Antihypertensive
A nurse is caring for a client who has developed bradycardia. Which prescription should the nurse question?
A. Propranolol
B. Furosemide
C. Spironolactone
D. Valsartan
Answer: A
Choice A is correct. Propranolol is a non-selective beta-blocker. Propranolol is used in the management of hypertension and migraine prevention. While it reduces blood pressure, it can also decrease heart rate (bradycardia) by blocking beta-1 receptors. Therefore, if a client is experiencing bradycardia, the client should not receive any medications that can lower the heart rate further.
A nurse is educating a client newly prescribed rivaroxaban (Xarelto) for deep vein thrombosis. Which statement by the client indicates a need for further teaching?
A."I should report any unusual bruising or prolonged bleeding."
B."I can stop taking it once I feel better to lower my bleeding risk."
C."I should tell my dentist I am on a blood thinner before any procedures."
D."I should avoid over-the-counter NSAIDs unless my provider approves."
Answer: B
B."I can stop taking it once I feel better to lower my bleeding risk.
Abruptly stopping rivaroxaban is dangerous and significantly increases the risk of stroke, DVT recurrence, and thrombotic events. The client must understand it must not be stopped without provider guidance. The other statements are all correct and indicate good understanding of anticoagulation safety.
The nurse is caring for a client who is using over-the-counter nasal decongestant drops and reports unrelieved and worsening nasal congestion. What is the appropriate instruction for this client?
A. Discontinue the medication for several days
B. Use a combination of oral decongestant medications and drops for better results
C. Switch to a stronger dose of the decongestant drops
D. Increase the frequency of the nasal decongestant drops
Answer: A
A. Discontinue the medication for several days
Choice A is correct. Intranasal sympathomimetics, due to their local action, produce few systemic effects. However, one side effect associated with their use is rebound congestion. Prolonged use causes hypersecretion of mucus and worsened nasal congestion once the drug effects wear off. This rebound effect sometimes leads to a cycle of increased drug use as the condition worsens. Because of the risk of rebound congestion, intranasal sympathomimetics should be used for no longer than 3-5 days. Prolonged use of decongestant drops (3 to 5 days) can lead to rebound congestion, which is relieved by discontinuing the medication for several days.
Choice B is incorrect. The nurse should instruct the client to discontinue the nose drops. Additionally, the nurse should not tell a client which medications to take; this responsibility belongs to the doctor.
Choice C is incorrect. A more potent decongestant is not needed. Stronger doses may not necessarily provide better relief and could increase the risk of side effects.
Choice D is incorrect. The frequency should not be increased. Overusing the drops can cause the nasal passages to become more congested when the medication wears off, creating a cycle of worsening symptoms.
A client taking ciprofloxacin reports sudden pain in the Achilles tendon. What is the nurse’s best response?
A. “Apply heat and continue the medication.”
B. “This is expected with antibiotic therapy.”
C. “Stop exercising until symptoms improve.”
D. “Stop the medication and notify the provider immediately.”
Answer: D
Answer: D. “Stop the medication and notify the provider immediately.”
Rationale: Fluoroquinolones carry a black box warning for tendonitis and tendon rupture.
A nurse is caring for a pregnant client with epilepsy who is taking valproic acid. The client asks if she can continue the medication. Which response by the nurse is most appropriate?
A."Valproic acid is safe in pregnancy as long as folic acid is taken."
B."This is a decision only you can make — I cannot offer any guidance."
C."Valproic acid carries a Black Box Warning for major congenital malformations including neural tube defects. You should discuss alternatives with your provider immediately."
D."The medication can be safely continued through the first trimester only."
Answer: C
C."Valproic acid carries a Black Box Warning for major congenital malformations including neural tube defects. You should discuss alternatives with your provider immediately."
Valproic acid carries a Black Box Warning for causing major congenital malformations — most notably neural tube defects (e.g., spina bifida) — and is strongly contraindicated in pregnancy unless no safer alternative exists. The nurse should educate the client about this risk and ensure the provider is involved in the discussion about alternative anticonvulsants. Folic acid supplementation does not eliminate the teratogenic risk.
This nurse is caring for a client who is receiving prescribed hydralazine. Which of the following findings would indicate a therapeutic response?
A. Blood pressure 120/70 mm Hg
B. Pulse (P) 67/minute
C. Total cholesterol 185 mg/dL [﹤200 mg/dL]
D. aPTT 45 seconds [30-40 seconds]
Answer: A
Choice A is correct. Hydralazine is a vasodilator and is intended to treat hypertension. The client's blood pressure of 120/70 mm Hg is within normal limits and indicates a therapeutic effect.
✓ The client is at risk for falls with this medication related to orthostatic hypotension.
The nurse is preparing to administer enoxaparin. Which of the following laboratory test results should the nurse monitor while the client is receiving enoxaparin?
A. platelet count
B. activated partial thromboplastin time (aPTT)
C. international normalized ratio (INR)
D. white blood cell (WBC) count
Answer: A
A. platelet count
Choice A is correct. Enoxaparin is a low molecular weight-based heparin (LMWH). One of the adverse events of enoxaparin is heparin-induced thrombocytopenia (HIT). This severe condition results in a 50% or more decrease in the platelet count while also causing thrombosis. Therefore, it is reasonable to monitor the platelet count after initiating enoxaparin.
Choice B is incorrect. Unlike unfractionated heparin, enoxaparin does not require aPTT monitoring. aPTT is appropriate for monitoring a client receiving unfractionated heparin.
Choice C is incorrect. INR is used to measure the effectiveness of warfarin. INR is not relevant to the use of enoxaparin.
Choices D are incorrect. WBC count would be monitored for an array of indications, such as chemotherapy treatment and bacteremia.
A client with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium bromide inhalation therapy. The nurse knows that the primary therapeutic effect of ipratropium is to?
A. Dilate coronary arteries
B. Inhibit histamine release
C. Relax bronchial smooth muscle
D. Block muscarinic receptors
Answer: C
C. Relax bronchial smooth muscle
Choice C is correct. The primary therapeutic effect of ipratropium bromide is to relax bronchial smooth muscle (muscarinic receptor antagonist), leading to bronchodilation and improved airflow in clients with COPD and asthma.
Choice A is incorrect. Ipratropium bromide does not have a significant effect on coronary arteries.
Choice B is incorrect. Ipratropium bromide does not inhibit histamine release. It primarily works as an anticholinergic bronchodilator by blocking muscarinic receptors in the airways.
