NR 508 NR508 Pharmacology Mid-term Exam Review
NR 508-Pharmacology Mid-term
Queston 1
2 / 2 pts
A patent has three consecutve blood pressure
... [Show More] readings of 140/95 mm Hg. The patent’s body mass
index is 24. A fastng plasma glucose is 100 mg/dL. Creatnine clearance and cholesterol tests are normal.
The primary care NP should order:
a β-blocker.
an angiotensin-convertng enzyme inhibitor.
Correct!
a thiazide diuretc.
dietary and lifestyle changes.
The patent has stage I hypertension. Because there are no compelling indicatons for other treatment, a
thiazide diuretc should be used initally to treat the hypertension. Dietary and lifestyle changes should
also be recommended but are not sufcient for patents with stage I hypertension. Other drugs may be
added later if thiazide diuretc therapy fails.
Queston 2
2 / 2 ptsAn African-American patent is taking captopril (Capoten) 25 mg twice daily. When performing a physical
examinaton, the primary care nurse practtoner (NP) learns that the patent contnues 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 diuretc to this patent’s regimen.
change the drug to losartan (Cozaar) 50 mg once daily.
recommend a low-sodium diet in additon to the medicaton.
Some African-American patents do not appear to respond as well as whites in terms of blood pressure
reducton. The additon of a low-dose thiazide diuretc ofen allows for efcacy in blood pressure
lowering that is comparable with that seen in white patents. Increasing the captopril dose is not
indicated. Losartan is an angiotensin receptor blocker (ARB) and is not indicated in this case.
Queston 3
2 / 2 pts
A 50-year-old woman reports severe, frequent hot flashes and vaginal dryness. She is having irregular
periods. She has no family history of CHD or breast cancer and has no personal risk factors. The primary
care NP should recommend:estrogen-only HT.
Correct!
low-dose oral contraceptve therapy.
selectve serotonin reuptake inhibitor therapy untl menopause begins.
estrogen-progesterone HT.
Oral contraceptve pills are not approved by the U.S. Food and Drug Administraton for management of
perimenopausal symptoms except to treat irregular menstrual bleeding. This patent has a low risk for
CHD and breast cancer, so oral contraceptve pills are relatvely safe. She is also at risk for pregnancy, so
oral contraceptve pills can help to prevent that.
Queston 4
2 / 2 pts
The primary care NP is prescribing a medicaton for an off-label use. To help prevent a medicaton error,
the NP should:
Correct!
write “off-label use” on the prescripton and provide a ratonale.call the pharmacist to explain why the instructons deviate from common use.
write the alternatve drug regimen on the prescripton and send it to the pharmacy.
tell the patent to ignore the label directons and follow the verbal instructons given in the clinic.
When prescribing a drug for an off-label use, the provider should specify this on the writen prescripton
and should provide a ratonale so that the pharmacist understands why the prescripton is different from
the normal use. Calling the pharmacist would not provide writen documentaton. Merely writng the
different instructons can lead to errors if the pharmacist changes the label to conform to usual
standards. The patent may forget verbal instructons and follow the usual regimen instead.
Queston 5
2 / 2 pts
The primary care nurse practtoner (NP) sees a patent in the clinic who has a blood pressure of 130/85
mm Hg. The patent’s laboratory tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120
mg/dL; and fastng plasma glucose, 100 mg/dL. The NP calculates a body mass index of 29. The patent
has a positve family history for cardiovascular disease. The NP should:
prescribe a thiazide diuretc.
consider treatment with an angiotensin-convertng enzyme inhibitor.reassure the patent that these fndings are normal.
Correct!
counsel the patent about dietary and lifestyle changes.
The patent’s blood pressure indicates prehypertension, but the patent does not have cardiovascular risk
factors such as hyperlipidemia or hyperinsulinemia. The body mass index indicates that the patent is
overweight but not obese. Pharmacologic treatment is not recommended for prehypertension unless
compelling reasons are present. The fndings are not normal, so it is appropriate to counsel the patent
about diet and exercise.
