NR508 Test Banking Chapter 51-60

Chapter 51: Glucocorticoids Test Bank

MULTIPLE CHOICE

1.            A patient has been taking oral prednisone 60 mg daily for 3 days for an asthma exacerbation, which has resolved. The patient reports having gastrointestinal (GI) upset. The primary care nurse practitioner (NP) should:

a.            discontinue the prednisone.

b.            begin tapering the dose of the prednisone.

c.             order a proton pump inhibitor (PPI) to counter the effects of the steroid.

d.            change the prednisone dosing to every other day.

2.            A patient will require a long course of steroids to treat a chronic inflammatory condition. The primary care NP expects the specialist to order:

a.            prednisone daily.

b.            triamcinolone daily.

c.             hydrocortisone every other day.

d.            dexamethasone every other day.

3.            A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the primary care NP notes a decrease in the child’s linear growth rate. The NP should consult the child’s asthma specialist about:

a.            gradually tapering the child off the prednisone.

b.            a referral for possible growth hormone therapy.

c.             giving a double dose of prednisone every other day.

d.            dividing the prednisone dose into twice- daily dosing.

4.            A 70-year-old patient with COPD who is new to the clinic reports taking 10 mg of prednisone daily for several years. The primary care NP should:

a.            tell the patient to take the drug every other day before 9:00 AM.

b.            order a serum glucose, potassium level, and bone density testing.

c.             perform pulmonary function tests to see if the medication is still needed.

d.            begin a gradual taper of the prednisone to wean the patient off the medication.

5.            A primary care NP prescribes an oral steroid to a patient and provides teaching about the medication. Which statement by the patient indicates a need for further teaching?

 a.           “I should take this medication with food.”

b.            “I will take the medication at 8:00 AM each day.”

c.             “I can expect a decreased appetite while I am taking this medication.”

d.            “I should not stop taking the medication without consulting my provider.”

6.            A patient with ulcerative colitis takes 30 mg of methylprednisolone (Medrol) daily. The primary care NP sees this patient for bronchitis and orders azithromycin (Zithromax). The NP should:

a.            order intramuscular (IM) methylprednisolone.

b.            temporarily decrease the dose of methylprednisolone.

c.             change the dosing of methylprednisolone to 15 mg twice a day.

d.            stop the methylprednisolone while the patient is taking azithromycin.

7.            A patient is being tapered from long-term therapy with prednisolone and reports weight loss and fatigue. The primary care NP should counsel this patient to:

a.            consume foods high in vitamin D and calcium.

b.            begin taking dexamethasone because it has longer effects.

 c.            expect these side effects to occur as the medication is tapered.

d.            increase the dose of prednisolone to the most recent amount taken.

 

 

Chapter 52: Thyroid Medications Test Bank

MULTIPLE CHOICE

1.            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:

a.            methimazole.

b.            liothyronine.

c.             levothyroxine.

d.            propylthiouracil.

2.            A patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2 weeks. The patient reports continued fatigue. The primary care NP should:

a.            order a T4 level today.

b.            increase the dose to 100 mcg.

c.             check the TSH level in 1 week.

d.            reassure the patient that this will improve in several weeks.

3.            A primary care NP orders thyroid function tests. The patient’s TSH is 1.2 microunits/mL, and T4 is 1.7 ng/mL. The NP should:

a.            assess the patient for symptoms of hyperthyroidism.

b.            ask the patient about the use of medications such as lithium.

c.             tell the patient that the results most likely indicate hypothyroidism.

d.            ask an endocrinologist to evaluate for possible Hashimoto’s thyroiditis.

4.            An 80-year-old female patient with a history of angina has increased TSH and decreased T4. The primary care NP should prescribe              mcg of .

a.            25; liothyronine

b.            75; liothyronine

c.             25; levothyroxine

d.            75; levothyroxine

5.            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:

a.            increasing the dose to 90 mcg/day.

b.            decreasing the dose to 30 mcg/day.

c.             stopping the medication and checking  TSH and T4 in 4 weeks.

d.            discussing the need for lifetime replacement therapy with the child’s parents.

