NUR 334 EXAM 2 STUDY GUIDE WITH QUESTIONS AND ANSWERS – 2026 UPDATE WITH COMPLETE
SOLUTIONS.
1. Labs and Diagnostics
Recognizing cues: Abnormal lab values, signs of infection, inflammation, or organ dysfunction.
Analyzing cues: Determine if lab deviations indicate disease progression, drug effects, or
nutritional deficiencies.
Identify possible problems: Infection, anemia, electrolyte imbalances, organ failure.
Interventions – generate solutions: Repeat labs, assess patient history, monitor trends.
Interventions – take action: Notify provider, adjust medications, implement interventions based
on findings.
Sources: Adams et al., 2024; ATI, 2023
● We can test if you carry the antibody with a lab test called a titer.
● what lab values should a nurse monitor for methotrexate? why?
monitor CBC: WBC, RBC, platelets
- methotrexate causes myelosuppression
● What lab values do we check before administering -cillins?
BUN/Crea
● What lab values do you monitor while on tetracyclines?
BUN/Creat and ALT/AST because these drugs are metabolized and excreted in
the kidney and liver
● What lab values do you monitor for macrolides?
ALT/AST levels (liver function)
● Culture and sensitivity: A lab test to identify type of organism and its sensitivity to
different antibiotics
Important terms
• Broad Spectrum: An antibiotic that is effective against a wide variety of organisms.
• Narrow Spectrum: An antibiotic effective against a narrow spectrum of microbes
• Narrow spectrum is preferred in almost all circumstances.
• Prophylactic antibiotics: May be given to immunocompromised folks.
,• Pathogenicity: the ability of an organism to cause infection. Another way to say, how good is is
at avoiding the immune system.
• Virulence: Basically how easily transmissible the pathogen is
• Bactericidal: An antimicrobial that actually kills bacteria
• Bacteriostatic: An antimicrobial that inhibits bacterial growth
20. Which client statement indicates understanding of antibiotic resistance?
A. “I should complete my entire course of antibiotics.”
B. “I will stop the medication once I feel better.”
C. “If symptoms return, I’ll take leftover antibiotics.”
D. “I’ll save antibiotics in case of future infection.”
. The nurse understands that broad-spectrum antibiotics:
A. Are effective only against gram-positive organisms
B. Increase the risk of superinfection
C. Should be given only once daily
D. Are less likely to cause resistance
Which nursing action is most appropriate before initiating antibiotic therapy?
A. Obtain a culture specimen
B. Administer the first dose immediately
C. Restrict oral intake
D. Encourage extra fluids
2. Vaccinations
Recognizing cues: Immunization history, risk factors for vaccine-preventable diseases.
Analyzing cues: Assess immunity gaps, contraindications, potential reactions.
,Identify possible problems: Susceptibility to infection, adverse vaccine reactions.
Interventions – generate solutions: Provide appropriate vaccines, educate on benefits and risks.
Interventions – take action: Administer vaccines per schedule, monitor for adverse effects.
Sources: Adams et al., 2024 (Ch. 39); ATI, 2023
VACCINATION
• Introduces foreign proteins or inactive cells before the patient is exposed to the actual
pathogen
• Produces memory B cells, which can then rapidly produce IgG if exposed to the actual
pathogen
• We can test if you carry the antibody with a lab test called a titer.
• A few contraindications do exist for vaccines. Recent transplants, those with HIV, active cancer,
immunocompromised may not be able to get all vaccines.
TYPES OF VACCINES
• Live(attenuated) vaccines carry weakened pathogens. Contraindicated in immunocompromised
patients.
• Example: MMR
Inactivated is very similar, but is a virus that was inactivated by heat or chemicals.
These generally are poorer vaccines and require boosters.
Flu and Hep A are examples.
TYPES OF VACCINES CONTINUED
• Toxoid Vaccines contain bacterial toxins that are incapable of causing disease. Really great for
bacterial pathogens, like tetanus and diphtheria
• Recombinant technology artificially create viral genetic material. Examples: Hep B and HPV
Finally we have mRNA vaccines. COVID was the first widely used example of this. mRNA is
injected, and your cells will use that to manufacture spike proteins, that your body can then
identify.
Covid is still really the only one, but I suspect we will find more applications for the technology.
● what is the schedule for hep B vaccine administration
- first dose: at birth
- second dose: 30 days after first dose
- third dose: 6 months after second dose
, ● The Bperinatal Bnurse Brecognizes Bthat Bwhat Bvaccine Bcan Bbe Bsafely Bgiven
Bto Ba Bneonate?
