pharmacology nclex questions (1)

8/12/2019 Pharmacology NCLEX Questions (1)

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27.) Sildenafil (Viagra) is prescribed to treat

client with erectile dysfunction. A nurse revie

the client's medical record and would questio

the prescription if which of the following is n

in the client's history?

1. Neuralgia2. Insomnia

3. Use of nitroglycerin

4. Use of multivitamins


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3. Use of nitroglycerin

Rationale:

Sildenafil (Viagra) enhances the vasodilating effenitric oxide in the corpus cavernosum of the pen

thus sustaining an erection. Because of the effect

the medication, it is contraindicated with concur

use of organic nitrates and nitroglycerin. Sildena

not contraindicated with the use of vitamins.

Neuralgia and insomnia are side effects of the

medication.


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54.) A nurse reinforces discharge instructions to

postoperative client who is taking warfarin sodiu

(Coumadin). Which statement, if made by the clireflects the need for further teaching?

1. "I will take my pills every day at the same time

2. "I will be certain to avoid alcohol consumption

3. "I have already called my family to pick up a

Medic-Alert bracelet."

4. "I will take Ecotrin (enteric-coated aspirin) for

headaches because it is coated."


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4. "I will take Ecotrin (enteric-coated aspirin) for

headaches because it is coated."Rationale:

Ecotrin is an aspirin-containing product and sho

be avoided. Alcohol consumption should be avoid

by a client taking warfarin sodium. Taking prescmedication at the same time each day increases

client compliance. The Medic-Alert bracelet prov

health care personnel emergency information.


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55.) A client who is receiving digoxin (Lanoxin) daily ha

serum potassium level of 3.0 mEq/L and is complainin

anorexia. A health care provider prescribes a digoxin le

rule out digoxin toxicity. A nurse checks the results, kn

that which of the following is the therapeutic serum lev

(range) for digoxin?

1. 3 to 5 ng/mL2. 0.5 to 2 ng/mL

3. 1.2 to 2.8 ng/mL

4. 3.5 to 5.5 ng/mL


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2.) 0.5 to 2 ng/mLRationale:

Therapeutic levels for digoxin ran

from 0.5 to 2 ng/mL. Therefore,options 1, 3, and 4 are incorrect.


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56.) Heparin sodium is prescribed for the clie

The nurse expects that the health care providwill prescribe which of the following to monit

for a therapeutic effect of the medication?

1. Hematocrit level

2. Hemoglobin level

3. Prothrombin time (PT)

4. Activated partial thromboplastin time (aPT


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4. Activated partial thromboplastin time (aPT

Rationale:

The PT will assess for the therapeutic effect o

warfarin sodium (Coumadin) and the aPTT w

assess the therapeutic effect of heparin sodiu

Heparin sodium doses are determined basedthese laboratory results. The hemoglobin and

hematocrit values assess red blood cell

concentrations.


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57.) A nurse is monitoring a client who is taking propra

(Inderal LA). Which data collection finding would indi

potential serious complication associated with propran1. The development of complaints of insomnia

2. The development of audible expiratory wheezes

3. A baseline blood pressure of 150/80 mm Hg followed

blood pressure of 138/72 mm Hg after two doses of themedication

4. A baseline resting heart rate of 88 beats/min followe

a resting heart rate of 72 beats/min after two doses of t

medication


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2. The development of audible expiratory whee

Rationale:

Audible expiratory wheezes may indicate a ser

adverse reaction, bronchospasm. -Blockers m

induce this reaction, particularly in clients wit

chronic obstructive pulmonary disease or asthNormal decreases in blood pressure and heart

are expected. Insomnia is a frequent mild side

effect and should be monitored.


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70.) Oxybutynin chloride (Ditropan XL) is

prescribed for a client with neurogenic bladdWhich sign would indicate a possible toxic ef

related to this medication?

1. Pallor

2. Drowsiness

3. Bradycardia

4. Restlessness


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4. Restlessness

Rationale:

Toxicity (overdosage) of this medication producecentral nervous system excitation, such as

nervousness, restlessness, hallucinations, and

irritability. Other signs of toxicity include

hypotension or hypertension, confusion, tachycar

flushed or red face, and signs of respiratory

depression. Drowsiness is a frequent side effect o

medication but does not indicate overdosage.


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73.) A client with myasthenia gravis is

suspected of having cholinergic crisis.

Which of the following indicate that thi

crisis exists?

1. Ataxia

2. Mouth sores

3. Hypotension

4. Hypertension


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4. Hypertension

Rationale:

Cholinergic crisis occurs as a result of anoverdose of medication. Indications of

cholinergic crisis include gastrointestinal

disturbances, nausea, vomiting, diarrhea,abdominal cramps, increased salivation and

tearing, miosis, hypertension, sweating, and

increased bronchial secretions.


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74.) A client with myasthenia gravis is receiving

pyridostigmine (Mestinon). The nurse monitors for sign

and symptoms of cholinergic crisis caused by overdose

medication. The nurse checks the medication supply to

ensure that which medication is available for administr

if a cholinergic crisis occurs?

1. Vitamin K2. Atropine sulfate

3. Protamine sulfate

4. Acetylcysteine (Mucomyst)


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2. Atropine sulfate

Rationale:

The antidote for cholinergic crisis is

atropine sulfate. Vitamin K is the antid

for warfarin (Coumadin). Protamine

sulfate is the antidote for heparin, and

acetylcysteine (Mucomyst) is the antido

for acetaminophen (Tylenol).


