NURS 635 ACTUAL EXAM PAPER 2025/2026 QUESTIONS
WITH ANSWERS GRADED A+
✔✔Prior to developing a plan for the treatment of asthma, the patient's asthma should
be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent
asthma is classified as asthma symptoms that occur:
1. Daily
2. Daily and limit physical activity
3. Less than twice a week
4. More than twice a week and less than once a day - ✔✔4. More than twice a week
and less than once a day
✔✔Education for patients who use an inhaled beta-agonist and an inhaled
corticosteroid includes:
1. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.
2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.
3. Increase fluid intake to 3 liters per day.
4. Avoid use of aspirin or ibuprofen while using inhaled medications - ✔✔2. Use the
inhaled beta-agonist first, followed by the inhaled corticosteroid.
✔✔A stepwise approach to the pharmacologic management of asthma:
1. Begins with determining the severity of asthma and assessing asthma control
2. Is used when asthma is severe and requires daily steroids
3. Allows for each provider to determine their personal approach to the care of
asthmatic patients
4. Provides a framework for the management of severe asthmatics, but is not as helpful
when patients have intermittent asthma - ✔✔1. Begins with determining the severity of
asthma and assessing asthma contro
✔✔Treatment for mild intermittent asthma is:
1. Daily inhaled medium-dose corticosteroids
2. Short-acting beta-2-agonists (albuterol) as needed
3. Long-acting beta-2-agonists every morning as a preventative
4. Montelukast (Singulair) daily - ✔✔2. Short-acting beta-2-agonists (albuterol) as
needed
✔✔The first-line therapy for mild-persistent asthma is:
1. High-dose montelukast
2. Theophylline
3. Low-dose inhaled corticosteroids
4. Long-acting beta-2-agonists - ✔✔3. Low-dose inhaled corticosteroids
✔✔Patients who are at risk of a fatal asthma attack include patients:
1. With moderate persistent asthma
2. With a history of requiring intubation or ICU admission for asthma
,3. Who are on daily inhaled corticosteroid therapy
4. Who are pregnant - ✔✔2. With a history of requiring intubation or ICU admission for
asthma
✔✔Patients with COPD require monitoring of:
1. Beta-2-agonist use
2. Serum electrolytes
3. Blood pressure
4. Neuropsychiatric effects of montelukast - ✔✔1. Beta-2-agonist use
✔✔Patients with a COPD exacerbation may require:
1. Doubling of inhaled corticosteroid dose
2. Systemic corticosteroid burst
3. Continuous inhaled beta-2-agonists
4. Leukotriene therapy - ✔✔2. Systemic corticosteroid burst
✔✔Which antibiotic regime would be the most appropriate when treating community
acquired pneumonia with co-morbidities - ✔✔Azithromycin plus ceftriaxone
✔✔If an adult patient with comorbidities cannot reliably take oral antibiotics to treat
pneumonia, an appropriate initial treatment option would be:
1. IV or IM gentamicin
2. IV or IM ceftriaxone
3. IV amoxicillin
4. IV ciprofloxacin - ✔✔2. IV or IM ceftriaxone
✔✔A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who
has urinary retention. The nurse reviews the patient's chart before giving the
drug. Which part of the patient's history would be a contraindication to using this drug?
a.Asthma as a child
b.Gastroesophageal reflux
c.Hypertension
d.Hypothyroidism - ✔✔ANS: A
Bethanechol is contraindicated in patients with active or latent asthma, because
activation
of muscarinic receptors in the lungs causes bronchoconstriction. It increases the tone
and
motility of the gastrointestinal (GI) tract and is not contraindicated in patients with reflux.
It causes vasodilation and would actually lower blood pressure in a hypertensive
patient.
It causes dysrhythmias in hyperthyroid patients.
✔✔A patient with a cold used phenylephrine nasal spray, 2 sprays every 4 hours, for a
week. Since then it has become impossible to discontinue the medication because the
nasal congestion has increased. What action will the provider take?
