Week 5
A nurse is educating a client prescribed cyclobenzaprine for muscle spasms after a back injury. Which adverse effect should the nurse prioritize in patient teaching?
A. Hypoglycemia
B. Drowsiness and dizziness
C. Dry cough
D. Photosensitivity
ANS: B
Rationale: Cyclobenzaprine is a centrally acting muscle relaxant that often causes drowsiness, dizziness, and dry mouth. It has anticholinergic properties. Clients should avoid alcohol and other CNS depressants and be cautious with activities requiring alertness.
A client prescribed lisinopril for hypertension reports a persistent dry cough. What is the nurse’s best action?
A. Advise the client to take the medication with food
B. Document the symptom and reassure the client it's harmless
C. Notify the provider to consider an alternative medication
D. Instruct the client to stop taking the medication immediately
ANS: C
Rationale: A dry, persistent cough is a common side effect of ACE inhibitors like lisinopril due to bradykinin accumulation. The provider may switch the client to an ARB (e.g., losartan), which does not typically cause cough. The drug should not be discontinued without provider direction.
Before administering metoprolol to a client with heart failure, which assessment finding requires immediate action?
A. Blood pressure 118/72 mmHg
B. Heart rate 56 bpm
C. Blood glucose 110 mg/dL
D. Respiratory rate 18 breaths/min
ANS: B
Rationale: Beta blockers like metoprolol decrease heart rate and are held for HR < 60 bpm. They may cause bradycardia, hypotension, and fatigue, especially in older adults or those who are beta blocker naïve.
Raloxifene is prescribed for a postmenopausal woman to prevent osteoporosis. Which of the following should the nurse include in teaching?
A. "This medication increases your risk of uterine cancer."
B. "Report any leg swelling or calf pain immediately."
C. "You can stop taking calcium and vitamin D supplements."
D. "This drug must be taken with food."
ANS: B
Rationale: Raloxifene increases the risk for venous thromboembolism (VTE). Clients should report signs of DVT or PE (leg swelling, pain, shortness of breath). It does not increase uterine cancer risk like unopposed estrogen does.
A client receiving testosterone therapy for hypogonadism is concerned about swelling in his lower legs. What is the nurse’s best response?
A. "This is a normal response to the medication."
B. "Let’s notify the provider — this could indicate fluid retention."
C. "Try elevating your legs more often throughout the day."
D. "This is likely unrelated to the medication."
ANS: B
Rationale: Testosterone can cause sodium and water retention, which may lead to edema and weight gain. This effect should be evaluated by the provider, especially in clients with cardiac or renal risk factors.
A client is starting allopurinol for chronic gout. Which of the following statements by the client indicates understanding of the medication?
A. "I’ll stop taking this if I get a gout flare-up."
B. "Starting this medication may trigger a gout flare."
C. "I’ll expect this to relieve my pain during an attack."
D. "I don’t need to get any labs drawn while on this medication."
ANS: B
Rationale: Starting allopurinol can trigger a gout flare when it is started. Make sure patient is aware of this and that they may need to take NSAIDs or glucocorticoids when they start allopurinol to manage their symptoms or pain.
A nurse is monitoring a client newly prescribed amlodipine. Which of the following findings should the nurse report to the provider?
A. BP of 132/78 mmHg
B. Heart rate of 72 bpm
C. Peripheral edema in both ankles
D. Flushing after activity
ANS: C
Rationale: Amlodipine, a dihydropyridine calcium channel blocker, commonly causes peripheral edema due to vasodilation. While flushing is a benign side effect, edema may indicate poor tolerance or fluid retention requiring intervention.
A client with chronic stable angina uses sublingual nitroglycerin. Which instruction should the nurse include in teaching?
A. "Take one tablet every hour as needed for chest pain."
B. "Keep the tablets in your bathroom for easy access."
C. "You may repeat the dose every 5 minutes up to three times."
D. "Swallow the tablet whole with a glass of water."
ANS: C
Rationale: Sublingual nitroglycerin should be taken every 5 minutes up to 3 times during an angina attack. The tablet must dissolve under the tongue, not be swallowed. It should be stored in a cool, dark place, not the bathroom.