6.            A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency. When teaching this patient about the medication, the NP should:

a.            counsel the patient to take the medication with food.

b.            tell the patient that changing brands of the medication should be avoided.

c.             instruct the patient to stop taking the medication if signs of thyrotoxicosis occur.

d.            tell the patient that the drug may be stopped when thyroid function tests stabilize.

7.            A patient has been taking levothyroxine 100 mcg daily for several months. The patient comes to the clinic with complaints of insomnia and irritability. The primary care NP notes a heart rate of 92 beats per minute. The NP should:

a.            change to liothyronine 75 mcg/day.

b.            discontinue levothyroxine indefinitely.

c.             order propylthiouracil to counter the increased thyroid levels.

d.            order TSH and T4 levels and decrease the dose to 75 mcg/day.

 8.           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:

a.            thyrotropin.

b.            methimazole.

c.             levothyroxine.

d.            propylthiouracil.

9.            A patient with Graves’ disease is taking methimazole. After 6 months of therapy, the primary care NP notes normal T3 and T4 and elevated TSH. The NP should:

a.            order a complete blood count (CBC) with differential.

b.            order aspartate aminotransferase, AGT, and LDH tests.

c.             decrease the dose of the medication.

d.            add levothyroxine to the patient’s regimen.

 

Chapter 53: Diabetes Mellitus Agents

 Test Bank

MULTIPLE CHOICE

1.            A 40-year-old patient is in the clinic for a routine physical examination. The patient has a body mass index (BMI) of 26. The patient is active and walks a dog daily. A lipid profile reveals low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30 mg/dL, and triglycerides of 250 mg/dL. The primary care nurse practitioner (NP) should:

a.            order a fasting plasma glucose level.

b.            consider prescribing metformin (Glucophage).

c.             suggest dietary changes and increased exercise.

d.            obtain serum insulin and hemoglobin A1c levels.

2.            A patient is newly diagnosed with type 2 diabetes mellitus. The primary care NP reviews this patient’s laboratory tests and notes normal renal function, increased triglycerides, and deceased HDL levels. The NP should prescribe:

a.            nateglinide (Starlix).

b.            glyburide (Micronase).

c.             colesevelam (Welchol).

d.            metformin (Glucophage).

3.            A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping blood glucose within normal limits and has had multiple episodes of both hypoglycemia and hyperglycemia. As adjunct therapy to manage this problem, the primary care NP should prescribe:

 a.           pramlintide (Symlin).

b.            repaglinide (Prandin).

c.             glyburide (Micronase).

d.            metformin (Glucophage).

4.            A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3%. The NP should:

a.            begin insulin therapy.

b.            change to therapy with colesevelam (Welchol).

c.             add a third oral antidiabetic agent to this patient’s drug regimen.

d.            enroll the patient in a weight loss program to achieve better glycemic control.

5.            A 30-year-old white woman has a BMI of 26 and weighs 150 lb. At an annual physical examination, the patient’s fasting plasma glucose is 130 mg/dL. The patient walks 1 mile three or four times weekly. She has had two children who weighed 7 lb and 8 lb at birth. Her personal and family histories are noncontributory. The primary care NP should:

a.            order metformin (Glucophage).

b.            order a lipid profile, complete blood count, and liver function tests (LFTs).

c.             order an oral glucose tolerance test.

d.            set a weight loss goal of 10 to 15 lb.

