1. A client taking warfarin has an INR of 4.2. Which action
should
the nurse take?
A. Administer the next dose of warfarin
B. Hold the dose and notify the provider
C. Give vitamin K IV immediately
D. Prepare for platelet transfusion
Answer: B
Rationale: An INR >3.0 indicates increased bleeding risk.
The
nurse should hold the medication and notify the provider.
2. A client taking phenytoin shows swollen, bleeding gums.
What
should the nurse recommend?
A. Discontinue the drug
B. Increase fluid intake
C. Practice good oral hygiene
D. Reduce dietary sugar
Answer: C
Rationale: Gingival hyperplasia is a known side effect.
Encourage
oral care, not discontinuation.
3. A client is using a scopolamine patch for motion sickness.
What side effect should the nurse monitor?
A. Diarrhea
B. Blurred vision and dry mouth
C. Rash
D. Hearing loss
Answer: B
Rationale: Scopolamine has anticholinergic effects like dry
mouth,
blurred vision, and urinary retention.
4. A client is receiving morphine IV post-op. Which finding
is the
priority?
A. Nausea
B. Respiratory rate of 8/min
C. Itching
D. Sedation score of 2
Answer: B
Rationale: Respiratory depression (<12/min) is the most life
threatening side effect of opioids.
5. A nurse teaches a client taking cyclobenzaprine. Which
statement indicates understanding?
, A. “I will take this long-term.”
B. “I can drink alcohol in moderation.”
C. “I should avoid driving until I know how it affects me.”
D. “It will help my heart condition.”
Answer: C
Rationale: Cyclobenzaprine causes drowsiness. Clients
should
avoid driving or alcohol initially.
6. A client taking furosemide reports muscle cramps.
Which lab
value correlates with this symptom?
A. Sodium 142
B. Potassium 2.9
C. Chloride 101
D. Magnesium 2.0
Answer: B
Rationale: Furosemide can cause hypokalemia, which leads
to
muscle cramps. Normal potassium: 3.5–5.0.
7. A client with COPD is on prednisone. Which instruction
is
appropriate?
A. Stop taking it once symptoms resolve
B. Take on an empty stomach
C. Report black tarry stools
D. Avoid potassium-rich foods
Answer: C
Rationale: Corticosteroids increase the risk for GI bleeding
and
ulcers. Tarry stools may indicate bleeding.
8. A client prescribed clopidogrel should avoid which overthe
counter medication?
A. Acetaminophen
B. Ibuprofen
C. Famotidine
D. Guaifenesin
Answer: B
Rationale: NSAIDs like ibuprofen increase bleeding risk
when
combined with antiplatelet agents like clopidogrel.
9. A client is prescribed exenatide. What is a common side
effect?
A. Hyperglycemia
B. Constipation
C. Nausea
D. Tachycardia
should
the nurse take?
A. Administer the next dose of warfarin
B. Hold the dose and notify the provider
C. Give vitamin K IV immediately
D. Prepare for platelet transfusion
Answer: B
Rationale: An INR >3.0 indicates increased bleeding risk.
The
nurse should hold the medication and notify the provider.
2. A client taking phenytoin shows swollen, bleeding gums.
What
should the nurse recommend?
A. Discontinue the drug
B. Increase fluid intake
C. Practice good oral hygiene
D. Reduce dietary sugar
Answer: C
Rationale: Gingival hyperplasia is a known side effect.
Encourage
oral care, not discontinuation.
3. A client is using a scopolamine patch for motion sickness.
What side effect should the nurse monitor?
A. Diarrhea
B. Blurred vision and dry mouth
C. Rash
D. Hearing loss
Answer: B
Rationale: Scopolamine has anticholinergic effects like dry
mouth,
blurred vision, and urinary retention.
4. A client is receiving morphine IV post-op. Which finding
is the
priority?
A. Nausea
B. Respiratory rate of 8/min
C. Itching
D. Sedation score of 2
Answer: B
Rationale: Respiratory depression (<12/min) is the most life
threatening side effect of opioids.
5. A nurse teaches a client taking cyclobenzaprine. Which
statement indicates understanding?
, A. “I will take this long-term.”
B. “I can drink alcohol in moderation.”
C. “I should avoid driving until I know how it affects me.”
D. “It will help my heart condition.”
Answer: C
Rationale: Cyclobenzaprine causes drowsiness. Clients
should
avoid driving or alcohol initially.
6. A client taking furosemide reports muscle cramps.
Which lab
value correlates with this symptom?
A. Sodium 142
B. Potassium 2.9
C. Chloride 101
D. Magnesium 2.0
Answer: B
Rationale: Furosemide can cause hypokalemia, which leads
to
muscle cramps. Normal potassium: 3.5–5.0.
7. A client with COPD is on prednisone. Which instruction
is
appropriate?
A. Stop taking it once symptoms resolve
B. Take on an empty stomach
C. Report black tarry stools
D. Avoid potassium-rich foods
Answer: C
Rationale: Corticosteroids increase the risk for GI bleeding
and
ulcers. Tarry stools may indicate bleeding.
8. A client prescribed clopidogrel should avoid which overthe
counter medication?
A. Acetaminophen
B. Ibuprofen
C. Famotidine
D. Guaifenesin
Answer: B
Rationale: NSAIDs like ibuprofen increase bleeding risk
when
combined with antiplatelet agents like clopidogrel.
9. A client is prescribed exenatide. What is a common side
effect?
A. Hyperglycemia
B. Constipation
C. Nausea
D. Tachycardia