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76.) Carbidopa-levodopa (Sinemet) is prescrib

for a client with Parkinson's disease, and the n

monitors the client for adverse reactions to th

medication. Which of the following indicates t

the client is experiencing an adverse reaction?

1. Pruritus2. Tachycardia

3. Hypertension

4. Impaired voluntary movements


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4. Impaired voluntary movements

Rationale:

Dyskinesia and impaired voluntary movemenmay occur with high levodopa dosages. Naus

anorexia, dizziness, orthostatic hypotension,

bradycardia, and akinesia (the temporary muweakness that lasts 1 minute to 1 hour, also

known as the "on-off phenomenon") are freq

side effects of the medication.


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77.) Phenytoin (Dilantin), 100 mg orally three times daily

been prescribed for a client for seizure control. The nurse

reinforces instructions regarding the medication to the cli

Which statement by the client indicates an understanding

instructions?

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

swallow them."3. "If I forget to take my medication, I can wait until the n

dose and eliminate that dose."

4. "If my throat becomes sore, it's a normal effect of the

medication and it's nothing to be concerned about."


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1. "I will use a soft toothbrush to brush my teeth."

Rationale:

Phenytoin (Dilantin) is an anticonvulsant. Gingival hyperpbleeding, swelling, and tenderness of the gums can occur w

the use of this medication. The client needs to be taught g

oral hygiene, gum massage, and the need for regular denti

visits. The client should not skip medication doses, becaus

could precipitate a seizure. Capsules should not be chewed

broken and they must be swallowed. The client needs to b

instructed to report a sore throat, fever, glandular swellin

any skin reaction, because this indicates hematological tox


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78.) A client is taking phenytoin (Dilantin) fo

seizure control and a sample for a serum drulevel is drawn. Which of the following indicat

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


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2. 10 to 20 mcg/mL

Rationale:

The therapeutic serum drug level range forphenytoin (Dilantin) is 10 to 20 mcg/mL.

*A helpful hint may be to remember th

the theophylline therapeutic range andacetaminophen (Tylenol) therapeutic

range are the same as the phenytoin

(Dilantin) therapeutic range.*


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79.) Ibuprofen (Advil) is prescribed

for a client. The nurse tells the clieto take the medication:

1. With 8 oz of milk

2. In the morning after arising3. 60 minutes before breakfast

4. At bedtime on an empty stomac


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1. With 8 oz of milk

Rationale:Ibuprofen is a nonsteroidal anti-

inflammatory drug (NSAID). NSA

should be given with milk or food prevent gastrointestinal irritation.

Options 2, 3, and 4 are incorrect.


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80.) A nurse is caring for a client who is taking phenytoin (Dil

for control of seizures. During data collection, the nurse notes

the client is taking birth control pills. Which of the followinginformation should the nurse provide to the client?

1. Pregnancy should be avoided while taking phenytoin (Dilan

2. The client may stop taking the phenytoin (Dilantin) if it is ca

severe gastrointestinal effects.

3. The potential for decreased effectiveness of the birth control

exists while taking phenytoin (Dilantin).

4. The increased risk of thrombophlebitis exists while taking

phenytoin (Dilantin) and birth control pills together.


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3. The potential for decreased

effectiveness of the birth control pills

exists while taking phenytoin (Dilantin

Rationale:

Phenytoin (Dilantin) enhances the rate

estrogen metabolism, which can decrea

the effectiveness of some birth control

pills. Options 1, 2, are 4 are not accurat


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81.) A client with trigeminal neuralgia is bein

treated with carbamazepine (Tegretol). Whic

laboratory result would indicate that the clienexperiencing an adverse reaction to the

medication?

1. Sodium level, 140 mEq/L2. Uric acid level, 5.0 mg/dL

3. White blood cell count, 3000 cells/mm3

4. Blood urea nitrogen (BUN) level, 15 mg/dL


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3. White blood cell count, 3000 cells/mm3

Rationale:

Adverse effects of carbamazepine (Tegretol)appear as blood dyscrasias, including aplasti

anemia, agranulocytosis, thrombocytopenia,

leukopenia, cardiovascular disturbances,thrombophlebitis, dysrhythmias, and

dermatological effects. Options 1, 2, and 4

identify normal laboratory values.


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82.) A client is receiving meperidine hydrochlo

(Demerol) for pain. Which of the following are

side effects of this medication. Select all that a1. Diarrhea

2. Tremors

3. Drowsiness4. Hypotension

5. Urinary frequency

6. Increased respiratory rate


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2. Tremors

3. Drowsiness4. Hypotension

Rationale:

Meperidine hydrochloride is an opioid analge

Side effects include respiratory depression,

drowsiness, hypotension, constipation, urina

retention, nausea, vomiting, and tremors.


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88.) Dantrolene sodium (Dantrium) is prescribed for a

experiencing flexor spasms, and the client asks the nur

about the action of the medication. The nurse respondsknowing that the therapeutic action of this medication

which of the following?

1. Depresses spinal reflexes

2. Acts directly on the skeletal muscle to relieve spastici

3. Acts within the spinal cord to suppress hyperactive

reflexes

4. Acts on the central nervous system (CNS) to suppress

spasms


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2. Acts directly on the skeletal muscle to relieve spastici

Rationale:

Dantrium acts directly on skeletal muscle to relieve muspasticity. The primary action is the suppression of calc

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 that they address CNS suppression and the

depression of reflexes. Therefore, eliminate th

options.*


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89.) A nurse is reviewing the laboratory stud

on a client receiving dantrolene sodium

(Dantrium). Which laboratory test would idean adverse effect associated with the

administration of this medication?

