Chapter 62: Macrolides Test Bank
MULTIPLE CHOICE
1. A primary care nurse practitioner (NP) is prescribing once-daily azithromycin to a 25- year-old woman. When teaching her about the drug, the NP should tell her to:
a. take the medication on an empty stomach.
b. use a backup contraception method other than oral contraceptive pills.
c. expect severe gastrointestinal side effects while taking this drug.
d. cut the pill in half and take twice daily if side effects are severe.
2. A primary care NP is preparing to prescribe a macrolide antibiotic for a patient who has a history of a prolonged QT interval on electrocardiogram. Which macrolide antibiotic should the NP prescribe?
a. Erythromycin
b. Azithromycin
c. Clarithromycin
d. Telithromycin
3. Which antibiotic requires administration of a loading dose?
a. Ilosone
b. E-Mycin
c. Erythrocin
d. Zithromax
4. A patient has had severe diarrhea for 2 weeks. Laboratory testing reveals Clostridium difficile. The primary care NP should prescribe:
a. erythromycin.
b. azithromycin.
c. fidaxomicin.
d. clarithromycin.
5. A primary care NP is planning to order a macrolide antibiotic for a patient who is experiencing an exacerbation of chronic obstructive pulmonary disease. The patient is taking a cytochrome (CYP) 3A medication. The NP should order:
a. azithromycin.
b. clarithromycin.
c. erythromycin base.
d. erythromycin estolate.
6. A primary care NP sees a 6-month-old patient who has a persistent staccato cough. The NP is aware that there is a pertussis outbreak in the community. The NP should obtain appropriate cultures and treat empirically with:
a. erythromycin.
b. azithromycin.
c. clarithromycin.
d. telithromycin.
Chapter 63: Fluoroquinolones Test Bank
MULTIPLE CHOICE
1. A patient has been taking ciprofloxacin for 3 days and calls the primary care nurse practitioner (NP) to report having headaches and dizziness. The NP should:
a. change to levofloxacin.
b. decrease the dose of ciprofloxacin.
c. change to an antibiotic in another drug class.
d. reassure the patient that these are common side effects.
2. A primary care NP sees a patient who has fever, flank pain, and dysuria. The patient has a history of recurrent urinary tract infections (UTIs) and completed a course of trimethoprim-sulfamethoxazole (TMP/SMX) the week before. A urine test is positive for leukocyte esterase. The NP sends the urine for culture and should treat this patient empirically with:
a. gemifloxacin.
b. ciprofloxacin.
c. azithromycin.
d. TMP/SMX.
3. A patient is taking levofloxacin to treat sinusitis. The patient calls the primary care NP to report pain just above the heel of the right foot. The NP should:
a. change to ofloxacin.
b. change to ciprofloxacin.
c. discontinue the levofloxacin.
d. reassure the patient that this is a common side effect.
4. A patient who is taking a fluoroquinolone antibiotic for pyelonephritis develops
Clostridium difficile–associated disease (CDAD). The primary care NP should treat for
C. difficile and fluoroquinolone.
a. continue the
b. discontinue the
c. increase the dose of
d. decrease the dose of
5. A primary care NP provides teaching for a patient who is about to begin taking levofloxacin tablets to treat an infection. Which statement by the patient indicates a need for further teaching?
a. “I should use sunscreen while taking this medication.”
b. “I should take this medication on an empty stomach.”
c. “I should use caution while driving when taking this medication.”
d. “I should take the tablet 2 hours before taking vitamins or an antacid.”
6. A patient who has been taking ciprofloxacin for 14 days for treatment of a UTI is seen in the clinic for a follow-up urinalysis. The urinalysis reveals crystalluria. The primary care NP should:
a. discontinue the ciprofloxacin.
b. decrease the dose of ciprofloxacin.
c. change the antibiotic to norfloxacin.
d. counsel the patient to increase fluid intake.
7. A primary care NP is preparing to prescribe a fluoroquinolone for a patient who has a history of alcohol abuse that has caused liver damage. The NP should choose:
a. norfloxacin.
b. levofloxacin.
c. gemifloxacin.
d. ciprofloxacin.
Chapter 65: Sulfonamides Test Bank
MULTIPLE CHOICE
1. A patient has been taking trimethoprim-sulfamethoxazole (TMP/SMX) for 14 days. The patient calls the primary care nurse practitioner (NP) to report fever, rash, and enlarged lymph nodes. The NP should suspect:
a. serum sickness reaction.
b. immediate sensitivity reaction.
c. cytotoxic hypersensitivity reaction.
d. cell-mediated hypersensitivity reaction.
