NURS 617 EXAM 2 NEWEST 2024-2025 ACTUAL EXAM COMPLETE QUESTIONS & CORRECT DETAILED ANSWERS, Exams of Nursing

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NURS 617 EXAM 2 NEWEST 2024-

ACTUAL EXAM COMPLETE QUESTIONS AND

CORRECT DETAILED ANSWERS (VERIFIED

ANSWERS). GRADED A

• Can be given IV for acute or critically ill
• Rapid onset of action, immediate when given IV
• Short duration of action which results in rapid recovery from adverse effects
• Easy conversion to other nitrates, if necessary for long term nitrate therapy
• Very useful in those with acute CHF in association with ischemic heart disease or MI - ANSAdvantages of Nitroglycerin in treatment of heart failure
• Headache and Dizziness
• can cause hypotension and tachycardia
• Tolerance can develop - ANSDisadvantages of nitroglycerin in acute congestive heart failure
• headaches that should become less likely with continuous use, usually accompanied by facial flushing

• Tolerance and physical dependence can occur and can be decreased by incorporating "drug holidays"
• Hypotension and tachycardia at higher doses.
• Occasionally provoke angina
• Withdraw slowly - ANSDisadvantages of Nitrates in treatment of angina
• Highly toxic drug with very low therapeutic index
• GI adverse effects including anorexia, nausea and vomiting
• Bradycardia and arrhythmias are common
• Requires close observation of serum potassium because hypocalcemia increases the risk of toxicity.
• Use with St. John's wort may decrease plasma digoxin levels.
• Has not been shown to improve mortality - ANSDisadvantages of Digoxin
• Hypotension
• Contraindicated in pregnancy
• Very expensive
• May cause some skeletal muscle cramping
• Some references report a persistent nocturnal cough in some patients though the mechanism is unclear.

• headache and diarrhea are occasionally reported. - ANSDisadvantages of ARBs (sartans)
• Nitrates
• ACE inhibitors
• Beta Blockers
• CCB
• Antithrombotic drugs
• Statins - ANSWhat categories of drugs are used to treat Angina
• Possible bradycardia and CHF
• Orthostatic hypotension
• Can cause a variety of arrhythmias (especially likely with verapamil and nifedipine)
• Constipation
• May worsen GERD symptoms
• More expensive
• Other than some limited studies with nifedipine, these are generally not safe in pregnancy - ANSDisadvantages of Calcium Channel Blockers

• Reflex tachycardia
• Sodium and water retention and edema
• Frequently requires concomitant use of Beta blockers and diuretics
• Not useful as mono therapy - ANSDisadvantages of Direct acting vasodilators
• Selective alpha 1 receptor blockers and CCBs due to orthostatic hypotension risk
• CCB due to constipation
• Exercise caution with Beta blockers and CCBs due to risk of CHF
• Diuretics since older adults already have contracted blood volume (may have to use lower than normal dose to begin therapy) - ANSWhich antihypertensives should be avoided in older adults?
• Those with bilateral renal stenosis
• Those with history of angioedema
• Pregnant patients - ANSACE inhibitors are contraindicated in what patients?
• tinnitus
• confusion
• hyper-reflexia
• metabolic acidosis

• arrhythmias
• hypotension
• death - ANSWhat are signs of Thiocyanate poisoning? -May lower BP too much especially when being used with diuretics -May produce severe hyperkalemia especially in those with renal insufficiency -Angioedema -May cause an increase in renal insufficiency -Persistent nocturnal cough -Teratogenic in pregnancy - ANSDisadvantages of ACE inhibitors (-pril) -Potential for Bradycardia and CHF due to excessive slowing of the hear rate decreasing the force of myocardial contractility to the point of marked reduction of cardiac output. -Potential for Bronchospasm -Potential for peripheral vasoconstriction -Possible Hypoglycemia -Increase in triglycerides and lowers HDL

-Commonly results in beta receptor up-regulation and target cell hypersensitivity. Must withdraw slowly to prevent rebound tachycardia, angina, hypertension, etc.

• ANSDisadvantages of Non-Selective beta blockers <140/90 - ANSBlood pressure goal for hypertensive patients aged 18-59, those with diabetes, or patients with chronic kidney disease <150/90 - ANSBlood pressure goal in hypertensive patients 60+ years old with no diabetes of chronic kidney disease A cancer patient has pain at the tumor site and is worried the tumor has metastasized. What does the healthcare provider understand about his patient's complaint? a. Pain indicates the metastasis of a cancer. b. Pain is usually the initial symptom of cancer. c. Pain is primarily a result of pressure caused by the tumor. d. Pain is generally associated with late-stage cancer. - ANSd. Pain is generally associated with late-stage cancer.

