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1. A client with hypertension has been prescribed lisinopril. During a home visit, which
assessment finding would indicate that the medication is having the desired therapeutic
effect?
A) Heart rate of 92 beats per minute
B) Blood pressure reading of 128/78 mmHg
C) Blood pressure reading of 118/72 mmHg
D) Respiratory rate of 20 breaths per minute
Rationale: Lisinopril is an ACE inhibitor that works by blocking the conversion of angiotensin I
to angiotensin II, resulting in vasodilation and decreased peripheral resistance. The therapeutic
goal for hypertension management is to achieve a blood pressure below 130/80 mmHg in most
patients. A reading of 118/72 mmHg indicates successful blood pressure control, demonstrating
that the medication is effectively reducing vascular resistance and lowering systemic blood
pressure. The other options do not specifically indicate the desired therapeutic response to
lisinopril therapy.
2. A client with heart failure is prescribed furosemide. Which assessment finding would
require immediate nursing intervention?
A) Weight loss of 2 pounds in 24 hours
B) Serum potassium level of 3.8 mEq/L
C) Urine output of 30 mL per hour
D) Serum potassium level of 2.9 mEq/L
Rationale: Furosemide is a loop diuretic that works in the ascending loop of Henle to inhibit
sodium and chloride reabsorption, leading to significant diuresis. This medication causes
excessive potassium excretion, which can result in hypokalemia. A serum potassium level of 2.9
mEq/L is critically low and can lead to life-threatening cardiac arrhythmias, including
ventricular tachycardia and cardiac arrest. Normal serum potassium levels range from 3.5 to 5.0
mEq/L, and levels below 3.0 mEq/L require immediate intervention with potassium
supplementation and possibly temporary discontinuation of the diuretic.
,2|Page
3. A client with osteoarthritis reports taking over-the-counter NSAIDs daily for pain
management. Which assessment finding would indicate a potential adverse effect requiring
immediate physician notification?
A) Mild gastric upset after taking medication
B) Occasional headache in the morning
C) Slight swelling in the ankles
D) Dark, tarry stools and abdominal pain
Rationale: Non-steroidal anti-inflammatory drugs work by inhibiting cyclooxygenase enzymes,
which reduces prostaglandin synthesis and decreases inflammation and pain. However, this
mechanism also reduces protective prostaglandins in the gastric mucosa, increasing the risk of
gastrointestinal bleeding. Dark, tarry stools (melena) indicate upper gastrointestinal bleeding,
which is a serious complication that requires immediate medical evaluation. The client may need
to discontinue the NSAID and undergo diagnostic testing to assess the extent of bleeding. Other
options represent less serious or unrelated side effects.
4. A client with seasonal allergies asks the nurse about taking an over-the-counter
decongestant. Which statement indicates the client understands the medication teaching?
A) "I can take this medication whenever I feel stuffy without any concerns"
B) "This medication will make me sleepy, so I should take it at bedtime"
C) "I should avoid drinking water while taking this medication"
D) "I should use this medication for only a few days to avoid rebound congestion"
Rationale: Decongestants work by vasoconstricting blood vessels in the nasal passages, which
reduces swelling and congestion. However, prolonged use beyond 3-5 days can lead to rebound
congestion (rhinitis medicamentosa), where the nasal passages become more congested as the
medication wears off. This creates a cycle of dependence and worsening symptoms. Clients
should be educated about this risk and instructed to limit use to short-term relief. Additionally,
patients with hypertension should use decongestants with caution due to their vasoconstrictive
effects.
5. A postoperative client is prescribed a stool softener to prevent constipation. Which
outcome indicates the medication is effective?
A) Client reports having a bowel movement every three days
B) Client experiences abdominal cramping and diarrhea
C) Client reports nausea after taking the medication
D) Client has a soft, formed bowel movement without straining
,3|Page
Rationale: Stool softeners, such as docusate sodium, work by allowing water and lipids to
penetrate the stool, making it softer and easier to pass. The desired outcome is the passage of a
soft, formed bowel movement without the need for straining. This is particularly important for
postoperative clients who may have abdominal incisions or are at risk for increased intra-
abdominal pressure. Straining during defecation can cause wound dehiscence, increased pain, or
cardiovascular stress. The medication should promote comfortable elimination without
significant side effects.
