Chapter 36: Aspirin and Nonsteroidal Antiinflammatory Drugs Test Bank
MULTIPLE CHOICE
1. A patient reports having persistent mild to moderate pain in both knees usually associated with standing. The patient reports knee stiffness for 15 to 20 minutes each morning. The primary care nurse practitioner (NP) learns that the patient has used heating pads and acetaminophen, which no longer relieve the pain. The NP orders an erythrocyte sedimentation rate, which is normal. The NP should consider prescribing:
a. aspirin.
b. a cyclooxygenase-2 (COX-2) inhibitor.
c. glucosamine and chondroitin.
d. a topical nonsteroidal antiinflammatory drug (NSAID).
2. A 70-year-old patient describes moderate to severe pain associated with osteoarthritis in fingers, thumbs, hips, and knees. The patient is currently taking high-dose acetaminophen. The patient has a strong family history of cardiovascular disease and has been diagnosed with hypertension. To help alleviate this patient’s pain, the primary care NP should consider prescribing:
a. a COX-2 inhibitor and low-dose aspirin.
b. ketorolac (Toradol) and 325 mg of aspirin.
c. naproxen (Naprosyn) and low-dose aspirin.
d. indomethacin (Indocin) and 325 mg of aspirin.
3. A patient with mild to moderate osteoarthritis pain has been taking acetaminophen for pain. The primary care NP prescribes a nonselective NSAID. At a follow-up visit, the patient reports mild GI side effects. The NP should:
a. order misoprostol to take with the NSAID.
b. discontinue the NSAID and order tramadol.
c. change the medication to a COX-2 inhibitor.
d. change the medication to naproxen (Naprosyn).
4. A patient is taking 81 mg of aspirin daily to decrease MI risk and uses acetaminophen for mild osteoarthritis symptoms. For flare-ups of osteoarthritis pain, the primary care NP should prescribe:
a. ibuprofen (Motrin).
b. celecoxib (Celebrex).
c. naproxen (Naprosyn).
d. increasing the dose of aspirin.
5. An 80-year-old patient has been taking naproxen (Naprosyn) for osteoarthritis for 6 months. The patient reports adequate pain relief but complains of feeling tired. The primary care NP will order:
a. liver function tests.
b. a serum potassium level.
c. a complete blood count (CBC).
d. a creatinine clearance and urinalysis.
6. A patient who has rheumatoid arthritis begins taking naproxen (Naprosyn) 500 mg once daily for pain. After 1 week, the patient calls the primary care NP to report no change in inflammation. The NP should:
a. change the medication to tramadol.
b. change the medication to ketorolac (Toradol).
c. increase the dose of naproxen to 1000 mg daily.
d. counsel the patient that pain relief may not occur for another week.
7. The primary care NP sees an adolescent who reports moderate to severe dysmenorrhea. The NP recommends an NSAID and counsels the patient about its use. Which statement by the patient indicates a need for further teaching?
a. “I should not take this if I think I might be pregnant.”
b. “I should take this medication on a schedule for 2 to 3 days.”
c. “I will begin taking this 1 to 3 days before my period begins.”
d. “I will take this medicine every 4 to 6 hours as needed for pain.”
8. The primary care NP is performing a medication reconciliation on a patient who takes digoxin for congestive heart failure and learns that the patient uses ibuprofen as needed for joint pain. The NP should counsel this patient to:
a. use naproxen (Naprosyn) instead of ibuprofen.
b. increase the dose of digoxin while taking the ibuprofen.
c. use an increased dose of ibuprofen while taking the digoxin.
d. take potassium supplements to minimize the effects of the ibuprofen.
9. A primary care NP prescribes a nonselective NSAID for a patient who has osteoarthritis. The patient expresses concerns about possible side effects of this medication. When counseling the patient about the medication, the NP should tell this patient:
a. to avoid taking antacids while taking the NSAID.
b. to take each dose of the NSAID with a full glass of water.
c. that a few glasses of wine each day are allowed while taking the NSAID.
d. to decrease the dose of the NSAID if GI symptoms occur.
