AP P ENDI X
A
Answers for NCLEX Success
CHAPTER 1
1. C. Although most older drugs originated as plants, minerals,
or other natural products, newer drugs are mainly synthetic.
Synthetic drugs are standardized and therefore more consistent in their characteristics and efects than natural products.
2. B. Te frst drug to be developed in a group is usually considered the prototype or main example of the group, and
similar drugs that are developed later are compared to the
prototype. Knowledge of the prototype drug can help the
nurse understand the actions of other drugs in the class.
Most drugs can belong to multiple groups (e.g., a therapeutic group, a chemical group), depending on various characteristics. Drug groups and prototypes are usually quite
stable, and most new drugs ft into a known classifcation.
Te trade or brand name changes among manufacturers,
but the generic name stays the same.
3. D. Controlled or scheduled drugs are categorized by federal
law according to use and abuse potential. Tese drugs have
regulations that govern prescribing, dispensing, administering, and record-keeping. Almost all scheduled drugs
require prescriptions (i.e., cannot legally be sold over the
counter). Basic laws are federal, and states and local communities may enact additional laws.
4. C. Uses may be diferent, and recommended dosages of
over-the-counter (OTC) drugs are usually lower than prescription versions. Labels of OTC drugs contain a listing of
people who should not use the drugs, and the drugs are not
safe for everyone. Many OTC drugs are available to treat
cold symptoms, heartburn, constipation, and other common
problems. Insurance companies do not pay for OTC drugs.
5. D. Te U.S. Food and Drug Administration reviews studies
reported by others, mainly pharmaceutical companies, and
determines whether a drug is sufciently safe and efective to
be marketed. Te drug manufacturer is responsible for testing
the drug (in animals and people) and marketing the drug.
6. A, B, and C. All of these strategies, except for carrying several clients’ prescanned medications on a cart, potentially
reduce the risk of medication error. Te work-around of
removing more than one client’s medication from an automated medication dispensing system could lead to the
administration of the wrong medication to a client.
CHAPTER 2
1. D. Te “frst-pass efect” involves metabolism of an oral
drug in the liver so that only a portion of a drug dose
reaches the systemic circulation and becomes available
to act on target tissues or to be eliminated from the body.
Drug binding to plasma proteins afects drug distribution;
an increased amount of drug has to be absorbed before
efective therapeutic levels of unbound drug are reached.
2. C. Pharmacokinetics involves movement of a drug through
the body and its elimination. Drug binding with receptors
and drug efects on cells are pharmacodynamic processes.
Drug stimulation of normal cell functions describes an
agonist drug.
3. C. Te liver is mainly involved in drug metabolism. Te
gastrointestinal tract is mainly involved in absorption of
oral drugs, the cardiovascular system is concerned with
distribution, and the kidneys are concerned with excretion.
4. D. Receptors are mainly proteins that are manufactured
and eliminated like other proteins in the body. Teir numbers and binding capacities can be increased or decreased
in particular situations. Most receptors bind with relatively
few drugs. Some drugs do not require receptor binding for
their actions (e.g., antacids such as TUMS or Mylanta).
5. B. Activated charcoal is considered the “universal antidote.” Most therapeutic drugs do not have specifc antidotes; syrup of ipecac to induce vomiting with overdoses
of some drugs is no longer recommended (questionable
efectiveness, danger of aspiration of vomitus), and strong
laxatives are not indicated.
6. D. Te main goals of treatment are starting treatment as
soon as possible afer drug ingestion, supporting and stabilizing vital functions, preventing further damage from the
toxic agent by reducing absorption or increasing elimination, and administering antidotes when available and indicated. Given the time since ingestion and the drowsiness
of the girl, this is best accomplished by emergency medical
personnel.
CHAPTER 3
1. B. Te use of the abbreviation MS in an order is inappropriate. It is possible to interpret it as either magnesium sulfate or morphine sulfate.
2. C and D. Te nurse should assess the patient’s blood pressure prior to administering the antihypertensive agent. If
the blood pressure is less than 90 systolic or less than 60
diastolic, the medication should be held. Te nurse should
report the low blood pressure to the prescriber. A client
who has had a stroke can sufer from dysphagia, the inability to swallow. Te nurse must assess the client’s ability
to swallow prior to administering an oral medication. If the
client has dysphagia and the medication is administered,
the client is at risk for aspiration and pneumonia.
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Appendix A • Answers for NCLEX Success
3. A. In the event, a medication is ordered with a potentially
wrong abbreviation, the nurse should call the prescriber
and question the dosage. Also, it is essential to write out
micrograms or milligrams to prevent error.
4. C. Prior to administering any medication, the nurse assesses the client’s allergies. Clients who are allergic to penicillins are also likely to be allergic to cephalosporins.
5. D. Using bar code technology in the administration of medications will decrease medication administration errors.
6. C. An elixir is a liquid medication that is measured in milliliters (mL).
7. A. Te nurse frst assesses the client’s vital signs and level of
consciousness. Ten, it is necessary to notify the physician,
implement orders per the physician’s direction, and fll out
the incident report.
8. C. Te nurse administers six tablets, for a total of 300 mg.
9. D. Te nurse administers a subcutaneous injection with a
25-gauge syringe.
10. B. Many health care facilities do not permit the dorsogluteal muscle to be used for the administration of intramuscular injections.
11. B and D. Subcutaneous injections of insulin are administered at 45 or 90 degrees with a 25-gauge needle.
12. D. Te medication is mixed in 50 to 100 mL of fuid in a
separate container.
13. A. Te nurse should inquire what symptoms occurred that
prompted the client to say he was allergic to the medication. Sometimes clients state that they are allergic to a drug
when they actually have had an adverse reaction such as
nausea. If clients are truly allergic, resulting in an anaphylactic reaction, then it is imperative they not receive the
medication.
14. C. Teaching clients about drug therapy increases safety in
drug therapy.
15. B. It is important to know that drugs may cause virtually
any symptom or problem.
CHAPTER 4
1. A. Knowing a child’s growth and development level helps
practitioners order the correct formulation of a medication.
Some children need liquids. Some need chewable tablets,
whereas some may be able to swallow pills. Some may be
able to self-administer medications or participate in some
way, and some, depending on their fne and gross motor
skills, cognition, and psychosocial development, may be
completely dependent on others. Using an adult equivalent
medication or dose ofen results in overdosing, underdosing, or toxicity in a child; defnitive pediatric dosing may
never be determined on every medication, and diet and
exercise needs are important to pediatric management, but
initiating drug therapy is not dependent on these factors.
2. D. Genetic variability is the most likely cause of individual
diferences in therapeutic efect, tolerance, or variability
in medication administration. A 4-year-old child such as
Billy does not have cognitive understanding of the use of
this medication, so it does not afect his tolerance; he may
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think that refusing one medication will mean he does not
have to take any medications, but this is not the most likely
cause of his medication intolerance, and a prescriber would
not order a medication for a 4-year-old child that would
require swallowing pills.
3. D. Using an inhaler correctly can be tricky even for an
adult. Teaching Billy and his mother how to use a spacer
and inhaler is the most important determiner of adequate
absorption of the medication, and initiation of this process
requires a knowledge of growth and development. Clearing
Billy’s airway of secretions may help improve the absorption of albuterol, but it is not a factor in growth and development; the dose of albuterol is weight based and will need
to be increased as his age increases, and it is necessary to
monitor him for hypertension, not hypotension.
4. C. Te higher concentration of total body water results
in dilutional or lower drug efects, and the lower plasma
protein levels (to bind drugs) lead to an increased efect of
these drugs. Drug responses in infants can be either faster
or slower than those in adults, but they are ofen prolonged
rather than shortened because of the immaturity of organ
systems; neonates have a potential increased response to
drugs that afect the central nervous system because of the
immaturity of the blood–brain barrier, and drug response
does not fully mimic that of an adult until late adolescence.
CHAPTER 5
1. B. When a beta-adrenergic agonist is administered to an elderly
client, physiological changes cause a decrease in the number of
beta-adrenergic receptors. Tus, the client will require a larger
dose of medication to produce the desired efect.
2. D. It is important to assist the elderly client to maintain
her independence. By providing the client with a medication administration aid, her medications will be set up for
1 week, so she can more easily remember if she has taken
the medications.
3. B. As a client’s age increases, the digoxin dose should not
be greater than 0.125 mg. An older adult is prone to digoxin
toxicity due to a decreased creatinine clearance.
4. A. Aging results in body mass changes and the development of increased fat tissue. Tis general anesthetic agent is
lipid soluble, which means that this older client is prone to
respiratory depression following its administration.
5. C. Te nurse should explain to the client that chemotherapy is eliminated by the kidneys, and the increased intake
of water assists in eliminating the chemicals from the body.
6. A. To assist the client in maintaining medication adherence, the pharmacist should provide the client with a few
pills instead of the entire prescription. Tis prevents an
undue fnancial burden in the event that the medication’s
response is inefective or has adverse efects.
CHAPTER 6
1. D. Clomiphene citrate is the drug of choice for a couple
with infertility.
2. C. It is necessary to alternate the sides of the abdomen
when injecting subcutaneous menotropin.
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Appendix A • Answers for NCLEX Success
3. A. A woman with a seizure disorder who is taking antiepileptic agents such as phenytoin should consult her gynecologist and neurologist prior to becoming pregnant.
4. C. A pregnant woman should receive the infuenza vaccine
in the autumn to prevent infuenza. Te administration of
the vaccine at that time allows the woman to develop signifcant resistance to infuenza during the winter months.
5. C. Te supplement folic acid helps prevent neural tube
deformity.
6. B. Ginger helps prevent nausea and vomiting during
pregnancy.
7. A. Gestational diabetes places the fetus at risk for
hyperinsulinemia.
8. D. Diminished deep tendon refexes are indicative of hypermagnesemia and indicate the need for calcium gluconate IV.
9. A. A single dose of the tetanus–diphtheria–pertussis vaccine is recommended for all pregnant women during each
pregnancy. Te tetanus–diphtheria–pertussis is preferred
over the tetanus–diphtheria toxoid due the rise in pertussis rates. Live vaccines such as the live attenuated infuenza
vaccine and the measles, mumps, and rubella vaccine are
not recommended during pregnancy.
10. C. Te nurse should tell the woman that hand tremors are
common adverse efects.
11. A and C. Administration of indomethacin, especially before 32 weeks of gestation, can lead to premature closure
of the ductus arteriosus and oligohydramnios by reducing fetal urine output. Tis contributes to lower volumes
of amniotic fuid. Indomethacin does not afect the ductus
venosus or contribute to polyhydramnios.
12. B. Terbutaline is
hyperthyroidism.
contraindicated
in
clients
with
13. A. Dinoprostone is administered to promote cervical ripening.
14. C. Oxytocin should not be administered until 4 hours afer
the last dose of misoprostol.
CHAPTER 7
1. D. Estrogen increases protein anabolism, bone growth, and
epiphyseal closure in young adults; decreases low-density
lipoproteins; and increases vascularity in the skin.
2. B. Progesterone is known as the “hormone of pregnancy”
because of the endometrial support that the hormone provides. It is produced by the corpus luteum during the frst
few weeks of pregnancy and then by the placenta. Tis hormone maintains the optimal endometrial environment for
fetal development.
3. B. Vasomotor instability occurs as a result of estrogen defciency. Blood vessels dilate, resulting in a sudden, intense
warmth sensation that spreads over the body.
4. B. Hormone therapy is indicated for the relief of vasomotor
symptoms related to estrogen defciency. It is not indicated
for the treatment of osteoporosis, cardiovascular disease
prevention, or treatment of endometrial cancer.
5. A. Progesterone is secreted by the corpus luteum in the frst
few weeks of pregnancy. It plays an important role in the
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3
stabilization of the endometrium to support the pregnancy.
6. C. Te use of unopposed estrogen on an intact uterus increases the risk of endometrial cancer greatly. Terefore,
progestin is necessary to block the estrogenic efects on the
endometrium.
7. B, C, and D. Te application of a transdermal patch to
clean, dry skin is essential for the proper adherence and
absorption. Te patch should be applied the frst day of
menses or the Sunday following the start of menses. Te
woman should use a back-up method for the frst week of
use. Lotions and occlusive dressings should not be used at
the application site. Te patch should always be changed
on the same day of the week. When a new patch cycle is
delayed beyond the scheduled start date, the woman should
be instructed to apply a patch as soon as she remembers
and use back-up contraception for at least 1 week.
8. D. History of thromboembolism is an absolute contraindication of oral contraceptives because stroke and heart attack are greatly increased with previous thromboembolism.
9. C. Ortho Evra, DepoProvera, and Implanon are all hormonal methods of birth control in which the metabolism of
these hormones occurs in the liver. Impaired liver function
is a contraindication to hormonal contraceptive use. Tus,
a barrier method would be most appropriate.
10. A. Breakthrough bleeding with the administration of combination hormonal contraception is a common side efect
associated with this method. Breakthrough bleeding does
not indicate a sign of uterine abnormality. Te client will
need more client education regarding the adverse efects of
combination hormonal contraception.
CHAPTER 8
1. A. With male sex hormones, the most clear-cut indication
for use is to treat androgen defciency states (e.g., hypogonadism, cryptorchidism, impotence, oligospermia) in boys
and men.
