Pharmacotherapeutics in Primary Care Exam Practice Tests - 577 Verified Questions

Pharmacotherapeutics in Primary Care Exam Practice Tests

Course Introduction

Pharmacotherapeutics in Primary Care explores the principles and practice of medication management in the primary care setting. The course emphasizes evidence-based drug selection, safe prescribing, monitoring therapeutic outcomes, and addressing adverse drug reactions for common acute and chronic health conditions encountered in primary care. Students will develop clinical decision-making skills in pharmacology, considering patient age, comorbidities, organ function, and special populations. Additionally, legal, ethical, and collaborative aspects of prescriptive authority and patient education are integrated to prepare learners for safe and effective pharmacotherapeutic management in the primary care environment.

Recommended Textbook

Pharmacology for the Primary Care Provider 4th Edition by Edmunds

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73 Chapters

577 Verified Questions

577 Flashcards

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Chapter 1: Prescriptive Authority and Role Implementation:

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Sample Questions

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: The

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

Assistants

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Sample Questions

Q1) A primary care NP will begin practicing in a state in which the governor has opted out of the federal facility reimbursement requirement.The NP should be aware that this defines how NPs may write prescriptions:

A) without physician supervision in private practice.

B) as CRNAs without physician supervision in a hospital setting.

C) in any situation but will not be reimbursed for this by government insurers.

D) only with physician supervision in both private practice and a hospital setting.

Answer: B

Q2) 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

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Page 4

Chapter 3: General Pharmacokinetic and Pharmacodynamic Principles

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Sample Questions

Q1) 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

Q2) A patient will begin taking two drugs that are both protein-bound.The primary care NP should:

A) prescribe increased doses of both drugs.

B) monitor drug levels, actions, and side effects.

C) teach the patient to increase intake of protein.

D) stagger the doses of drugs to be given 1 hour apart.

Answer: B

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Page 5

Chapter 4: Special Populations: Geriatrics

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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) 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.

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6

Chapter 5: Special Populations: Pediatrics

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Sample Questions

Q1) An NP sees a preschooler in clinic for the first time.When obtaining a medication history,the NP notes that the child is taking a medication for which safety and effectiveness in children has not been established in drug information literature.The NP should:

A) discontinue the medication.

B) order serum drug levels to evaluate toxicity.

C) report the prescribing provider to the Food and Drug Administration (FDA).

D) ask the parent about the drug's use and side effects.

Q2) A parent brings a 5-year-old child to a clinic for a hospital follow-up appointment.The child is taking a medication at a dose equal to an adult dose.The parent reports that the medication is not producing the desired effects.The NP should:

A) order renal function tests.

B) prescribe another medication to treat this child's symptoms.

C) discontinue the drug and observe the child for toxic side effects.

D) obtain a serum drug level and consider increasing the drug dose.

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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 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.

Q2) A primary care NP recommends an over-the-counter medication for a patient who has acid reflux.When teaching the patient about this drug,the NP should tell the patient:

A) to take the dose recommended by the manufacturer.

B) not to worry about taking this drug with any other medications.

C) to avoid taking other drugs that cause sedation while taking this drug.

D) that over-the-counter acid reflux medications are generally safe to take with other medications.

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9

Chapter 8: Complementary and Alternative Therapies

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Sample Questions

Q1) 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.

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.

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10

Chapter 9: Establishing the Therapeutic Relationship

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Sample Questions

Q1) A primary care NP prepares to teach a patient about the management of a chronic condition.The patient says,"I don't want to know all of that.Just tell me what to take and when." The NP should initially:

A) give the patient basic written instructions about medications, follow up visits, and symptoms.

B) ask the patient to describe the disease process and the medications to evaluate understanding.

C) explain to the patient that without mutual cooperation, the treatment regimen will not be effective.

D) ask the patient to explore feelings and fears about having a chronic disease and taking medications.

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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Chapter 10: Practical Tips on Writing Prescriptions

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Sample Questions

Q1) The primary care NP sees a patient covered by Medicaid,writes a prescription for a medication,and is informed by the pharmacist that the medication is "off-formulary." The NP should:

A) inform the patient that an out-of-pocket expense will be necessary.

