Question

Question 1

2 / 2 pts

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:

flavoxate (Urispas).

bethanechol (Urecholine).

phenazopyridine (Pyridium).

oxybutynin chloride (Ditropan XL).

Question 2

2 / 2 pts

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:

zaleplon.

ZolpiMist.

ramelteon.

chloral hydrate.

Question 3

2 / 2 pts

A 5-year-old child who has no previous history of otitis media is seen in clinic with a temperature of 100° F. The primary care NP visualizes bilateral erythematous, nonbulging, intact tympanic membranes. The child is taking fluids well and is playing with toys in the examination room.The NP should:

prescribe azithromycin once daily for 5 days.

prescribe amoxicillin twice daily for 10 days.

prescribe amoxicillin-clavulanate twice daily for 10 days.

initiate antibiotic therapy if the child’s condition worsens.

Question 4

2 / 2 pts

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:

recommend acetaminophen.

recommend high-dose acetaminophen.

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

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

Question 5

2 / 2 pts

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

selegiline.

amantadine.

apomorphine.

modified-release levodopa.

Question 6

2 / 2 pts

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:

consume foods high in vitamin D and calcium.

begin taking dexamethasone because it has longer effects.

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

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

Question 7

2 / 2 pts

The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should:

perform a dipstick urinalysis.

prescribe desmopressin (DDAVP).

prescribe oxybutynin chloride (Ditropan XL).

teach exercises to strengthen the pelvic muscles.

Question 8

2 / 2 pts

A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the primary care NP notes a decrease in the child’s linear growth rate. The NP should consult the child’s asthma specialist about:

gradually tapering the child off the prednisone.

a referral for possible growth hormone therapy.

giving a double dose of prednisone every other day.

dividing the prednisone dose into twice-daily dosing.

Question 9

2 / 2 pts

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:

ask about alcohol intake.

suggest taking the medications with food.

reassure the patient that these side effects are common.

order liver and renal function tests and serum glucose.

Question 10

2 / 2 pts

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:

combination ICS/LABA inhaler twice daily.

short-acting 2-agonist (SABA) with oral corticosteroids when symptomatic.

combination ipratropium/albuterol inhaler twice daily.

SABA as needed plus a leukotriene modifier once daily.

Question 11

2 / 2 pts

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

donepezil (Aricept).

rivastigmine (Exelon).

memantine (Namenda).

galantamine (Razadyne).

Question 12

2 / 2 pts

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:

administer all of these vaccines today.

give the hepatitis A and influenza vaccines.

give the Varivax, hepatitis A, and influenza vaccines.

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

Question 13

2 / 2 pts

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:

order renal function tests.

prescribe another medication to treat this child’s symptoms.

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

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

Question 14

2 / 2 pts

An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65-year-old patient with recent onset of reactive airways disease who reports symptoms occurring every 1 or 2 weeks. At a follow-up appointment several months later, the patient reports no change in frequency of symptoms. The NP’s initial action should be to:

order spirometry to evaluate pulmonary function.

prescribe a systemic corticosteroid to help with symptoms.

ask the patient to describe how the medications are taken each day.

give the patient detailed information about the use of metered-dose inhalers.

Question 15

2 / 2 pts

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:

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

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

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

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

Question 16

2 / 2 pts

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

prescribe sildenafil (Viagra).

perform a medication history.

evaluate his cardiovascular status.

order a papaverine injection test to screen for erectile dysfunction.

Question 17

2 / 2 pts

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:

levodopa.

carbidopa.

pramipexole.

carbidopa/levodopa.

Question 18

2 / 2 pts

A patient who has migraine headaches without an aura reports difficulty treating the migraines in time because they come on so suddenly. The patient has been using over-the-counter NSAIDs. The primary care NP should prescribe:

frovatriptan (Frova).

sumatriptan (Imitrex).

cyproheptadine (Periactin).

dihydroergotamine (D.H.E. 45).

