Pharmacology for Advanced Practice Nurses Test Preparation - 577 Verified Questions

Pharmacology for Advanced Practice Nurses

Test Preparation

Course Introduction

This course provides advanced practice nursing students with an in-depth understanding of pharmacological principles, including drug classifications, mechanisms of action, pharmacokinetics, and pharmacodynamics. Emphasis is placed on clinical decision-making in prescribing and managing drug therapy for diverse populations across the lifespan. Students will explore the impact of genetics, comorbidities, and polypharmacy on medication selection and safety. The course also addresses legal, ethical, and regulatory aspects of pharmacologic management, enabling nurse practitioners and other advanced practice nurses to deliver safe, effective, and evidence-based medication therapies in various healthcare settings.

Recommended Textbook

Pharmacology for the Primary Care Provider 4th Edition by Edmunds

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73 Chapters

577 Verified Questions

577 Flashcards

Source URL: https://quizplus.com/study-set/962 Page 2

Chapter 1: Prescriptive Authority and Role Implementation: Tradition vsChange

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3 Verified Questions

3 Flashcards

Source URL: https://quizplus.com/quiz/18977

Sample Questions

Q1) As primary care nurse practitioners (NPs)continue to develop their role as prescribers of medications,it will be important to:

A) attain the same level of expertise as physicians who currently prescribe medications.

B) learn from the experiences of physicians and develop expertise based on evidence-based practice.

C) maintain collaborative and supervisorial relationships with physicians who will oversee prescribing practices.

D) develop relationships with pharmaceutical representatives to learn about new medications as they are developed.

Answer: B

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

Assistants

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6 Verified Questions

6 Flashcards

Source URL: https://quizplus.com/quiz/18978

Sample Questions

Q1) An important difference between physician assistants (PAs)and NPs is PAs:

A) always work under physician supervision.

B) are not required to follow drug treatment protocols.

C) may write for all drug categories with physician co-signatures.

D) have both inpatient and outpatient independent prescriptive authority.

Answer: A

Q2) A CNM:

A) may treat only women.

B) has prescriptive authority in all 50 states.

C) may administer only drugs used during labor and delivery.

D) may practice only in birthing centers and home birth settings.

Answer: B

Q3) 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 Page 4

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Page 5

Chapter 3: General Pharmacokinetic and Pharmacodynamic Principles

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11 Verified Questions

11 Flashcards

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Sample Questions

Q1) The primary care NP should understand that a drug is at a therapeutic level when it is:

A) at peak plasma level.

B) past 4 or 5 half-lives.

C) at its steady plasma state.

D) between minimal effective concentration and toxic levels.

Answer: D

Q2) A patient asks the primary care NP which medication to use for mild to moderate pain.The NP should recommend:

A) APAP.

B) Tylenol.

C) acetaminophen.

D) any over-the-counter pain product.

Answer: C

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6

Chapter 4: Special Populations: Geriatrics

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7 Verified Questions

7 Flashcards

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Sample Questions

Q1) An NP is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea.Using the Beers criteria,which of the following medications should the NP recommend for this patient?

A) Loratadine (Claritin)

B) Hydroxyzine (Vistaril)

C) Diphenhydramine (Benadryl)

D) Chlorpheniramine maleate (Chlorphen 12)

Q2) A nurse practitioner (NP)is considering a possible drug regimen for an 80-year-old patient who reports being forgetful.To promote adherence to the regimen,the NP should:

A) select drugs that can be given once or twice daily.

B) provide detailed written instructions for each medication.

C) order medications that can be given on an empty stomach.

D) instruct the patient to take a lower dose if side effects occur.

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Chapter 5: Special Populations: Pediatrics

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11 Verified Questions

11 Flashcards

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Sample Questions

Q1) An NP is prescribing a medication for a 6-month-old infant.The medication comes in the following formulations.Which one should the NP select to improve absorption and distribution of the medication?

A) Oral elixir

B) Rectal suppository

C) Lipid soluble compound

D) Sustained-release capsule

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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8

Chapter 6: Special Populations: Pregnant and Nursing

Women

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8 Verified Questions

8 Flashcards

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Sample Questions

Q1) A woman is in the 36th week of pregnancy.The nurse practitioner (NP)providing prenatal care learns that the woman has a history of two previous urinary tract infections during this pregnancy.A dipstick urinalysis in the office today is negative for leukocyte esterase and nitrites.The NP should:

A) prescribe a low-dose sulfonamide antibiotic for urinary tract infection prophylaxis.

B) order nitrofurantoin daily to minimize the patient's risk of urinary tract infection late in her pregnancy.

C) encourage the patient to increase daily water intake and to wear only cotton underwear.

D) order a voiding cystourethrogram to rule out structural anomalies that may cause urinary tract infection.

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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Page 9

Chapter 7: Over-the-Counter Medications

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7 Verified Questions

7 Flashcards

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Sample Questions

Q1) A patient asks a primary care NP whether over-the-counter drugs are safer than prescription drugs.The NP should explain that over-the-counter drugs are:

A) generally safe when label information is understood and followed.

B) safer because over-the-counter doses are lower than prescription doses of the same drug.

C) less safe because they are not well regulated by the Food and Drug Administration (FDA).

D) not extensively tested, so claims made by manufacturers cannot be substantiated.

Q2) A patient reports taking antioxidant supplements to help prevent cancer.The primary care NP should:

A) review healthy dietary practices with this patient.

B) make sure that the supplements contain large doses of vitamin A.

C) tell the patient that antioxidants are especially important for patients who smoke.

D) tell the patient that evidence shows antioxidants to be effective in preventing cancer.

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Chapter 8: Complementary and Alternative Therapies

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7 Verified Questions

7 Flashcards

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Sample Questions

Q1) A patient is diagnosed with lupus and reports occasional use of herbal supplements.The primary care NP should caution this patient to avoid:

A) ginseng.

