NCLEX - Week 7

Question 1

A client with chronic pain has been taking ibuprofen for several years. Which of the following laboratory tests would be most important to monitor?
A. Complete blood count (CBC)
B. Liver function tests (LFTs)
C. Serum creatinine and BUN
D. Thyroid function tests (TFTs)

Answer 1

C. Serum creatinine and BUN

Rationale:
Ibuprofen is an NSAID, and long-term use of NSAIDs can cause renal impairment. Monitoring serum creatinine and BUN can help identify early signs of renal dysfunction.

Question 2

A nurse is caring for a client who has just received a dose of morphine sulfate. Which of the following assessments is most important for the nurse to make?
A. Blood pressure
B. Level of pain
C. Respiratory rate
D. Urinary output

Answer 2

C. Respiratory rate

Rationale:
Morphine sulfate is an opioid agonist, and respiratory depression is a serious adverse effect.
The nurse should monitor the client’s respiratory rate closely.

Question 3

A client is receiving patient-controlled analgesia (PCA) with morphine sulfate after surgery. The client reports itching and nausea. What is the nurse’s best action?
A. Administer an antihistamine as ordered. B. Administer an antiemetic as ordered.
C. Discontinue the PCA infusion.
D. Notify the healthcare provider immediately.

Answer 3

B. Administer an antiemetic as ordered.

Rationale:
Itching and nausea are common side effects of morphine sulfate.
The nurse should administer an antiemetic as ordered to relieve these symptoms.

Question 4

A client with a history of chronic pain is being discharged home with a prescription for oxycodone. Which of the following statements indicates that the client understands the teaching?
A. “I can take this medication with a glass of wine to help me relax.”
B. “I should avoid driving or operating machinery while taking this medication.”
C. “I can take more medication than prescribed if my pain is not relieved.”
D. “I will only take this medication when I am experiencing severe pain.”

Answer 4

B. “I should avoid driving or operating machinery while taking this medication.”

Rationale:
Oxycodone is an opioid agonist that can cause sedation and impairment of coordination.
Clients should avoid activities that require alertness, such as driving or operating machinery, while taking this medication.

Question 5

A client who is physically dependent on opioids is experiencing withdrawal symptoms. Which of the following medications would the nurse anticipate administering?
A. Methadone
B. Naloxone
C. Ibuprofen
D. Acetaminophen

Answer 5

A. Methadone

Rationale:
Methadone is a long-acting opioid agonist used for the treatment of opioid dependence and withdrawal.
It can help reduce the severity of withdrawal symptoms.

Question 6

A nurse is administering naloxone to a client who has overdosed on heroin. What is the priority nursing action after administration?
A. Assess the client’s pain level.
B. Monitor the client’s respiratory rate.
C. Check the client’s blood pressure.
D. Evaluate the client’s level of consciousness.

Answer 6

B. Monitor the client’s respiratory rate.

Rationale:
Naloxone is an opioid antagonist that can rapidly reverse the effects of opioid overdose, including respiratory depression. The nurse should monitor the client’s respiratory rate closely after administration.

Question 7

A client is receiving celecoxib for osteoarthritis. Which of the following statements by the client indicates a need for further teaching?
A. “I should take this medication with food to prevent stomach upset.”
B. “I can stop taking this medication when my pain is gone.”
C. “I should report any signs of bleeding or bruising to my doctor.”
D. “I will avoid drinking alcohol while taking this medication.”

Answer 7

B. “I can stop taking this medication when my pain is gone.”

Rationale:
Celecoxib is a COX-2 inhibitor used for the long-term management of osteoarthritis. Clients should take this medication as prescribed, even if their pain is gone. Stopping the medication abruptly can lead to a flare-up of symptoms.

Question 8

A client is prescribed acetaminophen for fever. What is the maximum daily dose the nurse should administer?
A. 2000 mg
B. 3000 mg
C. 4000 mg
D. 5000 mg

Answer 8

B. 3000 mg

Rationale:
The maximum daily dose of acetaminophen for adults is 3000 mg. Exceeding this dose can increase the risk of liver damage.

Question 9

A client with a history of peptic ulcer disease is prescribed aspirin for the prevention of cardiovascular events. What is the nurse’s best action?
A. Administer the aspirin as ordered.
B. Question the aspirin order.
C. Administer a proton pump inhibitor with the aspirin.
D. Hold the aspirin and notify the healthcare provider.

Answer 9

C. Administer a proton pump inhibitor with the aspirin.

Rationale:
Aspirin can increase the risk of GI bleeding, especially in clients with a history of peptic ulcer disease.
Co-administration of a proton pump inhibitor can help reduce this risk.

