NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions)

Page 1 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 1 preview image

NR 508 Final ExamQuestion 12 / 2 ptsA patient who has diabetes reports intense discomfort when needing to void. Aurinalysis is normal. To treat this, the primary care NP should considerprescribing:flavoxate (Urispas).bethanechol (Urecholine).phenazopyridine (Pyridium).Correct!oxybutynin chloride (Ditropan XL).This patient is describing urge incontinence, or overactive bladder, which occurswhen the detrusor muscle is hyperactive, causing an intense urge to void beforethe bladder is full. Urge incontinence is associated with many conditions,including diabetes. Oxybutynin chloride, which is an anticholinergic, acts todecrease detrusor overactivity and is indicated for treatment of urgeincontinence. Flavoxate is used to treat dysuria associated with UTI. Bethanecholis indicated for urinary retention. Phenazopyridine is used to treat dysuria.Question 22 / 2 ptsA patient reports difficulty returning to sleep after getting up to go to the bathroomevery night. A physical examination and a sleep hygiene history arenoncontributory. The primary care NP should prescribe:zaleplon.Correct!ZolpiMist.ramelteon.

Page 2 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 2 preview image

Page 3 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 3 preview image

chloral hydrate.ZolpiMist oral spray is useful for patients who have trouble returning to sleep inthe middle of the night. Zaleplon and ramelteon are used for insomnia caused bydifficulty with sleep onset. Chloral hydrate is not typically used as outpatienttherapy.Question 32 / 2 ptsA 5-year-old child who has no previous history of otitis media is seen in clinic witha temperature of 100° F. The primary care NP visualizes bilateral erythematous,nonbulging, intact tympanic membranes. The child is taking fluids well and isplaying with toys in the examination room. The NP should:prescribe azithromycin once daily for 5 days.prescribe amoxicillin twice daily for 10 days.prescribe amoxicillin-clavulanate twice daily for 10 days.Correct!initiate antibiotic therapy if the child’s condition worsens.Signs and symptoms of otitis media that indicate a need for antibiotic treatmentinclude otalgia, fever, otorrhea, or a bulging yellow or red tympanic membrane.This child has a low-grade fever, no history of otitis media, a nonbulging tympanicmembrane, and no otorrhea, so watchful waiting is appropriate. When anantibiotic is started, amoxicillin is the drug of choice.Question 42 / 2 ptsAn 80-year-old patient with congestive heart failure has a viral upper respiratoryinfection. The patient asks the primary care NP about treating the fever, which is38.5° C. The NP should:Correct!recommend acetaminophen.

Page 4 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 4 preview image

recommend high-dose acetaminophen.tell the patient that antibiotics are needed with a fever that high.tell the patient a fever less than 40° C does not need to be treated.Patients with congestive heart failure may have tachycardia from fever thataggravates their symptoms, so fever should be treated. High doses should begiven with caution in elderly patients because of possible decreased hepaticfunction. Antibiotics should not be given without evidence of bacterial infection.Question 52 / 2 ptsA patient who takes levodopa and carbidopa for Parkinson’s disease reportsexperiencing freezing episodes between doses. The primary care NP shouldconsider using:selegiline.amantadine.Correct!apomorphine.modified-release levodopa.Apomorphine injection is used for acute treatment of immobility known as“freezing.”Question 62 / 2 ptsA patient is being tapered from long-term therapy with prednisolone and reportsweight loss and fatigue. The primary care NP should counsel this patient to:consume foods high in vitamin D and calcium.begin taking dexamethasone because it has longer effects.

