Anti-Infectives, Anti-inflammatories, Immunizations
A patient taking dimethyl fumarate has low lymphocytes and fever. What is the priority nursing concern?
A. constipation
B. infection risk
C. dehydration
D. hypotension
B — Low lymphocytes + fever = infection risk with fumarates.
A postoperative patient receiving morphine has respirations of 10/min and is difficult to arouse. Which action is priority?
A. Reassess in 1 hour
B. Give the next dose with food
C. Administer naloxone per order
D. Encourage ambulation
C — RR 10 + hard to arouse = give naloxone
A patient taking pantoprazole long term develops black tarry stools. What is the priority action?
A. Give the next dose with milk
B. Hold the medication and report possible GI bleeding
C. Document this as harmless
D. Instruct the patient to increase fiber
B — Black stools suggest possible GI bleed.
A patient has used oxymetazoline nasal spray for 7 days and now reports worse congestion. What is the best interpretation?
A. Expected allergy symptoms
B. Rebound congestion
C. Fungal infection
D. Bronchospasm
B — Oxymetazoline overuse causes rebound congestion (rhinitis medicamentosa)
A patient taking atorvastatin reports severe muscle pain and dark urine after beginning a new antibiotic. Which action should the nurse take first?
A. Hold the medication and notify the provider
B. Encourage fluids and rest
C. Tell the patient this is expected
D. Instruct the patient to take it with food
A — Severe muscle pain + dark urine after statin therapy suggests rhabdomyolysis/myopathy, especially with interacting antibiotics.
A patient receiving corticosteroids has glucose levels climbing each day. The nurse recognizes this as:
A. an expected risk of steroid therapy
B. a sign the patient is cured
C. a reason to give grapefruit juice
D. unrelated to the medication
A — Steroids raise blood glucose.
A patient taking lithium develops vomiting, coarse tremors, and confusion. Which action is priority?
A. Give the next dose with food
B. Hold the lithium and notify the provider
C. Encourage caffeine
D. Document as expected effects
B — Vomiting, tremors, confusion = lithium toxicity.
A postpartum client is receiving an oxytocin infusion after delivery. The nurse notes uterine contractions are becoming very frequent, and the fetal heart rate begins to show signs of distress. What is the nurse’s priority action?
A. Continue the infusion and monitor closely
B. Leave the client briefly to notify the provider
C. Stay with the client and intervene immediately
D. Give methylergonovine maleate
C. Stay with the client and intervene immediately
Rationale: Oxytocin can cause excessive uterine contractions, which may lead to fetal distress. The nurse should never leave a patient alone on an oxytocin drip and should respond right away to protect both mother and fetus.
A patient taking fingolimod has a heart rate of 44/min. What is the nurse’s priority action?
A. Document this as expected only
B. Administer the medication with food
C. Notify the provider
D. Encourage exercise
C — Fingolimod bradycardia requires immediate provider notification.
SATA Which teaching should the nurse include for opioid agonists?
A. Increase fluids and fiber
B. Rise slowly
C. Avoid alcohol
D. Respiratory depression is a concern
E. Stop stool softeners once pain improves
A, B, C, D — Core opioid teaching includes constipation prevention and respiratory safety.
A patient taking metoclopramide develops repetitive lip smacking and muscle spasms. The nurse suspects:
A. EPS
B. hypoglycemia
C. GI infection
D. opioid overdose
A — Metoclopramide can cause EPS.
A patient with glaucoma and BPH asks for an OTC antihistamine. Which response by the nurse is best?
A. “That is a safe first-line choice for you.”
B. “Take two doses at night only.”
C. “Use caution because antihistamines can worsen both conditions.”
D. “Only liquid forms cause problems.”
C — Antihistamines worsen glaucoma and urinary retention.
A patient taking niacin reports flushing and itching 20 minutes after the dose. Which instruction is best?
A. Stop the medication permanently
B. Take it with grapefruit juice
C. Take aspirin 30 minutes before the dose if prescribed
D. Skip meals before taking it
C — Aspirin before niacin helps reduce prostaglandin-mediated flushing.
SATA Which teaching is appropriate for insulin administration?
A. Rotate injection sites
B. Check blood glucose as directed
C. Recognize signs of hypoglycemia
D. Carry a rapid glucose source if prescribed
E. Use the exact same site every time
A, B, C, D — Standard insulin safety teaching.
A patient taking phenytoin has swollen, bleeding gums. Which teaching is most appropriate?
