Medication Management for Chronic Conditions, Exams of Nursing

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NCLEX PN ACTUAL EXAM 2024 QUESTIONS

AND ANSWERS WITH RATIONALE.

Question 1: A client with diabetes is admitted to the hospital with hyperglycemia. The nurse is aware that which of the following insulin types has the quickest onset of action? A) Regular insulin B) NPH insulin C) Lispro insulin D) Glargine insulin Answer 1: C) Lispro insulin Rationale: Lispro insulin has a rapid onset of action, typically within 15 minutes of administration. This makes it an appropriate choice for controlling postprandial hyperglycemia. Regular insulin has a slower onset, NPH insulin is intermediate- acting, and Glargine insulin has a slow and steady release with no pronounced peak. Question 2: A client with chronic kidney disease is prescribed a phosphate binder. Which medication is commonly used to reduce serum phosphate levels in patients with renal impairment? A) Furosemide B) Calcium carbonate C) Aluminum hydroxide D) Metolazone

Answer 2: C) Aluminum hydroxide Rationale: Aluminum hydroxide is a phosphate binder commonly used in patients with renal impairment. It works by binding to dietary phosphate in the GI tract, preventing its absorption. Furosemide is a loop diuretic, calcium carbonate is not typically used for phosphate binding, and metolazone is a thiazide diuretic. Question 3: A postoperative client receiving patient-controlled analgesia (PCA) reports feeling lightheaded and dizzy. The nurse's initial action should be to: A) Administer an antiemetic B) Assess the respiratory rate C) Increase the PCA dose D) Check the blood pressure Answer 3: Question 4: A client with heart failure is prescribed digoxin. The nurse should monitor for which early sign of digoxin toxicity? A) Nausea and vomiting B) Hyperkalemia C) Hypotension D) Visual disturbances

Answer 4: D) Visual disturbances Rationale: Visual disturbances, such as yellow-green halos around lights, are early signs of digoxin toxicity. Nausea and vomiting, hyperkalemia, and hypotension are not specific to digoxin toxicity. Question 5: A client with chronic obstructive pulmonary disease (COPD) is prescribed albuterol inhaler. The nurse instructs the client to use the albuterol inhaler before using other inhaled medications. What is the rationale for this instruction? A) Albuterol enhances the effects of other inhaled medications. B) Albuterol decreases the risk of bronchoconstriction. C) Albuterol opens the airways and facilitates better absorption of other medications. D) Albuterol reduces the risk of systemic side effects. Answer 5: C) Albuterol opens the airways and facilitates better absorption of other medications. Rationale: Albuterol is a bronchodilator that opens the airways, allowing better penetration and absorption of other inhaled medications. Using albuterol first can enhance the effectiveness of subsequent medications. Question 6: A client with a history of deep vein thrombosis (DVT) is receiving enoxaparin (Lovenox). The nurse should monitor the client for which adverse effect?

A) Hyperglycemia B) Hypertension C) Thrombocytopenia D) Hyponatremia Answer 6: C) Thrombocytopenia Rationale: Thrombocytopenia (a decrease in platelet count) is a potential adverse effect of enoxaparin. Monitoring platelet levels is essential during therapy. Hyperglycemia, hypertension, and hyponatremia are not typically associated with enoxaparin use. Question 7: A client with type 2 diabetes is prescribed metformin. The nurse instructs the client to monitor for which common side effect of metformin therapy? A) Hypertension B) Weight gain C) Hypoglycemia D) Gastrointestinal upset Answer 7: D) Gastrointestinal upset Rationale: Gastrointestinal upset, including nausea, vomiting, and diarrhea, is a common side effect of metformin. Metformin does not cause hypoglycemia, hypertension, or weight gain. Question 8:

A client is admitted to the hospital with suspected appendicitis. The nurse should place the client in which position to minimize pain and discomfort? A) Fowler's position B) Supine position C) Left lateral position D) Semi-Fowler's position Answer 8: D) Semi-Fowler's position Rationale: Placing the client in a semi-Fowler's position (with the head of the bed elevated) can help minimize pain and discomfort associated with appendicitis by reducing tension on the abdominal muscles. Fowler's position, supine position, and left lateral position may exacerbate the pain. These questions are meant for practice and review. Remember to consult current nursing literature and guidelines for the most up-to-date information. Question 9: A client with chronic kidney disease is prescribed a low-phosphorus diet. Which of the following foods should the nurse instruct the client to limit in order to comply with the dietary restrictions? A) Cheese B) Green leafy vegetables C) Citrus fruits D) Lean meats

