NCLEX RN Practice Question # 418-423

A client is in sinus bradycardia with a heart rate of 45 beats/min, complains of dizziness, and has a blood pressure of 82/60 mm Hg. Which of the following should the nurse anticipate will be prescribed?

1. Defibrillate the client.
2. Administer digoxin (Lanoxin).
3. Continue to monitor the client.
4. Prepare for transcutaneous pacing.

Sinus bradycardia


Atrial and ventricular rhythms are regular.
Atrial and ventricular rates are less than 60 beats/min.
PR interval and QRS width are within normal limits.
Treatment may be necessary if the client is symptomatic (signs of decreased cardiac output).
Note that a low heart rate may be normal for some individuals.


Attempt to determine the cause of sinus bradycardia; if a medication is suspected of causing the bradycardia, withhold the medication and notify the physician.
Administer oxygen as prescribed.
Administer atropine sulfate as prescribed to increase the heart rate to 60 beats/min.
Be prepared to apply a noninvasive (transcutaneous) pacemaker initially as prescribed if the atropine sulfate does not increase the heart rate sufficiently.
Avoid additional doses of atropine sulfate because this will induce tachycardia.
Monitor for hypotension and administer fluids intravenously as prescribed.
Depending on the cause of the bradycardia, the client may need a permanent pacemaker.

Sinus tachycardia


Atrial and ventricular rates are 100 to 180
Atrial and ventricular rhythms are regular.
PR interval and QRS width are within normal limits.


Identify the cause of the tachycardia.
Decrease the heart rate to normal by treating the underlying cause.

A client admitted to the hospital with chest pain and history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which of the following medications would need to be withheld for 48 hours before and after the procedure?

1. Regular insulin
2. Glipizide (Glucotrol)
3. Repaglinide (Prandin)
4. Metformin (Glucophage)


Preoperative care

Check with physician regarding withholding oral hypoglycemic medications or insulin.
Some long-acting oral antidiabetic medications are discontinued 24 to 48 hours before surgery.
Metformin (Glucophage)may need to be discontinued 48 hours before surgery andmaynot be restarted until renal function is normal postoperatively.
All other oral antidiabetic medications are usually withheld the day of surgery.
Insulin dose may be adjusted or withheld if IV insulin administration during surgery is planned.
Monitor blood glucose level.
Administer IV fluids as prescribed.

Intraoperative care

Monitor blood glucose levels frequently.
Administer IV short- or rapid-acting insulin as prescribed to maintain the blood glucose level lower than 200 mg/dL.

Postoperative care

Administer IV glucose and regular insulin infusions as prescribed until the client can tolerate oral feedings.
Administer supplemental short-acting insulin as prescribed based on blood glucose results.
Monitor blood glucose levels frequently if the client is receiving parenteral nutrition.
When the client is tolerating food, ensure that the client receives an adequate amount of carbohydrates daily to prevent hypoglycemia.
Client is at higher risk for cardiovascular and renal complications postoperatively.
Client is also at risk for impaired wound healing.

The nurse has just administered the first dose of omalizumab (Xolair) to a client. Which statement by the client would alert the nurse that the client may be experiencing a life threatening adverse reaction?

1. “I have a severe headache.”
2. “My feet are quite swollen.”
3. “I am nauseated and may vomit.”
4. “My lips and tongue are swollen.”



Omalizumab (Xolair) is a recombinant DNAderived humanized immunoglobulin G (IgG) murine monoclonal antibody that selectively binds to IgE to limit the release of mediators in the allergic response.
Used to treat allergy-related asthma; administered subcutaneously every 2 to 4 weeks
Dose is titrated based on the serum IgE level and body weight.
Contraindicated in those with hypersensitivity to the medication

Side effects

Injection site reactions
Viral infections
Upper respiratory infections


Assess respiratory rate, rhythm, and depth and auscultate lung fields bilaterally.
Assess for allergies and/or allergic reaction symptoms such as rash or urticaria.
Instruct the client that respiratory improvement will not be immediate.
Instruct the client not to stop taking or decrease the currently prescribed asthma medications unless instructed.
Avoid live virus vaccines for the duration of treatment.
Have medications for the treatment of severe hypersensitivity reactions available during ini

A client has begun therapy with theophylline (Theo-24). A nurse plans to teach the client to limit the intake of which of the following while taking this medication?