 6.           A patient who is newly diagnosed with type 2 diabetes mellitus has not responded to changes in diet or exercise. The patient is mildly obese and has a fasting blood glucose of 130 mg/dL. The patient has normal renal function tests. The primary care NP plans to prescribe a combination product. Which of the following is indicated for this patient?

a.            Metformin/glyburide (Glucovance)

b.            Insulin and metformin (Glucophage)

c.             Saxagliptin/metformin (Kombiglyze)

d.            Metformin/pioglitazone (ACTOplus met)

7.            A patient who has type 2 diabetes mellitus takes metformin (Glucophage). The patient tells the primary care NP that he will have surgery in a few weeks. The NP should recommend:

a.            taking the metformin dose as usual the morning of surgery.

b.            using insulin during the perioperative and postoperative periods.

c.             that the patient stop taking metformin several days before surgery.

d.            adding a sulfonylurea medication until recovery from surgery is complete.

8.            A patient who has diabetes is taking metformin 1000 mg daily. At a clinic visit, the patient reports having abdominal pain and nausea. The primary care NP notes a heart rate of 92 beats per minute. The NP should:

 a.           obtain LFTs.

b.            decrease the dose of metformin.

c.             change metformin to glyburide.

d.            order electrolytes, ketones, and serum glucose.

9.            A 12-year-old patient who is obese develops type 2 diabetes mellitus. The primary care NP should order:

a.            nateglinide (Starlix).

b.            glyburide (Micronase).

c.             colesevelam (Welchol).

d.            metformin (Glucophage).

 

 

 

Chapter 60: Cephalosporins Test Bank

MULTIPLE CHOICE

1.            An adult patient has cellulitis. The patient is a single parent with health insurance who works and is attending classes at a local university. To treat this infection, the primary care nurse practitioner (NP) should prescribe:

a.            cefdinir (Omnicef).

b.            cephalexin (Keflex).

c.             cefadroxil (Duricef).

d.            ceftriaxone (Rocephin).

2.            A primary care NP sees a patient who has dysuria, fever, and urinary frequency. The NP orders a urine dipstick, which is positive for nitrates and leukocyte esterase, and sends the urine to the laboratory for a culture. The patient is allergic to sulfa drugs. The NP should:

a.            order cefaclor (Ceclor).

b.            prescribe cefixime (Suprax).

c.             administer intramuscular ceftriaxone (Rocephin).

d.            wait for culture results before ordering an antibiotic.

3.            A patient is taking cefadroxil (Duricef) and comes to the clinic complaining of loose stools for several days. The primary care NP notes normal vital signs; warm, pink skin with elastic turgor; and moist mucous membranes. The NP should:

a.            order tests for Clostridium difficile– associated disease (CDAD).

b.            discontinue the cefadroxil.

c.             reassure the patient that loose stools are common with antibiotics.

d.            recommend consuming lactobacillus- containing foods to minimize diarrhea.

4.            A primary care NP provides teaching to a patient who will begin taking cefadroxil (Duricef). Which statement by the patient indicates a need for further teaching?

a.            “I should report any rash that occurs.”

b.            “I will take this medication twice daily.”

c.             “I should take this medication with food.”

d.            “Gastrointestinal (GI) symptoms are common but not worrisome.”

5.            A 70-year-old patient will begin taking cefdinir (Omnicef) for an acute exacerbation of COPD. Before initiating therapy, the primary care NP should order:

a.            liver function tests (LFTs).

b.            coagulation studies.

c.             an electrocardiogram (ECG).

d.            a creatinine clearance test.

6.            A patient is taking an aminoglycoside and a cephalosporin. The primary care NP should consider                the dose of

a.            increasing; cephalosporin

b.            decreasing; cephalosporin

c.             increasing; aminoglycoside

d.            decreasing; aminoglycoside

7.            A child with a febrile illness is taking a cephalosporin. While in the clinic for a follow-up visit, the child has a tonic-clonic seizure. The primary care NP should:

a.            administer acetaminophen because this is likely a febrile seizure.

b.            reassure the parent that seizures can occur while taking cephalosporins.

c.             ask the child’s parent how much of the cephalosporin the child has taken.

d.            suspect the development of a secondary central nervous system infection.