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NR508 Final Exam (Version 1, 2) & Study Guide (Version 1, 2), NR508 Midterm Exam (Version 1, 2, 3, 4, 5) & Study Guide (Version 1, 2) (Latest-2022): Chamberlain College of Nursing
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NR508 Midterm Exam (Latest-2022, Version-1) / NR 508 Midterm Exam / NR508 Week 4 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A|
NR508 Midterm Exam (Latest-2022, Version-1) / NR 508 Midterm Exam / NR508 Week 4 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A| NR508... [Show More] Week 4 Midterm Exam / NR 508 Week 4 Midterm Exam (Latest): Chamberlain College of Nursing Chamberlain NR 508 Midterm Exam / Chamberlain NR508 Midterm Exam (Latest) Question 1: A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should: a. use an existing guideline from a leading research hospital. b. follow the guideline provided by a third-party payer to help ensure reimbursement. c. review expert opinion and experimental, anecdotal, correlational study data. d. write the guideline to adhere to long-standing practice protocols already in use Question 2: A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. The NP should teach the patient to: a. change the patch four times daily. b. use the patch as needed for angina pain. c. use two patches daily and change them every 12 hours. d. apply one patch daily in the morning and remove in 12 hours. Question 3: A patient is diagnosed with asthma. The primary care nurse practitioner (NP) prescribes an inhaled corticosteroid and an inhaled bronchodilator medication and provides education about how to use inhalers. At a follow-up visit 2 weeks later, the patient’s pulmonary function tests are worse. The NP should: a. provide a detailed written asthma action plan for the patient. b. ask the patient to describe how the medications have been used. c. review the symptoms of an acute asthma exacerbation with the patient. d. teach the patient to use the albuterol more often and order an oral steroid. Question 4: A patient who will undergo surgery in implant a biosynthetic heart valve asks the primary care NP whether any medications will be necessary postoperatively. The NP should tell the patient that it will be necessary to take: a. daily low-dose aspirin for 1 year. b. heparin injections as needed based on activated partial thromboplastin time levels. c. lifelong warfarin combined with enoxaparin as needed. d. warfarin for 3 months postoperatively plus long-term aspirin. Question 5: A patient has a BMI of 35, a fasting plasma glucose of 120 mg/dL, elevated triglycerides, and a history of myocardial infarction. The primary care NP plans to initiate dietary and lifestyle counseling and should consider prescribing: a. ephedra. b. orlistat (Xenical). c. phentermine (Adipex-P). d. phentermine and topiramate (Onexa). Question 6: A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDs) daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should: a. prescribe cimetidine (Tagamet). b. prescribe omeprazole (Prilosec). c. teach the patient about a bland diet. d. change the NSAID to a corticosteroid. Question 7: A patient comes to the clinic reporting dizziness and fatigue associated with nausea and vomiting. The primary care NP suspects anemia and orders a complete blood count. The patient’s hemoglobin is elevated. The NP correctly concludes that the patient is not anemic. The NP has made an error in: a. context formulation. b. inappropriate knowledge base. c. cost-versus-benefit analysis. d. hypothesis triggering and information processing. Question 8: A patient who has diabetes is taking metformin 1000 mg daily. At a clinic visit, the patient reports having abdominal pain and nausea. The primary care NP notes a heart rate of 92 beats per minute. The NP should: a. obtain LFTs. b. decrease the dose of metformin. c. change metformin to glyburide. d. order electrolytes, ketones, and serum glucose. Question 9: An 80-year-old patient asks a primary care NP about OTC antacids for occasional heartburn. The NP notes that the patient has a normal complete blood count and normal electrolytes and a slight elevation in creatinine levels. The NP should recommend: a. calcium carbonate (Tums). b. aluminum hydroxide (Amphojel). c. sodium bicarbonate (Alka-Seltzer). d. magnesium hydroxide (Milk of Magnesia). Question 10: A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits. The patient reports lightheadedness associated with standing up. The NP should consult with the patient’s cardiologist about changing the medication to: a. amlodipine (Norvasc). b. isradipine (DynaCirc). c. verapamil HCl (Calan). d. short-acting nifedipine (Procardia). Question 11: A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors. The NP should recommend: a. orlistat (Xenical). b. surgical intervention. c. changes in diet and exercise. d. changes in diet and exercise along with short-term phentermine. Question 12: A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it. The NP notes that the information is from an internet site called “Prism.com.” The NP should tell this patient that: a. this information is probably from a drug advertisement website. b. this is factual, evidence-based material with accurate information. c. the information is from a nonprofit group that will not profit from drug sales. d. internet information is unreliable because anyone can post information there. Question 13: A primary care NP is preparing to order digoxin for an 80-year-old patient who has systolic heart failure. The NP obtains renal function tests, which are normal. The NP should: a. prescribe a digoxin 0.125 mg tablet once daily. b. give an initial dose of 0.5 mg digoxin tablet and then 0.125 mg every 6 hours 4. c. administer a digoxin 0.6 mg capsule once and then 0.3 mg every 8 hours 3. d. administer a loading dose of intravenous digoxin in the clinic and then give 0.125 mg once daily. Question 14: A patient who weighs 170 lb wishes to lose weight, with a target weight goal of 125 lb. To initiate a program that will result in a loss of 1 lb per week, the primary care NP should recommend a dietary intake of _____ kcal. a. 1000 b. 1200 c. 1700 d. 2000 Question 15: A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African-American woman. When selecting a drug and determining the correct dose, the NP should understand that the knowledge of how age, race, and gender may affect drug excretion is based on an understanding of: a. bioavailability. b. pharmacokinetics. c. pharmacodynamics. d. anatomy and physiology. Question 16: A patient who takes a calcium channel blocker is in the clinic for an annual physical examination. The cardiovascular examination is normal. As part of routine monitoring for this patient, the primary care NP should evaluate: a. serum calcium channel blocker level. b. complete blood count and electrolytes. c. liver function tests (LFTs) and renal function. d. thyroid and insulin levels. Question 17: A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe: a. mesalamine (Asacol). b. dicyclomine (Bentyl). c. simethicone (Phazyme). d. metoclopramide (Reglan). Question 18: A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled. The primary care NP should counsel this patient to: a. avoid foods that are high in vitamin K for several days. b. take a double dose of the medication the next morning. c. refill the prescription and take today's dose immediately. d. skip today's dose and resume a regular dosing schedule in the morning. Question 19: A patient who takes spironolactone for heart failure has begun taking digoxin (Lanoxin) for atrial fibrillation. The primary care NP provides teaching for this patient and asks the patient to repeat back what has been learned. Which statement by the patient indicates understanding of the teaching? a. "I should avoid high-sodium foods." b. "I should eat foods high in potassium." c. "I need to take a calcium supplement every day." d. "I should use a salt substitute while taking these medications." Question 20: The primary care NP sees a new African-American patient who has blood pressure readings of 140/90 mm Hg, 130/85 mm Hg, and 142/80 mm Hg on three separate occasions. The NP learns that the patient has a family history of hypertension. The NP should: a. initiate monotherapy with a thiazide diuretic. b. prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor. c. discuss dietary and lifestyle modifications with the patient. d. begin combination therapy with an ARB and a calcium-channel blocker. Question 21: An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a physical examination, the primary care nurse practitioner (NP) learns that the patient continues to have blood pressure readings of 135/90 mm Hg. The NP should: a. increase the captopril dose to 50 mg twice daily. b. add a thiazide diuretic to this patient's regimen. c. change the drug to losartan (Cozaar) 50 mg once daily. d. recommend a low-sodium diet in addition to the medication. Question 22: A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary care NP should recommend: a. adding docusate sodium (Colace). b. polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax). c. lactulose (Chronulac) and polyethylene glycol (MiraLAX). d. adding nonpharmacologic measures such as biofeedback Question 23: A woman with IBS has been taking antispasmodic medications and reports some relief, but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain. The NP should consider prescribing: a. alosetron (Lotronex). b. misoprostol (Cytotec). c. simethicone (Phazyme). d. tricyclic antidepressants (TCAs). Question 24: A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms. She has no family history or risk factors for coronary heart disease (CHD) or breast cancer but is concerned about these side effects of hormone therapy (HT). The NP should: a. tell her that starting HT now may reduce her risk of breast cancer. b. advise a short course of HT now that may decrease her risk for CHD. c. tell her that HT will not help control her symptoms during postmenopause. d. recommend herbal supplements for her symptoms to avoid HT side effects. Question 25: A patient who has atrial fibrillation (AF) has been taking warfarin (Coumadin). The primary care nurse practitioner (NP) plans to change the patient’s medication to dabigatran (Pradaxa). To do this safely, the NP should: a. initiate dabigatran when the patient's international normalized ratio (INR) is less than 2. b. start dabigatran 7 to 14 days after discontinuing warfarin. c. begin giving dabigatran 1 week before discontinuing warfarin. d. order frequent monitoring of the patient's INR after dabigatran therapy begins. Question 26: A 45-year-old patient who has a positive family history but no personal history of coronary artery disease is seen by the primary care NP for a physical examination. The patient has a body mass index of 27 and a blood pressure of 130/78 mm Hg. Laboratory tests reveal low-density lipoprotein, 110 mg/dL; high-density lipoprotein, 70 mg/dL; and triglycerides, 120 mg/dL. The patient does not smoke but has a sedentary lifestyle. The NP should recommend: a. 30 minutes of aerobic exercise daily. b. taking 81 to 325 mg of aspirin daily. c. beginning therapy with a statin medication. d. starting a thiazide diuretic to treat hypertension. Question 27: A sexually active patient tells the primary care NP that she has been unable to get her new COCP pill pack until today and has missed 3 days of pills. The NP should tell her to: a. use backup contraception and take 2 pills each day for the next 2 days. b. begin a new pack of pills today and use backup contraception for 7 days. c. begin a new pack of pills today, take a Plan B pill, and use backup contraception for 7 days. d. Take a pregnancy test, begin a new pack of pills today, and use backup contraception for 7 days. Question 28: A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping blood glucose within normal limits and has had multiple episodes of both hypoglycemia and hyperglycemia. As adjunct therapy to manage this problem, the primary care NP should prescribe: a. pramlintide (Symlin). b. repaglinide (Prandin). c. glyburide (Micronase). d. metformin (Glucophage). Question 29: The primary care NP sees a new patient for a routine physical examination. When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional extra beats followed by a pause. History reveals no past cardiovascular disease, but the patient reports occasional syncope and shortness of breath. The NP should: a. order an ECG and refer to a cardiologist. b. schedule a cardiac stress test and a graded exercise test. c. order a complete blood count (CBC) and electrolytes and consider a trial of procainamide. d. prescribe a B-blocker and anticoagulant and order 24-hour Holter monitoring. Question 30: A patient who has migraine headaches has begun taking timolol and 2 months after beginning this therapy reports no change in frequency of migraines. The patient’s current dose is 30 mg once daily. The primary care NP should: a. change the medication to propranolol. b. increase the dose to 40 mg once daily. c. obtain serum drug levels to see if the dose is therapeutic. d. tell the patient to continue taking the timolol and return in 1 month. Question 31: A patient who has breast cancer has been taking toremifene for 2 weeks. She tells her primary care NP that she thinks her tumor has grown larger. The NP should: a. schedule her for a breast ultrasound. b. reassure her that this is common and will subside. c. tell her she may need an increased dose of this medication. d. contact her oncologist to discuss adding another medication. Question 32: A CNM: a. may treat only women. b. has prescriptive authority in all 50 states. c. may administer only drugs used during labor and delivery. d. may practice only in birthing centers and home birth settings. Question 33: The primary care NP is preparing to prescribe a diuretic for a patient who has heart failure. The patient reports having had an allergic reaction to sulfamethoxazole-trimethoprim (Bactrim) previously. The NP should prescribe: a. ethacrynic acid. b. furosemide (Lasix). c. acetazolamide (Diamox). d. hydrochlorothiazide (HydroDIURIL). Question 34: In every state, prescriptive authority for NPs includes the ability to write prescriptions: a. for controlled substances. b. for specified classifications of medications. c. without physician-mandated involvement. d. with full, independent prescriptive authority. Question 35: The primary care NP is seeing a patient for a hospital follow-up after the patient has had a first myocardial infarction. The patient has a list of the prescribed medications and tells the NP that “no one explained anything about them.” The NP’s initial response should be to: a. ask the patient to describe the medication regimen. b. ask the patient to make a list of questions about the medications. c. determine what the patient understands about coronary artery disease. d. give the patient information about drug effects and any adverse reactions. Question 36: A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor. All of the patient’s baseline LFTs were normal. At a 6-month follow-up visit, the patient reports occasional headache. A lipid profile reveals a decrease of 20% in the