2. Blood pressure
3. Joint inflammation
4. Headaches
3. Joint inflammation
Rationale:
Colchicine is classified as an antigout agent. It interferes with the
ability of the white blood cells to initiate and maintain an inflam-
matory response to monosodium urate crystals. The client should
report a decrease in pain and inflammation in the affected joints,
as well as a decrease in the number of gout attacks. Colchicine
has no effect on the client's blood glucose or blood pressure; it is
not used to treat a headache.
A client has been given a prescription for gemfibrozil (Lopid). The

nurse plans to instruct the client to limit intake of which of the fol-
lowing foods while taking this medication?
1. Fish
2. Beef
3. Spicy foods
4. Citrus products

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2. Beef
Rationale:
Gemfibrozil is a lipid-lowering agent. It is given as part of a thera-
peutic regimen that also includes dietary counseling, specifically,
the limitation of saturated and other fats in the diet. Therefore the
intake of red meats is limited. Fish, foods that are spicy, and citrus
products will not affect the cholesterol level.
A nurse is caring for a client with glaucoma who is receiving ac-

etazolamide (Diamox Sequels) daily. Which of the following indi-
cates to the nurse that the client is experiencing an adverse effect
related to the medication?
1. Diarrhea
2. Lacrimation
3. Low back pain and dysuria
4. Irritability
3. Low back pain and dysuria
Rationale:
Acetazolamide is a carbonic anhydrase inhibitor. Nephrotoxicity
and hepatotoxicity can occur and are manifested by dark urine
and stools, jaundice, pain in the lower back, dysuria, crystalluria,
renal colic, and calculi. Bone marrow depression also may occur.
The remaining options are not adverse effects of the medication.
A 15-year-old child is scheduled to receive a series of the hepati-

tis B vaccine. The child arrives at the clinic for the first dose. The
nurse collects data on the child before administering the vaccine
and asks the child about a history of an allergy to:
1. Baker's yeast
2. Eggs
3. Penicillin
4. Sulfonamides
1. Baker's yeast

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Rationale:
A contraindication to receiving the hepatitis B vaccine is a previ-
ous anaphylactic reaction to common baker's yeast. An allergy to
eggs, penicillin, and sulfonamides is unrelated to the contraindica-
tion to receiving this vaccine.
Milk of magnesium
given for constipation
side effects: diarrhea
nursing considerations:
fluid volume deficit - replace fluids
Liver metabolizes MOST drugs

Kidneys excrete MOST drugs
Digoxin
slows heart
side effects:
bradycardia
asystole
ADRENERGICS
Used in Cardiac Arrest and COPD
Action: stimulate beta 2 receptors in lungs

(BETA 2 =LUNGS=2 lobes)
restrict peripheral system, Causes bronchodilation

lOMoARcPSD|3083804
Examples: Norepinephrine (Levophed), Dopamine (Intropine),

Adrenaline (epinephrine), Doputamine (Dobutrex), Albuterol
Side effects: dysrhythmias, tremors, anticholinergic effects, e.g.:

DRY MOUTH AND URINARY RETENTION
CNS: confusion, drowsy, inability to concentrate SAFTEY ISSUES

(dont drive car, ambulation issues etc)
Urinary bladder: retention and infection, CHECK OUTPUT
Cardiovascular system: conduction issues (tachy cardia), exacer-

bation of angina, increased HR, MONITOR BP, MONITOR PE-
RIPHERAL PULSES
Salivary glands: decreased saliva, increased dental decay
Gastrointestinal tract: constipation, reduced peristalsis
Eye: inability to accomodate
ANTIANXIETY AGENTS
USES: manic episodes, anxiety disorders and panic attacks
Action: affect neuro transmitters.
Examples: Librium (Chlordiazepoxide), Diazepam (Valium),

alprazolam (xanax), lorazepam (ativan), versed (midazalam),
vistaril (hydroxyzine), equanil
Subclasses: benzos, nonbenzos such as melatonin and herbals
such as Kava Kava
remember most benzos end in: "pam and am"

lOMoARcPSD|3083804
side effects (central nervous depression): sedation, confusion, he-

patic dysfunction, depression
potential for addiction/overdose
avoid alcohol
monitor liver function
stay in touch with client
respiratory depression (labs: AST & ALT values)
ANTIACIDS
Uses: peptic ulcer, indigestion, reflex esophagitis
neutralize gastric acid: Antiacids: Ampholjel (aluminuim hydrox-

ide), mik of magnesia, Maalox (both).
Central nervous depressant
THESE MEDS DO NOT COAT STOMACH
side effects: constipation or diarrhea or acid rebound effect
Interferes with absorption of antibiotics, iron preps, INH, ORAL
CONTRACEPTIVES (antibiotics also effects contraceptives!!!)
Monitor bowel function
may cause bowel addiction
timing: 1-2 hr AFTER eating and other medications

Fluid and electrolyte balances extremely important
monitor S&S of labs shifting
ANTIDYSRHYTHMICS

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e.g.: Atropine sulfate, lidocaine, pronestyl (procainamide),

quinidine, Isuprel (Isoproterenol)
Sub category: beta blockers (unique side effect: bronchospasm-
check always airway)
action: interfere with electrical excitability of heart

Uses: a fib and flutter, tachycardia, PVC's
side effects: light headiness, BRADYCARDIA, HYPOTENSION,

urinary retention
Monitor VS especial BP and pulses
Monitor Cardiac rhythm
POSITION CHANGES
EDUCATE SLOW FROM LAYING TO SITTING, SITTING TO
STANDING ETC (safety consideration)
ANTIBIOTICS
General Information
allergy
super infection GI, GU,
organ toxicity: liver & kidneys
teachings: taking it till its gone
culture and sensitivity
encourage fluids
check expiration dates (meds will work but will hurt organs more)

lOMoARcPSD|3083804
AMINOCLYCOCIDES (antibiotics)
family: aminoglycocides
examples: gentamycin, neomycin, streptomycin, tobramycin,
amikacin
action: inhibits protein synthesis in gram negative bacteria
uses: pseudomonias, e coli, severe infections of CNS, respiratory,

GI, urinary tract, bone, skin, soft tissue, acute pelvic inflammatory
disease, TB
MYACINS=MICE=Mice have big ear and ears look like kidneys

OTOTOXICTY, NEPHROTOXCITY
NV and diarrhea (due to given PO)

check 8th cranial nerve (ringing in ears)
Monitor Renal function, BUN IMPORTANT
urinary output 1200ml/day normal
Take for 7-10 days 3000ml/day
look at peak (1 hr after dose given) and troughs (just before you
hang a dose)
encourage fluids
CEPHALASPORINS (antibiotic)
cephalexin (Keflex)
cefaclor, ceftriaxone, cefedipime,
notice: cefs or cephs
uses: pharingitis, tonsillitis, otitis, upper lower respiratory, gonor-

rhea, meningitis, perioperative prophylaxis, UTI
side effects:

lOMoARcPSD|3083804
bone marrow depression

rash
abdominal, pain, NV, diarrhea
increased risk of bleeding
TAKE WITH FOOD cause GI upset !!!!!!!!!!!!!!!!!!!!!!!!
CROSS ALLERGY with PENICILLIN !!!!!!
Avoid Alcohol may cause flushing, muscle cramps

Obtain culture and sensitivity
may give false positives of:

glucose in urine
protein uria
FLUOROQUINOLONES (antibiotics)
Sample: Cipro (ciprofloxin)
Action: interferes with DNA of gram negative
Uses: E.Coli, pseudodomonoas, S aureus, chronic bacterial
prostatitis, post inhalation anthrax
Side effects: diarrhea

decreased WBC & hematocrit, elevated liver enzymes AST and
ALT, elevated alakine phosphotase
TAKE FLUIDS 3000 ml/day normal 1500/day
DO NOT TAKE WITH FOOD,

DO NOT TAKE WITH ANTIACIDS
DO NOT TAKE WITH IRON PREPARATIONS
MAY BE GIVEN WITH PROBENECID (GOUT MED), WHICH

HELPS CIPRO ACT BETTER (less cipro, less side effects with
more action)

lOMoARcPSD|3083804
nursing considerations: Teratogenic antibiotic that causes carti-

lage damage
MACROLIDES (antibiotics)
sample: eurythromycin, azethromycin, clindamycin
acute infections, acne, URI, prophylaxis before dental procedures

if allergic to PENICILLIN
Different from other mycins:

Side effects: diarrhea, CONFUSION, HEPATOXICITY
TAKE BEFORE MEALS AND NOT WITH FOODS

TAKE WITH FULL GLASS OF WATER
NEVER FRUIT JUICE
LIVER WILL CORRECT DAMAGE OVER TIME
INCREASES COUMADIN
INCREASES THEOPHILLIN
PENICILLINS (antibiotics)
used for more significant infections such as lyme disease.
syphilis,
Family of "cillin's"
MOST ALLERGIES (SEVERE: ANAPHYLACTIC=ABCs)

ASSESS HX OF REACTION BEFORE ADMINISTRATION
CROSS ALLERGY WITH CEPHALASPORIN
Renal and Liver damage

BUN, AST ALT

lOMoARcPSD|3083804
Urine output
SULFONAMIDES (antibiotics)
uses: ulcerative colitis, crohns disease, otitis media UUTI's and
upper respiratory
names: bactrim, Gantrisin, azulfidine
often seen with other antibiotics
UNIQUE SIDE EFFECTS

peripheral neuropathy, crystalluria, photosensitivity, GI upset,
stomatitis
Take with meals and food !!!!!!!!!!!!!!!!!!!!!!

FLUIDS IMPORTANT 3000ml/day !
MOUTH CARE due to stomatitis

MOUTH CARE
MOUTH CARE
ANTIACIDS WILL INTERFERE WITH UPTAKE
tetracyclines (antibiotics)
general infections, prohylaxis such as baby eyes upon birth
Uses: infection, acne ...
Doxycycline
Minocycline
tatracycline
UNIQUE TO THIS MED

lOMoARcPSD|3083804
discoloration of teeth if taken during pregnancy, glossitis, rash,

phototoxic reaction (blisters)
AVOID SUNLIGHT/ sunblock

NOTE EXPIRATION DATE make pt sick of beyond date
MONITOR RENAL FUNCTION
DO NOT TAKE WITH ANTACIDS OR MILK
TOPICAL APPLICATION MAY STAIN CLOTHS
GENITOURINARY INFECTION MEDICATIONS

Furadantin (nitrofurantoin)
Furadantin anti infective
UNIQUE side effects: asthma attacks, diarrhea
give with food or milk

monitor pulmonary status
take with cranberry juice helps acidify urine

do not eat alkaline foods almonds, milk, coconut and some veg-
gies
Pyridium
antianelgesic URINARY TRACT PAIN REDUCTION
UNIQUE: ORNAGE URINE
side effect
headache vertigo
Teach:
about color
Should be taken with meals

lOMoARcPSD|3083804
Viagra, Levitra, Cialis

Vasodilator
side effect: headache, hypotension, priapism (painful erection that

lasts 4 hours or more but is not accompanied by sexual excite-
ment)
CONTRAINDICATED: ALPHA BLOCKERS & NITRATES
DO NOT TAKE GRAPEFRUIT JUICE ( also lipitor and anticonvul-

sant not to be taken with grapefruit juice)
ANTICHOLINERGIC
inhibit action of acetylcholine, blocks parasympathetic nervous
system
action: dilates pupil, causes bronchodilation and decreases secre-

tions (often used preoperatively), decreased mobility and GI se-
cretions
Causes some hypotension, urinary retention, changes in heart

rate, dry mouth, blurred vision.
MONITOR OUTPUT
CONTRAINDICATED IN GLAUCOMA (because of pupil dilation
interferes with othalmic fluid drainage)
GIVE 30min bac meals hs, or 2hr pc
CONTRAINDICATED WITH:

lOMoARcPSD|3083804
PARALYTIC ILLEUS (would decrease motility even more)

BENIGN PROSTHETIC HYPERTROPHY (urinary retention issue)
ANTICOAGULANTS
HEPARIN
Action: blocks conversion of prothrombin to thrombin
used for PE, DVT, prophylaxis after MI
RISK = BLEEDING
SIDE EFFECTS: Hematuria (blood in urine) tissue irritation
Monitor clotting time PTT,

normal is 20-45 sec
Therapeutic levels 1.5 - 2.5 times control
Antagonist - protamine sulfate !!!!!! (produced by sperm of
salmon)
SC or IV (not given PO destroyed by GI tract)

Avoid use of aspirin and NSAIDS
ANTICOAGULANT
COUMADIN (warfarin)
action: interferes with synthesis of vitamin K-dependent clotting

factors
used for PE, venous thrombosis, DVT, prophylaxis after MI
SIDE EFFECT: bleeding, hemorrhage, alopecia (hairloss)

lOMoARcPSD|3083804
Monitor bleeding times with prothrombin test (PT)

Normal is 9-12 seconds
Therapeutic levels 1.5 times control (look for more than normal)
Antagonist vitamin K (AquaMephyton)
Monitor for bleeding (look at puncture sites, IV sites, hematuria)
Give PO
Avoid aspirin and NSAIDS
Pay attention with foods with vitamin K

Good diet hx frequently is very important, at every point of contact
High in Vitamin K:
green vegetables
pork
rice
yogurt
fish
milk
some cheeses
Vitamin C DECREASES effectiveness of this med (orange juice)

change in vitamin C intake will effect med outcome
Vitamin E will INCREASE the effectiveness of this med
Herbal Consideration with anticoagulants

the big three G's
Garlic
Ginger
Ginko
all will INCREASE the effect of the meds

lOMoARcPSD|3083804
ANTICONVULSANTS pg 76
Side effects: respiratory depression, aplastic anemia, GINGIVAL
HYPERTROPHY, ataxia
DON'T discontinue abruptly

Monito I&O's
Caution with the use of medication that lower seizure threshold
(work AGAINST this med: MAOI's - antidepressants, antipsy-
chotics)
TAKE WITH FOOD

CNA depressant (alcohol bad!!! leads to respiratory depression)
Drowsy (don't drive car, decision making, safety )
May turn urine PINK or BROWN)
MEDS TO KNOW:
(Phenytoin) Dilantin (lots of rules, read pg 76)
if given IV too quickly causes cardiac arrest
urine pink
NEVER EVER MIX WITH ANY OTHER MED
NEEDS IT'S OWN PORT
INCREASE VITAMIN D
MAGSULFATE used in OB
Check DEEP TENDON REFLEXES
RESPIRATORY ARREST SIDE EFFECT
Depakote (Valproic Acid)

DO NOT TAKE WITH CARBONATED BEVERAGES
TAKE WITH FOOD
ANTIDEPRESSANTS

lOMoARcPSD|3083804
MAOIs, SSRIs, Tricyclics

actions increase concentration of neurotransmitters
used in depression and chronic pain
ANTIDEPRESSANTS (MAOI's)
Marplan, Parnate, Nardil
side effects: HYPERTENSIVE CRISIS when taken with tyramine

containing foods
photo sensitivity
potentiate alcohol
AVOID wine, pickled products, herring, aged cheeses, bologna,

pepperoni, salami, bananas, raisins, beer, sour cream
What if patient is on lasixs as an antidiuretic who is told to eat ba-
nanas=conflict=monitor closely
Take a GOOD assessment

monitor output
takes 4 weeks to work
TEACHING with client that it takes time to work
Do not take with CNS stimulants or cold medicines

(teach: list of correct cold meds)
MAOI's with thyramine foods hypertensive crisis: severe

headache , palpitations, stiff neck, diaphoretic
intracranial hemorrhage
ANTIDEPRESSANT

lOMoARcPSD|3083804
Selected seratonin reuptake inhibitors (SSRI)

Prozac, Paxil, Zoloft
Uses: depression, obsessive compulsion disorder, bulimia
side effects:
anxiety, GI upset, change in appetite and bowel function, urinary
retention
SUICIDE PRECAUTIONS
takes 4 weeks for full effect
take AM
Monitor for suicide. Ask yes or no question: Do you have a plan?

biggest concern 2-3-4 weeks into treatment
Monitor nutrition and fluids
will turn urine pink
GI upset possible
Side effect: sedation, anticholinergic effects, confusion, postural

hypertension, urinary retention
ANTIDEPRESSANT Tricyclics
Elavil, Tofranil, Norpramin
depression, sleep apnea
side effects: sedation, anticholinergic effects, confusion, POS-

TURAL HYPOTENSION, urinary retention
Monitor for suicide

Take 2-6 weeks to work
monitor VS
take PM

lOMoARcPSD|3083804
wean off over time
IF rapidly discontinued: headache, vertigo rapid weight change,

no alcohol, monitor for sleep inducing drugs, avoid sun
ANTIDEPRESSANTS: heterocyclics
wellbutrin, desyrel
uses: depression and smoking cessation
UNIQUE side effects:

wellbutrin: agitation and insomnia
desyrel: sedation
avoid alcohol and CNS depressants, wean off slowly
ANTI DIABETIC MEDICATIONS

ONSET AND PEAK very important in relation to food require-
ments
INSULIN
type 1 insulin dependent client
(can be used with type 2 sometimes)
Pancreas does not produce any Insulin
If used with type 2, then used to augment not enough production

of insulin by pancreas.
Regular, Humulin R
FAST ACTING

lOMoARcPSD|3083804
Onset 0.5 - 1 hr
Peak 2-4 hr
Duration 6-8 hr
if taken with break fast, mid morning S&S of hypoglycemia
given SQ
REGULAR INSULIN is the ONLY insulin given by IV or by im-
planted pump.
NPH, Humulin N
INTERMEDIATE ACTING insulin
onset 2 hrs
peak 6-12 hrs
duration 18-26hr
if given in the morning , peak time early evening
Ultralente, Humulin U
SLOW ACTING
onset 4 hrs
peak 8-20 hrs
Duration 24 - 36 hrs
if given in the morning, late evening or morning might the time of

concern
Humulin 70/30
onset 0.5 hr
peak 2-12 hrs
duration 24 hrs

lOMoARcPSD|3083804
used for client not needed to mix
Looks at hemoglobin A1C (2-3 month sugar review)
INSULIN side effects

hypoglycemia
monitor BGS
short term -prick
long term - HA1C
ANTIDIABETICS
push client pancreas to produce more insulin
used for type 2 (non-insulin diabetes mellitus)
stimulate insulin release from the beta cells in pancreas
Diabinese, Orinase, dymelor, micronase
side effects: hypoglycemia

allergic skin reaction, GI upset
TAKE BEFORE BREAKFAST PO

Even if GI upset...must eat once med is taken
normal sugar 70-100 ml/dcl
Alcohol will affect action of meds, oral birth control, sulfonamides,

aspirin, MAOIs (hard med to coordinate with anything). All of
these increase chance of a hypoglycemic reaction.

lOMoARcPSD|3083804
TEACH family members what hypoglycemia looks like
Treatment of hypoglycemic event

GlucaGen (glucagon), stimulates liver to change glycogen to glu-
cose.
GlucaGen side effects:

hypotension, bronchospasm
may repeat in 15 min

once pt is alert, give carbohydrate orally to prevent secondary hy-
poglycemic reaction, side effect: coma
When assessing consider:

nutritional status, exercise status, stress, fevers, surgery, preg-
nancy etc. all affect metabolism
ANTIDIARRHEALS page 83
Action: slow peristalsis, increase tone of sphincters
lomotil (diphenoxylate/atropine), Kaopectate (bismuth subsali-

cate), immodium (loperamide)
side effect: constipation

may have anticholinergic effects
dizziness, drowsiness
DO NOT USE WITH ABDOMINAL PAIN
Monitor for urinary retention
Give 2 hr before or 3 hr after meds
ANTIEMETICS page 84
Tigan, compazine, raglan, antivert, zofran. dramamine

