NCLEX Questions
Top Meds on NCLEX RN
3rd Edition
Copyright © 2013 by NCLEX Preceptor
By:
NCLEX Preceptor
www.nclexpreceptor.com
*****
Chief Editor:
Jonathan Small, RN, PCCN, HIT-Pro
Introduction
How can you study for NCLEX pharmacology fast? We introduce you to the latest and best
medication ebook: an abundant collection of NCLEX questions and study material. Developed
by board certified nurse educators and reviewed by pharmacists, you will find numerous NCLEX
questions and review over 28 medication drug classes. Content is focused for nurses that are
preparing to take the NCLEX exam within the next 13 months. This book is an NCLEX review
study supplement and best used by nurses that have already taken or are currently taking a
pharmacology college course. You will receive NCLEX tips to help you pass the exam. I hope
you enjoy the study guide. We are sure that you will find this to be the fastest way for you to
learn NCLEX pharmacology.
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Blurbs and Reviews
“I wish I found this book earlier. It has saved me a lot of time studying medications. It is well
written and has a lot of review questions.”----Nancy B. Bell, RN Chicago, IL
“I love the NCLEX practice questions. This is a fast read with many of NCLEX tips.”----Cindy
Wright, RN Tupelo, MS
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for NCLEX. The book covers a large number of medications and made learning fun.”----Amy T.
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book has a lot of pharmacology review questions. Great Job."----Leslie Jennings, RN Houston,
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Many thanks to Maria Salvacion Gonzales RN, MAN and Rose Anne Cabral and Randy Thomas
PharmD who helped edit and revise this study guide.
NCLEX Questions: Top Meds on NCLEX RN 3rd Edition
Copyright © 2013 by NCLEX Preceptor
Table of Contents
Chapter 1:
Chapter 2:
Chapter 3:
Chapter 4:
Chapter 5:
Chapter 6:
Chapter 7:
Chapter 8:
Chapter 9:
Chapter 10:
Chapter 11:
Chapter 12:
Chapter 13:
Chapter 14:
Chapter 15:
Chapter 16:
Chapter 17:
Chapter 18:
Chapter 19:
Chapter 20:
Chapter 21:
Chapter 22:
Chapter 23:
Chapter 24:
Chapter 25:
Chapter 26:
Chapter 27:
Chapter 28:
Chapter 29:
Chapter 30:
Ace Inhibitors
Alpha Blockers
Angiotensin II Inhibitors
Antianginals
Antidysrhytmics
Antiemetics
Antifungals
Antibiotics
Anticoagulants
Anti-Depressants
Antihistamines
Beta Blockers
Calcium Channel Blockers
Antiplatelet
Benzodiazepines
Cardiac Glycosides
Diuretics
HIV anti agents
Insulins
NSAIDS
Opioid
Oral Hypoglycemic
Proton pump inhibitors
Respiratory
Statins
Thrombolytics
Vasopressors
Ophthalmic
OTC Remedies
Herbal Remedies
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Copyright © 2013 by NCLEX Preceptor
NCLEX Questions: Top Meds on NCLEX RN 3rd Edition
Copyright © 2013 by NCLEX Preceptor
Chapter 1
A Quick Review about ACE Inhibitors
What are ACE Inhibitors?
ACE Inhibitors or Angiotensin Converting Enzymes are any of a group of antihypertensive drugs
that relax arteries and promote renal excretion of salt and water by inhibiting the activity of an
angiotensin converting enzyme.
These are enzymes responsible for reducing vasculature resistance without increasing cardiac
output, rate or contractility.
NCLEX Alert! ACE Inhibitors are one of the most frequently tested antihypertensive drugs on
NCLEX.
These are the diseases that ACE Inhibitors treat:
1. Hypertension
2. Congestive heart failure
And, they lower the risk of stroke and heart attack.
You must remember that these inhibitors have side effects in our body, such as:
1. Postural hypotension (commonly known as ‘head rush’ or ‘dizzy spell’)
2. Fatigue
3. Loss of appetite
4. Nausea, vomiting, diarrhea
5. Hyperkalemia
6. Insomnia
7. Could exacerbate non-productive cough
8. Angiodema
Some of the commonly used ACE Inhibitors are Benazepril, Captopril, Enalapril and Fosinopril.
Also included in this classification are Lisinopril, Moexipril or Perindopril.
Now, what should be your nursing considerations in giving medications? As a nurse, you also
have to educate your clients in taking these drugs. Here are some medical considerations:
1. You have to remember that these medications cause retention of potassium. Hence,
monitor the electrolytes.
2. Take note that elderly clients are at highest risk for postural hypotension.
3. Always instruct your clients not to abruptly discontinue medications because rebound
hypertension can occur.
4. Do not forget to monitor the blood pressure frequently.
5. If your client has impaired renal function, you have to be cautious if they will be using
these drugs
6. Finally, notify the client’s physicians if dizziness still persists.
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Lab. Value Alert:
 Calcium 8.8 - 10.3 mg/dL
 Calcium, ionized 2.24 - 2.46 mEq/L
 Chloride 95 - 107 mEq/L
 Magnesium 1.6 - 2.4 mEq/L
 Phosphate 2.5 - 4.5 mEq/dL
 Potassium 3.6 - 5.2 mmol/L
 Sodium 135 - 145 mEq/L
If your client is on ACE inhibitors, you should see these desirable outcomes:
 Blood pressures controlled within normal limits
 Improved survival rates for clients suffering from acute MI
 Decreased workload on cardiovascular system
 Decrease or absence of chest pain
If you see these positive results, then you are on the right track!
NCLEX Tips to remember about these medications:
Tip #1: Most ACE drugs end with the suffix –pril, as in Ramipril, Quinapril, Trandolapril
Tip #2: If your client is taking diuretics, notify the physician before they take Lisonipril
Tip #3: Always double-check the drugs and their side effects with the client
Frequently Asked Questions (FAQs):
Q: What are the brand names of ACE Inhibitors?
A: Lotensin, Capoten, Vasotec, Monopril, Prinivil, Zestril, etc.
Q: Should the medications be taken immediately after eating?
A: No. The drug's absorption will be decreased if taken with food. So you should allot at least 1
hour before taking the meds.
You are now ready to take these NCLEX sample practice questions. Just remember the
guidelines given to you, and you can answer the following correctly:
1. Which statement, if made by the hypertensive client taking Lisinopril, indicates the
need for further teaching?
a. “I will take the medication with my Spironolactone.”
b. “I will inform the physician if my dizziness persists.”
c. “I will not stand up immediately after taking the medication.”
d. “I will have my daughter take my blood pressure from time to time.”
NCLEX Questions: Top Meds on NCLEX RN 3rd Edition
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2. The nurse correctly enumerates which of the following side effects in taking ACE
Inhibitors. Select all that apply:
1. Headache
2. Hypertension
3. Fatigue
4. Vomiting
5. Diarrhea
6. Cough
7. Loss of consciousness
3. A nurse is making her daily rounds. She remembers that Mrs. Rose is taking
Perindopril (Aceon); which of the following statement, when made by Mrs. Rose,
would warrant notification of the attending physician?
a. “The first time I took the medication, I had a headache.”
b. “I took my medication an hour before meals.”
c. “I’ve had a blood extraction today to determine my potassium level.”
d. “I have been feeling dizzy for three days now.”
4. Mrs. Sommers, a 53-year-old female diagnosed with Congestive Heart Failure is
taking Fosinopril (Monopril) 10 mg tablet once a day. Which of the following results
would require the need to notify the physician?
a. Creatinine 1.0 mg/dL
b. Potassium 12 mEq/L
c. Albumin 5 U/L
d. BUN 10 mg/dL
5. You are the nurse caring for Mrs. Jones, a 44-year-old client with hypertension. An
hour after taking Ramipril (Altace), you took her blood pressure and noted that it is
80/50. Which of the following nursing interventions should you do first?
a. Call the attending physician
b. Elevate her legs by adjusting the bed and placing her on a Trendelenburg position
c. Give her Furosemide (Lasix)
d. Give supplemental oxygen via nasal cannula at 3 lpm
ACE Inhibitors practice test answers:
1. A
2. 1,3,4,5,6
3. D
4. B
5. B
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Copyright © 2013 by NCLEX Preceptor
Chapter 2
NCLEX Overview of Alpha Blockers
How do you define Alpha Blockers?
Alpha blockers help relax certain muscles and help small blood vessels remain open. They work
by keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls
of smaller arteries and veins.
What will happen then if they block that effect?
When they block that effect, the vessels will remain open and relaxed.
As a nurse, you must know the diseases that Alpha blockers treat:
1. Hypertension
2. Benign Prostatic Hyperplasia or BPH
3. Raynaud’s Disease
4. Pheochromocytoma or commonly known as Adrenal gland tumors
In every drug, there will always be side effects. In giving Alpha blockers to your clients, you
could expect them to have signs of nausea, drowsiness, nasal congestion, weight gain and edema.
In addition, orthostatic hypotension and sodium and water retention might occur.
NCLEX tip #1: Drugs usually ending in suffix –zosin are used as alpha blockers; such as:
1. Alfuzosin
2. Prazosin
3. Tamsulosin
4. Doxazosin
5. Silodosin
6. Terazosin
NCLEX Question #1: As a nurse, what are your considerations in using alpha blockers?
Answer: Monitor fluid retention, edema and blood pressure. It is also a must to avoid over-thecounter medications, and possibly decrease salt intake. Finally, when waking up in the morning,
breathe deeply for a few minutes and then slowly sit up before standing as to avoid orthostatic
hypotension.
Now that you are aware of the above-mentioned nursing health teachings, what are the possible
outcomes when the client is already using the drugs?
Firstly, the renal blood flow of the client will be correctly maintained. Secondly, there will be a
noticeable reduction in symptoms of BPH, so the urine flow rates will be improved. Lastly, blood
pressure will be decreased within 15 minutes following oral administration in hypertensive
clients.
NCLEX tip #2: Alpha blockers are typically NOT preferred as the first treatment option for high
NCLEX Questions: Top Meds on NCLEX RN 3rd Edition
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blood pressure.
NCLEX tip #3: If high blood pressure is difficult to control, Alpha blockers need to be combined
with other drugs like diuretics.
Remember these three tips and you will be better in remembering Alpha Blockers.
You are now ready to take the NCLEX practice test. You will be able to answer the following
questions once you remember the tips given to you.
1. A client taking Tamsulosin returns to the outpatient department for a follow-up. Which of
the following statements made by the client indicates the need for further assessment?
a. “I get out of bed by sitting for a while first before standing up.”
b. “I always have my blood pressure taken by my niece who is taking up nursing.”
c. “Yesterday I was feeling tired and sleepy while driving to the laundromat.”
d. “I have started cooking with less salt than before.”
2. Which of the following clients can’t be prescribed with Tamsulosin?
a. Benign Prostatic hyperthropy
b. Coronary atherosclerosis
c. Raynaud’s disease
d. Pheochromocytoma
3. Which of the following foods can be taken by the client on alpha blockers?
a. Banana, oatmeal.
b. Sausage, bread
c. Egg noodles in beef broth
d. Custard, smoked ham
4. Which of the following are the side effects of Reserpine (Serpasil)?
a. Edema
b. Drowsiness
c. Weight gain
d. All of the above
5. When is the best time to take the initial dose of Prazosin (Minipress)?
a. At lunchtime
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b. After breakfast
c. One hour before breakfast
d. At bedtime
NCLEX Alpha Blocker practice test answers:
1. C
2. B
3. A
4. D
5. D
Get additional NCLEX Tips at www.nclexpreceptor.com
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Copyright © 2013 by NCLEX Preceptor
Chapter 3
Getting to know ARBs: an NCLEX Review
Let us first define ARBs.
ARBs or Angiotensin II Receptor Blockers block the action of angiotensin II, allowing the blood
vessels to widen, thus making it easier for the heart to pump blood.
NCLEX Note: Angiotensin II narrows and thickens blood vessels forcing the heart to work
harder which in turn increases blood pressure.
What are the diseases treated by ARBs?
1. Hypertension
2. Congestive Heart Failure
3. Kidney Failure in Diabetes
4. Chronic Kidney Diseases
5. Scleroderma
Frequently Asked Questions (FAQs):
Q: What are the common side effects of ARBs?
A: When using ARBs, the following are the expected side effects:
 Headache, dizziness and lightheadedness
 Nasal congestion
 Vomiting and diarrhea
 Back and leg pain
 Hyperkalemia
 Angioedema
Q: As a nurse, what should I tell my clients to educate them about these drugs?
A: You have to consider the following in taking ARBs:
 These drugs are not to be taken by pregnant women or breastfeeding mothers.
 Use cautiously in clients with hypovolemia, hepatic or renal dysfunction.
 Notify the client’s physicians if edema occurs, but do not stop taking these drugs without
consulting your doctor.
 Slowly change positions
 You also have to watch out for hypotension because there might be reduction in fluid
volume through excessive perspiration, dehydration vomiting and diarrhea.
Q: If the drugs have been taken ceremoniously and accurately, what are the possible and
expected outcomes?
A: The effects of ARBs when taken correctly by your clients are:
 Prevention and treatment of diabetic nephropathy
 Decrease in sodium and potassium retention
 Decrease in the heart’s workload
 There is a better improvement in clients who are not able to tolerate ACE Inhibitors.
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NCLEX Tip: Drugs used as ARBs usually end with suffix –sartan; as follows:
1. Candesartan
2. Eprosartan
3. Irbesartan
4. Losartan
5. Olmesartan
6. Telmisartan
7. Valsartan
As a nurse, you might actually be familiar with the brand used by physicians like Diovan,
Micardis, Benicar, Cozaar, Avapro, Teveten and Atacand.
Remember that not all physicians are very particular with the brand names, so you might as well
remember their generics.
NCLEX Very Important Tip: These drugs are PREGNANCY CATEGORY D: They may cause
fetal injury or even death.
Be ready for the NCLEX practice test given below. You have to remember the tips given to you
in answering these questions.
1. The nurse receives the latest blood chemistry of Mr. Henry who is taking Cozaar for his
hypertension. Which of the following should alert the nurse?
a. Serum albumin 5 gm/dL
b. Calcium 8.5 mg/dL
c. Potassium 9 mEq/L
d. Hgb 18 gm/dL
2. Which of the following statements made by the client would alert the nurse to hold giving of
the drug Telmisartan:
a. “I have had my menstruation delayed for about 3 weeks now.”
b. “I drink lots of fluids to compensate for my excessive perspiration.”
c. “I elevate my legs whenever my blood pressure is low.”
d. “I rise up from bed slowly until I don’t feel dizzy.”
3. Which of the following should the nurse instruct the client to watch out for while taking
ARBs?
a. Decreased in level of consciousness
b. Constipation
c. Insomnia
d. Angioedema
4. A client taking Olmesartan develops a dry cough, what is the appropriate action?
a. Continue taking the medicine as it is an expected side effect
b. Discontinue taking the medicine
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c. Decrease the drug in half
d. Take the medicine with antihistamine
5. A client with hypertension is to take an Angiotensin II Receptor Blocker. Which of the
following should be included in the health teaching? Select all that apply:
1. monitor BP daily
2. avoid the use of NSAID
3. Stop treatment if cough develops
4. Have blood drawn for potassium levels
NCLEX ARBs practice test answers:
1.
2.
3.
4.
5.
C
A
D
A
1,4
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Chapter 4
NCLEX: Better View of Antianginals
How do Antianginals work?
