NR599 MIDTERM and final EXAM LATEST 2024-2025
QUESTIONS AND 100% CORRECT ANSWERS
CHAMBERLAIN COLLEGE OF NURSING
A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98
beats/minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A
stat CBC shows a platelet count of less than 100,000 mm3. The nurse will:
a. administer oxygen and notify the provider.
b. discontinue the heparin and notify the provider.
c. request an order for protamine sulfate.
d. request an order for vitamin K (phytonadione). - ANSWER-b.
A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include
which statement when teaching this patient?
a. Dabigatran should be taken on an empty stomach to improve absorption.
b. It is important not to crush, chew, or open capsules of dabigatran.
c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin].
d. To remember to take dabigatran twice daily, a pill organizer can be useful. - ANSWER-b.
A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary
intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this
patient?
a. Aspirin, clopidogrel, omeprazole
b. Aspirin, heparin, abciximab [ReoPro]
c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin]
d. Heparin, alteplase, abciximab [ReoPro] - ANSWER-b.
A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will
anticipate an order to:
a. decrease the dose of carbamazepine.
b. increase the dose of warfarin.
c. perform more frequent aPTT monitoring.
d. provide extra dietary vitamin K. - ANSWER-b.
,A nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute
myocardial infarction. The nurse should administer this drug:
a. by bolus injection.
b. by infusion pump over 24 hours.
c. slowly over 90 minutes.
d. via monitored, prolonged infusion. - ANSWER-a.
A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest
radiograph is negative. The nurse will expect this patient to:
a. begin taking antituberculosis drugs at the beginning of treatment with etanercept.
b. have periodic chest radiographs during treatment with etanercept.
c. have regular monitoring of symptoms to detect active tuberculosis.
d. undergo tuberculosis treatment prior to beginning etanercept treatment. - ANSWER-d.
A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will
begin a course of abatacept [Orencia]. What will the nurse include when teaching the child's family
about this drug?
a. That abatacept and methotrexate must both be taken to be effective
b. To continue getting vaccinations during therapy with abatacept
c. That signs of infection may warrant immediate discontinuation of abatacept
d. That a tumor necrosis factor (TNF) antagonist may be added if this therapy is not effective -
ANSWER-c.
A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is
currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?
a. That an eye examination is necessary at the beginning of therapy with this drug
b. That the dose of NSAIDs may be decreased when beginning hydroxychloroquine
c. To obtain tests of renal and hepatic function while taking this drug
d. To stop taking methotrexate when starting hydroxychloroquine - ANSWER-a.
,A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been
taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the
methotrexate. The nurse will tell the patient that etanercept methotrexate.
a. has synergistic effects with
b. helps reduce adverse effects associated with
c. is better at delaying progression of joint damage than
d. has fewer adverse effects than - ANSWER-c.
A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells
the nurse she would like to get pregnant. What will the nurse tell her?
a. That leflunomide is not dangerous during the first trimester of pregnancy.
b. That plasma levels of leflunomide will drop rapidly when she stops taking it.
c. To ask her provider about an 11-day course of cholestyramine.
d. To stop taking leflunomide when she stops using contraception. - ANSWER-c.
A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The
nurse will teach this patient about the importance of:
a. having routine renal and hepatic function tests.
b. limiting folic acid consumption.
c. reporting alopecia and rash.
d. taking the medication on a daily basis. - ANSWER-a.
A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a
nursing student. Which statement by the student indicates a need for further education about the
care of a patient receiving this drug?
a. "Angioedema and hypersensitivity may occur, but they are usually self-limiting and mild."
b. "I should be prepared to administer epinephrine, glucocorticoids, and oxygen if needed."
c. "I will administer an antihistamine and acetaminophen before beginning the infusion."
d. "I will monitor this patient's blood pressure, respiratory rate, and oxygen saturation closely." -
ANSWER-a.
A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized
symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral
, glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse
why methotrexate is necessary since pain and swelling have been well controlled with the other
medications. The nurse will tell the patient that:
a. a methotrexate regimen can reduce overall costs and side effects of treatment.
b. starting methotrexate early can help delay joint degeneration.
c. starting methotrexate now will help increase life expectancy.
d. with methotrexate, doses of NSAIDs can be reduced to less toxic levels. - ANSWER-b, ,
A patient who has gout will begin taking febuxostat [Uloric] and colchicine. What will the nurse
include when teaching this patient about this drug regimen?
a. "You are taking both drugs in order to prevent hepatic side effects."
b. "You may stop taking the febuxostat after your uric acid levels decrease."
c. "You will have to take both drugs indefinitely to treat your symptoms."
d. "You will stop taking the colchicine within 6 months after starting therapy." - ANSWER-d.
A patient with chronic gout is admitted to the hospital for treatment for an infection. The patient is
receiving allopurinol and ampicillin. The nurse is preparing to administer medications and notes that
the patient has a temperature of 101° F and a rash. What will the nurse do?
a. Withhold the allopurinol and notify the prescriber of the drug reaction.
b. Withhold the ampicillin and contact the provider to request a different antibiotic.
c. Request an order for an antihistamine to minimize the drug side effects.
d. Suggest giving a lower dose of the allopurinol while giving ampicillin. - ANSWER-a.
A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient
has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to
begin therapy with probenecid. What will the nurse do?
a. Give the medication as ordered and observe the patient closely for gastrointestinalside effects.
b. Request an order to lower the dose of the nonsteroidal anti-inflammatorydrug.
c. Restrict the patient's fluid intake to minimize the risk of renal injury.
d. Suggest delaying the probenecid therapy until the acute episode has subsided. - ANSWER-d.
