NUR 635 FINAL EXAM 1 LATEST VERSIONS (VERSION A AND B) 2024 ACTUAL EXAM 100 QUESTIONS AN, Exams of Nursing

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NUR 635 FINAL EXAM 1 LATEST VERSIONS

(VERSION A AND B) 2024 ACTUAL EXAM 100

QUESTIONS AND CORRECT DETAILED

ANSWERS ALREADY GRADED A+

The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be: 1.Ciprofloxacin 2.Azithromycin 3.Amoxicillin 4.Doxycycline - ANSWER>>2.Azithromycin Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

1. Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days
2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
3. Rapid strep test and symptomatic care if strep test is negative
4. Observation only, with further assessment if she worsens - ANSWER>>2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:
5. For excessive weight loss
6. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
7. Monthly for tolerance to the haloperidol
8. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients - ANSWER>>2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)

Digoxin levels need to be monitored closely when the following medication is started:

1. Loratadine
2. Diphenhydramine
3. Ipratropium
4. Albuterol - ANSWER>>4. Albuterol Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? A.Betamethasone, an inhaled corticosteroid B.Salmeterol, an inhaled long-acting beta-agonist C.Albuterol, a short-acting beta-agonist D.Montelukast, a leukotriene modifier - ANSWER>>B.Salmeterol, an inhaled long- acting beta-agonist Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
5. Used for the treatment of chronic obstructive pulmonary disease (COPD)
6. Used in the treatment of asthma
7. Combined with albuterol for treatment of asthma exacerbations
8. Combined with fluticasone for the treatment of persistent asthma - ANSWER>>1. Used for the treatment of chronic obstructive pulmonary disease (COPD) Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:
9. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day
10. Beclomethasone needs to be used every day to treat her asthma
11. Report any systemic side effects she is experiencing, such as weight gain

4. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation - ANSWER>>2. Beclomethasone needs to be used every day to treat her asthma When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed:
5. Montelukast twice a day is started when there is an asthma exacerbation.
6. Patients may experience weight gain on montelukast.
7. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
8. Lethargy and hypersomnia may occur when taking montelukast. - ANSWER>>3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. When educating patients who are starting on inhaled corticosteroids, the provider should tell them that:
9. They need to get any live vaccines before starting the medication.
10. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective.
11. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.
12. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids - ANSWER>>3. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. Howard is a seventy-two-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: Urinary retention Cardiac output Peripheral edema

Skin for rash - ANSWER>>Urinary retention Second generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are: A.More effective than first generation antihistamines B.Less sedating than the first generation antihistamines C.Prescription products, therefore are covered by insurance D.Able to be taken with CNS sedatives, such as alcohol - ANSWER>>B.Less sedating than the first generation antihistamines

4. Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug Administration due to the:
5. Risk of life-threatening dermatological reactions
6. Increased incidence of cardiac events when LTBAs are used
7. Increased risk of asthma-related deaths when LTBAs are used
8. Risk for life-threatening alterations in electrolytes - ANSWER>>3. Increased risk of asthma-related deaths when LTBAs are used 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:
9. Daily
10. Daily and limit physical activity
11. Less than twice a week
12. More than twice a week and less than once a day - ANSWER>>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:
13. 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 - ANSWER>>2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid. A stepwise approach to the pharmacologic management of asthma:
5. Begins with determining the severity of asthma and assessing asthma control
6. Is used when asthma is severe and requires daily steroids
7. Allows for each provider to determine their personal approach to the care of asthmatic patients
8. Provides a framework for the management of severe asthmatics, but is not as helpful when patients have intermittent asthma - ANSWER>>1. Begins with determining the severity of asthma and assessing asthma contro Treatment for mild intermittent asthma is:
9. Daily inhaled medium-dose corticosteroids
10. Short-acting beta- 2 - agonists (albuterol) as needed
11. Long-acting beta- 2 - agonists every morning as a preventative
12. Montelukast (Singulair) daily - ANSWER>>2. Short-acting beta- 2 - agonists (albuterol) as needed The first-line therapy for mild-persistent asthma is:
13. High-dose montelukast
14. Theophylline
15. Low-dose inhaled corticosteroids
16. Long-acting beta- 2 - agonists - ANSWER>>3. Low-dose inhaled corticosteroids Patients who are at risk of a fatal asthma attack include patients:
17. With moderate persistent asthma
18. With a history of requiring intubation or ICU admission for asthma
19. Who are on daily inhaled corticosteroid therapy