Page 5 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 5 preview image

expect these side effects to occur as the medication is tapered.Correct!increase the dose of prednisolone to the most recent amount taken.Sudden discontinuation or rapid tapering of glucocorticoids in patients who havedeveloped adrenal suppression can precipitate symptoms of adrenalinsufficiency, including nausea, weakness, depression, anorexia, myalgia,hypotension, and hypoglycemia. When patients experience these symptomsduring a drug taper, the dose should be increased to the last dose. Vitamin Ddeficiency is common while taking glucocorticoids, but these are not symptoms ofvitamin D deficiency. Changing to another glucocorticoid is not recommended.Patients should be taught to report the side effects so that action can be takenand should not be told that they are to be expected.Question 72 / 2 ptsThe primary care nurse practitioner (NP) sees a 50-year-old woman who reportsfrequent leakage of urine. The NP learns that this occurs when she laughs orsneezes. She also reports having an increased urge to void even when herbladder is not full. She is not taking any medications. The NP should:Correct!perform a dipstick urinalysis.prescribe desmopressin (DDAVP).prescribe oxybutynin chloride (Ditropan XL).teach exercises to strengthen the pelvic muscles.A focused history with a careful physical examination is essential for determiningthe cause of incontinence. Urinalysis can rule out urinary tract infection (UTI),which can cause incontinence. Medications are prescribed after determining thecause, if any, and treating underlying conditions. Exercises to strengthen thepelvic muscles are part of treatment.Question 82 / 2 pts

Page 6 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 6 preview image

A 7-year-old patient who has severe asthma takes oral prednisone daily. At awell-child examination, the primary care NP notes a decrease in the child’s lineargrowth rate. The NP should consult the child’s asthma specialist about:gradually tapering the child off the prednisone.a referral for possible growth hormone therapy.Correct!giving a double dose of prednisone every other day.dividing the prednisone dose into twice-daily dosing.Administration of a double dose of a glucocorticoid every other morning has beenfound to cause less suppression of the HPA axis and less growth suppression inchildren. Because the child has severe asthma, an oral steroid is necessary.Growth hormone therapy is not indicated. Twice-daily dosing would not changethe HPA axis suppression.Question 92 / 2 ptsA patient who is taking isoniazid and rifampin for latent TB is seen by the primarycare NP for a routine follow-up visit. The patient reports having nausea, vomiting,and a decreased appetite. The NP should:Correct!ask about alcohol intake.suggest taking the medications with food.reassure the patient that these side effects are common.order liver and renal function tests and serum glucose.Concomitant use of alcohol with isoniazid increases the risk of hepatitis. Thispatient shows signs of hepatitis, so the NP should ask about alcoholconsumption. Isoniazid should be taken on an empty stomach.

Page 7 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 7 preview image

Question 102 / 2 ptsA primary care NP sees a child with asthma to evaluate the child’s response tothe prescribed therapy. The child uses an ICS twice daily and an albuterolmetered-dose inhaler as needed. The child’s symptoms are well controlled. TheNP notes slowing of the child’s linear growth on a standardized growth chart. TheNP should change this child’s medication regimen to a:combination ICS/LABA inhaler twice daily.short-acting β2-agonist (SABA) with oral corticosteroids when symptomatic.combination ipratropium/albuterol inhaler twice daily.Correct!SABA as needed plus a leukotriene modifier once daily.A leukotriene modifier may be used as an alternative to ICS for children whoexperience systemic side effects of the ICS. This child’s symptoms are wellcontrolled, so there is no need to step up therapy to include a LABA. Oralcorticosteroids should be used only for severe exacerbations. Ipratropium andalbuterol are used for severe exacerbations.Question 112 / 2 ptsA patient is newly diagnosed with Alzheimer’s disease stage 6 on the GlobalDeterioration Scale. The primary care NP should prescribe:donepezil (Aricept).rivastigmine (Exelon).Correct!memantine (Namenda).galantamine (Razadyne).

