ANSWERS & RATIONALES Question 1. The client is receiving preoperative teaching from the nurse.

Which of the clients medications will the nurse advise the client to take the morning of surgery? 1. Parnate (tranylcypromine) 2. Lanoxin (digoxin) 3. ASA (aspirin) 4. Echinacea Looking for answers(s):2 Explanation: A is INCORRECT because Parnate is an antidepressant which is a monoamine oxidase inhibitor (MAOI). MAOIs can have serious interactions, such as hypertensive crisis, with some anesthetic medications used during surgery. B is CORRECT because in most cases, clients are advised to take routine cardiac medications before surgery. All medications should be thoroughly reviewed before surgery and evaluated as to appropriateness. C is INCORRECT because aspirin inhibits platelet aggregation and as such interferes with normal clotting. This can put the client at risk for excessive bleeding during and after surgery. Most surgeons ask their clients to stop taking aspirin at least 2 weeks before surgery. D is INCORRECT because herbal supplements, such as Echinacea, can have undesirable interactions with anesthetic medications used during surgery. Question 2. Which side effect is expected with bethanechol (Urecholine)? 1. Irritability 2. Urinary urgency 3. Tachycardia 4. Hypertension Looking for answers(s):2 Explanation: A is INCORRECT because irritability is not a common side effect of the drug. B is CORRECT because urinary urgency is a common side effect of the drug, which is used to treat urinary retention. C is INCORRECT because bradycardia is an adverse effect of the drug. D is INCORRECT because the cholinergic (muscarinic) effect causes hypotension and bradycardia, not hypertension. Syncope and cardiac arrest are also potentially lifethreatening effects of the drug. Question 3. The client takes digoxin (Lanoxin) 0.25 mg daily for atrial fibrillation. The client also takes several herbal supplements. The nurse advises against taking which herb? 1. Gingko 2. Flaxseed 3. Green tea 4. Licorice

Looking for answers(s):4 Explanation: A is INCORRECT because gingko is not contraindicated with digoxin. B is INCORRECT because flaxseed is not contraindicated with digoxin. C is INCORRECT because green tea is not contraindicated with digoxin. D is CORRECT because licorice can contribute to digoxin toxicity. Question 4. The nurse is giving Bactrim (trimethoprim-sulfamethoxazole) IV. Which action by the nurse would indicate a need for further instruction on the administration of medication? 1. Wearing gloves while giving the drug 2. Recapping the needle after giving the drug 3. Mixing the drug in 150 mL of diluent 4. Discarding the tubing in a biomedical waste container Looking for answers(s):2 Explanation: A is INCORRECT because this action is not a concern; wearing gloves is always a safe procedure. B is CORRECT because this action indicates a need for further instruction; recapping increases the risk of a needle stick, and potential exposure to HIV or hepatitis. C is INCORRECT because this is not a concern; the amount of diluent would be appropriate. D is INCORRECT because this action is not a concern; the infusion set should be handled safely, and placed in an appropriate biomedical waste container. Question 5. For which effect(s) of a high dose of dopamine (Intropin), norepinephrine (Levophed), or phenylephrine (Neo-Synephrine) should the nurse assess? 1. Increased heart rate and contractility 2. Vasodilation of blood vessels in heart and skeletal muscle 3. Relaxation of vascular smooth muscles 4. Systemic vasoconstriction in GI tract, skin and kidneys Looking for answers(s):4 Explanation: A is INCORRECT because only dopamine increases contractility. Phenylephrine causes tachycardia, but norepinephrine causes bradycardia. B is INCORRECT because these drugs are vasopressors, causing vasoconstriction. C is INCORRECT because these drugs are vasopressors, causing vasoconstriction. D is CORRECT because all of these drugs cause vasoconstriction. They are used to increase perfusion during shock. Question 6. To administer psyllium (Metamucil) for constipation, the nurse should: 1. Have the pharmacy mix it in 6 oz. of orange juice and send it to the nursing unit 2. Mix it in 2 oz. of water or juice at the clients bedside and have the client drink it immediately 3. Mix it in 8 oz of water at the bedside, have the client drink it immediately, and follow with 8 oz of water 4. Mix it in applesauce, or other soft food, and give it with a hot drink

Looking for answers(s):3 Explanation: A is INCORRECT because the drug would be congealed by the time it was received from the pharmacy. The drug may be mixed and taken with juice if the client prefers. B is INCORRECT because this volume of liquid is inadequate. C is CORRECT because if the mixture is not taken immediately, it will congeal. Also, the action of the drug is to combine with water to form an emollient gel, which promotes peristalsis. Adequate water or liquid is essential to drug effectiveness. D is INCORRECT because the granules are not to be chewed. Mixing with fluid forms the emollient gel or viscous solution, which is key to the effectiveness of the bulk-forming laxative. Question 7. The drug Naprosyn (naproxen) would be contraindicated in a client with: 1. Dysmenorrhea 2. Rheumatoid arthritis 3. Gout 4. Ulcer disease Looking for answers(s):4 Explanation: A is INCORRECT because Naprosyn is indicated for use in clients with dysmenorrhea. B is INCORRECT because Naprosyn is indicated for use in clients with rheumatoid arthritis. C is INCORRECT because Naprosyn is indicated for use in clients with gout. D is CORRECT because side effects of Naprosyn include GI ulceration, bleeding, and perforation, and would be contraindicated in a client with existing ulcer disease. Question 8. The nurse tells the client who is using a client-controlled analgesia (PCA), that a desired outcome is: 1. Increased drug dependence 2. Decreased drug tolerance 3. Increased drug effectiveness 4. Decreased drug dosage Looking for answers(s):3 Explanation: A is INCORRECT because dependence is not the desired outcome, and is not as likely with effective pain management. B is INCORRECT because drug tolerance might increase, not decrease, with frequent use of a drug. C is CORRECT because PCA provides the client with the greatest control and the greatest drug effectiveness, because the client will be able to administer the drug as needed before the pain level worsens. D is INCORRECT because the desired outcome is not necessarily a decreased dosage, but rather, less medication as an end-result of effective pain management. Question 9. The nurse will know pilocarpine has produced the desired action when which manifestation is observed? 1. Pupil constriction

