Quizzes 7-12 Flashcards
1
Q
A patient who had type 2 diabetes mellitus will begin taking a bile acid sequestrant. Which bile acid sequestrant should the primary care NP order? Colesevelam (Welchol) Colestipol (Colestid) Cholestyramine (Questran) Cholestyramine (Questran Light)
A
-colesevelam (welchol)
2
Q
A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor. All of the patient’s baseline LFT were normal. At a 6-month follow-up visit, the patient reports occasional headache. A lipid profile reveals a decrease of 20% in the patient’s LDL cholesterol. The NP should:
order LFTs.
order CK-MM tests.
consider decreasing the dose of the medication.
reassure the patient that this side effect is common.
A
reassure the patient that this side effect is common
3
Q
The primary care nurse practitioner (NP) sees a patient for a physical examination and orders laboratory tests that reveal low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30mg/dL, and triglycerides of 350 mg/dL. The patient has no previous history of coronary heart disease. The NP should consider prescribing:
ezetimibe (Zetia).
gemfibrozil (Lopid).
simvastatin (Zocor).
nicotinic acid (Niaspan).
A
-gemfibrozil (lopid)
4
Q
A patient who has atrial fibrillation (AF) has been taking warfarin (coumadin). The primary care nurse practitioner (NP) plans to change the patient’s medication to dabigatran (Pradaxa). To do this safely, the NP should:
initiate dabigatran when the patient’s international normalized ratio (INR) is less than 2.
start dabigatran 7 to 14 days after discontinuing warfarin.
begin giving dabigatran 1 week before discontinuing warfarin.
order frequent monitoring of the patient’s INR after dabigatran therapy begins.
A
-initiate dabigatran when the patient’s international normalized ration (INR) is less than 2
5
Q
A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant. The NP should expect that this patient will use of the following anticoagulant medications?
Aspirin
Heparin
Dabigatran
Warfarin
A
-heparin
6
Q
An 80-year old patient who has persistent AF takes warfarin (coumadin) for anticoagulation therapy. The patient has an INR of 3.5. The primary care NP should consider:
lowering the dose of warfarin.
rechecking the INR in 1 week.
omitting a dose and resuming at a lower dose.
omitting a dose and administering 1 mg of vitamin K.
A
-rechecking the INR in 1 week
7
Q
Which of the following statements is true regarding unfractionated heparin (UFH) and low molecular weight heparin (LMWH): SATA
- LMWH has a longer half-life and increased bioavailability compared to UFH - the anticoagulant effect of heparin starts with its binding to antithrombin III - no effect on existing clots
A
- LMWH has a longer half-life and increased bioavailability compared to UFH
- the anticoagulant effect of heparin starts with its binding to antithrombin III
- no effect on existing clots
8
Q
The mechanism of action of clopidogrel is by inhibiting the binding of ADP to its receptors on platelets and subsequent ADP-mediated activation of IIb/IIIa complex:
True/False
A
True
9
Q
A patient comes to the clinic with a complaint of gradual onset of left-sided weakness. The primary care NP notes slurring of the patient’s speech. A family member accompanying the patient tells the NP that these symptoms began 4 or 5 hours ago. The NP will activate the emergency medical system and expects to administer: 325 mg of chewable aspirin. LMWH. intravenous alteplase and aspirin. warfarin (Coumadin) and aspirin.
A
-325 mg of chewable aspirin
10
Q
A patient who has disabling intermittent claudication is not a candidate for surgery. Which of the following medications should the primary care NP prescribe to treat this patient? Cilostazol (Pletal) Warfarin (Coumadin) Pentoxifylline (Trental) Low-dose, short-term aspirin
A
cilostazol (pletal)
11
Q
A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass index of 26. The woman asks the primary care NP about using a statin medication. The NP should:
-begin therapy with atorvastatin 10 mg per day
A
begin therapy with atorvastatin 10 mg per day
12
Q
A patient who has diabetes is taking simvastatin (zocor) 80 mg daily to treat LDL cholesterol level of 170 mg/dl. The patient has a body mass index of 29. At a follow-up visit, the patient’s LDL level is 120 mg/dl. The primary care NP should consider:
increasing the simvastatin to 80 mg twice daily.
adding nicotinic acid to the patient’s drug regimen.
changing the medication to ezetimibe/simvastatin (Vytorin).
referring the patient to a dietitian for assistance with weight reduction.
A
changing the medication to ezetimibe/simvastatin (vytorin)
13
Q
A primary care NP sees a 46-year old male patient and orders a fasting lipoprotein profile that reveals LDL of 190 mg/dl, HDL of 40 mg/dl, and triglycerides of 200 mg/dl. The patient has no previous history of coronary heart disease, but the patient’s father developed coronary heart disease at age 55 years. The NP should prescribe: atorvastatin (Lipitor). gemfibrozil (Lopid). cholestyramine (Questran). lovastatin/niacin (Advicor).