10. A patient who has osteoarthritis is scheduled to have knee surgery. The patient takes aspirin for MI prophylaxis and naproxen (Naprosyn) for pain and inflammation. Which statement by the patient to the primary care NP indicates a need for further teaching?
a. “I should stop taking aspirin at least 5 days before surgery.”
b. “I will check with the surgeon to see if I need to stop taking the naproxen.”
c. “I will need to stop taking both medications 1 week before I have surgery.”
d. “Both of these medications interfere with platelet production and may cause blood clots.”
Chapter 37: Disease-Modifying Antirheumatic Drugs and Immune Modulators Test Bank
MULTIPLE CHOICE
1. A patient has recent weight loss, fatigue, and recurrent low-grade fever along with pain and stiffness of knees and hands. The primary care nurse practitioner (NP) notes symmetric joint swelling and warmth of these joints. The NP should:
a. refer the patient to a specialist.
b. order erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and antinuclear antibody (ANA) tests.
c. begin therapy with methotrexate.
d. order x-rays of the affected joints.
2. The primary care NP follows a patient who is being treated for RA with methotrexate. The patient asks the NP why the medication does not seem to alleviate pain. The NP tells the patient that:
a. an immunomodulator may be needed to control pain.
b. a higher dose of methotrexate may be needed to achieve pain control.
c. if methotrexate does not control pain, an opioid analgesic may be necessary.
d. methotrexate is used to slow disease progression and preserve joint function.
3. A patient who is being treated for RA reports having continued pain, which the patient describes as moderate and persistent. The NP should prescribe:
a. acetaminophen.
b. a cyclooxygenase-2 (COX-2) inhibitor.
c. an opioid analgesic.
d. an NSAID.
4. A patient who has a history of stomach ulcers is taking a nonselective NSAID along with a DMARD for RA. The primary care NP should:
a. order a glucocorticoid.
b. change to acetaminophen.
c. order a proton pump inhibitor (PPI).
d. change to a selective COX-2 inhibitor.
5. A patient who has just been diagnosed with RA is experiencing minimal pain and mild symptoms. The primary care NP should consult with a rheumatologist and should recommend:
a. ibuprofen.
b. methotrexate.
c. acetaminophen.
d. herbal remedies.
6. A patient has been taking a COX-2 selective NSAID to treat pain associated with a recent onset of RA. The patient tells the primary care NP that the pain and joint swelling are becoming worse. The patient does not have synovitis or extraarticular manifestations of the disease. The NP will refer the patient to a rheumatologist and should expect the specialist to prescribe:
a. methotrexate.
b. corticosteroids.
c. opioid analgesics.
d. hydroxychloroquine.
7. A patient is taking a cytokine immunomodulator to treat RA. The primary care NP caring for this patient should:
a. obtain periodic complete blood counts (CBCs) and liver function tests (LFTs).
b. perform annual tuberculosis (TB) skin testing.
c. advise the patient of an increased risk of bone cancer.
d. administer the intranasal live attenuated influenza vaccine (LAIV) each year.
8. A patient who has RA has been taking methotrexate for 6 months and tells the primary care NP that symptoms seem to be getting worse. The NP refers the patient back to the rheumatologist and should expect the rheumatologist to:
a. add prednisone to the drug regimen.
b. add adalimumab to the drug regimen.
c. change to a combination of adalimumab and etanercept.
d. discontinue methotrexate because 50% of patients do not respond.
9. A patient who is taking methotrexate for RA sees the primary care NP for an annual physical examination. The patient’s alanine aminotransferase (ALT) and AGT are elevated. The NP should:
a. decrease the dose of methotrexate.
b. recheck ALT and AGT levels in 2 weeks.
c. contact the patient’s rheumatologist to discuss discontinuing the drug.
d. counsel the patient not to take acetaminophen while taking methotrexate.
Chapter 38: Gout Medications Test Bank
MULTIPLE CHOICE
1. A patient who has hypertension is taking a thiazide diuretic. The patient has a serum uric acid level of 8 mg/dL. The primary care nurse practitioner (NP) caring for this patient should:
a. prescribe colchicine.
b. discontinue the thiazide diuretic.
c. order a 24-hour urine collection.
d. refer the patient to a rheumatologist.
