226Question
A client receiving chemotherapy has an absolute neutrophil count of 400/mm3 and asks to start an over-the-counter probiotic capsule for loose stools. What is the nurse's best response?
- “Probiotics are safe for everyone, so you can start the capsule today.”
- “Take twice the label dose, since the chemotherapy lowers your helpful bacteria.”
- “Please check with your provider first, because the live organisms can cause a bloodstream infection when the white cell count is very low.”
- “Open the capsule into a cup of hot tea so the organisms spread evenly.”
Show the answer and explanation
Answer: C. “Please check with your provider first, because the live organisms can cause a bloodstream infection when the white cell count is very low.”
Topic: probiotic safety in immunocompromised clients
Probiotic supplements contain live microorganisms. In clients who are severely neutropenic or immunocompromised, these organisms can translocate and cause bacteremia or fungemia, so such products should be used only with the provider's approval.
Why the others are wrong
- A – Probiotics are not safe for everyone; neutropenic clients are at risk of invasive infection.
- B – Increasing the dose raises the infection risk and is not recommended.
- D – Hot liquid kills the organisms and the product is still unapproved for this client.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
227Question
A client with constipation who eats mostly refined, low-fiber foods agrees to add more fiber. Which instruction best supports gut health with the least discomfort?
- Add all the extra fiber in a single day so that results appear by tomorrow morning at the latest
- Raise fiber intake but limit fluids to prevent bloating
- Swap whole grains for refined grains, which are gentler on the bowel
- Add whole grains, legumes and vegetables gradually and drink more fluid as fiber rises
Show the answer and explanation
Answer: D. Add whole grains, legumes and vegetables gradually and drink more fluid as fiber rises
Topic: fiber and gut health
Whole grains, legumes and vegetables feed beneficial gut bacteria and add stool bulk. Increasing fiber gradually limits gas and bloating, and adequate fluid lets the fiber soften the stool rather than harden it.
Why the others are wrong
- A – A sudden jump in fiber commonly causes bloating, cramping and gas.
- B – Fiber without enough fluid can make stool harder and worsen constipation.
- C – Refined grains have the fiber removed and do not support bowel regularity.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
228Question
A client with iron deficiency anemia has taken oral ferrous sulfate daily for 6 weeks. Which finding should the nurse report as a sign that the therapy is not working?
- Stools that are dark green to black and formed, with no abdominal pain
- Mild constipation that improves with added fluid and fiber in the diet
- Occasional mild nausea when the tablet is taken on an empty stomach
- Ongoing fatigue and dizziness, with a hemoglobin value that has not risen at the follow-up check
Show the answer and explanation
Answer: D. Ongoing fatigue and dizziness, with a hemoglobin value that has not risen at the follow-up check
Topic: evaluating oral iron therapy
Dark stools, constipation and mild nausea are common, expected effects of oral iron. A rising hemoglobin and reticulocyte count with improved energy shows effectiveness. Persistent symptoms with an unchanged hemoglobin suggest poor absorption, inadequate dose, ongoing blood loss or another cause, and the provider should be told.
Why the others are wrong
- A – Dark stool is an expected effect of iron and is not a sign of failure.
- B – Constipation is a common side effect that is managed with fluids and fiber.
- C – Mild nausea is common with iron and can be reduced by taking it with a small amount of food.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
229Question
A client who has just been diagnosed with osteoporosis is prescribed weekly alendronate. Which statement by the client shows correct understanding of how to take it?
- “I will take it first thing in the morning with a full glass of plain water and stay upright for at least 30 minutes.”
- “I will take it with my morning coffee so I remember to do it each week.”
- “I will take it with calcium-fortified orange juice so my bones get calcium right away.”
- “I will take it at bedtime and lie down so the tablet settles in my stomach.”
Show the answer and explanation
Answer: A. “I will take it first thing in the morning with a full glass of plain water and stay upright for at least 30 minutes.”
Topic: bisphosphonate administration and food
Bisphosphonates are poorly absorbed and irritate the esophagus. They should be taken on an empty stomach with a full glass of plain water, and the client stays upright and waits at least 30 minutes before eating, drinking or taking other medicine. Coffee, juice and calcium-containing products reduce absorption.
Why the others are wrong
- B – Coffee interferes with the absorption of the drug.
- C – Calcium-fortified juice binds the drug and lowers absorption.
- D – Lying down after the dose increases the risk of esophageal irritation and ulcers.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
230Question
A client who recently started an albuterol inhaler for asthma reports jitteriness and a racing heart. The client drinks four cups of coffee and an energy drink daily. Which instruction is most appropriate?