B) write the prescription for a generic drug if it meets the patient's needs.

C) call the patient's insurance provider to advocate for this particular drug.

D) contact the pharmaceutical company to see if medication samples are available.

Q2) 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.

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Chapter 11: Evidence-Based Decision Making and Treatment Guidelines

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Sample Questions

Q1) The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma.The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes.The NP should:

A) provide pharmaceutical company samples of the medication for the patient.

B) inform the patient that the drug must be paid for out of pocket because it is not covered.

C) order the closest formulary-approved approximation of the drug and monitor effectiveness.

D) write a letter of medical necessity to the insurer to explain the need for this particular medication.

Q2) A patient comes to the clinic reporting dizziness and fatigue associated with nausea and vomiting.The primary care NP suspects anemia and orders a complete blood count.The patient's hemoglobin is elevated.The NP correctly concludes that the patient is not anemic.The NP has made an error in:

A) context formulation.

B) inappropriate knowledge base.

C) cost-versus-benefit analysis.

D) hypothesis triggering and information processing.

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Chapter 12: Design and Implementation of Patient Education

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Sample Questions

Q1) A patient who has recently developed prediabetic symptoms is overweight and has a sedentary lifestyle.The primary care NP has prescribed an oral antidiabetic agent.The patient says,"I suppose I'll need insulin like my mother and grandfather did." To educate this patient about managing this disease,the NP should initially:

A) determine how the patient feels about using insulin.

B) provide written educational materials about diet and exercise.

C) compare the actions of oral antidiabetic agents with insulin injections. D) tell the patient that the medication plus exercise may prevent the need for insulin.

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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14

Chapter 13: Dermatologic Agents

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Sample Questions

Q1) 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.

Q2) 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.

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15

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

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7 Verified Questions

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Sample Questions

Q1) A primary care NP examines a patient who complains of chronic,intermittent watery eyes and runny nose.The NP notes cobblestone-like papillae inside the upper eyelid with nonerythematous conjunctivae.The NP should:

A) prescribe intranasal corticosteroids.

B) refer the patient to an ophthalmologist.

C) prescribe trifluridine ophthalmic eye drops.

D) apply fluorescein dye to examine the cornea.

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 sees a patient who reports persistent seasonal symptoms of rhinorrhea,sneezing,and nasal itching every spring unrelieved with diphenhydramine (Benadryl).The NP should prescribe:

A) azelastine (Astelin).

B) triamcinolone (Nasacort AQ).

C) phenylephrine (Neo-Synephrine).

D) cromolyn sodium (Nasalcrom).

Q2) A parent asks an NP which over-the-counter medication would be best to give to a 5-year-old child who has a viral respiratory illness with nasal congestion and a cough.The NP should recommend which of the following?

A) Diphenhydramine (Benadryl)

B) Increased fluids with a teaspoon of honey

C) Over-the-counter pseudoephedrine with guaifenesin (Sudafed)

D) An antitussive/expectorant combination such as Robitussin DM

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Chapter 16: Asthma and Chronic Obstructive Pulmonary

Disease Medications

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Sample Questions

Q1) A primary care NP sees a child with asthma to evaluate the child's response to the prescribed therapy.The child uses an ICS twice daily and an albuterol metered-dose inhaler as needed.The child's symptoms are well controlled.The NP notes slowing of the child's linear growth on a standardized growth chart.The NP should change this child's medication regimen to a:

A) combination ICS/LABA inhaler twice daily.

B) short-acting b2-agonist (SABA) with oral corticosteroids when symptomatic.

C) combination ipratropium/albuterol inhaler twice daily.

D) SABA as needed plus a leukotriene modifier once daily.

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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Page 18

Chapter 17: Hypertension and Miscellaneous

Antihypertensive Medications

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Sample Questions

Q1) 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.

