NR508 Test Banking Chapter 41-50

Question # 00627896
Course Code : NR508
Subject: Health Care
Due on: 08/13/2021
Posted On: 08/13/2021 11:04 AM
Tutorials: 1
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Chapter 42: Medications for Dementia Test Bank

MULTIPLE CHOICE

1.            A patient is identified as having stage 2 Alzheimer’s disease and elects to take donepezil (Aricept). The patient asks the primary care nurse practitioner (NP) how long the medication will be needed. The NP should tell the patient that donepezil must be taken:

a.            until symptoms improve.

b.            indefinitely because it is not curative.

c.             for 24 weeks, which is when cognitive function improves in most patients.

d.            until symptoms worsen, when a switch to memantine (Namenda) will be needed.

2.            A patient who has Alzheimer’s disease has been taking donepezil for 1 year. The patient’s spouse reports a worsening of symptoms. The primary care NP should consider:

a.            switching to ginkgo biloba.

b.            adding an antidepressant medication.

c.             changing to galantamine (Razadyne).

d.            adding memantine hydrochloride (Namenda).

3.            Early-stage Alzheimer’s disease is diagnosed in a patient, and the primary care NP recommends therapy with a ChE inhibitor. The patient asks why drug treatment is necessary because most functioning is intact. The NP should explain that medication may:

a.            delay progression of symptoms.

b.            produce temporary disease remission.

c.             prevent depressive effects of the disease.

d.            reduce the need for adjunct medications later on.

4.            A patient has a diagnosis of depression and Alzheimer’s disease with mild, intermittent symptoms. The primary care NP should prescribe a(n):

a.            antidepressant.

b.            ChE inhibitor.

c.             antidepressant and ginkgo biloba.

d.            antidepressant and a ChE inhibitor.

5.            A patient who has Alzheimer’s disease begins taking donepezil (Aricept). After 3 months of treatment, the patient does not show improvement of symptoms. The primary care NP should:

a.            switch to rivastigmine (Exelon).

b.            switch to galantamine (Razadyne).

c.             switch to memantine (Namenda).

d.            continue donepezil and reevaluate in 3 months.

6.            A patient is newly diagnosed with Alzheimer’s disease stage 6 on the Global Deterioration Scale. The primary care NP should prescribe:

a.            donepezil (Aricept).

b.            rivastigmine (Exelon).

c.             memantine (Namenda).

d.            galantamine (Razadyne).

7.            A patient has been taking donepezil (Aricept) for several months after being diagnosed with Alzheimer’s disease. The patient’s spouse brings the patient to the clinic and reports that the patient seems to be having visual hallucinations. The primary care NP should:

a.            increase the dose.

b.            decrease the dose.

c.             switch to memantine (Namenda).

d.            switch to galantamine (Razadyne).

8.            A patient who has Alzheimer’s disease is taking 10 mg of donepezil daily and reports difficulty sleeping. The primary care NP should recommend:

a.            decreasing the dose to 5 mg.

b.            increasing the dose to 15 mg.

c.             taking the drug in the morning.

d.            taking the drug in the evening.

9.            A patient who is diagnosed with Alzheimer’s disease experiences visual hallucinations. The primary care NP should initially prescribe:

a.            donepezil (Aricept).

 b.           rivastigmine (Exelon).

c.             memantine (Namenda).

d.            galantamine (Razadyne).

MULTIPLE CHOICE

1.            A patient who has partial seizures has been taking phenytoin (Dilantin). The patient has recently developed thrombocytopenia. The primary care nurse practitioner (NP) should contact the patient’s neurologist to discuss changing the patient’s medication to:

a.            topiramate (Topamax).

b.            levetiracetam (Keppra).

c.             zonisamide (Zonegran).

d.            carbamazepine (Tegretol).

2.            A patient is newly diagnosed with generalized epilepsy. The primary care NP will refer this patient to a neurologist and should expect this patient to begin taking:

a.            phenytoin (Dilantin).

b.            topiramate (Topamax).

c.             lamotrigine (Lamictal).

d.            levetiracetam (Keppra).

