NUR 340 EXAM 2 LATEST VERSIONS
2024 (VERSION A AND B) COMPLETE
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS
The following information was included in the change of shift report on a patient who is prescribed
aspirin for its anticoagulant effects. Which patient symptom would be the first priority for the nurse
to report to the attending physician?
two liquid stools in past 24 hours
nauseous symptoms
heartburn when recumbent
dark tarry stools - ANSWERS,Dark tarry stools suggest slow upper GI bleeding which would be the
priority symptom to report to the physician.
The patient has an order for administration of a glucocorticoid. The nurse would question this order
if the patient also has which condition?
rheumatoid arthritis
systemic fungal infections
asthma
systemic lupus erythematosus - ANSWERS,Systemic fungal infection
The nurse should question administration of a glucocorticoid to a patient with any type of infection,
because the drug suppresses immune responses that would normally allow the body to fight
infection. Glucocorticoids are absolutely contraindicated for patients with systemic fungal infections.
The use of glucocorticoids in a patient with asthma, systemic lupus erythematosus or RA is expected,
because these are autoimmune, inflammatory disorders that would respond to glucocorticoid
intervention.
The nurse is preparing to administer an initial dose of aspirin and obtains a brief health history.
Based on an understanding of the therapeutic effects of this drug, the nurse would anticipate the
patient to have which medical diagnosis?
arthritis
,asthma
chronic renal disease
ulcerative colitis - ANSWERS,arthritis
The nurse should anticipate that the initial dose of aspirin will begin to reduce inflammation;
therefore, the nurse would expect the patient to be experiencing an inflammatory disorder, such as
arthritis. Aspirin would be inappropriate for patients with ulcerative colitis, because these patients
are already at risk for bleeding, and the use of aspirin could potentiate further bleeding. Aspirin can
exacerbate asthma and should not be used with these patients. Aspirin can impair renal function; it
is not given to treat renal disease.
The nurse is administering high-dose intravenous methylprednisolone to a patient who is
experiencing an acute relapse of multiple sclerosis. Which chronic condition, if present, could be
negatively affected by this treatment?
Inflammatory bowel disease
Diabetes mellitus
Rheumatoid arthritis
Asthma - ANSWERS,Diabetes mellitus
High-dose glucocorticoids interfere with glucose metabolism and require careful use with patients
who have diabetes. Each of the other diseases can be treated with glucocorticoids.
A patient with rheumatoid arthritis is on long-term treatment with hydroxychloroquine sulfate
(Plaquenil). Which patient condition would the nurse would be most concerned in this patient?
poor skin turgor and increased urine specific gravity
presence of visual disturbances
decreased range of motion and crepitation
upper abdominal discomfort - ANSWERS,Visual disturbances may be indicative of irreversible retinal
damage that can occur even after the drug has been discontinued. Other side effects of immediate
concern are related to signs and symptoms of infection because Plaquenil can cause decreased
WBCs. Decreased range of motion would indicate the medication is no longer effective in treatment
of RA. Plaquenil can cause GI problems, but this is a common side effect that can be alleviated by
taking the medication with food. Plaquenil does not cause dehydration.
Medication education for a patient receiving glucocorticoids should include the preferred use of
which medication for management of mild pain?
Aspirin
,Naproxen sodium
Acetaminophen
Ibuprofen - ANSWERS,The nurse should counsel the patient to use acetaminophen for mild pain,
because it does not cause gastric upset, as do nonsteroidal anti-inflammatory drugs (NSAIDs) such as
aspirin, ibuprofen, and naproxen sodium. Because glucocorticoids can also cause gastric distress,
concurrent use of glucocorticoids with NSAIDs can lead to gastric ulceration. See Lehne p. 914
A patient is prescribed hydroxychloroquine (Plaquenil) for rheumatoid arthritis. The nurse will need
to emphasize the importance of follow-up care with which inter-professional discipline?
rheumatologist
endocrinologist
pharmacist
ophthalmologist - ANSWERS,Although rare, retinal damage is the most serious toxic side effect of
hydroxychloroquine (Plaquenil). The patient on this drug should have an *ophthalmological*
examination prior to starting treatment and regularly thereafter (think baseline and trends).
Retinopathy has occurred in some patients after treatment has been completed. The patient would
already be seeing the rheumatologist for treatment; although follow-up care is very important, the
rheumatologist won't be able to assess for all adverse effects from the drug. The pharmacist would
provide counseling about the drug. Since RA is not an endocrine disease, an endocrinologist would
not be needed.
A patient wants to use medication rather than surgery for gall stones. The nurse explains that drugs
used to dissolve gallstones are most effective for which gall stones?
are located within the gallbladder
consist of cholesterol
are located within the bile duct
can be seen on an X-ray - ANSWERS,consist of Cholesterol
Chenodiol and Ursodiol, bile acids used to dissolve gallstones in carefully selected patients, promote
dissolution of stones that are composed of cholesterol rather than those composed mainly of
calcium. Gallstones composed of calcium are radiopaque and show up on X-ray. Those composed of
cholesterol are radiolucent, so are not visible on X-ray. See Lehne p 1023
The nurse is caring for a patient with ulcerative colitis who is being treated with azathioprine
(Imuran). Which laboratory test result should be monitored periodically?
