Nclexrn Quiz: Adverse Effects And Drug Interactions
20 questions · exam conditions
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Adverse Effects And Drug InteractionsQuestion 1 of 20

A 57-year-old client is started on enalapril for hypertension in an outpatient clinic. Two days later the client calls reporting swelling of the lips and tongue and difficulty swallowing; no rash is noted. What finding requires IMMEDIATE intervention to prevent further complications?

Swelling of lips and tongue after starting enalapril
Mild dizziness when standing quickly
Dry cough that occurs occasionally at night
Blood pressure of 138/84 mmHg at home
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Nclexrn Quiz: Adverse Effects And Drug Interactions

Practice Adverse Effects And Drug Interactions in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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This quiz focuses on Adverse Effects And Drug Interactions, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

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Question 1

A 57-year-old client is started on enalapril for hypertension in an outpatient clinic. Two days later the client calls reporting swelling of the lips and tongue and difficulty swallowing; no rash is noted. What finding requires IMMEDIATE intervention to prevent further complications?

  1. Swelling of lips and tongue after starting enalapril (correct answer)
  2. Mild dizziness when standing quickly
  3. Dry cough that occurs occasionally at night
  4. Blood pressure of 138/84 mmHg at home
Explanation: This question tests understanding of adverse effects and drug interactions, particularly angioedema from ACE inhibitors. The key findings are swelling of lips and tongue with difficulty swallowing shortly after starting enalapril, indicating angioedema. Immediate intervention is required to prevent airway obstruction. Dizziness, dry cough, and slightly elevated BP are common and less urgent. Assessment of airway patency is vital. The nursing process prioritizes emergency response. A transferable strategy is to monitor for angioedema in the first weeks of ACE inhibitor therapy.

Question 2

A 63-year-old client in an outpatient clinic takes sildenafil as needed and is prescribed nitroglycerin sublingual tablets for new episodes of chest pain. The client states, "I took sildenafil last night." Current vital signs are BP 96/58 mmHg, HR 92/min, and the client reports dizziness when standing. What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Instruct the client to avoid taking nitroglycerin and notify the provider due to risk of severe hypotension. (correct answer)
  2. Teach the client to take one nitroglycerin tablet and then drive to the pharmacy for aspirin because chest pain is the priority.
  3. Recommend that the client take sildenafil daily as a preventive measure because it relaxes blood vessels and reduces episodes of chest pain.
  4. Advise the client to increase fluid intake and continue both medications as prescribed because low blood pressure is from dehydration.
Explanation: The safest action is to recognize that sildenafil and nitroglycerin both cause vasodilation; combined, they can cause severe hypotension, especially with a blood pressure of 96/58 and dizziness on standing. The nurse should therefore instruct the client not to use the nitroglycerin and should notify the provider to arrange a safer alternative. Teaching the client to take a nitroglycerin tablet and then drive to the pharmacy is unsafe because the interaction may worsen the hypotension and the client is already dizzy, so driving is inappropriate. Recommending daily sildenafil as a preventive measure is incorrect because sildenafil is not indicated for preventing chest pain and daily use does not treat angina; it also continues the interaction risk. Advising increased fluid intake and continuing both medications misattributes the hypotension to dehydration and overlooks the serious drug interaction, so it does not protect the client. The priority is to stop the nitroglycerin exposure and seek provider guidance.

Question 3

A 66-year-old client with chronic obstructive pulmonary disease uses an albuterol inhaler and is started on propranolol for tremor. At follow-up in an outpatient clinic, the client reports increased shortness of breath and wheezing not relieved by albuterol. Which medication should the nurse QUESTION for a client with these symptoms?

  1. Propranolol therapy in a client with COPD using albuterol (correct answer)
  2. Inhaled albuterol used as needed
  3. Inhaled corticosteroid used daily
  4. Normal saline nasal spray used for dryness
Explanation: This question tests understanding of adverse effects and drug interactions, focusing on beta-blockers antagonizing beta-agonists in COPD. The key symptoms are increased shortness of breath and wheezing unrelieved by albuterol in a client on propranolol, due to bronchoconstriction. Questioning propranolol in a COPD client using albuterol is appropriate as nonselective beta-blockers worsen symptoms. Albuterol, corticosteroids, and saline are standard. Assessment of respiratory response is essential. The nursing process emphasizes evaluating therapy efficacy. A transferable strategy is to use cardioselective beta-blockers in respiratory conditions.

