20 Cancer / 20 EENT/ 100 Pharma Nursing

CANCER NURSING

1. The nurse is preparing a community presentation on the prevention of cancer. Which of the
following should be included as a primary risk factor for developing laryngeal cancer?
a.) chronic allergy
b.) chewing tobacco
c.) exposure to airborne environmental toxins
d.) smoking

2. Which of the following signs and symptoms would the nurse include in a teaching plan as an early
warning sign of laryngeal cancer?

a.) dysphagia
b.) hoarseness
c.) airway obstruction
d.) stomatitis

3. A client has just turned from post-anesthesia care unit (PICU) after undergoing a laryngectomy.
Which of the following interventions should the nurse include in the plan of care?

a.) maintain the head of the bed at 30 to 40 degrees

b.) teach the client how to use esophageal speech
c.) initiate small feedings of soft foods
d.) irrigate drainage tunes as needed

4. Which of the following areas is a priority to evaluate when completing discharge planning for a
client who has had a lobectomy for treatment of lung cancer?

a. the support available to assist the client at home

b) the distance of the client lives from the hospital
c) the client's ability to do home blood pressure monitoring
d) the client's knowledge of the causes of lung cancer

5. The factor that would have little influence in predisposing an individual to cancer of the larynx
would be:

a) air pollution
b) poor dental hygiene
c) heavy alcohol consumption
d) chronic respiratory disease

6. A nurse is instructing a client in how to perform a testicular self-examination (TSE). The nurse tells
the client:

a) to examine the testicles while lying down

b) that the best time for the examination is after a shower
c) to gently feel the testicle with one finger to feel for a growth
d) that testicular exams should be done at least every 6 months

7. A community nurse is conducting a health promotion program at a local school and is discussing
the risk factors associated with cancer. Which of the following, if identified by a student as a risk
factor, indicates a need for further instructions

a) viral factors
b) stress
c) low-fat and high-fiber diets
d) exposure to radiations

8. A client with cancer is receiving chemotherapy and develops thrombocytopenia. A nurse identifies
which interventions as the highest priority in the nursing plan of care?
a) ambulation three times daily
b) monitoring temperature
c) monitoring the platelet count
d) monitoring for pathological fractures

9. a nurse is monitoring the laboratory results of a client preparing to receive chemotherapy. The
nurse would determine that the white blood cell (WBC) count is normal if which of the following
results were present?

a) 3000 to 8000
b) 4000 10,000
c) 7000 to 15,000
d) 2000 to 5000

10. A community health nurse is instructing a group of female clients about breast self- examination
(BSE). The nurse would instruct the clients to perform the exam:

a) at the onset on menstruation

b) one week after menstruation begins
c) every month during ovulation
d) weekly at the same time of day

11. A nurse is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which
of the following in the care of this client?

a) removal of antiembolism stockings twice a day

b) assisting with range-of-motion leg exercises
c) elevating the knee gatch on the bed
d) checking placement of pneumatic compression boots

12. A client is diagnosed as having a bowel tumor. Several diagnostic tests are prescribed. A nurse
understands that which of the following test will confirm the diagnosis of malignancy?

a) magnetic resonance imaging (MRI)

b) computerized tomography (CT) scan
c) abdominal ultrasound
d) biopsy of the tumor

13. A client is diagnosed with multiple myeloma. The client asks a nurse about the diagnosis. The
nurse bases the response on which of the following descriptions of this disorder?

a) malignant exacerbation in the number of leukocytes

b) altered red blood cell production
c) altered production of lymph nodes
d) malignant proliferation of plasma cells and tumors within the bone

14. A nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of
the following would the nurse expect to specifically note in this disorder?

a) decreased number of plasma cells in the bone marrow

b) increased white blood cells
c) increased calcium level
d) decreased blood urea and nitrogen (BUN)

15. A nurse is developing a plan of care for a client with multiple myeloma. The nurse includes which
priority intervention in the plan of care?

a) coughing and deep breathing

b) forcing fluids
c) monitoring the red blood cell count
d) providing frequent oral care

16. A client is receiving external radiation to the neck for cancer of the larynx. The most likely side
effect to be expected is:
a) constipation
b) dyspnea
c) sore throat
d) diarrhea

17. A cervical radiation implant is placed in a client for treatment of cervical cancer. A nurse initiates
what most appropriate activity order for this client?

a) out of bed in a chair only

b) ambulate to the bathroom only
c) bed rest
d) out of bed ad lib

18. A client hospitalized for insertion of an internal cervical radiation implant. While giving care, a
nurse finds the radiation implant in the bed. The initial reaction by the nurse is to:

a) call the physician

b) pickup the implant with gloved hands and flush it down the toilet
c) reinsert the implant into the vagina immediately
d) pick up the implant with long-handled forceps and place it in a lead container

19. A nurse is caring for a client experiencing hematologic toxicity as a result of chemotherapy. The
nurse develops a plan of care for the client. The nurse plans to:

a) restrict all visitors

b) restrict fluid intake
c) insert an indwelling catheter to prevent skin down
d) restrict fresh fruits and vegetables in the diet

20. A nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count
is 10,000/mm3. On the basis of this laboratory value, the priority nursing assessment is which of the
following?