QUESTIONS AND 100% CORRECT ANSWERS
CHAMBERLAIN COLLEGE OF NURSING
A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98
beats/minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A
stat CBC shows a platelet count of less than 100,000 mm3. The nurse will:
a. administer oxygen and notify the provider.
b. discontinue the heparin and notify the provider.
c. request an order for protamine sulfate.
d. request an order for vitamin K (phytonadione). - ANSWER-b.
A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include
which statement when teaching this patient?
a. Dabigatran should be taken on an empty stomach to improve absorption.
b. It is important not to crush, chew, or open capsules of dabigatran.
c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin].
d. To remember to take dabigatran twice daily, a pill organizer can be useful. - ANSWER-b.
A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary
intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this
patient?
a. Aspirin, clopidogrel, omeprazole
b. Aspirin, heparin, abciximab [ReoPro]
c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin]
d. Heparin, alteplase, abciximab [ReoPro] - ANSWER-b.
A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will
anticipate an order to:
a. decrease the dose of carbamazepine.
b. increase the dose of warfarin.
c. perform more frequent aPTT monitoring.
d. provide extra dietary vitamin K. - ANSWER-b.
,A nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute
myocardial infarction. The nurse should administer this drug:
a. by bolus injection.
b. by infusion pump over 24 hours.
c. slowly over 90 minutes.
d. via monitored, prolonged infusion. - ANSWER-a.
A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest
radiograph is negative. The nurse will expect this patient to:
a. begin taking antituberculosis drugs at the beginning of treatment with etanercept.
b. have periodic chest radiographs during treatment with etanercept.
c. have regular monitoring of symptoms to detect active tuberculosis.
d. undergo tuberculosis treatment prior to beginning etanercept treatment. - ANSWER-d.
A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will
begin a course of abatacept [Orencia]. What will the nurse include when teaching the child's family
about this drug?
a. That abatacept and methotrexate must both be taken to be effective
b. To continue getting vaccinations during therapy with abatacept
c. That signs of infection may warrant immediate discontinuation of abatacept
d. That a tumor necrosis factor (TNF) antagonist may be added if this therapy is not effective -
ANSWER-c.
A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is
currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?
a. That an eye examination is necessary at the beginning of therapy with this drug
b. That the dose of NSAIDs may be decreased when beginning hydroxychloroquine
c. To obtain tests of renal and hepatic function while taking this drug
d. To stop taking methotrexate when starting hydroxychloroquine - ANSWER-a.
,A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been
taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the
methotrexate. The nurse will tell the patient that etanercept methotrexate.
a. has synergistic effects with
b. helps reduce adverse effects associated with
c. is better at delaying progression of joint damage than
d. has fewer adverse effects than - ANSWER-c.
A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells
the nurse she would like to get pregnant. What will the nurse tell her?
a. That leflunomide is not dangerous during the first trimester of pregnancy.
b. That plasma levels of leflunomide will drop rapidly when she stops taking it.
c. To ask her provider about an 11-day course of cholestyramine.
d. To stop taking leflunomide when she stops using contraception. - ANSWER-c.
A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The
nurse will teach this patient about the importance of:
a. having routine renal and hepatic function tests.
b. limiting folic acid consumption.
c. reporting alopecia and rash.
d. taking the medication on a daily basis. - ANSWER-a.
A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a
nursing student. Which statement by the student indicates a need for further education about the
care of a patient receiving this drug?
a. "Angioedema and hypersensitivity may occur, but they are usually self-limiting and mild."
b. "I should be prepared to administer epinephrine, glucocorticoids, and oxygen if needed."
c. "I will administer an antihistamine and acetaminophen before beginning the infusion."
d. "I will monitor this patient's blood pressure, respiratory rate, and oxygen saturation closely." -
ANSWER-a.
A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized
symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral
, glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse
why methotrexate is necessary since pain and swelling have been well controlled with the other
medications. The nurse will tell the patient that:
a. a methotrexate regimen can reduce overall costs and side effects of treatment.
b. starting methotrexate early can help delay joint degeneration.
c. starting methotrexate now will help increase life expectancy.
d. with methotrexate, doses of NSAIDs can be reduced to less toxic levels. - ANSWER-b, ,
A patient who has gout will begin taking febuxostat [Uloric] and colchicine. What will the nurse
include when teaching this patient about this drug regimen?
a. "You are taking both drugs in order to prevent hepatic side effects."
b. "You may stop taking the febuxostat after your uric acid levels decrease."
c. "You will have to take both drugs indefinitely to treat your symptoms."
d. "You will stop taking the colchicine within 6 months after starting therapy." - ANSWER-d.
A patient with chronic gout is admitted to the hospital for treatment for an infection. The patient is
receiving allopurinol and ampicillin. The nurse is preparing to administer medications and notes that
the patient has a temperature of 101° F and a rash. What will the nurse do?
a. Withhold the allopurinol and notify the prescriber of the drug reaction.
b. Withhold the ampicillin and contact the provider to request a different antibiotic.
c. Request an order for an antihistamine to minimize the drug side effects.
d. Suggest giving a lower dose of the allopurinol while giving ampicillin. - ANSWER-a.
A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient
has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to
begin therapy with probenecid. What will the nurse do?
a. Give the medication as ordered and observe the patient closely for gastrointestinalside effects.
b. Request an order to lower the dose of the nonsteroidal anti-inflammatorydrug.
c. Restrict the patient's fluid intake to minimize the risk of renal injury.
d. Suggest delaying the probenecid therapy until the acute episode has subsided. - ANSWER-d.