2. A patient comes to the clinic reporting sudden pain and swelling of one knee joint. The primary care NP suspects gout. When preparing to order diagnostic tests, the most important initial test the primary care NP should order is:
a. renal function tests.
b. serum uric acid levels.
c. 24-hour urine collection.
d. synovial fluid aspirate for Gram stain and culture.
3. Gout is diagnosed in a patient, and tests show the cause to be an underexcretion of uric acid. The primary care NP should prescribe:
a. febuxostat (Uloric).
b. colchicine (Colcrys).
c. allopurinol (Zyloprim).
d. probenecid (Benemid).
4. A primary care NP prescribes probenecid to treat a patient who has gout. The patient comes to the clinic 2 weeks later with severe flank pain. The NP should:
a. ask the patient about fluid intake.
b. order a urinalysis and urine culture.
c. change the medication to allopurinol.
d. recommend nonsteroidal antiinflammatory drugs (NSAIDs) to treat flank pain.
5. A patient who is obese and has hypertension is taking a thiazide diuretic and develops gouty arthritis, which is treated with probenecid. At a follow-up visit, the patient’s serum uric acid level is 7 mg/dL, and the patient denies any current symptoms. The primary care NP should discontinue the probenecid and:
a. prescribe colchicine.
b. prescribe febuxostat.
c. tell the patient to use an NSAID if symptoms recur.
d. counsel the patient to report recurrence of symptoms.
6. A patient with a history of gouty arthritis comes to the clinic with acute pain and swelling of the great toe. The patient is not currently taking any medications. The primary care NP should prescribe:
a. naproxen.
b. colchicine.
c. probenecid.
d. allopurinol.
7. A patient who is taking colchicine for gout is in the clinic 1 week after beginning the medication. The patient reports decreased appetite and nausea. The primary care NP should:
a. suspect worsening of gouty arthritis.
b. order vitamin B12 levels to assess for vitamin deficiency.
c. discontinue the colchicine for 48 hours until symptoms subside.
d. reassure the patient that these are common, temporary side effects.
8. A patient who has a previous history of renal stones will begin taking probenecid for gout. The primary care NP should:
a. add colchicine to the patient’s drug regimen.
b. counsel the patient to use high-dose aspirin for pain.
c. teach the patient to drink plenty of acidic fluids such as juice.
d. tell the patient to stop taking the medication when symptoms subside.
Chapter 39: Osteoporosis Treatment Test Bank
MULTIPLE CHOICE
1. A 55-year-old woman who experienced menopause at age 50 years undergoes central dual-energy x-ray absorptiometry and has a T-score greater than 2.5. The patient weighs 130 lb and has a body mass index of 22. She sits at a computer all day at work. The primary care nurse practitioner (NP) caring for this patient should:
a. prescribe a bisphosphonate.
b. prescribe hormone replacement therapy.
c. counsel the patient about diet and exercise.
d. prescribe a selective estrogen receptor modulator.
2. A 50-year-old white woman who is experiencing menopause asks the primary care NP what she can do to prevent osteoporosis. She has a negative family history and no risk factors. The NP should counsel her to:
a. consider bisphosphonate therapy in 5 years.
b. undergo bone density testing every 2 years.
c. avoid high-impact sports that can lead to fractures.
d. take supplemental calcium and vitamin D every day.
3. A 60-year-old woman has a central dual-energy x-ray absorptiometry with a T-score of
1.9. A health history reveals no risk factors for osteoporosis. The primary care NP should:
a. prescribe alendronate sodium (Fosamax).
b. counsel her to increase her physical activity.
c. prescribe calcitonin (Miacalcin nasal spray).
d. prescribe supplemental calcium and vitamin D.
4. A 70-year-old patient who has a high fracture risk has been taking alendronate (Fosamax) and calcium for 6 months. The primary care NP orders a urine NTx level, which is 42. The NP should discontinue the alendronate and prescribe:
a. raloxifene (Evista).
b. teriparatide (Forteo).
c. calcitonin (Miacalcin nasal spray).
d. ibandronate sodium (Boniva).