Question 10

A client is receiving a continuous infusion of morphine sulfate for pain management. The nurse assesses the client and finds that the client’s respiratory rate is 8 breaths/minute. What is the nurse’s priority action?

A. Stop the infusion and notify the healthcare provider immediately.
B. Administer naloxone as ordered.
C. Decrease the infusion rate.
D. Continue to monitor the client’s respiratory rate.

Answer 10

A. Stop the infusion and notify the healthcare provider immediately.

Rationale:
A respiratory rate of 8 breaths/minute indicates severe respiratory depression. The nurse should stop the morphine infusion and notify the healthcare provider immediately.

Question 11

A nurse is caring for a client receiving morphine sulfate via PCA. Which statement indicates the client understands how to use PCA?
A. “I need to tell the nurse when I need more pain medicine.”
B. “I should push the button whenever I feel any pain.”
C. “My family can push the button for me if I’m asleep.”
D. “I’ll probably get addicted to the morphine if I use the PCA.”

Answer 11

B. “I should push the button whenever I feel any pain.”

Rationale:
The client needs to understand that they control the amount of pain medicine they receive.

Question 12

A client is being discharged on a fentanyl transdermal patch for chronic pain. What is the most important instruction for the nurse to give the client regarding disposal?
A. “Flush the patch down the toilet.”
B. “Fold the patch and place it in the trash.” C. “Remove the patch and apply a new one in the same location.”
D. “Fold the sticky sides together and discard in a designated container.”

Answer 12

D. “Fold the sticky sides together and discard in a designated container.”

Rationale:
Fentanyl is a powerful opioid. The patch needs to be disposed of appropriately to prevent accidental exposure

Question 13

A client has been taking acetaminophen daily for headaches. What is the most important teaching point the nurse should emphasize?
A. “Acetaminophen is safe to take with any other over-the-counter medications.”
B. “Avoid drinking alcohol while taking this medication.”
C. “Take this medication on an empty stomach for best absorption.”
D. “You can take this medication for as long as you need to control your headaches.”

Answer 13

B. “Avoid drinking alcohol while taking this medication.”

Rationale:
Alcohol and acetaminophen can cause serious liver damage.
Clients must be aware of this interaction.

Question 14

A nurse is teaching a client about the common side effects of opioid analgesics. Which side effect should the client report immediately to the healthcare provider?
A. Constipation
B. Drowsiness
C. Itching
D. Difficulty breathing

Answer 14

D. Difficulty breathing

Rationale:
Difficulty breathing is a sign of respiratory depression, a life-threatening side effect of opioid overdose.

Question 15

A client is recovering from surgery and has a PCA pump. The nurse enters the room and observes that the client’s family member is pushing the PCA button. What is the nurse’s best action?
A. Document that the family member is assisting the client with pain control.
B. Explain to the family member that the client must push the button themself.
C. Encourage the client to rest, and tell the family member that you will take care of their pain.
D. Contact the healthcare provider and request that the PCA be discontinued.

Answer 15

B. Explain to the family member that the client must push the button themself.

Rationale:
Only the client should activate their PCA pump.
Family members should be educated on the dangers of activating the pump for the client.

Question 16

What type of pain is most effectively treated with adjuvant medications?
A. Acute pain
B. Neuropathic pain
C. Post-operative pain
D. Pain associated with inflammation

Answer 16

B. Neuropathic pain

Rationale:
Adjuvant medications are often used in conjunction with opioids to enhance pain relief for neuropathic pain, which results from nerve damage.

Question 17

Which of the following medications is classified as an adjuvant analgesic?
A. Ibuprofen
B. Gabapentin
C. Morphine
D. Acetaminophen

Answer 17

B. Gabapentin

Rationale:
Gabapentin is an anticonvulsant medication that is often used as an adjuvant analgesic for the treatment of neuropathic pain.

Question 18

A client is taking amitriptyline for neuropathic pain. Which side effect is most important for the nurse to monitor?
A. Orthostatic hypotension
B. Sedation
C. Dry mouth
D. Constipation

Answer 18

A. Orthostatic hypotension

Rationale:
Amitriptyline is a tricyclic antidepressant used as an adjuvant for pain, but it can cause orthostatic hypotension, which increases the risk of falls.

Question 19

What client education should be provided for a client prescribed an anticonvulsant for neuropathic pain?
A. Take the medication on an empty stomach.
B. Avoid driving or operating machinery until the effects are known.
C. Report any signs of infection to the healthcare provider immediately.
D. Increase fluid intake to prevent dehydration.