2. D. No known drug interactions have been reported with
concurrent androgen and heparin administration. Androgens may increase efects of cyclosporine and warfarin,
apparently by slowing their metabolism and increasing
their concentrations in the blood. Androgens also increase
efects of sulfonylurea antidiabetic drugs.
3. D. Androgens pose risk to the fetus and may produce possible masculinizing efects on a female fetus.
4. A, B, and C. Weighing on a regular basis identifes fuid
and electrolyte imbalance. Te drugs may cause or aggravate
acne. Scrupulous skin care and other antiacne treatment may
be needed, especially in adolescent boys. With transdermal
systems, apply the patch systems nightly to clean, dry skin on
the back, abdomen, upper arm, or thigh. Do not apply to the
scrotum. Rotate sites, within 7 days, between applications to
a site. Press frmly into place for adherence.
5. B. Phosphodiesterase type 5 inhibitors such as sildenafl
should not be prescribed for men who also take organic
nitrates, commonly used to treat angina, because the drug
combination can cause severe hypotension resulting in dizziness, syncope, heart attack, or stroke.
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Appendix A • Answers for NCLEX Success
6. B. Dutasteride needs to be taken indefnitely. Once a man
stops taking the drug, the prostate grows, and there are
signs of impaired urinary function.
7. A. Finasteride is most efective when taken early in the
course of benign prostatic hypertrophy.
8. A, C, D, and E. Tamsulosin should be swallowed whole.
Te capsule should not be opened or chewed. Tamsulosin
will improve urination by relaxing the muscles in the prostate and bladder neck. Te only contraindication to taking
tamsulosin is a hypersensitivity to the medication. It is not
contraindicated with an allergy to penicillin. Tamsulosin
does cause postural hypotension. It is important for the patient taking tamsulosin to change positions slowly to prevent hypotension.
CHAPTER 9
1. C. During heparin therapy, the aPTT should be maintained
at approximately 1.5 to 2.5 times the control or baseline
value. Te normal control value is 25 to 35 seconds, and
therapeutic values are 45 to 70 seconds, approximately.
2. A, C, and D. Warfarin, a pregnancy category X medication, is contraindicated during pregnancy because it crosses
the placenta and may produce fatal fetal hemorrhage. Te
U.S. Food and Drug Administration (FDA) has issued a
for warfarin due to its risk of
BLACK BOX WARNING
causing major or fatal bleeding.
3. C. Protamine sulfate is an antidote for standard heparin
and low molecular weight heparins
4. A, B, C, and E. Positive outcomes with the use or warfarin for the management of pulmonary embolism include
less or absent chest pain or signs of respiratory difculty,
absence of uncontrolled bleeding, and PT value of approximately 1.5 times control, or 18 seconds, and INR range on
warfarin of 2.0-3.0. Hematuria or blood in the stools is an
indication of adverse efects.
5. B. Warfarin is similar to vitamin K in structure and therefore
acts as a competitive antagonist to hepatic use of vitamin K.
Conversely, vitamin K serves as the antidote for warfarin.
6. D. Aspirin, a cyclooxygenase inhibitor, has potent antiplatelet efects. Te drug inhibits the production of thromboxane,
which under normal circumstances binds platelet molecules
together to form a plug over damaged blood vessels walls.
7. A. Te thienopyridine adenosine diphosphate receptor
antagonists, including clopidogrel, prasugrel, and ticlopidine, are the used for their antiplatelet activity. Te drugs
are indicated for reduction of myocardial infarction, stroke,
and vascular death in clients with atherosclerosis and afer
coronary stent placement.
8. A. With poor metabolizers of clopidogrel, the benefts of
the drug may not be adequate.
CHAPTER 10
1. A. Overall, the most efective blood lipid profle for prevention or management of metabolic syndrome and its sequelae
is high HDL cholesterol, low LDL cholesterol, and low total
cholesterol. A low triglyceride level is also desirable.
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2. D. Te total cholesterol-to-HDL cholesterol ratio is a number that is useful in predicting the risk of developing atherosclerosis (total cholesterol value is divided by the value
of the HDL cholesterol). Te ideal ratio is less than 4. Tis
person is at signifcant risk for atherosclerosis. Even with a
favorable ratio, it is still important to try to obtain an LDL
of less than 80 to 100 mg/dL, particularly in the presence
of multiple other risk factors for coronary artery disease.
3. A. Unless lipid levels are severely elevated, it may be appropriate to try 6 months of intensive diet therapy and
lifestyle modifcation before considering drug therapy. It
is essential that therapeutic lifestyle changes continue during drug therapy because the benefts of diet, exercise, and
drug therapy are additive.
4. A. Because the bulk of cholesterol synthesis appears to
occur at night, statins are normally administered in the
evening or at bedtime. However, atorvastatin has a long
half-life, and evidence suggests that atorvastatin can be
given without regard to time of day.
5. D. Statins are potentially teratogenic medications (pregnancy category X). Careful consideration should be given if
potential benefts warrant use of the drug class in pregnant
women despite potential risks.
6. D. It is essential that cholestyramine not be given with other
drugs; clients should take the other drugs 1 hour before
or 4 to 6 hours afer cholestyramine to minimize altered
absorption. Because cholestyramine binds bile acids, cholestyramine may interfere with normal fat digestion and
absorption and therefore may prevent absorption of the
fat-soluble vitamins A, D, E, and K; supplementation may
be required. Te drug can bind with vitamin K; therefore, it
is used with caution in people with any coagulopathy.
7. D. Gemfbrozil, rather than niacin, is usually preferred for
people with diabetes because niacin increases blood sugar.
8. A, C, and E. It is necessary to mix cholestyramine with
water or other fuids, soups, or cereals, or fruits such as applesauce, and to follow with more fuid. Good dental hygiene
is important because holding the mixture in the mouth can
damage teeth. Cholestyramine is not absorbed systemically,
so the main adverse efects are gastrointestinal ones such as
abdominal fullness, fatulence, diarrhea, and constipation.
CHAPTER 11
1. C. In chronic renal failure, erythropoietin production that
normally occurs in the kidneys is diminished resulting in
anemia. Epoetin alfa, a recombinant form of human erythropoietin, helps the body make more red blood cells.
2. C. Clients with chronic renal failure have anemia, partly
because the kidneys are no longer able to produce erythropoietin. Epoetin alfa and darbepoetin alfa are synthetic
versions of erythropoietin, which are given to stimulate
production of red blood cells and decrease anemia. Tese
drugs would not be used to decrease bleeding, increase
production of white blood cells, or improve renal function.
3. A. Iron is an essential component of red blood cells, and
hematopoietic drugs cannot function efectively without an
adequate supply of iron. Most clients need to take an iron
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Appendix A • Answers for NCLEX Success
supplement along with the drugs. Te drugs have no particular connection with potassium metabolism, and they are
not afected by the administration of antacids or analgesics.
4. D. Bone pain occurs in approximately one third to one half
of clients taking flgrastim.
5. D. Filgrastim afects the neutrophil count. When the neutrophil count falls below 500/mm3, clients are at increased
risk for infection.
6. A. Filgrastim generally results in fewer infections because
it stimulates production of infection-fghting white blood
cells in the bone marrow. It does not afect red blood cells,
prolong life expectancy, or decrease nausea and vomiting.
7. D. In the majority of clients, fu-like symptoms (e.g., fever,
chills, fatigue, muscle aches, headache) develop within 2
hours of administration and last up to 24 hours. Unless
contraindicated for other health reasons, clients can use
acetaminophen to manage these symptoms.
8. B. Interferons are used to treat chronic hepatitis C and a
few types of cancer. Adverse efects include fu-like symptoms and mental depression.
9. A, B, C, and F. Interleukins should be stored in the refrigerator. Te medication should not be administered if it is
discolored. Te patient should maintain a fuid intake of 2
to 3 quarts. If the patient develops a fever, the patient should
be taught to take acetaminophen. Te patient should be instructed to report shortness of breath and edema.
CHAPTER 12
1. A. Vaccines are antigens that elicit active immunity by simulating a person’s immune system to produce antibodies
against disease-producing microorganisms.
2. B. Vaccines manufactured from live organisms are contraindicated in people whose immune systems are suppressed
because, if given, the vaccines could cause disease rather
than prevent it.
3. B. Many children experience temporary redness and soreness as a local reaction to vaccines.
4. B. Vaccines may be contraindicated in clients receiving immunosuppressive drugs. People taking prednisone have a
decreased immune response. Tey cannot produce sufcient amounts of antibodies for immunity and may develop
the illness produced by the particular organism contained
in the vaccine. Te disease is most likely to occur with the
live virus vaccines (e.g., measles, mumps, rubella).
5. D. Current vaccine information on the benefts and risks of
immunization outlined in a Vaccine Information Statement
(VIS) for each recommended vaccines, along with indications, contraindications, and the timing of immunizations
doses, is available at the Centers for Disease Control and
Prevention Web site. Te VIS must be given to the client or
parent with each vaccine dose.
CHAPTER 13
1. C. Without the drugs, the body’s immune system would
destroy the transplanted organs. Immunosuppressants do
not prevent nephrotoxicity, hepatotoxicity, or bleeding dis-
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5
orders, and some immunosuppressants may cause these
disorders as adverse drug efects.
2. A. Skin cancers and lymphomas occur quite ofen in clients who have organ transplantation and take immunosuppressant drugs long term. Other types of cancer are not as
strongly associated with immunosuppression.
3. C. Grapefruit juice should not be used because it inhibits
the metabolism of cyclosporine and tacrolimus leading to
elevated drug levels. Orange juice may make the drug more
palatable.
4. A. Immunosuppressant drugs decrease a client’s ability to fght
infection. Tus, prevention of infection is extremely important, and all possible preventive measures should be instituted
by clients and others in the client’s environment. Frequent
hand washing is one of the simplest and most efective measures. Having a normal weight, adequate fuid intake, and suffcient rest and exercise are all part of a healthy lifestyle, which
may also help indirectly to decrease infections.
5. C. Antacids that contain calcium, magnesium, or aluminum as well as vitamin–mineral preparations containing
iron, magnesium, calcium, or zinc can bind with oral immunosuppressant drugs, interfering with their absorption
and therapeutic efects. Tis binding action increases the
risk of a rejection reaction. To prevent decreased absorption that could lead to inadequate immunosuppression, clients should take antacids at least 2 hours before or 4 hours
afer oral mycophenolate.
6. C. An increase in the patient’s white blood cell count indicates the development of an adverse efect related to lefunomide’s immunosuppressant action. Lefunomide (Arava)
is contraindicated in active hepatitis B or C infections.
Hepatotoxicity is a concern. Liver function tests should be
completed prior to the start of therapy.
7. A and B. Monoclonal antibodies make the cancer cell more
visible to the immune system and block growth signals.
CHAPTER 14
1. A. Vincristine causes fatigue. When combined with phenytoin
the patient has an increase in central nervous system depression and fatigue.
2. A. Clients receiving a drug that depresses bone marrow
function are at high risk of developing serious infections.
Every efort should be made to prevent infections in the
client. Although the client may be included in the vigilance
necessary to make sure that those in proximity understand
precautions, it is especially important that this be communicated to all others in the client’s environment. Fatigue
and weakness also ofen occur with bone marrow depression and require medical monitoring. Tere is no particular correlation between nausea and vomiting and blood cell
counts. Any fever should be reported, and antibiotics are
given rather than antipyretics.
3. A. Cytotoxic drugs damage both normal and malignant
cells and may cause severe adverse efects. Tey block
or slow cancer cell growth rather than stimulating it.
Administration of most of the drugs is cyclical, with cycles
of a few days, then a few weeks without the drugs, then a
repeat cycle as opposed to daily administration.
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Appendix A • Answers for NCLEX Success
4. A, B, and D. Te nurse tells the client to take the oral
cyclophosphamide on an empty stomach. If severe gastrointestinal upset occurs, she should take the drug with food.
To take cyclophosphamide on an empty stomach, it should
be taken 1 hour before a meal or 2 hours afer a meal.
5. B. Fulvestrant blocks estrogen receptors and decreases
estrogen-mediated growth simulation. Hormone inhibitor
drugs slow the growth of cancer cells that are stimulated by
hormones. Tey are not cytotoxic. Tey cause less damage
to normal cells than cytotoxic chemotherapy; however, the
drugs may still cause serious adverse efects. Tey do not
target specifc antigens or vital processes of cancer cells.
Biologic drugs do not have protective efects on normal cells.
6. A. Malignant tumors of the breast, uterus, ovary, and prostate are infuenced by hormones. Sex hormones act as
growth factors in some malignancies. For example, some
breast tumors have estrogen receptors, whereas prostate
cancer in men grows under stimulation by testosterone.
Hormone inhibitors slow the growth of cancer cells stimulated by hormones.
7. B. Leakage of a vesicant drug into tissues surrounding the
venipuncture site can cause severe tissue damage, which
should be prevented if possible. Drug administration is
ofen at a peripheral IV site, although it may occur via central line. Intramuscular administration is never appropriate.
CHAPTER 15
1. C. Te presence of infammation initiates the infux of leukocytes to the area of infammation to assist in tissue repair.