2. Clear appearance of iris 3. Corneal cloudiness 4. Pink conjunctiva Looking for answers(s):1 Explanation: A is CORRECT because the drug is a miotic which causes constriction of the pupil. (Mydriatics cause dilation). B is INCORRECT because the drug has no effect on the iris. C is INCORRECT because cloudiness of the cornea would be abnormal, not a positive effect. D is INCORRECT because the drug is not used to treat conjunctival inflammation. Question 10. The nurse knows that the optimal effect of an antacid for hyperacidity occurs when it is given at which time? 1. 1 hour before meals 2. With meals 3. 12 hours after meals 4. As the need arises Looking for answers(s):3 Explanation: A is INCORRECT because this does not give the optimal effect. B is INCORRECT because H2 blockers, such as Tagamet, are taken with meals. C is CORRECT because the acidity is the greatest 12 hours after eating. D is INCORRECT because the question asks for the optimal time. The client may take the antacid as needed until the H2 blocker, which is usually also prescribed, has taken effect. Question 11. The written order in the chart states 100,000 U Penicillin IV. The medication rand says 1,000,000 U IV and the bag from the pharmacy has 1,000,000 U. What should the nurse do? 1. Give 100,000 U 2. Give 1,000,000 U 3. Check with the pharmacy 4. Check with the MD Looking for answers(s):4 Explanation: A is INCORRECT because there is a discrepancy between the chart and the rand. B is INCORRECT because there is a discrepancy between the chart and the rand. C is INCORRECT because the dose from the pharmacy is different from the order in the chart. D is CORRECT because the original order needs to be verified. The usual adult dose IV is 15 million units every 46 hours. Question 12. For which reason is morphine sulfate (MS) given to a client with symptoms of pulmonary edema? 1. To reduce venous return 2. To relieve chest pain

3. To decrease alveolar congestion 4. To decrease heart rate Looking for answers(s):1 Explanation: A is CORRECT because MS is a vasodilator which will reduce venous return and decrease the workload of the heart. The drug also slows respiratory rate and decreases client anxiety. B is INCORRECT because chest pain is not a symptom of pulmonary edema. C is INCORRECT because MS does not decrease alveolar congestion. Positive pressure breathing treatments reduce the leaky capillary syndrome seen in pulmonary edema. D is INCORRECT because slowing the heart rate is not the primary purpose, although the drug does cause bradycardia. Question 13. What manifestation should the nurse recognize as a side effect of furosemide (Lasix)? 1. Nystagmus 2. Stomatitis 3. Muscle cramping 4. Hematuria Looking for answers(s):3 Explanation: A is INCORRECT because jerking eye movements (nystagmus) are associated with inner ear or cranial nerve damage. B is INCORRECT because mouth sores (stomatitis) are often a side effect of chemotherapy. C is CORRECT because loop diuretics like Lasix, as well as thiazide diuretics, cause a loss of potassium, which affects muscle function. D is INCORRECT because hematuria, blood in the urine, would not be expected from Lasix. Increased urine output would reflect the diuretic action of Lasix. Question 14. The nurse tells the client an expected side effect of Pyridium (phenazopyridine hydrochloride) is: 1. Urinary frequency 2. Jaundice 3. Bright orange urine 4. Urticaria Looking for answers(s):3 Explanation: A is INCORRECT because Pyridium is a urinary analgesic, and should eliminate the symptom of frequency caused by an infection. B is INCORRECT because jaundice is not expected; however, the drug is hepatotoxic. C is CORRECT because Pyridium will turn the urine bright orange, which may stain clothing or bedding. D is INCORRECT because, although a rash may develop from this drug, it is not an expected effect. If a rash develops, the physician should be notified.

Question 15Client-controlled analgesia (PCA) is being planned for the client with bone metastasis. Why would the nurse question this method of analgesia? 1. Central pain, not peripheral pain will be targeted 2. Pulmonary function may be diminished 3. The clients peripheral veins are fragile 4. The client may accidentally overdose Looking for answers(s):1 Explanation: A is CORRECT because with bone pain, NSAIDs and antispasmodics may be more effective. B is INCORRECT because pulmonary function actually increases with PCA, because sedation is less. C is INCORRECT because there is no data to support fragile veins. D is INCORRECT because there is a maximum dosage that is preset in the PCA. Question 16. The nurse should question an order for atropine sulfate, an anticholinergic, for a client with acute glaucoma because: 1. Photosensitivity will result 2. Aqueous humor flow will be obstructed 3. Visual acuity will be diminished 4. Intraocular pressure will be dangerously low Looking for answers(s):2 Explanation: A is INCORRECT because the drug does not cause photosensitivity. B is CORRECT because anticholinergics cause mydriasis, or pupil dilation, which impairs aqueous humor flow, and would increase intraocular pressure. C is INCORRECT because the drug does not directly cause diminished visual acuity (however, if intraocular pressure remained elevated, blindness would result). D is INCORRECT because the concern with glaucoma is a dangerously high intraocular pressure, not low pressure. Question 17. Which complaint by the client would be an expected side effect when atropine is given preoperatively? 1. Dizziness 2. Drowsiness 3. Urinary urgency 4. Light sensitivity Looking for answers(s):4 Explanation: A is INCORRECT because dizziness is not a side effect of atropine. B is INCORRECT because atropine is not a sedative. C is INCORRECT because atropine, an anticholinergic, causes urinary retention.