3.            A patient who takes carbamazepine (Tegretol) has been seizure-free for 2 years and asks the primary care NP about stopping the medication. The NP should:

a.            order an electroencephalogram (EEG).

b.            prescribe a tapering regimen of the drug.

c.             inform the patient that antiepileptic drug (AED) therapy is lifelong.

d.            tell the patient to stop the drug and use only as needed.

4.            A 12-month-old child with severe developmental delays was recently treated in an emergency department for a febrile seizure and is seen by the primary care NP for a follow-up visit. The child’s parent asks if it is necessary to continue giving the child phenobarbital. The NP should tell the parent that:

a.            the phenobarbital may be used on an as- needed basis.

b.            the phenobarbital may be stopped when an EEG is normal.

c.             once the febrile illness is past, the phenobarbital may be stopped.

d.            their child is at increased risk for seizures and should continue the phenobarbital.

5.            A patient who is taking phenytoin (Dilantin) for a newly diagnosed seizure disorder calls the primary care NP to report a rash. The NP should:

 a.           order a phenytoin level.

b.            reassure the patient that this is a self- limiting adverse effect.

c.             recommend that the patient take diphenhydramine to treat this side effect.

d.            tell the patient to stop taking the phenytoin and contact the neurologist immediately.

6.            A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order:

a.            coagulation studies.

b.            a complete blood count.

c.             an EEG.

d.            a creatinine clearance test.

7.            A 20-kg child takes valproic acid (Depakote) for seizures and has had regular dose increases with a current dose of 250 mg twice daily. The child continues to have one to two seizures each week along with significant drowsiness that interferes with school participation. The primary care NP should contact the child’s neurologist to discuss:

a.            obtaining a serum valproic acid level.

b.            changing the medication to gabapentin (Neurontin).

c.             increasing the valproic acid by 5 mg per kg of weight.

d.            adding lamotrigine (Lamictal) to this child’s drug regimen.

 8.           A patient who takes carbamazepine (Tegretol) for a seizure disorder is seen by a primary care NP for a routine physical examination. A complete blood count (CBC) reveals a low white blood cell (WBC) count. The NP should:

a.            order a WBC differential.

b.            discontinue the carbamazepine.

c.             reassure the patient that this effect is temporary.

d.            decrease the carbamazepine dose and recheck the CBC in 2 weeks.

 

 

 

Chapter 43: Analgesia and Pain Management Test Bank

MULTIPLE CHOICE

1.            A patient has been taking an opioid analgesic for chronic pain and tells the primary care nurse practitioner (NP) that the medication doesn’t work as well anymore. The NP should suspect drug:

a.            addiction.

b.            tolerance.

c.             modulation.

d.            dependence.

2.            A patient has pain caused by a chronic condition. The patient is reluctant to take opioids because of a fear of addiction. The primary care NP should tell the patient that opioids:

a.            carry a high risk of psychological dependence when used long-term.

b.            will help to improve the patient’s functional outcomes and quality of life.

c.             will eventually become ineffective fortreating pain when used over a long period.

d.            may require switching from one type of opioid to another to prevent tolerance over time.

3.            A patient is diagnosed with a condition that causes chronic pain. The primary care NP prescribes an opioid analgesic and should instruct the patient to:

a.            wait until the pain is at a moderate level before taking the medication.

b.            take the medication at regular intervals and not just when pain is present.

c.             start the medication at higher doses initially and taper down gradually.

d.            take the minimum amount needed even when pain is severe to avoid dependency.

4.            A patient who is a recovering alcoholic is preparing for surgery and expresses fears about using opioid analgesics postoperatively for pain. The primary care NP should tell the patient:

a.            that opioids should not be used.

b.            to take a very low dose of the opioid.

c.             that nonsteroidal antiinflammatory drugs will be the only safe option.

d.            that opioids are safe when taken as directed.

5.            A patient has been taking intramuscular (IM) meperidine 75 mg every 6 hours for 3 days after surgery. When the patient is discharged from the hospital, the primary care NP should expect the patient to receive a prescription for         mg orally every         hours.

a.            hydrocodone 30; 6

b.            hydrocodone 75; 6

c.             meperidine 300;12

d.            meperidine 75; 6

6.            A patient has been taking an opioid analgesic for 2 weeks after a minor outpatient procedure. At a follow-up clinic visit, the patient tells the primary care NP that he took extra doses for the past 2 days because of increased pain and wants an early refill of the medication. The NP should suspect:

a.            dependence.

b.            drug addiction.

c.             possible misuse.

d.            increasing pain.

