Nclexpn Quiz: Adverse Effects And Allergic Reactions

What this quiz covers

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

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Mild dry cough with clear lung sounds
2. Swelling of the lips and tongue with hoarseness (correct answer)
3. Blood pressure of 104/68 mm Hg after the first dose
4. Heart rate of 110/min after walking to the bathroom

Explanation: This question tests recognition of angioedema as a life-threatening adverse effect of ACE inhibitors and the need for immediate intervention. The client is experiencing classic signs of angioedema including swelling of the lips and tongue with hoarseness, which can rapidly progress to airway obstruction. Swelling of the lips and tongue with hoarseness (B) represents the most critical finding that requires immediate reporting as it indicates potential airway compromise. A mild dry cough (A) is a common side effect of ACE inhibitors that doesn't require immediate intervention. Blood pressure of 104/68 (C) after the first dose shows the medication is working but isn't dangerously low. Tachycardia after activity (D) is an expected physiological response. The principle of prioritization is that airway threats always take precedence over other concerns. A transferable strategy is to recognize that ACE inhibitor-induced angioedema can occur even after the first dose and requires immediate discontinuation of the medication and emergency treatment.

Question 2

1. Hold the medication and notify the registered nurse immediately (correct answer)
2. Document the findings and reassess the skin in 1 hour
3. Administer the next dose with food to reduce side effects
4. Request an order from the provider for a different antibiotic

Explanation: This question tests recognition of allergic reactions to medications and appropriate nursing response when a contraindicated drug has been administered. The client has a documented sulfonamide allergy and is now experiencing urticaria (hives) after receiving trimethoprim-sulfamethoxazole, which contains a sulfonamide component. Holding the medication and notifying the registered nurse immediately (A) is the priority action to prevent progression to a more severe allergic reaction. Documenting and reassessing in 1 hour (B) delays necessary intervention when an allergic reaction is occurring. Administering the next dose with food (C) is dangerous as it continues exposure to the allergen. Requesting a different antibiotic (D) is appropriate but not the immediate priority when an active allergic reaction is present. The principle of prioritization in adverse reactions is to stop the offending agent immediately and seek appropriate help. A transferable strategy is to always verify allergies before administration and recognize that any new symptoms after starting a medication could indicate an adverse reaction requiring immediate action.

Question 3

1. New shortness of breath or persistent cough (correct answer)
2. Urine turning a darker yellow color
3. Mild loss of appetite for 1 day
4. Headache relieved by rest

Explanation: This question tests recognition of pulmonary toxicity as a serious adverse effect of nitrofurantoin, especially in clients with renal impairment. The client's elevated creatinine (2.3 mg/dL) indicates significant kidney disease, which increases the risk of nitrofurantoin accumulation and toxicity. New shortness of breath or persistent cough (A) could indicate pulmonary fibrosis or pneumonitis, serious adverse effects of nitrofurantoin requiring immediate medical attention. Darker yellow urine (B) is an expected harmless effect of nitrofurantoin. Mild loss of appetite (C) is a minor side effect not requiring immediate reporting. Headache relieved by rest (D) is not concerning if self-limiting. The principle of adverse effect monitoring is that respiratory symptoms with nitrofurantoin require immediate evaluation due to potential for irreversible lung damage. A transferable strategy is to recognize that clients with renal impairment are at higher risk for drug toxicity and require closer monitoring for serious adverse effects.

Question 4

1. Amoxicillin 500 mg by mouth three times daily (correct answer)
2. Acetaminophen 650 mg by mouth every 6 hours as needed for pain
3. Normal saline nasal spray as needed for congestion
4. Increase oral fluids as tolerated

Explanation: This question tests recognition of cross-reactivity between penicillin and other beta-lactam antibiotics requiring medication reconciliation. The client has a history of anaphylaxis to penicillin, and amoxicillin is a penicillin-type antibiotic with high cross-reactivity risk. Questioning the amoxicillin order (A) is appropriate because clients with penicillin anaphylaxis should not receive penicillin derivatives. Acetaminophen (B) is safe and has no cross-reactivity with penicillin. Normal saline nasal spray (C) is a safe symptomatic treatment. Increasing oral fluids (D) is a supportive measure with no allergy concerns. The principle of medication safety is that documented severe allergies must be respected, and cross-reactive medications avoided. A transferable strategy is to recognize that penicillin allergy extends to all penicillin derivatives (amoxicillin, ampicillin) and requires careful consideration of alternative antibiotics.