D is CORRECT because atropine is an anticholinergic, and causes pupil dilation and sensitivity to light Question 18. Which nursing action would result in decreased absorption of Catapres via a transdermal patch? 1. Washing skin with soap and water before application 2. Applying patch to hairless site on upper arm 3. Changing the system once every 7 days 4. Placing the patch on the anterior or inner thigh Looking for answers(s):4 Explanation: A is INCORRECT because this is a proper nursing action to maximize absorption. The site should be dried thoroughly before application. B is INCORRECT because this is a proper nursing action to maximize absorption. Any hairless site may be used, but the sites should be rotated. Absorption is greatest when placed on the chest and upper arm. Avoid cuts or calluses. C is INCORRECT because this is a proper nursing action to maximize absorption. The patch is applied once every 7 days. D is CORRECT because absorption is decreased when placed on the thigh, most likely because the thigh frequently has more adipose. Question 19. The client is to receive 30 mEq of potassium chloride in each 1000 mL of IV fluid. 700 mL of IV fluid remains in the present infusion. A 10 mL-vial containing 20 mEq of KCL is available. How much KCL should be added to the existing IV? 1. 5 mL 2. 10.5 mL 3. 15.5 mL 4. 21 mL Looking for answers(s):2 Explanation: A is INCORRECT because this amount is insufficient. B is CORRECT because there should be 3 mEq in each 100 mL. With 700 mL remaining, 21 mEq should be added to the existing IV10.5 mL. C is INCORRECT because this amount is excessive. D is INCORRECT because this amount is excessive. Question 20. When should prescribed medication be given to achieve optimum pain management for a client 24 hours after surgery?

1. After the pain becomes severe 2. When the client asks 3. Before the pain is severe 4. When the client looks uncomfortable Looking for answers(s):3 Explanation: A is INCORRECT because if pain is allowed to intensify before each dose of medication, it will take longer and require more medication to manage the pain. B is INCORRECT because cultural norms and fear of addiction may cause a client to avoid asking for pain medication as often as needed. C is CORRECT because if pain is allowed to intensify before each dose of medication, it will take longer and require more medication to manage the pain. D is INCORRECT because some clients may not appear to be in pain, although the pain may be severe and real. Question 21. A client who has been taking digitalis for heart failure is admitted with nausea and a potassium level of 2.5 mEq/L. The nurse should first assess for signs of: 1. Metabolic acidosis 2. Bowel obstruction 3. Digitalis toxicity 4. Renal failure Looking for answers(s):3 Explanation: A is INCORRECT because a low potassium would more likely be associated with metabolic alkalosis. B is INCORRECT because a bowel obstruction may cause a loss of fluids and electrolytes, but there is insufficient data to draw that conclusion. C is CORRECT because the combination of digitalis and low potassium increases the risk of digitalis toxicity. The client may complain of nausea, vomiting, and yellow vision. D is INCORRECT because renal failure would likely cause an increase in potassium, and would not be associated with a decrease. Question 22. To deliver 1000 mL of D5W in 12 hours (15 gtt/mL), at what drip rate should the nurse set the infusion? 1. 20 gtt/min 2. 25 gtt/min 3. 30 gtt/min 4. 35 gtt/min

Looking for answers(s):1 Explanation: A is CORRECT because the formula for calculating drops per minute is: mL per hour (83 mL) times drop factor (15 gtt/mL) divided by 60 minutes equals about 20 drops per minute. B is INCORRECT because this rate is too fast. C is INCORRECT because this rate is too fast. D is INCORRECT because this rate is too fast. Question 23. The client takes phenytoin (Dilantin) 300 mg PO every evening for a seizure disorder. Which other medication will the nurse recommend against taking? 1. Prazosin (Minipress) 2. Famotidine (Pepcid) 3. Antacids (Maalox, Gelusil) 4. Sumatriptan (Imitrex) Looking for answers(s):3 Explanation: A is INCORRECT because prazosin is not contraindicated with phenytoin. B is INCORRECT because famotidine is not contraindicated with phenytoin. C is CORRECT because antacids decrease the effect of phenytoin, as they do with many other medications. D is INCORRECT because sumatriptan is not contraindicated with phenytoin. Question 24. The nurse needs to start intravenous lines on 4 clients. Which IV line should be started first? 1. A client just admitted for severe pain from cancer 2. A client who will be going to elective surgery in 1 hour 3. A client who needs a new IV started for an antibiotic that is due in 15 minutes 4. A client who will receive 2 units of packed red blood cells after being typed and crossmatched Looking for answers(s):1 Explanation: A is CORRECT because the client with severe pain has the most immediate need for an intervention. B is INCORRECT because the nurse still has some time before the client needs to have the IV in place for surgery. C is INCORRECT because, according to the 30 minute rule, the nurse still has 45 minutes before the antibiotic must be administered.