5. A 60-year-old female patient has begun taking a daily bisphosphonate to prevent osteoporosis and complains of gastrointestinal (GI) upset and dyspepsia. The primary care NP’s initial response should be to:
a. prescribe a proton pump inhibitor (PPI).
b. order intravenous (IV) bisphosphonates.
c. suggest that she take the drug with food.
d. review the instructions for taking the drug with the patient.
6. A 50-year-old woman with osteopenia will begin taking raloxifene (Evista). When counseling this patient about this drug regimen, the primary care NP should tell her to:
a. go for walks daily.
b. take the medication 1 hour before meals.
c. sit upright for 30 minutes after taking the drug.
d. avoid using diuretics while taking this medication.
7. A 60-year-old woman is in the clinic for an annual well-woman examination. She has been taking alendronate (Fosamax) 10 mg daily for 4 years. Her last bone density test yielded a T-score of 2.0. Her urine NTx level today is 22. She walks daily. Her fracture risk is low. The primary care NP should recommend that she:
a. take a 1- to 2-year drug holiday.
b. change to 70 mg of alendronate weekly.
c. decrease the alendronate dose to 5 mg daily.
d. change to ibandronate (Boniva) 3 mg IV every 3 months.
8. A patient who has several risk factors for osteoporosis has a bone density test that indicates osteopenia. The primary care NP plans to prescribe a bisphosphonate. Before initiating treatment, the NP should:
a. order an upper GI x-ray.
b. initiate PPI therapy.
c. order serum calcium and vitamin D levels.
d. prescribe a calcium and vitamin D supplement.
Chapter 40: Muscle Relaxants
Test Bank
MULTIPLE CHOICE
1. The primary care nurse practitioner (NP) is seeing a patient who reports chronic lower back pain. The patient reports having difficulty sleeping despite taking ibuprofen at bedtime each night. The NP should prescribe:
a. diazepam (Valium).
b. metaxalone (Skelaxin).
c. methocarbamol (Robaxin).
d. cyclobenzaprine (Flexeril).
2. A patient reports having an acute onset of low back pain associated with lifting a heavy object the day before. Besides advising the patient to rest and apply ice, the primary care NP should prescribe:
a. an opioid analgesic.
b. metaxalone (Skelaxin)
c. cyclobenzaprine (Flexeril).
d. a nonsteroidal antiinflammatory drug (NSAID).
3. A patient who was in a motor vehicle accident has been treated for lower back muscle spasms with metaxalone (Skelaxin) for 1 week and reports decreased but persistent pain. A computed tomography scan is normal. The primary care NP should:
a. suggest ice and rest.
b. order physical therapy.
c. prescribe diazepam (Valium).
d. add an opioid analgesic medication.
4. A patient with lower back pain and right-sided sciatica has taken an NSAID and a TCA for 1 week. The patient reports some decrease in pain but is experiencing increased tingling and numbness of the right leg. The primary care NP should:
a. order a magnetic resonance imaging (MRI) study.
b. order physical therapy.
c. refer the patient to a neurologist.
d. continue the TCA for 1 more week.
5. A 70-year-old patient has low back pain and will begin taking metaxalone (Skelaxin). The primary care NP should counsel this patient to:
a. drink extra fluids.
b. avoid taking NSAIDs.
c. get up from a chair slowly.
d. take care to avoid slips and falls.
6. A patient comes to the clinic complaining of low back pain unrelieved by NSAIDs. The patient has a history of angle-closure glaucoma and renal disease. The primary care NP should prescribe:
a. tizanidine (Zanaflex).
b. metaxalone (Skelaxin).
c. acetaminophen (Tylenol).
d. cyclobenzaprine (Flexeril).
7. A patient has acute low back pain caused by lifting a heavy object. The patient reports having one or two drinks with meals each day. The primary care NP should prescribe:
a. an NSAID.
b. diazepam (Valium).
c. metaxalone (Skelaxin).
d. acetaminophen (Tylenol).
