IV Fluids
A patient with severe hyponatremia is ordered 3% NS. What is the priority assessment?
A. Urine output
B. Lung sounds
C. Bowel sounds
D. Skin turgor
Answer: B
Rationale: Hypertonic fluids can cause fluid overload and pulmonary edema. Lung assessment is essential to detect crackles or respiratory distress.
A patient taking aspirin reports ringing in the ears. What is this?
Expected effect
B. GI irritation
C. Toxicity
D. Allergy
Answer: C
Rationale: Tinnitus is an early sign of salicylate toxicity.
Which finding requires immediate intervention in a patient receiving morphine?
A. Constipation
B. RR 8/min
C. Itching
D. Nausea
Answer: B
Rationale: Respiratory depression is the most dangerous opioid adverse effect. RR < 12 requires holding the dose and notifying the provider.
A patient on heparin develops abdominal pain and low platelets. Suspect:
A. HIT
B. DVT
C. MI
D. Stroke
Answer: A
Rationale: Heparin-induced thrombocytopenia is a dangerous immune reaction.
Pseudoephedrine should be avoided in:
A. Asthma
B. Hypertension
C. GERD
D. Hypothyroidism
Answer: B
Rationale: It causes vasoconstriction and can worsen hypertension.
Which patient should NOT receive hypotonic fluids?
A. DKA
B. Hypernatremia
C. Increased intracranial pressure
D. Dehydration
Answer: C
Rationale: Hypotonic fluids shift water into cells, worsening cerebral edema in patients with increased ICP.
Which lab value requires holding clopidogrel?
A. Hgb 12
B. Platelets 90,000
C. WBC 5,000
D. INR 1.0
Answer: B
Rationale: Antiplatelets increase bleeding risk; platelets <100,000 require holding the medication.
Which medication reverses opioid overdose?
A. Naloxone
B. Protamine sulfate
C. Vitamin K
D. Acetylcysteine
Answer: A
Rationale: Naloxone rapidly reverses opioid-induced respiratory depression but has a short half‑life, requiring repeated dosing.
Enoxaparin teaching includes:
A. Massage the site
B. Expel the air bubble
C. Inject into abdomen
D. Monitor INR
Answer: C
Rationale: Enoxaparin is given SC in the abdomen; the air bubble should NOT be expelled.
Dextromethorphan is used for:
A. Productive cough
B. Nasal congestion
C. Fever
D. Dry Cough
Answer: D
Rationale: It suppresses the cough reflex.
Which IV fluid is isotonic?
A. 0.9% NS
B. 0.45% NS
C. 3% NS
D. D5W (after metabolism)
Answer: A
Rationale: 0.9% NS is isotonic and expands extracellular volume. Hypotonic fluids shift water into cells, while hypertonic fluids pull water out of cells.
Aspirin is contraindicated in:
A. Stroke
B. MI
C. Active GI bleed
D. Diabetes
Answer: C
Rationale worsens bleeding and should not be given during active hemorrhage.
A patient on hydromorphone reports severe constipation. What is the best nursing action?
A. Hold the medication
B. Encourage fluids and fiber
C. Administer a stool softener
D. Reduce the dose
Answer: C
Rationale: Opioids slow GI motility. Stool softeners or laxatives are standard preventive therapy.
A patient on warfarin has an INR of 5.2. What is the priority?
A. Give Vitamin K
B. Increase dose
C. Continue therapy
D. Give protamine
Answer: A
Rationale: INR > 4.5 increases bleeding risk; Vitamin K reverses warfarin.
Dextromethorphan should NOT be taken with:
A. MAOIs
B. NSAIDs
C. Antacids
D. Steroids
Answer: A
Rationale: Risk of serotonin syndrome.
A patient receiving isotonic fluids is at greatest risk for:
A. Cerebral edema
B. Fluid overload
C. Severe dehydration
D. Hypokalemia
Answer: B
Rationale: Isotonic fluids expand intravascular volume and can cause hypertension, edema, and heart failure exacerbation.
A patient on heparin has aPTT within normal range. The nurse expects:
A. Dose increase
B. Dose decrease
C. Therapy stopped
D. No change
Answer: A
Rationale: Therapeutic aPTT should be prolonged; normal aPTT suggests underdosing.
Which patient should avoid codeine?
A. COPD
B. Hypertension
C. Diabetes
D. Hypothyroidism
Answer: A
Rationale: Codeine suppresses respiratory drive, dangerous in COPD patients.
Warfarin takes several days to work because:
A. It is excreted slowly
B. It affects clotting factors already in circulation
C. It is given orally
D. It is protein-bound
Answer: B
Rationale: Warfarin inhibits synthesis of new clotting factors; existing ones must degrade first.
Which symptom should be reported when taking pseudoephedrine?
A. Mild nasal dryness
B. Palpitations and chest pain
C. Mild headache
D. Dry mouth
Answer: B
Rationale: Cardiovascular symptoms may indicate serious adverse effects.
Lactated Ringer’s is contraindicated in which condition?
A. Burns
B. Hypovolemia
C. Liver failure
D. GI losses
Answer: C
Rationale: LR contains lactate, which the liver converts to bicarbonate. Liver failure prevents this metabolism, risking acidosis.
Which statement by a patient on warfarin needs teaching?
A. “I’ll have my blood checked regularly.”
B. “I’ll use an electric razor.”
C. “I can take ibuprofen for headaches.”
D. “I’ll report any unusual bleeding.”
Answer: C
Rationale: NSAIDs increase bleeding risk and should be avoided.
A patient receiving fentanyl develops pinpoint pupils. What does this indicate?
A. Allergic reaction
B. Toxicity
C. Withdrawal
D. Tolerance
Answer: B
Rationale: Miosis is a classic sign of opioid overdose along with respiratory depression and decreased LOC.
Which food should be limited with warfarin?
A. Bananas
B. Leafy greens
C. Milk
D. Citrus fruits
Answer: B
Rationale: Vitamin K decreases warfarin effectiveness.
A patient taking high doses of dextromethorphan recreationally is at risk for:
A. Liver failure
B. Hyperglycemia
C. Kidney stones
D. Hallucinations and dissociation
Answer: D
Rationale: Abuse can cause dissociative, hallucinogenic effects.