4. Who are pregnant - ANSWER>>2. With a history of requiring intubation or ICU admission for asthma Patients with COPD require monitoring of:
5. Beta- 2 - agonist use
6. Serum electrolytes
7. Blood pressure
8. Neuropsychiatric effects of montelukast - ANSWER>>1. Beta- 2 - agonist use Patients with a COPD exacerbation may require:
9. Doubling of inhaled corticosteroid dose
10. Systemic corticosteroid burst
11. Continuous inhaled beta- 2 - agonists
12. Leukotriene therapy - ANSWER>>2. Systemic corticosteroid burst Which antibiotic regime would be the most appropriate when treating community acquired pneumonia with co-morbidities - ANSWER>>Azithromycin plus ceftriaxone If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:
13. IV or IM gentamicin
14. IV or IM ceftriaxone
15. IV amoxicillin
16. IV ciprofloxacin - ANSWER>>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 - ANSWER>>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. - ANSWER>>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 - ANSWER>>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 - ANSWER>>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) - ANSWER>>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 - ANSWER>>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. - ANSWER>>a. Ask the patient about usual dietary preferences. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

• Dwayne hasn't been taking his carbamazepine because it causes insomnia.

• Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.
• Dwayne was not originally prescribed the correct amount of carbamazepine.
• Carbamazepine is probably not the right antiseizure medication for Dwayne. - ANSWER>>-Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance. Carbamazepine has a Black Box Warning due to life-threatening:

1. Renal toxicity, leading to renal failure
2. Hepatotoxicity, leading to liver failure
3. Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis
4. Cardiac effects, including supraventricular tachycardia - ANSWER>>3. Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis Carbamazepine has a black box warning recommending testing for the HLA-B* allele in patients with Asian ancestry prior to starting therapy due to: A. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B1502 allele B. Increased risk for drug interactions in Asian patients with the HLA-B1502 allele C. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B* allele D. Patients who have the HLA-B1502 allele being more likely to have a resistance to carbamazepine - ANSWER>>C. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B1502 allele Long-term monitoring of patients who are taking carbamazepine includes:
5. Routine troponin levels to assess for cardiac damage
6. Annual eye examinations to assess for cataract development
7. Monthly pregnancy tests for all women of childbearing age
8. Complete blood count every 3 to 4 months - ANSWER>>4. Complete blood count every 3 to 4 months

Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be:

1. Increase her dose
2. Assess for suicidal ideation
3. Discontinue the medication immediately
4. Decrease her dose to half then slowly titrate up the dose - ANSWER>>2. Assess for suicidal ideation Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause: Contraceptive failure Excessive weight gain Reduced lamotrigine levels, requiring doubling the dose of lamotrigine Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed

• ANSWER>>Reduced lamotrigine levels, requiring doubling the dose of lamotrigine Patients with pheochromocytoma should avoid which of the following classes of drugs due to the possibility of developing hypertensive crisis? A. Expectorants B. Beta- 2 - agonists C. Antitussives D. Antihistamines - ANSWER>>B. Beta- 2 - agonists The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient? a. A patient with diarrhea b. A terminally ill patient who has opioid-induced constipation c. A patient who is scheduled for a colonoscopy

d. A patient who will be having colon surgery in the morning - ANSWER>>b. A terminally ill patient who has opioid-induced constipation Jamie has glucose- 6 - phosphate dehydrogenase deficiency (G6PD) and requires an antibiotic. Which class of antibiotics should be avoided in this patient?

1. Penicillins
2. Macrolides
3. Cephalosporins
4. Sulfonamides - ANSWER>>4. Sulfonamides James has been diagnosed with cluster headaches. Appropriate acute therapy would be: 1.Butalbital and aspirin (Fiorinal) 2.Meperidine IM (Demerol) 3.Oxygen 100% for 15 to 30 minutes 4.Indomethacin (Indocin) - ANSWER>>3.Oxygen 100% for 15 to 30 minutes 18 y.o. patient diagnosed with frequent migraines, what Is abortive therapy for migraines? - ANSWER>>-triptans- (ABORTIVE MEDS FOR MIGRAINES) What is an appropriate drug for the treatment of migraine headaches in an 18-year-old?

• ANSWER>>Propranolol aka indera Is the key to prevention of osteoporosis, which is false? - ANSWER>>- If exercise is corporated into regular activity vitamin d and calcium are not needed (vitamin d and calcium supplements are still needed) Which of the following meds is most appropriate for a patient with neuropathic pain? - ANSWER>>Gabapentin

Jasmine's mother and aunt have suffered from osteoporosis. At 27, Jasmine wants to do whatever she can to prevent getting the disease when she gets older. Which of the following are steps that Jasmine can take, according to the National Osteoporosis Foundation (NOF), to prevent osteoporosis? - ANSWER>>--get daily vitamin d recommendations

• engage in regular weight-bearing exercise
• talk to a healthcare provider about bone health
• avoid smoking and excessive use of alcohol Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?

1. Selective estrogen receptor modulators
2. Aspirin
3. Glucocorticoids
4. Calcium supplements - ANSWER>>3. Glucocorticoids A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? a. Administer the drug at intervals longer than the drug half-life. b. Administer this medication intravenously. c. Monitor plasma drug levels. d. Teach the patient that maximum drug effects will occur within a short period. - ANSWER>>c. Monitor plasma drug levels. A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same drug. Which statement informs the prescriber's response when explaining this phenomenon to the patient? a) Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect. b) Because the drug preparations are chemically equivalent, the actions of the two brands must be identical.

c) Inactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug's onset of action. d) The bioavailability of a drug is determined by the amount of the drug in each dose - ANSWER>>Ans C.- Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the drug. A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? a.The drug was not completely dissolved in the IV solution. b.A loading dose was not given. c.The medication is being given at a frequency that is longer than its half-life. d.The patient is taking another medication that binds to serum albumin. - ANSWER>>d.The patient is taking another medication that binds to serum albumin. When writing out a prescription do you write daily or Qday? - ANSWER>>Daily- duh A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time? a. Immediately before conception b. During the first trimester c. During the second trimester d. During the third trimester - ANSWER>>b. During the first trimester A 5-year-old has gray teeth. When taking a medication history, the provider will ask about previous use of which group of medications? - ANSWER>>-Tetracyclines

Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are associated with growth suppression. Salicylates are associated with Reye syndrome. Sulfonamides are associated with kernicterus in newborns. A provider is reviewing an older adult patient's chart during a routine visit. Which patient information is of most concern regarding the renewing of medication prescriptions for highly protein-bound drugs? a.Chronic constipation b.Increased body fat c.Low serum albumin d.Low serum creatinine - ANSWER>>-Low serum albumin When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound? - ANSWER>>-The duration of action of the medication will be longer. An older adult patient is entering into the immediate postoperative period after a total hip replacement. The patient's son concerned about related pain asks meperidine be prescribed since, "I had it for severe pain when I injured when I was younger." What action will the provider take to reduce the patient's risk for injury while addressing the patient's pain? a. Prescribe meperidine and request the initiation of the fall risk protocol. b. Provide a PRN order for diphenhydramine for the expected side effect of itching. c. Prescribe morphine and discuss the rationale with the patient's son. d. Offer to prescribe diazepam to reduce the patient's anxiety and thus reduce the need for narcotics. - ANSWER>>Ans- Prescribe morphine and discuss the rationale with the patient's son. In older adults, meperidine is not effective at usual doses and causes more confusion, delirium, and neurotoxicity than in younger patients. Morphine is recommended for

severe pain among the older population. A fall risk protocol is appropriate, but the drug ordered is not. Diphenhydramine is not recommended for older adult patients, because it causes blurred vision. Both diphenhydramine and diazepam have central nervous system (CNS) sedative effects, which will compound the CNS effects of the narcotic. Diazepam also produces prolonged sedation in older adults. A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/ mm Hg. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse will monitor for which side effect? a. Hypotension b. Tachycardia c. Tachypnea d. Urinary retention - ANSWER>>b. Tachycardia Beta agonists are used for asthma because of their beta2 effects on bronchial smooth muscle, causing dilation. Beta1 effects cause tachycardia and hypertension. Beta receptors do not exert effects on the bladder. 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 - ANSWER>>Ans A: 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 who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug? a. "This drug carries some risk of developing hallucinations and psychotic symptoms." b. "This medication may cause your urine to turn brown, black, or dark green." c. "You may experience blurred vision, dry mouth, or constipation." d. "You will need to have liver function tests performed while taking this medication." - ANSWER>>c. "You may experience blurred vision, dry mouth, or constipation." A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do? a. Ask the patient to complete a seizure frequency chart for the past few weeks. b. Contact the provider to request an order for serum drug levels. c. Reinforce the need to take the medications as prescribed. d. Request an order to increase the dose of the antiepileptic drug - ANSWER>>b. Contact the provider to request an order for serum drug levels. A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct? a.

