NR 508 Week 4 Mid-Term
Question 12 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:
testosterone therapy.
estrogen-only therapy.
nonhormonal drugs for osteoporosis.
estrogen-progesterone therapy for
1 to 2 years.
Question 22 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:
aprepitant (Emend).
ondansetron (Zofran).
scopolamine transdermal.
prochlorperazine (Compazine).
Question 32 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:
thyrotropin.
methimazole.
levothyroxine.
propylthiouracil.
Question 42 pts
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:
prescribe a thiazide diuretic and
an angiotensin-converting enzyme inhibitor.
perform a careful cardiovascular
physical assessment.
counsel the patient about dietary
and lifestyle changes.
order a urinalysis and creatinine
clearance and begin therapy with a ?-blocker.
Question 52 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:
methimazole.
liothyronine.
levothyroxine.
propylthiouracil.
Question 62 pts
When prescribing a medication for
a chronic condition, the primary care NP should tell the patient:
to contact the pharmacy whenever
refills are needed.
that it is necessary to return to
the clinic for each monthly refill of the medication.
about the frequency of clinic
visits necessary for the number of refills authorized.
to ask the pharmacist to supply
several months’ worth of the medication at a time.
Question 72 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:
increasing the dose to 90 mcg/day.
decreasing the dose to 30 mcg/day.
stopping the medication and
checking TSH and T4 in 4 weeks.
discussing the need for lifetime
replacement therapy with the child’s parents.
Question 82 pts
A patient who has IBS experiences
diarrhea, bloating, and pain but does not want to take medication. The primary
care NP should recommend:
25 g of fiber each day.
avoiding gluten and lactose in the
diet.
increasing water intake to eight
to ten glasses per day.
beginning aerobic exercise, such
as running, every day.
Question 92 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:
take one cycle of COCPs.
take a home pregnancy test.
use condoms for the next 7 days.
contact the clinic if she misses a
period.
Question 102 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:
mesalamine (Asacol).
dicyclomine (Bentyl).
simethicone (Phazyme).
metoclopramide (Reglan).
Question 112 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:
may cause different adverse
effects.
does not necessarily have the same
therapeutic effect.
is likely to be less safe than the
brand specified in the prescription.
may vary in the amount of drug
that reaches the site of action in the body.
Question 122 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 minute with a regular rhythm. The NP should:(PSVT)
administer intravenous fluids and
obtain serum electrolytes.
administer amiodarone in the
clinic and observe closely for response.
order digoxin and verapamil and
ask the patient to return for a follow-up examination in 1 week.
send the patient to an emergency
department for evaluation and treatment.
Question 132 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:
should consider another form of contraception
after 1 year.
may have irregular bleeding,
especially in the first month or so.
will need to take calcium and
vitamin D every day while using this method.
will have to take oral
contraceptive pills in addition to Depo-Provera when she takes antibiotics.
Question 142 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:
changing to amlodipine.
ordering renal function tests.
increasing the dose of nifedipine.
evaluation of left ventricular
function.
Question 152 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:
schedule a treadmill stress test.
order genetic testing for this
patient.
discontinue the
trimethoprim-sulfamethoxazole.
refer the patient to a
cardiologist for further evaluation.
Question 162 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 ?-blocker.
an angiotensin-converting enzyme
inhibitor.
a thiazide diuretic.
dietary and lifestyle changes.
Question 172 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.
obtain a morning serum
testosterone level.
Question 182 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:
order diphenoxylate (Lomotil).
prescribe alosetron after ruling
out pregnancy.
refer her to a gastroenterologist
for endoscopy.
increase the fiber in her diet to
30 g per day.
Question 192 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:
continuation of the PPI for 4 to 8
weeks.
a PPI, amoxicillin, and
metronidazole for 14 days.
a PPI, clarithromycin, and
amoxicillin for 14 more days.
a PPI, bismuth subsalicylate,
tetracycline, and metronidazole.
