Maryville NUR 615 Final Detailed Exam 2025

Mr. Holloway presents to your clinic with a significantly swollen, painful big toe and you diagnose him with gout. Of the following options which would be the best treatment for Mr. Holloway? - Correct Ans-Low-dose colchicine How is low dose colchicine prescribed? - Correct Ans-1.2 mg followed by 0.6 mg one hour later or 1.8 mg total How is high dose colchicine prescribed? - Correct Ans-1.2 mg followed by 0.6 mg Q4/Q6 or 4.8 mg total Patient education when prescribing colchicine includes? - Correct Ans-Colchicine always causes some degree of diarrhea You have a patient who is taking allopurinol to prevent gout. What labs will you monitor for this patient on allopurinol? - Correct Ans-BUN, creatinine, and creatinine clearance Mr. Thompson has just started taking febuxostat (Uloric) to treat his gout and he needs to be educated on what to expect. - Correct Ans-Gout may worsen with therapy Ms. Jensen has been on prednisone for 6 months. Patients who have been on prednisone for some time should be assessed for what - Correct Ans-Osteoporosis What dose predinisone do in diabetics? - Correct Ans-Worsen blood glucose control What teaching do you given patients taking prednisone? - Correct Ans-report and black, tarry stools or abdominal pain When you place a patient on prednisone and the total dose exceeds 1 gram, what additional drug should you prescribe - Correct Ans-Omeprazole, a proton-pump inhibitor to prevent PUD Janet has fractured her ankle and you give her a prescription for Vicodin (acetaminophen +hydrocodone). What education should you provide before they leave your clinic? - Correct Ans-Patient should not take any other medications that contain acetaminophen What is the first line of pain control? - Correct Ans-NSAIDS Margaret has been on 60 mg of prednisone for 10 days for her severe asthma exacerbation. Since she is breathing much better it is time to discontinue the NUR 615 NUR 615 medication. What should you know when discontinuing this drug? - Correct Ans Develop a tapering schedule to slowly wean Margaret off the prednisone Why must steroids be tapered? - Correct Ans-avoid both recurrent activity of the underlying disease process and possible cortisol deficiency resulting from the hypothalamic-pituitary-adrenal axis (HPA) suppression during the period of steroid therapy. Patients who are currently on or will start chronic corticosteroid therapy should be monitored for what? - Correct Ans-serum glucose Patients with rheumatoid arthritis who are on a chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects - Correct Ans Vitamin D, calcium supplement, and bisphosphate What is the FDA Black Box Warning for ALL nonsteroidal anti-inflammatory drugs (NSAIDS)? - Correct Ans-Increased risk of CV thrombotic events, Stroke, MI Potential for causing life-threatening gastrointestinal bleeds What do NSAIDs increase the risk of? - Correct Ans-CV thrombotic events, MI, stroke If you are getting ready to prescribe an NSAID, a complete drug history should be conducted as NSAIDs interact with which drug? - Correct Ans-Warfarin Gabriella is a 3-year old diagnosed with otitis media and an upper respiratory infection. You prescribe her an antibiotic (probably amoxicillin) and ibuprofen. What education should the parents receive? - Correct Ans-Need to keep well hydrated while taking ibuprofen William is a 78-year old who takes two aspirin every morning while he reads his newspaper to treat arthritis pain in his back. He states the aspirin helps him to "get moving" each day. Lately he has had some heartburn from the aspirin. After you rule out an acute GI bleed, what would be an appropriate course of treatment for William? - Correct Ans-Add an H2 blocker such as ranitidine to his therapy Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is? - Correct Ans-Tinnitus You have a patient that is on long-tern aspirin therapy and what lab should be conducted annually? - Correct Ans-CBC Monitoring a patient on a high-dose aspirin level includes - Correct Ans-Salicylate level, CBC, Urine pH NUR 615 NUR 615 Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include - Correct Ans-Dizziness, confusion, diaphoresis, and tachycardia What are the signs and symptoms of hyperglycemia? - Correct Ans-polyuria, polydispsia, weight loss DKA- Fruity breath, tachypnea, lethargy, obtunded Nonselective beta-blockers and consuming alcohol can create serious drug interactions with insulin because they do what? - Correct Ans-Mask the s/s of altered glucose levels Lispro is an insulin analogue produced by recombinant DNA technology. Based on the statements below which is NOT TRUE? a. Duration of action is increased when the dose in increased b. Optimal time of preprandial injection is 15 minutes c. It has no pronounced peak d. It is compatible with neutral protamine Hagedorn insulin - Correct Ans-a. Duration of action is increased when the dose in increased Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: - Correct Ans-Decreases glycogneolysis by the liver When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research? a. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. b. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia. c. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime. d. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. - Correct Ans-a. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemic control throughout the day. If this is done: - Correct Ans-The initial dose of glargine is reduced by 20% to avoid hypoglycemia Prior to prescribing metformin, you as the provider should - Correct Ans-Draw a serum creatinine to assess renal function Type 2 diabetes is a complex disorder involving - Correct Ans-a suboptimal response of insulin sensitive tissues in the liver NUR 615 NUR 615 Routine screening of asymptomatic adults for diabetes is appropriate for: - Correct Ans Native americans African americans Hispanics The action of "gliptins" is different from other antidiabetic agents because they: - Correct Ans-act on the incretin system to indirectly increase insulin production GLP-1 agonists - Correct Ans-Directly bind to a receptor in the pancreatic beta cell Avoid concurrent administration of exenatide with which of the following drugs? - Correct Ans-Digoxin, warfarin, lovastatin Administration of exenatide is by subcutaneous injection: - Correct Ans-60 minutes prior to the morning and evening meal Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil (PTU). Patients should be taught to report: - Correct Ans-Fever and sore throat Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for - Correct Ans-tachycardia, angina What should you teach your patients when they are prescribed levothyroxine? - Correct Ans-Take medication on an empty stomach, preferably 30 minutes before breakfast When methimazole is started for hyperthyroidism it may take ________ to see a total reversal of hyperthyroid symptoms. - Correct Ans-6-12 months In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for - Correct Ans-beta blocker When starting a patient on levothyroxine for hypothyroidism the patient will