Chapter 11: Evidence-Based Decision Making and Treatment Guidelines Test Bank
MULTIPLE CHOICE
1. The primary care nurse practitioner (NP) is using critical thinking skills when:
a. using standardized protocols to guide patient care.
b. adhering to scientific principles to solve a patient problem.
c. following the practices of seasoned mentors when giving care.
d. analyzing current research and synthesizing new approaches to patient care.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year. When deciding whether or not to prescribe this formulation, the NP should:
a. tell the patient that when postmarketing data is available, it will be considered.
b. review the pharmaceutical company promotional materials about the new medication.
c. prescribe the medication if it is less expensive than the current drug formulation.
d. prescribe the medication if the new drug is available in an extended-release form.
8. 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
9. 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.
Chapter 12: Design and Implementation of Patient Education Test Bank
MULTIPLE CHOICE
1. 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.
2. A patient who has recently developed prediabetic symptoms is overweight and has a sedentary lifestyle. The primary care NP has prescribed an oral antidiabetic agent. The patient says, “I suppose I’ll need insulin like my mother and grandfather did.” To educate this patient about managing this disease, the NP should initially:
a. determine how the patient feels about using insulin.
b. provide written educational materials about diet and exercise.
c. compare the actions of oral antidiabetic agents with insulin injections.
d. tell the patient that the medication plus exercise may prevent the need for insulin.
3. A patient who is newly diagnosed with hypertension is to begin taking two antihypertensive medications. The primary care NP gives the patient written drug information and starts to discuss medication side effects. The patient interrupts and says, “I don’t want to know all that. Just tell me what to take and when.” The NP should:
a. explain that medication side effects can have serious consequences.
b. ask the patient about previous experiences with medication side effects.
c. give the patient a copy of the medication package insert to read at home.
d. refer the patient to a website with information about hypertension drug therapy.
4. 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.
5. A primary care NP is reviewing written information about a newly prescribed medication with a patient. To evaluate this patient’s understanding of the information, the NP should ask the patient to:
a. read the information aloud.
b. describe how the medication will be taken.
c. write down questions about the medication.
d. tell the NP if the information is unclear.
6. 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.
7. 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.
Chapter 13: Dermatologic Agents Test Bank
MULTIPLE CHOICE
1. A primary care nurse practitioner (NP) prescribes a topical cream medication. Which statement by the patient indicates understanding of proper application of this medication?
a. “I should apply this medication after bathing.”
b. “I need to use a tongue blade to apply this medication.”
c. “I should apply this medication liberally to all affected areas.”
d. “I will apply this medication using circular strokes to ensure absorption.”
2. An NP student asks the primary care NP about guidelines for using topical steroids. The NP should tell the student that:
a. evidence-based guidelines are available for each product.
b. standardized guidelines have been developed for use in children.
c. standardized guidelines may be found for disease-specific conditions.
d. evidence-based studies support limited corticosteroid use in pregnancy.
3. A 5-year-old child has atopic dermatitis that is refractory to treatment with hydrocortisone acetone 2.5% cream. The primary care NP should prescribe:
a. desonide cream 0.01%.
b. triamcinolone acetonide.
c. fluocinolone cream 0.2%.
d. betamethasone dipropionate ointment 0.05%.
4. A patient has been treated for severe contact dermatitis on both arms with clobetasol propionate cream. At a follow-up visit, the primary care NP notes that the condition has cleared. The NP should:
a. prescribe triamcinolone cream for 2 weeks.
b. recommend continuing treatment for 2 more weeks.
c. discontinue the clobetasol and schedule a follow-up visit in 2 weeks.
d. discontinue the clobetasol and recommend prn use for occasional flare-ups.
5. A primary care NP prescribes fluocinolone cream for a patient who has contact dermatitis. At a follow-up visit in 2 weeks, the patient reports decreased pruritus but continues to have excoriated, erythematous areas. The NP should:
a. obtain a culture of the skin to monitor for superinfection.
b. discontinue the fluocinolone and order betamethasone cream.
c. begin gradually tapering the fluocinolone at 2-week intervals.
d. tell the patient to continue using the fluocinolone for 3 to 4 more weeks.