Answer 9: A) Cheese Rationale: Cheese is a high-phosphorus food, and clients with chronic kidney disease often need to limit phosphorus intake. Green leafy vegetables, citrus fruits, and lean meats are generally lower in phosphorus. Question 10: A postoperative client is at risk for developing deep vein thrombosis (DVT). Which nursing intervention is essential to prevent DVT in this client? A) Encourage ambulation and leg exercises B) Administer antipyretic medications C) Elevate the affected extremity D) Apply cold compresses to the affected area Answer 10: A) Encourage ambulation and leg exercises Rationale: Encouraging ambulation and leg exercises helps promote blood circulation and prevent stasis, reducing the risk of deep vein thrombosis (DVT). Administering antipyretic medications, elevating the affected extremity, and applying cold compresses are not specific interventions for DVT prevention. Question 11: A client with heart failure is prescribed a loop diuretic. The nurse monitors for which potential adverse effect of loop diuretic therapy? A) Hyperkalemia B) Hypocalcemia

C) Hypokalemia D) Hypernatremia Answer 11: C) Hypokalemia Rationale: Loop diuretics can cause potassium loss, leading to hypokalemia. Monitoring potassium levels is essential during therapy. Hyperkalemia, hypocalcemia, and hypernatremia are not typically associated with loop diuretic use. Question 12: A client with pneumonia is prescribed oxygen therapy. The nurse understands that oxygen is administered to improve which physiological parameter? A) Blood pressure B) Oxygen saturation C) Heart rate D) Respiratory rate Answer 12: B) Oxygen saturation Rationale: Oxygen therapy is administered to improve oxygen saturation levels in the blood. It helps correct hypoxemia, ensuring an adequate supply of oxygen to body tissues. While oxygen therapy may indirectly affect other parameters, the primary goal is to improve oxygen saturation. Question 13:

A client is prescribed warfarin for anticoagulation therapy. The nurse instructs the client to avoid consuming large amounts of which vitamin due to its interaction with warfarin? A) Vitamin A B) Vitamin C C) Vitamin D D) Vitamin K Answer 13: D) Vitamin K Rationale: Warfarin is an anticoagulant that interferes with vitamin K-dependent clotting factors. Consistent intake of vitamin K is important to maintain a stable response to warfarin. Clients should avoid drastic changes in vitamin K intake. Question 14: A client with type 1 diabetes is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse anticipates the administration of which type of insulin? A) Regular insulin B) NPH insulin C) Lispro insulin D) Glargine insulin Answer 14: A) Regular insulin Rationale: Regular insulin is typically used for the management of diabetic ketoacidosis (DKA) due to its quick onset and short duration of action. It helps lower blood glucose

levels rapidly. NPH insulin, lispro insulin, and glargine insulin have different onset and duration characteristics. Question 15: A client with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse instructs the client to monitor for which common side effect of ACE inhibitor therapy? A) Hyperkalemia B) Hypoglycemia C) Hypokalemia D) Hyponatremia Answer 15: A) Hyperkalemia Rationale: ACE inhibitors can lead to an increase in potassium levels, known as hyperkalemia. Monitoring potassium levels is important during ACE inhibitor therapy. Hypoglycemia, hypokalemia, and hyponatremia are not typically associated with ACE inhibitors. These questions are intended for practice and review. For the most accurate and up- to-date information, consult current nursing literature and guidelines. Question 16: A client is admitted with a diagnosis of acute pancreatitis. Which dietary intervention should the nurse recommend for this client? A) High-fat diet

B) Low-protein diet C) Low-carbohydrate diet D) NPO (nothing by mouth) status Answer 16: D) NPO (nothing by mouth) status Rationale: NPO status is often prescribed for clients with acute pancreatitis to rest the pancreas and reduce the secretion of pancreatic enzymes. This helps alleviate inflammation. High-fat, low-protein, and low-carbohydrate diets are generally avoided in acute pancreatitis. Question 17: A client with rheumatoid arthritis is prescribed methotrexate. The nurse monitors for which potential adverse effect of methotrexate therapy? A) Hyperkalemia B) Hepatotoxicity C) Hypercalcemia D) Hyponatremia Answer 17: B) Hepatotoxicity Rationale: Methotrexate can cause hepatotoxicity, and liver function should be monitored regularly during therapy. Hyperkalemia, hypercalcemia, and hyponatremia are not typically associated with methotrexate use. Question 18:

A client with chronic obstructive pulmonary disease (COPD) is prescribed oxygen therapy. The nurse educates the client about the importance of using oxygen as prescribed to prevent which complication? A) Hypercapnia B) Hypoxemia C) Hypocapnia D) Respiratory alkalosis Answer 18: A) Hypercapnia Rationale: The use of oxygen therapy in COPD should be carefully monitored to avoid suppressing the respiratory drive excessively, leading to hypercapnia (elevated carbon dioxide levels). Oxygen is prescribed to correct hypoxemia, but excessive administration can have detrimental effects in COPD patients. Question 19: A client with heart failure is prescribed an angiotensin receptor blocker (ARB). The nurse explains to the client that ARBs work by: A) Increasing heart rate B) Blocking the conversion of angiotensin I to angiotensin II C) Enhancing sodium reabsorption D) Dilating peripheral blood vessels Answer 19: B) Blocking the conversion of angiotensin I to angiotensin II Rationale:

Angiotensin receptor blockers (ARBs) block the action of angiotensin II by preventing its binding to receptors. This leads to vasodilation and a reduction in aldosterone secretion. ARBs do not increase heart rate, enhance sodium reabsorption, or dilate peripheral blood vessels directly. Question 20: A client is receiving heparin therapy for deep vein thrombosis (DVT). The nurse monitors for which adverse effect of heparin? A) Hypokalemia B) Thrombocytopenia C) Hypernatremia D) Hypoglycemia Answer 20: B) Thrombocytopenia Rationale: Thrombocytopenia (a decrease in platelet count) is a potential adverse effect of heparin therapy. Monitoring platelet levels is essential during treatment. Hypokalemia, hypernatremia, and hypoglycemia are not typically associated with heparin use. Question 21: A client with chronic pain is prescribed a transdermal fentanyl patch. The nurse instructs the client to avoid: A) Exercising B) Using heating pads C) Drinking caffeine D) Taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer 21: B) Using heating pads Rationale: Using heating pads with a transdermal fentanyl patch can increase drug absorption, potentially leading to overdose. Exercising, drinking caffeine, and taking NSAIDs are not contraindicated with fentanyl patches. Question 22: A client with hyperthyroidism is scheduled for radioactive iodine therapy. The nurse explains that the primary goal of this therapy is to: A) Increase thyroid hormone production B) Suppress thyroid hormone production C) Replace thyroid hormones D) Remove the thyroid gland Answer 22: B) Suppress thyroid hormone production Rationale: Radioactive iodine therapy is used to selectively destroy or suppress thyroid tissue, reducing the production of thyroid hormones. It aims to achieve a euthyroid (normal thyroid function) state. Increasing thyroid hormone production, replacing thyroid hormones, and removing the thyroid gland are not the primary goals of this therapy. These questions are meant for practice and review. For the most accurate and up-to- date information, consult current nursing literature and guidelines. Question 23:

A client with diabetes is prescribed metformin. The nurse instructs the client to monitor for which potential side effect of metformin? A) Hypertension B) Hypoglycemia C) Lactic acidosis D) Hyperlipidemia Answer 23: C) Lactic acidosis Rationale: Metformin use is associated with a rare but serious side effect called lactic acidosis. Clients should be instructed to seek medical attention if they experience symptoms such as weakness, muscle pain, or difficulty breathing. Metformin does not cause hypertension, hypoglycemia, or hyperlipidemia. Question 24: A client with chronic kidney disease is prescribed erythropoietin (EPO). The nurse understands that the purpose of EPO therapy is to: A) Increase blood pressure B) Stimulate red blood cell production C) Reduce inflammation D) Enhance immune function Answer 24: B) Stimulate red blood cell production Rationale: Erythropoietin (EPO) is a hormone that stimulates the production of red blood cells in the bone marrow. It is often prescribed to treat anemia associated with chronic

kidney disease. EPO does not increase blood pressure, reduce inflammation, or enhance immune function. Question 25: A client with a history of peptic ulcer disease is prescribed omeprazole. The nurse explains to the client that omeprazole works by: A) Neutralizing gastric acid B) Increasing gastric motility C) Inhibiting gastric acid secretion D) Enhancing gastric mucosal protection Answer 25: C) Inhibiting gastric acid secretion Rationale: Omeprazole is a proton pump inhibitor that works by inhibiting the proton pump in gastric parietal cells, reducing the secretion of gastric acid. It does not neutralize acid, increase motility, or enhance mucosal protection. Question 26: A client with a history of coronary artery disease is prescribed nitroglycerin. The nurse instructs the client about the proper administration of nitroglycerin, emphasizing that it should be taken: A) Before meals B) With meals C) On an empty stomach D) Sublingually as needed for chest pain Answer 26: D) Sublingually as needed for chest pain