D is INCORRECT because the process of typing and crossmatching the blood will take awhile, leaving the nurse time to start other IV lines. Question 25. When the client returns to the post-anesthesia recovery room following surgery, the nurse should start oxygen via mask in order to initially: 1. Hyperventilate the lungs 2. Prevent hypostatic pneumonia 3. Minimize effects of hypoventilation 4. Speed the elimination of anesthesia Looking for answers(s):3 Explanation: A is INCORRECT because the client does not experience hyperventilation. B is INCORRECT because once the client is awake, if the client does not soon begin to breathe deeply and cough, hypostatic pneumonia will result. C is CORRECT because general anesthesia reduces respiratory muscle function, and pulmonary expansion decreases. Oxygen supplementation minimizes the effects of hypoventilation until the client is awake. D is INCORRECT because oxygen therapy, given by mask or cannula, does not increase respiratory rate or depth. This is important in order to eliminate the anesthetic. Question 26. Two hours after receiving morphine (MS) 8 mg IV, which is ordered q 4 hr., the client complains of severe chest pain. What is the appropriate nursing intervention? 1. Tell the client to wait 2 hours for more medication 2. Change the clients position and reassess the pain in one hour 3. Reassess the clients vital signs and contact the physician 4. Give 4 mg of MS, since half the time has passed Looking for answers(s):3 Explanation: A is INCORRECT because waiting two hours could be life-threatening if the client is having another MI. B is INCORRECT because the client may be having another MI, and waiting could be life-threatening. C is CORRECT because the dosage is not sufficient to manage the clients pain. The client may be experiencing an extension of the infarction. D is INCORRECT because the chest pain needs to be evaluated, not masked by a narcotic; moreover, the nurse cannot change the dosage or frequency without a physicians order.

Question 27. The nurse should teach relaxation techniques to a client in pain, in order to: 1. Eliminate the need for analgesia 2. Reduce pain stimulation 3. Enable the client to sleep better 4. Enhance the effects of the analgesic Looking for answers(s):4 Explanation: A is INCORRECT because relaxation should not be a substitute for appropriate analgesics in managing pain. B is INCORRECT because relaxation does not reduce the stimuli. C is INCORRECT because the purpose is to achieve effective pain management. If this is effective, the client should then be able to sleep. D is CORRECT because relaxation will increase the effectiveness of the prescribed analgesic. Question 28. The nurse would recognize tetany following a thyroidectomy if the client experienced which symptom? 1. Hoarseness and weak voice 2. Numbness and tingling around the mouth 3. Hypotension and vertigo 4. Tachycardia Looking for answers(s):2 Explanation: A is INCORRECT because hoarseness and a weak voice would indicate damage to the laryngeal nerve, or irritation from endotracheal intubation. B is CORRECT because numbness and tingling around the mouth, fingertips or toes are due to hypocalcemia; tetany or carpopedal spasms are other signs of hypocalcemia. Calcium is necessary for normal nerve function. During thyroid surgery, the parathyroid glands may accidentally be removed, causing hypocalcemia after the surgery. C is INCORRECT because hypotension would occur from blood loss. D is INCORRECT because tachycardia could indicate an infection, bleeding or thyroid storm. Question 29. The client has received atropine 1 mg IV push. What effects would the nurse expect from this drug? 1. Decreased pulse and increased blood pressure 2. Increased pulse and blurred vision

3. Decreased pulse and bronchoconstriction 4. Increased pulse and decreased blood pressure Looking for answers(s):2 Explanation: A is INCORRECT because the drug increases heart rate, and there is no expected effect on blood pressure. B is CORRECT because the anticholinergic (antimuscarinic) effects of atropine include increased heart rate and blurred vision. The drug is frequently used for bradycardia, but has no expected effect on blood pressure. C is INCORRECT because the drug increases heart rate and dries respiratory secretions; it does not constrict the bronchioles. D is INCORRECT because the drug does not affect the blood pressure. Question 30. Which nursing measure would most likely prevent atelectasis in a postoperative client? 1. Encouraging fluids hourly 2. Ambulating every shift 3. Using an incentive spirometer 4. Humidifying the room air Looking for answers(s):3 Explanation: A is INCORRECT because fluids do not promote deep breathing, although they will liquefy secretions if they accumulate. B is INCORRECT because ambulation is important to prevent venous stasis, relieve gas distention, and promote intestinal motility. C is CORRECT because an incentive spirometer promotes deep breathing, which improves oxygenation and prevents alveolar collapse. D is INCORRECT because humidification does not promote deep breathing. Question 31. What time frame reflects the onset of action for sublingual nitroglycerin? 1. 12 minutes 2. 34 minutes 3. 56 minutes 4. 78 minutes Looking for answers(s):1 Explanation: A is CORRECT because the onset of the drug is 13 minutes. The peak effect is unknown. The duration of effects may be 3060 minutes. The half-life is 4 minutes.

B is INCORRECT because this amount of time is too long. C is INCORRECT because this amount of time is too long. D is INCORRECT because this amount of time is too long. Question 32. A client has had a thyroidectomy. Which assessment during the immediate postop period would be most important for the nurse to make? 1. Check behind the neck for bleeding 2. Palpate the carotid pulse regularly 3. Check the mouth and tongue for irritation 4. Check for return of the gag reflex Looking for answers(s):1 Explanation: A is CORRECT because bloody drainage may pool behind the neck, and not be visible on the dressing. B is INCORRECT because the carotid pulse should not be damaged during the surgery. C is INCORRECT because there is no reason to expect oral irritation. D is INCORRECT because, when the effects of general anesthesia are gone, there should be no impairment of the gag reflex. (Cranial nerves IX and X govern the gag reflex; these are not affected by thyroid surgery). Question 33. Which side effect of Synthroid should the nurse teach the client to report? 1. Irritability 2. Stomatitis 3. Ankle edema 4. Hematuria Looking for answers(s):1 Explanation: A is CORRECT because the action of the drug is to increase the metabolic rate. Irritability, insomnia, and nervousness are frequent side effects. B is INCORRECT because mouth sores are not expected. C is INCORRECT because ankle edema, seen with heart failure or venous stasis, is not a common side effect. The drug does have cardiac effects, but the dosage would be altered before cardiovascular failure would occur. D is INCORRECT because there are no known urologic effects. Question 34. What is an important nursing intervention for a client receiving allopurinol (Zyloprim) for hyperuricemia? 1. Encouraging the client to eat foods high in iron 2. Giving the drug before meals