- Take extra puffs of the inhaler every few minutes until the jitteriness and racing heart settle down
- Stop the inhaler for a week and see whether the symptoms disappear
- Cut back on coffee, cola and energy drinks, and report tremor or palpitations that persist
- Take the inhaler only on a full stomach so the heart effects are blunted
Show the answer and explanation
Answer: C. Cut back on coffee, cola and energy drinks, and report tremor or palpitations that persist
Topic: caffeine and beta-agonist effects
Albuterol is a beta2-agonist that can cause tremor, nervousness and tachycardia, and caffeine adds similar stimulant effects. Reducing caffeine lowers the combined effect, and symptoms that continue should be reported. The rescue inhaler must not be stopped or overused on one's own.
Why the others are wrong
- A – More puffs increase the stimulant effects and may mask poor asthma control.
- B – Stopping a needed inhaler can leave asthma uncontrolled.
- D – Taking an inhaled drug with food does not change its cardiac effects.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
231Question
A client with severe COPD who uses home oxygen has lost weight over three months. Which statement by the client shows understanding of the nutritional plan?
- “I should have three very large meals so I get all my calories at once.”
- “I should drink plenty of fluids during meals to keep my stomach full.”
- “I should eat my biggest meal late at night, just before I lie down.”
- “I will eat small, frequent meals, rest before eating and keep my oxygen on during meals.”
Show the answer and explanation
Answer: D. “I will eat small, frequent meals, rest before eating and keep my oxygen on during meals.”
Topic: nutrition in COPD
Breathing hard raises energy needs in COPD, while breathlessness, fatigue and a full stomach pressing on the diaphragm make eating difficult. Small, frequent, nutrient-dense meals, rest beforehand and oxygen during meals help the client take in enough calories and protein.
Why the others are wrong
- A – Large meals raise the diaphragm and increase breathlessness.
- B – Fluids with meals cause early fullness, which reduces the amount of food eaten.
- C – A large meal followed by lying down increases dyspnea and reflux.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
232Question
A client with diverticulitis is prescribed ciprofloxacin and also takes a daily multivitamin with minerals and an antacid. Which instruction should the nurse give?
- Take everything together with breakfast so that no dose is forgotten and the routine stays simple for you every day
- Take ciprofloxacin at least 2 hours before, or 6 hours after, the antacid and mineral supplements
- Take the antacid first to protect the stomach, then the ciprofloxacin right after
- Crush the ciprofloxacin and mix it with the multivitamin to improve absorption
Show the answer and explanation
Answer: B. Take ciprofloxacin at least 2 hours before, or 6 hours after, the antacid and mineral supplements
Topic: fluoroquinolone and mineral interaction
Metal ions such as calcium, magnesium, aluminum, iron and zinc bind fluoroquinolones in the gut and sharply reduce absorption. Ciprofloxacin is spaced at least 2 hours before or 6 hours after antacids and mineral products, and calcium supplements are kept apart from it as well.
Why the others are wrong
- A – Taking everything together lets the minerals bind the antibiotic.
- C – Taking the antacid immediately beforehand still allows binding in the stomach and intestine.
- D – Mixing with minerals increases binding, and tablets should not be crushed without direction.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
233Question
A nurse is teaching a client who will take metformin long term for type 2 diabetes. Which teaching best helps prevent a medication-related nutrient depletion?
- Include vitamin B12 sources such as eggs, fish, dairy or fortified cereal, and have the B12 level checked periodically
- Add extra vitamin K foods such as kale each day to offset the drug
- Take a daily vitamin A supplement to replace what the drug removes
- No dietary teaching is needed because metformin does not change nutrient levels
Show the answer and explanation
Answer: A. Include vitamin B12 sources such as eggs, fish, dairy or fortified cereal, and have the B12 level checked periodically
Topic: drug-induced vitamin B12 depletion
Long-term metformin can reduce vitamin B12 absorption, which may lead to anemia and neuropathy. Clients should include B12 foods, and levels are checked periodically, especially if numbness, tingling or fatigue develop.
Why the others are wrong
- B – Vitamin K is not depleted by metformin, and kale would be a distraction.
- C – Vitamin A is not depleted by metformin, and excess is toxic.
- D – Long-term metformin does lower vitamin B12 absorption in many clients.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
234Question
A client with a high LDL cholesterol and hypertension asks for an example of a meal that supports heart health. Which meal should the nurse suggest?