Queston 6
2 / 2 pts
A patent 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:
give clopidogrel afer administering cardioversion.
Correct!
administer cardioversion without using antcoagulants.
give warfarin and aspirin before atemptng cardioversion.give low-dose aspirin before administering cardioversion.
If the onset of AF has occurred within 48 hours, cardioversion can be done without antcoagulaton.
Clopidogrel is used in other cases for patents who cannot take aspirin. For patents with rheumatc
mitral valve disease and AF or a history of systemic embolism, cardioversion plus aspirin is used.
Warfarin is used in patents with one or more risk factors for stroke.
Queston 7
2 / 2 pts
A patent in the clinic reports frequent episodes of bloatng, abdominal pain, and loose stools to the
primary care nurse practtoner (NP). An important queston the NP should ask about the abdominal pain
is:
Correct!
the relaton of the pain to stools.
what tme of day the pain occurs.
whether the pain is sharp or diffuse.
the age of the patent when the pain began.The new Rome II guidelines maintain that irritable bowel syndrome (IBS) of any subtype is characterized
by a strong relatonship between abdominal pain and defecaton because of visceral hypersensitvity to
gut-related events. The other characteristcs of pain may be assessed to help guide management of IBS,
but the frst is necessary for a correct diagnosis.
Queston 8
2 / 2 pts
A 55-year-old woman has a history of myocardial infarcton (MI). A lipid profle reveals LDL of 130 mg/dL,
HDL of 35 mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass index of 26.
The woman asks the primary care NP about using a statn medicaton. The NP should:
recommend dietary and lifestyle changes frst.
Correct!
begin therapy with atorvastatn 10 mg per day.
discuss quality-of-life issues as part of the decision to begin medicaton.
tell her there is no clinical evidence of efcacy of statn medicaton in her case.
This woman would be using a statn medicaton for secondary preventon because she already has a
history of MI, so a statn should be prescribed. Dietary and lifestyle changes should be a part of therapy,
but not the only therapy. She is relatvely young, and quality-of-life issues are not a concern. There is no
clinical evidence to support use of statns as primary preventon in women.
Queston 92 / 2 pts
A 2-year-old child has chronic “toddler’s” diarrhea, which has an unknown but benign etology. The
child’s parent asks the primary care NP if a medicaton can be used to treat the child’s symptoms. The NP
should recommend giving:
diphenoxylate (Lomotl).
atapulgite (Kaopectate).
Correct!
an electrolyte soluton (Pedialyte).
bismuth subsalicylate (Pepto-Bismol).
Antdiarrheals are not recommended in children. Opioids are contraindicated in children younger than 2
years. Bismuth and atapulgite are not recommended in children younger than 3 years of age. Oral
rehydraton with electrolyte soluton is safe for young children.
Queston 10
2 / 2 pts
A patent who has hyperlipidemia has been taking atorvastatn (Lipitor) 60 mg daily for 6 months. The
patent’s inital lipid profle showed LDL of 180 mg/dL, HDL of 45 mg/dL, and triglycerides of 160 mg/dL.
The primary care NP orders a lipid profle today that shows LDL of 105 mg/dL, HDL of 50 mg/dL, and
triglycerides of 120 mg/dL. The patent reports muscle pain and weakness. The NP should:order liver functon tests (LFTs).
Correct!
order a creatne kinase-MM (CK-MM) level.
change atorvastatn to twice-daily dosing.
add gemfbrozil (Lopid) to the patent’s medicaton regimen.
Hepatotoxicity and muscle toxicity are the two primary adverse effects of greatest concern with statn
use. Patents 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. Gemfbrozil is not
indicated.
Queston 11
2 / 2 pts
A patent brings writen informaton about a medicaton 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 informaton is from an internet
site called “Prism.com.” The NP should tell this patent that:
Correct!
this informaton is probably from a drug advertsement website.this is factual, evidence-based material with accurate informaton.
the informaton is from a nonproft group that will not proft from drug sales.
internet informaton is unreliable because anyone can post informaton there.
Commercial internet sites are identfable by “com” at the end of their web address. Many provide
reliable informaton, but others may be more interested in selling something. Nonproft groups use “org”
at the end of their web addresses. Internet informaton is reliable as long as the internet user is aware of
how things are posted and by whom.
Queston 12
2 / 2 pts
A patent who is taking an ACE inhibitor sees the primary care NP for a follow-up visit. The patent
reports having a persistent cough. The NP should:
Correct!
consider changing the medicaton to an ARB.
order a bronchodilator to counter the bronchospasm caused by this drug.ask whether the patent has had any associated facial swelling with this cough.
reassure the patent that tolerance to this adverse effect will develop over tme.
A persistent cough may occur with ACE inhibitors and may warrant discontnuaton of the drug. An ARB
would be the next drug of choice because it does not have this side effect. The cough is not related to
bronchospasm. Angioedema is not related to ACE inhibitor–induced cough. Patents do not develop
tolerance to this side effect.
Queston 13
2 / 2 pts
A primary care NP is prescribing a drug for a patent who does not take any other medicatons. The NP
should realize that:
CYP450 enzyme reactons will not interfere with this drug’s metabolism.
substrates such as alcohol cannot interfere with the drug when the patent is abstaining.
food-drug interactons are limited to those where food enhances or inhibits drug absorpton.
Correct!
a thorough history of diet, alcohol use, smoking, and over-the-counter and herbal products is required.
Drugs are not the only substances that interfere with drug kinetcs and dynamics. The primary care NP
should conduct a thorough history of food and alcohol intake, smoking, and over-the-counter and herbal
supplements to identfy things that might interfere with a drug. All of these may interfere with CYP
enzymes. Alcohol intake can influence this even when the patent is abstaining because of long-term
effects on the liver.Queston 14
2 / 2 pts
A male patent tells the primary care NP he is experiencing decreased libido, lack of energy, and poor
concentraton. The NP performs an examinaton and notes increased body fat and gynecomasta. A
serum testosterone level is 225 ng/dL. The NP’s next acton should be to:
order LH and FSH levels.
order a serum prolactn level.
prescribe testosterone replacement.
Correct!
obtain a morning serum testosterone level.
To diagnose hypogonadism, two serum testosterone levels must be drawn, with serum collected in the
morning. LH, FSH, and prolactn levels may be drawn as well. Testosterone replacement should not be
prescribed untl the diagnosis is defnitve.
Queston 15
2 / 2 pts
In every state, prescriptve authority for NPs includes the ability to write prescriptons:for controlled substances.
Correct!
for specifed classifcatons of medicatons.
without physician-mandated involvement.
with full, independent prescriptve authority.
All states now have some degree of prescriptve authority granted to NPs, but not all states allow
authority to prescribe controlled substances. Many states stll require some degree of physician
involvement with certain types of drugs.
Queston 16
2 / 2 pts
A patent who has an upper respiratory infecton reports using over-the-counter cold preparatons. The
primary care NP should counsel this patent to use cauton when taking additonal over-the-counter
medicatons such as:
Correct!
antpyretcs.calcium supplements.
acid reflux medicatons.
antoxidant supplements.
Cold preparatons ofen contain antpyretcs such as acetaminophen or aspirin. Patents should be
cautoned about taking additonal antpyretcs to avoid overdose.
Queston 17
2 / 2 pts
The primary care NP has referred a child who has signifcant gastrointestnal reflux disease to a specialist
for consideraton for a fundoplicaton and gastrostomy tube placement. The child’s weight is 80% of what
is recommended for age, and a recent swallow study revealed signifcant risk for aspiraton. The child’s
parents do not want the procedure. The NP should:
compromise with the parents and order a nasogastric tube for feedings.
Correct!
initate a discussion with the parents about the potental outcomes of each possible acton.refer the family to a case manager who can help guide the parents to the best decision.
understand that the child’s parents have a right to make choices that override those of the medical team.
In general, the goal of a health care decision maker is to choose an acton that is most likely to deliver
the outcomes the patent wants. Initatng a discussion about outcomes helps parents decide based on
end results. A nasogastric tube is not the best choice for the child, and compromising without frst
exploring optons is incorrect. As part of the therapeutc relatonship, the NP should be involved with
patents’ decisions. Although patents and families have the right to make decisions, the NP has an
obligaton to ensure that the decisions are informed decisions.
Queston 18
2 / 2 pts
A patent who has experienced fve to seven liquid stools for 3 days is seen in the clinic by the primary
care NP. The patent reports having had fever, mucoid stools, and nausea without vomitng. The patent
has been drinking Gatorade to stay hydrated. The NP obtains a stool specimen for culture and should
prescribe:
diphenoxylate (Lomotl).
atapulgite (Kaopectate).
Correct!
bismuth subsalicylate (Pepto-Bismol).loperamide hydrochloride (Imodium).
Bismuth reduces symptoms through antdiarrheal and antbacterial propertes and can decrease nausea
and vomitng. Opioid antdiarrheals should be given afer the cause of infectous diarrhea is treated;
these can actually prolong symptoms because they slow transit of the causatve organisms through the
gut. Atapulgite can be used because it binds bacteria and toxins in the gastrointestnal tract, but
bismuth is a beter choice in this case because it helps to treat nausea. The patent is drinking Gatorade
and is getng electrolyte replacement.
Queston 19
2 / 2 pts
A patent reports having occasional acute constpaton with large, hard stools and pain and asks the
primary care NP about medicaton to treat this conditon. The NP learns that the patent drinks 1500 mL
of water daily; eats fruits, vegetables, and bran; and exercises regularly. The NP should recommend:
a daily bulk laxatve.
long-term docusate sodium.
Correct!
a saline laxatve as needed.glycerin suppositories as needed.
Mild short-term constpaton may be treated with a saline laxatve or a bulk laxatve as needed. Daily
laxatves are not recommended. Glycerin suppositories can cause irritaton of the rectum with long-term
use.
Queston 20
2 / 2 pts
A postpartum woman will begin taking the minipill while she is nursing her infant. The primary care NP
should instruct the patent:
to use backup contracepton while taking the minipill.
to contnue using the minipill for 6 months afer she stops nursing.
that irregular periods while taking the minipill may indicate she is pregnant.
Correct!
that this method does not increase her risk of thromboembolic events.
Minipills are used primarily in breasteeding women. There is no increased risk for thromboembolic
events for women taking these pills. It is not necessary to use a backup method of contracepton.
Women should be advised to contact the provider when they stop nursing so that a COCP can be
prescribed. The more disrupted the bleeding patern, the more likely it is that ovulaton is inhibited.Queston 21
2 / 2 pts
A patent 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:
orlistat (Xenical).
surgical interventon.
changes in diet and exercise.
Correct!
changes in diet and exercise along with short-term phentermine.
This patent is grade 2 overweight (obese), so a short-term course of phentermine is useful, especially as
there are no cardiovascular risk factors. Orlistat is a second-line drug. Surgical interventon is indicated
when other therapies fail. Changes in diet and physical actvity alone do not bring immediate results, and
patents ofen get discouraged.
Queston 22
2 / 2 pts
A patent who has asthma and who is known to the primary care NP calls the NP afer hours and asks for
a refll of an albuterol metered-dose inhaler. The patent has not been seen in the clinic for more than a
year. The NP should:call the pharmacy to order the medicaton with several reflls.
send an electronic prescripton to the pharmacy for one tme only.
send the patent to the emergency department for evaluaton of symptoms.
Correct!
refll the drug and tell the patent that an ofce visit is necessary for further reflls.
The patent needs the medicaton and is known to the NP so a refll is not inconsistent with practce
guidelines. However, further reflls should not be provided untl the patent is seen and has an updated
asthma acton plan. The patent should be informed of this; simply reflling the prescripton sends a
message that it is acceptable to get reflls without being seen.
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