Page 8 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 8 preview image

Patients with moderate to severe dementia (stages 5 to 7) may be started onmemantine.Question 122 / 2 ptsThe primary care NP sees a 12-month-old infant who needs the MMR, Varivax,influenza, and hepatitis A vaccines. The child’s mother tells the NP that she ispregnant. The NP should:Correct!administer all of these vaccines today.give the hepatitis A and influenza vaccines.give the Varivax, hepatitis A, and influenza vaccines.withhold all of these vaccines until after the baby is born.Although live-virus vaccines should not be administered to mothers duringpregnancy, they may be given to children whose mothers are pregnant.Question 132 / 2 ptsA parent brings a 5-year-old child to a clinic for a hospital follow-up appointment.The child is taking a medication at a dose equal to an adult dose. The parentreports that the medication is not producing the desired effects. The NP should:order renal function tests.prescribe another medication to treat this child’s symptoms.discontinue the drug and observe the child for toxic side effects.Correct!obtain a serum drug level and consider increasing the drug dose.By a child’s first birthday, the liver’s metabolic capabilities are not only mature butalso more vigorous than the adult liver, meaning that certain drugs may need tobe given in higher doses or more often. It is prudent to obtain a serum drug level

Page 9 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 9 preview image

and then consider increasing the dose to achieve the desired effect. Renalfunction tests are not indicated. Unless the child is experiencing toxic effects, thedrug does not need to be discontinued.Question 142 / 2 ptsAn NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterolmetered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing fora 65-year-old patient with recent onset of reactive airways disease who reportssymptoms occurring every 1 or 2 weeks. At a follow-up appointment severalmonths later, the patient reports no change in frequency of symptoms. The NP’sinitial action should be to:order spirometry to evaluate pulmonary function.prescribe a systemic corticosteroid to help with symptoms.Correct!ask the patient to describe how the medications are taken each day.give the patient detailed information about the use of metered-dose inhalers.It is essential to explore with the older patient what he or she is actually doingwith regard to daily medication use and compare this against the “prescribed”medication regimen before ordering further tests, prescribing any increase inmedications, or providing further education.Question 152 / 2 ptsA patient is diagnosed with a condition that causes chronic pain. The primarycare NP prescribes an opioid analgesic and should instruct the patient to:wait until the pain is at a moderate level before taking the medication.Correct!take the medication at regular intervals and not just when pain is present.start the medication at higher doses initially and taper down gradually.take the minimum amount needed even when pain is severe to avoiddependency.

Page 10 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 10 preview image

Chronic pain requires routine administration of drugs, and patients should takeanalgesics routinely without waiting for increased pain.Question 162 / 2 ptsA patient tells the primary care NP that he has difficulty getting and maintainingan erection. The NP’s initial response should be to:prescribe sildenafil (Viagra).Correct!perform a medication history.evaluate his cardiovascular status.order a papaverine injection test to screen for erectile dysfunction.Because the use of multiple medications is associated with a higher prevalenceof erectile dysfunction, a medication history should be performed first to see ifany medications have sexual side effects. A cardiovascular evaluation may beassessed next. Papaverine injection tests are useful screening tools after athorough history has been performed. Medications are prescribed only after adiagnosis is determined and other causes have been ruled out.Question 172 / 2 ptsA 55-year-old patient develops Parkinson’s disease characterized by unilateraltremors only. The primary care NP will refer the patient to a neurologist andshould expect initial treatment to be:levodopa.carbidopa.Correct!pramipexole.

Page 11 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 11 preview image

carbidopa/levodopa.Patients younger than 65 years of age should be started with a dopamineagonist.Question 182 / 2 ptsA patient who has migraine headaches without an aura reports difficulty treatingthe migraines in time because they come on so suddenly. The patient has beenusing over-the-counter NSAIDs. The primary care NP should prescribe:frovatriptan (Frova).Correct!sumatriptan (Imitrex).cyproheptadine (Periactin).dihydroergotamine (D.H.E. 45).If the patient is able to take medication at the earliest onset of migraine, ergotsare usually effective. Triptans are more effective when patients have difficulty“catching the headache in time.” Sumatriptan begins to work in 15 minutes andso would be indicated for this patient. Frovatriptan has a longer half-life.Cyproheptadine is not a first-line migraine treatment.Question 192 / 2 ptsA woman tells a primary care NP that she is considering getting pregnant. Duringa health history, the NP learns that the patient has seasonal allergies, asthma,and epilepsy, all of which are well controlled with a second-generationantihistamine daily, an inhaled steroid daily with albuterol as needed, and anantiepileptic medication daily. The NP should counsel this patient to:take her asthma medications only when she is having an acute exacerbation.Correct!avoid using antihistamine medications during her first trimester of pregnancy.