1. Creatinine2. Liver function tests

3. Blood urea nitrogen

4. Hematological function tests


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2. Liver function tests

Rationale:

Dose-related liver damage is the most serious adveffect 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 loweseffective dosage for the shortest time necessary.

*Eliminate options 1 and 3 because these t

both assess kidney function.*


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91.) Cyclobenzaprine (Flexeril) is prescribed for a

client to treat muscle spasms, and the nurse is

reviewing the client's record. Which of the followdisorders, if noted in the client's record, would

indicate a need to contact the health care provid

regarding the administration of this medication?

1. Glaucoma2. Emphysema

3. Hyperthyroidism

4. Diabetes mellitus


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1. Glaucoma

Rationale:Because this medication has anticholinergic

effects, it should be used with caution in clien

with a history of urinary retention, angle-clos

glaucoma, and increased intraocular pressurCyclobenzaprine hydrochloride should be use

only for short-term 2- to 3-week therapy.


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104.) Disulfiram (Antabuse) is prescribed for a cl

who is seen in the psychiatric health care clinic. T

nurse is collecting data on the client and is proviinstructions regarding the use of this medication

Which is most important for the nurse to determ

before administration of this medication?

1. A history of hyperthyroidism2. A history of diabetes insipidus

3. When the last full meal was consumed

4. When the last alcoholic drink was consumed


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4. When the last alcoholic drink was consumed

Rationale:

Disulfiram is used as an adjunct treatment for selected clients

chronic alcoholism who want to remain in a state of enforced

sobriety. Clients must abstain from alcohol intake for at least 1

hours before the initial dose of the medication is administered

most important data are to determine when the last alcoholic d

was consumed. The medication is used with caution in clients diabetes mellitus, hypothyroidism, epilepsy, cerebral damage,

nephritis, and hepatic disease. It is also contraindicated in sev

heart disease, psychosis, or hypersensitivity related to the

medication.


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105.) A nurse is collecting data from a client

the client's spouse reports that the client is ta

donepezil hydrochloride (Aricept). Whichdisorder would the nurse suspect that this cli

may have based on the use of this medication

1. Dementia2. Schizophrenia

3. Seizure disorder

4. Obsessive-compulsive disorder


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1. Dementia

Rationale:

Donepezil hydrochloride is a cholinergic agenused in the treatment of mild to moderate

dementia of the Alzheimer type. It enhances

cholinergic functions by increasing theconcentration of acetylcholine. It slows the

progression of Alzheimer's disease. Options 2

and 4 are incorrect.


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106.) Fluoxetine (Prozac) is prescribed for the client. Th

nurse reinforces instructions to the client regarding the

administration of the medication. Which statement by

client indicates an understanding about administration

the medication?

1. "I should take the medication with my evening meal.

2. "I should take the medication at noon with an antaci

3. "I should take the medication in the morning when I

arise."

4. "I should take the medication right before bedtime w

snack."


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3. "I should take the medication in the morni

when I first arise."

Rationale:Fluoxetine hydrochloride is administered in t

early morning without consideration to meal

*Eliminate options 1, 2, and 4 because tare comparable or alike and indicate

taking the medication with an antacid o

food.*


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107.) A client receiving a tricyclic antidepressant arrive

the mental health clinic. Which observation indicates tthe 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" anymo

3. Arrives at the clinic neat and appropriate in appeara4. Reports sleeping 12 hours per night and 3 to 4 hours

during the day


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3. Arrives at the clinic neat and appropriate in

appearance

Rationale:Depressed individuals will sleep for long periods,

not able to go to work, and feel as if they cannot

anything." Once they have had some therapeutic

effect from their medication, they will report

resolution of many of these complaints as well as

demonstrate an improvement in their appearanc


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108.) A nurse is performing a follow-up teaching

session with a client discharged 1 month ago who

taking fluoxetine (Prozac). What information wobe important for the nurse to gather regarding th

adverse effects related to the medication?

1. Cardiovascular symptoms

2. Gastrointestinal dysfunctions

3. Problems with mouth dryness

4. Problems with excessive sweating


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2. Gastrointestinal dysfunctions

Rationale:

The most common adverse effects related tofluoxetine include central nervous system (CN

and gastrointestinal (GI) system dysfunction

This medication affects the GI system by causnausea and vomiting, cramping, and diarrhe

Options 1, 3, and 4 are not adverse effects of

medication.


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109.) A client taking buspirone (BuSpar) for

month returns to the clinic for a follow-up vis

Which of the following would indicate medica

effectiveness?

1. No rapid heartbeats or anxiety

2. No paranoid thought processes3. No thought broadcasting or delusions

4. No reports of alcohol withdrawal symptom


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1. No rapid heartbeats or anxiety

Rationale:

Buspirone hydrochloride is not recommende

the treatment of drug or alcohol withdrawal,

paranoid thought disorders, or schizophrenia

(thought broadcasting or delusions). Buspirohydrochloride is most often indicated for the

treatment of anxiety and aggression.


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111.) A client arrives at the health care clinic and

the nurse that he has been doubling his daily dos

of bupropion hydrochloride (Wellbutrin) to help get better faster. The nurse understands that the

client is now at risk for which of the following?

1. Insomnia

2. Weight gain

3. Seizure activity

4. Orthostatic hypotension


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3. Seizure activity

Rationale:

Bupropion does not cause significant orthost

blood pressure changes. Seizure activity is

common in dosages greater than 450 mg dail

Bupropion frequently causes a drop in bodyweight. Insomnia is a side effect, but seizure

activity causes a greater client risk.