A client prescribed sildenafil for erectile dysfunction is also taking isosorbide for angina. What is the nurse’s priority action?
A. Encourage the client to avoid alcohol
B. Educate about the risk of priapism
C. Instruct the client to report flushing and headache
D. Notify the provider of the potential drug interaction
ANS: D
Rationale: Sildenafil + nitrates like isosorbide can cause life-threatening hypotension due to excessive vasodilation. This combination is contraindicated. The provider should be notified immediately.
Which statement by a client taking clomiphene for infertility indicates a need for further teaching?
A. "I might experience hot flashes or mood swings."
B. "This medication helps me ovulate."
C. "Once I become pregnant, I will keep taking clomiphene."
D. "I should report any visual disturbances to my provider."
ANS: C
Rationale: Clomiphene is only used to stimulate ovulation; it should be discontinued once pregnancy is achieved. Side effects include hot flashes, mood changes, and visual disturbances, which should be reported
The nurse is monitoring a post-op client receiving IV morphine. Which assessment finding requires immediate action?
A. Respiratory rate of 8 breaths/min
B. Mild confusion
C. Complaints of constipation
D. Pinpoint pupils
ANS: A
Rationale: A respiratory rate <10 indicates respiratory depression, the most serious opioid side effect. Sedation precedes respiratory depression, especially in opioid-naive patients. Constipation and miosis are expected; confusion may occur but is less immediately dangerous.
A client receiving IV nitroprusside for hypertensive crisis suddenly develops confusion and muscle twitching. What is the nurse’s priority action?
A. Reassure the client and continue monitoring
B. Assess for other signs of hyperkalemia
C. Stop the infusion and notify the provider immediately
D. Administer naloxone as prescribed
ANS: C
Rationale: These are signs of cyanide toxicity, a rare but life-threatening adverse effect of nitroprusside, especially with prolonged use. The nurse should immediately stop the infusion and contact the provider.
A client taking atorvastatin reports new onset of muscle pain and weakness. What should the nurse do first?
A. Encourage the client to increase fluid intake
B. Instruct the client to take the medication with food
C. Notify the provider and assess creatine kinase (CK) levels
D. Reassure the client this is a common side effect
ANS: C
Rationale: Muscle pain and weakness may indicate rhabdomyolysis, a rare but serious complication of statins like atorvastatin. The provider should be notified immediately, and CK levels assessed. Do not reassure without further evaluation.
Which lab value would indicate that levothyroxine therapy is effective?
A. Increased TSH
B. Decreased TSH
C. Increased calcium
D. Decreased T4
ANS: B
Rationale: In hypothyroidism, TSH is high because the body is trying to stimulate more thyroid hormone. As levothyroxine increases T4, TSH should decrease toward normal levels. TSH is the most sensitive indicator of treatment response.
A client taking methimazole for hyperthyroidism reports a sore throat and fever. What is the nurse’s best action?
A. Reassure the client this is an expected side effect
B. Encourage fluids and rest at home
C. Instruct the client to stop the medication
D. Notify the provider and assess white blood cell count
ANS: D
Rationale: Sore throat and fever may indicate agranulocytosis, a rare but serious side effect of methimazole. The nurse should notify the provider immediately and obtain a CBC to assess WBC count.
Which client statement about ketorolac (Toradol) requires follow-up by the nurse?
A. "I’m using it for a few days after surgery."
B. "I take it on an empty stomach for faster relief."
C. "My doctor said this works as well as opioids."
D. "I’ve been drinking more fluids to protect my kidneys."
ANS: B
Rationale: NSAIDs, including ketorolac, should be taken with food to reduce the risk of GI bleeding or ulcers. They are nephrotoxic, especially with dehydration or pre-existing renal impairment. Short-term use (e.g., 5 days max) is typical.
Which client history would cause the nurse to question an order for valsartan?
A. Type 2 diabetes
B. Renal artery stenosis
C. Asthma
D. Hyperlipidemia
ANS: B
Rationale: ARBs (like valsartan) are contraindicated in clients with renal artery stenosis because they can severely impair renal perfusion. Asthma and hyperlipidemia are not contraindications. Always check renal labs and blood pressure before administration.
