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.
... [Show More] Creatinine clearance and cholesterol tests are normal.
The primary care NP should order:
a β-blocker.
an angiotensin-converting enzyme inhibitor.
Correct!
a thiazide diuretic.
dietary and lifestyle changes.
The patient has stage I hypertension. Because there are no compelling indications for other treatment, a
thiazide diuretic should be used initially to treat the hypertension. Dietary and lifestyle changes should
also be recommended but are not sufficient for patients with stage I hypertension. Other drugs may be
added later if thiazide diuretic therapy fails.
Question 2
2 / 2 pts
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 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 contraceptive therapy.
selective serotonin reuptake inhibitor therapy until menopause begins.
estrogen-progesterone HT.
Oral contraceptive pills are not approved by the U.S. Food and Drug Administration for management of
perimenopausal symptoms except to treat irregular menstrual bleeding. This patient has a low risk for
CHD and breast cancer, so oral contraceptive pills are relatively safe. She is also at risk for pregnancy, so
oral contraceptive pills can help to prevent that.
Question 4
2 / 2 pts
The primary care NP is prescribing a medication for an off-label use. To help prevent a medication error,
the NP should:
Correct!
write “off-label use” on the prescription and provide a rationale.
call the pharmacist to explain why the instructions deviate from common use.
write the alternative drug regimen on the prescription and send it to the pharmacy.
tell the patient to ignore the label directions and follow the verbal instructions given in the clinic.
When prescribing a drug for an off-label use, the provider should specify this on the written prescription
and should provide a rationale so that the pharmacist understands why the prescription is different from
the normal use. Calling the pharmacist would not provide written documentation. Merely writing the
different instructions can lead to errors if the pharmacist changes the label to conform to usual
standards. The patient may forget verbal instructions and follow the usual regimen instead.
Question 5
2 / 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:
prescribe a thiazide diuretic.
consider treatment with an angiotensin-converting enzyme inhibitor.
reassure the patient that these findings are normal.
Correct!
counsel the patient about dietary and lifestyle changes.
The patient’s blood pressure indicates prehypertension, but the patient does not have cardiovascular risk
factors such as hyperlipidemia or hyperinsulinemia. The body mass index indicates that the patient is
overweight but not obese. Pharmacologic treatment is not recommended for prehypertension unless
compelling reasons are present. The findings are not normal, so it is appropriate to counsel the patient
about diet and exercise.
Question 6
2 / 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:
give clopidogrel after administering cardioversion.
Correct!
administer cardioversion without using anticoagulants.
give warfarin and aspirin before attempting cardioversion.
give low-dose aspirin before administering cardioversion.
If the onset of AF has occurred within 48 hours, cardioversion can be done without anticoagulation.
Clopidogrel is used in other cases for patients who cannot take aspirin. For patients with rheumatic
mitral valve disease and AF or a history of systemic embolism, cardioversion plus aspirin is used.
Warfarin is used in patients with one or more risk factors for stroke.
Question 7
2 / 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:
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 8
2 / 2 pts
A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile 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 statin medication. The NP should:
recommend dietary and lifestyle changes first.
Correct!
begin therapy with atorvastatin 10 mg per day.
discuss quality-of-life issues as part of the decision to begin medication.
tell her there is no clinical evidence of efficacy of statin medication in her case.
This woman would be using a statin medication for secondary prevention because she already has a
history of MI, so a statin should be prescribed. Dietary and lifestyle changes should be a part of therapy,
but not the only therapy. She is relatively young, and quality-of-life issues are not a concern. There is no
clinical evidence to support use of statins as primary prevention in women.
Question 9
2 / 2 pts
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:
diphenoxylate (Lomotil).
attapulgite (Kaopectate).
Correct!
an electrolyte solution (Pedialyte).
bismuth subsalicylate (Pepto-Bismol).
Antidiarrheals are not recommended in children. Opioids are contraindicated in children younger than 2
years. Bismuth and attapulgite are not recommended in children younger than 3 years of age. Oral
rehydration with electrolyte solution is safe for young children.
Question 10
2 / 2 pts
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 11
2 / 2 pts
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:
Correct!
this information is probably from a drug advertisement website.
this is factual, evidence-based material with accurate information.
the information is from a nonprofit group that will not profit from drug sales.
internet information is unreliable because anyone can post information there.
Commercial internet sites are identifiable by “com” at the end of their web address. Many provide
reliable information, but others may be more interested in selling something. Nonprofit groups use “org”
at the end of their web addresses. Internet information is reliable as long as the internet user is aware of
how things are posted and by whom.
Question 12
2 / 2 pts
A patient who is taking an ACE inhibitor sees the primary care NP for a follow-up visit. The patient
reports having a persistent cough. The NP should:
Correct!
consider changing the medication to an ARB.
order a bronchodilator to counter the bronchospasm caused by this drug.
ask whether the patient has had any associated facial swelling with this cough.
reassure the patient that tolerance to this adverse effect will develop over time.
A persistent cough may occur with ACE inhibitors and may warrant discontinuation 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. Patients do not develop
tolerance to this side effect.
Question 13
2 / 2 pts
A primary care NP is prescribing a drug for a patient who does not take any other medications. The NP
should realize that:
CYP450 enzyme reactions will not interfere with this drug’s metabolism.
substrates such as alcohol cannot interfere with the drug when the patient is abstaining.
food-drug interactions are limited to those where food enhances or inhibits drug absorption.
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 kinetics 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 identify things that might interfere with a drug. All of these may interfere with CYP
enzymes. Alcohol intake can influence this even when the patient is abstaining because of long-term
effects on the liver.
Question 14
2 / 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:
order LH and FSH levels.
order a serum prolactin 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 prolactin levels may be drawn as well. Testosterone replacement should not be
prescribed until the diagnosis is definitive.
Question 15
2 / 2 pts
In every state, prescriptive authority for NPs includes the ability to write prescri [Show Less]