Pathophysiology and Pharmacology for Advanced Practice Chapter Exam Questions - 577 Verified Questio

Pathophysiology and Pharmacology for Advanced Practice

Chapter Exam Questions

Course Introduction

This course explores the complex physiological and pathological processes underlying human disease, integrating these concepts with the pharmacological principles essential for advanced clinical practice. Students will examine alterations in normal body function across the lifespan, focusing on the mechanisms and manifestations of major disease states. The course emphasizes the rationale for pharmacological interventions, including drug selection, mechanisms of action, therapeutic effects, side effects, and interactions. Through case studies and clinical scenarios, learners will develop the skills necessary to apply pathophysiological and pharmacological knowledge to the advanced assessment, diagnosis, and management of diverse patient populations.

Recommended Textbook

Pharmacology for the Primary Care Provider 4th Edition by Edmunds

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73 Chapters

577 Verified Questions

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2

Chapter 1: Prescriptive Authority and Role Implementation:

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Q1) Which of the following statements is true about the prescribing practices of physicians?

A) Older physicians tend to prescribe more appropriate medications than younger physicians.

B) Antibiotic medications remain in the top five classifications of medications prescribed.

C) Most physicians rely on a "therapeutic armamentarium" that consists of less than 100 drug preparations per physician.

D) The dominant form of drug information used by primary care physicians continues to be that provided by pharmaceutical companies.

Answer: D

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Chapter 2: Historical Review of Prescriptive Authority:

Role of Nurses (NPs, CNMs, CRNAs, and CNSs)and Physician

Assistants

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Sample Questions

Q1) The current trend toward transitioning NP programs to the doctoral level will mean that:

A) NPs licensed in one state may practice in other states.

B) full prescriptive authority will be granted to all NPs with doctoral degrees.

C) NPs will be better prepared to meet emerging health care needs of patients.

D) requirements for physician supervision of NPs will be removed in all states.

Answer: C

Q2) CRNAs in most states:

A) must have a Drug Enforcement Administration (DEA) number to practice.

B) must have prescriptive authority to practice.

C) order and administer controlled substances but do not have full prescriptive authority.

D) administer medications, including controlled substances, under direct physician supervision.

Answer: C

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4

Chapter 3: General Pharmacokinetic and Pharmacodynamic Principles

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Sample Questions

Q1) A patient is taking drug A and drug B.The primary care NP notes increased effects of drug B.The NP should suspect that in this case drug A is a cytochrome P450 (CYP450)enzyme:

A) inhibitor.

B) substrate.

C) inducer.

D) metabolizer.

Answer: A

Q2) A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes,"Dispense as Written." The NP should explain that a different brand of this drug: A) may cause different adverse effects.

B) does not necessarily have the same therapeutic effect.

C) is likely to be less safe than the brand specified in the prescription.

D) may vary in the amount of drug that reaches the site of action in the body.

Answer: D

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Chapter 4: Special Populations: Geriatrics

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Sample Questions

Q1) An 86-year-old patient is seen in clinic for a scheduled follow-up after starting a new oral medication 1 month prior.The patient reports no change in symptoms,and a laboratory test reveals a subtherapeutic serum drug level.The NP caring for this patient should:

A) consider ordering more frequent dosing of the drug.

B) titrate the patient's dose upward and recheck in 1 month.

C) ask the patient about any increased frequency of bowel movements.

D) determine the number of pills left in the patient's prescription bottle.

Q2) A thin 90-year-old patient who will begin taking warfarin has experienced a recent weight loss of 15 pounds.The NP caring for this patient should:

A) obtain a baseline liver function test (LFT) before starting the drug.

B) write the initial prescription at the lowest possible dose.

C) encourage the patient to consume a diet high in fat and protein.

D) counsel the patient to take the drug with food to enhance absorption.

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6

Chapter 5: Special Populations: Pediatrics

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Sample Questions

Q1) An NP is prescribing a drug that is known to be safe in children but is unable to find recommendations about drug dosing.The recommended adult dose is 100 mg per dose.The child weighs 14 kg.Using Clark's rule,the NP should order _____ mg per dose.

A) 20

B) 10

C) 14

D) 9.3

Q2) A nurse practitioner (NP)is preparing to prescribe a medication for a 5-year-old child.To determine the correct dose for this child,the NP should:

A) calculate the dose at one third of the recommended adult dose.

B) estimate the child's body surface area (BSA) to calculate the medication dose.

C) divide the recommended adult dose by the child's weight in kilograms (kg).

D) follow the drug manufacturer's recommendations for medication dosing.

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Chapter 6: Special Populations: Pregnant and Nursing

Women

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Sample Questions

Q1) 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.

Q2) 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.

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8

Chapter 7: Over-the-Counter Medications

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Sample Questions

Q1) 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.

Q2) 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.

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9

Chapter 8: Complementary and Alternative Therapies

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Sample Questions

Q1) 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.

Q2) 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.

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Chapter 9: Establishing the Therapeutic Relationship

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Sample Questions

Q1) A primary care NP sees a 5-year-old child who is morbidly obese.The child has an elevated hemoglobin A c 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.

Q2) 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.

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11

Chapter 10: Practical Tips on Writing Prescriptions

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Sample Questions

Q1) The primary care nurse practitioner (NP)writes a prescription for an antibiotic using an electronic drug prescription system.The pharmacist will fill this prescription when:

A) the electronic prescription is received.

B) the patient brings a written copy of the prescription.

C) a copy of the written prescription is faxed to the pharmacy.

D) the pharmacist accesses the patient's electronic record to verify.

Q2) The neighbor of a primary care NP asks the NP to write a prescription for an antibiotic.The NP should tell the neighbor:

A) a prescription will be written one time only.

B) she will ask a colleague to write the prescription.

C) that it is illegal to write prescriptions for friends.

D) that it is best if the neighbor sees a health care provider before obtaining a prescription.

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Chapter 11: Evidence-Based Decision Making and Treatment Guidelines

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Sample Questions

Q1) The primary care nurse practitioner (NP)is using critical thinking skills when:

A) using standardized protocols to guide patient care.

B) adhering to scientific principles to solve a patient problem.

C) following the practices of seasoned mentors when giving care.

D) analyzing current research and synthesizing new approaches to patient care.

Q2) The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement.The child's weight is 80% of what is recommended for age,and a recent swallow study revealed significant risk for aspiration.The child's parents do not want the procedure.The NP should:

A) compromise with the parents and order a nasogastric tube for feedings.

B) initiate a discussion with the parents about the potential outcomes of each possible action.

C) refer the family to a case manager who can help guide the parents to the best decision.

D) understand that the child's parents have a right to make choices that override those of the medical team.

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Page 13

Chapter 12: Design and Implementation of Patient Education

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Sample Questions

Q1) A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it.The NP notes that the information is from an internet site called "Prism.com." The NP should tell this patient that:

A) this information is probably from a drug advertisement website.

B) this is factual, evidence-based material with accurate information.

C) the information is from a nonprofit group that will not profit from drug sales.

D) internet information is unreliable because anyone can post information there.

Q2) A primary care NP is developing a handout to give to patients who will begin self-administering insulin.When developing this handout,the NP should:

A) provide detailed descriptions of each step in the process of injecting insulin.

B) use correct medical terminology when describing insulin self-administration.

C) provide as much factual information as possible about insulin administration.

D) address one or two educational objectives that describe what the patient will learn.

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Chapter 13: Dermatologic Agents

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Sample Questions

Q1) A patient has been treated for severe contact dermatitis on both arms with clobetasol propionate cream.At a follow-up visit,the primary care NP notes that the condition has cleared.The NP should:

A) prescribe triamcinolone cream for 2 weeks.

B) recommend continuing treatment for 2 more weeks.

C) discontinue the clobetasol and schedule a follow-up visit in 2 weeks.

D) discontinue the clobetasol and recommend prn use for occasional flare-ups.

Q2) A primary care NP prescribes fluocinolone cream for a patient who has contact dermatitis.At a follow-up visit in 2 weeks,the patient reports decreased pruritus but continues to have excoriated,erythematous areas.The NP should:

A) obtain a culture of the skin to monitor for superinfection.

B) discontinue the fluocinolone and order betamethasone cream.

C) begin gradually tapering the fluocinolone at 2-week intervals.

D) tell the patient to continue using the fluocinolone for 3 to 4 more weeks.

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15

Chapter 14: Eye, Ear, Throat, and Mouth Agents

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Sample Questions

Q1) The primary care NP examines an adolescent who complains of severe right ear pain for the past 3 days.When retracting the pinna of the right ear to examine the ear,the NP notes erythema,edema,and pain and a large amount of white exudate in the ear canal.The NP should prescribe:

A) benzocaine otic drops tid.

B) ciprofloxacin otic drops qid.

C) glycerin oil drops weekly.

D) acetic acid, boric acid, and isopropyl alcohol solution.

Q2) The primary care NP teaches a patient how to instill eye drops for a prescription that requires two drops twice daily.Which statement by the patient indicates understanding of the teaching?

A) "I should gently massage my eyes for 3 to 5 minutes after instilling the drops."

B) "I should put in one drop and wait 5 minutes before putting in the other one."

C) "To make sure the medicine is evenly distributed, I should blink several times."

D) "I may continue wearing my soft contact lenses while I am using this medication."

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Chapter 15: Upper Respiratory Agents

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Sample Questions

Q1) An NP prescribes azelastine for a patient who has allergic rhinitis.The NP will teach the patient that this drug:

A) may cause a bitter aftertaste.

B) will not provide maximum relief for a few weeks.

C) will cause rebound congestion if withdrawn suddenly.

D) can cause many systemic side effects such as drowsiness.

Q2) A patient asks an NP about using an oral over-the-counter decongestant medication for nasal congestion associated with a viral upper respiratory illness.The NP learns that this patient uses loratadine (Claritin),a b-adrenergic blocker,and an intranasal corticosteroid.The NP would be concerned about which adverse effects?

A) Liver toxicity

B) Excessive drowsiness

C) Rebound congestion

D) Tremor, restlessness, and insomnia

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Chapter 16: Asthma and Chronic Obstructive Pulmonary

Disease Medications

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Sample Questions

Q1) A 50-year-old patient who recently quit smoking reports a frequent morning cough productive of yellow sputum.A chest x-ray is clear,and the patient's FEV is 80% of predicted.Pulse oximetry reveals an oxygen saturation of 97%.The primary care NP auscultates clear breath sounds.The NP should:

A) reassure the patient that these symptoms will subside.

B) prescribe a moderate-dose ICS twice daily.

C) order a long-acting anticholinergic with albuterol twice daily.

D) prescribe an albuterol metered-dose-inhaler, 2 puffs every 4 hours as needed.

Q2) A patient with asthma is given an asthma action plan and returns to the clinic in 2 weeks to follow up on symptoms.Which statement by the patient indicates a need for further teaching?

A) "I use the ICS as needed when I am wheezing."

B) "A side effect of albuterol may be shortness of breath."

C) "I should rinse my mouth thoroughly after using an ICS."

D) "I put the albuterol metered-dose inhaler in my mouth with my lips sealed around it."

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Chapter 17: Hypertension and Miscellaneous

Antihypertensive Medications

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Sample Questions

Q1) The primary care NP sees a new African-American patient who has blood pressure readings of 140/90 mm Hg,130/85 mm Hg,and 142/80 mm Hg on three separate occasions.The NP learns that the patient has a family history of hypertension.The NP should:

A) initiate monotherapy with a thiazide diuretic.

B) prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.

C) discuss dietary and lifestyle modifications with the patient.

D) begin combination therapy with an ARB and a calcium-channel blocker.

Q2) The primary care NP sees a new patient who has diabetes and hypertension and has been taking a thiazide diuretic for 6 months.The patient's blood pressure at the beginning of treatment was 150/95 mm Hg.The blood pressure today is 138/85 mm Hg.The NP should:

A) order a -blocker.

B) add an angiotensin-converting enzyme inhibitor.

C) continue the current drug regimen.

D) change to an aldosterone antagonist medication.

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Page 19

Chapter 18: Coronary Artery Disease and Antianginal Medications

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Sample Questions

Q1) A patient who will begin using nitroglycerin for angina asks the primary care NP how the medication works to relieve pain.The NP should tell the patient that nitroglycerin acts to:

A) dissolve atheromatous lesions.

B) relax vascular smooth muscle.

C) prevent catecholamine release.

D) reduce C-reactive protein levels.