Choice D is incorrect. While this is true, it is a mechanism of action rather than a therapeutic effect. Blocking muscarinic receptors results in relaxation of bronchial smooth muscle, which leads to bronchodilation, the primary therapeutic effect of ipratropium bromide.
A nurse is preparing to administer gentamicin (Garamycin) to a patient. Which assessment finding is most important to report to the provider before giving the dose?
A: The patient reports mild nausea after breakfast
B: The patient's serum creatinine has risen from 0.9 to 2.1 mg/dL since admission
C: The patient has a documented penicillin allergy
D: The patient's temperature is 38.2°C (100.8°F)
Answer: B
B: The patient's serum creatinine has risen from 0.9 to 2.1 mg/dL since admission
Rationale: Gentamicin is an aminoglycoside with a high risk of nephrotoxicity. A significant rise in serum creatinine indicates worsening renal function, which reduces drug clearance and can lead to toxic accumulation. The dose must be held and the provider notified. Peak and trough levels should also be monitored closely to prevent irreversible kidney damage and hearing loss.
A client who has been taking phenytoin long-term asks why they need to see the dentist more often. Which explanation by the nurse is most accurate?
A.Phenytoin causes xerostomia (dry mouth) that increases cavity risk
B.Phenytoin causes gingival hyperplasia (overgrowth of gum tissue), which requires regular dental care
C.Phenytoin stains teeth permanently and must be managed by a dentist
D.Phenytoin decreases saliva pH, causing rapid enamel erosion
Answer: B
B.Phenytoin causes gingival hyperplasia (overgrowth of gum tissue), which requires regular dental care
A well-known adverse effect of phenytoin is gingival hyperplasia — overgrowth of gum tissue — which is more pronounced with poor oral hygiene. Clients should be taught to brush and floss diligently and see a dentist regularly. This is a high-yield NCLEX teaching point for phenytoin. It is not related to dry mouth, tooth staining, or pH changes.
The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question?
A. captopril for a client with congestive heart failure
B. metoprolol for a client with multiple premature ventricular contractions (PVCs)
C. verapamil for a client with atrial fibrillation
D. spironolactone for a client with end-stage renal disease
Answer: D
Choice D is correct. Spironolactone is a potassium-sparing diuretic and is primarily indicated in treating essential hypertension. The potential (significant) issue is that clients with end-stage renal disease commonly have hyperkalemia because of the significantly reduced glomerular filtration rate and rely on dialysis to remove nitrogenous waste, water, and electrolytes. It would be detrimental for a client with ESRD to receive spironolactone because this medication will raise serum potassium levels that are already high. This prescription requires follow-up.
A nurse is caring for a client receiving a continuous heparin infusion whose aPTT result is 180 seconds (normal control: 30 seconds; therapeutic: 60–100 seconds). The client has no bleeding signs. What is the nurse's priority action?
A.Continue the infusion — the aPTT is within an acceptable range
B.Hold the infusion, notify the provider, and prepare protamine sulfate
C.Decrease the infusion per the institutional heparin protocol and recheck aPTT in 6 hours
D.Administer vitamin K to counteract the heparin effect
Answer: B
B.Hold the infusion, notify the provider, and prepare protamine sulfate
An aPTT of 180 seconds is approximately 6x the control value — dangerously supratherapeutic. The infusion must be stopped and the provider notified. Protamine sulfate is the antidote for unfractionated heparin overdose and should be prepared. Option C (adjusting per protocol) may be appropriate in less extreme values, but 180 seconds requires immediate escalation. Vitamin K reverses warfarin, not heparin.
The nurse is caring for an infant with viral croup syndrome (laryngotracheobronchitis). The nurse anticipates that the physician will prescribe:
A. Dexamethasone.
B. Albuterol.
C. Amoxicillin.
D. Montelukast.
Answer: A
A. Dexamethasone.
Choice A is correct. In viral croup, the upper airway (larynx and trachea) becomes inflamed and edematous, leading to narrowing of the airway and symptoms such as stridor, hoarseness, and a "barking" cough. Dexamethasone reduces mucosal edema in the subglottic space (the narrowest part of the pediatric airway), improving breathing and decreasing the severity and frequency of symptoms.
Choice B is incorrect. Croup is an upper airway problem caused by inflammation and swelling, not bronchoconstriction.
Choice C is incorrect. Amoxicillin is prescribed for certain bacterial infections such as otitis media, streptococcal pharyngitis, or bacterial pneumonia.
Choice D is incorrect. Montelukast is a leukotriene receptor antagonist used for chronic asthma and allergic rhinitis management. Montelukast reduces bronchial inflammation and hypersensitivity by blocking leukotrienes, which are part of the inflammatory process in asthma. It has no proven benefit in the acute management of croup and does not reduce airway edema or improve stridor.
A client receiving azithromycin reports palpitations and dizziness. Which is the nurse’s priority action?
A. Encourage fluids
B. Assess the client’s QT interval
C. Administer the next dose with food
D. Reassure the client this is expected
Answer: B
Answer: B. Assess the client’s QT interval
Rationale: Azithromycin can prolong the QT interval and increase the risk of dysrhythmias.
A nurse is administering IV phenytoin (Dilantin) to a client in status epilepticus. Which action is most important during administration?
A.Infuse rapidly via a small peripheral IV to ensure fast onset
B.Mix phenytoin in dextrose 5% water (D5W) for compatibility
C.Administer no faster than 50 mg/min and monitor cardiac rhythm continuously
D.Use an intramuscular route if IV access is difficult
Answer: C
C.Administer no faster than 50 mg/min and monitor cardiac rhythm continuously
IV phenytoin carries a Black Box Warning: rapid infusion can cause severe hypotension and fatal cardiac arrhythmias. The maximum rate is 50 mg/min (25 mg/min in elderly or cardiac patients), and continuous cardiac monitoring is mandatory. Phenytoin is incompatible with dextrose solutions — it must be mixed only in normal saline. IM administration causes erratic absorption and tissue necrosis and is contraindicated.
The nurse is teaching a client who has hypertension about the newly prescribed medication, diltiazem. Which of the following should the nurse include in the teaching?
A. "A nagging cough can occur as a side effect of the medication."
B. "This medication may cause you to go to the bathroom more often."
C. "Avoid taking the medication with grapefruit juice."
D. "You will need to increase your dietary intake of potassium-rich foods."
Answer: C
C. "Avoid taking the medication with grapefruit juice."
Rationale: Diltiazem and other calcium channel blockers should not be taken with grapefruit because of the risk of serious potentiation of the drug, leading the client to develop profound bradycardia and hypotension.