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action: increases GI motility, block effect of dopamnie in chemore-

ceptor trigger zone
side effect : sedation, anticholinergic
Used before chemotherapy

when used with viral infection may cause REY syndrome (toxic
encepalopathy)
ANTIGUNGALS
nyastatin, FLAGYL (Metranidazole) , Diflucan
candidasis, oral thrish
THINK LIVER!!!!
Hepatoxicity
CAN CAUSE THROMBOCYTOPENIA
Bleeding risk
LEUKOPENIA
pruritus (body itching)
MUST GIVE WITH FOODS (GI upset) OR MILK
AFTS LATS
ORAL HYGIENE
ASSESS, assess and reassess
ANTIGOUT AGENTS

lOMoARcPSD|3083804
cholchicine (colsalide)ONLY IN ACUTE , probenecid (benemid)

CHRONIC, Allopurinol (Zyloprim)
decreases production and action of uric acid
RENAL CULCULI (KIDNEY STONES)

AGRANULOCYTOSIS
GI UPSET
FLUIDS!
UNIQUE: Take With food and/or milk (most antacids take WITH-
OUT FOOD, hence this med is unique)
ANTHISTAMINE
Phenergan (promethazine HCl), Dioenhydramine HCl (Benadryl),
lratidine, Zyrtec, Allegra, chlor-trimeton
side effects: drowsiness, dry mouth, photosensitivity
bronchospasm
avoid alcohol
give with food
use sunscreen
ASSES RESPIRATORY
hard candy good implementation to deal with mouth care
ANTILIPIDEMIC AGENTS page 88

Bile Acid sequestrants: eg questrant (blockers)

lOMoARcPSD|3083804
HMG-CoA reductase inhibitor (statins) e.g: lipitor/atorvastatin (in-

feres with synthesis)
side effects: constipation, fat-solubale vitamin deficiency
cannot be combined with other meds

take PM before bedtime
keep assessing diet
ANTIHYPERTENSIVES (several groups)

will affect BP (HTN) side effect hypo tension
ANTIHYPERTENSIVES Beta Adrenergic Blockers

B is for beats
works on heart itself
decreases excitability of heart

decreases O2 consumption Good for post MI)
uses: HTN, angina, supraventricular tachycardia, decreases re-

lease of renin
meds: tenormin (atenolol), corgard (nadalol), inderal (propanalol)

OLOL OLOL
side effect: hypotension

BETA BLOCKERS CAN CAUSE BRONCHOSPAMS AND
CHANGES BEATS OF THE HEART
CAN MASK SIGNS OF SHOCK AND HYPOGLYCEMIA

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UNIQUE: take WITH meals

DO NOT DISC RAPIDLY ( 2weeks)
Not as effective in african americans
ANTIHYPERTENSIVES calcium channel blockers

C = cardio+ heart (same as B)
Procardia (nifidipine), Calan (verapamil), cardizem (diltiazem)
inhibits calcium across cell membrane, slow conduction
uses: angina, HTN, interstitial cystitis (odd use)
note-ipine!
side effects: hypotension, GI stuff, AV blockm

monitor for edema, pulses and BP important, SOB,
remember: if you lower BP, pulse goes up, except if you also give
meds to lower pulse as well.
DO NOT CHEW < OPEN BROKEN time released
ANTIHYPERTENSIVES ACE inhibitors

captopril, enalapril
ACE inhibitors = ACE = Arteries

decrease BP by affecting the arteries in the body (primary func-
tion)
A for ACE, pril for ACE inhibitors = A-pril

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side effects: GI upset, orthostatic hypotension, dizziness
action: blocks Angiotensin I to Angiotensin II (vasoconstriction) in

lungs, resulting in VASODILATION =systemic decrease in BP
uses: HTN, CHF
give 1 hr ac to 3 hr pc food
change position slowly
monitor VS
makes pt feel lethargic, may go away
ANTIHYPERTENSIVES angiotensin II receptor antagonist (ACE

blocker/ARBS)
powerful vasoconstrictor (effecting angiotensin II)
Candesartan (atacand), losartan (cozaar)
identify by: sartan's

uses: HTN, HF, MI, Diabetic neuropathy, stroke prevention
side effects: hypertension, dizziness, GI distress
monitor VS (BP and pulses)

do not chew or divide sustained release tabs
ANTIHYPERTENSIVES Alpha -1 Adrenergic Blockers

blocks alpha 1 receptors in the peripheral blod vessels (heart it-
self is NOT affected)
uses: HTN, BPH (benign prostatic hypertrophy),

lOMoARcPSD|3083804
side effects: reflex tachy cardia, orthostatic hypotension,

UNIQUE: nasal congestion
admin first dose at bedtime to avoid fainting !!!
monitor BUN , weight and edema (may cause peripheral edema)

monitor weight shift changes
change positions slowly
ANTIHYPERTENSIVES Centrally acting alpha-adrenergics

stimulates receptors in the medulla decrease rate and force of
heart
uses HTN
drugs: Aldomet, Catapres
side effects: hypotension

UNIQUE: sedation
fluid retention
check BO and pulses
ANTIHYPERTENSIVES Direct acting vasodilators

works in vascular bed, relaxes smooth muscle causing vasodilata-
tion causing lower BP
Apresoline (hydralazine), Menoxidil (also a treatment for alopecia)

Rogan(?)
side effect: tachy cardia (decreases BP in peripheral bed, in-

creases HR, often seen together with beta blockers)

lOMoARcPSD|3083804
increase in body hair
MUST TEACH: check pulse rate when meds taken, if less then 60
MUST be held, then call primary to see what to do
monitor BP
hypotension, change position slowly, may cause lethargy and
tiredness, goes away with time
Bipolar meds
Lithium, Tegretol, Depakote
uses: mostly used during manic episodes
DO NOT TAKE CARBONATED BEVERAGES WITH THESE

DRUGS
They are also anticonvulsants
sub classes: Lithium
Lithium
is a salt and has a lot of rules.
Dangerous drug to use, controls manic phase and must assess

client as to where client is at in the cycle of bipolar.
dosages change all the time
very tight therapeutic range

blood drawn q 2-3 weeks, inspect pt q 2weeks
FLUIDS IMPORTANT MUST TAKE 3000 ml /day
Dehydration cashes severe response

lOMoARcPSD|3083804
Tegretol and Depakote

given over the entire bipolar cycle
dosages do not change too much
KIDNEY FUNCTION and LIVER IMPORTANT

BUN, ALT and AST
General side effects and nursing consideration of bipolar meds

side effects: GI upset, tremors, polydispsia, polyuria
monitor serum levels: Lithium salt most important

GIVE WITH MEALS
increase fluid intake Fluid fluid fluid especially with lithium
ANTINEOPLASTIC AGENTS (chemo drugs)

decreased red blood cells - impaired O2 transport-air hunger
decreased WBC - infection
stomatitis
encourage fluids 3000ml/day
therapeutic communication very important
b. 0.5 to 2.0 ng/mL

A newly admitted client takes digoxin 0.25 mg/day. The nurse
knows that which is the serum therapeutic range for digoxin?
a. 0.1 to 1.5 ng/mL

b. 0.5 to 2.0 ng/mL

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c. 1.0 to 2.5 ng/mL

d. 2.0 to 4.0 ng/mL
a. It is in the high (elevated) range.

The client's serum digoxin level is 3.0 ng/mL. What does the
nurse know about this serum digoxin level?
a. It is in the high (elevated) range.

b. It is in the low (decreased) range.
c. It is within the normal range.
d. It is in the low average range.
a. Increase the serum digoxin sensitivity level

The client is also taking a diuretic that decreases her potassium
level. The nurse expects that a low potassium level (hypokalemia)
could have what effect on the digoxin?
a. Increase the serum digoxin sensitivity level

b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level
b. Headaches
When a client first takes a nitrate, the nurse expects which symp-
tom that often occurs?
a. Nausea and vomiting

b. Headaches
c. Stomach cramps
d. Irregular pulse rate
c. Decrease heart rate and decrease myocardial contractility.

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The nurse acknowledges that beta blockers are as effective as

antianginals because they do what?
a. Increase oxygen to the systemic circulation.

b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility.

The health care provider is planning to discontinue a client's beta
blocker. What instruction should the nurse give the client regard-
ing the beta blocker?
a. The beta blocker should be abruptly stopped when another car-

diac drug is prescribed.
c. The beta blocker dose should be maintained while taking an-
other antianginal drug.
d. Half the beta blocker dose should be taken for the next several
weeks.
c. To block the beta1-adrenergic receptors in the cardiac tissues

The beta blocker acebutolol (Sectral) is prescribed for dysrhyth-
mias. The nurse knows that what is the primary purpose of the
drug?
a. To increase the beta1 and beta2 receptors in the cardiac tis-

sues
b. To increase the flow of oxygen to the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
d. To block the beta2-adrenergic receptors in the cardiac tissues

lOMoARcPSD|3083804
a. "Apply the patch to a nonhairy area of the upper torso or arm."

A client is to be discharged home with a transdermal nitroglycerin
patch. Which instruction will the nurse include in the client's
teaching plan?
a. "Apply the patch to a nonhairy area of the upper torso or arm."

b. "Apply the patch to the same site each day."
c. "If you have a headache, remove the patch for 4 hours and
then reapply."
d. "If you have chest pain, apply a second patch next to the first
patch."
d. Client stating that pain is 0 out of 10

A nurse is monitoring a client with angina for therapeutic effects of
nitroglycerin. Which assessment finding indicates that the nitro-
glycerin has been effective?
a. Blood pressure 120/80 mm Hg

b. Heart rate 70 beats per minute
c. ECG without evidence of ST changes
d. Client stating that pain is 0 out of 10
d. Chest pain
The nurse is monitoring a client during IV nitroglycerin infusion.
Which assessment finding will cause the nurse to take action?
a. Blood pressure 110/90 mm Hg

b. Flushing
c. Headache
d. Chest pain

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d. "I can take up to five tablets at 3-minute intervals for chest pain
if necessary."
Which statement made by the client demonstrates a need for fur-
ther instruction regarding the use of nitroglycerin?
a. "If I get a headache, I should keep taking nitroglycerin and use

Tylenol for pain relief."
b. "I should keep my nitroglycerin in a cool, dry place."
c. "I should change positions slowly to avoid getting dizzy."
d. "I can take up to five tablets at 3-minute intervals for chest pain
if necessary."
a. Client states that she has no chest pain.

Which client assessment would assist the nurse in evaluating
therapeutic effects of a calcium channel blocker?
a. Client states that she has no chest pain.

b. Client states that the swelling in her feet is reduced.
c. Client states the she does not feel dizzy.
d. Client states that she feels stronger.
d. "This medication will work for 24 hours and you will need to
change the patch daily."
What statement is the most important for the nurse to include in
the teaching plan for a client who has started on a transdermal ni-
troglycerin patch?
a. "This medication works faster than sublingual nitroglycerin

works."
b. "This medication is the strongest of any nitroglycerin prepara-
tion available."
c. "This medication should be used only when you are experienc-
ing chest pain."

lOMoARcPSD|3083804
d. "This medication will work for 24 hours and you will need to
change the patch daily."
c. Apply the nitroglycerin patch for 14 hours and remove it for 10

hours at night.
What will the nurse instruct the client to do to prevent the develop-
ment of tolerance to nitroglycerin?
a. Apply the nitroglycerin patch every other day.

b. Switch to sublingual nitroglycerin when the client's systolic
blood pressure elevates to more than 140 mm Hg.
c. Apply the nitroglycerin patch for 14 hours and remove it for 10
hours at night.
d. Use the nitroglycerin patch for acute episodes of angina only.
b. "It's best to keep it in its original container away from heat and
light."
The client asks the nurse how nitroglycerin should be stored while
traveling. What is the nurse's best response?
a. "You can protect it from heat by placing the bottle in an ice

chest."
b. "It's best to keep it in its original container away from heat and
light."
c. "You can put a few tablets in a resealable bag and carry it in
your pocket."
d. "It's best to lock them in the glove compartment to keep them
away from heat and light."
d. "I should sit or lie down after I take a nitroglycerin tablet to pre-
vent dizziness."
Which statement indicates to the nurse that the client understands
sublingual nitroglycerin medication instructions?

lOMoARcPSD|3083804
a. "I will take up to five doses every 3 minutes for chest pain."
b. "I can chew the tablet for the quickest effect."
c. "I will keep the tablets locked in a safe place until I need them."
d. "I should sit or lie down after I take a nitroglycerin tablet to pre-
vent dizziness."
b. Apply the ointment to a nonhairy part of the upper torso.

What instruction should the nurse provide to the client who needs
to apply nitroglycerin ointment?
a. Use the fingers to spread the ointment evenly over a 3-inch

area.
b. Apply the ointment to a nonhairy part of the upper torso.
c. Massage the ointment into the skin.
d. Cover the application paper with ointment before use.
b. Decrease the intravenous nitroglycerin by 10 mcg/min.

A client receiving intravenous nitroglycerin at 20 mcg/min com-
plains of dizziness. Nursing assessment reveals a blood pressure
of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate
of 16 breaths/min. What is the nurse's priority action?
a. Assess the client's lung sounds.

b. Decrease the intravenous nitroglycerin by 10 mcg/min.
c. Stop the nitroglycerin infusion for 1 hour, and then restart.
d. Recheck the client's vital signs in 15 minutes but continue the
infusion.

The nurse is monitoring a client taking digoxin (Lanoxin) for treat-
ment of heart failure. Which assessment finding indicates a thera-
peutic effect of the drug?

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a. Heart rate 110 beats per minute

c. Urinary output 40 mL/hr
d. Blood pressure 90/50 mm Hg
a. Administer ordered dose of digoxin.

A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What
is the nurse's priority action?
a. Administer ordered dose of digoxin.

b. Hold future digoxin doses.
c. Administer potassium.
d. Call the health care provider.
a. Evaluate digoxin levels.

A client is taking digoxin (Lanoxin) 0.25 mg and furosemide
(Lasix) 40 mg. When the nurse enters the room, the client states,
"There are yellow halos around the lights." Which action will the
nurse take?
a. Evaluate digoxin levels.

b. Withhold the furosemide
c. Administer potassium.
d. Document the findings and reassess in 1 hour.
a. Loss of appetite with slight bradycardia

Which assessment finding will alert the nurse to suspect early
digoxin toxicity?
a. Loss of appetite with slight bradycardia

b. Blood pressure 90/60 mm Hg
c. Heart rate 110 beats per minute

lOMoARcPSD|3083804
d. Confusion and diarrhea
b. To administer digoxin immune FAB (antidote)

The nurse reviews a client's laboratory values and finds a digoxin
level of 10 ng/mL and a serum potassium level of 5.9 mEq/L.
What is the nurse's primary intervention?
a. To administer atropine
b. To administer digoxin immune FAB
c. To administer epinephrine
d. To administer Kayexalate
b. Crackles in the lungs

Which assessment finding will alert the nurse to possible toxic ef-
fects of amiodarone?
a. Heart rate 100 beats per minute

b. Crackles in the lungs
c. Elevated blood urea nitrogen
d. Decreased hemoglobin
b. Continuous blood pressures

d. Presence of chest pain
What must the nurse monitor when titrating intravenous nitroglyc-
erin for a client? (Select all that apply.)
a. Continuous oxygen saturation

b. Continuous blood pressures
c. Hourly ECGs
d. Presence of chest pain
e. Serum nitroglycerin levels
f. Visual acuity

lOMoARcPSD|3083804
b. Hypokalemia
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25
mg/day. What type of electrolyte imbalance does the nurse expect
to occur?
a. Hypocalcemia
b. Hypokalemia
c. Hyperkalemia
d. Hypermagnesemia
c. Hydrochlorothiazide
What would cause the same client's electrolyte imbalance?
a. High dose of digoxin

b. Digoxin taken daily
c. Hydrochlorothiazide
d. Low dose of hydrochlorothiaizde

A nurse teaching a client who has diabetes mellitus and is taking
hydrochlorothiazide 50 mg/day. The teaching should include the
importance of monitoring which levels?
a. Hemoglobin and hematocrit

b. Blood urea nitrogen (BUN)
c. Arterial blood gases
c. High-ceiling (loop) diuretic

A client has heart failure and is prescribed Lasix. The nurse is
aware that furosemide (Lasix) is what kind of drug?

lOMoARcPSD|3083804
a. Thiazide diuretic
b. Osmotic diuretic
c. High-ceiling (loop) diuretic
d. Potassium-sparing diuretic
a. Hypokalemia
The nurse acknowledges that which condition could occur when
taking furosemide?
a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
b. Hyperkalemia
The client has been receiving spironolactone (Aldactone) 50
mg/day for heart failure. The nurse should closely monitor the
client for which condition?
a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
a. Have the client lie down when taking a nitroglycerin sublingual

tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain
persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
A client who has angina is prescribed nitroglycerin. The nurse re-
views which appropriate nursing interventions for nitroglycerin

lOMoARcPSD|3083804
a. Have the client lie down when taking a nitroglycerin sublingual

tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain
persists.
c. Apply Transderm-Nitro patch to a hairy area to protect skin from
burning.
d. Call the health care provider after taking 5 tablets if chest pain
persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
b. Fasting blood glucose level of 140 mg/dL

Which laboratory value will the nurse report to the health care
provider as a potential adverse response to hydrochlorothiazide
(HydroDIURIL)?
a. Sodium level of 140 mEq/L

b. Fasting blood glucose level of 140 mg/dL
c. Calcium level of 9 mg/dL
d. Chloride level of 100 mEq/L
b. "This combination promotes diuresis but decreases the risk of

hypokalemia."
What is the best information for the nurse to provide to the client
who is receiving spironolactone (Aldactone) and furosemide
(Lasix) therapy?
a. "Moderate doses of two different diuretics are more effective

than a large dose of one."
b. "This combination promotes diuresis but decreases the risk of
hypokalemia."
c. "This combination prevents dehydration and hypovolemia."
d. "Using two drugs increases the osmolality of plasma and the
glomerular filtration rate."

lOMoARcPSD|3083804
c. Administer 2 mEq potassium chloride per kilogram per day IV.