, A) Prescribe an oral decongestant to replace the intranasal phenylephrine.
B) Order an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
C) Increase the dose of phenylephrine to 4 sprays every 4 hours.
D) Stop the phenylephrine and discuss using an intranasal antihistamine. - ✔✔B) Order
an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
✔✔Which medication should be used for asthma patients as part of step 1
management?
a. Combination inhaled glucocorticoids/long-acting beta2 agonists
b. Inhaled low-dose glucocorticoids
c. Long-acting beta2 agonists
d. Short-acting beta2 agonists - ✔✔d. Short-acting beta2 agonists
✔✔An older adult patient with chronic obstructive pulmonary disease (COPD) develops
bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider
to:
a. obtain a sputum culture and wait for the results before prescribing an antibiotic.
b. order empiric antibiotics while waiting for sputum culture results.
c. treat symptomatically, because antibiotics are usually ineffective against bronchitis.
d. treat the patient with more than one antibiotic without obtaining culture - ✔✔b. order
empiric antibiotics while waiting for sputum culture results.
✔✔Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate
pain. The appropriate first-line medication would be __________.
A. ibuprofen (Advil)
B. acetaminophen with hydrocodone (Vicodin)
C. oxycodone (OxyContin)
D. oral morphine (Roxanol) - ✔✔A. ibuprofen (Advil)
✔✔Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:
1.For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
2.For pedal edema throughout therapy
3.Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
4.For vision changes, such as red-green blindness, at least annually - ✔✔1.For
phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
✔✔A patient has recently begun taking carbamazepine (Tegretol) as an adjunct
medication to treat refractory seizures. The patient has a serum carbamazepine level of
18 mcg/mL. What action will the nurse take?
a. Ask the patient about usual dietary preferences.
b. Reassure the patient that this is a therapeutic drug level.
c. Report a subtherapeutic drug dose to the provider.
d. Suspect a drug-drug interaction. - ✔✔a. Ask the patient about usual dietary
preferences.
WITH ANSWERS GRADED A+
✔✔Prior to developing a plan for the treatment of asthma, the patient's asthma should
be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent
asthma is classified as asthma symptoms that occur:
1. Daily
2. Daily and limit physical activity
3. Less than twice a week
4. More than twice a week and less than once a day - ✔✔4. More than twice a week
and less than once a day
✔✔Education for patients who use an inhaled beta-agonist and an inhaled
corticosteroid includes:
1. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.
2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.
3. Increase fluid intake to 3 liters per day.
4. Avoid use of aspirin or ibuprofen while using inhaled medications - ✔✔2. Use the
inhaled beta-agonist first, followed by the inhaled corticosteroid.
✔✔A stepwise approach to the pharmacologic management of asthma:
1. Begins with determining the severity of asthma and assessing asthma control
2. Is used when asthma is severe and requires daily steroids
3. Allows for each provider to determine their personal approach to the care of
asthmatic patients
4. Provides a framework for the management of severe asthmatics, but is not as helpful
when patients have intermittent asthma - ✔✔1. Begins with determining the severity of
asthma and assessing asthma contro
✔✔Treatment for mild intermittent asthma is:
1. Daily inhaled medium-dose corticosteroids
2. Short-acting beta-2-agonists (albuterol) as needed
3. Long-acting beta-2-agonists every morning as a preventative
4. Montelukast (Singulair) daily - ✔✔2. Short-acting beta-2-agonists (albuterol) as
needed
✔✔The first-line therapy for mild-persistent asthma is:
1. High-dose montelukast
2. Theophylline
3. Low-dose inhaled corticosteroids
4. Long-acting beta-2-agonists - ✔✔3. Low-dose inhaled corticosteroids
✔✔Patients who are at risk of a fatal asthma attack include patients:
1. With moderate persistent asthma
2. With a history of requiring intubation or ICU admission for asthma