Hepatitis BB
● What Bwould Bthe Bnurse Bidentify Bas Ba Bvaccine Bthat Bis Ba Btoxoid?
Tetanus
Immunosuppressants
BInhibit Bimmune
Bresponse
Used Bto Bprevent Btissue Brejection Bin Bpatients Breceiving
Btransplanted Btissues Bor Borgans Band Btreat Bsevere Binflammatory
Bdisorders.
High Brisk Bfor Binfections/ Bsickness
BWash Bhands, Bavoid Bcrowds.
Cause: Bbone Bmarrow Bsuppression
BMonitor: BNeutrophils Band Banemia
Causes: BNephrotoxic, BNeutropenia- Bmonitor BKidney BBUN, BCreatine.
VACCINES B– BHPV, BFLU, BBOOSTERS B– BEDUCATION, Bwhy Btake Bthem? BHow
Bmany? Blive Bvaccines B– Bwho Bcan’t Bhave Bthem?
HPV/guardasil.
Depending Bon Bage, B2-3 Bdoses. B11-45, BOver B15you
Bget B3 BOlder Bones Bget B3 Bdoses, Band Byounger Bones Bget
B2 Bdoses. BPrevents Bcervical Bcancer.
Boosters
Provides Ba Bsustained Bimmunity Bso Bthe Bbody Bcan Bfight Bit Bbetter Bnext Btime.
BReintroduces Bthe Bpathogen Bso Bthe Bbody Bcan Bfight Bthe Binfection Bbetter.
Flu B–
Annual Bvaccine. B(Vaccines Bactivate Byour Bimmune Bsystem).
BPregnant, Bimmunocompromised, Be.g. B(HIV, Bcancer Bpatients,
Borgan Btransplants) Bpregnant Bbabies Bcan’t Bhave Blive Bvaccines.
Do Bnot Btake Bif Ballergic Bto Beggs.
Patients Bon Bimmunosuppressant Btherapy Bshould Bbe Bmonitored Bof Bthe Bcritical Bserious Badverse
Beffects: Bbone Bmarrow Bsuppression Band B decrease Bcell Bproduction
A Btype Bthat Breduces Bthe Beffectiveness Bof Boral Bcontraceptives B= BRIFAMPIN B(used Bfor Banti-TB,
Bgiven Boral Bor BIV)
Type Bof Bvaccine Bthat Bcannot Bbe Bgiven Bto Bimmunosuppressed Bclients B= Blive
SOLUTIONS.
1. Labs and Diagnostics
Recognizing cues: Abnormal lab values, signs of infection, inflammation, or organ dysfunction.
Analyzing cues: Determine if lab deviations indicate disease progression, drug effects, or
nutritional deficiencies.
Identify possible problems: Infection, anemia, electrolyte imbalances, organ failure.
Interventions – generate solutions: Repeat labs, assess patient history, monitor trends.
Interventions – take action: Notify provider, adjust medications, implement interventions based
on findings.
Sources: Adams et al., 2024; ATI, 2023
● We can test if you carry the antibody with a lab test called a titer.
● what lab values should a nurse monitor for methotrexate? why?
monitor CBC: WBC, RBC, platelets
- methotrexate causes myelosuppression
● What lab values do we check before administering -cillins?
BUN/Crea
● What lab values do you monitor while on tetracyclines?
BUN/Creat and ALT/AST because these drugs are metabolized and excreted in
the kidney and liver
● What lab values do you monitor for macrolides?
ALT/AST levels (liver function)
● Culture and sensitivity: A lab test to identify type of organism and its sensitivity to
different antibiotics
Important terms
• Broad Spectrum: An antibiotic that is effective against a wide variety of organisms.
• Narrow Spectrum: An antibiotic effective against a narrow spectrum of microbes
• Narrow spectrum is preferred in almost all circumstances.
• Prophylactic antibiotics: May be given to immunocompromised folks.
,• Pathogenicity: the ability of an organism to cause infection. Another way to say, how good is is
at avoiding the immune system.
• Virulence: Basically how easily transmissible the pathogen is
• Bactericidal: An antimicrobial that actually kills bacteria
• Bacteriostatic: An antimicrobial that inhibits bacterial growth
20. Which client statement indicates understanding of antibiotic resistance?
A. “I should complete my entire course of antibiotics.”
B. “I will stop the medication once I feel better.”
C. “If symptoms return, I’ll take leftover antibiotics.”
D. “I’ll save antibiotics in case of future infection.”
. The nurse understands that broad-spectrum antibiotics:
A. Are effective only against gram-positive organisms
B. Increase the risk of superinfection
C. Should be given only once daily
D. Are less likely to cause resistance
Which nursing action is most appropriate before initiating antibiotic therapy?