The nurse is assessing a client who is taking furosemide (Lasix).
The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L,
and sodium is 140 mEq/L. What is the nurse's primary interven-
tion?
a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly.

b. Administer Kayexalate.
c. Administer 2 mEq potassium chloride per kilogram per day IV.
d. Administer PhosLo, two tablets three times per day.
c. The fact that Lasix has shown efficacy in treating persons with
renal insufficiency.
A nurse admits a client diagnosed with pneumonia. The client has
a history of chronic renal insufficiency, and the health care
provider orders furosemide (Lasix) 40 mg twice a day. What is
most important to include in the teaching plan for this client?
a. That the medication will have to be monitored very carefully

owing to the client's diagnosis of pneumonia.
b. The fact that Lasix has been proven to decrease symptoms
with pneumonia.
c. The fact that Lasix has shown efficacy in treating persons with
renal insufficiency.
d. That the medication will need to be given at a higher than nor-
mal dose owing to the client's medical problems.
c. Fish
A client taking spironolactone (Aldactone) has been taught about
the therapy. Which menu selection indicates that the client under-
stands teaching related to this medication?

lOMoARcPSD|3083804
a. Apricots
b. Bananas
c. Fish
d. Strawberries
c. A 47-year-old client with anuria

Which client would the nurse need to assess first if the client is re-
ceiving mannitol (Osmitrol)?
a. A 67-year-old client with type 1 diabetes mellitus

b. A 21-year-old client with a head injury
c. A 47-year-old client with anuria
d. A 55-year-old client receiving cisplatin to treat ovarian cancer
b. Assess lung sounds before and after administration.

c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
A client is ordered furosemide (Lasix) to be given via intravenous
push. What interventions should the nurse perform? (Select all
that apply.)
a. Administer at a rate no faster than 20 mg/min.

b. Assess lung sounds before and after administration.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
e. Monitor ECG continuously.
f. Insert an arterial line for continuous blood pressure monitoring.
c. Decreased aldosterone
A client with hyperaldosteronism is prescribed spironolactone (Al-
dactone). What assessment finding would the nurse evaluate as a
positive outcome?

lOMoARcPSD|3083804
a. Decreased potassium level

b. Decreased crackles in the lung bases
c. Decreased aldosterone
d. Decreased ankle edema
c. Lungs clear.
A client with acute pulmonary edema receives furosemide (Lasix).
What assessment finding indicates that the intervention is work-
ing?
a. Potassium level decreased from 4.5 to 3.5 mEq/L.

b. Crackles auscultated in the bases.
c. Lungs clear.
d. Output 30 mL/hr.
a. Decreased intracranial pressure

Which assessment indicates a therapeutic effect of mannitol (Os-
mitrol)?
a. Decreased intracranial pressure

b. Decreased potassium
c. Increased urine osmolality
d. Decreased serum osmolality
c. Stage 1 hypertension
A client's blood pressure (BP) is 145/90. According to the guide-
lines for determining hypertension, the nurse realizes that the
client's BP is at which stage?
a. Normal
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension

lOMoARcPSD|3083804
a. Diuretic
The nurse acknowledges that the first-line drug for treating this
client's blood pressure might be which drug?
a. Diuretic
b. Alpha blocker
c. ACE inhibitor
d. Alpha/beta blocker
c. Beta blockers and ACE inhibitors

The nurse is aware that which group(s) of antihypertensive drugs
are less effective in African-American clients?
a. Diuretics
b. Calcium channel blockers and vasodilators
c. Beta blockers and ACE inhibitors
d. Alpha blockers
b. hydrochlorothiazide
The nurse knows that which diuretic is most frequently combined
with an antihypertensive drug?
a. chlorthalidone
b. hydrochlorothiazide
c. bendroflumethiazide
d. potassium-sparing diuretic
a. Beta1 blocker
The nurse explains that which beta blocker category is preferred
for treating hypertension?

lOMoARcPSD|3083804
a. Beta1 blocker
b. Beta2 blocker
c. Beta1 and beta2 blockers
d. Beta2 and beta3 blockers
d. Constant, irritating cough

Captopril (Capoten) has been ordered for a client. The nurse
teaches the client that ACE inhibitors have which common side ef-
fects?
a. Nausea and vomiting

b. Dizziness and headaches
c. Upset stomach
d. Constant, irritating cough
b. Blocking angiotensin II from AT1 receptors

A client is prescribed losartan (Cozaar). The nurse teaches the
client that an angiotensin II receptor blocker (ARB) acts by doing
what?
a. Inhibiting angiotensin-converting enzyme

b. Blocking angiotensin II from AT1 receptors
c. Preventing the release of angiotensin I
d. Promoting the release of aldosterone
b. Dizziness
c. Headache
e. Ankle edema
During an admission assessment, the client states that she takes
amlodipine (Norvasc). The nurse wishes to determine whether or
not the client has any common side effects of a calcium channel
blocker. The nurse asks the client if she has which signs and
symptoms? (Select all that apply.)

lOMoARcPSD|3083804
a. Insomnia
b. Dizziness
c. Headache
d. Angioedema
e. Ankle edema
f. Hacking cough
a. "I will check my blood pressure daily and take my medication

when it is over 140/90."
Which statement indicates that the client needs additional instruc-
tion about antihypertensive treatment?
a. "I will check my blood pressure daily and take my medication

b. "I will include rest periods during the day to help me tolerate the
fatigue my medicine may cause."
c. "I will change my position slowly to prevent feeling dizzy."
d. "I will not mow my lawn until I see how this medication makes
me feel."
a. Call the health care provider to switch the medication.

A nurse is caring for a client who is taking an angiotensin-convert-
ing enzyme inhibitor and develops a dry, nonproductive cough.
What is the nurse's priority action?
a. Call the health care provider to switch the medication.

b. Assess the client for other symptoms of upper respiratory infec-
tion.
c. Instruct the client to take antitussive medication until the symp-
toms subside.
d. Tell the client that the cough will subside in a few days.

lOMoARcPSD|3083804
d. spironolactone (Aldactone)
The nurse is reviewing a medication history on a client taking an
ACE inhibitor. The nurse plans to contact the health care provider
if the client is also taking which medication?
a. docusate sodium (Colace)

b. furosemide (Lasix)
c. morphine sulfate
d. spironolactone (Aldactone)
b. Respiratory assessment
A client is prescribed a noncardioselective beta1 blocker. What
nursing intervention is a priority for this client?
a. Assessment of blood glucose levels

b. Respiratory assessment
c. Orthostatic blood pressure assessment
d. Teaching about potential tachycardia
c. The client who has stopped taking a beta blocker due to cost.
Which client will the nurse assess first?
a. The client who has been on beta blockers for 1 day.

b. The client who is on a beta blocker and a thiazide diuretic.
c. The client who has stopped taking a beta blocker due to cost.
d. The client who is taking a beta blocker and Lasix (furosemide).
d. Get up slowly from a sitting to a standing position.

The nurse is caring for a client with hypertension who is pre-
scribed Clonidine transdermal preparation. What is the correct in-
formation to teach this client?
a. Change the patch daily at the same time.

lOMoARcPSD|3083804
b. Remove the patch before taking a shower or bath.

c. Do not take other antihypertensive medications while on this
patch.
d. Get up slowly from a sitting to a standing position.
c. Hypotension
A calcium channel blocker has been ordered for a client. Which
condition in the client's history is a contraindication to this medica-
tion?
a. Hypokalemia
b. Dysrhythmias
c. Hypotension
d. Increased intracranial pressure
a. Alteration in cardiac output related to effects on the sympathetic

nervous system
Which is a priority nursing diagnosis for a client taking an antihy-
pertensive medication?
a. Alteration in cardiac output related to effects on the sympathetic

nervous system
b. Knowledge deficit related to medication regimen
c. Fatigue related to side effects of medication
d. Alteration in comfort related to nonproductive cough
a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
When a newly admitted client is placed on heparin, the nurse ac-
knowledges that heparin is effective for preventing new clot for-

lOMoARcPSD|3083804
mation in clients who have which disorder(s)? (Select all that ap-
ply.)
a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
a. protamine sulfate
A client who received heparin begins to bleed, and the physician
calls for the antidote. The nurse knows that which is the antidote
for heparin?
a. protamine sulfate
b. vitamin K
c. aminocaproic acid
d. vitamin C
a. A longer half-life than heparin

A client is prescribed enoxaparin (Lovenox). The nurse knows that
low-molecular-weight heparin (LMWH) has what kind of half-life?
a. A longer half-life than heparin

b. A shorter half-life than heparin
c. The same half-life as heparin
d. A four-times shorter half-life than heparin

The nurse is teaching a client about clopidogrel (Plavix). What is
important information to include?
a. Constipation may occur.

lOMoARcPSD|3083804
b. Hypotension may occur.

d. Normal dose is 25 mg tablet per day.
d. Subcutaneously
A client is prescribed dalteparin (Fragmin). LMWH is administered
via which route?
a. Intravenously
b. Intramuscularly
c. Intradermally
d. Subcutaneously
b. warfarin (Coumadin)
A client is being changed from an injectable anticoagulant to an
oral anticoagulant. Which anticoagulant does the nurse realize is
administered orally?
a. enoxaparin sodium (Lovenox)

b. warfarin (Coumadin)
c. bivalirudin (Angiomax)
d. lepirudin (Refludan)
*therapeutic range is 2.0-3.0

A client is taking warfarin 5 mg/day for atrial fibrillation. The
client's international normalized ration (INR) is 3.8. The nurse
would consider the INR to be what?
a. Within normal range

c. Low INR range

lOMoARcPSD|3083804
d. Low average INR range
d. To suppress platelet aggregation

Cilostazol (Pletal) is being prescribed for a client with coronary
artery disease. The nurse knows that which is the major purpose
for antiplatelet drug therapy?
a. To dissolve the blood clot

b. To decrease tissue necrosis
c. To inhibit hepatic synthesis of vitamin K
d. To suppress platelet aggregation
A client is admitted to the emergency department with an acute
myocardial infarction. Which drug category does the nurse expect
to be given to the client early for the prevention of tissue necrosis
following blood clot blockage in a coronary or cerebral artery?
a. Anticoagulant agent
b. Antiplatelet agent
d. Low-molecular-weight heparin (LMWH)
b. Activated partial thromboplastin time (aPTT) of 120 seconds
*normal therapeutic range is 45-75 secs

A client is receiving an intravenous heparin drip. Which laboratory
value will require immediate action by the nurse?
a. Platelet count of 150,000

b. Activated partial thromboplastin time (aPTT) of 120 seconds
c. INR of 1.0
d. Blood urea nitrogen (BUN) level of 12 mg/dL

lOMoARcPSD|3083804
b. Administer vitamin K.
A client who has been taking warfarin (Coumadin) is admitted with
coffee-ground emesis. What is the nurse's primary action?
a. Administer vitamin E.
b. Administer vitamin K.
c. Administer protamine sulfate.
d. Administer calcium gluconate.
a. Administer an additional dose of warfarin (Coumadin).

The client has an international normalized ratio (INR) value of 1.5.
What action will the nurse take?
a. Administer an additional dose of warfarin (Coumadin).

b. Hold the next dose of warfarin (Coumadin).
c. Increase the heparin drip rate.
d. Administer protamine sulfate.
c. "I will increase dark-green, leafy vegetables in my diet."

A client is receiving warfarin (Coumadin) for a chronic condition.
Which client statement requires immediate action by the nurse?
a. "I will avoid contact sports."

b. "I will take my medication in the early evening each day."
c. "I will increase dark-green, leafy vegetables in my diet."
d. "I will contact my health care provider if I develop excessive
bruising."
a. "I take aspirin daily for headaches."

A client is taking enoxaparin (Lovenox) daily. Which client state-
ment requires additional monitoring?

lOMoARcPSD|3083804
a. "I take aspirin daily for headaches."

b. "I take ibuprofen (Motrin) at least once a week for joint pain."
c. "Whenever I have a fever, I take acetaminophen (Tylenol)."
d. "I take my medicine first thing in the morning."
c. Administer the medication into subcutaneous tissue.

A nurse is preparing to administer enoxaparin sodium (Lovenox)
to a client for prevention of deep vein thrombosis. What is an es-
sential nursing intervention?
a. Draw up the medication in a syringe with a 22-gauge, 1-½ inch

needle.
b. Utilize the Z-track method to inject the medication.
c. Administer the medication into subcutaneous tissue.
d. Rub the administration site after injecting.
b. Administer protamine sulfate.

A client has been admitted through the emergency department
and requires emergency surgery. The client has been receiving
heparin. What nursing intervention is essential?
a. Teach the client about the phenytoin.

b. Administer protamine sulfate.
c. Assess the INR before surgery.
d. Administer vitamin K.
b. Teach the client of potential drug interactions with anticoagu-

lants.
A client who is taking warfarin (Coumadin) requests an aspirin for
headache relief. What is the nurse's best response?

lOMoARcPSD|3083804
a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess

pain in 30 minutes.
b. Teach the client of potential drug interactions with anticoagu-
lants.
c. Explain to the client that ASA is contraindicated and administer
ibuprofen as ordered.
d. Explain that the headache is an expected side effect and will
subside shortly.
b. "It usually takes about 3 days to achieve a therapeutic effect for

warfarin, so the heparin is continued until the warfarin is therapeu-
tic."
A client is started on warfarin (Coumadin) therapy while still re-
ceiving intravenous heparin. The client questions the nurse about
the risk for bleeding. How should the nurse respond?
a. "Your concern is valid. I will call the doctor to discontinue the

heparin."
b. "It usually takes about 3 days to achieve a therapeutic effect for
warfarin, so the heparin is continued until the warfarin is therapeu-
tic."
c. "Because of your valve replacement, it is especially important
for you to be anticoagulated. The heparin and warfarin together
are more effective than one alone."
d. "Because you are now up and walking, you have a higher risk
of blood clots and therefore need to be on both medications."
d. "I should use a soft toothbrush for dental hygiene."

The nurse evaluates that the client understood discharge teaching
regarding warfarin (Coumadin) based on which statement?
a. "I will double my dose if I forget to take it the day before."

b. "I should keep taking ibuprofen for my arthritis."

lOMoARcPSD|3083804
c. "I should decrease the dose if I start bruising easily."

d. "I should use a soft toothbrush for dental hygiene."
c. Risk for injury

Which nursing diagnosis would be possible for a client receiving
intravenous heparin therapy?
a. Potential for fluid volume excess

b. Potential for pain
c. Risk for injury
d. Potential for body image disturbance
c. Hyperlipidemia
A client has a serum cholesterol level of 265 mg/dL, triglyceride
level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum
levels indicate?
a. Hypolipidemia
b. Normolipidemia
c. Hyperlipidemia
d. Alipidemia
a. 150 to 200 mg/dL

The nurse knows that the client's cholesterol level should be
within which range?
a. 150 to 200 mg/dL

b. 200 to 225 mg/dL
c. 225 to 250 mg/dL
d. Greater than 250 mg/dL
b. It is the desired level of HDL.

lOMoARcPSD|3083804
A client's high-density lipoprotein (HDL) is 60 mg/dL. What does

the nurse acknowledge concerning this level?
a. It is lower than the desired level of HDL.

b. It is the desired level of HDL.
c. It is higher than the desired level of HDL.
d. It is a much lower HDL level than desired.
d. Liver enzymes
A client is taking lovastatin (Mevacor). Which serum level is most
important for the nurse to monitor?
a. Blood urea nitrogen

b. Complete blood count
c. Cardiac enzymes
d. Liver enzymes
b. Rhabdomyolysis
The client is taking rosuvastatin (Crestor). What severe skeletal
muscle adverse reaction should the nurse observe for?
a. Myasthenia gravis
b. Rhabdomyolysis
c. Dyskinesia
d. Agranulocytosis

When a client is taking ezetimibe (Zetia), she asks the nurse how
it works. The nurse should explain that Zetia does what?

b. Binds with bile acids in the intestines to reduce LDL levels.

lOMoARcPSD|3083804
c. Inhibits HMG-CoA reductase, which is necessary for cholesterol

production in the liver.
d. Forms insoluble complexes and reduces circulating cholesterol
in blood.
b. "I will increase fiber in my diet."

Which statement indicates the client understands discharge in-
structions regarding cholestyramine (Questran)?
a. "I will take Questran 1 hour before my other medications."

b. "I will increase fiber in my diet."
c. "I will weigh myself weekly."
d. "I will have my blood pressure checked weekly."
b. Administer aspirin 30 minutes before nicotinic acid.

The nurse plans which intervention to decrease the flushing reac-
tion of niacin?
a. Administer niacin with an antacid.

b. Administer aspirin 30 minutes before nicotinic acid.
c. Administer diphenhydramine hydrochloride (Benadryl) with
niacin.
d. Apply cold compresses to the head and neck.
b. "Take this medication at the same time each day."

The nurse is reviewing instructions for a client taking an HMG-
CoA reductase inhibitor (statin). What information is essential for
the nurse to include?
a. "Take this medication on an empty stomach."

b. "Take this medication at the same time each day."
c. "Take this medication with breakfast."
d. "Take this medication with an antacid."

lOMoARcPSD|3083804
b. "You may experience headaches with this medication."

A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipi-
demia type IV. What is important for the nurse to teach the client?
a. "Take aspirin before the medication if you experience facial

flushing."
b. "You may experience headaches with this medication."
c. "You will need to have weekly blood drawn to assess for hyper-
kalemia."
d. "Cholesterol levels will need to be assessed daily for one
week."
d. "I will continue my exercise program to help increase my high-

density lipoprotein serum levels."
Which statement made by the client indicates understanding
about discharge instructions on antihyperlipidemic medications?
a. "Antihyperlipidemic medications will replace the other interven-

tions I have been doing to try to decrease my cholesterol."
b. "It is important to double my dose if I miss one in order to main-
tain therapeutic blood levels."
c. "I will stop taking the medication if it causes nausea and vomit-
ing."
d. "I will continue my exercise program to help increase my high-
density lipoprotein serum levels."
c. Muscle pain.
A client is prescribed ezetimibe (Zetia). Which assessment finding
will require immediate action by the nurse?
a. Headache.
b. Slight nausea.

lOMoARcPSD|3083804
c. Muscle pain.
d. Fatigue.
c. Have the client increase fluids and fiber in his diet.

A nurse is caring for a client taking cholestyramine (Questran).
The client is complaining of constipation. What will the nurse do?
a. Call the health care provider to change the medication.

b. Tell the client to skip a dose of the medication.
c. Have the client increase fluids and fiber in his diet.
d. Administer an enema to the client.
d. "I should stir the powder in as small an amount of fluid as pos-

sible to maintain potency of the medication."
Which statement indicates to the nurse that the client needs fur-
ther medication instruction about colestipol (Colestid)?
a. "The medication may cause constipation, so I will increase fluid

and fiber in my diet."
b. "I should take this medication 1 hour after or 4 hours before my
other medications."
c. "I might need to take fat-soluble vitamins to supplement my
diet."
d. "I should stir the powder in as small an amount of fluid as pos-
sible to maintain potency of the medication."
b. Elevated liver function tests

Which assessment finding in a client taking an HMG-CoA reduc-
tase inhibitor will the nurse act on immediately?
a. Decreased hemoglobin
b. Elevated liver function tests
c. Elevated HDL

lOMoARcPSD|3083804
d. Elevated LDL
b. "These factors may put you at higher risk for myopathy."

A 70-year-old client who is taking several cardiac antidysrhythmic
medications has been prescribed simvastatin (Zocor) 80 mg/day.
What is essential information for the nurse to teach the client?
a. "This dose may lower your cholesterol too much."

b. "These factors may put you at higher risk for myopathy."
c. "You should not take this drug with cardiac medications."
d. "This combination will cause you to have nausea and vomiting."
b. Hepatic disease
A client diagnosed with hypercholesterolemia is prescribed lovas-
tatin (Mevacor). The nurse is reviewing the client's history and
would contact the health care provider about which of these con-
ditions in the client's history?
a. Chronic pulmonary disease

b. Hepatic disease
c. Leukemia
d. Renal disease
c. gemfibrozil (Lopid)
A nurse is caring for a client with elevated triglyceride levels who
is unresponsive to HMG-CoA reductase inhibitors. What medica-
tion will the nurse administer?
a. cholestyramine (Questran)
b. colestipol (Colestid)
c. gemfibrozil (Lopid)
d. simvastatin (Zocor)

lOMoARcPSD|3083804
a. Impaction
The nurse would question an order for cholestyramine (Questran)
if the client has which condition?
a. Impaction
b. Glaucoma
c. Hepatic disease
d. Renal disease
c. Client is on oral contraceptives.

The nurse reviews the history for a client taking atorvastatin (Lipi-
tor). What will the nurse act on immediately?
a. Client takes medications with grape juice.

b. Client takes herbal therapy including kava kava.
c. Client is on oral contraceptives.
d. Client was started on penicillin for a respiratory infection.
The beta blocker can mask symptoms of hypoglycemia.