A. Stop all oral care
B. Increase calcium only
C. Practice good oral hygiene and see a dentist regularly
D. Crush the medication before taking it
C — Phenytoin causes gingival hyperplasia; oral care is priority.
A male client with benign prostatic hyperplasia has been taking finasteride for 2 weeks and says, “This medicine is not working. I still have urinary problems.” What is the nurse’s best response?
A. “You should stop taking it and call the provider today.”
B. “This medication often takes 6 to 12 months for full effect.”
C. “You should double the dose until symptoms improve.”
D. “This medicine works immediately only if taken with food.”
Answer: B. “This medication often takes 6 to 12 months for full effect.”
Rationale: Antiandrogen agents such as finasteride reduce prostate hyperplasia gradually and may take 6 to 12 months before the client notices full benefit.
A patient on long-term glucocorticoids has hyperglycemia, mood changes, and delayed wound healing. These findings are:
A. unrelated
B. expected corticosteroid risks
C. signs of lithium toxicity
D. signs of serotonin syndrome
B — These are expected corticosteroid complications.
A patient dependent on opioids receives nalbuphine and becomes restless, diaphoretic, and anxious. What is the best interpretation?
A. improved analgesia
B. acute withdrawal
C. allergic reaction
D. expected sedation
B — Nalbuphine in opioid-dependent patient can precipitate withdrawal.
A patient with GERD says, “I lie flat after meals so my food digests better.” Which response is best?
A. “That is a helpful strategy.”
B. “Try taking antacids with orange juice.”
C. “You should elevate the head of your bed and avoid lying flat after meals.”
D. “Eat a large bedtime snack instead.”
C — GERD teaching includes avoiding lying flat after meals.
SATA Which effects are expected after albuterol administration?
A. Tremors
B. Tachycardia
C. Nervousness
D. Bronchoconstriction
E. Improved airflow
A, B, C, E — Albuterol commonly causes tremor, tachycardia, nervousness, and improved airflow.
Which lab finding is most concerning in a patient taking a statin?
A. Hgb 12.8 g/dL
B. AST and ALT elevated
C. Sodium 138 mEq/L
D. Glucose 102 mg/dL
B — Elevated liver enzymes = possible statin hepatotoxicity.
SATA Which findings are associated with hypoglycemia?
A. Diaphoresis
B. Shakiness
C. Confusion
D. Tachycardia
E. Fruity breath only
A, B, C, D — Classic hypoglycemia findings.
A patient taking haloperidol develops fever, muscle rigidity, and confusion. The nurse should suspect:
A. serotonin syndrome
B. NMS
C. cholinergic crisis
D. opioid withdrawal
B — Fever + rigidity + confusion = Neuroleptic Malignant Syndrome.
A client is prescribed sildenafil for erectile dysfunction and tells the nurse he also uses nitroglycerin for chest pain. Which response by the nurse is most appropriate?
A. “Take both medications together with food.”
B. “These drugs can be taken together if spaced 4 hours apart.”
C. “Using these medications together can cause life-threatening hypotension.”
D. “Nitroglycerin will decrease the effect of sildenafil only slightly.”
Answer: B. “This medication often takes 6 to 12 months for full effect.”
Rationale: Antiandrogen agents such as finasteride reduce prostate hyperplasia gradually and may take 6 to 12 months before the client notices full benefit.
Which instruction is most important for a patient taking methotrexate or another immunosuppressive medication?
A. Seek care for signs of infection
B. Increase raw food intake
C. Skip all follow-up labs
D. Stop the drug abruptly if tired
A — Infection precautions are essential with immunosuppressants.
Which finding requires the most immediate intervention in a patient receiving opioids?
A. nausea
B. constipation
C. pain rating 6/10
D. respiratory rate 9/min
D — RR 9/min is life-threatening respiratory depression.
Which patient statement about laxative use requires correction?
A. “I will increase fluids when possible.”
B. “I will try diet changes too.”
C. “Daily stimulant laxatives are best for long-term prevention.”
D. “I should report severe cramping.”
C — Daily stimulant laxative use causes dependence.
A patient using an inhaled corticosteroid develops oral thrush. Which instruction is most important?
A. Rinse the mouth after each use
B. Take the medication on an empty stomach
C. Use it only at bedtime
D. Double the next dose if wheezing continues
A — Rinse mouth after inhaled corticosteroids to prevent thrush.
SATA Teaching for a patient taking cholestyramine should include which statements?