B) echinacea.

C) ginkgo biloba.

D) St. John's wort.

Q2) A patient develops hepatotoxicity from chronic acetaminophen use.The primary care NP may recommend:

A) milk thistle.

B) chondroitin.

C) coenzyme Q.

D) glucosamine.

Q3) A patient has been using an herbal supplement for 2 years that the primary care NP knows may have toxic side effects.The NP should:

A) tell the patient to stop taking the supplement immediately.

B) inform the patient of the risks of toxic side effects with this supplement.

C) refer the patient to a CAM provider who can manage this patient's therapy.

D) prescribe another herbal drug that has fewer adverse effects than the one the patient is taking.

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Page 11

Chapter 9: Establishing the Therapeutic Relationship

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7 Verified Questions

7 Flashcards

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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) To increase the likelihood of successful pharmacotherapy,when teaching a patient about using a medication,the primary care nurse practitioner (NP)should:

A) encourage the patient to participate in the choice of the medication.

B) provide education about the medication actions and adverse effects.

C) stress the importance of taking the medication exactly as it is prescribed.

D) give the patient copies of medication package inserts describing the drug use.

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12

Chapter 10: Practical Tips on Writing Prescriptions

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7 Verified Questions

7 Flashcards

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Sample Questions

Q1) A patient who has asthma and who is known to the primary care NP calls the NP after hours and asks for a refill of an albuterol metered-dose inhaler.The patient has not been seen in the clinic for more than a year.The NP should:

A) call the pharmacy to order the medication with several refills.

B) send an electronic prescription to the pharmacy for one time only.

C) send the patient to the emergency department for evaluation of symptoms.

D) refill the drug and tell the patient that an office visit is necessary for further refills.

Q2) The primary care NP is prescribing a medication for an off-label use.To help prevent a medication error,the NP should:

A) write "off-label use" on the prescription and provide a rationale.

B) call the pharmacist to explain why the instructions deviate from common use.

C) write the alternative drug regimen on the prescription and send it to the pharmacy.

D) tell the patient to ignore the label directions and follow the verbal instructions given in the clinic.

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Chapter 11: Evidence-Based Decision Making and Treatment Guidelines

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9 Verified Questions

9 Flashcards

Source URL: https://quizplus.com/quiz/18987

Sample Questions

Q1) A patient takes a cardiac medication that has a very narrow therapeutic range.The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient's medical plan.The NP knows that the bioavailability of the drug varies from brand to brand.The NP should:

A) contact the insurance provider to explain why this particular formulation is necessary.

B) change the patient's medication to a different drug class that doesn't have these bioavailability variations.

C) accept the situation and monitor the patient closely for drug effects with each prescription refill.

D) ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense.

Q2) 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.

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Chapter 12: Design and Implementation of Patient Education

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7 Verified Questions

7 Flashcards

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Sample Questions

Q1) A patient who is newly diagnosed with hypertension is to begin taking two antihypertensive medications.The primary care NP gives the patient written drug information and starts to discuss medication side effects.The patient interrupts and says,"I don't want to know all that.Just tell me what to take and when." The NP should:

A) explain that medication side effects can have serious consequences.

B) ask the patient about previous experiences with medication side effects.

C) give the patient a copy of the medication package insert to read at home.

D) refer the patient to a website with information about hypertension drug therapy.

Q2) 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.

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Chapter 13: Dermatologic Agents

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12 Verified Questions

12 Flashcards

Source URL: https://quizplus.com/quiz/18989

Sample Questions

Q1) A primary care NP is performing a well-child checkup on an adolescent patient and notes approximately 20 papules and comedones and 10 pustules on the patient's face,chest,and back.The patient has not tried any over-the-counter products to treat these lesions.The NP should begin treatment with:

A) salicylic acid.

B) topical tretinoin.

C) oral antibiotics.

D) benzoyl peroxide and topical clindamycin.

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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16

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

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7 Verified Questions

7 Flashcards

Source URL: https://quizplus.com/quiz/18990

Sample Questions

Q1) A primary care nurse practitioner (NP)sees a patient who has a 1-week history of watery,painful eyes with copious amounts of clear discharge and a sore throat.The NP observes bilateral erythema of the conjunctivae and palpates enlarged preauricular lymph nodes.The NP should prescribe _____ drops.

A) ganciclovir

B) ophthalmic antibiotic

C) sympathomimetic ophthalmic

D) nonsteroidal antiinflammatory

Q2) A patient who has year-round allergic rhinitis uses an intranasal corticosteroid and a daily oral antihistamine.The patient reports persistent watery and itchy eyes.The primary care NP observes profuse clear,watery discharge and a cobblestone appearance inside the upper eyelids,with clear conjunctivae.The patient has tried topical azelastine (Astelin)and topical diclofenac (Voltaren)without improvement.The NP should prescribe _____ drops.

A) timolol (Timoptic)

B) pilocarpine (Isopto)

C) nedocromil (Tilade)

D) dexamethasone (Decadron)

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Chapter 15: Upper Respiratory Agents

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8 Verified Questions

8 Flashcards

Source URL: https://quizplus.com/quiz/18991

Sample Questions

Q1) A child with chronic allergic symptoms uses an intranasal steroid for control of symptoms.At this child's annual well-child checkup,the NP should carefully review this child's:

A) urinalysis.

B) blood pressure.

C) height and weight.

D) liver function tests.

Q2) A patient comes to the clinic with a 3-day history of fever and a severe cough that interferes with sleep.The patient asks the NP about using a cough suppressant to help with sleep.The NP should:

A) order a narcotic antitussive to suppress cough.

B) obtain a thorough history of the patient's symptoms.

C) suggest that the patient try a guaifenesin-only over-the-counter product.

D) prescribe an antibiotic to treat the underlying cause of the patient's cough.

