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1. What should the nurse monitor to evaluate the effectiveness of carbamazepine (Tegretol) in the management of a client’s trigeminal neuralgia?

• Pain intensity
• Liver function
• Cardiac output
• Seizure activity

2. A nurse is planning care for a client with cancer who is receiving the plant alkaloid vinCRIStine. In contrast to the side effects of most chemotherapeutic agents, what is a common side effect of vinCRIStine that the nurse must address in the client’s care plan?

• Nausea
• Alopecia
• Constipation
• Hyperuricemia

3. A client receiving chemotherapy asks the nurse why an antibiotic was also prescribed. Which tissue affected by chemotherapy should the nurse consider when formulating a response?

• Liver
• Blood
• Bone marrow
• Lymph nodes

4. A nurse administers the drug desmopressin acetate (DDAVP) to a client with diabetes insipidus. What should the nurse monitor to evaluate the effectiveness of the drug?

• Arterial blood pH
• Intake and output
• Fasting serum glucose
• Pulse and respiratory rates

5. A nurse administers leucovorin calcium to a client before the prescribed methotrexate (Trexall). The client asks the reason for this. What effect of leucovorin calcium should the nurse consider when formulating a response?

• Potentiates metabolite required for destruction of cancer cells
• Supplies levels of folic acid required by blood-forming organs
• Acts synergistically with antineoplastic drugs to destroy cancer cells
• Increases production of phagocytes to help remove debris from destroyed cancer cells

6. A client receiving morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate?

• Nasotracheal suction
• Mechanical ventilation
• Naloxone administration
• Cardiopulmonary resuscitation

7. A nurse is administering 40 mg of furosemide (Lasix) intravenously. Which sensation reported by the client does the nurse consider when determining that it is being administered too quickly?

• “Bladder feels full”
• “Ears are plugged up”
• “Heart is beating fast”
• “Left arm feels numb”

8. A client with a history of tuberculosis reports difficulty hearing. Which medication should the nurse consider is related to this response?

• Streptomycin
• Pyrazinamide
• Isoniazid (INH)
• Ethambutol (Myambutol)

9. A client who has been diagnosed with Lyme disease is started on doxycycline (Vibramycin) as part of the therapy. What should the nurse do when administering this drug?

• Administer the medication with meals or a snack.
• Provide orange or other citrus fruit juice with the medication.
• Give the medication an hour before milk products are ingested.
• Offer antacids thirty minutes after administration if GI side effects occur.

10. Some clients self-prescribe over-the-counter glucosamine to help relieve joint pain and stiffness. Which condition should the nurse identify as a reason for a client to reconsider taking this medication?

• Osteoarthritis
• Heart disease
• Hyperthyroidism
• Diabetes mellitus

11. Nesiritide (Natrecor), a vasodilator, is prescribed for a client with acute heart failure and pulmonary edema. The nurse is assessing the clients response to the medication. Which clinical manifestation should decrease when the medication is effective?

• Dyspnea
• Hypotension
• Unstable angina
• Premature heartbeats

12. After several days of IV therapy for chloroquine-resistant malaria, the health care provider replaces the IV medication with oral quinine, 2 g per day in divided doses. The nurse advises the client to take this medication after meals to:

• delay its absorption.
• minimize gastric irritation.
• decrease stimulation of appetite.
• reduce its antidysrhythmic action.

13. A client is receiving phenytoin (Dilantin) for a seizure disorder and heparin for a deep vein thrombosis. Warfarin (Coumadin) is added in preparation for discontinuing the heparin. Why must the nurse observe the client closely during the initial days of treatment with Coumadin?

• Warfarin affects the metabolism of phenytoin.
• Phenytoin decreases warfarin’s anticoagulant effect.
• Warfarin’s action is greater in clients with seizure disorders.
• Seizures increase the metabolic degradation rate of warfarin.

14. After surgery a client develops a deep vein thrombosis and a pulmonary embolus. Heparin via a continuous drip at 1200 units/hr is prescribed. Several hours later, vancomycin (Vancocin) 500 mg intravenously every 12 hours is prescribed. The client has one IV site: a peripheral line in the left forearm. What action should the nurse take?

• Stop the heparin, flush the line, and administer the vancomycin.
• Use a piggyback setup to administer the vancomycin into the heparin.
• Start another IV line for the vancomycin and continue the heparin as prescribed.
• Hold the vancomycin and tell the health care provider that the drug is incompatible with heparin.

15. Preparation of a client for a subtotal thyroidectomy may include the administration of potassium iodide solution. The client refuses to take the medication. What explanation should the nurse give as to why this medication should be taken?

• The metabolic rate of the body will increase.
• It will reduce the risk of hemorrhage during surgery.
• It will maintain the functioning of the parathyroid glands.
• The amount of thyroid hormones being secreted will decrease.

16. Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. The nurse responds, “It:

• increases gastric motility.”
• neutralizes gastric acidity.”
• facilitates histamine release.”
• inhibits gastric acid secretion.”

17. Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug?

• Supports a better response to stress
• Promotes a decrease in blood pressure
• Decreases episodes of shortness of breath
• Controls an excessive loss of potassium from the body

18. A client who is receiving phenytoin (Dilantin) asks why folic acid (Folate) was prescribed. What is the best explanation by the nurse?

• Absorption from foods is inhibited.
• The action of phenytoin is potentiated.
• Absorption of iron from foods is improved.
• Neuropathy caused by phenytoin is prevented.

19. A nurse is providing instructions for a client who is receiving phenytoin (Dilantin) but has limited access to health care. What side effect is the basis for the nurse’s emphasis on meticulous oral hygiene?