Question 5

1. Client 2 with mild nausea after taking metformin
2. Client 4 who is drowsy after taking diphenhydramine
3. Client 1 with wheezing and oxygen saturation 89% after ceftriaxone (correct answer)
4. Client 3 with increased urination after taking furosemide

Explanation: This question tests prioritization of clients experiencing medication-related adverse effects using the ABCs (airway, breathing, circulation) framework. Client 1 is experiencing signs of anaphylaxis (wheezing, facial flushing) with hypoxemia (oxygen saturation 89%) after receiving ceftriaxone, indicating respiratory compromise. Client 1 with wheezing and low oxygen saturation (C) requires immediate intervention due to airway/breathing compromise. Client 2's mild nausea (A) is a common side effect of metformin that doesn't require urgent intervention. Client 4's drowsiness (B) is an expected effect of diphenhydramine with stable respirations. Client 3's increased urination (D) is the expected therapeutic effect of furosemide with acceptable potassium level. The principle of prioritization is that respiratory compromise always takes precedence over expected side effects or therapeutic responses. A transferable strategy is to use ABC prioritization and recognize that beta-lactam antibiotics like ceftriaxone can cause immediate hypersensitivity reactions requiring emergency intervention.

Question 6

1. Administer the medication and monitor for rash
2. Hold the dose and notify the registered nurse of the allergy (correct answer)
3. Ask the client if she is willing to take the medication anyway
4. Give the medication with food to prevent stomach upset

Explanation: This question tests recognition of medication allergy documentation and the nurse's responsibility to prevent allergic reactions. The client has a documented allergy to azithromycin with a previous reaction of hives, and the same medication has been ordered. Holding the dose and notifying the registered nurse (B) is the priority to prevent re-exposure to a known allergen that previously caused an allergic reaction. Administering the medication (A) violates the principle of allergy avoidance and could cause a severe reaction. Asking if the client is willing to take it (C) is inappropriate as it puts the client at risk. Giving with food (D) doesn't prevent allergic reactions. The principle of medication safety is that documented allergies must be strictly observed, and the nurse has a duty to advocate for safe medication administration. A transferable strategy is to always verify allergies before administration and recognize that the nurse must refuse to give medications to which the client has documented allergies.

Question 7

1. Teach the client to use a soft toothbrush and electric razor
2. Hold warfarin and notify the registered nurse immediately (correct answer)
3. Administer the next dose of warfarin with the evening meal
4. Recheck the INR at the next scheduled lab draw

Explanation: This question tests recognition of a serious drug interaction between warfarin and trimethoprim-sulfamethoxazole resulting in excessive anticoagulation. The client's INR of 5.2 is critically elevated (therapeutic range typically 2-3), and he's showing signs of bleeding including bleeding gums and melena (dark, tarry stools). Holding warfarin and notifying the registered nurse immediately (B) is the priority to prevent further bleeding complications. Teaching about bleeding precautions (A) is important but not the immediate priority when active bleeding is occurring. Administering the next dose (C) would worsen the bleeding risk. Rechecking the INR later (D) delays necessary intervention for a critical value. The principle of prioritization is that active bleeding with supratherapeutic anticoagulation requires immediate intervention. A transferable strategy is to recognize that antibiotics, especially sulfonamides, can potentiate warfarin's effects and require close INR monitoring.

Question 8

1. Increase the IV infusion rate to finish the medication quickly.
2. Stop the IV infusion immediately and notify the charge nurse. (correct answer)
3. Administer a prescribed PRN dose of an oral antihistamine.
4. Document the client's reports and continue to monitor the vital signs.

