Question

A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor?

Answer 1

Correct Answers:

QT prolongation

Rationale :

🔷 Ondansetron (a 5-HT3 antagonist) can prolong the QT interval, increasing risk for torsades de pointes.

🔷 The risk is higher with IV dosing, high doses, electrolyte abnormalities (low K⁺/Mg²⁺), or underlying cardiac disease.

🔷 QT prolongation may be silent initially, so monitoring ECG and assessing for palpitations/syncope is important in at-risk clients.

🔷 Identifying QT changes early helps prevent progression to life-threatening dysrhythmias.

🔷 Teaching includes reporting dizziness, fainting, or irregular heartbeat promptly while on therapy.

Polyuria

🔷 Polyuria is not a typical adverse effect of ondansetron and does not reflect its primary pharmacologic risks.

🔷 Ondansetron more commonly causes constipation and headache than increased urination.

Dependent edema

🔷 Dependent edema is not a common or expected adverse effect of ondansetron.

🔷 Edema would prompt evaluation for cardiac/renal causes rather than being attributed to this antiemetic.

Photosensitivity

🔷 Photosensitivity is not a classic ondansetron effect and is more associated with certain antibiotics or diuretics.

🔷 Monitoring for cardiac rhythm changes is the higher-yield safety focus for ondansetron.

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Answer 2

Correct Answers:

Warm the bottle in the hands before administration to reduce dizziness

Rationale :

🔶 Cold ear drops can stimulate the vestibular apparatus and trigger dizziness/vertigo and nausea.

🔶 Warming the bottle in the hands brings the drops closer to body temperature, improving comfort and tolerance.

🔶 This increases adherence because the client is less likely to avoid doses due to unpleasant sensations.

🔶 Proper administration also supports accurate medication delivery to the infected canal and reduces sudden discomfort.

🔶 Teaching should also include keeping the ear positioned to allow the drops to coat the canal and avoiding contamination of the dropper tip.

Insert the dropper tip deeply into the ear canal

🔶 Deep insertion risks trauma to the canal and contamination of the dropper.

🔶 The tip should remain above the canal opening to maintain sterility and prevent injury.

Insert a cotton swab into the ear before each dose

🔶 Cotton swabs can push debris deeper and irritate or abrade the canal.

🔶 This increases infection risk and can worsen inflammation rather than helping.

Administer the drops while the client is sitting upright

🔶 Upright positioning can reduce the drop’s ability to stay in the canal and increases leakage.

🔶 Side-lying with affected ear up is typically used to improve canal coating and absorption.

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Answer 3

Correct Answers:

Docusate sodium
Magnesium hydroxide
Psyllium
Bisacodyl

Rationale :

Docusate sodium

🔷 Docusate is a stool softener that lowers surface tension, allowing water and fat to penetrate stool.

🔷 It helps prevent straining by producing softer stools, especially in clients with hemorrhoids or post-op restrictions.

🔷 It works best with adequate fluid intake to support stool hydration.

🔷 It is not used for rapid relief but for gentle stool softening over time.

🔷 Teaching includes maintaining hydration and not expecting immediate results after the first dose.

Magnesium hydroxide

🔷 Magnesium hydroxide is an osmotic laxative that draws water into the intestines to stimulate peristalsis.

🔷 It can provide relatively quick relief compared to stool softeners.

🔷 It increases stool water content, making stools easier to pass.

🔷 Overuse can cause electrolyte disturbances and is used cautiously in renal impairment.

🔷 Teaching includes avoiding excessive or prolonged use without provider guidance.

Psyllium

🔷 Psyllium is a bulk-forming laxative that absorbs water and expands, increasing stool bulk.

🔷 Increased bulk stimulates peristalsis and supports more regular bowel movements.

🔷 It must be taken with adequate water to prevent obstruction or choking risk.

🔷 Bulk agents are helpful for chronic constipation when hydration and fiber are low.

🔷 Teaching includes mixing properly, drinking fluids, and expecting gradual improvement.

Bisacodyl

🔷 Bisacodyl is a stimulant laxative that increases intestinal motility and fluid secretion.

🔷 It is often used for short-term constipation relief or bowel prep.

🔷 Overuse can lead to cramping and laxative dependence with chronic use.