A
atorvastatin (Lipitor)
14
Q
Which of the following statements is true regarding the RX product Vascepa (icosapent ethyl)? SATA
- it contains only EPA - it is used for lowering triglyceride levels
A
it contains only EPA
-it is used for lowering triglyceride levels
15
Q
There is a boxed warning about stopping DOAC agents in AF patients because DOAC agents are short-acting and if stopped can quickly return patients to their risk of stroke before starting therapy.
True/False
A
-true
16
Q
A male patient was released from the hospital after the placing of a coronary stent. The patient needs to be treated with an antiplatelet medication. After reviewing the drugs available with the NP, the patient shares with the NP that he has no insurance and that he recently lost his job. Based on the patient’s needs and current drugs available, which medication will the NP most likely prescribed?
-clopidogrel
A
-clopidogrel
17
Q
Which of the following statements is true regarding the new oral anticoagulants Eliquis, Pradaxa, and Xarelto? SATA
- xarelto is the only one given once per day - eliquis leads to FEWER bleeds when compared to warfarin
A
- xarelto is the only one given once per day
- eliquis leads to FEWER bleeds when compared to warfarin
18
Q
A 55-year-old African American patient has three consecutive blood pressure readings of 140/95 mm Hg. The patient’s body
mass index is 24. A fasting plasma glucose is 100 mg/dL. Creatinine clearance and cholesterol tests are normal. The primary care
NP should order:
-A thiazide diuretic
-Dietary and lifestyles changes only
-An angiotensin-converting enzyme inhibitor
-A beta-blocker
A
-A thiazide diuretic
19
Q
An 80-year-old male patient will begin taking an a-antiadrenergic medication. The primary care NP should teach this patient to:
- be aware that priapism is a common side effect.
- take the medication in the morning with food.
- restrict fluids to aid with diuresis.
- ask for assistance while bathing.
A
-ask for assistance while bathing
20
Q
A patient is in the clinic for an annual physical examination. The primary care NP obtains a medication history and learns that the
patient is taking a ß-blocker and nitroglycerin. The NP orders laboratory tests, performs a physical examination, and performs a
review of systems. Which finding may warrant discontinuation of the B-blocker in this patient?
-Increased triglycerides
-Decreased exercise tolerance
-Wheezing, dyspnea, and cough
-Nausea, vomiting, and anorexia
A
Wheezing, dyspnea, and coughV
21
Q
An 80-year-old patient has begun taking propranolol (Inderal) and reports feeling tired all of the time. The primary care NP
should:
-recommend that the patient take the medication at bedtime.
-tell the patient that tolerance to this side effect will occur over time.
-contact the patient’s cardiologist to discuss decreasing the dose of propranolol.
-tell the patient to stop taking the medication immediately.
A
contact the patient’s cardiologist to discuss decreasing the dose of propranolol
22
Q
A patient will begin treatment with a beta-blocker. The patient wants to know about the most common side effects. The NP should educate the patient
and discuss the folowing: (SELECT ALL THAT APPLY)
-Fatigue
-Tachycardia
-Insomnia
-Sexual dysfunction
A
- Fatigue
- Insomnia
- Sexual dysfunction
23
Q
A patient who has stable angina pectoris and a history of previous myocardial infarction takes nitroglycerin and verapamil. The
patient asks the primary care nurse practitioner (NP) why it is necessary to take verapamil. The NP should tell the patient that
verapamil:
-improves blood flow and oxygen delivery to the heart.
-has a positive inotropic effect to increase cardiac output.
-increases the rate of cantraction of the cardiac muscle.
-increases the force of contraction of the cardiac muscle.
A
improves blood flow and oxygen delivery to the heart.
24
Q
A patient who is taking nifedipine develops mild edema of both feet. The primary care NP should contact the patient’s cardiologist
to discuss:
-Increasing the dose of nifedipine.
-evaluation of left ventricular function.
-ordering renal function tests.
-changing to amlodipine.
A
changing to amlodipine
25
Which of the following adverse effects are associated with calcium channel blockers? (SELECT ALL THAT APPLY)
- Dizziness
- Headache
- Hyperlipidemia
- Sedation
Dizziness
| -Headache
26
Clinical studies have found that ACEIS are clinically proven to reduce total mortality by preventing deaths from progressive heart
failure. ACEIS should be given to all patients with symptomatic or asymptomatic heart failure because ACEIS: (SELECT ALL THAT
APPLY)
-Decrease renal blood flow
-Reverse ventricular remodeling
-Restore the heart to its normal elliptical shape
-Reduce ventricular dilation
- Reverse ventricular remodeling
- Restore the heart to its normal elliptical shape
- Reduce ventricular dilation
27
A patient who is taking an ACE inhibitor sees the primary care NP for a follow-up visit. The patient reports having a persistent
cough. The NP should:
- consider changing the medication to an ARB.
