& Answers
1. A nurse is performing the third check before administering hydromorphone to a client. After
opening the unit-dose packet, the client tells the nurse they do not want to take the medication
now. Which of the following actions should the nurse take? - ANS ✔ - Dispose of the medication
with a second nurse as a witness. The nurse is legally required to have a witness when disposing
of a controlled substance
2. A nurse is reinforcing teaching with a newly licensed nurse about using metoprolol to treat
hypertension. Which of the following conditions should the nurse include as a contraindication
for this medication? - ANS ✔ - Bradycardia. Metoprolol is a beta blocker that slows the
conduction through the AV node. Therefore, it is contraindicated for clients who have
bradycardia, or a heart rate that is consistently less than 60/min
3. A nurse is reinforcing teaching about immunizations with a client who is pregnant. Which of the
following vaccines should the nurse include in the teaching as a safe to administer during
pregnancy? - ANS ✔ - Tetanus and Diphtheria(td). The nurse should include that either the Td
vaccine or the tetanus, diphtheria, and pertussis(Tdap) vaccine is safe for administration during
pregnancy. Tdap is the preferred vaccine
4. A nurse is assisting in the care of a client who has a history of psychosis and is taking
chlorpromazine. Which of the following actions should the nurse take to contract the adverse
effects of this medication? - ANS ✔ - Inform the client to apply sunblock before going outside
counter act photosensitivity. Chlorpromazine increases skin's sensitivity to UV light = temporary
pigmentation changes and increase risk of sunburn
5. A nurse is instilling timolol eyedrops for a client who has glaucoma. Which of the following
actions should the nurse take after instilling the eyedrops? - ANS ✔ - Press the nasolacrimal duct
to prevent the medication from absorbing into systemic circulation
6. A nurse is reinforcing teaching with a client who is receiving Enalapril 20mg PO daily. The nurse
should instruct the client to monitor for which of the following adverse effects of this
medication? - ANS ✔ - Dry cough. Persistent fry of nonproductive cough is an adverse effect of
enalapril. Underlying cause of the dry cough is the accumulation of bradykinin from the
medication. Client should notify the provider of this adverse effects.
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, 7. A nurse is caring for a client who is taking phenylephrine. The nurse should plan to monitor the
client for which of the following manifestations as an adverse effect of this medication? - ANS ✔
- Increase Heart rate due to cardiac effects, can cause tachycardia and other cardiac
dysrhythmias
8. A nurse is caring for a client who has multiple sclerosis and a new prescription for baclofen.
Which of the following findings indicates to the nurse that the medication is having a therapeutic
effects? - ANS ✔ - Decreased muscle spasticity. Baclofen is a antispasmodic that decrease muscle
spasticity in a client who has MS
9. A nurse is caring for a client who is receiving methylprednisolone. Which of the following
laboratory values should the nurse plan to monitor? (SATA) - ANS ✔ - WBC
Serum K
Blood glucose
Increase risk for infection = leukocytosis
Causes hypokalemia as well as fluid and sodium retention
Increase blood glucose levels
10. A nurse is reinforcing teaching with a client who has a prescription for scopolamine transdermal
patches to prevent motion sickness, which of the following statements by the client indicates an
understanding of the teaching? - ANS ✔ - I should place the patch behind my ear. Place patch on
the hairless area of skin behind the ear
11. A nurse is evaluating a male client who is receiving amphotericin B via intermittent IV bolus.
Which of the following findings indicates an adverse reaction to this medication? - ANS ✔ -
Hypotension. High-alert medication due to potentially serious adverse effects, including
hypotension. Should report nephrotoxicity, hypokalemia, and cardiac dysrhythmias
12. At 0800, 1,000ml IV infusion for a client, which is running at 125ml/hr. How much fluid is left in
the IV bag at 1300. - ANS ✔ - 375 ml
13. A nurse is reviewing the medical record of a client who has a new prescription for
dimenhydrinate to treat motion sickness. Which of the following conditions in the client's
medical record should the nurse report to the provider? - ANS ✔ - Benign Prostatic hyperplasia
might have urinary hesitancy and retention and. Thereore should not take it due the
anticholinergic adverse effects of the medication.
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