Question 202 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:
inhibitor.
substrate.
inducer.
metabolizer.
Question 212 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:
order a ?-blocker.
add an angiotensin-converting
enzyme inhibitor.
continue the current drug regimen.
change to an aldosterone
antagonist medication.
Question 222 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:
obtain a stool specimen and order
vancomycin.
order testing for Clostridium
difficile and consider metronidazole therapy.
prescribe diphenoxylate (Lomotil)
to provide symptomatic relief.
reassure the patient that diarrhea
is a common side effect of antibiotic therapy.
Question 232 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:
compromise with the parents and
order a nasogastric tube for feedings.
initiate a discussion with the
parents about the potential outcomes of each possible action.
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.
Question 242 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?
“I have to take a pill only every
3 months.”
“I should expect to have only four
periods each year.”
“I will need to use condoms for
only 7 more days.”
“This type of pill has fewer side
effects than other types.”
Question 252 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:
provide pharmaceutical company
samples of the medication for the patient.
inform the patient that the drug
must be paid for out of pocket because it is not covered.
order the closest
formulary-approved approximation of the drug and monitor effectiveness.
write a letter of medical
necessity to the insurer to explain the need for this particular medication.
Question 262 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:
order LFTs.
order CK-MM tests.
consider decreasing the dose of
the medication.
reassure the patient that this
side effect is common.
Question 272 pts
A patient who takes a thiazide
diuretic will begin taking an ACE inhibitor. The primary care NP should counsel
the patient to:
report wheezing and shortness of
breath, which may occur with these drugs.
take care when getting out of bed
or a chair after the first dose of the ACE inhibitor.
discuss taking an increased dose
of the thiazide diuretic with the cardiologist.
minimize fluid intake for several
days when beginning therapy with the ACE inhibitor.
Question 282 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:
estrogen-only HT now.
estrogen-only HT in 5 years.
estrogen-progesterone HT now.
estrogen-progesterone HT in 5
years.
Question 292 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:
dissolve atheromatous lesions.
relax vascular smooth muscle.
prevent catecholamine release.
reduce C-reactive protein levels.
Question 302 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:
obtain a complete blood count and
serum electrolytes.
prescribe a rectal antiemetic
medication.
admit to the hospital for
intravenous (IV) rehydration.
encourage the patient to take
small, frequent sips of Gatorade.
Question 312 pts
A patient who has severe arthritis
and who takes nonsteroidalantiinflammatory 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:
prescribe cimetidine (Tagamet).
prescribe omeprazole (Prilosec).
teach the patient about a bland
diet.
change the NSAID to a corticosteroid.
Question 322 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:
obtain an electrocardiogram.
administer oxygen at 2 L/minute.
give 325 mg of chewable aspirin.
call EMS.
Question 332 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:
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.
obtain a digoxin level before the
patient takes the next dose of digoxin.
Question 342 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:
avoid foods that are high in
vitamin K for several days.
take a double dose of the
medication the next morning.
refill the prescription and take
today’s dose immediately.
skip today’s dose and resume a
regular dosing schedule in the morning.
Question 352 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:
discontinue the phentermine.
increase the dose of phentermine.
continue the phentermine at the
same dose.
change to a combination of
phentermine and topiramate.
Question 362 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:
30 minutes of aerobic exercise
daily.
taking 81 to 325 mg of aspirin
daily.
beginning therapy with a statin
medication.
starting a thiazide diuretic to
treat hypertension.
Question 372 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:
order serum electrolytes.
obtain renal function tests.
consider prescribing a ?-blocker.
call the patient’s cardiologist to
discuss adding digoxin to the patient’s regimen.
Question 382 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:
prescribe a TCA.
discontinue the antidiarrheal
medication.
encourage the patient to increase
water intake.
lower the dose of the
antispasmodic medication.
Question 392 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:
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.