Antianginals work by relaxing smooth muscle, producing a vasodilator effect on the peripheral
veins and arteries with more prominent effects on the veins.
Hence, cardiac workload is reduced due to decrease in venous return because of peripheral
vasodilation.
You might ask what certain diseases an Antianginal medication treats. An Antianginal treats
Angina and it also controls perioperative blood pressure.
For better understanding of these medications, you must know specific drugs used and their side
effects:
1. Erythrityl Tetranitrate (Cardilate)
2. Isosorbide Mononitrate (Imdur, Monoket)
3. Isosorbide Dinitrate (Iso-Bid, Isordil, Isotrate, Sorbitrate)
4. Nitroglycerin (NTG, Nitrostat, Nitrolingual)
5. Nitroglycerin ointment 2% (Nitro-Bid, Nitrol, Nitrodisc, Transderm-Nitro)
NCLEX information #1: Notice their suffixes. You will see that most Antianginals end with the
suffix –nitrate.
Let us move on with the side effects of these drugs. As a nurse, you may notice your clients who
are taking an Antianginal to have the following signs:
 Headache, blurred vision and dry mouth
 Postural Hypotension
 Syncope
 Reflex tachycardia
Now, there must be some nursing considerations and drug teachings that you have to tell your
clients; and what are these?
1. Let them know that the purpose of transdermal patch is to prevent chest pain and they
allow the client to maintain ADLs.
2. Advise your client that alcohol will potentiate postural hypotension. So remember, as a
nurse, you have to tell your clients to limit alcohol consumption.
3. Report to physician continuous headaches, blurred vision or dry mouth.
4. Topical application is used for sustained protection against angina attacks.
5. Avoid skin contact with topical form.
If your client is successful in maintaining these medications, you will see some progress like
prevention of chest pains (due to coronary artery disease); there will also be acute relief of an
attack of angina pectoris; lastly, the demand of cardiac oxygen will be decreased.
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Remember the precautions given to you, and your clients will be off the hook in no time.
NCLEX information #2: It is very important for you to remember that Sublingual Nitroglycerin
is given for an immediate response. You can give your clients 3 doses in every five-minute
interval.
NCLEX information #3: If your client has a Nirtroglycerin patch, remember to remove it before
defibrillation or cardioversion.
Are you ready for the NCLEX practice test? Here it goes:
1. A client discharged with sublingual nitroglycerin (Nitrostat) should be taught to:
a. take the medication with Sildenafil Citrate
b. avoid abrupt changes in posture
c. take the medication 5 minutes after the pain has started
d. stop taking the medication if a burning sensation is present
2. How will the nurse evaluate the efficacy of Isordil?
a. relief of chest pain in 3-5 minutes
b. relief of tremors at rest
c. asking for the fourth tablet of Isordil
d. increase in urine output
3. A home health nurse instructs a client on the use of a nitrate patch. The nurse tells the client
that the following will prevent client tolerance to nitrates?
a. Never remove the patches
b. Have a 24-hour “no nitrate” period
c. Have a 12-hour “no nitrate” period
d. Keep nitrate patches on for 24 hours, then off for 24 hours
4. How should the nurse ensure that the potency of nitroglycerin is not compromised?
a. Keep the medicine in a tightly closed, dark glass container
b. A new supply of medication is purchased every year
c. Sublingual tablets are swallowed for immediate absorption
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d. Take the 1st dose of nitroglycerin after 15 minutes of observed pain
5. Which of the following statements, if made by the client, indicates a need for further
teaching?
a. “I can still drink wine occasionally.”
b. “I will notify my doctor if the dizziness does not wear off."
c. “I shall wash my hands after applying the patch.”
d. “I shall rest while monitoring the effect of the nitroglycerin.'
Antianginal practice test answers:
 B
 A
 C
 A
 A
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Chapter 5
A Closer Look at Antidysrhytmics: An NCLEX Review
What do Antidysrhytmics do?
Antidysrhytmics decrease the cardiac excitability. They can also delay the cardiac conduction in
either the atrium or ventricle. Lastly, they increase the rate of repolarization.
In studying Antidysrhytmics, you have to remember the diseases that they treat. Antidysrhytmics
are used to treat:
 Ventricular dysrhythmia
 Supraventricular dysrhythmia
 Ventricular fibrillation
 Atrial flutter
 Bradycardias or PVCs related to slow heart rate
If you see any of these diseases in a client, then you may anticipate that the physician will order
medications that could help their conditions like Quinidine Sulfate, Disopyramide, Lidocaine
hydrochloride, Amiodarone, etc.
Frequently Asked Questions (FAQs):
Q: As a nurse, what should I tell my clients taking Antidysrhytmics? What are my
considerations?
A: If you encounter clients taking such medications, you have to bear in mind the following tips:
 Closely monitor your client for dysrhythmias that are precipitated by the treatment.
 Hook your client to a cardiac monitor and assess for changes in their cardiac rhythm.
 Always remember to avoid giving IV injections rapidly.
 Also, remember that Digitalis enhances cardiac depressant effects.
 All cardiac depressant medications are contraindicated in clients with sinus or AV node
blocks.
 If joint pain and inflammation occurs, notify the physician.
Vital Sign Value Alert: Normal resting heart rate for adults ranges from 60 to 100 beats a minute
Q: How do I know if the drugs are taking effect?
A: Of course, if these drugs are given to your client properly, there will be positive and desirable
results that will manifest in your clients. You will notice that the drugs will correct their
abnormal cardiac function and there will also be a decrease in electrical conduction.
Moreover, your clients might have either a decrease or increase in automaticity.
Q: What are other medications used as Antidysrhytmics?
A: Like what have been said earlier, Quinidine Sulfate (Quinidex), Disopyramide (Norpace), and
Lidocaine Hydrochloride (Xylocaine) are prescribed by physicians. Other drugs like Tocainide
(Tonocard), Mexiletine (Mexitil), Amiodarone Hydrocholoride (Cordarone), Procainamide
(Pronestyl), and Atropine Sulfate are also given to clients.
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These medications are effective if they are used properly by your clients.
Just remember that Disopyramide (Norpace) is contraindicated for use in clients with CHF.
With this information in mind, you now have a better understanding of Antidysrhytmics. You
should be ready for the NCLEX Antidysrhytmics practice test.
Below are five sample questions that you have to answer.
 The doctor orders to start the client with Ventricular dysrhythmia on Cordarone. Which of
the following should the nurse prepare?
a. Pulse oximeter
b. Cardiac monitor
c. TENS machine
d. Electroencephalogram
 A client with cardiac disease is on a monitor and the nurse observes ventricular
tachycardia at a rate of 140 bpm. The client is conscious with a GCS of 15/15. What is
the appropriate nursing action?
a. Obtain arterial blood gas values
b. Begin cardiopulmonary resuscitation
c. Administer Lidocaine IV push
d. Defibrillate the client
 A client is reported to be in first-degree heart block. What is a nursing measure to assess
the status of his dysrhythmia?
a. Evaluate ECG rhythm strip
b. Count the radial pulse for 1 full minute
c. Determine the cardiac rate at the PMI
d. Correlate blood pressure with hourly pulse checks
 A client is being treated with Procainamide (Pronestyl). After administration of the drug,
the client complains of dizziness. What nursing intervention should be prioritized?
a. Administer oral nitroglycerin tablets
b. Auscultate the apical pulse then obtain the blood pressure
c. Obtain a 12-lead ECG
d. Heart rate and rhythm on the rhythm strip
 The client taking Tocainide (Tonocard) complains of dry mouth. What should the nurse
do?
a. Refer to the attending physician
b. Taper the dosage of the medication
c. Decrease the frequency of the medication
d. Offer sugar-free gum
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NCLEX Antidysrhytmics practice test answer key:
1. B
2. C
3. A
4. B
5. D
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Chapter 6
NCLEX Better Review of Antiemetics
What do Antiemetics do?
Antiemetics depress the chemoreceptor trigger zone and vomiting center. In other words, they
block the messages to the part of the brain that controls nausea and vomiting.
In what kind of diseases should Antiemetics be given to?
If a client is experiencing motion sickness, intractable hiccups, gastroesophageal reflux, and
gastroparesis (gastrointestinal hypomotility), a physician could prescribe Antiemetics.
These drugs could also be used to prevent and treat postoperative nausea and vomiting. It may
also be given as prophylaxis of chemotherapy-related emesis.
What should you expect when giving antiemetic drugs? What are the side effects and the
desirable outcomes?
As a nurse, you have to know the side effects of Antiemetics like drowsiness or sedation, blurred
vision, dry mouth, fatigue, constipation and difficulty in urination. A client may also become
photosensitive.
On the other hand, the desirable effects that might manifest in your clients are control (and even
prevention) of vomiting, decrease in gastrointestinal secretions and motility, and they may inhibit
the secretion of saliva and sweat. Also, another positive outcome of the drugs is when the client
inhibits emesis induced by cytotoxic chemotherapeutic agents.
NCLEX Tips in drug education:
Tip #1: Monitor the client’s vital signs and I and O
Vital Sign Value Alert: Normal Vital Signs :
 Blood pressure: 90/60 mm/Hg to 120/80 mm/Hg
 Breathing: 12 - 18 breaths per minute
 Pulse: 60 - 100 beats per minute
 Temperature: 97.8 - 99.1 degrees Fahrenheit / average 98.6 degrees Fahrenheit
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Tip #2: Limit odors in the client’s room when the client is nauseated and/or vomiting
Tip #3: Protect your client from injury
Tip #4: Limit oral intake to clear liquids when the client is nauseated and/or vomiting
NCLEX additional nursing considerations in giving Antiemetics:
Tip #5: Note that subcutaneous injection may cause tissue irritation and necrosis
Now, let us learn some drugs that are used as Antiemetics. Below is the list of medications that
you have to know, as a nurse:
 Chlorpromazine hydrochloride (Thorazine)
 Promethazine (Phenergan)
 Prochlorperazine (Compazine)
 Thiethylperazine maleate (Torecan)
 Hydroxyzine (Atarax, Vistaril)
 Dimenhydrinate (Dramamine, Marmine)
 Metoclopramide (Reglan)
 Aprepitant (Emend)
 Droperidol (Inapsine)
 Trimethobenzamide (Tigan)
 Dolasetron (Ansemet)
 Granisetron (Kytril)
 Ondasetron (Zofran)
NCLEX reminder regarding medications:
Tip #6: Droperidol should be administered with extreme caution in the presence of risk factors
for development of prolonged QT syndrome.
Tip #7: Antiemetics often end in “setron”. Example: Dolasetron, Granisetron, Ondasetron
Better be ready for the NCLEX! So here are the practice questions to exercise what you have
learned:
1. A 29-year-old client with breast cancer, Ms. Jessica Myers, is scheduled for a
chemotherapy session today. The nurse notes which of the following medications are to
be administered prior to the procedure?
a. OndasetronHCl (Zofran)
b. ClotrimazoleHCl (Lotrimin)
c. Tartrate (Stadil)
d. Persantine (Dipyridamole)
2. In giving home instructions to the client with a prescribed antiemetic, the nurse is correct
to explain the following, except?
a. Avoid driving after taking the medicine
b. It is normal to have difficulty in urinating
c. Notify the physician if you have trouble swallowing
d. Limit odors to prevent further nausea
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3. The nurse also instructs the client taking Metoclopramids (Reglan) to discontinue the
medicine and call the physician if which of the following side effects occur with long
term use?
a. Anxiety or irritability
b. Dry mouth not minimized by the use of sugar-free candy
c. Excessive drowsiness or excitability
d. Uncontrolled rhythmic movements of the face or limbs
4. A client has a PRN order for Ondasetron (Zofran). A nurse knows that this medication is
given to the postoperative client for the relief of:
a. Urinary retention
b. Paralytic Ileus
c. Stomach upset
d. Nausea and vomiting
5. A nurse is about to give the client his daily dose of Prochlorperazine (Compazine); she
would assess for which of the following side effects of this medication?
a. Excessive lacrimation
b. Blurred vision
c. Diarrhea
d. Drooling
NCLEX Antiemetic practice test answers:
 A
 B
 D
 D
 B
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Chapter 7
A Quick Review of Antifungals
Antifungals usually destroy fungi and inhibit fungal growth.
The antifungal drugs could treat vaginal fungal infections, candidiasis, dermal infections, tinea
infections, diaper dermatitis and scaling due to dandruff.
In giving antifungal medications, you must consider these client learnings:
Learning 1: Avoid exposure to the sun because the medication increases photosensitivity.
Learning 2: Creams are not recommended to be used with tampons or diaphragms.
Learning 2: Avoid contact with eyes, nose, mouth and do not swallow it.
Learning 3: Client must return to the physician if no results are obtained after 4 weeks of
treatment.
Learning 4: Avoid alcohol during treatment.
Learning 5: Monitor for hypersensitivity reactions.
NCLEX Focused Tip for drug use:
Tip #1: Not recommended for use during pregnancy and lactation
Tip #2: For oral Antifungals: Monitor hepatic functions
Lab Value Alert: Normal Liver Function Tests:
 ALT. 7 to 55 units per liter (U/L)
 AST. 8 to 48 U/L
 ALP. 45 to 115 U/L
 Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
 Total protein. 6.3 to 7.9 g/dL
 Bilirubin. 0.1 to 1.0 mg/dL
 GGT. 9 to 48 U/L
 LD. 122 to 222 U/L
 PT. 9.5 to 13.8 seconds
To better understand Antifungals, as a nurse, you have to remember the side effects as well as the
desirable outcomes of these drugs.
For the side effects, your client will have signs of the following:
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







Nausea
Vomiting
Headache
Vaginal Irritation
Erythema
Peeling
Pruritus and urticaria
Hepatotoxicity
Now, what are the positive outcomes for clients taking antifungal drugs? There is a noted
disruption of fungal cell mitosis. Also, there is alteration of permeability of fungal cell
membrane. And finally, there is fungistatic and fungicidal in vitro against a wide variety of yeast
and yeast-like fungi.
Question: What drugs are commonly used as antifungal?
Answer: Antifungal drugs could be orally taken or topically applied, such as:
 Amphotericin B (Fungizone)
 Clotrimazole (Lotrimin, Gyne-Lotrimin)
 Fluconazole (Diflucan)
 Griseofulvin (Fulvicin)
 Ketoconazole (Nizoral)
 Terconazole (Terazol)
 Metronidazole (Flagyl)
 Miconazole (Micatin, Monistat 3)
 Nystatin (Mycolog)
 Oxiconazole (Oxistat)
NCLEX Reminders for antifungal drugs:
#1: Suffix: Antifungals often end in “nazole”. Example: Fluconazole, Ketoconazole, Miconazole,
Terconazole, Oxiconazole
#2: Urine may turn red-brown in a client taking Flagyl.
#3: Take Griseofulvin with foods high in fat (e.g. milk or ice cream) to decrease GI upset and
assist in absorption.
NCLEX Preceptor has prepared sample practice questions on Antifungals. You are now ready to
take it after the review given to you.
1. During the administration of Amphotericin B, what would be the priority of nursing care?
a. Monitor creatinine levels
b. Observe for signs of hyperkalemia
c. Monitor serum glucose
d. Encourage diet low in calories and protein
2. Ms. Moore, is being treated for candidiasis. Which of the following statements, if made
by the 23-year-old female client, indicates the need for further teaching?
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a.
b.
c.
d.
“I shall notify the physician once I suspect that I am pregnant.”
