Question 1 A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse’s priority assessments?

A) Respiratory rate, seizure activity, and electrolytes
B) Pain intensity, respiratory rate, and level of consciousness
C) Liver function studies, pain intensity, and blood glucose level
D) Respiratory rate, pain intensity, and mental status

Question 2 A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient?

A) Blood pressure (BP): 98/50, pulse (P): 120, respirations (R): 40
B) BP: 130/88, P: 92, R: 28
C) BP: 150/90, P: 80, R: 16
D) BP: 170/98, P:110, R: 20

Question 3 A nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the nurse should be aware that

A) intravenous lidocaine may be preferable to topical application
B) lidocaine must be potentiated with another anesthetic in order to achieve pain control
C) pain relief is unlikely to be achieved due to the destruction of nerve endings in the burn site
D) there is a risk of systemic absorption of the lidocaine through the patient’s traumatized skin

Question 4 A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia.Which of the following will the nurse include in a teaching plan for this patient? (Select all that apply.)

A) The drug should not be used for longer than 1 month.
B) It should be taken 1 hour to 90 minutes before going to bed
C) The drug does not cause sleepiness in the morning
D) One of the most common adverse effects of the drug is headache
E) It is available in both quick-onset and continuous-release oral forms

Question 5 A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine. When planning this patient’s subsequent care, what nursing diagnosis should the nurse prioritize?

A) Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine
B) Risk for Constipation related to decreased gastrointestinal peristalsis
C) Risk for Infection related to immunosuppressive effects of phenelzine
D) Risk for Injury related to drug–drug interactions or drug–nutrient interactions

Question 6 Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse will advise the patient to avoid

A) alcohol
B) vitamin C
C) fatty foods
D) dairy product

Question 7 A 62-year-old woman has been prescribed a fentanyl transdermal patch for chronic cancer pain. The patient asks the nurse how long it will take for her to experience pain relief. The nurse will instruct the patient that she should feel pain relief in approximately

A) 6 hours
B) 12 hours
C) 24 hours
D) 32 hours

Question 8 A nurse is assigned to a patient who is taking lithium. Which of the following drug serum levels would indicate that the patient is at risk for adverse effects of the drug?

A) 0.3 mEq/L
B) 0.6 mEq/L
C) 1.7 mEq/L
D) 1.2 mEq/L

Question 9 A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who express a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated?

A) A patient who received treatment for kidney failure due to an overdose of acetaminophen
B) A patient whose pulmonary embolism was treated with a heparin infusion
C) A patient with a history of angina who experienced a non-ST wave myocardial infarction
D) A patient whose stage III pressure ulcer required intravenous antibiotics and a vacuum dressing

Question 10 The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be

A) “Continue the prescribed dose. It may take several days to work.”
B) “I’ll ask the nurse practitioner if the dosage can be increased.”
C) “I’ll ask the nurse practitioner if the haloperidol can be discontinued and another drug started.”
D) “I’ll report this to the nurse practitioner and see if he will add another drug to enhance the effects of the haloperidol.”

Question 11 A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to

A) avoid the small veins in the dorsum of the hand or the wrist
B) inject the diazepam very quickly, 15 mg in 10 to15 seconds
C) administer after diluting the drug with gabapentin in intravenous solution
D) inject very slowly, no faster than 100 mg/minute

Question 12 A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient’s characteristics likely to influence possible treatment with phenytoin?

A) The patient will require oral phenytoin rather than intravenous administration
B) Phenytoin is contraindicated within 48 hours of alcohol use due to the possibility of paradoxical effects
C) The patient’s heavy alcohol use will compete with phenytoin for binding sites and he will require a higher-than-normal dose
D) The patient’s protein deficit will likely increase the levels of the free drug in his blood

Question 13 A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of

A) seizure disorders
B) low blood pressure
C) increased intraocular pressure
D) diabetic hyperlipidemia

Question 14 A patient who is experiencing withdrawal from heavy alcohol use have developed psychosis and been treated with haloperidol. Which of the following assessment findings should prompt the care team to assess the patient for neuroleptic malignant syndrome?

