NRSG 2010 AQ MED SURG DRUGS QUESTIONS AND ANSWERS

Exam (elaborations) NRSG 2010 AQ MED SURG DRUGS QUESTIONS AND ANSWERS Quiz: Medical-Surgical Drugs Correct Answers: 7 3 Confidence: Just a guess Stats Issue with this question? 4. The provider prescribes one unit of packed red blood cells to be administered to a client. To ensure the client's safety, which measure should the nurse take during administration of blood products? Correct1 Stay with client during first 15 minutes of infusion. 2 Flush packed red blood cells with 5% dextrose and 0.45% normal saline. 3 Discontinue the intravenous catheter if a blood transfusion reaction occurs. 4 Administer the red blood cells through a percutaneously inserted central catheter line with a 20-gauge needle. The nurse should remain with the client for the first 15 to 30 minutes. Any severe reaction usually occurs with the infusion of the first 50 mL of blood. Blood components are viscous, requiring a large needle to be used for venous access. A 20-gauge needle is not used to access a central catheter line. Normal saline is the solution to administer with blood productions. Lactated Ringer and dextrose in water are not used for infusion because of hemolysis. 75%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 8. NRSG 2010 AQ MED SURG DRUGS QUESTIONS AND ANSWERS A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow pigmentation of the skin, and an enlarged liver due to vitamin toxicity. What type of toxicity does the nurse suspect? Correct1 Retinol (vitamin A) 2 Thiamine (vitamin B1) 3 Pyridoxine (vitamin B6) 4 Ascorbic acid (vitamin C) These adaptations, as well as anemia, irritability, pruritus, and an enlarged spleen, occur with vitamin A toxicity. Excess thiamine is excreted in the urine and rarely, if ever, causes toxicity; an excessive dose may elicit an allergic reaction in some individuals. Excess vitamin C (ascorbic acid) does not cause these adaptations or toxicity; however, vitamin C may cause diarrhea or renal calculi. Pyridoxine (vitamin B6) is relatively nontoxic, and excess amounts are excreted in the urine. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal. 54%of students nationwide answered this question correctly. View Topics 5 Confidence: Just a guess Stats Issue with this question? 10. A client with diabetes asks how exercise will affect insulin and dietary needs. What information does the nurse share about insulin and exercise? Correct1 "Exercise increases the need for carbohydrates and decreases the need for insulin." 2 "Exercise increases the need for insulin and increases the need for carbohydrates." 3 "Regular physical activity decreases the need for insulin and decreases the need for carbohydrates." 4 "Intensive physical activity decreases the need for carbohydrates but does not affect the need for insulin." Exercise increases the uptake of glucose by active muscle cells without the need for insulin; carbohydrates are needed to supply energy for the increased metabolic rate associated with exercise. The need for insulin is decreased. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success. 57%of students nationwide answered this question correctly. View Topics 5 Confidence: Just a guess Stats Issue with this question? 12. A client with a new diagnosis of type 1 diabetes is told that lifelong insulin will be needed. The client becomes agitated and says, "I am scared of shots. If that is my only option, I’ll just have to go into a coma and die!" What is the nurse’s best response? Correct1 "Injections are not the only option available for insulin." 2 "It won’t be so bad; you will get used to it if you will only try." 3 "This is one of those times when you need to act like an adult." 4 "Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability for your decision." An insulin nasal spray was approved by the Food and Drug Administration (FDA) in 2014 and is available for clients who do not want insulin injections. The nurse should use therapeutic communication in interacting with clients. Intimidating the client by suggesting that actions are childlike and suggesting that the client’s concerns are not significant are not therapeutic responses. The nurse’s primary concern should be for the client’s well-being, not protection from liability. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multipleresponse question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. 66%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 14. A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this medication after discharge. How will the nurse respond? Correct1 "Antiseizure drugs will probably be continued for life." 2 "Phenytoin prevents any further occurrence of seizures." 3 "This drug needs to be taken during periods of emotional stress." 4 "Your antiseizure drug usually can be stopped after a year's absence of seizures." Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the drug irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiologic condition. 53%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 17. A client develops thrombophlebitis in the right calf. Bed rest is prescribed, and an IV of heparin is initiated. What drug action will the nurse include when describing the purpose of this drug to the client? Correct1 Prevents extension of the clot 2 Reduces the size of the thrombus 3 Dissolves the blood clot in the vein 4 Facilitates absorption of red blood cells Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets. Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins. Heparin does not facilitate the absorption of red blood cells. 60%of students nationwide answered this question correctly. View Topics 6 Confidence: Just a guess Stats Issue with this question? 