Musculoskeletal Medications
A client newly prescribed alendronate reports difficulty swallowing pills. Which instruction should the nurse give to prevent major complications?
A. “Crush the tablet and mix it with applesauce.”
B. “Take the medication first thing in the morning with a full glass of water.”
C. “Take the medication with food to prevent irritation.”
D. “Take the medication right before bedtime.”
Correct Answer: B
Rationales:
A. Incorrect. Crushing increases esophageal exposure → severe irritation.
B. Correct. Must be taken on an empty stomach, upright, full glass of water to prevent esophageal ulceration.
C. Incorrect. Food reduces absorption by 60% or more.
D. Incorrect. Bedtime use increases risk of reflux and esophageal damage
A client taking omeprazole for long-term GERD management reports muscle cramps and tremors. Which laboratory test should the nurse anticipate?
A. Serum potassium
B. Serum magnesium
C. Serum sodium
D. Serum calcium
Correct Answer: B
Rationales:
A. Incorrect. PPIs do not commonly cause hyper- or hypokalemia.
B. Correct. Chronic PPI use can cause hypomagnesemia, leading to cramps, tremors, arrhythmias.
C. Incorrect. Sodium is not affected by PPIs.
D. Incorrect. Calcium absorption may decrease slightly, but magnesium loss is more clinically significant.
A 72-year-old client with benign prostatic hyperplasia (BPH) is prescribed tamsulosin. Which statement by the client indicates correct understanding of how this medication works?
A. “It will increase how much urine my kidneys make each day.”
B. “It relaxes muscles in my prostate and bladder neck so urine can flow more easily.”
C. “It shrinks my prostate permanently so I won’t have symptoms again.”
D. “It makes my urine less acidic so it doesn’t irritate my bladder.”
Correct Answer: B
Rationales:
A. Incorrect. Tamsulosin does not increase urine production; it affects outflow resistance.
B. Correct. Tamsulosin is an alpha-1 adrenergic blocker that relaxes smooth muscle in the prostate and bladder neck, decreasing obstruction and improving urinary flow.
C. Incorrect. It does not shrink the prostate; that’s more typical of 5-alpha-reductase inhibitors (e.g., finasteride).
D. Incorrect. It does not change urine pH.
A client experiencing chest pain takes one sublingual nitroglycerin tablet. How many additional doses may the client take before calling 911 if pain persists?
A. One
B. Two
C. Three
D. Four
Correct Answer: B (Total of 3 doses: 1 initial + 2 additional)
Rationales:
A. Incorrect. One additional dose is not the maximum allowed.
B. Correct. Sublingual nitro may be taken every 5 minutes for up to 3 total doses. If pain persists → call EMS.
C. Incorrect. This option incorrectly suggests 4 total doses.
D. Incorrect. Four doses significantly increase risk of severe hypotension.
A client with asthma reports using their albuterol inhaler 10-12 times per day. Which nursing action is MOST important?
A. Instruct the client to decrease use to avoid addiction
B. Notify the provider because this indicates poor asthma control
C. Teach the client to use albuterol on a fixed daily schedule
D. Advise the client to stop the medication immediately
Correct Answer: B
Rationales:
A. Incorrect. Albuterol is not addictive; excessive use signals worsening control.
B. Correct. Using albuterol >2× per week or 10+ times/day indicates poorly controlled asthma, requiring reassessment and likely step-up therapy.
C. Incorrect. Albuterol is PRN, not scheduled.
D. Incorrect. Stopping abruptly could worsen bronchospasm.
A client starting insulin glargine asks why they should not mix it with other insulins. Which explanation is appropriate?
A. “Mixing glargine increases the risk of hypoglycemia.”
B. “Glargine has a unique pH and cannot be mixed with other insulins.”
C. “Mixing glargine makes it peak too quickly.”
D. “Glargine must be diluted before injection.”
Correct Answer: B
Rationales:
A. Incorrect. Hypoglycemia risk is unrelated to mixing.
B. Correct. Glargine has an acidic pH that causes precipitation in subcutaneous tissue; mixing alters absorption and action.
C. Incorrect. Glargine has no peak, regardless of mixing.
D. Incorrect. Glargine is never diluted.
A client receiving filgrastim for chemotherapy-induced neutropenia reports bone pain rated 5/10. Which action should the nurse take?
A. Hold the filgrastim and notify the provider
B. Administer acetaminophen as prescribed
C. Apply heat to the client’s joints
D. Discontinue all pain medications until reassessment
Correct Answer: B
Rationales:
A. Incorrect. Bone pain is expected due to bone marrow stimulation, not a reason to stop therapy.
B. Correct. Acetaminophen is recommended for filgrastim-induced bone pain.
C. Incorrect. Heat may reduce comfort temporarily but is not the primary action.
D. Incorrect. Pain medications should not be withheld; managing discomfort is important.
Before administering an IV cephalosporin, the nurse reviews the client’s allergy history. Which finding is MOST concerning?
A. History of a mild rash when taking amoxicillin
B. Allergy to sulfonamides
C. Previous anaphylactic reaction to penicillin
D. History of seasonal allergies
Correct Answer: C
Rationales:
A. Incorrect. A mild rash suggests a non–IgE-mediated reaction; cephalosporins may still be used.
B. Incorrect. Sulfa allergies are unrelated to beta-lactam antibiotics.
C. Correct. A history of penicillin anaphylaxis poses the greatest risk for cross-reactive anaphylaxis with cephalosporins.
D. Incorrect. Seasonal allergies don’t affect antibiotic selection.
Which client finding would the nurse identify as an expected adverse effect of doxorubicin?