**Beta blockers decrease the body's adrenergic "fight-or-flight" re-
sponse and may block the symptoms and signals of hypo-
glycemia that a diabetic normally perceives as the blood sugar
drops. Beta blockers may inhibit glycogenolysis, resulting in hypo-
glycemia and have no effect on the development of insulin resis-
tance.
A type I diabetic on insulin reports that he takes propranolol (In-
deral) for his hypertension. This raises a concern and the nurse
will teach the patient to check glucose levels more frequently be-
cause:
1. The beta blocker can produce insulin resistance.
2. The two agents used together will increase the risk of ketoaci-
dosis.

lOMoARcPSD|3083804
3. Propranolol will increase insulin requirements by antagonizing

the effects at the receptors.
4. The beta blocker can mask symptoms of hypoglycemia.
Pulse
Rationale: In the absence of ECG monitoring, the nurse would as-
sess the pulse for rate, regularity, quality, and volume, noting any
changes. The nurse should also teach the patient to monitor the
pulse for rate and regularity, before sending the patient home.
The nurse is monitoring for the therapeutic effects of antidysrhyth-
mic therapy.
When monitoring for therapeutic effect of any antidysrhythmic
agent, the nurse would be sure to assess:
1.Pulse
2.Blood pressure
3.Drug level
4.Hourly urine output
3. Heart failure
Rationale: Calcium channel blockers such as verapamil (Calan)
are used cautiously or are contraindicated in patients with heart
failure because of the negative inotropic effects on cardiac muscle
which may precipitate or worsen heart failure. Verapamil and cal-
cium channel blockers are often prescribed to treat these condi-
tions.
Because of its effect on the heart, verapamil (Calan,Covera- HS,
Isoptin SR, Verelan) should be used with extra caution or is con-
traindicated in patients with:
1.Hypertension
2.Tachycardia
3.Heart failure
4.Angina

lOMoARcPSD|3083804
1. hypotension. 3. dizziness. 4. weakness

Common adverse effects of antidysrhythmic medications
include: (Select all that apply.)
1. hypotension.
2. hypertension.
3. dizziness.
4. weakness
5. panic attacks
2. Do not stop taking this medication abruptly; the dosage must

be decreased gradually if it is discontinued.
Rationale: Beta blockers such as propranolol should never be
stopped abruptly because of the possible rebound hypertension
and increased dysrhythmias that may occur. The nurse may teach
the patient to take the medication on an empty stomach and to be
cautious with drowsiness while taking beta blockers.
A patient is given a prescription for propranolol (Inderal) 40 mg
bid. The most important instruction for the nurse to give this pa-
tient is:
1. Take this medication on an empty stomach, as food interferes
with its absorption.
2. Do not stop taking this medication abruptly; the dosage must
be decreased gradually if it is discontinued.
3. If the patient experiences any disturbances in hearing, the pa-
tient should notify the health care provider immediately.
4. The patient may become very sleepy while taking this medica-
tion; do not drive.
4. Thrombin, fibrin
Rationale: Prothrombinase converts prothrombin to thrombin.
Thrombin then converts fibrinogen to long strands of fibrin, which
provide a framework for the clot. Thrombin and fibrin are formed

lOMoARcPSD|3083804
only after the injury occurs. Fibrin strands form an insoluble web
over the injured area to stop blood loss.
The nurse's understanding of the clotting mechanism is important
in administering anticoagulant drugs. The nurse understands that
which of the following clotting factors are formed after injury to the
vessels?
1.Fibrin, vitamin K
2.Thromboplastin, fibrinogen
3.Prothrombin, thrombin
4.Thrombin, fibrin
2."Heparin does not thin the blood but prevents clots from forming
as easily in the blood vessels."
Rationale: Anticoagulants do not change the viscosity of the
blood. Instead, anticoagulants exert a negative charge on the sur-
face of the platelets, so that clumping or aggregation of cells is in-
hibited.
The patient receiving heparin therapy asks how the "blood thin-
ner" works. The best response by the nurse would be:
1."Heparin makes the blood less thick."
2."Heparin does not thin the blood but prevents clots from forming
as easily in the blood vessels."
3."Heparin decreases the number of platelets so that blood clots
more slowly."
4."Heparin dissolves the clot."
4. Whether the patient's pulse and blood pressure are within nor-
mal limits
Rationale: Potassium channel blockers such as amiodarone, like
other antidysrhythmics, may cause significant bradycardia and hy-
potension. The light-headedness and dizziness may be associ-
ated with a drop in cardiac output due to bradycardia and hy-

lOMoARcPSD|3083804
potension. The significant finding of dizziness would first be as-

sessed in relation to the known adverse effects of the drug.
A patient was admitted from the emergency department after re-
ceiving treatment for dysrhythmias and will be started on amio-
darone (Cordarone, Pacerone) because of lack of therapeutic ef-
fects from his other antidysrhythmic therapy. When the nurse
checks with him in the afternoon, he complains of feeling light-
headed and dizzy. The nurse will first assess:
1. Whether there is the possibility of sleep deprivation from the
stress of admission to the hospital
2. Whether an allergic reaction is occurring with anticholinergic-
like symptoms
3. Whether the amiodarone level is not yet therapeutic enough to
treat the dysrhythmias
4. Whether the patient's pulse and blood pressure are within nor-
mal limits
1,2,3,4
1. teaching the patient or family to give sulx.utaneous
injections at home.
2. teaching the patient or family nol to ta~ any OTC
drugs without first consulting with the health care
provider.
3. teaching the patient to observe for unexplained bleeding
such as pink, red, or dark brown urine or bloody gums.
4. teaching the patient to monitor for the development
of DVT.
Nursing interventions for a patient receiving enoxaparin (Lovenox)
may include: (Select all that apply.)
1. teaching the patient or family to give sulx.utaneous
injections at home.
2. teaching the patient or family nol to ta~ any OTC
drugs without first consulting with the health care
provider.

lOMoARcPSD|3083804
3. teaching the patient to observe for unexplained bleeding

such as pink, red, or dark brown urine or bloody gums.
4. teaching the patient to monitor for the development
of DVT.
5. teaching the importance of drinking grapefruit juice
daily.
4. aPT one and a half to two and a half times the control value.
Rationale: aPT is the coagulation study that monitors oral antico-
agulant use, such as warfarin. A result of one and a half to two
and a half times the control value indicates adequate anticoagula-
tion. aPTT is the coagulation study that monitors heparin use. An
aPT level of one would indicate a less-than-therapeutic level of
anticoagulation.
The nurse receives the patient's lab values throughout warfarin
drug therapy. The expected therapeutic level is:
1 aPTT of three to four times the normal control value.
2 aPTT one to two times the patient's baseline level.
3 aPT one to two times the patient's last result.
4 aPT one and a half to two and a half times the control value.
3. Bruising and epistaxis

Rationale: Thrombolytic agents dissolve existing clots rapidly and
continue to have effects for 2 to 4 days. All forms of bleeding must
be monitored and reported immediately. Skin rash with urticaria,
wheezing with labored respirations, and temperature elevation of
100.8º F are not symptoms of adverse effects directly attributed to
thrombolytic therapy.
A patient is receiving a thrombolytic agent, alteplase (Activase),
following an acute myocardial infarction. Which condition is most
likely attributed to thrombolytic therapy with this agent?
1 Skin rash with urticaria
2 Wheezing with labored respirations

lOMoARcPSD|3083804
3 Bruising and epistaxis

4 Temperature elevation of 100.8º F
2. To reduce the risk of a stroke from a blood clot

Rationale: Antiplatelet drugs such as clopidogrel are given to in-
hibit platelet aggregation and thus reduce the risk of thrombus for-
mation. Antiplatelet drugs do not exert antiinflammatory, an-
tipyretic, or analgesic effects. The antiplatelet and anticoagulant
drugs do not prevent emboli formation. Thrombolytics dissolve ex-
isting blood clots.
A patient has started clopidogrel (Plavix) after experiencing a TIA
(transient ischemic attack). The desired therapeutic effects of this
drug will be:
1 Anti-inflammatory and antipyretic effects
2 To reduce the risk of a stroke from a blood clot
3 Analgesic as well as clot-dissolving effects
4 To stop clots from becoming emboli
ACE Inhibitors
Antihypertensive
Acetaminophen
Non Opioid Analgesic & Antipyretic
Acyclovir
Antiviral
Albuterol
Bronchodilator

lOMoARcPSD|3083804
Aldactone
Diuretic
Allopurinol
Antigout Agent & Antihyperuricemic
Ambien
Sedative/Hypnotic
Aminophylline
Bronchodilator
Amiodarone
Antiarrhythmic
Amphotericin
Antifungal
Ampicillin
Anti-infective
Antacids
Antiulcer
Antabuse
Alcohol Abuse Therapy Adjunct
Aspirin

lOMoARcPSD|3083804
Non Opiod Analgesic & Antipyretic
Atenolol
Antianginal & antihypertensive
Atropine
Antiarrhythmic
AZT
Antiretroviral
Benadryl
Allergy & Cough & Cold
Beta Blockers
Antihypertensive
Calcium Channel Blocker

Antihypertensive
Captopril
Antihypertensive
Cialis
Erectile Dysfunction Agent
Ciprofloxacin
Anti-infective

lOMoARcPSD|3083804
Clozaril
Antipsychotic
Codeine
Allergy, Cough & Cold, Antitussive & Opioid Analgesic
Coumadin
Anticoagulant
Cyclosporine
Immunosuppressant & Antirheumatic
Digoxin
Antiarrythmic & Inotropic
Dilatin
Antiarryhmic & Anticonvulsant
Evista
Bone Reabsorbtion Inhibitor
Fentanyl
Opioid Analgesic
Flagyl
Antiprotozoas, Anti-infective & Antiulcer

lOMoARcPSD|3083804
Gentamicin
Anti-infective
Glucophage
Antidiabetic
Haloperidol
Antipsychotic
Heparin
Anticoagulant
Imitrex
Vascular Headache Suppressant
Insulin
Antidiabetic Hormone
Kayexalate
Hypokalemic & Electrolyte Modifiers
Keflex
Anti-infective
Lactulose
Laxitive

lOMoARcPSD|3083804
Lasix
Diurectic
Levodopa
Antiparkinson
Lidocaine
Anesthetic
Lipitor
Lipid Lowering Agent
Lithium
Mood Stabilizer
Magnesium Sulfate
Mineral & Electrolyte Replacement
Mannitol
Diuretic
MAO
Inhibitor Anti-depressant
Morphine
Opioid Analgesic
Morphine

lOMoARcPSD|3083804
Opioid Analgesic
Narcan
Antidote
Neomycin
Anti-infective
Neostigmine
Antimyasthenics
Neupogen
Colony Stimulating Factor
Neurontin
Analgesic Adjunct, Anticonvulsant & mood stabilizer for chronic
pain or bipolar
Nitroglycerin
Antianginal
Pitocin
Hormone, induces labor
Plaquenil
Antimalaria & antirheumatic
Procrit

lOMoARcPSD|3083804
Antianemic
Pronestyl
Antiarrhythmic
Protonix
Antiulcer Agent
Questran
Lipid Lowering Agent
Reglan
Antiemetic
Remicade
Antirheumatic
Restoril
Sedative & Hypnotic
Rifampin
Antitubercular
Ritalin
CNS Stimulant
Steroids (Prednisone)
Anti-asthmatic & Corticosteroid

lOMoARcPSD|3083804
Synthroid
Hormone for Thyroid
Tagamet
Antiulcer Agent
Tetracycline
Anti-infective
Thorazine
Antiemetic & Antipsychotic
Tofranil
Antidepressant
-afil
phosphodiesterase (PDE) inhibitor
-asone
corticosteroid
-bicin
antineoplastic; cytotoxic agent
-bital
barbiturate (sedative)

lOMoARcPSD|3083804
-caine
local anesthetic
cef-, ceph-
cephalosporin antibiotic
-cillin
penicillin antibiotic
cort
corticosteroid
-cycline
tetracycline antibiotic
-dazole
anthelmintic; antibiotic; antibacterial
-dipine
calcium channel blocker
-dronate
bisphosphonate; bone resorption inhibitor
-eprazole
proton pump inhibitor (PPI)

lOMoARcPSD|3083804
-fenac
nonsteroidal anti-inflammatory drug (NSAID)
-floxacin
quinolone antibiotic
-gliptin
antidiabetic; inhibitor of the DPP-4 enzyme
-glitazone
antidiabetic; thiazolidinedione
-iramine
antihistamine
-lamide
carbonic anhydrase inhibitor
-mab
monoclonal antibody
-mustine
alkylating agent (antineoplastic)
-mycin
antibiotic; antibacterial
-nacin

lOMoARcPSD|3083804
muscarinic antagonist (anticholinergic)
-nazole
antifungal
-olol
beta blocker
-olone
corticosteroid; anabolic steroid
-onide
corticosteroid
-oprazole
proton pump inhibitor (PPI)
parin; -parin
antithrombotic; anticoagulant (blood thinner)
-phylline
xanthine derivative (bronchodilator)
-pramine
tricyclic antidepressant (TCA)
pred; pred-
corticosteroid

lOMoARcPSD|3083804
-pril
ACE inhibitor
-profen
nonsteroidal anti-inflammatory drug (NSAID)
-sartan
angiotensin II receptor blocker; ARB
-semide
loop diuretic (water pill)
-setron
serotonin 5-HT3 receptor antagonist; antiemetic and antinauseant
-statin
HMG-CoA reductase inhibitor; statins
sulfa-
antibiotic; anti-infective; anti-inflammatory
-tadine
antihistamine; antiviral; anti-influenza-A
-terol
beta agonist; bronchodilator

lOMoARcPSD|3083804
-thiazide
thiazide diuretic (water pill)
-tinib
antineoplastic (kinase inhibitor)
-trel
female hormone (progestin)
tretin-; tretin; -tretin

retinoid; dermatologic agent; form of vitamin A
-triptan
antimigraine; selective 5-HT receptor agonist
-tyline
tricyclic antidepressant (TCA)
vir; -vir
antiviral; (anti-HIV, anti-hepatitis, anti-herpes, anti-
cytomegalovirus (CMV), anti-flu)
-vudine
antiviral; nucleoside analogues
-zepam
benzodiazepine

lOMoARcPSD|3083804
-zolam
benzodiazepine
-zosin
alpha blocker
-dipine
Ca channel blocker
(prevents Ca+ from enering heart & blood vessels ==> decreases
heart pump strength, & relaxes blood vessels)
tx: Hypertension, Angina, Arrhythmias
-afil
erectile dysfunction
-caine
anesthetics
-pril
Angio-tensin Converting Enzyme (ACE) inhibitors
(Vasodilator; decreases resistance by decreasing Angiotensin II

levels)
-pam, -lam
benzodiazepine

lOMoARcPSD|3083804
-statin
antilipidemic
(lowers LDL's)
tx: high LDL's
-asone, -solone
corticosteroid
-olol
beta blocker
(decreases heart rate & cardiac output ==> decreases b/p &
slows beats & force of heart.
tx: Hypertension, Heart arrhythmias, Angina, Prevent reoccuring

heart attack
-ide
Diuretics
('P" it out ==> decreases excess fluid; decrease heart workload)
tx: Hypertension, Edema
-prazole
proton pump inhibitor
-vir
antiviral

lOMoARcPSD|3083804
-ase
thrombolytic
-azine
antiemetic
-phylline
bronchodilator
-arin
anticoagulant
(decreases clotting)
-tidine
antiulcer
-zine
antihistamine
-cycline
antibiotic
-mycin
aminoglycoside
-floxacin

lOMoARcPSD|3083804
antibiotic
-tyline
tricyclic antidepressant
-pram, -ine
SSRI
-prin, -dine, -grel, -mole

Antiplatelets
(keeps blood platelets from forming by preventing them from

sticking together)
-sartan
Angiotensin II Receptor Blockers (ARBS)
Blocks Angiotensin II from having any effects on the heart and

blood vessels. This keeps blood pressure from rising.
tx: heart failure & hypertension
-ide, -ine, plus( nitrates, minoxidil)

Vasodilators
(relaxes blood vessels, & increases blood & O2 supply to heart,

reducing heart's workload.
tx: Angina

lOMoARcPSD|3083804
Lanoxin
Digitalis Preparations: Digoxin/Digitoxin
(increases force of heart contractions. Benefecial in heart failue &

iregular heart beats)
tx: Heart failure symptoms if NOT responding to Ace inhibitors &

Diuretics. Arrhthymias especially Atrial Fibrillation.
anaphylaxis Assessment
hives, rash
difficulty breathing
dilated pupils
decreased BP, increased pulse, increased respirations
anaphylaxis Nursing Considerations

.3ml of epi 1:1000 solution
massage site to speed up absorption
can repeat in 15-20 minutes
Delayed Allergic Reaction Assessment

rash, hives
swollen joints
Delayed Allergic Reaction Nursing Considerations

skin care
antihistamines, topical
corticosteroids
Dermatological Reactions Assessment

hives, rashes, lesions

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Exfoliate dermatitis (rash, enlarged lymph nodes, enlarged lives)

Stevens-Johnson Syndrome( dark red papules that dont itch or
hurt)
Dermatological Reactions Nursing Considerations

frequent skin care
avoid rubbing, tight clothing, harsh soaps, perfumed lotions
oatmeal baths, gentle skin care
Stomatitis Assessment
swollen gums
swollen red tounge
bad breath
difficulty swallowing
Stomatitis nursing considerations

frequent mouth care with non alcoholic solution
frequent, small feedings-non spicy foods
antifungal meds
Superinfection assessment
fever
diarrhea
black hairy tounge
vaginal itching/discharge
Superinfection Nursing Care

frequent mouth care
good skin care
antifungal meds

lOMoARcPSD|3083804
Bone Marrow Depression Assessment

fever
chills
sore throat
back pain
dark urine
low blood cells
Bone Marrow Depression Nursing Considerations

monitor CBC
rest
protection from infections
avoid activities that may cause injury
Liver Impairment Assessment

fever
malaise
n/v
jaundice
light stools, dark urine
elevated bilirubin
Liver Impairment Nursing Considerations

small frequent feedings
good skin care
comfort measures
rest
Renal Impairment Assessment

elevated BUN, CR
Altered K, Na

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Decreased Hct
Edema
Fatigue
Renal Impairment Nursing Considerations

diet/fluid restrictions
electrolyte replacement
dialysis
Ocular Impairment Assessment

blurred vision, color vision changes, blindness
Ocular Impairment Nursing Considerations

monitor vision carefully
monitor lighting and exposure to light
Auditory Impairment Assessment

dizziness
ringing in ears
loss of balance, hearing
Auditory Impairment Nursing Considerations

prevent falls
monitor hearing ability
CNS impairment Assessment

confusion, delirium
insomnia
drowsiness
halluncinations

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CNS impairment Nursing Considerations

safety measures to prevent injury
avoid activities that require alertness(driving a car)
orient to surrounding frequently
Anticholinergic Effects assessment

dry mouth
blurred vision
nasal congestion
urinary retention
heart burn
impotence
Anticholinergic Effect nursing considerations

sugarless lozenges
good mouth care
void before taking medication
safety measure for vision changes
Parkinson-like Effects Assessment

akinesia
tremors
drooling
changes in gait
Parkinson-like Nursing Considerations

safety measure for gait changes
anticholinergic/antiparkinson meds

lOMoARcPSD|3083804
Cholinegergics
-stigmine
Thiazide Diuretics
-thiazide
Local Anesthetic
-caine
Beta Blockers
-olol
Antifungals
-azole
Aminoglycoside
-micin/mycin
Fluoroquinolone
-floaxin
Cephalosporin
-cef/ceph
Alpha Adrenergic Blocker

-zosin
Benzodiazepenes

lOMoARcPSD|3083804
-zepam
ACE Inhibitors
-pril
Calcium Channel Blockers

-dipine
Thrombolytics
-ase
Corticosteroid
-sone
Bronchodilator
-terol
Proton Pump Inhibitor (PPI)

-prazole
Neuromuscular Blocking Agent

-curium/curonium
Antivirals
-ovir/avir
Tetracycline
-cycline

lOMoARcPSD|3083804
Antilipedemic
-statin
Angiotensin Receptor Blockades (ARBs)

-sartan
H2 Histamine Blockers
-tidine
Nonselective beta-blockers may be used to treat hypertension

and
supraventricular arrhythmias
An example of a cardioselective beta-blocker includes

atenolol (Tenormin)
When teaching a patient about beta-blockers such as atenolol

(Tenormin) and metoprolol (Lopressor), it is important to inform
the patient that
abrupt medication withdrawal may lead to a rebound hypertensive
crisis
Propranolol (Inderal) is an effective

nonselective beta-adrenergic antagonist
During assessment of a patient diagnosed with pheochromocy-

toma, the nurse auscultates a blood pressure of 210/110 mm Hg.
The nurse would expect to administer which medication?

lOMoARcPSD|3083804
phentolamine (Regitine)
When assessing for cardiovascular effects of a beta-blocker, the

nurse understands that these drugs produce
a negative inotropic, negative chronotropic, and negative dro-
motropic effect
Beta-blockers are used to treat which disorders? (Select all that

apply)
*Hypertension
*Angina pectoris
*Cardiac dysrhythmias
The priority nursing diagnosis for a patient taking metoprolol (Lo-

pressor) would be
Ineffective tissue perfusion (cerebral and cardiovascular) related
to effects of medication
Patient teaching for a patient being discharged on a beta-blocker

includes which statement?
"If you take your pulse and it is less than 60, hold your medicine
and call your health care provider for instructions."
The nurse is admitting a patient with a history of angina and hy-

pertension who is currently experiencing moderate heart failure.
The patient's current medication regimen includes digoxin,
furosemide, and accupril. Which medication would be most bene-
ficial to add to this patient's treatment plan?
carvedilol (Coreg)

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Epinephrine, as an adrenergic (sympathomimetic) drug, produces

which of the following therapeutic effects?
Increased heart rate and contractility
The doctor has ordered dopamine to treat your patient's hypov-

olemic shock due to severe blood loss. For the medication to be
effective, the physician must also order
fluid replacement
Your patient is receiving dobutamine as a continuous infusion.