Explanation: Chest tightness and generalized pruritus (itching) developing within minutes of starting an IV antibiotic are early indicators of a potentially life-threatening hypersensitivity reaction or anaphylaxis. The immediate priority is to stop the infusion — removing ongoing exposure to the suspected allergen — before taking any other action. Additional subsequent steps include notifying the PHCP (not only the charge nurse), assessing vital signs, maintaining IV access with normal saline, and preparing for emergency interventions such as epinephrine and oxygen if the reaction progresses. Increasing the infusion rate (A) would accelerate allergen delivery and worsen the reaction. Giving an oral antihistamine (C) is not the first action for a potentially life-threatening reaction and does not address the ongoing allergen exposure. Documenting and monitoring without intervening (D) allows the reaction to progress unchecked.

Question 9

1. The client is experiencing an expected therapeutic response to the medication.
2. The client is developing a localized allergic reaction to the medication.
3. The client is experiencing an adverse effect related to excessive anticoagulation. (correct answer)
4. The client's medication dose is likely too low to be effective.

Explanation: New bruising in unusual locations and spontaneous gum bleeding are clinical cues of excessive anticoagulation — a significant adverse effect of anticoagulant therapy that increases the risk of serious or fatal hemorrhage. The nurse must withhold the next dose, obtain coagulation studies (INR/PT), and notify the PHCP promptly. Anticoagulation does not cause bruising and bleeding as a therapeutic response (A) — these are signs of excessive effect, not optimal effect. The findings describe systemic bleeding manifestations, not a localized allergic reaction (B), which would typically present as rash, hives, or pruritus. Multiple bleeding sites and abnormal bruising indicate excessive anticoagulation (too high), not insufficient dosing (D).

Question 10

1. It is normal to develop a persistent, dry cough while taking this medication.
2. Notify the provider immediately if you experience swelling of your face or tongue. (correct answer)
3. You should expect your heart rate to increase significantly for the first week.
4. The medication may cause your skin to become very dry and flaky.

Explanation: Angioedema — rapid swelling of the face, lips, tongue, or throat — is a rare but potentially life-threatening adverse effect of ACE inhibitors that requires immediate emergency evaluation. It results from ACE inhibitor-induced accumulation of bradykinin, which can cause dangerous airway compromise. This is the most critical safety information to reinforce. Regarding Choice A: a persistent dry cough does affect 10 to 15% of clients on ACE inhibitors (also mediated by bradykinin accumulation) and is a legitimate adverse effect. However, framing it as simply 'normal' is misleading — clients should report it to their provider, as persistent cough may warrant switching to an ARB. A significant increase in heart rate (C) is not an expected effect of ACE inhibitors. Dry, flaky skin (D) is not a recognized ACE inhibitor adverse effect.

Question 11

1. The client's age of 68 years.
2. The history of COPD and hip fracture.
3. The respiratory rate of 8 breaths/min. (correct answer)
4. The oxygen saturation of 88%.

Explanation: A respiratory rate of 8 breaths/min — well below the normal adult range of 12 to 20 — is the primary mechanism-specific indicator of opioid-induced respiratory depression. Opioids act centrally to decrease the drive to breathe; the most sensitive and specific clinical marker of this effect is a reduction in respiratory rate, particularly below 10 to 12 breaths/min. The SpO2 of 88% (D) is also a critical and alarming finding that must be addressed, but it is a downstream consequence of the depressed respiratory rate rather than the primary mechanism indicator. When respiratory rate is very low, oxygen saturation will fall as a result. Both are serious; however, RR 8 is the finding that most directly identifies opioid toxicity as the cause. Age and medical history (A and B) are predisposing risk factors, not current clinical findings that indicate the adverse effect.

Question 12

1. An antibiotic given for surgical prophylaxis.
2. A prescribed stool softener given earlier that morning.
3. A daily maintenance medication for COPD.
4. The morphine being delivered via the PCA pump. (correct answer)

Explanation: Morphine is an opioid analgesic that acts as a central nervous system depressant. Its most dangerous adverse effect is respiratory depression — it reduces the brain's sensitivity to carbon dioxide and decreases the drive to breathe, causing both decreased rate and depth of respirations. A PCA pump allows client-controlled dosing that can accumulate to toxic levels, particularly in older adults, clients with COPD (who have reduced respiratory reserve), and those who are sleeping or sedated. The combination of difficulty arousing, RR 8, and SpO2 88% in a client receiving continuous opioid access is the classic presentation of opioid-induced respiratory depression. Surgical prophylactic antibiotics (A) do not cause respiratory depression or altered consciousness. COPD medications (C) such as bronchodilators or inhaled corticosteroids do not cause this pattern. A stool softener (B) has no CNS or respiratory effects.