a) assess level of consciousness

b) assess temperature
c) assess bowel sounds
d) assess skin turgor

ANSWERS

1.) D ..... 2.) B ..... 3.) A .....4.) a ..... 5) b

6) b ..... 7) c ..... 8) c ..... 9) b ..... 10) b

11) c .... 12) d .... 13) d .... 14) c .... 15) b

16) c .... 17) c .... 18) d .... 19) d .... 20) a

EENT NURSING

1. A client with glaucoma has been prescribed pilocarpine (Pilocar). The nurse explaining the use of
this medication would state that it is useful because it works by:

a) dilating the pupil

b) constricting intraocular vessels
c) constricting the pupil
d) relaxing the ciliary muscles

2. A client who was diagnosed with chronic open-angle glaucoma has been started on medication
therapy with timolol maleate (Timoptic). The nurse assesses for which of the following possible
adverse systemic responses to the drugs?

a) tachycardia
b) anxiety
c) bradycardia
d) hypertension

3. A client underwent cataract removal with an intraocular lens transplant. The nurse is giving the
client discharge instructions. Which instructions should the nurse include?

a) avoid lifting objects weighing more than 5 lb (2.2kg)

b) lie on your abdomen when in bed
c) keep rooms brightly lit
d) avoid straining during bowel movements or bending at he waist

4. Before cataract surgery, the nurse is to instill several types of eye drops into a client's right eye.
The accepted abbreviation for the right eys is:

a) OD
b) OS
c) QU
d) RE

5. The nurse who is planning care for a client who is legally blind should do which of the following as
most important to ensure the client's safety?

a) leave doors partially closed

b) orient the client verbally and physically to the room
c) provide radio and television for stimulation
d) describe the weather and community events for the client

6. A client who is legally blind has been admitted to the cardiac unit. Which of the following actions
by the nurse would be best to promote adjustment to the environment?

a) speak slowly and in a low-pitched voice while facing the client

b) post a sign on the door indicating the client is blind
c) explain unit noises and physical surroundings
d) give clear, concise, simple instructions to the client

7. The nurse explains to a client with newly diagnosed atrophic macular degeneration that this is a
condition characterized by:

a) rapid and severe loss of vision

b) separation of the retina from the choroid
c) atrophy and degeneration of outer pigmentation layer of the retina
d) scar formation between the retina and the choroid

8. A client is blind in the right eye. From which direction should the nursing staff approach the
client?

a) from directly in front of the client

b) from the right side of the client
c) from the left side of the client
d) from directly behind the client

9. The nurse is caring for a client who is in the recovery area following cataract surgery. The nurse
would ask the client about which of the following manifestations that would indicate onset of retinal
detachment as a postoperative complication?

a) increased lacrimation
b) flashing lights and loss of part of the visual field
c) sudden, severe eye pain
d) inability to move the eye and loss of accommodation

10. Which of the following statements indicates that the client has understood home care
instructions following cataract surgery?

a) I should not bend over to pick up objects from the floor

b) I can sleep on whichever side I want as long as my head is raised
c) I may not watch television for 6 weeks
d) I should keep the protective eye shield in place 24 hours a day

ANSWERS

1) C ..... 2) C ..... 3) D ..... 4) A ..... 5) B

6) C ..... 7) C ..... 8) C ..... 9) B ..... 10) A

11. A 70-year old client comes to the outpatient clinic complaining of increasing difficulty with
"close-work" such as knitting. She indicates she does not have difficulty seeing objects on either side
but does state that straight lines appear distorted or wavy. The nurse suspects which of the
following disorders that is consistent with the client's reported symptoms?

a) cataracts
b) macular degeneration
c) glaucoma
d) subconjunctival hemorrhage

12. The nurse notes a slight cloudy appearance to the lens of a 64-year old client's eye. Which of the
following symptoms should the nurse question the client about?

a) sense of a curtain falling over vision

b) blurring of vision
c) slight but constant eye pain
d) double vision

13. A client is being admitted to the post-anesthesia recovery area following lens removal and
replacement in the left eye for a cataract. The nurse places the client into which of the following
most appropriate position?

a) on the left side with the head of bed elevated 30 degrees

b) on the right side with the head of bed elevated 30 degrees
c) supine with the head of bed flat
d) upright with the head and neck turned to the right

14. A nurse is doing preoperative teaching for an older client who will have cataract surgery on his
right eye. The nurse concludes the client needs further teaching if he says:

a) I will sleep on my left side after the surgery

b) I will wipe my nose gently if it is congested after surgery
c) I will bend below my waist frequently to increase circulation after surgery
d) I will call my physician if I have sharp and sudden pain or a fever after surgery

15. The parents report that the child has a runny nose, fever, cough, and irritable and constantly
rubbing his ears. The nurse would expect to see tympanic membrane that appears as which of the
following:

a) bulging and red

b) clear and inverted
c) pearly gray
d) scarred

16. The nurse is caring for a 15-month old child with a first episode of otitis media. Which of the
following interventions should the nurse include in instructions to the child's parents?

a) explain that the child should complete the full 5 days antibiotics
b) provide them with handout describing care of myringotomy tubes
c) describe the tympanocentesis to detect persistent infections
d) emphasize the importance of a return visit after completion of antibiotics

17. On initial examination of a 15-month old child with suspected otitis media, which group of
findings would the RN anticipate finding?

a) periorbital edema, absent light reflex and translucent tympanic membrane

b) irritability, rhinorrhea, and bulging tympanic membrane
c) diarrhea, enlarged parotid gland
d) vomiting, pulling at ears and pearly white tympanic membrane

18. A client reports ongoing problems with vertigo. The nurse should question the client about which
of the following accompanying manifestations to determine whether the client has developed
Meniere's disease?