Titration of this medication is based upon which factors? (Select
all that apply.)
*Heart rate
*Blood pressure
*Urine output
Your patient is to receive dopamine 5 mcg/kg/min. He weighs 176

lb. You have dopamine 400 mg in 500 mL D5W. You will infuse
this at
30 mL/hr.
When assessing for cardiovascular effects of an adrenerigic (sym-

pathomimetic) drug, the nurse understands that these drugs pro-
duce
a positive inotropic, positive chronotropic, and positive dro-
motropic effect
A hypertensive crisis may occur if adrenergic (sympathomimetic)

drugs are given along with
MAO inhibitors

lOMoARcPSD|3083804
The nurse assesses the intravenous infusion site of a patient re-

ceiving dopamine and finds it is infiltrated. The nurse will prepare
which of the following medications to treat this infiltration?
phentolamine (Regitine)
A patient using Afrin nasal spray complains of worsening cold

symptoms and tells the nurse, "I don't understand why this is not
working. I am using it almost every 3 hours!" The nurse's re-
sponse based on knowledge that
the patient is suffering from rebound congestion related to exces-
sive use of the Afrin nasal spray
Cholinergic (parasympathomimetic) drugs have which therapeutic

effect?
Increased gastroinstestinal motility
Cholinergic (parasympathomimetic) drugs are indicated for which

situation
Lowering intraocular pressure in patients with glaucoma
During postoperative teaching, the nurse explains that the patient

is receiving bethanechol (Urecholine) to treat
urinary atony
Adverse reactions to bethanechol include

headache
The nurse would question an order for cevimeline (Evoxac) in a

patient with a history of

lOMoARcPSD|3083804
narrow-angle glaucoma
The nurse administering donepezil (Aricept) to a patient under-

stands that the expected therapeutic action of this drug is to
increase levels of acetylcholine in the brain by blocking its break-
down
When providing teaching to a patient diagnosed with myasthenia

gravis, which instruction regarding the administration of physostig-
mine (Antilirium) is most appropriate?
Take the medication 30 minutes before meals
Side effects to expect from anticholinergic (parasympatholytic)

drugs, such as atropine, include which effects? (Select all that ap-
ply)
*Dilated pupils (mydriasis)
*Urinary retention
*Dry mouth
A patient presents with symptomatic bardycardia. The nurse pre-

pared to administer which dose of atropine intravenously?
0.5 mg
A patient presents to the emergency room with insecticide poison-

ing. The nurse prepares to administer which dose of atropine in-
travenously?
2 mg
The nurse monitors a patient taking tolterodine (Detrol) for which

thereapeutic effect?

lOMoARcPSD|3083804
Decreased in urinary frequency
The nurse monitors a patient prescribed dicyclomine (Bentyl) for

which therapeutic effect?
Decrease in gastrointestinal motility
A priority nursing diagnosis for a patient receiving anticholinergic

(parasympatholytic) drugs would be
Impaired gas exchange related to thickened respiratory secretions
Which would be the most appropriate application time for a pa-

tient prescribed a scopolamine patch for motion sickness?
4 to 5 hours before travel
Which is an expected outcome associated with the administration

of digoxin?
Decreased heart rate
The patient has a serum digoxin level drawn and it comes back
0.4 ng/mL. The nurse recognized that this is:
below the therapeutic level
A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg.

When the nurse enters the room, the patient states, "There are
nice yellow halos around the lights." which action will the nurse
take?
Evaluate the patient for other symptoms of digoxin toxicity

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The patient weighs 44 lb and is to be digitalized. The digitazlizing

dose is to be 0.03 mg/kg in three divided doses. How much will
the nurse administer per dose?
0.2 mg
Which are therapeutic effects of digoxin?

Positive inotropic, negative chronotropic, and negative
dromotropic
Which effects would alert the nurse to suspect early digitalis toxic-
ity?
Nausea and vomiting
Phosphodiesterase inhibitors have an added advantage in treat-

ing hear failure because they cause a positive inotropic effect and
vasodilation
The nurse reviews a patient's laboratory values and finds a

digoxin level of 10 and a serum potassium level of 6.2. The nurse
would notify the health care provider and anticipate administering
digoxin immune FAB
Assessment of a patient is receiving a positive inotropic drug

would include reviewing which values?
Serum electrolytes
The nurse would question the use of milrinone (Primacor) in a pa-

tient with which disorder?
systolic heart failure

lOMoARcPSD|3083804
When teaching a patient regarding the administration of digoxin,

the nurse instructs the patient not to take this medication with
which food?
Wheat bran
Which is an indication for use of the antidysrhythmic drug lido-

caine?
Ventricular arrhythmias
When giving adelnosine, it is important to remember to

give it as a fast intravenous push
To prevent the occurrence of cinchonism in a patient prescribed

quinidine, the nurse emphasizes the importance of
avoiding ingestion of antacids
Adenosine is used to treat which condition?

Paroxysmal supraventricular tachycardia (PSVT)
Sodium channel blockers are considered which class of antiar-

rhythmic drugs?
Class I
Ibutilide (Corvert) is a class III antiarrythmnic drug that is used for

conversion of recent-onset of atrial fibrillation and flutter
For which potential side effects would the nurse monitor patients
prescribed amiodarone? Select all that apply
*Bluish skin discoloration
*Hypothyroidism

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*Photosensitivity
Before administering a dose of an antiarrhythmic drug to an as-

signed patient, which assessments wold be of highest priority?
Apical pulse and blood pressure
Which classification of drugs is used to treat both hypertension

and dysrhythmias?
Calcium channel blockers
Calcium channel blockers have which pharmacodynamic effect?

Coronary vasodilation
Amiodarone toxicity is evidenced in which body system?

Pulmonary
Which instruction should be included in the discharge teaching for

a patient with a transdermal nitroglycerin patch?
"Apply the patch to a nonhairy, nonfatty area of the upper torso or
arms"
Nitrates relieve angina pain by reducing preload, which is

blood volume within the heart
Which are common side effects of nitroglycerin? Select all that

apply
*Flushing
*Headache
*Hypotension

lOMoARcPSD|3083804
Which statements by the patient demonstrates a need for further

education regarding nitroglycerin?
"I can take up to three tablets at 5-min. intervals for chest pain."
Calcium channel blocers reduce myocardial oxygen demand by

reducing afterload, which is
pressure against which the heart must pump
Which nitrate preparation or dosage form has the longest duration

of action?
Transdermal nitroglycerin patch
In order to prevent the development of tolerance, the nurse in-

structs the patient to perform which action?
Apply the nitroglycerin patch for 14 hours each and remove for 10
hours at night
Before administering isosorbide mononitrate (Imdur), a priority as-

sessment would include
blood pressure
The patient asks how nitroglcerin should be stored while traveling.

What is the nurse's best response?
"it's best to keep it in its original container away from heat and
light."
Patient teaching regarding sublingual nitroglycerin should include

which statement?

lOMoARcPSD|3083804
"Sit or lie down after you take a nitroglycerin tablet to prevent

dizziness."
What is the best way to prevent tolerance to nitrates when using

transdermal patches?
Remove the patch at night for 8 hours, and then apply a new
patch in the morning
Which statement indicates that the patient understands discharge

teaching about nitroglycerin?
"I will need to keep the nitroglycerin stored in the bottle it comes
in."
A patient who is taking sublingual nitroglycerin is complaining of

flushing and headaches. What is the nurse's best response?
"These are the most common side effects of nitroglycerin. They
should subside with continued use of nitroglycerin."
When applying nitroglycerin ointment, the nurse should perform

which action?
Apply the ointment to a nofatty, nonhairy part of the upper torso
When titrating intravenous nitroglycerin, what does the nurse

monitor? Select all that apply
*Blood pressure
*Heart rate
*Chest pain
A patient receiving intravenous nitroglycerin at 20 mcg/min com-

plains of dizziness. Nursing assessment reveals a blood pressure

lOMoARcPSD|3083804
of 85/40 mm Hg. heart rate of 110 beats/min, and respiratory rate

of 16 breaths/min. What is the nurse's best action?
Decrease the intravenous nitroglycerin by 10 mcg/min
Nitrates relieve angina pain by reducing afterload, which is

pressure against which the heart must pump
During patient teaching, the nurse explains that nitroglycerin re-

lieves chest pain primarily by which action?
Decreasing the workload of the heart
It is most important to instruct a patient prescribed nitroglycerin to

avoid which substances?
Erectile dysfunction medications
When caring for a patient with angina, the nurse would question
an order for a noncardioselective beta-blocker in a patient with co-
existing
bronchial asthma
Which statement, if made by your patient, signifies that additional

patient teaching regarding antihypertensive treatment is required?
"I will check my blood pressure every day and take my medication
An annoying side effect of ACE inhibitors that may be minimized

by switching to an angiotensin receptor blocking drug includes
a dry, nonproductive cough

lOMoARcPSD|3083804
Which would the nurse question if ordered concurrently with ACE

inhibitors?
potassium
Which would be a priorit assessment prior to administering

eplerenone (Inspra)?
Serum electrolytes
The nurse would plan to administer which calcium channel block-

ing drug to a patient with cerebral arterial spasms following a sub-
arachnoid hemorrhage?
nimodipine (Nimotop)
The nurse would question an order for a calcium channel blocking

drug in a patient with which condition?
Hypotension
Which statement would be most appropriate during discharge

teaching for a patient receiving transdermal clonidine (Catapres)?
"The patch should be applied to a nonhairy site, and abrupt with-
drawal should be avoided."
When explaining different medication regimens to treat hyperten-

sion during a community education program, it would be accurate
to state that African-American probably respond best to which
combination of medications?
Diuretics and calcium channel blockers
Carvedilol (Coreg) is classified as a

Dual action alpha, and beta-receptor blocker

lOMoARcPSD|3083804
When administering nitroprusside (Nipride) intravenously, the

nurse would monitro for which sign of toxicity? Select all that ap-
ply
*Abdominal pain
*Diaphoresis
*Muscle twitching
*Hypertension
The nurse would monitro for reflex tachycardia in a patient receiv-

ing which classification of antihypertensive drugs?
Direct-acting vasodilators
A patient prescribed prazosin (Minipress) does not have a history

of hypertension. The nurse would assess for what disorder for
which this medication is also used?
Obstructive benign prostatic hyperplasia
ACE inhibitors and angiotensin receptor blockers both work to de-

crease blood pressure by
preventing aldosterone secretion
Which is a priority nursing diagnosis for a patient taking an antihy-

pertensive medication?
Ineffective tissue perfusion related to disease process and/or
medication
When teaching a patient about carvedilol (Coreg), the nurse ex-

plains that this medication reduces blood pressure by (Select all
that apply)

lOMoARcPSD|3083804
*reducing heart rate

*vasodilation
Which laborator value might indicate an adverse response to hy-

drochlorothiazide (HydroDiuril)?
Glucose levels
When teaching a patient why spironolactone (Aldactone and

furosemide (Lasix) are prescribed together, the nurse's state-
ments are based on knowledge that
this combingation promotes diuresis but decreases the risk of hy-
pokalemia
Which laboratory value depics a known side effect of furosemide

(Lasix)?
Hypokalemia
A patient is admitted to the hospital with pneumonia and has a

history of chronic renal insufficiency. The physician orders
furosemide (Lasix) 40 mg twice a day because it
is effective in treating patients with renal insufficiency
A patient taking spironolactone (Aldacone) requests assistance

with dietary choices. The nurse would recomment which food
choices? (Select all that apply)
*Lean meat
*Apples
*Squash

lOMoARcPSD|3083804
The nurse would question the use of mannitol on which of the fol-
lowing patients?
A 47 year old patient with anuria
Acetazolamide (Diamox) is used to treat which disorder? Select

all that apply
*Edema associated with heart failure
*High-altitude sickness
*Open-angle glaucoma
When preparing to administer furosemide (Lasix) intravenously to

a patient with renal dysfunction, the nurse plans implementation
based on knowledge that the medication should be administered
no faster than which rate?
4 mg/min
Potassium-sparing diuretics may cause which adverse reactions?

Select all that apply
*Hyperkalemia
*Dizziness
*Headache
A patient asks about taking postassium supplements while taking

spironolactone (Aldactone). What is the nurse's best response?
"You are on a diuretic that is potassium-sparing, so there is no
need for extra potassium."
The nurse would expect to administer which diuretic to treat a pa-

tient diagnosed with primary hyperaldosteronism?
spironolactone (Aldactone)

lOMoARcPSD|3083804
The nurse prepares to administer which diuretic to treat a patient

suffering from acute pulmonary edema?
furosemide (Lasix)
When assessing for therapeutic effects of mannitol, the nurse

would expect to see
decreased intracranial pressure
When assessing a patient on triamterene (Dyrenium), the nurse

would specifically monitor for which adverse effect?
Hyperkalemia
When teaching a patient about signs and symptoms of hy-

pokalemia, the nurse will instruct the patient to notify the health
care provider if which occurs?
Leg cramps
The nurse would question the health care provider if which type of
diuretics is prescribed to a patient with gout?
Thiazide diuretics
The nurse would assess which laboratory value to determine the

effectiveness of intravenous heparin?
Activated partial thromboplastin time (aPTT)
A patient who has been anticoagulated with warfarin (Coumadin)

is admitted with gastrointestinal bleeding. The nurse will anticipate
administering which substance?
vitamin K

lOMoARcPSD|3083804
The nurse understands that a patient's international normalized

ratio (INR) value of 2.5 means that
the patient's warfarin dose is therapeutic
Which statement when made by the patient indicates deficient

knowledge regarding warfarin?
"I will increase the dark green leafy vegetables in my diet."
Which of the following medications has antiplatelet properties?

clopidogrel
While preparing a patient with acute chest pain for an emergency

angioplasty, the nurse would
tirofiban (Aggrastat)
Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent

and treat deep vein thrombosis and pulmonary embolism. This
drug is in which drug group?
Low molecular weight heparin
The patient asks what the difference is between dalteparin (Frag-

min) and heparin. What is the nurse's best respons?
"Dalteparin is a low molecular weight heparin that has a more pre-
dictable anticoagulant effect."
Before emergency surgery, the nurse would anticipate administer-

ing which medication to a patient receiving heparin?
protamine sulfate

lOMoARcPSD|3083804
Nursing care for a patient receiving alteplase (Activase) would in-

clude which action? Select all that apply
*Record vital signs and report changes
*Observe for signs and symptoms of bleeding
*Assess for cardiac dysrhythmias
A patient who is taking an anticoagulant requests as aspirin for

headache relief. What is the nurse's bes action?
Take advantage of a teachable moment to inform the patient of
potential drug interactions with anticoagulants
A patient is started on oral anticoagulant therapy while still receiv-

ing intravenous heparin. The patient is concerned about risk for
bleeding. What is the nurse's best response?
"It is usually takes 4 to 5 days to achieve a full therapeutic effect
for warfarin, so the heparin is continued to help prevent blood
clots until the warfarin is working up to speed."
The nurse evaluates understanding of discharge instructions re-

garding warfarin (Coumadin) when the patient states
"I should use a soft toothbrush for dental hygiene."
Before administering alteplase (Activase), it is important for the

nurse to perform which action?
Perform all necessary venipunctures
The nurse formulates a plan of care for a patient receiving heparin

based upon which nursing diagnosis?
Risk for injury

lOMoARcPSD|3083804
The nurse recognized that patient teaching regarding warfarin

(Coumadin) has been successful when the patient acknowledges
an increased risk of bleeding with conccurent use of which herbal
product? Select all that apply
*Garlic
*Ginko
*Ginseng
While observing a patient self-administer enoxaparin (Lovenox),

the nurse identifies the need for further teaching when the patient
Massages the site after administration of the medication
Which statement will indicate to the nurse that the patient under-
stands the discharge instructions regarding cholestyramine
(Questran)?
"I will decrease fiber in my diet."
The nurse plans which of the following interventions to decrease

the flushing reaction of niacin?
Administer aspirin 30 minutes before nicotinic acid
HMG-CoA reductase inhibitors (statins) are generally adminis-

tered at which time?
In the evening
Which are common side effects of fenofibrate (Tricor), a fibric acid

derivative? Select all that apply
*ausea, vomiting, and abdominal pain
*Increase in gallstone formation
*Impotence

lOMoARcPSD|3083804
Discharge teaching for a patient receiving an antilipemic medica-

tion would include
"Continue your exercise program, and maintain a diet high in
omega-3 fatty acids."
What is the mechanism of action of ezetimibe (Zetia)?

