NURS 6521 Final Exam – Questions and Answers

NURS 6521 Final Exam – Questions and Answers   Selected Answer: tyleno l. Selected Answer: body surface area. Selected Answer: avoid the small veins in the dorsum of the hand or the wrist. A Nurse Practitioner has questioned why a patient's physician has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of a patient's infection. Which of the following facts provides the best rationale for the use of narrow-spectrum antibiotics whenever possible? Selected Answer: The use of broad-spectrum antibiotics can create a risk for a superinfection. Selected Answer: Dietary habits A postmenopausal patient is prescribed bisphosphonates to treat osteoporosis. The nurse will instruct the patient to take the drug Selected Answer: Selected Answer: first thing in the morning. magnesium sulfate toxicity. A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy? Selected Answer: Prostatic neoplasia A patient with AIDS has developed a number of secondary infections in recent weeks, including Kaposi's sarcoma. As a result of this most recent diagnosis, his care team has opted to begin treatment with interferon alfa-2a. The nurse is aware that this drug will address the etiology of Kaposi sarcoma by Selected Answer: inhibiting tumor growth by enhancing inflammation. Selected Answer: whether the pregnant woman uses illegal substances. A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team. What aspect of the patient's condition would contraindicate the use of cyclophosphamide for the treatment of leukemia? Selected Answer: The patient's bone marrow function is significantly depressed. Selected Answer: ventrogluteal muscle. A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a regular dosage of methotrexate. The APRN will advise her to take which of the following vitamin supplements while taking the drug? Selected Answer: Vitamin D An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with Selected Answer: vancomycin. Selected Answer: stop using creams, ointments, and oils on the child's skin and scalp. A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend? Selected Answer: Acetaminophen A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss with the woman the use of Selected Answer: food containing iron or calcium. Selected Answer: Neurotoxici ty An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation? Selected Answer: Ineffective Family Therapeutic Regimen Management Selected Answer: the increase in the neutrophil count is only transient. Selected Answer: Increased drug distribution resulting from hemodynamic changes A Nurse Practitioner is assigned to a patient who is at 32 weeks' gestation and is receiving terbutaline (Brethine) IV for 24 hours to control preterm labor. Which of the following nursing actions will the nurse take to decrease the risk of hypotension and promote circulation to the fetus? Selected Answer: Instruct the patient to lie on her left side during the infusion. A Nurse Practitioner is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy- induced anemia. Which of the following will the nurse do with the unused portion of the drug? Selected Answer: Discard the unused portion of the drug. Selected Answer: put gloves on to protect herself. Drugs have a valid medical use but a high potential for abuse, both psychological and physiologic. In an emergency, a Schedule 2 drug may be prescribed by telephone if a written prescription cannot be provided at the time. However, a written prescription must be provided within 72 hours with the words authorization for emergency dispensing written on the prescription. These prescriptions cannot be refilled. A new prescription must be written each time. Examples include certain amphetamines and barbiturates. This is scheduled drug Selected Answer: Schedule 2 A 29-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is? Selected Answer: Anxiety related to perceived danger of drug therapy to fetus or infant A Nurse Practitioner is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to Selected Answer: stay well hydrated by drinking at least eight 8-oz glasses of water daily. Selected Answer: Hepatic function Selected Answer: "You might find that your face becomes flushed or you get a headache after you take Viagra." A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient's erectile dysfunction (ED)? Selected Answer: Exogenous testosterone Selected Answer: with a glass of water 1 hour before or 2 hours after a meal. Selected Answer: perform relaxation techniques after the treatments. Selected Answer: use sterile technique when applying the medication. A 9-year-old boy was bought to his primary care provider by his mother with signs and symptoms of hookworm infection and will be sent home with a prescription for mebendazole. When provided patient and family education, the nurse should teach the mother with which of the following measures to avoid reinfection following treatment? Selected Answer: The importance of vigilant hygiene for the boy and the other members of the family A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman's care should prioritize which of the following potential nursing diagnoses? Selected Answer: Risk for Injury related to loss of vision or thrombotic events Selected Answer: Hepatotoxicity Selected Answer: Leukopen ia Selected Answer: once a day. Selected Answer: Risk for Infection related to suppressed bone marrow function Selected Answer: The peak and trough blood levels A Nurse Practitioner is explaining to a pregnant 21-year-old college student why she cannot continue to take ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering into the fetal circulation. The nurse tells the patient that the main reason this happens is because Selected Answer: drugs compete with the hormones of pregnancy for albumin- binding sites. A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The nurse should teach the patient to supplement this treatment with a diet that is high in Selected Answer: iron-rich foods such as beans and leafy green vegetables. An oncology nurse is aware of the risks for injury that exist around the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks of injury, the nurse should take which of the following actions? Selected Answer: Prime the IV tubing with an approved IV solution rather than with the drug itself. Selected Answer: Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected. Selected Answer: A 48-year-old Caucasian man who has adult- onset diabetes Selected Answer: Elevated prothrombin time A Nurse Practitioner will monitor which of the following when assigned to a patient taking allopurinol for chronic gout who visits the clinic every 2 months? Selected Answer: Liver function tests A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include Selected Answer: uterine tachysystole. A Nurse Practitioner