Rationale: Pain is generally associated with the late stages of cancer. Pressure, obstruction, invasion of a structure sensitive to pain, stretching, tissue destruction, and inflammation can cause pain. Pain is not the initial symptom of cancer nor does it indicate that the cancer has metastasized A differential rise in which blood cell is typically seen with parasitic infections? a. Eosinophils b. Lymphocytes c. Neutrophils d. Basophils - ANSa. Eosinophils A differential rise in which white blood cell is typically seen with viral infections? a. Lymphocytes b. Eosinophils c. Monocytes d. Neutrophils - ANSa. Lymphocytes A direct result of anaerobic metabolism during hypoxic cell injury is:

a. increased ATP b. metabolic acidosis c. tissue ischemia d. all of the above. - ANSb. metabolic acidosis Rationale: When oxygen is not available, cells switch to anaerobic metabolism, which yields an acid called lactate, or lactic acid. A direct result of anaerobic metabolism during hypoxic cell injury is: a. metabolic acidosis. b. tissue ischemia. c. all of the above. d. increased adenosine triphosphate (ATP). - ANSa. metabolic acidosis. A healthcare professional is assessing a child who has complete trisomy of the twenty-first chromosome. What findings does the professional relate to this condition?

a. High pitched voice, tall stature, gynecomastia, and an IQ of 60 to 90 b. Widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair c. An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears d. Circumoral cyanosis, edema, of the feet, short stature, and mental slowness - ANSc. An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears Rationale: This child has Trisomy 21, also known as Down syndrome. These children typically present with IQs ranging from 25 to 70. The facial appearance is distinctive and exhibits a low nasal bridge, epicanthal folds, protruding tongue, and flay, low-set ears. Widely spaced nipples and edema of the newborn's feet are characteristic of Turner syndrome. The high-pitched voice and gynecomastia are characteristic of Klinefelter syndrome. A monocyte is a circulating white blood cell that transforms into which of the following cells once it enters the tissue during an inflammatory response? a. Neutrophil b. Macrophage c. Mast cell d. Fibroblast - ANSb. Macrophage

Rationale: Monocytes must mature into macrophages once they enter the tissues to become active phagocytes. A patient has been diagnosed with acute lymphocytic leukemia (ALL) and ask the healthcare professional to describe it. What description by the professional is most accurate? a. In (ALL), immature blasts cells replace normal myelocytic cells, megakaryocytes, and erythrocytes. b. (ALL) is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. c. The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL. d. B cells fail to mature into plasma cells that synthesize immunoglobulins - ANSb. (ALL) is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. Rationale: (ALL) is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. Leukemia is a malignant disorder of leukocytes and does not involve immunoglobulins. The BCR-ABL gene has been identified in chronic myelogenous leukemia, no acute lymphocytic leukemia (ALL).

A patient has been hospitalized for a large deep vein thrombosis and states he is the third person in his family to have this condition in the last two years. What response by the healthcare professional is most appropriate? a. "Were they all men or both men and women?" b. "This condition is not transmitted genetically." c. "Familial thromboses tend to be very severe." d. "We can test your blood for factor V Leiden." - ANSd. "We can test your blood for factor V Leiden." Rationale: Factor V Leiden results from a single nucleotide mutation of guanine to adenine at nucleotide 1691 (G1691A) and is the most common hereditary thrombophilia. It is autosomal dominant so would not be confined to one sex. Most people with this disorder do not have clinically significant events. A person comes to the healthcare clinic and reports night sweats and fever. The healthcare professional obtains a chest x-ray which shows a mediastinal mass. What other assessment or diagnostic test does the professional provide as a priority?

a. Arrange for familial DNA testing b. Assess the patient's skin c. Listen to heart sounds d. Test for blood anemia - ANSc. Listen to heart sounds Rationale: This patient has signs of Hodgkin lymphoma (HL) Pericardial involvement can lead to pericardial friction rub and pericardial effusion. The professional should listen to the patient's heart for the sounds that characterize these conditions. The patient may demonstrate itchy skin lesions, but this would not take priority over heart sounds. Familial DNA testing would not be a priority. Anemia accompanies many healthcare conditions and so would be nonspecific for Hodgkin lymphoma (HL). A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome? a. Fragile X b. Turner c. Down d. Klinefelter - ANSd. Klinefelter