Inhibiting absorption of dietary and biliary cholesterol in the small
intestine
Cholestyramine (Questran) decreases lipid levels by

binding to bile in the intestinal tract, forming an insoluble complex
that is excreted in the feces.
Which statement, made by the patient, demonstrates a knowl-

edge deficit regarding colestipol (Colestid)?
"I should mix and stir the powder in as small an amount of fluid as
possible in order to maintain potency of the medication."
Atorvastatin (Lipitor) decreases lipid levels by

Inhibiting HMG-CoA reductase, the enzyme responsible for the
biosynthesis of cholesterol in the liver.
Which test will the nurse use to assess for adverse reactions to
HMG-CoA reductase inhibitors?
Liver functin tests
Discharge teaching for a patient receiving simvastatin (Zocor)

should include the importance of reporting which symptoms that
might indicate a serious adverse reaction to the medication?

lOMoARcPSD|3083804
Muscle pain
The nurse would question an order for simvastatin (Zocor) in a

patient with which condition?
Hepatic disease
A patient with elevated triglyceride levels unresponsive to HMG-

CoA reductase inhibitors will most likely be prescribed which
drug?
gemfibrozil (Lopid)
The nurse would question an order for colesevelam (Welchol) in a

patient with which conditon?
Complete bowel obstruction
The nurse will assess a patient receiving gemfibrozil (Lopid) and

warfarin (Coumadin) for which adverse effect?
Increased risk of bleeding
Antacids are used for

peptic ulcer disease & GERD
Aluminum hydroxide is an antacid that treats

hyperphosphatemia
Aluminum hydroxide is an antacid that causes

hypophosphatemia
classes of antacids

lOMoARcPSD|3083804
alminum, MG, NA, and Ca compounds
Misoprostyl (Cytotec) & Sucralfate (Carafate) are

gastric protectants
gastric protectant: an antisecretory med that enhances mucosal

defenses & suppresses secretion of gastric acid & maintains sub-
mucosal blood flow by promoting vasodilation; used to prevent ul-
cers w/ NSAID use
Misoprostyl (cytotec)
gastric protectant: creates a protective barrier against acid &

pepsin
sucralfate (Carafate)
Infliximab is an immunodulator that

reduces inflammation in Crohns disease, thereb reducing diarrhea
Loperamide is an
antidiarrheal med
Ondansetron is an antiemetic used for

post op N/V as well as N/V induced w/ chemotherapy
Pancrelipase is a pancreatic enzyme used w/ patients w/ pancre-

atitis as a
digestive aid to reduce fatty stool & improve nutritional status
CNS effects w/ Cinetidine (Tagament) occur in elderly; signs?

lOMoARcPSD|3083804
confusion
sucralfate is a gastric protectant and is given

1 hour before meals and at bedtime
Misoprostol is a gastric protectant and is given to prevent

ulcers w/ NSAID and aspirin use
triple therapy of h. pylori infection include

two antibacterial drugs and a proton pump inhibitor
Questron therapy is use not compliant due to

its terrible taste; encourage to drink w/ fruit juice
Benylin DM, Pertissis

Antitussive/Expectorant Medication
ES, Vicks Formula 44

Robitussin
Acyclovir (Zovirax)
Antiviral
Ribavarin (Virazole)
Antiviral

lOMoARcPSD|3083804
Zidovudine (AZT)
Antiviral
Zalcitabine (HIVID)
Antiviral
Didanosine (Videx)
Antiviral
Famciclovir (Famvir)
Antiviral
Ganciclovir (Cytovene)
Antiviral
Amantadine (Symmetrel)\
Antiviral
Rimantadine (Flumadine)
Antiviral
Oseltamivir (Tamiflu)
Antiviral
Zanamivir (Relenza)
Antiviral

lOMoARcPSD|3083804
Ritalin
Medications used for ADHD
Dexedrine
Medications used for ADHD
Fosamax
Bone-Reabsorption Inhibitor
Actonel
Boniva
Truphylline
Bronchodilator
Brethaire
Bronchodilator
Atrovent
Bronchodilator
Proventil
Bronchodilator

lOMoARcPSD|3083804
Adrenalin, Primatene Mist

Bronchodilator
Mucomyst
Bronchodilator
Intal
Bronchodilator
Serevent
Bronchodilator
Singulair
Bronchodilator
Diamox
Carbonic Anhydrase Inhibitor
Lanoxin (Digoxin)
Cardiac Glycosides
Carafate
Cytoprotective Agents
Hydrodiuril
Diuretics
Diuril

lOMoARcPSD|3083804
Diuretics
Aldactone
Diuretics
Lasix
Diuretics
Edecrin
Diuretics
Bumex
Diuretics
Mannitol
Diuretics
Hygroton, Thalitone
Diuretics
Calcium carbonate
Electrolyte and Replacement solution
Calcium chloride
MgCl, Slow mag


lOMoARcPSD|3083804
K-Dur, Slow K, Micro-K

Kaon Liquid
Sodium chloride
FeS04, Feosol
Iron Preparation
Imferon
Iron Preparation
Calcium
Mineral
Vitamin D
Mineral
Sodium fluoride
Mineral
Potassium
Mineral

lOMoARcPSD|3083804
Tearisol
Eye Medication
Liquifilm Tears
Eye Medication
Visine, Murine Plus

Eye Medication
Timoptic
Eye Medication
Betagan
Eye Medication
Alcaine
Eye Medication
Pontocaine
Eye Medication
Ocu-Pred
Eye Medication
Garamycin
Eye Medication

lOMoARcPSD|3083804
Tobrex
Eye Medication
Herplex
Eye Medication
Stoxil
Eye Medication
Propine
Eye Medication
Ocufen
Eye Medication
Norepinephrine
Used to treat shock, cardiac arrest and anaphylaxis
Dopamine
Epinephrine
Isoproterenol
Phenylephrine (Neo-Synephrine)

lOMoARcPSD|3083804
Dobutamine hydrocholoride (Dobutrex)

Milrinone (Primacor)
Sodium Nitroprusside (Nitropress)

Diphenhydramine HCL (Benedryl)

Librium
Antianxiety Agent
Valium
Antianxiety Agent
Xanax
Antianxiety Agent
Klonopin
Antianxiety Agent
Ativan
Antianxiety Agent

lOMoARcPSD|3083804
Serax
Antianxiety Agent
Versed
Antianxiety Agent
BuSpar
Antianxiety Agent
Hydroxyzine (Vistaril), (Atarax)

Antianxiety Agent
Kava
Herbal Antianxiety Agent
Melatonin
Herbal Antianxiety Agent
Aluminum hydroxide gel (Amphojel)

Antacid Medication
Calcium carbonate (Titralac)

Antacid Medication
Aluminium hydroxide and magnesium trisilicate

Antacid Medication

lOMoARcPSD|3083804
Magnesium hydroxide (Milk of Magnesia)

Antacid Medication
Aluminium hydroxide and Magnesium hydroxide (Maalox)

Antacid Medication
Procainamide (Pronestyl)
Antidysrhythmics
Disopyramine (Norpace)
Antidysrhythmics
Lidocaine
Antidysrhythmics
Mexiletine Hydrochloride (Mexitil)

Antidysrhythmics
Tocainide Hydrochloride (Tonocard)

Antidysrhythmics
Flecainide (Tambocor)
Antidysrhythmics
Propafenone Hydrochloride (Rythmol)

Antidysrhythmics

lOMoARcPSD|3083804
Propananol (Inderol)
Antidysrhythmics
Acebutolol (Sectral)
Antidysrhythmics
Esmolol Hydrochloride (Brevibloc)

Antidysrhythmics
Amiodarone Hydrochloride (Cordarone)

Antidysrhythmics
Ibutilide fumarate (Corvert)

Antidysrhythmics
Verapamil (Calan)
Antidysrhythmics
Diltiazem Hydrochloride (Cardizem)

Antidysrhythmics
Gentamicin
Aminoglycoside
Neomycin
Aminoglycoside
Streptomycin

lOMoARcPSD|3083804
Aminoglycoside
Tobramycin
Aminoglycoside
Cephalexin (Keflex)
Cephalosporin 1st generation
Cefaclor (Ceclor)
Cephalosporin 2nd generation
Ceftriaxone (Rocephin)
Cephalosporin 3rd generation
Cefepime (maxipime)
Cephalosporin 4th generation
Ciprofloxacin (Cipro)
Fluoroquinolone
Levofloxacin (Levoquin)
Fluoroquinolone
Norfloxacin (Noroxin)
Fluoroquinolone
Vancomycin
Glycopeptide

lOMoARcPSD|3083804
Clindamycin HCL Phosphate (Cleocin)

Lycosamide
Erythromycin (Erythrocin)
Macrolide
Azethromycin (Zithromax)
Macrolide
Amoxicillin
Penicillin
Ampicillin
Penicillin
Methicilin
Penicillin
Penicillin G
Penicillin
Penicillin V
Penicillin
Sulfisoxazole (Gentrisin)
Sulfonamide

lOMoARcPSD|3083804
Sulfasalazine (Azulfidine)
Sulfonamide
Doxycycline (Vibramycin)
Tetracycline
Minocycline (Minocin)
Tetracycline
Tetracycline HCL (Panmycin)

Tetracycline
Bacitracin ointment
Topical Antibacterial
Neosporin cream
Povidone -iodine solution

Silver sulfadiazine cream (Silvadene)

Tolna flake cream (Tinactin)


lOMoARcPSD|3083804
Nystatin cream (Mycostatin)

Nitrofurantoin (Furadantin)
Genitourinary Medication
Phenazopyridine (Pyridium)
Genitourinary Medication
Oxybutynin (Ditropan)
Genitourinary Medication, Anticholinergic
Hyoscynamine (Anaspaz)
Propantheline (Pro-Banthine)
Derifenacin (Enablex)
Sildenafil (Viagra)
Genitourinary Medication, Anti-impotence
Verdenafil (Levitra)
Genitourinary Medication, Anti-impotence
Finasteride (Proscar, Propecia)

lOMoARcPSD|3083804
Genitourinary Medication, Testosterone inhibitor
TPN prevents catabolism of this electrolyte from this tissue

prevents catabolism of protien from muscle or fat
what two meds may be added to TPN solution to prevent prob-

lems
insulin and or heparin
what are two main products of TPN

amino acids and dextrose
lipids aka __ may be added to TPN 1-3 x a week

fat emulsion
what are 6 conditions for a patient to recieve TPN

GI, trauma, burn, malnutrtion, cancer, AIDS
what type of line is used for TPN

central line for 4 weeks
what type of line is used for PPN

peripheral line for ten days
what is the maximum % of dextrose used for a PPN

10% maximum of dextrose to avoid vein irritation
how much dextrose may be used for a TPN

lOMoARcPSD|3083804
greater than 10%
what size and type of catheter is used for acentral line TPN
18G triple lumen
peripherally inserted central catheter aka this, used in basilic or

cephalic vein when TPN is needed for up to 3 months
PICC line
what is not to be added to TPN solutions

no blood or meds
why ask pt. if they are allergic to eggs if receiving a lipid solution
of TPN
fat emulsion may have egg yolk phospholipids
how is TPN tube placement verified

xray
when should nurse assess pt. TPN insertion site for infection and
patency
each shift
how often should BS levels be monitored for hyperglycemia while

on TPN
every 6 hours
what labs are studied due to TPN causing excess amino acid in-
take will increase these levels

lOMoARcPSD|3083804
total protein, prealbumin, albumin, BUN/creatinine will all increase
these two blood tests if abnormally high may indicate problems

with glucose or protein metabolism or excess lipids
lymphocyte, liver function
in malnourished clients watch for this of a drop in potassium,

magnesium and phosphate
refeeding syndrome
what are the outcomes for TPN goals

maintain fluid, electrolyte, and weight
how is TPN solution stored

store in fridge
how often should TPN tube and bag be replaced

bag and tube every 24 hours
like blood products being infused what type of tubing should be

used for TPN
inline filter
what is the only solution to be able to piggyback a TPN

lipids
at what rate should TPN solution be started

50 ml/hr

lOMoARcPSD|3083804
besides vitals what other signs should be noted during TPN

I and O
the lipid infusion should be connected to TPN solution tubing be-

low the filter at a rate of for first 1/2 hour
1 ml/minute
once TPN is completed and new bag is not available what should
be hung instead to prevent hypoglycemia
hang a 10% dextrose bag
if TPN is dislodged or pulled out what is to be in replace until an-

other TPN is placed
PPN of less than 10% Dextrose
how is TPN to be discontinued

taper down to prevent hypoglycemia
assess temperature every __ hours for presence of infection

every 4 hours
report an increased weight of _- per week due to possible fluid

overload or retention
more than 3 pounds per week
if TPN solutions are behind schedule what is to be done

do not catch up set at normal rate

lOMoARcPSD|3083804
what is a hallmark sign of air embolism of TPN

low BP and churning heart murmur
what does the client need to do when a tube or cap is changed on

TPN
valsalva maneuver
what position is client to be in if air embolism occurs during TPN

left trendlenberg
what medication will increase BS tests and create a false reading

of TPN therapy
corticosteroids
what should the BS maintained while on TPN

less than 200 mg/dL
what is the best way to find out if TPN is effective

prealbumin levels
-olol; -lol
beta adrenergic blocker, antihypertensive, and/or antianginal
* atenolol, metoprolol, propranolol, timolol
-floxacin
fluoroquinolone, antibiotics
* ciprofloxacin, levofloxacin
-cycline

lOMoARcPSD|3083804
tetracycline, antibiotic
* doxycycline, tetracycline
-statin
HMG CoA reductase inhibitor, lipid lowering agent
* atorvastatin, simvastatin
-prazole
GI proton pump inhibitor, antiulcer
* omeprazole, pantoprazole
-sartan
ARB angiotensin II receptor antagonist, antihypertensive
* losartan
-pril
angiotensin converting enzyme (ACE) inhibitor, antihypertensive
* captopril, lisinopril
-zosin
peripherally acting alpha-1 blocker, antihypertensive
* terazosin
-tidine
histamine H2 antagonist (GI), antiulcer
* cimetidine, famotidine, ramitidine
-vir
antiviral, antiinfective
* acyclovir

lOMoARcPSD|3083804
-sone; -lone; pred-

corticosteroid
* betamethasone, cortisone, dexamethasone, prednisone
-cillin
penicillin, antibiotic (check allergy)
* amoxicillin, piperacillin, oxacillin
cef-, ceph-
cephalosporin antibiotics (check allergy to this class and peni-
cillins)
* cefazolin, cefotetan, ceftriazone
-dipine
calcium channel blocker, antianginal, antihypertensive
* amlodipine, nicardipine, nifedipine
-dronate
bisphosphonate, bone resorption inhibitor (helps with bone loss)
* alendronate, risendronate
-micin; -mycin
aminoglycoside, antibiotic
* gentamycin, tobramycin
-azole
antifungal antimicrobial
* flucanazole, miconazole

lOMoARcPSD|3083804
-phylline
xanthine type of bronchodilator
* theophylline
sulfa-
sulfonamide, antibiotic (check allergy to sulfa)
*
-tidine
histamine H2 antagonist (GI), antiulcer
* cimetidine, famotidine, ranitidine
-terol
adrenergic type of bronchodilator
* albuterol, salmeterol
-triptan
vascular headache suppressant, serotonin (5HT-1) agonist
* sumatriptan
-zepam; zolam
benzodiazepene, anti-anxiety, sedative-hypnotic
* diazepam, lorazepam, alprazolam, midazolam
-ase; -plase
thrombolytic agent (-ase usually indicates enzyme)
* streptokinase, alteplase, reteplase
-omycin

lOMoARcPSD|3083804
macrolide, antibiotic
* arithromycin, azithromycin
nitr-; -nitr-
nitrate, vasodilator, antianginal
* nitroglycerin, isosorbide dinitrate or mononitrate
-parin
anticoagulant, heparin or heparinoid
* enoxaparin, heparin
sal-; -sal-
contains salicylate (check allergies to salicylates or aspirin)
* salsalate (nonopioid analgesic), sulfasalazine (GI anti-
inflammatory)
1 tsp to ml
5 ml
tbsp to ml
15 ml
1 oz to ml
30 ml
1 cup (8 oz) to ml
240 ml
1 soda (12 oz) to ml

lOMoARcPSD|3083804
360 ml
1 pint to ml
480 ml
1 quart to ml
960 ml
1 mg to ng
1000 ng
1g to mg
1000 mg
1 gr to mg
60 mg
1 kg to lb
2.2 lb
1 L to kg
1 kg
AIR EMBOLISM
TACHYCARDIA
DYSPNEA
HYPOTENSION
CYANOSIS
DECREASED LEVEL OF CONSCIOUSNESS

lOMoARcPSD|3083804
CATHETER EMBOLISM
DECREASED BLOOD PRESSURE
PAIN ALONG THE VEIN
WEAK, RAPID PULSE
CYANOSIS OF THE NAIL BEDS
LOSS OF CONSCIOUSNESS
CIRCULATORY OVERLOAD
INCREASED BLOOD PRESSURE
DISTENDED JUGULAR VEINS
RAPID BREATHING
DYSPNEA
MOIST COUGH & CRACKLES
ELECTROLYTE OVERLOAD
SIGNS DEPEND ON THE SPECIFIC ELECTROLYTE OVER-
LOAD IMBALANCE
HEMATOMA
ECCHYMOSIS, IMMEDIATE SWELLING & LEAKAGE OF
BLOOD AT THE SITE, HARD & PAINFUL LUMPS AT THE SITE.
INFECTION
LOCAL- REDNESS, SWELLING & DRAINAGE AT THE SITE
SYSTEMIC- CHILLS. FEVER, MALAISE, HEADACHE, NAUSEA,
VOMITING, BACKACHE, TACHYCARDIA
INFILTRATION

lOMoARcPSD|3083804
EDEMA, PAIN,& COOLNESS AT THE SITE, MAY OR MAY NOT

HAVE BLOOD RETURN.
PHLEBITIS
HEAT, REDNESS, TENDERNESS AT THE SITE, NOY HARD OR
SWOLLEN
IV INFUSION SLUGGISH
THROMBOPHLEBITIS
HARD & CORDLIKE VEIN
HEAT, REDNESS, & TENDERNESS AT THE SITE
IV INFUSION SLUGGISH
TISSUE DAMAGE
SKIN COLOR CHANGES, SLOUGHING OF THE SKIN
DISCOMFORT AT THE SITE
Anti-infectives
used for the treatment of infections:
Antihypertensives
lower blood pressure and increase blood flow th the myocardium
Antidiarrheals
decrease gastric mobility and reduce water content in the intesti-
nal tract
Diuretics

lOMoARcPSD|3083804
decrease water and sodium absorbed from the loop of Henle

(loop diuretics) or inhibit antidiuretic hormone (potassium-sparing
diuretics)
Antacids
reduce hydrochloric acid in the stomach
Antipyretics
reduce fever
Antihistamines
block the release of histamine in allergic reactions
Bronchodilators
dilate large air passages and are commonly presecribed for
clients with asthma and chronic obstructive lung disease
Laxatives
promote the passage of stool
Anticoagulants
prevent clot formation by decreasing vitamin K levels and blocking
the clotting chain or by preventing platelet aggregation
Antianemics
increase factors necessary for red blood cell production
Narcotics/analgesics
relieve moderate to severe pain.

lOMoARcPSD|3083804
Anticonvulsants
used for the management of seizure disorder and treatment of
bipolar disorder
Anticholinergics
cause the mucous membranes to become dry; therefore, oral se-
cretions are decreased
Anticholinergics are often administered

preoperatively
Mydriatics
dilate the pupils and are used in the treatment of clients with
cataracts
Miotics
constrict the pupil and are used in the treatment of clients with
glaucoma
Angiotensin-converting agents
primary and secondary HTN
Beta adrenergic blockers