2. D. Normal or typical fora refers to microbe that normally
resides in a body region. When the sputum specimen was
obtained, a relatively large amount of oral secretions were
expectorated into the specimen container taking with it
normal fora from the mouth. To avoid this, the nurse will
have the client rinse the mouth out well prior to collecting
a sputum specimen and will give clear instructions to the
client to cough deeply in order to obtain a specimen of pulmonary secretions rather than oral secretions.
3. B. Antibiotics can afect benefcial bacteria as well as harmful bacteria. When some of the normal fora in the vagina
are killed, this can alter the vaginal environment by ridding the vagina of bacteria that normally keeps the yeastlike fungus from proliferating. As a result, an overgrowth
of fungi can occur.
4. B. Colonization indicates growth without infection. In
other words, bacteria are growing and reproducing but do
not cause tissue injury, probably because intact skin and
mucous membranes form a barrier against invasion. Even
though the health care worker does not have an infection,
the worker still poses a danger to clients because methicillin-resistant Staphylococcus aureus can spread to clients, so
the health care worker can act as a carrier.
tial to let the prescriber know so that an appropriate antibiotic can be ordered. Te nurse would not stop the current
drug or ask the pharmacist for a diferent drug without an
order. Te nurse would not tell the client that the prescriber
ordered the wrong antibiotic because the prescriber did not
make an error; rather, the prescriber provided empiric therapy based on the most likely cause of infection until information regarding susceptibility was known.
7. D. Te most important action a nurse can take to prevent
the spread of infection is good hand hygiene. Te nurse and
all health care providers should wash their hands before
and afer client contact.
CHAPTER 16
1. C and E. Infammation is the normal body response to
tissue damage from any source, and it may occur in any
tissue or organ. Prostaglandins E2, D2, F2alpha, and I2 induce
infammation and also enhance the efects of other mediators of the infammatory response. In addition, there is a
release of arachidonic acid.
2. A. Acetaminophen is efective in reducing pain but not
decreasing infammation.
3. D. A client who is dehydrated has a fever with an elevation
in body temperature.
4. D. Te nurse should instruct the grandparents that aspirin increases children’s risk of developing Reye’s syndrome,
and they should not give the drug to children.
5. A. Tinnitus is ringing in the ears and is indicative of salicylate toxicity, also known as salicylism.
6. B. Te client should take aspirin with food to prevent gastric irritation.
7. B. Toddlers with high fevers should be treated with acetaminophen and ibuprofen. Te medications are administered in an alternating schedule.
8. A. Percocet contains acetaminophen, and the two medications should not be administered together.
9. C. Te child has developed a hypersensitivity reaction to
ibuprofen. Tis places him at risk for salicylate hypersensitivity in the future.
10. B. Lithium toxicity will result when combined with
meloxicam.
11. A. Dyspnea is a sign of heart failure and the reopening of
the ductus arteriosus.
12. A. Te client should report chest pain because COX-2
inhibitors are associated with an increased risk of myocardial infarction and cerebrovascular accident.
13. A. Te client who states that he or she will stop taking the
colchicine because of diarrhea requires client education
about the medication. Colchicine is used to decrease the
infammation by eliminating the serum uric acid.
5. B. All mechanisms of resistance are intrinsic, with the
exception of genetic transfer of material that confers drug
resistance.
14. D. Excruciating pain in the lower abdomen is indicative of
the development of uric acid stones in clients receiving a
uricosuric agent.
6. B and E. Notify the prescriber of the culture and sensitivity
report. Once the susceptibility report is available, it is essen-
15. C. Te client who has an acute gout fare-up is treated with
a uricosuric agent. In the event, he is status postmyocardial
Frandsen12e9781975136130-appA.indd 6
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Appendix A • Answers for NCLEX Success
infarction and is administered anticoagulant agent, and it is
important to assess the client for bleeding.
CHAPTER 17
1. D. Te increased activity of the sympathetic nervous system, which assists in the body’s response to stress, stimulates the release of cortisol.
2. A. Prednisone decreases the infammatory response by
reducing the accumulation of neutrophils and macrophages at sites of infammation.
3. A. Te administration of systemic corticosteroids such as
prednisone results in atrophy of the adrenal cortex.
4. B. Te administration of corticosteroids by nebulizer
decreases mucous secretion and infammation in a client
with chronic obstructive pulmonary disease.
5. C. Afer anaphylactic shock resulting from an allergic reaction, corticosteroids may increase or restore cardiovascular
responsiveness to adrenergic drugs.
6. D. Taking this dose of futicasone places the client at risk
for adrenocortical insufciency from hypothalamic–pituitary–adrenal (HPA) suppression.
7. C. Te administration of corticosteroids to clients afer
liver transplant suppresses cellular and humoral immune
responses and helps prevent rejection of transplanted
tissue.
8. C. Te administration of corticosteroids before the administration of chemotherapy helps prevent nausea and vomiting, which is an adverse efect of chemotherapy.
9. A. It is recommended that systemic corticosteroid medications be administered on alternate days. Te dose administered is two times the normal daily dose.
10. C. Corticosteroids alter the synthesis of DNA, resulting in
diminished growth.
11. A. Te woman will most likely require a larger dose of corticosteroid as a result of her husband’s diagnosis. Periods
of increased stress require larger doses of corticosteroids.
12. A. Te administration of systemic corticosteroids leads to
an increase in blood glucose. Te nurse should assess the
client for hyperglycemia.
13. D. Clients receiving systemic corticosteroids may experience euphoria, insomnia, and psychosis.
14. A. Te nurse should assess the client receiving systemic
corticosteroid therapy for adrenocortical excess.
CHAPTER 18
1. A. Penicillin allergy is the most common cause of druginduced anaphylaxis. Piperacillin–tazobactam is a combination product containing an extended-spectrum
antipseudomonal penicillin and a beta-lactamase inhibitor.
Cross-allergenicity occurs among all the penicillins; therefore, asking the client about past reactions to penicillins is a
necessary intervention before giving this medication. Drug
administration is intravenous; thus, it is unlikely to cause
stomach upset. Afer diluting the drug in intravenous fuid,
administration occurs slowly through a small-bore needle
Frandsen12e9781975136130-appA.indd 7
7
in a large vein to prevent vein irritation and pain during
infusion. It is important to monitor the site and ensure that
it remains patent throughout the administration.
2. B. Amoxicillin–clavulanate is an orally administered combination product containing the antibiotic amoxicillin and
the beta-lactamase inhibitor clavulanate. It is available in
250-, 500-, and 875-mg tablets; each of which contains 125
mg of clavulanate. Administering two 250-mg tablets of
amoxicillin–clavulanate provides an overdosage (250 mg)
of clavulanate.
3. B. Research has demonstrated that antibiotics must be
present in the client when the frst skin incision to provide
the most protection against infections acquired during surgery. Tat means that most antibiotics are ideally given no
more than 1 hour before, not afer, the frst skin incision.
4. A. First-generation cephalosporins are primarily efective
against gram-positive bacteria. Second-generation cephalosporins are more active against gram-negative bacteria than
frst-generation drugs. Tird-generation cephalosporins
further extend the spectrum of activity against gram-negative organisms. Fourth-generation cephalosporins are the
broadest of all in spectrum acting against some gram-positive and many gram-negative organisms, including greater
stability against degradation by beta-lactamase enzymes.
5. B, C, and D. Cefazolin, meropenem, and aztreonam all
rely on renal clearance, and their dosages must be reduced
in acute renal failure. Te elimination of nafcillin does not
entirely rely on renal clearance, because it is 60% metabolized by the liver.
6. B. An adverse efect of imipenem is central nervous system
toxicity including seizures, which is undesirable for this client with a head injury and seizure activity. Although imipenem may be given concomitantly with gentamicin, mixing
these drugs together in the same IV fuid inactivates the
gentamicin. Imipenem is a broad-spectrum antibiotic that
should be infused over 40 to 60 minutes.
CHAPTER 19
1. B. Gentamicin is excreted via the kidneys, and alterations
in renal function may cause nephrotoxicity. Possible nephrotoxicity is a well-known adverse efect of gentamicin, and
in this case, the nurse should notify the physician. A and C
are incorrect because the client could be experiencing renal
impairment, and giving more gentamicin, even half the dose,
may still cause drug toxicity and nephrotoxicity. D is incorrect
because gentamicin could be contributing to the renal impairment. Although obtaining a trough level might help evaluate
the gentamicin regimen, the nurse should not administer the
drug until he or she discusses it with the physician.
2. A. Once-daily aminoglycoside dosing is contraindicated in
clients with endocarditis, and only the conventional dosing
regimen should be used. B is incorrect because gentamicin and ampicillin are recommended in endocarditis, and
they increase the risk of treatment success, not failure. C is
incorrect because the single daily dose of gentamicin is a
maximum of 7 mg/kg, not 15 mg/kg, once daily. D is incorrect because streptomycin is not the recommended aminoglycoside for use in endocarditis.
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8
Appendix A • Answers for NCLEX Success
3. C. Te addition of ciprofoxacin has led to documented
drug interactions with anticonvulsants and antidysrhythmics, and the prescriber should choose an alternative if
possible. A is incorrect because the client needs to take
the anticonvulsant for seizures as well as an antibiotic for
pyelonephritis. Altering the administration schedule may
precipitate seizures. B is incorrect because even if levels are
obtained, it is the concurrent administration of ciprofoxacin that can alter the levels of the anticonvulsant. In addition, an interaction with the antidysrhythmic agent may
prolong the QT interval. D is incorrect because all antibiotics should be taken for the entire duration of therapy, even
if the client feels better or the fever is gone.
4. B. Ciprofoxacin can chelate with cations, and iron, multivitamins, calcium, magnesium, aluminum salts, and sucralfate
may signifcantly reduce the absorption of ciprofoxacin.
Terefore, ciprofoxacin should be taken 2 hours before or 6
hours afer administration of the other agents. A is incorrect
because Maalox impairs the absorption of ciprofoxacin. C is
incorrect because loop diuretics, not thiazide diuretics, potentiate the efects of nephrotoxicity. D is incorrect because of the
interaction with Maalox and ciprofoxacin. Tiazide diuretics
do not interact with ciprofoxacin like loop diuretics do.
5. D. Photosensitivity may occur with exposure to direct or
indirect sunlight; therefore, the client should avoid prolonged
exposure to the sun. Sunscreens do not prevent photosensitivity reactions. A is incorrect because clients may take ciprofoxacin with food to avoid gastrointestinal upset. B is incorrect
because adequate fuid intake should accompany a ciprofoxacin dose to prevent drug crystals from forming in the urinary
tract. C is incorrect because ciprofoxacin interacts with antacids, resulting in impaired ciprofoxacin absorption.
CHAPTER 20
1. B. Clients who are asymptomatic receive doxycycline or
ciprofoxacin for 60 days following exposure to anthrax.
2. D. Tetracycline should be taken with a full glass of water.
3. A. Tetracycline is contraindicated with calcium or dairy
products.
4. B. When a client reports mouth pain and difculty swallowing when taking an anti-infective agent such as tetracycline, it is necessary to inspect the client’s mouth for
white patchy areas. Tese areas indicate Candida albicans, a
superinfection of the mouth.
5. A. When administering demeclocycline, it is important to
monitor the client’s blood urea nitrogen (BUN). Increases
in the BUN are secondary to antianabolic efects.
6. A. It is important to assess if the woman is breast-feeding.
If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk, or by direct administration,
the drug displaces bilirubin from binding sites on albumin.
As a result, bilirubin may accumulate in the bloodstream
(hyperbilirubinemia) and central nervous system (kernicterus), causing life-threatening toxicity.
7. D. To prevent crystalluria, it is essential that clients receive
2000 mL of fuids in a 24-hour period.
8. B. When taken concurrently with sulfsoxazole, St. John’s
wort enhances the efects of the sulfsoxazole.
Frandsen12e9781975136130-appA.indd 8
9. B. When applying silver sulfadiazine to a burned area, it is
important to wear sterile gloves.
10. C. When administering sulfamethoxazole and trimethoprim intravenously, it is necessary to dilute the medication in 125 mL of 5% dextrose and water.
11. D. Bundle-branch block and changes in the ST and T waves
are cardiac-related adverse efects of nitrofurantoin.
12. A, C, E, and F. Yellowing of the skin indicates an
accumulation of phenazopyridine. In addition, bruising, sore throat, and fever indicate an accumulation of
phenazopyridine.
CHAPTER 21
1. C. Erythromycin is the drug of choice for Legionnaire’s
disease.
2. A. Clarithromycin should be administered on an empty
stomach. Administration with calcium products will prevent the absorption of clarithromycin.
3. A. Te loss of hearing with the administration of macrolides is an adverse efect of the medication. Afer the nurse
assesses the patient’s hearing, it is important to notify the
patient’s family of the hearing loss and to tell the parents to
notify the physician. Te nurse does not have the authority
to discontinue erythromycin.
4. D. Changes in behavior with crying or laughing is an
adverse efect of erythromycin.
5. C. Clarithromycin is the prophylactic drug of choice for
patients who are predisposed to cardiac endocarditis.
Patients who have had rheumatic fever are at risk for the
development of this infectious cardiac condition.
6. A. Advise the student to return to the clinic. A diferent
antibiotic may be indicated.
