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NUR 635 MIDTERM EXAM|2025-2026|ACTUAL EXAM
WITH 100+QUESTIONS WITH ANSWERS AND
RATIONALES|ALREADY GRADED A+
A woman who is breastfeeding her infant must take a prescription medication for 2 weeks. The medication is safe, butthe patient wants to make sure her baby receives as little of thedrug as possible. What will the nurse tell the patient to do? (65) A. Give the baby formula as long as the mother is taking themedication B. Take the medication immediately after breastfeeding C. Pump breast milk and feed the baby by bottle D. Take the medication 1 hour before breastfeeding (ANS: B) Taking the medication immediately after breastfeedingminimizes the drug concentration in the breast milk at the nextfeeding. Disrupting breastfeeding is not indicated. Pumping the breast milk will not diminish the drugs or drug concentration in the breast milk. Taking the medication 1 hour before breastfeeding will increase concentrations of the drug in the breast milk.
- A pregnant patient is in premature labor. Which class of drugwill she be given? (40) A. Alpha1 agonist B. Anticholinergic C. Beta2 agonist D. 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.
- 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) A. “Metoprolol has no effect on diabetes mellitus or on yourinsulin requirements.” B. “Metoprolol interferes with the effects of insulin, so you mayneed to increase your insulin dose.” C. “Metoprolol may mask signs of hypoglycemia, so youneed to monitor your blood glucose closely.” D. “Metoprolol may potentiate the effects of the insulin, so thedose 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
D. Sinus bradycardia. (ANS: B) The signs and symptoms describe left-sided heart failure, in which the blood normally handled by the left ventricleand forced out through the aorta into the body backs up into thelungs, 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’sheart 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 B. Hypertension C. Severe pain D. Tourette syndrome (ANS: A) Kapvay ER is used to treat ADHD and is given as a singledose at bedtime. This form of clonidine is not used for hypertension, severe pain, or treatment of Tourette syndrome.
- 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 occurwith other dopamine agonists is: (105) A. Sleep attacks. B. Dizziness. C. Hallucinations. D. Dyskinesias. (ANS: A) A few patients taking pramipexole have experienced sleep attacks, or an overwhelming and irresistible sleepiness thatcomes 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 replacementsurgery in 2 months. What will the nurse recommend for this patient? (498) A. The patient should ask her provider about an OC with lessprogestin. B. The patient should discuss an alternative method ofbirth control prior to surgery. C. The patient should request an OC containing less estrogen after surgery. D. The patient should take the OC at bedtime after her surgeryto reduce side effects. (ANS: B) Patients taking an OC who undergo surgery in which immobilization
- A clinic nurse is assessing an adolescent male patient who hasbeen receiving androgen therapy for hypogonadism via a transdermal patch. The patient’s last clinic visit was 4 weeks earlier. Which part of the interval history is of most concern to thenurse? (519) A.Five-pound weight gain B. Increased growth of pubic hair C. Rash at the site of the patch D. Presence of acne (ANS: A) Patients receiving testosterone may experience edemasecondary to sodium and water retention. Treatment involves discontinuing the drug and giving diuretics if needed. Masculinization of both females and males may occur and boys may experience growth of pubic hair, which is an expected effect. Patients may develop a sensitivity rash at the site of transdermalapplication. Acne is an expected effect.
- A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing inthe ears. The plasma salicylate level is 300 μg/mL, and the urinepH is 6.0. What will the nurse do? (577) A. Increase the aspirin dose to treat the patient’s headache. B. Notify the provider of possible renal toxicity.
C. Prepare to provide respiratory support, because the patientshows signs of overdose. D.Withhold the aspirin until the patient’s symptomshave subsided. (ANS: D) This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above the therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signsof renal impairment include oliguria and weight gain, which arenot present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.
- When metro nidazole [Flagyl] is a component of the H. pyloritreatment regimen, the patient must be instructed to do what? (663) A.Avoid any alcoholic beverages B. Avoid foods containing tyramine C. Take the drug on an empty stomach D. Take the drug with food
order: (943) A. a combination opioid/NSAID and an adjunctive analgesic. B. a fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic. C. an increase in the oxycodone and NSAID doses. D. intramuscular morphine sulfate and acetaminophen. (ANS: B) As pain increases in severity, more powerful opioids should be used. This patient has been taking oxycodone, which is a moderate-strength opioid; fentanyl is stronger. Because the painis chronic and is now severe and because the patient has opioid tolerance, a transdermal patch may be used. Long-term use of NSAIDs is not recommended because of the risk of thrombotic events. The patient also is describing neuropathic pain, which canbe treated with an adjuvant analgesic. Fixed- dose combination drugs are not recommended for increasing pain. NSAIDs are not recommended long term. Intramuscular medications are not recommended because of the pain associated with administration
- A patient in her second trimester of pregnancy tells the nurse she is worried thata medication she took before knowing she was pregnant might have harmed the fetus. What will the nurse do? (59)
A. Ask the patient what she took and when she learned she was pregnant. B. Contact the patient’s provider to request an ultrasound. C. Counsel the patient to consider termination of the pregnancy. D. Suggest to the patient that she go to a high-risk pregnancy center. (ANS: A) When a pregnant patient is exposed to a known or potential teratogen, the first step is to find out when the drug was taken and when the pregnancy beganto determine whether the drug was taken during the period of organogenesis, whenthe fetus is most vulnerable to teratogenic effects. If exposure occurred during this phase, the provider may order an ultrasound. Counseling the patient to terminate apregnancy is not a nursing role. Until more is known about this patient’s fetus, it isnot necessary to refer her to another pregnancy center.