23. A client reports nausea, vomiting, and seeing a yellow light around objects. A diagnosis of hypokalemia is made. Upon a review of the client's prescribed medication list, the nurse determines that what is the likely cause of the clinical findings? Correct1 Digoxin (Lanoxin) 2 Furosemide (Lasix) 3 Propranolol (Inderal) 4 Spironolactone (Aldactone) These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia. Although furosemide most likely contributed to the hypokalemia, the client's symptoms are consistent with digitalis toxicity. Although propranolol can cause nausea, vomiting, and blurred vision, the presence of hypokalemia and yellow vision are more suggestive of digitalis toxicity. A side effect of spironolactone is hyperkalemia, not hypokalemia. 59%of students nationwide answered this question correctly. A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the client? Incorrect1 The dietary intake of carbohydrates must be restricted. Correct2 Thyroxine replacement therapy will be required indefinitely. 3 Chemotherapy may be used in conjunction with the surgery. 4 A tracheostomy requires an alternative means of communication. Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent hypothyroidism. Increased intake of carbohydrates and proteins is needed because of the increased metabolic activity associated with hyperthyroidism. Chemotherapy is uncommon; radiation may be used to eradicate remaining tissue. A tracheostomy is not planned; it is needed only in an emergency related to respiratory distress. Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude. 85%of students nationwide answered this question correctly. View Topics 7 Confidence: Just a guess Stats Issue with this question? 2. A client who had abdominal surgery is receiving patient-controlled analgesia intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client, with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is experiencing pain still. What should the nurse do first? Incorrect1 Monitor the client's pain level for another hour. Correct2 Determine the integrity of the intravenous delivery system. 3 Reprogram the pump to deliver a bolus dose every 8 minutes. 4 Arrange for the client to be evaluated by the healthcare provider. Initially, integrity of the intravenous system should be verified to ensure that the client is receiving medication. The intravenous tubing may be kinked or compressed or the catheter may be dislodged. Continued monitoring will result in the client experiencing unnecessary pain. The nurse may not reprogram the pump to deliver larger or more frequent doses of medication without a healthcare provider's prescription. The healthcare provider should be notified if the system is intact and the client is not obtaining relief from pain. The prescription may have to be revised; the basal dose may be increased, the length of the delay may be reduced, or another medication or mode of delivery may be prescribed. 52%of students nationwide answered this question correctly. View Topics 0 Confidence: Just a guess Stats Issue with this question? 3. A client has been admitted with severe edema and hypertension. Intravenous furosemide has been prescribed. Which subjective clinical manifestations lead the nurse to suspect that the furosemide is infusing too rapidly? Select all that apply. Incorrect1 Hunger Correct2 Tinnitus Correct3 Weakness Correct4 Leg cramps 5 Excess salivation Tinnitus is a central nervous system side effect of furosemide. Weakness and leg cramps result from hypokalemia caused by an overload of furosemide. Nausea and anorexia, not hunger, are side effects of dehydration that may occur with an overload of furosemide. Dry mouth, not salivation, results from dehydration caused by an overload of furosemide. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function. 44%of students nationwide answered this question correctly. View Topics 7 Confidence: Just a guess Stats Issue with this question? 5. ; A client is receiving heparin sodium intravenously at 1500 units/hour. The concentration in the bag is 25,000 units/500 milliliters. The nurse determines that how many milliliters will infuse during the nurse's 8-hour shift? Record your answer using a whole number. ___ mL The ordered rate is 1500 u/hr. The available concentration is 25,000 u in 500 mL. Make the necessary conversions and use dimensional analysis to determine the appropriate rate in mL/h. The ratio and proportion method is not appropriate for this situation. 6 Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be available for you to determine your response, which you will then type in the provided space. 57%of students nationwide answered this question correctly. View Topics 9 Confidence: Just a guess Stats Issue with this question? 6. Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the drug is being used primarily for which of its properties? Incorrect1 Analgesic 2 Antipyretic Correct3 Antiinflammatory 4 Antiplatelet The antiinflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not the rationale for prescribing it for clients with rheumatoid arthritis. Aspirin does not preserve bone integrity. Flexion contractures are prevented by exercise, not aspirin. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question. 73%of students nationwide answered this question correctly. View Topics 2 Confidence: Just a guess Stats Issue with this question? 7. A client is to receive total parenteral nutrition (TPN) via a central venous access device/catheter. What information about this treatment would the nurse recognize as accurate? Incorrect1 The jugular vein is the most commonly used catheter insertion site. Correct2 The TPN may be administered intermittently rather than continuously. 3 The client will experience a moderate amount of pain during the procedure. 