3 Liver function tests

4 Hematologic function tests

17. The nurse is reviewing the record of a client who has been prescribed baclofen (Lioresal). Which of
the following disorders, if noted in the client's history, alerts the nurse to contact the physician?
1 Coronary artery disease
2 Diabetes mellitus
3 Seizure disorders
4 Hyperthyroidism
18. Cyclobenzaprine hydrochloride (Flexeril) is prescribed for the client for muscle spasms. The nurse is
reviewing the client's record. Which of the following disorders, if noted in the client's record, indicates
a need to contact the physician regarding the administration of this medication?
1 Glaucoma
2 Hyperthyroidism
3 Emphysema
4 Diabetes mellitus
19. The client is to receive a prescription for methocarbamol (Robaxin). The nurse reinforces instructions
to the client regarding the medication. Which of the following client statements indicates a need for
further education?
1 "My urine may turn brown or green."
2 "If my vision becomes blurred I don't need to be concerned about it."
3 "I might get some nasal congestion from this medication."
4 "This medication is prescribed to help relieve my muscle spasms."
20. The nurse is reviewing the physician's orders for an adult client who has been admitted to the hospital
following a back injury. Carisoprodol (Soma) is prescribed for the client to relieve the muscle spasms.
The physician has prescribed 350 mg to be administered QID. When preparing to give this
medication, the nurse determines that this dosage is
1 The normal adult dosage
2 A lower than normal dosage
3 A higher than normal dosage
4 A dosage requiring further clarification
ANSWERS
1.4
RATIONALE: Allopurinol is an antigout medication. It decreases uric acid production by inhibiting the
enzyme xanthine oxidase, and reduces uric acid concentrations in both serum and urine.
TEST-TAKING STRATEGY: Knowledge regarding this medication is required to answer the question.
Use the process of elimination. Note that options 1 and 2 are similar in that they both address a cardiac
situation. This leaves options 3 and 4. Knowledge that this medication is in the antigout classification will
assist in directing you to the correct option. If you had difficulty with this question, take time now to
review the action of allopurinol.

2.3
RATIONALE: Allopurinol is an antigout medication that may increase the effect of oral anticoagulants.
Warfarin sodium is an anticoagulant, and if this medication is prescribed for the client, the nurse questions
the order. Ergonovine is an antimigraine medication. Pentazocine is an opioid analgesic. Mebendazole is
an anhelmintic.
TEST-TAKING STRATEGY: Knowledge regarding the medication interactions related to allopurinol is
required to answer this question. If you had difficulty with this question, take time now to review the
interactions associated with this medication.

3.2
RATIONALE: Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full
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therapeutic effect may take 1 or more weeks. Allopurinol is to be given with milk or immediately
following meals. If clients develop a rash,irritation of the eyes, or swelling of the lips or mouth, they
should contact the physician because this may indicate hypersensitivity.
TEST-TAKING STRATEGY: Knowledge regarding client instructions related to this medication will
assist in answering the question. Option 4 can be easily eliminated because it indicates a hypersensitivity,
which is not a normal expected response. From this point, use the process of elimination and nursing
knowledge. If you had difficulty with this question, take time now to review client instructions related to
allopurinol.

4. 2
RATIONALE: Aspirin may be used to reduce the risk of recurrent TIA or stroke, or reduce the risk of MI
in clients with unstable angina or with a history of a previous MI.The normal dose for clients being
treated with aspirin to decrease thrombosis and MI is 300 to 325 mg daily. Clients being treated to prevent
TIAs are usually prescribed 1.3 daily in 2 to 4 divided doses. Clients with rheumatoid arthritis are treated
with 3.2 to 6.0 g daily in divided doses.
TEST-TAKING STRATEGY: Knowledge regarding the use of aspirin as prophylaxis is required to
answer this question. Read the question carefully. Note the key words "reduce the risk of MI." This should
indicate to you that the client is receiving the medication as a preventive measure, directing you to the
lowest dose of medication in the options. If you had difficulty with this question, take time now to review
aspirin dosages.

5. 1
RATIONALE: Colchicine is contraindicated in severe Gl, renal, hepatic or cardiac disorders, and in
clients with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy
manifested as generalized weakness. This medication should be used with caution in clients with impaired
hepatic function, the elderly, and the debilitated.
TEST-TAKING STRATEGY: Use the process of elimination. Note that options 2, 3, and 4 are all
endocrine-related disorders. Option 1, the correct option, is different from the others. Review this
medication now if you had difficulty with this question.

6.4
RATIONALE: Probenecid is a medication used for clients with gout to inhibit the reabsorption of uric
acid by the kidney and promote excretion of uric acid in the urine. Uric acid is produced when purine is
catabolized. Clients are instructed to modify their diets and limit excessive purine intake. High-purine
foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring,
shrimp, mackerel, gravy, and yeast.
TEST-TAKING STRATEGY: Note the key word 'avoid.Use the process of elimination. Options 1 and 3
are highnutrient foods, so eliminate these options first. From this point, use knowledge regarding the
purpose of the medication, the treatment for gout, and food sources high in purine to select the correct
option. If you had difficulty with
this question, take time now to review foods that are high in purine.

7.2
RATIONALE: Auranofin is the one gold preparation that is given orally rather than by injection.
Gastrointestinal reactions including diarrhea, abdominal pain, nausea, and loss of appetite are common
early in therapy, but usually subside in the first 3 months. Early symptoms of toxic reactions include a
rash, purple blotches, pruritus, mouth lesions, and a metallic taste in the mouth.
TEST-TAKING STRATEGY: Knowledge that auranofin is a gold preparation will assist you in
answering the question.Use the process of elimination. Option 4, joint pain, can be eliminated because the
medication is administered to reduce the joint pain. Note that the question is asking for a toxic effect;
therefore, from the options remaining, you should be directed to the correct option, metallic
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taste.Remember, gold is a metal. If you had difficulty with this question, take time now to review toxicity
related to gold
compounds.

