1. A client with myasthenia gravis reports the occurrence of difficulty chewing. The physician prescribes pyridostigmine bromide (Mestinon) to increase muscle strength for this activity. The nurse instructs the client to take the medication at what time, in relation to meals?

a. after dinner daily when most fatigued
b. before breakfast daily
c. as soon as arising in the morning
d. thirty minutes before each meal

2. A client is advised to take senna (Senokot) for the treatment of constipation asks the nurse how this medication works. The nurse responds knowing that it:

a. accumulates water in the stool and increases peristalsis
b. stimulates the vagus nerve
c. coats the bowel wall
d. adds fiber and bulk to the stool

3. A client is receiving heparin sodium by continuous intravenous infusion. The nurse monitors the client for which adverse effect of this therapy?

a. decreased blood pressure
b. increased pulse rate
c. ecchymoses
d. tinnitus

4. A client is being treated for acute congestive heart failure (CHF) and the client’s vital signs are as follows: BP 85/50 mm Hg; pulse, 96 bpm; respirations, 26 cpm. The physician prescribes digoxin (Lanoxin). To evaluate a therapeutic effectiveness of this medication, the nurse would expect which of the following changes in the client’s vital signs?

a. BP 85/50 mm Hg, pulse 60 bpm, respirations 26 cpm
b. BP 98/60 mm Hg, pulse 80 bpm, respirations 24 cpm
c. BP 130/70 mm Hg, pulse 104 bpm, respirations 20 cpm
d. BP 110/40 mm Hg, 110 bpm, respirations 20 cpm

5. Diazepam (Valium) is prescribed for a client with anxiety. The nurse instructs the client to expect which side effect?

a. incoordination
b. cough
c. tinnitus
d. hypertension

6. A client receives oxytocin (Pitocin) to induce labor. During the administration of the oxytocin, it is most important for the nurse to monitor:

a. urinary output
b. fetal heart rate
c. central venous pressure
d. maternal blood glucose

7. A clinic nurse is performing assessment on a client who is being seen in the clinic for the first time. When asking about the client’s medication history, the client tells the nurse that he takes nateglinide (Starlix). The nurse then questions the client about the presence of which disorder that is treated with this medication?

a. hypothyroidism
b. insomnia
c. type 2 diabetes mellitus
d. renal failure

8. A client who is taking rifampin (Rifadin) as part of the medication regimen for the treatment of tuberculosis calls the clinic nurse and reports that her urine is a red-orange color. The nurse tells the client to:

a. come to the clinic to provide a urine sample
b. stop the medication until further instructions are given by the physician
c. take the medication dose with an antacid to prevent this adverse effect
d. expect a red-orange color in urine, feces, sweat, sputum, and tears as a harmless side effect

9. A nurse is caring for a client with a tracheostomy that has been diagnosed with a respiratory infection. The client is receiving vancomycin hydrochloride (Vancocin) 500 mg intravenously every 12 hours. Which of the following would indicate to the nurse that the client is experiencing an adverse effect of the medication?

a. decreased hearing acuity
b. photophobia
c. hypotension
d. bradycardia

10. A nurse is caring for a client with a diagnosis of metastatic breast carcinoma who is receiving tamoxifen citrate (Nolvadex) 10 mg orally twice daily. Which of the following would indicate to the nurse that the client is experiencing a side effect related to the medication?

a. hypetension
b. diarrhea
c. nose bleeds
d. vaginal bleeding

11. A client has just been given a prescription for diphenoxylate with atropine (Lomotil). The nurse teaches the client which of the following about the use of this medication?

a. drooling may occur while taking this medication
b. irritability may occur while taking this medication
c. this medication contains a habit-forming ingredient
d. take the medication with a laxative of choice

12. A nurse is gathering data from client about the client’s medication history and notes that the client is taking tolterodine tartrate (Detrol LA). The nurse determines that the client is taking the medication to treat which disorder?

a. glaucoma
b. renal insufficiency
c. pyloric stenosis
d. urinary frequency and urgency

13. A client has an order to receive psyllium (Metamucil) daily. The nurse administers this medication with:

a. a multivitamin and mineral supplement
b. a dose of an antacid
c. applesauce
d. eight ounces of liquid

14. A nurse is teaching a client taking cyclosporine (Sandimmune) after renal transplant about medication information. The nurse tells the client to be especially alert for:

a. signs of infection
b. hypotension
c. weight loss
d. hair loss

15. A nurse reinforces dietary instruction for the client receiving spironolactone (Aldactone). Which food would the nurse instruct the client to avoid while taking this medication?

a. crackers
b. shrimp
c. apricots
d. popcorn

16. Oral lactulose (Chronulac) is prescribed for the client with a hepatic disorder and the nurse provides instructions to the client regarding this medication. Which statement by the client indicates a need for further instructions?