Answer 19

B. Avoid driving or operating machinery until the effects are known.

Rationale:
Anticonvulsants can cause drowsiness and impair coordination, making activities requiring alertness, like driving, unsafe until tolerance is established.

Question 20

What is the primary mechanism of action by which tricyclic antidepressants help reduce chronic pain?
A. Reducing inflammation
B. Blocking opioid receptors
C. Enhancing the effects of opioids
D. Inhibiting serotonin reuptake

Answer 20

C. Enhancing the effects of opioids

Rationale:
Tricyclic antidepressants, when used as adjuvants, enhance the analgesic effects of opioids and are not used as a substitute.

Question 21

When administering glucocorticoids as an adjuvant for pain, the nurse should prioritize monitoring for which potential complication?
A. Hyperglycemia
B. Hypotension
C. Bradycardia
D. Hypokalemia

Answer 21

A. Hyperglycemia

Rationale:
Glucocorticoids can increase blood glucose levels.
Monitoring for hyperglycemia is essential, especially in diabetic patients, to prevent complications.

Question 22

Which electrolyte imbalance is a common concern when using glucocorticoids for pain management?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyperphosphatemia

Answer 22

B. Hypokalemia

Rationale:
Glucocorticoids can promote potassium loss.
Hypokalemia can lead to cardiac arrhythmias and muscle weakness, requiring close monitoring and potential supplementation.

Question 23

What important teaching point should the nurse include for a client starting bisphosphonates for bone pain related to cancer?
A. Take the medication with a full glass of milk.
B. Remain upright for at least 30 minutes after taking the medication.
C. Take the medication at bedtime to prevent daytime drowsiness.
D. Crush the medication and mix it with applesauce for easier swallowing.

Answer 23

B. Remain upright for at least 30 minutes after taking the medication.

Rationale:
Remaining upright helps prevent esophageal irritation and potential ulceration from the medication.

Question 24

What is the rationale for using CNS stimulants as adjuvant analgesics?
A. They increase energy levels, making it easier to cope with pain.
B. They directly block pain receptors in the spinal cord.
C. They reduce anxiety and depression associated with chronic pain.
D. They potentiate the effects of opioid medications.

Answer 24

A. They increase energy levels, making it easier to cope with pain.

Rationale:
CNS stimulants promote alertness and counteract opioid-induced sedation, helping patients engage in activities and cope with pain more effectively.

Question 25

Which common side effect of CNS stimulants used for pain management should be addressed in client education? A. Insomnia B. Weight gain C. Bradycardia D. Hypotension

Answer 25

A. Insomnia Rationale: CNS stimulants can interfere with sleep. Clients should be advised to avoid taking them late in the day to minimize sleep disruption

Question 26

When administering an opioid agonist-antagonist, the nurse should carefully monitor for which potential adverse effect? A. Respiratory depression B. Abdominal cramps C. Orthostatic hypotension D. Urinary retention

Answer 26

B. Abdominal cramps Rationale: Opioid agonist-antagonists can cause gastrointestinal side effects, including abdominal cramps, which should be monitored and managed.

Question 27

A client with chronic pain is considering the use of a transcutaneous electrical nerve stimulation (TENS) unit. What information should the nurse provide? A. TENS is a highly invasive procedure that requires surgical implantation. B. TENS uses electrical impulses to block pain signals, providing non-pharmacological relief. C. TENS is most effective for the treatment of severe, acute pain. D. TENS should be used in conjunction with high doses of opioid medications.

Answer 27

B. TENS uses electrical impulses to block pain signals, providing non-pharmacological relief. Rationale: TENS is a non-invasive method using low-voltage electrical currents to stimulate nerve fibers, reducing pain perception.

Question 28

Which of the following adjuvant medications can cause a decrease in the effectiveness of carbamazepine? A. Glucocorticoids B. Anticonvulsants C. Tricyclic antidepressants D. Bisphosphonates

Answer 28

B. Anticonvulsants Rationale: Concurrent use of anticonvulsants can alter carbamazepine metabolism, potentially reducing its effectiveness. Monitoring for therapeutic drug levels is crucial.

Question 29

A client receiving dexamethasone for pain management reports increased thirst and frequent urination. What potential complication should the nurse suspect? A. Hypokalemia B. Hyperglycemia C. Hyponatremia D. Hypocalcemia

Answer 29

B. Hyperglycemia Rationale: Dexamethasone, a glucocorticoid, can lead to hyperglycemia, causing increased thirst and urination as the body tries to excrete excess glucose.