Q2) A patient who has stable angina and uses sublingual nitroglycerin tablets is in the clinic and begins having chest pain.The primary care NP administers a nitroglycerin tablet and instructs the patient to lie down.The NP's next action should be to:

A) obtain an electrocardiogram.

B) administer oxygen at 2 L/minute.

C) give 325 mg of chewable aspirin.

D) call EMS.

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20

Chapter 19: Heart Failure and Digoxin

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Sample Questions

Q1) A patient who takes spironolactone for heart failure has begun taking digoxin (Lanoxin)for atrial fibrillation.The primary care NP provides teaching for this patient and asks the patient to repeat back what has been learned.Which statement by the patient indicates understanding of the teaching?

A) "I should avoid high-sodium foods."

B) "I should eat foods high in potassium."

C) "I need to take a calcium supplement every day."

D) "I should use a salt substitute while taking these medications."

Q2) A patient has heart failure.A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling.The patient takes low-dose furosemide and an ACE inhibitor.The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg.The NP should:

A) order serum electrolytes.

B) obtain renal function tests.

C) consider prescribing a -blocker.

D) call the patient's cardiologist to discuss adding digoxin to the patient's regimen.

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Page 21

Chapter 20: Beta-Blockers

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Sample Questions

Q1) 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:

A) nadolol (Corgard).

B) carvedilol (Coreg).

C) timolol (Blocadren).

D) propranolol (Inderal).

Q2) A patient who has migraine headaches has begun taking timolol and 2 months after beginning this therapy reports no change in frequency of migraines.The patient's current dose is 30 mg once daily.The primary care NP should:

A) change the medication to propranolol.

B) increase the dose to 40 mg once daily.

C) obtain serum drug levels to see if the dose is therapeutic.

D) tell the patient to continue taking the timolol and return in 1 month.

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Chapter 21: Calcium Channel Blockers

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Sample Questions

Q1) A patient who has angina is taking nitroglycerin and long-acting nifedipine.The primary care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits.The patient reports lightheadedness associated with standing up.The NP should consult with the patient's cardiologist about changing the medication to:

A) amlodipine (Norvasc).

B) isradipine (DynaCirc).

C) verapamil HCl (Calan).

D) short-acting nifedipine (Procardia).

Q2) A patient who is taking nifedipine develops mild edema of both feet.The primary care NP should contact the patient's cardiologist to discuss:

A) changing to amlodipine.

B) ordering renal function tests.

C) increasing the dose of nifedipine.

D) evaluation of left ventricular function.

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Chapter 22: ACE Inhibitors and Angiotensin Receptor

Blockers

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Q1) The primary care NP is considering prescribing captopril (Capoten)for a patient.The NP learns that the patient has decreased renal function and has renal artery stenosis in the right kidney.The NP should:

A) initiate ACE inhibitor therapy at a low dose.

B) consider a different drug class to treat this patient's symptoms.

C) give the captopril with a thiazide diuretic to improve renal function.

D) order lisinopril (Zestril) instead of captopril to avoid increased nephropathy.

Q2) 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:

A) consider changing the medication to an ARB.

B) order a bronchodilator to counter the bronchospasm caused by this drug.

C) ask whether the patient has had any associated facial swelling with this cough.

D) reassure the patient that tolerance to this adverse effect will develop over time.

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Chapter 23: Antiarrhythmic Agents

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Q1) Persistent atrial fibrillation (AF)is diagnosed in a patient who has valvular disease,and the cardiologist has prescribed warfarin (Coumadin).The patient is scheduled for electrical cardioversion in 3 weeks.The patient asks the primary care nurse practitioner (NP)why the procedure is necessary.The NP should tell the patient:

A) this medication prevents clots but does not alter rhythm.

B) if the medication proves effective, the procedure may be canceled.

C) there are no medications that alter the arrhythmia causing AF.

D) to ask the cardiologist if verapamil may be ordered instead of cardioversion.

Q2) 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:

A) order an ECG and refer to a cardiologist.

B) schedule a cardiac stress test and a graded exercise test.

C) order a complete blood count (CBC) and electrolytes and consider a trial of procainamide.

D) prescribe a -blocker and anticoagulant and order 24-hour Holter monitoring.

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Chapter 24: Antihyperlipidemic Agents

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Q1) A patient who has type 2 diabetes mellitus will begin taking a bile acid sequestrant.Which bile acid sequestrant should the primary care NP order?

A) Colesevelam (Welchol)

B) Colestipol (Colestid)

C) Cholestyramine (Questran)

D) Cholestyramine (Questran Light)

Q2) A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor)continues to have LDL cholesterol of 140 mg/dL after 3 months of therapy.The primary care NP increases the dose from 10 mg daily to 20 mg daily.The patient reports headache and dizziness a few weeks after the dose increase.The NP should:

A) change the atorvastatin dose to 15 mg twice daily.

B) change the patient's medication to cholestyramine (Questran).

C) add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily.

D) recommend supplements of omega-3 along with the atorvastatin.

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Chapter 25: Agents that Act on Blood

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Sample Questions

Q1) 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:

A) initiate dabigatran when the patient's international normalized ratio (INR) is less than 2.

B) start dabigatran 7 to 14 days after discontinuing warfarin.

C) begin giving dabigatran 1 week before discontinuing warfarin.

D) order frequent monitoring of the patient's INR after dabigatran therapy begins.

Q2) 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?

A) Cilostazol (Pletal)

B) Warfarin (Coumadin)

C) Pentoxifylline (Trental)

D) Low-dose, short-term aspirin

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Chapter 26: Antacids and the Management of GERD

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Sample Questions

Q1) A patient who has gastroesophageal reflux disease (GERD)undergoes an endoscopy,which shows a hiatal hernia.The patient is mildly obese.The patient asks the primary care nurse practitioner (NP)about treatment options.The NP should tell this patient that:

A) a fundoplication will be necessary to correct the cause of GERD.

B) over-the-counter (OTC) antacids can be effective and should be tried first.

C) elevation of the head of the bed at night can relieve most symptoms.

D) a combination of lifestyle changes, medications, and surgery may be necessary.

Q2) 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:

A) calcium carbonate (Tums).

B) aluminum hydroxide (Amphojel).

C) sodium bicarbonate (Alka-Seltzer).

D) magnesium hydroxide (Milk of Magnesia).