patient’s LDL cholesterol. The NP should: a. order LFTs. b. order CK-MM tests. c. consider decreasing the dose of the medication. d. reassure the patient that this side effect is common. Question 37: A patient receives an inhaled corticosteroid to treat asthma. The patient asks the primary care NP why the drug is given by this route instead of orally. The NP should explain that the inhaled form: a. is absorbed less quickly. b. has reduced bioavailability. c. has fewer systemic side effects. d. provides dosing that is easier to regulate. Question 38: The primary care nurse practitioner (NP) sees a patient for a physical examination and orders laboratory tests that reveal low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30 mg/dL, and triglycerides of 350 mg/dL. The patient has no previous history of coronary heart disease. The NP should consider prescribing: a. ezetimibe (Zetia). b. gemfibrozil (Lopid). c. simvastatin (Zocor). d. nicotinic acid (Niaspan). Question 39: A woman who is taking a progestin-only pill has just stopped nursing her 9-month-old infant and tells the primary care NP that she would like to space her children about 2 years apart. The NP should: a. discontinue the progestin-only pill. b. prescribe a COCP and a folic acid supplement. c. prescribe a progestin-only pill for another 6 months. d. suggest that she use a barrier method of contraception. Question 40: A primary care NP sees a 3-year-old patient who has been vomiting for several days. The child has had fewer episodes of vomiting the past day and is now able to take sips of fluids without vomiting. The child has dry oral mucous membranes, 2-second capillary refill, and pale but warm skin. The child’s blood pressure is 88/46 mm Hg, the heart rate is 110 beats per minute, and the temperature is 37.2° C. The NP should: a. prescribe promethazine. b. prescribe a scopolamine patch. c. begin oral rehydration therapy. d. send the child to the hospital for IV fluids. Question 41: A patient has been using an herbal supplement for 2 years that the primary care NP knows may have toxic side effects. The NP should: a. tell the patient to stop taking the supplement immediately. b. inform the patient of the risks of toxic side effects with this supplement. c. refer the patient to a CAM provider who can manage this patient's therapy. d. prescribe another herbal drug that has fewer adverse effects than the one the patient is taking. Question 42: An 80-year-old patient who has persistent AF takes warfarin (Coumadin) for anticoagulation therapy. The patient has an INR of 3.5. The primary care NP should consider: a. lowering the dose of warfarin. b. rechecking the INR in 1 week. c. omitting a dose and resuming at a lower dose. d. omitting a dose and administering 1 mg of vitamin K. Question 43: A patient is in the clinic complaining of nausea and vomiting that has lasted 2 to 3 days. The patient has dry oral mucous membranes, a blood pressure of 90/56 mm Hg, a pulse of 96 beats per minute, and a temperature of 38.8° C. The primary care NP notes a capillary refill of greater than 3 seconds. The NP should: a. obtain a complete blood count and serum electrolytes. b. prescribe a rectal antiemetic medication. c. admit to the hospital for intravenous (IV) rehydration. d. encourage the patient to take small, frequent sips of Gatorade. Question 44: A patient asks a primary care NP whether over-the-counter drugs are safer than prescription drugs. The NP should explain that over-the-counter drugs are: a. generally safe when label information is understood and followed. b. safer because over-the-counter doses are lower than prescription doses of the same drug. c. less safe because they are not well regulated by the Food and Drug Administration (FDA). d. not extensively tested, so claims made by manufacturers cannot be substantiated. Question 45: A patient has been taking levothyroxine 100 mcg daily for several months. The patient comes to the clinic with complaints of insomnia and irritability. The primary care NP notes a heart rate of 92 beats per minute. The NP should: a. change to liothyronine 75 mcg/day. b. discontinue levothyroxine indefinitely. c. order propylthiouracil to counter the increased thyroid levels. d. order TSH and T4 levels and decrease the dose to 75 mcg/day. Question 46: A patient who has asthma and who is known to the primary care NP calls the NP after hours and asks for a refill of an albuterol metered-dose inhaler. The patient has not been seen in the clinic for more than a year. The NP should: a. call the pharmacy to order the medication with several refills. b. send an electronic prescription to the pharmacy for one time only. c. send the patient to the emergency department for evaluation of symptoms. d. refill the drug and tell the patient that an office visit is necessary for further refills. Question 47: A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug: a. may cause different adverse effects. b. does not necessarily have the same therapeutic effect. c. is likely to be less safe than the brand specified in the prescription. d. may vary in the amount of drug that reaches the site of action in the body. Question 48: A patient who has congestive heart failure and arthritis has been taking chlorthalidone (Zaroxolyn) 25 mg daily for 6 months. The primary care NP notes a persistent blood pressure of 145/90 mm Hg. The NP should: a. ask the patient which medications are used for pain. b. add furosemide (Lasix) to the patient's drug regimen. c. increase the dose of chlorthalidone to 100 mg daily. d. recommend that the patient use salt substitutes to season foods. Question 49: The primary care NP sees a patient who has a history of hypertension and alcoholism. The patient is not taking any medications. The NP auscultates crackles in both lungs and palpates the liver 2 cm below the costal margin. Laboratory tests show an elevated creatinine level. The NP will refer this patient to a cardiologist and should prescribe: a. albuterol metered-dose inhaler. b. furosemide (Lasix). c. spironolactone (Aldactone). d. chlorthalidone (Zaroxolyn). Question 50: A patient with chronic back pain that is unrelieved by prescription analgesic medications asks a primary care nurse practitioner (NP) about acupuncture treatments. The NP should tell this patient: a. biofield therapy has been shown to be more effective than acupuncture. b. creatine has been shown to be an effective herbal choice to treat back pain. c. there is no valid research documenting the efficacy of this treatment for pain. d. most studies that show benefits of alternative therapies are based on observation. Question 51: A patient with congestive heart failure will begin therapy with a diuretic medication. The primary care NP orders laboratory tests, which reveal a glomerular filtration rate (GFR) of 25 mL/minute. The initial drug the NP should prescribe is: a. metolazone. b. furosemide (Lasix). c. spironolactone (Aldactone). d. hydrochlorothiazide (HydroDIURIL). Question 52: The primary care NP sees a patient several months after a myocardial infarction (MI). The patient has been taking furosemide to treat heart failure. The NP notes that the patient has edema of the hands, feet, and ankles. The NP should add which drug to this patient’s regimen? a. Ethacrynic acid b. Chlorothiazide (Lozol) c. Triamterene (Dyrenium) d. Spironolactone (Aldactone) Question 53: An important difference between physician assistants (PAs) and NPs is PAs: a. always work under physician supervision. b. are not required to follow drug treatment protocols. c. may write for all drug categories with physician co-signatures. d. have both inpatient and outpatient independent prescriptive authority. Question 54: A primary care NP is developing a handout to give to patients who will begin self-administering insulin. When developing this handout, the NP should: a. provide detailed descriptions of each step in the process of injecting insulin. b. use correct medical terminology when describing insulin self-administration. c. provide as much factual information as possible about insulin administration. d. address one or two educational objectives that describe what the patient will learn. Question 55: An 80-year-old patient has begun taking propranolol (Inderal) and reports feeling tired all of the time. The primary care NP should: a. tell the patient to stop taking the medication immediately. b. recommend that the patient take the medication at bedtime. c. tell the patient that tolerance to this side effect will occur over time. d. contact the patient's cardiologist to discuss decreasing the dose of propranolol. Question 56: An 80-year-old male patient will begin taking an B-antiadrenergic medication. The primary care NP should teach this patient to: a. ask for assistance while bathing. b. restrict fluids to aid with diuresis. c. take the medication in the morning with food. d. be aware that priapism is a common side effect. Question 57: A woman who uses a transdermal contraceptive calls the primary care NP to report that while dressing that morning she discovered that the patch had come off and she was unable to find the patch. The NP should tell her to apply a new patch and: a. take one cycle of COCPs. b. take a home pregnancy test. c. use condoms for the next 7 days. d. contact the clinic if she misses a period. Question 58: A woman who has been taking a COCP tells the primary care NP that, because of frequent changes in her work schedule, she has difficulty remembering to take her pills. The woman and the NP decide to change to a vaginal ring. The NP will instruct her to insert the ring: a. within 7 days after her last active pill. b. and use a backup contraceptive for 7 days. c. and continue the COCP for one more cycle. d. on the same day she stops taking her COCP. Question 59: A 12-year-old patient has acute diarrhea and an upper respiratory infection. Other family members have had similar symptoms, which have resolved. The primary care NP should recommend: a. diphenoxylate (Lomotil). b. attapulgite (Kaopectate). c. an electrolyte solution (Pedialyte). d. bismuth subsalicylate (Pepto-Bismol). Question 60: A patient is taking drug A and drug B. The primary care NP notes increased effects of drug B. The NP should suspect that in this case drug A is a cytochrome P450 (CYP450) enzyme: a. inhibitor. b. substrate. c. inducer. d. metabolizer [Show Less]
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NR508 Week 4 Midterm Exam (Latest-2022, Version-2) / NR 508 Week 4 Midterm Exam / NR508 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A|
NR508 Week 4 Midterm Exam (Latest-2022, Version-2) / NR 508 Week 4 Midterm Exam / NR508 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A| ... [Show More] NR508 Week 4 Midterm Exam / NR 508 Week 4 Midterm Exam (Latest): Chamberlain College of Nursing Chamberlain NR 508 Midterm Exam / Chamberlain NR508 Midterm Exam (Latest) Question 1. (2 pts): Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months. She has a positive family history of breast cancer. The primary care NP should recommend: a. testosterone therapy. b. estrogen-only therapy. c. nonhormonal drugs for osteoporosis. d. estrogen-progesterone therapy for 1 to 2 years. Question 2. (2 pts): A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe: a. aprepitant (Emend). b. ondansetron (Zofran). c. scopolamine transdermal. d. prochlorperazine (Compazine). Question 3. (2 pts): A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased. The NP should consult with an endocrinologist and order: a. thyrotropin. b. methimazole. c. levothyroxine. d. propylthiouracil. Question 4.(2pts): A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body mass index of 24, and exercises regularly. The patient has no known risk factors for cardiovascular disease. The primary care NP should: a. prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor. b. perform a careful cardiovascular physical assessment. c. counsel the patient about dietary and lifestyle changes. d. order a urinalysis and creatinine clearance and begin therapy with a b-blocker. Question 5. (2 pts): A patient reports fatigue, weight loss, and dry skin. The primary care nurse practitioner (NP) orders thyroid function tests. The patient’s thyroid stimulating hormone (TSH) is 40 microunits/mL, and T4 is 0.1 ng/mL. The NP should refer the patient to an endocrinologist and prescribe: a. methimazole. b. liothyronine. c. levothyroxine. d. propylthiouracil. Question 6. (2 pts): When prescribing a medication for a chronic condition, the primary care NP should tell the patient: a. to contact the pharmacy whenever refills are needed. b. that it is necessary to return to the clinic for each monthly refill of the medication. c. about the frequency of clinic visits necessary for the number of refills authorized. d. to ask the pharmacist to supply several months' worth of the medication at a time. Question 7. (2 pts): A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day. The child weighs 15 kg. The primary care NP sees the child for a 3-year-old check-up. The NP should consult with a pediatric endocrinologist to discuss: a. increasing the dose to 90 mcg/day. b. decreasing the dose to 30 mcg/day. c. stopping the medication and checking TSH and T4 in 4 weeks. d. discussing the need for lifetime replacement therapy with the child's parents. Question 8. (2 pts): A patient who has IBS experiences diarrhea, bloating, and pain but does not want to take medication. The primary care NP should recommend: a. 25 g of fiber each day. b. avoiding gluten and lactose in the diet. c. increasing water intake to eight to ten glasses per day. d. beginning aerobic exercise, such as running, every day. Question 9. (2 pts): A woman who uses a transdermal contraceptive calls the primary care NP to report that while dressing that morning she discovered that the patch had come off and she was unable to find the patch. The NP should tell her to apply a new patch and: a. take one cycle of COCPs. b. take a home pregnancy test. c. use condoms for the next 7 days. d. contact the clinic if she misses a period. Question 10. (2 pts): A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe: a. mesalamine (Asacol). b. dicyclomine (Bentyl). c. simethicone (Phazyme). d. metoclopramide (Reglan). Question 11. (2 pts): A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug: a. may cause different adverse effects. b. does not necessarily have the same therapeutic effect. c. is likely to be less safe than the brand specified in the prescription. d. may vary in the amount of drug that reaches the site of action in the body. Question 12. (2 pts): A patient comes to the clinic with a history of syncope and weakness for 2 to 3 days. The primary care NP notes thready, rapid pulses and 3-second capillary refill. An ECG reveals a heart rate of 198 beats per a. administer intravenous fluids and obtain serum electrolytes. b. administer amiodarone in the clinic and observe closely for response. c. order digoxin and verapamil and ask the patient to return for a follow-up examination in 1 week. d. send the patient to an emergency department for evaluation and treatment. Question 13. (2 pts): An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won’t have to deal with pills or periods. The primary care NP should