A. Mix the powder with fluid or applesauce
B. Swallow the powder dry for best effect
C. Increase fluids and fiber
D. Watch for signs of vitamin K deficiency
E. Take all other medications at the same time
A, C, D — Cholestyramine must be mixed with fluid, increases constipation risk, and can lower vitamin K.
A diabetic patient taking propranolol reports feeling shaky. Why should the nurse be concerned?
A. Beta blockers can mask hypoglycemia
B. The medication causes hyperthyroidism
C. This always means stroke
D. It proves the medication is ineffective
A — Beta blockers mask hypoglycemia symptoms.
Which statement by a patient taking levodopa/carbidopa indicates need for further teaching?
A. “I will not stop this medication suddenly.”
B. “I may notice symptom rebound if I stop abruptly.”
C. “I should double it if I miss a dose.”
D. “I will report worsening symptoms.”
C — Never double levodopa doses.
A client with preeclampsia is receiving magnesium sulfate. During assessment, the nurse finds absent deep tendon reflexes, decreased respirations, and confusion. Which medication should the nurse prepare to administer?
A. Vitamin K
B. Calcium gluconate
C. Leucovorin
D. Amifostine
Answer: B. Calcium gluconate
Rationale: These findings suggest magnesium toxicity. Calcium gluconate is the antidote used to reverse the cardiac and toxic effects of magnesium sulfate.
SATA Which teaching points apply to glucocorticoid therapy?
A. Do not stop abruptly
B. Monitor for infection
C. Monitor blood glucose
D. Delayed wound healing can occur
E. Double the dose without guidance if symptoms return
A, B, C, D — Steroids: infection risk, hyperglycemia, delayed healing, taper slowly.
Which statement about naloxone by a family member of a patient prescribed opioids indicates understanding?
A. “It treats constipation from opioids.”
B. “It reverses respiratory depression from opioids.”
C. “It prevents pain from returning.”
D. “It should be given before each opioid dose.”
B — Naloxone reverses opioid respiratory depression.
SATA Which findings are common with oxybutynin?
A. Dry mouth
B. Blurred vision
C. Constipation
D. Diarrhea
E. Urinary retention
A, B, C, E — Oxybutynin causes anticholinergic effects.
A patient receiving ipratropium reports urinary retention and dry mouth. These findings are most consistent with:
A. cholinergic excess
B. expected beta-2 stimulation
C. anticholinergic effects
D. opioid toxicity
C — Ipratropium adverse effects are classic anticholinergic findings.
A patient taking ezetimibe and a bile acid sequestrant asks when to take the ezetimibe. What is the best response?
A. At the same time as the sequestrant
B. One hour before or four hours after the sequestrant
C. Only at bedtime
D. Only with dairy products
B — Ezetimibe should be separated from bile acid sequestrants for absorption
A patient newly prescribed levothyroxine says, “I will take it with breakfast and calcium.” Which response is best?
A. “That is correct.”
B. “Take it at bedtime with milk.”
C. “Take it on an empty stomach and separate it from calcium.”
D. “Only take it when you feel tired.”
C — Levothyroxine = empty stomach, separate from calcium.
SATA Which findings are consistent with extrapyramidal symptoms?
A. Shuffling gait
B. Neck spasms
C. Tremors
D. Hyperglycemia
E. Restlessness
A, B, C, E — EPS includes tremor, dystonia, akathisia, shuffling gait.
SATA: A client is receiving cisplatin for cancer treatment. Which adverse effects should the nurse monitor for? Select all that apply.
A. Nephrotoxicity
B. Ototoxicity
C. Neurotoxicity
D. Pulmonary fibrosis
E. Bone marrow suppression
Answers: A, B, C, E
Rationale: Cisplatin is associated with nephrotoxicity, neurotoxicity, ototoxicity, nausea/vomiting, mucositis, and bone marrow suppression. Pulmonary fibrosis is more strongly associated with bleomycin.
A patient receiving natalizumab develops new confusion and weakness. The nurse should suspect:
A. PML
B. gastritis
C. pancreatitis
D. gout
A — New neuro changes on natalizumab = possible PML.
A patient taking ibuprofen for chronic pain reports black stools and epigastric pain. The nurse should suspect:
A. GI bleeding
B. therapeutic effect
C. respiratory depression
D. dehydration only
A — NSAIDs increase GI bleed risk.
SATA Which instructions should be included for a patient taking nystatin suspension for oral candidiasis?