- reassure the patient that tolerance to this adverse effect will develop over time.
- order a bronchodilator to counter the bronchospasm caused by this drug.
- ask whether the patient has had any associated facial swelling with this cough.
consider changing the medication to an ARB
28
A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to:
- report wheezing and shortness of breath, which may occur with these drugs,
- discuss taking an increased dose of the thiazide diuretic with the cardiologist.
- minimize fuid intake for several days when beginning therapy with the ACE inhibitor.
- take care when getting out of bed or a chair after the first dose of the ACE Inhibitor.
take care when getting out of bed or a chair after the first dose of the ACE Inhibitor
29
Which of the following statements is true regarding the use of loop diuretics? (SELECT ALL THAT APPLY)
- May cause hyperkalemia
- May cause ototoxicity
- It is a potent diuretic that, if given in excessive amounts, may lead to profound losses of water and electrolyte depletion
- Loop diuretics relieve the congestive symptoms of pulmonary and peripheral edema
May cause ototoxicity
- It is a potent diuretic that, if given in excessive amounts, may lead to profound losses of water and electrolyte depletion
- Loop diuretics relieve the congestive symptoms of pulmonary and peripheral edema
30
The primary care NP is preparing to prescribe a diuretic for a patient who has heart failure, The patient reports having had an
allergic reaction to sulfamethoxazole-trimethoprim (Bactrim) previously. The NP should prescribe:
-furosemide (Lasix).
-ethacrynic acid.
-acetazolamide (Diamox).
-hydrochlorothiazide (HydroDIURIL).
ethacrynic acid
31
A patient with congestive heart failure will begin therapy with a diuretic medication. The primary care NP orders laboratory tests,
which reveal a glomerular filtration rate (GFR) of 25 mL/minute. The initial drug the NP should prcscribe is:
-hydrochlorothiazide (HydroDIURIL).
-metolazone.
-furosemide (Lasix).
-spironolactone (Aldactone).
metolazone
32
Mrs. Smith is a 43-year-old Caucasian female patient who presents to the clinic for a follow up appointment. She has diabetes and
hypertension and has been taking a thiazide diuretic for 6 months. Her blood pressure at the beginning of treatment was 155/95
mm Hg. The blood pressure today is 144/90 mm Hg. The NP should:
-continue the current drug regimen
-change to an aldasterone antagonist medication
-add an angiotensin-converting enzyme inhibitor
-order a Beta-blocker
add an angiotensin-converting enzyme inhibitor
33
A patient is in the clinic for a follow-up examination after a myocardial infarction (MI). The patient has a history of left ventricular
systolic dysfunction. The primary care NP should expect this patient to be taking:
-carvedilol (Coreg).
-propranolol (Inderal).
-timolol (Blocadren).
-nadolol (Corgard).
carvedilol (Coreg
34
A patient who takes a calcium channel blocker is in the clinic for an annual physical examination. The cardiovascular examination
is normal. As part of routine monitoring for this patient, the primary care NP should evaluate:
-thyroid and insulin levels.
-complete blood count and electrolytes.
-liver function tests (LFTS) and renal function.
-serum calcium channel blocker level.
liver function tests (LFTS) and renal function
35
A patient who has stable angina is taking nitroglycerin and a B-blocker. The patient tells the primary care NP that the cardiologist is considering adding a calcium channel blocker. The NP should anticipate that the cardiologist will prescribe:
- nifedipine (Procardia XL).
- verapamil HCI (Calan).
- isradipine (DynaCirc).
- nicardipine (Cardene).
verapamil HCI (Calan).
36
A patient has been taking furosemide 80 mg once daily for 4 weeks and returns for a follow-up visit. The primary care NP notes a
blood pressure of 100/60 mm Hg. The patient's lungs are clear, and there is no peripheral edema. The patient's serum potassium
is 3.4 mEg/L. The NP should:
-change furosemide dose the 40 mg twice daily.
-increase furosemide to 80 mg twice daily.
-decrease furosemide to 60 mg once daily.
-continue furosemide at the current dose.
5 pts
decrease furosemide to 60 mg once daily
37
A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet. The primary
care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg. The NP should:
-obtain a serum drug level.
-order an electrocardiogram (ECG) and serum electrolytes.
-change the medication to a thiazide diuretic.
-question the patient about potassium intake.
order an electrocardiogram (ECG) and serum electrolytes
38
A patient who has a history of angina has sublingual nitroglycerin tablets to use as needed. The primary care nurse practitioner (NP) reviews this medication with the patient at the patient's annual physical examination. Which statement by the patient
indicates understanding of the medication?
"I should call 9-1-1 if chest pain persists 5 minutes after the first dose."
"I should take 3 nitroglycerin tablets 5 minutes apart and then call 9-1-1."
"I should take aspirin along with the nitroglycerin when I have chest pain."