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Chapter 16: Asthma and Chronic Obstructive Pulmonary

Disease Medications

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9 Verified Questions

9 Flashcards

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Sample Questions

Q1) A primary care nurse practitioner (NP)is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms.The patient's forced expiratory volume in 1 second (FEV )is 80% of the predicted value.The patient's current medication regimen is an albuterol metered-dose inhaler,2 puffs every 4 hours as needed.The NP should prescribe:

A) montelukast (Singulair) po daily.

B) ipratropium bromide bid with albuterol.

C) a low-dose inhaled corticosteroid (ICS), 2 puffs bid.

D) a long-acting b-adrenergic agonist (LABA), 1 puff bid.

Q2) A 70-year-old patient who has COPD takes theophylline daily and uses a SABA for exacerbation of symptoms.The patient reports using the SABA three or four times each week when short of breath.The patient reports feeling jittery and nauseated and having trouble sleeping.The primary care NP should:

A) obtain a serum theophylline level.

B) order a creatinine clearance level.

C) prescribe a leukotriene modifier instead of theophylline.

D) discontinue the SABA and change to ipratropium bromide.

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Chapter 17: Hypertension and Miscellaneous

Antihypertensive Medications

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7 Verified Questions

7 Flashcards

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Sample Questions

Q1) A 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) a -blocker.

B) an angiotensin-converting enzyme inhibitor.

C) a thiazide diuretic.

D) dietary and lifestyle changes.

Q2) A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions.The patient does not smoke,has a body mass index of 24,and exercises regularly.The patient has no known risk factors for cardiovascular disease.The primary care NP should:

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

B) perform a careful cardiovascular physical assessment.

C) counsel the patient about dietary and lifestyle changes.

D) order a urinalysis and creatinine clearance and begin therapy with a b-blocker.

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Page 20

Chapter 18: Coronary Artery Disease and Antianginal Medications

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7 Verified Questions

7 Flashcards

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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 primary care NP prescribes a nitroglycerin transdermal patch,0.4 mg/hour release,for a patient with chronic stable angina.The NP should teach the patient to:

A) change the patch four times daily.

B) use the patch as needed for angina pain.

C) use two patches daily and change them every 12 hours.

D) apply one patch daily in the morning and remove in 12 hours.

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21

Chapter 19: Heart Failure and Digoxin

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7 Verified Questions

7 Flashcards

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Sample Questions

Q1) 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.

Q2) 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:

A) serum electrolytes.

B) blood glucose levels.

C) serum thyroid levels.

D) complete blood counts (CBCs).

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Chapter 20: Beta-Blockers

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8 Verified Questions

8 Flashcards

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Sample Questions

Q1) An 80-year-old patient with chronic stable angina has begun taking nadolol (Corgard)20 mg once daily in addition to taking nitroglycerin as needed.After 1 week,the patient reports no change in frequency of nitroglycerin use.The primary care nurse practitioner (NP)should change the dose of nadolol to _____ mg _____ daily.

A) 40; once

B) 80; once

C) 20; twice

D) 40; twice

Q2) A patient with a history of coronary heart disease develops atrial fibrillation.The primary care NP refers the patient to a cardiologist who performs direct current cardioversion.The NP should expect the patient to begin taking which -blocker medication?

A) Nadolol (Corgard)

B) Sotalol (Betapace)

C) Timolol (Blocadren)

D) Propranolol (Inderal)

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Chapter 21: Calcium Channel Blockers

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7 Verified Questions

7 Flashcards

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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) An African-American patient who is obese has persistent blood pressure readings greater than 150/95 mm Hg despite treatment with a thiazide diuretic.The primary care NP should consider prescribing a(n):

A) angiotensin receptor blocker.

B) -blocker.

C) ACE inhibitor.

D) calcium channel blocker.

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24

Chapter 22: ACE Inhibitors and Angiotensin Receptor

Blockers

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Sample Questions

Q1) An African-American patient is taking captopril (Capoten)25 mg twice daily.When performing a physical examination,the primary care nurse practitioner (NP)learns that the patient continues to have blood pressure readings of 135/90 mm Hg.The NP should:

A) increase the captopril dose to 50 mg twice daily.

B) add a thiazide diuretic to this patient's regimen.

C) change the drug to losartan (Cozaar) 50 mg once daily.

D) recommend a low-sodium diet in addition to the medication.

Q2) 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.

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25

Chapter 23: Antiarrhythmic Agents

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Sample Questions

Q1) 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:

A) discontinue the medication immediately.

B) reassure the patient that this is a therapeutic drug level.

C) order an ECG, CBC, liver function tests (LFTs), and renal function tests.

D) admit the patient to the hospital and obtain a cardiology consultation.

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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Sample Questions

Q1) 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 30 mg/dL,and triglycerides of 350 mg/dL.The patient has no previous history of coronary heart disease.The NP should consider prescribing:

A) ezetimibe (Zetia).

B) gemfibrozil (Lopid).

C) simvastatin (Zocor).

D) nicotinic acid (Niaspan).

Q2) 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:

A) atorvastatin (Lipitor).

B) gemfibrozil (Lopid).

C) cholestyramine (Questran).

D) lovastatin/niacin (Advicor).

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Chapter 25: Agents that Act on Blood

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Sample Questions

Q1) 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:

A) lowering the dose of warfarin.

B) rechecking the INR in 1 week.

C) omitting a dose and resuming at a lower dose.

D) omitting a dose and administering 1 mg of vitamin K.

Q2) A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled.The primary care NP should counsel this patient to:

A) avoid foods that are high in vitamin K for several days.

B) take a double dose of the medication the next morning.

C) refill the prescription and take today's dose immediately.

D) skip today's dose and resume a regular dosing schedule in the morning.

