NUR 340 EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS

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. A patient who has taken glucocorticoids for 3 years tells a nurse, "I've lost my job. I don't know how I'm going to support my family and pay all the bills." Which glucocorticoid dosage adjustment would the nurse expect? - ANSWERS,Increased dosage At times of physiological stress, the adrenals secrete large amounts of glucocorticoids and epinephrine (which maintain blood pressure and plasma levels of glucose). If glucocorticoid levels are insufficient, hypotension and hypoglycemia occur. The dose should be increased to compensate for the increased levels of stress. Reducing the dosage would put the patient at risk for glucocorticoid insufficiency. Alternate-day dosing results in decreased drug levels, which would put the patient at risk for glucocorticoid insufficiency. The dosage needs to be increased, but without knowledge of the current dose, doubling the dose may result in an inappropriately high dosage A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing an adverse effect of the medication? DEXA scan that indicates osteoporosis increased erythrocyte sedimentation rate (ESR) no improvement in symptoms a recent 5-pound weight loss - ANSWERS,DEXA scan that indicates osteoporosis Osteoporosis is an adverse effect of corticosteroid use. Weight gain, not weight loss, is seen with corticosteroid use. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication. The nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex). Which information is most important to communicate to the health care provider? serum potassium is 5.1 mEq/L. platelet count is 149,500/mm3 blood glucose is 110 mg/dL white blood cell count (WBC) is 1500 mm3 - ANSWERS,The highest priority is the very low WBC count. Bone marrow suppression is a possible side effect of methotrexate, and the patient's resulting low WBC count places the patient at high risk for infection. The low platelet count is close to normal, and will need to be addressed because the patient is on methotrexate. However, the WBC count is a higher priority. The other laboratory values are also abnormal but are not far from normal values and would not have any immediate serious consequences. A nurse is teaching a patient who is ordered to take oral NSAIDs for an ankle sprain. Because a common side effect of NSAIDs is gastrointestinal distress, how does the nurse instruct the patient to take this medication? with milk at bedtime after an antacid only as needed - ANSWERS,To reduce the risk of GI distress, NSAIDs can be taken with milk or food. Taking these medications at bedtime would increase the risk of gastritis because the patient would be in a flat position during the night. Antacids reduce absorption. Pain medications work best if taken before the pain is severe. The nurse is caring for a patient taking high-dose glucocorticoids and is creating a plan of care for the patient. This medication places the patient at greatest risk for which nursing diagnosis? disturbed sensory perception, auditory. infection. fluid volume deficit. inflammation. - ANSWERS,Patients taking glucocorticoids are at risk for infection, because glucocorticoids increase the susceptibility to infection by suppressing host defenses. Glucocorticoids do not disturb sensory perception. Glucocorticoids do not put the patient at risk for fluid volume deficit, but rather for fluid volume retention. Glucocorticoids can be used to treat inflammation; they don't put the patient at greater risk for inflammation A patient with systemic lupus erythematosus (SLE) asks the rheumatology nurse about belimumab (Benlysta), a new drug for SLE. How does the nurse respond? - ANSWERS,Belimumab has modest benefits and may contribute to mortality. benlysta, while promising, demonstrated only modest benefits to a limited population of patients with SLE. It has significant side effects and, in clinical trials, there was a slightly higher mortality rate with this drug than with the placebo. The nurse is administering mitoxantrone (Novantrone) to a patient with multiple sclerosis who was unresponsive to immunomodulators. The nurse teaches the patient to hold the drug and call the physician for which symptoms? headache and elevated blood pressure dizziness and orthostatic hypotension diaphoresis and hypoglycemia 3 lb. weight gain in 1 day and shortness of breath - ANSWERS,3 lb. weight gain in 1 day and SOB Mitoxantrone is cytotoxic and can produce irreversible side effects such as cardiotoxicity months to years after the drug is discontinued. The effects on the heart are manifested as reduced left ventricular ejection fraction and/or heart failure. A rapid weight gain should be quickly followed up on by the health care provider because it is a sign of heart failure