4 Catheter placement must be confirmed by fluoroscopy before the TPN is initiated. Although the central venous catheter remains in situ, total parenteral nutrition does not have to infuse continuously. Continuous versus intermittent administration depends on the health care provider's prescription. Placement of the tube after the procedure is verified by x-ray, not fluoroscopy. The subclavian veins are used most often; the jugular vein is too close to hair-growing areas, which increases the possibility of sepsis, and neck movements may interfere with maintaining placement of the catheter. Although a feeling of pressure may be experienced, it is not a painful procedure. STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals. 39%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 9. A nurse is teaching an older adult client about managing chronic pain with acetaminophen. Which client statement indicates that the teaching is effective? Incorrect1 "I can drink beer with this, but not wine." 2 "I need to limit my intake of acetaminophen to 650 mg a day." 3 "I should take an emetic if I accidentally overdose on the acetaminophen." Correct4 "I have to be careful about which over-the-counter cold preparations I take when I have a cold." Many over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. A typical single dose is 650 mg a day for adults. Acetaminophen should not exceed 3 to 4 g a day, with a lower dose preferred in older adults. An emetic is contraindicated because it may reduce the client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity. Alcohol of any type, when taken with acetaminophen, increases the risk of liver injury. 73%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 11. A client with a seizure disorder is receiving phenytoin and phenobarbital. What client statement indicates that the instructions regarding the medications are understood? Incorrect1 "I will not have any seizures with these medications." 2 "These medicines must be continued to prevent falls and injury." Correct3 "Stopping the drugs can cause continuous seizures and I may die." 4 "By my staying on the medicines I will prevent postseizure confusion." Sudden withdrawal of antiepileptic medication can cause status epilepticus. It is important to take medication as prescribed to lessen the frequency of seizures; there is no guarantee that seizures will stop. Medication may or may not eliminate the seizures; stress may precipitate a seizure. Antiepileptics are not prescribed to prevent falls and injury. Although seizures may occur while the client is taking the medications, the medications do not stop postseizure confusion. 70%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 13. A client with an intractable infection is receiving vancomycin. Which laboratory blood test result should the nurse report? Incorrect1 Hematocrit: 45% 2 Calcium: 9.0 mg/dL (2.25 mmol/L) 3 White blood cells (WBC): 10,000 mm3 (10 X 109/L) Correct4 Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L) Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a healthy adult is 10 to 20 mg/dL (3.6-7.1 mmol/L). This hematocrit is expected in a healthy adult; the range is from 40 to 52. The expected range of the WBC count is 5,000 to 10,000 mm3 (5-10 X 109/L) for a healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25-2.75 mmol/L) for a healthy adult. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet). 68%of students nationwide answered this question correctly. View Topics 8 Confidence: Just a guess Stats Issue with this question? 15. Which nursing interventions are important when caring for clients receiving IV digoxin? Select all that apply. Correct1 Monitor the heart rate closely Correct2 Check the blood levels of digoxin 3 Administer the dose over 1 minute Correct4 Monitor the serum potassium level 5 Give the drug with other infusing medications Bradycardia or other dysrhythmias may occur; therefore, the heart rate and rhythm should be monitored. ECG monitoring should be continuous. The digoxin level is checked before administration to avoid toxicity. A low serum potassium level when digoxin is administered can contribute to toxicity. Digoxin should be given over a 5-minute period through a Y-tube or three-way stopcock. There are many syringe, Y-site, and additive incompatibilities; the manufacturer recommends that digoxin not be administered with other drugs. 69%of students nationwide answered this question correctly. Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking this medication? Incorrect1 Prevents an infection 2 Limits abdominal distention 3 Minimizes intestinal edema Correct4 Reduces the blood ammonia level Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the gastrointestinal tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to prevent infection. Neomycin has little or no effect on intestinal edema. Neomycin does not reduce abdominal distention. STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently. 31%of students nationwide answered this question correctly. View Topics 4 Confidence: Just a guess Stats Issue with this question? 18. A client who had a femoropopliteal bypass graft is receiving clopidogrel postoperatively. What should the nurse teach the client related to the medication? Incorrect1 Eliminate grapefruit from the diet 2 Eat more roughage if constipation occurs Correct3 Report any occurrence of multiple bruises 4 Take the medication on an empty stomach Clopidogrel is a platelet aggregation inhibitor that decreases the probability of clots forming where the graft was placed, but it also increases bleeding tendencies when the dosage is excessive. Clopidogrel does not interact with grapefruit, which is permitted on the diet. Diarrhea, not constipation, is more likely to occur with clopidogrel. Clopidogrel should be taken with food to decrease the side effects of gastric discomfort, diarrhea, and gastrointestinal bleeding. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying. 60%of students nationwide answered this question correctly. View Topics 1 Confidence: Just a guess Stats Issue with this question? 19. A client is taking lithium sodium. The nurse should notify the healthcare provider for which laboratory value? Incorrect1 Negative protein in the urine 2 Prothrombin of 12.0 seconds 3 Blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L) Correct4 White blood cell (WBC) count of 15,000 mm3 (15 X 109/L) White cell counts can increase with this drug. The expected range of the WBC count is 5000 to 10,000 mm3 (5-10 X 109/L) for a healthy adult. Urinalysis, BUN, and prothrombin are not necessary, and these are normal values. STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) Amount of time needed; (2) Amount of time available; (3) "Best" time to study; (4) Time for emergencies and relaxation. 