Rationale: A disorder in the chromosome (47, XXY karyotype) results in a disorder known as Klinefelter syndrome. Turner syndrome has a karyotype of 45, X. Down syndrome is caused by Trisomy 21. Fragile X syndrome is caused by microscopically observable breaks and gaps in the X chromosome. A positive tuberculin skin test for detecting the presence of tuberculosis is indicative of which type of hypersensitivity reaction? a. Type IV b. Type II c. Type I d. Type III - ANSa. Type IV Rationale: Because this reaction takes 24 to 72 hours to appear, it is a classic example of a type IV hypersensitivity reaction. Accumulation of which of the following molecules results in irreversible cell injury? a. Calcium b. Melanin

c. Lipids d. Water - ANSa. Calcium Rationale: The accumulation of calcium causes irreversible mitochondrial injury. ACE inhibitors Loop and Thiazide diuretics Beta blockers Cardiac Glycosides Nitrates - ANSWhat are the major drug classes used to treat heart failure ACE inhibitors - ANSblocks angiotensin converting enzyme which converts the inactive protein, angiotensin 1 into the very active protein, angiotensin 2. In this way, the normal actions of angiotensin 2 are blocked (peripheral arterial vasoconstriction and stimulation of aldosterone secretion by adrenal gland) therefore lowering blood pressure. ACE inhibitors (-pril) ARBs (sartan) - ANSWhich antihypertensive classes are glucose neutral and can be used relatively safely in diabetics

ACE inhibitors (-pril) - ANSWhich drug class used to treat heart failure has been shown to increase life expectancy? ACE inhibitors because they tend to increase serum potassium - ANSWhich antihypertensive can be used with thiazide diuretics to offset the hypokalemia Acebutolol Atenolol Betaxolol Bisoprolol Esmolol Metoprolol Nebivolol - ANSExamples of Selective Beta 1 Blockers Adaptive cellular mechanisms function to: a. speed up cellular death. b. prevent cellular aging. c. treat disease.

d. protect cells from injury. - ANSd.protect cells from injury. Adrenergic Neuron Blocers - ANSLower blood pressure by either directly preventing the release of norepinephrine from sympathetic nerve endings or by depleting the nerve endings of stored norepinephrine. Adverse Effect - ANSA drug-induced, secondary effect of a drug that produces a change in a patients condition that is noxious, harmful or unpleasant, which requires treatment or reduction or discontinuation of the drug and which usually occurs at therapeutic doses. Allergic reaction - ANSAn immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication; a type of adverse drug event. Alpha 1 blockers - ANSDirect antagonists on alpha 1 receptors located on the smooth muscle cells making up the walls of the peripheral arterioles and peripheral veins. This blocks the normal vasoconstrictive effects of the sympathetic nervous system causing veins to become more dilated. This results in decreased peripheral resistance and decreased venous return therefore lowering blood pressure.

Alpha 1 blockers (-zosins) - ANSAntihypertensive medication that can treat both HTN and BPH? Alpha 1 blockers (-zosins) - ANSWhich antihypertensive drug class may increase the sensitivity of insulin receptors, improving efficacy of insulin and is a good choice for diabetics with HTN? Alpha 1 blockers (-zosins) - ANSWhich antihypertensive medication class significantly reduces left ventricular afterload and is very effective in management of CHF alpha 2 adrenergic agonists - ANSInteract with alpha 2 receptors in the CV control center in the brain stem and inhibit the discharge of the sympathetic nervous system and reduce sympathetic activation of the heart and the peripheral vascular system. End results are decrease of myocardial contractility and heart rate and reduction of cardiac output and BP. Alpha methyldopa Clonidine Guanfacine - ANSExamples of Alpha 2 Adrenergic Agonists.

Amlodipine Diltiazem Felodipine Isradipine Nicardipine Nimodipine Nisoldipine Verapamil - ANSExamples of Calcium Channel Blockers An elevation of which cell accounts for a "left shift" in the white blood cell count differential? a. Lymphocytes b. Bands and PMNs c. Monocytes d. Basophils - ANSb. Bands and PMNs Rationale: In the typical presentation of the white blood cell differential, bands (immature neutrophils) and PMNs (polymorphonucleocytes) are placed to the left.