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Chapter 27: Histamine-2 Blockers and Proton Pump

Inhibitors

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Q1) A patient is given a diagnosis of peptic ulcer disease.A laboratory test confirms the presence of Helicobacter pylori.The primary care NP orders a proton pump inhibitor (PPI)before meals twice daily,clarithromycin,and amoxicillin.After 14 days of treatment,H.pylori is still present.The NP should order:

A) continuation of the PPI for 4 to 8 weeks.

B) a PPI, amoxicillin, and metronidazole for 14 days.

C) a PPI, clarithromycin, and amoxicillin for 14 more days.

D) a PPI, bismuth subsalicylate, tetracycline, and metronidazole.

Q2) 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:

A) order cimetidine (Tagamet).

B) add metronidazole to the drug regimen.

C) change from ranitidine to omeprazole (Prilosec).

D) reassure the patient that drug effects take several weeks.

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Chapter 28: Laxatives

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Sample Questions

Q1) A patient reports having occasional acute constipation with large,hard stools and pain and asks the primary care NP about medication to treat this condition.The NP learns that the patient drinks 1500 mL of water daily; eats fruits,vegetables,and bran; and exercises regularly.The NP should recommend:

A) a daily bulk laxative.

B) long-term docusate sodium.

C) a saline laxative as needed.

D) glycerin suppositories as needed.

Q2) A primary care NP sees a patient who reports having decreased frequency of stools over the past few months.In the clinic today,the patient has severe abdominal cramping and an abdominal radiograph shows an increased stool load in the sigmoid colon and rectum.The NP should:

A) give magnesium hydroxide (Milk of Magnesia).

B) start daily methylcellulose (Citrucel) and increased fluids.

C) order a sodium phosphate enema and psyllium (Metamucil).

D) recommend polyethylene glycol (MiraLAX) and 2000 mL of fluid daily.

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Chapter 29: Antidiarrheals

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Sample Questions

Q1) 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:

A) diphenoxylate (Lomotil).

B) attapulgite (Kaopectate).

C) an electrolyte solution (Pedialyte).

D) bismuth subsalicylate (Pepto-Bismol).

Q2) A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP.The patient asks about medications to stop the diarrhea.The NP tells the patient that antidiarrheal medications are:

A) not curative and may prolong the illness.

B) useful in cases of acute infection with elevated temperature.

C) most beneficial when symptoms persist longer than 2 weeks.

D) useful when other symptoms, such as hematochezia, develop.

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Chapter 30: Antiemetics

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Sample Questions

Q1) A patient who is about to begin chemotherapy expresses concern to the primary care NP about gastrointestinal side effects of the treatments.The NP should reassure the patient that:

A) most newer chemotherapeutic agents do not cause nausea and vomiting.

B) antiemetics will be administered as needed if nausea and vomiting occur.

C) taking ondansetron before chemotherapy decreases nausea and vomiting.

D) a scopolamine patch is an effective way to prevent nausea and vomiting.

Q2) 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: A) daily.

B) every 3 days.

C) as needed for nausea.

D) 1 hour before embarking.

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Chapter 31: Medications for Irritable Bowel Syndrome and Other

Gastrointestinal

Problems

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Q1) 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:

A) mesalamine (Asacol).

B) dicyclomine (Bentyl).

C) simethicone (Phazyme).

D) metoclopramide (Reglan).

Q2) A patient in the clinic reports frequent episodes of bloating,abdominal pain,and loose stools to the primary care nurse practitioner (NP).An important question the NP should ask about the abdominal pain is:

A) the relation of the pain to stools.

B) what time of day the pain occurs.

C) whether the pain is sharp or diffuse.

D) the age of the patient when the pain began.

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Chapter 32: Diuretics

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Sample Questions

Q1) A patient develops hypertension.The primary care nurse practitioner (NP)plans to begin diuretic therapy for this patient.The NP notes clear breath sounds,no organomegaly,and no peripheral edema.The patient's serum electrolytes are normal.The NP should prescribe:

A) furosemide (Lasix).

B) triamterene (Dyrenium).

C) acetazolamide (Diamox).

D) hydrochlorothiazide (HydroDIURIL).

Q2) A patient who has congestive heart failure and arthritis has been taking chlorthalidone (Zaroxolyn)25 mg daily for 6 months.The primary care NP notes a persistent blood pressure of 145/90 mm Hg.The NP should:

A) ask the patient which medications are used for pain.

B) add furosemide (Lasix) to the patient's drug regimen.

C) increase the dose of chlorthalidone to 100 mg daily.

D) recommend that the patient use salt substitutes to season foods.

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34

Chapter 33: Male Genitourinary Agents

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Sample Questions

Q1) A patient who has BPH is taking alfuzosin (Uroxatral)and finasteride (Proscar).The patient has had two urinary tract infections (UTIs)in the past 2 months.A urinalysis in the clinic is negative for leukocyte esterase but positive for hematuria.The primary care NP should:

A) discontinue finasteride.

B) refer the patient to a urologist.

C) change alfuzosin to tamsulosin.

D) add doxazosin to the drug regimen.

Q2) A man who has cardiovascular disease and takes nitroglycerin for angina pain develops erectile dysfunction.The primary care NP who cares for this patient should recommend:

A) sildenafil (Viagra).

B) testosterone injections.

C) vascular reconstruction surgery.

D) use of a vacuum constriction device.

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Chapter 34: Drugs for Urinary Incontinence and Urinary Analgesia

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Q1) A patient has a UTI and will begin treatment with an antibiotic.The patient reports moderate to severe suprapubic pain.The primary care NP should prescribe:

A) ibuprofen as needed.

B) bethanechol (Urecholine).

C) phenazopyridine (Pyridium).

D) increased oral fluid intake to dilute urine.

Q2) A primary care NP prescribes oxybutynin chloride for an 80-year-old patient to treat urinary incontinence.When teaching this patient about this medication,the NP should tell the patient:

A) to increase intake of fluids and fiber.

B) that alcohol may be consumed in moderation.

C) that drowsiness may be a transient adverse effect.

D) that hypertension may occur and to report headaches.

Q3) A serious side effect associated with desmopressin is:

A) dehydration.

B) hypotension.

C) hyponatremia.

D) urinary retention.

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Chapter 35: Acetaminophen

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Sample Questions

Q1) An 80-year-old patient with congestive heart failure has a viral upper respiratory infection.The patient asks the primary care NP about treating the fever,which is 38.5° C.The NP should:

A) recommend acetaminophen.