Question 13

1. Risk for infection related to the surgical incision.
2. Impaired gas exchange related to medication-induced respiratory depression. (correct answer)
3. Acute pain related to ineffective PCA pump use.
4. Deficient fluid volume related to post-operative status.

Explanation: Impaired gas exchange related to medication-induced respiratory depression is the priority nursing hypothesis because it represents an immediately life-threatening condition. At a respiratory rate of 8 breaths/min with an SpO2 of 88%, the client is in acute respiratory compromise with insufficient oxygen delivery to vital organs including the brain. Without immediate intervention, this can progress to respiratory arrest and cardiac arrest. All nursing actions must address this hypothesis first. Risk for infection (A) is a valid post-operative concern but is a lower-acuity hypothesis that does not threaten immediate survival. Acute pain (C) is contradicted by the current presentation — a client in respiratory depression from opioid excess is not experiencing inadequate analgesia. Fluid volume deficit (D) may be a concurrent concern but is secondary to the life-threatening respiratory emergency.

Question 14

1. Increase the oxygen flow rate to 6 L/min via a face mask.
2. Prepare to administer a prescribed dose of naloxone. (correct answer)
3. Encourage the client to use the incentive spirometer every hour.
4. Place the client in a prone position to improve lung expansion.

Explanation: Naloxone (Narcan) is a competitive opioid antagonist — it rapidly reverses opioid-induced CNS and respiratory depression by displacing morphine from opioid receptors. It is the specific, targeted pharmacological solution to opioid toxicity and is the most appropriate immediate solution for this client's life-threatening situation. Increasing oxygen (A) may temporarily support SpO2 but does not reverse the underlying cause — the client will continue to have a depressed drive to breathe without reversal of the opioid effect. Incentive spirometry (C) requires an alert and cooperative client — this client is difficult to arouse and cannot perform the maneuver. Prone positioning (D) is not an appropriate intervention for opioid respiratory depression and could compromise the airway in an obtunded client.

Question 15

1. The client's vital signs and level of consciousness have stabilized. (correct answer)
2. The client reports that their pain is now manageable at a 3 out of 10.
3. The client is able to perform range-of-motion exercises.
4. The client's SpO2 has increased to 92% on room air.

Explanation: The success of naloxone in reversing opioid-induced respiratory depression is measured by the return of the two findings that defined the emergency: restoration of an adequate respiratory rate (now 14 breaths/min, within normal range) and return of normal level of consciousness (now alert and oriented). Together, these confirm that the opioid toxicity has been counteracted and vital organ perfusion is being restored. Pain at 3/10 (B) is a relevant clinical concern but does not measure the reversal of the adverse effect — and the opioid reversal may well have unmasked the underlying pain. Range-of-motion ability (C) is not a meaningful outcome measure for this scenario. SpO2 of 92% on room air (D) is a partial improvement but represents a decrease from the client's 0800 baseline of 95% on 2 L/min supplemental oxygen — it does not confirm full recovery, and SpO2 alone does not capture the respiratory rate or consciousness improvements that define successful reversal.

Question 16

1. A mild and expected allergic reaction to the antibiotic.
2. The development of a secondary Clostridioides difficile infection. (correct answer)
3. A normal physiological response as the body clears the infection.
4. An interaction between the antibiotic and the client's diet.

Explanation: Broad-spectrum antibiotics disrupt the normal protective microbiome of the gastrointestinal tract, eliminating competing bacteria and allowing Clostridioides difficile (C. diff) to proliferate and produce toxins that damage the colonic epithelium. The classic presentation is multiple episodes of watery, foul-smelling diarrhea — often described as having a distinctive unpleasant odor — following antibiotic use. This is a recognized and serious complication of antibiotic therapy requiring Contact Precautions, specific treatment (oral vancomycin or fidaxomicin), and hand hygiene with soap and water. Watery diarrhea is not a symptom of allergic reaction to antibiotics (A), which would more typically present as rash or urticaria. It is not a normal response (C); multiple daily episodes with this character require investigation. A diet-drug interaction (D) would not present with this specific clinical picture.