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28

Chapter 26: Antacids and the Management of GERD

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Sample Questions

Q1) A patient who has GERD with erosive esophagitis has been taking a PPI for 4 weeks and reports a decrease in symptoms.The patient asks the primary care NP if the medication may be discontinued.The NP should tell the patient that:

A) the dose may be decreased for long-term therapy.

B) antireflux surgery must be done before the PPI can be discontinued.

C) the condition may eventually be cured, but therapy must continue for years.

D) once the symptoms have cleared completely, the medication may be discontinued.

Q2) A patient who has GERD has been taking a PPI for 2 months and reports a slight decrease in symptoms.The next response of the primary care NP is to:

A) add a histamine-2-receptor agonist.

B) increase the dose of the PPI.

C) change to long-term, low-dose PPI therapy.

D) refer the patient to an endocrinologist for endoscopy and further management.

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Chapter 27: Histamine-2 Blockers and Proton Pump

Inhibitors

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Sample Questions

Q1) 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:

A) prescribe cimetidine (Tagamet).

B) prescribe omeprazole (Prilosec).

C) teach the patient about a bland diet.

D) change the NSAID to a corticosteroid.

Q2) A patient with erosive esophagitis is taking lansoprazole (Prevacid).The primary care NP performs a medication history and learns that the patient also takes digoxin.The NP should recommend:

A) decreasing the dose of digoxin.

B) obtaining a serum digoxin level.

C) changing the PPI to omeprazole.

D) increasing the dose of lansoprazole.

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Page 30

Chapter 28: Laxatives

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Sample Questions

Q1) 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.

Q2) 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:

A) decrease fluid intake to avoid cardiac overload.

B) change the laxative to docusate sodium (Colace).

C) take the digoxin 2 hours before taking the psyllium.

D) ask the cardiologist about taking an increased dose of digoxin.

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Chapter 29: Antidiarrheals

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Sample Questions

Q1) 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:

A) obtain a stool specimen and order vancomycin.

B) order testing for Clostridium difficile and consider metronidazole therapy.

C) prescribe diphenoxylate (Lomotil) to provide symptomatic relief.

D) reassure the patient that diarrhea is a common side effect of antibiotic therapy.

Q2) 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).

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Chapter 30: Antiemetics

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Sample Questions

Q1) A primary care NP sees a patient 2 days after an outpatient surgical procedure.The patient reports using ondansetron for nausea.The NP notes a blood pressure of 88/56 mm Hg,and the patient reports feeling faint.The NP should suspect:

A) hemorrhage.

B) dehydration.

C) drug toxicity.

D) drug interaction.

Q2) 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.

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33

Chapter 31: Medications for Irritable Bowel Syndrome and Other

Gastrointestinal Problems

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Sample Questions

Q1) A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS.The patient comes to the clinic and reports having dry mouth,difficulty urinating,and more frequent constipation.The primary care NP notes a heart rate of 92 beats per minute.The NP should:

A) prescribe a TCA.

B) discontinue the antidiarrheal medication.

C) encourage the patient to increase water intake.

D) lower the dose of the antispasmodic medication.

Q2) A woman has severe IBS and takes hyoscyamine sulfate (Levsin),simethicone (Phazyme),and a TCA.She reports having continued severe diarrhea.The primary care NP should:

A) order diphenoxylate (Lomotil).

B) prescribe alosetron after ruling out pregnancy.

C) refer her to a gastroenterologist for endoscopy.

D) increase the fiber in her diet to 30 g per day.

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Chapter 32: Diuretics

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Sample Questions

Q1) The primary care NP sees a patient several months after a myocardial infarction (MI).The patient has been taking furosemide to treat heart failure.The NP notes that the patient has edema of the hands,feet,and ankles.The NP should add which drug to this patient's regimen?

A) Ethacrynic acid

B) Chlorothiazide (Lozol)

C) Triamterene (Dyrenium)

D) Spironolactone (Aldactone)

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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Chapter 33: Male Genitourinary Agents

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Sample Questions

Q1) 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.

Q2) The primary care NP is preparing to prescribe sildenafil for a man who has erectile dysfunction.The NP should remember to tell this patient:

A) to avoid oral nitrates while taking this medication.

B) that the drug may cause penile aching.

C) to use a condom if his sexual partner is pregnant.

D) dyspepsia may occur and may warrant discontinuation of the drug.

Q3) A patient tells the primary care NP that he has difficulty getting and maintaining an erection.The NP's initial response should be to:

A) prescribe sildenafil (Viagra).

B) perform a medication history.

C) evaluate his cardiovascular status.

D) order a papaverine injection test to screen for erectile dysfunction.

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Page 36

Chapter 34: Drugs for Urinary Incontinence and Urinary Analgesia

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Sample Questions

Q1) A patient who has diabetes reports intense discomfort when needing to void.A urinalysis is normal.To treat this,the primary care NP should consider prescribing:

A) flavoxate (Urispas).

B) bethanechol (Urecholine).

C) phenazopyridine (Pyridium).

D) oxybutynin chloride (Ditropan XL).

Q2) A patient reports dribbling small amounts of urine but also has difficulty initiating a urine stream.The primary care NP should prescribe: A) solifenacin (VESIcare).

B) bethanechol (Urecholine).

C) phenazopyridine (Pyridium).

D) oxybutynin chloride (Ditropan XL).

Q3) A serious side effect associated with desmopressin is:

A) dehydration.

B) hypotension.

C) hyponatremia.

D) urinary retention.

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Page 37

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) A patient in the clinic reports taking a handful of acetaminophen extra-strength tablets about 12 hours prior.The patient has nausea,vomiting,malaise,and drowsiness.The patient's aspartate aminotransferase and alanine aminotransferase are mildly elevated.The primary care NP should:

A) expect the patient to sustain permanent liver damage.

B) reassure the patient that these symptoms are reversible.

C) tell the patient that acetylcysteine cannot be given this late.

D) administer activated charcoal to remove acetaminophen from the body.