Rationale: Nitroglycerin is commonly administered sublingually (under the tongue) for the rapid relief of chest pain associated with angina. It is not typically taken before or with meals, and it is not intended for routine use as a preventive measure. Question 27: A client with a history of heart failure is prescribed spironolactone. The nurse monitors the client for which potential side effect of spironolactone? A) Hypokalemia B) Hyperkalemia C) Hyponatremia D) Hypocalcemia Answer 27: B) Hyperkalemia Rationale: Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia. Monitoring potassium levels is important during therapy. It does not typically cause hypokalemia, hyponatremia, or hypocalcemia. Question 28: A client is receiving chemotherapy and is at risk for neutropenia. The nurse advises the client to avoid which activity to reduce the risk of infection? A) Eating raw fruits and vegetables B) Performing gentle aerobic exercise C) Practicing deep breathing exercises D) Attending social gatherings

Answer 28: A) Eating raw fruits and vegetables Rationale: To reduce the risk of infection during neutropenia, clients are often advised to avoid raw fruits and vegetables, as these may harbor bacteria. Gentle aerobic exercise, deep breathing exercises, and attending social gatherings are generally encouraged. Question 29: A client with chronic respiratory insufficiency is prescribed bilevel positive airway pressure (BiPAP). The nurse explains that BiPAP is primarily used to: A) Administer high-flow oxygen B) Assist with mechanical ventilation C) Improve chest expansion during inhalation D) Facilitate deep breathing exercises Answer 29: B) Assist with mechanical ventilation Rationale: BiPAP is a form of noninvasive positive pressure ventilation (NIPPV) that assists with mechanical ventilation. It is commonly used to support breathing in clients with respiratory insufficiency. It does not administer high-flow oxygen, specifically improve chest expansion, or facilitate deep breathing exercises. Question 30: A client with a history of seizures is prescribed phenytoin. The nurse instructs the client to report which symptom as a potential sign of phenytoin toxicity? A) Drowsiness B) Nausea

C) Ataxia D) Blurred vision Answer 30: D) Blurred vision Rationale: Blurred vision is a potential sign of phenytoin toxicity. Clients taking phenytoin should be monitored for symptoms such as ataxia, nystagmus, and blurred or double vision. Drowsiness, nausea, and ataxia are common side effects but may also indicate toxicity if severe. Question 31: A client with chronic kidney disease is prescribed a low-protein diet. The nurse instructs the client to limit the intake of which type of protein? A) Plant-based protein B) Animal-based protein C) Dairy-based protein D) Nut-based protein Answer 31: B) Animal-based protein Rationale: Animal-based proteins are typically higher in phosphorus, which may need to be restricted in clients with chronic kidney disease. Plant-based proteins, dairy-based proteins, and nut-based proteins are generally lower in phosphorus. Question 32:

A client with a history of hypertension is prescribed a thiazide diuretic. The nurse monitors the client for which potential side effect of thiazide diuretic therapy? A) Hypokalemia B) Hyperkalemia C) Hyperglycemia D) Hypoglycemia Answer 32: C) Hyperglycemia Rationale: Thiazide diuretics can cause hyperglycemia by impairing glucose tolerance. Monitoring blood glucose levels is important during therapy. Hypokalemia, hyperkalemia, and hypoglycemia are not typically associated with thiazide diuretic use. Question 33: A client with type 2 diabetes is prescribed acarbose. The nurse instructs the client to take acarbose with: A) Breakfast B) Lunch C) Dinner D) Snacks Answer 33: A) Breakfast Rationale:

Acarbose is an alpha-glucosidase inhibitor that is taken with the first bite of each main meal. It helps slow the digestion of carbohydrates and reduces postprandial glucose levels. It is not typically taken with snacks. Question 34: A client with a history of heart failure is prescribed digoxin. The nurse monitors for which sign of digoxin toxicity? A) Bradycardia B) Hypertension C) Diarrhea D) Visual disturbances Answer 34: D) Visual disturbances Rationale: Visual disturbances, such as halos or yellow-green color perception, can be early signs of digoxin toxicity. Bradycardia, hypertension, and diarrhea are not specific to digoxin toxicity. Question 35: A client with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium bromide. The nurse instructs the client that ipratropium works by: A) Relaxing bronchial smooth muscle B) Reducing inflammation C) Inhibiting bacterial growth D) Suppressing cough reflex Answer 35: A) Relaxing bronchial smooth muscle