"Aspirin is safe during the second and third trimesters of pregnancy." b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." c. "Aspirin may induce premature labor and should be avoided in the third trimester." d. "You should use a first-generation nonsteroidal anti-inflammatory medication." - ANSWER>>b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." A pt is given new diagnosis of RA, basis for methotrexate? - ANSWER>>Starting early can delay joint degeneration 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? - ANSWER>>-Suggest delaying the probenecid therapy until the acute episode has subsided. A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient? a. Colchicine b. Glucocorticoids c. Nonsteroidal anti-inflammatory drugs d. Urate-lowering drugs - ANSWER>>d. Urate-lowering drugs A patient has severe Paget's disease of the bone. The patient asks the nurse what can be done to alleviate the pain. The nurse will suggest that the patient discuss the use of which medication with the provider? a. Alendronate [Fosamax] b. Calcifediol [25-Hydroxy-D3]

c. Calcitonin-salmon [Miacalcin] d. Long-acting NSAIDs - ANSWER>>c. Calcitonin-salmon [Miacalcin] Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to? a-Take the medication in the morning with meals .b-Take the medication 2 hours before bedtime. c-Take the medication with a glass of water after rising in the morning. d-Take the medication during lunc - ANSWER>>c-Take the medication with a glass of water after rising in the morning. The nurse is caring for an older adult patient after a right hip open reduction internal fixation (ORIF). The patient is taking an opioid every 6 hours as needed for pain. The nurse discusses obtaining an order from the prescriber for which medication? a.Docusate sodium [Colace] b.GoLYTELY c.Lactulose d.Polyethylene glycol [MiraLax] - ANSWER>>a.Docusate sodium [Colace] The tricyclic antidepressants should be prescribed cautiously in patients with:

1. Eczema
2. Asthma
3. Diabetes
4. Heart disease - ANSWER>>4. Heart disease Suzanne is started on paroxetine (Paxil), an SSRI, for depression. Education regarding her antidepressant includes: A.SSRIs may take 2 to 6 weeks before she will have maximum drug effects B.Red-green color blindness may occur and should be reported C.If she experiences dry mouth or heart rates greater than 80, stop taking the drug immediately

D.She should eat lots of food high in fiber to prevent constipation - ANSWER>>A.SSRIs may take 2 to 6 weeks before she will have maximum drug effects A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient? a. Alprazolam [Xanax] b. Amitriptyline [Elavil] c. Buspirone [Buspar] d. Paroxetine [Paxil] - ANSWER>>c. Buspirone [Buspar] Prior to starting antidepressants, patients should have laboratory testing to rule out: a.Hypothyroidism b.Anemia c.Diabetes mellitus d.Low estrogen levels - ANSWER>>a.Hypothyroidism An appropriate drug for the treatment of depression with anxiety would be: a.Alprazolam (Xanax) b.Escitalopram (Lexapro) c.Buspirone (Buspar) d.Amitriptyline (Elavil - ANSWER>>b.Escitalopram (Lexapro) Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the SSRI. What is the initial dosage adjustment when starting a taper off antidepressants? a. Change dose to every other day dosing for a week b. Reduce dose by 50% for 3 to 4 days c. Reduce dose by 50% every other day d. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life - ANSWER>>b. Reduce dose by 50% for 3 to 4 days

Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)? a. It has a shorter half-life and withdrawal syndrome has a faster onset without taper. b. It has the longest half-life and the withdrawal syndrome has a faster onset. c. It is quasi-addictive in the dopaminergic reward system. d. It is the most activating of SSRI medications and will cause the person to have sudden deep sadness. - ANSWER>>a. It has a shorter half-life and withdrawal syndrome has a faster onset without taper. A patient who wants to quit smoking has begun taking varenicline [Chantix]. The patient reports experiencing mood swings and depression and a desire to cause harm to herself. What will the nurse tell this patient? a. "These symptoms are common and will disappear over time." b. "These symptoms may indicate an underlying psychiatric disorder." c. "You may need an increased dose to overcome these symptoms of nicotine withdrawal." d. "You should notify your provider of these symptoms immediately." (can cause Neuropsychiatric symptoms) - ANSWER>>d. "You should notify your provider of these symptoms immediately." (can cause Neuropsychiatric symptoms) A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss the dose. a. increasing; allopurinol b. increasing; warfarin c. reducing; allopurinol d. reducing; warfarin - ANSWER>>d. reducing; warfarin A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the