Question 4

A 76-year-old client in long-term care is taking donepezil for Alzheimer disease and is started on oxybutynin for urinary urgency. Over the next week, staff report increased confusion and the client has a dry mouth and constipation. What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Notify the provider that oxybutynin may worsen cognition and counteract donepezil (correct answer)
  2. Increase the donepezil dose to overcome the urinary medication effects
  3. Limit oral fluids to decrease urinary frequency
  4. Administer an over-the-counter sleep aid at bedtime for agitation
Explanation: This question tests understanding of adverse effects and drug interactions, specifically anticholinergic effects counteracting cholinesterase inhibitors. The key findings are increased confusion, dry mouth, and constipation in a client on donepezil and oxybutynin, indicating antagonism. Notifying the provider that oxybutynin may worsen cognition and counteract donepezil is priority for safety and symptom management. Increasing donepezil risks side effects; limiting fluids worsens constipation; sleep aids add anticholinergics. Assessment of cognitive changes is key. The decision-making principle is to avoid opposing mechanisms. A transferable strategy is to review anticholinergic burden in dementia clients.

Question 5

A 29-year-old postpartum client in an outpatient clinic started a combined oral contraceptive pill 2 weeks ago and is taking rifampin for tuberculosis. The client reports breakthrough bleeding and is concerned about pregnancy risk. What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Teach the client to use a backup nonhormonal contraceptive method while taking rifampin (correct answer)
  2. Reassure the client that rifampin increases contraceptive effectiveness
  3. Instruct the client to stop rifampin immediately
  4. Recommend doubling the oral contraceptive dose without consulting the provider
Explanation: This question tests understanding of adverse effects and drug interactions, particularly reduced contraceptive efficacy from enzyme inducers. The key concern is breakthrough bleeding and pregnancy risk in a client on oral contraceptives and rifampin, due to induced metabolism. Teaching to use backup contraception is priority to prevent unintended pregnancy safely. Reassuring increased effectiveness is incorrect; stopping rifampin risks TB; doubling dose is unsafe without orders. Assessment involves recognizing interaction effects. The decision-making principle is client education on risks. A transferable strategy is to counsel on alternative contraception with inducers.

Question 6

A 70-year-old client with chronic back pain takes oxycodone as needed and was newly prescribed lorazepam for anxiety. In a medical-surgical unit, the nurse finds the client difficult to arouse with slurred speech; vital signs are BP 102/60 mmHg, HR 54/min, RR 8/min, SpO2 90% on room air. What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Encourage the client to ambulate with assistance to improve alertness
  2. Hold further sedating medications and support ventilation while notifying the provider/rapid response team (correct answer)
  3. Offer a snack and recheck blood glucose in 30 minutes
  4. Administer the next scheduled dose of lorazepam to prevent withdrawal
Explanation: This question tests understanding of adverse effects and drug interactions, particularly respiratory depression from opioid-benzodiazepine combinations. The key findings are difficulty arousing, slurred speech, bradypnea, and low SpO2 in a client on oxycodone and lorazepam, suggesting sedation overdose. Holding sedating medications, supporting ventilation, and notifying the provider or rapid response team is priority to prevent respiratory arrest. Ambulating may increase fall risk; offering a snack addresses hypoglycemia not indicated; administering more lorazepam worsens sedation. Assessment of respiratory status is crucial in polypharmacy. The decision-making principle is to prioritize reversal of life-threatening effects. A transferable strategy is to monitor sedation levels when combining CNS depressants.

Question 7

A 45-year-old client in the emergency department has a history of anaphylaxis to penicillin documented in the chart. The client receives intravenous piperacillin-tazobactam for suspected sepsis and within minutes develops wheezing, facial swelling, and generalized hives; vital signs are BP 88/52 mmHg, HR 122/min, RR 28/min, SpO2 89% on room air. What finding requires IMMEDIATE intervention to prevent further complications?

  1. Administer oral diphenhydramine when the client is able to swallow
  2. Document the reaction in the allergy section of the medical record after the next set of vital signs
  3. Obtain a sputum culture before any additional interventions
  4. Stop the antibiotic infusion and administer intramuscular epinephrine per protocol (correct answer)
Explanation: This question tests understanding of adverse effects and drug interactions, specifically anaphylaxis from beta-lactam antibiotics in allergic clients. The key findings are wheezing, facial swelling, hives, and hypotension shortly after piperacillin-tazobactam in a client with penicillin allergy, indicating anaphylaxis. Stopping the infusion and administering epinephrine is immediate to reverse airway compromise and shock, prioritizing client safety. Documenting after vital signs delays care; obtaining sputum is irrelevant; diphenhydramine is adjunctive but not first-line. The nursing process requires rapid assessment and intervention in allergic reactions. Prioritizing airway and circulation is key in emergencies. A transferable strategy is to always verify allergies before administering antibiotics.

