NUR-635 final exam review
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is
taking oral contraceptives. What will the nurse tell the patient?
a. She may need to increase her dose of phenytoin while taking oral contraceptives.
b. She should consider a different form of birth control while taking phenytoin.
c. She should remain on oral contraceptives, because phenytoin causes birth defects.
d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin.
b. She should consider a different form of birth control while taking phenytoin.
Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding
pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of
oral contraceptives or use an alternative method of birth control.
A nurse is caring for a patient who recently immigrated from a third world country. The patient is
thin and appears malnourished. The nurse notes that the patient has loose and missing teeth,
gingivitis, and bleeding gums. The patient has multiple sores and ecchymoses. The nurse will expect
the provider to order?
a. Cyanocobalamin (vitamin B12)
b. High-dose nicotinic acid
c. Intramuscular thiamine for 1 to 2 weeks
d. Intravenous ascorbic acid d. Intravenous ascorbic acid
This patient has scurvy with acute, severe symptoms, and needs intravenous vitamin C.
First line drug of choice for community acquired pneumonia in a previously healthy is?
a. Penicillin
b. Amoxicillin
c. Azithromycin
d. Levaquin c. Azithromycin
One month after starting phenytoin for seizures, a 28-year-old male presents with complaints of
fever, rash, and swollen lymph nodes. The NP suspects which syndrome?
,a. Phenytoin toxicity
b. Phenytoin hypersensitivity reaction
c. Normal side effects of phenytoin
d. Mononucleosis b. Phenytoin hypersensitivity reaction
A patient with previous compliant levels of carbamazepine now presents with subtherapeutic blood
levels. The NP suspects?
a. Noncompliance
b. Patient financial strain
c. Malnutrition
d. Expected lab finding d. Expected lab finding
Carbamazepine auto induces metabolism leading to lower levels of the drug.
The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir,
zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the
nurse finds a rash and notes that the patient has a temperature of 101.1 F. What is the nurse's best
course of action?
a. Tell the patient that this is an expected response to these medications and to continue the agents
as prescribed
b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber
c. Have the patient continue the abacavir but discontinue the other two agents for 3 weeks
d. Instruct the patient to continue all three medications and administer an antihistamine for the
symptoms b. Have the patient hold the medications and arrange for an immediate evaluation
by the prescriber
a.
ANS: B- The patient is showing early symptoms of a fatal hypersensitivity reaction.
The NP educates the patient regarding the black box warning on carbamazepine by advising the
patient to report signs and symptoms indicative of?
a. Liver toxicity
b. Kidney failure
c. Skin reaction
,d. Suicidal tendencies c. Skin reaction
Carbamazepine can cause SJS and TEN (toxic epidermal necrolysis)
Carbamazepine monitoring should include all of the following except?
a. Routine CBC
b. Osteoporosis screening
c. Carbamazepine drug levels
d. Monthly glucose d. Monthly glucose
A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would
prompt the nurse to hold the drug and notify the prescriber for further assessment?
a. "I get a little dizzy sometimes"
b. "I had a headache last week that lasted for about an hour"
c. "I've broken out in a rash on my chest and back"
d. "Last night I woke up twice with a bad dream" c. "I've broken out in a rash on my chest and
back"
Rash may indicate development of Stevens-Johnson Syndrome.
A young woman taking Lamictal for seizures presents to the office requesting birth control. She has
decided she wants daily oral contraceptives. The NP educates the patient regarding the fact?
a. Oral contraceptives will interact with Lamictal and are not a good option
b. Oral contraceptives can cause Lamictal levels to become toxic
c. Lamictal doses will need to be increased while taking oral contraceptives
d. Back up contraceptives will need to be used if taking Lamictal c. Lamictal doses will need to be
increased while taking oral contraceptives
Tricyclic antidepressants should be avoided in?
a. Smokers
b. Heart failure patients
c. Native americans
, d. CYP450 gene mutation patients b. Heart failure patients
When educating patients regarding antidepressants, the NP should include?
a. It may take 2-3 days for medications to take effect
b. It may take 2-3 weeks for medications to take effect
c. Oral contraceptives will require a back up method
d. An improvement in depression means the medication is effective b. It may take 2-3 weeks for
medications to take effect
After ordering IM Haldol for the patient, the NP knows to assess for EPS using which tool?
a. Peak and trough levels
b. Continuous EKG monitoring
c. AIMS test
d. MMEc. AIMS test
AIMS is the abnormal involuntary movement scale
Prior to administering albuterol for an acute asthma attack, the NP understands that?
a. These two medications cannot be given together
b. Digoxin dosage will need to be increased
c. Digoxin dosage will need to be decreased
d. The patient should be hooked up to continuous EKG monitoring b. Digoxin dosage will need
to be increased
Albuterol can decrease digoxin levels by 16%-22%.