6. A primary care NP is considering using a topical immunosuppressive agent for a patient who has atopic dermatitis that is refractory to treatment with topical corticosteroids. The NP should:
a. begin therapy with pimecrolimus (Elidel).
b. tell the patient that these agents may be used long-term.
c. counsel the patient that these agents are more likely to cause skin atrophy.
d. tell the patient that laboratory monitoring for hypothalamic-pituitary-adrenal (HPA) suppression will be necessary.
7. A primary care NP sees a child who has honey-crusted lesions with areas of erythema around the nose and mouth. The child’s parent has been applying Polysporin ointment for 5 days and reports no improvement in the rash. The NP should prescribe:
a. mupirocin.
b. neomycin.
c. a systemic antibiotic.
d. Polysporin with a corticosteroid.
8. A patient is seen by a primary care NP to evaluate a rash. The NP notes three ring-shaped lesions with elevated, erythematous borders and two smaller, scaly patches on the patient’s abdomen. The patient has not used any over-the-counter medications on the rash. The NP should prescribe:
a. terbinafine (Lamisil).
b. oxiconazole (Oxistat).
c. ketoconazole (Nizoral).
d. miconazole (Lotrimin AF).
9. An 18-month-old child who attends day care has head lice and has been treated with permethrin 1% (Nix). The parent brings the child to the clinic 1 week later, and the primary care NP notes live bugs on the child’s scalp. The NP should order:
a. lindane.
b. malathion.
c. ivermectin.
d. permethrin 5%.
10. A patient who has scabies has been treated by the primary care NP twice with permethrin (Elimite). The second application was administered 10 days after the first. The patient returns to the clinic with mild pruritus and erythema. The NP does not observe new burrows on the skin. The NP should:
a. order lindane.
b. order malathion.
c. re-treat with permethrin.
d. prescribe triamcinolone 0.1%.
11. A primary care NP is performing a well-child checkup on an adolescent patient and notes approximately 20 papules and comedones and 10 pustules on the patient’s face, chest, and back. The patient has not tried any over-the-counter products to treat these lesions. The NP should begin treatment with:
a. salicylic acid.
b. topical tretinoin.
c. oral antibiotics.
d. benzoyl peroxide and topical clindamycin.
12. A primary care NP is preparing to irrigate and suture a laceration on a patient’s thumb. To anesthetize the site, the NP should use:
a. lidocaine hydrochloride.
b. lidocaine with epinephrine.
c. bupivacaine hydrochloride.
d. bupivacaine with epinephrine.
Chapter 14: Eye, Ear, Throat, and Mouth Agents Test Bank
MULTIPLE CHOICE
1. A primary care nurse practitioner (NP) sees a patient who has a 1-week history of watery, painful eyes with copious amounts of clear discharge and a sore throat. The NP observes bilateral erythema of the conjunctivae and palpates enlarged preauricular lymph nodes. The NP should prescribe drops.
a. ganciclovir
b. ophthalmic antibiotic
c. sympathomimetic ophthalmic
d. nonsteroidal antiinflammatory
2. A primary care NP examines a patient who complains of chronic, intermittent watery eyes and runny nose. The NP notes cobblestone-like papillae inside the upper eyelid with nonerythematous conjunctivae. The NP should:
a. prescribe intranasal corticosteroids.
b. refer the patient to an ophthalmologist.
c. prescribe trifluridine ophthalmic eye drops.
d. apply fluorescein dye to examine the cornea.
3. The primary care NP teaches a patient how to instill eye drops for a prescription that requires two drops twice daily. Which statement by the patient indicates understanding of the teaching?
a. “I should gently massage my eyes for 3 to 5 minutes after instilling the drops.”
b. “I should put in one drop and wait 5 minutes before putting in the other one.”
c. “To make sure the medicine is evenly distributed, I should blink several times.”
d. “I may continue wearing my soft contact lenses while I am using this medication.”
4. The primary care NP examines an adolescent who complains of severe right ear pain for the past 3 days. When retracting the pinna of the right ear to examine the ear, the NP notes erythema, edema, and pain and a large amount of white exudate in the ear canal. The NP should prescribe:
a. benzocaine otic drops tid.
b. ciprofloxacin otic drops qid.
c. glycerin oil drops weekly.
d. acetic acid, boric acid, and isopropyl alcohol solution.