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112.) A hospitalized client is started on phenelzine sulfa

(Nardil) for the treatment of depression. The nurse inst

the client to avoid consuming which foods while takingmedication? Select all that apply.

1. Figs

2. Yogurt

3. Crackers4. Aged cheese

5 Tossed salad

6. Oatmeal cookies


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1. Figs

2. Yogurt

4. Aged cheeseRationale:

Phenelzine sulfate (Nardil) is a monoamine oxidase

inhibitor(MAOI). The client should avoid taking in food

that are high in tyramine. Use of these foods could triggpotentially fatal hypertensive crisis. Some foods to avoi

include yogurt, aged cheeses, smoked or processed mea

red wines, and fruits such as avocados, raisins, and figs

) li i h di b lli h h b


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119.) A client with diabetes mellitus who has been

controlled with daily insulin has been placed on

atenolol (Tenormin) for the control of anginapectoris. Because of the effects of atenolol, the nu

determines that which of the following is the mos

reliable indicator of hypoglycemia?

1. Sweating2. Tachycardia

3. Nervousness

4. Low blood glucose level

L bl d l l l


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4. Low blood glucose level

Rationale:

-Adrenergic blocking agents, such as atenolol,inhibit the appearance of signs and symptoms of

acute hypoglycemia, which would include

nervousness, increased heart rate, and sweating.

Therefore, the client receiving this medication shadhere to the therapeutic regimen and monitor b

glucose levels carefully. Option 4 is the most relia

indicator of hypoglycemia.

) A i i t d i i t di


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125.) A nurse is preparing to administer digo

(Lanoxin), 0.125 mg orally, to a client with h

failure. Which vital sign is most important fonurse to check before administering the

medication?

1. Heart rate

2. Temperature

3. Respirations

4. Blood pressure

1 H t t


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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. Because bradycardia may be a clinical sign

toxicity, the nurse counts the apical heart rate for 1 full

minute before administering the medication. If the pul

rate is less than 60 beats/minute in an adult client, thenurse would withhold the medication and report the pu

rate to the registered nurse, who would then contact th

health care provider.

126 ) A nurse is caring for a client who has been prescri


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126.) A nurse is caring for a client who has been prescri

furosemide (Lasix) and is monitoring for adverse effect

associated with this medication. Which of the followin

should the nurse recognize as a potential adverse effect

Select all that apply.

1. Nausea

2. Tinnitus

3. Hypotension4. Hypokalemia

5. Photosensitivity

6. Increased urinary frequency


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2. Tinnitus

3. Hypotension

4. HypokalemiaRationale:

Furosemide is a loop diuretic; therefore, an expected ef

is increased urinary frequency. Nausea is a frequent sid

effect, not an adverse effect. Photosensitivity is an occaside effect. Adverse effects include tinnitus (ototoxicity

hypotension, and hypokalemia and occur as a result of

sudden volume depletion.


59/128

128.) A nurse is providing instructions to an adolescent

has a history of seizures and is taking an anticonvulsan

medication. Which of the following statements indicate

that the client understands 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 medicati4. "If I forget my morning medication, I can take two p

bedtime."

3 "I can't drink alcohol while I am taking my


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3. I can t drink alcohol while I am taking my

medication."

Rationale:Alcohol will lower the seizure threshold and shou

avoided. Adolescents can obtain a driver's license

most states when they have been seizure free for

year. Anticonvulsants cause acne and oily skin;therefore a dermatologist may need to be consult

If an anticonvulsant medication is missed, the he

care provider should be notified.

150 ) A client complaining of not feeling well is seen in


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150.) A client complaining of not feeling well is seen in

clinic. The client is taking several medications for the

control of heart disease and hypertension. These

medications include a -blocker, digoxin (Lanoxin), an

diuretic. A tentative diagnosis of digoxin toxicity is mad

Which of the following assessment data would support

diagnosis?

1. Dyspnea, edema, and palpitations2. Chest pain, hypotension, and paresthesia

3. Double vision, loss of appetite, and nausea

4. Constipation, dry mouth, and sleep disorder

3 Double vision loss of appetite and nausea


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3. Double vision, loss of appetite, and nausea

Rationale:

Double vision, loss of appetite, and nausea are sigof digoxin toxicity. Additional signs of digoxin

toxicity include bradycardia, difficulty reading, v

alterations such as green and yellow vision or see

spots or halos, confusion, vomiting, diarrhea,decreased libido, and impotence.

*gastrointestinal (GI) and visual disturban

occur with digoxin toxicity*

151 ) A client is being treated for acute congestive


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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: bloodpressure, 100/60 mm Hg; pulse, 96 beats/min; a

respirations, 24 breaths/min. After the initial do

which of the following is the priority assessment?

1. Monitoring weight loss2. Monitoring temperature

3. Monitoring blood pressure

4. Monitoring potassium level


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3. Monitoring blood pressure

Rationale:

Bumetanide is a loop diuretic. Hypotension i

common side effect associated with the use o

medication. The other options also require

assessment but are not the priority.*priority ABCsairway, breathing, and

circulation*

152 ) Intravenous heparin therapy is prescrib


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152.) Intravenous heparin therapy is prescrib

for a client. While implementing this

prescription, a nurse ensures that which of thfollowing medications is available on the nur

unit?