Q2) The primary care nurse practitioner (NP)sees a patient in the clinic who has a blood pressure of 130/85 mm Hg.The patient's laboratory tests reveal high-density lipoprotein,35 mg/dL; triglycerides,120 mg/dL; and fasting plasma glucose,100 mg/dL.The NP calculates a body mass index of 29.The patient has a positive family history for cardiovascular disease.The NP should:

A) prescribe a thiazide diuretic.

B) consider treatment with an angiotensin-converting enzyme inhibitor.

C) reassure the patient that these findings are normal.

D) counsel the patient about dietary and lifestyle changes.

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Chapter 18: Coronary Artery Disease and Antianginal Medications

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Sample Questions

Q1) 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.

Q2) 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.

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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 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.

Q2) 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

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22

Chapter 21: Calcium Channel Blockers

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Sample Questions

Q1) A patient who takes a calcium channel blocker is in the clinic for an annual physical examination.The cardiovascular examination is normal.As part of routine monitoring for this patient,the primary care NP should evaluate:

A) serum calcium channel blocker level.

B) complete blood count and electrolytes.

C) liver function tests (LFTs) and renal function.

D) thyroid and insulin levels.

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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23

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) A patient who takes an ACE inhibitor and a thiazide diuretic for hypertension will begin taking spironolactone.The primary care NP should counsel this patient to:

A) avoid foods that are high in potassium.

B) use a salt substitute when seasoning foods.

C) discuss changing the ACE inhibitor to an ARB with the cardiologist.

D) avoid taking antacids containing magnesium while taking these drugs.

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Chapter 23: Antiarrhythmic Agents

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Q1) 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.

Q2) A patient who is taking trimethoprim-sulfamethoxazole for prophylaxis of urinary tract infections tells the primary care NP that a sibling recently died from a sudden cardiac arrest,determined to be from long QT syndrome.The NP should:

A) schedule a treadmill stress test.

B) order genetic testing for this patient.

C) discontinue the trimethoprim-sulfamethoxazole.

D) refer the patient to a cardiologist for further evaluation.

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25

Chapter 24: Antihyperlipidemic Agents

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Sample Questions

Q1) A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor.All of the patient's baseline LFTs were normal.At a 6-month follow-up visit,the patient reports occasional headache.A lipid profile reveals a decrease of 20% in the patient's LDL cholesterol.The NP should:

A) order LFTs.

B) order CK-MM tests.

C) consider decreasing the dose of the medication.

D) reassure the patient that this side effect is common.

Q2) A patient who has diabetes is taking simvastatin (Zocor)80 mg daily to treat LDL cholesterol level of 170 mg/dL.The patient has a body mass index of 29.At a follow-up visit,the patient's LDL level is 120 mg/dL.The primary care NP should consider:

A) increasing the simvastatin to 80 mg twice daily.

B) adding nicotinic acid to the patient's drug regimen.

C) changing the medication to ezetimibe/simvastatin (Vytorin).

D) referring the patient to a dietitian for assistance with weight reduction.

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Chapter 25: Agents that Act on Blood

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Sample Questions

Q1) A patient who has had a new onset of AF the day prior will undergo cardioversion that day.The primary care NP will expect the cardiologist to:

A) give clopidogrel after administering cardioversion.

B) administer cardioversion without using anticoagulants.

C) give warfarin and aspirin before attempting cardioversion.

D) give low-dose aspirin before administering cardioversion.

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

Q3) A patient who is obese is preparing to have surgery.To help prevent venous thromboembolism (VTE),the primary care NP should prescribe:

A) low-dose aspirin once daily.

B) clopidogrel (Plavix) 75 mg once daily.

C) enoxaparin (Lovenox) 30 mg twice daily.

D) warfarin (Coumadin) titrated to achieve an INR of 3.5.

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Page 27

Chapter 26: Antacids and the Management of GERD

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Sample Questions

Q1) A patient is taking a low-dose PPI for long-term management of GERD and reports taking sodium bicarbonate (Alka-Seltzer)to help with occasional heartburn.The primary care NP should tell the patient to:

A) change to aluminum hydroxide (Amphojel).

