NUR 123 Exam #2 Fall 2025

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Free NUR 123 Exam #2 Fall 2025 Questions

1.

Which signs and symptoms should a nurse recognize as indicators of lidocaine toxicity? (Select all that apply.)

  • Slurred speech
  • Seizure activity
  • Loss of sensation to the lower extremities
  • Fever
  • Muscle twitching

Explanation

Explanation
Correct Answer:
 A. Slurred speech
B. Seizure activity
E. Muscle twitching

Explanation
A. Slurred speech
 Slurred speech is a common early sign of lidocaine toxicity, indicating central nervous system (CNS) depression. When lidocaine accumulates in the bloodstream, it can cause neurological disturbances, including difficulty articulating words. This happens because lidocaine interferes with normal nerve function, impairing communication between the brain and muscles involved in speech. This is one of the initial symptoms that can signal the need for intervention.

B. Seizure activity
 Seizure activity is a more severe manifestation of lidocaine toxicity. As lidocaine affects the CNS, it can cause excitation or overactivity of the neurons, leading to seizures. This is a critical sign, as it suggests the drug concentration has reached levels that significantly impact brain function. Immediate medical attention is required to prevent further complications, including status epilepticus or permanent brain damage.

E. Muscle twitching
 Muscle twitching is another indicator of lidocaine toxicity, reflecting hyperexcitability in the neuromuscular system. This can occur due to the drug’s effects on sodium channels in nerves, which may cause abnormal firing of neurons. Muscle twitching is an early symptom, often noticed in the limbs, and is part of the spectrum of CNS-related side effects of lidocaine toxicity. Monitoring and prompt intervention are essential to prevent escalation to more severe symptoms like seizures.

2.

A nurse is preparing to administer metformin 500 mg PO BID to a patient. Which factor would contraindicate the administration of metformin to this patient?

  • A history of hypertension
  • Allergy to sulfonamides
  • A history of renal disease
  • The ingestion of carbohydrates

Explanation

Explanation
Correct Answer:
 C. A history of renal disease

Explanation:
 Metformin is contraindicated in patients with a history of renal disease, particularly those with impaired kidney function, as it is primarily excreted through the kidneys. Renal dysfunction can lead to the accumulation of metformin in the body, increasing the risk of lactic acidosis, a rare but serious side effect. Kidney function should be assessed before initiating metformin, and it should be avoided in patients with a glomerular filtration rate (GFR) below 30 mL/min.

3.

What drug is used to reverse muscle paralysis caused by pancuronium?

  • Neostigmine
  • Dantrolene
  • Flumazenil
  • Midazolam

Explanation

Explanation
Correct Answer:
 A. Neostigmine

Explanation:
 Neostigmine is used to reverse muscle paralysis caused by non-depolarizing neuromuscular blockers such as pancuronium. It works by inhibiting acetylcholinesterase, which allows acetylcholine to accumulate at the neuromuscular junction, thereby stimulating muscle contraction.

4.

What drug reduces skeletal muscle metabolism activity seen in malignant hyperthermia?

  • Dantrolene
  • Neostigmine
  • Flumazenil
  • Midazolam

Explanation

Explanation
Correct Answer:
 A. Dantrolene

Explanation:
 Dantrolene is the primary treatment for malignant hyperthermia, a life-threatening condition triggered by certain anesthetic agents. It works by inhibiting calcium release from the sarcoplasmic reticulum, reducing muscle contraction and metabolism.

5.

Which anesthetic drug is used during surgery because it helps open the airways (bronchodilation) in patients with asthma?

  • Midazolam
  • Propofol
  • Pentobarbital
  • Ketamine

Explanation

Explanation
Correct Answer:
 D. Ketamine

Explanation

D. Ketamine
 Ketamine is a dissociative anesthetic that has bronchodilatory properties, making it particularly useful in patients with asthma or other respiratory conditions. It works by inhibiting the NMDA (N-methyl-D-aspartate) receptors, leading to sedation and analgesia, while also causing relaxation of the bronchial muscles, which helps in opening the airways. This makes ketamine a preferred choice for asthmatic patients undergoing surgery, as it reduces the risk of bronchospasm and helps maintain airway patency.

