1. A post-op client is given ondansetron. Which is an
expected
outcome?
A. Decreased heart rate
B. Absence of nausea
C. Increased bowel sounds
D. Sedation
Answer: B
Rationale: Ondansetron is a serotonin antagonist used to
prevent
or treat nausea and vomiting.
2. 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.
3. Which lab value should be monitored regularly for a
client on
statins?
A. BUN
B. AST and ALT
C. Sodium
D. Hematocrit
Answer: B
Rationale: Statins can cause liver damage. Monitor liver
enzymes
(AST/ALT).
4. 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.
5. 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.
6. 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.
7. 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.
8. A client taking carbidopa/levodopa reports facial
twitching
and eye spasms. What should the nurse do?
A. Reassure the client this is expected
B. Hold the dose and notify the provider
C. Administer diphenhydramine
D. Document and continue monitoring
Answer: B
Rationale: Facial twitching and spasms are signs of toxicity.
Notify
the provider to adjust dosage.
9. A client is receiving morphine IV post-op. Which finding
is the
priority?
A. Nausea
expected
outcome?
A. Decreased heart rate
B. Absence of nausea
C. Increased bowel sounds
D. Sedation
Answer: B
Rationale: Ondansetron is a serotonin antagonist used to
prevent
or treat nausea and vomiting.
2. 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.
3. Which lab value should be monitored regularly for a
client on
statins?
A. BUN
B. AST and ALT
C. Sodium
D. Hematocrit
Answer: B
Rationale: Statins can cause liver damage. Monitor liver
enzymes
(AST/ALT).
4. 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.
5. 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.
6. 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.
7. 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.
8. A client taking carbidopa/levodopa reports facial
twitching
and eye spasms. What should the nurse do?
A. Reassure the client this is expected
B. Hold the dose and notify the provider
C. Administer diphenhydramine
D. Document and continue monitoring
Answer: B
Rationale: Facial twitching and spasms are signs of toxicity.
Notify
the provider to adjust dosage.
9. A client is receiving morphine IV post-op. Which finding
is the
priority?
A. Nausea