Question 19

2 / 2 pts

A woman tells a primary care NP that she is considering getting pregnant. During a health history, the NP learns that the patient has seasonal allergies, asthma, and epilepsy, all of which are well controlled with a second-generation antihistamine daily, an inhaled steroid daily with albuterol as needed, and an antiepileptic medication daily. The NP should counsel this patient to:

take her asthma medications only when she is having an acute exacerbation.

avoid using antihistamine medications during her first trimester of pregnancy.

discontinue her seizure medications at least 6 months before becoming pregnant.

use only oral corticosteroids and not inhaled steroids while pregnant for improved asthma control.

Question 20

2 / 2 pts

A patient who has partial seizures has been taking phenytoin (Dilantin). The patient has recently developed thrombocytopenia. The primary care nurse practitioner (NP) should contact the patient’s neurologist to discuss changing the patient’s medication to:

topiramate (Topamax).

levetiracetam (Keppra).

zonisamide (Zonegran).

carbamazepine (Tegretol).

Question 21

2 / 2 pts

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:

change the medication to a cephalosporin.

decrease the dose to 250 mg every 6 hours.

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

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

Question 22

2 / 2 pts

A 75-year-old patient who lives alone will begin taking a narcotic analgesic for pain. To help ensure patient safety, the NP prescribing this medication should:

assess this patient’s usual sleeping patterns.

ask the patient about problems with constipation.

obtain a baseline creatinine clearance test before the first dose.

perform a thorough evaluation of cognitive and motor abilities.

Question 23

2 / 2 pts

A patient has been taking intramuscular (IM) meperidine 75 mg every 6 hours for 3 days after surgery. When the patient is discharged from the hospital, the primary care NP should expect the patient to receive a prescription for _____ mg orally every _____ hours.

hydrocodone 30; 6

hydrocodone 75; 6

meperidine 300;12

meperidine 75; 6

Question 24

2 / 2 pts

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

prescribe colchicine.

prescribe febuxostat.

tell the patient to use an NSAID if symptoms recur.

counsel the patient to report recurrence of symptoms.

Question 25

2 / 2 pts

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:

admit him to the hospital for detoxification.

ask him how much he had to drink last night.

prescribe lorazepam (Ativan) to help with symptoms.

suggest that he talk to a counselor about alcohol abuse.

Question 26

2 / 2 pts

A primary care NP sees a patient who has fever, flank pain, and dysuria. The patient has a history of recurrent urinary tract infections (UTIs) and completed a course of trimethoprim-sulfamethoxazole (TMP/SMX) the week before. A urine test is positive for leukocyte esterase. The NP sends the urine for culture and should treat this patient empirically with:

gemifloxacin.

ciprofloxacin.

azithromycin.

TMP/SMX.

Question 27

2 / 2 pts

A patient who takes carbamazepine (Tegretol) has been seizure-free for 2 years and asks the primary care NP about stopping the medication. The NP should:

order an electroencephalogram (EEG).

prescribe a tapering regimen of the drug.

inform the patient that antiepileptic drug (AED) therapy is lifelong.

tell the patient to stop the drug and use only as needed.

Question 28

2 / 2 pts

A primary care NP has been working with a young woman who wants to quit smoking before she begins having children. She has made several attempts to quit using nicotine replacement therapy and is feeling discouraged. She does not want to take medication at this time. The NP should:

discuss the effects of smoking on fetal development.

ask her to write down any factors that triggered her relapses.

give her information about the long-term effects of smoking.

convince her that taking medication will be essential in her case.

Question 29

2 / 2 pts

A primary care NP prescribes a nonselective NSAID for a patient who has osteoarthritis. The patient expresses concerns about possible side effects of this medication. When counseling the patient about the medication, the NP should tell this patient:

to avoid taking antacids while taking the NSAID.

to take each dose of the NSAID with a full glass of water.

that a few glasses of wine each day are allowed while taking the NSAID.

to decrease the dose of the NSAID if GI symptoms occur.

Question 30

2 / 2 pts

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:

methotrexate.

corticosteroids.

opioid analgesics.

hydroxychloroquine.

Question 31

2 / 2 pts

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:

dependence.

drug addiction.

possible misuse.

increasing pain.