a) purulent discharge from the ear and pain

b) headache and double vision
c) nausea, vomiting, and headache
d) tinnitus, hearing loss, and a sense of fullness in the ear

19. A client with sensironeural hearing loss should be assessed using which of the following?

a) tympanocentesis
b) transillumination of the sinuses
c) electronystagmography
d) weber and Rinne tests

20. A 75-year old client reports to the nurse during the admission process that she was recently
diagnosed with age-related hearing loss. The client most likely describing:

a) otalgia
b) meniere's disease
c) presbycussis
d) otitis media

ANSWERS

11) B ..... 12) B ..... 13) B ..... 14) C ..... 15) A

16) D ..... 17) B ..... 18) D ..... 19) D ..... 20) C

PHARMA NURSING

1. A client with bacterial pneumonia is to be started on intravenous antibiotics. Which of the

following diagnostic tests must be completed before antibiotic therapy begins?

a.) urinalysis
b.) sputum culture
c.) chest radiograph
d.) red blood cell count

2. Which of the following anti-tuberculosis drugs can cause damage to the eight cranial nerve?

a. streptomycin
b. isoniazid (INH)
c. para-aminosalicylic acids (PAS)
d. ethambutol hydrochloride (myambutol)

3. What is the rationale that supports multi-drug treatment for clients with tuberculosis?

a) multiple drug potentiate the drug's actions

b) multiple drugs reduce undesirable drug side effects
c) multiple drugs allow reduced drug dosages to be given
d) multiple drugs reduce development of resistant strains of bacteria

4. The nurse should caution sexually active female clients taking INH that the drug has which of the
following effects?

a) increases the risk of vaginal infection

b) has mutagenic effects on ova
c) decreases the effectiveness of oral contraceptives
d) inhibits ovulation

5. Isoniazid (INH) and Rifamficin (Rifadin) have been prescribed for a client with tuberculosis. A
nurse reviews the medical record of the client. Which of the following, if noted in the client's history,
would require physician notification?

a) heart disease
b) allergy to penicillin
c) hepatitis B
d) rheumatic fever

6. Digoxin is administered intravenously to a client with heart failure, primarily because the drug
acts to:

a) dilate coronary artery

b) increase myocardial contractility
c) decrease cardiac dysrhytmias
d) decrease electrical conductivity in the heart

7. The nurse teaches the client with angina about the common expected side effects of nitroglycerin,
including:

a) headache
b) high blood pressure
c) shortness of breath
d) stomach cramps

8. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct
the client to use the drug when chest pain occurs?

a) take one tablet every 2 to 5 minutes until chest pain stops

b) take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes
c) take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the
physician if pain persists after three tablets
d) take one tablet. If the pain persists after 5 minutes, take two tablets. If pain still persists 5
minutes later, call the physician

9. Because smoking cessation is a critical strategy for the client diagnosed with Buerger's disease,
the nurse anticipates that the client will go home with a prescription for which of the following
medications?

a) nicotine ( nicontrol)
b) nitroglycerin
c) furosimide ( lasix)
d) ibuprofen

10. A client with leukemia is receiving busulfan (myleran). Allopurinol (zyloprim) is prescribed for the
client. The purpose of the allopurinol is to:

a) prevent gouty arthritis

b) prevent hyperuricemia
c) prevent diarrhea
d) prevent stomatitis

11. Epidural analgesia is administered to woman for pain relief following a CS birth. The nurse
assigned
to care for the woman ensures that which medication is readily available if respiratory depression
occurs?

a) Bethamethasone (celestone)
b) Morphine sulfate
c) Meperidine hydrochloride (demelor)
d) Nalaxone (narcan)

12. Methylerogonovine (methergine) is prescribed for a postpartum woman to treat postpartum

hemorrhage.
Before administration, the priority nursing assessment is to check the:

a) Amount if lochia
b) BP
c) Deep tendon reflexes
d) uterine tone

13. A nurse is caring for the patient who is receiving pitocin (oxytocin) for the induction of labor. The
nurse
discontinues the pitocin infusion if which one of the following is noted on the assessment of the
client?

a) drowsiness
b) fatigue
c) early decelerations of fetal heart rate
d) uterine hyperstimulation

14. A pregnant client is magnesium sulfate for the management of preeclamsia. A nurse determines
that the client experiencing toxicity from the medication if which of the following is noted
on assessment?

a) presence of deep tendon reflexes

b) serum magnesium level of 6 mEq/L
c) proteinuria +3
d) respirations of 10 per minute

15. A woman with pre-eclampsia is receiving magnesium sulfate. The nurse assigned to care for the
client determines that the magnesium sulfate therapy is effective if?

a) ankle clonus is noted

b) BP decreases
c) seizure do not occur
d) scotomas are present

16. Methylergonovine (metthergine) is prescribed for a client with postpartum hemorrhage. Prior to
administering the medication, a nurse contacts the health care provider who prescribed the
medication if which of the following conditions is documented?

a) perpheral vascular disease

b) hypothyroidism
c) hypotension
d) diabetes mellitus

17. Vitamin K ( Aquamephyton) is prescribed for a neonate. Nurse Jarell prepares the medication and
selects which muscle site to administer the medication?

a) deltoid
b) dorso gluteal
c) vastus lateralis
d) biceps

18. Ms. Nanette, a clinical instructor, asks a nursing student to describe the procedure of
administering erythromycin ointment to the eyes of a neonate. The instructor determines that
student needs further teaching if she states;

a) " I will cleanse the neonate's eyes before instilling ointment"

b) " I will flush the eyes after instilling the ointment"
c) I will instill the eye ointment into each of the neonate's conjunctival sacs within 1 hour after birth
d) "administration of the eye ointment may be delayed until an hour or so after birth so that eye
contact and parent-infant bonding can occur

