NCLEX-PN Test #17 3 — Questions and Answers
Question 1: A client prescribed lisinopril (ACE inhibitor) reports a persistent dry cough that has been present since starting the medication. What should the nurse do?
- Reassure the client that the cough will resolve with continued use
- Recommend cough suppressants and continue the medication
- Report the finding to the provider — dry cough is a significant ACE inhibitor side effect that may require changing to an ARB (Correct answer)
- Instruct the client to stop taking the medication immediately
Correct answer: Report the finding to the provider — dry cough is a significant ACE inhibitor side effect that may require changing to an ARB
Persistent dry cough is the most common side effect of ACE inhibitors (incidence ~10–15%), caused by bradykinin accumulation in the airways. It does not resolve with time. The standard management is to switch to an ARB (angiotensin receptor blocker) such as losartan, which provides similar blood pressure and renal protection without causing cough.
Question 2: A client receiving gentamicin (aminoglycoside antibiotic) reports ringing in the ears and difficulty hearing. What should the nurse do first?
- Document the complaint and monitor at the next medication pass
- Hold the next dose and notify the provider immediately — these are signs of ototoxicity (Correct answer)
- Increase fluid intake to promote drug excretion
- Administer the next dose at half the prescribed rate
Correct answer: Hold the next dose and notify the provider immediately — these are signs of ototoxicity
Tinnitus (ringing in ears) and hearing loss are signs of aminoglycoside ototoxicity (cochlear damage), which can be irreversible. The nurse must hold the medication and notify the provider immediately. Aminoglycosides also cause nephrotoxicity. Peak and trough levels and renal function must be monitored closely during therapy.
Question 3: A client prescribed prednisone (corticosteroid) for 6 weeks asks the nurse what side effects to monitor for. Which response is most complete?
- "Prednisone is very safe for short-term use with no significant side effects."
- "Monitor for weight gain, increased blood pressure, elevated blood sugar, increased susceptibility to infection, and GI upset." (Correct answer)
- "The only concern is some nausea; take it with food."
- "Long-term use is fine as the body adjusts to the medication over time."
Correct answer: "Monitor for weight gain, increased blood pressure, elevated blood sugar, increased susceptibility to infection, and GI upset."
Corticosteroids have multiple significant side effects: fluid retention and weight gain, hypertension, hyperglycemia (diabetogenic), immunosuppression (increased infection risk), peptic ulcers, osteoporosis (long-term), mood changes, adrenal suppression, and Cushingoid features. Clients must not stop abruptly — taper required to prevent adrenal crisis.
Question 4: A client with Parkinson's disease is prescribed levodopa-carbidopa (Sinemet). Which meal timing instruction should the nurse provide?
- Take with a high-protein meal for better absorption
- Take the medication 30–60 minutes before meals or 1–2 hours after, as high-protein meals compete with absorption (Correct answer)
- Take at bedtime only to avoid daytime side effects
- Take with calcium-rich foods to prevent bone loss
Correct answer: Take the medication 30–60 minutes before meals or 1–2 hours after, as high-protein meals compete with absorption
Levodopa competes with dietary amino acids (protein) for absorption through the same transporter in the gut and blood-brain barrier. High-protein meals significantly reduce levodopa absorption and efficacy. Taking it before or well after meals optimizes absorption. Some clients use a protein redistribution diet (low protein during day, higher at evening).
Question 5: A client prescribed warfarin has an INR of 5.8 (therapeutic range 2.0–3.0). The client has no active bleeding. What is the expected nursing action?
- Continue warfarin at the current dose and recheck in 1 week
- Administer vitamin K (phytonadione) as ordered and hold warfarin doses per protocol (Correct answer)
- Administer fresh frozen plasma immediately
- Increase warfarin dose to bring the INR within range
Correct answer: Administer vitamin K (phytonadione) as ordered and hold warfarin doses per protocol
An INR of 5.8 is significantly supratherapeutic, indicating high bleeding risk. Without active bleeding, management typically includes: holding warfarin doses and administering oral/IV vitamin K (phytonadione) to reverse anticoagulation as ordered. Fresh frozen plasma is reserved for major bleeding with supratherapeutic INR. The dose will be adjusted after INR normalizes.
Question 6: The nurse is monitoring a client receiving IV amphotericin B. Which adverse effect requires the most vigilant monitoring?
- Mild infusion-site discomfort
- Nephrotoxicity — rising serum creatinine and decreased urine output (Correct answer)
- Peripheral neuropathy
- Alopecia
Correct answer: Nephrotoxicity — rising serum creatinine and decreased urine output
Amphotericin B ("ampho-terrible") is highly nephrotoxic in up to 80% of patients. Monitoring includes: serum creatinine and BUN before each dose, urine output, and electrolytes (hypokalemia and hypomagnesemia are common). Pre-hydration with normal saline and liposomal formulations (AmBisome) reduce but do not eliminate nephrotoxicity.
NCLEX-PN Test #17 3
A client prescribed lisinopril (ACE inhibitor) reports a persistent dry cough that has been present since starting the medication.
What should the nurse do?