- A patient has just given birth to a baby boy with a cleft palate. The nurse willreview the patient’s medication history with special emphasis on drugs taken during which period? (63) A. Before she became pregnant B. During the first trimester C. During the second trimester D. During the third trimester
reporting new-onset headache, nervousness, and flushing. What should the nurse do? A. Reassure the patient that her symptoms are not from the terbutaline. B. Notify the practitioner that the patient is having a possible allergic reactionto the medication. C. Continue to monitor the patient closely and explain that these are normal adverse reactions to terbutaline. D. Tell the patient that she is experiencing normal preterm labor symptoms. (ANS: C)
- A nurse is administering terbutaline 0.25 mg subcutaneously as ordered by the practitioner. The patient's heart rate is 150 bpm , her blood pressure is 88/55 mm Hg , and she is shaking and complaining of chest discomfort. Which order can thenurse anticipate receiving? A. Continue the administration of terbutaline; these are normal adverse reactions. B. Administer propranolol. C. Administer a bolus with IV fluids. D. Start administering magnesium sulfate. (ANS: B)
- Terbutaline is labeled for use as a bronchodilator. It is used on an unlabeled basis to
suppress preterm labor. What is the classification and mechanism of actionof terbutaline? A. Terbutaline is an alpha-adrenergic agonist that works by relaxing smooth muscle, including the uterus, when the alpha-adrenergic receptor agonistsare stimulated. B. Terbutaline is a beta-adrenergic agonist that works by relaxing smooth muscle, including the uterus, when the beta-adrenergic receptor agonists are stimulated. C. Terbutaline is a beta-adrenergic agonist that works by expanding smooth muscle, including the uterus, when the beta-adrenergic receptor agonists arestimulated. D. Terbutaline is an alpha-adrenergic agonist that works by contracting smoothmuscle, including the uterus, when the alpha-adrenergic receptor agonists are stimulated. (ANS: B)
- A nurse is caring for an infant after a surgical procedure. After ensuring that theordered dose is appropriate for the infant’s age and weight, the nurse administers anarcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths/minute and a heart rate of 110 beats/minute .The infant is asleep in the parent’s arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of: (Ch9 #1) A. An allergic reaction to the medication. B. Immaturity of the blood-brain barrier in the infant.
kidney function.
- Which factors increase the need for APRNs to have full prescriptive authority?(2) A. More patients will have access to health care. B. Enrollment in medical schools is predicted to decrease. C. Physician’s assistants are being utilized less often. D. APRN education is more complex than education for physicians. (ANS: A) Implementation of the Affordable Care Act has increased the number of individuals with health care coverage, and thus the number who have access to health care services. The increase in the number of patients creates the need for more providers with prescriptive authority. APRNs can fill this practice gap.
- A patient is experiencing toxic side effects from atropine, including deliriumand hallucinations. Which medication will the nurse expect to administer? (45) A. Donepezil [Aricept] B. Edrophonium [Reversol] C. Neostigmine [Prostigmin] D. Physostigmine (ANS: D) Physostigmine is the drug of choice for treating poisoning from atropineand other
drugs that cause muscarinic blockade. Donepezil is used to treat Alzheimer disease. Edrophonium is used to distinguish between a myasthenic crisisand a cholinesterase inhibitor overdose. Neostigmine does not cross the blood- brain barrier and would not effectively treat this patient’s CNS symptoms.
- A nurse is caring for a patient who has myasthenia gravis. The prescriber hasordered neostigmine [Prostigmin]. An important initial nursing action before administration of the medication includes assessing: (47) A. the ability to raise the eyelids. B. level of fatigue. C. skeletal muscle strength. D. swallowing ability. (ANS: D) Many patients hospitalized for myasthenia gravis do not have the musclestrength to swallow well and need a parenteral form of the medication; therefore, assessing the patient’s ability to swallow is an important initial safety measure. Evaluating the patient’s ability to raise the eyelids, level of fatigue, and skeletal muscle strength are important assessments before drug administration and duringdrug treatment, because they indicate the effectiveness of the drug and help determine subsequent doses.
- A patient with stable exertional angina has been receiving a beta blocker. Before
- A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats/minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient’s lips and nail bedsare pink, and there is no respiratory distress. The nurse will anticipate providing: (425) A. an angiotensin-converting enzyme (ACE) inhibitor. B. intravenous nitroglycerin and a beta blocker. C. ranolazine (Ranexa) and quinidine. D. supplemental oxygen and intravenous morphine. (ANS: B) This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen isindicated if cyanosis or respiratory distress is present. IV morphine may be given ifthe pain is unrelieved by nitroglycerin.
- Which finding would indicate that terazosin has been effective for a patientwith BPH? (528)
A. Decreased prostate size B. Increased urinary frequency C. Improved urinary hesitation D. Decreased serum PSA levels (ANS: C) Terazosin is an alpha1-adrenergic antagonist. These medications relaxthe smooth muscles of the bladder neck to improve urinary symptoms experiencedwith BPH. They do not decrease the size of the prostate. Increased urinary frequency is a sign of worsening BPH.
- A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen [Lioresal]. Which statement by the parent indicates a need forfurther teaching? (125) A. “I can expect my child to be more drowsy when receiving this medication.”