Question 32

2 / 2 pts

An elderly patient with dementia exhibits hostility and uncooperativeness. The primary care NP prescribes clozapine (Clozaril) and should counsel the family about:

a decreased risk of extrapyramidal symptoms.

improved cognitive function.

the need for long-term use of the medication.

a possible increased risk of heart disease and stroke.

Question 33

2 / 2 pts

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:

are more likely to be toxic.

cause serious adverse effects.

carry more risk for serious allergic reactions.

must be given intramuscularly or intravenously.

Question 34

2 / 2 pts

A woman who is pregnant tells an NP that she has been taking sertraline for depression for several years but is worried about the effects of this drug on her fetus. The NP will consult with this patient’s psychiatrist and will recommend that she:

stop taking the sertraline now.

continue taking the antidepressant.

change to a monoamine oxidase inhibitor (MAOI).

discontinue the sertraline a week before delivery.

Question 35

2 / 2 pts

A patient who has HIV is being treated with Emtriva. The patient develops hepatitis B. The primary care NP should contact the patient’s infectious disease specialist to discuss:

adding zidovudine.

changing to Truvada.

changing to tenofovir.

ordering Combivir and tenofovir.

Question 36

2 / 2 pts

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:

suggest ice and rest.

order physical therapy.

prescribe diazepam (Valium).

add an opioid analgesic medication.

Question 37

2 / 2 pts

A primary care NP sees a patient who has dysuria, fever, and urinary frequency. The NP orders a urine dipstick, which is positive for nitrates and leukocyte esterase, and sends the urine to the laboratory for a culture. The patient is allergic to sulfa drugs. The NP should:

order cefaclor (Ceclor).

prescribe cefixime (Suprax).

administer intramuscular ceftriaxone (Rocephin).

wait for culture results before ordering an antibiotic.

Question 38

2 / 2 pts

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

prescribe TMP-SMX.

prescribe topical mupirocin four times daily.

suggest that the patient apply warm soaks three times daily.

refer the patient to the surgeon for further evaluation.

Question 39

2 / 2 pts

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:

prevent the virus from developing resistance.

cause episodes to be shorter and less frequent.

actually eradicate the virus and cure the disease.

reduce the chance of transmitting the virus to others.

Question 40

2 / 2 pts

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

serum glucose and liver function tests (LFTs).

bone marrow density and ophthalmologic tests.

ophthalmologic, hearing, and serum glucose tests.

color vision, serum glucose, and LFTs.

Question 41

2 / 2 pts

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 serial audiometric test.

a serum blood urea nitrogen (BUN) and creatinine.

a urinalysis and complete blood count.

serum calcium, magnesium, and sodium.

Question 42

2 / 2 pts

A 40-year-old woman asks the primary care NP what she can do to minimize her risk of osteoporosis. She takes 800 mg of calcium and drinks 2 cups of skim milk each day. The NP should recommend that she:

decrease dietary fat.

limit her caffeine intake.

consume a high-protein diet.

drink diet instead of sugary sodas.

Question 43

2 / 2 pts

A patient has a sore throat with fever. The primary care NP observes erythematous 4+ tonsils with white exudate. A rapid antigen strep test is negative, and a culture is pending. The NP orders amoxicillin as empiric treatment. The patient calls the next day to report a rash. The NP should suspect:

penicillin drug allergy.

a viral cause for the patient’s symptoms.

a serum sickness reaction to the penicillin.

scarlatiniform rash from the streptococcal infection.

Question 44

2 / 2 pts

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

change to TMP/SMX.

tell the patient to stop taking the drug immediately.

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

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

Question 45

2 / 2 pts

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?

Alprazolam

Buspirone

Melatonin

Zolpidem

Question 46

2 / 2 pts

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:

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

that she may consume alcohol while taking this medication.

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

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

Question 47

2 / 2 pts

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:

expect the patient to sustain permanent liver damage.

reassure the patient that these symptoms are reversible.

tell the patient that acetylcysteine cannot be given this late.

administer activated charcoal to remove acetaminophen from the body.