6. A client with rheumatoid arthritis complains of persistent joint pain and stiffness. Which
nursing intervention is most appropriate to address the pain?
A) Encourage the client to avoid all physical activity
B) Apply heat to affected joints for 30 minutes twice daily
C) Instruct the client to take NSAIDs on an empty stomach
D) Administer prescribed NSAIDs and apply cold packs to inflamed joints
Rationale: Arthritis involves inflammation of the joints, causing pain, swelling, and stiffness.
The most appropriate intervention includes both pharmacological and non-pharmacological
approaches. NSAIDs reduce inflammation and pain, while cold packs help decrease acute
inflammation and provide local anesthesia. Heat may be beneficial for chronic stiffness but
should be used cautiously with acute inflammation. Complete immobility can lead to joint
contractures and decreased function. NSAIDs should be taken with food to minimize
gastrointestinal side effects.
7. A client has been prescribed paroxetine for depression. Which statement by the client
indicates understanding of the medication's onset of action?
A) "I should expect to feel better within 2 to 3 days of starting the medication"
B) "If I don't feel better in a week, I should double the dose"
C) "I can stop taking this medication when I feel better"
D) "It may take 2 to 4 weeks before I notice improvement in my symptoms"
Rationale: Paroxetine is a selective serotonin reuptake inhibitor that works by increasing
serotonin levels in the synaptic cleft. The therapeutic effect of SSRIs typically requires 2 to 4
weeks of consistent use, as the brain needs time to adjust to the increased serotonin levels and
produce changes in mood and anxiety. Clients should be educated about this delayed onset to
prevent premature discontinuation. Abrupt discontinuation can cause withdrawal symptoms, and
dosage changes should only be made under healthcare provider guidance.
, 4|Page
8. A client asks the nurse about using St. John's Wort for depression. Which response is
most appropriate?
A) "It is completely safe and has no interactions with other medications"
B) "It works faster than prescription antidepressants"
C) "It is only effective for mild depression and has no side effects"
D) "It can interact with many medications, including antidepressants and birth control pills"
Rationale: St. John's Wort is an herbal supplement used for depression that affects the
cytochrome P450 enzyme system, particularly CYP3A4 and CYP2D6. This can lead to
significant drug interactions, including reduced effectiveness of oral contraceptives,
anticoagulants, cyclosporine, and many antidepressants. Serious interactions can occur when
combined with SSRIs, potentially leading to serotonin syndrome. The supplement can also cause
photosensitivity and gastrointestinal effects. Clients should be advised to discuss all supplements
with their healthcare provider before use.
9. A client with diabetes reports feeling shaky, diaphoretic, and confused. Which action
should the nurse take first?
A) Administer insulin immediately
B) Check the client's blood glucose level
C) Call the healthcare provider
D) Administer 15 grams of fast-acting carbohydrate
Rationale: The client is exhibiting classic signs of hypoglycemia, which include shakiness,
diaphoresis, confusion, and tachycardia. The immediate priority is to raise blood glucose levels
to prevent deterioration to unconsciousness or seizures. Fast-acting carbohydrates such as
glucose tablets, 4 ounces of fruit juice, or 15 grams of glucose gel should be administered if the
client is conscious and able to swallow. The blood glucose level should be checked after
administration to confirm improvement. Insulin would worsen the condition, and calling the
provider delays necessary treatment.
10. A client with type 1 diabetes is prescribed regular insulin. Which instruction is most
important regarding administration of this medication?
A) Administer the insulin 1 hour after meals
B) Rotate injection sites only on the abdomen
C) Shake the vial vigorously before drawing up the insulin
D) Administer the insulin 30 minutes before meals
Rationale: Regular insulin is a short-acting insulin with an onset of action of approximately 30
minutes and a peak of 2 to 3 hours. To properly match the rise in blood glucose after meals, it
should be administered 30 minutes before eating. This timing allows the insulin to begin working
1. A client with hypertension has been prescribed lisinopril. During a home visit, which
assessment finding would indicate that the medication is having the desired therapeutic
effect?
