NR508 Test Banking Chapter 26-30

Question # 00627893
Course Code : NR508
Subject: Health Care
Due on: 08/13/2021
Posted On: 08/13/2021 11:01 AM
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Chapter 26: Antacids and the Management of GERD Test Bank

MULTIPLE CHOICE

1.            A patient who has gastroesophageal reflux disease (GERD) undergoes an endoscopy, which shows a hiatal hernia. The patient is mildly obese. The patient asks the primary care nurse practitioner (NP) about treatment options. The NP should tell this patient that:

a.            a fundoplication will be necessary to correct the cause of GERD.

b.            over-the-counter (OTC) antacids can be effective and should be tried first.

c.             elevation of the head of the bed at night can relieve most symptoms.

d.            a combination of lifestyle changes, medications, and surgery may be necessary.

2.            A patient undergoes endoscopy, and a diagnosis of erosive esophagitis is made. The patient does not have health insurance and asks the primary care NP about using OTC antacids such as Tums. The NP should tell the patient that Tums:

a.            can help to heal erosions in esophageal tissue.

b.            do not help reduce symptoms of erosive esophagitis.

c.             neutralize stomach acid as well as proton pump inhibitors (PPIs).

d.            help reduce symptoms in conjunction with PPIs.

3.            A patient who has GERD with erosive esophagitis has been taking a PPI for 4 weeks and reports a decrease in symptoms. The patient asks the primary care NP if the medication may be discontinued. The NP should tell the patient that:

a.            the dose may be decreased for long-term therapy.

b.            antireflux surgery must be done before the PPI can be discontinued.

c.             the condition may eventually be cured, but therapy must continue for years.

d.            once the symptoms have cleared completely, the medication may be discontinued.

4.            A patient in the clinic reports heartburn 30 minutes after meals, a feeling of fullness, frequent belching, and a constant sour taste. The patient has a normal weight and reports having a high-stress job. The primary care NP should recommend:

a.            antacid therapy as needed.

b.            changes in diet to avoid acidic foods.

c.             daily treatment with a PPI.

d.            consultation with a gastroenterologist for endoscopy.

5.            A patient who has GERD has been taking a PPI for 2 months and reports a slight decrease in symptoms. The next response of the primary care NP is to:

a.            add a histamine-2-receptor agonist.

b.            increase the dose of the PPI.

c.             change to long-term, low-dose PPI therapy.

d.            refer the patient to an endocrinologist for endoscopy and further management.

6.            A patient is taking a low-dose PPI for long-term management of GERD and reports taking sodium bicarbonate (Alka-Seltzer) to help with occasional heartburn. The primary care NP should tell the patient to:

a.            change to aluminum hydroxide (Amphojel).

b.            use magnesium hydroxide (Milk of Magnesia) instead.

c.             continue using sodium bicarbonate (Alka- Seltzer) as needed.

 d.           take calcium carbonate (Tums) instead of sodium bicarbonate (Alka-Seltzer).

7.            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:

a.            calcium carbonate (Tums).

b.            aluminum hydroxide (Amphojel).

c.             sodium bicarbonate (Alka-Seltzer).

d.            magnesium hydroxide (Milk of Magnesia).

 

Chapter 27: Histamine-2 Blockers and Proton Pump Inhibitors Test Bank

MULTIPLE CHOICE

1.            A patient who has severe arthritis and who takes nonsteroidal antiinflammatory 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:

a.            prescribe cimetidine (Tagamet).

b.            prescribe omeprazole (Prilosec).

c.             teach the patient about a bland diet.

d.            change the NSAID to a corticosteroid.

2.            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. pylori is still present. The NP should order:

a.            continuation of the PPI for 4 to 8 weeks.

b.            a PPI, amoxicillin, and metronidazole for 14 days.

c.             a PPI, clarithromycin, and amoxicillin for 14 more days.

d.            a PPI, bismuth subsalicylate, tetracycline, and metronidazole.

3.            A patient with a diagnosis of peptic ulcer disease asks the primary care NP about nonpharmacologic treatment. Which statement by the NP is correct?

a.            “You should consume a diet that is high in fiber.”

b.            “One or two cups of coffee each day won’t hurt you.”

c.             “Alcoholic beverages are strictly prohibited when you have an ulcer.”

d.            “Lifestyle changes and proper diet may eliminate the need for medication.”

4.            A patient has NSAID-induced ulcer and has started taking ranitidine (Zantac). At a follow-up appointment 3 days later, the patient reports no alleviation of symptoms. The primary care NP should:

a.            order cimetidine (Tagamet).

b.            add metronidazole to the drug regimen.

c.             change from ranitidine to omeprazole (Prilosec).

d.            reassure the patient that drug effects take several weeks.

5.            An 80-year-old patient has a history of renal disease and develops a duodenal ulcer. The primary care NP should order a:

a.            normal dose of a histamine-2 blocker.

b.            decreased dose of a histamine-2 blocker.

c.             normal dose of a PPI.

d.            decreased dose of a PPI.

6.            A patient with peptic ulcer disease is taking a histamine-2 blocker and tells the primary care NP that over-the-counter antacid tablets help with the discomfort. The NP should tell this patient to:

a.            discontinue the antacid.

b.            discontinue the histamine-2 blocker.

c.             take the antacid and the histamine-2 blocker at the same time.

d.            take the histamine-2 blocker 2 hours before taking the antacid.

7.            A patient with erosive esophagitis is taking lansoprazole (Prevacid). The primary care NP performs a medication history and learns that the patient also takes digoxin. The NP should recommend:

a.            decreasing the dose of digoxin.

b.            obtaining a serum digoxin level.

c.             changing the PPI to omeprazole.

d.            increasing the dose of lansoprazole.

8.            A postmenopausal woman develops NSAID-induced ulcer. The primary care NP should prescribe:

a.            ranitidine (Zantac).

b.            omeprazole (Prilosec).

c.             esomeprazole (Nexium).

d.            pantoprazole (Protonix).

 

Chapter 28: Laxatives Test Bank

MULTIPLE CHOICE

1.            A primary care nurse practitioner (NP) sees a patient who is concerned about constipation. The NP learns that the patient has three to four bowel movements per week with occasional hard stools but no straining with defecation. The NP should recommend:

a.            increased intake of fluids and fiber.

b.            docusate sodium (Colace) as needed.

c.             psyllium (Metamucil) on a daily basis.

d.            polyethylene glycol (MiraLAX) as needed.

2.            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.            a daily bulk laxative.

b.            long-term docusate sodium.

c.             a saline laxative as needed.

d.            glycerin suppositories as needed.

3.            A 5-year-old child has chronic constipation. The primary care NP plans to prescribe a laxative for long-term management. In addition to pharmacologic therapy, the NP should also recommend      g of fiber per day.

a.            10

b.            15

c.             20

d.            25

4.            A patient who has cerebral palsy is wheelchair dependent and receives enteral nutrition via a gastrostomy tube. The patient has infrequent, hard bowel movements despite using a high-fiber formula and receiving 1500 mL of fluid per day. The NP should order:

a.            bisacodyl (Dulcolax).

b.            docusate sodium (Colace).

c.             polyethylene glycol (MiraLAX).

d.            sodium phosphate (Fleets) enema.

5.            A primary care NP sees a patient who reports having decreased frequency of stools over the past few months. In the clinic today, the patient has severe abdominal cramping and an abdominal radiograph shows an increased stool load in the sigmoid colon and rectum. The NP should:

a.            give magnesium hydroxide (Milk of Magnesia).

b.            start daily methylcellulose (Citrucel) and increased fluids.

c.             order a sodium phosphate enema and psyllium (Metamucil).

d.            recommend polyethylene glycol (MiraLAX) and 2000 mL of fluid daily.

 6.           A female patient who is underweight tells the primary care NP that she has been using bisacodyl (Dulcolax) daily for several years. The NP should:

a.            prescribe docusate sodium (Colace) and decrease bisacodyl gradually.

b.            suggest she use polyethylene glycol (MiraLAX) on a daily basis instead.

c.             tell her that long-term use of suppositories is safer than long-term laxative use.

d.            counsel the patient to discontinue the laxative and increase fluid and fiber intake.

7.            A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary care NP should recommend:

a.            adding docusate sodium (Colace).

b.            polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax).

c.             lactulose (Chronulac) and polyethylene glycol (MiraLAX).

d.            adding nonpharmacologic measures such as biofeedback.

8.            A patient who takes digoxin reports taking psyllium (Metamucil) three or four times each month for constipation. The primary care NP should counsel this patient to:

a.            decrease fluid intake to avoid cardiac overload.

b.            change the laxative to docusate sodium (Colace).

c.             take the digoxin 2 hours before taking the psyllium.

d.            ask the cardiologist about taking an increased dose of digoxin.

 

Chapter 29: Antidiarrheals Test Bank

MULTIPLE CHOICE

1.            A woman who is 4 months pregnant comes to the clinic with acute diarrhea and nausea. Her husband is experiencing similar symptoms. The primary care nurse practitioner (NP) notes a temperature of 38.5° C, a heart rate of 92 beats per minute, and a blood pressure of 100/60 mm Hg. The NP should:

a.            prescribe attapulgite to treat her diarrhea.

b.            obtain a stool culture and start antibiotic therapy.

c.             instruct her to replace lost fluids by drinking Pedialyte.

d.            refer her to an emergency department for intravenous (IV) fluids.