3. Encouraging the client to drink at least 23L of fluid daily 4. Straining the urine for sediment or stones Looking for answers(s):3 Explanation: A is INCORRECT because foods high in iron will have no effect on the purine level, and will not reduce serum uric acid. B is INCORRECT because the drug is frequently taken with milk or meals to minimize gastric irritation. C is CORRECT because hyperuricemia (gout) may cause renal damage; large amounts of daily fluids (20003000mL) will flush the kidneys. Decreased kidney function may result in drug accumulation. D is INCORRECT because straining is done for calculi. The development of kidney stones is a major concern, and hopefully will be avoided by drug therapy and fluids. Question 35. Which assessment finding would reflect the desired effect of digoxin? 1. Decrease in heart rate 2. Change in cardiac rhythm 3. Increase in blood pressure 4. Clearing of breath sounds Looking for answers(s):1 Explanation: A is CORRECT because digoxin, an inotropic drug, is given to slow the rate and increase the strength of cardiac contraction, and improve cardiac output. By increasing the force of myocardial contraction, an improvement in cardiac function will, in turn, affect the blood pressure, and hopefully eliminate the signs of congestive failure. B is INCORRECT because changes in the rhythm, such as bigeminy, would be a side effect. C is INCORRECT because digoxin acts directly on the heart. Blood pressure will, in turn, be affected indirectly due to improved cardiac function. D is INCORRECT because congested breath sounds, which will result from a failing left heart, are treated directly with diuretics to reduce the circulating volume. Question 36. Which needle gauge should the nurse select to administer a transfusion? 1. 18 gauge 2. 20 gauge 3. 22 gauge 4. 24 gauge

Looking for answers(s):1 Explanation: A is CORRECT because the needle must be at least an 18 gauge, or there will be lysis of the red blood cells. B is INCORRECT because this gauge is too small, and will cause lysis of the red blood cells. C is INCORRECT because this gauge is too small, and will cause lysis of the red blood cells. D is INCORRECT because this gauge is too small, and will cause lysis of the red blood cells. Question 37. Which complaint would alert the nurse to an allergic reaction to IV cefazolin (Ancef)? 1. Itching at the IV site 2. Abdominal cramps 3. Diarrhea 4. Increased urinary output Looking for answers(s):1 Explanation: A is CORRECT because itching at the insertion site, as well as more generalized rashes or urticaria, indicates a hypersensitivity to the drug. Phlebitis is also a common side effect at the IV site. The site should be changed every 48-72 hours. B is INCORRECT because abdominal cramps are a side effect of oral administration. Nausea and vomiting may also occur. C is INCORRECT because diarrhea is a side effect of oral administration. D is INCORRECT because, although kidneys excrete cephalosporins, an allergic reaction will not increase urine output. Question 38. The nurse should expect to give a preoperative enema to a client who is to undergo repair of a torn bladder in order to: 1. Prevent bacteria from the bowel entering the peritoneum 2. Relieve gas distention in the bowel 3. Prevent bowel evacuation during surgery 4. Insure return of peristalsis after surgery Looking for answers(s):3 Explanation: A is INCORRECT because it is not intended that the bowel will be entered during the procedure; moreover, bowel sterilization preoperatively would be necessary to prevent contamination of the sterile field.

B is INCORRECT because there is no indication of distention preoperatively, although that may be a problem postoperatively. C is CORRECT because having a bowel movement during surgery could potentially contaminate the operative field. D is INCORRECT because peristalsis returns when the effects of anesthesia or surgery have resolved. Question 39. The client complains of neck tension 12 hours after a thyroidectomy. Which nursing intervention would be appropriate? 1. Turning the neck from side to side slowly 2. Gently rubbing the back of the neck 3. Repositioning the sandbag to hold the neck to the right 4. Administering an antispasmodic as ordered Looking for answers(s):2 Explanation: A is INCORRECT because during the immediate postop period, the neck should remain immobile. Around the second to fourth day after surgery, range-of-motion exercises will be started. B is CORRECT because the clients neck is immobilized with sandbags to prevent sideto-side movement, hyperextension or flexion, which would strain the suture line. C is INCORRECT because turning the head to one side or the other will put a strain on the incision. D is INCORRECT because the neck tension is not from muscle spasm, but rather from the need to keep the neck in one position initially after surgery. Question 40. The nurse is to give 1 gram of lidocaine in 500 mL of D5W to run at 4 mg per minute. How many mL per minute will the client receive? 1. mL/min 2. 1 mL/min 3. 1 mL/min 4. 2 mL/min Looking for answers(s):4 Explanation: A is INCORRECT because this rate is too slow to deliver the ordered dose. B is INCORRECT because this rate is too slow to deliver the ordered dose. C is INCORRECT because this rate is too slow to deliver the ordered dose. D is CORRECT because with 1 gram in 500 mL, the concentration is 2 mg per mL. To administer the ordered 4 mg/min, the IV should run at 2 mL/min.