Rationale: Ipratropium bromide is an anticholinergic bronchodilator that relaxes bronchial smooth muscle, leading to increased airflow. It is not typically used to reduce inflammation, inhibit bacterial growth, or suppress the cough reflex. Question 36: A client with a history of peptic ulcer disease is prescribed ranitidine. The nurse educates the client that ranitidine works by: A) Neutralizing gastric acid B) Inhibiting gastric acid secretion C) Enhancing gastric mucosal protection D) Increasing gastric motility Answer 36: B) Inhibiting gastric acid secretion Rationale: Ranitidine is a histamine-2 (H2) receptor antagonist that works by inhibiting gastric acid secretion. It does not neutralize acid, enhance mucosal protection, or increase gastric motility. Question 37: A client with hypothyroidism is prescribed levothyroxine. The nurse instructs the client to take levothyroxine: A) With meals B) On an empty stomach in the morning C) Before bedtime D) With calcium supplements

Answer 37: B) On an empty stomach in the morning Rationale: Levothyroxine is best absorbed on an empty stomach, preferably in the morning. Taking it with meals, before bedtime, or with calcium supplements can interfere with absorption. Question 38: A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin. The nurse monitors the client for which potential adverse effect of enoxaparin? A) Hypertension B) Hyperglycemia C) Thrombocytopenia D) Hyponatremia Answer 38: C) Thrombocytopenia Rationale: Thrombocytopenia (a decrease in platelet count) is a potential adverse effect of enoxaparin. Monitoring platelet levels is essential during therapy. Hypertension, hyperglycemia, and hyponatremia are not typically associated with enoxaparin use. Question 39: A client with a history of migraine headaches is prescribed sumatriptan. The nurse instructs the client to take sumatriptan: A) As a preventive measure B) At the onset of a migraine attack C) Once daily before bedtime

D) With food to minimize gastric upset Answer 39: B) At the onset of a migraine attack Rationale: Sumatriptan is a serotonin receptor agonist used to treat migraines. It is taken at the onset of a migraine attack, not as a preventive measure or on a scheduled basis. Taking it with food may delay absorption but does not minimize gastric upset. Question 40: A client with a history of alcohol use disorder is prescribed disulfiram. The nurse instructs the client to avoid which substance while taking disulfiram? A) Caffeine B) Nicotine C) Alcohol-containing products D) High-fat foods Answer 40: C) Alcohol-containing products Rationale: Disulfiram is used to deter alcohol consumption by causing unpleasant reactions (e.g., nausea, vomiting) when alcohol is ingested. Clients taking disulfiram should avoid all forms of alcohol-containing products. Caffeine, nicotine, and high-fat foods do not interact with disulfiram in the same way. These questions are intended for practice and review. For the most accurate and up- to-date information, consult current nursing literature and guidelines.

Question 41: A client with a urinary tract infection (UTI) is prescribed ciprofloxacin. The nurse educates the client to avoid taking ciprofloxacin with: A) Dairy products B) Antacids C) Green leafy vegetables D) Whole grains Answer 41: A) Dairy products Rationale: Ciprofloxacin should not be taken with dairy products or calcium-fortified foods, as they can interfere with the absorption of the medication. Antacids, green leafy vegetables, and whole grains do not affect the absorption of ciprofloxacin. Question 42: A client with chronic obstructive pulmonary disease (COPD) is prescribed prednisone. The nurse monitors the client for which potential side effect of prednisone therapy? A) Hypoglycemia B) Hypokalemia C) Hyperglycemia D) Hyperkalemia Answer 42: C) Hyperglycemia Rationale:

Prednisone is a corticosteroid that can lead to hyperglycemia by promoting gluconeogenesis and insulin resistance. Monitoring blood glucose levels is important during therapy. Hypoglycemia, hypokalemia, and hyperkalemia are not typically associated with prednisone use. Question 43: A client with heart failure is prescribed spironolactone. The nurse monitors the client for which potential side effect of spironolactone? A) Hypokalemia B) Hyperkalemia C) Hyponatremia D) Hypocalcemia Answer 43: B) Hyperkalemia Rationale: Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia. Monitoring potassium levels is important during therapy. It does not typically cause hypokalemia, hyponatremia, or hypocalcemia. Question 44: A client with rheumatoid arthritis is prescribed methotrexate. The nurse instructs the client to avoid which supplement while taking methotrexate? A) Folic acid B) Calcium C) Iron D) Vitamin D Answer 44: