An 18-year-old female patient is being followed up for acne by the nurse
practitioner. During the facial exam, papules and pustules are noted mostly on
... [Show More] the
forehead and the chin areas. The patient has been using over-the-counter topical
antibiotic gels and medicated soap daily for 6 months without much improvement.
The nurse practitioner will recommend:
a. Isotretinoin (Accutane)
b. Tetracycline (Sumycin)
c. Clindamycin topical solution (Cleocin- T)
d. Minoxidil (Rogaine) - b. Tetracycline (Sumycin)
First-line treatment for acne vulgaris includes over-the-counter medicated soap and
water with topical antibiotic gels. The next step in treatment would be the initiation
of oral tetracycline.
A young adult presents for reassessment of uncontrolled asthma symptoms. The
patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed
and reports daytime symptoms more than 3 days/week, but not daily, and nighttime
awakenings 4 to 5 times/week. The patient's forced expiratory volume (FEV1) is
80% of predicted. The nurse practitioner upgrades the patient to the next stage of
treatment, which includes:
a. Budesonide with formoterol
b. Budesonide with montelukast
c. Cromolyn or nedocromil
d. Fluticasone with salmeterol - a. Budesonide with formoterol.The patient has moved from step 2 to step 3 on the asthma classification scale.
Therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist
(LABA) such as budesonide with formoterol is an appropriate starting point.
Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with
montelukast is an alternative. Cromolyn and nedocromil have been discontinued in
the United States.
Which of the following drugs can increase the risk of bleeding in patients who are
receiving anticoagulation therapy with warfarin sodium (Coumadin)?
a. Trimethoprim-sulfamethoxazole (Bactrim DS)
b. Carafate (Sucralfate)
c. Losartan (Cozaar)
d. Furosemide (Lasix) - a. Trimethoprim-sulfamethoxazole (Bactrim DS).
Warfarin sodium (Coumadin) interacts with Bactrim and will increase the risk of
bleeding; therefore, concurrent use is contraindicated.
A 22-year-old woman is going on a 5-day cruise for her honeymoon. She reports a
history of severe motion sickness. Which of the following medicines can be
prescribed for motion sickness?
a. Dimenhydrinate (Dramamine)
b. Metoclopramide (Reglan)
c. Ondansetron (Zofran)
d. Scopolamine patch (Transderm Scop) - d. Scopolamine patch (Transderm Scop)
Scopolamine patch (Transderm Scop) is a prescription medicine that is used for
motion/sea sickness. It is a small, circular patch that is placed behind the ear and iseffective for 3 days. Advise the patient to apply it 4 hours before the trip to be
effective. Because the question is asking about a "prescribed" medication, an overthe-counter (OTC) medicine, such as Dramamine, is an incorrect response. Zofran
is indicated for cancer-related nausea and vomiting (chemotherapy, radiation,
surgery).
The nurse practitioner is completing a health assessment on a 15-year-old female
patient who is in the office for her annual physical. The patient reports feelings of
hopelessness and sadness for several months, no history of suicidal ideations, and a
struggle with anorexia. The patient scores an 11 on Beck's Depression Inventory.
Which antidepressant will the nurse practitioner prescribe?
a. Sertraline (Zoloft)
b. Lithium carbonate (Eskalith)
c. Bupropion (Wellbutrin)
d. Escitalopram (Lexapro) - d. Escitalopram [Lexapro]
Escitalopram is a safe antidepressant for an adolescent who has severe depression
and no history of suicidal ideations. Sertraline is not a safe option for patients
younger than 24 years of age because of increased risk of suicidal ideation.
Bupropion is an atypical antidepressant and is not a first-line therapy for
depression. It is contraindicated in patients with anorexia nervosa. Lithium is
indicated for patients with bipolar disorder. [Show Less]