Question 41. The nurse discusses discharge planning with a client receiving cimetidine (Tagamet). Which side effect would influence the clients return to work? 1. Dizziness, which usually passes with time 2. Diarrhea that can be controlled with diet 3. Breast enlargement, which can be hidden by clothes 4. An unsightly rash that may be embarrassing in public Looking for answers(s):1 Explanation: A is CORRECT because a transient and short-lived side effect of cimetidine is dizziness. Initially it would be a problem, because driving to work would be unsafe. B is INCORRECT because, although this is a side effect, it occurs in a very small percentage of clients, and is not a safety risk. C is INCORRECT because, although this is a side effect, it occurs in a very small percentage of clients, and is not a safety risk. D is INCORRECT because, although this is a side effect, it occurs in a very small percentage of clients, and is not a safety risk. Question 42. The nurse needs to know that the primary purpose of Compazine prescribed for a client following a stapedectomy is to: . Relieve dizziness 2. Control vomiting 3. Reduce inflammation 4. Provide sedation Looking for answers(s):1 Explanation: A is CORRECT because ear surgery may cause dizziness. The dizziness may cause vomiting, resulting in excessive pressure in the ear. In many cases, the dizziness will resolve rapidly, not even requiring medication. B is INCORRECT because vomiting is not expected unless dizziness is present. The client generally has received a local anesthetic with sedation. Nausea, often associated with general anesthesia, is therefore not a concern. C is INCORRECT because Compazine has no anti-inflammatory properties D is INCORRECT because, although sedation is a side effect of Compazine, it is irrelevant in this situation. Question 43. The client is receiving Ceclor (cefaclor) for a respiratory infection, as well as probenecid (Benemid); the client has no history of gouty arthritis. What is the rationale for the use of probenecid?

1. To prevent hyperuricemia secondary to anti-infective therapy 2. To prolong serum levels of the anti-infective 3. To replace normal flora destroyed by the anti-infective 4. To reduce inflammation of the intercostals Looking for answers(s):2 Explanation: A is INCORRECT because there is not an increase in serum uric acid levels with anti-infective therapy. Probenecid is used in the treatment of hyperuricemia with gout. B is CORRECT because concurrent administration of probenecid and anti-infective (most often penicillin) decreases renal excretion of the penicillin and increases the drug half-life. C is INCORRECT because the drug does not restore the normal flora, which is destroyed with anti-infective therapy. D is INCORRECT because there is no data indicating intercostal inflammation, and probenecid is not an anti-inflammatory agent. It is classified as a uricosuric (antigout) agent. Question 44. The client is 6 hours post-craniotomy, and is becoming increasingly restless. What is the appropriate action by the nurse? 1. Check Glasgow coma scale 2. Obtain an order for sedation 3. Place the client flat in bed 4. Restrain the clients arms Looking for answers(s):1 Explanation: A is CORRECT because a client should be reassessed before calling the MD. None of the other options offered would provide data, or improve the clients condition before calling the MD. B is INCORRECT because restlessness may indicate hypoxia, or increasing ICP; sedation would mask the symptoms. C is INCORRECT because, if restlessness were due to increasing ICP, this position would further increase the cerebral pressure. D is INCORRECT because the cause of the restlessness needs to be found, rather than controlling the restless movements. Question 45. To achieve optimal therapeutic effect from erythromycin, under which condition should the nurse administer the medication?

1. With a full glass of water or juice 2. At mealtime, to minimize GI irritation 3. With an antacid, to increase absorption 4. At least 1 hour before or 2 hours after meals Looking for answers(s):4 Explanation: A is INCORRECT because the drug should not be taken with juices, which may change stomach pH. It should be taken with a full glass of water. B is INCORRECT because food affects absorption. If GI upset occurs, the drug may be taken with food, but it will not have the optimal therapeutic effect. C is INCORRECT because the drug is best absorbed in an acid environment in the duodenum. D is CORRECT because the optimal absorption is on an empty stomach, when the acidity of the stomach is the greatest. Question 46. Discharge teaching on the proper use of nitroglycerin sublingually would include instructions to: 1. Take one tablet each morning before breakfast 2. Take no more than three tablets within 15 minutes 3. Store tablets in a clear glass container 4. Call the MD if a tingling under the tongue occurs Looking for answers(s):2 Explanation: A is INCORRECT because NTG is taken only as needed, not on a regular schedule. B is CORRECT because the maximum dosage is 3 tablets taken 5 minutes apart, over a 15-minute period of time. The client needs to be assessed for a possible heart attack if the pain is not relieved by this dosage of NTG. C is INCORRECT because the effectiveness of the tablets will decrease when stored in clear glass. The pills are kept in a dark glass bottle. D is INCORRECT because the tingling is a normal, expected response, and indicates the tablets are still potent. Question 47. Which nursing diagnosis would be a priority immediately after a laryngectomy? 1. Impaired swallowing 2. Activity intolerance 3. Hypothermia 4. Ineffective airway clearance

Looking for answers(s):4 Explanation: A is INCORRECT because swallowing would be a concern later, when resuming oral intake. B is INCORRECT because there is no anticipated effect on activity. C is INCORRECT because there is no anticipated effect on body temperature. D is CORRECT because swelling in the operative area may result in airway obstruction. Question 48. What action of levothyroxine sodium (Synthroid) would the nurse expect in a client with myxedema (hypothyroidism)? 1. Production of thyroid-stimulating hormone (TSH) 2. Regeneration of the thyroid gland function 3. Stimulation of thyroid function 4. Replacement of thyroid hormone Looking for answers(s):4 Explanation: A is INCORRECT because the drug does not produce TSH, but is replacement therapy. B is INCORRECT because, with hypothyroidism, the gland does not regenerate. C is INCORRECT because the drug is replacement therapy. Thyroid function is permanently impaired. D is CORRECT because Synthroid is a synthetic thyroid hormone, and replaces the hormone, which would normally be secreted by the thyroid gland. Question 49. Which nursing action is indicated initially with a peripheral IV that is not infusing properly? 1. Elevate the infusion site 2. Check the skin around the infusion site 3. Increase the height of the solution 4. Irrigate the tubing with sterile saline Looking for answers(s):2 Explanation: A is INCORRECT because elevating the infusion site usually slows the infusion rate. Straightening the limb may help, if the IV needle is in an elbow or wrist area. B is CORRECT because inspection or assessment of the skin is the first action. If there are no signs of infiltration or phlebitis, then the nurse should assess the tubing, reposition the clients hand (or arm) or elevate the solution.

