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 nurse is teaching a client how to apply clotrimazole
vaginal
cream. What instruction is correct?
A. Use during menstruation
B. Stop once symptoms go away
C. Use applicator at bedtime
D. Use with a tampon
Answer: C
Rationale: For maximum effect, apply at bedtime using the
applicator. Avoid tampons during treatment.
3. A nurse is preparing to administer metoprolol. Which
assessment is priority?
A. Respiratory rate
B. Heart rate
C. Oxygen saturation
D. Blood glucose
Answer: B
Rationale: Metoprolol can cause bradycardia. Always check
HR
before administering.
4. A client with myasthenia gravis is prescribed
neostigmine.
Which finding indicates underdosing?
A. Bradycardia
B. Muscle weakness
C. Diarrhea
D. Excessive salivation
Answer: B
Rationale: Muscle weakness could indicate myasthenic
crisis,
requiring dosage adjustment.
5. A nurse gives regular insulin subcutaneously at 0700. At
what
, time should the nurse monitor for signs of hypoglycemia?
A. 0715
B. 0800
C. 0930
D. 1200
Answer: C
Rationale: Regular insulin peaks in 2–4 hours. Hypoglycemia
is
most likely around 0930–1100.
6. A nurse is administering digoxin to a client. Which finding
requires immediate action?
A. HR 62 bpm
B. Blurred vision with yellow halos
C. BP 140/88 mmHg
D. Urine output 400 mL in 8 hours
Answer: B
Rationale: Visual disturbances and halos are signs of
digoxin
toxicity, especially when paired with bradycardia.
7. A client takes aluminum hydroxide for GERD. What
adverse
effect should the nurse monitor?
A. Diarrhea
B. Constipation
C. Hypokalemia
D. Rash
Answer: B
Rationale: Aluminum-based antacids commonly cause
constipation.
8. What should the nurse include when teaching a client
taking
ferrous sulfate?
A. Take with milk
B. Take with food if GI upset occurs
C. Expect pale stools
D. Avoid vitamin C
Answer: B
Rationale: Iron can upset the stomach. If so, take with food
(but
not dairy). Vitamin C increases absorption.
9. A client is taking diphenhydramine. Which side effect is
most
likely?
A. Hypertension
B. Drowsiness
C. Diarrhea
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 nurse is teaching a client how to apply clotrimazole
vaginal
cream. What instruction is correct?
A. Use during menstruation
B. Stop once symptoms go away
C. Use applicator at bedtime
D. Use with a tampon
Answer: C
Rationale: For maximum effect, apply at bedtime using the
applicator. Avoid tampons during treatment.
3. A nurse is preparing to administer metoprolol. Which
assessment is priority?
A. Respiratory rate
B. Heart rate
C. Oxygen saturation
D. Blood glucose
Answer: B
Rationale: Metoprolol can cause bradycardia. Always check
HR
before administering.
4. A client with myasthenia gravis is prescribed
neostigmine.
Which finding indicates underdosing?
A. Bradycardia
B. Muscle weakness
C. Diarrhea
D. Excessive salivation
Answer: B
Rationale: Muscle weakness could indicate myasthenic
crisis,
requiring dosage adjustment.
5. A nurse gives regular insulin subcutaneously at 0700. At
what
, time should the nurse monitor for signs of hypoglycemia?
A. 0715
B. 0800
C. 0930
D. 1200
Answer: C
Rationale: Regular insulin peaks in 2–4 hours. Hypoglycemia
is
most likely around 0930–1100.
6. A nurse is administering digoxin to a client. Which finding
requires immediate action?
A. HR 62 bpm
B. Blurred vision with yellow halos
C. BP 140/88 mmHg
D. Urine output 400 mL in 8 hours
Answer: B
Rationale: Visual disturbances and halos are signs of
digoxin
toxicity, especially when paired with bradycardia.
7. A client takes aluminum hydroxide for GERD. What
adverse
effect should the nurse monitor?
A. Diarrhea
B. Constipation
C. Hypokalemia
D. Rash
Answer: B
Rationale: Aluminum-based antacids commonly cause
constipation.
8. What should the nurse include when teaching a client
taking
ferrous sulfate?
A. Take with milk
B. Take with food if GI upset occurs
C. Expect pale stools
D. Avoid vitamin C
Answer: B
Rationale: Iron can upset the stomach. If so, take with food
(but
not dairy). Vitamin C increases absorption.
9. A client is taking diphenhydramine. Which side effect is
most
likely?
A. Hypertension
B. Drowsiness
C. Diarrhea