Chapter 06: Special Populations: Pregnant and Nursing Women Test Bank
MULTIPLE CHOICE
1. A woman is in the 36th week of pregnancy. The nurse practitioner (NP) providing prenatal care learns that the woman has a history of two previous urinary tract infections during this pregnancy. A dipstick urinalysis in the office today is negative for leukocyte esterase and nitrites. The NP should:
a. prescribe a low-dose sulfonamide antibiotic for urinary tract infection prophylaxis.
b. order nitrofurantoin daily to minimize the patient’s risk of urinary tract infection late in her pregnancy.
c. encourage the patient to increase daily water intake and to wear only cotton underwear.
d. order a voiding cystourethrogram to rule out structural anomalies that may cause urinary tract infection.
2. A woman tells a primary care NP that she is considering getting pregnant. During a health history, the NP learns that the patient has seasonal allergies, asthma, and epilepsy, all of which are well controlled with a second-generation antihistamine daily, an inhaled steroid daily with albuterol as needed, and an antiepileptic medication daily. The NP should counsel this patient to:
a. take her asthma medications only when she is having an acute exacerbation.
b. avoid using antihistamine medications during her first trimester of pregnancy.
c. discontinue her seizure medications at least 6 months before becoming pregnant.
d. use only oral corticosteroids and not inhaled steroids while pregnant for improved asthma control.
3. A woman has just learned she is pregnant and is in her 10th gestational week. The woman reports that she takes valproic sodium (Depakote) for a seizure disorder and has been seizure-free for several years. The NP should:
a. prescribe folic acid supplements.
b. change her antiepileptic drug to lamotrigine (Lamictal).
c. order prophylactic vitamin K to be given in the second trimester.
d. recommend that she discontinue taking the valproic sodium by 12 weeks.
4. A woman who is pregnant develops gestational diabetes. The NP’s initial action is to:
a. prescribe an oral antidiabetic agent.
b. give her information about diet and exercise.
c. begin treating her with daily insulin injections.
d. reassure her that her glucose levels will return to normal after pregnancy.
5. A woman who takes an angiotensin converting enzyme inhibitor for hypertension tells her primary care NP that she is trying to get pregnant. The NP should:
a. consider replacing her angiotensin converting enzyme inhibitor with methyldopa.
b. lower her angiotensin converting enzyme inhibitor dose during the first trimester.
c. counsel her to increase her antihypertensive medications during pregnancy.
d. add an angiotensin receptor blocker (ARB) during the first trimester of her pregnancy.
6. A woman who is pregnant tells an NP that she has been taking sertraline for depression for several years but is worried about the effects of this drug on her fetus. The NP will consult with this patient’s psychiatrist and will recommend that she:
a. stop taking the sertraline now.
b. continue taking the antidepressant.
c. change to a monoamine oxidase inhibitor (MAOI).
d. discontinue the sertraline a week before delivery.
7. A woman is 4 weeks pregnant. The primary care NP sees her for her first prenatal visit and obtains a rubella titer, which is negative. The woman tells the NP that she drinks 2 cups of coffee and smokes 3 to 5 cigarettes each day. She denies alcohol use. The NP should:
a. administer rubella vaccine.
b. provide smoking cessation information.
c. counsel her to avoid caffeine while pregnant.
d. reassure her that her habits are not likely to cause harm.
8. A woman who is breastfeeding her infant asks the primary care NP what she can use for headaches while she is nursing. The NP tells her:
a. most medications enter breast milk and are not safe.
b. most over-the-counter medications are safe for the breastfed infant.
c. she may need to interrupt breastfeeding when taking headache medications.
d. she should consider weaning her infant to formula if her headaches are frequent.
Chapter 07: Over-the-Counter Medications Test Bank
MULTIPLE CHOICE
1. A patient asks a primary care nurse practitioner (NP) about using over-the-counter medications to treat an upper respiratory infection with symptoms of cough, fever, and nasal congestion. The NP should:
a. recommend a cough preparation that also contains acetaminophen.
b. suggest using single-ingredient products to treat each symptom separately.
c. recommend a product containing antitussive, antipyretic, and decongestant ingredients.
d. tell the patient that over-the-counter medications are usually not effective in manufacturer-recommended doses.
