Milestone exam 1 2024 question with
complete solution
Two hours after taking the first dose of penicillin, a client arrives at the emergency
department complaining of feeling ill, exhibiting hives, having difficulty breathing, and
experiencing hypotension. The nurse will develop an immediate plan of care based on
which finding?
A.Severe acute anaphylactic response
B.Side reaction that should resolve
C.Idiosyncratic reaction
D.Cumulative drug response
A - correct answer Rationale: Anaphylaxis related to penicillin can cause a life-
threatening allergic response characterized by bronchospasm, laryngeal edema, and a
precipitous drop in blood pressure. This client's ingestion of penicillin and presenting
clinical picture indicate the client is having an acute reaction with respiratory difficulty.
Options B, C, and D are other physiologic responses to medications, but immediate
action is required for a potential loss of airway, breathing, and circulation.
Which response best supports the observations that the nurse identifies in a client who
is experiencing a placebo effect?
A.Beneficial response or cure for disease
B.Behavioral or psychotropic responses
C.Malingering or drug-seeking behaviors
D.Psychological response to inert medication
D - correct answer Rationale:The placebo effect is a response in the client that is
caused by the psychological impact of taking an inert drug that has no biochemical
properties. A placebo effect can be therapeutic, negative, or ineffective but provides no
cure or benefit to the client's progress. The placebo effect may evoke behavioral
changes but does not affect neurochemical psychotropic changes. Malingering and drug
seeking are behaviors that a client exhibits to obtain treatment for nonexistent disorders
or obtain prescription medications.
A mother brings her 18-month-old child to the community health center because the
child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid
at the pharmacy and gave my child a half-ounce." The nurse sees that the bottle
contains loperamide. What is the next nursing action?
A.Tell the mother never to give this drug to her toddler.
B.Ask if any other siblings have experienced diarrhea.
C.Take the child's oral and tympanic temperatures.
D.Ask the mother when the child last voided.
, D - correct answer Rationale: Determining when the child last voided is most important
because urine output is decreased with dehydration and an 18-month-old with a 3-day
history of diarrhea could be severely dehydrated. Although the manufacturer states that
loperamide should not be given to a child younger than 2 years except under the
direction of a health care provider, option A is not the best answer for this question. In
addition, loperamide causes an anticholinergic effect of urinary retention. Data obtained
in options B and C are not as high a priority as option D in this situation.
A client receives an antihypertensive agent daily. Which action is most important for the
nurse to implement prior to administering the medication?
A.Verify the expiration date.
B.Obtain the client's blood pressure.
C.Determine the client's history of adverse reactions.
D.Review the client's medical record for a change in drug route.
B - correct answer Rationale:To determine the most accurate response to
antihypertensive therapy, baseline blood pressures should be obtained before an
antihypertensive drug is administered and should be compared with orthostatic vital
signs to determine whether any side effects are occurring. Although options A, C, and D
are required nursing actions prior to giving any drug, the therapeutic response should
be determined before another dose is administered.
A client with trichomoniasis (Trichomonas vaginalis) receives a prescription for
metronidazole. Which instruction is most important for the nurse to include in this client's
teaching plan?
A.Avoid alcohol consumption.
B.Complete the medication regimen.
C.Use a barrier contraceptive method.
D.Treat partner(s) concurrently.
A - correct answer Rationale:Clients should be instructed to avoid alcohol and products
containing alcohol while taking metronidazole because of the possibility of a disulfiram-
like reaction. Option B helps prevent the development of metronidazole-resistant T.
vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a
barrier contraceptive while taking metronidazole, and their partner(s) should be treated
concurrently. The most important instruction for client well-being is option A.
A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse,
"Why do I need to take all of these medications for TB?" What information should the
nurse provide?
A.Antiretroviral medications decrease the efficacy of the TB drugs.
B.Multiple drugs prevent the development of resistant organisms.
C.Duration of the medication regimen is shortened.
D.Potential adverse drug reactions are minimized.