7.            A patient who is taking an antibiotic to treat bronchitis reports moderate rib pain associated with frequent coughing. The primary care NP should consider prescribing:

a.            morphine.

b.            hydrocodone.

c.             hydromorphone.

 d.           oxycodone CR.

 

 

Chapter 44: Migraine Medications Test Bank

MULTIPLE CHOICE

1.            A patient who has migraine headaches takes sumatriptan as abortive therapy. The patient tells the primary care nurse practitioner (NP) that the sumatriptan is effective for stopping symptoms but that the episodes are occurring three to four times per month. The NP should consider the addition of:

a.            aspirin.

b.            topiramate.

c.             ergotamine.

d.            opioid analgesics.

2.            A patient comes to the clinic concerned about possible migraine headaches. The primary care NP conducts a history and physical examination, and the patient describes vise-like pressure in the back of the head that occurs almost daily during the work week. The NP should recommend:

a.            acetaminophen.

b.            topiramate.

c.             sumatriptan.

d.            ergotamine.

3.            A patient comes to the clinic and reports recurrent headaches. The patient has a headache

 diary, which reveals irritability and food cravings followed the next day by visual disturbances and unilateral right-sided headache, nausea, and photophobia lasting 2 to 3 days. The NP should recognize these symptoms as     migraine.

a.            classic

b.            hemiplegic

c.             basilar-type

d.            ophthalmoplegic

4.            A patient who has migraine headaches tells the primary care NP that drinking coffee and taking nonsteroidal antiinflammatory drugs (NSAIDs) seems to help with discomfort. The NP should tell the patient that:

a.            this combination can lead to longer lasting headache pain.

b.            these substances are not indicated for migraine headaches.

c.             doing this can increase the risk of more chronic migraines.

d.            an opioid analgesic would be a better choice for migraine pain.

5.            A patient takes rizatriptan (Maxalt) to abort migraine headaches but tells the primary care NP that the headaches have become more frequent since a promotion at work. The NP’s initial response should be to:

a.            prescribe topiramate (Topamax).

b.            stress the importance of establishing new routines.

c.             help the patient identify stressors associated with the new role.

d.            add a combination NSAID, aspirin, and caffeine product to the regimen.

6.            A primary care NP prescribes sumatriptan for abortive treatment of migraine headaches. The patient returns to the clinic 1 month later to report increased frequency of the headaches. The NP should:

a.            add an opioid analgesic.

b.            consider changing to dihydroergotamine (D.H.E. 45).

c.             suggest that the patient take sumatriptan with a NSAID.

d.            ask the patient how often the sumatriptan is used each week.

7.            A patient who has migraine headaches without an aura reports difficulty treating the migraines in time because they come on so suddenly. The patient has been using over- the-counter NSAIDs. The primary care NP should prescribe:

a.            frovatriptan (Frova).

b.            sumatriptan (Imitrex).

c.             cyproheptadine (Periactin).

d.            dihydroergotamine (D.H.E. 45).

8.            A patient who has mild to moderate migraine headaches has severe nausea and vomiting with each episode. For the best treatment of this patient, the primary care NP should prescribe:

a.            triptan nasal spray.

b.            metoclopramide and aspirin.

c.             an NSAID and prochlorperazine.

d.            sumatriptan and metoclopramide.

9.            A patient who has migraine headaches usually has two to three severe migraines each month. The patient has been using a triptan nasal spray but reports little relief and is concerned about missing so many days of work. The primary care NP should consider:

a.            an oral triptan plus an opioid analgesic.

b.            an injectable triptan plus an oral corticosteroid.

c.             an intramuscular steroid plus an opioid analgesic.

d.            dihydroergotamine hydrochloride plus an opioid analgesic.

