NURS 520 Final SP25
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Free NURS 520 Final SP25 Questions
1.
The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. What is this patient most likely experiencing?
- A) An allergic reaction
- B) An idiosyncratic drug effect on the bone marrow
- C) Iatrogenic disease of the skin
- D) Drug toxicity of the liver
Explanation
Explanation
The symptoms described—jaundice, dark urine, light-colored stools, nausea, vomiting, and malaise—are classic signs of liver dysfunction, often due to hepatotoxicity or drug-induced liver injury. Many medications can damage liver cells, leading to impaired bile excretion and systemic symptoms.
Why the other options are incorrect:
A) An allergic reaction:
Usually presents with rash, itching, hives, swelling, or respiratory issues—not liver-related symptoms like jaundice.
B) An idiosyncratic drug effect on the bone marrow:
Would more likely cause blood-related issues such as anemia, infection, or bleeding—not liver-specific signs.
C) Iatrogenic disease of the skin:
Refers to a skin condition caused by medical treatment, not systemic liver symptoms like jaundice or digestive distress.
The symptoms described—jaundice, dark urine, light-colored stools, nausea, vomiting, and malaise—are classic signs of liver dysfunction, often due to hepatotoxicity or drug-induced liver injury. Many medications can damage liver cells, leading to impaired bile excretion and systemic symptoms.
Why the other options are incorrect:
A) An allergic reaction:
Usually presents with rash, itching, hives, swelling, or respiratory issues—not liver-related symptoms like jaundice.
B) An idiosyncratic drug effect on the bone marrow:
Would more likely cause blood-related issues such as anemia, infection, or bleeding—not liver-specific signs.
C) Iatrogenic disease of the skin:
Refers to a skin condition caused by medical treatment, not systemic liver symptoms like jaundice or digestive distress.
2.
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body?
- A) It stimulates the liver to convert glycogen to glucose.
- B) It promotes the synthesis of amino acids into glucose.
- C) It stimulates the pancreas to reabsorb glucose.
- D) It promotes the passage of glucose into cells for energy.
Explanation
Explanation
Insulin is a hormone produced by the pancreas that allows glucose to enter cells, where it can be used for energy. Without insulin, glucose stays in the bloodstream, leading to high blood sugar levels. In type 1 diabetes, the body doesn’t produce insulin, so glucose can’t move into the cells properly.
Why the other options are incorrect:
A) It stimulates the liver to convert glycogen to glucose:
This is the action of glucagon, not insulin. Insulin promotes glucose storage, not release.
B) It promotes the synthesis of amino acids into glucose:
This describes gluconeogenesis, a process insulin typically inhibits.
C) It stimulates the pancreas to reabsorb glucose:
The pancreas produces insulin; it doesn’t reabsorb glucose. This is not a function of insulin.
Insulin is a hormone produced by the pancreas that allows glucose to enter cells, where it can be used for energy. Without insulin, glucose stays in the bloodstream, leading to high blood sugar levels. In type 1 diabetes, the body doesn’t produce insulin, so glucose can’t move into the cells properly.
Why the other options are incorrect:
A) It stimulates the liver to convert glycogen to glucose:
This is the action of glucagon, not insulin. Insulin promotes glucose storage, not release.
B) It promotes the synthesis of amino acids into glucose:
This describes gluconeogenesis, a process insulin typically inhibits.
C) It stimulates the pancreas to reabsorb glucose:
The pancreas produces insulin; it doesn’t reabsorb glucose. This is not a function of insulin.
3.
A patient with a history of hypertension is admitted for a procedure. If the patient's blood pressure decreases, which clinical manifestation would the nurse expect to see?
- A) Decreased heart rate
- B) Erythema
- C) Increased temperature
- D) Increased heart rate
Explanation
Explanation
When blood pressure drops, the body compensates by activating the sympathetic nervous system, which causes the heart to beat faster to maintain adequate perfusion to vital organs. This results in increased heart rate (tachycardia), a common physiological response to hypotension.
Why the other options are incorrect:
A) Decreased heart rate:
Bradycardia would not be expected in response to hypotension; it would worsen perfusion.
B) Erythema:
This refers to skin redness, often due to inflammation or infection, not related to changes in blood pressure.