Choice A is incorrect: ACE inhibitors such as captopril.
Choice B is incorrect: Diuretic such as spironolactone.
Choice D is incorrect: Diuretics such as furosemide.
A client taking warfarin has a therapeutic INR and reports taking a new antibiotic prescribed by another provider. The nurse knows which interaction is most clinically significant?
A.Antibiotics have no interaction with warfarin
B.Antibiotics decrease gut flora that produce vitamin K, potentially raising the INR and increasing bleeding risk
C.Antibiotics directly block warfarin metabolism, requiring dose increases
D.Antibiotics will lower the INR, so the warfarin dose should be doubled
Answer: B
B.Antibiotics decrease gut flora that produce vitamin K, potentially raising the INR and increasing bleeding risk
Many antibiotics alter gut flora that synthesize vitamin K, reducing its availability and potentiating warfarin's effect — raising the INR and bleeding risk. Additionally, some antibiotics inhibit CYP450 enzymes that metabolize warfarin. The nurse should alert the provider and plan for more frequent INR monitoring. The warfarin dose should never be doubled without monitoring.
The nurse is caring for a client who has been newly prescribed salmeterol. Which of the following prescribed medications should be reported to the primary healthcare provider (PHCP)?
A. Lithium
B. Captopril
C. Labetalol
D. Clonidine
Answer: C
C. Labetalol
Choice C is correct. Labetalol is a combined alpha and beta-adrenergic receptor blocker, therefore antagonizing salmeterol's therapeutic effect. Thus, labetalol would be contraindicated because of this adverse action.
Choice A is incorrect. Lithium is a mood stabilizer and is used in bipolar disorder—no known significant interaction with salmeterol.
Choice D is incorrect. Clonidine is a centrally acting alpha-2 agonist for hypertension; it does not interfere with salmeterol’s bronchodilatory action.
Choice B is incorrect. Captopril is an ACE inhibitor used for hypertension and heart failure—no direct interaction with salmeterol.
A nurse is administering vancomycin (Vancocin) IV and notices the patient's neck and upper chest have turned red and flushed during the infusion. What is the most likely cause and appropriate nursing action?
A: An allergic reaction — stop the infusion and administer epinephrine immediately
B: Red man syndrome from rapid infusion — slow the rate and notify the provider
C: A sign of vancomycin toxicity — hold all future doses
D: Normal skin flushing — document and continue at the same rate
Answer: B
B: Red man syndrome from rapid infusion — slow the rate and notify the provider
Rationale: Red man syndrome is a common infusion reaction to vancomycin caused by too-rapid administration. It is not a true allergic reaction. The nurse should slow or temporarily stop the infusion — vancomycin must be administered over at least 60 minutes. Diphenhydramine may be given. The infusion can typically be resumed at a slower rate after symptoms resolve.
A client with epilepsy has been stable on carbamazepine (Tegretol) for 2 years. The client is prescribed a new antibiotic and reports increased dizziness and diplopia at the next visit. The nurse suspects which interaction?
A.The antibiotic reduced carbamazepine absorption from the GI tract
B.The antibiotic inhibited CYP450 enzymes, raising carbamazepine levels and causing toxicity
C.The antibiotic induced CYP450 enzymes, lowering carbamazepine levels and causing breakthrough seizures
D.Carbamazepine is not affected by any drug interactions
Answer: B
B.The antibiotic inhibited CYP450 enzymes, raising carbamazepine levels and causing toxicity
Dizziness and diplopia are classic signs of carbamazepine toxicity. The therapeutic range is 4–12 mcg/mL. Some antibiotics (e.g., erythromycin, clarithromycin) inhibit CYP450 enzymes, reducing carbamazepine metabolism and causing toxic accumulation. Carbamazepine is itself a CYP450 inducer and has numerous drug interactions. The provider should be notified and a drug level drawn.
The nurse is administering prescribed furosemide to a client. Which of the following clinical manifestations would be consistent with the client developing fluid volume deficit? Select all that apply.
A. Tachycardia
B. Bradypnea
C. Weight gain
D. Decreased urine output
E. Tenting of the skin
Answers: A, D, E
A. Tachycardia
D. Decreased urine output
E. Tenting of the skin
Choice A is correct. Clients prescribed diuretics (such as furosemide) are at risk for fluid volume deficit. Tachycardia would be a finding consistent with a fluid volume deficit that the nurse should indeed monitor. If the client is tachycardic, the heart is beating faster to increase the cardiac output in a low volume setting - hence, the fluid volume deficit.
Choice D is correct. Decreased urine output would be a finding consistent with a fluid volume deficit. If the client is experiencing a fluid volume deficit, they have a decreased circulating blood volume. This leads to a decreased renal blood flow, causing a reduced urine output.
Choice E is correct. Tenting of the skin can occur due to a lack of fluid in the tissues and is a sign of fluid volume deficit.
Choice B is incorrect: Bradypnea is not an indication of fluid volume deficit that the nurse needs to monitor.
Choice C is incorrect: Weight loss, not gain, indicates fluid volume deficit that the nurse needs to monitor.
The emergency department (ED) nurse cares for a client receiving prescribed warfarin and reports dizziness, black tarry stools, and bloody gums. The international normalized ratio (INR) returns at 5 (0.9-1.2 seconds). The nurse anticipates the primary healthcare provider (PHCP) will prescribe which blood product?
A. Packed red blood cells (PRBCs)
B. Platelets
C. Granulocytes
D. Fresh frozen plasma (FFP)
Answer: D
D. Fresh frozen plasma (FFP)
Choice D is correct. FFP would be prescribed because this client is experiencing bleeding related to the prescribed warfarin. The client's INR is grossly elevated (therapeutic for VTE prophylaxis is 2-3), and FFP includes the Vitamin K-dependent clotting factors (factors II, VII, IX, X, proteins C, and S) that need to be replaced to stop the bleeding. Vitamin K may be prescribed, but the efficacy takes six to eight hours. FFP can treat the bleeding almost immediately.
Choices A, B, and C are incorrect. PRBCs are indicated to treat anemia. Platelets would be prescribed to treat thrombocytopenia. Granulocytes are rarely prescribed, but if they are prescribed, they are indicated for severe aplastic anemia, neutropenia, and neonatal sepsis.
The nurse is caring for a client who is receiving prescribed montelukast. Which of the following findings would indicate the client is having an adverse effect?