A) Heart rate of 92 beats per minute
B) Blood pressure reading of 128/78 mmHg
C) Blood pressure reading of 118/72 mmHg
D) Respiratory rate of 20 breaths per minute
Rationale: Lisinopril is an ACE inhibitor that works by blocking the conversion of angiotensin I
to angiotensin II, resulting in vasodilation and decreased peripheral resistance. The therapeutic
goal for hypertension management is to achieve a blood pressure below 130/80 mmHg in most
patients. A reading of 118/72 mmHg indicates successful blood pressure control, demonstrating
that the medication is effectively reducing vascular resistance and lowering systemic blood
pressure. The other options do not specifically indicate the desired therapeutic response to
lisinopril therapy.
2. A client with heart failure is prescribed furosemide. Which assessment finding would
require immediate nursing intervention?
A) Weight loss of 2 pounds in 24 hours
B) Serum potassium level of 3.8 mEq/L
C) Urine output of 30 mL per hour
D) Serum potassium level of 2.9 mEq/L
Rationale: Furosemide is a loop diuretic that works in the ascending loop of Henle to inhibit
sodium and chloride reabsorption, leading to significant diuresis. This medication causes
excessive potassium excretion, which can result in hypokalemia. A serum potassium level of 2.9
mEq/L is critically low and can lead to life-threatening cardiac arrhythmias, including
ventricular tachycardia and cardiac arrest. Normal serum potassium levels range from 3.5 to 5.0
mEq/L, and levels below 3.0 mEq/L require immediate intervention with potassium
supplementation and possibly temporary discontinuation of the diuretic.
,2|Page
3. A client with osteoarthritis reports taking over-the-counter NSAIDs daily for pain
management. Which assessment finding would indicate a potential adverse effect requiring
immediate physician notification?
A) Mild gastric upset after taking medication
B) Occasional headache in the morning
C) Slight swelling in the ankles
D) Dark, tarry stools and abdominal pain
Rationale: Non-steroidal anti-inflammatory drugs work by inhibiting cyclooxygenase enzymes,
which reduces prostaglandin synthesis and decreases inflammation and pain. However, this
mechanism also reduces protective prostaglandins in the gastric mucosa, increasing the risk of
gastrointestinal bleeding. Dark, tarry stools (melena) indicate upper gastrointestinal bleeding,
which is a serious complication that requires immediate medical evaluation. The client may need
to discontinue the NSAID and undergo diagnostic testing to assess the extent of bleeding. Other
options represent less serious or unrelated side effects.
4. A client with seasonal allergies asks the nurse about taking an over-the-counter
decongestant. Which statement indicates the client understands the medication teaching?
A) "I can take this medication whenever I feel stuffy without any concerns"
B) "This medication will make me sleepy, so I should take it at bedtime"
C) "I should avoid drinking water while taking this medication"
D) "I should use this medication for only a few days to avoid rebound congestion"
Rationale: Decongestants work by vasoconstricting blood vessels in the nasal passages, which
reduces swelling and congestion. However, prolonged use beyond 3-5 days can lead to rebound
congestion (rhinitis medicamentosa), where the nasal passages become more congested as the
medication wears off. This creates a cycle of dependence and worsening symptoms. Clients
should be educated about this risk and instructed to limit use to short-term relief. Additionally,
patients with hypertension should use decongestants with caution due to their vasoconstrictive
effects.
5. A postoperative client is prescribed a stool softener to prevent constipation. Which
outcome indicates the medication is effective?
A) Client reports having a bowel movement every three days
B) Client experiences abdominal cramping and diarrhea
C) Client reports nausea after taking the medication
D) Client has a soft, formed bowel movement without straining
,3|Page
Rationale: Stool softeners, such as docusate sodium, work by allowing water and lipids to
penetrate the stool, making it softer and easier to pass. The desired outcome is the passage of a
soft, formed bowel movement without the need for straining. This is particularly important for
postoperative clients who may have abdominal incisions or are at risk for increased intra-
abdominal pressure. Straining during defecation can cause wound dehiscence, increased pain, or
cardiovascular stress. The medication should promote comfortable elimination without
significant side effects.
