1
NURS 340
NURS 340/ NURS340 – Public Health Nursing |
WCU | 2026–2027 | Exam 2 Review with Verified
Questions and Answers
High-dose glucocorticoids interfere with glucose metabolism and require careful use
with patients who have diabetes. Each of the other diseases can be treated with
glucocorticoids.
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 - ANS ✓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.
NURS 340
, 2
NURS 340
Medication education for a patient receiving glucocorticoids should include the
preferred use of which medication for management of mild pain?
Aspirin
Naproxen sodium
Acetaminophen
Ibuprofen - ANS ✓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 - ANS ✓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.
NURS 340
, 3
NURS 340
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
can be seen on an X-ray - ANS ✓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 - ANS ✓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
NURS 340
, 4
NURS 340
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 - ANS ✓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? - ANS ✓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 - ANS ✓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.
NURS 340
NURS 340
NURS 340/ NURS340 – Public Health Nursing |
WCU | 2026–2027 | Exam 2 Review with Verified
Questions and Answers
High-dose glucocorticoids interfere with glucose metabolism and require careful use
with patients who have diabetes. Each of the other diseases can be treated with
glucocorticoids.
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 - ANS ✓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.
NURS 340
, 2
NURS 340
Medication education for a patient receiving glucocorticoids should include the
preferred use of which medication for management of mild pain?
Aspirin
Naproxen sodium
Acetaminophen
Ibuprofen - ANS ✓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 - ANS ✓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.
NURS 340
, 3
NURS 340
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
can be seen on an X-ray - ANS ✓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 - ANS ✓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
NURS 340
, 4
NURS 340
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 - ANS ✓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? - ANS ✓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 - ANS ✓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.
NURS 340