C) Increased temperature:
Temperature changes are usually linked to infection or inflammation, not directly to blood pressure changes.
When blood pressure drops, the body compensates by activating the sympathetic nervous system, which causes the heart to beat faster to maintain adequate perfusion to vital organs. This results in increased heart rate (tachycardia), a common physiological response to hypotension.
Why the other options are incorrect:
A) Decreased heart rate:
Bradycardia would not be expected in response to hypotension; it would worsen perfusion.
B) Erythema:
This refers to skin redness, often due to inflammation or infection, not related to changes in blood pressure.
C) Increased temperature:
Temperature changes are usually linked to infection or inflammation, not directly to blood pressure changes.
4.
The nurse knows the most critical concern for a patient with peptic ulcer disease is:
- A) Gastric bleeding
- B) Heartburn
- C) Insomnia
- D) Malnutrition
Explanation
Explanation
The most serious and potentially life-threatening complication of peptic ulcer disease is gastric bleeding. This can occur when an ulcer erodes through the lining of the stomach or duodenum and damages a blood vessel. Symptoms may include vomiting blood (hematemesis), black tarry stools (melena), or signs of shock. Prompt recognition and treatment are critical.
Why the other options are incorrect:
B) Heartburn:
While uncomfortable and common, heartburn is a symptom—not a critical complication.
C) Insomnia:
May result from discomfort or medication use, but it is not a life-threatening issue related to peptic ulcers.
D) Malnutrition:
Can occur over time due to decreased appetite or pain with eating, but it develops gradually and is less immediately dangerous than bleeding.
The most serious and potentially life-threatening complication of peptic ulcer disease is gastric bleeding. This can occur when an ulcer erodes through the lining of the stomach or duodenum and damages a blood vessel. Symptoms may include vomiting blood (hematemesis), black tarry stools (melena), or signs of shock. Prompt recognition and treatment are critical.
Why the other options are incorrect:
B) Heartburn:
While uncomfortable and common, heartburn is a symptom—not a critical complication.
C) Insomnia:
May result from discomfort or medication use, but it is not a life-threatening issue related to peptic ulcers.
D) Malnutrition:
Can occur over time due to decreased appetite or pain with eating, but it develops gradually and is less immediately dangerous than bleeding.
5.
A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication?
- A) Diphenhydramine [Benadryl]
- B) Loratadine [Claritin]
- C) Ibuprofen [Motrin]
- D) Multivitamin
Explanation
Explanation
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can interfere with the antiplatelet effect of low-dose aspirin when taken concurrently. It may reduce aspirin’s cardioprotective benefits and increase the risk of gastrointestinal bleeding. Patients taking daily aspirin for heart protection are advised to avoid ibuprofen or to consult a healthcare provider about proper timing if absolutely needed.
Why the other options are incorrect:
A) Diphenhydramine [Benadryl]:
An antihistamine used for allergies and sleep aid. It doesn’t interfere with aspirin’s antiplatelet effect.
B) Loratadine [Claritin]:
A non-sedating antihistamine, safe to use with low-dose aspirin.
D) Multivitamin:
Generally safe unless it contains high doses of vitamin E, which may slightly affect bleeding risk—but not in the way NSAIDs like ibuprofen do.
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can interfere with the antiplatelet effect of low-dose aspirin when taken concurrently. It may reduce aspirin’s cardioprotective benefits and increase the risk of gastrointestinal bleeding. Patients taking daily aspirin for heart protection are advised to avoid ibuprofen or to consult a healthcare provider about proper timing if absolutely needed.
Why the other options are incorrect:
A) Diphenhydramine [Benadryl]:
An antihistamine used for allergies and sleep aid. It doesn’t interfere with aspirin’s antiplatelet effect.
B) Loratadine [Claritin]:
A non-sedating antihistamine, safe to use with low-dose aspirin.
D) Multivitamin:
Generally safe unless it contains high doses of vitamin E, which may slightly affect bleeding risk—but not in the way NSAIDs like ibuprofen do.
6.
A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest?
- A) The patient should increase the dose until pain is controlled.
- B) The patient should use a first-generation nonsteroidal anti-inflammatory medication instead.