A. Alopecia and mucositis
B. Hypertensive crisis
C. Severe constipation
D. Pancreatitis
Correct Answer: A
Rationales:
A. Correct. Doxorubicin commonly causes alopecia, oral mucositis, and myelosuppression.
B. Incorrect. Doxorubicin does not cause hypertensive crises.
C. Incorrect. Constipation is not a hallmark adverse effect.
D. Incorrect. Pancreatitis is not associated with doxorubicin.
The nurse prepares lorazepam for a client experiencing status epilepticus. Which description best explains the purpose of lorazepam?
A. It decreases neuronal excitability by enhancing GABA activity
B. It blocks sodium channels to slow neuronal firing
C. It prevents seizure recurrence by increasing serotonin
D. It depresses the motor cortex by reducing dopamine
Correct Answer: A
Rationales:
A. Correct. Lorazepam is a benzodiazepine that enhances GABA, rapidly stopping seizures.
B. Incorrect. Sodium channel blockade describes phenytoin.
C. Incorrect. Serotonin is unrelated to seizure control.
D. Incorrect. Dopamine reduction would worsen movement disorders, not seizures.
A client is found unresponsive with pinpoint pupils and a respiratory rate of 6/min. The nurse should prepare to administer which medication?
A. Atropine
B. Naloxone
C. Flumazenil
D. Acetylcysteine
Rationales:
A. Incorrect. Atropine treats symptomatic bradycardia, not opioid overdose.
B. Correct. Naloxone reverses opioid-induced respiratory depression-classic triad: coma, pinpoint pupils, slow respirations.
C. Incorrect. Flumazenil reverses benzodiazepines.
D. Incorrect. Acetylcysteine treats acetaminophen toxicity.
The nurse is preparing lidocaine with epinephrine for a wound repair. What is the primary purpose of adding epinephrine?
A. To increase systemic absorption of lidocaine
B. To constrict local blood vessels and prolong anesthetic effects
C. To reduce the risk of allergic reactions
D. To reduce the pain of injection
Correct Answer: B
Rationales:
A. Incorrect. Epinephrine reduces systemic absorption, not increases it.
B. Correct. Epinephrine causes local vasoconstriction, which keeps lidocaine at the site longer and reduces bleeding.
C. Incorrect. Epinephrine does not prevent allergies.
D. Incorrect. It does not reduce injection pain.
A client with glaucoma is prescribed timolol eye drops. Which history finding should the nurse report to the provider before administering the medication?
A. Hypertension
B. Emphysema
C. Hypothyroidism
D. Osteoarthritis
Correct Answer: B
Rationales:
A. Incorrect. Systemic absorption of timolol may lower BP but is not a contraindication.
B. Correct. Timolol is a nonselective beta blocker; systemic absorption may cause bronchoconstriction, dangerous for clients with emphysema/COPD/asthma.
C. Incorrect. No significant interaction.
D. Incorrect. Timolol has no impact on musculoskeletal conditions.
A provider switches a client from furosemide to spironolactone. Which explanation by the nurse is most accurate?
A. “You’ll lose more potassium with spironolactone.”
B. “Spironolactone allows your body to retain potassium more effectively.”
C. “Spironolactone works more quickly than furosemide.”
D. “Both medications have similar potassium effects.”
Correct Answer: B
Rationales:
A. Incorrect. Opposite, furosemide is potassium-wasting.
B. Correct. Spironolactone is a potassium-sparing diuretic, reducing risk of hypokalemia.
C. Incorrect. Spironolactone is slower to take effect.
D. Incorrect. Their potassium effects are not similar.
The nurse reviews a client’s orders before the first dose of methotrexate for rheumatoid arthritis. Which finding requires immediate action?
A. AST/ALT slightly elevated
B. Positive pregnancy test
C. History of mild anemia
D. Taking folic acid daily
Correct Answer: B
Rationales:
A. Incorrect. Mild elevation may be monitored but is not a contraindication.
B. Correct. Methotrexate is highly teratogenic; absolutely contraindicated in pregnancy.
C. Incorrect. Mild anemia is expected in RA and not an immediate hold.
D. Incorrect. Folic acid is recommended to reduce methotrexate toxicity.
A male client taking cimetidine reports decreased libido and breast enlargement. How should the nurse respond?
A. “This is a temporary effect from increased testosterone.”
B. “This drug can block male hormones and cause these symptoms.”
C. “This indicates serious liver damage from the medication.”
D. “This reaction is harmless and requires no follow-up.”
Correct Answer: B
Rationales:
A. Incorrect. Testosterone does not increase; androgen blockade occurs.
B. Correct. Cimetidine has antiandrogenic effects → gynecomastia, decreased libido.
C. Incorrect. Liver injury is not the mechanism.
D. Incorrect. Although often reversible, symptoms should be monitored and may require a medication change.
Which instruction should the nurse include when teaching a client about tamsulosin?
A. “Change positions slowly to reduce your risk of dizziness or fainting.”
B. “You may stop taking this medication when your urinary symptoms improve.”
C. “Take this medication on an empty stomach for best effect.”
D. “Limit fluid intake to reduce the risk of urinary retention.”
Correct Answer: A
Rationales:
A. Correct. Tamsulosin can cause orthostatic hypotension, especially when therapy is started; slow position changes help prevent falls.
B. Incorrect. Symptoms return if the drug is stopped; provider should direct any dose changes.
C. Incorrect. It is often recommended to take with the same meal each day to maintain steady levels, not necessarily fasting.
