Adaptive Quiz

1. A nurse is providing discharge teaching to a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

A. Take ibuprofen as needed for headaches or other minor pains
B. Carry a medical alert ID card
C. Report to the laboratory weekly to have blood drawn for aPTT
D. Increase intake of dark green vegetables
✅ Answer: B. Carry a medical alert ID card
Rationale: Prevents unsafe medication interactions in emergencies.

2. A nurse is preparing to administer ampicillin 50 mg/kg/day PO divided into 4 equal doses for a toddler who weighs 33 lb. Ampicillin 125 mg/5 mL oral solution is available. How many mL should the nurse administer per dose?

✅ Answer: 7.5 mL/dose

Rationale: Correct pediatric dose calculation.

3. A charge nurse is monitoring a newly licensed nurse caring for a client receiving morphine via PCA pump. Which action requires intervention?

A. Instructing the client to administer a PCA dose prior to a dressing change
B. Providing increased fluids while the client is using the PCA pump
C. Informing the client’s partner that only the client should administer PCA doses
D. Maintaining the client on bed rest while the PCA pump is in use
✅ Answer: D. Maintaining the client on bed rest while the PCA pump is in use
Rationale: Clients may ambulate safely with PCA use.

4. A nurse is monitoring a client with diabetes insipidus who received desmopressin. Which finding indicates an adverse effect?

A. Thirst
B. Nocturia
C. Headache
D. Heart palpitations
✅ Answer: C. Headache
Rationale: Suggests water intoxication/hyponatremia.

5. A nurse is reinforcing teaching about contraindications to vaccines. Which example is a true contraindication for all vaccines?

A. Previous local reaction to an injectable vaccine
B. Previous severe allergic reaction to a vaccine component
C. Recent exposure to an infectious disease
D. Family history of allergy to penicillin
✅ Answer: B. Previous severe allergic reaction to a vaccine component
Rationale: Severe allergy (e.g., anaphylaxis) is a contraindication.

6. A nurse is preparing to administer IV hydromorphone for pain. Which action should the nurse take?

A. Administer the medication over 4 to 5 minutes
B. Place the client in a high-Fowler’s position
C. Assess the client’s pain level after administering the medication
D. Review the client’s last set of vital signs
✅ Answer: A. Administer the medication over 4 to 5 minutes
Rationale: IV opioids must be given slowly to prevent adverse effects.

7. A nurse is teaching a client with a new prescription for alosetron. Which client statement indicates understanding?

A. “Nausea is a common adverse effect of this medication.”
B. “I should contact my provider immediately if I experience constipation.”
C. “If I do not respond to treatment, my provider may increase the dosage weekly.”
D. “Abdominal pain with diarrhea can indicate a serious complication.”
✅ Answer: B. “I should contact my provider immediately if I experience constipation.”
Rationale: Constipation can lead to ischemic colitis.

8. A client with asthma and severe rheumatoid arthritis: Which medication delivery device is best?

A. Dry-powder inhaler (DPI)
B. Metered-dose inhaler (MDI) with spacer
C. Respimat
D. Nebulizer
✅ Answer: D. Nebulizer
Rationale: Requires minimal hand coordination.

9. A nurse is teaching a client with diabetes mellitus about pioglitazone. Which statement should the nurse include?

A. “Monitor for hypoglycemia 6 hours after taking this medication.”
B. “This medication cannot be taken if you have a sulfa allergy.”
C. “This medication can be taken when using insulin.”
D. “This medication is effective for type 1 diabetes.”
✅ Answer: C. “This medication can be taken when using insulin.”
Rationale: Used for type 2 DM, safe with insulin, but monitor for fluid retention.

10. A nurse is teaching a client with severe gout prescribed pegloticase. Which instruction should the nurse include?

A. “You will take this medication along with allopurinol.”
B. “You will take this medication by mouth.”
C. “There are very few adverse effects of this medication.”
D. “If you experience a flare-up, you can take an NSAID while receiving this medication.”
✅ Answer: D. “If you experience a flare-up, you can take an NSAID while receiving this medication.”
Rationale: Gout flares are common at initiation.

11. A nurse is teaching a client with type 2 DM starting metformin. Which adverse effect should be reported?

A. Weight gain
B. Myalgia
C. Hypoglycemia
D. Severe constipation
✅ Answer: B. Myalgia
Rationale: May indicate lactic acidosis.

12. A nurse caring for a client with asthma on inhaled glucocorticoid + LABA DPI should recognize which disadvantage?

A. Restricted dosage flexibility
B. Complicated delivery device
C. Serious systemic effects
D. Limited efficacy over time
✅ Answer: A. Restricted dosage flexibility
Rationale: Fixed-dose combinations limit individual dose adjustment.

13. A provider plans to use lidocaine + epinephrine for laceration repair. What is the action of epinephrine?

A. Acts as a catalyst for anesthetic properties of lidocaine
B. Delays systemic absorption of lidocaine
C. Opens blood vessels for rapid anesthesia
D. Prevents medication toxicity
✅ Answer: B. Delays systemic absorption of lidocaine
Rationale: Vasoconstriction prolongs anesthesia and reduces bleeding.

14. A nurse is preparing to administer amlodipine for HTN. Which adverse effects should the nurse monitor? (Select all that apply.)

A. Dizziness
B. Pale appearance
C. Palpitations
D. Abdominal pain
E. Peripheral edema
✅ Answers: A. Dizziness, C. Palpitations, E. Peripheral edema
Rationale: Common CCB effects due to vasodilation and fluid retention.

15. A nurse is teaching a client starting prednisone for rheumatoid arthritis. Which adverse effect should be reported?

A. Ototoxicity
B. Immunosuppression
C. Gastric ulceration
D. Liver toxicity
✅ Answer: C. Gastric ulceration
Rationale: Long-term corticosteroid use increases GI ulcer risk.

16. A nurse is caring for a client taking theophylline. Which medication is incompatible?

A. Cromolyn
B. Albuterol
C. Zafirlukast
D. Methylprednisolone
✅ Answer: C. Zafirlukast
Rationale: Increases theophylline levels → toxicity.