2. A patient asks a primary care NP whether over-the-counter drugs are safer than prescription drugs. The NP should explain that over-the-counter drugs are:
a. generally safe when label information is understood and followed.
b. safer because over-the-counter doses are lower than prescription doses of the same drug.
c. less safe because they are not well regulated by the Food and Drug Administration (FDA).
d. not extensively tested, so claims made by manufacturers cannot be substantiated.
3. A parent calls a clinic for advice about giving an over-the-counter cough medicine to a 6- year-old child. The parent tells the NP that the medication label does not give instructions about how much to give a child. The NP should:
a. order a prescription antitussive medication for the child.
b. ask the parent to identify all of the ingredients listed on the medication label.
c. calculate the dose for the active ingredient in the over-the-counter preparation.
d. tell the parent to approximate the dose at about one third to one half the adult dose.
4. A primary care NP recommends an over-the-counter medication for a patient who has acid reflux. When teaching the patient about this drug, the NP should tell the patient:
a. to take the dose recommended by the manufacturer.
b. not to worry about taking this drug with any other medications.
c. to avoid taking other drugs that cause sedation while taking this drug.
d. that over-the-counter acid reflux medications are generally safe to take with other medications.
5. A primary care NP is performing a previsit health history on a new patient. The patient reports taking vitamins every day. The NP should:
a. ask the patient to bring all vitamin bottles to the clinic appointment.
b. recommend natural vitamin products over synthetic vitamin products.
c. reassure the patient that vitamins that are high in folic acid are safe to take.
d. tell the patient that some vitamins, such as vitamin C, are safe in large doses.
6. A patient reports taking antioxidant supplements to help prevent cancer. The primary care NP should:
a. review healthy dietary practices with this patient.
b. make sure that the supplements contain large doses of vitamin A.
c. tell the patient that antioxidants are especially important for patients who smoke.
d. tell the patient that evidence shows antioxidants to be effective in preventing cancer.
7. A patient who has an upper respiratory infection reports using over-the-counter cold preparations. The primary care NP should counsel this patient to use caution when taking additional over-the-counter medications such as:
a. antipyretics.
b. calcium supplements.
c. acid reflux medications.
d. antioxidant supplements.
Chapter 08: Complementary and Alternative Therapies Test Bank
MULTIPLE CHOICE
1. A patient with chronic back pain that is unrelieved by prescription analgesic medications asks a primary care nurse practitioner (NP) about acupuncture treatments. The NP should tell this patient:
a. biofield therapy has been shown to be more effective than acupuncture.
b. creatine has been shown to be an effective herbal choice to treat back pain.
c. there is no valid research documenting the efficacy of this treatment for pain.
d. most studies that show benefits of alternative therapies are based on observation.
2. A primary care NP is aware that many patients in the community use herbal remedies to treat various conditions. The NP understands the importance of:
a. learning about the actions, uses, doses, and toxicities of these agents.
b. prescribing these agents when possible to ensure safe dosing.
c. counseling patients to stop using herbal products to avoid toxic side effects.
d. teaching patients that these products are unregulated and unsafe to use.
3. A patient has been using an herbal supplement for 2 years that the primary care NP knows may have toxic side effects. The NP should:
a. tell the patient to stop taking the supplement immediately.
b. inform the patient of the risks of toxic side effects with this supplement.
c. refer the patient to a CAM provider who can manage this patient’s therapy.
d. prescribe another herbal drug that has fewer adverse effects than the one the patient is taking.
4. A patient asks a primary care NP why herbal supplements are not regulated by the FDA. The nurse practitioner should tell the patient these products are not regulated by the FDA because they are:
a. natural, plant-based products and not man- made.
b. not marketed as products that can treat or cure disease.
c. regulated by the Dietary Supplement Health and Education Act.
d. covered by the Hatch-Richardson Bill of 1992, which allows them to make health claims without FDA approval.
