1. A client with myasthenia gravis reports the occurrence of difficulty chewing. The physician prescribes
pyridostigmine bromide (Mestinon) to increase muscle strength for this activity. The nurse instructs the client to
take the medication at what time, in relation to meals?

a. after dinner daily when most fatigued
b. before breakfast daily
c. as soon as arising in the morning
d. thirty minutes before each meal

Pyridostigmine is a cholinergic medication used to increase muscle strength for the client with myasthenia gravis. For the client who has difficulty chewing, the medication should be administered 30 minutes before meals to enhance the client’s ability to eat.

a. accumulates water in the stool and increases peristalsis
b. stimulates the vagus nerve
c. coats the bowel wall
d. adds fiber and bulk to the stool

a. decreased blood pressure
b. increased pulse rate
c. ecchymoses
d. tinnitus

Heparin sodium is an anticoagulant. The client who receives heparin sodium is at risk for bleeding. The nurse monitors
for signs of bleeding, which includes bleeding from the gums, ecchymoses on the skin, cloudy or pink-tinged urine,
tarry stools, and body fluids that test positive for occult blood.

4. A client is being treated for acute congestive heart failure (CHF) and the client’s vital signs are as follows: BP 85/50 mm Hg; pulse, 96 bpm; respirations, 26 cpm. The physician prescribes digoxin (Lanoxin). To evaluate a therapeutic effectiveness of this medication, the nurse would expect which of the following changes in the client’s vital signs?

a. BP 85/50 mm Hg, pulse 60 bpm, respirations 26 cpm
b. BP 98/60 mm Hg, pulse 80 bpm, respirations 24 cpm
c. BP 130/70 mm Hg, pulse 104 bpm, respirations 20 cpm
d. BP 110/40 mm Hg, 110 bpm, respirations 20 cpm

The main function of digoxin is inotropic. It produces increased myocardial contractility that is associated with an increased cardiac output. This causes a rise in the BP in a client with CHF. Digoxin also has a negative chronotropic effect (decreases heart rate) and will therefore cause a slowing of the heart rate. As cardiac output improves, there should be an improvement in respirations as well.

a. incoordination
b. cough
c. tinnitus
d. hypertension

a. urinary output
b. fetal heart rate
c. central venous pressure
d. maternal blood glucose

7. A clinic nurse is performing assessment on a client who is being seen in the clinic for the first time. When asking about the client’s medication history, the client tells the nurse that he takes nateglinide (Starlix). The nurse then questions the client about the presence of which disorder that is treated with this medication?

a. hypothyroidism
b. insomnia
c. type 2 diabetes mellitus
d. renal failure

Nateglinide (Starlix) is an antidiabetic medication used to treat type 2 diabetes mellitus in clients whose disease cannot
be adequately controlled with diet and exercise. It stimulates the release of insulin from beta cells of the pancreas by
depolarizing beta cells, leading to an opening of calcium channels. Resulting calcium influx induces insulin secretion.

a. come to the clinic to provide a urine sample
b. stop the medication until further instructions are given by the physician
c. take the medication dose with an antacid to prevent this adverse effect
d. expect a red-orange color in urine, feces, sweat, sputum, and tears as a harmless side effect

Rifampin (Rifadin) is an antitubercular medication used in conjunction with at least one other antitubercular agent for
initial treatment or retreatment of tuberculosis. Urine, feces, sputum, sweat, and tears may become red-orange in color.
The client should also be told that soft contact lenses may become permanently stained as a result of this harmless side
effect. There is no useful reason for the client to provide a urine sample. The client is not told to stop a medication.
Antacids are not usually taken with a medication because of interactive effects.

9. A nurse is caring for a client with a tracheostomy that has been diagnosed with a respiratory infection. The client is receiving vancomycin hydrochloride (Vancocin) 500 mg intravenously every 12 hours. Which of the following would indicate to the nurse that the client is experiencing an adverse effect of the medication?

a. decreased hearing acuity
b. photophobia
c. hypotension
d. bradycardia

Vancomycin hydrochloride (Vancocin) is an antibiotic. Adverse and toxic effects include nephrotoxicity characterized
by a change in the amount or frequency of urination, anorexia, nausea, vomiting, and increased thirst; ototoxicity
characterized by hearing loss due to damage to the auditory branch of the eight cranial nerve; and red-neck syndrome
from too rapid injection of the medication characterized by chills, fever, fast heartbeat,
nausea, vomiting, itching, rash and redness on the face, neck, arms, and back. When this medication is administered to
a client, nursing responsibilities include monitoring renal function laboratory results, intake and output, and hearing
acuity.

10. A nurse is caring for a client with a diagnosis of metastatic breast carcinoma who is receiving tamoxifen
citrate (Nolvadex) 10 mg orally twice daily. Which of the following would indicate to the nurse that the client is
experiencing a side effect related to the medication?

a. hypetension
b. diarrhea
c. nose bleeds
d. vaginal bleeding

Tamoxifen citrate is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues
containing high concentration of receptors such as the breasts, uterus, and vagina. Frequent side effects include hot
flashes, nausea, vomiting, vaginal bleeding or discharge, pruritus, and skin rash. Adverse or toxic effects include
retinopathy, corneal opacity, and decreased visual acuity.

a. drooling may occur while taking this medication
b. irritability may occur while taking this medication
c. this medication contains a habit-forming ingredient
d. take the medication with a laxative of choice

Diphenoxylate with atropine (Lomotil) is an antidiarrheal. The client should not exceed the recommended dose of this
medication because it may be habit-forming. Since this medication is an antidiarrheal, it should not be taken with a
laxative. Side effects of the medication include dry mouth and drowsiness.

12. A nurse is gathering data from client about the client’s medication history and notes that the client is taking
tolterodine tartrate (Detrol LA). The nurse determines that the client is taking the medication to treat which
disorder?

a. glaucoma
b. renal insufficiency
c. pyloric stenosis
d. urinary frequency and urgency

Tolterodine tartrate is an antispasmodic used to treat overactive bladder and symptoms of urinary frequency, urgency, or
urge incontinence. It is contraindicated in urinary retention and uncontrolled narrow-angle glaucoma. It is used with
caution in renal function impairment, bladder outflow obstruction, and gastrointestinal obstructive disease such as
pyloric stenosis.

a. a multivitamin and mineral supplement
b. a dose of an antacid
c. applesauce
d. eight ounces of liquid

Metamucil is a bulk-forming laxative. It should be taken with a full glass of water or juice, and followed by another
glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options
are incorrect.

a. signs of infection
b. hypotension
c. weight loss
d. hair loss

Cyclosporine is an immunosuppressant medication used to prevent transplant rejection. The client should be especially
alert for signs and symptoms of infection while taking this medication, and report them to the physician if experienced.
The client is also taught about other side effects of the medication, including hypertension, increased facial hair,
tremors, gingival hyperplasia, and gastrointestinal complaints.

a. crackers
b. shrimp
c. apricots
d. popcorn