"I should take nitroglycerin and then rest for 15 minutes before taking the next dose."
"I should call 9-1-1 if chest pain persists 5 minutes after the first dose
39
A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. NP should teach the patient to:
change the patch four times daily.
use the patch as needed for angina pain.
use two patches daily and change them every 12 hours.
apply one patch daily in the morning and remove in 12 hours.
apply one patch daily in the morning and remove in 12 hours.
40
A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The primary care nurse practitioner (NP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles. The NP should consult a cardiologist to discuss prescribing a(n):
B-blocker.
A loop diuretic.
An angiotensin-converting enzyme (ACE) inhibitor.
An angiotensin receptor blocker (ARB).
A loop diuretic.
41
```
A patient who has heart failure has been treated with furosemide and an ACE inhibitor. The patient's cardiologist has added digoxin to the patient's medication regimen. The primary care NP who cares for this patient should expect to monitor:
serum electrolytes.
blood glucose levels.
serum thyroid levels.
complete blood counts (CBCs).
```
serum electrolytes.
42
A patient who has been taking quinidine for several years reports lightheadedness, fatigue, and weakness. The primary care NP notes a heart rate of 110 beats per minute. The serum quinidine level is 6 µg/mL. The NP should:
discontinue the medication immediately.
reassure the patient that this is a therapeutic drug level.
order an ECG, CBC, liver function tests (LFTS), and renal function tests.
admit the patient to the hospital and obtain a cardiology consultation.
order an ECG, CBC, liver function tests (LFTS), and renal function tests.
43
The primary care NP refers a patient to a cardiologist who diagnoses long QT syndrome. The cardiologist has prescribed propranolol (Inderal). The patient exercises regularly and is not obese. The patient asks the NP what else can be done to minimize risk of sudden cardiac arrest. The NP should counsel the patient to:
drink extra fluids when exercising.
reduce stress with yoga and hot baths.
ask the cardiologist about an implantable defibrillator.
ask the cardiologist about adding procainamide to the drug regimen.
drink extra fluids when exercising.
44
Which of the following statements is true regarding the mechanism of action of digoxin in the treatment of HF? (SELECT ALL THAT APPLY)
has an inotropic effect on cardiac cells
produces a decreased force of contraction of the cardiac muscle
increases CO and produces mild diuresis, helping to relieve symptoms
It is most effective in HF caused by decreased left ventricular function and other low-output syndromes.
has an inotropic effect on cardiac cells
increases CO and produces mild diuresis, helping to relieve symptoms
It is most effective in HF caused by decreased left ventricular function and other low-output syndromes.
45
```
Which of the following drugs can exacerbate HF and should be avoided, when possible? (SELECT ALL THAT APPLY):
ibuprofen
lisinopril
pioglitazone
Furosemide
```
ibuprofen
| pioglitazone
46
Which of the following statements is true regarding the use of organic nitrates?
ensure a nitrate-free interval to prevent tolerance
produce vascular smooth muscle relaxation
are contraindicated with PDES inhibitors (sildenafil and others)
Only first and second statements are correct
All of the above statements are correct
All of the above statements are correct
47
Class I
Class II
Class III
Class IV
```
Class I
Sodium channel blocker
Class II
Beta-adrenoreceptor blocker
Class III
Potassium channel blocker
Class IV
Calcium channel blocker
```
48
A patient will begin treatment with amiodarone, To monitor for toxicity the NP should do the following (SELECT ALL THAT APPLY)
Perform baseline chest radiographs and pulmonary function tests
Thyroid function test at baseline and periodically during therapy
Obtain annual ophthalmic examination
Obtain ECG, serum creatinine, magnesium, and potassium levels every 3 months
Perform baseline chest radiographs and pulmonary function tests
Thyroid function test at baseline and periodically during therapy
Obtain annual ophthalmic examination
49
A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop diuretic, and an ACE inhibitor. The patient reports having nausea. The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg. The NP should:
decrease the dose of the diuretic to prevent further dehydration.
obtain a serum potassium level to assess for hyperkalemia.
hold the ACE inhibitor until the patient's blood pressure stabilizes.
obtain a digoxin level before the patient takes the next dose of digoxin.
obtain a digoxin level before the patient takes the next dose of digoxin.
50
The most common cause of death from digoxin toxicity is ventricular fibrillation.
True
False
True
51
The primary care NP sees a new patient for a routine physical examination. When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional extra beats followed by a pause. History reveals no past cardiovascular disease, but the patient reports occasional syncope and shortness of breath. The NP should:
order an ECG and refer to a cardiologist.
schedule a cardiac stress test and a graded exercise test.
order a complete blood count (CBC) and electrolytes and consider a trial of procainamide.
prescribe a B-blocker and anticoagulant and order 24-hour Holter monitoring.
order an ECG and refer to a cardiologist.