patient's ammonia level is elevated at 218 μg/dL. What medication should the nurse prepare to administer? a. 0.9% NS b. Docusate sodium [Colace] c. Lactulose d. Polyethylene glycol [MiraLax] - ANSWER>>c. Lactulose A patient who is known to be a heavy drinker is brought to the emergency department with ataxia and confusion. The patient cannot remember the events of the previous day. The examination reveals nystagmus, and the patient reports having double vision. The nurse will expect to administer which vitamin to this patient? a. Ascorbic acid (vitamin C) IV b. Intramuscular pyridoxine (vitamin B6) c. Intravenous thiamine (vitamin B1) d. Nicotinic acid (niacin) PO - ANSWER>>c. Intravenous thiamine (vitamin B1) The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia and can be treated as an outpatient would be: a. Levofloxacin b. Amoxicillin c. Ciprofloxacin d. Cephalexin - ANSWER>>a. Levofloxacin Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in: a. 12 to 24 hours b. 24 to 36 hours c. 48 to 72 hours d. 4 or 5 days - ANSWER>>c. 48 to 72 hours

A 59 year old post menopausal woman with hx of breast cancer at 40 years? - ANSWER>>Topical conjugated estrogen cream Which antibiotic regimen is most appropriate in treating CAP in an adult with comorbidities? - ANSWER>>Azithromycin plus ceftriaxone A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history? a. Asthma and allergic rhinitis b. Gouty arthritis c. Seborrheic dermatitis d. Systemic fungal infection - ANSWER>>d. Systemic fungal infection An 11-year-old boy received all childhood immunizations before attending school as a kindergartner. Which vaccines are recommended for this child at his current age? a. DTaP, MCV4, Varivax b. PCV-23, Td, MMR c. Tdap, MCV4, HPV d. Tdap, Varivax, hepatitis B - ANSWER>>c. Tdap, MCV4, HPV A patient admitted to the hospital has been using phenylephrine nasal spray [Neo- Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do? a. Request an order for an oral decongestant to replace the intranasal phenylephrine. b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn. c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.

d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine - ANSWER>>b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn. A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin: a.dries secretions to help suppress coughing so patients can rest. b.helps stimulate the flow of secretions to increase cough productivity .c.helps to relieve chest pain associated with a cough. d.stimulates the body's natural immune responses. - ANSWER>>b.helps stimulate the flow of secretions to increase cough productivity Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include: a. Understanding that obesity is a contraindication to prescribing phentermine b. Anorexiants may cause tolerance and should only be prescribed for 6 months c. Patients should be monitored for postural hypotension d. Renal function should be monitored closely while on anorexiants - ANSWER>>b. Anorexiants may cause tolerance and should only be prescribed for 6 months Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John's wort due to: a. Additive respiratory depression risk b. Additive effects affecting liver function c. The risk of serotonin syndrome d.The risk of altered cognitive functioning - ANSWER>>c. The risk of serotonin syndrome

Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first? a. Patients with kidney stones b. Pregnant patients c. Patients with heartburn d. Postmenopausal women - ANSWER>>a. Patients with kidney stones Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: a.. Iron deficiency anemia, vitamin B12 and calcium deficiency b. Folate and magnesium deficiency c. Elevated uric acid levels leading to gout d. Hypokalemia and hypocalcemia - ANSWER>>a.. Iron deficiency anemia, vitamin B12 and calcium deficiency An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: a. Electrolytes, including potassium and chloride b. Bone mineral density for osteoporosis c. Magnesium level d. Liver function - ANSWER>>a. Electrolytes, including potassium and chloride There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because:

1. Renal excretion is similar in both classes of drugs.
2. When these drug classes are metabolized in the liver they both produce resistant enzymes.
3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase- producing organisms.

4. There is not an issue with cross-resistance between the penicillins and cephalosporins. - ANSWER>>3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes:
5. Platelet count
6. BUN and creatinine
7. White blood cell count
8. AST, ALT, alkaline phosphatase, and bilirubin - ANSWER>>4. AST, ALT, alkaline phosphatase, and bilirubin A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be most concerning? a. Recent yeast infection b. Family history of cervical cancer c. Drinks two glasses of wine every night d. Patient is currently unemployed - ANSWER>>c. Drinks two glasses of wine every night To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of :a. urinary tract infections in young women. b. upper respiratory infections in adults. c. skin and soft tissue infections in adults. d. community-acquired pneumonia in patients with comorbidities. - ANSWER>>d. community-acquired pneumonia in patients with comorbidities. Fluoroquinolones have a Black Box warning regarding ____ even months after treatment. A. Renal dysfunction