UWorld NCLEX-PN Exam Study Guide: Questions &
Answers: A+ Score Guide
CKD foods - ANSWERCKD clients with chronic kidney disease (CKD) have decreased
glomerular filtration, resulting in retention of fluid, potassium, and phosphorus. Fluid
retention is initially treated with sodium restriction and diuretic therapy. Dietary
adjustments should also be made to reduce serum potassium and phosphorus.
Laboratory values are key to determining allowable foods. Dairy products (eg, milk,
yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and
avocados) contain high potassium levels. Dairy products also contain high
phosphorus levels.
Examples of allowable foods for CKD clients include apples, pears, grapes, pineapple,
blackberries, blueberries, and plums.
(Option 2) Avocados are high in potassium; the chips may be high in sodium.
(Options 3 and 4) Pudding and yogurt contain dairy products and are high in
phosphorous and potassium. Oranges are high in potassium.
Educational objective: The diet for a client with chronic kidney disease may need to
be restricted in fluids, sodium, potassium, and phosphorus. Dairy products (eg, milk,
yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and
avocados) contain high potassium levels. Dairy products are also high in phosphorus.
dicyclomine (Bentyl) - ANSWERDicyclomine (Bentyl) is an /antispasmodic drug
prescribed to manage symptoms of intestinal hypermotility in clients with irritable
bowel syndrome. Dicyclomine is contraindicated in clients with paralytic ileus as it
decreases intestinal motility and would exacerbate the condition (Option 2). The
nurse should question this prescription and contact the health care provider.
Tolterodine (Detrol LA), oxybutynin (Ditropan), and solifenacin (Vesicare) -
ANSWERantimuscarinic/anticholinergic medications
used for overactive bladder and urge urinary incontinence. They decrease urinary
urgency and frequency. The most common side effects are anticholinergic (eg, dry
mouth, constipation, cognitive dysfunction). The client's report of not urinating the
entire day while at work may indicate that the dosage is too high and is causing
urinary retention. Urinary retention can lead to bladder infections and distension.
This information should be reported to the health care provider (HCP).
(Option 2) Artificial saliva products and sugar-free hard candy and gum are
acceptable ways to manage dry mouth caused by anticholinergic medications.
(Option 3) Occasional dizziness is a side effect of tolterodine. The client should rise
and change positions slowly. However, if this client is receiving too high a dose,
,reduction of the dose may alleviate the dizziness. Severe dizziness should be
reported to the HCP.
(Option 4) Constipation can be managed with increased fiber in the diet, fluids, stool
softeners, or laxatives.
Educational objective: Anticholinergic medications (eg, tolterodine, oxybutynin,
solifenacin) are commonly used for overactive bladder. The client should experience
a reduction in the number of times needed to urinate, but the number should not
decrease below typical urination frequency. The nurse should also teach the client
how to manage the common side effects of dry mouth, constipation, and mild
dizziness.
Clozapine (Clorazil) - ANSWERatypical antipsychotic
stool colors - ANSWERsmall, dry, rocky-hard = constipation
light gray "clay-colored" = biliary obstruction
mucus or pus visible = ulcerative colitis / infectious colitis
greasy, foamy, foul-smelling fatty = chronic pancreatitis
black tarry = upper GI bleed
bright, red bloody = lower GI bleed
blood present on surface of stool = hemorrhoids
Digoxin - ANSWER(Lanoxin) is a cardiac glycoside that increases contractility (positive
inotropic effects) and decreases heart rate (negative chronotropic effects). It is used
to treat atrial fibrillation because, at therapeutic levels (0.5-2.0 ng/mL), it decreases
conduction through the sinoatrial node (SA) and ventricular heart rate. However,
drug toxicity is common due to digoxin's narrow therapeutic range. Clients are
instructed to recognize and report signs and symptoms of toxicity to the health care
provider (HCP), including the following:
Gastrointestinal symptoms, including anorexia, nausea, vomiting, and abdominal
pain, are frequently the earliest symptoms (Option 1).
Neurologic manifestations include lethargy, fatigue, weakness, and confusion.
Visual symptoms are characteristic and include alterations in color vision, scotomas,
and blindness (Option 3).
Cardiac arrhythmia is the most dangerous symptom. Digoxin toxicity can result in
bradycardia and heart block, which can cause dizziness or lightheadedness. Clients
, are instructed to check the pulse and tell the HCP if it is low or has skipped beats
(Option 2).