tell her that she: a. should consider another form of contraception after 1 year. b. may have irregular bleeding, especially in the first month or so. c. will need to take calcium and vitamin D every day while using this method. d. will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics. Question 14. (2 pts): A patient who is taking nifedipine develops mild edema of both feet. The primary care NP should contact the patient’s cardiologist to discuss: a. changing to amlodipine. b. ordering renal function tests. c. increasing the dose of nifedipine. d. evaluation of left ventricular function. Question 15. (2 pts): A patient who is taking trimethoprim-sulfamethoxazole for prophylaxis of urinary tract infections tells the primary care NP that a sibling recently died from a sudden cardiac arrest, determined to be from long QT syndrome. The NP should: a. schedule a treadmill stress test. b. order genetic testing for this patient. c. discontinue the trimethoprim-sulfamethoxazole. d. refer the patient to a cardiologist for further evaluation. Question 16. (2 pts): A patient has three consecutive blood pressure readings of 140/95 mm Hg. The patient’s body mass index is 24. A fasting plasma glucose is 100 mg/dL. Creatinine clearance and cholesterol tests are normal. The primary care NP should order: a. a b-blocker. b. an angiotensin-converting enzyme inhibitor. c. a thiazide diuretic. d. dietary and lifestyle changes. Question 17. (2 pts): A male patient tells the primary care NP he is experiencing decreased libido, lack of energy, and poor concentration. The NP performs an examination and notes increased body fat and gynecomastia. A serum testosterone level is 225 ng/dL. The NP’s next action should be to: a. order LH and FSH levels. b. order a serum prolactin level. c. prescribe testosterone replacement. d. obtain a morning serum testosterone level. Question 18. (2 pts): A woman has severe IBS and takes hyoscyamine sulfate (Levsin), simethicone (Phazyme), and a TCA. She reports having continued severe diarrhea. The primary care NP should: a. order diphenoxylate (Lomotil). b. prescribe alosetron after ruling out pregnancy. c. refer her to a gastroenterologist for endoscopy. d. increase the fiber in her diet to 30 g per day. Question 19. (2 pts): A patient is given a diagnosis of peptic ulcer disease. A laboratory test confirms the presence of Helicobacter pylori. The primary care NP orders a proton pump inhibitor (PPI) before meals twice daily, clarithromycin, and amoxicillin. After 14 days of treatment, H. pyloriis still present. The NP should order: a. continuation of the PPI for 4 to 8 weeks. b. a PPI, amoxicillin, and metronidazole for 14 days. c. a PPI, clarithromycin, and amoxicillin for 14 more days. d. a PPI, bismuth subsalicylate, tetracycline, and metronidazole. Question 20. (2 pts): A patient is taking drug A and drug B. The primary care NP notes increased effects of drug B. The NP should suspect that in this case drug A is a cytochrome P450 (CYP450) enzyme: a. inhibitor. b. substrate. c. inducer. d. metabolizer. Question 21. (2 pts): The primary care NP sees a new patient who has diabetes and hypertension and has been taking a thiazide diuretic for 6 months. The patient’s blood pressure at the beginning of treatment was 150/95 mm Hg. The blood pressure today is 138/85 mm Hg. The NP should: a. order a b-blocker. b. add an angiotensin-converting enzyme inhibitor. c. continue the current drug regimen. d. change to an aldosterone antagonist medication. Question 22. (2 pts): A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should: a. obtain a stool specimen and order vancomycin. b. order testing for Clostridium difficile and consider metronidazole therapy. c. prescribe diphenoxylate (Lomotil) to provide symptomatic relief. d. reassure the patient that diarrhea is a common side effect of antibiotic therapy. Question 23. (2 pts): The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should: a. compromise with the parents and order a nasogastric tube for feedings. b. initiate a discussion with the parents about the potential outcomes of each possible action. c. refer the family to a case manager who can help guide the parents to the best decision. d. understand that the child's parents have a right to make choices that override those of the medical team. Question 24. (2 pts): The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners. Which statement by the patient indicates she understands the regimen? a. "I have to take a pill only every 3 months." b. "I should expect to have only four periods each year." c. "I will need to use condoms for only 7 more days." d. "This type of pill has fewer side effects than other types." Question 25. (2 pts): The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma. The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes. The NP should: a. provide pharmaceutical company samples of the medication for the patient. b. inform the patient that the drug must be paid for out of pocket because it is not covered. c. order the closest formulary-approved approximation of the drug and monitor effectiveness. d. write a letter of medical necessity to the insurer to explain the need for this particular medication. Question 26. (2 pts): A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor. All of the patient’s baseline LFTs were normal. At a 6-month follow-up visit, the patient reports occasional headache. A lipid profile reveals a decrease of 20% in the patient’s LDL cholesterol. The NP should: a. order LFTs. b. order CK-MM tests. c. consider decreasing the dose of the medication. d. reassure the patient that this side effect is common. Question 27. (2 pts): A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to: a. report wheezing and shortness of breath, which may occur with these drugs. b. take care when getting out of bed or a chair after the first dose of the ACE inhibitor. c. discuss taking an increased dose of the thiazide diuretic with the cardiologist. d. minimize fluid intake for several days when beginning therapy with the ACE inhibitor. Question 28. (2 pts): A thin 52-year-old woman who has recently had a hysterectomy tells the primary care NP she is having frequent hot flashes and vaginal dryness. A recent bone density study shows early osteopenia. The woman’s mother had CHD. She has no family history of breast cancer. The NP should prescribe: a. estrogen-only HT now. b. estrogen-only HT in 5 years. c. estrogen-progesterone HT now. d. estrogen-progesterone HT in 5 years. Question 29. (2 pts): A patient who will begin using nitroglycerin for angina asks the primary care NP how the medication works to relieve pain. The NP should tell the patient that nitroglycerin acts to: a. dissolve atheromatous lesions. b. relax vascular smooth muscle. c. prevent catecholamine release. d. reduce C-reactive protein levels. Question 30. (2 pts): A patient is in the clinic complaining of nausea and vomiting that has lasted 2 to 3 days. The patient has dry oral mucous membranes, a blood pressure of 90/56 mm Hg, a pulse of 96 beats per minute, and a temperature of 38.8° C. The primary care NP notes a capillary refill of greater than 3 seconds. The NP should: a. obtain a complete blood count and serum electrolytes. b. prescribe a rectal antiemetic medication. c. admit to the hospital for intravenous (IV) rehydration. d. encourage the patient to take small, frequent sips of Gatorade. Question 31. (2 pts): A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDs) daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should: a. prescribe cimetidine (Tagamet). b. prescribe omeprazole (Prilosec). c. teach the patient about a bland diet. d. change the NSAID to a corticosteroid. Question 32. (2 pts): A patient who has stable angina and uses sublingual nitroglycerin tablets is in the clinic and begins having chest pain. The primary care NP administers a nitroglycerin tablet and instructs the patient to lie down. The NP’s next action should be to: a. obtain an electrocardiogram. b. administer oxygen at 2 L/minute. c. give 325 mg of chewable aspirin. d. call EMS. Question 33. (2 pts): A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop diuretic, and an ACE inhibitor. The patient reports having nausea. The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg. The NP should: a. decrease the dose of the diuretic to prevent further dehydration. b. obtain a serum potassium level to assess for hyperkalemia. c. hold the ACE inhibitor until the patient's blood pressure stabilizes. d. obtain a digoxin level before the patient takes the next dose of digoxin. Question 34. (2 pts): A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled. The primary care NP should counsel this patient to: a. avoid foods that are high in vitamin K for several days. b. take a double dose of the medication the next morning. c. refill the prescription and take today's dose immediately. d. skip today's dose and resume a regular dosing schedule in the morning. Question 35. (2 pts): A primary care NP has prescribed phentermine for a patient who is obese. The patient loses 10 lb in the first month but reports that the drug does not seem to be suppressing appetite as much as before. The NP should: a. discontinue the phentermine. b. increase the dose of phentermine. c. continue the phentermine at the same dose. d. change to a combination of phentermine and topiramate. Question 36. (2 pts): A 45-year-old patient who has a positive family history but no personal history of coronary artery disease is seen by the primary care NP for a physical examination. The patient has a body mass index of 27 and a blood pressure of 130/78 mm Hg. Laboratory tests reveal low-density lipoprotein, 110 mg/dL; high-density lipoprotein, 70 mg/dL; and triglycerides, 120 mg/dL. The patient does not smoke but has a sedentary lifestyle. The NP should recommend: a. 30 minutes of aerobic exercise daily. b. taking 81 to 325 mg of aspirin daily. c. beginning therapy with a statin medication. d. starting a thiazide diuretic to treat hypertension. Question 37. (2 pts): A patient has heart failure. A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling. The patient takes low-dose furosemide and an ACE inhibitor. The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg. The NP should: a. order serum electrolytes. b. obtain renal function tests. c. consider prescribing a B-blocker. d. call the patient's cardiologist to discuss adding digoxin to the patient's regimen. Question 38. (2 pts): A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS. The patient comes to the clinic and reports having dry mouth, difficulty urinating, and more frequent constipation. The primary care NP notes a heart rate of 92 beats per minute. The NP should: a. prescribe a TCA. b. discontinue the antidiarrheal medication. c. encourage the patient to increase water intake. d. lower the dose of the antispasmodic medication. Question 39. (2 pts): A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are: a. not curative and may prolong the illness. b. useful in cases of acute infection with elevated temperature. c. most beneficial when symptoms persist longer than 2 weeks. d. useful when other symptoms, such as hematochezia, develop. Question 40. (2 pts): A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits. The patient reports lightheadedness associated with standing up. The NP should consult with the patient’s cardiologist about changing the medication to: a. amlodipine (Norvasc). b. isradipine (DynaCirc). c. verapamil HCl (Calan). d. short-acting nifedipine (Procardia). Question 41. (2 pts): A patient who has been taking digoxin 0.25 mg daily for 6 months reports that it is not working as well as it did initially. The primary care NP should: a. recommend a reduced potassium intake. b. increase the dose of digoxin to 0.5 mg daily. c. hold the next dose of digoxin and obtain a serum digoxin level. d. contact the patient's pharmacy to ask if generic digoxin was dispensed. Question 42. (2 pts): A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet. The primary care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg. The NP should: a. obtain a serum drug level. b. order an electrocardiogram (ECG) and serum electrolytes. c. change the medication to a thiazide diuretic. d. question the patient about potassium intake. Question 43. (2 pts): The primary care nurse practitioner (NP) sees a patient in the clinic who has a blood pressure of 130/85 mm Hg. The patient’s laboratory tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120 mg/dL; and fasting plasma glucose, 100 mg/dL. The NP calculates a body mass index of 29. The patient has a positive family history for cardiovascular disease. The NP should: a. prescribe a thiazide diuretic. b. consider treatment with an angiotensin-converting enzyme inhibitor. c. reassure the patient that these findings are normal. d. counsel the patient about dietary and lifestyle changes. Question 44. (2 pts): A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor) continues to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP increases the dose from 10 mg daily to 20 mg daily. The patient reports headache and dizziness a few weeks after the dose increase. The NP should: a. recommend supplements of omega-3 along with the atorvastatin. b. change the atorvastatin dose to 15 mg twice daily. c. add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily. d. change the patient’s medication to cholestyramine Question 45. (2 pts): The primary care NP is seeing a patient for a hospital follow-up after the patient has had a first myocardial infarction. The patient has a list of the prescribed medications and tells the NP that “no one explained anything about them.” The NP’s initial response should be to: a. ask the patient to describe the medication regimen. b. ask the patient to make a list of questions about the medications. c. determine what the patient understands about coronary artery disease. d. give the patient information about drug effects and any adverse reactions. Question 46. (2 pts): A primary care NP sees a 5-year-old child who is morbidly obese. The child has an elevated hemoglobin A1c and increased lipid levels. Both of the child’s parents are overweight but not obese, and they tell the NP that they see nothing wrong with their child. They both state that it is difficult to refuse their child’s requests for soda or ice cream. The NP should: a. suggest that they give the child diet soda and low-fat frozen yogurt. b. understand and respect the parents' beliefs about their child's self-image. c. initiate a dialogue with the parents about the implications of the child's laboratory values. d. suggest family counseling to explore ways to improve parenting skills and limits. Question 47. (2 pts): A primary care NP is developing a handout to give to patients who will begin self-administering insulin. When developing this handout, the NP should: a. provide detailed descriptions of each step in the process of injecting insulin. b. use correct medical terminology when describing insulin self-administration. c. provide as much factual information as possible about insulin administration. d. address one or two educational objectives that describe what the patient will learn. Question 48. (2 pts): A patient reports