Question 48

2 / 2 pts

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:

discontinue the medication.

order serum drug levels to evaluate toxicity.

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

ask the parent about the drug’s use and side effects.

Question 49

2 / 2 pts

A patient who has Parkinson’s disease who takes levodopa and carbidopa reports having drooling episodes that are increasing in frequency. The primary care NP should order:

benztropine.

amantadine.

apomorphine.

modified-release levodopa.

Question 50

2 / 2 pts

The primary care NP sees a 6-month-old infant for a routine physical examination and notes that the infant has a runny nose and a cough. The parents report a 2-day history of a temperature of 99° F to 100° F and two to three loose stools per day. Other family members have similar symptoms. The infant has had two sets of immunizations at 2 and 4 months of age. The NP should:

administer the 6-month immunizations at this visit today.

schedule an appointment in 2 weeks for 6-month immunizations.

administer DTaP, Hib, IPV, hepatitis B, and PCV13 today and RV in 2 weeks.

withhold all immunizations until the infant’s temperature returns to normal and the cough is gone.

Question 51

2 / 2 pts

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:

monitor renal function for several months.

reassure the patient that complete recovery should occur.

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

monitor serum electrolytes and serum creatinine and BUN.

Question 52

2 / 2 pts

A patient has begun treatment for HIV. The primary care NP should monitor the patient’s complete blood count (CBC) at least every _____ months.

1 to 3

3 to 6

6 to 9

9 to 12

Question 53

2 / 2 pts

A patient who was recently diagnosed with COPD comes to the clinic for a follow-up evaluation after beginning therapy with a SABA as needed for dyspnea. The patient reports occasional mild exertional dyspnea but is able to sleep well. The patient’s FEV1 in the clinic is 85% of predicted, and oxygen saturation is 96%. The primary care NP should recommend:

a combination LABA/ICS twice daily.

influenza and pneumococcal vaccines.

ipratropium bromide (Atrovent) twice daily.

home oxygen therapy as needed for dyspnea.

Question 54

2 / 2 pts

A patient who takes 150 mg of clozapine (Clozaril) twice daily calls the primary care NP at 10:00 AM one day to report forgetting to take the 8:00 AM dose. The NP should counsel the patient to:

take the missed dose now.

take 75 mg of clozapine now.

wait and take the evening dose at the usual time.

take the evening dose 2 hours earlier than usual.

Question 55

2 / 2 pts

A patient has been taking fluoxetine 20 mg every morning for 5 days and calls the primary care NP to report decreased appetite, nausea, and insomnia. The NP should:

suggest taking a sedative at bedtime.

change the medication to bupropion.

add trazodone to the patient’s regimen.

reassure the patient that these effects will subside.

Question 56

2 / 2 pts

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

order topical fluconazole.

order metronidazole 500 mg twice daily for 7 days.

withhold treatment until culture results are available.

prescribe a clotrimazole vaginal suppository for 7 days.

Question 57

2 / 2 pts

An 80-year-old patient has a diagnosis of glaucoma, and the ophthalmologist has prescribed timolol (Timoptic) and pilocarpine eye drops. The primary care NP should counsel this patient:

that systemic side effects of these medications may be severe.

that the combination of these two drugs may cause drowsiness.

to begin an exercise program to improve cardiovascular health.

that a higher dose of one or both of these medications may be needed.

Question 58

2 / 2 pts

An 18-month-old child who attends day care has head lice and has been treated with permethrin 1% (Nix). The parent brings the child to the clinic 1 week later, and the primary care NP notes live bugs on the child’s scalp. The NP should order:

lindane.

malathion.

ivermectin.

permethrin 5%.

Question 59

2 / 2 pts

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

determine the patient’s height and weight.

ask the patient how high the temperature has been.

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

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

Question 60

2 / 2 pts

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

an immunomodulator may be needed to control pain.

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

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

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

Question 61

2 / 2 pts

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

ibuprofen as needed.

bethanechol (Urecholine).

phenazopyridine (Pyridium).

increased oral fluid intake to dilute urine.