Question 17

1. Severe hypotension and a significantly decreased heart rate.
2. High fever, muscle rigidity, and altered mental status. (correct answer)
3. A widespread, itchy rash accompanied by localized hives.
4. Excessive drowsiness and a decreased urge to urinate.

Explanation: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal idiosyncratic reaction to antipsychotic medications. The clinical hallmarks are the tetrad of: hyperthermia (high fever, often above 38.5 C), severe muscle rigidity (lead-pipe rigidity), altered mental status (ranging from confusion to coma), and autonomic instability (diaphoresis, tachycardia, blood pressure lability). Any combination of these findings — especially fever with rigidity — in a client receiving an antipsychotic requires immediate discontinuation of the medication and emergency evaluation. Hypotension with bradycardia (A) is not the NMS pattern; NMS typically produces autonomic instability with tachycardia. A widespread itchy rash with hives (C) describes an allergic/hypersensitivity reaction, not NMS. Drowsiness and decreased urination (D) are nonspecific findings that do not constitute the NMS presentation.

Question 18

1. Persistent tremors, sweating, and confusion. (correct answer)
2. Increased thirst and frequent urination.
3. Localized swelling and redness at the injection site.
4. A sudden increase in the client's blood pressure.

Explanation: Persistent tremors (shakiness), diaphoresis (sweating), and confusion are the classic triad of hypoglycemia — the most clinically significant and immediately dangerous adverse effect of antidiabetic therapy. As blood glucose falls below normal levels, the body releases catecholamines causing tremors, sweating, and anxiety, followed by neuroglycopenic symptoms like confusion, as the brain is deprived of its primary fuel. This requires immediate intervention. Increased thirst and frequent urination (B) describe hyperglycemia, which indicates the medication may be underdosing rather than an adverse effect of overdosing. Injection site reactions (C) apply to injectable medications, and this scenario specifies an oral agent. Blood pressure elevation (D) is not an expected adverse effect of antidiabetic medications.

Question 19

1. Significant weight loss and a decreased appetite.
2. Severe hypotension and a consistently slow heart rate.
3. A decrease in the client's serum blood glucose levels.
4. Increased susceptibility to infection and delayed wound healing. (correct answer)

Explanation: Long-term corticosteroid use suppresses the immune system by inhibiting inflammatory mediators, reducing lymphocyte activity, and impairing neutrophil function — all of which increase susceptibility to bacterial, viral, and fungal infections. Corticosteroids also impair wound healing by inhibiting fibroblast proliferation, collagen synthesis, and the inflammatory phase of the healing process. Additional well-known long-term adverse effects include adrenal suppression, osteoporosis, and Cushingoid features (weight gain, moon face, buffalo hump). Weight loss and appetite decrease (A) are the opposite of what is expected — corticosteroids characteristically cause weight gain and increased appetite. Decreased blood glucose (C) is also incorrect; corticosteroids cause hyperglycemia by promoting gluconeogenesis and insulin resistance, often worsening or unmasking diabetes. Hypotension and bradycardia (b) are not characteristic adverse effects.

Question 20

1. Place the client in a supine position to improve circulation.
2. Prepare to administer prescribed epinephrine and oxygen. (correct answer)
3. Encourage the client to drink water to flush out the medication.
4. Apply a moisturizing lotion to the rash to reduce the itching.

Explanation: Generalized rash with difficulty breathing after medication administration constitutes anaphylaxis — a life-threatening systemic allergic reaction. After stopping the medication and notifying the PHCP, the priority pharmacological interventions are epinephrine (which reverses bronchoconstriction, promotes vasoconstriction to counteract vasodilation, and is the only drug that directly reverses the pathophysiology of anaphylaxis) and supplemental oxygen (to address hypoxemia from airway compromise). These are the standard emergency countermeasures. For anaphylaxis, a supine position (A) is less appropriate than high-Fowler's for a client with respiratory distress — sitting upright improves respiratory mechanics. Drinking water (C) does not affect a systemically administered medication's action and is dangerous if airway is compromised. Lotion for itching (D) is an entirely insufficient response to anaphylaxis.