Question 8

A 74-year-old client in a medical-surgical unit takes metoprolol for hypertension and is started on diltiazem for atrial fibrillation rate control. Shortly after the first dose of diltiazem, the client becomes lightheaded; vital signs are BP 88/56 mmHg, HR 38/min. What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Reassess vital signs in 4 hours to see if symptoms resolve
  2. Give the next scheduled metoprolol dose to stabilize the heart rhythm
  3. Encourage the client to drink caffeinated beverages to raise heart rate
  4. Hold further doses and notify the provider of symptomatic bradycardia and hypotension (correct answer)
Explanation: This question tests understanding of adverse effects and drug interactions, particularly additive bradycardia and hypotension from beta-blockers and calcium channel blockers. The key findings are lightheadedness, hypotension, and bradycardia in a client on metoprolol and diltiazem, indicating hemodynamic compromise. Holding doses and notifying the provider is priority to prevent syncope or shock. Giving more metoprolol worsens effects; caffeine is inappropriate; reassessing later delays care. Assessment of vital signs is essential. The decision-making principle is to avoid additive AV node suppression. A transferable strategy is to monitor heart rate closely with combined rate controllers.

Question 9

A 55-year-old client with chronic kidney disease takes lisinopril and is newly prescribed trimethoprim-sulfamethoxazole for a skin infection. Two days later the client reports weakness; labs show potassium 5.9 mEq/L (normal 3.5–5.0). Which medication should the nurse QUESTION for a client with these symptoms?

  1. Polyethylene glycol taken for constipation
  2. Topical mupirocin applied to the wound
  3. Acetaminophen taken for discomfort
  4. Trimethoprim-sulfamethoxazole added to lisinopril therapy (correct answer)
Explanation: This question tests understanding of adverse effects and drug interactions, focusing on hyperkalemia from ACE inhibitors and certain antibiotics. The key finding is elevated potassium with weakness in a client on lisinopril and trimethoprim-sulfamethoxazole, especially with kidney disease. Questioning trimethoprim-sulfamethoxazole added to lisinopril is appropriate as this combination risks hyperkalemia. Mupirocin, acetaminophen, and polyethylene glycol are safe. Assessment of electrolytes in renal clients is essential. The nursing process prioritizes lab monitoring. A transferable strategy is to choose alternative antibiotics in hyperkalemia risk.

Question 10

A 62-year-old client in an outpatient clinic takes allopurinol for gout and is started on azathioprine after a kidney transplant. Within a week, the client develops fever and sore throat; labs show white blood cell count 2.1 × 10^3/µL (normal 4.5–11.0). Which medication should the nurse QUESTION for a client with these symptoms?

  1. Azathioprine prescribed while the client is taking allopurinol (correct answer)
  2. Calcium citrate supplement
  3. Docusate sodium for constipation prevention
  4. Topical hydrocortisone cream for itching
Explanation: This question tests understanding of adverse effects and drug interactions, specifically bone marrow suppression from azathioprine potentiated by allopurinol. The key findings are fever, sore throat, and low WBC in a client on allopurinol and azathioprine, indicating myelosuppression. Questioning azathioprine with allopurinol is appropriate as this interaction increases toxicity risk. Calcium, docusate, and hydrocortisone are safe. Assessment of blood counts is vital in immunosuppression. The nursing process prioritizes infection signs. A transferable strategy is to dose-adjust immunosuppressants with xanthine oxidase inhibitors.

Question 11

A 40-year-old client is admitted to the hospital with bipolar disorder and is taking lithium. The client was started on hydrochlorothiazide for hypertension 1 week ago and now has coarse tremor, vomiting, and unsteady gait; lithium level is 1.9 mEq/L (therapeutic 0.6–1.2). What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Administer the next dose of lithium to prevent relapse of mania
  2. Provide a high-protein snack to reduce nausea
  3. Encourage the client to restrict sodium intake to reduce blood pressure
  4. Hold lithium and notify the provider of suspected thiazide-related lithium toxicity (correct answer)
Explanation: This question tests understanding of adverse effects and drug interactions, focusing on lithium toxicity from sodium depletion by thiazides. The key findings are coarse tremor, vomiting, unsteady gait, and elevated lithium level in a client on lithium and hydrochlorothiazide, indicating toxicity. Holding lithium and notifying the provider is priority to prevent severe neurotoxicity and ensure safety. Administering lithium worsens toxicity; restricting sodium exacerbates it; a snack doesn't address the cause. Assessment of lithium levels and symptoms is crucial. The decision-making principle is to withhold in toxicity. A transferable strategy is to monitor levels when adding diuretics to lithium therapy.