a. “I need to take the medication with water’”
b. “ I need to increase fluid intake while taking the medication”
c. “ I need to increase fiber in the diet”
d. “I need to notify the physician of nausea occurs”

17. A home care nurse provides instructions to a client taking digoxin (Lanoxin) 0.25 mg daily. Which statement by the client indcates a need for further instructions?

a. “I will take my prescribed antacid if I become nauseated”
b. “It is important to have my blood drawn when prescribed”
c. “I will check my pulse before I take my medication”
d. “I will carry a medication identification card with me”

18. A client with anxiety disorder is taking buspirone (BuSpar) and tells the nurse that it is difficult to swallow the tablets. The nurse tells the client to:

a. dissolve the tablet in a cup of coffee
b. crush the tablet before taking it
c. call the physician for a change in medication
d. mix the tablet uncrushed in custard

19. A nurse is caring for a child with CHF provides instructions to the parents regarding the administration of digoxin (Lanoxin). Which statement by the mother indicates a need for further instructions?

a. “If my child vomits after I give the medication, I will not repeat the dose”
b. “I will check my child’s pulse before giving the medication”
c. “I will check the dose of the medication with my husband before I give the medication”
d. “I will mix the medication with food”

20. A nurse provides instructions to a client who will begin an oral contraceptives. Which statement by the client indicates the need for further instructions?

a. “I will take one pill daily at the same time every day”
b. “I will not need to use an additional birth control method once I start these pills”
c. “If I miss a pill I need to take it as soon as I remember”
d. “If I miss two pills I will take them both as soon as I remember and I will take two pills the next day also”

21. A nurse provides instructions to a client taking clorazepate (Tranxene) for management of an anxiety disorder. The nurse tells the client that:

a. drowsiness is a side effect that usually disappears with continued therapy
b. if dizziness occurs, call the physician
c. smoking increases the effectiveness of the medication
d. if gastrointestinal disturbances occur, discontinue the medication

22. A client with Parkinson’s disease has begun therapy with levodopa (L-dopa). The nurse determines that the client understands the action of the medication if the client verbalizes that results may not be apparent for:

a. 24 hours
b. Two to three days
c. One week
d. Two to three weeks

23. A nurse in a physician’s office is reviewing the results of a client’s phenytoin (Dilantin) level drawn that morning. The nurse determines that the client has a therapeutic drug level if the client’s result was:

a. 3 mcg/ml
b. 8 mcg/ml
c. 15 mcg/ml
d. 24mcg/ml

24. A nurse is caring for a client with a genitourinary tract infection receiving amoxicillin (Augmentin) 500 mg every 8 hours. Which of the following would indicate to the nurse that the client is experiencing an adverse effect related to the medication?

a. hypertension
b. nausea
c. headache
d. watery diarrhea

25. A nurse is caring for a client with glaucoma who receives a daily dose of acetazolamide (Diamox). Which of the following would indicate to the nurse that the client is experiencing an adverse effect of the medication?

a. constipation
b. difficulty swallowing
c. dark-colored urine and stools
d. irritability

26. A nurse is caring for a client with a diagnosis of meningitis who is receiving amphotericin B (Fungizone) intravenously. Which of the following would indicate to the nurse that the client is experiencing an adverse effect related to the medication?

a. nausea
b. decreased urinary output
c. muscle weakness
d. confusion

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image for a client who is taking spironolactone (Aldactone). The nurse based this diagnosis on assessment of which side effect of the medication?

a. edema
b. weight gain
c. excitability
d. decreased libido

28. A nurse is caring for the client with a history of mild heart failure who is receiving diltiazem hydrochloride (Cardizem) for hypertension. The nurse would assess the client for:

a. bradycardia
b. wheezing
c. peripheral edema and weight gain
d. apical pulse rate lower than baseline

29. The wound of a client with an extensive burn injury is being treated with the application of silver sulfadiazine (Silvadene). Which symptom would indicate to the nurse that the client is experiencing a side effect related to systemic absorption?

a. pain at the wound site
b. burning and itching at the wound site
c. a localized rash
d. photosensitivity

30. A nurse is caring for a client with a diagnosis of rheumatoid arthritis who is receiving sulindac (Clinoril) 150 mg po twice daily. Which finding would indicate to the nurse that the client is experiencing a side effect related to the medication?

a. diarrhea
b. photophobia
c. fever
d. tingling in the extremities

31. The nurse notes that the client is receiving filgrastim (Neupogen). The nurse checks which of the following to determine medication effectiveness?

a. neutrophil count
b. platelet count
c. blood urea nitrogen
d. creatinine level

32. A nurse is monitoring a client who is taking fluphenazine decanoate (Prolixin) for signs of leucopenia. Which finding indicates a sign of this blood dyscrasia?