2. An 80-year-old patient who has COPD takes TMP/SMX for acute exacerbations, which occur three or four times each year. To monitor this patient for adverse drug reactions, the primary care NP should order:
a. liver function tests.
b. blood urea nitrogen and creatinine.
c. serum bilirubin levels.
d. a complete blood count (CBC) with differential.
3. The primary care NP teaches a patient about TMP/SMX before prescribing it to treat a urinary tract infection (UTI). Which statement by the patient indicates a need for further teaching?
a. “I will take this medication with food.”
b. “I should drink a full glass of water with each dose.”
c. “I should stay out of direct sunlight and use sunscreen.”
d. “I should report any ringing in my ears or a sore throat.”
4. A primary care NP prescribes TMP/SMX for a patient who is experiencing an exacerbation of COPD. The patient calls the NP 2 days later to report increased fever, cough, and shortness of breath. The NP should tell the patient:
a. to stop taking the medication.
b. that symptoms such as sore throat and arthralgia are more worrisome.
c. to continue the medication because these are signs of the disease process.
d. that sulfisoxazole (Gantrisin) will be prescribed instead to minimize side effects.
5. A patient is seen in the clinic with a 1-week history of frequent watery stools. The primary care NP learns that a family member had gastroenteritis a week prior. The patient was treated for a UTI with a sulfonamide antibiotic 2 months prior. The NP should suspect:
a. Clostridium difficile–associated disease (CDAD).
b. viral gastroenteritis.
c. serum sickness reaction.
d. recurrence of the UTI.
6. When prescribing TMP/SMX to children, the primary care NP should recall that:
a. dosing is based on the trimethoprim component of the drug.
b. TMP/SMX should not be prescribed for children younger than 2 years.
c. folic acid supplements must be given to children who take this medication.
d. the medication should be given three or four times per day because of rapid metabolism.
7. A patient is taking sulfisoxazole. The patient calls the primary care NP to report abdominal pain, nausea, and insomnia. The NP should:
a. change to TMP/SMX.
b. tell the patient to stop taking the drug immediately.
c. reassure the patient that these are minor adverse effects of this drug.
d. order a CBC with differential, platelets, and a stool culture.
Chapter 68: Antiretroviral Medications Test Bank
MULTIPLE CHOICE
1. A female patient who is 8 weeks pregnant is seen by a primary care nurse practitioner (NP) after a routine prenatal screen was positive for human immunodeficiency virus (HIV). A CD4 cell count is 750 cells/mm. The NP should:
a. begin immediate therapy with zidovudine and lamivudine.
b. begin therapy with zidovudine when she is in her second trimester.
c. delay treatment with antiretroviral medications until after her pregnancy.
d. initiate therapy with zidovudine if her CD4 cell count decreases to 500 cells/mm.
2. A patient who has HIV has been receiving a two-drug combination therapy for 6 months. At an annual physical examination, the primary care NP notes that the patient has a viral load of 60 copies/mL and a CD4 cell count of 350 cells/mm. The NP should contact the patient’s infectious disease specialist to discuss:
a. changing one of the medications.
b. changing both of the medications.
c. increasing the dose of both medications.
d. discontinuing the medications for a short period.
3. A primary care NP provides primary care for a woman who has HIV. The woman asks the NP if she will ever be able to have children. The NP should tell her:
a. none of the antiretroviral medications are safe to take during pregnancy.
b. she will need to take medications throughout her pregnancy and lactation.
c. there is no risk of disease transmission to a fetus if she complies with therapy.
d. strict adherence to antiretroviral therapy decreases her risk of transmitting HIV to the fetus.
4. A patient who has HIV frequently expresses concerns about the costs of treatment. The primary care NP should:
a. discuss the risks associated with underdosing of antiretroviral therapies.
b. suggest taking half doses of the medications on a regular basis.
c. suggest the patient limit therapy to a one- or two-drug regimen.
d. recommend an occasional “drug holiday” when cell and viral counts are good.
5. A patient has begun treatment for HIV. The primary care NP should monitor the patient’s complete blood count (CBC) at least every months.
a. 1 to 3
b. 3 to 6
c. 6 to 9
d. 9 to 12
6. A patient who has HIV is being treated with Emtriva. The patient develops hepatitis B. The primary care NP should contact the patient’s infectious disease specialist to discuss:
a. adding zidovudine.
b. changing to Truvada.
c. changing to tenofovir.
d. ordering Combivir and tenofovir.