<BP, pulse & CO
Benzodiazepine
anxiety & seizures

lOMoARcPSD|3083804
Phenothiazine
antipsych
Glucocorticoid
suppress immune system, anti-inflammatory, anti-allergy, anti-
stress
Antivirals
no virus
Cholesterol-lowering
lowers cholesterol and triglyceride levels
Angiotensin receptor blocker

primary and secondary HTN
Histamine 2 antagonist
inhibit gastric acid
Proton pump inhibitors

suppress gastric secretions
monoclonal antibodies
cancer treatment
cephalosporins
antibacterial

lOMoARcPSD|3083804
penicillins
antibacterial
tetracycline
antibacterial (wide range)
cholinergic
treat myasthenia gravis, glaucoma, Alzheimer's disease and de-
layed gastric emptying
Pro-Banthine
Anticholinergic Medication
Belladonna
Atropine sulfate
Atrovent
Spiriva
Iprotropium plus albuterol


lOMoARcPSD|3083804
Benztropine
Trihexyphenydil
Heparin
Anticoagulant Medication
Lovenox
Coumadin
Valium
Anticonvulsant Medication
Clonazepam
Cerebyx
Keppra

lOMoARcPSD|3083804
Dilantin
Luminal
Mysoline
Magnesium Sulfate
Depakote
Tegretol
Zarontin
Neurontin
Lamictal
Topamax

lOMoARcPSD|3083804
Nardil
MAO inhibitors
Prozac
SSRIs
Celexa
SSRIs
Lexapro
SSRIs
Luvox
SSRIs
Paxil
SSRIs
Zoloft
SSRIs
Elavil
Tricyclics
Tofranil
Tricyclics

lOMoARcPSD|3083804
Norpramin
Tricyclics
Sinequan
Tricyclics
Humalog
Rapid-Acting Insulin
NovoLog
Rapid-Acting Insulin
Humalog R
Short-Acting Insulin
Novolin R
Iletin II Regular
NPH
Intermediate-Acting Insulin
Lente
Intermediate-Acting Insulin

lOMoARcPSD|3083804
Ultralente
Long-Acting Insulin
Lantus
Very Long-Acting Insulin
Amaryl
Oral Hypoglycemic Agents, Sulfonylureas
Glucotrol
Micronase
Glucophage
Oral Hypoglycemic Agents, Biguanides
Precose
Oral Hypoglycemic Agents, Alpha Glucoside Inhibitors
Glyset
Oral Hypoglycemic Agents, Alpha Glucoside Inhibitors
Avandia
Oral Hypoglycemic Agents, Thiazolidinediones

lOMoARcPSD|3083804
Actus
Oral Hypoglycemic Agents, Thiazolidinediones
Prandin
Oral Hypoglycemic Agents, Meglitinides
Glucagon
Medication that Reverses Hypoglycemia
Kaopectate, Pepto-Bismol
Antidiarrheal Medication
Lomotil
Imodium
Paregoric
Tigan
Antiemetic Medications
Compazine
Zofran

lOMoARcPSD|3083804
Reglan
Phenergan
Diflucan
Antifungal Medication
Mycostatin
Diflucan
It is important for the nurse to be aware of the four sequential pro-

cesses of the pharmacokinetic phase. What are these processes?
a. Distribution, metabolism, excretion, absorption
b. Biotransformation, excretion, absorption, metabolism
c. Absorption, distribution, metabolism, excretion
d. Metabolism, distribution, absorption, excretion
c. Absorption, distribution, metabolism, excretion
It is expected that the nurse will question the health care provider
if a drug with a t ½ of >24 hours is ordered to be given more than
how often? (select all that apply)
a. Once daily
b. Twice daily

lOMoARcPSD|3083804
c. Twice weekly
d. Once weekly
a. Once daily
b. Twice daily
Which of these statements is correct?

a. A drug bound to a protein is an active drug
b. A drug non bound to a protein is an active drug
c. Most receptors are found under cell membrane
d. Toxic effects can result if the trough level is low
b. A drug non bound to a protein is an active drug
The nurse notices that one of the client's drugs has a low thera-
peutic index. What is the most important nursing implication of
this?
a. A wide margin of safety
b. A narrow margin of safety
c. Measured 1 hour after administration
d. Measured 10 minutes after administration
b. A narrow margin of safety
One of the client's drugs has a potential adverse effect of nephro-

toxicity. Which test is most accurate to determine renal function?
a. Creatinine clearance
b. Blood urea nitrogen
c. Glomerular filtration rate
d. Renal clearance
a. Creatinine clearance
The nurse reviews the client's medication regimen, including the

interval of drug dosage, which is related to which of the following?
a. Stimulation of receptors

lOMoARcPSD|3083804
b. Trough level
c. Therapeutic index
d. Half-life
d. Half-life
Nursing responsibilities in the assessment phase of the nursing

process include which responsibilities? (Select all that apply)
a. Identify side effects of drugs that are nonspecific
b. Check peak and trough levels of drugs
c. Advise client to avoid fatty foods prior to ingesting an enteric
coated tablet
d. Evaluate client's reaction to drug
a. Identify side effects of drugs that are nonspecific
b. Check peak and trough levels of drugs
During a medication review session, a client comments, "I just do

not know why I am taking all of these pills." This comment sug-
gests which nursing diagnosis?
a. Risk for injury
b. Deficient knowledge
c. Risk for aspiration
d. anxiety
b. Deficient knowledge
The nurse is developing goals in collaboration with the client.

Which is the best goal statement?
a. The client will self-administer albuterol by tomorrow
b. The client will self-administer the prescribed dose of albuterol
by the end of the second teaching session
c. The client will independently self-administer the prescribed
dose of albuterol by the end of the second teaching session
d. The client will organize her medications by tomorrow

lOMoARcPSD|3083804
c. The client will independently self-administer the prescribed

dose of albuterol by the end of the second teaching session
The nurse is aware of the many factors related to effective health

teaching about the medication. The most essential component of
the teaching plan is to do which?
a. Provide written instructions
b. Establish a trust relationship
c. Use colorful charts
d. Review community resources
b. Establish a trust relationship
A medication health teaching plan is tailored to a specific client.

Common topics for health teaching include which? (select all that
apply)
a. Importance of adherence to the prescribed regimen
b. How to administer medication(s)
c. What side/adverse effects to report to the health care provider
d. Instruction of the client on which foods should be eaten
a. Importance of adherence to the prescribed regimen
b. How to administer medication(s)
c. What side/adverse effects to report to the health care provider
The client's goals have been met during hospitalization. At the

time of discharge, which nursing diagnosis is most probable?
a. Knowledge deficient
b. Ineffective coping
c. Readiness for enhanced social interaction
d. Readiness for enhanced self-care activities
d. Readiness for enhanced self-care activities

lOMoARcPSD|3083804
The client asks about disposal of medications. What are the

nurse's best responses? (select all that apply)
a. "You should mix medications with coffee grounds before dis-
posal"
b. "you should pour medications down the sink"
c. "you should remove identifying information on the original con-
tainer"
d. "you should pulverize all tablets before disposal"
a. "You should mix medications with coffee grounds before dis-
posal"
c. "you should remove identifying information on the original con-
tainer"
The client is taking duastride (Avodart). Which client comment in-

dicates the need for more information about the drug?
a. "I'm glad I can take the medication with or without food"
b. "it is good that no lab tests and monitoring are required"
c. "this drug is expensive"
d. "I prefer to chew the drug before swallowing it"
d. "I prefer to chew the drug before swallowing it"
The nurse educator on the unit receives a list of high-alert drugs.

Which strategies are recommended to decrease the risk of errors
with these medications? (select all that apply)
a. Store medications alphabetically on their usual shelf
b. Limit access to these drugs
c. Use special labels
d. Provide increased information to the staff
b. Limit access to these drugs
c. Use special labels
d. Provide increased information to the staff

lOMoARcPSD|3083804
The nurse is aware that according to The Joint Commission,

which abbreviations are not on the do-not-use list for ordering or
documenting medications? (select all that apply)
a. QD
b. h.s
c. T.I.W
d. b.i.d
b. h.s
c. T.I.W
d. b.i.d
The client refuses to take his prescribed medications. Which is

the nurse's best response to this client?
a. Explain the benefits and side effects of the drug
b. Leave the medication at the patient's bedside to be taken later
c. Persuade the client to take the medication
d. Explain the risks of not taking the medication
d. Explain the risks of not taking the medication
An 8-month old boy is discharged from the hospital with a plan of

care to receive intramuscular (IM) injections each day. The par-
ents have been taught how to administer IM injections. Which
statement, if verbalized by the parents, indicates a need for more
teaching?
a. "I need to administer this medication in the upper, outer quad-
rant of this buttocks"
b. "IM injections are safe for children if administered correctly"
c. "When I give my child this injection, the safest place for inser-
tion is in the thigh"
d. "I will need someone to assist me to hold my child while I give
the injection"
a. "I need to administer this medication in the upper, outer quad-
rant of this buttocks"

lOMoARcPSD|3083804
A 4-year old client is to be discharged home on an oral liquid sus-

pension of 4mL per dose. Which would the nurse recommend to
ensure the highest level of accuracy in home administration of the
medication?
a. Using a household teaspoon
b. Using a cooking measuring spoon
c. Using an oral syringe
d. Using a graduated medicine cup
c. Using an oral syringe
A child is ordered to receive naloxone (Narcan) IV, STAT. The

child's weight is 20kg, and the recommended child's drug dosage
is 0.01 mg/kg. Naloxone is available in 400 mcg/mL solution. The
nurse should administer:
0.5 mL
A pediatric client is ordered to receive 3 mg/kg of a medication.

The client weighs 88 pounds. The medication is available in a 15
mg/mL elixir. How much medication should the client receive?
a. 2 mL
b. 4 mL
c. 8 mL
d. 16 mL
c. 8 mL
The nurse understands the differences between drug excretion in

children and that in adults. With this knowledge, the nurse makes
the which decision in administering medication to children?
a. Because most children need a higher dose of medications, the
nurse will contact the physician for an increase in the ordered
dose

lOMoARcPSD|3083804
b. Because children excrete drugs rapidly, the nurse will need to

assess carefully for therapeutic effects of the medication
c. The most important assessment is to evaluate for drug accu-
mulation, because excretion of drugs in children is slower
d. The excretion of most drugs is the same in children as in
adults, but assessments are important to avoid side effects
c. The most important assessment is to evaluate for drug accu-
mulation, because excretion of drugs in children is slower
A parent is learning to administer medication to a school-aged

child. Which strategy should the nurse teach the parent to achieve
cooperation in a child of this age?
a. Enlisting physical restraint
b. Tolerating violent reactions
c. Providing age-appropriate explanations
d. Establishing medication contracts
c. Providing age-appropriate explanations
The nurse is caring for a neonate with lower-than-normal albumin

levels. The nurse is ordered to administer a medication that is
highly bound protein. The nurse knows that the dose needs to be
altered in which way to respond to these factors?
a. The dose will be increased
b. The dose will be decreased
c. Highly protein-bound drugs will be contraindicated
d. The nurse must further clarify the medication order before ad-
ministration
b. The dose will be decrease
An older adult client comments, "It seems that all I do is take

medicines" What does this comment reflect?
a. That older adults consume 30% of all prescription medications
b. That older adults may have multiple chronic conditions

lOMoARcPSD|3083804
c. That older adults may take too many OTC preparations

d. That older adults may take too many herbal preparations
a. That older adults consume 30% of all prescription medications
The client has nine medications prescribed to take daily. Which

are common reasons for nonadherence to the drug regimen in the
older adult? (select all that apply)
a. Taking multiple drugs at one time
b. Impaired memory
c. Decreased dexterity
d. Increased mobility
a. Taking multiple drugs at one time
b. Impaired memory
c. Decreased dexterity
The nurse reviews the client's list of medications with the client.
The nurse knows that the 88-year old client's slower absorption or
oral medications is primarily because of which phenomenon?
a. Decreased cardiac output
b. Decreased blood flow
c. Decreased enzyme function
d. Increased pH of gastric secretions
d. Increased pH of gastric secretions
The older adult client has questions about oral drug metabolism.
Which information should be included in this client's teaching
plan?
a. First-pass effect
b. Enzyme function
c. Glomerular filtration rate
d. motility
a. First-pass effect

lOMoARcPSD|3083804
A 97-year old client asks why a protein supplement has been pre-
scribed. What Is the nurse's best response to the client?
a. "you have increased circulation of free drug"
b. "you have decreased hepatic size"
c. "you have decreased calcium absorption"
d. "you have increased motility"
a. "you have increased circulation of free drug"
An 80-year old client complains of recent onset of insomnia say-

ing, "if only I could get to sleep!" If a drug is prescribed, which
drug characteristics would be best for this situation? (select all
that apply)
a. Short-intermediate acting
b. Rapidly eliminated
c. Slowly eliminated
d. Multiple metabolites
a. Short-intermediate acting
b. Rapidly eliminated
The nurse is performing a health assessment on a newly admitted

client who is of Asian descent. The client looks at the floor when-
ever the nurse asks a question. Communication is enhanced
when the nurse does which action?
a. Frequently touches the client
b. Asks questions that only require "yes" or "no" for answers
c. Discontinues the health assessment
d. Uses eye contact sparingly
d. Uses eye contact sparingly
The nurse has been measuring the blood pressure of an African-

American client every 4 hours for the past 3 days in a hospital set-
ting. The blood pressure is consistently above 140/90. The client

lOMoARcPSD|3083804
has been compliant with the antihypertensive drug therapy while

hospitalized. The nurse will initially perform which action?
a. Question the client about types of food consumes in the past 3
to 4 days
b. Inform the prescriber that the antihypertensive drug therapy is
not working
c. Increase blood pressure measurements to every 2 hours
d. Place the client on a restricted fluid intake
b. Inform the prescriber that the antihypertensive drug therapy is
not working
A male nurse has been assigned to care for a young married

woman who practices Islam. It is important that the nurse perform
which action?
a. Not touch any part of the client's body
b. Delegate nursing care that involves touching to a female mem-
ber of the nursing team whenever appropriate
c. Touch the client only when her spouse is present
d. Communicate to the nurse manager that he cannot take care of
female clients who practice Islam
b. Delegate nursing care that involves touching to a female mem-
ber of the nursing team whenever appropriate
A nurse is teaching a 16-year old female client about a newly pre-

scribed medication. The client is bilingual in Spanish and English.
Which behavior best indicated the client's understanding of the in-
structions?
a. The client frequently nods her head while listening to the
nurse's instructions
b. The client stated that she understands the instructions
c. The client repeats the nurse's instruction to her mother who is
present during the teaching

lOMoARcPSD|3083804
d. The client does not ask the nurse for any clarification of the in-
structions
c. The client repeats the nurse's instruction to her mother who is
present during the teaching
An Asian client is being treated in the emergency department for a

fractured right ankle. The physician that after administration of the
codeine, the client which experience which response?
a. Quick relief of the pain
b. Little relief of the pain
c. Idiosyncratic responses
d. Signs of anaphylaxis
b. Little relief of the pain
A Native American client is newly diagnosed with diabetes melli-

tus type 2 and is prescribed the antidiabetic drug metformin (Glu-
cophage) 500 mg PO with morning and evening meals. Which
statement best indicated to the nurse that the client will adhere to
the pharmacotherapy?
a. "I will no longer put sugar on my cereal"
b. "I will feel better soon if I take this medicine"
c. I need to take the medicine as scheduled to reduce the possi-
bility of damage to my body"
d. "I have diabetes because of my ancestry"
c. I need to take the medicine as scheduled to reduce the possi-
bility of damage to my body"
The nurse is reviewing the client's laboratory results and current

medications. The nurse notes that the client's prothrombin time is
prolonged. What vitamin might be contributing to this?
a. Vitamin A
b. Vitamin B
c. Vitamin D

lOMoARcPSD|3083804
d. Vitamin E
d. Vitamin E
The client comes to the office with chief complaint of hair loss and
peeling skin. The nurse notes that many vitamins are on the list of
medications that the client reports using to treat liver disease. The
client's complaint may be caused by excess of what vitamin?
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D
a. Vitamin A
The nurse routinely includes health teaching about vitamins to

clients/ vitamin D has a major role in which process?
a. Ensuring night and color vision
b. Regulating calcium and phosphorous metabolism
c. Body growth
d. DNA and prothrombin synthesis
b. Regulating calcium and phosphorous metabolism
The nurse is doing preconception counseling with the client. Folic

acid is included in the health teaching pan because it is known to
prevent CNS anomalies and may offer protection from which dis-
order?
a. Colorectal cancer
b. Diabetes mellitus
c. Celiac disease
d. Migraine headaches
a. Colorectal cancer

lOMoARcPSD|3083804
A prenatal client tells the nurse that she is not taking vitamins be-
cause she heard that "vitamins may cause damage to my baby."
What is the best response by the nurse?
a. "vitamins can only help you and your baby"
b. "take extra vitamins now to make up for missed doses"
c. "megadoses of vitamins can be harmful in the first trimester"
d. "taking above the RDA of any vitamin is not recommended"
c. "megadoses of vitamins can be harmful in the first trimester"
The client asks the nurse about fat-soluble vitamins. What is the
nurse's best response?
a. Fat-soluble vitamins are metabolized rapidly
b. Fat-soluble vitamins cannot be stored in the liver
c. Fat-soluble vitamins are excreted slowly in urine
d. Fat-soluble vitamins cannot be toxic
c. Fat-soluble vitamins are excreted slowly in urine
The client complains of night blindness. The nurse correctly rec-

ommends which food?
a. Skim milk and peas
b. Whole milk and eggs
c. Nuts and yeast
d. Enriched bread and cereal
b. Whole milk and eggs
The alcoholic client has questions about his medications. The

nurse correctly explains that alcoholism can be associated with
deficiency of which vitamins?
a. A
b. B12
c. D
d. K
b. B12

lOMoARcPSD|3083804
The client complains of anorexia, nausea, and vomiting. The

client's list of medications include multiple large doses of vitamins.
The nurse notes that the client's complaints may be related to
early sign of toxicity of what vitamin?
a. A
b. B
c. C
d. D
d. D
The client has been vomiting and has weak, flabby muscles. The
client's pulse is irregular. The nurse would correctly suspect what
type of imbalance?
a. Hypokalemia
b. Hyperkalemia
c. Hypocalcemia
d. hypercalcemia
a. Hypokalemia
The client is receiving potassium supplements. What is the most

important nursing implication when administering this drug?
a. It cannot be given as an IV bolus
b. It must not be diluted
c. It b=must be chilled before administration
d. It must be given only at bedtime
b. It must not be diluted
The client is due to receive Kayexalate for complaints of nausea,

vomiting, abdominal cramps, short QT interval, weakness, and
oliguria. The nurse is aware that this drug is used to treat which
imbalance?