17. A nurse is caring for a client with a levonorgestrel IUD in place for 1 year. Which finding indicates an adverse effect?

A. Developed sensitivity to copper
B. Vaginal irritation or inflammation
C. Decreased menstrual bleeding
D. Spotting between cycles
✅ Answer: B. Vaginal irritation or inflammation
Rationale: Suggests infection/displacement.

18. Chlorothiazide pediatric dose calculation (28.6 lb, 20 mg/kg/day ÷ BID, 250 mg/5 mL).

✅ Answer: 2.6 mL/dose

Rationale: Correct pediatric dose calculation.

19. A client with newly diagnosed rheumatoid arthritis: When should methotrexate be prescribed?

A. Within 3 months of the initial diagnosis
B. When NSAIDs have not provided pain relief
C. During an exacerbation of symptoms
D. Once bone degeneration progresses
✅ Answer: A. Within 3 months of the initial diagnosis
Rationale: Early DMARD use prevents joint damage.

20. A client with menopause prescribed estrogen + progestin: Why prescribed?

A. Long-term use to reduce breast cancer risk
B. Short-term use to stimulate the endometrium
C. Long-term use to prevent osteoporosis
D. Short-term use to control urogenital atrophy
✅ Answer: D. Short-term use to control urogenital atrophy
Rationale: Relieves vaginal dryness/atrophy; not for long-term use due to risks.

Perfect ✅ Here’s your Set 2 (Questions 21–40) all neatly organized with answer choices, correct answers, and rationales:

Pharmacology ATI – Adaptive Quiz (Set 2: Questions 21–40)

21. A nurse in a long-term care facility is administering medications to a group of older adult clients. Which of the following factors of pharmacokinetics should the nurse consider when caring for this age group?

A. The excretion of medication is reduced.
B. The percentage of medication absorbed is increased.
C. The liver metabolizes medication more quickly.
D. The rate at which the liver metabolizes medication declines with age.
✅ Answer: D. The rate at which the liver metabolizes medication declines with age.
Rationale: Older adults have slower hepatic metabolism, prolonging drug half-life and increasing toxicity risk.

22. A nurse is teaching a client with chronic asthma who has a new prescription for cromolyn. Which of the following instructions should the nurse include in the teaching?

A. “Use the inhaler just before exercise.”
B. “The medication’s therapeutic effects can take up to several weeks to develop.”
C. “You will shake the medication container for 3 seconds.”
D. “You will need to exhale slowly after you inhale.”
✅ Answer: B. “The medication’s therapeutic effects can take up to several weeks to develop.”
Rationale: Cromolyn is a mast cell stabilizer for long-term control, not rescue therapy.

23. A nurse is reviewing the medical record of a client who has a prescription for a combination oral contraceptive. Which finding is a contraindication?

A. High cholesterol levels
B. Liver disease
C. Family history of ovarian cancer
D. Client report of hypermenorrhea
✅ Answer: B. Liver disease
Rationale: OCPs are metabolized by the liver, so liver disease increases toxicity risk.

24. A nurse is monitoring a client who received diphenoxylate-atropine. Which statement indicates effectiveness?

A. “I feel a little drowsy with this medication.”
B. “I am now drinking much more water.”
C. “I have not had a bowel movement today.”
D. “I no longer feel chest tightness.”
✅ Answer: C. “I have not had a bowel movement today.”
Rationale: Effectiveness = reduced diarrhea/intestinal motility.

25. A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem. Which should be included?

A. “Seizures can occur with this medication.”
B. “You should observe for manifestations of bleeding.”
C. “Check your hands and feet for sensory dysfunction.”
D. “This medication can increase the risk of ototoxicity.”
✅ Answer: A. “Seizures can occur with this medication.”
Rationale: Imipenem can lower seizure threshold, especially with renal impairment.

26. A nurse is planning care for a client with seizure disorder on valproic acid. Which labs should be monitored? (Select all that apply.)

A. BUN
B. PTT
C. AST
D. Urinalysis
E. ALT
✅ Answers: B. PTT, C. AST, E. ALT
Rationale: Valproic acid can cause hepatotoxicity and altered coagulation.

27. A nurse is explaining enteric-coated tablets. Which statement should be made?

A. “This coated tablet dissolves better in your stomach and intestines.”
B. “You are less likely to have an upset stomach with this pill because of the coating.”
C. “The coating improves absorption.”
D. “The coating allows a gradual release of medication.”
✅ Answer: B. “You are less likely to have an upset stomach with this pill.”
Rationale: Enteric coating prevents stomach irritation by dissolving in intestines.

28. A nurse is planning care for a client with IBS-D and a new prescription for alosetron. Which intervention is required?

A. The client must sign an agreement with the provider before beginning alosetron.
B. Stop taking alosetron if diarrhea continues for 1 week.
C. Expect slower heart rate while taking alosetron.
D. Use barrier birth control due to interactions.
✅ Answer: A. The client must sign an agreement with the provider before beginning alosetron.
Rationale: Alosetron carries serious GI risks, requiring strict prescribing program.

29. A nurse is teaching a client with urethritis prescribed oral erythromycin. Which statement should be included?

A. “Report persistent diarrhea to the provider.”
B. “Take with a full glass of milk.”
C. “This may cause vision loss.”
D. “Antacids reduce absorption.”
✅ Answer: A. “Report persistent diarrhea to the provider.”
Rationale: Persistent diarrhea may indicate C. difficile infection.

30. A nurse is caring for a client receiving bleomycin IV for lymphoma. Which assessment is priority?

A. Pulmonary function
B. CBC
C. Urinary output
D. Peripheral edema
✅ Answer: A. Pulmonary function
Rationale: Bleomycin toxicity → pulmonary fibrosis/pneumonitis.