🔷 Enteric-coated forms should not be crushed, and timing matters due to onset.

🔷 Teaching includes using the lowest effective dose for the shortest duration.

Loperamide

🔷 Loperamide is an antidiarrheal, not a laxative, because it slows intestinal motility.

🔷 Using it for constipation would worsen bowel stasis and discomfort.

Diphenoxylate with atropine

🔷 This is also an antidiarrheal that decreases GI motility.

🔷 It is not used to promote bowel movements and can worsen constipation.

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Answer 4

Correct Answers:

Bleeding

Rationale :

🔶 Heparin can cause thrombocytopenia and, in some cases, heparin-induced thrombocytopenia (HIT).

🔶 Low platelets reduce clotting ability, increasing risk for bleeding from gums, IV sites, urine, or GI tract.

🔶 Continuous infusion heightens the need for monitoring aPTT/anti-Xa and platelet trends.

🔶 Bleeding can be rapid and life-threatening, requiring prompt intervention and possible reversal.

🔶 Nursing care includes assessing for bruising, hematuria, melena, and declining blood pressure or rising heart rate.

Hypertension

🔶 Hypertension is not the primary complication of heparin-induced thrombocytopenia.

🔶 The immediate safety concern is hemorrhage risk due to impaired clotting.

Bradycardia

🔶 Bradycardia is not a typical direct complication associated with heparin thrombocytopenia.

🔶 Bleeding signs and lab monitoring are higher priority than heart rate slowing.

Infection

🔶 Thrombocytopenia does not directly increase infection risk; neutropenia is more infection-linked.

🔶 The urgent complication tied to low platelets and anticoagulation is bleeding.

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Answer 5

Correct Answers:

2.5

Rationale :

🔷 Ordered dose is 20 mg PO every 6 hr.

🔷 Available concentration is 40 mg/5 mL, which equals 8 mg/mL (40 ÷ 5).

🔷 Required volume = Ordered dose ÷ mg per mL = 20 ÷ 8 = 2.5 mL.

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Answer 6

Correct Answers:

Right documentation
Right medication
Right patient
Right time
Right route
Right dose

Rationale :

🔶 Right documentation

🔶 Accurate charting confirms what was given, when, and how, preventing duplicate or missed doses.

🔶 Documentation supports continuity of care and legal accountability for medication administration.

🔶 It helps evaluate responses and adverse effects related to timing and dosage.

🔶 Recording promptly improves safety for subsequent nurses and providers.

🔶 It also supports audit trails for quality improvement and error reduction.

🔶 Right medication

🔶 Verifying the correct drug prevents look-alike/sound-alike errors.

🔶 Checking the label against the MAR at key steps reduces wrong-drug administration.

🔶 Knowing the drug’s class supports identifying contraindications and interactions.

🔶 This right protects clients from ineffective therapy and harm.

🔶 It is reinforced by barcode scanning and independent double checks when required.

🔶 Right patient

🔶 Confirming identity with two identifiers prevents wrong-patient errors.

🔶 This is essential when clients have similar names or room changes occur.

🔶 Correct identification ensures the right MAR/order is applied to the correct person.

🔶 It is foundational to all other rights because a correct drug given to the wrong patient is still harmful.

🔶 It should be done every time, even if the nurse “knows” the client.

🔶 Right time

🔶 Correct timing maintains therapeutic drug levels and optimizes effectiveness.

🔶 Some meds require strict schedules (e.g., antibiotics, insulin) to prevent complications.

🔶 Timing reduces toxicity and supports predictable outcomes.

🔶 It also helps coordinate administration with meals or labs when required.

🔶 Following timing windows prevents accidental overdosing or missed therapeutic coverage.

🔶 Right route

🔶 Ensuring the correct route prevents serious injury (e.g., IV vs IM vs PO errors).

🔶 Route affects absorption, onset, and safety profile of medications.

🔶 Correct route ensures intended therapeutic effect and reduces local complications.

🔶 This includes verifying forms (enteric-coated, extended-release) are appropriate for the route.

🔶 It also includes assessing swallowing ability for PO meds and IV patency for IV meds.

🔶 Right dose

🔶 Correct dose prevents under-treatment and toxicity.