D. Incorrect. Adequate hydration is important; fluid restriction can worsen urinary issues.
Which assessment finding requires the nurse to hold a scheduled dose of metoprolol?
A. BP 158/88 mm Hg
B. Heart rate 54 bpm
C. Heart rate 68 bpm
D. Fasting glucose 110 mg/dL
Correct Answer: B
Rationales:
A. Incorrect. Elevated BP is an indication for therapy.
B. Correct. Metoprolol slows AV conduction; HR < 55–60 bpm indicates excessive beta blockade.
C. Incorrect. HR 68 is safe for administration.
D. Incorrect. Beta blockers may mask hypoglycemia symptoms but do not cause hyperglycemia.
A client with asthma is prescribed both albuterol and fluticasone inhalers. Which instruction is most appropriate?
A. “Use the fluticasone inhaler first to reduce airway inflammation.”
B. “Use albuterol first to open your airways before taking fluticasone.”
C. “Take both inhalers together for the strongest effect.”
D. “Fluticasone should only be used for acute symptoms.”
Correct Answer: B
Rationales:
A. Incorrect. Fluticasone cannot penetrate inflamed, constricted airways effectively.
B. Correct. Albuterol (bronchodilator) FIRST, then fluticasone (ICS) for optimal medication delivery.
C. Incorrect. They are never taken simultaneously.
D. Incorrect. ICS medications are maintenance, not rescue.
The nurse is administering lispro insulin. Which instruction is most important to give the client?
A. “You should eat your meal immediately after taking this insulin.”
B. “Take this insulin on an empty stomach only.”
C. “You may take this insulin at bedtime if your glucose is elevated.”
D. “You must mix it with regular insulin to achieve the best effect.”
Correct Answer: A
Rationales:
A. Correct. Lispro begins acting within minutes; the client must eat right away to prevent hypoglycemia.
B. Incorrect. Taking it on an empty stomach without eating immediately is dangerous.
C. Incorrect. Bedtime use increases hypoglycemia risk.
D. Incorrect. Lispro is never mixed with regular insulin.
Which finding in a client receiving epoetin alfa requires immediate intervention?
A. Hemoglobin increased from 9 g/dL to 10 g/dL
B. Blood pressure rising to 168/98 mm Hg
C. Reports of mild fatigue
D. Hematocrit increasing slowly over several weeks
Correct Answer: B
Rationales:
A. Incorrect. Gradual hemoglobin improvement is expected.
B. Correct. Epoetin alfa increases blood viscosity → risk of MI, stroke, hypertension (black box warning). Elevated BP is an urgent safety concern.
C. Incorrect. Fatigue is common in anemia; not emergent.
D. Incorrect. Slow hematocrit rise is appropriate.
Which assessment finding indicates a client receiving IV penicillin may be developing anaphylaxis?
A. Loose, watery stools
B. Urticaria and laryngeal edema
C. Flushed skin and sweating
D. Headache and nausea
orrect Answer: B
Rationales:
A. Incorrect. Diarrhea is a common GI side effect, not anaphylaxis.
B. Correct. Airway compromise (laryngeal edema) and urticaria indicate severe IgE-mediated penicillin allergy → emergency.
C. Incorrect. Flushed skin is nonspecific and may occur with many drugs.
D. Incorrect. Headache/nausea are not hallmark signs of anaphylaxis.
While administering doxorubicin through a peripheral IV, the nurse notes burning and redness at the site. What is the priority action?
A. Slow the infusion rate
B. Stop the infusion immediately
C. Apply a warm compress
D. Flush the IV line vigorously
Correct Answer: B
Rationales:
A. Incorrect. Slowing the rate allows more vesicant to leak into tissue.
B. Correct. Doxorubicin is a potent vesicant; signs of extravasation require immediate discontinuation.
C. Incorrect. Warm compresses can worsen tissue spread.
D. Incorrect. Flushing increases tissue injury.
Which finding in a client taking phenytoin requires follow-up?
A. Gingival overgrowth
B. Mild sedation
C. Nystagmus
D. Resting tachycardia
Correct Answer: D
Rationales:
A. Incorrect. Gingival hyperplasia is common and expected; dental hygiene education is needed, not emergency action.
B. Incorrect. CNS depression is dose-related and expected early in therapy.
C. Incorrect. Nystagmus may occur at therapeutic levels.
D. Correct. Phenytoin can cause bradycardia, NOT tachycardia. Tachycardia warrants evaluation for another cause or toxicity.
A client presents after ingesting a large amount of acetaminophen. Which explanation best describes how acetylcysteine works?
A. It increases renal excretion of acetaminophen
B. It binds directly to acetaminophen to neutralize it
C. It restores glutathione to prevent liver damage
D. It decreases absorption of acetaminophen in the stomach
Correct Answer: C
Rationales:
A. Incorrect. Metabolism, not excretion, is the issue.
B. Incorrect. It does not directly bind acetaminophen.
C. Correct. Acetylcysteine restores glutathione, which detoxifies the harmful metabolite (NAPQI), preventing liver failure.
D. Incorrect. It doesn’t alter gastric absorption.
A client receiving isoflurane during surgery develops tachycardia, muscle rigidity, and a rapid rise in end-tidal CO2. What condition does the nurse suspect?
A. Neuroleptic malignant syndrome
B. Malignant hyperthermia
C. Serotonin syndrome
D. Thyroid storm
Correct Answer: B
Rationales:
A. Incorrect. NMS is associated with antipsychotics, not anesthetics.
B. Correct. Isoflurane is a known trigger for malignant hyperthermia, characterized by abrupt skeletal muscle hypermetabolism.
