1. A client with a penicillin allergy is prescribed cephalexin. What
is the nurse’s priority?
A. Administer as ordered
B. Ask about previous reaction type
C. Hold the dose for 30 minutes
D. Give with food
Answer: B
Rationale: Cross-sensitivity may occur. Ask if the client had a true
anaphylactic reaction before administering.
2. A client on sildenafil experiences chest pain during
intercourse. What is the nurse’s next action?
A. Administer nitroglycerin
B. Encourage rest and fluids
C. Call emergency services
D. Administer aspirin
Answer: C
Rationale: Sildenafil + nitrates can cause life-threatening
hypotension. Do not give nitro—call 911.
3. A nurse is educating a client on atorvastatin. What side effect
should the client report immediately?
A. Headache
B. Muscle pain
C. Drowsiness
D. Constipation
Answer: B
Rationale: Myopathy can occur with statins and may progress to
rhabdomyolysis. Report muscle pain immediately.
4. A client uses sublingual nitroglycerin. Which instruction is
,correct?
A. Swallow the pill with water
B. Take up to 3 doses, 5 minutes apart
C. Store it in a warm area
D. Use it once weekly
Answer: B
Rationale: For chest pain, take 1 tablet every 5 minutes, up to 3
doses, and call 911 if no relief after the first.
5. A nurse is reviewing a client’s chart who is prescribed
gentamicin. Which finding should concern the nurse most?
A. Tinnitus
B. WBC 10,000
C. Urine output 50 mL/hr
D. Temperature 100.2°F
Answer: A
Rationale: Tinnitus is a sign of ototoxicity, a serious adverse effect
of gentamicin.
6. A client on clozapine reports fever and sore throat. What is the
priority action?
A. Reassure and monitor
B. Administer antipyretics
C. Check WBC count
D. Suggest lozenges
Answer: C
Rationale: Clozapine can cause agranulocytosis. A fever + sore
throat may signal low WBC—check labs.
7. 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.
8. Which statement indicates proper understanding of
enoxaparin (Lovenox) administration?
A. “I will inject it into my thigh muscle.”
B. “I will rub the site after injection.”
C. “I will inject it into my belly fat.”
D. “I must monitor my INR daily.”
Answer: C
Rationale: Enoxaparin is given subcutaneously, preferably in the
abdomen, and INR monitoring is not required.
9. A client receiving amphotericin B develops chills and fever.
What should the nurse do?
A. Stop the infusion
B. Document findings
C. Pre-medicate with acetaminophen
D. Increase infusion rate
Answer: C
Rationale: Infusion reactions are common. Premedication with
acetaminophen or diphenhydramine is standard.
10. A client with herpes simplex is prescribed acyclovir. What is the
most important teaching?
A. "Take on an empty stomach."
B. "Drink plenty of fluids."
C. "Discontinue when symptoms improve."
D. "Expect yellowing of the eyes."
Answer: B
is the nurse’s priority?
A. Administer as ordered
B. Ask about previous reaction type
C. Hold the dose for 30 minutes
D. Give with food
Answer: B
Rationale: Cross-sensitivity may occur. Ask if the client had a true
anaphylactic reaction before administering.
2. A client on sildenafil experiences chest pain during
intercourse. What is the nurse’s next action?
A. Administer nitroglycerin
B. Encourage rest and fluids
C. Call emergency services
D. Administer aspirin
Answer: C
Rationale: Sildenafil + nitrates can cause life-threatening
hypotension. Do not give nitro—call 911.
3. A nurse is educating a client on atorvastatin. What side effect
should the client report immediately?
A. Headache
B. Muscle pain
C. Drowsiness
D. Constipation
Answer: B
Rationale: Myopathy can occur with statins and may progress to
rhabdomyolysis. Report muscle pain immediately.
4. A client uses sublingual nitroglycerin. Which instruction is
,correct?
A. Swallow the pill with water
B. Take up to 3 doses, 5 minutes apart
C. Store it in a warm area
D. Use it once weekly
Answer: B
Rationale: For chest pain, take 1 tablet every 5 minutes, up to 3
doses, and call 911 if no relief after the first.
5. A nurse is reviewing a client’s chart who is prescribed
gentamicin. Which finding should concern the nurse most?
A. Tinnitus
B. WBC 10,000
C. Urine output 50 mL/hr
D. Temperature 100.2°F
Answer: A
Rationale: Tinnitus is a sign of ototoxicity, a serious adverse effect
of gentamicin.
6. A client on clozapine reports fever and sore throat. What is the
priority action?
A. Reassure and monitor
B. Administer antipyretics
C. Check WBC count
D. Suggest lozenges
Answer: C
Rationale: Clozapine can cause agranulocytosis. A fever + sore
throat may signal low WBC—check labs.
7. 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.
8. Which statement indicates proper understanding of
enoxaparin (Lovenox) administration?
A. “I will inject it into my thigh muscle.”
B. “I will rub the site after injection.”
C. “I will inject it into my belly fat.”
D. “I must monitor my INR daily.”
Answer: C
Rationale: Enoxaparin is given subcutaneously, preferably in the
abdomen, and INR monitoring is not required.
9. A client receiving amphotericin B develops chills and fever.
What should the nurse do?
A. Stop the infusion
B. Document findings
C. Pre-medicate with acetaminophen
D. Increase infusion rate
Answer: C
Rationale: Infusion reactions are common. Premedication with
acetaminophen or diphenhydramine is standard.
10. A client with herpes simplex is prescribed acyclovir. What is the
most important teaching?
A. "Take on an empty stomach."
B. "Drink plenty of fluids."
C. "Discontinue when symptoms improve."
D. "Expect yellowing of the eyes."
Answer: B