Chapter 70: The Immune System and Immunizations Test Bank
MULTIPLE CHOICE
1. The parents of a 2-month-old infant ask the primary care nurse practitioner (NP) if they can immunize their child by giving one or two immunizations per month instead of following the recommended immunization schedule for vaccines at 2, 4, 6, 12, and 15 months of age. The NP should:
a. respect the parents’ wishes and agree to the revised schedule for immunizations.
b. explain that prolonging the vaccine regimen will lead to a decrease in final antibody concentrations.
c. tell the parents that protection from diseases may be delayed until all immunizations have been given.
d. inform the parents that a prolonged interval between some vaccines may require restarting the series for those vaccines.
2. The primary care NP sees a 5-year-old child for a prekindergarten physical examination. The child’s parents do not have immunization records, and a local record search does not provide proof of vaccinations, although the parent thinks the child may have had some vaccines several years ago. The NP’s initial action will be to:
a. perform serologic tests for measles, rubella, and tetanus antigens.
b. administer TdaP, MMR, Varivax, PCV13, hepatitis A, hepatitis B, and IPV vaccines.
c. administer DTaP, Hib, hepatitis A, hepatitis B, MMR, Varivax, IPV, RV, and PCV13 vaccines.
d. ask the parent to look for immunization records and schedule an appointment for vaccines when those are found.
3. The primary care NP sees a 6-month-old infant for a routine physical examination and notes that the infant has a runny nose and a cough. The parents report a 2-day history of a
temperature of 99° F to 100° F and two to three loose stools per day. Other family members have similar symptoms. The infant has had two sets of immunizations at 2 and 4 months of age. The NP should:
a. administer the 6-month immunizations at this visit today.
b. schedule an appointment in 2 weeks for 6- month immunizations.
c. administer DTaP, Hib, IPV, hepatitis B, and PCV13 today and RV in 2 weeks.
d. withhold all immunizations until the infant’s temperature returns to normal and the cough is gone.
4. A woman who is pregnant and is planning to breastfeed tells the primary care NP that she has never had chickenpox. The NP should:
a. administer the Varivax vaccine today.
b. administer the varicella-zoster immune globulin.
c. recommend the Varivax vaccine as soon as possible after her baby is born.
d. instruct her to receive the Varivax vaccine after her baby has been weaned.
5. The primary care NP is performing a physical examination on a 6-month-old infant with cerebral palsy who has not had previous immunizations. The NP plans to begin vaccinations and should include:
a. DTaP vaccine.
b. TdaP vaccine.
c. TD vaccine only.
d. tetanus vaccine only.
6. A parent whose child received a fourth DTaP at a recent 15-month visit calls the primary care NP to report that the child is fussy, has a temperature of 38.3° C, and has redness and swelling at the injection site. The NP should:
a. admit the child to the hospital for observation of developing symptoms.
b. flag the child’s chart to avoid administration of pertussis vaccine in the future.
c. report these adverse reactions to the Vaccine Adverse Event Reporting System (VAERS).
d. instruct the parent to give the child acetaminophen as needed for fever or localized discomfort.
7. The primary care NP sees an 11-month-old infant for the first time and notes that the infant has not received the Hib vaccine. The NP should:
a. give the Hib vaccine now with no boosters.
b. give the Hib vaccine now and booster in 2 to 3 months.
c. give the Hib vaccine now and booster at age 4 to 6 years.
d. tell the parents that the child is too old to begin receiving the Hib vaccine.
8. The primary care NP sees a 12-month-old infant who needs the MMR, Varivax, influenza, and hepatitis A vaccines. The child’s mother tells the NP that she is pregnant. The NP should:
a. administer all of these vaccines today.
b. give the hepatitis A and influenza vaccines.
c. give the Varivax, hepatitis A, and influenza vaccines.
d. withhold all of these vaccines until after the baby is born.
9. The primary care NP performs a physical examination on an 89-year-old patient who is about to enter a skilled nursing facility. The patient reports having had chickenpox as a child. The NP should:
a. obtain a varicella titer.
b. administer the Varivax vaccine.
c. give the patient the Zostavax vaccine.
d. plan to prescribe Zovirax if the patient is exposed to shingles.