31. A nurse is teaching a postmenopausal client with alendronate. Which instruction is correct?

A. “You can lie down 15 minutes after taking this medication.”
B. “Take this medication on an empty stomach.”
C. “Crush this medication for absorption.”
D. “Avoid antacids/calcium while taking this medication.”
✅ Answer: B. “Take this medication on an empty stomach.”
Rationale: Must be taken on empty stomach with water; remain upright 30+ minutes.

32. A nurse is teaching a client with chronic constipation on psyllium. Which instruction should be included?

A. “This medication is for short-term use only.”
B. “Eat a low-residual diet.”
C. “Mix this with water and follow with an additional glass of liquid.”
D. “Adverse effects of cramps will go away in time.”
✅ Answer: C. “Mix this with water and follow with an additional glass of liquid.”
Rationale: Psyllium is a bulk-forming laxative; must take with fluids.

33. A nurse is preparing to administer oxytocin at 41 weeks. Which action should be taken?

A. Place oxytocin vaginally every 10 min.
B. Check BP and pulse every 15 min.
C. Stop oxytocin for contractions >30 sec.
D. Increase dose to obtain contractions every 2–3 min.
✅ Answer: D. Increase dose to obtain contractions every 2–3 min.
Rationale: Goal: contractions lasting 45–60 sec every 2–3 min.

34. A nurse is teaching about nifedipine for preterm labor. Which mechanism should be explained?

A. Prevents bacterial vaginosis
B. Inhibits calcium entry into uterine cells
C. Decreases CNS activity
D. Stimulates beta-2 receptors in uterus
✅ Answer: B. Inhibits calcium entry into uterine cells
Rationale: Nifedipine is a calcium channel blocker → relaxes uterine smooth muscle.

35. A nurse is teaching about amitriptyline for depression. Which client statement shows understanding?

A. “I’ll take this when I feel symptoms.”
B. “I should take this before bedtime.”
C. “This may cause excess salivation.”
D. “I might lose weight while on this medication.”
✅ Answer: B. “I should take this before bedtime.”
Rationale: Amitriptyline causes sedation and anticholinergic effects.

36. A nurse is teaching about baclofen for MS spasms. Which statement indicates understanding?

A. “Adverse effects include urinary frequency.”
B. “I should eat more fiber for diarrhea.”
C. “This medication can cause addiction.”
D. “I should not stop this medication suddenly.”
✅ Answer: D. “I should not stop this medication suddenly.”
Rationale: Sudden withdrawal → hallucinations, seizures, rebound spasticity.

37. A nurse notes phenytoin level = 14 mcg/mL in a child with epilepsy. What should the nurse do?

A. Administer the dose
B. Administer half the dose
C. Do not administer
D. Clarify with provider
✅ Answer: A. Administer the dose
Rationale: Therapeutic range = 10–20 mcg/mL → safe to give as ordered.

38. A client with alcohol use disorder develops tremors/restlessness a few hours after admission. Which medication is given first?

A. Acamprosate
B. Naltrexone
C. Chlordiazepoxide
D. Disulfiram
✅ Answer: C. Chlordiazepoxide
Rationale: Benzodiazepine prevents withdrawal seizures and delirium tremens.

39. A nurse is caring for a client on acarbose for type 2 diabetes. Which adverse effect is monitored?

A. Insomnia
B. Diarrhea
C. Joint pain
D. Polycythemia
✅ Answer: B. Diarrhea
Rationale: Acarbose → GI upset (diarrhea, abdominal cramping, flatulence).

40. A client on high-dose hydroxychloroquine reports which symptom requiring concern?

A. “I have sores in my mouth.”
B. “I feel like the room is spinning.”
C. “My eyes look yellow.”
D. “I have had a change in my vision recently.”
✅ Answer: D. “I have had a change in my vision recently.”
Rationale: Hydroxychloroquine toxicity → retinal damage/vision changes.

A. The excretion of medication is reduced.
B. The percentage of medication absorbed is increased.
C. The liver metabolizes medication more quickly.
D. The rate at which the liver metabolizes medication declines with age.
✅ Answer: D. The rate at which the liver metabolizes medication declines with age.
Rationale: Older adults have slower hepatic metabolism, prolonging drug half-life and increasing toxicity risk.

22. A nurse is teaching a client with chronic asthma who has a new prescription for cromolyn. Which of the following instructions should the nurse include in the teaching?

A. “Use the inhaler just before exercise.”
B. “The medication’s therapeutic effects can take up to several weeks to develop.”
C. “You will shake the medication container for 3 seconds.”
D. “You will need to exhale slowly after you inhale.”
✅ Answer: B. “The medication’s therapeutic effects can take up to several weeks to develop.”
Rationale: Cromolyn is a mast cell stabilizer for long-term control, not rescue therapy.

23. A nurse is reviewing the medical record of a client who has a prescription for a combination oral contraceptive. Which finding is a contraindication?

A. High cholesterol levels
B. Liver disease
C. Family history of ovarian cancer
D. Client report of hypermenorrhea
✅ Answer: B. Liver disease
Rationale: OCPs are metabolized by the liver, so liver disease increases toxicity risk.

24. A nurse is monitoring a client who received diphenoxylate-atropine. Which statement indicates effectiveness?

A. “I feel a little drowsy with this medication.”
B. “I am now drinking much more water.”
C. “I have not had a bowel movement today.”
D. “I no longer feel chest tightness.”
✅ Answer: C. “I have not had a bowel movement today.”
Rationale: Effectiveness = reduced diarrhea/intestinal motility.

25. A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem. Which should be included?

A. “Seizures can occur with this medication.”
B. “You should observe for manifestations of bleeding.”
C. “Check your hands and feet for sensory dysfunction.”
D. “This medication can increase the risk of ototoxicity.”
✅ Answer: A. “Seizures can occur with this medication.”
Rationale: Imipenem can lower seizure threshold, especially with renal impairment.

26. A nurse is planning care for a client with seizure disorder on valproic acid. Which labs should be monitored? (Select all that apply.)

A. BUN
B. PTT
C. AST
D. Urinalysis
E. ALT
✅ Answers: B. PTT, C. AST, E. ALT
Rationale: Valproic acid can cause hepatotoxicity and altered coagulation.