(Option 4) There is no need to routinely check blood pressure before taking the
medicine. This client should be instructed to check the pulse and withhold digoxin if
the heart rate is <60/min.
Educational objective: Clients receiving digoxin are instructed to measure their pulse
before taking the medication and withhold digoxin if their heart rate is <60/min.
Clients should also be taught to recognize and report signs and symptoms of digoxin
toxicity (eg, anorexia, nausea, diarrhea, lethargy, confusion, cardiac arrhythmias,
visual changes) to the health care provider.
tetracycline
(eg, tetracycline, doxycycline, minocycline): - ANSWERThe following should be taught
to clients taking tetracyclines
Take on an empty stomach - for optimum absorption, tetracyclines should be taken 1
hour before or 2 hours after meals (Option 3)
Avoid antacids or dairy products - tetracyclines should not be taken with iron
supplements, antacids, or dairy products as they bind with the drug and decrease its
absorption (Option 1)
Take with a full glass of water - tetracyclines can cause pill-induced esophagitis and
gastritis; the risk can be reduced by taking with a full glass of water and remaining
upright after pill ingestion
Photosensitivity - severe sunburn can occur with tetracycline. The client should use
sunblock (Option 5).
Medications such as tetracycline and rifampin can decrease the effectiveness of oral
contraceptives; additional contraceptive techniques will be needed (Option 4).
(Option 2) Tetracycline taken at bedtime has been associated with esophageal
irritation and stricture development as it increases reflux of the gastric contents into
the esophagus. This can be prevented by taking the medicine with plenty of water
and during the day when upright
Educational objective: Tetracyclines should be taken 1 hour before or 2 hours after
meals with plenty of water. They should not be taken with dairy products or within 2
hours of taking antacids. Clients should use sunblock due to photosensitivity and
plan to use additional contraceptive techniques.
paroxetine (paxil) - ANSWERa selective serotonin reuptake inhibitor (SSRI) often
prescribed for major depression and anxiety disorders. Other SSRIs include
citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline
(Zoloft). Weight gain is a common side effect of long-term SSRI use. The nurse should
Answers: A+ Score Guide
CKD foods - ANSWERCKD clients with chronic kidney disease (CKD) have decreased
glomerular filtration, resulting in retention of fluid, potassium, and phosphorus. Fluid
retention is initially treated with sodium restriction and diuretic therapy. Dietary
adjustments should also be made to reduce serum potassium and phosphorus.
Laboratory values are key to determining allowable foods. Dairy products (eg, milk,
yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and
avocados) contain high potassium levels. Dairy products also contain high
phosphorus levels.
Examples of allowable foods for CKD clients include apples, pears, grapes, pineapple,
blackberries, blueberries, and plums.
(Option 2) Avocados are high in potassium; the chips may be high in sodium.
(Options 3 and 4) Pudding and yogurt contain dairy products and are high in
phosphorous and potassium. Oranges are high in potassium.
Educational objective: The diet for a client with chronic kidney disease may need to
be restricted in fluids, sodium, potassium, and phosphorus. Dairy products (eg, milk,
yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and
avocados) contain high potassium levels. Dairy products are also high in phosphorus.
dicyclomine (Bentyl) - ANSWERDicyclomine (Bentyl) is an /antispasmodic drug
prescribed to manage symptoms of intestinal hypermotility in clients with irritable
bowel syndrome. Dicyclomine is contraindicated in clients with paralytic ileus as it
decreases intestinal motility and would exacerbate the condition (Option 2). The
nurse should question this prescription and contact the health care provider.
Tolterodine (Detrol LA), oxybutynin (Ditropan), and solifenacin (Vesicare) -
ANSWERantimuscarinic/anticholinergic medications
used for overactive bladder and urge urinary incontinence. They decrease urinary
urgency and frequency. The most common side effects are anticholinergic (eg, dry
mouth, constipation, cognitive dysfunction). The client's report of not urinating the
entire day while at work may indicate that the dosage is too high and is causing
urinary retention. Urinary retention can lead to bladder infections and distension.
This information should be reported to the health care provider (HCP).
(Option 2) Artificial saliva products and sugar-free hard candy and gum are
acceptable ways to manage dry mouth caused by anticholinergic medications.