- C) The patient should use acetaminophen because of its anti-inflammatory effects.
- D) The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome.
Explanation
Explanation
First-generation NSAIDs like ibuprofen or naproxen are often more effective than aspirin for treating menstrual cramps, as they provide stronger COX inhibition, which reduces the production of prostaglandins responsible for uterine contractions and pain. These medications are commonly recommended for dysmenorrhea.
Why the other options are incorrect:
A) The patient should increase the dose until pain is controlled:
Increasing aspirin dosage without guidance can raise the risk of toxicity and bleeding.
C) The patient should use acetaminophen because of its anti-inflammatory effects:
Acetaminophen is not a strong anti-inflammatory and is generally less effective for menstrual cramps compared to NSAIDs.
D) The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome:
Reye's syndrome is a concern with aspirin use in children and teenagers, especially during viral illnesses—not in adult women treating menstrual cramps.
First-generation NSAIDs like ibuprofen or naproxen are often more effective than aspirin for treating menstrual cramps, as they provide stronger COX inhibition, which reduces the production of prostaglandins responsible for uterine contractions and pain. These medications are commonly recommended for dysmenorrhea.
Why the other options are incorrect:
A) The patient should increase the dose until pain is controlled:
Increasing aspirin dosage without guidance can raise the risk of toxicity and bleeding.
C) The patient should use acetaminophen because of its anti-inflammatory effects:
Acetaminophen is not a strong anti-inflammatory and is generally less effective for menstrual cramps compared to NSAIDs.
D) The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome:
Reye's syndrome is a concern with aspirin use in children and teenagers, especially during viral illnesses—not in adult women treating menstrual cramps.
7.
A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?
- A) Monitor plasma drug levels
- B) Administer this medication intravenously
- C) Administer the drug at intervals longer than the drug half-life
- D) Teach the patient that maximum drug effects will occur within a short period
Explanation
Explanation
Drugs with a narrow therapeutic range have a small margin between therapeutic and toxic doses. Because of this, the nurse must monitor plasma drug levels closely to ensure the drug concentration stays within the safe and effective range. This helps prevent toxicity or subtherapeutic effects.
Why the other options are incorrect:
B) Administer this medication intravenously:
Route of administration depends on the drug, not its therapeutic range. Narrow-range drugs can be oral, IV, or other forms.
C) Administer the drug at intervals longer than the drug half-life:
This could lead to subtherapeutic levels. Dosing is usually more frequent to maintain steady levels.
D) Teach the patient that maximum drug effects will occur within a short period:
The timing of effects varies with each drug and is not directly related to the therapeutic range.
Drugs with a narrow therapeutic range have a small margin between therapeutic and toxic doses. Because of this, the nurse must monitor plasma drug levels closely to ensure the drug concentration stays within the safe and effective range. This helps prevent toxicity or subtherapeutic effects.
Why the other options are incorrect:
B) Administer this medication intravenously:
Route of administration depends on the drug, not its therapeutic range. Narrow-range drugs can be oral, IV, or other forms.
C) Administer the drug at intervals longer than the drug half-life:
This could lead to subtherapeutic levels. Dosing is usually more frequent to maintain steady levels.
D) Teach the patient that maximum drug effects will occur within a short period:
The timing of effects varies with each drug and is not directly related to the therapeutic range.
8.
A patient has had blood pressures of 150/95 and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order:
- A) An adrenergic neuron blocker
- B) A beta blocker
- C) Counseling on lifestyle changes
- D) A thiazide diuretic
Explanation
Explanation
This patient meets the criteria for Stage 1 hypertension (systolic 130–139 or diastolic 80–89 mm Hg), but with normal diagnostic tests and no evidence of end-organ damage, the first-line recommendation is lifestyle modification. These include dietary changes, exercise, weight loss, limiting alcohol, and reducing sodium intake. Medications are typically considered if lifestyle changes are ineffective or if the patient has additional risk factors.
Why the other options are incorrect:
A) An adrenergic neuron blocker:
These are rarely used due to significant side effects and are not first-line treatment.
B) A beta blocker:
Beta blockers are not recommended as initial therapy for uncomplicated hypertension unless the patient has other conditions like heart failure or post-MI.