5. A parent brings in a 2-month-old infant with a 5-day history of a white coating on the tongue and decreased oral intake. The primary care NP should prescribe:
a. clotrimazole, one troche tid.
b. chlorhexidine, 15 mL oral rinse bid.
c. carbamide peroxide, 2 to 3 drops tid.
d. nystatin oral suspension, 200,000 units qid.
6. A patient who has year-round allergic rhinitis uses an intranasal corticosteroid and a daily oral antihistamine. The patient reports persistent watery and itchy eyes. The primary care NP observes profuse clear, watery discharge and a cobblestone appearance inside the upper eyelids, with clear conjunctivae. The patient has tried topical azelastine (Astelin) and topical diclofenac (Voltaren) without improvement. The NP should prescribe drops.
a. timolol (Timoptic)
b. pilocarpine (Isopto)
c. nedocromil (Tilade)
d. dexamethasone (Decadron)
7. An 80-year-old patient has a diagnosis of glaucoma, and the ophthalmologist has prescribed timolol (Timoptic) and pilocarpine eye drops. The primary care NP should counsel this patient:
a. that systemic side effects of these medications may be severe.
b. that the combination of these two drugs may cause drowsiness.
c. to begin an exercise program to improve cardiovascular health.
d. that a higher dose of one or both of these medications may be needed.
Chapter 15: Upper Respiratory Agents Test Bank
MULTIPLE CHOICE
1. A patient tells a nurse practitioner (NP) that several coworkers have upper respiratory infections and asks about the best way to avoid getting sick. The NP should recommend which of the following?
a. Echinacea
b. Frequent hand washing
c. Zinc gluconate supplements
d. Normal saline nasal irrigation
2. A patient comes to the clinic with a 3-day history of fever and a severe cough that interferes with sleep. The patient asks the NP about using a cough suppressant to help with sleep. The NP should:
a. order a narcotic antitussive to suppress cough.
b. obtain a thorough history of the patient’s symptoms.
c. suggest that the patient try a guaifenesin- only over-the-counter product.
d. prescribe an antibiotic to treat the underlying cause of the patient’s cough.
3. An NP prescribes azelastine for a patient who has allergic rhinitis. The NP will teach the patient that this drug:
a. may cause a bitter aftertaste.
b. will not provide maximum relief for a few weeks.
c. will cause rebound congestion if withdrawn suddenly.
d. can cause many systemic side effects such as drowsiness.
4. A parent asks an NP which over-the-counter medication would be best to give to a 5-year- old child who has a viral respiratory illness with nasal congestion and a cough. The NP should recommend which of the following?
a. Diphenhydramine (Benadryl)
b. Increased fluids with a teaspoon of honey
c. Over-the-counter pseudoephedrine with guaifenesin (Sudafed)
d. An antitussive/expectorant combination such as Robitussin DM
5. A child with chronic allergic symptoms uses an intranasal steroid for control of symptoms. At this child’s annual well-child checkup, the NP should carefully review this child’s:
a. urinalysis.
b. blood pressure.
c. height and weight.
d. liver function tests.
6. An NP sees a patient who reports persistent seasonal symptoms of rhinorrhea, sneezing, and nasal itching every spring unrelieved with diphenhydramine (Benadryl). The NP should prescribe:
a. azelastine (Astelin).
b. triamcinolone (Nasacort AQ).
c. phenylephrine (Neo-Synephrine).
d. cromolyn sodium (Nasalcrom).
7. A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that include runny nose and sneezing. The NP should counsel this patient to:
a. take the lowest recommended dose initially.
b. monitor for hypertension while taking the drug.
c. take the antihistamine with a decongestant for best effect.
d. watch for symptoms of paradoxical excitation with this medication.
8. A patient asks an NP about using an oral over-the-counter decongestant medication for nasal congestion associated with a viral upper respiratory illness. The NP learns that this patient uses loratadine (Claritin), a ?-adrenergic blocker, and an intranasal corticosteroid. The NP would be concerned about which adverse effects?
a. Liver toxicity
b. Excessive drowsiness
c. Rebound congestion
d. Tremor, restlessness, and insomnia