lOMoARcPSD|3083804
a. Hypocalcemia
b. Severe hypercalcemia
c. Hypokalemia
d. Severe hyperkalemia
d. Severe hyperkalemia
The nurse reviews the client's list of medications and results of

laboratory tests. Which drug type may cause an elevated serum
sodium level?
a. Antifungals
b. Oral contraceptives
c. Cortisone preparations
d. antiepileptics
c. Cortisone preparations
The client's magnesium level is 2.7 mEq/L. Specific health teach-

ing by the nurse for this client should include which suggestion?
a. Eat fruits, fish, and peanut butter
b. Avoid selected laxatives and antacids
c. Avoid magnesium, which is irritating to the stomach
d. Measure weight daily
b. Avoid selected laxatives and antacids
The client is receiving fluid replacement. The nurse's health

teaching with this client includes which suggestions? (select all
that apply)
a. Measure weight daily
b. Know that thirst means a mild fluid deficit
c. Monitor fluid intake
d. Avoid the use of calcium supplements
a. Measure weight daily
b. Know that thirst means a mild fluid deficit
c. Monitor fluid intake

lOMoARcPSD|3083804
The client gained 10 pounds in 2 days. It is determined that the

weight gain is caused by fluid retention. The nurse correctly esti-
mates that the weight gain may be equivalent to how many liters
of fluid?
a. 2
b. 3
c. 4
d. 5
c. 4
The health teaching for a client with hypophosphatemia includes

eating which foods?
a. Meat, milk, whole grain cereals, nuts
b. Dairy products, vitamin D supplements
c. Dairy products, protein-rich foods
d. Dairy products, nuts, vitamin c supplements
a. Meat, milk, whole grain cereals, nuts
The nurse reviews the client's medications as part of the initial in-
terview for admission to the cardiac clinic. Which comment by the
client indicates a need for health teaching? (select all that apply)
a. "tetracycline does not affect my medications"
b. "I can take as much calcium as I want"
c. "calcium increases the effects of my digoxin"
d. Magnesium and potassium deficits can cause digoxin toxicity
a. "tetracycline does not affect my medications"
b. "I can take as much calcium as I want"
The nurse determines the client's gastric residual before adminis-

tering an enteral feeding; the last feeding was 240mL. the client
will be discharged on enteral feedings. It is important to include in

lOMoARcPSD|3083804
the health teaching plan that a residual of more than which

amount would indicate a delayed gastric emptying (based on last
feeding)?
a. 100 mL
b. 125 mL
c. 150 mL
d. 175 mL
b. 125 mL
It is essential for the client who self-administers the enteral feed-

ings to know that the feeding should be administered at which
temperature?
a. Slightly warmed
b. Chilled
c. Ice cold
d. Room temperature
d. Room temperature
The nurse reviews the client's plan of care, which includes strate-
gies to prevent which common complication of enteral feedings?
a. Aspiration
b. Constipation
c. Diarrhea
d. Muscle weakness
c. Diarrhea
The client is receiving TPN. Health teaching for this client includes
the Valsalva maneuver, which is done to prevent which condition?
a. Infection
b. Air embolism
c. Dehydration
d. Fat embolism
b. Air embolism

lOMoARcPSD|3083804
The client has been on TPN for 1 month, and there is an order to
discontinue TPN tomorrow. The nurse contacts the health care
provider because sudden interruption of TPN therapy may cause
which condition?
a. Dehydration
b. Tremors
c. Hyperglycemia
d. hypoglycemia
d. hypoglycemia
The nurse prepares to present the Be A.L.E.R.T campaign to col-

leagues. Which instructions are important to include? (select all
that apply)
a. Elevate head of bed to 90 degrees
b. Wear gloves when handling feeding tube
c. Label enteral equipment
d. Verify that enteral tubing connects formula to feeding tube
b. Wear gloves when handling feeding tube
c. Label enteral equipment
d. Verify that enteral tubing connects formula to feeding tube
The client receives TPN at home. The visiting nurse assists the
family with the care plan, which includes changing the TPN solu-
tion and tubing how often?
a. Every 24 hours
b. Every 36 hours
c. Every 48 hours
d. Every 72 hours
a. Every 24 hours

lOMoARcPSD|3083804
The visiting nurse has a caseload of adult and pediatric clients re-
ceiving TPN at home. The nurse carefully checks all orders for
TPN solutions. Which orders (all have appropriate amounts of es-
sential fatty acids, vitamins, and minerals) requires the nurse to
contact the health care provider?
a. Adults: water 32 mL/kg/d; energy 32 kcal/kg/d; amino acids
1.2g/kg/d
b. Adults: water 34 mL/kg/d; amino acids 2g/kg/d
c. Children: water 32 mL/kg/d; energy 120 kcal/kg/d; amino acids
2.5g/kg/d
d. Children: water 38 mL/kg/d; energy 58 kcal/kg/d; amino acids
2g/kg/d
b. Adults: water 34 mL/kg/d; amino acids 2g/kg/d
acetaminophen (Tylenol)
0.2-0.6 (>5 is toxic)
carbamezepine (Tegretol)
4-12
digoxin (Lanoxin)
0.5-2.0
lidocaine (Xylocaine)
1.5-6.0
lithium (Eskalith)
0.5-1.5
phenytoin (Dilantin)

lOMoARcPSD|3083804
10-20
procainamide (Pronestyl)
4-8
quinidine (Quinalgute)
2-6
salicylate (Aspirin)
100-200 (>200 is toxic)
theophylline (Theo-Dur)
10-20
valproic acid (Depakene)

50-100
vancomycin (Vancocin)
30-40 (peak), 5-10 (trough)
thorazine
an antipsychotic agen used in treating manic-depression and hal-
lucination
mellaril
an antipsychotic agent used in treating psychotic and severe de-
pression

lOMoARcPSD|3083804
parnate
an MAOI usually usedin treating severe depression in patients
who have failed to respond to other treatments
zoloft
considered the first line of treatment in panic-anxiety disorders
and mild to moderate depresssion
a patient with hyperthyroidism is given phenobarbital to achieve

what?
sedation
carafate
the action of this drrug is to line and protect the stomach, it is bet-
ter able to do so if the medication can come in contact with the
stomach
depo-provera
this medication suppresses endometrial bleeding
brevicon
this medication is a contraceptive agent
ANALGESICS
Drugs used to relieve or eliminate pain:
Aspirin
NSAID's e.g. Ibuprofen—
Morphine
Aspirin

lOMoARcPSD|3083804
Do not give together with other anticoagulants. Stop taking Aspirin

some days before surgery. Do not give to children with viral infec-
tion(Reye
syndrome)
NSAID's e.g. Ibuprofen

Take with food; contraindicated for people with GI
ulcers
Morphine
A respiratory depressant. It should be withheld if the respirations
are below 10
ANTI-CONVULSANTS:
Dilantin: Causes gum hyperplasia. Advice client to visit dentist fre-
quently
ANTIINFLAMMATORY
Predisone: Causes Cushing like symptoms. Common side effects
are
immunosupression(monitor client for infection), hyperglycemia
ANTI-COAGULANTS
Heparin:
Coumadin:
Coumadin:
Monitor pt's lab work—PT. Antidote is Vitamin K
Heparin:

lOMoARcPSD|3083804
Monitor pt's lab work-PTT. Antidote is protamine sulfate
ANTI-PARKINSONIAN
Cogentin:
Sinemet:
Cogentin:
Used to treat EPS
Sinemet:
Drug is effective when tremors are not observed
RESPIRATORY
Theophylline/Aminophylline: Side effects--Tachycardia
CARDIOVASCULAR
Digoxin (Lanoxin): Signs of toxicity: Pt will complain of visual
change in colors.
They would also complain of loss of appetite.
ANTIHYPERTENSIVE (PRE-ECLAMPSIA)
Magnesium Sulfate: Monitor for deep tendon reflex and respira-
tory depression
DIURETICS
Hydrochlothiazide
Lasix
Aldactone

lOMoARcPSD|3083804
Hydrochlothiazide
Monitor potassium levels
Lasix
Monitor potassium levels
Aldactone
Potassium sparing
PSYCHOTROPICS
Lithium Carbonate:.
MAOI inhibitors:
Disulfiram (Antabuse)
Lithium Carbonate:.
Know therapeutic range (0.8 to 1.2mEq). Also know
symptoms of toxicity. Adequate fluid and salt intake is important
MAOI inhibitors:
Have dangerous food-drug interactions. Food with Tyramine
should be avoided. For example: aged cheese, wine etc.
Disulfiram (Antabuse)
Used for alcohol aversion therapy. Clients started on
Disulfiram must avoid any form of alcohol or they would develop a
severe reaction.
Teach pt to avoid some over-the-counter cough preparations,
mouthwash etc.
MATERNITY DRUGS

lOMoARcPSD|3083804
Oxytocin: Assess uterus frequently for tetanic contraction.
ANTIDOTES
Narcan
Calcium Gluconate
Vitamin K
Narcan:
Reverses the effects of narcotics
Calcium Gluconate:
Antidote for magnesium sulfate
Vitamin K
Antidote for Coumadin
Tegretol:
mood stabilizer - bipolar / anticonvulsant - carbamezepine
Atropine: What checks do you do before giving this drug ?

BP
Atropine
an antispasmodic that may be administered preoperattively to re-
lax smooth muscles
Epogen:
Used in treating anemia because it increases RBC production.

lOMoARcPSD|3083804
Acyclovir:
anti-viral medication used in treating shingles.
arterial blood gases lab test measures what?

oxygen and pH levels
hemoglobin laboratory test measures?

rbc's and other things
glucose laboratory test measures?

glucose
electrolyte laboratory test measures?

measures potassium
gantrinsin
used in urinary tract infections
the most common angle for an intramuscular injection

90 degrees
patient on lasix may need

potassium supplements, to weigh self each wk. and change posi-
tions slowly to prevent dizziness, orthrostatic hypotension is a
side effect of diuretic
terbutaline
beta1 direct agonist. Reduces premature uterine contractions

lOMoARcPSD|3083804
antihistamines adverse reactions

sedation, dry mouth, blurred vision, urinary retention
adrenergic stimulants adverse reactions

anxiety apprehension headache cerebral hemorrhage
adverse reactions to skeletal muscle relaxants

drowsiness, incoordination, GI upset
adverse reactions of uterine relaxants

heart palpitations, nausea, vomiting, headache
sign of digoxin toxicity

green yellow vision
digoxin is given to treat

elevated heart rate in chf client
lovenox is contraindicated in clients

on a kosher diet due to the pork content
lasix
helps decrease edema in the body
why do we give a client who is being treated for CHFa loading

dose of digoxin

lOMoARcPSD|3083804
gives the patient an adequate blood level to achieve therapeutic

relief as quick as possible
imodium
is used to treat diarrhea
apresoline
is an antihypertensive medication
vistaril
tused as an antiemetic or in higher doses as a tranquilizer
narcoan is given to overcome a narcotic overdose by

reverse CNS and respiratory depression
the desired effect of morphine is

pain relief
lithium
a medication used to treat bi-polar disorders
valium
a tranquilizer used to relieve anxiety and relax muscles
epinepherine
hormone that speeds up heart
inderal

lOMoARcPSD|3083804
the first beta blocker (trade name Inderal) used in treating hyper-
tension and angina pectoris and essential tremor
angina pectoris
chest pain, which may radiate to the left arm and jaw, that occurs
when there is an insufficient supply of blood to the heart muscle
histamine
amine formed from histidine that stimulates gastric secretions and
dilates blood vessels, a regulating body substance released in ex-
cess during allergic reactions causing swelling and inflammation
of tissues
aminophylline
used in bronchoconstriction broncial asthma and chronic obstruc-
tive pulmonary disease, and congestive heart failure, relaxes
smooth muscle of the respiratory tract
beta-antagonist
decreases contraction of smooth muscle
decongestant
decrease the amount of mucus secreation from the bronchi ,re-
duces congestion and swelling of membranes, such as those of
the nose and eustachian tube in an infection
adequate folic acid will helop to prevent

birth defects

lOMoARcPSD|3083804
whats the medication of choice for an alcoholic going through

withdrawls
valium vit b1 and b12 and folic acid
tigan
A medication used to treat nausea and vomiting
admininster eye drops by dropping

lower conjuctiva
benadryl
is an anti-hystemine that decreases itching
lipitor is best given

at night this is when the body makes the most cholesterol
an important nursing interverntion while taking lasix

weights and vital signs. baseline is needed to determine the effec-
tiveness of therapy
decadron
A drug in the steriod family that is used to decrease swelling in the
brain.
heparin
prevents blood clotting
vancomycin

lOMoARcPSD|3083804
Anti-infective given for potentially life threatening

infections(MRSA)
acyclovir
an oral antiviral drug (trade name Zovirax) used to treat genital
herpes
clomid
a fertility drug that is used to stimulate ovulation and that has
been associated with multiple births
an adverse reaction to atropine sulfate

tachycardia
oxytocin
stimulates uterine contraction
barbituates
drugs that depress the activity of the central nervous system, re-
ducing anxiety but imparing memory and judgement induces
sleepiness
side effects would be expected with elderly patients taking barbi-

turates
excitement confusion depression
absorption
the time it take the drug to be taken into the body to the time it en-
ters the blood stream

lOMoARcPSD|3083804
distribution
the transport of drugs into the body
sublingual nitroglycerine
dilate blood vessels and increase circulation
streptase
lysis of thrombi in acute myocardial infarction
coumadin
an anticoagulant use to prevent and treat a thrombus or embolus
the drug of choice treating pancreatitis

demeral
cbc
a test ordered for suspected bleeding disorders
BUN
a test ordered for suspected renal disease
Blood glucose
a test ordered for suspected diabetes
cromolyn
drug used to prevent asthma attacks or decrease in allergic re-
sponse

lOMoARcPSD|3083804
the appropriate size needle for intradermal injection

27 gauge 1/2 inch needle
the appropriate size needle for subcutaneanous injections

25 gauge, 5/8 inch needle
cipro
medication given for UTI, bone, joint, skin infectons
theophylline
a bronchodilator used to treat asthma and bronchitis and emphy-
sema
the antidote for heparin

protamine sulfate
the antidote for coumadin

vit k
ace inhibitors
ACTION: prevent the conversion of angiotensin I to angiotensin II
in the lungs USES: CHF, HTN , usually end in PRIL
side effects of ace inhibitors

A dry, hacking cough is COMMON. Hyperkalemia, renal tubular
damage, decreased B/P, dizziness, nausea & diarrhea
NURSING IMPLICATIONSof ace inhibitors

lOMoARcPSD|3083804
: Administer 1 hr before meals to increase absorption
the antidote for anticoagulants

VITAMIN K
tolerance
the diminishing effect with regular use of the same dose of a drug,
requiring the user to take larger and larger doses before experi-
encing the drug's effect
cumulative
the drug is not completly metabolized and is excreted before the
next dose is given
synergistic
drugs that work together so the total effect is greater than if given
seperatly
antitussive
any medicine used to suppress or relieve coughing
expectorant
drug that breaks up mucus and promotes coughing
urecholine
this drug produces smooth muscle contraction(bladder tone) and
is used for abdominal and urinary retention
synthroid

lOMoARcPSD|3083804
A medication used to treat hypothyroidism
prilosec
antacid that suppresses acid secretion in the stomach best given
on empty stomach
Kcl
Potassium chloride, it is often given to cardiac patients whose
potassium is depleted by diuretic medications, such as Lasix.
tetracycline
comonly prescribed for acne vuglgaris
• Dental staining in children
silvadene
an antibiotic used topically in burn treatment
zocor
an oral lipid-lowering medicine administered to reduce blood
cholesterol levels
fosamax
a medication used to treat osteoporosis, limit dairy products while
taking this med
avandia
type 2 diabetes mellitus , oral diabetic drug doesn't produce more
insulin, only gets glucose level to norm

lOMoARcPSD|3083804
specificgravity
measures a patients hydration status
the type of insulin used in an emergency situation is

regular
protease inhibitor is best taken

on an empty stomach 1hr b4 or 2hrs. after a meal
neupogen
stimulates the production of neutraphils
leukine
useful in treating patients with bone marrow transplant
gantrisin
is the most common anti-biotic to treat UTI's
what size needle would you use to administer vit. b12 to an aver-
age size person
22 gauge 1inch needle
cogentin
medication used to treat parkinson's disease
glucophage
an antidiabetic drug prescribed to treat type II diabetes the
action: decreases cellular resistance to insulin

lOMoARcPSD|3083804
characteristics of mild CNS depression

slow in initiating conversation
when should coumadin be administered

afternoon
troche
throat lozenger
adverse reactions to hyperthyroid medications

bronchospasms, iodism, weight gain and sleeping patterns in-
crease
adverse reactions to hypothroid

headache and insominia
Aldactone is often prescribed for children with CHF because

Potassium sparing diuretic
corticosteriods is taken
with or after meals
decadron is best given

with a glass of milk to decrease gastric distress
what medication would be given fo an overdose of a cholinergic

drug
atropine anticholenergic

lOMoARcPSD|3083804
patients who are receiving vancomycin by IV infusion should be

assessed before administration and during for
hearing damage; this drug is both ototoxic and nephrotoxic
boniva
maintain adequate intake of calcium and vit. d
Cortisone acetate
Glucocorticoid
Hydrocortisone (Solu-Cortef)
Glucocorticoid
Dexamethasone (Decadron)
Glucocorticoid
(Solu-Medrol)
Glucocorticoid
Prednisone (Deltasone)
Glucocorticoid
Budesonide (Pulmicort)
Glucocorticoid
Montelukast sodium (Singulair)

Leukotriene-Receptor Blocker

lOMoARcPSD|3083804
Florinef
Mineralocorticoids
Cyclosporine
Immunosuppressant
Cascara
Laxatives and Stool Softeners
Bisacodyl (Dulcolax)
Phenolphthalein
(Feen-A-Mint)
Mineral oil
Docusate (Colace)
Milk of Magnesia
Metamucil

lOMoARcPSD|3083804
Polyethylene glycol and electrolytes (Colyte)

Edrophonium (Tensilon)
Musculoskeletal Medications
Neostigmine (Prostigmin)
Pyridostigmine bromide (Mestinon)

Alendronate sodium (Fosamax)

Glucosamine
Atropine sulfate
Mydriatic and Cycloplegic Medication
Cyclopentolate (Cydogyl)
Mydriatic and Cycloplegic Medication
Morphine sulfate
Narcotic (Opioid Anagesic)

lOMoARcPSD|3083804
Codeine
Dolophine
Darvon
Demerol
Dilaudid
Oxycodone (Percodan)
Hydrocodone/ Acetaminophen (Vicodin)

Nitroglycerin, Nitro-Bid, Nitrostat

Nitrate/Antianginal
Isosorbide, lsordil,Sorbitrate
Nitrate/Antianginal

lOMoARcPSD|3083804
Ibuprofen, Motrin
NSAID
Indomethacin, lndocin
NSAID
Naproxen, Naprosyn
NSAID
Celecoxib, Celebrex
NSAID
Ketorolac
NSAID
Calcitonin
Paget's Disease Medication
Etidronate disodium
Mithramycin
Retavase
Thrombolytics
Activase

lOMoARcPSD|3083804
Thrombolytics
Tissue plasminogen activator (tPA)

Thrombolytics
Eminase
Thrombolytics
Streptokinase
Thrombolytics
Tagamet
Medication for Ulcer
Zantac
Carafate
Pepcid
Axid
Prilosec

lOMoARcPSD|3083804
Prevacid
AcipHex
Nexium
Protonix
Cytotec
Ethinyl
Women's Health Medication
Ovral
Norplant
Estradiol

lOMoARcPSD|3083804
Premarin
Provera, Depo-Provera
Hytrin
Men's Health Medications
Flomax
Proscar
Avodart
Viagra
Levitra
Cialis

lOMoARcPSD|3083804

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Exam Autumn 2018, questions and answers

Pharmacology (Arizona State University)

StuDocu is not sponsored or endorsed by any college or university

For the client taking epinephrine, the nurse realizes there is a

3.A client is prescribed metoprolol (Lopressor) to treat hyperten-

4.Atenolol (Tenormin) is prescribed for a client. The nurse realizes

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5.The nurse realizes that beta1 receptor stimulation is differenti-

6. A client is given epinephrine (Adrenalin), an adrenergic agonist

7.The nurse is administering atenolol (Tenormin) to a client.

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2. The nurse teaches the client receiving atropine to expect which

3. When benztropine (Cogentin) is ordered for a client, the nurse

4. Dicyclomine (Bentyl) is an anticholinergic, which the nurse real-

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5. The nurse realizes that cholinergic agonists mimic which

6. The nurse is administering a cholinergic agonist and should

7. When the client has a cholinergic overdose, the nurse antici-

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2. Several children are admitted for diagnosis with possible atten-

3. A client is taking benzphetamine. The nurse teaches the client

4. The nurse monitoring a client for methylphenidate withdrawal

5. The nurse teaches a client about which common side effect of

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6. The nurse who is teaching the client to self-administer medica-

7. A newborn client is in respiratory distress. The nurse antici-

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d. It is a long-acting drug that is frequently associated with depen-

3. A client is taking zolpidem (Ambien) for insomnia. The nurse

4. A client received spinal anesthesia. Which is most important for

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5. A nurse is teaching a client about zolpidem. Which is important

6. A client is taking triazolam (Halcion). Which instructions about

7. A client is to receive conscious sedation for a minor surgical

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2. Phenytoin (Dilantin) has been prescribed for a client with

3. When administering phenytoin (Dilantin), the nurse realizes

4. A client is taking clonazepam (Klonopin) for absence (petit mal)

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5. A client is admitted to the emergency department with status

6. The nurse should monitor the client receiving phenytoin (Di-

7. A client is taking valproic acid (Depakote). The nurse should

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2. A client is receiving carbidopa-levodopa for parkinsonism. What

3. A family member of a client with Alzheimer's disease asks the

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4. A client is taking rivastigmine (Exelon). The nurse should teach

5. Nursing interventions for the client taking carbidopa-levodopa

6. What should the client who is taking anticholinergic therapy for

7. A client is taking tacrine (Cognex) to improve cognitive function.

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b. That obstacles should be removed from pathways to avoid in-

2. For the client receiving pyridostigmine administration, the nurse

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