Question 12

A 68-year-old client is hospitalized for heart failure exacerbation and receives intravenous furosemide. The client also takes gentamicin for a gram-negative infection. After 2 days, the client reports ringing in the ears and difficulty hearing conversations. Which symptom indicates an adverse effect of the medication regimen?

  1. Occasional cough with deep breathing exercises
  2. Increased urine output after diuretic therapy
  3. Mild thirst after fluid restriction
  4. Tinnitus and decreased hearing (correct answer)
Explanation: This question tests understanding of adverse effects and drug interactions, specifically ototoxicity from aminoglycosides potentiated by loop diuretics. The key symptoms are tinnitus and decreased hearing in a client on gentamicin and furosemide, indicating auditory damage. This indicates an adverse effect requiring intervention to prevent permanent hearing loss. Increased urine output is expected; mild thirst from restriction; cough from exercises are benign. Assessment of sensory changes is vital. The decision-making principle is to monitor for toxicity in combinations. A transferable strategy is to baseline and serial audiometry with ototoxic drugs.

Question 13

A 79-year-old client in a hospital unit takes digoxin for heart failure and was started on furosemide yesterday for fluid overload. This morning the client reports nausea and sees "yellow halos" around lights; apical pulse is 52/min and potassium is 3.1 mEq/L (normal 3.5–5.0). What is the nurse's PRIORITY action?

  1. Administer the scheduled digoxin dose and then recheck the potassium level, possibly before notifying the provider.
  2. Hold digoxin and notify the provider of possible digoxin toxicity related to hypokalemia. (correct answer)
  3. Encourage the client to restrict fluids to 1 liter per day and continue furosemide as ordered.
  4. Administer an antacid for nausea and reassess the client's apical pulse and symptoms in 1 hour.
Explanation: These findings—nausea, yellow halos, bradycardia, and hypokalemia after starting a loop diuretic—are signs of digoxin toxicity; low potassium increases digoxin effect and risk of dysrhythmias. The nurse's priority is to hold the next digoxin dose and notify the provider for evaluation, not to continue or reinforce the cause. Administering the scheduled digoxin dose, even with later potassium rechecking, can worsen toxicity. Restricting fluids and continuing furosemide manages volume overload but leaves hypokalemia untreated and may lower potassium further, increasing toxicity. An antacid treats nausea symptomatically and delays care for the underlying drug interaction. Holding the drug and alerting the provider directly addresses the toxicity and its electrolyte trigger; therefore, that is the correct priority.

Question 14

A 66-year-old client in an outpatient clinic takes lisinopril for hypertension and spironolactone for heart failure. The client reports weakness and palpitations; assessment shows irregular pulse. Lab results: potassium 6.2 mEq/L (normal 3.5–5.0), creatinine 1.6 mg/dL (normal 0.6–1.3). What finding requires IMMEDIATE intervention to prevent further complications?

  1. Teach the client to rise slowly from a seated position to prevent orthostatic hypotension during this clinic visit
  2. Encourage the client to eat potassium-rich foods to prevent muscle cramps associated with diuretic therapy
  3. Place the client on cardiac monitoring and notify the provider of hyperkalemia (correct answer)
  4. Schedule a follow-up blood pressure check in 2 weeks to evaluate the response to current medications
Explanation: The client takes lisinopril, an ACE inhibitor, and spironolactone, a potassium-sparing diuretic; together these strongly increase hyperkalemia risk. A potassium level of 6.2 mEq/L with weakness, palpitations, and an irregular pulse signals that a fatal dysrhythmia may develop. Placing the client on cardiac monitoring and notifying the provider is the immediate priority. Teaching the client to rise slowly addresses orthostatic hypotension but does not treat the life-threatening hyperkalemia or arrhythmia risk. Encouraging potassium-rich foods would raise potassium further and is contraindicated, especially when the client is already taking a potassium-sparing diuretic and an ACE inhibitor. Scheduling a follow-up blood pressure check in 2 weeks delays urgent treatment for a potassium level above 6.0, which can progress to ventricular fibrillation or asystole.