,3. Who are on daily inhaled corticosteroid therapy
4. Who are pregnant - ✔✔2. With a history of requiring intubation or ICU admission for
asthma
✔✔Patients with COPD require monitoring of:
1. Beta-2-agonist use
2. Serum electrolytes
3. Blood pressure
4. Neuropsychiatric effects of montelukast - ✔✔1. Beta-2-agonist use
✔✔Patients with a COPD exacerbation may require:
1. Doubling of inhaled corticosteroid dose
2. Systemic corticosteroid burst
3. Continuous inhaled beta-2-agonists
4. Leukotriene therapy - ✔✔2. Systemic corticosteroid burst
✔✔Which antibiotic regime would be the most appropriate when treating community
acquired pneumonia with co-morbidities - ✔✔Azithromycin plus ceftriaxone
✔✔If an adult patient with comorbidities cannot reliably take oral antibiotics to treat
pneumonia, an appropriate initial treatment option would be:
1. IV or IM gentamicin
2. IV or IM ceftriaxone
3. IV amoxicillin
4. IV ciprofloxacin - ✔✔2. IV or IM ceftriaxone
✔✔A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who
has urinary retention. The nurse reviews the patient's chart before giving the
drug. Which part of the patient's history would be a contraindication to using this drug?
a.Asthma as a child
b.Gastroesophageal reflux
c.Hypertension
d.Hypothyroidism - ✔✔ANS: A
Bethanechol is contraindicated in patients with active or latent asthma, because
activation
of muscarinic receptors in the lungs causes bronchoconstriction. It increases the tone
and
motility of the gastrointestinal (GI) tract and is not contraindicated in patients with reflux.
It causes vasodilation and would actually lower blood pressure in a hypertensive
patient.
It causes dysrhythmias in hyperthyroid patients.
✔✔A patient with a cold used phenylephrine nasal spray, 2 sprays every 4 hours, for a
week. Since then it has become impossible to discontinue the medication because the
nasal congestion has increased. What action will the provider take?
, A) Prescribe an oral decongestant to replace the intranasal phenylephrine.
B) Order an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
C) Increase the dose of phenylephrine to 4 sprays every 4 hours.
D) Stop the phenylephrine and discuss using an intranasal antihistamine. - ✔✔B) Order
an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
✔✔Which medication should be used for asthma patients as part of step 1
management?
a. Combination inhaled glucocorticoids/long-acting beta2 agonists
b. Inhaled low-dose glucocorticoids
c. Long-acting beta2 agonists
d. Short-acting beta2 agonists - ✔✔d. Short-acting beta2 agonists
✔✔An older adult patient with chronic obstructive pulmonary disease (COPD) develops
bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider
to:
a. obtain a sputum culture and wait for the results before prescribing an antibiotic.
b. order empiric antibiotics while waiting for sputum culture results.
c. treat symptomatically, because antibiotics are usually ineffective against bronchitis.
d. treat the patient with more than one antibiotic without obtaining culture - ✔✔b. order
empiric antibiotics while waiting for sputum culture results.
✔✔Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate
pain. The appropriate first-line medication would be __________.
A. ibuprofen (Advil)
B. acetaminophen with hydrocodone (Vicodin)
C. oxycodone (OxyContin)
D. oral morphine (Roxanol) - ✔✔A. ibuprofen (Advil)
✔✔Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:
1.For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
2.For pedal edema throughout therapy
3.Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
4.For vision changes, such as red-green blindness, at least annually - ✔✔1.For
phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
✔✔A patient has recently begun taking carbamazepine (Tegretol) as an adjunct
medication to treat refractory seizures. The patient has a serum carbamazepine level of
18 mcg/mL. What action will the nurse take?
a. Ask the patient about usual dietary preferences.
b. Reassure the patient that this is a therapeutic drug level.
c. Report a subtherapeutic drug dose to the provider.
d. Suspect a drug-drug interaction. - ✔✔a. Ask the patient about usual dietary
preferences.