- A fried fish sandwich with tartar sauce, coleslaw and a regular cola
- A bacon cheeseburger with seasoned fries and a chocolate milkshake
- Baked salmon with brown rice and steamed broccoli, with unsweetened tea
- Pasta in cream sauce with garlic bread, a side of sausage and a sweet tea
Show the answer and explanation
Answer: C. Baked salmon with brown rice and steamed broccoli, with unsweetened tea
Topic: heart-healthy meal selection
Heart-healthy eating emphasizes fish and other lean protein that is baked or grilled, whole grains, vegetables and unsweetened drinks, while limiting saturated fat, sodium, refined carbohydrate and added sugar.
Why the others are wrong
- A – Frying, a creamy sauce and a sweetened soda add saturated fat and sugar.
- B – Bacon, cheese, fries and a milkshake are high in saturated fat, sodium and sugar.
- D – Cream sauce, refined pasta and sausage are high in saturated fat and sodium.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
235Question
A client newly started on warfarin plans to begin a daily kale smoothie “for my health.” Which response by the nurse is best?
- “Avoid all green vegetables for as long as you take warfarin.”
- “Eat greens only on the days your INR is drawn.”
- “Greens have no connection to warfarin, so eat whatever you like.”
- “Keep the amount of leafy greens about the same from week to week so your INR stays steady, and tell your provider before changing your diet.”
Show the answer and explanation
Answer: D. “Keep the amount of leafy greens about the same from week to week so your INR stays steady, and tell your provider before changing your diet.”
Topic: vitamin K consistency with warfarin
Leafy greens are rich in vitamin K, which opposes warfarin. The goal is a consistent weekly intake so that the dose can be set against a steady vitamin K level, not avoidance. Sudden large changes in intake can swing the INR.
Why the others are wrong
- A – Complete avoidance is unnecessary; consistent intake is the goal.
- B – Eating greens only on test days gives a misleading INR and unstable control.
- C – Vitamin K in greens directly counteracts warfarin, so diet matters.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
236Question
A client with type 1 diabetes who takes basal and rapid-acting insulin says he plans to have two beers with friends on Saturday night. Which instruction should the nurse give?
- “Drink only with food, check your glucose before bed, and know that a low can occur hours later.”
- “Drink on an empty stomach, since the alcohol will then raise your glucose.”
- “Choose sugar-free mixed drinks, which have no effect on your glucose.”
- “Skip the bedtime glucose check, since alcohol keeps your sugar steady overnight.”
Show the answer and explanation
Answer: A. “Drink only with food, check your glucose before bed, and know that a low can occur hours later.”
Topic: alcohol and hypoglycemia risk in diabetes
Alcohol blocks glucose production by the liver, so blood glucose can drop for many hours after drinking, especially without food, and symptoms of hypoglycemia can be mistaken for intoxication. Alcohol should be taken with food in modest amounts, with glucose checks before bed.
Why the others are wrong
- B – Drinking without food increases the risk of hypoglycemia, not hyperglycemia.
- C – Sugar-free mixers lower carbohydrate but alcohol still suppresses liver glucose output.
- D – Skipping the check removes the chance to catch a dangerous overnight low.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
237Question
A hospitalized client is due for a scheduled dose of insulin lispro before lunch, but the lunch tray is delayed by about one hour. What should the nurse do?
- Give the insulin now as scheduled, then offer a snack as soon as the lunch tray finally arrives later
- Hold insulin for the whole day and ask the provider for new orders at the next visit
- Give the insulin shortly before the meal is served, once the tray is confirmed to be on its way
- Give half of the dose now and the rest when the client eats
Show the answer and explanation
Answer: C. Give the insulin shortly before the meal is served, once the tray is confirmed to be on its way
Topic: timing insulin with meals
Rapid-acting insulin starts working within about 15 minutes and peaks in 1 to 2 hours, so it must be coordinated with food. If the meal is delayed, giving the dose on schedule could cause hypoglycemia, so the nurse gives it when the meal is about to be served.
Why the others are wrong
- A – The insulin would act before food is available, risking hypoglycemia.
- B – Holding the whole day's insulin without an order can lead to hyperglycemia.
- D – Splitting a dose without an order is not safe practice.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
238Question
A client takes levothyroxine and also takes a daily calcium supplement and an iron tablet each morning. Which instruction should the nurse include?
- Take all three together with breakfast so that no dose is missed
- Take levothyroxine with the calcium so the bones receive the hormone directly
- Take levothyroxine at a different time each day depending on appetite
- Take levothyroxine with water 30 to 60 minutes before breakfast, and take calcium and iron at least 4 hours later
Show the answer and explanation
Answer: D. Take levothyroxine with water 30 to 60 minutes before breakfast, and take calcium and iron at least 4 hours later
Topic: levothyroxine timing and interactions
Levothyroxine absorption is reduced by food, calcium, iron and antacids. It is swallowed with water while the stomach is empty, at the same time every day, usually 30 to 60 minutes before breakfast, and separated from calcium and iron by about 4 hours.