C. Incorrect. Serotonin syndrome causes hyperreflexia and agitation, not rigidity with rising ETCO2.
D. Incorrect. Thyroid storm presents with fever and tachycardia, but not muscle rigidity.
Which instruction should the nurse give a client to reduce systemic absorption of timolol eye drops?
A. “Blink rapidly for 30 seconds after application.”
B. “Close your eyes tightly and avoid touching your eyelids.”
C. “Press your finger against the inner corner of your eye for 1-2 minutes.”
D. “Rinse your eyes with warm water after instilling the drops.”
Correct Answer: C
Rationales:
A. Incorrect. Blinking increases systemic absorption.
B. Incorrect. Closing the eyes does not occlude the tear duct.
C. Correct. Punctal occlusion prevents medication from draining into systemic circulation via the nasolacrimal duct.
D. Incorrect. Rinsing decreases medication effectiveness.
A client receiving digoxin develops symptomatic bradycardia. Which medication should the nurse expect to administer?
A. Adenosine
B. Losartan
C. Atropine
D. Diltiazem
Correct Answer: C
Rationales:
A. Incorrect. Adenosine slows AV conduction further; dangerous here.
B. Incorrect. Does not affect heart rate.
C. Correct. Atropine blocks vagal stimulation → increases HR.
D. Incorrect. Diltiazem slows AV conduction further.
Which client statement indicates correct understanding of raloxifene therapy for osteoporosis?
A. “This medication works like estrogen in my bones.”
B. “This medication increases my calcium absorption from foods.”
C. “I won’t have to worry about blood clots while taking this medication.”
D. “This medication rebuilds the bone I have already lost.”
Correct Answer: A
Rationales:
A. Correct. Raloxifene is a SERM; acts like estrogen in bone to reduce resorption.
B. Incorrect. Does not enhance calcium absorption.
C. Incorrect. SERMs increase risk of DVT/PE.
D. Incorrect. It preserves bone; does not regenerate lost bone.
A client using aluminum hydroxide several times per day for dyspepsia reports new constipation. Which action should the nurse take?
A. Teach the client that constipation is a common adverse effect
B. Discontinue the medication because constipation indicates toxicity
C. Advise the client to take the medication with milk
D. Suggest doubling the dose to reduce constipation
Correct Answer: A
Rationales:
A. Correct. Aluminum-based antacids commonly cause constipation due to reduced GI motility.
B. Incorrect. Not toxic; expected adverse effect.
C. Incorrect. Milk increases acid secretion; counterproductive.
D. Incorrect. Increasing the dose worsens constipation.
A client with erectile dysfunction is prescribed sildenafil. Which concurrent medication would cause the nurse to question this prescription?
A. Metoprolol
B. Nitroglycerin
C. Hydrochlorothiazide
D. Atorvastatin
Correct Answer: B
Rationales:
A. Incorrect. Beta blockers can be used cautiously with sildenafil; they do not cause the same severe BP drop as nitrates.
B. Correct. Sildenafil + nitrates (like nitroglycerin) → profound, potentially fatal hypotension due to synergistic vasodilation; this is a major contraindication.
C. Incorrect. Thiazide diuretics are not a direct contraindication, though BP should be monitored.
D. Incorrect. Statins can be safely combined with sildenafil.
A nurse prepares to administer amiodarone to a client with recurrent ventricular tachycardia. The client asks, “What type of drug is this?” Which response is correct?
A. “It is a calcium channel blocker.”
B. “It is a potassium channel blocker used to control abnormal heart rhythms.”
C. “It is a beta blocker used to slow your heart rate.”
D. “It is a sodium channel blocker used for atrial fibrillation only.”
Correct Answer: B
Rationales:
A. Incorrect. Verapamil/diltiazem are CCBs; not amiodarone.
B. Correct. Amiodarone is a Class III antidysrhythmic that prolongs repolarization by blocking potassium channels.
C. Incorrect. Beta blockers are Class II agents.
D. Incorrect. Sodium channel blockers are Class I; amiodarone treats both atrial and ventricular dysrhythmias.
A client newly prescribed tiotropium reports new blurry vision. What is the nurse’s priority action?
A. Document the finding as an expected side effect
B. Teach the client to blink more frequently
C. Instruct the client to seek immediate evaluation
D. Tell the client to continue therapy and monitor symptoms
Correct Answer: C
Rationales:
A. Incorrect. Although dry mouth is common, blurred vision is not expected.
B. Incorrect. Blinking does not address the underlying issue.
C. Correct. Blurry vision may indicate acute narrow-angle glaucoma, a medical emergency precipitated by tiotropium.
D. Incorrect. Delayed intervention risks permanent vision loss.
A client taking metformin for type 2 diabetes presents with increasing drowsiness, rapid breathing, and muscle pain. What complication does the nurse suspect?
A. Hyperosmolar hyperglycemic syndrome
B. Lactic acidosis
C. Hypoglycemia
D. Diabetic ketoacidosis
Correct Answer: B
Rationales:
A. Incorrect. HHS presents with extreme hyperglycemia and dehydration, not rapid respirations.
B. Correct. Metformin can cause life-threatening lactic acidosis, especially during dehydration, renal impairment, or contrast dye exposure.
C. Incorrect. Hypoglycemia presents with sweating, tremors, not Kussmaul-type respirations.
D. Incorrect. DKA is typically associated with type 1 diabetes.
A platelet transfusion is most appropriate for which client?