27. A nurse is explaining enteric-coated tablets. Which statement should be made?

A. “This coated tablet dissolves better in your stomach and intestines.”
B. “You are less likely to have an upset stomach with this pill because of the coating.”
C. “The coating improves absorption.”
D. “The coating allows a gradual release of medication.”
✅ Answer: B. “You are less likely to have an upset stomach with this pill.”
Rationale: Enteric coating prevents stomach irritation by dissolving in intestines.

28. A nurse is planning care for a client with IBS-D and a new prescription for alosetron. Which intervention is required?

A. The client must sign an agreement with the provider before beginning alosetron.
B. Stop taking alosetron if diarrhea continues for 1 week.
C. Expect slower heart rate while taking alosetron.
D. Use barrier birth control due to interactions.
✅ Answer: A. The client must sign an agreement with the provider before beginning alosetron.
Rationale: Alosetron carries serious GI risks, requiring strict prescribing program.

29. A nurse is teaching a client with urethritis prescribed oral erythromycin. Which statement should be included?

A. “Report persistent diarrhea to the provider.”
B. “Take with a full glass of milk.”
C. “This may cause vision loss.”
D. “Antacids reduce absorption.”
✅ Answer: A. “Report persistent diarrhea to the provider.”
Rationale: Persistent diarrhea may indicate C. difficile infection.

30. A nurse is caring for a client receiving bleomycin IV for lymphoma. Which assessment is priority?

A. Pulmonary function
B. CBC
C. Urinary output
D. Peripheral edema
✅ Answer: A. Pulmonary function
Rationale: Bleomycin toxicity → pulmonary fibrosis/pneumonitis.

31. A nurse is teaching a postmenopausal client with alendronate. Which instruction is correct?

A. “You can lie down 15 minutes after taking this medication.”
B. “Take this medication on an empty stomach.”
C. “Crush this medication for absorption.”
D. “Avoid antacids/calcium while taking this medication.”
✅ Answer: B. “Take this medication on an empty stomach.”
Rationale: Must be taken on empty stomach with water; remain upright 30+ minutes.

32. A nurse is teaching a client with chronic constipation on psyllium. Which instruction should be included?

A. “This medication is for short-term use only.”
B. “Eat a low-residual diet.”
C. “Mix this with water and follow with an additional glass of liquid.”
D. “Adverse effects of cramps will go away in time.”
✅ Answer: C. “Mix this with water and follow with an additional glass of liquid.”
Rationale: Psyllium is a bulk-forming laxative; must take with fluids.

33. A nurse is preparing to administer oxytocin at 41 weeks. Which action should be taken?

A. Place oxytocin vaginally every 10 min.
B. Check BP and pulse every 15 min.
C. Stop oxytocin for contractions >30 sec.
D. Increase dose to obtain contractions every 2–3 min.
✅ Answer: D. Increase dose to obtain contractions every 2–3 min.
Rationale: Goal: contractions lasting 45–60 sec every 2–3 min.

34. A nurse is teaching about nifedipine for preterm labor. Which mechanism should be explained?

A. Prevents bacterial vaginosis
B. Inhibits calcium entry into uterine cells
C. Decreases CNS activity
D. Stimulates beta-2 receptors in uterus
✅ Answer: B. Inhibits calcium entry into uterine cells
Rationale: Nifedipine is a calcium channel blocker → relaxes uterine smooth muscle.

35. A nurse is teaching about amitriptyline for depression. Which client statement shows understanding?

A. “I’ll take this when I feel symptoms.”
B. “I should take this before bedtime.”
C. “This may cause excess salivation.”
D. “I might lose weight while on this medication.”
✅ Answer: B. “I should take this before bedtime.”
Rationale: Amitriptyline causes sedation and anticholinergic effects.

36. A nurse is teaching about baclofen for MS spasms. Which statement indicates understanding?

A. “Adverse effects include urinary frequency.”
B. “I should eat more fiber for diarrhea.”
C. “This medication can cause addiction.”
D. “I should not stop this medication suddenly.”
✅ Answer: D. “I should not stop this medication suddenly.”
Rationale: Sudden withdrawal → hallucinations, seizures, rebound spasticity.

37. A nurse notes phenytoin level = 14 mcg/mL in a child with epilepsy. What should the nurse do?

A. Administer the dose
B. Administer half the dose
C. Do not administer
D. Clarify with provider
✅ Answer: A. Administer the dose
Rationale: Therapeutic range = 10–20 mcg/mL → safe to give as ordered.

38. A client with alcohol use disorder develops tremors/restlessness a few hours after admission. Which medication is given first?

A. Acamprosate
B. Naltrexone
C. Chlordiazepoxide
D. Disulfiram
✅ Answer: C. Chlordiazepoxide
Rationale: Benzodiazepine prevents withdrawal seizures and delirium tremens.

39. A nurse is caring for a client on acarbose for type 2 diabetes. Which adverse effect is monitored?

A. Insomnia
B. Diarrhea
C. Joint pain
D. Polycythemia
✅ Answer: B. Diarrhea
Rationale: Acarbose → GI upset (diarrhea, abdominal cramping, flatulence).

40. A client on high-dose hydroxychloroquine reports which symptom requiring concern?

A. “I have sores in my mouth.”
B. “I feel like the room is spinning.”
C. “My eyes look yellow.”
D. “I have had a change in my vision recently.”
✅ Answer: D. “I have had a change in my vision recently.”
Rationale: Hydroxychloroquine toxicity → retinal damage/vision changes.

41. A nurse is caring for a client who has a suspected adrenal insufficiency. Which of the following medications should the nurse anticipate the provider using to determine the presence of adrenal insufficiency?

A. Prednisone
B. Cosyntropin ✅
C. Dexamethasone
D. Ketoconazole

Rationale: Cosyntropin is a synthetic form of ACTH used in the ACTH stimulation test to evaluate adrenal gland function.