Why the others are wrong
- A – Food and minerals together reduce levothyroxine absorption.
- B – Calcium binds levothyroxine and lowers absorption; the drug does not act on bone this way.
- C – Irregular timing causes fluctuating absorption and unstable hormone levels.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
239Question
A nurse is reviewing the medication list of a 76-year-old client with osteopenia. Which medication is most likely to increase urinary calcium loss and contribute to bone loss?
- Hydrochlorothiazide
- Atorvastatin
- Furosemide
- Amlodipine
Show the answer and explanation
Answer: C. Furosemide
Topic: drugs that affect bone and calcium balance
Loop diuretics such as furosemide increase urinary excretion of calcium, which can raise parathyroid hormone and promote bone loss with long-term use. Thiazide diuretics, in contrast, reduce urinary calcium loss.
Why the others are wrong
- A – Thiazides lower urinary calcium excretion and may help preserve bone.
- B – Atorvastatin lowers cholesterol and does not cause calcium loss.
- D – Amlodipine is a calcium channel blocker that does not alter calcium excretion.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
240Question
An older adult who eats mostly tea and toast has bleeding gums and tiny hemorrhages around the hair follicles. Which foods should the nurse recommend adding to the diet?
- White rice, pasta, plain crackers and sweet biscuits
- Oranges, strawberries and bell peppers
- Butter, cheese and heavy cream
- Salted nuts and pretzels
Show the answer and explanation
Answer: B. Oranges, strawberries and bell peppers
Topic: vitamin C deficiency
Bleeding gums and perifollicular hemorrhages suggest vitamin C deficiency (scurvy), which impairs collagen formation. Citrus fruit, berries and peppers are rich sources of vitamin C.
Why the others are wrong
- A – Refined starches contain very little vitamin C.
- C – Dairy fats are not a vitamin C source.
- D – Salted snacks provide sodium and little vitamin C.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
241Question
The parent of a 9-year-old who eats mostly packaged macaroni and toaster pastries wants to add a daily gummy multivitamin. What should the nurse suggest to make the child's eating more nutritious?
- Offer apple slices with nut butter and cut vegetables with hummus when the child comes home from school
- Stir a second packet of powdered cheese sauce into the macaroni to raise its protein
- Choose the pastries with the highest vitamin fortification and serve two per day
- Give the gummy vitamin and leave the rest of the child's diet as it is
Show the answer and explanation
Answer: A. Offer apple slices with nut butter and cut vegetables with hummus when the child comes home from school
Topic: nutrient-dense food versus supplements in children
Nutrient-dense whole foods supply fiber, protein, healthy fat and a range of vitamins that a supplement cannot match. Swapping processed snacks for fruit, vegetables and protein-containing foods makes each eating occasion count.
Why the others are wrong
- B – More powdered cheese sauce adds sodium and processed ingredients without meaningful nutrition.
- C – Fortified pastries still contain mostly refined flour and added sugar.
- D – A gummy vitamin does not supply fiber or protein and leaves the poor diet unchanged.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
242Question
A client who has taken large daily doses of a vitamin A supplement for acne reports headache, nausea, blurred vision and dry, peeling skin. Which explanation best accounts for these findings?
- Vitamin A deficiency, which dries the skin and blurs vision
- A reaction to vitamin C, which causes the skin to peel
- Water-soluble vitamins build up quickly in the blood and cause toxicity
- Vitamin A is fat-soluble and is stored in the liver and fat, so large doses can accumulate to toxic levels
Show the answer and explanation
Answer: D. Vitamin A is fat-soluble and is stored in the liver and fat, so large doses can accumulate to toxic levels
Topic: fat-soluble vitamin toxicity
Fat-soluble vitamins (A, D, E and K) are stored in the liver and fatty tissue rather than excreted quickly, so excess intake accumulates. Hypervitaminosis A causes headache, nausea, blurred vision, dry skin and liver injury.
Why the others are wrong
- A – The history of high-dose intake points to excess, not deficiency.
- B – Vitamin C was not taken, so it does not explain the findings.
- C – Water-soluble vitamins are mostly excreted in urine and rarely build up.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
243Question
A nurse is teaching the parent of an exclusively breastfed 2-week-old infant. Which instruction best helps prevent rickets?