B) use magnesium hydroxide (Milk of Magnesia) instead.

C) continue using sodium bicarbonate (Alka-Seltzer) as needed.

D) take calcium carbonate (Tums) instead of sodium bicarbonate (Alka-Seltzer).

Q2) A patient undergoes endoscopy,and a diagnosis of erosive esophagitis is made.The patient does not have health insurance and asks the primary care NP about using OTC antacids such as Tums.The NP should tell the patient that Tums:

A) can help to heal erosions in esophageal tissue.

B) do not help reduce symptoms of erosive esophagitis.

C) neutralize stomach acid as well as proton pump inhibitors (PPIs).

D) help reduce symptoms in conjunction with PPIs.

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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 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.

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Chapter 28: Laxatives

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Q1) A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation.The patient reports having an increased frequency of episodes.The primary care NP should recommend:

A) adding docusate sodium (Colace).

B) polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax).

C) lactulose (Chronulac) and polyethylene glycol (MiraLAX).

D) adding nonpharmacologic measures such as biofeedback.

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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Q1) A 2-year-old child has chronic "toddler's" diarrhea,which has an unknown but benign etiology.The child's parent asks the primary care NP if a medication can be used to treat the child's symptoms.The NP should recommend giving:

A) diphenoxylate (Lomotil).

B) attapulgite (Kaopectate).

C) an electrolyte solution (Pedialyte).

D) bismuth subsalicylate (Pepto-Bismol).

Q2) 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.

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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 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 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).

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Page 33

Chapter 32: Diuretics

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Q1) The primary care NP sees a patient who has heart failure following an MI 6 months before this visit.The patient has been taking an ACE inhibitor,nitroglycerin,furosemide,and hydrochlorothiazide.The NP auscultates crackles in both lungs and notes pitting edema of both feet.The NP should prescribe:

A) mannitol.

B) metolazone.

C) acetazolamide (Diamox).

D) spironolactone (Aldactone).

Q2) A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet.The primary care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg.The NP should:

A) obtain a serum drug level.

B) order an electrocardiogram (ECG) and serum electrolytes.

C) change the medication to a thiazide diuretic.

D) question the patient about potassium intake.

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Chapter 33: Male Genitourinary Agents

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Q1) A man who has benign prostatic hypertrophy (BPH),in whom prostate carcinoma has been ruled out,asks the primary care nurse practitioner (NP)about beginning drug therapy to treat his symptoms.The NP notes that he consistently has blood pressure readings around 145/90 mm Hg.The NP should prescribe:

A) tadalafil (Cialis).

B) doxazosin (Cardura).

C) tamsulosin (Flomax).

D) finasteride (Proscar).

Q2) A patient who has BPH is taking tamsulosin and dutasteride and asks the primary care NP why he needs to take both medications.The NP should tell him:

A) the combination helps reduce the risk of prostate carcinoma.

B) two-drug therapy is required before corrective prostatectomy surgery.

C) both drugs are given so that smaller doses of each drug may be administered. D) one gives faster symptom relief, whereas the other shrinks the size of the prostate.

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Chapter 34: Drugs for Urinary Incontinence and Urinary Analgesia

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Sample Questions

Q1) 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).

Q2) A serious side effect associated with desmopressin is:

A) dehydration.

B) hypotension.

C) hyponatremia.

D) urinary retention.

Q3) A parent brings an 8-year-old child to the clinic because the child continues to wet the bed despite using cognitive-behavioral measures and a bed alarm system.The NP should prescribe:

A) solifenacin (VESIcare).

B) tolterodine (Detrol LA).

C) desmopressin (DDAVP).

D) phenazopyridine (Pyridium).

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Chapter 35: Acetaminophen

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Sample Questions

Q1) A parent asks a primary care NP how much acetaminophen to give a 2-year-old child who has a temperature of 37.5° C.The NP should tell the parent that:

A) acetaminophen is not safe in children younger than 6 years.

B) acetaminophen may mask a fever and prevent treatment of other symptoms.

