1. 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
Rationale: Acyclovir can cause nephrotoxicity. Hydration is
essential to reduce the risk.
2. A client started on fluoxetine 5 days ago reports
increased
energy and planning their funeral. What should the nurse
do?
A. Encourage journaling
B. Monitor sleep
C. Notify the provider immediately
D. Provide distraction techniques
Answer: C
Rationale: Increased energy + suicidal ideation early in SSRI
therapy is dangerous and should be reported.
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 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.
5. 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.
6. A child prescribed methylphenidate for ADHD should be
monitored for which effect?
A. Drowsiness
B. Increased appetite
C. Weight loss and insomnia
D. Bradycardia
Answer: C
Rationale: Stimulants like methylphenidate commonly cause
decreased appetite, insomnia, and weight loss.
7. What lab value should be monitored in a client receiving
propylthiouracil (PTU)?
A. Glucose
B. TSH and T3/T4
C. Calcium
D. Sodium
Answer: B
Rationale: PTU suppresses thyroid hormone. Monitor TSH,
T3, and
T4 to assess effectiveness.
8. 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.
9. A client is prescribed exenatide. What is a common side
effect?
A. Hyperglycemia
B. Constipation
C. Nausea
D. Tachycardia
Answer: C
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
Rationale: Acyclovir can cause nephrotoxicity. Hydration is
essential to reduce the risk.
2. A client started on fluoxetine 5 days ago reports
increased
energy and planning their funeral. What should the nurse
do?
A. Encourage journaling
B. Monitor sleep
C. Notify the provider immediately
D. Provide distraction techniques
Answer: C
Rationale: Increased energy + suicidal ideation early in SSRI
therapy is dangerous and should be reported.
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 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.
5. 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.
6. A child prescribed methylphenidate for ADHD should be
monitored for which effect?
A. Drowsiness
B. Increased appetite
C. Weight loss and insomnia
D. Bradycardia
Answer: C
Rationale: Stimulants like methylphenidate commonly cause
decreased appetite, insomnia, and weight loss.
7. What lab value should be monitored in a client receiving
propylthiouracil (PTU)?
A. Glucose
B. TSH and T3/T4
C. Calcium
D. Sodium
Answer: B
Rationale: PTU suppresses thyroid hormone. Monitor TSH,
T3, and
T4 to assess effectiveness.
8. 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.
9. A client is prescribed exenatide. What is a common side
effect?
A. Hyperglycemia
B. Constipation
C. Nausea
D. Tachycardia
Answer: C