NUR 635 MIDTERM EXAM NEWEST

NUR 635 MIDTERM EXAM NEWEST

EXAM ALL 75 QUESTIONS AND CORRECT DETAILED

ANSWERS WITH ADDITIONAL EXTRA POINTS FOR

REVIEW |ALREADY GRADED A+

• A woman who is breastfeeding her infant must take a prescription

medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do? (65)

• Give the baby formula as long as the mother is taking the

medication

• Take the medication immediately after breastfeeding
• Pump breast milk and feed the baby by bottle
• Take the medication 1 hour before breastfeeding

(ANS: B) Taking the medication immediately after breastfeeding minimizes

the drug concentration in the breast milk at the next feeding. Disrupting breastfeeding is not indicated. Pumping the breast milk will not diminish the drugs or drug concentration in the breast milk. Taking the medication

• hour before breastfeeding will increase concentrations of the drug in the

breast milk.

• A pregnant patient is in premature labor. Which class of drug will

she be given? (40)

• Alpha1 agonist
• Anticholinergic
• Beta2 agonist
• Beta2 antagonist

(ANS: C) Beta2 agonists cause relaxation of uterine muscle, slowing or

stopping the contractions that precipitate labor. An alpha1 agonist would have effects on the heart and arterioles. Anticholinergic drugs generally are given for their effects on the urinary and GI tracts and do not affect uterine muscle. A beta2 antagonist would cause increased constriction of uterine muscle. 1 / 4

• A patient with type 1 diabetes is taking NPH insulin, 30 units every day.

A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the patient? (63)

• “Metoprolol has no effect on diabetes mellitus or on your

insulin requirements.”

• “Metoprolol interferes with the effects of insulin, so you may need to

increase your insulin dose.”

• “Metoprolol may mask signs of hypoglycemia, so you need

to monitor your blood glucose closely.”

• “Metoprolol may potentiate the effects of the insulin, so the dose

should be reduced.”

(ANS: C) Because metoprolol may mask the signs of hypoglycemia, the

patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to- drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels.

• Which are conditions that may be treated using beta blockers? Select

all that apply. (68)

• Cardiac dysrhythmias
• Heart failure
• Hypotension
• Hypothyroidism
• Stage fright 2 / 4

(ANS: A , B , E) Beta blockers are used to treat cardiac dysrhythmias,

heart failure, and stage fright. They are used to treat hypertension and hyperthyroidism.

• A patient taking a beta blocker complains of shortness of breath. The

patient has respirations of 28 breaths/minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats/minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are

consistent with: (72)

• Bronchoconstriction.
• Left-sided heart failure.
• Rebound cardiac excitation.
• Sinus bradycardia.

(ANS: B) The signs and symptoms describe left-sided heart failure, in

which the blood normally handled by the left ventricle and forced out through the aorta into the body backs up into the lungs, producing respiratory signs and symptoms. The patient’s signs and symptoms are not indicative of bronchoconstriction, which would cause wheezing and diminished breath sounds.Rebound cardiac excitation occurs when the beta blocker is withdrawn, not during administration of the drug. The patient’s heart rate is elevated, so sinus bradycardia is not present.

• A prescriber orders clonidine [Kapvay] ER tablets for a 12-year- old

child. The nurse understands that this drug is being given to treat which condition? (83)

A. ADHD

• Hypertension
• Severe pain
• Tourette syndrome

(ANS: A) Kapvay ER is used to treat ADHD and is given as a single dose

at bedtime. This form of clonidine is not used for hypertension, severe pain, or treatment of Tourette syndrome. 3 / 4

• A nurse is teaching a group of nurses about Parkinson medications.

The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine

agonists is: (105)

• Sleep attacks.
• Dizziness.
• Hallucinations.
• Dyskinesias.

(ANS: A) A few patients taking pramipexole have experienced sleep

attacks, or an overwhelming and irresistible sleepiness that comes on without warning. Dizziness, hallucinations, and dyskinesias are listed as side effects of pramipexole and other dopamine agonists.

• A patient is taking a combination oral contraceptive (OC) and tells the

nurse that she is planning to undergo knee replacement surgery in 2 months. What will the nurse recommend for this patient? (498)

• The patient should ask her provider about an OC with less

progestin.

• The patient should discuss an alternative method of birth

control prior to surgery.

• The patient should request an OC containing less estrogen

after surgery.

• The patient should take the OC at bedtime after her surgery to

reduce side effects.

(ANS: B) Patients taking an OC who undergo surgery in which

immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The estrogen-containing OC should be stopped 4 weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.

• / 4