C) antipyretics are usually not necessary for temperatures less than 37.7° C.

D) antipyretics should be given to prevent seizures, but nonsteroidal antiinflammatory drugs are a better choice.

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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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 osteoarthritis is scheduled to have knee surgery.The patient takes aspirin for MI prophylaxis and naproxen (Naprosyn)for pain and inflammation.Which statement by the patient to the primary care NP indicates a need for further teaching?

A) "I should stop taking aspirin at least 5 days before surgery."

B) "I will check with the surgeon to see if I need to stop taking the naproxen."

C) "I will need to stop taking both medications 1 week before I have surgery."

D) "Both of these medications interfere with platelet production and may cause blood clots."

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Chapter 37: Disease-Modifying Antirheumatic Drugs and Immune Modulators

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Q1) A patient has recent weight loss,fatigue,and recurrent low-grade fever along with pain and stiffness of knees and hands.The primary care nurse practitioner (NP)notes symmetric joint swelling and warmth of these joints.The NP should:

A) refer the patient to a specialist.

B) order erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and antinuclear antibody (ANA) tests.

C) begin therapy with methotrexate.

D) order x-rays of the affected joints.

Q2) 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.

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Page 39

Chapter 38: Gout Medications

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Sample Questions

Q1) 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).

Q2) A patient who has a previous history of renal stones will begin taking probenecid for gout.The primary care NP should:

A) add colchicine to the patient's drug regimen.

B) counsel the patient to use high-dose aspirin for pain.

C) teach the patient to drink plenty of acidic fluids such as juice.

D) tell the patient to stop taking the medication when symptoms subside.

Q3) 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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Page 40

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 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.

Q2) A patient comes to the clinic complaining of low back pain unrelieved by NSAIDs.The patient has a history of angle-closure glaucoma and renal disease.The primary care NP should prescribe:

A) tizanidine (Zanaflex).

B) metaxalone (Skelaxin).

C) acetaminophen (Tylenol).

D) cyclobenzaprine (Flexeril).

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Chapter 41: Medications for Attention Deficit/Hyperactivity Disorder

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Q1) An adult patient reports feeling unfocused all the time,loses things,and has difficulty completing tasks and says that this is interfering with family relations and work.The symptoms have been present as long as the patient can remember,although there is no previous documentation of attention-deficit/hyperactivity disorder (AD/HD)in this patient's medical history.The primary care nurse practitioner (NP)should:

A) tell the patient that a diagnosis of AD/HD as a child is a prerequisite for diagnosing this in adults.

B) conduct a thorough evaluation to document behaviors associated with AD/HD and begin treatment if indicated.

C) suggest that the patient may have a major depressive disorder and refer the patient for psychiatric evaluation and treatment.

D) prescribe a methylphenidate trial, ask the patient to keep a diary of behaviors and feelings, and reevaluate in 1 to 2 months.

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Chapter 42: Medications for Dementia

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Q1) 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.

Q2) A patient is identified as having stage 2 Alzheimer's disease and elects to take donepezil (Aricept).The patient asks the primary care nurse practitioner (NP)how long the medication will be needed.The NP should tell the patient that donepezil must be taken:

A) until symptoms improve.

B) indefinitely because it is not curative.

C) for 24 weeks, which is when cognitive function improves in most patients.

D) until symptoms worsen, when a switch to memantine (Namenda) will be needed.

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44

Chapter 43: Analgesia and Pain Management

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Sample Questions

Q1) A patient is diagnosed with a condition that causes chronic pain.The primary care NP prescribes an opioid analgesic and should instruct the patient to:

A) wait until the pain is at a moderate level before taking the medication.

B) take the medication at regular intervals and not just when pain is present.

C) start the medication at higher doses initially and taper down gradually.

D) take the minimum amount needed even when pain is severe to avoid dependency.

Q2) 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.

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Chapter 44: Migraine Medications

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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 patient who is taking phenytoin (Dilantin)for a newly diagnosed seizure disorder calls the primary care NP to report a rash.The NP should:

A) order a phenytoin level.