A. Hypertension
B. Hallucinations
C. Constipation
D. Urinary retention
Answer: B
Choice B is correct. Montelukast is a leukotriene receptor antagonist indicated in managing asthma, allergic rhinitis, and exercise-induced asthma. This medication has a serious adverse reaction to neuropsychiatric alterations, including depression, hallucinations, aggression, and thoughts of suicidality. Any of these neuropsychiatric changes should be reported immediately to the physician.
Choice A is incorrect. Montelukast does not cause hypertension. This could occur with a client taking a corticosteroid because of its propensity to cause the individual to retain sodium and water.
Choice C is incorrect. Constipation is not an adverse reaction of montelukast.
Choice D is incorrect. Urinary retention is not an adverse reaction of montelukast. This could be found if the client were exposed to anticholinergic drugs such as tricyclic antidepressants
Which assessment finding in a client taking gentamicin should the nurse report immediately?
A. Mild nausea
B. Increased appetite
C. Ringing in the ears
D. Occasional headache
Answer: C
Answer: C. Ringing in the ears
Rationale: Gentamicin can cause ototoxicity, which may present as tinnitus, hearing loss, or balance disturbances.
A nurse is caring for a client taking valproic acid (Depakote) who suddenly reports severe abdominal pain, nausea, and vomiting. Which complication should the nurse suspect first?
A: Therapeutic drug level — this is an expected GI side effect
B: Drug-induced pancreatitis, a life-threatening adverse effect of valproic acid
C: Hepatic encephalopathy from elevated ammonia levels
D: Hyponatremia related to SIADH caused by valproic acid
Answer: B
B: Drug-induced pancreatitis, a life-threatening adverse effect of valproic acid
Valproic acid carries a Black Box Warning for life-threatening pancreatitis, which can occur at any time during therapy. Severe abdominal pain, nausea, and vomiting are the hallmark symptoms and require immediate provider notification and discontinuation of the drug. Hepatotoxicity (also a Black Box Warning) presents with jaundice and elevated LFTs, not acute abdominal pain. GI upset is common but severe pain is never dismissed.
The nurse is teaching a continuing education course regarding cardiovascular medications. It would be appropriate for the nurse to reinforce which condition is a contraindication to administering beta-blockers?
A. Atrial fibrillation
B. Myocardial infarction
C. Congestive heart failure (CHF)
D. Cardiogenic shock
Answer: D
Choice D is correct. For the client in cardiogenic shock, administering a beta-blocker would be contraindicated because they are negatively inotropic and would decrease cardiac output (CO) that is already compromised. Often, cardiogenic shock occurs due to an acute drop in cardiac output from a massive acute myocardial infarction. Cardiogenic shock is a medical emergency, and the treatment aims to quickly increase cardiac output and restore blood pressure.
Choices A, B, and C are incorrect. These are all conditions under which beta blockers are indicated.
A client receiving warfarin (Coumadin) for atrial fibrillation has an INR of 5.8. The client reports no active bleeding. Which action by the nurse is most appropriate?
A.Administer the next scheduled warfarin dose as ordered
B.Hold warfarin and notify the provider immediately
C.Give oral vitamin K per standing orders without contacting the provider
D.Apply ice to injection sites and monitor for 4 hours
Answer: B
B.Hold warfarin and notify the provider immediately
An INR of 5.8 is significantly above the therapeutic range of 2–3 for atrial fibrillation and represents serious over-anticoagulation. The nurse should hold warfarin and notify the provider, who will determine if vitamin K or other reversal is needed. The nurse should never administer vitamin K without a provider order. Continuing the dose would worsen the situation.
Normal (no anticoagulation): 0.8–1.2
Therapeutic for atrial fibrillation / DVT / PE: 2.0–3.0
Therapeutic for mechanical heart valves: 2.5–3.5
Dangerous / supratherapeutic: above 4.0 (high bleeding risk)
Critical (like the 5.8 in the question): above 5.0 — hold warfarin, notify provider, consider reversal
The nurse is teaching a client about how to use a metered-dose inhaler (MDI). Which of the following statements by the client indicates effective teaching? Select all that apply.
A. “I will be careful not to shake the canister before using it.”
B. “I will inhale the medication through my nose.”
C. “After I deliver a dose, I will hold my breath for 10 seconds, then exhale slowly through my nose."
D. “I will only inhale one spray with one breath.”
E. "While holding the mouthpiece away from my mouth, I will take a deep breath and exhale completely before inhaling the medication."
Answers: C, D, E
Choices C is correct. For clients with a metered dose inhaler (MDI), after a dose is administered, they should hold their breath for ten seconds to allow for the medication to be dispersed in their lungs, then exhale slowly through the nose (or through pursed lips).
Choice D is correct. The client should only administer one dose (or press the button once) per breath.
Choice E is correct. Before the client administers a dose of the medication from the inhaler, the client should hold the MDI away from their mouth, take a deep breath, and exhale completely. This is necessary to empty any residual lung volume and prepares the airway to receive medication.
Choice A is incorrect. A common mistake clients make when using metered-dose inhalers includes failing to shake the canister.
Choice B is incorrect. A common mistake clients make when using metered-dose inhalers includes inhaling through the nose rather than the mouth.
A nurse is reviewing the medication administration record for a patient receiving treatment for a urinary tract infection caused by E. coli. The patient is on ciprofloxacin 400 mg IV every 12 hours. Four hours after the second dose, the patient reports new-onset confusion, agitation, and seeing things that are not there. The patient has no prior psychiatric history. Which action should the nurse take first?
A: Administer the PRN ondansetron — nausea from the IV antibiotic may be causing agitation
B: Perform a full neurological assessment and notify the provider, identifying ciprofloxacin CNS toxicity as a likely cause
C: Check a STAT blood glucose — hypoglycemia is the most likely cause given the diabetic history
D: Apply soft restraints and request a psychiatric consult for new-onset hallucinations
Answer: B
B: Perform a full neurological assessment and notify the provider, identifying ciprofloxacin CNS toxicity as a likely cause
Fluoroquinolones like ciprofloxacin carry a Black Box Warning for serious CNS adverse effects including confusion, hallucinations, agitation, and delirium — which can occur even after just one or two doses. This is a recognized but underappreciated toxicity. The nurse's first action is to perform a neurological assessment and notify the provider, identifying ciprofloxacin as the likely causative agent. Blood glucose is already documented as normal (112 mg/dL), making hypoglycemia unlikely. Restraints without identifying the cause is inappropriate and potentially harmful. Ondansetron does not address a CNS reaction. The provider will likely discontinue ciprofloxacin and switch to a different antibiotic class
A client prescribed phenytoin (Dilantin) reports nausea, blurred vision, and unsteady gait. The nurse checks a serum phenytoin level and it reads 28 mcg/mL. Which interpretation is correct?