A. Client with hemoglobin of 8 g/dL
B. Client with INR of 3.2 while on warfarin
C. Client with platelet count of 12,000/mm³
D. Client with WBC count of 3,000/mm³
Correct Answer: C
Rationales:
A. Incorrect. Low Hgb → consider RBC transfusion, not platelets.
B. Incorrect. Elevated INR → consider vitamin K or FFP.
C. Correct. Platelets <20,000/mm³ place the client at high bleeding risk → transfusion indicated.
D. Incorrect. Low WBC count does not require platelets.
A client receiving both gentamicin and vancomycin is at highest risk for which complication?
A. Hepatic failure
B. Ototoxicity and nephrotoxicity
C. Cardiac dysrhythmias
D. Severe constipation
Correct Answer: B
Rationales:
A. Incorrect. These drugs affect kidneys and ears, not the liver.
B. Correct. Both gentamicin and vancomycin are high-risk nephrotoxic and ototoxic medications.
C. Incorrect. These antibiotics do not commonly cause dysrhythmias.
D. Incorrect. Constipation is unrelated.
Which assessment finding in a client taking cyclosporine requires immediate intervention?
A. Swollen, tender gums
B. BP 150/90 mm Hg
C. Increasing serum creatinine
D. Mild tremor
Correct Answer: C
Rationales:
A. Incorrect. Gum hypertrophy is common and not emergent.
B. Incorrect. Hypertension is expected, though it requires monitoring, not urgent intervention.
C. Correct. Rising creatinine = nephrotoxicity, the most critical adverse effect requiring rapid provider notification.
D. Incorrect. Tremors may occur at therapeutic doses.
A client taking oxcarbazepine reports nausea, headache, and confusion. Which laboratory abnormality should the nurse suspect?
A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationales:
A. Incorrect. Potassium levels are not commonly affected.
B. Correct. Oxcarbazepine can cause SIADH, leading to clinically significant hyponatremia, which causes confusion, nausea, and headache.
C. Incorrect. Calcium is unaffected.
D. Incorrect. Magnesium imbalance is associated with PPIs, not this medication.
The nurse prepares to administer vitamin K to a client with a critically elevated INR. The nurse understands that vitamin K works by:
A. Enhancing the breakdown of clotting factors
B. Increasing platelet aggregation
C. Promoting synthesis of clotting factors II, VII, IX, and X
D. Neutralizing circulating warfarin molecules
Correct Answer: C
Rationales:
A. Incorrect. Warfarin inhibits clotting factor synthesis; vitamin K reverses this.
B. Incorrect. Vitamin K does not affect platelets.
C. Correct. Vitamin K is required for hepatic production of vitamin K-dependent clotting factors.
D. Incorrect. Vitamin K does not bind or neutralize warfarin.
What is the mechanism of action for dantrolene in treating malignant hyperthermia?
A. Increasing calcium release from the sarcoplasmic reticulum
B. Blocking neuromuscular transmission at the synapse
C. Inhibiting calcium release in skeletal muscle
D. Enhancing dopamine levels in basal ganglia
Correct Answer: C
Rationales:
A. Incorrect. Calcium release is already excessive in malignant hyperthermia.
B. Incorrect. That describes paralytics like succinylcholine.
C. Correct. Dantrolene blocks calcium release → reduces muscle rigidity and hypermetabolism.
D. Incorrect. Dopamine enhancement treats Parkinson’s, not MH.
Which systemic adverse effect should the nurse monitor for in a client using timolol eye drops?
A. Tachycardia
B. Hypotension and bradycardia
C. Polyuria
D. Hyperkalemia
Correct Answer: B
Rationales:
A. Incorrect. Timolol, a beta blocker, slows the heart, not speeds it up.
B. Correct. Systemic absorption may cause bradycardia, AV block, and hypotension.
C. Incorrect. No effect on kidney output.
D. Incorrect. Potassium balance is unaffected.
A client in the ED is receiving IM epinephrine for anaphylaxis. Which assessment indicates the medication is effective?
A. Persistent wheezing
B. Decreasing stridor
C. Lowering blood glucose
D. Bradycardia
Correct Answer: B
Rationales:
A. Incorrect. Wheezing persisting = inadequate response.
B. Correct. Improvement in upper airway obstruction indicates epinephrine effectiveness.
C. Incorrect. Epinephrine raises glucose.
D. Incorrect. Epinephrine causes tachycardia, not bradycardia.
A client taking baclofen for muscle spasticity reports that they stopped the medication abruptly yesterday. Which symptom is the nurse most concerned about?
A. Increased thirst
B. Hallucinations and seizures
C. Mild constipation
D. Headache
Rationales:
A. Incorrect. Not associated with baclofen withdrawal.
B. Correct. Abrupt cessation can cause seizures, hallucinations, high fever, rebound spasticity; life-threatening.
C. Incorrect. Constipation may occur during therapy, not withdrawal.
D. Incorrect. Headache is nonspecific and less urgent.
Which client statement indicates a need for immediate follow-up while using a scopolamine patch?
A. “My mouth feels dry.”
B. “I feel a little sleepy.”
C. “My vision suddenly seems blurry on one side.”
D. “I am having less sweating than usual.”
Correct Answer: C
Rationales:
A. Incorrect. Dry mouth = expected anticholinergic effect.
B. Incorrect. Sedation is common and not emergent.
C. Correct. Unilateral blurred vision → possible accidental eye contamination, causing acute mydriasis or worsening narrow-angle glaucoma → requires prompt evaluation.
D. Incorrect. Heat intolerance occurs but is not a priority.
A client is prescribed oral bethanechol for postoperative urinary retention. Which statement by the client indicates correct understanding?