8.3
RATIONALE: Diflunisal may be given with water, milk,or meals. The tablets should not be crushed or
broken open.
TEST-TAKING STRATEGY: Eliminate option 4 first as the least likely option. Next, noting the words
"film-coated" will assist in eliminating options I and 2. Additionally, these options are similar in that they
both suggest breaking the tablets. If you had difficulty with this question, review the procedure for
administration now.

9.3
RATIONALE: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal PO adult dose for
an elderly client is 300 to 800 mg three to four times daily.
TEST-TAKING STRATEGY: This may be a difficult question. Noting the word "elderly" in the
question will assist in eliminating option 4. From the remaining options it is necessary to be familiar with
normal dosages. Review the normal dosage for this medication now if you had difficulty with this
question.

10. 2
RATIONALE: Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the
frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and in clients
with multiple sclerosis.
TEST-TAKING STRATEGY: Knowledge that this medication is a skeletal muscle relaxant is required
to answer this question. If you knew the action of this medication, you would easily be directed to option
2. Review this medication now if you had difficulty with this question.

11.1
RATIONALE: Baclofen is a CNS depressant and frequently causes drowsiness, dizziness, weakness, and
fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the
possible reactions.
TEST-TAKING STRATEGY: Knowledge that baclofen is a CNS depressant used to treat muscle
spasticity will easily direct you to option 1. If you had difficulty with this question, review the side effects
of this medication now.

12.2
RATIONALE: Baclofen is a CNS depressant. The client should be cautioned against the use of alcohol
and other ; CNS depressants because baclofen potentiates the depressant activity of these agents.
Constipation rather than diarrhea is an adverse effect of bacloten. It is not necessary to restrict fluids, but
the client should be warned that urinary retention can occur. Fatigue is related to a CNS effect that.is most
intense during the early phase of therapy and diminishes with continued medication use. It is not
necessary that the client notify the physician.
TEST-TAKING STRATEGY: Knowledge that baclofen is a CNS depressant will easily direct you to
option 2. If you; were unsure of the correct option, use general principles related to medication
administration. Alcohol should be"avoided with the use of many medications.

13. 1
RATIONALE: Baclofen is dispensed in tablets of 10 and 20 mg for oral use. Dosages are low initially
and then gradually increased. Maintenance doses range from 15 to 20 mg administered three to four times
a day.
3
TEST-TAKING STRATEGY: Knowledge regarding the normal adult maintenance dosage is required to
answer this question. This may be a difficult question, and if you are unfamiliar with this maintenance
dosage, learn it now.

14.2
RATIONALE: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue
are more intense in the early phase of therapy and diminish with continued medication use. The client
should be instructed never to abruptly withdraw or stop the medication because abrupt withdrawal can
cause hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these
symptoms will subside and to encourage the client to continue the use of the medication.
TEST-TAKING STRATEGY: Note the key words "most appropriate." Eliminate option 4 first because it
is a rather extreme nursing response. Next, eliminate options 1 and 3 because these responses do not
represent the scope of nursing practice.

15.3
RATIONALE: Dantrolene sodium acts directly on skeletal muscle to relieve muscle spasticity. The
primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn
decreases the ability of the skeletal muscle to contract.
TEST-TAKING STRATEGY: Options 1, 2, and 4 are all similar in that they address the CNS (spinal
cord, CNS,spinal) and the depression of reflexes. Therefore, eliminate these options. Review this
medication now if you had difficulty with this question.

16.3
RATIONALE: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the
risk of liver damage, tests of liver function should be performed prior to treatment and throughout the
treatment interval. It is administered in the lowest effective dosage for the shortest time necessary.
TEST-TAKING STRATEGY: Eliminate options 1 and 2 because these tests both assess kidney function.
From the remaining options, it is necessary to recall that this medication affects liver function. Review
this medication now if you had difficulty with this question.

17.3
RATIONALE: Clients with seizure disorders may have a lowered seizure threshold when baclofen is
administered. Concurrent therapy may require an increase in the anticonvulsive medication.
TEST-TAKING STRATEGY: Knowledge regarding the contraindications and the cautions associated
with the administration of baclofen is required to answer this question.If you are unfamiliar with these
contraindications and cautions, review them now.

18. 1
RATIONALE: Because this medication has anticholinergic effects, it should be used with caution with
clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure.
Cyclobenzaprine should be used only for short-term 2- to 3-week therapy.
TEST-TAKING STRATEGY: Knowledge that this medication has anticholinergic effects will easily
assist in directing you to option 1. If you are unfamiliar with this medication and the contraindications
associated with its administration, review now.

19.2
RATIONALE: The client needs to be told that the urine may turn brown, black, or green. Other adverse
effects include blurred vision, nasal congestion, urticaria, and rash.The client needs to be instructed that if
these adverse effects occur, the physician needs to be notified.
TEST-TAKING STRATEGY: Note the key words "need for further education." This may assist you in
the process of elimination and direct you to option 2. If you had difficulty with this question, take time
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now to review.
20. 1
RATIONALE: The normal adult dosage for carisoprodol is 350 mg PO three to four times daily.
TEST-TAKING STRATEGY: This question may be difficult if you are not familiar with the normal
medication dosage. Review this medication now if you had difficulty with this question.