Question 30

What dietary modifications should be recommended for a client receiving glucocorticoids for pain? A. Increase potassium intake B. Restrict sodium intake C. Limit protein consumption D. Increase calcium intake

Answer 30

A. Increase potassium intake Rationale: Glucocorticoids can cause hypokalemia, making potassium-rich foods important to replenish this electrolyte.

Question 31

A client is being discharged home after a total hip replacement. Which medication is most likely to be ordered for the client's pain? A. Aspirin B. Hydromorphone C. Acetaminophen D. Celecoxib

Answer 31

B. Hydromorphone Rationale: Hydromorphone is a strong opioid analgesic frequently used for managing moderate to severe postoperative pain, like that experienced after major surgery such as a total hip replacement.

Question 32

A client who has been taking oxycodone for an extended period reports that the medication is no longer effectively controlling their pain. What is this phenomenon called? A. Tolerance B. Dependence C. Withdrawal D. Addiction

Answer 32

A. Tolerance Rationale: Tolerance refers to the decreased effectiveness of a drug over time, requiring higher doses to achieve the same analgesic effect. It's a common issue with chronic opioid use.

Question 33

A nurse is assessing a client for pain. Which of the following findings is a subjective data? A. The client rates their pain as 8 out of 10. B. The client is grimacing. C. The client has a heart rate of 110 beats per minute. D. The client’s blood pressure is 140/90 mm Hg.

Answer 33

A. The client rates their pain as 8 out of 10. Rationale: Pain rating is based on the client's perception and report, making it subjective data. The other options are objective, measurable signs.

Question 34

What is a priority nursing intervention for a client receiving epidural analgesia? A. Monitoring respiratory rate B. Assessing bowel sounds C. Monitoring for urinary retention D. Assessing the epidural insertion site for signs of infection

Answer 34

A. Monitoring respiratory rate Rationale: Epidural analgesia can lead to respiratory depression if the medication migrates upward in the spinal column. Close monitoring of respiratory rate is essential to detect early signs of this complication.

Question 35

Which non-pharmacological pain management technique involves the application of pressure to specific points on the body? A. Acupressure B. Massage therapy C. Transcutaneous electrical nerve stimulation (TENS) D. Heat therapy

Answer 35

A. Acupressure Rationale: Acupressure stimulates specific points, releasing endorphins and promoting relaxation. The other options involve different mechanisms for pain relief.

Question 36

A nurse is caring for a client who is receiving morphine sulfate for pain. The nurse knows that which of the following medications can increase the risk of respiratory depression when given concurrently with morphine sulfate? A. Benzodiazepines B. Acetaminophen C. Ibuprofen D. Antibiotics

Answer 36

A. Benzodiazepines Rationale: Benzodiazepines are CNS depressants that, when combined with opioids like morphine, significantly increase the risk of respiratory depression, potentially leading to life-threatening consequences.

Question 37

A client is receiving a continuous infusion of fentanyl for pain management. The nurse observes that the client is somnolent, with a respiratory rate of 6 breaths per minute. What should the nurse do first? A. Administer naloxone per protocol. B. Stimulate the client by calling their name and shaking them gently. C. Decrease the fentanyl infusion rate per protocol. D. Elevate the head of the bed and apply oxygen via nasal cannula.

Answer 37

A. Administer naloxone per protocol. Rationale: Naloxone is an opioid antagonist that can rapidly reverse the effects of opioid overdose, including respiratory depression, in situations like this where the client exhibits clear signs of severe opioid toxicity.

Question 38

A client is prescribed ibuprofen for pain relief. What teaching point should the nurse emphasize to minimize gastrointestinal side effects? A. “Take the medication on an empty stomach for better absorption.” B. “Take the medication with food or milk.” C. “Crush the tablets and mix them with applesauce.” D. “Take the medication at bedtime to avoid daytime drowsiness.”

Answer 38

B. “Take the medication with food or milk.” Rationale: Food or milk helps buffer the irritating effects of ibuprofen on the stomach lining, reducing the risk of dyspepsia, heartburn, or ulceration

Question 39

What is a significant risk associated with the long-term use of high doses of acetaminophen? A. Liver damage B. Kidney failure C. Gastrointestinal bleeding D. Respiratory depression

Answer 39

A. Liver damage Rationale: Acetaminophen overdose or chronic use of high doses can lead to hepatotoxicity, potentially resulting in severe liver damage or failure

Question 40

A client is receiving an opioid medication for pain. What is a priority assessment for the nurse to perform before administering the medication? A. Respiratory rate B. Blood pressure C. Temperature D. Pain level

Answer 40

A. Respiratory rate Rationale: Opioids can cause respiratory depression, a potentially life-threatening complication. Assessing respiratory rate before administration helps establish a baseline and identify any pre-existing respiratory compromise that could be worsened by opioids.