D) A thiazide diuretic:
Although effective, this medication would be considered after lifestyle changes have been attempted and failed or if additional risk factors exist.
This patient meets the criteria for Stage 1 hypertension (systolic 130–139 or diastolic 80–89 mm Hg), but with normal diagnostic tests and no evidence of end-organ damage, the first-line recommendation is lifestyle modification. These include dietary changes, exercise, weight loss, limiting alcohol, and reducing sodium intake. Medications are typically considered if lifestyle changes are ineffective or if the patient has additional risk factors.
Why the other options are incorrect:
A) An adrenergic neuron blocker:
These are rarely used due to significant side effects and are not first-line treatment.
B) A beta blocker:
Beta blockers are not recommended as initial therapy for uncomplicated hypertension unless the patient has other conditions like heart failure or post-MI.
D) A thiazide diuretic:
Although effective, this medication would be considered after lifestyle changes have been attempted and failed or if additional risk factors exist.
9.
The healthcare provider orders Lasix 40 mg IV now. The concentration available is Lasix 20 mg/mL. How many mL will the patient receive?
- A) 5 mL
- B) 6 mL
- C) 4 mL
- D) 2 mL
Explanation
Explanation
Use the formula:
Ordered dose ÷ Concentration = Volume to administer
40 mg ÷ 20 mg/mL = 2 mL
The patient will receive 2 mL of the IV Lasix solution to get the prescribed 40 mg dose.
Why the other options are incorrect:
A) 5 mL:
5 mL × 20 mg/mL = 100 mg, which is more than ordered.
B) 6 mL:
6 mL × 20 mg/mL = 120 mg, which exceeds the prescribed dose.
C) 4 mL:
4 mL × 20 mg/mL = 80 mg, which is twice the ordered amount.
Use the formula:
Ordered dose ÷ Concentration = Volume to administer
40 mg ÷ 20 mg/mL = 2 mL
The patient will receive 2 mL of the IV Lasix solution to get the prescribed 40 mg dose.
Why the other options are incorrect:
A) 5 mL:
5 mL × 20 mg/mL = 100 mg, which is more than ordered.
B) 6 mL:
6 mL × 20 mg/mL = 120 mg, which exceeds the prescribed dose.
C) 4 mL:
4 mL × 20 mg/mL = 80 mg, which is twice the ordered amount.
10.
A patient is taking a drug that has known toxic side effects. What will the nurse do?
- A) Instruct patient on the importance of monitoring the function of all organs potentially affected by the drug.
- B) Ensure that complete blood counts are ordered periodically.
- C) Discontinue all the patient's medications
- D) Instruct the patient they should only follow-up if symptoms develop.
Explanation
Explanation
When a patient is prescribed a medication with known toxic effects, it is essential for the nurse to educate the patient about ongoing monitoring, including the need for regular testing of affected organs (e.g., liver, kidneys, heart). This helps detect early signs of toxicity and ensures safe continuation of therapy.
Why the other options are incorrect:
B) Ensure that complete blood counts are ordered periodically:
While appropriate for drugs that affect blood cells, it may not cover all organ systems affected. Broader monitoring is usually needed.
C) Discontinue all the patient's medications:
This is inappropriate unless directed by the healthcare provider. Stopping medications abruptly could be harmful.
D) Instruct the patient they should only follow-up if symptoms develop:
This is unsafe, as toxic effects can be silent or progress before symptoms appear. Proactive monitoring is essential.
When a patient is prescribed a medication with known toxic effects, it is essential for the nurse to educate the patient about ongoing monitoring, including the need for regular testing of affected organs (e.g., liver, kidneys, heart). This helps detect early signs of toxicity and ensures safe continuation of therapy.
Why the other options are incorrect:
B) Ensure that complete blood counts are ordered periodically:
While appropriate for drugs that affect blood cells, it may not cover all organ systems affected. Broader monitoring is usually needed.
C) Discontinue all the patient's medications:
This is inappropriate unless directed by the healthcare provider. Stopping medications abruptly could be harmful.
D) Instruct the patient they should only follow-up if symptoms develop:
This is unsafe, as toxic effects can be silent or progress before symptoms appear. Proactive monitoring is essential.
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