- Add iron-fortified cereal to the infant's feedings starting now, because the bones need extra iron to grow
- Place the infant in direct midday sunlight for an hour each day
- Give a vitamin D supplement of 400 international units daily, starting soon after birth
- Mix a daily calcium supplement into the breast milk
Show the answer and explanation
Answer: C. Give a vitamin D supplement of 400 international units daily, starting soon after birth
Topic: vitamin D supplementation in infants
Human milk contains little vitamin D, and infants should avoid direct sun, so exclusively or partly breastfed infants are given a daily vitamin D supplement of 400 international units. Vitamin D deficiency causes rickets with bowed legs and delayed growth.
Why the others are wrong
- A – Solid foods are not introduced at 2 weeks, and iron does not prevent rickets.
- B – Infants should not be exposed to direct sunlight for prolonged periods.
- D – Calcium without vitamin D does not prevent rickets and should not be added to milk.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
244Question
A client who started a B-complex supplement reports bright yellow urine and is worried. What should the nurse explain?
- It signals a kidney infection, and a urine culture and antibiotics should be started today
- The vitamin is leaking from the liver where it is stored
- Extra riboflavin is excreted in the urine and colors it, which is harmless
- It means the dose is too low to be absorbed by the body
Show the answer and explanation
Answer: C. Extra riboflavin is excreted in the urine and colors it, which is harmless
Topic: excretion of water-soluble vitamins
B vitamins are water-soluble and are not stored in large amounts. Whatever the body does not use, including riboflavin, is filtered by the kidneys and excreted, producing bright yellow urine, which is harmless.
Why the others are wrong
- A – Without pain, fever or burning, a urine color change alone does not suggest infection.
- B – Water-soluble vitamins are not stored in the liver in this way.
- D – Bright urine suggests the body took what it needed and excreted the rest.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
245Question
A client with a long history of heavy alcohol use is admitted with confusion, an unsteady gait and abnormal eye movements. An IV dextrose solution is ordered. Which order should the nurse anticipate?
- Hold all vitamins until the blood glucose result returns
- Folic acid alone, without any other vitamin
- Vitamin K to reverse the confusion
- Thiamine given before the dextrose solution
Show the answer and explanation
Answer: D. Thiamine given before the dextrose solution
Topic: thiamine deficiency in alcohol use disorder
These findings suggest Wernicke encephalopathy from thiamine deficiency. Glucose metabolism uses up the remaining thiamine, so giving dextrose first can worsen the encephalopathy. Thiamine is given before or with the glucose.
Why the others are wrong
- A – Holding vitamins delays the treatment of a neurologic emergency.
- B – Folic acid does not treat or prevent the encephalopathy.
- C – Vitamin K treats clotting deficits, not these neurologic findings.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
246Question
During a clinic visit, a client with two children says, “At the end of the month I skip meals so the kids can eat.” Which action by the nurse is most appropriate?
- Screen formally for food insecurity and refer to social work or community food resources, such as food pantries and nutrition assistance programs
- Tell the client that skipping meals is a safe way to manage a tight budget
- Suggest a daily vitamin supplement to replace the meals that are missed
- Advise buying cheaper brands at the store and take no further action
Show the answer and explanation
Answer: A. Screen formally for food insecurity and refer to social work or community food resources, such as food pantries and nutrition assistance programs
Topic: food insecurity assessment and referral
Skipping meals because money runs out is a sign of food insecurity. The nurse screens, then connects the client with social work and community resources such as food pantries and federal nutrition assistance, addressing both nutrition and the underlying cause.
Why the others are wrong
- B – Chronic meal skipping is not safe and the statement dismisses a real need.
- C – A vitamin does not supply calories or protein and does not fix access to food.
- D – Brief advice with no follow-up does not address the lack of food resources.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
247Question
A nurse is teaching a client to plan balanced meals using the MyPlate model. Which plate arrangement is correct for an adult?
- Half grains, a quarter protein and a quarter fruit, with no vegetables
- Half protein, a quarter vegetables and a quarter grains, with dairy omitted
- Half dairy products, a quarter grains and a quarter protein
- Half fruits and vegetables, the other half divided between grains and protein, with dairy on the side
Show the answer and explanation
Answer: D. Half fruits and vegetables, the other half divided between grains and protein, with dairy on the side
Topic: MyPlate meal planning
MyPlate places fruits and vegetables on about half of the plate, with the other half split between grains (preferably whole) and lean protein, and a serving of dairy or a fortified alternative alongside.
Why the others are wrong
- A – Half grains and no vegetables departs from the model.
- B – Half protein is much more than the model recommends.
- C – Dairy is a side serving, not half the plate.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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