52
The primary care NP is preparing to prescribe isosorbide dinitrate sustained release (Dilatrate SR) for a patient who has chronic stable angina. The NP should recommend initial dosing of:
60 mg four times daily at 6-hour intervals.
40 mg twice daily 30 minutes before meals.
60 mg on awakening and 40 mg 7 hours later.
80 mg three times daily at 8:00 AM, 1:00 PM, and 6:00 PM.
40 mg twice daily 30 minutes before meals.
53
A patient in the clinic reports heartburn 30 minutes after meals, a feeling of fullness, frequent belching, and a constant sour taste. The patient has a normal weight and reports having a high-stress job. The primary care NP should recommend:
antacid therapy as needed.
changes in diet to avoid acidic foods.
daily treatment with a PPI.
consultation with a gastroenterologist for endoscopy.
daily treatment with a PPI.
54
Which of the following statements is true regarding the use of antiacids? (SELECT ALL THAT APPLY)
Antiacids are weak bases that neutralize gastric hydrochloric acid
Antiacids also have a number of cytoprotective effects
Antiacids protect the stomach by coating the mucosal lining
Antiacids with high ANC usually are more effective than others
Antiacids are weak bases that neutralize gastric hydrochloric acid
Antiacids also have a number of cytoprotective effects
Antiacids with high ANC usually are more effective than others
55
```
An 80-year-old patient asks a primary care NP about OTC antacids for occasional heartburn. The NP notes that the patient has a normal complete blood count and normal electrolytes and a slight elevation in creatinine levels. The NP should recommend:
calcium carbonate (Tums).
aluminum hydroxide (Amphogel).
sodium bicarbonate (Alka-Seltzer).
magnesium hydroxide (Milk of Magnesia).
```
calcium carbonate (Tums).
56
A patient has NSAID-induced ulcer and has started taking ranitidine (Zantac). At a follow-up appointment 3 days later, the patient reports no alleviation of symptoms. The primary care NP
should:
order cimetidine (Tagamet).
add metronidazole to the drug regimen.
change from ranitidine to omeprazole (Prilosec).
reassure the patient that drug effects take several weeks.
change from ranitidine to omeprazole (Prilosec).
57
```
A postmenopausal woman develops NSAID-induced ulcer. The primary care NP should prescribe:
ranitidine (Zantac).
omeprazole (Prilosec).
esomeprazole (Nexium).
pantoprazole (Protonix).
```
ranitidine (Zantac).
58
```
A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDS) daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should:
prescribe cimetidine (Tagamet).
prescribe omeprazole (Prilosec).
teach the patient about a bland diet.
change the NSAID to a corticosteroid.
```
prescribe omeprazole (Prilosec).
59
Which of the following statements is true regarding the use of proton pump inhibitors (PPIS)? (SELECT ALL THAT APPLY)
PPIs are the most potent available inhibitors of gastric acid secretion
Some adverse effects include: nausea, headache, diarrhea, GI disturbance, and bone fractures with long-term use
A dose adjustment is necessary when using PPIS to treat geriatric patients
PPIs and H2-blockers should not be used
PPIs are the most potent available inhibitors of gastric acid secretion
Some adverse effects include: nausea, headache, diarrhea, GI disturbance, and bone fractures with long-term use
PPIs and H2-blockers should not be used
60
```
A 5-year-old child has chronic constipation. The primary care NP plans to prescribe a laxative for long-term management. In addition to pharmacologic therapy, the NP should also recommend ____ gram of fiber per day.
10
15
20
25
```
10
61
A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary
care NP should recommend:
adding docusate sodium (Colace).
polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax).
lactulose (Chronulac) and polyethylene glycol (MiraLAX).
adding nonpharmacologic measures such as biofeedback.
adding docusate sodium (Colace).
62
A patient who takes digoxin reports taking psyllium (Metamucil) three or four times each month for constipation. The primary care NP should counsel this patient to:
decrease fluid intake to avoid cardiac overload.
change the laxative to docusate sodium (Colace).
take the digoxin 2 hours before taking the psyllium.
ask the cardiologist about taking an increased dose of digoxin
take the digoxin 2 hours before taking the psyllium
63
```
A 12-year-old patient has acute diarrhea and an upper respiratory infection. Other family members have had similar symptoms, which have resolved. The primary care NP should recommend:
diphenoxylate (Lomotil).
attapulgite (Kaopectate).
an electrolyte solution (Pedialyte).
bismuth subsalicylate (Pepto-Bismol).
```
an electrolyte solution (Pedialyte).
64
A woman who is 4 months pregnant comes to the clinic with acute diarrhea and nausea. Her husband is experiencing similar symptoms. The primary care nurse practitioner (NP) notes a
temperature of 38.5° C, a heart rate of 92 beats per minute, and a blood pressure of 100/60 mm Hg. The NP should:
prescribe attapulgite to treat her diarrhea.
obtain a stool culture and start antibiotic therapy.
instruct her to replace lost fluids by drinking Pedialyte.
refer her to an emergency department for intravenous (IV) fluids.
refer her to an emergency department for intravenous (IV) fluids.