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Chapter 36: Aspirin and Nonsteroidal Antiinflammatory Drugs

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Sample Questions

Q1) A patient with mild to moderate osteoarthritis pain has been taking acetaminophen for pain.The primary care NP prescribes a nonselective NSAID.At a follow-up visit,the patient reports mild GI side effects.The NP should:

A) order misoprostol to take with the NSAID.

B) discontinue the NSAID and order tramadol.

C) change the medication to a COX-2 inhibitor.

D) change the medication to naproxen (Naprosyn).

Q2) The primary care NP sees an adolescent who reports moderate to severe dysmenorrhea.The NP recommends an NSAID and counsels the patient about its use.Which statement by the patient indicates a need for further teaching?

A) "I should not take this if I think I might be pregnant."

B) "I should take this medication on a schedule for 2 to 3 days."

C) "I will begin taking this 1 to 3 days before my period begins."

D) "I will take this medicine every 4 to 6 hours as needed for pain."

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Chapter 37: Disease-Modifying Antirheumatic Drugs and Immune Modulators

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Sample Questions

Q1) A patient has been taking a COX-2 selective NSAID to treat pain associated with a recent onset of RA.The patient tells the primary care NP that the pain and joint swelling are becoming worse.The patient does not have synovitis or extraarticular manifestations of the disease.The NP will refer the patient to a rheumatologist and should expect the specialist to prescribe:

A) methotrexate.

B) corticosteroids.

C) opioid analgesics.

D) hydroxychloroquine.

Q2) 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.

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Chapter 38: Gout Medications

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Sample Questions

Q1) A primary care NP prescribes probenecid to treat a patient who has gout.The patient comes to the clinic 2 weeks later with severe flank pain.The NP should:

A) ask the patient about fluid intake.

B) order a urinalysis and urine culture.

C) change the medication to allopurinol.

D) recommend nonsteroidal antiinflammatory drugs (NSAIDs) to treat flank pain.

Q2) A patient who has hypertension is taking a thiazide diuretic.The patient has a serum uric acid level of 8 mg/dL.The primary care nurse practitioner (NP)caring for this patient should:

A) prescribe colchicine.

B) discontinue the thiazide diuretic.

C) order a 24-hour urine collection.

D) refer the patient to a rheumatologist.

Q3) Gout is diagnosed in a patient,and tests show the cause to be an underexcretion of uric acid.The primary care NP should prescribe:

A) febuxostat (Uloric).

B) colchicine (Colcrys).

C) allopurinol (Zyloprim).

D) probenecid (Benemid).

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Page 41

Chapter 39: Osteoporosis Treatment

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Sample Questions

Q1) A 60-year-old female patient has begun taking a daily bisphosphonate to prevent osteoporosis and complains of gastrointestinal (GI)upset and dyspepsia.The primary care NP's initial response should be to:

A) prescribe a proton pump inhibitor (PPI).

B) order intravenous (IV) bisphosphonates.

C) suggest that she take the drug with food.

D) review the instructions for taking the drug with the patient.

Q2) A 50-year-old woman with osteopenia will begin taking raloxifene (Evista).When counseling this patient about this drug regimen,the primary care NP should tell her to:

A) go for walks daily.

B) take the medication 1 hour before meals.

C) sit upright for 30 minutes after taking the drug.

D) avoid using diuretics while taking this medication.

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Chapter 40: Muscle Relaxants

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Sample Questions

Q1) A patient has acute low back pain caused by lifting a heavy object.The patient reports having one or two drinks with meals each day.The primary care NP should prescribe:

A) an NSAID.

B) diazepam (Valium).

C) metaxalone (Skelaxin).

D) acetaminophen (Tylenol).

Q2) A patient who was in a motor vehicle accident has been treated for lower back muscle spasms with metaxalone (Skelaxin)for 1 week and reports decreased but persistent pain.A computed tomography scan is normal.The primary care NP should:

A) suggest ice and rest.

B) order physical therapy.

C) prescribe diazepam (Valium).

D) add an opioid analgesic medication.

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43

Chapter 41: Medications for Attention Deficit/Hyperactivity

Disorder

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Sample Questions

Q1) The parent of a 4-year-old child is concerned that the child may have AD/HD and wants to know if medications can be given.The primary care NP should tell the parent that:

A) children cannot be diagnosed with AD/HD at this age.

B) alternative therapies to treat AD/HD are used at this age.

C) symptoms at this age are more likely due to environmental factors.

D) most drugs for AD/HD are not approved for children younger than 6 years.

Q2) A child has been taking methylphenidate 5 mg at 8 AM,12 PM,and 4 PM for 30 days after a new diagnosis of AD/HD and comes to the clinic for evaluation.The child's mother reports that the child exhibits some nervousness and insomnia but is doing much better in school.The primary care NP should suggest:

A) discontinuing the 4 PM dose.

B) increasing the dose to 10 mg each time.

C) giving 10 mg at 8 AM and 5 mg at noon.

D) changing the dosing to 15 mg twice daily.

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Page 44

Chapter 42: Medications for Dementia

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Sample Questions

Q1) 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).

Q2) 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).

Q3) 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.

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Page 45

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 who has mild to moderate migraine headaches has severe nausea and vomiting with each episode.For the best treatment of this patient,the primary care NP should prescribe:

A) triptan nasal spray.

B) metoclopramide and aspirin.

C) an NSAID and prochlorperazine.

D) sumatriptan and metoclopramide.

Q2) A patient who has migraine headaches usually has two to three severe migraines each month.The patient has been using a triptan nasal spray but reports little relief and is concerned about missing so many days of work.The primary care NP should consider:

A) an oral triptan plus an opioid analgesic.

B) an injectable triptan plus an oral corticosteroid.

C) an intramuscular steroid plus an opioid analgesic.

D) dihydroergotamine hydrochloride plus an opioid analgesic.