49%of students nationwide answered this question correctly. View Topics 5 Confidence: Just a guess Stats Issue with this question? 20. A nurse provides discharge teaching about ampicillin that is prescribed for a client. The nurse evaluates that the teaching is effective when the client makes which statement? Incorrect1 "I will miss eating grapefruit." Correct2 "I must increase my fluid intake." 3 "I can stop taking this medication any time." 4 "I should take this medication just after eating." The client should increase fluid intake when taking ampicillin to prevent nephrotoxicity; side effects include oliguria, hematuria, proteinuria, and glomerulonephritis. An antibiotic should be continued until the entire prescription is completed; discontinuing before completion lowers its serum level, thereby decreasing its effectiveness. Ampicillin should be taken when the stomach is empty, either one to two hours before eating or three to four hours after eating. There are no restrictions on eating grapefruit when taking an antibiotic; this is contraindicated when taking some calcium channel blockers because grapefruit juice increases their serum level. 50%of students nationwide answered this question correctly. View Topics 2 Confidence: Just a guess Stats Issue with this question? 21. A client develops severe bone marrow suppression related to cancer treatment. What is important for the nurse to include in the client's teaching? Incorrect1 Be prepared to experience alopecia. 2 Increase fluids to at least 3 liters/day. Correct3 Use a soft toothbrush for oral hygiene. 4 Monitor your intake and output of fluids. Thrombocytopenia occurs with several cancer treatment programs; using a soft toothbrush helps prevent bleeding gums. Although alopecia does occur, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Monitoring intake and output of fluids is not related to bone marrow suppression. 79%of students nationwide answered this question correctly. View Topics 5 Confidence: Just a guess Stats Issue with this question? 22. A client is receiving combination chemotherapy for treatment of metastatic carcinoma. For which systemic side effect should the nurse monitor the client? Incorrect1 Ascites 2 Nystagmus Correct3 Leukopenia 4 Polycythemia Leukopenia, a reduction in white blood cells, is a systemic effect of chemotherapy as a result of myelosuppression. Ascites is not a side effect of chemotherapy. Chemotherapy does not affect the eyes; nystagmus is an involuntary, rapid rhythmic movement of the eyeballs. Also, nystagmus is a local, not a systemic, response. The red blood cells will be decreased, not increased. STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals. 81%of students nationwide answered this question correctly. View Topics 5 Confidence: Just a guess Stats Issue with this question? 24. What will the nurse do to assess a client's response to ongoing serum albumin therapy for cirrhosis of the liver? Incorrect1 Monitor the client's vital signs. 2 Measure the client's urine output every half hour. Correct3 Obtain the client's weight at least once every day. 4 Determine the client's urine albumin level each shift. The increased osmotic effect after the administration of albumin increases intravascular volume and urinary output; weight loss reflects fluid loss. Vital signs do not change drastically; however, they should be checked routinely. Urinary output is measured hourly, every 8 hours, and every 24 hours; half-hour outputs are insignificant in this instance. Serum albumin levels are significant; however, albumin in the urine indicates kidney dysfunction, not liver dysfunction. 40%of students nationwide answered this question correctly. View Topics 5 Confidence: Just a guess Stats Issue with this question? 25. During a blood transfusion a client develops chills and a headache. What is the priority nursing action? Incorrect1 Cover the client. Correct2 Stop the transfusion at once. 3 Decrease the rate of the blood infusion. 4 Notify the healthcare provider immediately. Chills, headache, nausea, and vomiting are all signs of a transfusion reaction. The infusion must be stopped before treatment of symptoms begins. Slowing the infusion will continue the reaction, which may lead to kidney damage. The healthcare provider should be notified after the transfusion is stopped. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add to your test scores points that you have lost in the past. 86%of students nationwide answered this question correctly. View Topics 8 Confidence: Just a guess Stats Issue with this question? 26. What should the nurse assess to determine if a client is experiencing the therapeutic effect of valsartan? Incorrect1 Lipid profile 2 Apical pulse 3 Urinary output Correct4 Blood pressure Angiotensin II receptor blockers (ARBs) lower the blood pressure; they block the receptor sites in smooth muscles and adrenal glands so vasoconstriction is prevented. ARBs do not directly affect lipid profile, apical pulse, or urinary output. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. 71%of students nationwide answered this question correctly. View Topics 7 Confidence: Just a guess Stats Issue with this question? 27. Alprazolam is prescribed for a client who is anxious. For what therapeutic effect will the nurse monitor the client? Incorrect1 Reduced anger Correct2 Resting quietly 3 Sleeping soundly 4 Reduced blood pressure Alprazolam, an anxiolytic, promotes muscle relaxation, reduces anxiety, and facilitates rest. Possible adverse reactions to alprazolam are anger and hostility. Although drowsiness is a side effect of alprazolam, caused by depression of central nervous system activity, it is not a hypnotic. Transient hypotension is a side effect of alprazolam, but this is not why it is given to an anxious client. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet). 