6.

Education for the nurse caring for the patient receiving the hormonal agent leuprolide would include which instructions?

  • The drug may cause hot flashes, erectile dysfunction, and decreased libido.
  • Vaginal bleeding may occur.
  • An increased dose of warfarin will be necessary.
  • Liver function tests must be assessed weekly.

Explanation

Explanation
Correct Answer:
 A. The drug may cause hot flashes, erectile dysfunction, and decreased libido.

Explanation:
 Leuprolide is a GnRH agonist used in the treatment of hormone-sensitive cancers such as prostate cancer and endometriosis. It works by suppressing the production of sex hormones, which can lead to symptoms such as hot flashes, erectile dysfunction, and decreased libido. These side effects are commonly associated with the drug’s mechanism of action in reducing testosterone levels in men and estrogen levels in women. The nurse should inform patients of these potential effects to ensure they are prepared and can manage them effectively.

7.

A nurse is caring for a patient who is taking ritonavir, a protease inhibitor, to treat Human Immunodeficiency Virus (HIV). Which adverse effect of this drug will the nurse monitor the patient for?

  • Increased TSH level
  • Decreased ALT level
  • Hypercalcemia
  • Hyperglycemia

Explanation

Explanation
Correct Answer:
 D. Hyperglycemia

Explanation

D. Hyperglycemia
 Ritonavir, a protease inhibitor used in the treatment of HIV, is known to cause hyperglycemia as a common side effect. Protease inhibitors, including ritonavir, can impair insulin sensitivity and promote insulin resistance, leading to elevated blood glucose levels. The nurse should monitor blood glucose levels regularly and be alert for symptoms of hyperglycemia, such as increased thirst, frequent urination, and fatigue. Long-term use of ritonavir may increase the risk of developing diabetes in some patients.

8.

A healthcare provider prescribes 1000 mLs D5NS over 6 hours. The nurse calculates the flow rate for this infusion to be how many mLs per hour? Provide a numerical response rounded to a whole number.

  • 200 mLs/hour
  • 167 mLs/hour
  • 150 mLs/hour
  • 125 mLs/hour

Explanation

Explanation
Correct Answer:
 B. 167 mLs/hour

Explanation:
 To calculate the flow rate, divide the total volume (1000 mLs) by the time (6 hours):
1000 mLs ÷ 6 hours = 166.67 mLs/hour.
Rounding to the nearest whole number gives 167 mLs/hour. Therefore, the correct flow rate is 167 mLs per hour.

9.

The nurse knows that which med is given to a patient who is experiencing a hypoglycemic reaction in the emergency department?

  • 500 mLs of D5W
  • Insulin
  • Toast and peanut butter
  • Glucagon

Explanation

Explanation
Correct Answer:
 A. 500 mLs of D5W

Explanation

A. 500 mLs of D5W
 In an emergency department setting, the first-line treatment for severe hypoglycemia is usually intravenous dextrose (D5W). This solution rapidly raises blood glucose levels. The 500 mLs of D5W provides a high concentration of glucose that can help treat acute hypoglycemia in patients who are unable to ingest food or oral glucose due to altered consciousness or other complications. Administering IV dextrose is a fast and effective way to treat severe hypoglycemia.

10.

Which statement shows a patient's understanding of the administration schedule of antiretroviral drugs?

  • "If I miss a dose, I don't worry about it."
  • "I have a printed schedule and I follow it closely every day."
  • "When I miss a dose, I just double the amount next time."
  • "I take the pills whenever I wake up in the morning."

Explanation

Explanation
Correct Answer:
 B. "I have a printed schedule and I follow it closely every day."

Explanation

B. "I have a printed schedule and I follow it closely every day."
 Following a strict and consistent administration schedule is crucial for the effectiveness of antiretroviral therapy (ART) in managing HIV. Adherence to the prescribed schedule helps maintain the appropriate drug levels in the body and prevents the development of drug resistance. Having a printed schedule and following it carefully ensures the patient takes their medication at the correct times each day, improving the chances of successful treatment outcomes.

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