42. A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus. Which of the following information should the nurse include?

A. Respiratory depression can occur 7 min after morphine is administered ✅
B. The morphine will peak in 10 min
C. Withhold if RR <16/min
D. Administer over 2 min

Rationale: IV morphine acts rapidly with peak effect in ~20 min, but respiratory depression can occur as early as 7 min.

43. A nurse is reviewing the medical record of a client taking vitamin D. Which finding indicates a risk for vitamin D deficiency

A. Middle-age
B. Obesity ✅
C. Dark-colored eyes
D. Light-pigmented skin

Rationale: Obesity sequesters vitamin D in fat tissue, lowering bioavailability.

44. A nurse is caring for a client with COPD taking fluticasone via inhaler long-term. Which adverse effect should the nurse monitor?

A. GFR <60
B. ALT 82
C. Anorexia and weakness ✅
D. Varicose veins

Rationale: Long-term inhaled corticosteroids can cause systemic effects including adrenal suppression, weakness, osteoporosis, anorexia.

45. A nurse is teaching a client newly diagnosed with Alzheimer’s disease about donepezil. Which instruction should the nurse include?

A. Chew thoroughly before swallowing
B. Take this medication late in the evening ✅
C. Take with food
D. Double dose if missed

Rationale: Donepezil is taken at bedtime to minimize daytime drowsiness.

46. A nurse teaching a client with cancer pain about opioids. Which statement indicates understanding?

A. “Opioids don’t relieve pain without severe adverse effects.”
B. “Physical dependence is not the same as addiction.” ✅
C. “Tolerance means it won’t work anymore.”
D. “Respiratory depression is the most common long-term adverse effect.”

Rationale: Dependence and tolerance are expected physiological responses, not addiction.

47. A nurse is caring for a client with cystic fibrosis prescribed high-dose ibuprofen. Which is the expected outcome?

A. Thinned pulmonary secretions
B. Slowed progression of pulmonary damage ✅
C. Potentiated bronchodilator effect
D. Decreased risk of fevers

Rationale: High-dose ibuprofen reduces inflammation and slows lung damage progression in CF.

48. A nurse teaching a client prescribed combination oral contraceptives (28-day cycle). Which instruction should be included?

A. If you miss 1 pill during week 1, take it with the next dose
B. Leg cramps are common
C. Monitor BP for hypotension
D. You can take 7 inert pills with little pregnancy risk if you took the active pills for 3 weeks ✅

Rationale: Placebo pills allow withdrawal bleeding while maintaining contraceptive protection.

49. A nurse is caring for a client with RA starting etanercept. Which lab should be reviewed before giving the medication?

A. Ability to swallow
B. Results of last PPD test ✅
C. Serum creatinine
D. Blood glucose

Rationale: Etanercept suppresses the immune system → screen for TB prior to therapy.

50. A nurse is caring for a postpartum breastfeeding client prescribed depot medroxyprogesterone acetate (DMPA). When should the first dose be given?

A. 3 months postpartum
B. At 6 weeks postpartum ✅
C. Within 5 days postpartum
D. During first week of first menstrual cycle

Rationale: At 6 weeks postpartum for breastfeeding women to avoid interference with lactation/infant growth.

51. A nurse teaching a client with PUD about bismuth subsalicylate. Which statement is correct?

A. Decrease prostaglandins
B. Increase bicarbonate
C. Decrease bacteria in GI tract ✅
D. Increase stomach blood flow

Rationale: Bismuth has antibacterial action against H. pylori.

52. A nurse teaching a parent of a child with severe reactive airway disease about glucocorticoids. Which statement is correct?

A. Inhaled glucocorticoids less likely to cause thrush
B. Oral glucocorticoids hazardous during stress
C. Oral glucocorticoids more likely to slow linear growth ✅
D. Inhaled glucocorticoids effective for acute bronchospasm

Rationale: Oral glucocorticoids cause more systemic adverse effects in children.

53. A nurse is caring for a client with asthma requiring long-term treatment. Which medication increases risk of asthma-related death if used alone?

A. Salmeterol ✅
B. Fluticasone
C. Budesonide
D. Theophylline

Rationale: LABA monotherapy increases risk of asthma-related death. Always combine with inhaled corticosteroid.

54. A nurse is caring for a client prescribed subdermal etonogestrel. Which finding should be reported to the provider?

A. Takes St. John’s wort ✅
B. Breastfeeds a 6-month-old
C. Parent with hypertension
D. Positive HPV test

Rationale: St. John’s wort induces metabolism → reduces contraceptive effectiveness.

55. A nurse suspects a client is having an allergic reaction. Which factor increases risk?

A. Initial dose
B. Large dose
C. Oral route
D. Previous exposure ✅

Rationale: Prior sensitization is the greatest risk factor for allergic reaction.

56. A nurse is caring for a client newly diagnosed with RA. Which medication is expected for daily management?

A. Celecoxib
B. Prednisone
C. Adalimumab ✅
D. Abatacept

Rationale: DMARDs (adalimumab) slow progression and prevent joint damage.

57. A nurse teaching a client with H. pylori infection prescribed doxycycline. Which instruction is correct?

A. Take with meals
B. Continue if pregnant
C. Wear protective clothing in the sun ✅
D. Expect severe diarrhea

Rationale: Doxycycline causes photosensitivity.

58. A nurse teaching a client with gout prescribed allopurinol. When should client discontinue?

A. Nausea
B. Metallic taste
C. Fever ✅
D. Drowsiness

Rationale: Fever may indicate life-threatening hypersensitivity (Stevens-Johnson syndrome).

59. A nurse caring for a client with acute pulmonary edema prescribed furosemide 40 mg IV bolus. How should it be administered?

A. Undiluted over 2 min ✅
B. Diluted over 20 min
C. Rapid IV push
D. Diluted over 5 min

Rationale: IV furosemide must be given slowly (1–2 min) to avoid ototoxicity/hypotension.

60. A nurse caring for a client with atrial fibrillation scheduled for cardioversion. Which medication should be anticipated?