will instruct a patient taking allopurinol to take each dose Selected Answer: after a meal. A Nurse Practitioner is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group? Selected Answer: Atherosclerosis of the penile artery A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is Selected Answer: an allergic response. adverse effects? Selected Answer: Increased heart rate Selected Answer: Consult the prescriber for discontinuation of the drug Selected Answer: Lid margin crusting and pruritus A 20-year-old female patient is receiving topical clindamycin for acne vulgaris. She develops a rash and urticaria along with severe itching where the medication is applied. The nurse will formulate which of the following nursing diagnoses for the patient? Selected Answer: Risk for Injury related to allergic reactions Selected Answer: Headaches and chest pain A Nurse Practitioner is performing patient education for a woman who has just been prescribed a bisphosphonate. Which of the following diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate? Selected Answer: Low bone density and a family history of osteoporosis A Nurse Practitioner is caring for a 64-year-old female patient who is receiving IV heparin and reports bleeding from her gums. The nurse checks the patient's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which of the following drugs may be ordered? Selected Answer: Protamine sulfate Selected Answer: complete the entire course of drug therapy. Selected Answer: body fluids such as urine, saliva, tears, and sputum may become discolored. Selected Answer: plasma concentrations regularly. Selected Answer: a baseline complete blood count. A Nurse Practitioner is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation? Selected Answer: A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects. Selected Answer: the patient is at greater risk for high serum levels of the drug. When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.) Selected Answers: The patient will not develop an infection. The patient will not experience bone pain. The patient will not develop febrile neutropenia. A Nurse Practitioner who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem? Selected Answer: ADH D Selected Answer: with high-fat meals. A Nurse Practitioner is caring for a patient who is at 28 weeks' gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize? Selected Answer: Fetal heart rate (FHR) Selected Answer: immature liver and kidney function in infants and children. A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather's antidepressant to improve his mood. After immediately phoning the boy's stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem? Selected Answer: Hypertensive crisis Selected Answer: PMS. Selected Answer: stand or sit upright for at least 30 minutes after taking alendronate.. On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which of the following responses by the nurse is most appropriate? Selected Answer: "It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke" Selected Answer: The patient will experience complete bladder emptying Selected Answer: A 62-year-old male with cancer Selected Answer: once a day. Selected Answer: microcepha ly. An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which of the following cancerous cells is most susceptible to the effects of chemotherapeutic drugs? Selected Answer: Cells that have a rapid mitotic rate A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of Selected Answer: caffeine. Selected Answer: Salicylat es A male patient is experiencing climacteric symptoms secondary to androgen deficiency. His physician has prescribed testosterone. The nursing assessment reveals that the patient has had a myocardial infarction. The combination of testosterone therapy and a history of myocardial infarction would place that patient at a significantly higher risk of Selected Answer: hypercholesterolemia. Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which of the following facts should underlie the nurse's response to Mr. Lepp? Selected Answer: The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. An immunocompromised patient with a diagnosis of candidiasis has failed to respond to conservative therapy and has consequently begun treatment with amphotericin B. The nurse is aware that this drug achieves a therapeutic effect by way of its influence on Selected Answer: the permeability of fungal cell walls. A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure Selected Answer: that serum levels of the drug are being monitored. A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the patient's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis? Selected Answer: The use of ciprofloxacin is contraindicated in pregnancy. Selected Answer: staining of permanent teeth. Selected Answer: Infiltration, edema, or phlebitis at the infusion site A Nurse Practitioner is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to Selected Answer: use an alternative form of birth control, if taking an oral contraceptive. A Nurse Practitioner has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases? Selected Answer: Non-Hodgkin's lymphoma A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient? Selected Answer: The use of dexrazoxane in conjunction with doxorubicin A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient's childbearing potential. The nurse will inform the patient that during sibutramine therapy she should Selected Answer: use adequate contraception. A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect? Selected Answer: By inactivating clotting factors and thus stopping the coagulation cascade A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? Selected Answer: That the infant's skin has greater permeability than that of an adult Selected Answer: "Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision." A Nurse Practitioner is working with a 57-year-old man who is a former intravenous drug abuser. He has been prescribed a weekly dosage of methotrexate for his rheumatoid arthritis. Which of the following will the nurse include in her teaching plan for this patient? Selected Answer: Drink plenty of water every day Selected Answer: the first 2 months of pregnancy. A 66-year-old woman has experienced a significant decline in her quality of life as a result of worsening rheumatoid arthritis. Her physician has prescribed etanercept and the APRN is responsible for facilitating this new aspect of the patient's drug regimen. This will involve the administration of Selected Answer: weekly subcutaneous injections. A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse's assessment? Selected Answer: Where the medications will be stored Selected Answer: in the buccal pouch. Selected Answer: "Lately, I have to get up three or four times a night to go to the bathroom."