A. “I should try to urinate about 30 to 60 minutes after I take this medication.”
B. “This medication will relax my bladder muscle so it can hold more urine.”
C. “I should take this medication at bedtime so I can sleep while it works.”
D. “If I feel nauseated, I should take it with a large meal to prevent stomach upset.”
Correct Answer: A
Rationales:
A. Correct. Bethanechol is a cholinergic agonist that stimulates bladder contraction; oral onset is 30-60 minutes, so voiding attempts should occur during that window.
B. Incorrect. It contracts bladder muscle; it does not relax it.
C. Incorrect. Giving it at bedtime risks incontinence and is not recommended.
D. Incorrect. Taking with food may worsen GI upset; usually taken on an empty stomach unless otherwise directed.
A client takes both verapamil and digoxin. Which assessment finding is the nurse most concerned about?
A. Heart rate 48 bpm
B. BP 152/84 mm Hg
C. Regular heart rhythm
D. Complaints of mild headache
Correct Answer: A
Rationales:
A. Correct. Verapamil slows AV conduction; digoxin increases vagal tone. Combined, they may cause severe bradycardia or AV block.
B. Incorrect. Mildly elevated BP is not urgent.
C. Incorrect. A regular rhythm is reassuring.
D. Incorrect. Mild headache is not the priority concern.
A client using inhaled cromolyn for chronic asthma calls the clinic reporting coughing and wheezing immediately after inhalation. What is the nurse’s best response?
A. “This is normal; continue using the medication.”
B. “This may be a bronchospasm caused by the medication; stop and notify your provider.”
C. “Try taking the medication with food to reduce irritation.”
D. “Increase the dose for better control of your symptoms.”
Correct Answer: B
Rationales:
A. Incorrect. Immediate bronchospasm is not expected and can be dangerous.
B. Correct. Cromolyn can rarely trigger paradoxical bronchospasm, requiring provider evaluation.
C. Incorrect. Cromolyn inhalation has no relationship to food intake.
D. Incorrect. Increasing the dose may worsen bronchospasm.
Which over-the-counter medication should a client taking levothyroxine avoid within 4 hours of administration?
A. Acetaminophen
B. Vitamin C
C. Prenatal vitamins containing iron
D. Ibuprofen
Correct Answer: C
Rationales:
A. Incorrect. Does not affect absorption.
B. Incorrect. Vitamin C does not impair levothyroxine binding.
C. Correct. Iron, magnesium, calcium bind levothyroxine → reduced absorption; separate by 4 hours.
D. Incorrect. Ibuprofen does not affect thyroid hormone absorption.
A client taking daily low-dose aspirin reports new black, tarry stools. How should the nurse interpret this finding?
A. Expected aspirin effect
B. Sign of GI bleeding
C. Result of increased platelet production
D. Unrelated to aspirin use
Correct Answer: B
Rationales:
A. Incorrect. Black stools are never expected.
B. Correct. Aspirin impairs platelet aggregation → increases risk of GI ulcers and bleeding.
C. Incorrect. Aspirin reduces platelet activity, not production.
D. Incorrect. GI bleeding is a well-documented adverse effect of aspirin.
What action should the nurse take to help prevent nephrotoxicity when administering IV amphotericin B?
A. Restrict fluids for 12 hours before administration
B. Administer a 500-1000 mL normal saline bolus prior to infusion
C. Increase the infusion rate to reduce vein irritation
D. Administer the medication by IM injection if creatinine is elevated
Correct Answer: B
Rationales:
A. Incorrect. Fluid restriction increases nephrotoxicity risk.
B. Correct. Prehydration with normal saline reduces renal vasoconstriction and drug deposition → lower nephrotoxicity.
C. Incorrect. Faster rates increase risk for severe infusion reactions.
D. Incorrect. Amphotericin B is never given IM.
A client taking prednisone for chronic inflammation asks why the dose must be increased during times of stress. What is the nurse’s best explanation?
A. “The medication becomes less effective during stress.”
B. “Your body requires more corticosteroids during physical and emotional stress.”
C. “The additional dose prevents high blood pressure.”
D. “Prednisone is eliminated faster during stress.”
Correct Answer: B
Rationales:
A. Incorrect. Effectiveness does not diminish under stress.
B. Correct. During stress, the body releases extra cortisol; prednisone replaces this physiologic need to prevent adrenal crisis.
C. Incorrect. Extra doses are not used to control BP.
D. Incorrect. Metabolism does not increase significantly.
Which client statement indicates effective therapeutic response to donepezil for Alzheimer’s disease?
A. “I am remembering upcoming appointments more easily.”
B. “My heart rate is increasing since starting this medication.”
C. “My ability to walk long distances has improved.”
D. “I have stopped losing weight since taking this medication.”
Correct Answer: A
Rationales:
A. Correct. Donepezil increases acetylcholine → improved cognitive function, memory, and executive function.
B. Incorrect. Donepezil can cause bradycardia, not tachycardia.
C. Incorrect. It does not improve motor function.
D. Incorrect. Weight changes are not primary therapeutic markers.
A client receives IV diazepam and subsequently develops profound sedation. Which medication should the nurse anticipate administering?
A. Naloxone
B. Flumazenil
C. Protamine sulfate
D. Digoxin immune Fab
Correct Answer: B
Rationales:
A. Incorrect. Naloxone reverses opioids, not benzodiazepines.
B. Correct. Flumazenil is the specific benzodiazepine receptor antagonist, reversing sedation.
C. Incorrect. Protamine reverses heparin.
D. Incorrect. Digoxin immune Fab treats digoxin toxicity.
Which nursing priority applies when administering IV propofol for procedural sedation?