Page 12 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 12 preview image

discontinue her seizure medications at least 6 months before becomingpregnant.use only oral corticosteroids and not inhaled steroids while pregnant for improvedasthma control.Optimal treatment of asthma during pregnancy includes treatment of comorbidallergic rhinitis, which can trigger symptoms. Antihistamines are recommendedafter the first trimester, if possible. Asthma medications should be continuedduring pregnancy because poorly controlled asthma can be detrimental to thefetus; she should continue using her daily inhaled corticosteroid. Althoughdiscontinuing seizure medications is optimal, this must be done in conjunctionwith this woman’s neurologist because management of epilepsy duringpregnancy is beyond the scope of the primary care provider. Oral corticosteroidshave greater systemic side effects and greater effects on the fetus and should beused only as necessary.Question 202 / 2 ptsA patient who has partial seizures has been taking phenytoin (Dilantin). Thepatient has recently developed thrombocytopenia. The primary care nursepractitioner (NP) should contact the patient’s neurologist to discuss changing thepatient’s medication to:topiramate (Topamax).levetiracetam (Keppra).zonisamide (Zonegran).Correct!carbamazepine (Tegretol).Evidence-based recommendations exist showing carbamazepine to be effectiveas monotherapy for partial seizures. Because this patient has developed aserious side effect of phenytoin, changing to carbamazepine may be a goodoption. The other three drugs may be added to phenytoin or another first-linedrug when drug-resistant seizures occur, but are not recommended asmonotherapy.Question 21

Page 13 of 13

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 13 preview image

2 / 2 ptsA patient is taking dicloxacillin (Dynapen) 500 mg every 6 hours to treat a severepenicillinase-resistant infection. At a 1-week follow-up appointment, the patientreports nausea, vomiting, and epigastric discomfort. The primary care NP should:change the medication to a cephalosporin.decrease the dose to 250 mg every 6 hours.reassure the patient that these are normal adverse effects of this drug.Correct!order blood cultures, a white blood cell (WBC) count with differential, and liverfunction tests (LFTs).When giving penicillinase-resistant penicillins, it is important to monitor therapywith blood cultures, WBC with differential cell counts, and LFTs before treatmentand weekly during treatment. This patient may have typical gastrointestinal sideeffects, but the symptoms may also indicate hepatic damage. Changing themedication is not indicated, unless serious side effects are present. Decreasingthe dose is not indicated.Question 222 / 2 ptsA 75-year-old patient who lives alone will begin taking a narcotic analgesic forpain. To help ensure patient safety, the NP prescribing this medication should:assess this patient’s usual sleeping patterns.ask the patient about problems with constipation.obtain a baseline creatinine clearance test before the first dose.Correct!perform a thorough evaluation of cognitive and motor abilities.The body system most significantly affected by increased receptor sensitivity inelderly patients is the central nervous system, making this population sensitive tonumerous drugs. It is important to evaluate motor and cognitive function before

Preview Mode

This document has 41 pages. Sign in to access the full document!

Report

Learning Tools

Writing Tools

Browse Resources

NR508 Nursing Diagnosis Final Exam With Answers (75 Solved Questions) - Page 1

Study Now!

Document Details

Related Documents

Laboratory 8 Muscle Soreness Lab Manual

Case Diana

Identifying a Local Healthcare Economic Issue

Dashboard Metrics Evaluation 1 Dashboard Metrics E

NRP 563 DQ 2

NRP 563 DQ 7

Clinical Supervision Report Week 2

NU 185 Exam 5 Final

NURS FPX 4010 Assessment 3

Strategies for Difficult Venipuncture

Company

Explore

Study Tools