having occasional acute constipation with large, hard stools and pain and asks the primary care NP about medication to treat this condition. The NP learns that the patient drinks 1500 mL of water daily; eats fruits, vegetables, and bran; and exercises regularly. The NP should recommend: a. a daily bulk laxative. b. long-term docusate sodium. c. a saline laxative as needed. d. glycerin suppositories as needed. Question 49. (2 pts): A patient who has heart failure has been treated with furosemide and an ACE inhibitor. The patient’s cardiologist has added digoxin to the patient’s medication regimen. The primary care NP who cares for this patient should expect to monitor: a. serum electrolytes. b. blood glucose levels. c. serum thyroid levels. d. complete blood counts (CBCs). Question 50. (2 pts): A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms. She has no family history or risk factors for coronary heart disease (CHD) or breast cancer but is concerned about these side effects of hormone therapy (HT). The NP should: a. tell her that starting HT now may reduce her risk of breast cancer. b. advise a short course of HT now that may decrease her risk for CHD. c. tell her that HT will not help control her symptoms during postmenopause. d. recommend herbal supplements for her symptoms to avoid HT side effects. Question 51. (2 pts): A primary care NP is performing a previsit health history on a new patient. The patient reports taking vitamins every day. The NP should: a. ask the patient to bring all vitamin bottles to the clinic appointment. b. recommend natural vitamin products over synthetic vitamin products. c. reassure the patient that vitamins that are high in folic acid are safe to take. d. tell the patient that some vitamins, such as vitamin C, are safe in large doses. Question 52. (2 pts): An 80-year-old patient asks a primary care NP about OTC antacids for occasional heartburn. The NP notes that the patient has a normal complete blood count and normal electrolytes and a slight elevation in creatinine levels. The NP should recommend: a. calcium carbonate (Tums). b. aluminum hydroxide (Amphojel). c. sodium bicarbonate (Alka-Seltzer). d. magnesium hydroxide (Milk of Magnesia). Question 53. (2 pts): A 50-year-old woman with a family history of CHD is experiencing occasional hot flashes and is having periods every 3 to 4 months. She asks the primary care NP about HT to relieve her symptoms. The NP should: a. prescribe estrogen-only therapy. b. initiate oral contraceptive pills now. c. discuss using bioidentical HT. d. plan to use estrogen-progesterone therapy when menopause begins. Question 54. (2 pts): A patient who has breast cancer has been taking toremifene for 2 weeks. She tells her primary care NP that she thinks her tumor has grown larger. The NP should: a. schedule her for a breast ultrasound. b. reassure her that this is common and will subside. c. tell her she may need an increased dose of this medication. d. contact her oncologist to discuss adding another medication. Question 55. (2 pts): A patient reports having episodes of dizziness, nausea, and lightheadedness and describes a sensation of the room spinning when these occur. The primary care NP will refer the patient to a specialist who, after diagnostic testing, is likely to prescribe: a. meclizine. b. ondansetron. c. scopolamine. d. dimenhydrinate Question 56. (2 pts): The primary care NP sees a patient who has a history of hypertension and alcoholism. The patient is not taking any medications. The NP auscultates crackles in both lungs and palpates the liver 2 cm below the costal margin. Laboratory tests show an elevated creatinine level. The NP will refer this patient to a cardiologist and should prescribe: a. albuterol metered-dose inhaler. b. furosemide (Lasix). c. spironolactone (Aldactone). d. chlorthalidone (Zaroxolyn). Question 57. (2 pts): A perimenopausal woman tells the primary care NP that she is having hot flashes and increasingly severe mood swings. The woman has had a hysterectomy. The NP should prescribe: a. estrogen-only HT. b. low-dose oral contraceptive therapy. c. selective serotonin reuptake inhibitor therapy until menopause begins. d. estrogen-progesterone HT. Question 58. (2 pts): A primary care NP prescribes a COCP for a woman who is taking them for the first time. After teaching, the woman should correctly state the need for using a backup form of contraception if she: a. is having vomiting or diarrhea. b. delays taking a pill by 5 or 6 hours. c. takes nonsteroidal antiinflammatory drugs several days in a row. d. has recurrent headaches or insomnia. Question 59. (2 pts): A patient who has had a new onset of AF the day prior will undergo cardioversion that day. The primary care NP will expect the cardiologist to: a. give clopidogrel after administering cardioversion. b. administer cardioversion without using anticoagulants. c. give warfarin and aspirin before attempting cardioversion. d. give low-dose aspirin before administering cardioversion. Question 60. (2 pts): A patient in the clinic reports frequent episodes of bloating, abdominal pain, and loose stools to the primary care nurse practitioner (NP). An important question the NP should ask about the abdominal pain is: a. the relation of the pain to stools. b. what time of day the pain occurs. c. whether the pain is sharp or diffuse. d. the age of the patient when the pain began. [Show Less]
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NR508 Midterm Exam (Latest-2022, Version-3) / NR 508 Midterm Exam / NR508 Week 4 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A|
NR508 Midterm Exam (Latest-2022, Version-3) / NR 508 Midterm Exam / NR508 Week 4 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A| NR508... [Show More] Week 4 Midterm Exam / NR 508 Week 4 Midterm Exam (Latest): Chamberlain College of Nursing Chamberlain NR 508 Midterm Exam / Chamberlain NR508 Midterm Exam (Latest) Question 1: A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor) continues to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP increases the dose from 10 mg daily to 20 mg daily. The patient reports headache and dizziness a few weeks after the dose increase. The NP should: a. recommend supplements of omega-3 along with the atorvastatin. b. change the atorvastatin dose to 15 mg twice daily. c. add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily. d. change the patient’s medication to cholestyramine Question 2: A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6 months. The patient’s initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL, and triglycerides of 160 mg/dL. The primary care NP orders a lipid profile today that shows LDL of 105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient reports muscle pain and weakness. The NP should: a.order liver function tests (LFTs). b. order a creatine kinase-MM (CK-MM) level. c. change atorvastatin to twice-daily dosing. d. add gemfibrozil (Lopid) to the patient’s medication regimen Question 3: A patient comes to the clinic with a 4-day history of 10 to 12 liquid stools each day. The patient reports seeing blood and mucus in the stools. The patient has had nausea but no vomiting. The primary care NP notes a temperature of 37.9° C, a heart rate of 96 beats per minute, and a blood pressure of 90/60 mm Hg. A physical examination reveals dry oral mucous membranes and capillary refill of 4 seconds. The NP’s priority should be to: a. obtain stool cultures. b. begin rehydration therapy. c. consider prescribing metronidazole. d. administer opioid antidiarrheal medications. Question 4: A perimenopausal woman tells the primary care NP that she is having hot flashes and increasingly severe mood swings. The woman has had a hysterectomy. The NP should prescribe: a. estrogen-only HT. b. estrogen-progesterone HT. c. low-dose oral contraceptive therapy. d. selective serotonin reuptake inhibitor therapy until menopause begins. Question 5: A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. The NP should teach the patient to: a. change the patch four times daily. b. use the patch as needed for angina pain. c. use two patches daily and change them every 12 hours. d. apply one patch daily in the morning and remove in 12 hours. Question 6: A parent calls a clinic for advice about giving an over-the-counter cough medicine to a 6-year-old child. The parent tells the NP that the medication label does not give instructions about how much to give a child. The NP should: a. order a prescription antitussive medication for the child. b. ask the parent to identify all of the ingredients listed on the medication label. c. calculate the dose for the active ingredient in the over-the-counter preparation. d. tell the parent to approximate the dose at about one third to one half the adult dose. Question 7: A patient who has disabling intermittent claudication is not a candidate for surgery. Which of the following medications should the primary care NP prescribe to treat this patient? a. Cilostazol (Pletal) b. Warfarin (Coumadin) c. Pentoxifylline (Trental) d. Low-dose, short-term aspirin Question 8: The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners. Which statement by the patient indicates she understands the regimen? a. "I have to take a pill only every 3 months." b. "I should expect to have only four periods each year." c. "I will need to use condoms for only 7 more days." d. "This type of pill has fewer side effects than other types." Question 9: The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma. The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes. The NP should: a. provide pharmaceutical company samples of the medication for the patient. b. inform the patient that the drug must be paid for out of pocket because it is not covered. c. order the closest formulary-approved approximation of the drug and monitor effectiveness. d. write a letter of medical necessity to the insurer to explain the need for this particular medication. Question 10: A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency. When teaching this patient about the medication, the NP should: a. counsel the patient to take the medication with food. b. tell the patient that changing brands of the medication should be avoided. c. instruct the patient to stop taking the medication if signs of thyrotoxicosis occur. d. tell the patient that the drug may be stopped when thyroid function tests stabilize. Question 11: A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are: a. not curative and may prolong the illness. b. useful in cases of acute infection with elevated temperature. c. most beneficial when symptoms persist longer than 2 weeks. d. useful when other symptoms, such as hematochezia, develop. Question 12: The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is “off-formulary.” The NP should: a. inform the patient that an out-of-pocket expense will be necessary. b. write the prescription for a generic drug if it meets the patient's needs. c. call the patient's insurance provider to advocate for this particular drug. d. contact the pharmaceutical company to see if medication samples are available. Question 13: A patient who has type 2 diabetes mellitus takes metformin (Glucophage). The patient tells the primary care NP that he will have surgery in a few weeks. The NP should recommend: a. taking the metformin dose as usual the morning of surgery. b. using insulin during the perioperative and postoperative periods. c. that the patient stop taking metformin several days before surgery. d. adding a sulfonylurea medication until recovery from surgery is complete. Question 14: A thin 52-year-old woman who has recently had a hysterectomy tells the primary care NP she is having frequent hot flashes and vaginal dryness. A recent bone density study shows early osteopenia. The woman’s mother had CHD. She has no family history of breast cancer. The NP should prescribe: a. estrogen-only HT now. b. estrogen-only HT in 5 years. c. estrogen-progesterone HT now. d. estrogen-progesterone HT in 5 years. Question 15: A patient who has diabetic gastroparesis sees a gastroenterology specialist who orders metoclopramide (Reglan). Within 24 hours, the patient describes having extrapyramidal symptoms (EPS) to the primary care NP. The NP will contact the gastroenterologist and should expect to prescribe: a. benztropine (Cogentin). b. cimetidine. c. an SSRI antidepressant. d. a TCA. Question 16: The primary care NP is preparing to prescribe isosorbide dinitrate sustained release (Dilatrate SR) for a patient who has chronic, stable angina. The NP should recommend initial dosing of: a. 60 mg four times daily at 6-hour intervals. b. 40 mg twice daily 30 minutes before meals. c. 60 mg on awakening and 40 mg 7 hours later. d. 80 mg three times daily at 8:00 AM, 1:00 PM, and 6:00 PM. Question 17: A patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2 weeks. The patient reports continued fatigue. The primary care NP should: a. order a T4 level today. b. increase the dose to 100 mcg. c. check the TSH level in 1 week. d. reassure the patient that this will improve in several weeks. Question 18: The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should: a. compromise with the parents and order a nasogastric tube for feedings. b. initiate a discussion with the parents about the potential outcomes of each possible action. c. refer the family to a case manager who can help guide the parents to the best decision. d. understand that the child's parents have a right to make choices that override those of the medical team. Question 19: A female patient who is underweight tells the primary care NP that she has been using bisacodyl (Dulcolax) daily for several years. The NP should: a. prescribe docusate sodium (Colace) and decrease bisacodyl gradually. b. suggest she use polyethylene glycol (MiraLAX) on a daily basis instead. c. tell her that long-term use of suppositories is safer than long-term laxative use. d. counsel the patient to discontinue the laxative and increase fluid and fiber intake. Question 20: A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan. The NP knows that the bioavailability of the drug varies from brand to brand. The NP should: a. contact the insurance provider to explain why this particular formulation is necessary. b. change the patient's medication to a different drug class that doesn't have these bioavailability variations. c. accept the situation and monitor the patient closely for drug effects with each prescription refill. d. ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense. Question 21: A patient is in the clinic for a follow-up examination after a myocardial infarction (MI). The patient has a history of left ventricular systolic dysfunction. The primary care NP should expect this patient to be taking: a. nadolol (Corgard). b. carvedilol (Coreg). c. timolol (Blocadren). d. propranolol (Inderal). Question 22: A male patient tells the primary care NP he is experiencing decreased libido, lack of energy, and poor concentration. The NP performs an examination and notes increased body fat and gynecomastia. A serum testosterone level is 225 ng/dL. The NP’s next action should be to: a. order LH and FSH levels. b. order a serum prolactin level. c. prescribe testosterone replacement. d. obtain a morning serum testosterone level. Question 23: An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a physical examination, the primary care nurse practitioner (NP) learns that the patient continues to have blood pressure readings of 135/90 mm Hg. The NP should: a. increase the captopril dose to 50 mg twice daily. b. add a thiazide diuretic to this patient's regimen. c. change the drug to losartan (Cozaar) 50 mg once daily. d. recommend a low-sodium diet in addition to the medication. Question 24: A 50-year-old woman who is postmenopausal is taking an aromatase inhibitor as part of a breast cancer treatment regimen. She calls her primary care NP to report that she has had hot flashes and increased vaginal discharge but no bleeding. The NP should: a. schedule her for a gynecologic examination. b. recommend that she use a barrier method of contraception. c. tell her to stop taking the medication and call her oncologist. d. reassure her that these are normal side effects of the medication. Question 25: A 40-year-old patient is in the clinic for a routine physical examination. The patient has a body mass index (BMI) of 26. The patient is active and walks a dog daily. A lipid profile reveals low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30 mg/dL, and triglycerides of 250 mg/dL. The primary care nurse practitioner (NP) should: a. order a fasting plasma glucose level. b. consider prescribing metformin (Glucophage). c. suggest dietary changes and increased exercise. d. obtain serum insulin and hemoglobin A1c levels. Question 26: The primary care NP is seeing a patient for a hospital follow-up after the patient has had a first myocardial infarction. The patient has a list of the prescribed medications and tells the NP that “no one explained anything about them.” The NP’s initial response should be to: a. ask the patient to describe the medication regimen. b. ask the patient to make a list of questions about the medications. c. determine what the patient understands about coronary artery disease. d. give the patient information about drug effects and any adverse reactions. Question 27: A man with a BMI of 38 and a waist size of 48 inches is seen in the clinic for an annual well check-up. The primary care NP orders laboratory tests and notes a fasting plasma glucose of 110 mg/dL, triglyceride level of 220 mg/dL, and high-density lipoprotein level of 40 mg/dL. The man’s blood pressure is 160/110 mm Hg. The man has a history of cardiovascular disease and tells the NP he has tried to lose weight numerous times. The NP should consider: a. orlistat (Xenical). b. phentermine (Adipex-P). c. an oral antidiabetic agent. d. a strict low-fat, low-sodium diet. Question 28: A primary care NP orders thyroid function tests. The patient’s TSH is 1.2 microunits/mL, and T4 is 1.7 ng/mL. The NP should: a. assess the patient for symptoms of hyperthyroidism. b. ask the patient about the use of medications such as lithium. c. tell the patient that the results most likely indicate hypothyroidism. d. ask an endocrinologist to evaluate for possible Hashimoto's thyroiditis. Question 29: A postmenopausal woman develops NSAID-induced ulcer. The primary care NP should prescribe: a. ranitidine (Zantac). b. omeprazole (Prilosec). c. esomeprazole (Nexium). d. pantoprazole (Protonix). Question 30: A patient who is newly diagnosed with type 2 diabetes mellitus has not responded to changes in diet or exercise. The patient is mildly obese and has a fasting blood glucose of 130 mg/dL. The patient has normal renal function tests. The primary care NP plans to prescribe a combination product. Which of the following is indicated for this patient? a. Metformin/glyburide (Glucovance) b. Insulin and metformin (Glucophage) c. Saxagliptin/metformin (Kombiglyze) d. Metformin/pioglitazone (ACTOplus met) Question 31: A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors. The NP should recommend: a. Metformin/glyburide (Glucovance) b. Insulin and metformin (Glucophage) c. Saxagliptin/metformin (Kombiglyze) d. Metformin/pioglitazone (ACTOplus met) Question 32: A patient has been using an herbal supplement for 2 years that the primary care NP knows may have toxic side effects. The NP should: a. tell the patient to stop taking the supplement immediately. b. inform the patient of the risks of toxic side effects with this supplement. c. refer the patient to a CAM provider who can manage this patient's therapy. d. prescribe another herbal drug that has fewer adverse effects than the one the patient is taking. Question 33: A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping blood glucose within normal limits and has had multiple episodes of both hypoglycemia and hyperglycemia. As adjunct therapy to manage this problem, the primary care NP should prescribe: a. pramlintide (Symlin). b. repaglinide (Prandin). c. glyburide (Micronase). d. metformin (Glucophage). Question 34: A patient who takes spironolactone for heart failure has begun taking digoxin (Lanoxin) for atrial fibrillation. The primary care NP provides teaching for this patient and asks the patient to repeat back what has been learned. Which statement by the patient indicates understanding of the teaching? a. "I should avoid high-sodium foods." b. "I should eat foods high in potassium." c. "I need to take a calcium supplement every day." d. "I should use a salt substitute while taking these medications." Question 35: A patient who is taking nifedipine develops mild edema of both feet. The primary care NP should contact the patient’s cardiologist to discuss: a. changing to amlodipine. b. ordering renal function tests. c. increasing the dose of nifedipine. d. evaluation of left ventricular function. Question 36: A patient who has atrial fibrillation (AF) has been taking warfarin (Coumadin). The primary care nurse practitioner (NP) plans to change the patient’s medication to dabigatran (Pradaxa). To do this safely, the NP should: a. initiate dabigatran when the patient's international normalized ratio (INR) is less than 2. b. start dabigatran 7 to 14 days after discontinuing warfarin. c. begin giving dabigatran 1 week before discontinuing warfarin. d. order frequent monitoring of the patient's INR after dabigatran therapy begins. Question 37: A patient who takes an ACE inhibitor and a thiazide diuretic for hypertension will begin taking spironolactone. The primary care NP should counsel this patient to: a. avoid foods that are high in potassium. b. use a salt substitute when seasoning foods. c. discuss changing the ACE inhibitor to an ARB with the cardiologist. d. avoid taking antacids containing magnesium while taking these drugs. Question 38: A patient has been taking furosemide 80 mg once daily for 4 weeks and returns for a follow-up visit. The primary care NP notes a blood pressure of 100/60 mm Hg. The patient’s lungs are clear, and there is no peripheral edema. The patient’s serum potassium is 3.4 mEq/L. The NP should: a. continue furosemide at the current dose. b. decrease furosemide to 60 mg once daily. c. increase furosemide to 80 mg twice daily. d. change furosemide dose the 40 mg twice daily. Question 39: The primary care NP is reviewing evidence-based recommendations about the off-label use of a particular drug. Which recommendation should influence the NP’s decision about prescribing the medication? a. Data from randomized, experimental studies b. Patient reports about effectiveness of the drug for this purpose c. Pharmaceutical company reports using anecdotal evidence d. Endorsement of this use by a leading practitioner in the field Question 40: A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary care NP should recommend: a. adding docusate sodium (Colace). b. polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax). c. lactulose (Chronulac) and polyethylene glycol (MiraLAX). d. adding nonpharmacologic measures such as biofeedback. Question 41: A primary care NP sees a 5-year-old child who is morbidly obese. The child has an elevated hemoglobin A1c and increased lipid levels. Both of the child’s parents are overweight but not obese, and they tell the NP that they see nothing wrong with their child. They both state that it is difficult to refuse their child’s requests for soda or ice cream. The NP should: a. suggest that they give the child diet soda and low-fat frozen yogurt. b. understand and respect the parents' beliefs about their child's self-image. c. initiate a dialogue with the parents about the implications of the child's laboratory values. d. suggest family counseling to explore ways to improve parenting skills and limits. Question 42: A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body mass index of 24, and exercises regularly. The patient has no known risk factors for cardiovascular disease. The primary care NP should: a. prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor. b. perform a careful cardiovascular physical assessment. c. counsel the patient about dietary and lifestyle changes. d. order a urinalysis and creatinine clearance and begin therapy with a b-blocker. Question 43: A patient who has diabetes mellitus and congestive heart failure takes insulin and warfarin. The patient will begin taking exogenous testosterone to treat secondary hypogonadism. The primary care NP should recommend: a. increasing the dose of warfarin. b. more frequent blood glucose monitoring. c. a higher than usual dose of testosterone. d. increasing insulin doses to prevent hypoglycemia. Question 44: A primary care NP sees a patient who reports having decreased frequency of stools over the past few months. In the clinic today, the patient has severe abdominal cramping and an abdominal radiograph shows an increased stool load in the sigmoid colon and rectum. The NP should: a. give magnesium hydroxide (Milk of Magnesia). b. start daily methylcellulose (Citrucel) and increased fluids. c. order a sodium phosphate enema and psyllium (Metamucil). d. recommend polyethylene glycol (MiraLAX) and 2000 mL of fluid daily. Question 45: A primary care NP writes a prescription for an off-label use for a drug. To help ensure compliance, the NP should: a. include information about the off-label use on the E-script. b. provide the patient with written instructions about how to use the medication. c. tell the patient to let the pharmacist know that the drug is being used for an off-label use. d. follow up by phone in several days to see if the patient is using the drug appropriately. Question 46: A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug: a. may cause different adverse effects. b. does not necessarily have the same therapeutic effect. c. is likely to be less safe than the brand specified in the prescription. d. may vary in the amount of drug that reaches the site of action in the body. Question 47: A 2-year-old child has chronic “toddler’s” diarrhea, which has an unknown but benign etiology. The child’s parent asks the primary care NP if a medication can be used to treat the child’s symptoms. The NP should recommend giving: a. diphenoxylate (Lomotil). b. attapulgite (Kaopectate). c. an electrolyte solution (Pedialyte). d. bismuth subsalicylate (Pepto-Bismol). Question 48: A primary care NP has prescribed phentermine for a patient who is obese. The patient loses 10 lb in the first month but reports that the drug does not seem to be suppressing appetite as much as before. The NP should: a. discontinue the phentermine. b. increase the dose of phentermine. c. continue the phentermine at the same dose. d. change to a combination of phentermine and topiramate. Question 49: A patient is newly diagnosed with type 2 diabetes mellitus. The primary care NP reviews this patient’s laboratory tests and notes normal renal function, increased triglycerides, and deceased HDL levels. The NP should prescribe: a. nateglinide (Starlix). b. glyburide (Micronase). c. colesevelam (Welchol). d. metformin (Glucophage). Question 50: A 50-year-old woman with a family history of CHD is experiencing occasional hot flashes and is having periods every 3 to 4 months. She asks the primary care NP about HT to relieve her symptoms. The NP should: a. prescribe estrogen-only therapy. b. initiate oral contraceptive pills now. c. discuss using bioidentical HT. d. plan to use estrogen-progesterone therapy when menopause begins. Question 51: A primary care NP prescribes a COCP for a woman who is taking them for the first time. After teaching, the woman should correctly state the need for using a backup form of contraception if she: a. is having vomiting or diarrhea. b. delays taking a pill by 5 or 6 hours. c. takes nonsteroidal antiinflammatory drugs several days in a row. d. has recurrent headaches or insomnia. Question 52: A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled. The primary care NP should counsel this patient to: a. avoid foods that are high in vitamin K for several days. b. take a double dose of the medication the next morning. c. refill the prescription and take today's dose immediately. d. skip today's dose and resume a regular dosing schedule in the morning. Question 53: A patient comes to the clinic with a 2-day history of cough and wheezing. The patient has no previous history of asthma. The patient reports having heartburn for several months, which has worsened considerably. The primary care NP makes a diagnosis of asthma and orders oral steroids and inhaled albuterol. The patient’s condition worsens, and a chest radiograph obtained 2 days later shows bilateral infiltrates. The NP has failed to: a. confirm the diagnosis. b. determine the aggressiveness of therapy. c. prescribe an adequate dose of medications. d. allow the drugs an adequate amount of time to work. Question 54: A 5-year-old child has chronic constipation. The primary care NP plans to prescribe a laxative for long-term management. In addition to pharmacologic therapy, the NP should also recommend _____ g of fiber per day. a. 10 b. 15 c. 20 d. 25 Question 55: A patient in the clinic reports heartburn 30 minutes after meals, a feeling of fullness, frequent belching, and a constant sour taste. The patient has a normal weight and reports having a high-stress job. The primary care NP should recommend: a. antacid therapy as needed. b. changes in diet to avoid acidic foods. c. daily treatment with a PPI. d. consultation with a gastroenterologist for endoscopy. Question 56: A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits. The patient reports lightheadedness associated with standing up. The NP should consult with the patient’s cardiologist about changing the medication to: a. amlodipine (Norvasc). b. isradipine (DynaCirc). c. verapamil HCl (Calan). d. short-acting nifedipine (Procardia). Question 57: A 40-year-old woman tells the primary care nurse practitioner (NP) that she does not want more children and would like a contraceptive. She does not smoke and has no personal or family history of cardiovascular disease. She has frequent tension headaches. For this patient, the NP should prescribe: a. condoms. b. tubal ligation. c. monophasic combined oral contraceptive pill (COCP). d. low-estrogen COCP. Question 58: A woman who has been taking a COCP tells the primary care NP that, because of frequent changes in her work schedule, she has difficulty remembering to take her pills. The woman and the NP decide to change to a vaginal ring. The NP will instruct her to insert the ring: a. within 7 days after her last active pill. b. and use a backup contraceptive for 7 days. c. and continue the COCP for one more cycle. d. on the same day she stops taking her COCP. Question 59: A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDs) daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should: a. prescribe cimetidine (Tagamet). b. prescribe omeprazole (Prilosec). c. teach the patient about a bland diet. d. change the NSAID to a corticosteroid. Question 60: A patient in the clinic develops sudden shortness of breath and tachycardia. The primary care NP notes thready pulses, poor peripheral perfusion, and a decreased level of consciousness. The NP activates the emergency medical system and should anticipate that this patient will receive: a. intravenous alteplase. b. low-dose aspirin and warfarin. c. low-molecular-weight heparin (LMWH). d. unfractionated heparin (UFH) and warfarin. [Show Less]
