CSLB General Building (B) — All Questions
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A client is prescribed warfarin. Which laboratory value is used to monitor its therapeutic effect?
- a.Prothrombin time and international normalized ratio (INR)✓
- b.Activated partial thromboplastin time (aPTT)
- c.Platelet count only
- d.Serum potassium
Warfarin is monitored using the prothrombin time and INR. The aPTT is used to monitor heparin, not warfarin.
A client receiving IV heparin has an aPTT far above the therapeutic range and is bleeding. Which medication is the antidote?
- a.Vitamin K
- b.Protamine sulfate✓
- c.Calcium gluconate
- d.Naloxone
Protamine sulfate reverses heparin. Vitamin K reverses warfarin, and naloxone reverses opioids.
A nurse is administering digoxin. Which finding requires the nurse to hold the dose and notify the provider?
- a.Blood pressure of 118/72 mm Hg
- b.Respiratory rate of 16 breaths per minute
- c.Apical heart rate of 52 beats per minute✓
- d.Temperature of 98.6 F (37 C)
Digoxin should be held for an apical heart rate below 60 beats per minute in adults because it can further slow the heart and may signal toxicity. The other vital signs are within normal limits.
A client is starting an angiotensin-converting enzyme (ACE) inhibitor. Which side effect should the nurse teach the client to report?
- a.Improved appetite
- b.Increased salivation
- c.Darkened urine that clears quickly
- d.A persistent dry cough✓
ACE inhibitors commonly cause a persistent dry cough due to bradykinin accumulation. Clients should report it, and angioedema, though rare, is an emergency.
A nurse prepares to administer an aminoglycoside antibiotic. Which parameters are most important to monitor?
- a.Renal function and drug peak and trough levels✓
- b.Blood glucose and hemoglobin A1c
- c.Serum calcium and phosphate
- d.Thyroid hormone levels
Aminoglycosides are nephrotoxic and ototoxic, so renal function and peak and trough serum levels must be monitored to ensure safety and efficacy.
A client is prescribed 250 mg of a medication. The pharmacy supplies 125 mg tablets. How many tablets should the nurse administer?
- a.Half a tablet
- b.Two tablets✓
- c.Four tablets
- d.One tablet
Using desired over available, 250 mg divided by 125 mg per tablet equals two tablets. Accurate dose calculation prevents a medication error.
A nurse teaches a client taking an oral corticosteroid long term. Which instruction is correct?
- a.Stop the medication abruptly when symptoms improve
- b.Take the medication on an empty stomach
- c.Do not stop the medication suddenly; taper as directed✓
- d.Avoid monitoring blood glucose
Long-term corticosteroids must be tapered to avoid adrenal insufficiency. They should be taken with food, and blood glucose should be monitored because they raise glucose.
A client is receiving IV furosemide. Which electrolyte imbalance should the nurse monitor for?
- a.Hyperkalemia
- b.Hypernatremia
- c.Hypercalcemia
- d.Hypokalemia✓
Loop diuretics such as furosemide promote potassium excretion and can cause hypokalemia. The nurse monitors potassium and watches for muscle weakness and cardiac dysrhythmias.
A client taking a monoamine oxidase inhibitor (MAOI) for depression requires dietary teaching. Which food should be avoided?
- a.Aged cheese and cured meats✓
- b.Fresh apples
- c.White rice
- d.Steamed carrots
Tyramine-rich foods such as aged cheese and cured meats can trigger a hypertensive crisis in clients taking MAOIs and must be avoided.
A nurse administers insulin lispro, a rapid-acting insulin. When should the nurse ensure the client is ready to eat?
- a.Two hours after the injection
- b.Within about 15 minutes of the injection✓
- c.Only at bedtime
- d.Meal timing does not matter
Rapid-acting insulin such as lispro begins working within about 15 minutes, so food should be available promptly to prevent hypoglycemia.
A client is prescribed morphine for pain. Which assessment is most important before and after administration?
- a.Bowel sounds only
- b.Skin turgor
- c.Respiratory rate and level of sedation✓
- d.Deep tendon reflexes
Opioids such as morphine can cause respiratory depression and sedation, so respiratory rate and sedation level must be assessed before and after administration.
A client taking phenytoin for seizures needs teaching. Which instruction is appropriate?
- a.Skip doses if you feel well
- b.Stop the drug if a rash appears without contacting the provider
- c.Expect the urine to turn blue
- d.Maintain good oral hygiene because of gum overgrowth risk✓
Phenytoin commonly causes gingival hyperplasia, so meticulous oral hygiene is important. Doses should not be skipped, and any rash should be reported because it may signal a serious reaction.
A nurse is administering a beta-blocker such as metoprolol. Which parameter should be checked before administration?
- a.Apical heart rate and blood pressure✓
- b.Urine specific gravity
- c.Serum bilirubin
- d.White blood cell count
Beta-blockers lower heart rate and blood pressure, so both should be assessed before administration and the dose held for significant bradycardia or hypotension per parameters.
A client on lithium for bipolar disorder reports vomiting, coarse tremors, and confusion. What does the nurse suspect?
- a.A therapeutic drug response
- b.Lithium toxicity✓
- c.A common cold
- d.Normal side effects that require no action
Vomiting, coarse tremors, and confusion are signs of lithium toxicity. The narrow therapeutic range makes level monitoring and adequate hydration essential.
A client is prescribed an oral tetracycline antibiotic. Which instruction is correct?
- a.Take it with milk or antacids to reduce stomach upset
- b.Take it only with grapefruit juice
- c.Avoid dairy products and antacids near the time of the dose✓
- d.Double the dose if a dose is missed
Calcium in dairy and antacids binds tetracycline and reduces its absorption, so they should be separated from the dose. Doses should not be doubled if missed.
A nurse is preparing to administer a medication and notes the client has a documented allergy to it. What is the nurse's action?
- a.Give a smaller dose to test tolerance
- b.Administer with an antihistamine to prevent a reaction
- c.Give the medication and monitor closely
- d.Hold the medication and notify the prescriber✓
A documented allergy is a contraindication. The nurse holds the drug and notifies the prescriber to clarify or change the order, preventing a potentially life-threatening reaction.
A client is receiving an IV infusion of potassium chloride. Which action is essential for safety?
- a.Infuse diluted potassium slowly using an infusion pump✓
- b.Administer potassium by rapid IV push
- c.Give potassium undiluted for faster effect
- d.Stop cardiac monitoring during the infusion
IV potassium must always be diluted and infused slowly with a pump; it is never given by IV push because rapid administration can cause fatal cardiac arrest. Cardiac monitoring is important.
A client taking an opioid reports no bowel movement for three days. Which intervention should the nurse anticipate?
- a.Withholding all fluids
- b.Initiating a bowel regimen with a stool softener and increased fluids✓
- c.Discontinuing the opioid without consulting the provider
- d.Restricting dietary fiber
Opioids commonly cause constipation, so a prophylactic bowel regimen with stool softeners, fluids, and fiber is appropriate. Fluids and fiber should be increased, not restricted.