2. Potassium chloride

3. Phytonadione (vitamin K )

4. Aminocaproic acid (Amicar)

1 Protamine sulfate


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Rationale:

The antidote to heparin is protamine sulfate;should be readily available for use if excessiv

bleeding or hemorrhage occurs. Potassium

chloride is administered for a potassium defi

Vitamin K is an antidote for warfarin sodium

Aminocaproic acid is the antidote for

thrombolytic therapy.


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160.) Meperidine hydrochloride (Demerol) is

prescribed for the client with pain. Which of

following would the nurse monitor for as a sid

effect of this medication?

1. Diarrhea

2. Bradycardia3. Hypertension

4. Urinary retention

4 Urinary retention


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Rationale:

Meperidine hydrochloride (Demerol) iopioid analgesic. Side effects of this

medication include respiratory depress

orthostatic hypotension, tachycardia,drowsiness and mental clouding,

constipation, and urinary retention.

162.) Carbamazepine (Tegretol) is prescribed


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162.) Carbamazepine (Tegretol) is prescribed

a client with a diagnosis of psychomotor seizu

The nurse reviews the client's health history,knowing that this medication is contraindicat

which of the following disorders is present?

1. Headaches

2. Liver disease

3. Hypothyroidism

4. Diabetes mellitus

2. Liver disease


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2. Liver disease

Rationale:

Carbamazepine (Tegretol) is contraindicatedliver disease, and liver function tests are

routinely prescribed for baseline purposes an

are monitored during therapy. It is also

contraindicated if the client has a history of b

dyscrasias. It is not contraindicated in the

conditions noted in the incorrect options.

164.) A client receives a prescription for methocarbamo


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p p

(Robaxin), and the nurse reinforces instructions to the

regarding the medication. Which client statement wou

indicate a need for further instructions?1. "My urine may turn brown or green."

2. "This medication is prescribed to help relieve my mu

spasms."

3. "If my vision becomes blurred, I don't need to beconcerned about it."

4. "I need to call my doctor if I experience nasal conges

from this medication."

3. "If my vision becomes blurred, I don't need to


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3 y ,

concerned about it."

Rationale:

The client needs to be told that the urine may tur

brown, black, or green. Other adverse effects incl

blurred vision, nasal congestion, urticaria, and ra

The client needs to be instructed that, if these adeffects occur, the health care provider needs to b

notified. The medication is used to relieve muscle

spasms.

170.) Atenolol hydrochloride (Tenormin) is


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7 ) y ( )

prescribed for a hospitalized client. The nurs

should perform which of the following as apriority action before administering the

medication?

1. Listen to the client's lung sounds.

2. Check the client's blood pressure.

3. Check the recent electrolyte levels.

4. Assess the client for muscle weakness.

2. Check the client's blood pressure.

R ti l


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Rationale:

Atenolol hydrochloride is a beta-blocker used to treat hyperten

Therefore the priority nursing action before administration of

medication is to check the client's blood pressure. The nurse al

checks the client's apical heart rate. If the systolic blood pressu

below 90 mm Hg or the apical pulse is 60 beats per minute or

the medication is withheld and the registered nurse and/or he

care provider is notified. The nurse would check baseline renalliver function tests. The medication may cause weakness, and t

nurse would assist the client with activities if weakness occurs.

*Beta-blockers have "-lol" at the end of the medicatio

name*

171.) A nurse is preparing to administer


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7 p p g

furosemide (Lasix) to a client with a diagnosi

heart failure. The most important laboratoryresult for the nurse to check before administe

this medication is:

1. Potassium level

2. Creatinine level

3. Cholesterol level

4. Blood urea nitrogen

1 Potassium level


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1. Potassium level

Rationale:

Furosemide is a loop diuretic. The medication caa decrease in the client's electrolytes, especially

potassium, sodium, and chloride. Administering

furosemide to a client with low electrolyte levels c

precipitate ventricular dysrhythmias. Options 2 a4 reflect renal function. The cholesterol level is

unrelated to the administration of this medicatio

172.) A nurse provides dietary instructi


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7 p y

to a client who will be taking warfarin

sodium (Coumadin). The nurse tells thclient to avoid which food item?

1. Grapes

2. Spinach3. Watermelon

4. Cottage cheese

2. Spinach


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Rationale:

Warfarin sodium is an anticoagulant.Anticoagulant medications act by antagonizin

the action of vitamin K, which is needed for

clotting. When a client is taking an anticoagu

foods high in vitamin K often are omitted fro

the diet. Vitamin K-rich foods include green,

leafy vegetables, fish, liver, coffee, and tea.

182.) A client with angina pectoris is experiencing ches

h di d h l f h d i i


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that radiates down the left arm. The nurse administers

sublingual nitroglycerin tablet to the client. The client'

is unrelieved, and the nurse determines that the client nanother nitroglycerin tablet. Which of the following vit

signs is most important for the nurse to check before

administering the medication?

1. Temperature2. Respirations

3. Blood pressure

4. Radial pulse rate

Rationale:


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Nitroglycerin acts directly on the smooth muscle

the blood vessels, causing relaxation and dilation

a result, hypotension can occur. The nurse would

check the client's blood pressure before administ

the second nitroglycerin tablet. Although the

respirations and apical pulse may be checked, thvital signs are not affected as a result of this

medication. The temperature also is not associat

with the administration of this medication.