“I shall experience some skin peeling.”
“I can still wear tampons as long as I complete the medication regimen.”
“I shall wash my hands after applying the cream.”
3. A client is diagnosed with herpes simplex type 1. Which topical treatment should be
anticipated?
a. Mupirocin (Bactoban)
b. Acyclovir (Zovirax)
c. Masoprocol (Actinex)
d. Isotretinoin (Accutane)
4. Which client teaching is correct when taking Antifungals?
a. Avoid exposure to the sun
b. Avoid fatty foods
c. Discontinue if itching occurs
d. Occasional drinking is allowed
5. The nurse is correct when she instructed a client taking Griseofulvin (Fulvicin) to take the
medication with which of the following food or drinks?
a. Bread
b. Saltines
c. Milk
d. Fruit juice
Answer key for practice Exam on Antifungals:
1. A
2. C
3. B
4. A
5. C
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Chapter 8
NCLEX Straightforward Approach to Antibiotics
Question: Why do we have to use antibiotics? Because:
a. They inhibit bacterial DNA.
b. They inhibit protein synthesis.
c. They interfere with the formation of the bacterial cell wall.
d. All of the above
e. None of the above
Answer: D – All of the above
Let us discuss the diseases that antibiotics could treat. Antibiotics are usually prescribed by
physicians in cases of infections. It could be skin/skin structure infection, respiratory tract
infections, gonococcal and community- or hospital-acquired infections.
Antibiotics are also given in cases of meningitis, and as surgical prophylaxis and inhalation
anthrax, among others.
As a nurse, you need to be also familiar with the different drugs used as antibiotics. The most
commonly used antibiotic is Penicillin V (PEN VEE K), Amoxicillin (Amoxil), Clarithromycin
(Biaxin) and Azithromycin (Zithromax).
There are also other antibiotics prescribed by physicians like:
 Gentamycin (Garamycin)
 Amikacin (Amikin)
 Ceftazidime (Fortaz)
 Cefepime (Maxipime)
 Ciprofloxacin (Cipro)
 Moxifloxacin (Avelox)
 Tetracycline (Achromycin)
 Doxycycline (Vibramycin)
NCLEX Reminder about antibiotic drugs' side effects:
Being a nurse, you must also be aware of the possible side effects that your clients might
encounter like headache, hypotension and skin rash. Your clients may also become
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photosensitive. Also, they may have signs of pain and tenderness at the injection site (of
antibiotic). Finally, persons using antibiotics could have ototoxicity as a serious side effect.
In case of hearing loss, you have to learn that it is irreversible. You just have to assess the peak
and trough levels to determine its toxic level.
It will also be better if antibiotics are started from first generation classes so as to prevent
development of increased resistance.
NCLEX Additional reminders about the drugs:
A. PREFIXES used:
Reminder #1: Floroquinolones often end in “floxacin”
Example: Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin,
Reminder #2: Cephalosporins often start with “cef” or “ceph”
Example: Cefadroxil, Cefaclor, Cefoxitin, Ceftriaxone, Cefepime,Cephradine, Cephalexin,
Cephalothin
B. CONTRAINDICATIONS
Reminder #3: Fluoroquinolones are contraindicated if a client has epilepsy, QT prolongation,
pre-existing CNS lesions, CNS inflammation or suffered a stroke.
You might have to wonder, “As a nurse, what are the desirable outcomes when antibiotics are
taken effectively?” You have to be reminded that the positive effects are:
1. Negative bacterial result on culture; and,
2. Negative infection postpoperatively
You have learned the different kinds of antibiotics; their side effects and desirable effects, as well
as the diseases they treat.
It is also your obligation, as a nurse, to be knowledgeable of nursing considerations in giving
these medications to your clients.
The key that you have to remember are as follows:
a. Take blood cultures before starting antibiotics
b. Assess for ototoxicity (change in hearing, ringing in the ears, dizziness or unsteady gait)
c. Assess for nephrotoxocity (monitor BUN and Creatinine)
Lab Value Alert: Normal BUN and CREA
 BUN: 7 - 20 mg/dL
 Creatinine: 0.6 to 1.3 mg/dL
d. Drink 2 to 3 liters of fluid daily
e. Absorption is reduced by milk products and antacids
f. Minimize using higher generation in less severe infections and in those in which risk
factors for multidrug resistance are not present
g. Dilute solution and administer slowly to decrease phlebitis on IV site.
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h. Avoid direct or artificial sunlight
Share This Book with Friends and Classmates
To check what you have learned, NCLEX Antibiotic practice test is given to you. There are five
questions below that you need to answer to better understand the lesson.
1. In a client taking Moxifloxacin (Avelox), which of the following laboratory test results
would alert the nurse to inform the physician?
a. BUN 15 mg/dL
b. Creatinine 5 mg/dL
c. Potassium 5 mEq/L
d. Sodium 138 mEq/L
2. A client with an ongoing infusion of Ciproflolaxin complains of pain at the IV site. The
nurse sees that the medicine is not infusing and upon inspection of the site, she finds that
the site is swollen, pale and cool to touch. Which of the following is the appropriate
nursing intervention?
a. Discontinue the IV infusion and put warm packs on the IV site
b. Slow the IV infusion and observe if the swelling subsides
c. Discontinue the IV infusion and start a new line on the same vein near the
previous site
d. Notify the attending physician
3. In caring for the client who has cellulitis on the left leg, the following are appropriate
interventions when starting the client on antibiotics, except?
a. Performing a skin test prior to starting the antibiotic
b. Having blood cultures drawn after the first dose of the antibiotic
c. Requesting for a baseline blood chemistry prior to initiating the antibiotic
d. Assessing for previous allergies to antibiotics
4. A 10-year-old child with a diagnosis of sepsis is being treated with Amikacin. Which of
the following statements by the child should alert the nurse to discontinue the medication
and inform the physician?
a. “I can feel a little bit of headache.”
b. “I can feel some pain on my injection site.”
c. “I am hungry and would like some cheeseburger.”
d. “I can hear a buzzing sound that does not go away.”
5. Which of the following statements made by the client indicates an understanding of the
home instructions being given to him while taking oral Doxycycline?
a. “I will take this medication with food.”
b. “I can still go to the tanning salon and have a mild tan.”
c. ”I can take them with my Iron supplement.”
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d. “If diarrhea persists, take a Loperamide.”
NCLEX Antibiotic practice test answers:
1. B
2. A
3. B
4. D
5. A
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Chapter 9
NCLEX REVIEW: An Easier Way to Study
Anticoagulants
Anticoagulants simply inactivate or decrease the synthesis of clotting factors. These drugs are
usually used to treat various diseases like Thrombosis, Pulmonary embolism, atrial fibrillation
and Myocardial Infarction (MI).
As a nurse, you have to know the common side effects that your clients may experience in using
anticoagulants. The effects vary from client to client but commonly, you will see the following
signs:
 Bleeding gums
 Hypotension
 Hematuria
 Epistaxis
 Thrombocytopenia
 Hemorrhagic tendency
Not only do you have to remember the above-mentioned side effects of the drugs, you also need
to distinguish the positive outcomes that these medications could give, like:
1. Prolonged prothrombin time
2. Prevention of new thrombus formation; and,
3. Reduction of the risk of heart attack and stroke
How do you give your clients the proper education regarding these medications? What should
you tell your clients?
If you are administering these drugs subcutaneously, NEVER rub the injection site. You also
need to observe signs of bleeding, and consequently instruct your clients what not and what to do
to prevent bleeding. Set certain measures for it.
Also, you have to monitor the PT, APTT and INR levels of the client.
Lab Value Alert:
 PT (Prothrombin Time): approximately 10 to 14 seconds
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 APPT (Activated Partial Thromboplastin Time): 20 to 36 seconds
 INR: 2.0 to 3.0
And for women using oral contraceptives, you have to advise them that anticoagulants may
decrease their effectiveness if taken together with contraceptives.
NCLEX Important Reminder: ANTICOAGULANT is NOT RECOMMENDED for pregnant and
lactating women.
Let us now review the commonly used drugs as anticoagulants:
1. Heparin
2. Enoxaparin (Lovenox)
3. Dalteparin sodium (Fragmin)
4. Warfarin sodium (Coumadin)
NCLEX Notice: Most anticoagulants end with the suffix –parin like Fondaparinux, Heparin, etc.
NCLEX Alert:
Alert #1: Over dosage of Heparin: Antidote – Protamine sulfate
Alert #2: Over dosage of Warfarin: Antidote – Vitamin K
But remember, even though you have antidotes, it is still better to educate your clients to take
anticoagulants in moderation and in accordance with physician’s prescriptions.
NCLEX Anticoagulant practice test is a set of five questions about the discussion given above.
 Compute the following: The attending physician orders Heparin sodium 20,000 units in
1,000 mL. The current IV fluid is set at a regulation of 70 cc per hour. How many units of
heparin shall the client receive per hour ?
a. 1,400 mL
b. 2.5 mL
c. 3.5 mL
d. 350 mL
 In a client on Coumadin therapy, which of the following nursing considerations should
the nurse implement? Select all that apply:
1. Consult with the physician before taking vitamins
2. Monitor complete blood count weekly
3. Monitor INR and Protime weekly
4. Do not take herbal medicines
 Upon interview the nurse noted that Ms. Lionel has had an embolic stroke. Which type of
treatment should the nurse expect?
a. Aspirin therapy
b. Cefepime Therapy
c. Heparin Therapy
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d. Vitamin K Therapy
 Which of the following discharge instructions indicates that the client on Coumadin
Therapy needs additional teaching?
a. “I should shave with a manual razor.”
b. “I should use soft-bristled toothbrush.”
c. “I should return for my laboratory appointments.”
d. “I should monitor for signs of bleeding.”
 Which nursing action would be appropriate for a client on continuous infusion of heparin
with a PTT greater than 170 seconds?
a. Slow the heparin drip
b. Stop the heparin and notify the physician
c. Maintain the heparin at the current infusion rateIncrease the infusion rate and
notify the physician
NCLEX Anticoagulants practice test answer key:
1. A
2. 1, 2, 3, 4
3. C
4. A
5. B
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Chapter 10
NCLEX Review: What are Antidepressants?
Antidepressants are used to treat depressions. These drugs are also prescribed for clients with
OCD or Obsessive-Compulsive Disorder, Bulimia and Enuresis (in children).
What are the common side effects of antidepressants to your clients?
As a nurse, you will notice signs of headache and nausea in clients taking antidepressants. Aside
from these, clients will experience restlessness, may become photosensitive and could have
anticholinergic effects.
For clients taking SSRIs (like Prozac) and MAOIs (as Nardil), there is a huge tendency to
develop insomnia; and for clients who are using Tricyclic antidepressants (such as Toftranil and
Aventyl), they could have feeling of sedation.
As a nurse, how will I know if the drugs are taking effect?
For clients taking appropriate doses and frequencies of antidepressants, you could see positive
effects, like:
 Their symptoms (of depression) are being controlled,
 There will also be reduction of seizure threshold; and,
 For obese clients, their appetite will be suppressed.
It is much better to understand these medications in order to learn the nursing considerations you
have to tell your clients.
NCLEX Antidepressant review sets the following client education guidelines:
 For drugs like SSRIs (Paxil, Luvox and Effexor) and MAOIs (Marplan and Parnate), you
have to instruct your clients to take them IN THE MORNING.
 For Tricyclic antidepressants (like Elavil, Sinequan, Wellbutrin and Zyban), ask your
clients not to do activities that require alertness.
 Monitor the suicidal clients, especially during increased energy levels.
 Remember to avoid the following:
a. Alcoholic beverages
b. Foods that require bacteria or molds for their preparation
c. Foods that contain TYRAMINE for their preservation
NCLEX advice in discontinuing antidepressants:
a. Discontinue use before surgery because they may have adverse interactions with
anesthetics
b. Do not abruptly discontinue the use of antidepressants
As a nurse, you must be familiar with the three categories of antidepressants. Most of the drugs
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that will be discussed on this part have been used as examples.
The three categories of Antidepressants:
First Category: SSRI or Selective serotonin reuptake inhibitor
The antidepressants in this category are believed to increase the extracellular level of serotonin.
Drugs under this category are:
 Fluoxetine (Prozac)
 Sertraline hydrochloride (Zoloft)
 Paroxetine hydrochloride (Paxil)
 Fluvoxamine (Luvox)
 Venlafaxine (Effexor)
Second Category: MAOI or Monoamine oxidase inhibitor
These drugs interact with specific foods and drugs (sympathomimetic or tyramine-containing)
that may cause severe hypertensive crisis which will then cause blood pressure increase, as well
as PR and temperature rise, and could cause tremors.
 Isocarboxazid (Marplan)
 Phenelzine sulfate (Nardil)
 Tranylcypromine sulfate (Parnate)
Third Category: Tricyclic Antidepressants
Some drugs under this category usually end in suffixes –tyline or -pramine such as:
 Notriptyline hydrochloride (Aventyl)
 Imipramine hydrochloride (Toftranil)
 Amitriptyline hydrochloride (Elavil)
 Bupropion (Wellbutrin and Zyban)
 Doxepin hydrochloride (Sinequan)
NCLEX Antidepressant practice test will be given below. This is a set of 5 multiple choice items
regarding the review given above:
1. A client diagnosed with short-term depression is taking Wellbutrin. Which of the
following symptoms, if exhibited by the client, requires priority nursing intervention?
a. Tachycardia
b. Agitation
c. Seizures
d. Dizziness
2. A client receiving Phenelzine sulfate (Nardil) must be taught to avoid which of the
following foods?
a. Fish, potatoes, and corn
b. Pasta, mint, and ice cream
c. Aged cheeses, beer and avocados
d. Chicken, eggs, and carrots
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3. For a child who is being treated for enuresis, which Tricyclic antidepressant should the
nurse anticipate the doctor to order?
a. Midazolam (Versed)
b. Buspirone (BuSpar)
c. Amitryptiline hydrochloride (Elavil)
d. Imipramine hydrochlodride (Tofranil)
4. In teaching the parents of the child being treated for enuresis, the nurse informs them that
the maximum desired effects of Tofranil may:
a. Start during the first week of treatment
b. Start during the second week of treatment
c. Not occur for 2 to 3 weeks after the start of treatment
d. Not occur after a month of starting the treatment
5. A home health nurse visits the client taking amitriptyline hydrochloride (Elavil), The
nurse evaluates that the medication is most effective for this client if the client reports
which of the following?
a. Having problems concentrating on tasks
b. Sleeping 14-16 hours a day
c. Jittery most of the time
d. Ability to get to work on time each day
NCLEX Antidepressant practice test answer key:
 C
 C
 D
 C
 D
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Chapter 11
An Easier Approach to Antihistamines
What are the main tasks of Antihistamines?
Antihistamines have two major tasks: first, they block histamine receptor sites, and second, they
control the protein synthesis and prevent inflammation.
These drugs usually treat allergy symptoms. Moreover, they are also used to cure congestion,
otitis media, motion sickness and urticaria.
If a client uses antihistamine, he will most likely experience drowsiness and dizziness as side
effects. As a nurse, you will also have to watch out for signs of urinary retention, constipation
and hypotension. Aside from those, clients could also have blurred vision, dry mouth and GI
irritation. As for children using Antihistamines, they may exhibit paradoxical reaction.