Question 15

A 70-year-old client in the emergency department has chronic obstructive pulmonary disease and takes theophylline. The client started ciprofloxacin yesterday for bronchitis and now has nausea, insomnia, and a heart rate of 126/min with frequent premature ventricular contractions on assessment. What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Administer the next theophylline dose with food to reduce nausea
  2. Hold theophylline and notify the provider of suspected elevated theophylline level (correct answer)
  3. Encourage the client to ambulate to reduce anxiety and improve sleep
  4. Give a PRN antacid and reassess symptoms in 30 minutes
Explanation: This question tests understanding of adverse effects and drug interactions affecting theophylline metabolism. The client shows theophylline toxicity symptoms (nausea, insomnia, tachycardia, PVCs) after starting ciprofloxacin, which inhibits cytochrome P450 enzymes that metabolize theophylline, increasing serum levels. Holding theophylline and notifying the provider (B) is the priority because theophylline has a narrow therapeutic index and toxicity can progress to seizures and life-threatening arrhythmias. Administering with food (A) doesn't address the dangerous interaction, encouraging ambulation (C) is unsafe with cardiac arrhythmias, and giving antacids (D) delays critical intervention for toxicity. The nursing priority is recognizing drug interactions that affect medications with narrow therapeutic ranges and intervening before serious complications develop. When fluoroquinolones are prescribed with theophylline, dose reduction is typically required, and nurses must monitor for CNS and cardiac toxicity signs.

Question 16

A 58-year-old client is admitted to a medical-surgical unit for pneumonia and has a history of atrial fibrillation treated with warfarin. The provider starts trimethoprim-sulfamethoxazole today for a urinary tract infection; the client reports new gum bleeding and dark stools. Latest labs: INR 5.6 (normal 0.8–1.2). What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Administer vitamin K as prescribed and prepare to transfuse fresh frozen plasma
  2. Hold warfarin and notify the provider about the elevated INR and bleeding (correct answer)
  3. Give the antibiotic with food to reduce gastrointestinal irritation
  4. Teach the client to increase intake of vitamin K-rich foods while on antibiotics
Explanation: This question tests understanding of adverse effects and drug interactions between warfarin and antibiotics. The client has an INR of 5.6 (therapeutic range for atrial fibrillation is 2-3) with active bleeding symptoms after starting trimethoprim-sulfamethoxazole, which inhibits warfarin metabolism and increases anticoagulation. Holding warfarin and notifying the provider (B) is the priority action because the client has supratherapeutic anticoagulation with active bleeding that requires immediate intervention. While vitamin K and fresh frozen plasma (A) may be needed for severe bleeding, the first action is to stop the causative medication and alert the provider; giving the antibiotic with food (C) doesn't address the dangerous interaction, and increasing vitamin K foods (D) is inappropriate during acute bleeding with elevated INR. The nursing process requires assessment and immediate intervention when recognizing drug interactions that cause bleeding complications. Nurses must monitor INR closely when antibiotics are added to warfarin therapy and recognize that many antibiotics potentiate warfarin's effects through various mechanisms.

Question 17

A 62-year-old client on a telemetry unit takes metoprolol for hypertension. The provider administers verapamil for new-onset atrial flutter; 30 minutes later the client reports dizziness and fatigue. Vital signs: HR 38/min, BP 86/50 mm Hg, RR 18/min, SpO2 96% on room air. What finding requires IMMEDIATE intervention to prevent further complications?

  1. Hold further doses and notify the provider of symptomatic bradycardia and hypotension (correct answer)
  2. Teach the client to avoid grapefruit juice while taking verapamil and report worsening fatigue
  3. Reassure the client that fatigue is expected after rate-control therapy and continue cardiac monitoring
  4. Encourage oral fluids, place the client supine, and recheck the blood pressure in 1 hour
Explanation: The correct action is to hold further doses and notify the provider of symptomatic bradycardia and hypotension. Metoprolol and verapamil have additive negative chronotropic and inotropic effects; at HR 38/min with dizziness and BP 86/50, the client is showing a dangerous drug interaction that can progress to heart block or cardiovascular collapse. Avoiding grapefruit juice and reporting worsening fatigue are important verapamil teaching points, but they do not address the immediate crisis. Reassuring the client that fatigue is expected and continuing cardiac monitoring treats fatigue as a normal side effect when it is actually a warning sign of instability; reassurance alone provides no urgent treatment. Encouraging fluids, placing the client supine, and rechecking blood pressure in 1 hour may support the blood pressure temporarily, but it delays the priority: stopping further medication and getting the provider involved. Therefore, the nurse must halt additional negative inotropic and chronotropic effects and notify immediate.