187.) A clinic nurse prepares to administer an


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MMR (measles, mumps, rubella) vaccine to a

child. How is this vaccine best administered?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 aspec

the thigh

3 Subcutaneously in the outer aspect of the


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3. Subcutaneously in the outer aspect of the

upper arm

Rationale:The MMR vaccine is administered

subcutaneously in the outer aspect of the upp

arm. The gluteal muscle is most often used fointramuscular injections. The MMR vaccine i

not administered by the intramuscular route

195.) A nurse is caring for a client who is taking metopr


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95 ) g g p

(Lopressor). The nurse measures the client's blood pres

(BP) and apical pulse (AP) immediately beforeadministration. The client's BP is 122/78 mm/Hg and t

is 58 beats/min. Based on this data, which of the follow

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.

Rationale:


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Rationale:

Metoprolol (Lopressor) is classified as a beta-adrenergic block

is used in the treatment of hypertension, angina, and myocard

infarction. Baseline nursing assessments include measurement

and AP immediately before administration. If the systolic BP is

90 mm/Hg and the AP is below 60 beats/min, the nurse should

withhold the medication and document this action. Although

registered nurse should be informed of the client's vital signs, inecessary to do so immediately. The medication should not be

administered because the data is outside of the prescribed

parameters for this medication. The nurse should not administ

half of the medication, or alter any dosages at any point in tim

201.) A nurse is preparing to administer eardrop

i f Th l


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an infant. The nurse plans to:

1. Pull up and back on the ear and direct the solu

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 thesolution toward the wall of the canal.

4. Pull up and back on the ear lobe and direct the

solution toward the wall of the canal.

3. Pull down and back on the ear and direct the


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solution toward the wall of the canal.

Rationale:When administering eardrops to an infant, the

nurse pulls the ear down and straight back. In

adult or a child older than 3 years, the ear is pu

up and back to straighten the auditory canal. Tmedication is administered by aiming it at the

of the canal rather than directly onto the eardr

205.) A nurse is assisting in preparing to administer

acetylcysteine (Mucomyst) to a client with an overdose of


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acetylcysteine (Mucomyst) to a client with an overdose of

acetaminophen (Tylenol). The nurse prepares to administ

medication by:1. Administering the medication subcutaneously in the del

muscle

2. Administering the medication by the intramuscular rou

the gluteal muscle

3. Administering the medication by the intramuscular roumixed in 10 mL of normal saline

4. Mixing the medication in a flavored ice drink and allow

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 st


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allowing the client to drink the medication through a st

Rationale:

Because acetylcysteine has a pervasive odor of rotten egmust be disguised in a flavored ice drink. It is consume

preferably through a straw to minimize contact with th

mouth. It is not administered by the intramuscular or

subcutaneous route.*Knowing that the medication is a solution that

also used for nebulization treatments will assis

you to select the option that indicates an oral ro


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209.) A client with multiple sclerosis is receiving diazep

(Valium), a centrally acting skeletal muscle relaxant. W

of the following would indicate that the client is

experiencing a side effect related to this medication?

1. Headache

2. Drowsiness


4. Increased salivation

2 Drowsiness


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2. Drowsiness

Rationale:Incoordination and drowsiness ar

common side effects resulting fro

this medication. Options 1, 3, andare incorrect.

210.) Dantrolene (Dantrium) is prescribed fo

li t ith i l d i j f di f


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client with a spinal cord injury for discomfor

resulting from spasticity. The nurse tells theclient about the importance of follow-up and

need for which blood study?

1. Creatinine level

2. Sedimentation rate3. Liver function studies

4. White blood cell count

3. Liver function studies

Rationale:


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Rationale:

Dantrolene can cause liver damage, and thenurse should monitor liver function studies.

Baseline liver function studies are done befor

therapy starts, and regular liver function stud

are performed throughout therapy. Dantrolediscontinued if no relief of spasticity is achiev

in 6 weeks.

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


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

phenytoin (Dilantin) to control seizures. A phenytoin b

level is drawn, and the results reveal a level of 35 mcg/mWhich of the following symptoms would be expected a

result of this laboratory result?

1. Nystagmus

2. Tachycardia3. Slurred speech

4. No symptoms, because this is a normal therapeutic l

3. Slurred speech

R ti l


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Rationale:

The therapeutic phenytoin level is 10 tomcg/mL. At a level higher than 20

mcg/mL, involuntary movements of th

eyeballs (nystagmus) appear. At a levelhigher than 30 mcg/mL, ataxia and

slurred speech occur.

213.) A client is admitted to the hospital with

complaints of back spasms The client states "I h


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complaints of back spasms. The client states, I h

been taking two or three aspirin every 4 hours fo

past week and it hasn't helped my back." Aspirinintoxication is suspected. Which of the following

complaints would indicate aspirin intoxication?

1. Tinnitus

2. Constipation

3. Photosensitivity

4. Abdominal cramps

1. Tinnitus

Rationale:


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Mild intoxication with acetylsalicylic acid (aspirin) is c

salicylism and is commonly experienced when the dailydosage is higher than 4 g. Tinnitus (ringing in the ears)

the most frequently occurring effect noted with intoxic

Hyperventilation may occur because salicylate stimulat

the respiratory center. Fever may result because salicylinterferes with the metabolic pathways involved with o

consumption and heat production. Options 2, 3, and 4

incorrect.

214.) A health care provider initiates carbidopa/levodopa

(Sinemet) therapy for the client with Parkinson's disease.


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days after the client starts the medication, the client comp

of nausea and vomiting. The nurse tells the client that:1. Taking an antiemetic is the best measure to prevent the

nausea.

2. Taking the medication with food will help to prevent th

nausea.