During an acute inflammatory response, the rise in these immature and mature neutrophils creates what is known in the clinical environment as a "left shift." An elevation of which cells accounts for a "left shift" in the white blood cell count differential? a. Lymphocytes b. Polymorphonucleocytes (PMNs) c. Basophils d. Monocytes - ANSb. Polymorphonucleocytes (PMNs) Rationale: In the typical presentation of the white blood cell differential, PMNs are placed to the left. During an acute inflammatory response, the rise in neutrophils creates what is known in the clinical environment as a "left shift." An individual with damage to the spinal cord may experience atrophy of which of the following organs? a. Skeletal muscles b. Skin

c. Liver d. Brain - ANSa. Skeletal muscles Rationale: Lack of nerve stimulation to skeletal muscles results in muscle atrophy. Angina Arrhythmia therapy Migraines Hyperthyroidism Anxiety - ANSAlternate uses for non-selective beta blockers Angina, Arrhythmias, Migraine prophylaxis, and M.I. - ANSAlternative uses for Calcium channel blockers Angioedema - ANSWhat would voice changes and swelling of the tongue indicate in a patient taking ACE inhibitors? This may occur with the first dose or within the first month of use Angiotensin II Receptor Blockers (ARBs) - ANSLower blood pressure by blocking the angiotensin II enzyme from causing vasoconstriction

Anticoagulant drugs - ANSDrug class that prevents mural thrombosis following an acute MI and prevents re-thrombosis of coronary arteries following successful therapy Antiplatelet drugs - ANSDrug class that can be used prophylactically to prevent initial coronary thrombosis and has been shown to decrease the incidence of a second thrombotic event after successful recovery from a first coronary event Apixaban Betrixaban Rivaroxaban - ANSFactor Xa Inhibitors useful for DVT and PE prophylaxis Apixaban Edoxaban Rivaroxaban - ANSFactor Xa Inhibitors useful for DVT and PE treatment Apixaban Rivaroxaban - ANSFactor Xa Inhibitors that reduce the risk of recurrence of DVT and PE

Apixaban Rivaroxaban - ANSFactor Xa Inhibitors that reduce the risk of stroke and systemic embolism in patients with nonvalvular A-fib. ARBs (sartans) - ANSAntihypertensive medication class that is glucose neutral, lipid neutral and has minimal adverse effects Aspirin - ANSBinds to and blocks the synthesis of the COX 1 and COX 2 enzymes which prevents the formation of the prostaglandin thromboxane A2 which promotes the agglutination of platelets. Blood clotting is then slowed and the tendency for a patient to form a thrombus is prevented. Asthmatics Diabetics (can still take ISA beta blockers) Those with PVD - ANSWho should not take non-selective beta blockers Autocrine stimulation is the ability of cancer cells to do what? a. Encourage secretions that turn off normal growth inhibitors b. Secrete growth factors that stimulate their own growth

c. Divert nutrients away from normal tissue for their own use d. Stimulate angiogenesis to create their own blood supply - ANSb. Secrete growth factors that stimulate their own growth Rationale: Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. The other options describe other activities of cancer cells but not autocrine stimulation. Beneficial inhibitory drug interaction - ANSGiving Protamine when there is excessive bleeding from overdose of Heparin is an example of what type of drug interaction? Beneficial inhibitory drug interaction - ANSUse of Naloxone after an overdose of Meperidine is an example of what type of drug interaction? Beneficial potentiative drug-drug interaction - ANSAspirin and Codeine are both analgesic drugs and when administered concurrently the combo provides better pain relief than either one alone. What type of drug interaction is this?

Beneficial Potentiative Drug-Drug Interaction - ANSUse of Beta Blockers and Diuretics together for hypertension will provide better control blood pressure. What type of drug interaction is this? Beta Blockers (-lol) ACE inhibitors (-pril) - ANSWhich classes of antihypertensives prevent reflex tachycardia associated with the lowering of blood pressure Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes? a. Gene amplification b. Chromosome function c. Chromosome translocation d. Point mutation - ANSc. Chromosome translocation Rationale: Chromosome translocations, in which a piece of one chromosome is translocated to another chromosome, can activate oncogenes. One of the best examples is the t(8;14) designates a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. A point mutation is the alteration of one or

a few nucleotide base pairs. Gene amplification is the result of repeated duplication of a region of a chromosome, so that instead of the normal two copies of a gene, tens or even hundreds of copies are present. Chromosome fusion occurs during translocation. Calcium Channel Blockers - ANSBind to various sites on the calcium transport channels inhibiting the entry of calcium ions into muscle cells therefore decreasing the force of contraction of these muscle cells. This leads to decrease in myocardial contraction, a decrease in cardiac output, a decrease in peripheral vascular tone and peripheral resistance, and decrease in BP. Captopril Enalapril Benazepril Lisinopril Fosinopril Moexipril Perindopril Quinapril Ramipril Trandolapril - ANSExamples of ACE inhibitors