2.            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:

a.            obtain a stool specimen and order vancomycin.

b.            order testing for Clostridium difficile and consider metronidazole therapy.

c.             prescribe diphenoxylate (Lomotil) to provide symptomatic relief.

d.            reassure the patient that diarrhea is a common side effect of antibiotic therapy.

3.            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:

a.            not curative and may prolong the illness.

b.            useful in cases of acute infection with elevated temperature.

c.             most beneficial when symptoms persist longer than 2 weeks.

d.            useful when other symptoms, such as hematochezia, develop.

4.            A patient who has experienced five to seven liquid stools for 3 days is seen in the clinic by the primary care NP. The patient reports having had fever, mucoid stools, and nausea without vomiting. The patient has been drinking Gatorade to stay hydrated. The NP obtains a stool specimen for culture and should prescribe:

a.            diphenoxylate (Lomotil).

b.            attapulgite (Kaopectate).

c.             bismuth subsalicylate (Pepto-Bismol).

d.            loperamide hydrochloride (Imodium).

5.            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:

a.            diphenoxylate (Lomotil).

b.            attapulgite (Kaopectate).

c.             an electrolyte solution (Pedialyte).

d.            bismuth subsalicylate (Pepto-Bismol).

6.            A patient comes to the clinic with a 4-day history of 10 to 12 liquid stools each day. The patient reports seeing blood and mucus in the stools. The patient has had nausea but no vomiting. The primary care NP notes a temperature of 37.9° C, a heart rate of 96 beats per minute, and a blood pressure of 90/60 mm Hg. A physical examination reveals dry oral mucous membranes and capillary refill of 4 seconds. The NP’s priority should be to:

a.            obtain stool cultures.

 b.           begin rehydration therapy.

c.             consider prescribing metronidazole.

d.            administer opioid antidiarrheal medications.

7.            A 12-year-old patient has acute diarrhea and an upper respiratory infection. Other family members have had similar symptoms, which have resolved. The primary care NP should recommend:

a.            diphenoxylate (Lomotil).

b.            attapulgite (Kaopectate).

c.             an electrolyte solution (Pedialyte).

d.            bismuth subsalicylate (Pepto-Bismol).

 

Chapter 30: Antiemetics Test Bank

MULTIPLE CHOICE

1.            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:

a.            aprepitant (Emend).

b.            ondansetron (Zofran).

c.             scopolamine transdermal.

d.            prochlorperazine (Compazine).

2.            A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise. The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch:

a.            daily.

b.            every 3 days.

c.             as needed for nausea.

d.            1 hour before embarking.

3.            A primary care NP sees a patient 2 days after an outpatient surgical procedure. The patient reports using ondansetron for nausea. The NP notes a blood pressure of 88/56 mm Hg, and the patient reports feeling faint. The NP should suspect:

a.            hemorrhage.

b.            dehydration.

c.             drug toxicity.

d.            drug interaction.

4.            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:

a.            meclizine.

b.            ondansetron.

c.             scopolamine.

d.            dimenhydrinate.

5.            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:

a.            obtain a complete blood count and serum electrolytes.

b.            prescribe a rectal antiemetic medication.

c.             admit to the hospital for intravenous (IV) rehydration.

d.            encourage the patient to take small, frequent sips of Gatorade.

6.            A patient who is about to begin chemotherapy expresses concern to the primary care NP about gastrointestinal side effects of the treatments. The NP should reassure the patient that:

a.            most newer chemotherapeutic agents do not cause nausea and vomiting.

b.            antiemetics will be administered as needed if nausea and vomiting occur.

c.             taking ondansetron before chemotherapy decreases nausea and vomiting.

d.            a scopolamine patch is an effective way to prevent nausea and vomiting.

7.            A primary care NP sees a 3-year-old patient who has been vomiting for several days. The child has had fewer episodes of vomiting the past day and is now able to take sips of fluids without vomiting. The child has dry oral mucous membranes, 2-second capillary refill, and pale but warm skin. The child’s blood pressure is 88/46 mm Hg, the heart rate is 110 beats per minute, and the temperature is 37.2° C. The NP should:

a.            prescribe promethazine.

b.            prescribe a scopolamine patch.

c.             begin oral rehydration therapy.

d.            send the child to the hospital for IV fluids.

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NR508 Test Banking Chapter 26-30

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