10.          A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four times each month. The NP should:

 a.           add a selective serotonin reuptake inhibitor (SSRI) antidepressant.

b.            change to dihydroergotamine hydrochloride.

c.             prescribe a ?-blocker such as propranolol.

d.            prescribe an anticonvulsant such as topiramate.

11.          A patient who is diagnosed with migraine headaches has a history of cardiovascular disease and hypertension. The NP should prescribe:

a.            triptan nasal spray.

b.            rizatriptan (Maxalt).

c.             cyproheptadine (Periactin).

d.            dihydroergotamine (D.H.E. 45).

12.          A patient reports frequent headaches to the primary NP. The patient describes the headaches as unilateral and moderate in intensity, accompanied by nausea, vomiting, and photophobia. There is no aura, and the headaches generally last 24 to 48 hours. The NP should:

a.            prescribe dihydroergotamine (D.H.E. 45).

b.            prescribe topiramate (Topamax) as migraine prophylaxis.

c.             recognize these as classic migraines and order sumatriptan (Imitrex).

d.            suggest treatment with acetaminophen because these are probably tension headaches.

 

 

Chapter 46: Antiparkinson Agents Test Bank

MULTIPLE CHOICE

1.            A patient who has Parkinson’s disease takes levodopa and carbidopa. The patient asks the primary care nurse practitioner (NP) why two drugs are necessary. The NP should explain that both drugs are needed to:

a.            prolong effects of the levodopa.

b.            delay progression of the disease.

c.             decrease adverse peripheral side effects.

d.            enhance passage of both drugs across the blood-brain barrier.

2.            A patient who has Parkinson’s disease and who takes levodopa reports that the drug effects wear off more quickly than before. The primary care NP should:

a.            add carbidopa.

b.            add amantadine.

c.             increase the dose of levodopa.

d.            add a monoamine oxidase B inhibitor (MAO-B).

3.            A patient who has Parkinson’s disease takes levodopa and carbidopa. The patient reports experiencing tremors between doses. The primary care NP should:

a.            add entacapone.

b.            add amantadine.

c.             discontinue the carbidopa.

d.            increase the dose of levodopa.

4.            A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing freezing episodes between doses. The primary care NP should consider using:

a.            selegiline.

b.            amantadine.

c.             apomorphine.

d.            modified-release levodopa.

5.            A patient who has Parkinson’s disease who takes levodopa and carbidopa reports having drooling episodes that are increasing in frequency. The primary care NP should order:

a.            benztropine.

b.            amantadine.

c.             apomorphine.

d.            modified-release levodopa.

6.            A patient who is diagnosed with Parkinson’s disease will begin taking levodopa and carbidopa. The patient asks the primary care NP what dietary interventions may be helpful in improving symptoms. The NP should recommend:

a.            consuming a high-calorie diet.

b.            consuming a low-carbohydrate diet.

c.             avoiding extra fluids during meal times.

d.            minimizing intake of high-protein foods during the day.

7.            A 55-year-old patient develops Parkinson’s disease characterized by unilateral tremors only. The primary care NP will refer the patient to a neurologist and should expect initial treatment to be:

a.            levodopa.

b.            carbidopa.

c.             pramipexole.

d.            carbidopa/levodopa.

8.            A 65-year-old patient is diagnosed with Parkinson’s disease. The patient has emphysema and narrow-angle glaucoma. The primary care NP should consider beginning therapy with:

a.            selegiline.

b.            benztropine.

c.             carbidopa/levodopa.

d.            ropinirole hydrochloride.

 

Chapter 47: Antidepressants Test Bank

MULTIPLE CHOICE

1.            A patient reports having feelings of hopelessness and anxiety for the past few months. The primary care nurse practitioner (NP) performs a history and learns that these feelings occur almost daily. The patient also reports having headaches and difficulty concentrating at work along with wanting to sleep all the time. The patient has gained 5 lb in the past 6 months. The NP should:

a.            tell the patient that these symptoms should resolve on their own.

b.            reassure the patient that these are symptoms of minor depression.

c.             tell the patient that an exercise regimen alone should be effective.

d.            assess the patient for alcohol and drug use and for suicidal ideation.