7. D. Pretreatment with diphenhydramine and slowing the
vancomycin infusion will decrease the histamine reaction
that occurs with a vancomycin infusion.
CHAPTER 22
1. B. Vitamin B6 (pyridoxine) is given along with isoniazid to
decrease the risk of peripheral neuropathy.
2. B. Taking isoniazid and alcohol in combination increases
the risk of liver damage.
3. A. Increased serum aspartate aminotransferase would indicate liver damage, an adverse efect of isoniazid.
4. A. Numbness and tingling of extremities would indicate
peripheral neuropathy, an adverse efect of isoniazid.
5. B. Both isoniazid and rifampin can be hepatotoxic. Te use
of the two drugs together increases the risk of liver damage,
which would produce these symptoms.
6. C. Rifampin causes a harmless red-orange discoloration of
body fuids. Tis can permanently stain sof contact lenses.
Te client should consult an eye care provider before wearing contact lenses.
7. D. In general, rifampin reduces the efectiveness of protease
inhibitors. Increased viral load and decreased CD4 count
are indications that the protease inhibitor is not efective
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Appendix A • Answers for NCLEX Success
and that the human immunodefciency virus (HIV) disease
has worsened.
8. B. Rifampin induces the metabolism of a multitude of
drugs. Te drug regimen requires careful review.
9. A. Te most serious adverse efect of pyrazinamide is
hepatotoxicity.
10. C. Pyrazinamide decreases the renal excretion of urates.
Tis could worsen an attack of gout.
11. B. A serious adverse efect of ethambutol is optic neuritis.
12. C. A newer fuoroquinolone such as levofoxacin may
be added to the drug regimen to treat drug-resistant
tuberculosis.
13. D. Te nursing staf should directly observe that the client
successfully takes each dose of medication.
CHAPTER 23
9
16. A. Te development of jaundice and fu-like symptoms
when on a regimen of nevirapine can result in hepatic failure and encephalopathy.
17. A. Te administration of an antifungal agent, such as
amphotericin B, with etravirine results in diminished antifungal activity because the etravirine occupies the substrates for metabolism.
18. A. Te development of a prolonged QT interval is indicative of an adverse efect of saquinavir and may warrant discontinuation of the drug.
19. C. When the mother is mixing nelfnavir to administer to
her young child, the nurse teaches her to mix the medication in water, milk, or formula.
20. A. Raltegravir blocks HIV integrase, thus preventing HIV-1
provirus replication.
21. D. Te route of administration of enfuvirtide is
subcutaneous.
1. B. New viruses are formed by breaking of from the cell
membrane or causing lysis of the cell.
22. C. Yellowing of the skin is an adverse efect of maraviroc. It
may be a sign of life-threatening hepatic dysfunction.
2. A. Acyclovir decreases viral shedding, enhances healing of
the lesions, and decreases pain related to the outbreak of
genital herpes.
CHAPTER 24
3. C. It is important to administer topical acyclovir with a
gloved hand.
4. D. Te administration of probenecid and acyclovir results
in an increased serum acyclovir level.
5. A. Docosanol is an over-the-counter topical antiviral agent
that should be applied in the early stages of herpes labialis.
6. C. Ganciclovir should be administered following dialysis.
Administration before dialysis would result in the medication being dialyzed out of the body.
7. A. Valganciclovir should be administered while consuming
a high-fat diet.
8. B. Nasal faring is indicative of severe alterations in the
infant’s pulmonary function.
9. C. Te nurse should discard the SPAG-2 unit to prevent
pulmonary complications.
10. D. Neuraminidase is the viral enzyme that is inhibited by
oseltamivir.
11. D. People with asthma should not take zanamivir because
of the risk of bronchospasm.
12. B. Te most severe adverse efect of lamivudine is pancreatitis. If the man develops severe upper abdominal pain, it
could be a sign of pancreatitis, and it is necessary to notify
the primary health care provider.
13. C. Te development of the clinical manifestations of muscle
pain and fatty stools is indicative of lactic acidosis and steatosis. Tese conditions are adverse efects of lamivudine.
14. B. An infant born of a mother infected with HIV should be
administered zidovudine within 6 to 12 hours afer birth.
15. B. Infants born to mothers whose viral load (number
of HIV RNA particles within the blood) is signifcantly
below normal should receive zidovudine combined with
nevirapine.
Frandsen12e9781975136130-appA.indd 9
1. B. A client with breast cancer who is being treated with
cytotoxic chemotherapy agents is at greatest risk for developing a systemic fungal infection.
2. D. Histoplasmosis is a common infection that occurs due
to exposure to spores while remodeling old buildings.
Histoplasmosis develops when the spores are inhaled into
the lungs and rapidly develop into the tissue-invasive yeast
cells that reach the bloodstream, which are distributed
throughout the body.
3. C. Allergic bronchopulmonary aspergillosis is an allergic reaction to inhaled Aspergillus spores in people with
asthma. Tese spores are found in hot water faucets, saunas, hot tubs, and swimming pools.
4. A. Amphotericin B is administered for meningitis infections of cryptococcosis.
5. D. Aspirin is administered with amphotericin B to decrease
the symptoms of chilling, fever, nausea, malaise, and generalized discomfort.
6. C. Te administration of fuconazole and phenytoin
increases the serum levels of phenytoin, predisposing the
client to phenytoin toxicity. Tis occurs because fuconazole interacts with cytochrome P-450 enzymes to produce
a signifcant interaction, decreasing phenytoin metabolism
and increasing the risk of toxicity.
7. B. It is necessary to call the prescriber and inform him or
her that the maximum dosage of fuconazole is 200 mg/h IV.
8. A. A full dose of fuconazole should be administered afer
the dialysis treatment.
9. D. An elevated alanine aminotransferase (200 unit/L)
is indicative of hepatotoxicity that is related to hepatic
necrosis.
10. C. It is necessary to administer oral fuconazole to a client
on a full stomach or with food to prevent gastric upset.
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Appendix A • Answers for NCLEX Success
11. A. It is essential that intravenous caspofungin be administered only in normal saline solution and never with
dextrose.
12. B. Caspofungin should be administered in 250 mL of normal saline over 1 hour.
13. B. Griseofulvin is best absorbed when administered with a
high-fat meal.
14. D. A client with a known allergy to penicillin should not
receive griseofulvin due to a cross-reaction between penicillins and griseofulvin.
15. D. Amphotericin B and fucytosine are administered
together to enhance the efectiveness of treatment.
CHAPTER 25
1. D. Te emergency department should suspect that the
swimming pool is contaminated with Giardia.
2. D. Te nurse should teach a woman to avoid sexual
intercourse.
3. C. Te man will experience fushing, which is a disulfram
response. Te preparation of prescription cough syrup contains alcohol.
4. A. Te nurse should assess the client for decreased diarrhea
and abdominal pain.
5. A. Primaquine
chemoprophylaxis.
is
administered
for
malarial
6. B. A person who takes chloroquine should have frequent
ophthalmologic examinations due to possible decrease in
visual acuity.
7. A. Enterobius vermicularis is a pinworm that causes the
most common parasitic worm infection in the United
States.
8. B. Phenytoin decreases serum levels of mebendazole.
9. A. Permethrin inhibits the infux of sodium ions through
the nerve cell membranes channels of the parasites to delay
repolarization. Tis action results in the paralysis or death
of the scabies.
10. B. It is necessary to apply spinosad to dry scalp and keep on
for 10 minutes before rinsing.
CHAPTER 26
1. B. All angiotensin-converting enzyme inhibitors can commonly cause a nonproductive cough and a tickling in the
throat. Approximately 10% to 20% of clients experience
this minor but annoying side efect. Te cough resolves
when the drug is discontinued.
2. D. Following lifestyle modifcations, Te Joint National
Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC 7) recommends initial treatment with a thiazide diuretic if there are no coexisting diseases or complications.
3. A, B, and C. Because hyperkalemia is an adverse efect
of angiotensin-converting enzyme inhibitors, the nurse
should instruct clients not to use potassium supplements
or salt substitutes containing potassium without consulting
the prescriber.
Frandsen12e9781975136130-appA.indd 10
4. A, C, and D. Drugs that act directly on the renin–angiotensin system, including angiotensin II receptor blockers
(ARBs), angiotensin-converting enzyme (ACE) inhibitors,
and direct renin inhibitors, can cause injury and death to
a developing fetus. Calcium channel blockers are in pregnancy category C. Tere is a chance of fetal harm if the
drug is administered during pregnancy, but the potential
benefts may outweigh the potential risk.
5. A and B. Taking the dose at bedtime decreases the frequency of ambulation and the upright position. Changing
position slowly decreases the occurrence of postural hypotension. A variety of lifestyle modifcations to decrease the
risk of falls should also be addressed by the nurse.
6. D. ARBs, ACE inhibitors, and beta-blockers are less efective as monotherapy in African Americans. Overall, African
Americans are more likely to have severe hypertension and
require multiple drugs as a result of having low circulating
renin, increased salt sensitivity, and a higher incidence of
obesity.
7. C. Nitroprusside is a potent vasodilator that decreases
peripheral vascular resistance. Te drug is given by continuous intravenous (IV) infusion and requires continuous
blood pressure monitoring, most efectively by intra-arterial monitoring.
8. A. Te nurse should ensure that serum thiocyanate levels
are measured if nitroprusside is given longer than 72 hours
because it is metabolized to thiocyanate. Hemodialysis can
reverse the symptoms of thiocyanate toxicity (e.g., nausea,
vomiting, muscle twitching or spasm, seizures). It is necessary to stop the infusion afer 72 hours if the serum thiocyanate level is more than 12 mg/dL; stoppage should occur
at 48 hours in renal impairment.
CHAPTER 27
1. A. Te serum level of quinidine is elevated (therapeutic
serum levels: 2–6 mcg/mL), and levels greater than 6 mcg/
mL are toxic. Te provider should be notifed immediately.
Monitoring urine pH may be warranted because alkaline
urine decreases renal excretion of quinidine, and serum levels
can increase. Te most common adverse efects of quinidine
are tinnitus, vomiting, severe diarrhea, vertigo, and headache.
2. C. Lidocaine goes through extensive frst-pass efect in the
liver, making oral dosages inefective. Afer intravenous
(IV) administration of a bolus dose, therapeutic efects
occur rapidly, within several minutes. It is important to
check that the solution of lidocaine does not contain epinephrine. Solutions of lidocaine with epinephrine are used
for local anesthesia but not for IV administration.
3. A. Clinical use of class III agents is increasing because they
are associated with less ventricular fbrillation, more relief
of symptoms, and decreased mortality compared with class
I drugs.
4. D. Amiodarone is highly lipid soluble, and the drug and
its metabolites accumulate in the liver, lung, fat, skin, and
other tissues. With IV administration, the onset of action
usually is within several hours. With oral administration,
the onset of action may be delayed from a few days up to a
week or longer. However, because of the long serum half-
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Appendix A • Answers for NCLEX Success
life of amiodarone, loading doses are ofen given; higher
loading doses can reduce the time required for therapeutic
efects. Low doses (100–200 mg/d) may prevent recurrence
of atrial fbrillation with less toxicity than higher doses.
CHAPTER 28
1. B, C, and D. Nonmodifable risk factors for the development of CAD include age, gender, ethnicity, and genetics.
Modifable risk factors are smoking, hypertension, obesity,
diabetes mellitus, and physical inactivity.
2. C. Variant angina (also called Prinzmetal’s or vasospastic
angina) occurs at rest or with minimal exertion, ofen at
night, and at the same time each day. Conditions that precipitate vasospasm include exposure to cold, smoking, and
emotional stress.
3. D. Clients taking one or more antianginal drugs in longacting formations such as discs should carry or have
administered a drug in short-acting formation as well to
be used for acute attacks. To minimize tolerance to hemodynamic efects afer prolonged use, it is necessary to use
the lowest efective dose and an intermittent dosage schedule. High-dose uninterrupted treatment causes tolerance to
the vasodilating efects of the drug, and although tolerance
reduces adverse efects, the therapeutic efects decrease,
and short-acting nitrates may be less efective at relieving
acute pain.
4. C. It is necessary to rotate application sites because the ointment can irritate the skin. Te drug is not as well absorbed
from distal portions of the extremities because of decreased
blood fow, and sites of application include nonhairy parts
of the upper body. It is necessary to wipe of previous ointment prior to applying a new dose.
5. C. Nitrates and phosphodiesterase enzyme type 5 inhibitors decrease blood pressure. Concurrent use of nitrates in
any form or route of administration is contraindicated with
phosphodiesterase enzyme inhibitors because the combination may potentiate severe hypotensive efects.
6. A. Headache is an anticipated adverse efect from the venodilation that occurs with nitroglycerin. Te headache is
commonly relieved with acetaminophen.
7. A, B, and C. It is necessary to replace nitroglycerin every 6
months or when there is question about the drug’s potency.
For instance, if the tablet does not sting when placed under
the tongue, a fresh bottle may be required. Te nurse
should instruct the client to keep the drug in the original
dark container because the drug can break down on exposure to light. Te recommended dose is one tablet sublingually every 5 minutes, up to three tablets.