65%of students nationwide answered this question correctly. A nurse must administer streptomycin 1 g intramuscularly (IM) to a client with tuberculosis. The vial contains 500 mg/mL. How much solution must the nurse administer? Record your answer using a whole number. ___ mL The prescribed dose is 1 g. The available concentration is 500 mg/mL. Use the dimensional analysis and/or ratio and proportion methods to determine how many milliliters the nurse should administer. When using the ratio and proportion method, first convert the prescribed dose unit to the available concentration unit. 1 84%of students nationwide answered this question correctly. View Topics 9 Confidence: Just a guess Stats Issue with this question? 29. After surgery for cancer, a client is to receive chemotherapy. When teaching the client about the side effects of chemotherapy, what advice should the nurse share about alopecia characteristics? Incorrect1 Usually rare Correct2 Not permanent 3 Frequently prolonged 4 Sometimes preventable Once the drugs that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture. Alopecia is a common side effect of chemotherapy. Hair loss persists while the drugs are being received; once the drugs are withdrawn, the hair grows back. Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. 82%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 30. An obese client must self-administer insulin at home. The nurse will teach the client to inject insulin at which angle? Incorrect1 30-degree angle 2 60-degree angle 3 45-degree angle Correct4 90-degree angle Injection should be made at a 90-degree angle for most patients, including those of normal weight. Injecting at a 30-degree angle or a 60-degree angle is not appropriate for the obese, normal weight, the child, or the thin client. If injecting into a child or a thin client, the injection should be made at a 45- degree angle. 69%of students nationwide answered this question correctly. A client with an acute episode of ulcerative colitis is admitted to the hospital. When reviewing the client's laboratory results, the nurse identifies that the client's blood chloride level is decreased. What is the most efficient way this can be corrected? Incorrect1 Low-residue diet Correct2 Intravenous therapy 3 Oral electrolyte solution 4 Total parenteral nutrition (TPN) Intravenous therapy ensures a rapid, well-controlled technique for electrolyte (chloride) replacement. There is no assurance that adequate chloride will be ingested and absorbed. Oral electrolyte solution is not a rapid or well-controlled method for correcting electrolyte deficiencies. TPN is not necessary at this time, although it may be used eventually. 58%of students nationwide answered this question correctly. View Topics 4 Confidence: Just a guess Stats Issue with this question? 2. A nurse is caring for a client who is a victim of trauma and is to receive a blood transfusion. How should the nurse respond when the client expresses fear that acquired immunodeficiency syndrome (AIDS) may be acquired as a result of the blood transfusion? Incorrect1 "The blood is treated with radiation to kill the virus." 2 "The ability to directly identify HIV has eliminated this concern." 3 "Consideration should be given to donating your own blood for transfusion." Correct4 "Screening for the human immunodeficiency virus (HIV) antibodies has minimized this risk." Although blood is screened for the antibodies, there is a period between the time a potential donor is infected and the time when antibodies are detectable; there is still a risk, but it is minimal. There is no current method of destroying the virus in a blood transfusion. The screening tests involve identification of the antibody, not the virus itself; the virus can be identified by the polymerase chain reaction test but is not part of routine screening. Although many people consider autotransfusion for elective procedures, a trauma victim does not have this option. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. 80%of students nationwide answered this question correctly. View Topics 8 Confidence: Just a guess Stats Issue with this question? 4. A client admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease has received a prescription for a medication that is delivered via a nebulizer. When teaching about use of the nebulizer, the nurse should teach the client to do what? Incorrect1 Hold the breath while spraying the medication into the mouth. 2 Position the lips loosely around the mouthpiece and take rapid, shallow breaths. Correct3 Seal the lips around the mouthpiece and breathe in and out, taking slow, deep breaths. 4 Inhale the medication from the nebulizer, remove the mouthpiece from the mouth, and then exhale. Sealing the lips around the mouthpiece ensures that medication is delivered on inspiration; slow, deep breaths promote better deposition and efficacy of medication deep into the lungs. The breath should not be held; a nebulizer treatment delivers medication by inhaling it into the mouth through a mouthpiece. Positioning the lips loosely around the mouthpiece may allow room air to be inhaled, which will dilute the aerosolized medication; rapid, shallow breaths mainly will deposit medication in the oral cavity and will not effectively deliver medication deep into the lung. Inhaling the medication from the nebulizer, removing the mouthpiece from the mouth, and then exhaling allows valuable aerosolized medication to be deposited into the air when the client removes the mouthpiece from the mouth to exhale; the client will not receive the full dose of aerosolized medication. 66%of students nationwide answered this question correctly. View Topics 8 Confidence: Just a guess Stats Issue with this question? 5. Which statement made by a client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? 