Which statement indicates the client needs more teaching about amiodarone therapy?
A. "I’ll have regular eye exams while taking this medication."
B. "I need frequent lung and thyroid tests."
C. "I should avoid drinking grapefruit juice."
D. "This medication is only for while I am in the hospital and I will go home on another oral med."
ANS: D
Rationale: Amiodarone is typically given in an IV-loading dose (bolus), then via IV infusion, and then transitioned to oral medication the patient can be discharged on. Amiodarone requires regular monitoring due to risks for pulmonary fibrosis, thyroid dysfunction, liver toxicity, and ocular changes.
Which statement indicates a client needs further teaching about long-term prednisone use?
A. "I’ll take this medication in the morning with food."
B. "I can stop this medication whenever I feel better."
C. "I’ll monitor for signs of infection."
D. "I understand this may affect my blood sugar levels."
ANS: B
Rationale: Prednisone must be tapered, not stopped abruptly, due to risk of adrenal insufficiency. Long-term use suppresses the HPA axis. Clients should monitor for infection, hyperglycemia, and GI bleeding.
A nurse is teaching a client about fludrocortisone for Addison’s disease. Which statement indicates a correct understanding?
A. "I should report any swelling in my ankles."
B. "I need to avoid eating too much salt."
C. "I’ll take this medication only when symptoms appear."
D. "This drug will help lower my blood pressure."
ANS: A
Rationale: Fludrocortisone mimics aldosterone, promoting sodium and water retention, which can cause hypertension and edema. Clients should report swelling, weight gain, or signs of fluid overload. This med is taken daily, not PRN.
A client receives naloxone after IV morphine administration. Which of the following should the nurse anticipate?
A. Prolonged sedation
B. Severe constipation
C. Return of pain and possible need for redosing
D. Bronchospasm
ANS: C
Rationale: Naloxone reverses opioid effects but has a short half-life, so opioid effects can return, especially with longer-acting opioids like hydromorphone. The nurse should monitor for re-sedation and pain recurrence. It does not cause bronchospasm or constipation itself.
A client taking warfarin has an INR of 4.5. Which action should the nurse take first?
A. Hold the next dose and notify the provider
B. Prepare to administer vitamin K
C. Document the finding as therapeutic
D. Encourage the client to eat more leafy greens
ANS: A
Rationale: An INR of 4.5 is above the therapeutic range (2–3) and increases the risk of bleeding. The next dose should be held, and the provider should be notified. Vitamin K may be given depending on the client’s bleeding risk and provider judgment. Dietary advice should be consistent and individualized, not reactionary.
A nurse is caring for a client receiving IV lidocaine for ventricular dysrhythmias. Which finding indicates potential toxicity?
A. Numbness and tingling
B. Nausea
C. Drowsiness and confusion
D. Mild tachycardia
ANS: C
Rationale: Lidocaine toxicity can cause CNS symptoms such as confusion, tremors, drowsiness, and seizures. It has a narrow therapeutic index and must be closely monitored during IV infusion.
A nurse is caring for a client with chronic kidney disease who is prescribed calcitriol. Which of the following lab values should the nurse monitor to evaluate the effectiveness of the medication?
A. Serum potassium
B. Serum phosphorus
C. Serum calcium
D. Serum creatinine
ANS: C
Rationale: Calcitriol is the active form of vitamin D and is used to treat hypocalcemia, particularly in clients with CKD who cannot convert vitamin D to its active form. The nurse should monitor serum calcium to assess treatment effectiveness. While phosphorus and creatinine are relevant in CKD, they are not direct indicators of calcitriol efficacy.
Which of the following clients is most likely to receive hydroxyprogesterone caproate?
A. A client at 38 weeks with mild preeclampsia
B. A client with a history of preterm birth currently 18 weeks pregnant
C. A client in active labor at 37 weeks
D. A client receiving induction of labor with oxytocin
ANS: B
Rationale: Hydroxyprogesterone caproate is a tocolytic used to prevent preterm labor, especially in women with a history of spontaneous preterm birth. It is administered as a weekly IM injection during weeks 16 to 36 of pregnancy.