Question 62

2 / 2 pts

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

modafinil (Provigil).

guanfacine (Intuniv).

bupropion (Wellbutrin).

atomoxetine (Strattera).

Question 63

2 / 2 pts

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:

use naproxen (Naprosyn) instead of ibuprofen.

increase the dose of digoxin while taking the ibuprofen.

use an increased dose of ibuprofen while taking the digoxin.

take potassium supplements to minimize the effects of the ibuprofen.

Question 64

2 / 2 pts

A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order:

coagulation studies.

a complete blood count.

an EEG.

a creatinine clearance test.

Question 65

2 / 2 pts

A patient who has Alzheimer’s disease is taking 10 mg of donepezil daily and reports difficulty sleeping. The primary care NP should recommend:

decreasing the dose to 5 mg.

increasing the dose to 15 mg.

taking the drug in the morning.

taking the drug in the evening.

Question 66

2 / 2 pts

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:

discontinuing the 4 PM dose.

increasing the dose to 10 mg each time.

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

changing the dosing to 15 mg twice daily.

Question 67

2 / 2 pts

A 60-year-old woman is in the clinic for an annual well-woman examination. She has been taking alendronate (Fosamax) 10 mg daily for 4 years.Her last bone density test yielded a T-score of 2.0.Her urine NTx level today is 22. She walks daily. Her fracture risk is low. The primary care NP should recommend that she:

take a 1- to 2-year drug holiday.

change to 70 mg of alendronate weekly.

decrease the alendronate dose to 5 mg daily.

change to ibandronate (Boniva) 3 mg IV every 3 months.

Question 68

2 / 2 pts

The primary care nurse practitioner (NP) is seeing a patient who reports chronic lower back pain. The patient reports having difficulty sleeping despite taking ibuprofen at bedtime each night. The NP should prescribe:

diazepam (Valium).

metaxalone (Skelaxin).

methocarbamol (Robaxin).

cyclobenzaprine (Flexeril).

Question 69

2 / 2 pts

A patient reports smoking two or more packs of cigarettes per day and expresses a desire to quit smoking. The primary care NP learns that the patient smokes heavily during breaks at work and during the evening but with no established schedule. The NP should recommend:

bupropion (Wellbutrin).

nicotine replacement gum or nasal spray.

a high-dose 24-hour nicotine patch.

intensive smoking cessation counseling.

Question 70

2 / 2 pts

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:

Clostridium difficile–associated disease (CDAD).

viral gastroenteritis.

serum sickness reaction.

recurrence of the UTI.

Question 71

2 / 2 pts

A female patient has vaginal candidiasis and has taken a single dose of fluconazole without resolution of the infection. The primary care NP obtains a culture and should order:

oral ketoconazole.

griseofulvin for 4 weeks.

another dose of fluconazole.

topical miconazole (Monistat).

Question 72

2 / 2 pts

A patient reports difficulty falling asleep and staying asleep every night and has difficulty staying awake during the commute to work every day.The NP should:

suggest the patient try diphenhydramine first.

perform a thorough history and physical examination.

teach about avoiding caffeine and good sleep hygiene.

suggest melatonin and consider prescribing Ambien if this is not effective.

Question 73

2 / 2 pts

A patient who is newly diagnosed with schizophrenia is overweight and has a positive family history for type 2 diabetes mellitus. The primary care NP should consider initiating antipsychotic therapy with:

ziprasidone (Geodon).

olanzapine (Zyprexa).

risperidone (Risperdal).

chlorpromazine (Thorazine).

Question 74

2 / 2 pts

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

Liver toxicity

Excessive drowsiness

Rebound congestion

Tremor, restlessness, and insomnia

Question 75

2 / 2 pts

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:

change to a tricyclic antidepressant medication.

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

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

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

Question

Question 1

2 / 2 pts

What is a major determinant of the resting membrane potential necessary for transmission of nerve impulses?