B - correct answer A multidrug regimen is prescribed for a client with HIV and TB to
prevent the development of resistance of the tubercle bacilli. Although antitubercular
medications can inhibit some antiretrovirals, a multidrug regimen is needed to inhibit the
proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is
complete solution
Two hours after taking the first dose of penicillin, a client arrives at the emergency
department complaining of feeling ill, exhibiting hives, having difficulty breathing, and
experiencing hypotension. The nurse will develop an immediate plan of care based on
which finding?
A.Severe acute anaphylactic response
B.Side reaction that should resolve
C.Idiosyncratic reaction
D.Cumulative drug response
A - correct answer Rationale: Anaphylaxis related to penicillin can cause a life-
threatening allergic response characterized by bronchospasm, laryngeal edema, and a
precipitous drop in blood pressure. This client's ingestion of penicillin and presenting
clinical picture indicate the client is having an acute reaction with respiratory difficulty.
Options B, C, and D are other physiologic responses to medications, but immediate
action is required for a potential loss of airway, breathing, and circulation.
Which response best supports the observations that the nurse identifies in a client who
is experiencing a placebo effect?
A.Beneficial response or cure for disease
B.Behavioral or psychotropic responses
C.Malingering or drug-seeking behaviors
D.Psychological response to inert medication
D - correct answer Rationale:The placebo effect is a response in the client that is
caused by the psychological impact of taking an inert drug that has no biochemical
properties. A placebo effect can be therapeutic, negative, or ineffective but provides no
cure or benefit to the client's progress. The placebo effect may evoke behavioral
changes but does not affect neurochemical psychotropic changes. Malingering and drug
seeking are behaviors that a client exhibits to obtain treatment for nonexistent disorders
or obtain prescription medications.
A mother brings her 18-month-old child to the community health center because the
child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid
at the pharmacy and gave my child a half-ounce." The nurse sees that the bottle
contains loperamide. What is the next nursing action?
A.Tell the mother never to give this drug to her toddler.
B.Ask if any other siblings have experienced diarrhea.
C.Take the child's oral and tympanic temperatures.
D.Ask the mother when the child last voided.
, D - correct answer Rationale: Determining when the child last voided is most important
because urine output is decreased with dehydration and an 18-month-old with a 3-day
history of diarrhea could be severely dehydrated. Although the manufacturer states that
loperamide should not be given to a child younger than 2 years except under the
direction of a health care provider, option A is not the best answer for this question. In
addition, loperamide causes an anticholinergic effect of urinary retention. Data obtained
in options B and C are not as high a priority as option D in this situation.
A client receives an antihypertensive agent daily. Which action is most important for the
nurse to implement prior to administering the medication?
A.Verify the expiration date.
B.Obtain the client's blood pressure.
C.Determine the client's history of adverse reactions.
D.Review the client's medical record for a change in drug route.
B - correct answer Rationale:To determine the most accurate response to
antihypertensive therapy, baseline blood pressures should be obtained before an
antihypertensive drug is administered and should be compared with orthostatic vital
signs to determine whether any side effects are occurring. Although options A, C, and D
are required nursing actions prior to giving any drug, the therapeutic response should
be determined before another dose is administered.
A client with trichomoniasis (Trichomonas vaginalis) receives a prescription for
metronidazole. Which instruction is most important for the nurse to include in this client's
teaching plan?
A.Avoid alcohol consumption.
B.Complete the medication regimen.
C.Use a barrier contraceptive method.
D.Treat partner(s) concurrently.
A - correct answer Rationale:Clients should be instructed to avoid alcohol and products
containing alcohol while taking metronidazole because of the possibility of a disulfiram-
like reaction. Option B helps prevent the development of metronidazole-resistant T.
vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a
barrier contraceptive while taking metronidazole, and their partner(s) should be treated
concurrently. The most important instruction for client well-being is option A.
A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse,
"Why do I need to take all of these medications for TB?" What information should the
nurse provide?
A.Antiretroviral medications decrease the efficacy of the TB drugs.
B.Multiple drugs prevent the development of resistant organisms.
C.Duration of the medication regimen is shortened.
D.Potential adverse drug reactions are minimized.
B - correct answer A multidrug regimen is prescribed for a client with HIV and TB to
prevent the development of resistance of the tubercle bacilli. Although antitubercular
medications can inhibit some antiretrovirals, a multidrug regimen is needed to inhibit the
proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is