(Option 3) Occasional dizziness is a side effect of tolterodine. The client should rise
and change positions slowly. However, if this client is receiving too high a dose,
,reduction of the dose may alleviate the dizziness. Severe dizziness should be
reported to the HCP.
(Option 4) Constipation can be managed with increased fiber in the diet, fluids, stool
softeners, or laxatives.
Educational objective: Anticholinergic medications (eg, tolterodine, oxybutynin,
solifenacin) are commonly used for overactive bladder. The client should experience
a reduction in the number of times needed to urinate, but the number should not
decrease below typical urination frequency. The nurse should also teach the client
how to manage the common side effects of dry mouth, constipation, and mild
dizziness.
Clozapine (Clorazil) - ANSWERatypical antipsychotic
stool colors - ANSWERsmall, dry, rocky-hard = constipation
light gray "clay-colored" = biliary obstruction
mucus or pus visible = ulcerative colitis / infectious colitis
greasy, foamy, foul-smelling fatty = chronic pancreatitis
black tarry = upper GI bleed
bright, red bloody = lower GI bleed
blood present on surface of stool = hemorrhoids
Digoxin - ANSWER(Lanoxin) is a cardiac glycoside that increases contractility (positive
inotropic effects) and decreases heart rate (negative chronotropic effects). It is used
to treat atrial fibrillation because, at therapeutic levels (0.5-2.0 ng/mL), it decreases
conduction through the sinoatrial node (SA) and ventricular heart rate. However,
drug toxicity is common due to digoxin's narrow therapeutic range. Clients are
instructed to recognize and report signs and symptoms of toxicity to the health care
provider (HCP), including the following:
Gastrointestinal symptoms, including anorexia, nausea, vomiting, and abdominal
pain, are frequently the earliest symptoms (Option 1).
Neurologic manifestations include lethargy, fatigue, weakness, and confusion.
Visual symptoms are characteristic and include alterations in color vision, scotomas,
and blindness (Option 3).
Cardiac arrhythmia is the most dangerous symptom. Digoxin toxicity can result in
bradycardia and heart block, which can cause dizziness or lightheadedness. Clients
, are instructed to check the pulse and tell the HCP if it is low or has skipped beats
(Option 2).
(Option 4) There is no need to routinely check blood pressure before taking the
medicine. This client should be instructed to check the pulse and withhold digoxin if
the heart rate is <60/min.
Educational objective: Clients receiving digoxin are instructed to measure their pulse
before taking the medication and withhold digoxin if their heart rate is <60/min.
Clients should also be taught to recognize and report signs and symptoms of digoxin
toxicity (eg, anorexia, nausea, diarrhea, lethargy, confusion, cardiac arrhythmias,
visual changes) to the health care provider.
tetracycline
(eg, tetracycline, doxycycline, minocycline): - ANSWERThe following should be taught
to clients taking tetracyclines
Take on an empty stomach - for optimum absorption, tetracyclines should be taken 1
hour before or 2 hours after meals (Option 3)
Avoid antacids or dairy products - tetracyclines should not be taken with iron
supplements, antacids, or dairy products as they bind with the drug and decrease its
absorption (Option 1)
Take with a full glass of water - tetracyclines can cause pill-induced esophagitis and
gastritis; the risk can be reduced by taking with a full glass of water and remaining
upright after pill ingestion
Photosensitivity - severe sunburn can occur with tetracycline. The client should use
sunblock (Option 5).
Medications such as tetracycline and rifampin can decrease the effectiveness of oral
contraceptives; additional contraceptive techniques will be needed (Option 4).
(Option 2) Tetracycline taken at bedtime has been associated with esophageal
irritation and stricture development as it increases reflux of the gastric contents into
the esophagus. This can be prevented by taking the medicine with plenty of water
and during the day when upright
Educational objective: Tetracyclines should be taken 1 hour before or 2 hours after
meals with plenty of water. They should not be taken with dairy products or within 2
hours of taking antacids. Clients should use sunblock due to photosensitivity and
plan to use additional contraceptive techniques.
paroxetine (paxil) - ANSWERa selective serotonin reuptake inhibitor (SSRI) often
prescribed for major depression and anxiety disorders. Other SSRIs include
citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline
(Zoloft). Weight gain is a common side effect of long-term SSRI use. The nurse should