1 "I will need to have my eyes and vision examined once a year." Incorrect2 "I will need to check my blood sugar at home to evaluate my response to my treatment plan." 3 "I can improve metabolic and cardiac risk factors of this disease if I follow a low-calorie diet and lose weight." Correct4 "Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication." Type 1 diabetes mellitus (DM) is an autoimmune disorder in which beta cells are destroyed. No insulin or very little insulin is produced. Therefore a person with type 1 DM will need lifelong insulin injections to control blood sugar. Early detection of changes in the eye permits treatment plan adjustments that can slow or halt progression of retinopathy. Blood glucose monitoring should be done at home to evaluate the treatment plan. Disease risk factors can be improved with weight loss and a low-calorie diet. Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) A sound understanding of the subject; (2) The ability to follow explicitly the directions given at the beginning of the test; (3) The ability to comprehend what is read; (4) The patience to read each question and set of options carefully before deciding how to answer the question; (5) The ability to use the computer correctly to record answers; (6) The determination to do well; (7) A degree of confidence. 74%of students nationwide answered this question correctly. View Topics 0 Confidence: Just a guess Stats Issue with this question? 6. The laboratory international normalized ratio (INR) results of a client receiving warfarin have been variable. The nurse interviews the client to determine factors contributing to the problem. Which is most important for the nurse to identify? 1 Use of analgesics Incorrect2 Serum glucose level 3 Serum potassium levels Correct4 Adherence to the prescribed drug regimen The dosage of warfarin is adjusted according to INR results; if the client fails to take the drug as prescribed, test results will not be reliable in monitoring the client's response to therapy. Although some medications can affect the absorption or metabolism of warfarin and should be investigated, this is less likely to be a cause of fluctuations in laboratory values. Serum glucose level and serum potassium levels do not affect the absorption of warfarin. 75%of students nationwide answered this question correctly. View Topics 5 Confidence: Just a guess Stats Issue with this question? 7. Several hours after administering insulin, the nurse is assessing a client for an adverse response to the insulin. Which client responses are indicative of a hypoglycemic reaction? Select all that apply. Correct1 Tremors 2 Anorexia Correct3 Confusion 4 Glycosuria Correct5 Diaphoresis Confusion is typically the first sign of a hypoglycemic reaction. Tremors are a sympathetic nervous system response that occurs because circulating glucose in the brain decreases. Diaphoresis is a cholinergic response to hypoglycemia. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur. Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass. 63%of students nationwide answered this question correctly. View Topics 4 Confidence: Just a guess Stats Issue with this question? 8. l The healthcare provider’s prescription for intravenous fluid states that the client is to receive 1 L of fluid every 8 hours. If the equipment delivers 15 drops/mL, at what rate should the nurse regulate the flow? Record your answer using a whole number. ___ drops/minute The prescribed dose is 1 L to be infused with a total infusion time of 8 hours. The drop factor is 15 gtt/mL. Use the formula below to calculate the rate of the infusion in drops per minute. 8 63%of students nationwide answered this question correctly. View Topics 4 Confidence: Just a guess Stats Issue with this question? 9. A client with hepatitis B asks the nurse, "Are there any medications to help me get rid of this problem?" Which is the best response by the nurse? Incorrect1 "Sedatives can be given to help you relax." 2 "We can give you immune serum globulin." 3 "Vitamin supplements are frequently helpful and hasten recovery." Correct4 "There are medications to help reduce viral load and liver inflammation." Drugs are available to help reduce the viral load (antivirals), including lamivudine, ribavirin, and adefovir dipivoxil. Although sedatives can be given to help the client relax, sedatives are given only as needed and do not treat the hepatitis. The response "We can give you immune serum globulin" is used only during the incubation period. Vitamins are used as adjunctive therapy and will not eliminate the hepatitis. 82%of students nationwide answered this question correctly. View Topics 6 Confidence: Just a guess Stats Issue with this question? 11. The healthcare provider prescribes epoetin for a client who has acquired immunodeficiency syndrome (AIDS). What step will the nurse include during administration of this drug? 1 Administer the drug via the Z-track technique. Incorrect2 Shake the vial before withdrawing the solution. 3 Obtain the client's pulse rate before administration. Correct4 Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle. Epoetin is administered via the subcutaneous or intravenous route; a 1-inch (2.5-cm), 25-gauge needle is appropriate for either method of administration. The client's vital signs, particularly the blood pressure, need to be monitored only routinely to determine the effectiveness of the medication. Epoetin is not administered via the intramuscular route, so the Z-track technique is not used. Shaking the vial denatures the glycoprotein, making the medication biologically inactive and therefore ineffective. 24%of students nationwide answered this question correctly. View Topics 1 Confidence: Just a guess Stats Issue with this question? 12. Carbidopa/levodopa is prescribed for a client with Parkinson disease. What will the nurse teach the client about this medication? 1 "Take this medication between meals." Incorrect2 "Blood levels of the drug should be monitored weekly." 3 "It can cause happy feelings followed by feelings of depression." Correct4 "You may experience dizziness when moving from sitting to standing." Carbidopa/levodopa is a metabolic precursor of dopamine; it reduces sympathetic outflow by limiting vasoconstriction, which may result in orthostatic hypotension. Carbidopa/levodopa should be administered with food to minimize gastric irritation. Although periodic tests to evaluate hepatic, renal, and cardiovascular status are required for prolonged therapy, whether these tests should be done on a weekly basis has not been established. Carbidopa/levodopa may produce either happiness or depression, but no established pattern of such responses exists. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. 68%of students nationwide answered this question correctly. A client with anorexia nervosa is admitted to the critical care unit following a period of prolonged starvation. What signs or symptoms indicate to the nurse that the client may have hypokalemia? Select all that apply. Correct1 Muscle weakness 2 Metabolic alkalosis Correct3 Cardiac dysrhythmias 4 Respiratory rate of 24 or higher 5 Serum potassium of 5.5 mEq/L (5.5 mmol/L) Potassium is a component of the sodium-potassium pump that is essential for cellular functioning, especially muscle contraction; a deficiency of either potassium or sodium results in weakness. Potassium is important for muscle contraction; the heart is a muscle, and hypokalemia causes dysrhythmias. Decreased functioning of respiratory muscles may result in respiratory acidosis, not metabolic alkalosis. A serum potassium level of 5.5 mEq/L (5.5 mmol/L) is within the upper range of normal. A low respiratory rate, not a rapid one, would be expected because of the weakened respiratory muscles. Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy. 38%of students nationwide answered this question correctly. View Topics 2 Confidence: Just a guess Stats Issue with this question? 14. A client is admitted to the hospital with pancytopenia as a result of chemotherapy. What should the nurse plan to teach this client in an effort to minimize the risk of complications as a result of pancytopenia? Correct1 Avoid traumatic injuries and exposure to infection. 2 Perform frequent mouth care with a firm toothbrush. Incorrect3 Increase oral fluid intake to a minimum of 3 L daily. 4 Report any unusual muscle cramps or tingling sensations in the extremities. Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection. Aggressive oral hygiene can precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic by-products of chemotherapy, this has no effect on pancytopenia. Muscle cramps or tingling sensations in the extremities are adaptations to hypocalcemia; hypocalcemia is unrelated to pancytopenia. 78%of students nationwide answered this question correctly. View Topics 4 Confidence: Just a guess Stats Issue with this question? 16. What should the nurse expect the healthcare provider to prescribe if a client exhibits clinical indicators of warfarin overdose? 1 Heparin Correct2 Vitamin K Incorrect3 Iron dextran 4 Protamine sulfate Warfarin depresses prothrombin activity and inhibits formation of several clotting factors by the liver. Its antagonist is vitamin K, which is involved in prothrombin formation. Heparin is an anticoagulant. Iron dextran is an iron supplement, not an antidote for warfarin. Protamine sulfate is the antidote for heparin overdose. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. 88%of students nationwide answered this question correctly. View Topics 6 Confidence: Just a guess Stats Issue with this question? 17. A client is receiving imatinib for chronic myelogenous leukemia (CML). The nurse should assess for which complication of this protein-tyrosine kinase inhibitor? Select all that apply. 1 Hair loss Incorrect2 Stomatitis 3 Dehydration Correct4 Signs of infection Correct5 Bleeding tendencies Imatinib affects the bone marrow, causing neutropenia; an adequate number of neutrophils are necessary to fight bacterial infections. Imatinib affects the bone marrow, causing thrombocytopenia; an adequate number of thrombocytes are necessary to prevent bleeding. Hair loss is a complication associated with antimetabolites. Stomatitis is a complication associated with antimetabolites and antitumor antibiotics. Severe fluid retention is a side effect, not dehydration. 9%of students nationwide answered this question correctly. View Topics 8 Confidence: Just a guess Stats Issue with this question? 19. A nurse concludes that a client has a hypoglycemic reaction to insulin. Which clinical findings support this conclusion? Select all that apply. Correct1 Irritability Incorrect2 Glycosuria 3 Dry, hot skin Correct4 Heart palpitations 5 Fruity odor of breath Irritability, a neuroglycopenic symptom, occurs when the glucose in the brain declines to a low level. Heart palpitations, a neurogenic symptom, occur when the sympathetic nervous system responds to a rapid decline in blood glucose. Because the blood glucose level is decreased, the renal threshold is not exceeded, and there is no glycosuria. Dry, hot skin is consistent with dehydration, which often is associated with hyperglycemic states. Fruity odor of the breath is associated with hyperglycemia; it is caused by the breakdown of fats as a result of inadequate insulin supply. 47%of students nationwide answered this question correctly. View Topics 1 Confidence: Just a guess Stats Issue with this question? 21. The chemotherapy protocol prescribed for a client with tuberculosis includes vitamin B6 and isoniazid (INH). What does the nurse identify as the reason for prescribing vitamin B6? 1 Improve the nutritional status of the client Incorrect2 Enhance the tuberculostatic effect of INH 3 Accelerate the destruction of dormant tubercular bacilli Correct4 Counteract the peripheral neuritis that INH may cause One of the most common side effects of INH is peripheral neuritis, and vitamin B6 will counteract this problem. It does help nutrition, but that is not the specific reason it is given. It counters the side effects of isoniazid; it does not act to enhance its action. It does not speed the destruction of the causative organism. Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams have specified time limits, you should pace yourself during the practice testing period accordingly. It is helpful to estimate the time that can be spent on each item and still complete the examination in the allotted time. You can obtain this figure by dividing the testing time by the number of items on the test. For example, a 1-hour (60-minute) testing period with 50 items averages 1.2 minutes per question. The NCLEX exam is not a timed test. Both the number of questions and the time to complete the test varies according to each candidate's performance. However, if the test taker uses the maximum of 5 hours to answer the maximum of 265 questions, each question requires 1.3 minutes on average. 