The NP opts NOT to give a beta agonist to which patient?
a. Asthmatic
b. Allergic reaction
c. History of pheochromocytoma
d. Bronchoconstriction c. History of pheochromocytoma
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is
taking oral contraceptives. What will the nurse tell the patient?
a. She may need to increase her dose of phenytoin while taking oral contraceptives.
b. She should consider a different form of birth control while taking phenytoin.
c. She should remain on oral contraceptives, because phenytoin causes birth defects.
d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin.
b. She should consider a different form of birth control while taking phenytoin.
Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding
pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of
oral contraceptives or use an alternative method of birth control.
A nurse is caring for a patient who recently immigrated from a third world country. The patient is
thin and appears malnourished. The nurse notes that the patient has loose and missing teeth,
gingivitis, and bleeding gums. The patient has multiple sores and ecchymoses. The nurse will expect
the provider to order?
a. Cyanocobalamin (vitamin B12)
b. High-dose nicotinic acid
c. Intramuscular thiamine for 1 to 2 weeks
d. Intravenous ascorbic acid d. Intravenous ascorbic acid
This patient has scurvy with acute, severe symptoms, and needs intravenous vitamin C.
First line drug of choice for community acquired pneumonia in a previously healthy is?
a. Penicillin
b. Amoxicillin
c. Azithromycin
d. Levaquin c. Azithromycin
One month after starting phenytoin for seizures, a 28-year-old male presents with complaints of
fever, rash, and swollen lymph nodes. The NP suspects which syndrome?
,a. Phenytoin toxicity
b. Phenytoin hypersensitivity reaction
c. Normal side effects of phenytoin
d. Mononucleosis b. Phenytoin hypersensitivity reaction
A patient with previous compliant levels of carbamazepine now presents with subtherapeutic blood
levels. The NP suspects?
a. Noncompliance
b. Patient financial strain
c. Malnutrition
d. Expected lab finding d. Expected lab finding
Carbamazepine auto induces metabolism leading to lower levels of the drug.
The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir,
zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the
nurse finds a rash and notes that the patient has a temperature of 101.1 F. What is the nurse's best
course of action?
a. Tell the patient that this is an expected response to these medications and to continue the agents
as prescribed
b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber
c. Have the patient continue the abacavir but discontinue the other two agents for 3 weeks
d. Instruct the patient to continue all three medications and administer an antihistamine for the
symptoms b. Have the patient hold the medications and arrange for an immediate evaluation
by the prescriber
a.
ANS: B- The patient is showing early symptoms of a fatal hypersensitivity reaction.
The NP educates the patient regarding the black box warning on carbamazepine by advising the
patient to report signs and symptoms indicative of?
a. Liver toxicity
b. Kidney failure
c. Skin reaction
,d. Suicidal tendencies c. Skin reaction
Carbamazepine can cause SJS and TEN (toxic epidermal necrolysis)
Carbamazepine monitoring should include all of the following except?
a. Routine CBC
b. Osteoporosis screening
c. Carbamazepine drug levels
d. Monthly glucose d. Monthly glucose
A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would
prompt the nurse to hold the drug and notify the prescriber for further assessment?
a. "I get a little dizzy sometimes"
b. "I had a headache last week that lasted for about an hour"
c. "I've broken out in a rash on my chest and back"
d. "Last night I woke up twice with a bad dream" c. "I've broken out in a rash on my chest and
back"
Rash may indicate development of Stevens-Johnson Syndrome.
A young woman taking Lamictal for seizures presents to the office requesting birth control. She has
decided she wants daily oral contraceptives. The NP educates the patient regarding the fact?
a. Oral contraceptives will interact with Lamictal and are not a good option
b. Oral contraceptives can cause Lamictal levels to become toxic
c. Lamictal doses will need to be increased while taking oral contraceptives
d. Back up contraceptives will need to be used if taking Lamictal c. Lamictal doses will need to be
increased while taking oral contraceptives
Tricyclic antidepressants should be avoided in?
a. Smokers
b. Heart failure patients
c. Native americans
, d. CYP450 gene mutation patients b. Heart failure patients
When educating patients regarding antidepressants, the NP should include?
a. It may take 2-3 days for medications to take effect
b. It may take 2-3 weeks for medications to take effect
c. Oral contraceptives will require a back up method
d. An improvement in depression means the medication is effective b. It may take 2-3 weeks for
medications to take effect
After ordering IM Haldol for the patient, the NP knows to assess for EPS using which tool?
a. Peak and trough levels
b. Continuous EKG monitoring
c. AIMS test
d. MMEc. AIMS test
AIMS is the abnormal involuntary movement scale
Prior to administering albuterol for an acute asthma attack, the NP understands that?
a. These two medications cannot be given together
b. Digoxin dosage will need to be increased
c. Digoxin dosage will need to be decreased
d. The patient should be hooked up to continuous EKG monitoring b. Digoxin dosage will need
to be increased
Albuterol can decrease digoxin levels by 16%-22%.
The NP opts NOT to give a beta agonist to which patient?
a. Asthmatic
b. Allergic reaction
c. History of pheochromocytoma
d. Bronchoconstriction c. History of pheochromocytoma