One of the most common antihistamine drugs is Benadryl (Diphenhydramine). There are also
other sorts of this medication, like:
 Promethazine hydrochloride (Phenergan)
 Hydroxyzine hydrochloride (Vistaril, Atarax)
 Cetirizine (Zyrtec)
 Fexofenadine (Allegra)
 Fluticasone (Flonase, Flovent)
 Triamcinolone (Nasacort)
However, as a nurse, you have to advise clients to take certain precautions in taking these drugs
because they should always be taken in moderation.
If your client asks you about considerations regarding these drugs, what do you have to say?
As a nurse, you have to make sure to tell your clients about the following:
 Avoid activities that require mental alertness.
 Take antihistamine 30 minutes before an event that will trigger motion sickness.
 Taking candy or ice chips for dry mouth could also help the condition of the client.
 You have to warn your client not to take the medications with alcohol.
 Avoid SC injection and administer IM injections in a large muscle to prevent tissue
irritation.
NCLEX Important consideration #1: Monitor for signs of urinary dysfunction
NCLEX Important consideration #2: Antihistamines should not be used for treatment of asthma
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Question: What are the expected desirable effects of antihistamine to clients?
Answer: As a nurse responsible for clients taking Antihistamines, you should see that there is a
decrease in symptoms of histamine excess, and a decrease in postoperative nausea.
Antihistamines also aid in sleeping. Lastly, the effect of preoperative narcotics is potentiated.
Remember the guidelines given to you above before answering the NCLEX Antihistamine
practice test. This is a 5-item quiz to assess your learning.
1. A nurse is teaching the client on the effects of diphenhydramine hydrochloride
(Benadryl). Which of the following should not be included in the teaching session?
a. Use sugar-free gum or candy to alleviate dry mouth
b. Avoid consuming alcoholic drinks while on this medication
c. Administer one hour prior to eating
d. Avoid operating heavy machineries
2. The doctor ordered Diphenhydramine 35 mg IM for the client who had an allergic
reaction to peanuts. In giving the medication, the nurse notes that the label on the vial
says Diphenhydramine 25 mg/ml and that 1 vial has 2ml. How should the nurse give
the medication?
a. 2.8 mg using gauge 24 needle
b. 1.4 mg using gauge 22 needle
c. 0.7 mg using gauge 16 needle
d. 1.7 mg using gauge 18 needle
3. A nurse is ordered to administer Hydroxyzine (Vistaril) IM to a client. Prior to
injection, the nurse explains that:
a. The client’s blood pressure will increase.
b. There will be some pain in the injection site.
c. Frequent urination will be experienced in the next 4 hours.
d. The client will feel some pain at the injection site.
4. A client is using Diphenhydramine (Benadryl) 1% as a topical cream for allergic
dermatitis. What should be relieved by this medication?
a. Pain
b. Urticaria
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c. Headache
d. Skin redness
5. During follow up, the client on daily doses of antihistamines is equipped with the
correct understanding that the side effect while taking this medication is:
a. Urinary retention
b. Hyperexcitability
c. Hypertension
d. Bleeding tendencies
NCLEX Antihistamine answer key:
1. C
2. B
3. D
4. B
5. A
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Chapter 12
NCLEX Provides a Clearer Discussion of BetaAdrenergic Blockers
NCLEX Beta-Adrenergic Blockers Facts:
Fact #1: Beta-Adrenergic Blockers decrease the cardiac workload
Fact #2: Beta-Adrenergic Blockers decrease myocardial oxygen consumption
Beta-Adrenergic Blockers treat diseases like Angina, Dysrhythmias, Hypertension and Migraine
headaches. Physicians also recommend these drugs for the treatment of Glaucoma and especially,
Acute MI.
The usual side effects of Beta-Adrenergic Blockers to clients are nausea, vomiting,
hyperglycemia, hypotension and depression. Other clients may manifest signs of bradycardia,
while others may experience bronchospasm.
Finally, clients could also have Agranulocytosis (lowered white blood cells count).
As a nurse, you have to be familiar with these side effects.
You might ask, “What should I tell my clients regarding drug education?” First and foremost,
you have to remember the things that need to be monitored like signs of congestive heart failure.
If you observe that the pulse or BP is not within the prescribed parameters, HOLD THE
MEDICATION.
Lab Value Alert: Normal Blood Pressure Range from 120/80 but monitor of signs of
hypotension.
If a client is experiencing orthostatic hypotension, change their positions slowly. Also, you have
to assess any respiratory distress and signs of wheezing and dyspnea.
Moreover, if your client is on insulin, instruct them to monitor their blood glucose level.
Lab Value Alert: Normal Blood Random Blood Sugar: 70 – 140 mg/dL
And, as a nurse, it is a must to remind your client not to stop this medication abruptly because
rebound hypertension, rebound tachycardia or an angina attack can occur.
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Frequently Asked Questions (FAQs):
Question: What are the drugs used as Beta-Adrenergic Blockers?
Answer: Below are the drugs used as Beta-Adrenergic Blockers:
 Metoprolol (Lopressor)
 Atenolol (Tenormin)
 Propranolol (Inderal)
 Nadolol (Corgard)
 Carvedilol (Coreg)
 Esmolol (Brevibloc)
NCLEX Alert: Beta-Adrenergic Blockers end in suffix –lol
Question: What are the positive outcomes of these drugs?
Answer: You will see that the drugs are taking effect if there is:
 Decrease in blood pressure and heart rate
 Decrease in occurrence of chest pain
NCLEX Beta-Adrenergic Blockers practice test:
Instruction: You are given a 5-item questionnaire regarding Beta-Adrenergic Blockers. Tick the
letter of the correct answer.
 A 49-year-old male client verbalizes that he does not want to take Propranolol (Inderal)
anymore. Which of the following statements made by the client is a probable reason
behind his refusal?
a. “I have problems with slow bowel movement.”
b. "I have difficulty sleeping."
c. “I have diminished sexual function.”
d. "I often feel jittery.”
 Which of the following clients are not advised to take Beta-Adrenergic blockers
a. COPD
b. MI
c. Angina pectoris
d. CKD
 Mr. Davidson, a 39-year-old hypertensive client is on Carvedilol (Coreg) for 2 months.
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Which of the following is a sign that the client has developed a drug tolerance?
a. Polyuria
b. Weight loss
c. Gradual rise in blood pressure
d. Rapid decrease in blood pressure
 A client is prescribed with Atenolol (Tenormin). The nurse determines that the client
needs further teaching when the client states the need to:
a. Report shortness of breath to the physician
b. Change positions slowly
c. Monitor blood pressure regularly
d. Taper or discontinue the medication when the client feels well
 In a client receiving Metoprolol (Lopressor), which of the following is a frequent side
effect of the medication:
a. Impotence
b. Hypoglycemia
c. Night blindness
d. Tachycardia
NCLEX Beta-Adrenergic Blockers practice test answer key:
1. C
2. A
3. C
4. D
5. A
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Chapter 13
A Better Guide to Calcium Channel Blockers
List of the diseases that Calcium Channel Blockers cure:
 Hypertension
 Dysrhythmia
 Chronic Stable Angina
What does Calcium Channel Blocker do?
Calcium Channel Blocker, from the words itself, blocks calcium channel receptors which causes
decrease in cardiac contractility.
If your client takes this medication continuously, they will get desirable effects such as correction
of abnormal heart rhythm, decrease in the occurrence of chest pain, heart rate and blood pressure.
Furthermore, cardiosuppresant effect of beta-blockers will intensify.
What are the drugs used as Calcium Channel Blocker?
As a nurse, you have to be familiar with different Calcium Channel Blockers like Amlodipine,
Verapamil, Nifedipine, Diltiazem, Felodipine and Nicardipine.
NCLEX Alert: Notice that these drugs usually end with the suffix –dipine.
What are the usual brands of these Calcium Channel Blockers?
Some physicians are not very particular with the drugs’ brand names, but others are. So, you
might as well learn some brands used as Calcium Channel Blockers.
 Amlodipine (Norvasc)
 Verapamil (Calan, Isoptin)
 Nifedipine (Procardia)
 Diltiazem (Cardizem)
 Felodipine (Plendil)
 Nicardipine (Cardene)
If, for example, your client is taking Amlodipine, what are the nursing drug teachings that you
must tell them?
As a nurse, you have to advise your client to monitor signs of CHF, liver enzymes and kidney
function tests. You also need to instruct them not to chew or crush sustained release tablets. Also,
advise clients to notify their physicians immediately when dizziness or fainting occurs.
Lab Value Alert: Normal Kidney Function Tests
 BUN: 7 – 20mg/dL
 Creatinine: 0.6 to 1.3 mg/dL
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Lab Value Alert: Normal Liver Function Tests
 ALT. 7 to 55 units per liter (U/L)
 AST. 8 to 48 U/L
 ALP. 45 to 115 U/L
 Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
 Total protein. 6.3 to 7.9 g/dL
 Bilirubin. 0.1 to 1.0 mg/dL
 GGT. 9 to 48 U/L
 LD. 122 to 222 U/L
 PT. 9.5 to 13.8 seconds
Lastly, you have to notify your clients to keep fast-acting nitrateson in hand in case of acute
attacks.
NCLEX Important Reminder: If your client is taking Anti-hypertensives, remind them NOT to
drink grapefruit juice because it increases the level of the medicine in the blood.
Are you ready for the NCLEX Calcium Channel Blocker practice test?
Five questions are given below to see if you have understood the discussion.
1. Which side effect needs to be explained in the client teaching for a client taking Ca channel
blockers?
a. increase in weight
b. rash with pruritus
c. peripheral edema
d. tachycardia
2. The physician ordered Verapamil (Calan) 5 mg IV for a client with atrial fibrillation. The nurse
ensures which item is most essential when administering this medication:
a. Oxygen
b. blood pressure monitor
c. cardiac monitor
d. pulse oximeter
3. A client with hypertension is on treatment with diltiazem hydrochloride (Cardizem). What
should the nurse assess prior to giving the drug?
a. Wheezing
b. Bradycardia
c. Apical pulse rate lower than the baseline
d. Peripheral edema and weight gain
4. Mr. Davidson is taking Amlodipine (Norvasc) for chronic stable angina. Which of the
following indicates that the client is experiencing an adverse effect of the medication?
a. Hypotension
b. Headache
c. Flushing
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d. Peripheral edema
5. When the nurse instructs a client with a new prescription for Nifedipine (Procardia), she
correctly informs the client to:
a. Limit alcohol consumption to 2 ounces per day
b. Expect urinary retention as a side effect
c. Monitor his pulse daily
d. cut the dose is half if fainting occurs
NCLEX Calcium Channel Blocker practice test answer key:





C
C
D
A
C
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Chapter 14
A Better Way to Understand Antiplatelet Drugs
Why do we use antiplatelet drugs?
Antiplatelet drugs are used in cases like CVA, MI, RHD, Pericarditis, Pulmonary embolism,
Acute Coronary Syndrome and clients with deep vein thrombosis.
These drugs inhibit the aggregation of platelets in the clotting process and prevent thrombus
formation. Hence, antiplatelet drugs prolong the bleeding time of clients.
Some examples of drugs used as antiplatelet are:
 Aspirin
 Clopidogrel (Plavix)
 Pentoxifylline (Trental)
 Cilostazol (Pletal)
 Ticlopidine (Ticlid)
If clients use these drugs effectively, the positive outcomes would be prevention of stroke, MI
and vascular death (after recent attack). Clients will also experience relief of intermittent
claudication in lower extremities (legs).
However, such drugs could also have side effects to clients. Common side effects that clients
experience while using antiplatelet medications are bruising, hematuria, gastrointestinal bleeding
and neutropenia. Some clients could also have tarry stools.
As a nurse, what should be your considerations in drug teaching your clients?
First, you have to instruct clients to take measures to prevent bleeding, and if bleeding occurs,
monitor the time of occurrences. It is also very important to prevent clients who have history of
peptic ulcers from administering these drugs.
Most importantly, always give food or antacids to clients taking this medication to minimize GI
upset.
NCLEX Alert: Relay to your clients not to take OTC medicines containing aspirin or NSAIDs
without consulting a physician.
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Here are some NCLEX Antiplatelet practice tests for you:
1. A 50-year-old woman comes into the outpatient clinic for a check-up for echymosis
around the toes. Upon interview she tells the nurse that she had been prescribed a new
medication, namely Plavix, about a week ago. Which of the following should the
nurse tell the client?
a. “It is a normal side effect of the medication and you should be fine.”
b. “It’s impossible that you got the echymosis from Plavix.”
c. “With cases such as this, I’m afraid I have to refer you to the infectious disease
committee.”
d. “Please wait here for a while, the doctor will see you in a bit.”
2. A client is rushed at the emergency department for taking almost a whole bottle
Aspirin. Which of the following should the nurse monitor?
a. Tourniquet test
b. Shortened bleeding time
c. Oxygen saturation
d. ABG results
3. A client with an acute pulmonary emboli is receiving Pentoxifylline (Trental). Which
of the following indicates that the client is experiencing an adverse effect of the
medication:
a. Hypertension
b. Abdominal pain
c. Bradycardia
d. Positive peripheral pulses
4. The client is receiving high doses of aspirin to prevent the evolution of stroke. Which
of the following is the most appropriate health teaching by the nurse?
a. Tell the client not to brush his teeth
b. Provide active ROM exercises to prevent clot formation
c. Allow the client to sit at the bedside only
d. Tell the client to use an electric razor for shaving
5. Ms. Cruz is prescribed with Ticlodipine (Ticlid) following a thrombotic stroke. As the
nurse provides instructions, which client statement indicates that the client has
understood the instructions given?
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a.
b.
c.
d.
“I should not take this medicine on sick days.”
“This medicine will cure the stroke.”
“I’ll take the medicine with meals.”
“This medicine needs to be taken with aspirin.”
NCLEX Antiplatelet practice test answer key:
1. D
2. D
3. B
4. D
5. C
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Chapter 15
NCLEX Better Guide to Benzodiazepines
What do Benzodiazepines do?
Benzodiazepines depress the CNS (Central Nervous System) of a client and they also produce
relaxation which could cause the depression of the limbic system.
What do these drugs treat?
Benzodiazepines treat anxiety and tension, as well as muscle spasm. Physicians also prescribe
these drugs for acute alcohol withdrawal and as preoperative medication.
What are the specific examples of Benzodiazepines?
To quickly remember Benzodiazepines, you have to know that they usually end in suffixes –
zolam as in: Alprazolam (Xanax) and Midazolam (Versed); and –zepam like: Clonazepam
(Klonopin), Diazepam (Valium), Oxazepam (Serax) and Lorazepam (Ativan).
Other Benzodiazepines are:
 Chlordiazepoxide (Librium)
 Zolpidem (Ambien)
 Buspirone (Bu Spar)
 Eszopiclone (Lunesta)
NCLEX Alert #1: Benzodiazepines intoxication will present somnolence, confusion and
diminished reflexes to coma.
NCLEX Alert #2: Flumazenil (Romazicon) IV reverses toxicity in 5 minutes.