19. Dr. Garcia has prescribed Phenobartal sodium (luminal sodium), 25 mg PO bid, for a child with
febrile seizures. The medication label reads: Phenobartal sodium, 20 mg per 5ml. Nurse Kris has
determined that the dosage prescribed is a safe for a child. The nurse prepares to administer how
many milliliters per dose to the child?

a) 4.7 ml
b) 4.5 ml
c) 6.25 ml
d) 7 ml

20. Cloxacillin (tegopen), 100 mg PO every 8 hours, is prescribed for a child with an elevated
remperature who is suspected of having a respiratory tract infection. The child weighs 17 lbs. the
safe pediatric dosage is 50 mg/kg/day. The nurse determines that:

a) the dose is too high

b) the dose is too low
c) the dose is safe
d) there is not enough information to determine safe dose

ANSWERS

1.) B ..... 2.) A ..... 3.) D ..... 4.) c .....5) c

6) b ..... 7) a ..... 8) c ..... 9) a ..... 10) b

11) A ... 12) B ... 13) D ... 14) D ... 15) C

16) A ... 17) C ... 18) B ... 19) C ... 20) B

21. Diphenhydramine ydrochloride (Benadryl), 25mg PO every 6 hours, is prescribed for a child with
an allergic reaction. The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg/day. The nurse
determines that:
a) the dose is to high
b) the ose is too low
c) the dose is safe
d) there is not enough information to determine safe dose

22.Morphine sulfate, 2.5mg, IV piggyback, in 10ml of normal saline, is prescribed for a child post-
operatively. The medication label reads: 1/15gr/ml. The nurse prepares to add how many ml of
morphine sulfate to the 10ml NSS?

a) 0.62ml
b) 0.82ml
c) 0.72ml
d) 0.92ml

23. Dr. Lauzon's order reads: Ampicillin (omnipen), 125 mg IV per 6 hour. The medication label
reads: 1g and reconstitute with 7.4ml of bacteriostatic water. A nurse prepares to draw up how
many ml to administer one dose?
a) 0.54ml
b) 0.92ml
c) 1.1ml
d) 7.4ml

24. Salicylic acid is prescribed for Mang Macario, client diagnosed with psoriasis. A nurse monitors
him, knowing that which of the following would indicate the presence of systemic toxicity from this
medication?

a) decrease RR
b) diarrhea
c) constipation
d) tinnitus

25. Nurse Arlene is monitoring the lab reuslts for a client receiving an antineoplastic medication by
the IV route. The nurse prepares to initiate bleeding precautions if which lab results is noted?

a) WBC count of 5000 cells/ml

b) platelet of 50,000 cells/ml
c) clotting time of 10 minutes
d) ammonia level of 20mg/dL

26. A nurse is providing medication instructions to a client with breast cancer who is taking
cyclophosphamide (cytoxan), the nurse tells the client to:

a) take the medication with food

b) increase fluid intake to 2000 to 3000 ml per day
c) decrease sodium intake while taking the medication
d) increase potassium intake while taking the medication

27. A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When
implementing the plan, the nurse tells the client to:

a) take aspirin (ASA) as needed for headache

b) drink beverages containing alcohol in moderate amounts
c) consult with the physician before receiving immunizations
d) be sure to receive flu and pneumonia vaccines

28. A client with ovarian cancer is being rteated with vincristine (Oncovin). A nurse monitors the
client, knowing that which of the following is a side effect specific to this medication?

a) diarrhea
b) numbness and tingling in the fingers and toes
c) chest pain
d) hair loss

29. A client with metastatic breast cancer is receiving Tamoxifen (Nolvadex). A nurse specifically
monitors which of the following laboratory values while the client is taking this medication?

a) potassium level
b) glucose level
c) calcium level
d) prothrombin time

30. Megestrol acetate (Megace), an antineoplastic medication, is prescribed for a client with
metastatic endometrial carcinoma. A nurse reviews the client's history and contacts the physician if
which of the following is documented in the client's history?

a) asthma
b) myocardial infarction
c) thrombophlebitis
d) gout

31. Marissa has a breast cancer and is admitted to a hospital for treatment with IV vincristine
(Oncovin). She tells the nurse that she has been told by friends that she is going to loose all her hair.
The most appropriate response in which of the following?

a) you will not lose your hair

b) your friends are connect
c) hair loss may occur, but it will grow back just it is now
d) hair loss may occur, and it will grow back, but it may have a different color and texture

32. A client with acute leukemia is being treated with busulfan (Myeleran). Which of the following
laboratory values would a nurse specifically monitor during treatment with this medication?

a) blood glucose
b) uric acid level
c) potassium level
d) cltting time

33. Vasopressin ( Pitressin) is oredered for a client with diabetes insipidus. A nurse is particularly
cautious in monitoring the client receiving this medication if the client has which o the following
preexisting condition?

a) depreression
b) endometriosis
c) coronary artery disease
d) phechromocytoma

34. Nurse Christian provides teaching to a client who is taking levothyroxine (Synthroid). The nurse
tells the client to take the medication:

a) with food
b) on an empty stomach
c) at bedtime with snack
d) at lunchtime

35. A nurse provides medication instructions to a client who is taking Synthroid. The nurse instructs
the client to notify the physician if which of the following occurs?