Microscopic urine examination
Complete blood count (CBC) with differential
Serum albumin
, Immunoglobulin survey - ANSWERS,The nurse should monitor the CBC, because neutropenia is a
major adverse effect of azathioprine (Imuran). Another major adverse effect is pancreatitis.
Microscopic urinalysis is not indicated. The immunoglobulin and serum albumin levels do not require
monitoring in relation to this drug.
The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage
II moderate rheumatoid arthritis (RA). What information about the patient would be the most
important information for the nurse to communicate to the health care provider?
a history of infectious mononucleosis as a teenager
family history of age-related macular degeneration of the retina
uses large doses of vitamins and health foods to treat the RA
discontinued taking birth control pills 8 weeks ago - ANSWERS,Discontinued taking BC pills around 8
weeks ago
Methotrexate is teratogenic (causes birth defects), can lead to fetal death; the patient should be
taking contraceptives during methotrexate therapy. The other information will not impact the choice
of methotrexate as therapy.
The health care provider left an order to discontinue prednisone. What will the nurse do next? -
ANSWERS,Ask the health care provider for instructions to taper the prednisone dose
Prednisone must be tapered according to physician order to avoid adrenal insufficiency. Dosage
adjustments are not within the pharmacist's or nurse's scope of practice unless there is a standing
protocol or order.
The nurse is providing education to a patient with ulcerative colitis who is being treated with
sulfasalazine (Azulfidine). What statement by the patient best demonstrates understanding of the
action of sulfasalazine? "Azulfidine - ANSWERS,reduces the inflammation."
Sulfasalazine reduces the inflammation associated with ulcerative colitis; this statement indicates
understanding. Although similar to sulfonamides, sulfasalazine is not used to treat infections; further
teaching is needed. Sulfasalazine does not enhance the immune response or increase the
reabsorption of fluid; further teaching is needed.
The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse expects the
prescriber to order that the drug be administered at what time? - ANSWERS,0800
Early morning administration mimics the burst of glucocorticoids normally released by the adrenal
glands at dawn (circadian rhythm). Patients on alternate-day therapy or who take one daily dose
should receive this medication before 0900. Therefore, 0800 is the only time listed that matches this
criterion.
2024 (VERSION A AND B) COMPLETE
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS
The following information was included in the change of shift report on a patient who is prescribed
aspirin for its anticoagulant effects. Which patient symptom would be the first priority for the nurse
to report to the attending physician?
two liquid stools in past 24 hours
nauseous symptoms
heartburn when recumbent
dark tarry stools - ANSWERS,Dark tarry stools suggest slow upper GI bleeding which would be the
priority symptom to report to the physician.
The patient has an order for administration of a glucocorticoid. The nurse would question this order
if the patient also has which condition?
rheumatoid arthritis
systemic fungal infections
asthma
systemic lupus erythematosus - ANSWERS,Systemic fungal infection
The nurse should question administration of a glucocorticoid to a patient with any type of infection,
because the drug suppresses immune responses that would normally allow the body to fight
infection. Glucocorticoids are absolutely contraindicated for patients with systemic fungal infections.
The use of glucocorticoids in a patient with asthma, systemic lupus erythematosus or RA is expected,
because these are autoimmune, inflammatory disorders that would respond to glucocorticoid
intervention.
The nurse is preparing to administer an initial dose of aspirin and obtains a brief health history.
Based on an understanding of the therapeutic effects of this drug, the nurse would anticipate the
patient to have which medical diagnosis?
arthritis
,asthma
chronic renal disease
ulcerative colitis - ANSWERS,arthritis
The nurse should anticipate that the initial dose of aspirin will begin to reduce inflammation;
therefore, the nurse would expect the patient to be experiencing an inflammatory disorder, such as
arthritis. Aspirin would be inappropriate for patients with ulcerative colitis, because these patients
are already at risk for bleeding, and the use of aspirin could potentiate further bleeding. Aspirin can
exacerbate asthma and should not be used with these patients. Aspirin can impair renal function; it
is not given to treat renal disease.
The nurse is administering high-dose intravenous methylprednisolone to a patient who is
experiencing an acute relapse of multiple sclerosis. Which chronic condition, if present, could be
negatively affected by this treatment?
Inflammatory bowel disease
Diabetes mellitus
Rheumatoid arthritis
Asthma - ANSWERS,Diabetes mellitus
High-dose glucocorticoids interfere with glucose metabolism and require careful use with patients
who have diabetes. Each of the other diseases can be treated with glucocorticoids.