52%of students nationwide answered this question correctly. View Topics 1 Confidence: Just a guess Stats Issue with this question? 22. A client with myasthenia gravis is receiving pyridostigmine bromide to control symptoms. Recently, the client has begun experiencing increased difficulty in swallowing. What nursing action is most effective in preventing aspiration of food? 1 Place a tracheostomy set in the client's room. 2 Assess respiratory status after meals. Incorrect3 Request for the diet to be changed from soft to clear liquids. Correct4 Coordinate mealtimes with the peak effect of the medication. Dysphagia should be minimized during peak effect of pyridostigmine bromide, thereby decreasing the probability of aspiration. A tracheostomy set is a treatment for, rather than equipment to prevent, aspiration. Although it is vital that the client's respiratory function be monitored, assessing the client's respiratory status will not prevent aspiration. There are insufficient data to determine whether changing the diet from soft foods to clear liquids is appropriate; also, liquids are aspirated more easily then semisolids. 64%of students nationwide answered this question correctly. View Topics 9 Confidence: Just a guess Stats Issue with this question? 23. The healthcare provider prescribes cisplatin for a client with metastatic cancer. What will the nurse do to prevent toxic effects? 1 Ask the client's healthcare provider about prescribing leucovorin. 2 Encourage regular vigorous oral care. Correct3 Increase hydration to promote diuresis. Incorrect4 Assist the client in selecting foods appropriate for a high-protein, low-residue diet. Cisplatin is nephrotoxic and can cause kidney damage unless the client is adequately hydrated to flush the kidneys. Leucovorin, a form of folic acid, is used to combat toxic effects of methotrexate; cisplatin does not interfere with folic acid metabolism. Gentle, not vigorous, oral care is needed to cleanse the mouth without further aggravating the expected stomatitis. A low-residue diet is unnecessary. Prolonged gastrointestinal irritation is not the major concern; nausea and vomiting last about 24 hours, and although diarrhea may occur and last longer, it is not the primary concern. 63%of students nationwide answered this question correctly. View Topics 3 Confidence: Just a guess Stats Issue with this question? 25. A nurse gave a client the prescribed sodium polystyrene sulfonate. What assessment finding indicates that the drug has been effective? 1 The presence of diarrhea 2 A narrowing of the QRS complex Incorrect3 An increase in serum calcium level Correct4 A decrease in serum potassium level Sodium polystyrene sulfonate is given to treat hyperkalemia. Therefore the effectiveness of the medication is determined by a decreasing serum potassium level. Sodium polystyrene sulfonate binds with the potassium in the gastrointestinal system and often causes diarrhea. Sodium polystyrene sulfonate has no effect on serum calcium levels. A wide QRS complex is a late finding in hyperkalemia. Sodium polystyrene sulfonate takes time to work and therefore would not be the drug of choice for hyperkalemia evidenced by a widening QRS complex. Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the "old" material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don’t wait until the middle to end of the semester to try to cram information. 64%of students nationwide answered this question correctly. View Topics 4 Confidence: Just a guess Stats Issue with this question? 26. The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the healthcare provider has prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse will teach the client to take the medication on which schedule? 1 With a meal Incorrect2 Only at bedtime Correct3 At a specific time prescribed 4 Until symptoms are gone For theophylline to be effective, therapeutic serum levels must be maintained by taking the medication at the prescribed time. If the medication is not taken at the prescribed time, the level may drop below the therapeutic range. The medication will not be effective if it drops below the therapeutic range. Theophylline should be given after a meal and with a full glass of water to decrease gastric irritability. It should not be taken at night, as it can cause central nervous system stimulation resulting in insomnia, restlessness, irritability, etc. Theophylline is used for long-term medication therapy. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal. 77%of students nationwide answered this question correctly. A client using fentanyl transdermal patches for pain management in late-stage cancer dies. What should the hospice nurse who is caring for this client do about the patch? 1 Tell the family to remove and dispose of the patch. Incorrect2 Leave the patch in place for the mortician to remove. 3 Have the family return the patch to the pharmacy for disposal. Correct4 Remove and dispose of the patch in an appropriate receptacle. The nurse should remove and dispose of the patch in a manner that protects self and others from exposure to the fentanyl. Having the family remove and dispose of the patch or having the mortician remove the patch is not safe. It is not the responsibility of nonprofessionals because they do not know how to protect themselves and others from exposure to the fentanyl. It is unnecessary to return a used fentanyl patch to the pharmacy. Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation). 86%of students nationwide answered this question correctly. View Topics 0 Confidence: Just a guess Stats Issue with this question? 28. A client with tuberculosis is to begin combination therapy with isoniazid, rifampin, pyrazinamide