A.The level is subtherapeutic; the dose should be increased
B.The level is within therapeutic range; symptoms are unrelated to the drug
C.The level is supratherapeutic; these are signs of phenytoin toxicity
D.The level is critical; prepare for immediate seizure intervention
Answer: C
C.The level is supratherapeutic; these are signs of phenytoin toxicity
The therapeutic range for phenytoin is 10–20 mcg/mL. A level of 28 mcg/mL is above the therapeutic range and the client is showing classic signs of phenytoin toxicity: nystagmus, ataxia (unsteady gait), diplopia/blurred vision, nausea, and confusion. The nurse should hold the dose and notify the provider. Toxicity does not typically cause acute seizures, but the drug must be adjusted.
The nurse is providing discharge instructions to a client prescribed lisinopril. Which of the following instructions should the nurse include? Select all that apply.
A. "You will need to take your pulse for one minute before each dose."
B. "You may notice the need to go to the bathroom more often."
C. "Limit your intake of foods such as avocados and apricots."
D. "You may notice a decrease in your ability to taste foods."
E. "The goal of this medication is to lower your cholesterol."
Answers: C, D
C. "Limit your intake of foods such as avocados and apricots."
D. "You may notice a decrease in your ability to taste foods."
Choice C is correct. Lisinopril is an ACE inhibitor (ACE-I) and may cause hyperkalemia. It would be correct for the nurse to instruct the client to limit their intake of potassium-rich foods such as avocados, bananas, apricots, and legumes. If the client lowers their potassium intake, it could decrease the likelihood of developing dangerously high potassium levels.
Choice D is correct. ACEIs may also cause a client to have a reduced taste sensation (dysgeusia). This may make the client more likely to use salt, worsening hypertension. Thus, it is appropriate to instruct the client to season their food more naturally.
✓ The most serious adverse effect is angioedema. ACEIs increase bradykinin by inhibiting its degradation. Bradykinin is believed to be responsible for the angioedema seen with ACEI.
A client on warfarin therapy reports eating large daily servings of spinach, kale, and broccoli since starting the medication. The nurse anticipates which laboratory finding?
A.INR above therapeutic range due to increased warfarin effect
B.INR below therapeutic range due to reduced warfarin effect
C.aPTT elevated above normal limits
D.No change in INR because diet has no impact on warfarin
Answer: B
B.INR below therapeutic range due to reduced warfarin effect
Warfarin inhibits vitamin K-dependent clotting factors. Foods high in vitamin K (leafy greens like spinach, kale, broccoli) provide substrate for clotting factor synthesis, opposing warfarin's action and lowering the INR below the therapeutic range. Clients should maintain consistent (not zero) vitamin K intake. aPTT monitors heparin, not warfarin.
You are caring for an 80-year-old woman with a long-standing history of asthma. You are preparing to give a dose of theophylline to the patient. You know that the most critical sign to assess before giving this dose is:
A. Temperature
B. Blood Pressure
C. Urinary Output
D. Pulse
Answer: D
D. Pulse
Choice D is correct. The nurse should evaluate the character of the pulse since one of the toxic effects of theophylline is cardiac arrhythmias. If the pulse rate is significantly increased or erratic, it may alert the nurse regarding a potential arrhythmia from theophylline drug toxicity.
The nurse is teaching a client about newly prescribed doxycycline. Which of the following statements, if made by the client, would require further teaching? Select all that apply.
A. “I should take this medication with milk or cheese.”
B. “If I develop foul-smelling diarrhea I should contact my doctor.”
C. “I need to wear sunscreen outdoors while taking this medication.”
D. “I can stop this medication when I feel better.”
E. “I should take this medication on an empty stomach.”
Answers: A, D
Choices A and D are correct. These statements are incorrect and require follow-up.
➢ Premature discontinuation of antibiotics leads to therapeutic failure. Therefore, all antibiotics must be continued for the entire course, not when the symptoms abate.
➢ Doxycycline absorption may decrease when the client takes it with calcium.
➢ The client should be instructed not to take this medication with calcium-rich foods, dairy products, or antacids containing calcium. The client should take this medication on an empty stomach.
Choices B, C, and E are incorrect. These statements are correct and do not require follow-up.
➢ Doxycycline may cause superinfections such as C. diff. Foul-smelling diarrhea that may be accompanied by abdominal cramping should be reported.
➢ Doxycycline can also cause skin reactions, including photosensitivity. The client should be instructed to wear protective clothing, hats, and sunscreen outdoors.
➢ The client should take this medication on an empty stomach to avoid any drug/food interactions.
A nurse is educating a client about carbamazepine (Tegretol). Which instruction is most important to include regarding dietary restrictions?
A.Avoid high-potassium foods such as bananas and oranges
B.Avoid grapefruit and grapefruit juice, which can significantly increase drug levels
C.Take the medication with a high-fat meal for best absorption
D.Limit fluid intake to prevent drug dilution and subtherapeutic levels
Answer: B
B.Avoid grapefruit and grapefruit juice, which can significantly increase drug levels
Grapefruit and grapefruit juice inhibit CYP3A4 enzymes in the gut wall, which are responsible for metabolizing carbamazepine. This interaction can significantly raise serum carbamazepine levels, leading to toxicity (dizziness, diplopia, ataxia). Clients should be instructed to avoid grapefruit products entirely during therapy. Fluid restriction and high-fat meal requirements are not relevant to carbamazepine.
While reviewing a client's medication list, the nurse understands which prescribed medication(s) is/are classified as calcium channel blockers. Select all that apply.
A. Nifedipine
B. Propranolol
C. Verapamil
D. Hydralazine
E. Digoxin
Answers: A, C
Choices A and C are correct. Nifedipine and verapamil are calcium channel blockers ( CCBs). Other CCBs include amlodipine, nicardipine, felodipine, and diltiazem.
Choice B is incorrect. β-blockers can be identified by their suffix ending with "-lol."
Choice D is incorrect. Hydralazine is a direct vasodilator.
Choice E is incorrect. Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.
The nurse is caring for a client receiving a continuous heparin infusion. Which of the following laboratory data should the nurse monitor? Select all that apply.
A. Activated Partial thromboplastin time (aPTT)
B. Platelet count
C. Prothrombin time (PT)
D. Neutrophil count
E. International normalized ratio (INR)
Answers: A, B
A. Activated Partial thromboplastin time (aPTT)
B. Platelet count
Choice A is correct. For a client receiving a continuous infusion of heparin, the nurse needs to monitor the client's aPTT. Heparin prolongs the aPTT (the goal is 1½ to 2 times the control value) and should be observed frequently. The normal aPTT is 30-40 seconds.