🔶 Dose verification is critical in pediatrics, renal impairment, and high-alert meds.

🔶 Double-checking calculations and concentrations prevents decimal errors.

🔶 Correct dosing supports predictable therapeutic response.

🔶 It also reduces avoidable adverse effects and complications.

Right room

🔶 There is no standard medication right called “right room.”

🔶 The focus is on correct patient identification, not location.

Right provider

🔶 “Right provider” is not traditionally part of the core six rights.

🔶 Provider verification occurs through order validation, but it is not one of the classic six rights.

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Answer 7

Correct Answers:

Beta blockers work by directly relaxing blood vessels, allowing for easier blood flow and decreased blood pressure.

Rationale :

🔷 Beta blockers primarily block beta-1 receptors in the heart, lowering heart rate and contractility, which reduces cardiac output and blood pressure.

🔷 They also reduce renin release from the kidneys, decreasing downstream vasoconstriction and volume effects.

🔷 The combined result is decreased workload on the heart and improved blood pressure control.

🔷 In clinical effect, many clients experience reduced sympathetic drive, which contributes to lower vascular tone over time.

🔷 Among the provided options, “allowing for easier blood flow and decreased blood pressure” most closely reflects the overall BP-lowering outcome, even though the primary mechanism is cardiac beta-1 blockade.

Decrease angiotensin II production

🔷 That describes ACE inhibitors/ARBs effect on the renin-angiotensin system, not primary beta blocker action.

🔷 Beta blockers reduce renin release, but they do not directly “decrease angiotensin II production” as the main MOA.

Increase heart rate and force

🔷 Beta blockers do the opposite: they decrease heart rate and contractility.

🔷 Increasing HR/contractility would raise BP and myocardial oxygen demand.

Promote sodium and water excretion

🔷 That describes diuretics, which lower blood volume.

🔷 Beta blockers do not act as primary natriuretics/diuretics.

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Answer 8

Correct Answers:

The medication should be applied on a regular schedule for the rest of the client's life.

Rationale :

🔶 Open-angle glaucoma is a chronic condition requiring lifelong control of intraocular pressure (IOP) to prevent optic nerve damage.

🔶 Timolol is a beta blocker eye drop that decreases aqueous humor production, lowering IOP.

🔶 The goal is prevention of vision loss; symptoms may be minimal, so consistent use is essential even without pain.

🔶 Stopping when IOP “normalizes” can allow pressure to rise again, silently damaging the optic nerve.

🔶 Long-term adherence and follow-up eye pressure checks are central to preventing irreversible blindness.

Apply when experiencing eye pain

🔶 Open-angle glaucoma is often painless, so waiting for pain delays treatment and increases vision loss risk.

🔶 Timolol is scheduled therapy, not PRN pain treatment.

Use for 10 days then taper

🔶 Glaucoma therapy is not short-term and does not follow a taper-to-stop approach.

🔶 Lifelong management is required for ongoing pressure control.

Use until IOP returns to normal

🔶 Normal IOP is maintained by continued therapy; stopping usually causes rebound elevation.

🔶 Glaucoma damage is progressive and irreversible, so ongoing prevention is essential.

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Answer 9

Correct Answers:

Intravenous

Rationale :

🔷 Parenteral routes bypass the GI tract and include injections/infusions such as IV, IM, and subcutaneous.

🔷 Intravenous administration delivers medication directly into the bloodstream for rapid onset.

🔷 IV therapy is used for emergencies, titratable meds, and when PO route is not possible.

🔷 It allows precise control of dosing and continuous infusion if needed.

🔷 Because it is invasive, it carries risks like infection, infiltration, and phlebitis, requiring monitoring.

Otic drops

🔷 Otic is a topical route applied to the ear canal, not parenteral.

🔷 It does not enter systemic circulation directly like injections do.

Oral tablet

🔷 Oral medications are enteral and absorbed through the GI tract.

🔷 This is the opposite of parenteral administration.

Rectal suppository

🔷 Rectal administration is also an enteral/mucosal route, not parenteral.

🔷 It does not involve injection into tissues or bloodstream.

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Answer 10

Correct Answers:

Adenosine

Rationale :

🔶 Adenosine is the first-line medication for stable SVT because it temporarily blocks AV nodal conduction.