A) The patient demonstrates a significant increase in agitation after being given haloperidol
B) The patient develops muscle rigidity and a sudden, high fever
C) The patient complains of intense thirst and produces copious amounts of urine
D) The patient develops yellowed sclerae and intense pruritis (itchiness)

Question 15 A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that

A) she will report this to the physician immediately
B) the drug is not going to work for her and the medication needs to be changed
C) optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment
D) it may take up to 6 months for the drug to relieve her anxiety

Question 16 A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)?

A) A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep
B) A 20-year-old woman who will take the drug about once a week
C) A 52-year-old woman who needs to fall asleep quickly and stay asleep all night
D) A 46-year-old man who receives an antidepressant and needs a sleep aid

Question 17 A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect by

A) decreasing the influx of sodium into neurons.
B) increasing the levels of available glutamate.
C) simultaneously potentiating the effects of GABA and inhibiting reuptake.
D) by slowing the function of calcium channels within the neurological system.

Question 18 A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms?

A) Amphetamines
B) Sedative–hypnotic drugs
C) Benzodiazepines
D) Opioids

Question 19 Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency?

A) Reduction of severe hypertension
B) Increased level of consciousness
C) Restoration of normal sinus rhythm
D) Resolution of respiratory acidosis

Question 20 A postsurgical patient has been provided with a morphine patient-controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient’s concerns?

A) “You don’t need to worry. It’s actually not true that you can get addicted to the medications we use in a hospital setting.”
B) “If you do become addicted, we’ll make sure to provide you with the support and resources necessary to help you with your recovery.”
C) “It’s important that you accept that your current need to control your pain is more important than fears of becoming addicted.”
D) “It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction.”

Question 21 A nurse is talking to an 18-year-old patient who has had a seizure disorder since she was 10 years old and is taking phenytoin (Dilantin). The nurse should suggest that she take which of the following?

A) A potassium supplement
B) An iron supplement
C) Folic acid
D) Vitamin C

Question 22 Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work?

A) Alprazolam (Xanax)
B) Buspirone (BuSpar)
C) Diazepam (Valium)
D) Lorazepam (Ativan)

Question 23 A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for

A) a diet high in fat
B) a history of current or past alcohol use
C) current nicotine use
D) a diet high in carbohydrates

Question 24 A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for

A) dizziness
B) diarrhea
C) increased secretions
D) facial flushing

Question 25 A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan

A) has less strength in each dose than do individual doses of morphine
B) has a shorter half-life than morphine
C) combined with morphine, increases the physiologic action of the morphine
D) causes the respiratory rate to decrease

Question 26 A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine (Zyprexa). Which of the following clients likely has the highest susceptibility to the adverse effects of olanzapine?

A) A client who is morbidly obese and who has a sedentary lifestyle
B) A client who has type 1 diabetes and who practices poor glycemic control
C) A client who has a body mass index of 16.5 (underweight) and who smokes one pack of cigarettes daily
D) A client who was recently treated with intravenous antibiotics because of cellulitis in his lower leg

Question 27 A patient has been prescribed lithium therapy.Which of the following signs and symptoms will the nurse tell the patient to report immediately?

A) Increased urination
B) Muscle twitching
C) Hair loss
D) Increased thirst

Question 28 A trauma patient has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the patient’s

A) urine specific gravity
B) skin integrity
C) bowel patterns.
D) core body temperature

Question 29 A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in

A) gastrointestinal distress
B) acute renal failure
C) cognitive deficits
D) liver damage.

Question 30 A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon (Sonata). The nurse will be sure to ask the patient if she is taking

A) secobarbital (Seconal)
B) oxycodone (Percodan)
C) cimetidine (Zantac)
D) meperidine (Demerol)