C is INCORRECT because, although elevating the solution higher above the infusion site may help, it should be done only after checking for infiltration or phlebitis. D is INCORRECT because irrigation should not be the initial action. If no signs of infiltration or phlebitis are present, irrigation may be done after aspirating for a blood return, and if there is no indication of dislodging a clot at the tip of the needle. Question 50. Which side effect of diltiazem (Cardizem) would the nurse instruct the client to expect? 1. Postural hypotension with position changes 2. Reflex tachycardia and hypertension 3. Abdominal discomfort and diarrhea 4. Bleeding gums with brushing Looking for answers(s):1 Explanation: is CORRECT because diltiazem is a calcium blocker which produces coronary vasodilation and lowers blood pressure. B is INCORRECT because the drug may slow SA and AV conduction and pulse rate. C is INCORRECT because the drug causes constipation. D is INCORRECT because the drug may cause gingival hyperplasia. Question 51. To evaluate the effects of isosorbide dinitrate (Isordil) given for heart failure, the nurse must know that the drug reduces myocardial workload by: 1. Increasing venous capacity 2. Increasing peripheral vascular resistance 3. Increasing cardiac output 4. Increasing afterload Looking for answers(s):1 Explanation: A is CORRECT because vasodilating agents, such as Isordil, relax the venous smooth muscle and increase the capacity of the systemic venous bed, trapping blood, and decreasing venous return. B is INCORRECT because resistance is decreased with the relaxation of the venous smooth muscle. C is INCORRECT because vasodilation will reduce cardiac output. D is INCORRECT because vasodilation will reduce preload and afterload. Question 52. What is the desired effect of pilocarpine hydrochloride when used to treat glaucoma?

1. Reducing inflammation in the eyes 2. Reducing intraocular pressure 3. Increasing aqueous humor production 4. Dilating the pupils Looking for answers(s):2 Explanation: A is INCORRECT because the drug has no anti-inflammatory properties. B is CORRECT because pilocarpine is a miotic which constricts the pupil, improves aqueous humor flow, and reduces the intraocular pressure. C is INCORRECT because the drug does not increase the amount of aqueous humor; it improves the flow of aqueous humor. D is INCORRECT because the drug causes pupil constriction. Agents causing pupil dilation are contraindicated with glaucoma. Question 53. A client newly diagnosed with rheumatoid arthritis is started on ASA 4 gm/day in divided doses. Which mild symptoms of toxicity should the nurse tell the client that the dosage will initially produce? 1. Tinnitus 2. GI bleeding 3. Dizziness 4. Nausea Looking for answers(s):1 Explanation: A is CORRECT because high dosages, 26 gm per day in divided doses, may cause tinnitus (ringing in the ears). The dosage is reduced until the symptom is gone. B is INCORRECT because using enteric-coated aspirin should prevent the risk of GI bleeding. C is INCORRECT because dizziness may indicate anemia from GI bleeding. D is INCORRECT because using enteric-coated aspirin can minimize nausea, which is a side effect. Question 54. Which herbal supplement might the nurse recommend to a client for motion sickness? 1. Echinacea 2. Glucosamine 3. Chamomile 4. Ginger

Looking for answers(s):4 Explanation: A is INCORRECT because echinacea is used to improve the immune system. B is INCORRECT because glucosamine is an amino acid that plays a role in cartilage synthesis and is used for arthritis and joint injuries. C is INCORRECT because chamomile is considered an anti-inflammatory, antispasmodic, anti-infective, and a mild sedative. D is CORRECT because ginger has some antiemetic properties, and in appropriate doses can be used for nausea and vomiting as well as motion sickness. Question 55. (What is the proper administration of trimethoprim-sulfamethoxazole (Bactrim) IV, used to treat Pneumocystis pneumonia? 1. Give the drug through a central line catheter 2. Give the drug slowly over one hour 3. Mix the drug in normal saline 4. Discard the drug if clear Looking for answers(s):2 Explanation: A is INCORRECT because a peripheral site may be used. The site should be checked frequently because phlebitis is common. B is CORRECT because the drug should be given over 6090 minutes. C is INCORRECT because each 5 mL ampule is diluted in 125 mL of D5W. D is INCORRECT because the solution should be clear. Discard if cloudy or if a precipitate is present. Question 56. Postoperative coughing and deep breathing by the client will minimize the incidence of which complication? 1. Hypostatic pneumonia 2. Bronchial constriction 3. Acute bronchitis 4. Aspiration pneumonia Looking for answers(s):1 Explanation: A is CORRECT because surgery and general anesthesia cause hypoventilation, and increase the risk of atelectasis and hypostatic pneumonia when secretions accumulate. B is INCORRECT because the concern is with hypoventilation and collapsed alveoli. Large airways may become plugged with mucus, but they are not generally swollen and edematous as a result of surgery.