65
A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should:
obtain a stool specimen and order vancomycin.
order testing for Clostridium difficile and consider metronidazole therapy.
prescribe diphenoxylate (Lomotil) to provide symptomatic relief.
reassure the patient that diarrhea is a common side effect of antibiotic therapy.
order testing for Clostridium difficile and consider metronidazole therapy
66
```
A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe:
aprepitant (Emend).
ondansetron (Zofran).
scopolamine transdermal.
prochlorperazine (Compazine).
```
ondansetron (Zofran).
67
```
A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise, The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch:
daily.
every 3 days.
as needed for nausea.
1 hour before embarking.
```
every 3 days.
68
A patient reports having episodes of dizziness, nausea, and lightheadedness and describes a sensation of the room spinning when these occur. The primary care NP will refer the patient to a specialist who, after diagnostic testing, is likely to prescribe:
meclizine.
ondansetron.
scopolamine.
Dimenhydrinate.
meclizine.
69
```
A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe:
mesalamine (Asacol).
dicyclomine (Bentyl).
simethicone (Phazyme).
metoclopramide (Reglan).
```
dicyclomine (Bentyl).
70
A patient who has IBS has been taking dicyclomine and reports decreased pain and diarrhea but is now having occasional constipation. The primary care NP should recommend:
beginning treatment with an SSRI.
beginning therapy with a TCA.
over-the-counter (OTC) laxatives as needed when constipated.
increasing the amounts of raw fruits and vegetables in the diet.
over-the-counter (OTC) laxatives as needed when constipated
71
```
A woman with IBS has been taking antispasmodic medications and reports some relief, but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain. The NP should consider prescribing:
alosetron (Lotronex).
misoprostol (Cytotec).
simethicone (Phazyme).
tricyclic antidepressants (TCAS).
```
tricyclic antidepressants (TCAS).
72
A diet with adequate fiber is the cornerstone of treatment for IBS, and 25 grams per day is recommended.
True
False
True
73
A patient in the clinic reports heartburn 30 minutes after meals, a feeling of fullness, frequent belching, and a constant sour taste. The patient has a normal weight and reports having a high-stress job. The primary care NP should recommend:
antacid therapy as needed.
changes in diet to avoid acidic foods.
daily treatment with a PPI.
consultation with a gastroenterologist for endoscopy.
daily treatment with a PPI.
74
Which of the following statements is true regarding the use of antiacids? (SELECT ALL THAT APPLY)
Antiacids are weak bases that neutralize gastric hydrochloric acid
Antiacids also have a number of cytoprotective effects
Antiacids protect the stomach by coating the mucosal lining
Antiacids with high ANC usually are more effective than others
Antiacids are weak bases that neutralize gastric hydrochloric acid
Antiacids also have a number of cytoprotective effects
Antiacids with high ANC usually are more effective than others
75
```
An 80-year-old patient asks a primary care NP about OTC antacids for occasional heartburn. The NP notes that the patient has a normal complete blood count and normal electrolytes and a slight elevation in creatinine levels. The NP should recommend:
calcium carbonate (Tums).
aluminum hydroxide (Amphogel).
sodium bicarbonate (Alka-Seltzer).
magnesium hydroxide (Milk of Magnesia).
```
calcium carbonate (Tums).
76
A patient has NSAID-induced ulcer and has started taking ranitidine (Zantac). At a follow-up appointment 3 days later, the patient reports no alleviation of symptoms. The primary care NP
should:
order cimetidine (Tagamet).
add metronidazole to the drug regimen.
change from ranitidine to omeprazole (Prilosec).
reassure the patient that drug effects take several weeks.
change from ranitidine to omeprazole (Prilosec).
77
```
A postmenopausal woman develops NSAID-induced ulcer. The primary care NP should prescribe:
ranitidine (Zantac).
omeprazole (Prilosec).
esomeprazole (Nexium).
pantoprazole (Protonix).
```
ranitidine (Zantac).
78
```
A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDS) daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should:
prescribe cimetidine (Tagamet).
prescribe omeprazole (Prilosec).
teach the patient about a bland diet.
change the NSAID to a corticosteroid.
```
prescribe omeprazole (Prilosec).
79
Which of the following statements is true regarding the use of proton pump inhibitors (PPIS)? (SELECT ALL THAT APPLY)
- PPIs are the most potent available inhibitors of gastric acid secretion
- Some adverse effects include: nausea, headache, diarrhea, GI disturbance, and bone fractures with long-term use
- A dose adjustment is necessary when using PPIS to treat geriatric patients
- PPIs and H2-blockers should not be used
PPIs are the most potent available inhibitors of gastric acid secretion
Some adverse effects include: nausea, headache, diarrhea, GI disturbance, and bone fractures with long-term use
PPIs and H2-blockers should not be used
80
```
A 5-year-old child has chronic constipation. The primary care NP plans to prescribe a laxative for long-term management. In addition to pharmacologic therapy, the NP should also recommend ____ gram of fiber per day.