a) cold intolerance
b) tremors
c) excessively dry skin
d) fatigue

36. A nurse performs an admission assessment on Marina who visits the clinic for the first time. The
client tells that she is taking propylthiouracil (PTU) daily. The nurse continues to collect data from
the client, suspecting that the client has history of:

a) cushing's syndrome
b) addison's disease
c) myxedema
d) grave's disease

37. A client is receiving somatropin (Humatrope). the nurse monitors which significant laboratory
study during therapy with this medication?

a) amylase
b) lipase
c) BUN
d) TSH

38. A client is scheduled for a subtotal thyroidectomy. Iodine solution (lugol solution) is prescribed. A
nurse prepares to administer the medication, knowing the therapeutic effect of this medication to:

a) increase thyroid hormone production

b) supresses thyroid hormone production
c) replace thyroid hormone
d) prevent the oxidation of iodine
39. Calcium carbonate is prescribed for a client with hypocalcemia. Nurse Billy should instruct the
client to take the medication:

a) with meals
b) one hour after meals
c) just aftr meals
d) evry 4 hours

40. A daily dose of prednisone (Deltasone) is prescribed for a client. A nurse provides instruction to
the client regarding medication. The nurse is correct to say that the best time to take the medication
is:

a) at bedtime
b) at noon
c) early morning
d) anytime, but must be on the same time, each day

ANSWERS

21) B ..... 22) B ..... 23) B ..... 24) D ..... 25) B

26) A ..... 27) C ..... 28) B ..... 29) B ..... 30) C

31) D ..... 32) C ..... 33) C ..... 34) A ..... 35) B

36) D ..... 37) C ..... 38) C ..... 39) C ..... 40) D

41. Prednisone (Deltasone) is prescribed for a client with diabetes mellitus who is aking NPH insulin
daily. Which of the following prescriptions does the nurse anticipate during the therapy with the
prednisone?
a) a decreased amount of daily NPH insulin
b) an increased amount of daily NPH insulin
c) an additional dose of prednisone daily
d) an additional OHA daily

42. A nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe.
Which of the following actions, if performed by the client, needs further teaching?

a) injects air into NPH insulin vial first

b) injects an amount of air equal to the desired dose of insulin to the vial
c) withdraws the NPH insulin first
d) withdraws the regular insulin first

43. A home care nurse visits a client recently diagnosed with diabetes mellitus. The client is taking
NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse
tells the client to:

a) freeze the insulin

b) refrigerate the insulin
c) keep the insulin at room temperature
d) store the insulin in a dark, dry place

44. Sildenafil citrate (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews
the client’s medical record and would question the prescription if which of the following is noted in
client’s history?

a) neuralgia
b) use of NTG
c) use of multivitamins
d) insomnia

46.A client taking Bisacodyl (Dulcolax) wants to achieve rapid effect from the medication. A nurse
tells the client to take the medication:

a) with a large meal

b) on an empty stomach
c) at bedtime
d) with two glasses of juice

47. A client has RPN order for Loperamide ( Immodium). A nurse should plan to administer this
medication if the client has:

a) hematest-positive NGT drainage

b) abdominal pain
c) constipation
d) an episode of diarrhea

48. A nurse teaches a client taking metochlopromide (Reglan) to discontinue the medication
immediately and call the physician if which of the following side effects occurs with long- term use?

a) anxiety or irritability
b) dry mouth not minimized by the use of sugar-free hard candy
c) excessive drowsiness and excitability
d) uncontrolled rhythmic movements

49. A client begun medication therapy pancre-lipase. A nurse would conclude that the medication is
having the optimal intended benefit if which of the following effects is observed?

a) reduction of steatorrhea
b) absence o abdominal pain
c) relief and heartburn
d) weight loss

50. A client with history of duodenal ulcer is taking calcium carbonate chewable tablets. A nurse
would conclude that the client is experiencing optimal effects of the medication if:

a) muscles twitching stops

b) heartburn is relieved
c) serum calcium level rice
d) serum phosphorus level decrease

51. A hospitalized client asks a nurse for sodium bicarbonate to relieve heartburn following meal.
The nurse interprets that this client could not receive this medication if the client did not experience
which of the following condition?

a) urinary calculi
b) chronic bronchitis
c) metabolic alkalosis
d) respiratory acidosis

52. A client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) has been taking
misoprostol (Cytotec). A nurse would conclude that the medication was having the intended
therapeutic effect if the client did not experience which of the following symptoms?

a) decreased platelet count

b) decreased WBC
c) epigastric pain
d) diarrhea

53. Dr. Sy has written an order for ranitidine (Zantac), 300 mg once daily. A nurse would schedule
the medication for which of the following times?

a) before breakfast
b) after lunch
c) with supper
d) at bedtime

54. A client has been prescribed a cough formula containing codein sulfate. A nurse has given the
client instructions for its use. The nurse concludes that the client understands the instruction if the
client verbalizes to self-assess for:

a) excitability
b) constipation
c) rapid pulse
d) excessive urination

55. Mang Tomas has been taking Isoniazid (INH) for six weeks now. The client complains to a nurse
about numbness, paresthesias and tingling in the extremities. The nurse interprets that the client is
experiencing:

a) small blood vessel spasm

b) impaired peripheral circulation
c) hypercalcemia
d) peripheral neuritis

56. Carina is newly diagnosed TB patient and is about to begin with Isoniazid therapy. The nurse
plans to teach the client to:

a) use alcohol in small amounts only

b) report yellow eyes or skin immediately
c) increase intake of Swiss or aged cheese
d) avoid vitamin supplements during therapy