A. Amlodipine
B. Diltiazem ✅
C. Nifedipine
D. Lidocaine

Rationale: Diltiazem (calcium channel blocker) is used for rate control in atrial fibrillation.

61. A nurse is caring for a client who is receiving sumatriptan for cluster headaches. Which of the following findings should the nurse expect as an adverse effect?

A. Hypotension
B. Tinnitus
C. Urinary retention
D. Chest pressure ✅

Answer: D. Chest pressure

Rationale: Sumatriptan, a serotonin agonist, causes vasoconstriction to relieve migraines/cluster headaches. A common adverse effect is chest pressure/heaviness due to coronary vasospasm.

62. A nurse is caring for a client with rheumatoid arthritis who has a prescription for methotrexate. Which instruction should the nurse include?

A. Drink 2–3 liters of water per day ✅
B. Avoid folic acid supplements
C. Expect infection risk only in the first month
D. Take the medication every day

Answer: A. Drink 2–3 liters of water per day

Rationale: Methotrexate can cause renal toxicity from crystallization. Adequate hydration prevents this. Clients should also take folic acid to reduce oral ulcers and watch for ongoing infection risk.

63. A nurse is caring for a client with premenstrual disorder (PMD) prescribed fluoxetine. The client asks, “When will I notice benefits?”

A. Within a few days
B. After 2 months
C. Immediately
D. After several weeks ✅

Answer: D. After several weeks

Rationale: Fluoxetine (an SSRI) takes about 4 weeks for full therapeutic effects, not immediate or only a few days.

64. A nurse is teaching a client with ulcerative colitis prescribed sulfasalazine. Which adverse effect should the nurse monitor for?

A. Jaundice ✅
B. Constipation
C. Oral candidiasis
D. Sedation

Answer: A. Jaundice

Rationale: Sulfasalazine can cause hepatotoxicity. Clients should report jaundice, abdominal pain, or fatigue immediately.

65. A nurse is teaching a client with a new fentanyl transdermal patch prescription. Which statement shows understanding?

A. “The patch will not cause constipation.”
B. “I must stop drinking grapefruit juice.”
C. “I’ll use a heating pad to boost effectiveness.”
D. “The patch will give me relief faster than pills.” ✅

Answer: D. The patch will give me relief faster than pills

Rationale: Fentanyl patches provide continuous absorption for consistent pain relief. They do not eliminate constipation, and heating pads increase overdose risk.

66. A nurse is caring for a client with Alzheimer’s disease prescribed memantine. Which lab finding is a contraindication?

A. ALT 60
B. Creatinine clearance 35 mL/min ✅
C. HbA1c 5%
D. BMI 31

Answer: B. Creatinine clearance 35 mL/min

Rationale: Memantine is excreted unchanged in urine. Renal impairment (CrCl <40) increases risk of accumulation and toxicity.

67. A nurse is caring for a female client taking clomiphene for infertility. Which finding indicates the medication was effective?

A. Decreased LH
B. Follicular enlargement and corpus luteum formation ✅
C. Increased hCG levels
D. Blocked LH release

Answer: B. Follicular enlargement and corpus luteum formation

Rationale: Clomiphene stimulates LH and FSH, promoting ovulation. Effectiveness is confirmed by follicular enlargement.

68. A nurse is reviewing a client’s history with multiple sclerosis prescribed tizanidine. Which comorbidity increases risk of adverse effects?

A. Pneumonia
B. BPH
C. Hepatitis ✅
D. Diabetes

Answer: C. Hepatitis

Rationale: Tizanidine is metabolized in the liver. Hepatic impairment increases toxicity risk.

69. A nurse is preparing to administer IV nitroprusside. Which action should the nurse take?

A. Regulate infusion by weight
B. Change solution every 48 hr
C. Ensure greenish tint in solution
D. Cover medication with amber bag ✅

Answer: D. Cover medication with amber bag

Rationale: Nitroprusside is light-sensitive; exposure can produce toxic byproducts (cyanide). Solution should be clear, not green.

70. A nurse is caring for a client taking ginkgo biloba at home. Which effect should the nurse expect?

A. Decreased platelet aggregation ✅
B. Prevention of migraines
C. Increased risk of DVT
D. Lower cholesterol levels

Answer: A. Decreased platelet aggregation

Rationale: Ginkgo biloba increases bleeding risk by decreasing platelet aggregation.

71. A nurse is caring for a client at 39 weeks’ gestation with gestational hypertension prescribed misoprostol for cervical ripening. Which history finding increases risk of complications?

A. Positive bacterial vaginosis culture
B. History of failure to progress
C. Previous cesarean delivery ✅
D. Positive Rh sensitization

Answer: C. Previous cesarean delivery

Rationale: Misoprostol increases risk of uterine rupture in clients with a prior uterine surgery (C-section).

72. A nurse is caring for a client with tuberculosis taking rifampin. Which adverse effect should the nurse monitor for?

A. Red-tinged urine ✅
B. Tinnitus
C. Blurred vision
D. Dry mouth

Answer: A. Red-tinged urine

Rationale: Rifampin causes red-orange discoloration of body fluids (urine, sweat, tears). This is harmless but expected.

73. A nurse reviews the record of a client scheduled for labor induction prescribed misoprostol. Which condition is a contraindication?

A. Gestational diabetes
B. Past cesarean delivery ✅
C. Preeclampsia
D. Genital herpes

Answer: B. Past cesarean delivery

Rationale: Increases risk of uterine rupture.

74. A nurse is assessing a client with multidrug-resistant TB taking ethambutol. Which adverse effect should the nurse identify?

A. Mottling of extremities
B. Orange-red urine
C. Yellowing of sclera
D. Loss of red/green color discrimination ✅

Answer: D. Loss of red/green color discrimination

Rationale: Ethambutol can cause optic neuritis, leading to red-green color blindness.