The ratio between intracellular K+ and extracellular Na+

The ratio between intracellular Na+ and extracellular K+

The ratio between intracellular Na+ and extracellular sodium

The ratio between intracellular K+ and extracellular potassium

Question 2

2 / 2 pts

Chvostek sign and Trousseau sign indicate

hypercalcemia.

hypokalemia.

hyperkalemia.

hypocalcemia.

Question 3

2 / 2 pts

Physiologic pH is maintained around 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of

1:20.

10:2.

10:5.

20:1.

Question 4

2 / 2 pts

Water movement between the intracellular fluid compartment and the extracellular compartment is primarily a function of

osmotic forces.

antidiuretic hormone.

hydrostatic forces.

plasma oncotic pressure.

Question 5

2 / 2 pts

Which are indications of dehydration?

Tachycardia and weight loss

Muscle weakness and decreased deep tendon reflexes

Polyuria and hyperventilation

Decreased hemoglobin and hematocrit

Question 6

2 / 2 pts

At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the

capillary oncotic pressure is lower than the interstitial hydrostatic pressure.

capillary hydrostatic pressure is higher than the capillary oncotic pressure.

interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure.

interstitial oncotic pressure is higher than the interstitial hydrostatic pressure.

Question 7

2 / 2 pts

In hyperkalemia, cardiac rhythm changes are a direct result of

cardiac cell repolarization.

depression of the sinoatrial (SA) node.

cardiac cell hypopolarization.

cardiac cell hyperexcitability.

Question 8

2 / 2 pts

Clinical manifestations that include unexplained weight loss, dyspnea on exertion, use of accessory muscles, and tachypnea with prolonged expiration are indicative of

chronic bronchitis.

pneumonia.

asthma.

emphysema.

Question 9

2 / 2 pts

In ARDS, alveoli and respiratory bronchioles fill with fluid as a result of the

compression on the pores of Kohn, thus preventing collateral ventilation.

inactivation of surfactant and the impairment of type II alveolar cells.

increased capillary hydrostatic pressure that forces fluid into the alveoli and respiratory bronchioles.

increased capillary permeability, which causes alveoli and respiratory bronchioles to fill with fluid.

Question 10

2 / 2 pts

Pulmonary edema usually begins at a pulmonary capillary wedge pressure or left atrial pressure of _____ mm Hg.

20

40

30

10

Question 11

2 / 2 pts

The most successful treatment for chronic asthma begins with

drugs that reduce bronchospasm.

broad-spectrum antibiotics.

elimination of the causative agent.

drugs that decrease airway inflammation.

Question 12

2 / 2 pts

High altitudes may produce hypoxemia through

decreased inspired oxygen.

diffusion abnormalities.

hypoventilation.

shunting.

Question 13

2 / 2 pts

Which pleural abnormality involves a site of pleural rupture that act as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration?

Open pneumothorax

Secondary pneumothorax

Tension pneumothorax

Spontaneous pneumothorax

Question 14

2 / 2 pts

Clinical manifestations of pulmonary hypertension include

dyspnea on exertion and paroxysmal nocturnal dyspnea.

productive cough and rhonchi bilaterally.

peripheral edema and jugular venous distention.

systemic blood pressure greater than 130/90.

Question 15

2 / 2 pts

In tuberculosis, the body walls off the bacilli in a tubercle by stimulating which action?

macrophages that release TNF-alpha (TNF-α)

apoptotic infected macrophages that activate cytotoxic T cells.

phagocytosis by neutrophils and eosinophils.

formation of immunoglobulin G to initiate the complement cascade.

Question 16

2 / 2 pts

A(n) _____ is a circumscribed area of suppuration and destruction of lung parenchyma.

empyema

cavitation

consolidation

abscess

Question 17

2 / 2 pts

_____ is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury.

Pneumonia

Acute pulmonary edema

Pulmonary emboli

Acute respiratory distress syndrome (ARDS)

Question 18

0 / 2 pts

Dyspnea is not a result of

fatigue of the intercostal muscles and diaphragm.

decreased pH, increased PaCO2, and decreased PaO2.

stimulation of stretch or J-receptors.

decreased blood flow to the medulla oblongata.