57. Aling Sonia has been started on a long term therapy with rifampin (Rifadin). A nurse teaches the
client that the medication:

a) should be double dosed if one dose is forgotten

b) may be discontinued independently if symptoms are gone in 3 months
c) causes orange discoloration of sweat, tears, urine and feces
d) should always be taken with foods or antacids

58. A nurse has given a client taking ethambutol (myambutol) information about the medication.
The nurse evaluates that the client understands the instructions if the client states to immediately
report:

a) GI side effects
b) Impaired sense of hearing
c) Orange-red discoloration of body secretions
d) Difficulty in discriminating the color red from green

59. Conrado is diagnosed with TB and is being treated with Isoniazid. Before giving the client the
first dose a nurse assesses that which of the following baseline studies has been completed?

a) coagulation times
b) electrolytes
c) serum creatinine
d) liver enzymes

60. A nurse provides discharge instructions to a post-op client who is taking warfarin sodium
(coumadin). Which statement, if made by the client, reflects the need for further teaching?

a) I will take aspirin for my headache

b) I will be certain to limit my alcohol consumption
c) I will take my pills every day at the same time
d) I have already called my family to pick up a Medic-Alert bracelet

ANSWERS
31) B ….. 32) C ….. 33) B ….. 34) B

36) B ….. 37) D ….. 38) D ….. 39) B ….. 40) C

41) C ….. 42) C ….. 43) D ….. 44) B ….. 45) D

46) C ….. 47) C ….. 48) B ….. 49) A ….. 50) D

61. A client has serum potassium of 3.0 mEq/L and is complaining of anorexia. A physician orders a
digitalis level to rule out digitalis toxicity. A nurse checks the results, knowing that which of the
following is the therapeutic serum level of digitals?

a) 0.5 to 2.0 ng/ml

b) 1.2 to 2.8 ng/ml
c) 3.0 ng/ml
d) 3.5 ng/ml

62. A nurse is monitoring a client who is taking propranolol (Inderal). Which of the following
assessment data would indicate a potential serous complication associated with Propranolol?

a) Baseline BP of 150/80 mmHg followed by a BP of 138/72mmHg after 2 doses of medication

b) Baseline resting heart rate of 88bpm followed by a resting heart rate of 73bpm after 2 doses of
medication
c) Development of audible expiratory wheels
d) Complaints of insomnia

63 A home health care nurse is visiting an elderly client at home. Furosemide (Lasix) is prescribed
for the client. The nurse teaches the client about medication. Which of the following statements, if
made by the client, indicates the need for further teaching?

a) I will take my medication every morning with breakfast

b)I will call my doctor if my ankle swell or my rings get tight
c)I need to drink lots of coffee and tea to keep myself healthy
d)I will sit up slowly before standing each morning

64. A nurse is caring for a client receiving a heparin IV infusion. The nurse anticipates that which lab
study will be prescribed to monitor its therapeutic effect?

a) Prothrombin time (PT)

b) Activated partial thromboplastin time (APTT)
c) Hematocrit (Hct)
d) Hemoglobin (Hgb)

65. A home health nurse instructs a client about the use of nitrate patch. The nurse tells the client
which of the following that will prevent client tolerance to nitrates?

a) do not remove the patches

b)have a 12 hour “ no nitrate” time
c) have a 24 hour no nitrate” time
d)keep nitrates on 24 hours,then off 24 hours

66. A client is admitted to a medical unit with nausea and bradycardia. The family hands nurse a
small white envelope labeled :hearth pill”. The envelope is sent to a pharmacy and reveals digoxin
(Lanoxin). A family member states, “That doctor doesn’t know how to take care of my family”. The
most therapeutic response by the nurse would be:

a)“You’re concerned your love one receives the best care”

b)“You’re right! I’ve never seen a doctor put pills in an envelope”
c)“I think you’re wrong. The physician has been in practice for over 30 year
d)“Don’t worry about this. I’ll take car of everything

67. A nurse is caring for a client receiving dopamine (Intropine). Which of the following potential
nursing diagnoses is appropriate for this client?
a)increased cardiac output
b)fluid volume excess
c)impaired tissue perfusion
d)altered sensory perception

68. A client with CHF is on 1g sodium diet. A nurse understands that which medication prescribed for
the client promotes sodium excretion while conserving potassium?

a)spinorolactone (Aldactone)
b)furosemide (Lasix)
c)ethacrynic acid (edecrin)
d)hydrochlorotiazide (hydrodiuril)

69. A client has developed paroxysmal noctural dyspnea (PND). Which of the following medications
does a nurse anticipate will be prescribed by the physician?

a)lidocaine (xylocaine)
b)propranolol (inderal)
c)bumetanide (bumex)
d)urokinase (abbokinase)

70. A client arrives in the ER complaining of unrelieved chest pain for 2 days. The pain has subsided
slightly but never disappeared. When the nurse approaches the client with a 0.4 NTG sublingual
tablet, the client states, “I don’t need that. My dad takes that for his heart. There’s nothing wrong
with my heart”. The nurse interprets that the client is exhibiting which type of reaction?

a)obsessive-compulsive
b)denial
c)projection
d)angry

71. Aling Coring, 66 yrs old, is complaining of not feeling well is being seen in clinic. She is taking
several medications for the control of heart disease and hypertension. The medications include
atenolol (Tenormin), digoxin (Lanoxin), and chlorothiazide (Diuril). A tentative diagnosis of digoxin
toxicity is made. Which of the following assessment data will support this diagnosis?

