NUR 340 FINAL EXAM QUESTIONS WITH
CORRECT DETAILED ANSWERS AND
RATIONALES LATEST UPDATE
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 - ANSWER>>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
1
,Ibuprofen - ANSWER>>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 -
ANSWER>>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
2
,can be seen on an X-ray - ANSWER>>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 - ANSWER>>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 28year-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 agerelated 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 -
3
, ANSWER>>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? - ANSWER>>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
- ANSWER>>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? -
ANSWER>>0800
4
CORRECT DETAILED ANSWERS AND
RATIONALES LATEST UPDATE
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 - ANSWER>>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
1
,Ibuprofen - ANSWER>>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 -
ANSWER>>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
2
,can be seen on an X-ray - ANSWER>>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 - ANSWER>>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 28year-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 agerelated 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 -
3
, ANSWER>>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? - ANSWER>>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
- ANSWER>>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? -
ANSWER>>0800
4