A. Swish the medication in the mouth
B. Follow directions for swallow vs spit
C. Stop it as soon as symptoms improve after one dose
D. Use it exactly as prescribed
E. It treats fungal, not bacterial, infection
A, B, D, E — Nystatin must coat oral mucosa and complete full therapy.
A patient using cromolyn develops wheezing and chest tightness. What should the nurse do first?
A. Notify the provider
B. Encourage deep breathing
C. Administer milk
D. Reassure the patient this is harmless
A — Wheezing after cromolyn may indicate paradoxical bronchospasm.
A patient taking gemfibrozil and simvastatin complains of weakness and muscle tenderness. The nurse should recognize this as risk for:
A. hypoglycemia
B. pancreatitis
C. myopathy
D. bradycardia
C — Gemfibrozil + statin significantly increases myopathy risk.
A patient with diabetes says, “I stopped taking my insulin because I was not eating much.” The nurse’s best response is:
A. “That is always safe.”
B. “You should never monitor glucose during illness.”
C. “Medication decisions during poor intake or illness should be discussed with the provider because glucose can still become unsafe.”
D. “Insulin is only needed after large meals.”
C — Illness can still increase glucose; must discuss sick-day plan.
SATA Which findings suggest serotonin syndrome in a patient taking an SSRI?
A. Agitation
B. Fever
C. Diarrhea
D. Hyperreflexia
E. Bradycardia
A, B, C, D — Agitation, fever, diarrhea, hyperreflexia = serotonin syndrome.
A client receiving doxorubicin asks why the provider keeps ordering cardiac monitoring. Which explanation by the nurse is best?
A. “This drug commonly causes severe hypertension.”
B. “This medication places you at high risk for cardiomyopathy.”
C. “The drug causes immediate heart failure in all patients.”
D. “Cardiac monitoring is only needed if the urine turns orange.”
B. “This medication places you at high risk for cardiomyopathy.”
Rationale: Doxorubicin can cause cardiomyopathy, so long-term cardiac monitoring is important. Orange-yellow urine is an expected effect and is not the reason for cardiac follow-up
SATA Which findings should be reported in a patient taking fludrocortisone?
A. Edema
B. Weight gain
C. Hypertension
D. Potassium depletion
E. Mild hunger only
A, B, C, D — Fludrocortisone causes fluid retention + hypokalemia.
SATA Which descriptions are consistent with neuropathic pain?
A. Burning
B. Shooting
C. Stabbing
D. Cramping after exercise
E. Radiating nerve pain
A, B, C, E — Burning, shooting, stabbing, radiating = neuropathic pain.
A patient taking bethanechol becomes sweaty and bradycardic. Which interpretation is best?
A. Expected opioid effect
B. Cholinergic effect
C. Anticholinergic toxicity
D. Beta-blocker overdose
B — Bethanechol causes cholinergic effects like bradycardia and sweating.
SATA Which findings are concerning in a patient taking pseudoephedrine?
A. Blood pressure 178/92
B. Palpitations
C. Restlessness
D. Clear lungs
E. Severe headache
A, B, C, E — HTN, palpitations, restlessness, headache are concerning sympathomimetic effects
SATA Which findings in a patient taking beta blockers require follow-up before administration?
A. Heart rate 54/min
B. Wheezing
C. Blood pressure 88/54
D. History of asthma
E. Temperature 98.6°F
A, B, C, D — Bradycardia, hypotension, wheezing, and asthma history all require caution.
A patient with thyroid replacement therapy begins to have palpitations and insomnia. What should the nurse suspect?
A. undertreatment
B. overreplacement
C. infection
D. opioid withdrawal
B — Palpitations and insomnia = overreplacement.
A patient taking valproic acid reports right upper quadrant pain and jaundice. Which adverse effect is most concerning?
A. hepatotoxicity
B. ototoxicity
C. neutropenia
D. hyperthyroidism
A — RUQ pain + jaundice with valproate = hepatotoxicity.
SATA: A nurse is teaching a client about alendronate for osteoporosis. Which statements by the nurse are appropriate? Select all that apply.
A. “Take this medication first thing in the morning.”
B. “Lie down for 30 minutes after taking it.”
C. “Take it 30 minutes before eating.”
D. “Remain sitting or standing after taking it.”
E. “This medication is safe for patients with chronic kidney disease.”
Answers: A, C, D
Rationale: Bisphosphonates should be taken first thing in the morning, 30 minutes before food, and the client should remain upright for 30 minutes. They are not recommended in CKD because of nephrotoxicity risk.