75. A nurse is teaching a female client prescribed pravastatin for hyperlipidemia. Which teaching is correct?

A. Can be taken with grapefruit juice
B. Can be continued during pregnancy
C. Should be taken with the morning meal ✅
D. Requires WBC monitoring

Answer: C. Should be taken with the morning meal

Rationale: Pravastatin is best taken with food (often evening meal). Statins are contraindicated in pregnancy.

76. A nurse admits a client who reports drinking 1 pint whiskey daily for 6 years. Last drink was 10 hr ago. Which medication should be given?

A. Chlordiazepoxide ✅
B. Disulfiram
C. Naloxone
D. Acetaminophen

Answer: A. Chlordiazepoxide

Rationale: A benzodiazepine used to manage alcohol withdrawal symptoms and prevent delirium tremens.

77. A nurse is caring for a client taking fludrocortisone. Which finding indicates an adverse effect?

A. Hypotension
B. Weight loss
C. Hypokalemia ✅
D. Anorexia

Answer: C. Hypokalemia

Rationale: Fludrocortisone promotes sodium and water retention, potassium excretion, leading to hypokalemia.

78. A nurse is caring for a client with heart failure taking digoxin. The client reports nausea and refuses food. What action should the nurse take first?

A. Encourage eating
B. Administer an antiemetic
C. Inform provider
D. Check apical pulse ✅

Answer: D. Check apical pulse

Rationale: Nausea with digoxin may indicate toxicity. Assessing apical pulse is the priority before notifying the provider.

79. A nurse is caring for a client taking combination oral contraceptives (OC). Which finding indicates an estrogen deficiency?

A. Mid-cycle breakthrough bleeding/spotting ✅
B. Breast tenderness
C. Migraine headaches
D. Nausea

Answer: A. Mid-cycle breakthrough bleeding/spotting

Rationale: Estrogen deficiency leads to spotting, hypomenorrhea, amenorrhea.

80. A nurse is teaching a client with ADHD prescribed amphetamine/dextroamphetamine. Which finding should be reported immediately?

A. Restlessness
B. Insomnia
C. Palpitations ✅
D. Weight gain

Answer: C. Palpitations

Rationale: Palpitations may indicate cardiac dysrhythmias, a serious adverse effect requiring immediate provider notification.

81. A nurse is planning discharge teaching for a client with major depressive disorder and a new prescription for phenelzine (MAOI). Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine?

A. Broiled beef steak ✅
B. Macaroni and cheese
C. Pepperoni pizza
D. Smoked salmon

Answer: A. Broiled beef steak

Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, processed/smoked meats, beer, wine), which can lead to hypertensive crisis. Fresh meats like broiled beef steak are safe.

82. A nurse is checking a client who is receiving an IV infusion of telavancin for Streptococcus pyogenes. Which of the following actions should the nurse include?

A. Check to see if the client’s urine is blue in color
B. Check the client for pruritus ✅
C. Check for hypertension
D. Check for numbness in the limbs

Answer: B. Check the client for pruritus

Rationale: Telavancin can cause pruritus and flushing if infused too rapidly, similar to red man syndrome with vancomycin. The nurse should monitor for these infusion-related reactions.

83. A nurse is providing discharge teaching about lithium toxicity to a client who has a new prescription for lithium. Which of the following statements by the client indicates understanding of the teaching?

A. “I should take naproxen if I have a headache because aspirin can cause lithium toxicity.”
B. “I can develop lithium toxicity if I eat foods with lots of sodium.”
C. “I can develop lithium toxicity if I experience vomiting or diarrhea.” ✅
D. “I might need to take a daily diuretic along with my lithium to prevent lithium toxicity.”

Answer: C. “I can develop lithium toxicity if I experience vomiting or diarrhea.”

Rationale: Lithium is excreted by the kidneys. Dehydration, vomiting, or diarrhea can cause sodium and water depletion, increasing lithium levels and risk of toxicity.

NSAIDs increase toxicity (A incorrect).
High sodium actually decreases lithium levels (B incorrect).
Diuretics increase toxicity (D incorrect).

84. A nurse is planning care for a client with thrombophlebitis who has a prescription for heparin via continuous IV infusion. Which of the following actions should the nurse include?

A. Infuse the heparin using an electronic IV pump ✅
B. Administer vitamin K if the client has indications of hemorrhage
C. Adjust the dosage of heparin based on the client’s PT levels
D. Inform the client that the heparin will dissolve the thrombus

Answer: A. Infuse the heparin using an electronic IV pump

Rationale: Heparin should always be administered with an electronic infusion pump to ensure accurate dosing and prevent overdose.

Antidote is protamine sulfate, not vitamin K (B incorrect).
Heparin is monitored with aPTT, not PT (C incorrect).
Heparin prevents clot extension but does not dissolve clots (D incorrect).

85. A nurse is teaching a client who has allergic rhinitis about a new prescription for brompheniramine. Which of the following statements should the nurse include?

A. “Report gastrointestinal disturbances immediately.”
B. “You might find that you develop a dry mouth.” ✅
C. “You should not experience any central nervous system alterations.”
D. “Increased urinary frequency is an expected effect.”

Answer: B. “You might find that you develop a dry mouth.”

Rationale: Brompheniramine is a first-generation antihistamine. It causes anticholinergic effects (dry mouth, urinary retention, constipation, blurred vision) and CNS depression such as sedation.

86. A nurse is planning discharge teaching for a client with major depressive disorder and a new prescription for phenelzine (MAOI). Which of the following foods should the nurse include as safe?

A. Broiled beef steak ✅
B. Macaroni and cheese
C. Pepperoni pizza
D. Smoked salmon

Answer: A. Broiled beef steak

Rationale: Same as Q81—fresh meats are safe; aged/processed foods with tyramine are contraindicated.

87. A nurse is checking a client who is receiving IV telavancin. Which finding should the nurse monitor for?

A. Blue urine
B. Pruritus and flushing ✅
C. Hypertension
D. Numbness in the limbs

Answer: B. Pruritus and flushing

Rationale: Infusion-related reactions (pruritus/flushing) are the most notable adverse effects, requiring monitoring.