8. A. Smoking reduces the efcacy of beta-adrenergic blockers.
Nicotine increases heart rate and blood pressure, decreases
delivery of blood and oxygen to the heart, increases the
risk of life-threatening dysrhythmias, and increases platelet
adhesion and aggregation, promoting clot formation.
9. A. Te nurse needs to teach the client that when a betablocker is being discontinued afer prolonged use, it should
be tapered in dosage and gradually discontinued, or
rebound angina can occur.
Frandsen12e9781975136130-appA.indd 11
11
10. D. Clients taking ranolazine should not take it with grapefruit juice, which afects hepatic enzymes. Tey may take
the drug with or without meals, should not crush the tablets, and may take it with beta-adrenergic blockers.
11. B. Beta-adrenergic blocks inhibit chronotropic, inotropic,
and vasoconstrictor responses to catecholamines, epinephrine, and norepinephrine.
12. C and D. Expected outcomes include absence of bleeding
complications and a 12-lead ECG, which shows a decrease
in ST-segment elevations by 50% of initial height.
CHAPTER 29
1. A and C. Giving a drug with beta1 agonist activity causes
an increased force of cardiac contraction, increased speed
of electrical conduction, increased heart rate, increased
blood pressure, and increased renin production.
2. A. Adrenergic medications may increase blood glucose
levels.
3. C. Te extravasation of dopamine can cause local tissue
damage at the insertion site when using a peripheral vein.
If extravasation confrmed, the provider should be notifed, and diluted phentolamine should be injected into the
area with a small-gauge hypodermic needle as soon as possible to prevent sloughing and necrosis of the tissue, and a
new infusion site should be secured to continue dopamine
administration. Assess blood pressure frequently if resuming the dopamine infusion is delayed.
4. C. Dobutamine acts on beta1 receptors in the heart to
increase the force of myocardial contraction with a minimal increase in heart rate.
5. C. In hypovolemic shock, adrenergics are second-line
agents that may be used if adequate fuid volume replacement does not restore sufcient blood pressure and circulation to maintain organ perfusion.
6. D. Confrming the blood pressure with a manual blood
pressure reading will verify the accuracy of the blood pressure from the arterial line, which will determine the appropriate next step.
7. B. In distributive shock, the main defcit lies in peripheral
circulation, with decreased systemic vascular resistance,
altered oxygen extraction, but constant blood volume.
Characteristic in hypovolemic shock is decreased blood
volume, which leads to low cardiac output and inadequate
oxygen transport.
8. B. Anaphylactic shock, which is due to massive vasodilation caused by release of histamine in response to a severe
allergic reaction, is a form of distributive shock.
CHAPTER 30
1. D. It is important to assess the liver enzymes because an
elderly client with right-sided heart failure is at risk for
developing a hypoxic liver injury. In addition, most medications are metabolized in the liver. Any elevation in the
liver enzymes places the elderly client at risk for medication
toxicity due to inadequate metabolism of the medications.
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12
Appendix A • Answers for NCLEX Success
2. A. A client who has had an acute myocardial infarction is
at risk for developing lef-sided heart failure. If the client
takes nonsteroidal anti-infammatory agents, such as ibuprofen routinely, this may increase the risk of developing
lef-sided heart failure due to the retention of sodium.
3. D. Digoxin decreases the heart rate to increase myocardial contractility and output. If the client’s heart rate is less
than 60 beats/min, the digoxin should be withheld and the
health care provider should be notifed due to potential
toxicity.
4. A. Negative chronotropic efects are probably caused by
several factors. First, digoxin has a direct depressant efect
on cardiac conduction tissue, decreasing the number of
electrical impulses that are allowed to reach the ventricles
from supraventricular sources. Second, digoxin indirectly
stimulates the vagus nerve. Increased efciency of myocardial contraction and vagal stimulation decreases compensatory tachycardia, which results from the sympathetic
nervous system response to inadequate circulation.
5. A. A creatinine level of 2.0 mg/dL is indicative of impaired
renal function. Impaired renal function requires the dosage
of digoxin to be reduced to prevent toxicity.
6. C. Te development of premature ventricular contractions
in a client who is being digitalized is a sign of developing
digitalis toxicity.
7. D. A client who is being treated for hypothyroidism has
a decreased metabolic rate. A decreased metabolic rate
places the client at risk for digitalis toxicity.
8. A. Milrinone lactate causes vasodilation by relaxing the
vascular smooth muscle. In addition, milrinone lactate
increases the force of contraction of the ventricles by inhibiting phosphodiesterase, an enzyme that metabolizes cyclic
adenosine monophosphate (cAMP). Increased cAMP in
the myocardial cells enhances myocardial contractility by
relaxing the cardiac smooth muscle.
9. A. If a client receiving milrinone lactate experiences a signifcant decrease in blood pressure, the infusion rate should
be reduced, and then the physician should be notifed.
10. D. Because furosemide is potassium-depleting, a potassium-rich, low-sodium diet is recommended, and the nurse
should instruct the patient on symptoms of hypokalemia
such as weakness, fatigue, muscle cramps, and palpitations.
11. A. Enalapril maleate is teratogenic and can cause birth
defects or fetal demise. Because this client is of childbearing
age, she should be instructed to use efective contraception.
12. D. Angiotensin II receptor blockers, such as losartan potassium, block the renin–angiotensin II system to decrease
vasoconstriction and allow for increased myocardial
output.
13. B. Limiting dietary sodium decreases fuid volume and
assists in decreasing edema.
CHAPTER 31
1. A. Adrenergic drugs relieve nasal congestion and swelling
by constricting arterioles and reducing blood fow to nasal
mucosa.
Frandsen12e9781975136130-appA.indd 12
2. C. Oxymetazoline is only for short-term use because
rebound nasal swelling can occur with excessive or
extended use.
3. A, B, C, and D. Te FDA label for the use of prescription
opioid cough and cold medications in children younger
than 18 years of age warns of all of the concerns in that
population.
4. A. Mucolytics are administered by inhalation to liquefy
mucus in the respiratory tract. Sodium chloride solution
and acetylcysteine are ofen used as mucolytics.
5. B. Cold remedies referred to as “nondrowsy” or “daytime”
formulas contain a nasal decongestant but do not contain
an antihistamine. Tose preparations referred to as “p.m.”
or “night” formulas contain a sedating antihistamine to
promote sleep.
6. B. For those adults who regularly take vitamin C, it appears
that the vitamin plays a role in the defense mechanisms of
the respiratory system. Tere is not agreement that vitamin
C shortens the duration of colds and alleviates its symptoms in adults, although clinical trials with adults have
been partially positive.
CHAPTER 32
1. B. Diphenhydramine is indicated in adults to prevent or
treat allergic reactions. Confusion (with impaired thinking,
judgment, and memory), dizziness, hypotension, sedation,
syncope, unsteady gait, and paradoxical central nervous system stimulation can occur with administration of diphenhydramine in older adults. Tese efects, especially sedation,
lend themselves to misinterpretation as senility or mental
depression. Older men with prostatic hypertrophy may have
difculty voiding while taking these drugs. Te drug is not
recommended for use in newborn infants (premature or
full term) or children with chickenpox or a fu-like infection. When used in young children, doses should be small
because of drug efects on the brain and nervous system.
2. C. Epinephrine, rather than an antihistamine, is the drug of
choice for treating severe anaphylaxis.
3. A, B, and C. Antihistamines are efective in inhibiting vascular permeability, and they also reduce edema formation
and pruritus associated with histamine release. Tey do not
prevent histamine release or reduce the amount released.
4. D. Second-generation H1 antagonists (also called selective
or nonsedating agents) were developed mainly to produce
less sedation than the frst-generation drugs. Tey cause
less central nervous system depression because they are
selective for peripheral H1 receptors and do not cross the
blood–brain barrier.
5. B. For treatment of the common cold, studies have demonstrated that antihistamines do not relieve symptoms and
are not recommended.
CHAPTER 33
1. B. Prescribers ofen order beclomethasone, a steroid inhalant medication, concomitantly with one or more bronchodilators, such as albuterol, and clients may take these drugs
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Appendix A • Answers for NCLEX Success
with another anti-infammatory drug, such as a leukotriene
modifer or a mast cell stabilizer. It is necessary to use the
inhaled bronchodilator frst followed by the steroid inhalant medication. Te bronchodilator increases the lumen
of the bronchial tree, which subsequently increases the
amount of steroid reaching the distal lung felds.
2. A. A serum theophylline level of 25 mcg/mL is at a toxic
level. Te nurse should hold the dose and notify the health
care provider. Serious adverse efects frequently occur at
this serum drug level, including anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other
dysrhythmias, and tonic–clonic convulsions. Ventricular
dysrhythmias or convulsions may be the frst sign of toxicity.
3. D. Cigarette smokers usually need higher doses to maintain
therapeutic blood levels because they metabolize theophylline rapidly. When clients stop smoking, metabolism of
the drug decreases, and less drug is necessary to maintain
therapeutic levels.
4. C. Proper technique ensures that the drug is distributed
into the lower airway. While pressing down on the inhaler,
the client should take a slow, deep breath for 3 to 5 seconds,
hold the breath for approximately 10 seconds, and exhale
slowly.
5. A, C, and D. Local adverse efects with use of a steroid
inhaler (oropharyngeal candidiasis, hoarseness) can be
decreased by reducing the dose, administering the drug less
ofen, rinsing the mouth afer use, or using a spacer device.
Tese measures decrease the amount of drug deposited in
the oral cavity.
6. B. Montelukast is a leukotriene receptor antagonist. By
blocking leukotrienes, it blocks bronchoconstriction and
infammation. Leukotriene-modifer drugs, such as montelukast, help prevent asthma attacks but are not helpful in
relieving an acute attack.
CHAPTER 34
1. D. Adverse efects of furosemide include fuid and electrolyte imbalances (e.g., hyponatremia, hypokalemia, fuid
volume defcit) and ototoxicity. Ototoxicity, which is associated with high plasma drug levels (greater than 50 mcg/
mL), is the adverse efect that can usually be avoided by
administering intravenous push orders slowly.
2. A. Te lack of crackles on auscultation of the lungs indicates the absence of fuid in the lung felds, a desired fnding. All other responses indicate the potential for continued
fuid overload.
3. C. Concomitant use of hydrochlorothiazide with an oral
hypoglycemic agent can result in decreased efects of the
oral antidiabetic with resultant hyperglycemia.
4. B. Loop diuretics are efective in clients with renal impairment. However, in chronic renal failure, they have lower
peak concentrations at their site of action, which decreases
diuresis. Renal elimination of the drugs is also prolonged.
If renal dysfunction becomes more severe during treatment (as demonstrated by oliguria or increases in blood
urea nitrogen or creatinine), the diuretic may need to be
discontinued.
Frandsen12e9781975136130-appA.indd 13
13
5. A, C, and D. Spironolactone is a potassium-sparing
diuretic. Clients should limit the amount of potassium
being ingested from food or supplements. Salt substitutes
typically contain half sodium and half potassium, which
can result in high potassium levels for someone on a potassium-sparing diuretic. Te patient should call the nurse
practitioner if experiencing any signifcant adverse efects
from the medication.
6. B. Tiazides are diuretic drugs that are chemically related
to the sulfonamides. Tere is a known cross-sensitivity
of some sulfonamide-allergic clients to a sulfonamide
nonantibiotic.
CHAPTER 35
1. A. Liver disease may decrease the production of bile, which
is necessary for the absorption of fat-soluble vitamins.
Answer B results in a vitamin excess, answer C is not a
factor in vitamin defciency, and answer D results in iron
excess.
2. B. Vitamin A, a fat-soluble vitamin, is stored in the body
and can rise to toxic levels. Answers A, C, and D are all
water-soluble vitamins, which are rapidly eliminated from
the body.
3. A. Excess doses of vitamin A during pregnancy are teratogenic. Te other clients represent situations where vitamin
A administration is therapeutic.
4. D. Vitamin K decreases the anticoagulant efect of warfarin. Tis vitamin has no efect on aspirin, enoxaparin, or
heparin. Te antidote for heparin is protamine sulfate.
5. A. Vitamin K occurs in the vegetables spinach, brussels
sprouts, and broccoli. Te foods in answers B, C, and D
represent sources of other vitamins.
6. C. Pernicious anemia is caused by conditions in which the
gastric mucosa secretes insufcient amounts of intrinsic
factor, which is needed for absorption of vitamin B12 from
the gut. Oral vitamin B12 would not be absorbed, so the
drug must be given intramuscularly.
7. B. Iron supplements cause stools to dark green or black in
color. Answer A is not correct because adverse efects of
iron can include either diarrhea or constipation, answer C
is incorrect because an antacid will decrease absorption of
iron, and answer D is incorrect because fruit juice, which
contains vitamin C, will increase iron absorption and is
recommended for administration of oral iron preparations.
8. C. Te reticulocyte count measures the number of immature red blood cell in the circulation. Normally, there are
few; as anemia improves, the reticulocyte count returns to
normal. Answers A, B, and D are laboratory studies that do
not provide information on the progress of iron therapy.
9. B. Hypokalemia increases the risk of digoxin toxicity.
Hyperkalemia decreases digoxin efectiveness. Iron levels
are not related to digoxin toxicity.