NCLEX Alert #3: These drugs are not to be taken if breastfeeding
As a nurse, you have to know what to educate your clients regarding these drugs. Remember the
following nursing considerations to tell your clients about Benzodiazepines:




Monitor liver and renal functions tests and blood counts
Assess for symptoms of leukopenia (sore throat, fever, weakness)
Avoid tasks that require mental alertness
Do not mix Librium or Valium with any other drug or IV fluid, inject directly into a vein
over a 1-minute period
 Physical dependency commonly develops
 Tapered gradually over 2 to 6 weeks to lessen withdrawal symptoms
Lab Value Alert: Normal Kidney Function Tests
 BUN: 7 – 20mg/dL
 Creatinine: 0.6 to 1.3 mg/dL
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Lab Value Alert: Normal Liver Function Tests
 ALT. 7 to 55 units per liter (U/L)
 AST. 8 to 48 U/L
 ALP. 45 to 115 U/L
 Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
 Total protein. 6.3 to 7.9 g/dL
 Bilirubin. 0.1 to 1.0 mg/dL
 GGT. 9 to 48 U/L
 LD. 122 to 222 U/L
 PT. 9.5 to 13.8 seconds
Lab Value Alert: Normal complete blood count (CBC) Adults
 Red blood cell count
Male: 4.32-5.72 trillion cells/L
Female: 3.90-5.03 trillion cells/L
 Hemoglobin
Male: 13.5-17.5 grams/dL
Female: 12.0-15.5 grams/dL
 Hematocrit
Male: 38.8-50.0 percent
Female: 34.9-44.5 percent
 White blood cell count 3.5-10.5 billion cells/L
 Platelet count 150-450 billion/L
Frequently Asked Questions (FAQs):
Question #1: What are the side effects of these medications?
Answer: The side effects that clients usually have are hypotension, urinary incontinence,
constipation, slurred speech, and blurred or double vision. Some clients could also have amnesia,
tremor and Ataxia. And most clients have signs of daytime sedation.
Question #2: I am taking Diazepam. What are the desirable outcomes that I should experience?
Answer: If you take your medications accurately (in accordance to physician’s order), most
likely your anxiety level will be reduced. Your muscles will also be relaxed and you could have a
sedative-hypnotic feeling. Remember that your medication is also an anticonvulsant drug.
You are now ready to take the NCLEX practice test for this Chapter. Listed below are five
questions regarding Benzodiazepines. Select the correct answer for each multiple choice
question.
1. Mr. Lucas is taking Xanax. Which of the following indicates an expected side effect of
the drug?
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a.
b.
c.
d.
Agitated
Drowsiness
Tachycardia
Hypertension
2. The doctor ordered for a Diazepam (Valium) IV to a client who is having a seizure. What
is the appropriate action of the nurse?
a. Push the prescribed dose over 60 minutes
b. Mix the prescribe dose in 100 cc of 5% dextrose in normal saline
c. Administer the prescribed dose via IV push
d. Dilute the prescribe dose in 50 cc of sterile water
3. The nurse teaches the client about the drug Clonazepam (Klonopin). Which of the
following statements by the client indicate the need for further teaching?
a. “I should take this medicine with food.”
b. “I can take this medicine before bedtime if it tends to make me feel drowsy.”
c. “Slurred speech should disappear in about six weeks.”
d. “My drowsiness will decrease over time with continued treatment.”
4. A client admitted for acute alcohol withdrawal is ordered Diazepam 7.5 mg intravenously.
The medication bottle indicates that the content is “5 mg/ml”. How many ml should the
nurse administer?
a. 0.67 ml
b. 1 ml
c. 1.5 ml
d. 1.2 ml
5. A client is prescribed with Zolpidem (Ambien) for insomnia. To produce a maximal
effect of the medication, the nurse tells the client to take the medication:
a. Following the evening meal
b. With a full glass of water on an empty stomach
c. With milk or an antacid
d. At bedtime with a snack
NCLEX Benzodiazepines practice test answers:
1. B
2. C
3. C
4. C
5. B
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Chapter 16
What you need to know about Cardiac Glycosides
Cardiac glycosides are medications that produce a positive inotropic action that increases the
force of myocardial contraction. Medications such as digitalis do this by decreasing the
conduction of the impulses through the AV node.
Some of the diseases that cardiac glycosides treat are:
 Supraventricular tachycardia
 Congestive heart failure
 Atrial fibrillation
 Atrial flutter
Imagine you are a nurse taking care of a client taking cardiac glycosides like Digoxin. What are
some of the side affects you should monitor? You should monitor for anorexia, nausea &
vomiting, visual disturbances, fatigue, drug-induced dysrhythmias, and photophobia.
Two of the most common cardiac glycosides are Digoxin (Lanoxin) and Digitoxin
(Crystodigin).
Suppose you are the nurse assigned to take care of a client on cardiac glycosides. Remember that
you should monitor their electrolyte levels and renal function tests:
Lab Value Alert: Normal Electrolyte levels:
 Calcium 8.8 - 10.3 mg/dL
 Calcium, ionized 2.24 - 2.46 mEq/L
 Chloride 95 - 107 mEq/L
 Magnesium 1.6 - 2.4 mEq/L
 Phosphate 2.5 - 4.5 mEq/dL
 Potassium 3.6 to 5.2 mmol/L
 Sodium1 35 - 145 mEq/L
Lab Alert Value: Normal Renal Function Tests:
 BUN: 7-20 mg/dL
 Crea: 0.6 – 1.3 mg/dL
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As a nurse you should remember to monitor clients taking cardiac glycosides for cardiac
abnormalities such as PVCs. Make sure to assess for an apical pulse greater than 60 before
administering these medications. Contact the physician immediately for apical pulses less than
60, signs of confusion, or abnormal digoxin levels.
Lab Value Alert: Normal digitalis values range from 0.8 to 2.0 nanograms per milliliter.
Your desired goals of a client taking cardiac glycosides are:
 Decreased conduction of the heart cells
 Increases cardiac output and blood flow to the kidneys
 Change to Normal Sinus Rhythm
Frequently asked questions (FAQs):
Q: What nursing precautions should I follow?
A: Hold medication dose if apical heart rate is less than 60 for an adult and less than 90 for a
child.
Q: What dietary instructions should I follow?
A: The client’s physician may prescribe a low-salt diet and a potassium supplement.
Consider the following questions for practice:
 A client diagnosed with renal failure is taking Digoxin. Which of the following statements, if
made by the client, needs further evaluation?
a. “I have gained some weight.”
b. “It increases my voiding.”
c. “I don’t feel shortness of breath during walking.”
d. “Lately I have no appetite and would skip meals.”
 A 10-year-old child with congestive heart failure on Lanoxin vomited more than twice.
Before the next dose of the Lanoxin, the nurse should:
a. Hold the dose and notify the physician
b. Assess for symptoms of toxicity
c. Evaluate the adjunct of Lasix
d. Assess the pulse and respiratory rate
 Which statement made by the client taking Lanoxin 0.25 mg OD would indicate the need for
further teaching?
a. “I will take antacids if I have an upset stomach.”
b. “I will carry a medication identification card with me all times.”
c. “I will check my pulse after taking this drug.”
d. “I will have my blood drawn when prescribed.”
 A client has been prescribed Digoxin (Lanoxin) for congestive heart failure. His initial vital
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signs are as follows: BP 85/50 mmHg, PR 96 beats per minute, RR 26 breaths per minute.
The nurse would expect which changes in the vital signs to assess therapeutic effectiveness:
a. BP 110/50 mmHg, PR 115 beats per minute , RR 20 breaths per minute
b. BP 98/60 mmHg, PR 80 beats per minute , RR 24 breaths per minute
c. BP 85/50 mmHg, PR 60 beats per minute , RR 26 breaths per minute
d. BP 130/70 mmHg, PR 104 beats per minute , RR 20 breaths per minute
 The nurse is providing home instructions to the mother of a child with congestive heart
failure regarding the administration of Digoxin (Lanoxin). Which statement by the mother
indicates that further teaching is needed?
a. “If my child vomits after I give the medication, I will not repeat the dose.”
b. “I will mix the medication with food.”
c. “I will check the dose of the medication with my husband before I give the medication.”
d. “I will check my child’s pulse rate before administering the medication.”
NCLEX Tip: Prefix: Cardiac glycosides start with “dig-” Example: Digoxin, Digitoxin
Remember: Quinidine and Verapamil both increase plasma levels of Digitalis
NCLEX Alert: It is important for you to know that the antidote for Digitalis toxicity is Digoxin
immune FAB (Digibind)
Cardiac Glycoside practice Questions answer key:
1. D
2. A
3. A
4. B
5. B
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Chapter 17
NCLEX Approach to Diuretics: Water Pills
Diuretics, also known as “water pills” are medications used to get rid of the body’s water and
sodium. They are usually recommended by physicians to clients with Hypertension, Glaucoma,
Edema, Hypercalcemia, Hepatic cirrhosis and for those who have renal diseases.
There are five categories of diuretics. They are:
1. “Loop Diuretics”: Furosemide (Lasix), Torsemide ( Demdex), and Bumetanide (Bumex)
NCLEX Tip #1: Notice that some Loop diuretics end in suffix –semide
2. “Thiazide Diuretics”: Chlorothiazide (Diuri), Methylchothiazide (Aquatensen; Enduron), and
Hydrochlorothiazide (HydroDIURIL; Esidrix)
NCLEX Tip #2: Notice that diuretics under this category end in suffix –thiazide
NCLEX Tip #3: Be aware that thiazides should only be used to clients with normal renal
functions.
3. “Osmotic Diuretics”: Mannitol (Osmitrol) and Urea (Ureaphil)
NCLEX Tip #4: Take note that prolonged use of Mannitol can cause metabolic acidosis.
4. “Carbonic Anhydrase Inhibitors”: Acetazolamide (Diamox), Dichlorphenamide (Daranide),
and Methazolamide (Naptazane)
5. “Potassium-Sparing Diuretic”: Spirinolactone (Aldactone), Triamterene (Dyrenium), and
Amiloride (Midamor)
What are the positive outcomes that clients should expect?
Clients who are using diuretics effectively will normally have relief of congestion. Diuretics also
help maintain acid-base balance. They also restore the volume status of clients. Also, clients will
have diuresis; and lastly, they prevent sodium, potassium or chloride reabsorption.
Do diuretics have side effects?
Yes. Different drugs have different side effects to clients. As for diuretics, the common side
effect is dehydration. So you have to advise your clients to take rehydration measures.
Another side effect of these drugs is hypokalemia. So, as a nurse, one of the important laboratory
exams that you have to monitor is the potassium level of the client.
Lab Value Alert: Normal Potassium Level : 3.6 to 5.2 mmol/L
Some clients will also experience hypotension, more specifically, orthostatic hypotension,
hyponatremia, and hyperglycemia. Those taking Mannitol might have pulmonary edema. This
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would tell you to monitor their blood pressure and food intake and output. Evaluation of daily
weight should also be done.
Lab Value Alert: Normal Sodium Level : 135 - 145 mEq/L
Normal Random Blood Sugar: 70 – 140 mg/dL
Below are some tips on how to educate your clients regarding diuretics:
For those clients taking Digoxin and Lithium, make sure to be cautious in taking diuretics. And
finally, always administer these drugs in the morning.
These tips are very easy to understand. "NCLEX Approach to Diuretics: Water Pills" provided
you details that are easy to understand and even memorize.
Now, let us proceed to the NCLEX approach to Diuretics: Diuretics are frequently tested on the
NCLEX exam. Below is a five-item quiz to see if you really did understand our lesson.
1. A nurse had just received the laboratory results of Mr. Wyatt, a client with chronic kidney
disease, who is receiving Furosemide every 8 hours. Which of the following laboratory
results indicates a need to alert the physician?
a. Creatinine 1.5 mg/dl
b. Potassium 1.3 mEq/L
c. Sodium 130mEq/L
d. RBS 82 mg/dL
2. Upon discharge, the nurse explains to Mr. Wyatt how to take the prescribed Furosemide
(Lasix) 40 mg once a day. What time of the day should the nurse instruct the patient to
take the medication?
a. At bedtime
b. At noon
c. After dinner
d. In the morning
3. Which of the following should the nurse monitor daily in a client receiving frequent
doses of diuretics?
a. Weight
b. Calcium levels
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c. Lithium levels
d. Abdominal girth
4. A client is on Acetazolamide and Digoxin. Which of the following statements by the
client should be reported for follow-ups?
a. “I noticed that my cough has been relieved.”
b. “I do early morning walks.”
c. “I sleep with three pillows at night.”
d. “I have lost weight.”
5. Which assessment finding is the nurse most likely to expect in a client who has received
Mannitol 60cc IV bolus?
a. Anuria
b. Hypoglydemia
c. Hypoxemia
d. Hypotension
NCLEX Approach to Diuretics: Water Pills practice test answer key:
 B
 D
 A
 C
 D
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Chapter 18
NCLEX Tips: What you need to know about Anti-HIV
Drugs
This chapter will discuss the medications used to treat HIV and AIDS. Be reminded that these
medications do not cure AIDS. Clients with HIV or AIDS will hope to expect the following
outcomes from Anti-HIV drugs:
 Prevents HIV from multiplying and destroying infection-fighting CD4 cells
 Prevents infections
 Prevents HIV to advancing to AIDS
These medications do not reduce the risk of transmission.
What are the specific drugs used as Anti-HIV? As a nurse, you have to be familiar with the
different drugs that physicians prescribe to clients with HIV or AIDS. These medications are
separated into four categories, namely:
First.
Second.
Third.
Fourth.
Non-nucleoside Reverse Transcriptase Inhibitors or NNRTIs
Nucleoside Reverse Transcriptase Inhibitors or NRTIs
Protease Inhibitors
Fusion Inhibitors
Each category has different specific drugs. Under NNRTI Category, there are Nevirapine
(Viramune), Delavirdine (Rescriptor) and Efavirenz (Sustiva); for NRTI Category, drugs like
Abacavir (Ziagen), Stavudine (Zerit) and Didanosine (Videx).
NCLEX Alert: Most Anti-HIV drugs end in suffix –vir, such as Saquinavir (Fortovase and
Invirase), Indinavir (Crixivan) and Nelfinavir (Viracept), which are under Protease Inhibitors.
And under Fusion Inhibitor, there is Enfuvirtide (Fuzeon).
Frequently Asked Questions:
Q: What are the side effects in using Anti-HIV drugs?
A: Clients using Anti-HIV drugs usually experience the following side effects:
 They have rashes
 They usually experience diarrhea, vomiting and nausea
 Clients develop anemia or neutropenia, Peripheral neuropathy, liver damage and
Lipodystrophy
 Clients also have GI discomfort
Q: Are there any precautions in taking specific Anti-HIV drugs?
A: There are some specific precautions given to clients taking certain drugs. For instance, if your
client is taking Invirase and Crixivan, you have to alert them to eat food that are high-in fat.
Also, when injecting Enfuvirtide, clients should use an insulin syringe to decrease the skin
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reaction of this drug. Lastly, you have to take food in taking the prescribed medications except
in drugs like Videx and Agenerase.
Q: If I have a client using Anti-HIV drugs, what should I advise them as part of nursing
considerations and drug teaching?
A: As a nurse, you have to know how to advise your clients in using Anti-HIV medications. You
need to relay the following teachings to your clients:
 Have CD4 count and viral load regularly tested
 Avoid exposure to infection. Advise them to always wash their hands in a regular basis.
 Report any sore throat, fever or other gins of infection directly to you or to their
physician.
 Most importantly, tell your client to take medication at the same time each day because
that will maintain consistency in blood level.