• Hyperplasia of the gums
• Alkalinity of the oral secretions
• Irritation of the gingiva and destruction of tooth enamel
• Promotion of plaque and bacterial growth at the gum lines

20. A client with tuberculosis asks the nurse why vitamin B6 (pyridoxine) is given with isoniazid (INH). What explanation should the nurse provide?

• “It will improve your immunologic defenses.”
• “The tuberculostatic effect of isoniazid is enhanced.”
• “Isoniazid interferes with the synthesis of this vitamin.”
• “Destruction of the tuberculosis organisms is accelerated.”

21. The nurse explains to the family of a client suspected of having myasthenia gravis that edrophonium (Enlon) is used to establish the diagnosis. An increase in which factor will confirm the diagnosis?

• Symptoms
• Consciousness
• Blood pressure
• Muscle strength

22. A nurse is reviewing the history and physicals of several clients from the clinic who are taking rifampin (Rifadin) for the treatment of tuberculosis. Which client presents a specific concern for the nurse?

• 45-year-old taking a loop diuretic
• 26-year-old taking oral contraceptives
• 32-year-old taking a proton pump inhibitor
• 72-year-old taking intermediate-acting insulin

23. Carbidopa/levodopa (Sinemet) is prescribed for a client with Parkinson disease. What should the nurse teach the client about this medication?

• “Take this medication between meals.”
• “Blood levels of the drug should be monitored weekly.”
• “It can cause happy feelings followed by feelings of depression.”
• “You may experience dizziness when moving from sitting to standing.”

24. A client with a head injury has been receiving dexamethasone (Decadron). The health care provider plans to reduce the dexamethasone (Decadron) dosage gradually and to continue a lower maintenance dosage. Which effect associated with the gradual dosage reduction of the drug should the nurse explain to the client?

• Builds glycogen stores in the muscles
• Produces antibodies by the immune system
• Allows the increased intracranial pressure to return to normal
• Promotes return of cortisone production by the adrenal glands

25. A client will be taking nitrofurantoin (Macrobid) 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client?

• Increase your intake of fluids.
• Strain the urine for crystals and stones.
• Stop the drug if your urinary output increases.
• Maintain the exact time schedule for taking the drug.

26. A nurse provides instruction when the beta blocker atenolol (Tenormin) is prescribed for a client with moderate hypertension. What action identified by the client indicates to the nurse that the client needs further teaching?

• Move slowly when changing positions.
• Take the medication before going to bed.
• Expect to feel drowsy when taking this drug.
• Count the pulse before taking the medication.

27. Which medication should the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema?

• Morphine
• Phenobarbital
• HydrOXYzine
• Chloral hydrate

28. A client with type 2 diabetes develops gout, and allopurinol (Zyloprim) is prescribed. The client is also taking metformin (Glucophage) and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do?

• Decrease the daily dose of NSAIDs.
• Limit fluid intake to one quart a day.
• Take the medication on an empty stomach.
• Monitor blood glucose levels more frequently.

29. A client receiving chemotherapy for cancer develops sores in the mouth and asks the nurse why this happened. What is the nurses best response?

• “The sores occur because of the direct irritating effects of the drug.”
• “These tissues are poorly nourished because you have a decreased appetite.”
• “The rapidly dividing cells of the gastrointestinal tract are damaged by the drug.”
• “This side effect occurs because it targets the cells of the gastrointestinal system.”

30. A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client’s spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do?

• Add a placebo to the morphine to appease the spouse.
• Discuss with the spouse the risk for morphine addiction.
• Assess the client’s pain before increasing the dose of morphine.
• Check the client’s heart rate before increasing the mor-phine to the next level.

31. What information should the nurse include when teaching a client about antacid tablets?

• Take them at 4-hour intervals.
• Take them 1 hour before meals.
• They are as effective as the liquid forms.
• They interfere with the absorption of other drugs.

32. A client says, “I take baking soda in water when I get heartburn.” The nurse suggests an antacid containing aluminum and magnesium hydroxide instead of baking soda. What is the advantage these antacids have over baking soda?

• They contain little, if any, sodium.
• Absorption by the stomach mucosa is markedly enhanced.
• There is no direct effect on the systemic acid-base balance when taken as directed.
• Few side effects such as diarrhea or constipation are experienced when they are used properly.

33. A health care provider prescribes a vitamin tablet that contains vitamin B complex. What should the nurse teach the client?

• It may turn the urine bright yellow.
• The daily fluid intake should be increased.
• The drug should be taken on an empty stomach.
• It may accumulate in the body if an excessive amount is taken.

34. A client with rheumatoid arthritis has been taking a steroid medication for the past year. For which complication of prolonged use of this medication should the nurse assess the client?

• Decreased white blood cells
• Increased C-reactive protein
• Increased sedimentation rate
• Decreased serum glucose levels

35. Which test result should a nurse review to determine if the antibiotic prescribed for the client will be effective?

• Serologic test
• Sensitivity test
• Serum osmolality
• Sedimentation rate

36. A client is to have mafenide (Sulfamylon) cream applied to burned areas. For which serious side effect of mafenide therapy should the nurse monitor this client?

• Curling ulcer
• Renal shutdown
• Metabolic acidosis
• Hemolysis of red blood cells

37. After receiving streptomycin sulfate for 2 weeks as part of the medical regimen for tuberculosis, the client states, “I feel like I am walking like a drunken seaman.” The nurse withholds the drug and promptly reports the problem to the health care provider. Which part of the body does the nurse determine is being affected as indicated by the symptom reported by the client?

• Pyramidal tracts
• Cerebellar tissue
• Peripheral motor end-plates
• Eighth cranial nerve’s vestibular branch