a. blurred vision
b. constipation
c. sore throat
d. dry mouth

33. A nurse is administering amphotericin B (Fungizone) to a client intravenously to treat a fungal infection. The nurse monitors the result of which electrolyte study during therapy with this medication?

a. sodium
b. potassium
c. calcium
d. chloride

34. A clinic nurse asks a client with diabetes mellitus being seen in the clinic for the first time to list the medications that she is taking. Which combination of medications taken by the client should the nurse report to the physician?

a. Acetohexamide (Dymelor) and trimethoprim-sulfamethoxazole (Bactrim)
b. Chlorpropamide (Diabenase) and amitriptyline (Elavil)
c. Glyburide (DiaBeta) and Lanoxin (Digoxin)
d. Tolbutamide (Orinase) and amoxicillin (Amoxil)

35. A nurse is caring for a client receiving streptogramin (Synercid) by intravenous intermittent infusion for the treatment of a bone infection develops diarrhea. Which nursing action would the nurse implement?

a. administer an antidiarrheal agent
b. notify the physician
c. discontinue the medication
d. monitor the client’s temperature

36. A client has been taking fosinopril (Monopril) for 2 months. The nurse determines that the client is having the intended effects of therapy if the nurse notes which of the following?

a. lowered BP
b. lowered pulse rate
c. increased WBC
d. increased monocyte count

37. A client is taking labetalol (Normodyne). The nurse monitors the client for which frequent side effect of the medication?

a. tachycardia
b. impotence
c. increased energy level
d. night blindness

38. An older client has been using cascara sagrada on a long-term basis. The nurse determines that which laboratory result is a result of the side effects of this medication?

a. sodium 135 mEq/L
b. sodium 145 mEq/L
c. potassium 3.1 mEq/L
d. potassium 5.0 mEq/L

39. A client has an order to begin short-term therapy with enoxaparin (Lovenox). The nurse explains to the client that this medication is being ordered to:

a. dissolve urinary calculi
b. reduce the risk of deep vein thrombosis
c. relieve migraine headaches
d. stop progression of multiple sclerosis

40. Quinidine gluconate (Dura Quin) is prescribed for a client. The nurse reviews the client’s medical record, knowing that which of the following is a contraindication in the use of this medication?

a. complete atrioventricular (AV) block
b. muscle weakness
c. asthma
d. infection

41. A client has been taking benzonatate (Tessalon) as ordered. The nurse tells the client that this medication should do which of the following?

a. take away nausea and vomiting
b. calm the persistent cough
c. decrease anxiety level
d. increase comfort level

42. Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the nurse monitors the client for signs of an adverse effect related to the medication. Which of the following indicates an adverse effect?

a. nausea
b. diarrhea
c. anorexia
d. proteinuria

43. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse tells the client:

a. to take the medication with food only
b. to rise slowly from a lying to a sitting position
c. to discontinue the medication if nausea occurs
d. that a therapeutic effect will be noted immediatedly

44. A female client tells the clinic nurse that her skin is very dry and irritated. Which product would the nurse suggest that the client apply to the dry skin?

a. glycerin emollient
b. aspercreame
c. myoflex
d. acetic acid solution

45. A client with advanced cirrhosis of the liver is not tolerating protein well, as eveidenced by abnormal laboratory values. The nurse anticipates that which of the following medications will be prescribed for the client?

a. lactulose (Chronulac)
b. ethacrynic acid (Edecrin)
c. folic acid (Folvite)
d. thiamine (Vitamin B1)

46. A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to include which of the following in a list of foods that are acceptable?

a. baked potato
b. bananas
c. oranges
d. pears canned in water

47. A client is taking famotidine (Pepcid) asks the home care nurse what would be the best medication to take for a headache. The nurse tells the client that it would be best to take:

a. aspirin (acetylsalicylic acid, ASA)
b. ibuprofen (Motrin)
c. acetaminophen (Tylenol)
d. naproxen (Naprosyn)

48. A nurse has taught a client taking a xanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu?

a. chocolate milk
b. cranberry juice
c. coffee
d. cola

49. A client with histoplasmosis has an order for ketoconazole (Nizoral). The nurse teaches the client to do which of the following while taking this medication?

a. take the medication on an empty stomach
b. take the medication with an antacid
c. avoid exposure to sunlight
d. limit alcohol to 2 ounces per day

50. A nurse is preparing the client’s morning NPH insulin dose and notices a clumpy precipitate inside the insulin vial. The nurse should:

a. draw up and administer the dose
b. shake the vial in an attempt to disperse the clumps
c. draw the dose from a new vial
d. warm the bottle under running water to dissolve the clump


ANSWERS and RATIONALE