6. A client with rheumatoid arthritis complains of persistent joint pain and stiffness. Which
nursing intervention is most appropriate to address the pain?
A) Encourage the client to avoid all physical activity
B) Apply heat to affected joints for 30 minutes twice daily
C) Instruct the client to take NSAIDs on an empty stomach
D) Administer prescribed NSAIDs and apply cold packs to inflamed joints
Rationale: Arthritis involves inflammation of the joints, causing pain, swelling, and stiffness.
The most appropriate intervention includes both pharmacological and non-pharmacological
approaches. NSAIDs reduce inflammation and pain, while cold packs help decrease acute
inflammation and provide local anesthesia. Heat may be beneficial for chronic stiffness but
should be used cautiously with acute inflammation. Complete immobility can lead to joint
contractures and decreased function. NSAIDs should be taken with food to minimize
gastrointestinal side effects.
7. A client has been prescribed paroxetine for depression. Which statement by the client
indicates understanding of the medication's onset of action?
A) "I should expect to feel better within 2 to 3 days of starting the medication"
B) "If I don't feel better in a week, I should double the dose"
C) "I can stop taking this medication when I feel better"
D) "It may take 2 to 4 weeks before I notice improvement in my symptoms"
Rationale: Paroxetine is a selective serotonin reuptake inhibitor that works by increasing
serotonin levels in the synaptic cleft. The therapeutic effect of SSRIs typically requires 2 to 4
weeks of consistent use, as the brain needs time to adjust to the increased serotonin levels and
produce changes in mood and anxiety. Clients should be educated about this delayed onset to
prevent premature discontinuation. Abrupt discontinuation can cause withdrawal symptoms, and
dosage changes should only be made under healthcare provider guidance.
, 4|Page
8. A client asks the nurse about using St. John's Wort for depression. Which response is
most appropriate?
A) "It is completely safe and has no interactions with other medications"
B) "It works faster than prescription antidepressants"
C) "It is only effective for mild depression and has no side effects"
D) "It can interact with many medications, including antidepressants and birth control pills"
Rationale: St. John's Wort is an herbal supplement used for depression that affects the
cytochrome P450 enzyme system, particularly CYP3A4 and CYP2D6. This can lead to
significant drug interactions, including reduced effectiveness of oral contraceptives,
anticoagulants, cyclosporine, and many antidepressants. Serious interactions can occur when
combined with SSRIs, potentially leading to serotonin syndrome. The supplement can also cause
photosensitivity and gastrointestinal effects. Clients should be advised to discuss all supplements
with their healthcare provider before use.
9. A client with diabetes reports feeling shaky, diaphoretic, and confused. Which action
should the nurse take first?
A) Administer insulin immediately
B) Check the client's blood glucose level
C) Call the healthcare provider
D) Administer 15 grams of fast-acting carbohydrate
Rationale: The client is exhibiting classic signs of hypoglycemia, which include shakiness,
diaphoresis, confusion, and tachycardia. The immediate priority is to raise blood glucose levels
to prevent deterioration to unconsciousness or seizures. Fast-acting carbohydrates such as
glucose tablets, 4 ounces of fruit juice, or 15 grams of glucose gel should be administered if the
client is conscious and able to swallow. The blood glucose level should be checked after
administration to confirm improvement. Insulin would worsen the condition, and calling the
provider delays necessary treatment.
10. A client with type 1 diabetes is prescribed regular insulin. Which instruction is most
important regarding administration of this medication?
A) Administer the insulin 1 hour after meals
B) Rotate injection sites only on the abdomen
C) Shake the vial vigorously before drawing up the insulin
D) Administer the insulin 30 minutes before meals
Rationale: Regular insulin is a short-acting insulin with an onset of action of approximately 30
minutes and a peak of 2 to 3 hours. To properly match the rise in blood glucose after meals, it
should be administered 30 minutes before eating. This timing allows the insulin to begin working