B) reassure the patient that this is a self-limiting adverse effect.

C) recommend that the patient take diphenhydramine to treat this side effect.

D) tell the patient to stop taking the phenytoin and contact the neurologist immediately.

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 who takes levodopa and carbidopa reports having drooling episodes that are increasing in frequency.The primary care NP should order:

A) benztropine.

B) amantadine.

C) apomorphine.

D) modified-release levodopa.

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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) An 80-year-old patient experiences prolonged sadness after the death of a spouse.The patient reports being unable to sleep or eat.The primary care NP should prescribe _____ mg _____ daily.

A) trazodone 50; three times

B) trazodone 100; three times

C) mirtazapine 15; at bedtime

D) mirtazapine 30; at bedtime

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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 comes to the clinic and reports having insomnia that began within the last year.The primary care nurse practitioner (NP)learns that the patient often lies awake worrying about problems at work.The patient feels fatigued during the day and experiences frequent stomach discomfort.The NP should prescribe:

A) buspirone.

B) melatonin.

C) alprazolam.

D) diphenhydramine.

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Chapter 49: Antipsychotics

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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 with a recent diagnosis of schizophrenia is taking thioridazine (Mellaril)to treat psychotic symptoms.The patient's family member is concerned that the patient continues to have little interest in activities and has difficulty beginning even simple tasks.The primary care NP should contact the patient's psychiatrist to discuss changing to:

A) fluphenazine (Prolixin).

B) risperidone (Risperdal).

C) chlorpromazine (Thorazine).

D) prochlorperazine (Compazine).

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Chapter 50: Substance Abuse

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Q1) 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.

Q2) A patient who is an alcoholic is seen in the clinic,and the primary care NP admits the patient to the hospital for acute withdrawal.The patient has elevated liver enzymes.The NP should expect the inpatient provider to prescribe:

A) lorazepam (Ativan).

B) diazepam (Valium).

C) acamprosate (Campral).

D) chlordiazepoxide (Librium).

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Chapter 51: Glucocorticoids

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Q1) A patient is being tapered from long-term therapy with prednisolone and reports weight loss and fatigue.The primary care NP should counsel this patient to:

A) consume foods high in vitamin D and calcium.

B) begin taking dexamethasone because it has longer effects.

C) expect these side effects to occur as the medication is tapered.

D) increase the dose of prednisolone to the most recent amount taken.

Q2) 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.

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Chapter 52: Thyroid Medications

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Q1) A patient who has hypothyroidism has been taking levothyroxine 50 mcg daily for 2 weeks.The patient reports continued fatigue.The primary care NP should:

A) order a T₄ level today.

B) increase the dose to 100 mcg.

C) check the TSH level in 1 week.

D) reassure the patient that this will improve in several weeks.

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.

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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Chapter 53: Diabetes Mellitus Agents

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Q1) 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).

Q2) 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).

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55

Chapter 54: Contraceptives

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Sample Questions

Q1) 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.

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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Chapter 55: Hormone Replacement Therapy

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12 Flashcards

Source URL: https://quizplus.com/quiz/19031

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 perimenopausal woman tells the primary care NP that she is having hot flashes and increasingly severe mood swings.The woman has had a hysterectomy.The NP should prescribe:

A) estrogen-only HT.

B) low-dose oral contraceptive therapy.

C) selective serotonin reuptake inhibitor therapy until menopause begins.

D) estrogen-progesterone HT.

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Chapter 56: Drugs for Breast Cancer

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Source URL: https://quizplus.com/quiz/19032

Sample Questions

Q1) 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).

Q2) A woman who is being treated with radiotherapy for breast cancer asks her primary care nurse practitioner (NP)about using dietary supplements to improve her chance of recovery.The NP should tell her that:

A) vitamin E is not harmful but has not been shown to change outcomes.

B) no supplements have been shown to alter outcomes or response to therapy.

C) folic acid and other B vitamins may improve ability to tolerate chemotherapy.

D) vitamin C, taken at least 6 days per week, may lower her risk of cancer recurrence.