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NR508 Week 4 Midterm Exam (Latest-2022, Version-4) / NR 508 Week 4 Midterm Exam / NR508 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A|
NR508 Week 4 Midterm Exam (Latest-2022, Version-4) / NR 508 Week 4 Midterm Exam / NR508 Midterm Exam: Chamberlain College of Nursing |100% Correct Q & A| ... [Show More] NR508 Week 4 Midterm Exam / NR 508 Week 4 Midterm Exam (Latest): Chamberlain College of Nursing Chamberlain NR 508 Midterm Exam / Chamberlain NR508 Midterm Exam (Latest) Question 1 A patient is given a diagnosis of peptic ulcer disease. A laboratory test confirms the presence of Helicobacter pylori. The primary care NP orders a proton pump inhibitor (PPI) before meals twice daily, clarithromycin, and amoxicillin. After 14 days of treatment, H. pylori is still present. The NP should order: continuation of the PPI for 4 to 8 weeks. Correct! a PPI, amoxicillin, and metronidazole for 14 days. a PPI, clarithromycin, and amoxicillin for 14 more days. a PPI, bismuth subsalicylate, tetracycline, and metronidazole. A PPI, along with amoxicillin and metronidazole, is used as first-line treatment in macrolide-allergic patients and for re-treatment for 14 days if first-line treatment of choice failed because of occasional resistance to clarithromycin. Question 2 A patient is newly diagnosed with type 2 diabetes mellitus. The primary care NP reviews this patient’s laboratory tests and notes normal renal function, increased triglycerides, and deceased HDL levels. The NP should prescribe: nateglinide (Starlix). glyburide (Micronase). colesevelam (Welchol). Correct! metformin (Glucophage). Metformin is recommended as initial pharmacologic treatment for type 2 diabetes. It has been shown to decrease triglycerides and LDLs. Question 3 The primary care NP is considering prescribing captopril (Capoten) for a patient. The NP learns that the patient has decreased renal function and has renal artery stenosis in the right kidney. The NP should: Correct! initiate ACE inhibitor therapy at a low dose. consider a different drug class to treat this patient’s symptoms. give the captopril with a thiazide diuretic to improve renal function. orderlisinopril (Zestril) instead of captopril to avoid increased nephropathy. Patients with impaired renal function should use low-dose ACE inhibitors. It is not necessary to avoid ACE inhibitors with unilateral renal stenosis. Question 4 A woman who has been taking a COCP for 2 months tells the primary care NP that she has had several headaches, breakthrough bleeding, and nausea. The NP should counsel the woman: to change to a progestin-only pill. to stop taking the COCP immediately. to use a backup form of contraception. Correct! that these effects will likely decrease in another month. Breakthrough bleeding, nausea, and headaches are common during the first 3 months of therapy and should improve without intervention. Progestin-only pills are used for lactating women only. Prolonged bleeding and severe headache would warrant discontinuation of the COCP. Backup contraception is not indicated. Question 5 A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6 months. The patient’s initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL, and triglycerides of 160 mg/dL. The primary care NP orders a lipid profile today that shows LDL of 105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient reports muscle pain and weakness. The NP should: order liver function tests (LFTs). Correct! order a creatine kinase-MM (CK-MM) level. change atorvastatin to twice-daily dosing. add gemfibrozil (Lopid) to the patient’s medication regimen. Hepatotoxicity and muscle toxicity are the two primary adverse effects of greatest concern with statin use. Patients who report muscle discomfort or weakness should have a CK-MM level drawn. LFTs are indicated with signs of hepatotoxicity. It is not correct to change the dosing schedule. Gemfibrozil is not indicated. Question 6 An 80-year-old patient who has persistent AF takes warfarin (Coumadin) for anticoagulation therapy. The patient has an INR of 3.5. The primary care NP should consider: lowering the dose of warfarin. Correct! rechecking the INR in 1 week. omitting a dose and resuming at a lower dose. omitting a dose and administering 1 mg of vitamin K. This patient’s INR is only minimally prolonged, so no dose reduction is required. The NP should recheck the INR periodically. If the INR becomes more prolonged, lowering the dose of warfarin is recommended. If the INR approaches 5, omitting a dose and resuming at a lower dose is recommended. Vitamin K is used for an INR of 9 or greater. Question 7 Persistent atrial fibrillation (AF) is diagnosed in a patient who has valvular disease, and the cardiologist has prescribed warfarin (Coumadin). The patient is scheduled for electrical cardioversion in 3 weeks. The patient asks the primary care nurse practitioner (NP) why the procedure is necessary. The NP should tell the patient: Correct! this medication prevents clots but does not alter rhythm. if the medication proves effective, the procedure may be canceled. there are no medications that alter the arrhythmia causing AF. to ask the cardiologist if verapamil may be ordered instead of cardioversion. Persistent AF lasts longer than 7 days and episodes fail to terminate on their own, but episodes can be terminated by electrical cardioversion after therapeutic warfarin therapy for 3 weeks. Warfarin does not alter AF. β-Blockers, calcium channel blockers, and digoxin are sometimes given to alter the rate. Verapamil is not an alternative to cardioversion for patients with persistent AF. Question 8 A patient who has had a previous myocardial infarction has a blood pressure of 135/82 mm Hg. The patient’s body mass index is 28, and the patient has a fasting plasma glucose of 105 mg/dL. The primary care NP should prescribe: Correct! an angiotensin-converting enzyme inhibitor. a thiazide diuretic. lifestyle modifications. a calcium-channel blocker. This patient has prehypertension but has a compelling reason for treatment. Patients who have had a myocardial infarction should be treated with a β-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ARB). Question 9 An 80-year-old female patient with a history of angina has increased TSH and decreased T4. The primary care NP should prescribe _____ mcg of _____. 25; liothyronine 75; liothyronine Correct! 25; levothyroxine 75; levothyroxine Elderly individuals may experience exacerbation of cardiovascular disease and angina with thyroid hormone replacement. It is advisable to start low at 25 mcg and work up as tolerated. Liothyronine is a synthetic T3. Question 10 CRNAs in most states: must have a Drug Enforcement Administration (DEA) number to practice. must have prescriptive authority to practice. Correct! order and administer controlled substances but do not have full prescriptive authority. administer medications, including controlled substances, under direct physician supervision. Only five states grant independent prescriptive authority to CRNAs. CRNAs do not require prescriptive authority because they dispense a drug immediately to a patient and do not prescribe. Without prescriptive authority, they do not need a DEA number. Question 11 A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor. All of the patient’s baseline LFTs were normal. At a 6-month follow-up visit, the patient reports occasional headache. A lipid profile reveals a decrease of 20% in the patient’s LDL cholesterol. The NP should: order LFTs. order CK-MM tests. consider decreasing the dose of the medication. Correct! reassure the patient that this side effect is common. LFTs should be performed at baseline, 12 weeks after initiation of therapy, and only periodically thereafter. Headaches are common side effects, but do not raise concern about hepatotoxicity. CK-MM tests are indicated if patients report muscle pain or weakness. It is not necessary to decrease the medication. Question 12 A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS. The patient comes to the clinic and reports having dry mouth, difficulty urinating, and more frequent constipation. The primary care NP notes a heart rate of 92 beats per minute. The NP should: prescribe a TCA. discontinue the antidiarrheal medication. encourage the patient to increase water intake. Correct! lower the dose of the antispasmodic medication. Patients taking antispasmodic medications should be monitored for anticholinergic side effects, such as increased heart rate, dry mouth, difficulty urinating, and constipation. The NP should lower the dose if needed. TCAs are used to treat pain long-term. Because the antidiarrheal medication is used as needed, there is no reason to discontinue it. Increasing water intake may improve symptoms associated with side effects but would not treat the underlying cause of these symptoms. Question 13 A patient with erosive esophagitis is taking lansoprazole (Prevacid). The primary care NP performs a medication history and learns that the patient also takes digoxin. The NP should recommend: decreasing the dose of digoxin. Correct! obtaining a serum digoxin level. changing the PPI to omeprazole. increasing the dose of lansoprazole. Because PPIs decrease gastric acid, they may interfere with the absorption of drugs that require absorption in an acid stomach, including digoxin. It may be necessary to increase the dose of digoxin but not before obtaining a serum digoxin level. All PPIs have this effect, so changing to another PPI would not solve the problem. Increasing the dose of lansoprazole would decrease the absorption of digoxin. Question 14 A patient in the clinic develops sudden shortness of breath and tachycardia. The primary care NP notes thready pulses, poor peripheral perfusion, and a decreased level of consciousness. The NP activates the emergency medical system and should anticipate that this patient will receive: You Answered intravenousalteplase. low-dose aspirin and warfarin. low-molecular-weight heparin (LMWH). Correct Answer unfractionated heparin (UFH) and warfarin. This patient has unstable pulmonary embolism (PE) and should receive thrombolytic therapy. Intravenous alteplase is the preferred agent. UFH and warfarin are recommended for stable PE. LMWH is beneficial in submassive PE and deep vein thrombosis (DVT) but is controversial for treatment of massive PE. Question 15 A patient who has gastroesophageal reflux disease (GERD) undergoes an endoscopy, which shows a hiatal hernia. The patient is mildly obese. The patient asks the primary care nurse practitioner (NP) about treatment options. The NP should tell this patient that: a fundoplication will be necessary to correct the cause of GERD. over-the-counter (OTC) antacids can be effective and should be tried first. elevation of the head of the bed at night can relieve most symptoms. Correct! a combination of lifestyle changes, medications, and surgery may be necessary. People with GERD often have hiatal hernia, but this is not the cause of GERD. The approach to treatment of GERD may include lifestyle changes, medications, and surgery. OTC antacids are sometimes used but are rarely used as first-line treatment. Question 16 A 40-year-old patient is in the clinic for a routine physical examination. The patient has a body mass index (BMI) of 26. The patient is active and walks a dog daily. A lipid profile reveals low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30 mg/dL, and triglycerides of 250 mg/dL. The primary care nurse practitioner (NP) should: Correct! order a fasting plasma glucose level. consider prescribing metformin (Glucophage). suggest dietary changes and increased exercise. obtain serum insulin and hemoglobin A1c levels. Testing for type 2 diabetes should be considered in all adults with a BMI greater than 25 who have risk factors such as HDL less than 35 mg/dL or triglycerides greater than 250 mg/dL. A fasting plasma glucose level greater than 126 mg/dL indicates diabetes. Metformin is not indicated unless testing is positive. Lifestyle changes may be part of the treatment plan. Serum insulin level is not indicated. Question 17 A primary care NP prescribes a COCP for a woman who is taking them for the first time. After teaching, the woman should correctly state the need for using a backup form of contraception if she: Correct! is having vomiting or diarrhea. delays taking a pill by 5 or 6 hours. takes nonsteroidal antiinflammatory drugs several days in a row. has recurrent headaches or insomnia. Vomiting and diarrhea may cause oral contraceptive failure, so women should be advised to use backup contraception if they experience these. The other conditions do not lead to oral contraceptive failure. Question 18 A patient comes to the clinic reporting dizziness and fatigue associated with nausea and vomiting. The primary care NP suspects anemia and orders a complete blood count. The patient’s hemoglobin is elevated. The NP correctly concludes that the patient is not anemic. The NP has made an error in: context formulation. inappropriate knowledge base. cost-versus-benefit analysis. Correct! hypothesis triggering and information processing. Faulty hypothesis triggering occurs when the clinician fails to consider appropriate initial hypotheses. The patient had nausea and vomiting, which can cause dehydration, leading to orthostatic hypotension and dizziness. The NP made an assumption that the dizziness was caused by anemia and ordered a complete blood count. Faulty information gathering occurs when clinicians fail to order appropriate tests. An error in context formulation occurs when clinicians and patients have different goals. Errors in knowledge base would occur if the practitioner did not perform a complete history and physical, missing important information. An error in cost-versus-benefit analysis could occur if the clinician ordered expensive tests that were not necessary for diagnosis and treatment. Question 19 A patient who has diabetic gastroparesis sees a gastroenterology specialist who orders metoclopramide (Reglan). Within 24 hours, the patient describes having extrapyramidal symptoms (EPS) to the primary care NP. The NP will contact the gastroenterologist and should expect to prescribe: Correct! benztropine (Cogentin). cimetidine. an SSRI