C is INCORRECT because pneumonia, rather than bronchitis, results from surgery. . D is INCORRECT because after surgery, the concern is with hypoventilation (hypostasis). (Aspiration pneumonia may result if the client vomits during or immediately after surgery; coughing and deep breathing will not prevent this type of pneumonia). Question 57. The physician orders phenytoin (Dilantin) 150 mg IV push for a seizure activity. What is the appropriate intervention for safe administration of IV Dilantin? 1. Giving 50 mg/min slow IV push closest to the insertion site 2. Mixing it in D5W and running over 3 minutes 3. Injecting it at Y-connector to mix with existing IV solution 4. Adding it to existing IV and running over 4 hours Looking for answers(s):1 Explanation: A is CORRECT because the rate for direct IV administration should not exceed 50 mg over 1 minute (25 mg/min in elderly clients). Rapid administration may cause severe hypotension or CNS depression. B is INCORRECT because the drug will precipitate with dextrose. If given by intermittent infusion, the drug should be mixed in 0.9% NaCl in a concentration of 1 10 mg/mL. Do not exceed 50 mg/min. Follow with normal saline to minimize local irritation. C is INCORRECT because the existing solution would need to be known. The drug will precipitate with dextrose, and is incompatible with potassium chloride frequently added to IV infusions. D is INCORRECT because the existing IV may be incompatible with the drug, particularly dextrose. If given intermittently, it should run within 4 hours at rate not to exceed 50 mg/min. Question 58. Discontinuing steroid therapy abruptly may precipitate which lifethreatening situation? 1. Increased appetite and weight gain 2. Hypotension and hypoglycemia 3. Edema and hypertension 4. Decreased wound healing and petechiae Looking for answers(s):2 Explanation: A is INCORRECT because these are less serious side effects of the drug, a glucocorticoid, which results in hyperadrenalism. B is CORRECT because these are signs of adrenal suppression, which is potentially lifethreatening. Although the drug is used to manage adrenal insufficiency, it suppresses normal adrenal function, and if it is stopped suddenly, adrenal suppression and circulatory collapse may occur.

C is INCORRECT because these are less serious side effects of the drug, a glucocorticoid, which results in hyperadrenalism. D is INCORRECT because these are less serious side effects of the drug, a glucocorticoid, which results in hyperadrenalism. Question 59The client is taking 80 mg of prednisone PO daily to treat graft-versus-host (GVH) disease one year after a bone marrow transplant. What should the client avoid? 1. Alcohol 2. Grapefruit juice 3. Acetaminophen 4. Foods high in potassium Looking for answers(s):1 Explanation: A is CORRECT because alcohol increases the side effects of prednisone. B is INCORRECT because grapefruit juice is not contraindicated with prednisone. C is INCORRECT because acetaminophen is not contraindicated with prednisone. D is INCORRECT because foods high potassium are not contraindicated with prednisone

Question 60. Which nursing action is best to relieve severe gas pains following surgery? 1. Instruct the client on relaxation techniques 2. Massage the abdomen from right to left 3. Encourage the client to ambulate several times daily 4. Offer sips of hot tea every hour Looking for answers(s):3 Explanation: A is INCORRECT because this is not the best action, although relaxation techniques are useful in pain management. B is INCORRECT because massage will not enhance diminished peristalsis, which is the likely cause of the gas distention. C is CORRECT because ambulation is the best intervention to relieve gas pains and promote peristalsis. D is INCORRECT because until peristalsis returns, the client may be NPO. Local heat may help. Question 61. What is the purpose of the nasogastric tube for a client postcholecystectomy?

1. Prevent accumulation of stomach contents 2. Prevent accumulation of bile in the small intestine 3. Promote passage of digestive enzymes through the pylorus 4. Inhibit HCL acid production in the stomach Looking for answers(s):1 Explanation: A is CORRECT because general anesthesia and the gallbladder inflammation will affect normal digestion and peristalsis. The NG tube is used to remove gastric secretions until peristalsis returns. B is INCORRECT because the passage of bile into the small intestine is desired, not something to be prevented. C is INCORRECT because until peristalsis returns, there is no movement of gastric contents. D is INCORRECT because the NG tube will not prevent HCL production; it will only remove the gastric contents. Question 62. A client, who has been taking aspirin for arthritis, is scheduled for surgery. For which postoperative problem should the nurse assess this client? 1. Electrolyte imbalance 2. Postoperative bleeding 3. Delayed wound healing 4. Increased inflammation Looking for answers(s):2 Explanation: A is INCORRECT because aspirin does not contribute to an electrolyte imbalance. B is CORRECT because aspirin has an anticoagulant effect, which can increase postoperative bleeding. If possible, the drug should be discontinued, or the dosage lessened, before surgery. C is INCORRECT because aspirin does not contribute to delayed wound healing. D is INCORRECT because aspirin does not contribute to an increase in inflammation. Aspirin is an anti-inflammatory. Question 63. Which technique would be inappropriate for the subcutaneous administration of heparin? 1. Applying gentle pressure after removing the needle 2. Drawing 0.1 mL air into the syringe before the heparin 3. Aspirating before injecting the heparin 4. Using the abdomen as an injection site

Looking for answers(s):3 Explanation: A is INCORRECT because gentle pressure is appropriate. The injection site should not be rubbed as with other injectable medications. B is INCORRECT because drawing air into the syringe before the drug is appropriate; it fills the needle with air after the injection, and prevents leakage of heparin into the intradermal site during insertion and withdrawal. C is CORRECT because aspirating is thought to cause tissue damage when the needle moves during aspiration. Small blood vessels may rupture, and bleeding and bruising will result. D is INCORRECT because the abdomen, above the level of the iliac crests, is an appropriate site for heparin injection, as are the thighs, back and upper arms.