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Chapter 45: Antiepileptics

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Sample Questions

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 12-month-old child with severe developmental delays was recently treated in an emergency department for a febrile seizure and is seen by the primary care NP for a follow-up visit.The child's parent asks if it is necessary to continue giving the child phenobarbital.The NP should tell the parent that:

A) the phenobarbital may be used on an as-needed basis.

B) the phenobarbital may be stopped when an EEG is normal.

C) once the febrile illness is past, the phenobarbital may be stopped.

D) their child is at increased risk for seizures and should continue the phenobarbital.

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Chapter 46: Antiparkinson Agents

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Sample Questions

Q1) A patient who takes levodopa and carbidopa for Parkinson's disease reports experiencing freezing episodes between doses.The primary care NP should consider using:

A) selegiline.

B) amantadine.

C) apomorphine.

D) modified-release levodopa.

Q2) A patient who has Parkinson's disease and who takes levodopa reports that the drug effects wear off more quickly than before.The primary care NP should:

A) add carbidopa.

B) add amantadine.

C) increase the dose of levodopa.

D) add a monoamine oxidase B inhibitor (MAO-B).

Q3) A patient who has Parkinson's disease takes levodopa and carbidopa.The patient reports experiencing tremors between doses.The primary care NP should:

A) add entacapone.

B) add amantadine.

C) discontinue the carbidopa.

D) increase the dose of levodopa.

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Page 49

Chapter 47: Antidepressants

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Sample Questions

Q1) The primary care NP has prescribed sertraline (Zoloft)for a patient who initially reported daily symptoms of hopelessness,sadness,insomnia,and weight loss.After several months of therapy,the patient no longer feels hopeless or sad but continues to have difficulty eating and sleeping.The NP should contact the patient's psychiatrist to discuss:

A) adding mirtazapine (Remeron).

B) changing to duloxetine (Cymbalta).

C) adding another selective serotonin reuptake inhibitor (SSRI) antidepressant.

D) an inpatient admission to the hospital.

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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Sample Questions

Q1) 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:

A) order a sleep study.

B) consider short-term zolpidem.

C) order ramelteon for several weeks.

D) reassure the patient and re-evaluate in 1 week.

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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Sample Questions

Q1) A patient who is overweight is diagnosed with schizophrenia.The primary care NP should consider prescribing:

A) olanzapine (Zyprexa).

B) ziprasidone (Geodon).

C) quetiapine (Seroquel).

D) aripiprazole (Abilify).

Q2) 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:

A) increase the dose of olanzapine.

B) decrease the dose of olanzapine.

C) maintain the same dose of olanzapine.

D) change from olanzapine to chlorpromazine.

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Chapter 50: Substance Abuse

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Sample Questions

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) A mother brings her a college-age son to the primary care NP and asks the NP to talk to him about alcohol use.He reports binge drinking on occasion and drinking only beer on weekends.The NP notes diaphoresis,tachycardia,and an easy startle reflex.The NP should:

A) admit him to the hospital for detoxification.

B) ask him how much he had to drink last night.

C) prescribe lorazepam (Ativan) to help with symptoms.

D) suggest that he talk to a counselor about alcohol abuse.

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Chapter 51: Glucocorticoids

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Sample Questions

Q1) 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."

Q2) A patient with ulcerative colitis takes 30 mg of methylprednisolone (Medrol)daily.The primary care NP sees this patient for bronchitis and orders azithromycin (Zithromax).The NP should:

A) order intramuscular (IM) methylprednisolone.

B) temporarily decrease the dose of methylprednisolone.

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

D) stop the methylprednisolone while the patient is taking azithromycin.

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Chapter 52: Thyroid Medications

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Sample Questions

Q1) A patient has been taking levothyroxine 100 mcg daily for several months.The patient comes to the clinic with complaints of insomnia and irritability.The primary care NP notes a heart rate of 92 beats per minute.The NP should:

A) change to liothyronine 75 mcg/day.

B) discontinue levothyroxine indefinitely.

C) order propylthiouracil to counter the increased thyroid levels.

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

Q2) 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.

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Chapter 53: Diabetes Mellitus Agents

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Sample Questions

Q1) A 12-year-old patient who is obese develops type 2 diabetes mellitus.The primary care NP should order:

A) nateglinide (Starlix).

B) glyburide (Micronase).

C) colesevelam (Welchol).

D) metformin (Glucophage).

Q2) A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping blood glucose within normal limits and has had multiple episodes of both hypoglycemia and hyperglycemia.As adjunct therapy to manage this problem,the primary care NP should prescribe:

A) pramlintide (Symlin).

B) repaglinide (Prandin).

C) glyburide (Micronase).

D) metformin (Glucophage).

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Chapter 54: Contraceptives

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Sample Questions

Q1) A primary care NP prescribes a COCP for a woman who has never taken oral contraceptives before.The woman is in a monogamous relationship,and she and her partner have been using condoms and wish to stop using them.Her last period was 1 week ago.The NP should:

A) perform an in-office pregnancy test before starting a COCP.

B) tell the patient to begin the first pill today and to continue using condoms for 7 days.

C) tell the patient to begin the first pill on the Sunday of or following her next menstrual period.

D) tell the patient to begin the first pill today and to return in 2 weeks for a pregnancy test.

Q2) A woman who has been taking a COCP for 2 months tells the primary care NP that she has had several headaches,breakthrough bleeding,and nausea.The NP should counsel the woman:

A) to change to a progestin-only pill.

B) to stop taking the COCP immediately.

C) to use a backup form of contraception.

D) that these effects will likely decrease in another month.

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Page 57

Chapter 55: Hormone Replacement Therapy

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Sample Questions

Q1) A 50-year-old woman with a family history of CHD is experiencing occasional hot flashes and is having periods every 3 to 4 months.She asks the primary care NP about HT to relieve her symptoms.The NP should:

A) prescribe estrogen-only therapy.