🔶 This brief AV node pause can terminate re-entrant tachycardias and restore normal sinus rhythm.

🔶 It has an extremely short half-life, so it is given as a rapid IV push followed by a flush.

🔶 The nurse should anticipate transient effects like flushing, chest pressure, and brief asystole on the monitor.

🔶 Continuous ECG monitoring is required to confirm rhythm conversion and detect recurrence.

Digoxin

🔶 Digoxin is not first-line for acute SVT conversion and has a slower onset.

🔶 It is more associated with rate control in atrial fibrillation and heart failure support.

Metoprolol

🔶 Beta blockers can slow AV conduction but are not the classic first-line rapid conversion drug like adenosine.

🔶 Metoprolol may be used for rate control or prevention, but adenosine is preferred for immediate termination.

Warfarin

🔶 Warfarin is an anticoagulant used for clot prevention, not acute SVT rhythm conversion.

🔶 It will not stop tachycardia and has delayed onset.

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QLexNursing

1 :
A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor?

2 :
A nurse is teaching a client how to administer neomycin, polymyxin B, and hydrocortisone otic drops for external otitis. Which instruction should the nurse include?

3 :
A nurse is teaching a client about over-the-counter laxatives. Which of the following medications should the nurse identify as laxatives? (Select All that Apply.)

4 :
A nurse is caring for a client who is receiving a continuous heparin infusion and has developed thrombocytopenia. Which is the most important concern for the nurse?

5 :
A nurse is preparing to administer liquid famotidine 20 mg PO every 6 hr for a client who has GERD. Available is famotidine 40 mg/5 mL. How many mL should the nurse administer?

6 :
What are the six rights of medication administration? (Select all that apply)

7 :
A nurse is reviewing the mechanism of action of beta blockers with a client who has hypertension. Which explanation should the nurse provide to describe how this medication works?

8 :
A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide?

9 :
Which of the following is an example of a parenteral route of medication administration?

10 :
A nurse is caring for a client who is experiencing supraventricular tachycardia. Which medication should the nurse prepare to administer?

QLexNursing

1 : A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor?

2 : A nurse is teaching a client how to administer neomycin, polymyxin B, and hydrocortisone otic drops for external otitis. Which instruction should the nurse include?

3 : A nurse is teaching a client about over-the-counter laxatives. Which of the following medications should the nurse identify as laxatives? (Select All that Apply.)

4 : A nurse is caring for a client who is receiving a continuous heparin infusion and has developed thrombocytopenia. Which is the most important concern for the nurse?

5 : A nurse is preparing to administer liquid famotidine 20 mg PO every 6 hr for a client who has GERD. Available is famotidine 40 mg/5 mL. How many mL should the nurse administer?

6 : What are the six rights of medication administration? (Select all that apply)

7 : A nurse is reviewing the mechanism of action of beta blockers with a client who has hypertension. Which explanation should the nurse provide to describe how this medication works?

8 : A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide?

9 : Which of the following is an example of a parenteral route of medication administration?

10 : A nurse is caring for a client who is experiencing supraventricular tachycardia. Which medication should the nurse prepare to administer?

1 :
A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor?

2 :
A nurse is teaching a client how to administer neomycin, polymyxin B, and hydrocortisone otic drops for external otitis. Which instruction should the nurse include?

3 :
A nurse is teaching a client about over-the-counter laxatives. Which of the following medications should the nurse identify as laxatives? (Select All that Apply.)

4 :
A nurse is caring for a client who is receiving a continuous heparin infusion and has developed thrombocytopenia. Which is the most important concern for the nurse?

5 :
A nurse is preparing to administer liquid famotidine 20 mg PO every 6 hr for a client who has GERD. Available is famotidine 40 mg/5 mL. How many mL should the nurse administer?

6 :
What are the six rights of medication administration? (Select all that apply)

7 :
A nurse is reviewing the mechanism of action of beta blockers with a client who has hypertension. Which explanation should the nurse provide to describe how this medication works?

8 :
A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide?

9 :
Which of the following is an example of a parenteral route of medication administration?

10 :
A nurse is caring for a client who is experiencing supraventricular tachycardia. Which medication should the nurse prepare to administer?