A patient with rheumatoid arthritis is on long-term treatment with hydroxychloroquine sulfate
(Plaquenil). Which patient condition would the nurse would be most concerned in this patient?
poor skin turgor and increased urine specific gravity
presence of visual disturbances
decreased range of motion and crepitation
upper abdominal discomfort - ANSWERS,Visual disturbances may be indicative of irreversible retinal
damage that can occur even after the drug has been discontinued. Other side effects of immediate
concern are related to signs and symptoms of infection because Plaquenil can cause decreased
WBCs. Decreased range of motion would indicate the medication is no longer effective in treatment
of RA. Plaquenil can cause GI problems, but this is a common side effect that can be alleviated by
taking the medication with food. Plaquenil does not cause dehydration.
Medication education for a patient receiving glucocorticoids should include the preferred use of
which medication for management of mild pain?
Aspirin
,Naproxen sodium
Acetaminophen
Ibuprofen - ANSWERS,The nurse should counsel the patient to use acetaminophen for mild pain,
because it does not cause gastric upset, as do nonsteroidal anti-inflammatory drugs (NSAIDs) such as
aspirin, ibuprofen, and naproxen sodium. Because glucocorticoids can also cause gastric distress,
concurrent use of glucocorticoids with NSAIDs can lead to gastric ulceration. See Lehne p. 914
A patient is prescribed hydroxychloroquine (Plaquenil) for rheumatoid arthritis. The nurse will need
to emphasize the importance of follow-up care with which inter-professional discipline?
rheumatologist
endocrinologist
pharmacist
ophthalmologist - ANSWERS,Although rare, retinal damage is the most serious toxic side effect of
hydroxychloroquine (Plaquenil). The patient on this drug should have an *ophthalmological*
examination prior to starting treatment and regularly thereafter (think baseline and trends).
Retinopathy has occurred in some patients after treatment has been completed. The patient would
already be seeing the rheumatologist for treatment; although follow-up care is very important, the
rheumatologist won't be able to assess for all adverse effects from the drug. The pharmacist would
provide counseling about the drug. Since RA is not an endocrine disease, an endocrinologist would
not be needed.
A patient wants to use medication rather than surgery for gall stones. The nurse explains that drugs
used to dissolve gallstones are most effective for which gall stones?
are located within the gallbladder
consist of cholesterol
are located within the bile duct
can be seen on an X-ray - ANSWERS,consist of Cholesterol
Chenodiol and Ursodiol, bile acids used to dissolve gallstones in carefully selected patients, promote
dissolution of stones that are composed of cholesterol rather than those composed mainly of
calcium. Gallstones composed of calcium are radiopaque and show up on X-ray. Those composed of
cholesterol are radiolucent, so are not visible on X-ray. See Lehne p 1023
The nurse is caring for a patient with ulcerative colitis who is being treated with azathioprine
(Imuran). Which laboratory test result should be monitored periodically?
Microscopic urine examination
Complete blood count (CBC) with differential
Serum albumin
, Immunoglobulin survey - ANSWERS,The nurse should monitor the CBC, because neutropenia is a
major adverse effect of azathioprine (Imuran). Another major adverse effect is pancreatitis.
Microscopic urinalysis is not indicated. The immunoglobulin and serum albumin levels do not require
monitoring in relation to this drug.
The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage
II moderate rheumatoid arthritis (RA). What information about the patient would be the most
important information for the nurse to communicate to the health care provider?
a history of infectious mononucleosis as a teenager
family history of age-related macular degeneration of the retina
uses large doses of vitamins and health foods to treat the RA
discontinued taking birth control pills 8 weeks ago - ANSWERS,Discontinued taking BC pills around 8
weeks ago
Methotrexate is teratogenic (causes birth defects), can lead to fetal death; the patient should be
taking contraceptives during methotrexate therapy. The other information will not impact the choice
of methotrexate as therapy.
The health care provider left an order to discontinue prednisone. What will the nurse do next? -
ANSWERS,Ask the health care provider for instructions to taper the prednisone dose
Prednisone must be tapered according to physician order to avoid adrenal insufficiency. Dosage
adjustments are not within the pharmacist's or nurse's scope of practice unless there is a standing
protocol or order.
The nurse is providing education to a patient with ulcerative colitis who is being treated with
sulfasalazine (Azulfidine). What statement by the patient best demonstrates understanding of the
action of sulfasalazine? "Azulfidine - ANSWERS,reduces the inflammation."
Sulfasalazine reduces the inflammation associated with ulcerative colitis; this statement indicates
understanding. Although similar to sulfonamides, sulfasalazine is not used to treat infections; further
teaching is needed. Sulfasalazine does not enhance the immune response or increase the
reabsorption of fluid; further teaching is needed.
The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse expects the
prescriber to order that the drug be administered at what time? - ANSWERS,0800
Early morning administration mimics the burst of glucocorticoids normally released by the adrenal
glands at dawn (circadian rhythm). Patients on alternate-day therapy or who take one daily dose
should receive this medication before 0900. Therefore, 0800 is the only time listed that matches this
criterion.