3. This is an expected side effect of the medication and wildecrease over time.

4. The nausea and vomiting will decrease when the dose o

levodopa is stabilized.

2. Taking the medication with food will help to prevent th

nausea.


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Rationale:

If carbidopa/levodopa is causing nausea and vomiting, thenurse would tell the client that taking the medication with

will prevent the nausea. Additionally, the client should be

instructed not to take the medication with a high-protein

because the high-protein will affect absorption. Antiemeti

from the phenothiazine class should not be used because tblock the therapeutic action of dopamine.

*eliminate options 3 and 4 because they are

comparable or alike*

222.) A nurse has administered a dose of diaze


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(Valium) to a client. The nurse would take whi

important action before leaving the client's roo1. Giving the client a bedpan

2. Drawing the shades or blinds closed

3. Turning down the volume on the television4. Per agency policy, putting up the side rails o

the bed

4. Per agency policy, putting up the side rails on the bed

Rationale:


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Diazepam is a sedative-hypnotic with anticonvulsant and

skeletal muscle relaxant properties. The nurse should instsafety measures before leaving the client's room to ensure

the client does not injure herself or himself. The most freq

side effects of this medication are dizziness, drowsiness, a

lethargy. For this reason, the nurse puts the side rails up o

bed before leaving the room to prevent falls. Options 1, 2,may be helpful measures that provide a comfortable, restf

environment, but option 4 is the one that provides for the

client's safety needs.

223.) A client with a psychotic disorder is bei


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treated with haloperidol (Haldol). Which of t

following would indicate the presence of a toxeffect of this medication?

1. Nausea

2. Hypotension3. Blurred vision

4. Excessive salivation

4. Excessive salivation


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Rationale:

Toxic effects include extrapyramidal sympto(EPS) noted as marked drowsiness and letha

excessive salivation, and a fixed stare. Akath

acute dystonias, and tardive dyskinesia are asigns of toxicity. Hypotension, nausea, and

blurred vision are occasional side effects.

224.) Neuroleptic malignant syndrome is suspec

i li t h i t ki hl i Whi h


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in a client who is taking chlorpromazine. Which

medication would the nurse prepare in anticipatof being prescribed to treat this adverse effect re

to the use of chlorpromazine?


2. Bromocriptine (Parlodel)3. Phytonadione (vitamin K)

4. Enalapril maleate (Vasotec)

2. Bromocriptine (Parlodel)

Rationale:


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Rationale:

Bromocriptine is an antiparkinsonian prolac

inhibitor used in the treatment of neuroleptic

malignant syndrome. Vitamin K is the antido

for warfarin (Coumadin) overdose. Protamin

sulfate is the antidote for heparin overdose.Enalapril maleate is an antihypertensive used

the treatment of hypertension.

225.) A nursing student is assigned to care for a client w

diagnosis of schizophrenia. Haloperidol (Haldol) is


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prescribed for the client, and the nursing instructor ask

student to describe the action of the medication. Whichstatement 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 postsynapti

dopamine receptors in the brain.

4. It blocks the binding of dopamine to the

postsynaptic dopamine receptors in the brain.


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p y p p p

Rationale:

Haloperidol acts by blocking the binding of dopato the postsynaptic dopamine receptors in the br

Imipramine hydrochloride (Tofranil) blocks the

reuptake of norepinephrine and serotonin. Donep

hydrochloride (Aricept) inhibits the breakdown o

released acetylcholine. Fluoxetine hydrochloride

(Prozac) is a potent serotonin reuptake blocker.

227.) When teaching a client who is being started


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imipramine hydrochloride (Tofranil), the nurse w

inform the client that the desired effects of themedication 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 administratio

4. Not occur until after a month of administratio

2. Not occur for 2 to 3 weeks of

administration


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administration

Rationale:The therapeutic effects of administratio

of imipramine hydrochloride may not

occur for 2 to 3 weeks after theantidepressant therapy has been initiat

Therefore options 1, 3, and 4 are incorr

231.) A client admitted to the hospital gives the n

a bottle of clomipramine (Anafranil) The nurse n


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a bottle of clomipramine (Anafranil). The nurse n

that the medication has not been taken by the cliin 2 months. What behaviors observed in the clie

would validate noncompliance with this medicat

1. Complaints of hunger

2. Complaints of insomnia3. A pulse rate less than 60 beats per minute

4. Frequent handwashing with hot, soapy water

4. Frequent handwashing with hot, soapy wa

Rationale:


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Clomipramine is commonly used in the treatm

of obsessive-compulsive disorder. Handwash

is a common obsessive-compulsive behavior.

Weight gain is a common side effect of this

medication. Tachycardia and sedation are sideffects. Insomnia may occur but is seldom a s

effect.

232.) A client in the mental health unit is

administered haloperidol (Haldol) The nurs


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administered haloperidol (Haldol). The nurs

would check which of the following to determmedication effectiveness?

1. The client's vital signs

2. The client's nutritional intake3. The physical safety of other unit clients

4. The client's orientation and delusional stat

4. The client's orientation and delusional status

Rationale:


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Haloperidol is used to treat clients exhibiting

psychotic features. Therefore, to determinemedication effectiveness, the nurse would check

client's orientation and delusional status. Vital si

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.

234.) A hospitalized client is started on phenel

sulfate (Nardil) for the treatment of depression


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sulfate (Nardil) for the treatment of depression

lunchtime, a tray is delivered to the client. Whfood item on the tray will the nurse remove?