10. D. Spironolactone is a potassium-sparing diuretic; concurrent use of oral potassium puts the client at risk for hyperkalemia. Te other drugs are diuretics, which decrease
potassium and require a potassium supplement.
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14
Appendix A • Answers for NCLEX Success
11. A. Angiotensin-converting enzyme inhibitors promote
potassium retention; concurrent use of a potassium supplement may result in hyperkalemia. Te other three drug
classes do not pose a risk of hyperkalemia when taken with
potassium.
drug–metabolizing system; therefore, they do not interfere
with the metabolism of other drugs. Tey are safer to use
in clients who are on multiple medications, especially those
who are known to be metabolized by the same cytochrome
P-450 system and those with narrow therapeutic windows.
12. D. Flushing with water ensures delivery of all crushed drug
and prevents clogging of the tube. Answer A is incorrect;
tube placement should be checked prior to administration,
answer B is incorrect because the head of the bed should
remain raised to prevent aspiration, and answer C is incorrect because immediate resumption of feeding may interfere with drug absorption.
2. C. Calcium- and aluminum-based antacids have the
adverse efect of constipation, whereas Mylanta, a magnesium-based antacid, has the adverse efect of diarrhea.
13. A. Administration prior to the feeding ensures that feeding
does not interfere with drug absorption. Te time is still
within 30 minutes of the scheduled time.
CHAPTER 36
1. B. Phentermine is an appetite suppressant with efects
thought to be due to direct stimulation of the satiety center
in the hypothalamic and limbic region.
2. A. People with diabetes mellitus may require increased
doses of insulin while taking phentermine because the
drug produces efects similar to those caused by stimulating the sympathetic nervous system.
3. D. Taken with meals, orlistat binds to gastric and pancreatic lipases in the gastrointestinal tract and can block the
absorption of 30% of ingested fat; increasing dosage does
not increase this percentage.
4. A. Encourage people to distribute fat calories over the three
main meals and to avoid high-fat meals to minimize the
gastrointestinal efects of abdominal pain, oily spotting,
fecal urgency and incontinence, fatulence with discharge,
fatty stools, and diarrhea.
5. C. Low-calorie diets provide 1200 to 1600 kcal/d. Te usual
recommendation is to reduce caloric intake by 500 to 1000
cal daily, to allow weight loss of 1 to 2 pounds weekly. Tis
rate of loss is likely to be more successful in terms of weight
loss, and continuing a reduced-calorie diet promotes
weight maintenance rather than weight regain.
6. C. Te National Heart, Lung, and Blood Institute (NHLBI)
of the National Institutes of Health and most other organizations generally recommend reserving drug therapy
for those with a body mass index, or BMI, of 30 kg/m2 or
greater and health problems (e.g., hypertension, dyslipidemia, coronary heart disease, type 2 diabetes, sleep apnea)
that are likely to improve with weight loss. Drug therapy
should be considered in conjunction with healthy eating
and an exercise program.
CHAPTER 37
1. A. A major disadvantage of cimetidine is that it inhibits
the cytochrome P-450 drug–metabolizing system in the
liver, decreasing hepatic metabolism of numerous other
drugs, including warfarin, thereby increasing blood levels
and risks of toxicity. Other histamine2 receptor antagonists,
such as ranitidine, do not afect the cytochrome P-450
Frandsen12e9781975136130-appA.indd 14
3. C. Sucralfate requires an acid pH for activation and should
not be given with an antacid, histamine2 receptor antagonist, or proton pump inhibitor because it may bind other
drugs and prevent their absorption. Sucralfate should be
given 2 hours before or afer other drugs and before meals.
4. C. Misoprostol is a synthetic form of prostaglandin E
approved for concurrent use with nonsteroidal antiinfammatory drugs (NSAIDs) to protect gastric mucosa
from NSAID-induced erosion and ulceration. Misoprostol
can cause abdominal cramps and miscarriage in pregnant
women.
5. A, C, D, and E. Common adverse efects of cimetidine
include diarrhea, dizziness, drowsiness, headache, confusion, and gynecomastia.
CHAPTER 38
1. A. Antiemetic drugs are used to prevent or treat nausea and
vomiting, but they are more efective in prophylaxis than
treatment.
2. A. Anticholinergics such as scopolamine and antihistamines such as dimenhydrinate and meclizine are the
drugs of choice for motion sickness–induced nausea.
Phenothiazines such as prochlorperazine are usually efective in preventing or treating nausea and vomiting induced
by drugs, radiation therapy, surgery, and most other stimuli, but they are usually inefective in motion sickness.
3. B. Clinical studies show corticosteroids such as dexamethasone increase the efectiveness of 5-HT3 receptor antagonists in controlling chemotherapy-induced nausea and
vomiting. Tey are commonly used in the management of
chemotherapy-induced emesis and postoperative nausea
and vomiting.
4. D. People with chronic health conditions, particularly diabetes, should seek medical assistance with symptoms of
vomiting. Few over-the-counter medications should be
taken without input from the health care provider. Only
dimenhydrinate and phosphorated carbohydrate solution
are available over the counter. Phosphorated carbohydrate
solution contains fructose, and clients with diabetes mellitus should be aware that serum glucose levels may increase
with its use.
5. B, C, and E. Dronabinol is a synthetic cannabinoid
approved for nausea and vomiting related to chemotherapy in people with cancer and as an appetite stimulant
in patients with AIDS. Adverse efects with dronabinol
include drowsiness, paranoia, or euphoria. Te drug has a
high potential for abuse and may cause withdrawal symptoms when abruptly discontinued.
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Appendix A • Answers for NCLEX Success
CHAPTER 39
1. A, C, and D. A high-fber, not a low-residue, diet is recommended to add bulk to stool and stimulate GI motility. Increasing exercise, maintaining adequate fuids, and
establishing regular bowel habits will all help promote
healthy bowel function.
2. D. Bulk-forming laxatives such as methylcellulose and
psyllium are contraindicated for clients with dysphagia
because they may cause obstruction. Clients with dysphagia are also not good candidates for bulk-forming laxatives,
because they may have decreased fuid intake secondary to
their dysphagia. Mineral oil in oral formation is contraindicated for these clients because it may be aspirated leading
to a lipid pneumonia. Docusate sodium is the safest choice
for this client.
3. B. Laxatives are contraindicated in the presence of undiagnosed abdominal pain and distention, which may indicate acute pathology such as an infamed organ. In the case
of appendicitis, laxatives are contraindicated because they
may lead to rupture of the appendix, with contents spilling
into the abdominal cavity causing life-threatening peritonitis. Laxatives are appropriate for the cancer client because
narcotics are ofen prescribed and may lead to constipation.
Laxatives are usually part of the preparation for a colonoscopy. Laxatives are ofen needed in clients with decreased
activity such as those with Parkinson’s disease to stimulate
bowel function.
4. A and B. Health care providers commonly give polyethylene glycol–electrolyte solution and bisacodyl to evacuate
the colon in preparation for a colonoscopy.
5. B. Magnesium hydroxide increases osmotic pressure in the
intestinal lumen and causes water to be retained.
CHAPTER 40
1. B. Clear liquids and bland foods are appropriate in the diet
of a young child who has diarrhea to replace fuid and electrolytes lost in the stool. Encouraging no fuids is very dangerous, especially in children, where the fuids lost through
diarrhea must be replaced. Milk may actually worsen
symptoms in those with lactose intolerance.
2. C. It is necessary to withhold the antibiotic and notify the
provider immediately. Clients who are receiving antibiotic
therapy may develop a serious complication called pseudomembranous colitis, or antibiotic-associated colitis due
to suppression of normal fora in the colon with resultant
proliferation of anaerobic Clostridium difcile organisms.
Tis superinfection produces symptoms of fever, abdominal pain, and diarrhea containing blood, mucus, and pus.
Treatment involves discontinuing the causative antibiotic
and changing therapy to metronidazole or vancomycin.
3. B. Diphenoxylate contains atropine, which causes pupil
dilation and closure of the fltration angle of the eye. In the
presence of undiagnosed glaucoma, this drug could lead to
increased intraocular pressure and eye pain. It is necessary
to discontinue the drug and notify the client’s provider of
the eye pain immediately.
Frandsen12e9781975136130-appA.indd 15
15
4. C. People with an allergy to aspirin and aspirin products
should not take bismuth subsalicylate because the drug
contains aspirin.
CHAPTER 41
1. A, C, and D. Te characteristics of metabolic syndrome are
high low-density lipoprotein (LDL) cholesterol and total
cholesterol, low HDL, increased blood pressure, impaired
glucose values, and abdominal obesity.
2. D. In diabetic ketoacidosis, the arterial pH is less than 7.35,
plasma bicarbonate is less than 15 mEq/L, blood glucose is
usually higher than 250 mg/dL, and ketones are present in
the urine. Te client also usually has Kussmaul’s respirations.
3. B. Te insulin begins to work in 1 to 1½ hours, and its peak
of action occurs in 4 to 12 hours, the most likely time a client will experience hypoglycemia.
4. C. Lipodystrophy (hypertrophy of subcutaneous tissue at
the injection site) can occur when the clients uses the same
injection sites. Hypertrophied tissue can afect the amount
or degree to which subcutaneous insulin is absorbed and
thereby afect blood glucose levels.
5. B. Te short-acting insulin (clear) should always be drawn
up frst because the intermediate-acting insulin (cloudy) can
inversely afect the short-acting insulin if mixed in the vial.
6. D. Insulin glargine is the only insulin not available for use
in a continuous insulin pump because its pharmacokinetics does not match that of the human body; this insulin has
a delayed absorption and a prolonged duration of action.
Tis form of insulin is used solely for injectable use only.
7. D. Te physician should be contacted for a presurgery order
because the client is not allowed to eat prior to surgery; this
should prevent a possible hypoglycemic reaction from the
insulin. Also, the client is likely to have high glucose levels the day of surgery due to the additional emotional and
physical stress of surgery.
8. B, C, and D. A decrease in polyuria, polyphagia, and a fasting blood glucose of 108 mg/dL are indicative of therapeutic outcomes of glyburide.
9. C. Hyperglycemic hyperosmolar nonketotic syndrome is
diferentiated from diabetic ketoacidosis by the absence of
ketones in the urine.
10. D. Because a heart catheterization procedure uses contrast
media, which places a stress on the kidneys, metformin,
which is also excreted in the kidneys unchanged, should be
stopped 48 hours prior to the procedure to prevent lactic
acidosis.
11. C. Hyperglycemic hyperosmolar nonketotic syndrome is
seen in clients with type 2 diabetes. Symptoms may include
polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness.
12. B. Symptoms of hypoglycemia include sweating, tremor,
tachycardia, inability to concentrate, slurred speech, and
drowsiness.
13. D. Clients should always take sitagliptin in the morning to
provide the best beneft.
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16
Appendix A • Answers for NCLEX Success
14. D. Lipodystrophy occurs when the same injection sites are
used, and it can afect the degree and amount of insulin
absorbed. Terefore, the nurse teaches the client to rotate
injection sites.
15. D. Pramlintide has a rapid onset of action, and the client
should be fed a meal immediately afer the medication is
administered.
16. A. Te most appropriate intervention is to address the client’s
feelings related to anxiety using therapeutic communication.
17. D. A podiatrist should cut only the toenails. Clients with
diabetes are more prone to have injuries on the feet that do
not heal well because decreased circulation and increased
blood glucose levels make injuries less likely to heal.
18. D. In diabetic ketoacidosis, blood glucose is elevated,
plasma bicarbonate is decreased, and ketones are present
in the urine.
19. B. Prednisone can decrease the efect of oral hypoglycemic
medications, insulin, diuretics, and potassium supplements.
CHAPTER 42
1. C. Women older than 60 years of age with a thyroid-stimulating hormone level below 0.1 mcg/L and a normal T3 and
T4 are at risk for developing atrial fbrillation.
2. A. A child with poor growth and development along with
slow pulse and subnormal temperature should be assessed
for cretinism.
3. B. A client treated with amiodarone has the potential of
developing thyroiditis.
4. B. Propranolol is administered as an adjuvant agent for the
control of blood pressure in clients with hyperthyroidism.
5. C. Propranolol blocks the beta-adrenergic in various organs
to control the symptoms of hyperthyroidism.
6. D. A client taking propylthiouracil (PTU) who develops a
sore throat and fever has also developed agranulocytosis.
7. A. Administration of levothyroxine should take place every
morning before breakfast on an empty stomach.
8. B. Assessment of the client’s heart rate should occur prior to
the administration of levothyroxine. If the heart rate is greater
than 100 beats/min, it is important to notify the prescriber.
9. D. A client who is being treated with levothyroxine and develops an audible S3, crackles in the lower lobes, edema of the
lower extremities, and a heart rate of 120 beats/min is sufering from heart failure—most commonly related to hyperthyroidism. Te dosage of the levothyroxine needs to be altered.
10. D. Oral contraceptives combined with levothyroxine cause
estrogens to increase thyroxine-binding globulin, thereby
increasing the amount of bound, inactive levothyroxine in
clients with hypothyroidism.
11. D. A thyroid stimulating hormone (TSH) is appropriate
laboratory test to assess thyroid function.
CHAPTER 43
1. C. Stress, in the form of anticipation of an examination,
leads to the release of corticotropin.