B) initiate oral contraceptive pills now.

C) discuss using bioidentical HT.

D) plan to use estrogen-progesterone therapy when menopause begins.

Q2) A man who has secondary hypogonadism associated with pituitary dysfunction will begin exogenous testosterone therapy.The patient asks the primary care NP about future chances of fathering children.The NP should tell him that:

A) fertility may improve with testosterone therapy.

B) exogenous testosterone therapy will shut down sperm production.

C) fertility can be restored when testosterone therapy is discontinued.

D) he should store sperm ahead of the initiation of testosterone therapy.

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Chapter 56: Drugs for Breast Cancer

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Sample Questions

Q1) 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.

Q2) A primary care NP sees a 60-year-old woman for a physical examination.The woman tells the NP she is taking tamoxifen for treatment of breast cancer.To monitor her response to this medication,the NP should order:

A) a chest radiograph.

B) bone mineral density testing.

C) serum bilirubin and creatinine.

D) liver enzymes and a complete blood count (CBC).

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Chapter 57: Principles for Prescribing Antiinfectives

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Q1) 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.

Q2) A patient who has had two recent urinary tract infections is in the clinic with dysuria and fever.The primary care NP reviews the patient's chart and notes that in both previous cases the causative organism and sensitivity were the same.The NP should:

A) treat the patient empirically without a culture.

B) order a microscopic evaluation of the urine and an antibiotic.

C) order a urine culture and treat empirically pending culture results.

D) order a urine culture and sensitivity and wait for results before treating.

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Chapter 58: Treatment of Specific Infections and Miscellaneous Antibiotics

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Sample Questions

Q1) A school-age child comes to the clinic with a 5-day history of cough and low-grade fever.The primary care NP auscultates crackles and diminished breath sounds bilaterally.The NP should:

A) order azithromycin.

B) prescribe doxycycline.

C) obtain a sputum culture.

D) recommend symptomatic treatment.

Q2) A primary care nurse practitioner (NP)sees a child who has several honey-colored crusted lesions around the nose and mouth.The NP notes that no other lesions are present.The NP should prescribe:

A) dicloxacillin.

B) clarithromycin.

C) mupirocin topical.

D) trimethoprim-sulfamethoxazole (TMP-SMX).

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Chapter 59: Penicillins

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Sample Questions

Q1) A patient is taking dicloxacillin (Dynapen)500 mg every 6 hours to treat a severe penicillinase-resistant infection.At a 1-week follow-up appointment,the patient reports nausea,vomiting,and epigastric discomfort.The primary care NP should:

A) change the medication to a cephalosporin.

B) decrease the dose to 250 mg every 6 hours.

C) reassure the patient that these are normal adverse effects of this drug.

D) order blood cultures, a white blood cell (WBC) count with differential, and liver function tests (LFTs).

Q2) A primary care nurse practitioner (NP)sees a 3-year-old child who has a history of recurrent otitis media.The child's parent tells the NP that the child is allergic to penicillin.The NP learns that the child developed an all-over rash 2 days after starting amoxicillin at age 2 years.The NP should:

A) order a penicillin skin test.

B) use cephalosporins when treating otitis media.

C) order penicillin desensitization so the child can take penicillin when needed.

D) use amoxicillin when needed because actual allergy correlates poorly with patient report.

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Chapter 60: Cephalosporins

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Sample Questions

Q1) A patient is taking cefadroxil (Duricef)and comes to the clinic complaining of loose stools for several days.The primary care NP notes normal vital signs; warm,pink skin with elastic turgor; and moist mucous membranes.The NP should:

A) order tests for Clostridium difficile-associated disease (CDAD).

B) discontinue the cefadroxil.

C) reassure the patient that loose stools are common with antibiotics.

D) recommend consuming lactobacillus-containing foods to minimize diarrhea.

Q2) A primary care NP provides teaching to a patient who will begin taking cefadroxil (Duricef).Which statement by the patient indicates a need for further teaching?

A) "I should report any rash that occurs."

B) "I will take this medication twice daily."

C) "I should take this medication with food."

D) "Gastrointestinal (GI) symptoms are common but not worrisome."

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Chapter 61: Tetracyclines

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Sample Questions

Q1) A woman has a Chlamydia infection.Before initiating treatment with a tetracycline antibiotic,the primary care nurse practitioner (NP)should:

A) perform a pregnancy test.

B) obtain baseline liver function and renal function tests.

C) check her bilirubin and serum amylase levels.

D) tell her she must stop using oral contraceptive pills.

Q2) A patient has urethritis.The primary care NP should prescribe: A) minocycline.

B) doxycycline.

C) tetracycline.

D) demeclocycline.

Q3) 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.

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Chapter 62: Macrolides

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Sample Questions

Q1) A primary care NP sees a 6-month-old patient who has a persistent staccato cough.The NP is aware that there is a pertussis outbreak in the community.The NP should obtain appropriate cultures and treat empirically with:

A) erythromycin.

B) azithromycin.

C) clarithromycin.

D) telithromycin.

Q2) A primary care NP is preparing to prescribe a macrolide antibiotic for a patient who has a history of a prolonged QT interval on electrocardiogram.Which macrolide antibiotic should the NP prescribe?

A) Erythromycin

B) Azithromycin

C) Clarithromycin

D) Telithromycin

Q3) Which antibiotic requires administration of a loading dose?

A) Ilosone

B) E-Mycin

C) Erythrocin

D) Zithromax

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65

Chapter 63: Fluoroquinolones

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Sample Questions

Q1) A primary care NP provides teaching for a patient who is about to begin taking levofloxacin tablets to treat an infection.Which statement by the patient indicates a need for further teaching?

A) "I should use sunscreen while taking this medication."

B) "I should take this medication on an empty stomach."

C) "I should use caution while driving when taking this medication."

D) "I should take the tablet 2 hours before taking vitamins or an antacid."