Question 402 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:
amlodipine (Norvasc).
isradipine (DynaCirc).
verapamil HCl (Calan).
short-acting nifedipine
(Procardia).
Question 412 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:
recommend a reduced potassium
intake.
increase the dose of digoxin to
0.5 mg daily.
hold the next dose of digoxin and
obtain a serum digoxin level.
contact the patient’s pharmacy to
ask if generic digoxin was dispensed.
Question 422 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:
obtain a serum drug level.
order an electrocardiogram (ECG)
and serum electrolytes.
change the medication to a
thiazide diuretic.
question the patient about
potassium intake.
Question 432 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.
counsel the patient about dietary
and lifestyle changes.
Question 442 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:
change the atorvastatin dose to 15
mg twice daily.
change the patient’s medication to
cholestyramine (Questran).
add ezetimibe (Zetia) and lower
the atorvastatin to 10 mg daily.
recommend supplements of omega-3
along with the atorvastatin.
Question 452 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:
ask the patient to describe the
medication regimen.
ask the patient to make a list of
questions about the medications.
determine what the patient
understands about coronary artery disease.
give the patient information about
drug effects and any adverse reactions.
Question 462 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:
suggest that they give the child
diet soda and low-fat frozen yogurt.
understand and respect the
parents’ beliefs about their child’s self-image.
initiate a dialogue with the
parents about the implications of the child’s laboratory values.
suggest family counseling to
explore ways to improve parenting skills and limits.
Question 472 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:
provide detailed descriptions of
each step in the process of injecting insulin.
use correct medical terminology
when describing insulin self-administration.
provide as much factual
information as possible about insulin administration.
address one or two educational
objectives that describe what the patient will learn.
Question 482 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 daily bulk laxative.
long-term docusate sodium.
a saline laxative as needed.
glycerin suppositories as needed.
Question 492 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:
serum electrolytes.
blood glucose levels.
serum thyroid levels.
complete blood counts (CBCs).
Question 502 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:
tell her that starting HT now may
reduce her risk of breast cancer.
advise a short course of HT now
that may decrease her risk for CHD.
tell her that HT will not help
control her symptoms during postmenopause.
recommend herbal supplements for
her symptoms to avoid HT side effects.
Question 512 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:
ask the patient to bring all
vitamin bottles to the clinic appointment.
recommend natural vitamin products
over synthetic vitamin products.
reassure the patient that vitamins
that are high in folic acid are safe to take.
tell the patient that some
vitamins, such as vitamin C, are safe in large doses.
Question 522 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:
calcium carbonate (Tums).
aluminum hydroxide (Amphojel).
sodium bicarbonate (Alka-Seltzer).
magnesium hydroxide (Milk of
Magnesia).
Question 532 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:
prescribe estrogen-only therapy.
initiate oral contraceptive pills
now.
discuss using bioidentical HT.
plan to use estrogen-progesterone
therapy when menopause begins.
Question 542 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:
schedule her for a breast
ultrasound.
reassure her that this is common
and will subside.
tell her she may need an increased
dose of this medication.
contact her oncologist to discuss
adding another medication.
Question 552 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:
meclizine.
ondansetron.
scopolamine.
dimenhydrinate.
Question 562 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:
albuterol metered-dose inhaler.
furosemide (Lasix).
spironolactone (Aldactone).
chlorthalidone (Zaroxolyn).
Question 572 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:
estrogen-only HT.
low-dose oral contraceptive
therapy.
selective serotonin reuptake
inhibitor therapy until menopause begins.
estrogen-progesterone HT.
Question 582 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:
is having vomiting or diarrhea.
delays taking a pill by 5 or 6
hours.
takes nonsteroidalantiinflammatory
drugs several days in a row.
has recurrent headaches or
insomnia.
Question 592 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.
administer cardioversion without
using anticoagulants.
give warfarin and aspirin before
attempting cardioversion.
give low-dose aspirin before
administering cardioversion.
Question 602 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:
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.