2.            A patient reports feelings of sadness and hopelessness along with difficulty sleeping and weight loss. The primary care NP learns that the patient’s mother died 6 months earlier. The NP should:

a.            offer a referral to a bereavement counselor.

b.            begin pharmacologic treatment with fluoxetine.

c.             determine whether medications are causing these symptoms.

d.            tell the patient that these symptoms will go away in a few months.

3.            A patient has been taking paroxetine (Paxil) for major depressive symptoms for 8 months. The patient tells the primary care NP that these symptoms improved after 2 months of therapy. The patient is experiencing weight gain and sexual dysfunction and wants to know if the medication can be discontinued. The NP should:

a.            change to a tricyclic antidepressant medication.

 b.           begin to taper the paroxetine and instruct the patient to call if symptoms increase.

c.             tell the patient to stop taking the medication and to call if symptoms get worse.

d.            continue the medication for several months and consider adding bupropion (Wellbutrin).

4.            The primary care NP has prescribed sertraline (Zoloft) for a patient who initially reported daily symptoms of hopelessness, sadness, insomnia, and weight loss. After several months of therapy, the patient no longer feels hopeless or sad but continues to have difficulty eating and sleeping. The NP should contact the patient’s psychiatrist to discuss:

a.            adding mirtazapine (Remeron).

b.            changing to duloxetine (Cymbalta).

c.             adding another selective serotonin reuptake inhibitor (SSRI) antidepressant.

d.            an inpatient admission to the hospital.

5.            A patient has been taking fluoxetine (Prozac) for depression and comes to the clinic to report nausea and jitteriness. The primary care NP notes tremors and sees that the patient is confused. The patient has a heart rate of 95 beats per minute. The NP should:

a.            change to bupropion (Wellbutrin).

b.            ask the patient about other medications.

c.             discontinue the fluoxetine immediately.

 d.           add mirtazapine (Remeron) to treat anxiety.

6.            A patient who has symptoms of depression also reports chronic pain. The primary care NP should begin therapy with:

a.            fluoxetine (Prozac).

b.            duloxetine (Cymbalta).

c.             bupropion (Wellbutrin).

d.            nortriptyline (Pamelor).

7.            An 80-year-old patient experiences prolonged sadness after the death of a spouse. The patient reports being unable to sleep or eat. The primary care NP should prescribe       mg         daily.

a.            trazodone 50; three times

b.            trazodone 100; three times

c.             mirtazapine 15; at bedtime

d.            mirtazapine 30; at bedtime

8.            The primary care NP sees a 16-year-old patient who reports feeling hopeless and sad. The child’s parent reports increased aggression and a decline in school performance. The NP should consider prescribing:

a.            fluoxetine (Prozac).

 b.           nortriptyline (Pamelor).

c.             tranylcypromine (Parnate).

d.            venlafaxine hydrochloride (Effexor).

9.            A 15-year-old patient who is seeing a psychiatrist began taking an antidepressant 1 week before a clinic visit with the primary care NP. The NP should:

a.            schedule weekly clinic visits to evaluate response to the medication.

b.            encourage the child to report feelings of self-harm to a school counselor.

c.             contact the patient by phone every 2 weeks to see how the medication is working.

d.            instruct the child’s parents to report changes in behavior to the child’s psychiatrist.

10.          A patient has been taking fluoxetine 20 mg every morning for 5 days and calls the primary care NP to report decreased appetite, nausea, and insomnia. The NP should:

a.            suggest taking a sedative at bedtime.

b.            change the medication to bupropion.

c.             add trazodone to the patient’s regimen.

d.            reassure the patient that these effects will subside.

 

Chapter 48: Antianxiety and Insomnia Agents Test Bank

MULTIPLE CHOICE

1.            A patient comes to the clinic and reports having insomnia that began within the last year. The primary care nurse practitioner (NP) learns that the patient often lies awake worrying about problems at work. The patient feels fatigued during the day and experiences frequent stomach discomfort. The NP should prescribe:

a.            buspirone.

b.            melatonin.

c.             alprazolam.

d.            diphenhydramine.