Q2) 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.

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Chapter 64: Aminoglycosides

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Sample Questions

Q1) A patient who was hospitalized for an infection was treated with an aminoglycoside antibiotic.The patient asks the primary care nurse practitioner (NP)why outpatient treatment wasn't an option.The NP should tell the patient that aminoglycoside antibiotics:

A) are more likely to be toxic.

B) cause serious adverse effects.

C) carry more risk for serious allergic reactions.

D) must be given intramuscularly or intravenously.

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) A patient is seen in the clinic with a 1-week history of frequent watery stools.The primary care NP learns that a family member had gastroenteritis a week prior.The patient was treated for a UTI with a sulfonamide antibiotic 2 months prior.The NP should suspect:

A) Clostridium difficile-associated disease (CDAD).

B) viral gastroenteritis.

C) serum sickness reaction.

D) recurrence of the UTI.

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Chapter 66: Antitubercular Agents

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Sample Questions

Q1) A patient comes to the clinic to have a Mantoux tuberculin skin test read after 48 hours.The primary care NP notes a 6-mm area of induration.The patient is a young adult with no known contacts and has never traveled abroad.The NP should:

A) repeat the test.

B) order a chest radiograph.

C) tell the patient the test is negative.

D) refer to an infectious disease specialist.

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 woman who takes oral contraceptive pills develops vaginal candidiasis.The primary care NP prescribes a single dose of fluconazole.When counseling the patient about this drug,the NP should tell her:

A) that the drug is safe if she were to become pregnant.

B) that she may consume alcohol while taking this medication.

C) to use a backup contraceptive method for the next 2 months.

D) that she may need a lower dose of fluconazole because she takes oral contraceptive pills.

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 who has HIV frequently expresses concerns about the costs of treatment.The primary care NP should:

A) discuss the risks associated with underdosing of antiretroviral therapies.

B) suggest taking half doses of the medications on a regular basis.

C) suggest the patient limit therapy to a one- or two-drug regimen.

D) recommend an occasional "drug holiday" when cell and viral counts are good.

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Chapter 69: Antiviral and Antiprotozoal Agents

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Sample Questions

Q1) A patient comes to the clinic before a trip to an area where malaria is endemic.The primary care NP will prescribe:

A) tinidazole (Tindamax).

B) metronidazole (Flagyl).

C) chloroquine (Plaquenil).

D) amantadine (Symmetrel).

Q2) A patient is taking amantadine to treat a viral infection.The patient calls the primary care NP to report having blurred vision.The NP should:

A) question the patient about suicidal ideation.

B) tell the patient to stop the medication immediately.

C) counsel the patient to avoid driving until this subsides.

D) tell the patient to come to the clinic for an electroencephalogram.

Q3) A patient who is taking metronidazole calls the primary care NP to report severe nausea and vomiting along with heart palpitations.The NP should:

A) counsel the patient to take the medication with food.

B) ask the patient about any recent alcohol consumption.

C) reassure the patient that these symptoms will subside.

D) instruct the patient to go to an emergency department for intravenous fluids.

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Chapter 70: The Immune System and Immunizations

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Sample Questions

Q1) The primary care NP sees a 65-year-old patient in October.The patient has a history of COPD and has not had any vaccines for more than 20 years.The NP should administer:

A) influenza and Td vaccines.

B) PCV 13 and influenza vaccines.

C) PPV 23, Td, and influenza vaccines.

D) PPV 23, influenza, and TdaP vaccines.

Q2) The primary care NP sees a 12-month-old infant who needs the MMR,Varivax,influenza,and hepatitis A vaccines.The child's mother tells the NP that she is pregnant.The NP should:

A) administer all of these vaccines today.

B) give the hepatitis A and influenza vaccines.

C) give the Varivax, hepatitis A, and influenza vaccines.

D) withhold all of these vaccines until after the baby is born.

Q3) A woman who is pregnant and is planning to breastfeed tells the primary care NP that she has never had chickenpox.The NP should:

A) administer the Varivax vaccine today.

B) administer the varicella-zoster immune globulin.

C) recommend the Varivax vaccine as soon as possible after her baby is born.

D) instruct her to receive the Varivax vaccine after her baby has been weaned.

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Page 73

Chapter 71: Weight Management

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Sample Questions

Q1) 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.

Q2) A primary care NP has prescribed phentermine for a patient who is obese.The patient loses 10 lb in the first month but reports that the drug does not seem to be suppressing appetite as much as before.The NP should:

A) discontinue the phentermine.

B) increase the dose of phentermine.

C) continue the phentermine at the same dose.

D) change to a combination of phentermine and topiramate.

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Chapter 72: Smoking Cessation

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Sample Questions

Q1) A patient who is using a nicotine patch for smoking cessation is in the clinic for a follow-up examination.The primary care NP notes a heart rate of 96 beats per minute and a blood pressure of 140/90 mm Hg.The patient reports feeling dizzy and complains of ringing in both ears.The NP should suspect:

A) nicotine withdrawal symptoms.

B) that the patient has been smoking.

C) hypersensitivity reaction to the nicotine patch.

D) minor cardiovascular effects of the nicotine patch.

Q2) A patient who smokes reports repeated attempts to quit smoking using a nicotine replacement patch.The patient says,"I always do well for a few weeks and then I just start smoking again." The primary care nurse practitioner (NP)should prescribe:

A) nortriptyline.

B) Nicorette gum.

C) a Nicotrol inhaler.

D) varenicline (Chantix).

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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 patient reports fatigue and increased frequency of stools over the past week and reports having just begun a regimen of dietary changes to prevent hypertension.The primary care NP notes a rapid,irregular heart rate and a blood pressure of 92/58 mm

Hg.The NP should question the patient about:

A) caffeine intake.

B) B vitamin intake.

C) fat-soluble vitamins.

D) use of salt substitutes.

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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