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Chapter 57: Principles for Prescribing Antiinfectives

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Source URL: https://quizplus.com/quiz/19033

Sample Questions

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 comes to the clinic with a history of fever of 102° F for several days,poor appetite,and cough.A sputum culture is pending,but Gram stain indicates a bacterial infection.The primary care nurse practitioner (NP)should:

A) begin empirical antibiotic therapy.

B) use a broad-spectrum antibiotic for initial treatment.

C) prescribe an antibiotic when culture and sensitivity results are known.

D) offer symptomatic treatment only unless the patient's condition worsens.

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Chapter 58: Treatment of Specific Infections and Miscellaneous Antibiotics

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Source URL: https://quizplus.com/quiz/19034

Sample Questions

Q1) 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).

Q2) 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.

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Chapter 59: Penicillins

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Source URL: https://quizplus.com/quiz/19035

Sample Questions

Q1) A patient with otitis media is treated for 10 days with amoxicillin.At the follow-up visit,the primary care NP notes bilateral erythematous,bulging tympanic membranes.The NP should prescribe:

A) intramuscular injection of penicillin G (Bicillin).

B) amoxicillin for 10 more days.

C) oral dicloxacillin (Dynapen) for 10 days.

D) oral amoxicillin-clavulanate (Augmentin) for 10 days.

Q2) A patient with group A b-hemolytic streptococcal pharyngitis is treated with penicillin V.At a follow-up visit 2 weeks later,the patient presents with edema of the hands and feet,blood pressure of 140/85 mm Hg,and cola-colored urine.A urine dipstick shows proteinuria.The primary care NP should:

A) perform a repeat throat culture.

B) prescribe 10 more days of penicillin V.

C) obtain an ASO titer and creatinine clearance.

D) order oral amoxicillin-clavulanate for 14 days.

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Chapter 60: Cephalosporins

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Source URL: https://quizplus.com/quiz/19036

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 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.

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Chapter 61: Tetracyclines

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Source URL: https://quizplus.com/quiz/19037

Sample Questions

Q1) 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.

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

A) minocycline.

B) doxycycline.

C) tetracycline.

D) demeclocycline.

Q3) 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.

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Chapter 62: Macrolides

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Source URL: https://quizplus.com/quiz/19038

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) A primary care nurse practitioner (NP)is prescribing once-daily azithromycin to a 25-year-old woman.When teaching her about the drug,the NP should tell her to:

A) take the medication on an empty stomach.

B) use a backup contraception method other than oral contraceptive pills.

C) expect severe gastrointestinal side effects while taking this drug.

D) cut the pill in half and take twice daily if side effects are severe.

Q3) Which antibiotic requires administration of a loading dose?

A) Ilosone

B) E-Mycin

C) Erythrocin

D) Zithromax

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64

Chapter 63: Fluoroquinolones

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7 Verified Questions

7 Flashcards

Source URL: https://quizplus.com/quiz/19039

Sample Questions

Q1) A patient who is taking a fluoroquinolone antibiotic for pyelonephritis develops Clostridium difficile-associated disease (CDAD).The primary care NP should treat for C.difficile and _____ fluoroquinolone.

A) continue the B) discontinue the C) increase the dose of D) decrease the dose of

Q2) 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."

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Chapter 64: Aminoglycosides

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Source URL: https://quizplus.com/quiz/19040

Sample Questions

Q1) 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.

Q2) A patient who was recently hospitalized and treated with gentamicin tells the primary care NP,"My kidney function test was abnormal and they stopped the medication." The patient is worried about long-term effects.The NP should:

A) monitor renal function for several months.

B) reassure the patient that complete recovery should occur.

C) refer the patient to a nephrologist for follow-up evaluation.

D) monitor serum electrolytes and serum creatinine and BUN.

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Chapter 65: Sulfonamides

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Source URL: https://quizplus.com/quiz/19041

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 taking sulfisoxazole.The patient calls the primary care NP to report abdominal pain,nausea,and insomnia.The NP should:

A) change to TMP/SMX.

B) tell the patient to stop taking the drug immediately.