2.            A patient tells the primary care NP about having difficulty giving presentations at work. The patient experiences anxiety and often feels faint or vomits. The NP should:

a.            prescribe buspirone.

b.            prescribe alprazolam.

c.             order a selective serotonin reuptake inhibitor (SSRI) antidepressant.

d.            recommend cognitive-behavioral therapy.

3.            An adolescent patient comes to the clinic and reports anxiety and poor sleep that have persisted since experiencing a hurricane 8 months prior. The patient has been receiving cognitive-behavioral therapy, which has helped a little. The primary care NP should order:

a.            doxepin.

b.            fluoxetine.

 c.            alprazolam.

d.            clonazepam.

4.            A patient reports difficulty falling asleep and staying asleep every night and has difficulty staying awake during the commute to work every day. The NP should:

a.            suggest the patient try diphenhydramine first.

b.            perform a thorough history and physical examination.

c.             teach about avoiding caffeine and good sleep hygiene.

d.            suggest melatonin and consider prescribing Ambien if this is not effective.

5.            A patient is in the clinic with acute symptoms of anxiety. The patient is restless and has not slept in 3 days. The primary care NP observes that the patient is irritable and has moderate muscle tension. The patient’s spouse reports that similar symptoms have occurred before in varying degrees for several years. The NP should refer the patient to a psychologist and should prescribe which drug for short-term use?

a.            Alprazolam

b.            Buspirone

c.             Melatonin

d.            Zolpidem

6.            A patient reports going to bed at 10:00 pm every night but often lays awake until midnight. The primary care NP instructs the patient to practice good sleep hygiene and to avoid caffeine in the evening. After 1 week of this regimen, the patient reports still lying awake until 11:00 PM. The NP should:

a.            order a sleep study.

b.            consider short-term zolpidem.

c.             order ramelteon for several weeks.

d.            reassure the patient and re-evaluate in 1 week.

7.            A patient reports difficulty returning to sleep after getting up to go to the bathroom every night. A physical examination and a sleep hygiene history are noncontributory. The primary care NP should prescribe:

a.            zaleplon.

b.            ZolpiMist.

c.             ramelteon.

d.            chloral hydrate.

 

Chapter 49: Antipsychotics Test Bank

MULTIPLE CHOICE

1.            The primary care nurse practitioner (NP) is performing a physical examination on a patient who has been taking mesoridazine (Serentil) for several weeks to treat schizophrenia. The patient is exhibiting rhythmic movements of the face and jaw. The NP should be concerned that the patient may:

a.            need a higher dose of mesoridazine.

 b.           need to change to thioridazine (Mellaril).

c.             have developed neuroleptic malignant syndrome.

d.            be exhibiting signs of an irreversible adverse effect.

2.            A patient with a recent diagnosis of schizophrenia is taking thioridazine (Mellaril) to treat psychotic symptoms. The patient’s family member is concerned that the patient continues to have little interest in activities and has difficulty beginning even simple tasks. The primary care NP should contact the patient’s psychiatrist to discuss changing to:

a.            fluphenazine (Prolixin).

b.            risperidone (Risperdal).

c.             chlorpromazine (Thorazine).

d.            prochlorperazine (Compazine).

3.            A 22-year-old male patient who has dropped out of college has increasingly disorganized behavior and delusional thinking. His parents report that he lives at home and has no desire to find a job or help around the house. The primary care NP has ruled out organic causes and has referred the patient to a psychiatrist for treatment. To prepare for the referral visit, the NP should:

a.            begin therapy with a low-potency antipsychotic.

b.            begin therapy with a high-potency antipsychotic.

 c.            obtain a complete blood count (CBC), serum lipids, and hemoglobin A1c.

d.            order liver function tests (LFTs), a CBC, an electrocardiogram (ECG), and a urinalysis.

4.            A patient who is newly diagnosed with schizophrenia is overweight and has a positive family history for type 2 diabetes mellitus. The primary care NP should consider initiating antipsychotic therapy with:

a.            ziprasidone (Geodon).

b.            olanzapine (Zyprexa).

c.             risperidone (Risperdal).

d.            chlorpromazine (Thorazine).