88. A nurse is teaching a client starting lithium therapy. Which situation increases risk of toxicity?

A. Eating high-sodium foods
B. Taking aspirin
C. Vomiting or diarrhea ✅
D. Daily use of loop diuretics

Answer: C. Vomiting or diarrhea

Rationale: Fluid/electrolyte loss (from vomiting/diarrhea) increases lithium reabsorption, leading to toxicity.\

89. A nurse is caring for a client receiving continuous IV heparin infusion. Which is essential?

A. Infuse using electronic IV pump ✅
B. Give vitamin K if hemorrhage occurs
C. Adjust based on PT levels
D. Tell client heparin dissolves clots

Answer: A. Infuse using electronic IV pump

Rationale: Prevents accidental overdose. Heparin is monitored with aPTT, antidote is protamine sulfate, and it does not dissolve clots.

90. A nurse is teaching a client with allergic rhinitis who is prescribed brompheniramine. Which effect should be expected?

A. GI upset
B. Dry mouth ✅
C. Increased urinary frequency
D. No CNS effects

Answer: B. Dry mouth

Rationale: Anticholinergic and sedative effects are common: dry mouth, blurred vision, constipation, urinary retention, and drowsiness.

A. Broiled beef steak ✅
B. Macaroni and cheese
C. Pepperoni pizza
D. Smoked salmon

Answer: A. Broiled beef steak

Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, processed/smoked meats, beer, wine), which can lead to hypertensive crisis. Fresh meats like broiled beef steak are safe.

82. A nurse is checking a client who is receiving an IV infusion of telavancin for Streptococcus pyogenes. Which of the following actions should the nurse include?

A. Check to see if the client’s urine is blue in color
B. Check the client for pruritus ✅
C. Check for hypertension
D. Check for numbness in the limbs

Answer: B. Check the client for pruritus

Rationale: Telavancin can cause pruritus and flushing if infused too rapidly, similar to red man syndrome with vancomycin. The nurse should monitor for these infusion-related reactions.

A. “I should take naproxen if I have a headache because aspirin can cause lithium toxicity.”
B. “I can develop lithium toxicity if I eat foods with lots of sodium.”
C. “I can develop lithium toxicity if I experience vomiting or diarrhea.” ✅
D. “I might need to take a daily diuretic along with my lithium to prevent lithium toxicity.”

Answer: C. “I can develop lithium toxicity if I experience vomiting or diarrhea.”

Rationale: Lithium is excreted by the kidneys. Dehydration, vomiting, or diarrhea can cause sodium and water depletion, increasing lithium levels and risk of toxicity.

NSAIDs increase toxicity (A incorrect).
High sodium actually decreases lithium levels (B incorrect).
Diuretics increase toxicity (D incorrect).

84. A nurse is planning care for a client with thrombophlebitis who has a prescription for heparin via continuous IV infusion. Which of the following actions should the nurse include?

A. Infuse the heparin using an electronic IV pump ✅
B. Administer vitamin K if the client has indications of hemorrhage
C. Adjust the dosage of heparin based on the client’s PT levels
D. Inform the client that the heparin will dissolve the thrombus

Answer: A. Infuse the heparin using an electronic IV pump

Rationale: Heparin should always be administered with an electronic infusion pump to ensure accurate dosing and prevent overdose.

Antidote is protamine sulfate, not vitamin K (B incorrect).
Heparin is monitored with aPTT, not PT (C incorrect).
Heparin prevents clot extension but does not dissolve clots (D incorrect).

85. A nurse is teaching a client who has allergic rhinitis about a new prescription for brompheniramine. Which of the following statements should the nurse include?

A. “Report gastrointestinal disturbances immediately.”
B. “You might find that you develop a dry mouth.” ✅
C. “You should not experience any central nervous system alterations.”
D. “Increased urinary frequency is an expected effect.”

Answer: B. “You might find that you develop a dry mouth.”

Rationale: Brompheniramine is a first-generation antihistamine. It causes anticholinergic effects (dry mouth, urinary retention, constipation, blurred vision) and CNS depression such as sedation.

86. A nurse is planning discharge teaching for a client with major depressive disorder and a new prescription for phenelzine (MAOI). Which of the following foods should the nurse include as safe?

A. Broiled beef steak ✅
B. Macaroni and cheese
C. Pepperoni pizza
D. Smoked salmon

Answer: A. Broiled beef steak

Rationale: Same as Q81—fresh meats are safe; aged/processed foods with tyramine are contraindicated.

87. A nurse is checking a client who is receiving IV telavancin. Which finding should the nurse monitor for?

A. Blue urine
B. Pruritus and flushing ✅
C. Hypertension
D. Numbness in the limbs

Answer: B. Pruritus and flushing

Rationale: Infusion-related reactions (pruritus/flushing) are the most notable adverse effects, requiring monitoring.

88. A nurse is teaching a client starting lithium therapy. Which situation increases risk of toxicity?

A. Eating high-sodium foods
B. Taking aspirin
C. Vomiting or diarrhea ✅
D. Daily use of loop diuretics

Answer: C. Vomiting or diarrhea

Rationale: Fluid/electrolyte loss (from vomiting/diarrhea) increases lithium reabsorption, leading to toxicity.

89. A nurse is caring for a client receiving continuous IV heparin infusion. Which is essential?

A. Infuse using electronic IV pump ✅
B. Give vitamin K if hemorrhage occurs
C. Adjust based on PT levels
D. Tell client heparin dissolves clots

Answer: A. Infuse using electronic IV pump

Rationale: Prevents accidental overdose. Heparin is monitored with aPTT, antidote is protamine sulfate, and it does not dissolve clots.

90. A nurse is teaching a client with allergic rhinitis who is prescribed brompheniramine. Which effect should be expected?

A. GI upset
B. Dry mouth ✅
C. Increased urinary frequency
D. No CNS effects

Answer: B. Dry mouth

Rationale: Anticholinergic and sedative effects are common: dry mouth, blurred vision, constipation, urinary retention, and drowsiness.