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

D) order a CBC with differential, platelets, and a stool culture.

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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Page 67

Chapter 66: Antitubercular Agents

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Source URL: https://quizplus.com/quiz/19042

Sample Questions

Q1) A patient has a Mantoux tuberculin skin test with a 12-mm area of induration.The patient has a cough,and a chest radiograph is positive.The primary care NP should refer this patient to an infectious disease specialist and should plan to monitor a regimen of:

A) isoniazid for 6 months.

B) isoniazid and rifapentine.

C) isoniazid, rifapentine, and ethambutol.

D) isoniazid, rifampin, pyrazinamide, and ethambutol.

Q2) 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.

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68

Chapter 67: Antifungals

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Source URL: https://quizplus.com/quiz/19043

Sample Questions

Q1) 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.

Q2) 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.

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Chapter 68: Antiretroviral Medications

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6 Verified Questions

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Source URL: https://quizplus.com/quiz/19044

Sample Questions

Q1) A primary care NP provides primary care for a woman who has HIV.The woman asks the NP if she will ever be able to have children.The NP should tell her:

A) none of the antiretroviral medications are safe to take during pregnancy.

B) she will need to take medications throughout her pregnancy and lactation.

C) there is no risk of disease transmission to a fetus if she complies with therapy.

D) strict adherence to antiretroviral therapy decreases her risk of transmitting HIV to the fetus.

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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Source URL: https://quizplus.com/quiz/19045

Sample Questions

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 has genital herpes has frequent outbreaks.The patient asks the primary care NP why it is necessary to take oral acyclovir all the time and not just for acute outbreaks.The NP should explain that oral acyclovir may:

A) prevent the virus from developing resistance.

B) cause episodes to be shorter and less frequent.

C) actually eradicate the virus and cure the disease.

D) reduce the chance of transmitting the virus to others.

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Chapter 70: The Immune System and Immunizations

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Source URL: https://quizplus.com/quiz/19046

Sample Questions

Q1) The primary care NP sees a 4-year-old child who has persistent asthma episodes for a well-child visit in October.The child recently completed a 7-day course of oral steroids.The NP plans to give the child flu vaccine and should:

A) administer LAIV today.

B) administer 0.5 mg TIV today.

C) wait 4 weeks and administer LAIV.

D) wait 4 weeks and administer 0.5 mg TIV.

Q2) A patient receives a hepatitis A vaccine and 4 weeks later develops symptoms of hepatitis.The patient has no history of exposure to blood or body fluids.The primary care NP should tell the patient that:

A) the symptoms are most likely caused by hepatitis B or C.

B) these symptoms are common adverse effects of the vaccine.

C) a prevaccine exposure to hepatitis A could be causing symptoms.

D) the vaccine is effective only after the second dose of hepatitis A vaccine.

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Chapter 71: Weight Management

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Source URL: https://quizplus.com/quiz/19047

Sample Questions

Q1) A patient who has hypothyroidism and is obese begins therapy with orlistat.The primary care NP teaches the patient about this drug and then asks the patient to describe its use.Which statement by the patient indicates understanding of the teaching?

A) "I may eat a high-fat diet while taking orlistat."

B) "I can expect the most benefit in the first few months."

C) "I should take fat-soluble vitamins each time I take orlistat."

D) "I should take an increased dose of levothyroxine while I am taking orlistat."

Q2) A patient has a BMI of 35,a fasting plasma glucose of 120 mg/dL,elevated triglycerides,and a history of myocardial infarction.The primary care NP plans to initiate dietary and lifestyle counseling and should consider prescribing:

A) ephedra.

B) orlistat (Xenical).

C) phentermine (Adipex-P).

D) phentermine and topiramate (Onexa).

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Chapter 72: Smoking Cessation

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Source URL: https://quizplus.com/quiz/19048

Sample Questions

Q1) 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).

Q2) 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.

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Chapter 73: Vitamins and Minerals

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Source URL: https://quizplus.com/quiz/19049

Sample Questions

Q1) 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.

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.

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