5.            A patient has been taking olanzapine (Zyprexa) for 3 weeks to treat schizophrenia. The primary care NP notes that the patient has more coherent speech and improved initiative and attentiveness but continues to have delusional ideation. The NP should:

a.            increase the dose of olanzapine.

b.            decrease the dose of olanzapine.

c.             maintain the same dose of olanzapine.

d.            change from olanzapine to chlorpromazine.

6.            An elderly patient with dementia exhibits hostility and uncooperativeness. The primary care NP prescribes clozapine (Clozaril) and should counsel the family about:

a.            a decreased risk of extrapyramidal symptoms.

b.            improved cognitive function.

c.             the need for long-term use of the medication.

d.            a possible increased risk of heart disease and stroke.

7.            A patient who takes 150 mg of clozapine (Clozaril) twice daily calls the primary care NP at 10:00 AM one day to report forgetting to take the 8:00 AM dose. The NP should counsel the patient to:

a.            take the missed dose now.

b.            take 75 mg of clozapine now.

c.             wait and take the evening dose at the usual time.

d.            take the evening dose 2 hours earlier than usual.

8.            A patient comes to the clinic for a physical examination 2 weeks after a last dose of clozapine (Clozaril). The primary care NP should:

a.            order a CBC with differential.

b.            obtain serum lipids and LFTs.

c.             obtain a serum clozapine level.

d.            assess for orthostatic hypotension.

9.            A patient who is overweight is diagnosed with schizophrenia. The primary care NP should consider prescribing:

a.            olanzapine (Zyprexa).

b.            ziprasidone (Geodon).

c.             quetiapine (Seroquel).

d.            aripiprazole (Abilify).

 

Chapter 50: Substance Abuse Test Bank

MULTIPLE CHOICE

1.            At an annual well-woman examination, the primary care nurse practitioner (NP) asks a patient about alcohol consumption. The woman reports she usually consumes six glasses of wine per week and occasionally will consume three or four glasses at a party. The NP smells alcohol on the woman’s breath. The woman says she is hung over today. The NP should:

a.            order liver function tests (LFTs) and a complete blood count.

b.            question her further about her nightly alcohol consumption—ask what size her wine glasses are.

c.             consider her at high risk for alcoholism.

d.            refer her to treatment for alcohol abuse.

2.            A mother brings her a college-age son to the primary care NP and asks the NP to talk to him about alcohol use. He reports binge drinking on occasion and drinking only beer on weekends. The NP notes diaphoresis, tachycardia, and an easy startle reflex. The NP should:

a.            admit him to the hospital for detoxification.

b.            ask him how much he had to drink last night.

c.             prescribe lorazepam (Ativan) to help with symptoms.

d.            suggest that he talk to a counselor about alcohol abuse.

3.            A patient who is an alcoholic is seen in the clinic, and the primary care NP admits the patient to the hospital for acute withdrawal. The patient has elevated liver enzymes. The NP should expect the inpatient provider to prescribe:

a.            lorazepam (Ativan).

b.            diazepam (Valium).

c.             acamprosate (Campral).

d.            chlordiazepoxide (Librium).

4.            A patient is brought to the clinic by a spouse because of increased somnolence and disorientation. The spouse tells the primary care NP that the patient has been taking oxycodone for postoperative pain. The NP notes a respiratory rate of 8 to 10 breaths per minute. The NP should:

a.            activate the emergency medical service

                (EMS) and administer oxygen.

b.            administer oral methadone (Dolophine).

c.             administer intramuscular naltrexone (ReVia).

d.            administer sublingual buprenorphine (Subutex).

5.            The primary care NP is preparing to prescribe acamprosate for a patient who is an alcoholic. Before initiating treatment with this medication, the NP should:

a.            assess renal function.

b.            obtain liver function tests.

c.             teach the patient never to take the drug with alcohol.

d.            tell the patient that this medication is used to treat withdrawal symptoms.

6.            The primary care NP prescribes disulfiram to a patient who has stopped drinking but continues to have cravings for alcohol. The NP must counsel the patient to:

a.            abstain from alcohol completely.

b.            report a garlic taste in the mouth.

c.             stop taking the drug after a few months.

d.            increase the drug dose after several months.

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NR508 Test Banking Chapter 41-50

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