Choice B is correct. Platelet counts that decrease by approximately 50% may indicate heparin-induced thrombocytopenia, which should be reported. This adverse effect may occur for a client receiving heparin products.
Choices C and E are incorrect. PT and INR are labs that should be monitored while a client is receiving warfarin.
Choice D is incorrect. Neutrophils are the most abundant form of white blood cells. Monitoring neutrophils is essential when a client is receiving clozapine, an atypical antipsychotic used to treat schizophrenia.
The nurse is caring for a client receiving albuterol via metered dose inhaler (MDI). Which of the following adverse/side effects of this medication would be expected? Select all that apply.
A. Tachycardia
B. Hypotension
C. Tremors
D. Dry mouth
E. Hyperglycemia
F. Bradycardia
Answers: A, C, D, E
A. Tachycardia
C. Tremors
D. Dry mouth
E. Hyperglycemia
Choices A, C, D, and E are correct. Albuterol is a short-acting bronchodilator indicated in treating asthma and other chronic respiratory illnesses. Side effects associated with this medication include hyperglycemia, tremors, hypokalemia, and nervousness. Albuterol can stimulate the beta-2 receptors in the salivary glands, which can cause a decrease in the production of saliva.
A nurse is caring for a 72-year-old patient admitted with aspiration pneumonia who is receiving clindamycin 600 mg IV every 8 hours. On day 5 of treatment, the patient develops 8–10 large-volume, foul-smelling watery stools over 12 hours, abdominal cramping, and a fever of 38.9°C. A stool sample is sent. Which set of nursing actions is most appropriate while awaiting results?
Vitals: BP 102/64, HR 108, RR 20, Temp 38.9°C, SpO2 94%. Labs: WBC 18.2 (baseline 9.1), Lactate 2.3 mmol/L, SCr 1.8 (baseline 1.1), Na 131. Last clindamycin dose given 2 hours ago. Next dose due in 6 hours.
A: Administer the next clindamycin dose as scheduled, push IV fluids, and send stool for culture — await results before changing the antibiotic
B: Hold the next clindamycin dose, notify the provider, initiate contact precautions, and begin aggressive IV fluid resuscitation given signs of early sepsis
C: Discontinue clindamycin, administer oral vancomycin immediately without waiting for culture results, and begin contact precautions
D: Administer loperamide (Imodium) to reduce stool frequency, continue clindamycin, and reassess in 4 hours
Answer: C
C: Discontinue clindamycin, administer oral vancomycin immediately without waiting for culture results, and begin contact precautions
This presentation is classic for Clostridioides difficile (C. diff) colitis — a well-known complication of clindamycin, one of the highest-risk antibiotics for disrupting colonic flora. The nurse's role at this stage is to hold the causative antibiotic pending provider review, initiate contact precautions immediately (C. diff is highly transmissible via spores), and address the patient's deteriorating hemodynamics: hypotension (BP 102/64), tachycardia (HR 108), rising creatinine, and lactate of 2.3 all indicate early sepsis requiring urgent IV fluid resuscitation.
Option C is incorrect because the nurse cannot independently discontinue antibiotics or initiate new ones — that requires a provider order.
Option D is dangerous: loperamide is contraindicated in infectious diarrhea as it traps toxins in the colon and can precipitate toxic megacolon.
A nurse is reviewing lab results for a client on valproic acid (Depakote). Which findings would be most concerning and require immediate provider notification?
A.Serum valproic acid level of 75 mcg/mL and normal liver enzymes
B.Platelet count of 95,000/mm³, AST three times normal, and ammonia level of 112 mcg/dL
C.Mild elevation in triglycerides and weight gain of 2 lbs over 1 month
D.Serum sodium of 138 mEq/L and potassium of 4.0 mEq/L
Answer: B
B.Platelet count of 95,000/mm³, AST three times normal, and ammonia level of 112 mcg/dL
This combination of findings signals multiple serious valproic acid toxicities simultaneously: thrombocytopenia (platelet count <100,000), hepatotoxicity (AST 3x normal — Black Box Warning for fatal liver failure), and hyperammonemia (ammonia >80 mcg/dL causes encephalopathy). This requires immediate provider notification. A drug level of 75 mcg/mL is therapeutic (50–100 mcg/mL), mild triglyceride elevation is expected, and the electrolytes are normal.
A nurse is teaching a client about newly prescribed hydrochlorothiazide (HCTZ). Which of the following statements, if made by the client, indicates an effective understanding of the potential side effects?
A. "I should be cautious about prolonged sun exposure as HCTZ can increase photosensitivity."
B. "I may experience drowsiness and sedation due to the central nervous system depressant effect of HCTZ."
C. "HCTZ can cause hypocalcemia, so I need to increase my intake of foods high in calcium."
D. "I might develop taste disturbances or loss of appetite as a common side effect of HCTZ."
Answer: A
Choice A is correct. HCTZ, like other thiazide diuretics, can increase the skin's sensitivity to sunlight, leading to exaggerated sunburn reactions. The client should be instructed to wear appropriate sunscreen and arrange to complete outdoor activities in the early morning or later evening hours.
Choice B is incorrect. Thiazide diuretics are not known to cause drowsiness or sedation. Antihypertensives such as clonidine are known to cause this effect.
Choice C is incorrect. Thiazide diuretics promote the retention of calcium. Unlike loop diuretics which waste calcium, thiazide diuretics cause the calcium to be reabsorbed.
Option D is incorrect. Taste disturbances and loss of appetite are not commonly associated with HCTZ use. ACE inhibitors are known to cause taste disturbances.
The nurse received a prescription for a continuous infusion of weight-based heparin for a client with acute coronary syndrome. Prior to administering the medication, the nurse should:
A. obtain a blood specimen to measure the creatinine.
B. weigh the client.
C. obtain a blood specimen to measure the international normalized ratio (INR).
D. verify that the client has a 20-gauge peripheral venous access device (VAD).
Answer: B
B. weigh the client.
Choice B is correct. The client needs to be weighed for prescribed a weight-based heparin infusion. An accurate weight, along with a baseline activated partial thromboplastin time (aPTT) and platelet count, should be obtained prior to the start of the infusion.