10. The primary care NP sees a 4-year-old child who has persistent asthma episodes for a well-child visit in October. The child recently completed a 7-day course of oral steroids. The NP plans to give the child flu vaccine and should:
a. administer LAIV today.
b. administer 0.5 mg TIV today.
c. wait 4 weeks and administer LAIV.
d. wait 4 weeks and administer 0.5 mg TIV.
11. The primary care NP sees a 4-year-old child who has received four doses of PCV 7 in the first 15 months of life. The NP should administer:
a. PCV 7.
b. PCV 13.
c. PPV 23.
d. no PCV.
12. The primary care NP sees a 65-year-old patient in October. The patient has a history of COPD and has not had any vaccines for more than 20 years. The NP should administer:
a. influenza and Td vaccines.
b. PCV 13 and influenza vaccines.
c. PPV 23, Td, and influenza vaccines.
d. PPV 23, influenza, and TdaP vaccines.
13. The primary care NP sees a 2-month-old infant for a well-baby examination in late November. The infant was born at 34 weeks’ gestation, does not have underlying cardiac or pulmonary conditions, and does not attend daycare. The NP should recommend:
a. one dose of palivizumab (Synagis) today.
b. no respiratory syncytial virus prophylaxis.
c. three monthly doses of palivizumab (Synagis).
d. monthly doses of palivizumab (Synagis) until April.
14. A 23-year-old woman who is sexually active has an abnormal Pap smear. She asks the primary care NP about the human papillomavirus vaccine (HPV). The NP should recommend:
a. no HPV vaccine.
b. a single HPV vaccine.
c. a three-vaccine series of HPV.
d. HPV vaccine for her partner.
15. A patient receives a hepatitis A vaccine and 4 weeks later develops symptoms of hepatitis. The patient has no history of exposure to blood or body fluids. The primary care NP should tell the patient that:
a. the symptoms are most likely caused by hepatitis B or C.
b. these symptoms are common adverse effects of the vaccine.
c. a prevaccine exposure to hepatitis A could be causing symptoms.
d. the vaccine is effective only after the second dose of hepatitis A vaccine.
16. The parent of a 2-month-old infant who will soon begin daycare refuses the rotavirus vaccine (RV) because of fears of intussusception. The parent tells the primary care NP that the daycare is strict about preventing infants who have fever or gastrointestinal symptoms from attending. The NP should tell the parent that:
a. herd immunity will protect the infant from infection.
b. asymptomatic children can spread rotavirus infection.
c. the risk of intussusception is nonexistent with the newer vaccine.
d. the infant can be treated with antibiotics if rotavirus infection occurs.
Chapter 72: Smoking Cessation Test Bank
MULTIPLE CHOICE
1. A patient who smokes reports repeated attempts to quit smoking using a nicotine replacement patch. The patient says, “I always do well for a few weeks and then I just start smoking again.” The primary care nurse practitioner (NP) should prescribe:
a. nortriptyline.
b. Nicorette gum.
c. a Nicotrol inhaler.
d. varenicline (Chantix).
2. An adolescent patient has recently begun smoking and reports a habit of fewer than five or six cigarettes per day. The patient does not want to quit smoking now but plans to do so after college. The primary care nurse practitioner should:
a. prescribe varenicline (Chantix).
b. recommend a nicotine transdermal patch.
c. refer the patient to a smoking cessation program.
d. begin a discussion about the negative effects of smoking.
3. A primary care NP has been working with a young woman who wants to quit smoking before she begins having children. She has made several attempts to quit using nicotine replacement therapy and is feeling discouraged. She does not want to take medication at this time. The NP should:
a. discuss the effects of smoking on fetal development.
b. ask her to write down any factors that triggered her relapses.
c. give her information about the long-term effects of smoking.
d. convince her that taking medication will be essential in her case.
4. A patient reports smoking two or more packs of cigarettes per day and expresses a desire to quit smoking. The primary care NP learns that the patient smokes heavily during breaks at work and during the evening but with no established schedule. The NP should recommend:
a. bupropion (Wellbutrin).
b. nicotine replacement gum or nasal spray.
c. a high-dose 24-hour nicotine patch.
d. intensive smoking cessation counseling.