A. Ensure that the medication is infused rapidly
B. Maintain strict aseptic technique with all tubing and vial access
C. Avoid monitoring respiratory status closely
D. Administer only through a central line
Correct Answer: B
Rationales:
A. Incorrect. Rapid IV bolus increases risk of apnea.
B. Correct. Propofol is formulated in a lipid emulsion → high risk of bacterial contamination; aseptic technique is critical.
C. Incorrect. Propofol can cause profound respiratory depression → must monitor airway continuously.
D. Incorrect. Propofol may be given via peripheral IV.
Which client action indicates correct self-administration of timolol eye drops?
A. Touching the dropper tip to the eye for accuracy
B. Allowing the drop to fall into the conjunctival sac without touching the eye
C. Instilling drops directly onto the cornea
D. Applying pressure to the upper eyelid immediately after instillation
Correct Answer: B
Rationales:
A. Incorrect. Touching the tip contaminates the bottle.
B. Correct. Proper technique is to drop medication into the lower conjunctival sac without touching the eye.
C. Incorrect. Instilling on the cornea causes pain and corneal damage.
D. Incorrect. Pressure should be applied to the inner canthus, not the upper eyelid.
A client asks about cabotegravir for HIV prevention. Which response by the nurse is correct?
A. “It’s an oral medication taken daily for prevention.”
B. “It is a long-acting injection administered every two months.”
C. “You take it only after potential HIV exposure.”
D. “This drug cures HIV infection.”
Correct Answer: B
Rationales:
A. Incorrect. Cabotegravir for PrEP is injectable, not oral.
B. Correct. Cabotegravir is a long-acting IM integrase inhibitor, given every 2 months for HIV PrEP.
C. Incorrect. It is used before exposure, not PEP.
D. Incorrect. No medication cures HIV.
The nurse provides education for a client starting allopurinol. Which statement indicates the client understands the medication’s mechanism of action?
A. “This medication helps my kidneys excrete more uric acid.”
B. “This medication reduces the production of uric acid in my body.”
C. “This medication neutralizes uric acid in my joints.”
D. “This medication removes purines from my diet.”
Correct Answer: B
Rationales:
A. Incorrect. Probenecid increases renal excretion, not allopurinol.
B. Correct. Allopurinol inhibits xanthine oxidase, decreasing uric acid formation.
C. Incorrect. It does not dissolve crystals already present.
D. Incorrect. Allopurinol does not alter digestion/absorption of purines.
The oncology nurse prepares to administer medications for chemotherapy-induced nausea and vomiting (CINV). Which regimen is appropriate?
A. Ondansetron combined with prochlorperazine
B. Pseudoephedrine and scopolamine
C. Benzonatate and diphenhydramine
D. Milk of magnesia and pantoprazole
Correct Answer: A
Rationales:
A. Correct. Ondansetron (5-HT3 antagonist) + prochlorperazine (dopamine antagonist) = evidence-based CINV treatment.
B. Incorrect. Pseudoephedrine = decongestant; scopolamine = motion sickness.
C. Incorrect. Benzonatate = cough suppressant; diphenhydramine = antihistamine.
D. Incorrect. Neither medication treats CINV.
A client taking bethanechol for urinary retention calls the clinic reporting abdominal cramping, increased salivation, and diarrhea. What is the nurse’s best response?
A. “These are expected side effects; continue the medication as prescribed.”
B. “Skip the next dose and double your dose tomorrow if symptoms improve.”
C. “These may be signs of too much medication; you should be evaluated by your provider.”
D. “Take an over-the-counter antidiarrheal and keep taking your bethanechol.”
Correct Answer: C
Rationales:
A. Incorrect. While some mild GI effects can occur, excessive cholinergic symptoms suggest overdose/toxicity and cannot be ignored.
B. Incorrect. Skipping and then doubling doses is unsafe and may worsen toxicity.
C. Correct. Bethanechol excess can cause cholinergic toxicity (abdominal cramping, diarrhea, increased secretions); provider must reassess dose and safety.
D. Incorrect. Treating symptoms with OTC meds without addressing the underlying drug toxicity is unsafe.
A client switching from an ACE inhibitor to sacubitril/valsartan asks why they must stop their current medication for a period of time before beginning the new one. What is the nurse’s best response?
A. “Taking both together may severely raise your blood pressure.”
B. “Your kidneys need time to filter out the old medication.”
C. “Using both medications too close together increases the risk of life-threatening angioedema.”
D. “The medications cancel each other out if taken without a break.”
Correct Answer: C
Rationales:
A. Incorrect. Combined effect does not raise BP; it lowers it.
B. Incorrect. Kidney clearance is not the reason for the washout period.
C. Correct. ACE inhibitors + sacubitril dramatically increase bradykinin, putting the client at high risk for angioedema → 36-hour washout required.
D. Incorrect. They do not cancel each other; they dangerously potentiate each other.
A hospitalized client is receiving IV methylprednisolone for a severe COPD exacerbation. Which finding requires immediate intervention?
A. Increased energy and mild agitation
B. Blood glucose of 278 mg/dL
C. Reports of improved breathing
D. Productive cough with purulent sputum
Correct Answer: B
Rationales:
A. Incorrect. Mood changes and agitation are common steroid effects.
B. Correct. Systemic steroids can cause significant hyperglycemia, requiring prompt management.
C. Incorrect. Improvement in airflow is expected.
D. Incorrect. COPD exacerbations commonly involve purulent sputum; this alone is not emergent.
A client taking both warfarin and levothyroxine has an increased risk for which complication?