B) recommend high-dose acetaminophen.

C) tell the patient that antibiotics are needed with a fever that high.

D) tell the patient a fever less than 40° C does not need to be treated.

Q2) An adult patient who has a viral upper respiratory infection asks the primary care nurse practitioner (NP)about taking acetaminophen for fever and muscle aches.To help ensure against possible drug toxicity,the NP should first:

A) determine the patient's height and weight.

B) ask the patient how high the temperature has been.

C) tell the patient to take 325 mg initially and increase as needed.

D) ask the patient about any other over-the-counter (OTC) cold medications being used.

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Chapter 36: Aspirin and Nonsteroidal Antiinflammatory Drugs

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Sample Questions

Q1) The primary care NP is performing a medication reconciliation on a patient who takes digoxin for congestive heart failure and learns that the patient uses ibuprofen as needed for joint pain.The NP should counsel this patient to:

A) use naproxen (Naprosyn) instead of ibuprofen.

B) increase the dose of digoxin while taking the ibuprofen.

C) use an increased dose of ibuprofen while taking the digoxin.

D) take potassium supplements to minimize the effects of the ibuprofen.

Q2) A patient who has rheumatoid arthritis begins taking naproxen (Naprosyn)500 mg once daily for pain.After 1 week,the patient calls the primary care NP to report no change in inflammation.The NP should:

A) change the medication to tramadol.

B) change the medication to ketorolac (Toradol).

C) increase the dose of naproxen to 1000 mg daily.

D) counsel the patient that pain relief may not occur for another week.

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Chapter 37: Disease-Modifying Antirheumatic Drugs and Immune Modulators

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Sample Questions

Q1) A patient is taking a cytokine immunomodulator to treat RA.The primary care NP caring for this patient should:

A) obtain periodic complete blood counts (CBCs) and liver function tests (LFTs).

B) perform annual tuberculosis (TB) skin testing.

C) advise the patient of an increased risk of bone cancer.

D) administer the intranasal live attenuated influenza vaccine (LAIV) each year.

Q2) The primary care NP follows a patient who is being treated for RA with methotrexate.The patient asks the NP why the medication does not seem to alleviate pain.The NP tells the patient that:

A) an immunomodulator may be needed to control pain.

B) a higher dose of methotrexate may be needed to achieve pain control.

C) if methotrexate does not control pain, an opioid analgesic may be necessary.

D) methotrexate is used to slow disease progression and preserve joint function.

Q3) A patient who has a history of stomach ulcers is taking a nonselective NSAID along with a DMARD for RA.The primary care NP should:

A) order a glucocorticoid.

B) change to acetaminophen.

C) order a proton pump inhibitor (PPI).

D) change to a selective COX-2 inhibitor.

Page 39

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Chapter 38: Gout Medications

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Sample Questions

Q1) A patient who is obese and has hypertension is taking a thiazide diuretic and develops gouty arthritis,which is treated with probenecid.At a follow-up visit,the patient's serum uric acid level is 7 mg/dL,and the patient denies any current symptoms.The primary care NP should discontinue the probenecid and:

A) prescribe colchicine.

B) prescribe febuxostat.

C) tell the patient to use an NSAID if symptoms recur.

D) counsel the patient to report recurrence of symptoms.

Q2) A patient with a history of gouty arthritis comes to the clinic with acute pain and swelling of the great toe.The patient is not currently taking any medications.The primary care NP should prescribe:

A) naproxen.

B) colchicine.

C) probenecid.

D) allopurinol.

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Chapter 39: Osteoporosis Treatment

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Sample Questions

Q1) A 50-year-old white woman who is experiencing menopause asks the primary care NP what she can do to prevent osteoporosis.She has a negative family history and no risk factors.The NP should counsel her to:

A) consider bisphosphonate therapy in 5 years.

B) undergo bone density testing every 2 years.

C) avoid high-impact sports that can lead to fractures.

D) take supplemental calcium and vitamin D every day.

Q2) A 55-year-old woman who experienced menopause at age 50 years undergoes central dual-energy x-ray absorptiometry and has a T-score greater than 2.5.The patient weighs 130 lb and has a body mass index of 22.She sits at a computer all day at work.The primary care nurse practitioner (NP)caring for this patient should:

A) prescribe a bisphosphonate.

B) prescribe hormone replacement therapy.

C) counsel the patient about diet and exercise.

D) prescribe a selective estrogen receptor modulator.

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Chapter 40: Muscle Relaxants

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Sample Questions

Q1) A patient reports having an acute onset of low back pain associated with lifting a heavy object the day before.Besides advising the patient to rest and apply ice,the primary care NP should prescribe:

A) an opioid analgesic.

B) metaxalone (Skelaxin)

C) cyclobenzaprine (Flexeril).

D) a nonsteroidal antiinflammatory drug (NSAID).

Q2) A patient with lower back pain and right-sided sciatica has taken an NSAID and a TCA for 1 week.The patient reports some decrease in pain but is experiencing increased tingling and numbness of the right leg.The primary care NP should:

A) order a magnetic resonance imaging (MRI) study.

B) order physical therapy.

C) refer the patient to a neurologist.

D) continue the TCA for 1 more week.

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Chapter 41: Medications for Attention Deficit/Hyperactivity

Disorder

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Sample Questions

Q1) A patient who has recently begun working at night reports having difficulty staying awake at work.The primary care NP should consider prescribing:

A) caffeine.

B) modafinil (Provigil).

C) methylphenidate (Ritalin).

D) dextroamphetamine (Dexedrine).

Q2) A child is taking methylphenidate (Ritalin)for AD/HD.The child's parent calls the primary care NP to report increased behavior problems and delusional thinking.The NP should:

A) increase the drug dose.

B) discontinue the medication.

C) change to dextroamphetamine.

D) order methylphenidate SR.

Q3) The parent of an 8-year-old child recently diagnosed with AD/HD verbalizes concerns about giving the child stimulants.The primary care NP should recommend:

A) modafinil (Provigil).

B) guanfacine (Intuniv).

C) bupropion (Wellbutrin).

D) atomoxetine (Strattera).

Page 43

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Chapter 42: Medications for Dementia

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Sample Questions

Q1) A patient who is diagnosed with Alzheimer's disease experiences visual hallucinations.The primary care NP should initially prescribe:

A) donepezil (Aricept).