antidepressant. a TCA. Cogentin is indicated to treat EPS side effects of medications such as metoclopramide. The patient should be monitored during the first 24 to 48 hours for any adverse reactions. Should EPS occur, treat with intramuscular diphenhydramine (Benadryl) 50 mg or benztropine (Cogentin) 1 to 2 mg Question 20 A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are: Correct! not curative and may prolong the illness. useful in cases of acute infection with elevated temperature. most beneficial when symptoms persist longer than 2 weeks. useful when other symptoms, such as hematochezia, develop. Treatment of patients with acute diarrhea with antidiarrheals can prolong infection and should be avoided if possible. Antidiarrheals are best used in patients with mild to moderate diarrhea and are used for comfort and not cure. They should not be used for patients with bloody diarrhea or high fever because they can worsen the disease. Prolonged diarrhea can indicate a more serious cause, and antidiarrheals should not be used in those cases. Question 21 A patient who takes a calcium channel blocker is in the clinic for an annual physical examination. The cardiovascular examination is normal. As part of routine monitoring for this patient, the primary care NP should evaluate: serum calcium channel blocker level. complete blood count and electrolytes. Correct! liver function tests (LFTs) and renal function. thyroid and insulin levels. Patients who take calcium channel blockers should have periodic renal and LFTs. Question 22 A primary care NP prepares to teach a patient about the management of a chronic condition. The patient says, “I don’t want to know all of that. Just tell me what to take and when.” The NP should initially: Correct! give the patient basic written instructions about medications, follow up visits, and symptoms. ask the patient to describe the disease process and the medications to evaluate understanding. explain to the patient that without mutual cooperation, the treatment regimen will not be effective. ask the patient to explore feelings and fears about having a chronic disease and taking medications. The patient has stated expectations about care and treatment for the condition. The NP should begin by respecting that and providing the amount of information the patient wants. As the therapeutic relationship grows, the NP may elicit more active participation and understanding. Question 23 A patient is in the clinic complaining of nausea and vomiting that has lasted 2 to 3 days. The patient has dry oral mucous membranes, a blood pressure of 90/56 mm Hg, a pulse of 96 beats per minute, and a temperature of 38.8° C. The primary care NP notes a capillary refill of greater than 3 seconds. The NP should: obtain a complete blood count and serum electrolytes. prescribe a rectal antiemetic medication. Correct! admit to the hospital for intravenous (IV) rehydration. encourage the patient to take small, frequent sips of Gatorade. If vomiting is not controlled, dehydration may occur. Patients who are dehydrated, as this patient is, must be treated with IV fluids in a hospital or emergency department setting. Question 24 A woman has severe IBS and takes hyoscyamine sulfate (Levsin), simethicone (Phazyme), and a TCA. She reports having continued severe diarrhea. The primary care NP should: orderdiphenoxylate (Lomotil). prescribealosetron after ruling out pregnancy. Correct! refer her to a gastroenterologist for endoscopy. increase the fiber in her diet to 30 g per day. Alosetron is given only to women with severe chronic diarrhea-predominant IBS and only after anatomic or biochemical abnormalities of the GI tract have been excluded. Because this woman’s symptoms are persistent and severe, diphenoxylate and increased dietary fiber are not indicated. Question 25 A patient with a history of coronary heart disease develops atrial fibrillation. The primary care NP refers the patient to a cardiologist who performs direct current cardioversion. The NP should expect the patient to begin taking which β-blocker medication? Nadolol (Corgard) Correct! Sotalol (Betapace) Timolol (Blocadren) Propranolol (Inderal) Sotalol is classified as a class II and III antiarrhythmic and is a preferred agent in patients with a history of coronary heart disease. Question 26 A patient who has GERD has been taking a PPI for 2 months and reports a slight decrease in symptoms. The next response of the primary care NP is to: Correct! add a histamine-2-receptor agonist. increase the dose of the PPI. change to long-term, low-dose PPI therapy. refer the patient to an endocrinologist for endoscopy and further management. If treatment with a PPI is inadequate by 2 months, histamine-2-receptor agonist therapy is indicated. Increasing the dose is not indicated. Long-term, lower dose therapy is used for recurrences of symptoms on a limited basis. When symptoms fail to resolve with pharmacologic treatments, patients should be referred to an endocrinologist. Question 27 A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet. The primary care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg. The NP should: obtain a serum drug level. Correct! order an electrocardiogram (ECG) and serum electrolytes. change the medication to a thiazide diuretic. question the patient about potassium intake. The patient is showing signs of hyperkalemia, so the NP should order an ECG and serum electrolytes. This should be done before changing the medication. Because hyperkalemia can cause fatal arrhythmias, an ECG is necessary. Question 28 An important difference between physician assistants (PAs) and NPs is PAs: Correct! always work under physician supervision. are not required to follow drug treatment protocols. may write for all drug categories with physician co-signatures. have both inpatient and outpatient independent prescriptive authority. PAs commonly have co-signature requirements and work under physician supervision. Question 29 A woman comes to the clinic to talk about weight reduction. The primary care nurse practitioner (NP) calculates a body mass index (BMI) of 28. The woman’s waist measures 34 inches. The woman tells the NP that she would like to lose 20 lb for her daughter’s wedding in 6 months. The NP should: suggest she try over-the-counter (OTC) orlistat. consider prescribing phentermine short-term. Correct! discuss her short-term and long-term weight loss goals. give her information about physical activity and diet modification. This woman’s BMI is in the moderate range for overweight, and her waist circumference is 34, which is not diagnostic for metabolic syndrome. Because her apparent motivation for losing weight is based on an upcoming event, the NP first should determine what her short-term and long-term weight loss goals are before initiating therapy. Orlistat is used long-term and would not be appropriate in this case. Phentermine should be used short-term and, because of serious risks, should be used only as adjunct therapy to lifestyle modifications. The initial intervention for weight loss is physical activity and diet modification. Question 30 An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a physical examination, the primary care nurse practitioner (NP) learns that the patient continues to have blood pressure readings of 135/90 mm Hg. The NP should: increase the captopril dose to 50 mg twice daily. Correct! add a thiazide diuretic to this patient’s regimen. change the drug to losartan (Cozaar) 50 mg once daily. recommend a low-sodium diet in addition to the medication. Some African-American patients do not appear to respond as well as whites in terms of blood pressure reduction. The addition of a low-dose thiazide diuretic often allows for efficacy in blood pressure lowering that is comparable with that seen in white patients. Increasing the captopril dose is not indicated. Losartan is an angiotensin receptor blocker (ARB) and is not indicated in this case. Question 31 A 40-year-old woman tells the primary care nurse practitioner (NP) that she does not want more children and would like a contraceptive. She does not smoke and has no personal or family history of cardiovascular disease. She has frequent tension headaches. For this patient, the NP should prescribe: condoms. tubal ligation. monophasic combined oral contraceptive pill (COCP). Correct! low-estrogen COCP. Low-estrogen COCPs are recommended for women older than 40 with or without cardiovascular risk. Monophasic COCPs are recommended for women with migraine headaches. Condoms are more useful for preventing sexually transmitted diseases and not as reliable as contraception. Tubal ligation has surgical risks. Question 32 A patient with a diagnosis of peptic ulcer disease asks the primary care NP about nonpharmacologic treatment. Which statement by the NP is correct? Correct! “You should consume a diet that is high in fiber.” “One or two cups of coffee each day won’t hurt you.” “Alcoholic beverages are strictly prohibited when you have an ulcer.” “Lifestyle changes and proper diet may eliminate the need for medication.” Balanced meals consumed at regular times that are high in fiber are encouraged. Caffeine increases acid secretion and should be avoided. Patients may consume alcohol in moderation. Although lifestyle changes and proper diet are an integral part of treatment for peptic ulcer disease, they do not eliminate the need for medications. Question 33 The neighbor of a primary care NP asks the NP to write a prescription for an antibiotic. The NP should tell the neighbor: a prescription will be written one time only. she will ask a colleague to write the prescription. that it is illegal to write prescriptions for friends. Correct! that it is best if the neighbor sees a health care provider before obtaining a prescription. It is not illegal to prescribe antibiotics for friends, but it is unethical. It is better if patients are seen and diagnosed appropriately before antibiotics are prescribed. The NP should recommend that the neighbor see a health care provider. Question 34 A patient who has diabetes is taking metformin 1000 mg daily. At a clinic visit, the patient reports having abdominal pain and nausea. The primary care NP notes a heart rate of 92 beats per minute. The NP should: obtain LFTs. decrease the dose of metformin. change metformin to glyburide. Correct! order electrolytes, ketones, and serum glucose. Symptoms of lactic acidosis include nausea, abdominal pain, and tachycardia. Tests should include electrolytes, ketones, and serum glucose. Question 35 A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop diuretic, and an ACE inhibitor. The patient reports having nausea. The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg. The NP should: decrease the dose of the diuretic to prevent further dehydration. obtain a serum potassium level to assess for hyperkalemia. hold the ACE inhibitor until the patient’s blood pressure stabilizes. Correct! obtain a digoxin level before the patient takes the next dose of digoxin. To monitor for toxicity, the health care provider must be alert to early signs of toxicity and must obtain a serum level. Nausea is an early sign of toxicity. Question 36 A female patient who is underweight tells the primary care NP that she has been using bisacodyl (Dulcolax) daily for several years. The NP should: Correct! prescribe docusate sodium (Colace) and decrease bisacodyl gradually. suggest she use polyethylene glycol (MiraLAX) on a daily basis instead. tell her that long-term use of suppositories is safer than long-term laxative use. counsel the patient to discontinue the laxative and increase fluid and fiber intake. Patients who abuse laxatives are at risk for cathartic colon and for electrolyte imbalances. These patients should be weaned from their stimulant laxative and placed on safer long-term laxatives, such as a bulk laxative or stool softener. Polyethylene glycol is a stimulant. Long-term use of suppositories causes rectal irritation. Discontinuing the laxative without a long-term laxative will lead to rebound constipation. Question 37 A patient who is obese is preparing to have surgery. To help prevent venous thromboembolism (VTE), the primary care NP should prescribe: low-dose aspirin once daily. clopidogrel (Plavix) 75 mg once daily. Correct! enoxaparin (Lovenox) 30 mg twice daily. warfarin (Coumadin) titrated to achieve an INR of 3.5. The American College of Clinical Pharmacy recommends against the use of aspirin alone for prophylaxis of VTE. Patients undergoing surgery who are at moderate to high risk for VTE should receive unfractionated heparin or low-molecular-weight heparin, such as enoxaparin. Aspirin may be part of the prophylaxis regimen. Clopidogrel and warfarin are not recommended. Question 38 A man with a BMI of 38 and a waist size of 48 inches is seen in the clinic for an annual well check-up. The primary care NP orders laboratory tests and notes a fasting plasma glucose of 110 mg/dL, triglyceride level of 220 mg/dL, and high-density lipoprotein level of 40 mg/dL. The man’s blood pressure is 160/110 mm Hg. The man has a history of cardiovascular disease and tells the NP he has tried to lose weight numerous times. The NP should consider: Correct! orlistat (Xenical). phentermine (Adipex-P). an oral antidiabetic agent. a strict low-fat, low-sodium diet. This man’s BMI and waist circumference indicate that he is obese, and he has more than three indicators of metabolic syndrome. Because of his history of cardiovascular disease, his past failed attempts to lose weight, and his elevated blood pressure, treatment is indicated. Phentermine would be a good initial choice but carries significant risks in patients with cardiovascular disease and high blood pressure. Orlistat is a safer choice for pharmacologic therapy. An oral antidiabetic agent would be used if insulin resistance were present, but his fasting plasma glucose is normal. A strict change in diet is warranted but in this case should be combined with pharmacologic treatment. Question 39 Which of the following has influenced an emphasis on primary care education in medical schools? Correct! Changes in Medicare reimbursement methods recommended in 1992 Competition from nonphysicians desiring to meet primary care shortages The need for monopolistic control in the marketplace of primary outpatient care The recognition that nonphysicians have variable success providing primary care The Physician Payment Review Commission in 1992 directly increased financial reimbursement to clinicians who provide primary care. Coupled with a shortage of primary care providers, this incentive led medical schools to place greater emphasis on preparing primary care physicians. Competition from nonphysicians increased coincidentally as professionals from other disciplines stepped up to meet the needs. Nonphysicians have had increasing success at providing primary care and have been shown to be safe and effective. Question 40 A patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2 weeks. The patient reports continued fatigue. The primary care NP should: order a T4 level today. increase the dose to 100 mcg. Correct! check the TSH level in 1 week. reassure the patient that this will improve in several weeks. Full therapeutic effectiveness may not be achieved for 3 