Choices A, C, and D are incorrect. Serum creatinine level is not required because kidney function does not affect heparin dosing. This is not true if the client were prescribed a low molecular weight-based heparin such as enoxaparin which is excreted by the kidneys; their biological half-life may be prolonged in clients with kidney failure. INR does not need to be obtained. This laboratory parameter is monitored when a client is receiving warfarin. Heparin does not require a 20-gauge peripheral vascular access device. This is a true statement for a client receiving a unit of packed red blood cells but not heparin.
The nurse is reviewing a client’s list of medications who has cystic fibrosis. The nurse anticipates a prescription for which medication? Select all that apply.
A. Multivitamin
B. Aspirin
C. Warfarin
D. Simvastatin
E. Salmeterol
Answers: A, E
Choices A and E are correct. Cystic Fibrosis is a multisystem disorder that causes gastrointestinal disturbances such as malabsorption of essential fat-soluble vitamins (A, D, E, and K). A multivitamin is prescribed to help mitigate these vitamin deficiencies. Salmeterol is a long-acting bronchodilator and has utility in cystic fibrosis as the airways may become narrowed or obstructed.
A nurse is preparing to administer the first dose of daptomycin (Cubicin) 6 mg/kg IV to a patient with MRSA bacteremia. During the pre-administration assessment, the nurse reviews the patient's current medications and identifies one that requires immediate clarification with the provider before the infusion is started. Which medication is it?
A: Aspirin — its antiplatelet effect combined with daptomycin increases the risk of serious bleeding complications
B: Insulin glargine — daptomycin causes significant hypoglycemia and the evening insulin dose must be held
C: Atorvastatin — concurrent use with daptomycin significantly increases the risk of myopathy and rhabdomyolysis, and the statin should be held or discontinued during therapy
D: Lisinopril — daptomycin is nephrotoxic and ACE inhibitors compound the renal risk requiring dose adjustment before starting
Answer: C
C: Atorvastatin — concurrent use with daptomycin significantly increases the risk of myopathy and rhabdomyolysis, and the statin should be held or discontinued during therapy
Daptomycin carries a well-documented risk of skeletal muscle toxicity — myopathy and rhabdomyolysis — which is significantly amplified when co-administered with HMG-CoA reductase inhibitors (statins) like atorvastatin. Both drugs independently cause muscle damage, and the combination can be life-threatening.
A client with a seizure disorder is admitted after a generalized tonic-clonic seizure. The client reports taking phenytoin as prescribed. A serum phenytoin level is 8 mcg/mL. Which factor would the nurse consider as a likely cause of the breakthrough seizure?
A.The level is toxic — the client took too much phenytoin
B.The level is subtherapeutic (below 10 mcg/mL), suggesting non-absorption, missed doses, or a drug interaction reducing levels
C.The level is therapeutic; the seizure was likely caused by a new brain lesion
D.A level of 8 mcg/mL is acceptable in clients with long-standing epilepsy
Answer: B
B.The level is subtherapeutic (below 10 mcg/mL), suggesting non-absorption, missed doses, or a drug interaction reducing levels
The therapeutic range for phenytoin is 10–20 mcg/mL. A level of 8 mcg/mL is subtherapeutic and insufficient to prevent seizures. Common causes include missed doses, poor absorption, drug interactions (carbamazepine and other CYP inducers lower phenytoin levels), or increased metabolism. The provider should be notified and the dose adjusted. A therapeutic level does not guarantee seizure control, but a subtherapeutic level is the first thing to investigate after a breakthrough seizure.
A nurse is reviewing the morning assessment and labs for a 66-year-old patient with heart failure with reduced ejection fraction (HFrEF) admitted for volume overload. The patient has been medically managed for 3 days. While preparing the morning medications, the nurse identifies a combination of findings that together represent an immediate patient safety concern. Which action should the nurse take first?
Morning labs (just resulted): K+ 5.8 mEq/L (yesterday: 4.9), Na+ 136, BUN 42, SCr 1.9 (baseline 1.6), eGFR 36. Today's vitals: BP 98/62, HR 52, RR 18, SpO2 96%. Telemetry: Sinus bradycardia, no peaked T-waves noted on current strip. Patient reports: Feeling more fatigued than yesterday, mild muscle weakness in legs.
A: Hold the furosemide dose — the patient's blood pressure is 98/62 and the diuretic will worsen hypotension and prerenal azotemia
B: Hold lisinopril and spironolactone, notify the provider urgently about the potassium of 5.8 mEq/L in the context of rising creatinine and symptoms of hyperkalemia, and obtain a stat ECG
C: Hold carvedilol — the heart rate of 52 bpm is below the threshold for administration and is the most urgent concern
D: Administer all medications as ordered and notify the provider at rounds — the potassium is only mildly elevated and the patient is on telemetry
Answer: B
B: Hold lisinopril and spironolactone, notify the provider urgently about the potassium of 5.8 mEq/L in the context of rising creatinine and symptoms of hyperkalemia, and obtain a stat ECG
The patient has a potassium of 5.8 mEq/L — a significant rise from 4.9 just yesterday — in the setting of worsening renal function (SCr up from 1.6 to 1.9, eGFR down to 36). The cause is clear: the patient is on two potassium-retaining agents at the same time — lisinopril (an ACE inhibitor that blocks aldosterone, reducing potassium excretion) and spironolactone (a potassium-sparing diuretic that directly antagonizes aldosterone). In a patient with CKD whose kidneys are already struggling to excrete potassium, this combination is well-known to cause dangerous hyperkalemia. Critically, the patient is now reporting fatigue and leg weakness — early neuromuscular symptoms of hyperkalemia — even though the telemetry strip does not yet show peaked T-waves. The absence of ECG changes does not rule out dangerous hyperkalemia; cardiac manifestations can appear suddenly. Both potassium-retaining medications must be held immediately, the provider notified urgently, and a stat 12-lead ECG obtained to detect early cardiac involvement.
Option A is also partially correct nursing judgment (furosemide + hypotension warrants caution) but does not address the primary danger.
Option C is a plausible distractor — carvedilol should indeed be held for HR under 60 — but a potassium of 5.8 with symptoms and rising creatinine represents the more immediately life-threatening concern and must be addressed first.
Option D is dangerous — a K+ of 5.8 that rose by 0.9 overnight with symptoms in a patient on two potassium-retaining drugs in the setting of worsening renal failure cannot wait until rounds.
The nurse is performing a staff education conference regarding warfarin. It is correct for the nurse to identify that warfarin may be prescribed to a client Select all that apply.