Frandsen12e9781975136130-appA.indd 16
2. A. Antidiuretic hormone regulates water balance. It raises
blood volume and arterial blood pressure in response to the
injury and shock.
3. A. An adult with decreased growth hormone has increased
cholesterol.
4. B. Grandmothers who are postmenopausal and have prescribed estrogen cream should keep it out of a child’s reach
because it may cause precocious puberty in girls if it is
absorbed topically.
5. D. It is important to evaluate the girl for diabetes insipidus; the development of nocturnal enuresis in a child who
is potty trained following a head injury should prompt this.
6. D. Erectile dysfunction in men diagnosed with acromegaly
can lead to psychosocial distress.
7. D. Te child’s insulin needs will increase because of the
increased risk of hyperglycemia with somatropin.
8. B. She will not need the somatropin when she stops growing.
9. C. When administering desmopressin to a child, the nurse
will most likely need to blow in the tube to administer the
medication.
10. A. Te most important electrolyte to be assessed afer the
administration of desmopressin is the sodium level to rule
out hyponatremia, which may lead to seizures.
11. A. When administering octreotide, it is necessary to
alternate the injection sites ofen and use the same ones
infrequently.
12. B. Te combination of chloroquine and octreotide may lead
to a drug interaction. Te man is at risk for a prolonged QTc,
leading to a ventricular dysrhythmia and cardiac arrest.
CHAPTER 44
1. A. Te nurse should administer the tetracycline at least 2
hours before or afer meals.
2. A. It is essential to monitor clients receiving calcium intravenously for cardiac dysrhythmias.
3. D. Te man’s initial serum calcium is 6.8 mg/dL, a sign
of hypocalcemia. Any value less than 8.5 mg/dL indicates
hypocalcemia. Vitamin D should help raise serum calcium.
4. C. Gastrointestinal adverse efects are the most common.
5. C. It is necessary to take the drug the frst thing in the
morning with water.
CHAPTER 45
1. C. Hypotension, nausea, vomiting, and muscle weakness in a
client who has been taking enoxaparin (an anticoagulant) is
most likely experiencing a hemorrhage of the adrenal cortex.
2. B. A woman who is craving salt states she is under a great
deal of stress, and recently received treatment for pneumonia is most likely sufering from addisonian crisis. Due to
the stress and pneumonia, she has developed a defciency
in mineralocorticoids. A craving for salt is a classic symptom of addisonian crisis.
3. D. Corticotropin is in excess in clients with Cushing’s
disease.
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Appendix A • Answers for NCLEX Success
17
4. A. A low level of adrenocorticotropic hormone and a high
level of cortisol are indicative of Cushing’s disease.
2. B. Pyridostigmine extended release at bedtime allows for
increased swallowing in the morning.
5. D. Muscle weakness is indicative of hypokalemia in clients
taking fudrocortisone acetate.
3. C. Atropine should be available when diagnosing myasthenia gravis with neostigmine.
6. B. A client with hypernatremia is a candidate for fudrocortisone acetate for treatment of adrenal insufciency.
4. C. Donepezil should be taken at bedtime.
7. A. Te woman should report fever or infection to the
primary health care provider.
8. C. Prescribers order ergotamine for the treatment of
migraine headaches. Ergot derivatives are contraindicated
with the administration of ketoconazole.
9. A. A client who is being treated with mitotane for an inoperable adrenocortical carcinoma should receive a steroid in
the event of trauma and shock.
10. D. Ketoconazole is better absorbed when taken with an
acidic beverage.
CHAPTER 46
1. A, B, and C. Efects of the sympathetic nervous system
include increased arterial blood pressure and cardiac output, pupil dilation to aid vision, and increased rate and
depth of respiration.
2. A. Acetylcholine activates muscarinic receptors.
3. A. Te sympathetic nervous system is known as the fghtor-fight system.
4. A, B, and C. Drugs that have the same efects on the
human body as stimulation of the sympathetic nervous system include sympathomimetic, adrenergic, and alpha- and
beta-adrenergic drugs.
5. A and B. When chronically exposed to high concentrations of substances that stimulate their function, the beta
receptors decrease in number and become less efcient
in stimulating adenyl cyclase. Te resulting decrease in
beta-adrenergic responsiveness is called desensitization or
down-regulation of receptors.
6. A. Drugs such as terbutaline have been developed to stimulate beta2 receptors in the respiratory tract and produce
bronchodilation (a desired efect) with decreased stimulation of beta1 receptors in the heart (an adverse efect).
7. A, B, and D. Functions that are stimulated by the parasympathetic nervous system include digestion, excretion,
and anabolism.
8. A. Parasympathomimetic, cholinomimetic, and cholinergic
are used to describe a drug that has the same efects on the
body as stimulation of the parasympathetic nervous system.
9. A, B, C, and D. Activation of the parasympathetic nervous
system will result in dilation of blood vessels in the skin,
decreased heart rate, increased motility of the gastrointestinal system, and constriction of smooth muscle of bronchi.
CHAPTER 47
1. A. Bronchospasm is a serious adverse efect of neostigmine.
Nausea is not serious, but it is common. Te other conditions are not symptoms.
Frandsen12e9781975136130-appA.indd 17
5. C. A rivastigmine patch should be applied to clean, dry
skin.
6. C. Memantine hydrochloride is administered for moderate to severe Alzheimer’s disease and is most commonly
administered if donepezil decreases in efectiveness.
7. C. Atropine is an antidote for cholinergic drugs.
8. A. Bethanechol is contraindicated in clients who have been
diagnosed with hyperthyroidism.
9. C. Te nurse should assess the client’s ability to void in 1
hour afer the administration of bethanechol.
10. C. As the dose of bethanechol is increased, the client is at
risk for orthostatic hypotension.
CHAPTER 48
1. C. Parkinson’s disease is characterized by an imbalance in
the neurotransmitters, resulting in a decrease in inhibitory
brain dopamine and a relative increase in excitatory acetylcholine. Te loss of dopamine leads to more excitatory
neurotransmitters. Te “pill-rolling” tremor is the cardinal
sign of Parkinson’s disease.
2. C. Static gait is indicative of muscle tension and rigidity.
Te woman needs an increase in levodopa/carbidopa.
3. A. Orthostatic hypotension is an adverse efect of levodopa/
carbidopa. When a client reports light-headedness and dizziness, the nurse should assess the blood pressure when the
client is lying down, sitting, and standing up.
4. D. Foods such as port wine cheese are high in tyramine.
Te combination of selegiline and foods containing tyramine will result in hypertension or hypertensive crisis.
5. B. Clients who develop symptoms one to two times per
month afer receiving antiparkinson medications have “of
time” symptoms. To combat these symptoms, they take
apomorphine hydrochloride.
6. C. When a client is taking tolcapone, it is necessary to assess
for jaundice of the skin and sclera because the medication
is highly toxic to the liver.
7. D. Te nurse instructs clients who are taking tolcapone
to report tea-colored urine to the prescriber because it
is indicative of hepatotoxicity and possible fatal liver
failure.
8. C. Te priority intervention when administering levodopa/
carbidopa/entacapone is to assess for diarrhea. Te client is
at risk for drug-induced colitis.
9. B and C. Increased tremors and static gait are symptoms
indicative of Parkinson’s disease that warrant a dosage
change of levodopa/carbidopa/entacapone.
10. A. Atropine sulfate is the drug of choice for sinus bradycardia. Atropine sulfate blocks vagal stimulation that contributes to sinus bradycardia.
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Appendix A • Answers for NCLEX Success
11. D. Scopolamine transdermal is the drug of choice to
control secretions at the end of life. Trihexyphenidyl is
administered for Parkinson’s disease to control tremors.
Tolterodine is an antimuscarinic used for the treatment
of overactive bladder to control symptoms of bladder
urgency. Tiotropium bromide is administered for the treatment of bronchospasm in clients with chronic obstructive
pulmonary disease.
12. C. Physostigmine salicylate is administered as an antidote
for an anticholinergic overdose or toxicity.
13. A. By avoiding overheating and staying well hydrated, people who take benztropine may prevent hyperpyrexia.
14. C. To diminish gastrointestinal upset, the nurse should
teach the client to take the medication with food.
CHAPTER 49
1. A. Te nurse should recognize that airway, breathing, and
circulation (ABCs) are priority considerations. Respiratory
depression is the most important adverse efect to observe for
in people taking an opioid such as morphine. Additionally,
it is necessary to assess clients taking morphine for the presence of hypotension. Bowel sounds are likely to be hypoactive rather than hyperactive, urination is likely to be less
frequent, and sleep is more likely than insomnia.
2. D. Pain is what the client says it is. Te nurse should
notify the surgeon of the inability to control the client’s
pain. People who are narcotic tolerant ofen require additional opioids to manage the pain associated with surgery.
Distraction should not be used to avoid administration of
medication in clients in pain.
3. C. Nausea and vomiting are common adverse efects. Te
other comments are not associated with the adverse efects
of pentazocine.
4. C. Administering narcotics through a patient-controlled
analgesia (PCA) pump allows the client to manage his or
her pain medication. Tis method provides more efective
pain relief.
5. A, B, and E. Te patient should be administered naloxone
and oxygen, and the head of the bed should be raised to the
semi-Fowler’s position.
6. C. Naloxone is an opioid antagonist. It counteracts the
overdose.
CHAPTER 50
1. B. Bupivacaine hydrochloride by the epidural route is the
most efective method of pain relief for a client in this
situation.
2. A. Local anesthetics decrease the permeability of the nerve
cell membrane to ions, especially sodium. Tis action
reduces the excitability of cell membranes.
taste is an adverse efect.
5. D. Following dental procedures in which a client has been
administered a local anesthetic, the nurse should assess
the child’s mouth for numbness before administering pain
medication.
6. A. It is necessary to withhold food and fuid in clients who
have had a local anesthetic in the mouth or throat to prevent aspiration until full sensation returns.
CHAPTER 51
1. A and D. Increased serum creatinine, hypercapnia, hyperkalemia, muscle rigidity, and hyperthermia are symptoms indicative of malignant hyperthermia, which may
occur afer the use of isofurane or any volatile inhalation
anesthetic.
2. C. Desfurane is contraindicated in clients who have
restricted airway disease due to the development of
bronchoconstriction.
3. A. A client who is allergic to eggs should not receive propofol. Te nurse should communicate this fnding to the
anesthesia provider.
4. A. Ketamine produces sedation and analgesia. It places the
patient in a trance-like state.
5. B, C, D, and E. Te use of propofol places the patient at risk
for the development of metabolic acidosis. Triglycerides,
alkaline phosphatase, lactate, and creatinine kinase should
be monitored.
6. B. Methohexital sodium is administered for sedation in clients receiving electroconvulsive therapy (ECT) because it
is the drug of choice prior to ECT. Methohexital does not
raise the seizure threshold.
7. B and C. Succinylcholine produces muscle relaxations
and fasciculation, relaxes the vocal cords, and terminates
laryngospasm.
8. C. Because of the extensive hepatic metabolism and biliary
excretion of vecuronium, patients with signifcant hepatic
impairment such as cirrhosis or cholestasis can experience
slow elimination and prolonged muscle paralysis.
9. B and D. For a client who develops respiratory insufciency and the inability to lif his or her head, it is necessary
to frst administer high-fow oxygen. Ten, it is necessary
to notify the anesthesia provider.
CHAPTER 52
1. B. Subcutaneous sumatriptan is administered to decrease
nausea and vomiting in clients diagnosed with acute
migraine, nausea, and vomiting.
2. A. Beta-blockers are administered as preventive antimigraine medications.
3. B. Epinephrine combined with a local anesthetic prolongs
the efectiveness of the local anesthetic.
3. A. A client who is administered lithium and naproxen
sodium is at risk for lithium toxicity.
4. B and F. A client who develops anxiety afer lidocaine is
administered epidurally is at risk for local anesthetic systemic toxicity (LAST). In addition, altered taste or metallic
4. B. Te administration of aspirin, acetaminophen, and caffeine in a client who smokes decreases the efects of caffeine to treat the migraine pain.
Frandsen12e9781975136130-appA.indd 18
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Appendix A • Answers for NCLEX Success
19
5. C. Te administration of ergotamine or ergot alkaloids
can cause life-threatening cardiac changes. It is essential
to instruct the client to notify the prescriber if changes
in the cardiac status occur. Emergency assistance may be
necessary.
12. B. A patient who takes carisoprodol should receive instruction about the signs and symptoms of an idiosyncratic
reaction.
6. D. A client who is receiving long-term therapy to treat
migraine headaches with ergotamine tartrate is at risk for
cardiac valvular fbrosis.
14. D. Dantrolene is the skeletal muscle of choice for the treatment of malignant hyperthermia.
7. C. Due to the risk of vasospasm and thromboembolism,
the triptans should not be administered following a subarachnoid bleed.
8. D. A client who takes sumatriptan/naproxen along with ibuprofen is at risk for developing a gastrointestinal bleed. It is
important to instruct the client not to take any nonsteroidal
anti-infammatory drug with sumatriptan and naproxen.
9. C. A 14-year-old girl has not fnished growing. Incomplete
growth of the long bone contraindicates the administration
of estradiol.
10. A. Antiepileptic agents such as valproic acid are the safest
medications to administer to a 16-year-old child. However,
the safety and efcacy of these agents have not been established in clients younger than 18 years of age.
11. B, C, and D. Bioavailability, half-life, and peak plasma concentration are increased in older adults and in patients with
renal failure taking zolpidem due to decreases in metabolic
rate and resultant increase in drug availability. Reduced
frst-pass efect and reduced receptor site activation, not
increases, would be expected in this population.
CHAPTER 53
1. D. Te cause of the infant’s seizure is his fever. Tis is a
febrile seizure.
2. A. Magnesium sulfate is administered parenterally to prevent seizures.
3. D. A client having a seizure lasting longer than 30 minutes
is experiencing status epilepticus.
4. C. Cocaine administration
development.
can
result
in
seizure
5. B. Diazepam is administered for status epilepticus.
6. A. A client taking phenobarbital who develops a rash may
be developing Stevens-Johnson syndrome and should be
seen by the primary health care provider immediately.
7. A. Te abrupt withdrawal of clonazepam results in the
development of status epilepticus.
8. C. Valproic acid has an adverse efect of bleeding. Te frst
sign of bleeding in this client is bruising and petechiae.
9. B. If a client switches brands of phenytoin, the client is at
risk for the development of toxicity.
10. C. It is necessary to instruct the client to report the development of skin rash when administered lamotrigine. Te
U.S. Food and Drug Administration has issued a black box
warning concerning potential development of serious dermatologic reactions.
11. A. Dantrolene is a peripherally acting skeletal muscle
relaxant.
Frandsen12e9781975136130-appA.indd 19
13. C. Baclofen has an adverse efect of hyperglycemia. It is
most important to assess the client’s blood sugar.
15. C. Hard candy assists in relieving thirst related to anticholinergic efects of cyclobenzaprine.
CHAPTER 54
1. B. Tere is increased central nervous system depression
when benzodiazepines are taken with alcohol.
2. B. Caution is necessary with benzodiazepines in clients
with impaired hepatic function, so it is important to establish baseline levels of liver function tests.
3. C and E. Oxazepam is administered for the reduction of
anxiety including anxiety associated with depression. Te
drug is also used for the management of alcohol withdrawal. It does not have analgesic, antidepressant, or antipsychotic properties.
4. A. Diltiazem is a calcium channel blocker that decreases
the metabolism of alprazolam and results in free drug circulating throughout the body. Tis leads to an increase in
adverse drug efects.
5. D. Regarding the mechanism of action of benzodiazepines,
these medications potentiate the efects of gamma-aminobutyric acid, an inhibitory neurotransmitter.
6. B. Lorazepam is an appropriate choice for elderly clients,
because accumulation in the brain is small, and it is not
afected by diminished hepatic or renal function.
7. C. St. John’s wort enhances central nervous system depression when combined with chlordiazepoxide.
8. A. Zolpidem is indicated for clients who are experiencing
difculty with sleep onset as well as difculty maintaining
sleep.
9. D. Diphenhydramine is the drug of choice prior to a diagnostic test that requires a pediatric client be sedated.
10. C. Te nurse should tell the client to go to bed immediately
afer taking the medication.
CHAPTER 55
1. D. Although urinary retention, constipation, and dry mouth
are adverse efects related to the anticholinergic properties
of imipramine, orthostatic hypotension poses the greatest
safety risk to the client. Te nurse should instruct the client
to rise slowly from a lying or sitting position to a standing one. Additionally, it is necessary to avoid activities that
require changes in position until the client knows how he
or she is afected by the risk of orthostatic hypotension.
2. B. With tricyclic antidepressants (TCAs), therapeutic efects occur 2 to 4 weeks afer initiation of therapy.
Contacting the prescriber, changing the medication, tapering the medication, or increasing doses are inappropriate
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20
Appendix A • Answers for NCLEX Success
given the delayed onset of action with TCAs and the risk
of toxic efects if too much of the drug is taken. It is not
appropriate for a nurse to advise a client to take a dose that
has not been prescribed of a medication.
3. A. A potentially fatal reaction (serotonin syndrome) may
occur when monoamine oxidase (MAO) inhibitors and
selective serotonin reuptake inhibitors (SSRIs) are used
concurrently. Te MAO inhibitor should be discontinued 2
weeks before treatment when SSRIs are initiated.
4. D. MAO inhibitors are third-line agents for the treatment
of depression mainly because they may interact with some
foods and drugs to produce severe hypertension and possible heart attack or stroke. Prescribers are most likely to
order MAO inhibitors when a client does not respond to
other antidepressant drugs or when electroconvulsive therapy is refused or contraindicated.
5. C. Fluoxetine elevates mood by blocking the reuptake of
the neurotransmitter serotonin in the brain.
6. B. Te meal containing the sandwich includes foods highest in tyramine. Tyramine is normally broken down by
MAO. In the presence of MAO inhibitors, tyramine levels
increase. Tis exerts a pressor efect, as well as increasing
the release of norepinephrine from nerve terminals; this
can result in a hypertensive crisis.
7. D. Te therapeutic range of lithium in the serum is 0.5
to 1.2 mEq/L. Adverse efects occur when lithium levels
exceed 1.5 mEq/L.
8. D. Because lithium does not bind with plasma protein and
is excreted solely by the kidneys, it is contraindicated in clients with renal system impairment.
9. C. People who receive diuretics are at high risk for lithium toxicity because the drug is a salt and retained in the
absence of sodium.
CHAPTER 56
1. B. Anhedonia is a lack of pleasure.
2. A. Monthly injections by a home care nurse assist in the
control of symptoms and increase medication adherence.
3. C. Chlorpromazine hydrochloride and all phenothiazines
should be injected in the ventrogluteal muscle.
4. B. Tardive dyskinesia is the long-term adverse efect of traditional phenothiazine antipsychotic agents.
5. A. Te development of high fever, respiratory depression,
and diminished level of consciousness is indicative of neuroleptic malignant syndrome.
6. C. Tardive dyskinesia is the most common adverse efect of
long-term administration of chlorpromazine.
7. D. Elderly women who take haloperidol are at greatest risk
for the development of tardive dyskinesia.
8. C. Prior to and following the administration of haloperidol decanoate, it is important to assess the client’s blood
pressure. Te client is at risk for developing orthostatic
hypotension.
9. B. Te most acceptable outcome of thiothixene is diminished psychosis and a normal blood pressure, with no signs
Frandsen12e9781975136130-appA.indd 20
or symptoms of hypotension.
10. B. Te development of a fever, sore throat, and malaise
afer beginning clozapine therapy is indicative of a low
white blood cell count. Te client needs to have a complete
blood count with diferential.
11. C. Te client has a knowledge defcit regarding the medication regimen. Te client should never stop taking the medication without consulting the health care provider.
CHAPTER 57
1. D. Restlessness and inability to sit still are hallmark symptoms of attention defcit hyperactivity disorder.
2. B. Having better relationships with his peers is an intended
or therapeutic efect of the medication.
3. B. Improved performance is an intended or therapeutic
efect of the medication.
4. B. Weight loss and anorexia are the most common adverse
efects of central nervous system stimulants.
5. D. Cardiac adverse
dextroamphetamine.
efects
are
common
with
6. A, B, and C. Weight loss with anorexia and dry mouth are
all adverse efects of amphetamine sulfate.
7. D. Te nurse should instruct the parents about using drug
holidays when the child is not in school. Tese assist in promoting growth.
8. D. Drug-free periods are initiated by the health care provider to allow for periods of growth and weight gain.
9. A. Even if the nurse has the right dose and right medication
in the ofce, he or she should check with the child’s mother,
father, or guardian to verify that the medication had not
been given that morning.
10. B. Central nervous system stimulants are the treatment of
choice for attention defcit hyperactivity disorder.
11. B. Central nervous system stimulants are the treatment of
choice for narcolepsy.
12. B. Because medication adherence is important, it is necessary to conduct client teaching for knowledge defcit
regarding the medication regimen.
13. C. Tis behavior indicates that the current medication is
inadequate for the boy’s symptoms.
14. A. Anorexia is an adverse efect of treatment of attention
defcit hyperactivity disorder.
15. A, B, C, D, and E. Excessive daytime drowsiness, fatigue,
cataplexy, hypnagogic hallucinations, and sleep paralysis
are all signs and symptoms of narcolepsy.
CHAPTER 58
1. D. Agitation is an increase in central nervous system stimulation and is associated with withdrawal.
2. A. Drug stimulation of the reward center of the brain contributes to compulsive drug use.
3. B. Flumazenil is an approved medication for use as an antidote for benzodiazepine overdose.
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Appendix A • Answers for NCLEX Success
4. C. Diaphoresis, nausea, vomiting, and tremors are all
symptoms of alcohol withdrawal.
5. B. Chlordiazepoxide is a short-acting benzodiazepine that
is the treatment of choice for alcohol withdrawal.
6. C. Bupropion is an approved treatment for smoking
cessation.
7. C. Cocaine overdose places the client at risk for life-threatening cardiac dysrhythmias, myocardial infarction, and
other associated cardiac symptoms.
8. B. A client who has been prescribed a central nervous system (CNS) stimulant may experience anorexia. Tis is an
adverse efect of CNS stimulants.
9. C. Respiratory depression is an adverse efect of opioid
overdose and can be fatal.
21
CHAPTER 60
1. C. A client who wears hearing aids is prone to the development of otitis externa.
2. C. Te duration of therapy with Cortisporin Otic is 10 days.
Te medication should be stopped afer 10 days to prevent
the development of resistance to the drug.
3. A. Ofoxacin is administered for otitis externa and otitis
media.
4. A. When instilling ear drops in the afected ear, tilt the head
to the opposite shoulder.
5. D. Prior to instilling ear drops, it is necessary to assess the
client’s ear for visible cerumen. Removal of the cerumen
should occur before giving the ear drops.
10. B. Naloxone is an opioid antagonist and is the treatment of
choice for opioid overdose.
6. B. A client who is taking ciprofoxacin should not eat calcium-fortifed juices, dairy products, iron, zinc, and calcium products along with antacids.
CHAPTER 59
7. B. Older clients who receive ciprofoxacin are at risk for
tendon rupture.
1. A. When the client’s intraocular pressure is 22 mm Hg or
above, the nurse should suspect that he or she has some
form of glaucoma. Te client may have diminished vision,
but there is no sign of this in the chart.
8. D. A child who develops wheezing with the administration
of amoxicillin is having an allergic reaction. It is essential
that the drug be discontinued and the child taken to the
emergency department for an evaluation.
2. B. If untreated, trauma to the eye can result in keratitis and
ultimately corneal ulceration.
9. D. A visible cone of light on the tympanic membrane
reveals a decrease in fuid in the tympanic membrane and
a resolving infection.
3. D. To avoid excessive systemic absorption, the ophthalmologist or nurse should use nasolacrimal occlusion, or the
application of fnger pressure on the lacrimal sac, during
and for 1 to 2 minutes following administration.
10. B. Amoxicillin combined with probenecid results in
increased efects of the amoxicillin.
4. C. Older people are at risk for developing increased intraocular pressure with cyclopentolate.
CHAPTER 61
5. D. Te administration of phenylephrine eyedrops places
the client at risk for developing hypertension. It is necessary to monitor the client’s blood pressure.
6. B. Occlusion of the nasolacrimal duct for 5 minutes prevents systemic absorption of the medication.
7. A. Selegiline hydrochloride is an anti-Parkinson’s medication and also a monoamine oxidase (MAO) inhibitor.
It is necessary to discontinue MAO inhibitors for 14 days
before starting an alpha2-adrenergic agonist.
8. C. Application of pressure to the lacrimal sac decreases the
systemic absorption of the medication, thus assisting in the
prevention of cardiac adverse efects.
9. D. Mannitol reduces intraocular pressure by creating
an osmotic gradient in between the plasma and ocular
fields.
10. B. Te school nurse should instruct the girl that bimatoprost is recommended only in clients 16 years of age and
older due to hyperpigmentation.
11. C. Afer 3 days of ciprofoxacin therapy, the development of
a swollen tongue is most commonly indicative of a hypersensitivity reaction.
12. C. It is important to tell the client how to handle trifuridine
safely because it is a hazardous substance.
Frandsen12e9781975136130-appA.indd 21
1. C. Androgens increase the production of sebum, contributing to the development of acne vulgaris.
2. B. Dexamethasone may contribute to the development of
acne.
3. B. A client who has been asthmatic for an extended period
is prone to the development of the dermatologic condition
atopic dermatitis.
4. C. Alcohol consumption contributes to the onset of rosacea.
5. A. Clients who use pimecrolimus are prone to the development of skin cancer.
6. D. Ciprofoxacin is the drug of choice for a gram-negative
sof tissue cellulitis.
7. B. Tetracycline suppresses leukocyte cytokines and proteinase enzymes that contribute to infammation.
8. D. Doxycycline and topical benzoyl peroxide are more
efective in treating acne than the administration of one
agent alone.
9. A. Benzoyl peroxide is applied topically for the treatment
of a mild case of acne vulgaris. Doxycycline would be prescribed if the topical agent was inefective.
10. B. A client taking isotretinoin who develops headaches and
nausea should be examined for the development of pseudotumor cerebri.
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