B) rivastigmine (Exelon).

C) memantine (Namenda).

D) galantamine (Razadyne).

Q2) A patient who has Alzheimer's disease begins taking donepezil (Aricept).After 3 months of treatment,the patient does not show improvement of symptoms.The primary care NP should:

A) switch to rivastigmine (Exelon).

B) switch to galantamine (Razadyne).

C) switch to memantine (Namenda).

D) continue donepezil and reevaluate in 3 months.

Q3) A patient is newly diagnosed with Alzheimer's disease stage 6 on the Global Deterioration Scale.The primary care NP should prescribe:

A) donepezil (Aricept).

B) rivastigmine (Exelon).

C) memantine (Namenda).

D) galantamine (Razadyne).

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Page 44

Chapter 43: Analgesia and Pain Management

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Sample Questions

Q1) A patient has pain caused by a chronic condition.The patient is reluctant to take opioids because of a fear of addiction.The primary care NP should tell the patient that opioids:

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

B) will help to improve the patient's functional outcomes and quality of life.

C) will eventually become ineffective for treating pain when used over a long period. D) may require switching from one type of opioid to another to prevent tolerance over time.

Q2) A patient has been taking an opioid analgesic for 2 weeks after a minor outpatient procedure.At a follow-up clinic visit,the patient tells the primary care NP that he took extra doses for the past 2 days because of increased pain and wants an early refill of the medication.The NP should suspect:

A) dependence.

B) drug addiction.

C) possible misuse.

D) increasing pain.

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Chapter 44: Migraine Medications

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Sample Questions

Q1) A patient takes rizatriptan (Maxalt)to abort migraine headaches but tells the primary care NP that the headaches have become more frequent since a promotion at work.The NP's initial response should be to:

A) prescribe topiramate (Topamax).

B) stress the importance of establishing new routines.

C) help the patient identify stressors associated with the new role.

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

Q2) A patient comes to the clinic concerned about possible migraine headaches.The primary care NP conducts a history and physical examination,and the patient describes vise-like pressure in the back of the head that occurs almost daily during the work week.The NP should recommend:

A) acetaminophen.

B) topiramate.

C) sumatriptan.

D) ergotamine.

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Chapter 45: Antiepileptics

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Q1) A 20-kg child takes valproic acid (Depakote)for seizures and has had regular dose increases with a current dose of 250 mg twice daily.The child continues to have one to two seizures each week along with significant drowsiness that interferes with school participation.The primary care NP should contact the child's neurologist to discuss:

A) obtaining a serum valproic acid level.

B) changing the medication to gabapentin (Neurontin).

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

D) adding lamotrigine (Lamictal) to this child's drug regimen.

Q2) A patient is newly diagnosed with generalized epilepsy.The primary care NP will refer this patient to a neurologist and should expect this patient to begin taking:

A) phenytoin (Dilantin).

B) topiramate (Topamax).

C) lamotrigine (Lamictal).

D) levetiracetam (Keppra).

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Chapter 46: Antiparkinson Agents

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Sample Questions

Q1) A 55-year-old patient develops Parkinson's disease characterized by unilateral tremors only.The primary care NP will refer the patient to a neurologist and should expect initial treatment to be:

A) levodopa.

B) carbidopa.

C) pramipexole.

D) carbidopa/levodopa.

Q2) A patient who has Parkinson's disease takes levodopa and carbidopa.The patient asks the primary care nurse practitioner (NP)why two drugs are necessary.The NP should explain that both drugs are needed to:

A) prolong effects of the levodopa.

B) delay progression of the disease.

C) decrease adverse peripheral side effects.

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

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Chapter 47: Antidepressants

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Sample Questions

Q1) A patient has been taking paroxetine (Paxil)for major depressive symptoms for 8 months.The patient tells the primary care NP that these symptoms improved after 2 months of therapy.The patient is experiencing weight gain and sexual dysfunction and wants to know if the medication can be discontinued.The NP should:

A) change to a tricyclic antidepressant medication.

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

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

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

Q2) A patient has been taking fluoxetine (Prozac)for depression and comes to the clinic to report nausea and jitteriness.The primary care NP notes tremors and sees that the patient is confused.The patient has a heart rate of 95 beats per minute.The NP should:

A) change to bupropion (Wellbutrin).

B) ask the patient about other medications.

C) discontinue the fluoxetine immediately.

D) add mirtazapine (Remeron) to treat anxiety.

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Chapter 48: Antianxiety and Insomnia Agents

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Q1) A patient is in the clinic with acute symptoms of anxiety.The patient is restless and has not slept in 3 days.The primary care NP observes that the patient is irritable and has moderate muscle tension.The patient's spouse reports that similar symptoms have occurred before in varying degrees for several years.The NP should refer the patient to a psychologist and should prescribe which drug for short-term use?

A) Alprazolam

B) Buspirone

C) Melatonin

D) Zolpidem

Q2) A patient reports difficulty returning to sleep after getting up to go to the bathroom every night.A physical examination and a sleep hygiene history are noncontributory.The primary care NP should prescribe:

A) zaleplon.

B) ZolpiMist.

C) ramelteon.

D) chloral hydrate.

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Chapter 49: Antipsychotics

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Q1) A patient who takes 150 mg of clozapine (Clozaril)twice daily calls the primary care

NP at 10:00 AM one day to report forgetting to take the 8:00 AM dose.The NP should counsel the patient to:

A) take the missed dose now.

B) take 75 mg of clozapine now.

C) wait and take the evening dose at the usual time.

D) take the evening dose 2 hours earlier than usual.

Q2) The primary care nurse practitioner (NP)is performing a physical examination on a patient who has been taking mesoridazine (Serentil)for several weeks to treat schizophrenia.The patient is exhibiting rhythmic movements of the face and jaw.The NP should be concerned that the patient may:

A) need a higher dose of mesoridazine.

B) need to change to thioridazine (Mellaril).

C) have developed neuroleptic malignant syndrome.

D) be exhibiting signs of an irreversible adverse effect.

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Chapter 50: Substance Abuse

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Q1) A patient is brought to the clinic by a spouse because of increased somnolence and disorientation.The spouse tells the primary care NP that the patient has been taking oxycodone for postoperative pain.The NP notes a respiratory rate of 8 to 10 breaths per minute.The NP should:

A) activate the emergency medical service (EMS) and administer oxygen.