10
15
20
25
```
10
81
A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary
care NP should recommend:
adding docusate sodium (Colace).
polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax).
lactulose (Chronulac) and polyethylene glycol (MiraLAX).
adding nonpharmacologic measures such as biofeedback.
adding docusate sodium (Colace).
82
A patient who takes digoxin reports taking psyllium (Metamucil) three or four times each month for constipation. The primary care NP should counsel this patient to:
decrease fluid intake to avoid cardiac overload.
change the laxative to docusate sodium (Colace).
take the digoxin 2 hours before taking the psyllium.
ask the cardiologist about taking an increased dose of digoxin.
take the digoxin 2 hours before taking the psyllium.
83
```
A 12-year-old patient has acute diarrhea and an upper respiratory infection. Other family members have had similar symptoms, which have resolved. The primary care NP should recommend:
diphenoxylate (Lomotil).
attapulgite (Kaopectate).
an electrolyte solution (Pedialyte).
bismuth subsalicylate (Pepto-Bismol).
```
an electrolyte solution (Pedialyte).
84
A woman who is 4 months pregnant comes to the clinic with acute diarrhea and nausea. Her husband is experiencing similar symptoms. The primary care nurse practitioner (NP) notes a
temperature of 38.5° C, a heart rate of 92 beats per minute, and a blood pressure of 100/60 mm Hg. The NP should:
prescribe attapulgite to treat her diarrhea.
obtain a stool culture and start antibiotic therapy.
instruct her to replace lost fluids by drinking Pedialyte.
refer her to an emergency department for intravenous (IV) fluids.
refer her to an emergency department for intravenous (IV) fluids.
85
A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should:
obtain a stool specimen and order vancomycin.
order testing for Clostridium difficile and consider metronidazole therapy.
prescribe diphenoxylate (Lomotil) to provide symptomatic relief.
reassure the patient that diarrhea is a common side effect of antibiotic therapy.
order testing for Clostridium difficile and consider metronidazole therapy.
86
```
A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe:
aprepitant (Emend).
ondansetron (Zofran).
scopolamine transdermal.
prochlorperazine (Compazine).
```
ondansetron (Zofran).
87
```
A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise, The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch:
daily.
every 3 days.
as needed for nausea.
1 hour before embarking.
.
```
every 3 days.
88
A patient reports having episodes of dizziness, nausea, and lightheadedness and describes a sensation of the room spinning when these occur. The primary care NP will refer the patient to a
specialist who, after diagnostic testing, is likely to prescribe:
meclizine.
ondansetron.
scopolamine.
Dimenhydrinate.
meclizine.
89
```
A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe:
mesalamine (Asacol).
dicyclomine (Bentyl).
simethicone (Phazyme).
metoclopramide (Reglan).
```
dicyclomine (Bentyl).
90
A patient who has IBS has been taking dicyclomine and reports decreased pain and diarrhea but is now having occasional constipation. The primary care NP should recommend:
beginning treatment with an SSRI.
beginning therapy with a TCA.
over-the-counter (OTC) laxatives as needed when constipated.
increasing the amounts of raw fruits and vegetables in the diet.
over-the-counter (OTC) laxatives as needed when constipated.
91
```
A woman with IBS has been taking antispasmodic medications and reports some relief, but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain. The NP should consider prescribing:
alosetron (Lotronex).
misoprostol (Cytotec).
simethicone (Phazyme).
tricyclic antidepressants (TCAS).
```
tricyclic antidepressants (TCAS).
92
A diet with adequate fiber is the cornerstone of treatment for IBS, and 25 grams per day is recommended.
True
False
True
93
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:
change to bupropion (Wellbutrin).
ask the patient about other medications.
discontinue the fluoxetine immediately.
add mirtazapine (Remeron) to treat anxiety.
ask the patient about other medications.
94
```
A patient who has symptoms of depression also reports chronic pain. The primary care NP should begin therapy with:
fluoxetine (Prozac).
duloxetine (Cymbalta).
bupropion (Wellbutrin).
nortriptyline (Pamelor).
```
duloxetine (Cymbalta).
95
```
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.
trazodone 50; three times
trazodone 100; three times
mirtazapine 15; at bedtime
mirtazapine 30; at bedtime
```
mirtazapine 15; at bedtime
96
```
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:
fluoxetine (Prozac).
nortriptyline (Pamelor).
tranylcypromine (Parnate).
venlafaxine hydrochloride (Effexor).