A. Blood clot formation
B. Excessive bleeding
C. Hyperthyroidism
D. Severe hypertension
Correct Answer: B
Rationales:
A. Incorrect. Opposite; warfarin decreases clotting.
B. Correct. Levothyroxine accelerates the breakdown of vitamin K-dependent clotting factors, potentiating warfarin → increased bleeding risk.
C. Incorrect. Levothyroxine dose does not induce hyperthyroidism when taken correctly.
D. Incorrect. Neither medication elevates BP significantly.
Which explanation best describes why a client taking clopidogrel should avoid over-the-counter omeprazole?
A. Omeprazole increases bleeding risk when combined with clopidogrel
B. Omeprazole decreases the activation of clopidogrel, reducing its antiplatelet effect
C. This combination leads to severe hypertension
D. Omeprazole raises the platelet count, counteracting clopidogrel
Correct Answer: B
Rationales:
A. Incorrect. Omeprazole does not potentiate bleeding with clopidogrel.
B. Correct. Omeprazole is a CYP2C19 inhibitor, reducing clopidogrel activation → risk for stent thrombosis or MI.
C. Incorrect. No hypertensive effect.
D. Incorrect. Omeprazole does not affect platelet counts.
Which client teaching is most important for ciprofloxacin?
A. “You may take this medication with milk for stomach upset.”
B. “Report any tendon pain or swelling immediately.”
C. “This medication will not interact with other medications.”
D. “Stop the medication if you develop a mild headache.”
Correct Answer: B
Rationales:
A. Incorrect. Milk reduces absorption due to chelation with calcium.
B. Correct. Fluoroquinolones carry a black box warning for tendon rupture, especially the Achilles tendon.
C. Incorrect. Ciprofloxacin has numerous interactions (warfarin, antacids, dairy, iron).
D. Incorrect. Mild headache is not an indicator to stop therapy.
A client taking hydrocortisone 40 mg/day asks which adverse effect requires the most vigilant monitoring. What should the nurse emphasize?
A. Risk of infection
B. Tinnitus
C. Hyperpigmentation
D. Lower-extremity edema
Correct Answer: A
Rationales:
A. Correct. Hydrocortisone causes immune suppression, increasing infection risk. This is the highest-priority teaching point.
B. Incorrect. Tinnitus is unrelated.
C. Incorrect. Hyperpigmentation occurs with Addison’s disease, not steroid therapy.
D. Incorrect. Edema may occur but is not the most dangerous complication.
A client with Parkinson’s disease abruptly stops taking levodopa/carbidopa. Which condition is the nurse MOST concerned about?
A. Hypertensive crisis
B. Malignant hyperthermia
C. Neuroleptic malignant-like syndrome (NMS)
D. Severe hypoglycemia
Correct Answer: C
Rationales:
A. Incorrect. No link to hypertensive crises.
B. Incorrect. Malignant hyperthermia is triggered by anesthetics, not levodopa withdrawal.
C. Correct. Abrupt cessation of dopaminergic therapy can cause NMS, characterized by rigidity, fever, tachycardia, altered mental status.
D. Incorrect. Levodopa does not affect glucose.
Which set of symptoms would the nurse recognize as most indicative of morphine toxicity?
A. Dilated pupils, tachypnea, restlessness
B. Pinpoint pupils, respiratory depression, unresponsiveness
C. Muscle rigidity, hyperthermia, tachycardia
D. Hypertension, tinnitus, vomiting
Correct Answer: B
Rationales:
A. Incorrect. These signs suggest stimulant toxicity, not opioids.
B. Correct. The opioid overdose triad: miosis (pinpoint pupils), respiratory depression, profound CNS depression/unresponsiveness.
C. Incorrect. This resembles NMS or malignant hyperthermia.
D. Incorrect. Hypertension/tinnitus → salicylate toxicity, not opioid toxicity.
A client presents with suspected acetaminophen overdose. Which complication is the nurse MOST concerned about?
A. Cardiac tamponade
B. Acute liver failure
C. Renal calculi
D. Respiratory alkalosis
Correct Answer: B
Rationales:
A. Incorrect. Acetaminophen does not affect the pericardium.
B. Correct. High doses produce a hepatotoxic metabolite (NAPQI) → acute liver failure, the most serious risk.
C. Incorrect. Not associated.
D. Incorrect. Acid-base imbalances are not hallmark complications.
A client using timolol eye drops reports new difficulty breathing and wheezing. What is the nurse’s priority action?
A. Encourage slow, deep breathing
B. Hold the medication and notify the healthcare provider immediately
C. Administer an over-the-counter decongestant
D. Advise the client that this is an expected temporary effect
Correct Answer: B
Rationales:
A. Incorrect. This does not address the underlying cause.
B. Correct. Wheezing may indicate systemic beta-blockade → bronchospasm, which is dangerous, especially in asthma/COPD clients. The drug must be stopped and the provider notified.
C. Incorrect. Decongestants may worsen cardiovascular effects.
D. Incorrect. Respiratory symptoms are not normal and can be life-threatening.
Which teaching should the nurse include for a client starting interferon beta-1a therapy?
A. “Take this medication by mouth daily.”
B. “You may experience flu-like symptoms after your injections.”
C. “You will not need to rotate injection sites with this drug.”
D. “This medication causes severe hyperglycemia; check your glucose.”
Correct Answer: B
Rationales:
A. Incorrect. Interferon beta is injectable, not oral.
B. Correct. Flu-like symptoms (fever, myalgia, chills) are common and expected early in therapy.
C. Incorrect. Injection site rotation prevents irritation and necrosis.
D. Incorrect. This drug does not alter glucose levels.