B) administer oral methadone (Dolophine).

C) administer intramuscular naltrexone (ReVia).

D) administer sublingual buprenorphine (Subutex).

Q2) At an annual well-woman examination,the primary care nurse practitioner (NP)asks a patient about alcohol consumption.The woman reports she usually consumes six glasses of wine per week and occasionally will consume three or four glasses at a party.The NP smells alcohol on the woman's breath.The woman says she is hung over today.The NP should:

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

B) question her further about her nightly alcohol consumption-ask what size her wine glasses are.

C) consider her at high risk for alcoholism.

D) refer her to treatment for alcohol abuse.

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Chapter 51: Glucocorticoids

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Sample Questions

Q1) 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.

Q2) 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."

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Chapter 52: Thyroid Medications

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Sample Questions

Q1) A patient with Graves' disease is taking methimazole.After 6 months of therapy,the primary care NP notes normal T and T 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.

Q2) An 80-year-old female patient with a history of angina has increased TSH and decreased T .The primary care NP should prescribe _____ mcg of _____.

A) 25; liothyronine

B) 75; liothyronine

C) 25; levothyroxine

D) 75; levothyroxine

Q3) A primary care NP orders thyroid function tests.The patient's TSH is 1.2 microunits/mL,and T 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.

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54

Chapter 53: Diabetes Mellitus Agents

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Sample Questions

Q1) 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).

Q2) 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 A c 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.

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Chapter 54: Contraceptives

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Q1) A 40-year-old woman tells the primary care nurse practitioner (NP)that she does not want more children and would like a contraceptive.She does not smoke and has no personal or family history of cardiovascular disease.She has frequent tension headaches.For this patient,the NP should prescribe:

A) condoms.

B) tubal ligation.

C) monophasic combined oral contraceptive pill (COCP).

D) low-estrogen COCP.

Q2) A woman who is taking a progestin-only pill has just stopped nursing her 9-month-old infant and tells the primary care NP that she would like to space her children about 2 years apart.The NP should:

A) discontinue the progestin-only pill.

B) prescribe a COCP and a folic acid supplement.

C) prescribe a progestin-only pill for another 6 months.

D) suggest that she use a barrier method of contraception.

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Chapter 55: Hormone Replacement Therapy

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Sample Questions

Q1) Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months.She has a positive family history of breast cancer.The primary care NP should recommend:

A) testosterone therapy.

B) estrogen-only therapy.

C) nonhormonal drugs for osteoporosis.

D) estrogen-progesterone therapy for 1 to 2 years.

Q2) A woman with a family history of breast cancer had her last menstrual period 12 months ago and is experiencing hot flashes.She has not had a hysterectomy.The primary care NP should recommend:

A) black cohosh.

B) estrogen-only therapy.

C) progesterone-only therapy.

D) limiting alcohol and caffeine intake.

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Chapter 56: Drugs for Breast Cancer

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Sample Questions

Q1) A patient who has breast cancer has been taking toremifene for 2 weeks.She tells her primary care NP that she thinks her tumor has grown larger.The NP should:

A) schedule her for a breast ultrasound.

B) reassure her that this is common and will subside.

C) tell her she may need an increased dose of this medication.

D) contact her oncologist to discuss adding another medication.

Q2) A 50-year-old woman who is postmenopausal is taking an aromatase inhibitor as part of a breast cancer treatment regimen.She calls her primary care NP to report that she has had hot flashes and increased vaginal discharge but no bleeding.The NP should:

A) schedule her for a gynecologic examination.

B) recommend that she use a barrier method of contraception.

C) tell her to stop taking the medication and call her oncologist.

D) reassure her that these are normal side effects of the medication.

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Chapter 57: Principles for Prescribing Antiinfectives

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Sample Questions

Q1) The primary care NP sees a patient who has a 1-week history of nasal congestion; red,watery eyes; cough; and a temperature ranging from 99.1° F to 100.5° F.The NP notes thin,white nasal discharge and an erythematous oropharynx without swelling or exudates.The NP should:

A) begin empiric antibiotic therapy to treat sinusitis.

B) reassure the patient that this is likely a viral infection.

C) prescribe antiviral medications and decongestants.

D) obtain a nasal culture and consider antibiotic therapy.

Q2) A new patient comes to see the primary care NP with fever,mild dehydration,and dysuria with flank pain.The patient tells the NP that a previous provider always prescribed trimethoprim-sulfamethoxazole and wonders why a urine culture is necessary because this antibiotic has worked in the past.The NP should tell this patient that a culture is necessary to help determine:

A) the correct dose of the antibiotic.

B) whether antibiotic resistance is occurring.

C) whether multiple organisms are causing infection.

D) the length of antibiotic therapy needed to treat the infection.

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Chapter 58: Treatment of Specific Infections and Miscellaneous Antibiotics

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Sample Questions

Q1) A patient comes to the clinic several days after an outpatient surgical procedure complaining of swelling and pain at the surgical site.The primary care NP notes a small area of erythema but no abscess or induration.The NP should:

A) prescribe TMP-SMX.

B) prescribe topical mupirocin four times daily.

C) suggest that the patient apply warm soaks three times daily.

D) refer the patient to the surgeon for further evaluation.

Q2) A female patient presents with grayish,odorous vaginal discharge.The primary care NP performs a gynecologic examination and notes vulvar and vaginal erythema.Testing of the discharge reveals a pH of 5.2 and a fishy odor when mixed with a solution of 10% potassium hydroxide.The NP should:

A) order topical fluconazole.

B) order metronidazole 500 mg twice daily for 7 days.

C) withhold treatment until culture results are available.

D) prescribe a clotrimazole vaginal suppository for 7 days.

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Page 60

Chapter 59: Penicillins

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Sample Questions

Q1) A patient was seen in a local emergency department and was treated empirically for pharyngitis with ampicillin and comes to the clinic 2 days later with an urticarial rash.The patient has no previous history of atopy and does not have respiratory symptoms.The primary care NP should suspect:

A) scarlatina.

B) mononucleosis.

C) serum sickness.

D) penicillin allergy.

Q2) The primary care NP administers penicillin G (Bicillin)to a 75-year-old patient who has COPD and heart failure.The patient takes digoxin,warfarin,and spironolactone.To help prevent drug interactions,the NP should order:

A) serum electrolytes.

B) coagulation studies.

C) creatinine clearance.