5. A patient is diagnosed with lupus and reports occasional use of herbal supplements. The primary care NP should caution this patient to avoid:
a. ginseng.
b. echinacea.
c. ginkgo biloba.
d. St. John’s wort.
6. A patient who takes warfarin (Coumadin) experiences excessive bleeding, even though serum drug levels are normal. The primary care NP should question this patient about the use of:
a. feverfew.
b. echinacea.
c. green tea.
d. ginkgo biloba.
7. A patient develops hepatotoxicity from chronic acetaminophen use. The primary care NP may recommend:
a. milk thistle.
b. chondroitin.
c. coenzyme Q.
d. glucosamine.
Chapter 09: Establishing the Therapeutic Relationship Test Bank
MULTIPLE CHOICE
1. To increase the likelihood of successful pharmacotherapy, when teaching a patient about using a medication, the primary care nurse practitioner (NP) should:
a. encourage the patient to participate in the choice of the medication.
b. provide education about the medication actions and adverse effects.
c. stress the importance of taking the medication exactly as it is prescribed.
d. give the patient copies of medication package inserts describing the drug use.
2. A patient has recurrent symptoms and tells the primary care NP that she can’t remember to take her medication all the time. The NP should:
a. give her shortened regimens of the drug to facilitate compliance.
b. provide written information about her condition and the medication.
c. administer the medication in the clinic to ensure that she takes the drug.
d. ask her about her lifestyle, her schedule, and her understanding of her condition.
3. A primary care NP prepares to teach a patient about the management of a chronic condition. The patient says, “I don’t want to know all of that. Just tell me what to take and when.” The NP should initially:
a. give the patient basic written instructions about medications, follow up visits, and symptoms.
b. ask the patient to describe the disease process and the medications to evaluate understanding.
c. explain to the patient that without mutual cooperation, the treatment regimen will not be effective.
d. ask the patient to explore feelings and fears about having a chronic disease and taking medications.
4. A parent brings a child who has moderate-persistent asthma to the clinic and tells the primary care NP that none of the child’s medications are working. The parent says, “Everybody tells me something different. I don’t know what to do.” The NP suspects that the parent is not administering the medications appropriately. The NP should initially:
a. perform a careful history of the child’s symptoms and the medications that are given.
b. provide a written asthma action plan and encourage the parent to call when symptoms are worse.
c. review what other providers have prescribed in the past and explain these interventions to the parent.
d. explain the different purposes of maintenance and rescue medications and give the parent a schedule for medication administration.
5. A primary care NP sees a 5-year-old child who is morbidly obese. The child has an elevated hemoglobin A1c and increased lipid levels. Both of the child’s parents are overweight but not obese, and they tell the NP that they see nothing wrong with their child. They both state that it is difficult to refuse their child’s requests for soda or ice cream. The NP should:
a. suggest that they give the child diet soda and low-fat frozen yogurt.
b. understand and respect the parents’ beliefs about their child’s self-image.
c. initiate a dialogue with the parents about the implications of the child’s laboratory values.
d. suggest family counseling to explore ways to improve parenting skills and limits.
6. A patient bursts into tears when the primary care NP diagnoses diabetes. The NP should:
a. ask the patient about past experiences with anyone who has this diagnosis.
b. reassure the patient that the medications and blood tests will become routine.
c. call in a social worker to assist the patient to obtain equipment and supplies.
d. refer the patient to a diabetes educator to provide teaching about the disease.
7. A primary care NP writes a prescription for an off-label use for a drug. To help ensure compliance, the NP should:
a. include information about the off-label use on the E-script.
b. provide the patient with written instructions about how to use the medication.
c. tell the patient to let the pharmacist know that the drug is being used for an off-label use.
d. follow up by phone in several days to see if the patient is using the drug appropriately.