a)chest pain, hypotension and paresthesias

b)constipation, dry mouth and sleep disorder
c)double vision, loss of appetite, and nausea
d)dyspnea, edema and palpitations

72. A client with diagnosis of CHF is seen in a clinic. The client is being is being treated with a variety
of medications including digoxin (Lanoxin) and furosimide (Lasix). Which of the following assessment
findings would lead the nurse to suspect that the client is hypokalemic?

a)diarrhea
b)intermittent intestinal colic
c)muscle weakness with leg cramps
d)tingling of the fingers and toes

73. A client is being discharged with a prescription for propranolol hcl (Inderal). In developing a
medication teaching plan, a nurse would include which of the following instructions?

a)exercise will prevent orthostatic hypotension

b)hot baths and showers are advised to increase vasodilation
c)medication should be taken on an empty stomach to enhance absorption
d)medication should be withheld if the pulse rate drops below 60 bpm

74. Cotrimoxazole (Bactrim) is prescribed to be administered by IV infusion to a client with recurrent

UTI. A nurse would plan to administer this medication:

a)over 60 to 90 minutes
b)over a period of 90 minutes
c) piggybacked into existing infusion of normal saline and potassium chloride
d)piggybacked into the peripheral line containing TPN
75. Following a kidney transplant, cyclosporine (Sandimmune) is prescribed for a client. Which of the
following laboratory results would indicate an adverse effect of the use of this medication?

a)decreased WBC count

b)decreased Hgb
c)elevated BUN
d)decreased creatinine

76.A public health nurse visits a client at home and instructs the client in administration of the
prescribed eye drops. Which of the following statements by the client indicates a need for further
teaching?

a)I can’t tilt my head back, pull down on the lower lid, and place the drop on the lower lid
b)I can lie down, pull down on he lower lid and place the drop on the lower lid
c)I can lie down, pull up the upper lid, and place the drop on the lower lid
d)I can lie on my side opposite to the eye I am going to place the drop. Put the drop in the corner of
my lid nearest my nose, and then slowly turn my other side while blinking

77. Ear drops are prescribed for an infant with otitis media. The most appropriate method to
administer the ear drops to the infant is:

a)pull up and back on the pinna and direct the solution onto the eardrum
b)pull down and back on the pinna and direct the solution onto the eardrum
c)pull down and back on the ear and direct the solution toward the wall of the canal
d)pull up and back on the ear and direct the solution toward the wall of the canal

78. A nurse is providing instructions to a client who will self-administering eye drops. To minimize
the systemic effects that eye drops can produce, the nurse instructs the client to:

a)eat prior to installing the drops

b)swallow several times after instilling the drops
c)blink vigorously to encourage tearing instilling drops
d)occlude nasolacrimal duct with a finger for several minutes after instilling the drops

79. A nurse is caring for Mrs. Lansing who is suffering from glaucoma. Which of the following
medications, if prescribed for the client, would the nurse question?

a)carbacol (Miostat)
b)pilocarpine HCl (Isopto carpine)
c)pilocarpine nitrate
d)atropine sulfate

80. A miotic medication has been prescribed for a client with glaucoma. The client asks the nurse
about the purpose of the medication. The nurse tells the client

a)the medication will lower the pressure in the eye and increase the blood flow in the retina
b)the medication will help dilate the eye to prevent pressure from occurring
c)the medication will relax the muscles of the eyes and prevent blurred vision
d)the medication will help to block the responses that are set to the muscles in the eye

ANSWERS

61) A ….. 62) C ….. 63) C ….. 64) B ….. 65) C

66) A ….. 67) D ….. 68) A ….. 69) C ….. 70) B

71) C ….. 72) C ….. 73) C ….. 74) A ….. 75) C

76) D ….. 77) C ….. 78) D ….. 79) D ….. 80) B

81. Pilocarpine Hydrochloride is prescribed for a client with glaucoma. Which of the following
medication does the nurse plan to have available in the event of systemic toxicity?

a) naloxone HCl (narcan)

b) pindolol (Visken)
c) AtSO4
d) Mesoridazine besylate (Serentil)

82. A nurse prepares for a client for irrigation as prescribed by a physician. In performing the
procedure, the nurse:

a) positions the client to turn her head so that the ear to be irrigated is facing upward
b) warms the solution to 100F
c) directs a slow steady stream of irrigation solution toward the eardrum
d) positions the client with affected side up following the irrigation

83. In the ER, a nurse is caring for a client diagnosed with Bell’s palsy. The client has been taking
acetaminophen (Tylenol), and Tylenol overdose is suspected. The nurse anticipates that the antidote
to be prescribed is:

a) auranofin
b) atropine sulfate
c) diazepam
d) acetylcysteine

84. A client with trigeminal neuralgia tells the nurse that he or she takes acetaminophen (Tylenol) on
a frequent daily basis for the relief of generalized discomfort. Which of the following laboratory
values would indicate toxicity associated with this medication?

a) platelet count of 400,000 cells/mL

b) direct bilirubin level of 2mg/dL
c) prothrombin time of 12 seconds
d) sodium of 140 mEq/L

85. A client is suspected of having myasthenia gravis. Edrophonium (Tensilon) 2 mg IV administered

to determine the diagnosis. Which of the following indicates that the client has myasthenia gravis?