A. Obtain a culture specimen
B. Administer the first dose immediately
C. Restrict oral intake
D. Encourage extra fluids
2. Vaccinations
Recognizing cues: Immunization history, risk factors for vaccine-preventable diseases.
Analyzing cues: Assess immunity gaps, contraindications, potential reactions.
,Identify possible problems: Susceptibility to infection, adverse vaccine reactions.
Interventions – generate solutions: Provide appropriate vaccines, educate on benefits and risks.
Interventions – take action: Administer vaccines per schedule, monitor for adverse effects.
Sources: Adams et al., 2024 (Ch. 39); ATI, 2023
VACCINATION
• Introduces foreign proteins or inactive cells before the patient is exposed to the actual
pathogen
• Produces memory B cells, which can then rapidly produce IgG if exposed to the actual
pathogen
• We can test if you carry the antibody with a lab test called a titer.
• A few contraindications do exist for vaccines. Recent transplants, those with HIV, active cancer,
immunocompromised may not be able to get all vaccines.
TYPES OF VACCINES
• Live(attenuated) vaccines carry weakened pathogens. Contraindicated in immunocompromised
patients.
• Example: MMR
Inactivated is very similar, but is a virus that was inactivated by heat or chemicals.
These generally are poorer vaccines and require boosters.
Flu and Hep A are examples.
TYPES OF VACCINES CONTINUED
• Toxoid Vaccines contain bacterial toxins that are incapable of causing disease. Really great for
bacterial pathogens, like tetanus and diphtheria
• Recombinant technology artificially create viral genetic material. Examples: Hep B and HPV
Finally we have mRNA vaccines. COVID was the first widely used example of this. mRNA is
injected, and your cells will use that to manufacture spike proteins, that your body can then
identify.
Covid is still really the only one, but I suspect we will find more applications for the technology.
● what is the schedule for hep B vaccine administration
- first dose: at birth
- second dose: 30 days after first dose
- third dose: 6 months after second dose
, ● The Bperinatal Bnurse Brecognizes Bthat Bwhat Bvaccine Bcan Bbe Bsafely Bgiven
Bto Ba Bneonate?
Hepatitis BB
● What Bwould Bthe Bnurse Bidentify Bas Ba Bvaccine Bthat Bis Ba Btoxoid?
Tetanus
Immunosuppressants
BInhibit Bimmune
Bresponse
Used Bto Bprevent Btissue Brejection Bin Bpatients Breceiving
Btransplanted Btissues Bor Borgans Band Btreat Bsevere Binflammatory
Bdisorders.
High Brisk Bfor Binfections/ Bsickness
BWash Bhands, Bavoid Bcrowds.
Cause: Bbone Bmarrow Bsuppression
BMonitor: BNeutrophils Band Banemia
Causes: BNephrotoxic, BNeutropenia- Bmonitor BKidney BBUN, BCreatine.
VACCINES B– BHPV, BFLU, BBOOSTERS B– BEDUCATION, Bwhy Btake Bthem? BHow
Bmany? Blive Bvaccines B– Bwho Bcan’t Bhave Bthem?
HPV/guardasil.
Depending Bon Bage, B2-3 Bdoses. B11-45, BOver B15you
Bget B3 BOlder Bones Bget B3 Bdoses, Band Byounger Bones Bget
B2 Bdoses. BPrevents Bcervical Bcancer.
Boosters
Provides Ba Bsustained Bimmunity Bso Bthe Bbody Bcan Bfight Bit Bbetter Bnext Btime.
BReintroduces Bthe Bpathogen Bso Bthe Bbody Bcan Bfight Bthe Binfection Bbetter.
Flu B–
Annual Bvaccine. B(Vaccines Bactivate Byour Bimmune Bsystem).
BPregnant, Bimmunocompromised, Be.g. B(HIV, Bcancer Bpatients,
Borgan Btransplants) Bpregnant Bbabies Bcan’t Bhave Blive Bvaccines.
Do Bnot Btake Bif Ballergic Bto Beggs.
Patients Bon Bimmunosuppressant Btherapy Bshould Bbe Bmonitored Bof Bthe Bcritical Bserious Badverse
Beffects: Bbone Bmarrow Bsuppression Band B decrease Bcell Bproduction
A Btype Bthat Breduces Bthe Beffectiveness Bof Boral Bcontraceptives B= BRIFAMPIN B(used Bfor Banti-TB,
Bgiven Boral Bor BIV)
Type Bof Bvaccine Bthat Bcannot Bbe Bgiven Bto Bimmunosuppressed Bclients B= Blive