```
fluoxetine (Prozac
97
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:
schedule weekly clinic visits to evaluate response to the medication.
encourage the child to report feelings of self-harm to a school counselor.
contact the patient by phone every 2 weeks to see how the medication is working.
Instruct the child’s parents to report changes in behavior to the child’s psychiatrist.
schedule weekly clinic visits to evaluate response to the medication.
98
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:
suggest taking a sedative at bedtime.
change the medication to bupropion.
add trazodone to the patient's regimen.
reassure the patient that these effects will subside.
reassure the patient that these effects will subside.
Side effects are seen with the first few doses but resolve in approximately 7 days. Patients should avoid taking sedatives while taking antidepressants
99
```
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:
buspirone.
melatonin.
alprazolam.
diphenhydramine.
```
buspirone.
100
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:
prescribe buspirone.
prescribe alprazolam.
order a selective serotonin reuptake inhibitor (SSRI) antidepressant.
recommend cognitive-behavioral therapy.
recommend cognitive-behavioral therapy
101
```
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:
doxepin.
fluoxetine.
alprazolam.
clonazepam.
```
fluoxetine.
This patient has posttraumatic stress disorder. If cognitive-behavioral therapy has not been effective, the patient should be given an SSRI as second-line treatment. Doxepin is a tricyclic antidepressant. The other two choices are benzodiazepines
102
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:
order a sleep study.
consider short-term zolpidem.
order ramelteon for several weeks.
reassure the patient and re-evaluate in 1 week.
reassure the patient and re-evaluate in 1 week
103
```
A patient with a recent diagnosis of schizophrenia is taking thloridazine (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:
fluphenazine (Prolixin).
risperidone (Risperdal).
chlorpromazine (Thorazine).
prochlorperazine (Compazine).
```
risperidone (Risperdal
104
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 fınd 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:
begin therapy with a low-potency antipsychotic.
begin therapy with a high-potency antipsychotic.
obtain a complete blood count (CBC), serum lipids, and hemoglobin A1c
order liver function tests (LFTS), a CBC, an electrocardiogram (ECG), and a urinalysis.
order liver function tests (LFTS), a CBC, an electrocardiogram (ECG), and a urinalysis.
105
```
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:
ziprasidone (Geodon).
olanzapine (Zyprexa).
risperidone (Risperdal).
chlorpromazine (Thorazine).
```
ziprasidone (Geodon).
106
```
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:
Increase the dose of olanzapine.
decrease the dose of olanzapine.
Maintain the same dose of olanzapine
Change from olanzapine to chlorpromazine
```
Increase the dose of olanzapine.
107
```
A patient comes to the clinic for a physical examination 2 weeks after a last dose of clozapine (Clozaril). The primary care NP should:
order a CBC with differential.
obtain serum lipids and LFTS.
obtain a serum clozapine level.
assess for orthostatic hypotension.
```
order a CBC with differential
108
```
A patient who has Parkinson's disease takes levodopa and carbidopa. The patient reports experiencing tremors between doses. The primary care NP should:
add entacapone.
add amantadine.
discontinue the carbidopa.
increase the dose of levodopa.
```
add entacapone.
109
```
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:
benztropine.
amantadine.
Apomorphine.
Modified-release levodopa
```
benztropine.
110
```
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:
selegiline.
benztropine.
carbidopa/levodopa.
ropinirole hydrochloride.
```
selegiline.
111
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:
switching to ginkgo biloba.
adding an antidepressant medication.
changing to galantamine (Razadyne).
adding memantine hydrochloride (Namenda).
adding memantine hydrochloride (Namenda).
112
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:
delay progression of symptoms.
produce temporary disease remission.
prevent depressive effects of the disease.
reduce the need for adjunct medications later on.
delay progression of symptoms.
113
```
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:
increase the dose.
decrease the dose.
switch to memantinc (Namenda).
switch to galantamine (Razadyne).
```
decrease the dose
Hallucinations may be a sign of drug toxicity. The NP should decrease the dose
114
```
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:
topiramate (Topamax).
levetiracetam (Keppra).
zonisamide (Zonegran).
carbamazepine (Tegretol).
```
carbamazepine (Tegretol).
Evidence-based recommendations exist showing carbamazepine to be effective as monotherapy for partial seizures. Because this patient has developed a serious side effect of phenytoin, changing to carbamazepine may be a good option. The other three drugs may be added to phenytoin or another first-line drug when drug-resistant seizures occur, but are not recommended as monotherapy
115
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:
order a phenytoin level.
reassure the patient that this is a self-limiting adverse effect.
recommend that the patient take diphenhydramine to treat this side effect.
tell the patient to stop taking the phenytoin and contact the neurologist immediately.
tell the patient to stop taking the phenytoin and contact the neurologist immediately.
116
```
A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order:
coagulation studies.
a complete blood count.
an EEG
a creatinine clearance test
```
coagulation studies.