Question 18

A 72-year-old client in a long-term care facility started tramadol yesterday for osteoarthritis pain and also takes sertraline daily. Today the nurse notes new agitation, diaphoresis, tremor, and diarrhea; vital signs are T 38.3°C (100.9°F), HR 118/min, BP 156/88 mm Hg. What finding requires IMMEDIATE intervention to prevent further complications?

  1. Hold the next dose of tramadol and notify the provider of possible serotonin syndrome (correct answer)
  2. Encourage increased oral fluids and reassess bowel sounds in 2 hours
  3. Administer the scheduled sertraline dose to prevent withdrawal symptoms
  4. Provide a cool compress and recheck temperature at the next medication pass
Explanation: This question tests understanding of adverse effects and drug interactions, specifically serotonin syndrome. The client presents with agitation, diaphoresis, tremor, diarrhea, fever, tachycardia, and hypertension after starting tramadol while taking sertraline - classic signs of serotonin syndrome from the interaction between these serotonergic medications. Holding tramadol and notifying the provider (A) is the best choice because serotonin syndrome can rapidly progress to life-threatening complications including seizures, rhabdomyolysis, and cardiovascular collapse. Encouraging fluids (B) addresses only one symptom without recognizing the dangerous syndrome, administering sertraline (C) would worsen the condition by adding more serotonin, and providing comfort measures (D) delays critical intervention. The nursing priority is recognizing medication interactions that cause serious adverse effects and intervening immediately to prevent progression. When multiple serotonergic drugs are combined, nurses must monitor for autonomic instability, neuromuscular changes, and altered mental status that indicate this medical emergency.

Question 19

A 72-year-old client in a long-term care facility takes warfarin for atrial fibrillation and was started on trimethoprim-sulfamethoxazole yesterday for a urinary tract infection. Today the client reports new gum bleeding and has dark, tarry stools; vital signs are BP 108/64 mmHg, HR 96/min, RR 18/min, SpO2 96% on room air. What is the nurse's PRIORITY action when noticing a drug interaction?

  1. Schedule the client for a routine international normalized ratio (INR) check at the next weekly lab draw
  2. Administer aspirin as ordered for pain to reduce inflammation
  3. Encourage increased oral fluids to help flush the urinary tract
  4. Hold the next dose of warfarin and notify the provider of suspected increased anticoagulation (correct answer)
Explanation: This question tests understanding of adverse effects and drug interactions, specifically the potentiation of anticoagulants by certain antibiotics. The key assessment findings are new gum bleeding and dark, tarry stools in a client on warfarin recently started on trimethoprim-sulfamethoxazole, indicating possible increased anticoagulation and gastrointestinal bleeding. Holding the next dose of warfarin and notifying the provider is the best choice to ensure client safety by preventing further bleeding and allowing for immediate medical evaluation. Administering aspirin is incorrect as it increases bleeding risk; encouraging fluids addresses the UTI but not the interaction; scheduling a routine INR ignores the urgency of symptoms. In the nursing process, assessment of bleeding signs and prompt intervention are critical for medication safety. Prioritizing notification of the provider facilitates timely adjustment of therapy. A transferable strategy is to always monitor for signs of bleeding in clients on anticoagulants when new medications are added.

Question 20

A 50-year-old client with epilepsy takes phenytoin and is started on fluconazole for oral candidiasis. Two days later the client has nystagmus, slurred speech, and unsteady gait. What finding requires IMMEDIATE intervention to prevent further complications?

  1. Unsteady gait and nystagmus after starting fluconazole while taking phenytoin (correct answer)
  2. White patches on the tongue prior to antifungal therapy
  3. Dry mouth after using mouthwash
  4. Mild sore throat from coughing
Explanation: This question tests understanding of adverse effects and drug interactions, focusing on phenytoin toxicity from azole antifungals inhibiting metabolism. The key findings are unsteady gait, nystagmus, and slurred speech in a client on phenytoin and fluconazole, signaling toxicity. Immediate intervention is required to prevent seizures or injury from toxicity. White patches are candidiasis; dry mouth from mouthwash; sore throat from coughing are less urgent. Assessment of neurologic status is crucial. The nursing process emphasizes symptom recognition. A transferable strategy is to monitor levels when adding inhibitors to anticonvulsants.