to 6 weeks. Measuring the TSH level is indicated to evaluate drug effectiveness. The dose should not be increased without first evaluating the patient’s TSH level. Question 41 A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The primary care nurse practitioner (NP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles. The NP should consult a cardiologist to discuss prescribing a(n): β-blocker. Correct! loop diuretic. angiotensin-converting enzyme (ACE) inhibitor. angiotensin receptor blocker (ARB). This patient shows signs of systolic heart failure. Treatment for heart failure should begin with a loop diuretic, with an ACE inhibitor added after the diuretic has been taken. β-Blockers are used in patients with minimal fluid retention and would be added later. ARBs are used if ACE inhibitors are not tolerated or are ineffective. Question 42 A primary care NP will begin practicing in a state in which the governor has opted out of the federal facility reimbursement requirement. The NP should be aware that this defines how NPs may write prescriptions: without physician supervision in private practice. Correct! as CRNAs without physician supervision in a hospital setting. in any situation but will not be reimbursed for this by government insurers. only with physician supervision in both private practice and a hospital setting. In 2001, the Centers for Medicare and Medicaid Services changed the federal physician supervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write prescriptions and dispense drugs without physician supervision. Question 43 A patient with congestive heart failure will begin therapy with a diuretic medication. The primary care NP orders laboratory tests, which reveal a glomerular filtration rate (GFR) of 25 mL/minute. The initial drug the NP should prescribe is: Correct! metolazone. furosemide (Lasix). spironolactone (Aldactone). hydrochlorothiazide (HydroDIURIL). Thiazides are the most frequently used and the least expensive drugs administered to treat hypertension and are considered first-line treatments. In patients with a GFR less than 30 mL/minute, thiazides are relatively ineffective, with the exception of metolazone. Furosemide may be added as a second-line drug. Potassium-sparing diuretics, such as spironolactone, should be used with great caution or avoided altogether in patients with renal insufficiency. Question 44 A patient in the clinic reports frequent episodes of bloating, abdominal pain, and loose stools to the primary care nurse practitioner (NP). An important question the NP should ask about the abdominal pain is: Correct! the relation of the pain to stools. what time of day the pain occurs. whether the pain is sharp or diffuse. the age of the patient when the pain began. The new Rome II guidelines maintain that irritable bowel syndrome (IBS) of any subtype is characterized by a strong relationship between abdominal pain and defecation because of visceral hypersensitivity to gut-related events. The other characteristics of pain may be assessed to help guide management of IBS, but the first is necessary for a correct diagnosis. Question 45 A woman who is taking a progestin-only pill has just stopped nursing her 9-month-old infant and tells the primary care NP that she would like to space her children about 2 years apart. The NP should: discontinue the progestin-only pill. Correct! prescribe a COCP and a folic acid supplement. prescribe a progestin-only pill for another 6 months. suggest that she use a barrier method of contraception. Serum folate levels may be decreased by oral contraceptives. Women who become pregnant shortly after stopping oral contraceptive use may have a greater chance of birth defects. This woman should become pregnant in about 6 months if she wants to space her children 2 years apart, so she needs an oral contraceptive. Progestin-only pills are used only during lactation. Question 46 A patient comes to the clinic with a 4-day history of 10 to 12 liquid stools each day. The patient reports seeing blood and mucus in the stools. The patient has had nausea but no vomiting. The primary care NP notes a temperature of 37.9° C, a heart rate of 96 beats per minute, and a blood pressure of 90/60 mm Hg. A physical examination reveals dry oral mucous membranes and capillary refill of 4 seconds. The NP’s priority should be to: obtain stool cultures. Correct! begin rehydration therapy. consider prescribing metronidazole. administer opioid antidiarrheal medications. Acute diarrhea is usually mild and self-limited. Nonpharmacologic measures, especially bowel rest and adequate hydration, are helpful and should be a priority. Stool cultures may be ordered after hydration therapy is begun. Metronidazole is indicated if C. difficile is present. Opioid antidiarrheals may prolong symptoms. Question 47 A primary care nurse practitioner (NP) sees a patient who is concerned about constipation. The NP learns that the patient has three to four bowel movements per week with occasional hard stools but no straining with defecation. The NP should recommend: Correct! increased intake of fluids and fiber. docusate sodium (Colace) as needed. psyllium (Metamucil) on a daily basis. polyethylene glycol (MiraLAX) as needed. The objective definition of constipation is two or fewer bowel movements per week or excessive straining. This patient does not meet these criteria, so the NP should recommend increasing fluids and fiber to help soften stools. Laxatives should not be used unless constipation is present or is chronic to avoid laxative dependence. Question 48 A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant. The NP should expect that this patient will use which of the following anticoagulant medications? Aspirin Correct! Heparin Dabigatran Warfarin Heparin does not cross the placental barrier and is the drug of choice for anticoagulation therapy during pregnancy, despite its category C classification. Aspirin is not recommended during the last 3 months of pregnancy. Dabigatran is not recommended. Warfarin crosses the placental barrier. Question 49 A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased. The NP should consult with an endocrinologist and order: thyrotropin. Correct! methimazole. levothyroxine. propylthiouracil. Patients with hyperthyroidism, or Graves’ disease, will require radioactive iodine. Elderly patients and patients with cardiovascular disease should be pretreated with an antithyroid medication such as methimazole. Thyrotropin is used to diagnose thyroid cancer. Levothyroxine is used to treat hypothyroidism. Propylthiouracil is also a thyroid suppressant, but methimazole is preferred. Question 50 The primary care NP is seeing a patient for a hospital follow-up after the patient has had a first myocardial infarction. The patient has a list of the prescribed medications and tells the NP that “no one explained anything about them.” The NP’s initial response should be to: ask the patient to describe the medication regimen. ask the patient to make a list of questions about the medications. Correct! determine what the patient understands about coronary artery disease. give the patient information about drug effects and any adverse reactions. When a patient is first diagnosed with a medical problem, education must start with explaining the pathophysiology in terms the patient will understand. When patients understand what has happened to them, they can move on to consider what to do about it. The other responses are part of an education plan but are not the initial response. Question 51 A patient has heart failure. A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling. The patient takes low-dose furosemide and an ACE inhibitor. The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg. The NP should: Correct! order serum electrolytes. obtain renal function tests. consider prescribing a β-blocker. call the patient’s cardiologist to discuss adding digoxin to the patient’s regimen. Patients with diastolic heart failure are sensitive to fluid depletion, which can cause decreased preload and stroke volume. This patient has a rapid heart rate and a low blood pressure, which can indicate dehydration, so serum electrolytes should be obtained. Renal function tests are not indicated. β-Blockers are used in patients who are stable. Digoxin should not be used in patients with diastolic failure. Question 52 A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should: obtain a stool specimen and order vancomycin. Correct! order testing for Clostridium difficile and consider metronidazole therapy. prescribediphenoxylate (Lomotil) to provide symptomatic relief. reassure the patient that diarrhea is a common side effect of antibiotic therapy. The guidelines for treatment of diarrhea emphasize comprehensive evaluation before treatment begins. Antibiotic use points to C. difficile as a possible cause, and metronidazole is often used to treat mild to moderate infection. Vancomycin is used when C. difficile is severe. Diphenoxylate can worsen the infection because it slows transit time of the bacteria in the gut. Prolonged diarrhea during antibiotic therapy should be investigated. Question 53 A patient is taking a low-dose PPI for long-term management of GERD and reports taking sodium bicarbonate (Alka-Seltzer) to help with occasional heartburn. The primary care NP should tell the patient to: change to aluminum hydroxide (Amphojel). use magnesium hydroxide (Milk of Magnesia) instead. continue using sodium bicarbonate (Alka-Seltzer) as needed. Correct! take calcium carbonate (Tums) instead of sodium bicarbonate (Alka-Seltzer). Sodium bicarbonate is not suitable for long-term use because of side effects. Calcium carbonate requires monitoring when used long-term but has the highest acid-neutralizing capacity. Antacids containing aluminum and magnesium can cause electrolyte imbalances. Question 54 A 12-year-old patient has acute diarrhea and an upper respiratory infection. Other family members have had similar symptoms, which have resolved. The primary care NP should recommend: diphenoxylate (Lomotil). attapulgite (Kaopectate). Correct! an electrolyte solution (Pedialyte). bismuth subsalicylate (Pepto-Bismol). Antidiarrheals are not generally recommended in children. Bismuth is not recommended in children younger than 16 years of age with viral illnesses because it can mask symptoms of Reye’s syndrome. Oral rehydration with electrolyte solution is safe. Question 55 A patient who has stable angina and uses sublingual nitroglycerin tablets is in the clinic and begins having chest pain. The primary care NP administers a nitroglycerin tablet and instructs the patient to lie down. The NP’s next action should be to: obtain an electrocardiogram. Correct Answer administer oxygen at 2 L/minute. give 325 mg of chewable aspirin. You Answered call EMS. When a patient experiences an acute attack of angina in the clinic, the primary care NP should be prepared to treat the condition. After giving nitroglycerin, oxygen should be administered. An electrocardiogram is not immediately indicated. Chewable aspirin is given if the angina is unrelieved and when the patient is being transported to the hospital. EMS should be activated if there is no pain relief 5 minutes after the first dose of nitroglycerin. Question 56 A primary care NP has prescribed phentermine for a patient who is obese. The patient loses 10 lb in the first month but reports that the drug does not seem to be suppressing appetite as much as before. The NP should: Correct! discontinue the phentermine. increase the dose of phentermine. continue the phentermine at the same dose. change to a combination of phentermine and topiramate. Tolerance to the effects of phentermine usually develops within a few weeks of starting therapy. When this occurs, the drug should be discontinued, not increased. Phentermine use is not recommended longer than a few weeks. Question 57 A patient who has hypothyroidism and is obese begins therapy with orlistat. The primary care NP teaches the patient about this drug and then asks the patient to describe its use. Which statement by the patient indicates understanding of the teaching? “I may eat a high-fat diet while taking orlistat.” Correct! “I can expect the most benefit in the first few months.” “I should take fat-soluble vitamins each time I take orlistat.” “I should take an increased dose of levothyroxine while I am taking orlistat.” In long-term studies on the use of orlistat, most of the weight loss occurred during the first months. Patients should not be counseled to eat a high-fat diet; the maximum amount of fat excretion is around 25% to 30%. Patients should take fat-soluble vitamins, but the vitamins should be taken at different times and not with orlistat. Orlistat interferes with levothyroxine absorption, so the two drugs should be taken at different times, and thyroid levels should be monitored with an increase in levothyroxine dose only when indicated by thyroid levels. Question 58 A patient who has an upper respiratory infection reports using over-the-counter cold preparations. The primary care NP should counsel this patient to use caution when taking additional over-the-counter medications such as: Correct! antipyretics. calcium supplements. acid reflux medications. antioxidant supplements. Cold preparations often contain antipyretics such as acetaminophen or aspirin. Patients should be cautioned about taking additional antipyretics to avoid overdose. Question 59 A patient with chronic back pain that is unrelieved by prescription analgesic medications asks a primary care nurse practitioner (NP) about acupuncture treatments. The NP should tell this patient: biofield therapy has been shown to be more effective than acupuncture. creatine has been shown to be an effective herbal choice to treat back pain. there is no valid research documenting the efficacy of this treatment for pain. Correct! most studies that show benefits of alternative therapies are based on observation. Current literature does not allow definitive conclusions to be drawn regarding the use of complementary and alternative medicine (CAM) because much of what appears in the literature continues to be based on observational reports and small studies. Biofield therapy has not been shown to be more effective than acupuncture. Creatine is used to increase muscle mass. Question 60 A patient who takes spironolactone for heart failure has begun taking digoxin (Lanoxin) for atrial fibrillation. The primary care NP provides teaching for this patient and asks the patient to repeat back what has been learned. Which statement by the patient indicates understanding of the teaching? Correct! “I should avoid high-sodium foods.” “I should eat foods high in potassium.” “I need to take a calcium supplement every day.” “I should use a salt substitute while taking these medications.” Patients should be taught to reduce their overall sodium intake by avoiding salty foods and not adding salt while cooking. Spironolactone is a potassium-sparing diuretic and carries a risk of hyperkalemia, which can make the myocardium more sensitive to the effects of digoxin. Hypercalcemia can predispose the patient to digoxin toxicity. Salt substitutes are high in potassium. [Show Less]
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