a) an increase in muscle strength within 1 to 3 minutes following administration of the medication

b) a decrease in muscle strength within 1 to 3 minutes following administration of the medication
c) joint pain swelling following administration of the medication
d) feelings of faintness, dizziness, hypotension, and signs of flushing in the client

86. A client with myasthenia gravis becomes increasingly weaker. The physician prepares to identify
whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing
severity of the disease (myasthenic crisis). An injection of edrophonium (tensilon) is administered.
Which of the following would indicate that the client is in cholinergic crisis?

a) an improvement of weakness
b) a temporary worsening of the weakness
c) no change in the condition
d) complaints of muscle spasm

87. A client with myasthenia gravis verbalizes complaints of feeling much weaker than normal. The
physician plans to implement a diagnosis test to determine if the client is experiencing myasthenic
crisis. The physician administer adrophonium (Tensilon). Which of the following would indicate that
the client is experiencing a myasthenic crisis?

a) increasing weakness
b) a temporary improvement in the condition
c) an increase in muscle spasm
d) no change in the condition

88. Levodopa (Carbidopa) is prescribed for a client with Parkinson’s disease. The nurse monitors the
client for adverse reactions to the medication. Which of he following would indicate that the client is
experiencing an adverse reaction?
a) pruritus
b) hypertension
c) tachycardia
d) impaired voluntary movements

89. Phenytoin (Dilantin), 100 mg PO three times daily, has been prescribed for a client for seizure
control. The community health nurse visits the client and provides teaching about the medication.
Which of the following statements, if made by client, would indicate effective teaching?

a) “It’s OK to break the capsules to make it easier for me to swallow them”

b) “I will use a soft toothbrush for my teeth”
c) “If I forgot to take my medication, I can wait until the next dose and eliminate that dose”
d) “If my throat becomes sore, it’s normal effect of the medication”

90. Rosalinda is taking Phenythoin for seizure control. A blood specimen for serum drug level is
drawn and the nurse reviews the result. Which of the following indicate a therapeutic serum drug
range?

a) 5 to 10 ug/mL
b) 10 to 20 ug/mL
c) 20 to 30 ug/mL
d) 30 to 40 ug/mL

91. A nurse is caring for a client receiving morphine sulfate, 10 mg SC every hours for pain. Because
this medication ha been prescribed for the client, which nursing action would be included in the plan
of care?

a) monitor client’s temperature

b) force fluids
c) maintain the client in supine position
d) encourage the client to cough and deep-breathe

92. Meperidene hydrochloride (Demerol) is ordered for a client with pain. Which of the following
would the nurse monitor for as a side effect of this medication?

a) hypertension
b) bradycardia
c) diarrhea
d) urinary retention

93. A nurse is caring for a client with severe back pain. Codeine sulfate has been prescribed. Which
of the following does the nurse specifically include in the plan of care while taking his medication?

a) monitor for hypertension

b) monitor fluid imbalance
c) monitor bowel activity
d) monitor peripheral pulses

94. Mannitol (Osmitrol) is prescribed for a client with increased ICP after a head injury. The nurse
prepares to administer this medication, knowing that the therapeutic action is to:

a) induce diuresis by raising the osmotic pressure of glomelular filtrate, thereby inhibiting the
tubular absorption of water and solutes
b) induce diuresis by promoting the reabsorption of sodium and water in the loop of Henle
c) prevent the filtration of sodium and water through the kidneys
d) prevent the filtration of sodium and potassium through the kidneys

95. Gina arrives at the ER complaining of back spasms. The client states “I have been taking 2 to 3
aspirins every 4 hours for the last week and it hasn’t helped my back”. Aspirin intoxication is
suspected and the nurse assesses the client for which of the following?

a) diarrhea
b) constipation
c) tinnitus
d) photosensitivity
96. A client with multiple sclerosis is receiving diazepam (Valium), a centrally acting skeletal muscle
relaxant. Which of the following, if noted during the assessment of the client would indicate that the
client is experiencing a side effect related to this medication?

a) headache
b) increased salivation
c) urinary retention
d) drowsiness

97. Allopurinol (Zylorim) has been prescribed for a client. The nurse prepares to administer this
medication knowing that which of the following information is accurate about this medication?

a) it is used for the lysis of thrombi obstructing coronary arteries

b) it prevents calcium ion entry across cell membranes of cardiac smooth muscle
c) it decreases sympathetic outflow from the CNS
d) it decreases uric acid production and produces uric acid concentrations in both the serum and
urine

98. Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client’s
record knowing that this medication would be contraindicated in which of the following disorders?

a) renal failure
b) hypothyroidism
c) diabetes mellitus
d) myxedema

99. Diclofenac is prescribed for a client with osteoarthritis. Which of the following medications, if
noted on the client’s record, would alert the nurse to consult with the physician?

a) warfarin sodium
b) serentil
c) primidone (mysoline)
d) stelazine

100. Baclofen (Lioresal) is prescribed for a client with multiple sclerosis. The nurse monitors the
client, knowing that the primary therapeutic effect of this medication is which of the following?

a) increased muscle tone

b) decreased muscle spasms
c) decreased local pain and tenderness
d) increased range of motion

ANSWERS

81) C ….. 82) B ….. 83) D ….. 84) B ….. 85) A

86) C ….. 87) A ….. 88) D ….. 89) B ….. 90) B

91) A ….. 92) A ….. 93) D ….. 94) A ….. 95) C

96) D ….. 97) D ….. 98) A ….. 99) C ….. 100) B