A. who has atrial fibrillation.
B. with a hemorrhagic stroke.
C. with a deep vein thrombosis.
D. who has had a mitral valve replacement.
E. with severe liver disease.
Answers: A, C, D
A. who has atrial fibrillation.
C. with a deep vein thrombosis.
D. who has had a mitral valve replacement
Choice A is correct. Anticoagulants, such as warfarin, increase clotting time to prevent thrombi from forming or growing larger. Atrial fibrillation can lead to a pooling of blood, which results in clotting. This places the client at risk for pulmonary embolism and embolic stroke. A client with atrial fibrillation would be expected to be prescribed warfarin.
Choice C is correct. Deep vein thrombosis can be prescribed with anticoagulant medications such as warfarin. Other anticoagulant medications that can be used include heparin and rivaroxaban.
Choice B is incorrect. History of hemorrhagic stroke is a contraindication for taking warfarin.
Choice E is incorrect. Warfarin is contraindicated in individuals with severe liver disease because the liver plays a key role in metabolizing the medication, and impairment of liver function can increase the risk of bleeding.
A nurse is caring for a 58-year-old client with moderate persistent asthma who has been prescribed salmeterol/fluticasone (Advair Diskus) for 3 months. During a routine visit, the client reports using their albuterol rescue inhaler 4–5 times per week and states, "I feel like the Advair isn't working anymore, so I've been using it twice a day instead of once." SpO₂ is 95% on room air. The client denies fever or URI symptoms. Which action by the nurse is most appropriate?
A. Reinforce that doubling the Advair dose is appropriate when symptoms worsen and document the client's self-adjustment.
B. Notify the provider that the client's asthma is poorly controlled and that the client is self-adjusting a long-acting beta-agonist/inhaled corticosteroid combination.
C. Instruct the client to discontinue the Advair immediately and use only albuterol until the provider can be reached.
D. Teach the client that increased albuterol use is expected with combination therapy and schedule a 6-month follow-up.
Answer: B
B. Notify the provider that the client's asthma is poorly controlled and that the client is self-adjusting a long-acting beta-agonist/inhaled corticosteroid combination.
The client is using rescue albuterol 4–5 times per week — a hallmark of poorly controlled or worsening asthma per guidelines. More critically, the client has self-increased their LABA/ICS combination without provider direction. LABAs (salmeterol) carry an FDA black box warning: they must never be used as the sole controller therapy without an ICS, and the dose must not be self-adjusted. Increasing LABA exposure raises the risk of fatal bronchospasm. The priority action is to contact the provider with a full clinical picture so the regimen can be safely evaluated and stepped up if indicated.
A — Incorrect. Self-doubling a LABA/ICS is dangerous and must never be endorsed. The nurse must escalate, not document self-adjustment as acceptable.
C — Incorrect. Abruptly discontinuing inhaled corticosteroids can precipitate rebound inflammation and a severe asthma exacerbation. This is not within nursing scope without a provider order.
D — Incorrect. Increased rescue inhaler use signals worsening control, not an expected finding. Delaying follow-up for 6 months with a poorly controlled client is a safety risk.
A nurse is preparing to administer the first dose of IV metronidazole (Flagyl) 500 mg to a patient with a confirmed anaerobic intra-abdominal infection. Before hanging the infusion, the nurse reviews the chart and identifies a finding that requires immediate clarification with the provider before the dose is given. Which finding is it?
Medical history: Epilepsy (on phenytoin 300 mg daily), liver cirrhosis (Child-Pugh Class B), alcohol use disorder (last drink 3 days ago). Allergies: Penicillin (rash). Most recent labs: ALT 112 U/L, AST 98 U/L, Total bilirubin 3.1 mg/dL, INR 1.9, Albumin 2.6 g/dL, Phenytoin level: 17 mcg/mL (therapeutic range 10–20 mcg/mL).
A: The patient's INR of 1.9 suggests bleeding risk and metronidazole should be withheld until it normalizes
B: Metronidazole inhibits CYP2C9, which metabolizes phenytoin — co-administration can cause phenytoin toxicity, and the provider must be notified before the dose is given
C: The patient's liver cirrhosis is an absolute contraindication to metronidazole and the drug cannot be used at all
D: The patient drank alcohol 3 days ago and metronidazole must not be given for at least 7 days after the last drink to prevent a disulfiram-like reaction
Answer: B
B: Metronidazole inhibits CYP2C9, which metabolizes phenytoin — co-administration can cause phenytoin toxicity, and the provider must be notified before the dose is given
Metronidazole is a significant inhibitor of CYP2C9, the enzyme responsible for metabolizing phenytoin. Co-administration reduces phenytoin clearance, causing drug accumulation even when the current level appears therapeutic (17 mcg/mL is near the upper limit of 10–20). Adding metronidazole without adjusting the phenytoin dose or increasing monitoring frequency can rapidly push the level into the toxic range (>20 mcg/mL), causing ataxia, nystagmus, confusion, and seizures — especially dangerous in a patient with epilepsy. The nurse must clarify this interaction with the provider before hanging the infusion.
Option A is a distractor; the INR reflects cirrhosis-related coagulopathy and does not contraindicate metronidazole.
Option C is incorrect — liver cirrhosis is not an absolute contraindication, but dose reduction and close monitoring are required.
Option D is incorrect — the 48-hour abstinence window is the clinical standard for the disulfiram-like reaction risk, not 7 days.
A nurse is caring for a client prescribed phenytoin (Dilantin). Which instructions should the nurse include in the discharge teaching? Select all that apply.
A. Brush and floss diligently and see a dentist regularly due to risk of gingival hyperplasia.
B. You may stop taking phenytoin if you have been seizure-free for 6 months.
C. Report signs of toxicity such as unsteady walking, slurred speech, or involuntary eye movements.
D. Avoid alcohol, as it can alter phenytoin levels and increase CNS depression.
E. Take phenytoin with antacids to reduce stomach upset.
F.Keep all follow-up appointments for blood draws to monitor serum drug levels
Answers: A, C, D, F
A. Brush and floss diligently and see a dentist regularly due to risk of gingival hyperplasia.
C. Report signs of toxicity such as unsteady walking, slurred speech, or involuntary eye movements.
D. Avoid alcohol, as it can alter phenytoin levels and increase CNS depression.
F. Keep all follow-up appointments for blood draws to monitor serum drug levels
B. Incorrect. Phenytoin must never be stopped abruptly — this can trigger status epilepticus. Any change to the regimen requires provider guidance and a slow taper.
E. Incorrect. Antacids reduce phenytoin absorption, leading to subtherapeutic levels. Phenytoin should be taken separately from antacids, calcium, and other absorption-reducing agents.