5. A patient who is using a nicotine patch for smoking cessation is in the clinic for a follow-up examination. The primary care NP notes a heart rate of 96 beats per minute and a blood pressure of 140/90 mm Hg. The patient reports feeling dizzy and complains of ringing in both ears. The NP should suspect:
a. nicotine withdrawal symptoms.
b. that the patient has been smoking.
c. hypersensitivity reaction to the nicotine patch.
d. minor cardiovascular effects of the nicotine patch.
6. A patient has been using a nicotine patch for several weeks and uses the 15 mg/16 hour patch. The patient reports having frequent continual cravings for cigarettes, especially on awakening in the morning. The primary care NP should:
a. prescribe varenicline (Chantix).
b. prescribe bupropion (Wellbutrin).
c. change to a 21 mg/24 hour nicotine patch.
d. suggest adding nicotine nasal spray for cravings.
7. A patient has been using a nicotine nasal spray for 4 months, one to two doses every hour while awake and as needed for cravings. The patient reports that the cravings have stopped and that one dose per hour is generally sufficient. The primary care NP should recommend:
a. changing to Nicorette gum as needed.
b. using a low-dose 16-hour patch for 2 weeks.
c. continuing one dose per hour for 2 more
months and then discontinuing.
d. beginning one dose every 2 hours for 1 week and then one dose every 4 hours.
Chapter 73: Vitamins and Minerals Test Bank
MULTIPLE CHOICE
1. An 80-year-old woman has chronically low hemoglobin despite a diet high in iron. The primary care nurse practitioner (NP) will perform laboratory tests to confirm a diagnosis and should suspect the patient will need:
a. omega-3 supplements.
b. a folic acid supplement.
c. a daily multivitamin with iron.
d. a diet high in green, leafy vegetables.
2. The parent of a 3-year-old is concerned that the child’s legs are not straight. The primary care NP notes marked bowing of the child’s lower extremities. Radiologic studies show decreased ossification of the child’s bones. The NP should:
a. prescribe vitamin D supplements.
b. recommend calcium supplements.
c. counsel the parent to increase the child’s milk intake.
d. ensure that the parent is buying vitamin D–fortified milk.
3. An adolescent girl reports having heavy menstrual periods. Her hemoglobin is consistently on the low end of the normal range. The primary care NP should prescribe:
a. iron supplements.
b. a folic acid supplement.
c. oral contraceptive pills.
d. increased red meats in her diet.
4. The parents of a 3-year-old child tell the primary care NP that their child is a very picky eater and they are worried about the child’s nutrition. The NP should recommend:
a. giving the child a daily multivitamin containing iron.
b. providing small portions of a variety of foods at each meal.
c. disciplining the child at mealtimes to ensure proper nutrition.
d. making sure the child’s cereals are fortified with vitamins and minerals.
5. A patient exhibits keratin deposits around hair follicles and has hardened pigmented “goose bump” lesions on all extremities. The primary care NP should consider prescribing:
a. thiamine.
b. vitamin A.
c. beta carotene.
d. ascorbic acid.
6. The primary care NP sees a patient for an annual physical examination. The patient reports chronic alcohol abuse. The NP should refer the patient for treatment and should prescribe:
a. niacin.
b. thiamine.
c. folic acid.
d. vitamin B6.
7. As patients age, it becomes particularly important to increase their intake of:
a. iron.
b. omega 3.
c. vitamin C.
d. B vitamins.
8. A 40-year-old woman asks the primary care NP what she can do to minimize her risk of osteoporosis. She takes 800 mg of calcium and drinks 2 cups of skim milk each day. The NP should recommend that she:
a. decrease dietary fat.
b. limit her caffeine intake.
c. consume a high-protein diet.
d. drink diet instead of sugary sodas.
9. A 13-month-old child drinks 40 to 48 ounces of milk every day. The parents report that the toddler eats a variety of baby fruits and vegetables but refuses meats and cereals. The primary care NP should order a:
a. complete blood count (CBC).
b. ferritin level.
c. vitamin D level.
d. serum calcium level.
10. A patient reports fatigue and increased frequency of stools over the past week and reports having just begun a regimen of dietary changes to prevent hypertension. The primary care NP notes a rapid, irregular heart rate and a blood pressure of 92/58 mm Hg. The NP should question the patient about:
a. caffeine intake.
b. B vitamin intake.
c. fat-soluble vitamins.
d. use of salt substitutes.
11. An adolescent girl has decided to become a vegetarian. The primary care NP should counsel her about iron intake and considering a vitamin containing:
a. zinc.
b. vitamin A.
c. vitamin C.
d. potassium.