1. Yogurt

2. Crackers

3. Tossed salad

4. Oatmeal cookies

1. Yogurt

Rationale:


114/128

Phenelzine sulfate is a monoamine oxidase

inhibitor (MAOI). The client should avoid tak

in foods that are high in tyramine. These food

could trigger a potentially fatal hypertensive

crisis. Foods to avoid include yogurt, agedcheeses, smoked or processed meats, red win

and fruits such as avocados, raisins, or figs.

235.) A tricyclic antidepressant is administered

a client daily. The nurse plans to monitor for t


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common side effects of the medication and

includes which of the following in the plan of c

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 re

daily.

1. Offer hard candy or gum periodically.

Rationale:

D h i id ff f i li


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Dry mouth is a common side effect of tricyclic

antidepressants. Frequent mouth rinsing with wsucking on hard candy, and chewing gum will

alleviate this common side effect. It is not necess

to monitor the blood pressure every 2 hours. In

addition, it is not necessary to check the WBC da

Weight gain is a common side effect and frequen

snacks will aggravate this problem.

236.) A client is being treated for depression with

amitriptyline hydrochloride. During the initial phases o

treatment the most important nursing intervention is:


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treatment, the most important nursing intervention is:

1. Prescribing the client a tyramine-free diet2. Checking the client for anticholinergic effects

3. Monitoring blood levels frequently because there is a

narrow range between therapeutic and toxic blood leve

this medication4. Getting baseline postural blood pressures before

administering the medication and each time the medic

is administered

4. Getting baseline postural blood pressures before administeri

medication and each time the medication is administered

Rationale:


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Rationale:

Amitriptyline hydrochloride is a tricyclic antidepressant often u

to treat depression. It causes orthostatic changes and can prod

hypotension and tachycardia. This can be frightening to the cl

and dangerous because it can result in dizziness and client fall

client must be instructed to move slowly from a lying to a sittin

standing position to avoid injury if these effects are experienceclient may also experience sedation, dry mouth, constipation,

blurred vision, and other anticholinergic effects, but these are

transient and will diminish with time.

240.) A client with Parkinson's disease has b

prescribed benztropine (Cogentin) The nurs


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prescribed benztropine (Cogentin). The nurs

monitors for which gastrointestinal (GI) sideeffect of this medication?

1. Diarrhea

2. Dry mouth

3. Increased appetite

4. Hyperactive bowel sounds

2. Dry mouth

Rationale:


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Rationale:

Common GI side effects of benztropine therapy includeconstipation and dry mouth. Other GI side effects inclu

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

an anticholinergic, which causes dry mouth*

242.) A client who was started on anticonvulsant therapy with

clonazepam (Klonopin) tells the nurse of increasing clumsines

t di i t ti th di ti Th li t i i ibl


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unsteadiness since starting the medication. The client is visibly

by these manifestations and asks the nurse what to do. The nuresponse 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 medic

3. Indicate that the client is experiencing a severe untoward re

to the medication4. Are worse during initial therapy and decrease or disappear w

long-term use

4. Are worse during initial therapy and decrease or disappear w

long-term use

Rationale:

D i t di d l i t d ff t


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Drowsiness, unsteadiness, and clumsiness are expected effects

medication during early therapy. They are dose related and usdiminish or disappear altogether with continued use of the

medication. It does not indicate that a severe side effect is occu

It is also unrelated to interaction with another medication. The

is encouraged to take this medication with food to minimize

gastrointestinal upset.*Eliminate options 2 and 3 first because they are

comparable or alike and because of the word "severe

option 3*

243.) A hospitalized client is havin

the dosage of clonazepam (Klonop


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g p ( p

adjusted. The nurse should plan to1. Weigh the client daily.

2. Observe for ecchymosis.

3. Institute seizure precautions.

4. Monitor blood glucose levels.

3. Institute seizure precautions.

Rationale:


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Clonazepam is a benzodiazepine used as ananticonvulsant. During initial therapy and du

periods of dosage adjustment, the nurse shou

initiate seizure precautions for the client. Opt

1, 2, and 4 are not associated with the use of t

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


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1. Administer the medication with an antacid.

2. Administer the medication with a carbonatedbeverage.

3. Ensure that the medication is administered at

same time each day.

4. Ensure that the medication is administered 2hours before breakfast only, when the client's

stomach is empty.

3. Ensure that the medication is administered at the same time

day.

Rationale:


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Valproic acid is an anticonvulsant, antimanic, and antimigrain

medication. It may be administered with or without food. It sh

not be taken with an antacid or carbonated beverage because t

products will affect medication absorption. The medication is

administered at the same time each day to maintain therapeut

serum levels.*Use general pharmacology guidelines to assist in

eliminating options 1 and 2. Eliminate option 4 becau

the closed-ended word "only."*

245.) A client taking carbamazepine (Tegretol) a

the nurse what to do if he misses one dose. The n

responds that the carbamazepine should be:


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responds that the carbamazepine should be:

1. Withheld until the next scheduled dose2. Withheld and the health care provider is notifi

immediately

3. Taken as long as it is not immediately before th

next dose4. Withheld until the next scheduled dose, which

should then be doubled

3. Taken as long as it is not immediately before th

next dose

Rationale:


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Rationale:

Carbamazepine is an anticonvulsant that should taken around the clock, precisely as directed. If a

is omitted, the client should take the dose as soon

it is remembered, as long as it is not immediately

before the next dose. The medication should not double dosed. If more than one dose is omitted, t

client should call the health care provider.

pharmacology nclex questions (1)

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