1. Coffee, cola, and chocolate
2. Oysters, lobster, and shrimp
3. Melons, oranges, and pineapple
4. Cottage cheese, creamcheese, and dairy creamers

Therapeutic Serum Medication Levels

Medication Therapeutic Range

Acetaminophen (Tylenol) 10-20 mcg/mL

Amikacin (Amikin) 25-30 mcg/mL

Amitriptyline 120-150 ng/mL

Carbamazepine (Tegretol) 5-12 mcg/mL

Chloramphenicol (Chloromycetin) 10-20 mcg/mL

Desipramine (Norpramin) 150-300 ng/mL

Digoxin (Lanoxin) 0.5-2 ng/mL

Disopyramide (Norpace) 2-5 mcg/mL

Ethosuximide (Zarontin) 40-100 mcg/mL

Gentamicin 5-10 mcg/mL

Imipramine (Tofranil) 150-300 ng/mL

Lidocaine (Xylocaine) 1.5-5 mcg/mL

Lithium (Lithobid) 0.5-1.2 mEq/L

Magnesium sulfate 4-7 mg/dL

Phenobarbital (Luminal) 10-30 mcg/mL

Phenytoin (Dilantin) 10-20 mcg/mL

Propranolol (Inderal) 50-100 ng/mL

Salicylate 100-250 mcg/mL

Theophylline 10-20 mcg/mL

Tobramycin (Nebcin) 5-10 mcg/mL

Valproic acid (Depakene) 50-100 mcg/mL

A client with tuberculosis is being started on antituberculosis therapy with isoniazid (INH). Before giving the client the first dose, a nurse ensures that which of the following baseline studies has been completed?

1. Electrolyte levels
2. Liver enzyme levels
3. Serum creatinine level
4. Coagulation times


Isoniazid (INH)


Isoniazid is bactericidal.
It inhibits the synthesis of mycolic acids and acts to kill actively growing organisms in the extracellular environment.
It inhibits the growth of dormant organisms in the macrophages and caseating granulomas.
It is active only during cell division and is used in combination with other antitubercular medications.

Contraindications and cautions

Isoniazid is contraindicated in clients with hypersensitivity or with acute liver disease.
Use with caution in clients with chronic liver disease, alcoholism, or renal impairment.
Use with caution in clients taking nicotinic acid (niacin).
Use with caution in clients taking hepatotoxic medications because the risk for hepatotoxicity increases.
Alcohol increases the risk of hepatotoxicity.
Isoniazid may increase the risk of toxicity of carbamazepine (Tegretol) and phenytoin (Dilantin).
Isoniazid may decrease ketoconazole (Nizoral) concentrations.

Side effects

Hypersensitivity reactions
Peripheral neuritis
Hepatotoxicity; increased liver function test levels
Pyridoxine (vitamin B6) deficiency
Irritation at injection site with intramuscular administration
Nausea and vomiting
Dry mouth
Vision changes


Assess for hypersensitivity.
Assess for hepatic dysfunction.
Assess for sensitivity to nicotinic acid.
Monitor liver function test results.
Monitor for signs of hepatitis, such as anorexia, nausea, vomiting, weakness, fatigue, dark urine, or jaundice; if these symptoms occur, withhold the medication and notify the physician.
Monitor for tingling, numbness, or burning of the extremities.
Assess mental status.
Monitor for visual changes, and notify the physician if they occur.
Assess for dizziness and initiate safety precautions.
Monitor complete blood count (CBC) and blood glucose levels.
Administer isoniazid 1 hour before or 2 hours after a meal because food may delay absorption.
Administer isoniazid at least 1 hour before antacids, especially those antacids that contain aluminum.
Administer pyridoxine as prescribed to reduce the risk of neurotoxicity.