D) liver transaminases aspartate aminotransferase and alanine aminotransferase.

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Chapter 60: Cephalosporins

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Sample Questions

Q1) 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.

Q2) 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).

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Chapter 61: Tetracyclines

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Sample Questions

Q1) A patient is taking tetracycline for a rickettsial infection and reports having heartburn.The primary care NP should:

A) ask the patient how the medication is taken.

B) tell the patient to take the medication with food.

C) tell the patient to use antacids when heartburn occurs.

D) recommend drinking milk when taking the medication.

Q2) A young woman will begin taking minocycline.The primary care NP should tell this patient to:

A) avoid taking antacids while taking this drug.

B) expect headaches while taking this medication.

C) always take the medication on an empty stomach.

D) use a backup form of contraception if currently taking oral contraceptive pills.

Q3) A patient has urethritis.The primary care NP should prescribe:

A) minocycline.

B) doxycycline.

C) tetracycline.

D) demeclocycline.

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Chapter 62: Macrolides

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Sample Questions

Q1) 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.

Q2) Which antibiotic requires administration of a loading dose?

A) Ilosone

B) E-Mycin

C) Erythrocin

D) Zithromax

Q3) 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.

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64

Chapter 63: Fluoroquinolones

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Sample Questions

Q1) 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.

Q2) 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.

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65

Chapter 64: Aminoglycosides

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Sample Questions

Q1) While a patient is receiving an aminoglycoside medication by intramuscular injection,the provider should instruct the patient to expect:

A) discomfort to the injection site, which can be treated with warm moist heat.

B) development of localized infection, which can be treated with an occlusive dressing.

C) discomfort to the injection site, which can best be relieved with narcotic analgesics.

D) development of localized bleeding, which may require the application of an occlusive dressing.

Q2) A primary care NP sees a patient who was recently hospitalized for infection and treated with gentamicin for 10 days.The patient tells the NP that the drug was discontinued early because "my blood level was too high." The NP should order:

A) a serial audiometric test.

B) a serum blood urea nitrogen (BUN) and creatinine.

C) a urinalysis and complete blood count.

D) serum calcium, magnesium, and sodium.

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Chapter 65: Sulfonamides

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Sample Questions

Q1) 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.

Q2) 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."

Q3) 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.

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Chapter 66: Antitubercular Agents

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Q1) A patient is taking isoniazid,pyrazinamide,rifampin,and streptomycin to treat TB.The primary care NP should routinely perform:

A) serum glucose and liver function tests (LFTs).

B) bone marrow density and ophthalmologic tests.

C) ophthalmologic, hearing, and serum glucose tests.

D) color vision, serum glucose, and LFTs.

Q2) A patient who is taking isoniazid and rifampin for latent TB is seen by the primary care NP for a routine follow-up visit.The patient reports having nausea,vomiting,and a decreased appetite.The NP should:

A) ask about alcohol intake.

B) suggest taking the medications with food.

C) reassure the patient that these side effects are common.

D) order liver and renal function tests and serum glucose.

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Chapter 67: Antifungals

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Sample Questions

Q1) A patient has been taking griseofulvin for 4 weeks to treat a tineal capitis infection.The primary care NP notes improvement but not complete cure.The NP should:

A) obtain a culture and change to ketoconazole.

B) add a topical antifungal cream and refill the griseofulvin prescription for 2 weeks.

C) renew the prescription after obtaining renal, liver, and hematopoietic tests.

D) prescribe griseofulvin for 4 more weeks and then re-evaluate the infection.

Q2) A patient was diagnosed with tinea corporis and given topical ketoconazole.The patient tells the primary care nurse practitioner (NP)that the infection is not getting better.The NP should:

A) prescribe griseofulvin.

B) prescribe oral ketoconazole.

C) obtain a culture of the infection site.

D) recommend 3 more weeks of treatment with the topical medication.

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Chapter 68: Antiretroviral Medications

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Sample Questions

Q1) 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.

Q2) 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

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Chapter 69: Antiviral and Antiprotozoal Agents

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Q1) A 60-year-old patient comes to the clinic reporting a sudden onset of a painful rash that began the day before.The primary care NP notes a vesicular rash along a dermatome on one side of the patient's back.The patient has a low-grade fever.The NP will prescribe:

A) varicella vaccine.

B) acyclovir (Zovirax).

C) metronidazole (Flagyl).

D) amantadine (Symmetrel).

Q2) A patient who is currently not sexually active has an outbreak of genital herpes.The patient asks the primary care NP how this could have occurred without active infection since being treated more than 2 years ago.The NP should tell the patient that:

A) the infection must be due to a resistant herpes simplex virus (HSV) strain.

B) the original infection may have been partially treated.

C) the current infection may be from contact with a toilet seat.

D) successful treatment won't prevent future outbreaks of active infection.

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Chapter 70: The Immune System and Immunizations

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Q1) 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.

Q2) 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.

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Chapter 71: Weight Management

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Sample Questions

Q1) A woman comes to the clinic to talk about weight reduction.The primary care nurse practitioner (NP)calculates a body mass index (BMI)of 28.The woman's waist measures 34 inches.The woman tells the NP that she would like to lose 20 lb for her daughter's wedding in 6 months.The NP should:

A) suggest she try over-the-counter (OTC) orlistat.

B) consider prescribing phentermine short-term.

C) discuss her short-term and long-term weight loss goals.

D) give her information about physical activity and diet modification.

Q2) A man with a BMI of 38 and a waist size of 48 inches is seen in the clinic for an annual well check-up.The primary care NP orders laboratory tests and notes a fasting plasma glucose of 110 mg/dL,triglyceride level of 220 mg/dL,and high-density lipoprotein level of 40 mg/dL.The man's blood pressure is 160/110 mm Hg.The man has a history of cardiovascular disease and tells the NP he has tried to lose weight numerous times.The NP should consider:

A) orlistat (Xenical).

B) phentermine (Adipex-P).

C) an oral antidiabetic agent.

D) a strict low-fat, low-sodium diet.

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Page 73

Chapter 72: Smoking Cessation

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Sample Questions

Q1) 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.

Q2) 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.

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Chapter 73: Vitamins and Minerals

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Sample Questions

Q1) 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.

Q2) 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.

Q3) As patients age,it becomes particularly important to increase their intake of: A) iron.

B) omega 3.

C) vitamin C.

D) B vitamins.

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