Question 41

A client with a history of opioid addiction is hospitalized for a fractured femur. What type of pain management strategy would be most appropriate for this client? A. Multimodal analgesia B. Patient-controlled analgesia (PCA) with morphine C. Intramuscular meperidine every 4 hours as needed D. High-dose oral oxycodone around the clock

Answer 41

A. Multimodal analgesia Rationale: Multimodal analgesia uses a combination of pain relief methods (pharmacological and non-pharmacological) tailored to the individual's needs. This approach minimizes reliance on opioids alone, especially important for a client with a history of opioid addiction, while addressing pain effectively.

Question 42

A client is prescribed a fentanyl transdermal patch for chronic pain. What teaching point is essential to prevent accidental overdose? A. “Change the patch every 24 hours.” B. “Avoid applying heat to the patch area.” C. “Cut the patch in half if you experience side effects.” D. “Apply the patch to the same location each time.”

Answer 42

B. “Avoid applying heat to the patch area.” Rationale: Heat can increase the rate of fentanyl absorption from the patch, potentially leading to a dangerous overdose.

Question 43

A client receiving long-term opioid therapy requests a laxative. What is the rationale for this request? A. Opioids can cause diarrhea. B. Opioids can cause constipation. C. Opioids can cause nausea and vomiting. D. Opioids can cause urinary retention.

Answer 43

B. Opioids can cause constipation. Rationale: Opioids slow down intestinal motility, a common side effect leading to constipation. Clients often require laxatives or stool softeners to manage this problem

Question 44

A client with chronic back pain is prescribed a nonsteroidal anti-inflammatory drug (NSAID). What potential adverse effect should the nurse monitor? A. Hypoglycemia B. Hypertension C. Gastrointestinal bleeding D. Urinary tract infection

Answer 44

C. Gastrointestinal bleeding Rationale: NSAIDs can irritate the stomach lining, increasing the risk of ulcers and GI bleeding, especially with prolonged use or in individuals with a history of peptic ulcer disease.

Question 45

A client with a history of alcohol abuse is admitted for acute pancreatitis. What pain medication order should the nurse question? A. Acetaminophen B. Morphine C. Hydromorphone D. Fentanyl

Answer 45

A. Acetaminophen Rationale: Acetaminophen can be hepatotoxic, especially in clients with pre-existing liver damage from alcohol abuse. The other opioids carry risks too, but acetaminophen poses a higher risk of exacerbating liver injury in this case.

Question 46

What is the primary purpose of using adjuvant medications in pain management? A. To enhance the effects of opioids and reduce opioid dosage B. To provide sedation and reduce anxiety. C. To replace opioids entirely in chronic pain management. D. To treat side effects of opioid medications.

Answer 46

A. To enhance the effects of opioids and reduce opioid dosage Rationale: Adjuvant medications complement opioids, boosting pain relief, addressing specific pain mechanisms (like nerve pain), and allowing lower opioid doses, thus reducing side effects.

Question 47

Which of the following medications is commonly used as an adjuvant analgesic for neuropathic pain? A. Dexamethasone B. Amitriptyline C. Ibuprofen D. Celecoxib

Answer 47

B. Amitriptyline Rationale: Amitriptyline is a tricyclic antidepressant that is effective in treating nerve pain by modulating pain signals in the nervous system

Question 48

A client is taking carbamazepine for trigeminal neuralgia. What dietary instruction is essential for this client? A. “Increase your intake of grapefruit juice.” B. “Avoid foods high in tyramine.” C. “Restrict your sodium intake.” D. “Avoid consuming alcohol.”

Answer 48

D. “Avoid consuming alcohol.” Rationale: Alcohol can interact with carbamazepine, increasing sedation and impairing coordination

Question 49

When assessing a client's pain, what mnemonic can help the nurse gather comprehensive data? A. PQRST B. ABCDE C. SAMPLE D. OPQRST

Answer 49

PQRST Provocative/Palliative factors, Quality, Region/Radiation, Severity, Timing) is a structured way to explore pain characteristics. The other mnemonics are used for different assessments

Question 50

Which of the following statements about pain management is accurate? A. Pain is always objective and can be easily measured. B. The client's self-report is the most reliable indicator of pain. C. Non-pharmacological pain management techniques are ineffective. D. Addiction is a common problem in clients receiving pain medication.

Answer 50

B. The client's self-report is the most reliable indicator of pain. Rationale: Pain is a subjective experience. The client's own description and rating are the primary source of information for assessment