NCLEX Anti-HIV Drugs practice test
1. The nurse is providing home instructions to a client prescribed with Invirase, the nurse
includes the following, except:
a. Take the medicine on an empty stomach
b. Come back for CD4 count and viral load testing
c. Take the medication at the same time each day
d. None of the above
2. A client with HIV is taking Enfuvirtide (Fuzeon) injections, The nurse teaches the client
which of the following to minimize skin reactions?
a. Do not rotate injection sites
b. Rub the site after injecting the medicine
c. Use an insulin syringe
d. Apply warm compress to injection sites
3. Which of the following side effects should the client taking Stavudine (Zerit) report to the
physician?
a. Nausea
b. Hypoglycemia
c. Dizziness
d. Peripheral neuropathy
4. The nurse has received the latest results for Mr. Perez, a client diagnosed with AIDS who
is receiving Lopinavir, (Kaletra). The nurse perceives that the client would have his
medication discontinued by his physician if which of the following significantly elevated
result is noted?
a. Serum amylase
b. Serum cholesterol
c. Sodium Bicarbonate
d. Creatinine
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5. Which of the following is the primary action of Didanosine (Videx)?
a. Antifungal
b. Cholinergic
c. Antiplatelet
d. Antiviral
NCLEX Anti-HIV Drugs practice test answer key:
1. A
2. C
3. D
4. A
5. D
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Chapter 19
NCLEX Essential: Information about Insulin
What does Insulin do?
Insulin is used to facilitate transport of glucose, potassium and magnesium into muscle and fat
cells.
It is also prescribed to treat Diabetes Mellitus Type 1 and 2.
What are the specific drugs used as Insulin?
There are actually six categories of Insulin. First you have what we call Rapid Acting Insulin.
The drugs under this category are Lispro (Humalog) and Aspart (Novolog). The second category
is Short Acting Insulin. The most common short acting insulins are Regular Insulins which are
Humulin R and Novolin R. The third category is Immediate Acting Insulin, such as Humulin
NPH and Lente (Novolin L). The fourth insulin category is Long Acting Insulin such as
Ultralente (Humulin U). Very Long Acting Insulin such as Glargine (Lantus) is the fifth insulin
category. Finally, there is Premixed Insulin, which primarily is a combination of the different
categories like NPH 70% and Regular 30% (Humulin 70/30) and Humalog Mix 75/25 which is a
combination of NPH 75% and Lispro 25%.
NCLEX Advisory: When drawing up Regular Insulin with a Long-Acting Insulin, draw up the
Regular first before the Long-Acting Insulin.
NCLEX Reminder #1: Never mix Lantus with other insulins
Frequently Asked Questions (FAQs):
Q: What are the side effects of Insulin?
A: There are some side effects that Insulin causes to clients like hypoglycemia, headaches, blurry
vision, weight gain, skin reactions and Lypodystrophy.
Q: As a nurse, what are the diet/eating considerations that I could advise my client who is taking
insulin?
A: If your client is taking Short Acting Insulin, remind him or her to take the medication 20 – 30
minutes prior to eating meals.
If your client is taking Rapid Acting Insulin, advise your client to eat immediately after
administering the medication.
Q: I need to administer Insulin to my client intravenously. What are my considerations about
this?
A: As a nurse, you always have to remember the following guidelines in administering insulin
intravenously:
 Never cleanse the skin with alcohol before injection.
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 Rotate injection sites to prevent lipodystrophy.
 Regular insulin is the only type of insulin that can be administered through IV route.
Q: My client is taking Insulin for over a month now. What desirable outcomes should I expect as
his nurse?
A: If your client is taking insulin considerately, the expected outcomes would be a decrease in
serum glucose and their diabetic condition will be maintained and controlled.
Lab Value Alert: Normal Random Blood Sugar: 70 – 140 mg/dL
As a nurse, you also need to be familiar with other precautions regarding Insulin:
NCLEX Reminder #2:Do not shake insulin bottles before use.
NCLEX Reminder #3:Do not administer cold insulin.
We have prepared a short NCLEX practice test for this chapter. Five questions are listed below to
assess how much learning you’ve had:
1. The doctor orders the client to receive 3 units of Humulin R and 5 units of Humulin U.
How should the nurse draw the medication in the insulin syringe?
a. Draw 5 units of the short acting insulin first then draw 3 units of the long acting
insulin.
b. Draw 3 units of Humulin U first then draw 5 units of Humulin R.
c. Draw 3 units of the short acting insulin first then draw 5 units of the long acting
insulin.
d. Draw 5 units of the long acting insulin first then draw 3 units of the short acting
insulin.
2. In teaching a client on how to inject insulin, which of the following should be included?
a. Apply an alcohol swab on the site preferred in every insulin injection
b. Rotate injection sites regularly
c. Prior to administering the insulin, aspirate first for any backflow of blood
d. Shake the bottle before use
3. The nurse is making her rounds at 4:00 pm and finds her diabetic client asleep. When
checking the medication sheet, the nurse notes that the client has received NPH 20 units
SC at 8:00 am. If the client was having a hypoglycemic reaction, how can the nurse
determine it?
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a.
b.
c.
d.
Check the client’s pupils for dilatation
Auscultate the client’s breath sounds
Smell the client’s breath
Check for diaphoresis
4. A client is found unresponsive and blood sugar levels were found to be 52 mg/dl. Which
nursing action is prioritized?
a. Advise the client to drink orange juice and give a lifesaver candy
b. Check the client’s urine for sugar and acetone
c. Give 50% glucose intravenously
d. Infuse 1L of D5W for 8 hours
5. The community nurse is teaching a group of diabetic clients about the role of insulin in
the body. Which of the following is the primary action of insulin?
a. Promotes the process of gluconeogenesis
b. Decreases intestinal absorption of glucose
c. Stimulates the pancreatic beta cells
d. Enhances transport of glucose across the cell walls
NCLEX Insulin practice test answer key:
 C
 B
 D
 C
 D
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Chapter 20
NCLEX Review: An Easier Approach to NSAIDs
What are the uses of NSAIDs?
NSAIDs or Non-steroidal Anti-inflammatory Drugs are used as analgesic, antipyretic and
anticoagulant drugs. They also inhibit prostaglandin synthesis.
NSAIDs treat diseases like rheumatoid arthritis, bursitis, osteoarthritis and tendinitis. They are
also used for pain, fever and headache. NSAIDS are prophylactic used for cardiovascular
problems and colon cancer.
As a nurse, you have to know the different specific drugs used as NSAIDs:
 Acetylsalicylic acid (Aspirin, ASA) – this drug is the most common agent responsible for
accidental poisoning in small children
 Ibuprofen (Advil, Motrin)
 Fenoprofen (Nalfron)
 Naproxen (Naprosyn)
 Acetaminophen (Tylenol, Tempra) – over dosage with this drug is treated with
Acetylcysteine
 Diclofenac (Voltaren)
NCLEX Tips for you to remember:
NCLEX Tip #1: Some NSAIDs end in suffix –profen or –fenac
NCLEX Tip #2: Aspirin should be continued three to seven days prior to surgery
If NSAIDs have taken effect, your client should feel relieved of their pains because there will be
reduction of pain intensity. If your client has fever, then it will be reduced, as well as the painful
swelling of body parts.
As a nurse, you might want to know what precautions you have to advise your clients in taking
NSAIDs.
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In administering NSAIDs, you have to remember the following tips:
1. Do not give to clients with liver or renal diseases
2. Do not give to clients if he is on anticoagulant
3. Do not give to children with flu symptoms because of the risk of Reye’s syndrome
4. Do not crush or cut enteric-coated forms
One of the things that you also need to monitor is the bleeding tendencies of clients. As a nurse,
you also need to watch out for the risk of toxicity if NSAIDs are taken with calcium blockers.
Frequently Asked Questions (FAQs):
Q: I have a client who is taking NSAIDs, what is the precaution that I should give with regards to
taking with food?
A: As a nurse, you have to advise your client to take NSAID with water, milk or food. Advise
them not to take such medications on an empty stomach.
Q: Are there any side effects that these drugs cause?
A: Yes. Take note of the following side effects of NSAID:
 Salicylism
 Tinnitus
 Gastric irritation
 Dizziness
 Rash, dermatitis
 Erosive gastritis with bleeding
 Hypotension
 Blood dyscrasias
 Sodium and water retention
NCLEX Alert: If overdose is suspected, call the National Poison Control Center at 1-800-2221222 and experts will give appropriate instructions.
Remember the NCLEX NSAID discussion we’ve learned. If you are now ready, try the NCLEX
NSAID practice test that we have prepared for you.
1. A client is to be prescribed with Aspirin once a day in the morning. Which of the
following medications should alert the physician in withholding the Aspirin?
a. Clopidoogrel
b. Metoprolol
c. Simvastatin
d. Losartan
2. A child has been brought to the emergency room and is suspected to be overdosed with
Acetaminophen (Tylenol). The nurse on duty will anticipate which of the following
antidotes?
a. Auranofin (Ridaura)
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b. Naloxone (Narcan)
c. Acetylcysteine (Mucomyst)
d. Aminophylline (Theophylline)
3. What should be the priority when planning care for a toddler who has ingested aspirin by
accident?
a. Body temperature
b. Bowel movement
c. Blood glucose
d. Blood lead levels
4. To an elderly client who is about to start taking Aspirin daily, which of the following
instructions should be emphasized?
a. Take the medication on an empty stomach
b. May take with Calcium channel blockers
c. Take the medication with food
d. Monitor blood glucose regularly
5. Which of the following statements made by the mother suspects the child of having
Reye’s syndrome:
a. “I can’t get him to go to the hospital since he had a flu; I had been giving him
Aspirin but he became more difficult to deal with.”
b. “He has had an increased appetite ever since he had the flu.”
c. “He seems constipated these days after I have given him Acetaminophen.”
d. “I have been prohibiting him to play with his playmates ever since he had the flu.”
NCLEX NSAIDs practice test answer key:
1. A
2. C
3. A
4. C
5. A
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NCLEX Questions: Top Meds on NCLEX RN 3rd Edition
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Chapter 21
Getting to Know Opioids: An NCLEX Review
What do Opioids do when taken effectively?
Opioids initially reduce the intensity of pain signals reaching the brain. If your client takes, for
example, Hydrocodone(Vicodin), his response to pain will be decreased.
Opioids also block the action of opioids-assisting in withdrawal and they also help suppress
peristalsis.
What are Opioids used for?
Since Opioids reduce the intensity of pain, hence, they treat acute and chronic pain. They are also
used for withdrawal and palliative care. Some physicians also prescribe this medication for
clients with diarrhea.
What are the specific examples of Opioids?
These are the drugs used as Opioids:
 Hydrocodone (Vicodin)
 Hydromorphone (Dilaudid)
 Oxycodone (OxyContin, Percocet)
 Meperidine hydrochloride (Demerol)
 Methadone
 Morphine sulfate
Taking Opioids usually have side effects. As a nurse, you may notice signs of itching, muscle
rigidity, nausea and vomiting.
Other side effects vary from client to client and may differ with the severity. You may also
encounter side effects such as sedation, cough suppression, paralytic ileus, respiratory
depression, and constriction of pupils.
Opioids also have effects on clients' emotions like signs of euphoria, apathy and impaired
judgment.
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NCLEX Alert #1: Overdose of Opioids can be reversed with Naloxone (Demerol) 50mg through
IM
NCLEX Alert #2: Overdose can lead to coma, respiratory depression, and worst, death.
Frequently Asked Questions:
Q: I am a nurse and I’m handling a client who is taking Methadone. What are the signs that I
should watch out for?
A: As a nurse, you need to watch out for signs of respiratory depression and toxicity. Be aware
also that drug tolerance might occur to your client. If these signs occur, report to the client’s
physician.
Q: My client is on Opioids medication, what are the restrictions that I should set and advise to
her?
A: If your client is taking Opioids, advise her to not be involved with activities that require
mental alertness. Also, tell your client not to stop taking her drugs abruptly.
You may encourage your client to increase fluid intake, too.
Q: I am 3 months pregnant, but am experiencing chronic pain in my leg area; is it recommended
to use Opioids?
A: No. Opioids are not recommended for pregnant women, unless prescribed by your Ob-Gyne.
Remember never to take any drugs which are not recommended by your doctor.
NCLEX Opioids practice test
Instruction: Five questions are given to assess what you’ve learned in this chapter. Read each
question carefully and encircle the letter of your answer.
 Postoperatively, a client has been given Morphine 7mg IV. At the recovery room while
the client is still asleep, the nurse notes the vital signs as : PR: 66, RR : 7, and BP 100/60.
Which of the following is the priority action of the nurse?
a.
Continue monitoring the client’s vital signs
b.
Prepare Atrophine sulfate from the ‘E’-cart
c.
Administer Naloxone (Narcan)
d.
Get the ECG machine and obtain a long lead II
 An elderly client is taking Meperidine (Demerol); which of the following symptoms
would the nurse recognize as a side effect of the medication?
a.
Disorientation
b.
Insomnia
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c.
d.
Tachyarrythmia
Hyperactivity
 The client has a STAT order for Demerol 50 mg IM because the client has severe pain.
Three hours later the client tells the nurse that the pain has come back and the nurse gives
another shot of Demerol with the same dosage and route. Which of the following
describes the nurse’s liability?
a.
No adverse effect was experienced by the client, so there is no liability.
b.
The client was in pain so the nurse is not liable.
c.
There is no liability for she had administered the drug at the same prescribed dose.
d.
The nurse had violated the narcotic law for she did not have orders for the second
administration of the drug.
 The nurse is providing discharge instructions to a client prescribed with Oxycontin; her
teaching would include?
a.
Limit intake of fluids
b.
Discontinue the drug if impaired judgment occurs
c.
Avoid driving a few hours after intake of the drug
d.
If pain persists take another dose
 The nurse would determine that relief of abdominal pain is achieved in a child who had
just been given Meperidine IM when which of the following has been done?
a.
Improved results with the incentive spirometer
b.
Frequent movement
c.
Pulse rate from 85 has increased to 95
d.
Increased in respiratory rate
NCLEX Opioids practice test answer key:
1. C
2. A
3. D
4. C
5. A
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Chapter 22
An Easier Way to Learn OHAs
Oral Hypoglycemic Agents or OHAs are used to treat Diabetes Mellitus Type 2. They stimulate
beta cells which help our body to secrete more insulin.
If a client has been taking OHAs effectively, his blood glucose will be within the normal range.
Also, hyperglycemia will be controlled.
What are the specific drugs used as OHAs?
As a nurse, you need to know that OHAs are separated in five categories, which are called:
I. Sulfonylureas - drugs under this category are known as Chlorpropamide (Diabinase) and
Tolbutamide (Orinase)
NCLEX Alert #1: Orinase can cause Disulfiram (Antabuse) type of reaction when alcohol is
ingested.
II. Biguanide – the most popular medication under this category is Metformin (Glucophage)
III. Alpha-Glucosidase Inhibitor – there are two commonly used drugs under this category:
a. Acarbase (Precose)
b. Miglitol (Glyset)
NCLEX Alert #2: Acarbose is contraindicated in clients with inflammatory bowel disease
IV. Thiazolidinediones – Pioglitazone (Actos) and Rosiglitazone (Avandia) are under this
category
V. Meglitinides – Nateglinide (Starlix) and Repaglinide (Prandin) are from this category
NCLEX Reminder: OHAs usually interact with Calcium Channel Blockers, Oral Contraceptives,
Glucocorticoids, Phenothiazines and Thiazide Diuretics, so make sure to inform the physician if
the client is taking medicines within these categories.
You might ask, as a nurse, what considerations you should advise your client regarding OHAs?
Here are the NCLEX OHAs client educations for drug use:
 These medications are taken with meals. Encourage your clients to eat first before taking
any OHAs.
 You have to monitor liver function tests of client.
 Instruct your clients the necessity of compliance on prescribed medication. With this,
always advise your clients to avoid OTC medications unless prescribed by the physician.
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Lab Value Alert: Normal Liver Function Tests
 ALT. 7 to 55 units per liter (U/L)
 AST. 8 to 48 U/L
 ALP. 45 to 115 U/L
 Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
 Total protein. 6.3 to 7.9 g/dL
 Bilirubin. 0.1 to 1.0 mg/dL
 GGT. 9 to 48 U/L
 LD. 122 to 222 U/L
 PT. 9.5 to 13.8 seconds
As a nurse, you also need to tell your clients about the expected side effects of OHAs like
jaundice, hypoglycemia, GI disturbance and edema. Other clients might also have skin reactions.
They may also feel dizzy and nauseous at times, plus they could gain weight, too.
Lab Value Alert: Normal Random Blood Sugar : 70 – 140 mg/dL
NCLEX OHAs Reviewer prepared a 5-item questionnaire regarding this chapter. This will assess
how much learning you’ve had.
Select the letter of your answer.
1. Which of the following would the nurse recognize to be a side effect of Pioglitazone
(Actos)?
a. Hypoglycemia
b. Weight loss
c. Dry mouth
d. Dry cough
2. After administering Tolbutamide (Orinase), the nurse instructs the client to avoid which
of the following food or drinks?
a. Carbonated beverages
b. Organ meats
c. Whole grain cereals
d. Alcohol
3. The nurse is explaining to the newly diagnosed DM 2 client his prescribed medicines.
Which of the following maintenance medicines of the client needs to be reported to the
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physician?
a. Diltiazem
b. Atorvastatin
c. Amiodarone
d. Carvedilol
4. In giving home instructions to the client on OHAs, the following are side effects of
Metformin, except?
a. Hypoglycemia
b. Dizziness
c. Hypertension
d. Nausea
5. Which of the following should be the expected outcome on clients taking Biguanides?
a. Controlled blood glucose
b. Weight loss
c. Improved condition in clients with inflammatory bowel diseases
d. Liver function tests are within normal range
NCLEX OHAs practice test answer key:
1. A
2. D
3. A
4. C
5. A
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Chapter 23
A Clearer View of Proton Pump Inhibitors
Proton Pump Inhibitors suppress gastric acid secretion. Thus, they are used to treat diseases like
Active Ulcer, Erosice esophagitis, Gastroesophageal reflux disease and Zollinger-Ellison
syndrome.
Proton Pump Inhibitors, like Prilosec, are sometimes combined with antibiotics (like
Clarithromycin – Biaxin) to treat clients with Helicobacter pylori infection in duodenal ulcer.
Moreover, clients taking this type of medication effectively will have a decrease in esophageal
reflux.
What are the specific drugs used as Proton Pump Inhibitors?
NCLEX Tip #1: Proton Pump Inhibitors usually end in suffix –prazole like:
 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)
NCLEX Tip #2: In taking Prevacid, sprinkle the granules over food. Do not chew the granules.
 Esomeprazole (Nexium)
 Pantoprazole (Protonix)
As a nurse, your nursing considerations for this medication are:
 Tell your clients to take these drugs before eating.
 When taking this medication, never crush or chew them; also, never open the capsules.
What are the side effects of Proton Pump Inhibitors?
The common side effects of this medication to clients are headache, dizziness and abdominal
pain. Other clients also experience diarrhea and could have rashes.
NCLEX Proton Pump Inhibitors practice test:
There are five questions prepared to assess your learning regarding this chapter. Choose the letter
of your answer.
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1. You are the nurse assigned to give Pantoprazole (Protonix) to Mr. Neil. You would
determine that the medication is effective when the client verbalizes relief of which
symptoms:
a. Dyspepsia
b. Blurred vision
c. Constipation
d. Seizures
2. The nurse teaches her client that the best time to take Prilosac (Omeprazole) is:
a. 30 minutes after meals
b. 30 minutes before meals
c. With meals
d. 2 hours after meals
3. In teaching the client the action of the drug Esomeprazole (Nexium), which of the
following is correct?
a. It inhibits secretion of hydrochloric acid.
b. It mobilizes pulmonarysecretions.
c. It aids in digestion of carbohydrates.
d. It absorbs fats into the cell wall.
4. In preparing the feeding for a client with a nasogastric tube, how will you include the
prescribed Lansoprazole (Prevacid)?
a. Crush the enteric coated tablet
b. Crush the capsule
c. Open the capsule and sprinkle the granules
d. Place the capsule below the client’s tongue
5. A client has come to the community health center for a check-up. He indicates that he has
been taking Omeprazole (Prilosec) for quite some time. The nurse understands that this
medication provides relief for which of the following symptoms?
a. Diarrhea
b. Melasma
c. Flatulence
d. Heartburn
NCLEX Proton Pump Inhibitors practice test answer key:
1. A
2. B
3. A
4. C
5. D
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NCLEX Questions: Top Meds on NCLEX RN 3rd Edition
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Chapter 24
NCLEX Guidelines to Respiratory Medications
There are three categories of Respiratory Medications:
I. Bronchodilators – they relax smooth muscles of the bronchi, reducing airway resistance. They
treat diseases like acute and chronic asthma, bronchitis and COPD.
Example of drugs:
 Epinephrine (Adrenaline)
 Theophylline (Theodur)
 Albuterol (Proventil and Ventolin)
 Ipatropium bromide (Atrovent)
NCLEX Note: Theophylline increases the risk of Digitalis toxicity and decreases the effects of
Lithium and Phenytoin.
As part of your nursing considerations, advise your clients with hypertension or dysrhythmias
not to take bronchodilators. Also, take note to administer IV theophylline and aminophylline
slowly. You need to use an infusion pump for this.
If your clients take Bronchodilator effectively, as a nurse, you should expect some desirable
outcomes like improvement in health status of client and reduction of exacerbations (of
symptoms). There will also be a decrease in number and severity of asthma attacks.
II. Anti-tubercular – they are the broad spectrum antibiotic, specific to TB Bacilli. These drugs
treat Pulmonary Tuberculosis and Extrapulmonary Tuberculosis.
Example of drugs:
 Isoniazid (INH)
 Rifampicin (Rifadin)
 Ethambutol (EMG and Myambutol)
 Pyrazinamide (PZA and Fibrazid)
In administering Isoniazid, combine it with Vitamin B6 (Pyridoxine) to prevent peripheral
neuritis.
Remember to monitor the liver function studies of your client who is taking anti-tubercular
drugs. If the drugs have taken effect, your client will no longer be contagious when sputum
culture is negative.
Lab Value Alert: Normal Liver Function Tests
 ALT. 7 to 55 units per liter (U/L)
 AST. 8 to 48 U/L
 ALP. 45 to 115 U/L
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





Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
Total protein. 6.3 to 7.9 g/dL
Bilirubin. 0.1 to 1.0 mg/dL
GGT. 9 to 48 U/L
LD. 122 to 222 U/L
PT. 9.5 to 13.8 seconds
III. Decongestant – they produce constriction of dilated arterioles. Clients taking decongestants
will have short relief of nasal congestion.
Drugs under this category treat allergic rhinitis, hay fever and acute coryza.
Example of drugs:
 Ephedrine HCL (Bronkotabs and Tedral)
 Phenylephrine (Neo-Synephrine)
 Oxymetazoline (Afrin)
Frequently Asked Questions:
As a nurse, what other nursing considerations should I know regarding Respiratory Medications?
Generally, you need to monitor for cardiac dysrhythmias and blood levels of medications. You
also need to provide adequate hydration to your client.
If your client is using MDIs, remind them to gargle after each dose and use a spacer to decrease
candidiasis.
Most importantly, tell your client not to take OTC medications where ephedrine is a common
ingredient. If your client, by any chance, is using OTC drugs as home remedies, evaluate their
medications properly.
Are there any side effects of these Respiratory Medications?
Yes. There are general side effects and specific side effects for each category. For instance, if
your client is using MDIs, clients might have Oropharyngeal candidiasis. On the other hand,
clients taking anti-tubercular drugs could also have hepatotoxicity. When a client is taking
Isoniazid, they could experience Peripheral neuritits, while those taking Rifampicin will have
orange body secretions.
Generally, the side effects that client could have are:
 Headache
 Hypertension
 Tremors
 Dysrhythmia
 Palpitation and tachycardia
 Gastric upset
 Optic neuritis
 Anxiety
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 Insomnia
 Dry mouth for those who are using inhalers
NCLEX Respiratory Medications practice test:
Read each question carefully and encircle the letter of your answer.
1. The physician ordered for Ms. Lancaster, your COPD client: Theophylline
(Aminophylline) 300mg in 100cc D5W at 27 mg/hr. What volume per hour would you set
the infusion pump to deliver the correct dose?
a. 7 cc/hr
b. 9 cc/hr
c. 11 cc/hr
d. 13 cc/hr
2. A client recovering from Bronchial Asthma has clear lungs and unlabored breathing upon
assessment, however, the nurse notes that the client’s IV line has infiltrated. What is the
most appropriate action of the nurse when giving the due Aminophylline IV dose of the
client?
a. Discontinue the drug
b. Inform the physician and suggest that the medication be changed to oral
c. Apply warm compress on the IV site and continue medication once the swelling
subsides
d. Have the IV site rest for 3 hours and reinsert IV line if client exhibits labored
breathing
3. The nurse should assess which of the following side effects of Aminophylline?
a. Agitation
b. Bradycardia
c. Ecchymosis
d. Drowsiness
4. The nurse would advise Mr. Garett, a client with asthma on Theophylline, to report which
of the following symptoms?
a. Heart palpitations
b. Weight gain
c. Excessive thirst
d. Ribbon-like stools
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5. Which of the following is an expected side effect of Rifampicin?
a. Diarrhea
b. Absent pedal pulses
c. Red-orange urine
d. Yellow sclerae
NCLEX Respiratory Medications practice test answer key:
1. B
2. B
3. A
4. A
5. C
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Chapter 25
NCLEX Clearer Guide to Statins
Statins, also known as HMG-CoA Reductase Inhibitors, decrease LDL cholesterol, but they
usually do not decrease the HDL cholesterol.
These medications are used to treat clients with Hyperlipidemia, Dyslipidemia and
Hypercholesterolemia.
However, the first line of treatment for increased cholesterol level is still dietary therapy.
Question: What are the specific drugs used as Statins?
Answer: Medications usually prescribed by physicians are:
 Atorvastatin (Lipitor)
 Lovastatin (Mevacor)
 Simvastatin (Zocor)
 Pravastatin (Pravachol)
 Fluvastatin (Lescol)
 Rosuvastatin (Crestor)
NCLEX Advisory: Lovastatin is highly protein bound and should not be administered with
anticoagulant.
NCLEX Tip: Statins usually end in suffix -statin
If these drugs are taken in by clients effectively, the desirable outcomes would be reduction of
the risk of coronary artery diseases and (risk and) recurrence of stroke.
There are also some side effects that these drugs cause to clients like nausea, headache, blurred
vision and muscle pain. Some clients also complain of rashes or flushing and GI disturbances.
Other clients could also have elevated liver enzymes, hyperglycemia and hyperuricemia.
Lab Value Alert: Normal Liver Function Tests
 ALT. 7 to 55 units per liter (U/L)
 AST. 8 to 48 U/L
 ALP. 45 to 115 U/L
 Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
 Total protein. 6.3 to 7.9 g/dL
 Bilirubin. 0.1 to 1.0 mg/dL
 GGT. 9 to 48 U/L
 LD. 122 to 222 U/L
 PT. 9.5 to 13.8 seconds
Lab Value Alert: Normal Random Blood Glucose: 70 – 140 mg/dL
Lab Value Alert: BUN: 7 – 20 mg/dL
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Question: As a nurse, what are my precautions and considerations about these drugs?
Answer: As a nurse, you have to consider the following client education regarding Statins:
 Advise your clients to take this during evening meal.
 Assess and monitor the increase in muscle pain and liver enzyme.
 Annual eye exam should be facilitated so as to monitor the formation of cataract.
 Never give to clients with preexisting gallbladder disease.
Five sets of questions are given to assess your understanding about this chapter. Encircle your
answer.
 In the client taking daily doses of Atorvastatin (Lipitor), what should be monitored in his
blood exam?
a. HbA1c
b. Lithium Levels
c. Lead Levels
d. Liver function tests
 In a client taking Lovastatin (Mevacor), which of the following blood exams is needed to
be monitored regularly?
a. bleeding time
b. creatinine levels
c. SGPT levels
d. blood glucose levels
 In providing education to a client prescribed with Simvastatin (Zocor). the nurse would
explain that this drug:
a. Increases glomerular filtration rate promoting excretion of cholesterol
b. Bind with fat to excrete cholesterol with bowel
c. Increases lipid metabolism of cholesterol
d. Inhibits hepatic synthesis of cholesterol
 In giving home instructions to the client, the nurse correctly tells the client to take
Rosuvastatin (Crestor) every
a. Evening meal
b. Morning at breakfast
c. Before lunch
d. Two hours after lunch
 The nurse also instructs which of the following as the side effects in taking Rosuvastatin?
a. Diarrhea
b. Hypoglycemia
c. Muscle pain
d. Decreased liver enzymes
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NCLEX Statins practice test answer key:
1. D
2. C
3. D
4. A
5. C
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Chapter 26
A Quicker Approach to Thrombolytics
What do thrombolytics do?
Thrombolytics convert plasminogen to plasmin to begin fibrinolysis. They are used to bind fibrin
in a thrombus and initiate fibrinolysis.
Thrombolytics are used to treat diseases like:
 Acute MI
 Central venous catheter clearance
 Acute pulmonary embolism
 Deep vein thrombosis
If these medications are used by clients effectively, the blood flow will be restored and emboli
will be dissolved.
What are the specific drugs used as thrombolytics?
The specific drug examples of thrombolytics are:
 Alteplase (t-PA, Activase)
 Streptokinase (Streptase, Kabikinase)
 Reteplase (Retavase)
 Urokinase (Abbokinase)
NCLEX Tip: Thrombolytics are contraindicated in clients with active internal bleeding,
uncontrolled hypertension, history of hepatic disease, renal disease, CVA, intracranial problems,
surgery or trauma.
NCLEX Alert: The antidote used for thrombolytic overdose is Aminocaproic acid (Amicar)
which is used only in acute, life-threatening conditions.
What are the side effects of these drugs?
Some clients complain about different side effects of these drugs like bleeding, dysrhythmias,
fever, allergic reactions and hypotension.
As a nurse, you have to remember the following reminders about client education regarding
these medications:
 Obtain the base vital signs and coagulation studies
 Medication must be infused through IV infusion pump
 Monitor for neurological changes and all secretions for occult blood
 Apply direct pressure over a venipuncture site for 20 to 30 minutes
 Instruct your client to use electric razor for shaving and to brush teeth gently
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There are five questions set to evaluate your learning about this chapter. Tick the letter of your
answer.
1. Which of the following clients is a candidate for thrombolytic therapy?
a. A client in post cesarean delivery
b. A client who has just underwent liver biopsy
c. A client who is admitted due to evolving MI
d. A client who is for Coronary bypass surgery
2. A client with MI is sent to the emergency department. The physician is considering
the use of Activase. Which of the following needs to be relayed to the physician?
a. The client had been having squeezing chest pain for more than 5 hours
b. The client has had a history of treatment with Alteplase 6 months ago
c. The client is taking Furosemide
d. The client has T wave inversions as presented in his 12-lead ECG
3. Which of the following clients are candidates for thrombolytic therapy? (Select all
that apply)
a. A client with acute pulmonary embolism
b. A client for Angiography
c. A client with a clogged central venous line
d. A client scheduled for coronary artery bypass graft
e. A client with chest pain and ST segment elevation seen on 12-lead ECG
f. A client with deep vein thrombosis
4. The client diagnosed with acute inferior myocardial infarction is being given
Streptokinase (Streptase). Which of the following is the primary purpose of this
medication?
a. Prevents platelet formation
b. Enhances further clot formation
c. Reduce myocardial oxygen demand
d. Dissolve the thrombus
5. A nurse with a client who had just received therapy with tissue plasminogen activator
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(t-PA, Activase) should have which item readily available?
a. Thermometer
b. Guided airway
c. Occult blood-test strips
d. Blood glucose strips
NCLEX Thrombolytic practice test answer key:
1. C
2. A
3. A, C, E and F
4. D
5. C
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Chapter 27
What You Have to Know about Vasopressors
Vasopressors cause vasoconstriction of blood vessels so as to increase blood pressure and
myocardial contractility, stroke volume and cardiac output. They are also used to enhance renal
blood flow.
Vasopressors treat diseases like anaphylactic shock and cardiac arrest. Some doctors also
prescribe this to clients with asthma.
Some specific examples of vasopressors are:
 Dopamine (Intropin)
 Dobutamine (Dobutrex)
 Inamrinone (Inocor)
 Epinephrine hydrochloride (Adrenalin)
 Norepinephrine (Levophed)
 Isoproterenol (Isuprel)
The usual side effects of vasopressors to clients are angina, restlessness, tachycardia and
dysrhythmias. Some clients complain of having urgency or urinary incontinence.
As a nurse, you need to monitor the urinary output of the client. You also have to monitor vital
signs, lung sounds and ECG.
Normal Value Alert: Normal urine output is 30-40 mL per hour
In giving these drugs, you have to administer them through a large vein.
NCLEX Alert: These drugs should not be given to clients with tachydysrhythmias or ventricular
fibrillation.
NCLEX Tip: If extravasation occurs, stop infusion immediately and infuse area with alphaadrenergic antagonist Phentolamine (Regitine).
NCLEX Vasopressor practice test is given to you to know if you have remembered the
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discussion above.
1. An order to start Dopamine infusion is being facilitated by the nurse. Which of the
following should the nurse carefully assess?
a. Intake and output of the client for three days
b. Previous allergy to penicillin
c. Potassium levels
d. Patency of the IV line
2. A chronic renal failure client in the intensive care unit is receiving Dopamine. Which of
the following is the positive effect of this drug?
a. Increased renal retention and water reabsorption
b. Increased cardiac contraction and stroke volume
c. Increased urinary output and uterine contractility
d. Increased insulin production
3. The doctor orders the following to Mrs. Jones: Norepinephrine (Levophed) 12mcg/min.
The pharmacy sends a premixed solution of 4mg Norepinephrine in 250 mL 5%
Dextrose. What is the dilution of Levophed per mL of 5% Dextrose?
a. 8 mcg/ml
b. 16 mcg/ml
c. 4 mcg/ml
d. 24 mcg/ml
4. Refering back to the order of Norepinephrine (Levophed) 12 mcg/min with a premixed
solution of 4mg Norepinephrine in 250 mL 5% Dextrose, calculate the rate of infusion
per minute using 8 mcg/min.
a. 0.5 ml/min.
b. 1 ml/min.
c. 8 ml/min.
d. 4 ml/min.
5. As the nurse monitors the Levophed Drip of the client, she notices that there is a leakage
of the medication on the IV site. Which of the following actions should the nurse
prioritize?
a. Infuse the area with Phentolamine
b. Inform the physician
c. Irrigate the site with saline solution
d. Stop the infusion
NCLEX Vasopressor practice test answer key:
1. D
2. B
3. B
4. A
5. D
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Chapter 28
An Intense Approach to Ophthalmic Medications
There are two classifications of Ophthalmic Medications: Mydriatics and Miotics.
1. Mydriatics – they block response of sphincter muscle of iris, causing pupillary dilatation.
These drugs are given as preoperative for eye surgeries and during eye examinations.
If taken considerably, the desired outcomes would be Mydriasis (pupillary dilatation) and
Cylopegia (relaxation of ciliary muscles)
These drugs are contraindicated in clients with glaucoma, cardiac dysrhythmias and cerebral
atherosclerosis. They are also to be used with caution in elderly clients and those with prostatic
hypertrophy, diabetes mellitus and Parkinsonism.
Some specific examples of drugs used under this category are:
 Atropine (Isopto Atropine)
 Homatropine (Isopto Homatropine)
 Tropicamide (Mydriacyl)
 Cyclopentolate (Cyclogyl)
 Phenylephrine (Mydfrin)
The side effects of these drugs are tachycardia, dermatitis and conjunctivitis. Some clients also
complain about being photophobic.
2. Miotics – these drugs contract ciliary muscle, causing pupillary constriction. These drugs are
used to treat chronic open-angle and closed-angle glaucoma and miosis during eye surgeries.
Clients who are using these medications effectively will expect positive outcomes like reduction
in intraocular pressure and increase in the outflow of aqueous humor.
Miotics are contraindicated in clients with retinal detachment, adhesions between the iris and
lens, or inflammatory diseases. These drugs are to be used with caution in clients with asthma,
hypertension, corneal abrasion, hyperthyroidism, coronary vascular disease, UTI, GI obstruction,
ulcer diseases, Parkinsonism and bradycardia.
Some specific drugs used as Miotics are:
 Pilocarpine hydrochloride (IsoptoCarpine, Pilocar)
 Carbachol (Miostat, Isoptocarbachol)
 Acetylcholine chloride (Miochol)
 Pilocarpine nitrate (Pilofrin, Pilagan)
 Isoflurophate (Floropryl)
The usual side effects that clients usually complain of are headache, decreased vision in poor
lighting, local irritation and eye pain. Some clients may also develop myopia.
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NCLEX Advisory:
Advisory #1: Atropine toxicity can produce dry mouth, hallucinations, headache, fever and
urinary retention or constipation which can worsen narrow-angle glaucoma.
Advisory #2: Miotic toxicity can produce vertigo and syncope, cardiac dysrhythmias,
hypotension, tremors or seizures.
Advisory #3: In administering eye drops:
- OS means left eye
- OU means both eyes
- OD means right eye
As a nurse, you have to be aware of the nursing considerations that you have to tell your clients
about drug use:
1. Monitor for toxic/side effects and allergic response and report eye pain to physician.
2. Instruct your client to apply punctual occlusion to the lacrimal duct during and immediately
after instillation of drops to decrease systemic absorption
3. Tell your clients to avoid driving or operating heavy machinery 24 hours after instillation of
medication, unless otherwise allowed by the physician.
NCLEX Tip about antidote: Atrophine sulfate is the antidote for Pilocarpine toxicity.
Here are five questions to evaluate what you have learned:
1. In preparation for cataract surgery, Cyclopentolate (Cyclogel) is to be administered. The
nurse knows that the purpose of administering this medication is to:
a. Provide miosis of the operative eye
b. Provide pupillary dilatation
c. Provide pupillary constriction
d. Lubricate the eye to be operated
2. The nurse receives an order to administer Phenylephrine (Mydfrin) to the client prior to
cataract surgery. Which of the following should alert the nurse to hold carrying out the
order and alert the physician?
a. Client is taking Amiodarone
b. Client is to be brought to the operating room after 30 minutes for a final eye
examination
c. Client has a history of elbow fracture
d. Client is taking Thyroxine
3. Which of the following are the side effects of Miotics? (Select all that apply):
1. Eye pain
2. Tachycardia
3. Dermatitis
4. Headache
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5. Photophobia
6. Mypopia
4. Mr. Lewin is diagnosed with closed-angle glaucoma and is receiving Pilocarpine nitrate.
He complains to his nurse feelings of syncope and vertigo, and when the nurse checks his
blood pressure, the reading is 80/60. The nurse anticipates which medication order of the
physician?
a. Atrophine sulfate
b. Naloxone
c. Dexamethasone
d. Protamine sulfate
5. The nurse receives an order for Isopto Atropine 2 gtts OD at 4pm. How should the nurse
give the medication?
a. Instill 2 drops on the left eye at 4pm
b. Instill 2 drops on both eyes once a day every 4pm
c. Instill 2 drops on the right eye at 4pm
d. Instill 2 drops on the right eye once a day every 4pm
NCLEX Opthalmic Medications answer key:
1. B
2. A
3. 1,4,6
4. A
5. C
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Chapter 29
OTC Medicines: An NCLEX Quick Review
Over–the–counter (or OTC) medicines are drugs that can be bought without a prescription. They
are usually taken to relieve earlier symptoms of diseases.
As a nurse, you still need to guide your clients in taking OTC medications. Advise them to read
the labels/product inserts carefully and always use with caution especially in children, elderly
and pregnant clients.
If your client is pregnant, advise them to consult first with their physicians before taking OTC
medicines.
Remember, if symptoms remain unchanged, tell them to visit their health provider right away.
Over-the-counter medicines may also interact with other medicines.
Some of the common drugs that are OTC are:
Medication
Indication
Ibuprofen (Advil, Midol, Motrin)
These drugs are used for pain and fever.
Loratadine (Claritin)
Most clients use this for runny nose and itchiness.
Bisacodyl (Dulcolax)
This is commonly used for constipation.
Ranitidine (Zantac)
Clients with heartburn usually use this.
Remember: this drug is best taken at night, to suppress
acid reduction
Bismuth subsalicylate (Pepto-Bismol)
Most clients use this drug for diarrhea, nausea and
upset stomach.
Aluminum Hydroxide (Gaviscon,
Clients experiencing heartburn and upset stomach also
Maalox)
use this.
Benzocaine (Orajel)
This is commonly used for toothache.
Acetaminophen (Tylenol)
If clients are in pain or with fever, they usually take
this.
NCLEX Alert: Watch out for Reye’s syndrome if changes in behaviour with nausea and vomiting
occur, and immediately consult with a physician.
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The most common side effects of OTCs are signs of rashes and itchiness, dizziness, nausea and
vomiting, diarrhea or constipation, drowsiness (especially for colds medicines), heartburn and
respiratory depression.
The following questions are given to evaluate your learning;
1. The community nurse teaches the client taking over-the-counter medications such as
Motrin that a common side effect of this drug would be:
a. Hypotonia
b. Loss of hearing
c. Decreased visual acuity
d. Uricaria
2. A client is rushed to the emergency room due to aspirin overdose. Which of the following
should the nurse monitor?
a. ABG results
b. Pulse oximetry
c. Oxygen saturation
d. Shortened bleeding time
3. A 5-year-old is suspected to have acetaminophen poisoning. Which of the following
laboratory results should receive priority attention by the nurse?
a. Sedimentation rate
b. WBC
c. Bilirubin
d. Neutrophils
4. A client taking Zantac asks the nurse why the label indicated that the medicine be taken at
bedtime. The nurse accurately responds:
a. “Because that’s their choice of time for consumers to take their drug.”
b. “Taking Zantac at bedtime suppresses acid production throughout the night.”
c. “So that no food is ingested when the medicine had been taken.”
d. "To coat your gastric mucosa so you won’t feel gastric pain.”
5. Which of the following clients is not advised to take over-the-counter medicines?
a. 15-year-old girl with cough
b. 40-year-old male with hyperacidity
c. 22-year-old woman with toothache
d. 33-year-old pregnant female with fever
NCLEX OTCs practice test answer key:
 D
 A
 C
 B
 D
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Chapter 30
NCLEX Guide: A Quick Glance at Herbal Medicines
Herbal medicines are the alternative plant-derived medicines to provide relief of symptoms of
diseases.
As a nurse, you need to remember that these medications are not safe for all clients to use, so
advise your client to always consult their physicians.
In giving medications like these, always check for allergic reactions.
NCLEX Alert #1: Inappropriate use may lead to adverse effects and even death.
NCLEX Alert #2: Avoid consuming alcohol while into these medications.
NCLEX Alert #3: These alternatives may have certain interaction with some drugs.
Below is the list of common herbal medicines, their indications and the side effects that clients
usually complain about.
Remember, safety and effectiveness of herbal medicines have not been scientifically proven.
Herbal Medicine
Indications
Side Effects
Aloe
Topical skin ailment;
Abdominal pain
Constipation
Diarrhea
Black cohosh
Premenstrual syndrome (PMS) Upset stomach
Acne
Headache
Osteoporosis
Vaginal spotting or bleeding
Weight gain
Echinacea
Suppresses inflammation
Fever, nausea and vomiting
Feverfew
Migraine
Nervousness and Insomnia
Fever
Heartburn
Suppresses inflammation
Diarrhea or constipation
Nausea and vomiting
Garlic
Hypertension
Heartburn
Hyperlipidemia
Nausea and vomiting
Atherosclerosis
Diarrhea
Ginger
Motion sickness
Heartburn
Diarrhea
Stomach upset
Osteoarthritis
Ginkgo biloba
Impotence
Stomach upset
Impaired circulation
Headache
Weak memory
Bleeding
Goldenseal
Bacterial, fungal and protozoal Ureterotonic
infections
Kava
Anxiety
CNS depression
Insomnia
Liver damage
Muscle relaxant
Skin problems
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(Contraindicated in clients
taking antipsychotics,
benzodiazepines and
barbiturates)
Ma huang / Ephedra
Bronchospasms
Obesity
St. John’s Wort
Depression
(Contraindicated with clients
taking antidepressants)
Saw palmetto
Valerian
BPH
Cough
Asthma
Insomnia
It can also exacerbate
Parkinson’s disease
Agitation and palpitations
Hypertension
Insomnia
Gastrointestinal disturbance
Fatigue
Dizziness
Dry mouth
Photosensitivity
Mild gastrointestinal upset
Headache
Headache
Daytime drowsiness
Palpitations
GI upset
Cardiac abnormality
NCLEX Note: Warfarin is most often potentiated with herbal medicines.
NCLEX Herbal Medicine practice test:
Below is a 5-item questionnaire about herbal medicines. Choose your answers carefully.
1. The community nurse visits a client who is taking Ma huang. Which of the following
signs and symptoms experienced by the client needs to be consulted to a physician?
a. Insomnia
b. Cough
c. Urticaria
d. Palpitations
2. The nurse noted that the client is currently taking St. John’s Wort. What would be the
health teaching needed?
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a.
b.
c.
d.
Report daytime drowsiness
Avoid sunbathing
Take the medicine with an OTC antihistamine
Palpitations are a normal side effect
3. A herbal alternative in alleviating the symptoms of prostate cancer in clients is:
a. Saw palmetto
b. Ginger
c. Aloe
d. Valerian
4. A herbal medicine appropriate for a client with anxiety manifesting restlessness and
nervousness would be:
a. Black cohosh
b. Ma Huang
c. Kava
d. Echinacea
5. Echinacea is an immune stimulant agent and also used externally for wound healing.
Home teaching regarding the use of this would be:
a. Monitor blood levels
b. Not to be given in clients taking anticoagulants
c. To be used with antacids
d. With a maximum effect that lasts up to 8 weeks
NCLEX Herbal Medicines practice test answer key:
1. D
2. B
3. A
4. C
5. D
End
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