Question 19

2 / 2 pts

The release of fibroblast growth factors affects ARDS by causing

disruption of alveolocapillary membrane.

pulmonary fibrosis.

pulmonary hypertension.

atelectasis and decreased lung compliance.

Question 20

2 / 2 pts

Which of the following types of croup is most common?

Autoimmune

Bacterial

Fungal

Viral

Question 21

2 / 2 pts

Chest wall compliance in infants is _____ in adults.

unlike that

lower than

higher than

the same as

Question 22

2 / 2 pts

What is the primary cause of RDS of the newborn?

Anemia

An immature immune system

Small alveoli

A surfactant deficiency

Question 23

0 / 2 pts

Which of the following statements about the advances in the treatment of RDS of the newborn is incorrect?

Treatment includes the instillation of exogenous surfactant down an endotracheal tube of infants weighing less than 1,000 g.

Administering glucocorticoids to women in preterm labor accelerates the maturation of the fetus’s lungs.

Supporting the infant’s respiratory function by using continuous positive airway pressure (CPAP). An infant’s respiratory function is supported by using continuous pressure (CPAP).

Administering oxygen to mothers during preterm labor increases their arterial oxygen before birth of the fetus.

Administration of oxygen to the mother is not a valid treatment of RDS.

Question 24

2 / 2 pts

Which immunoglobulin is present in childhood asthma?

IgG

IgA

IgE

IgM

Included in the long list of asthma-associated genes are those that code for increased levels of immune and inflammatory mediators (e.g., IL-4, IgE, and leukotrienes), nitric oxide, and transmembrane proteins in the endoplasmic reticulum.

Question 25

2 / 2 pts

Cystic fibrosis (CF) is caused by a(n)

autosomal dominant inheritance.

autosomal recessive inheritance.

infection.

malignancy.

Question

Question 1

2 / 2 pts

Clinical manifestations of fibromyalgia include

hot, tender, and edematous muscle groups bilaterally.

exercise intolerance and painful muscle cramps.

fasciculations of the upper and lower extremity muscles.

burning or gnawing pain at tender points and profound fatigue.

Question 2

0 / 2 pts

What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon?

Bursitis

Lateral epicondylitis

Lateral tendinitis

Medial tendinitis

Question 3

2 / 2 pts

_____ is the temporary displacement of two bones in which the bone surfaces partially lose contact.

Nonunion

Dislocation

Subluxation

Malunion

Question 4

2 / 2 pts

In ankylosing spondylitis, the CD8+ T cells are presented with which of the following antigens?

Tendons

Synovium

Cartilage

Ligaments

Question 5

2 / 2 pts

What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis?

Overproduction of uric acid

Increase in the glycosaminoglycan levels

Reduced excretion of purines

Overproduction of proteoglycans

Question 6

2 / 2 pts

_____ is a chronic inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints.

Paget disease

Fibromyalgia

Ankylosing spondylitis

Rheumatoid arthritis

Question 7

2 / 2 pts

Rhabdomyolysis is characterized by

lysis of skeletal muscle cells through the initiation of the complement cascade.

smooth muscle degeneration resulting from ischemia.

paralysis of skeletal muscles resulting from impaired nerve supply.

release of myoglobin from damaged striated muscle cells.

Question 8

0 / 2 pts

An insufficient dietary intake of vitamin _____ can lead to rickets in children.

D

B12

B6

C

Question 9

2 / 2 pts

Which protein, absent in muscle cells of Duchenne muscular dystrophy, mediates the anchoring of skeletal muscles fibers to the basement membrane?

Syntrophin

Dystrophin

Laminin

Troponin

Question 10

2 / 2 pts

Ewing sarcoma arises from

embryonal osteocytes.

metadiaphysis of long bones.

bone-producing mesenchymal cells.

bone marrow.

Question 11

2 / 2 pts

Osteochondrosis is caused by a(n)

bacterial infection of the bone.

nutritional deficiency of calcium and phosphorus.

imbalance between calcitonin and parathyroid hormone.

vascular impairment and trauma to bone.

Question 12

2 / 2 pts

Molecular analysis has demonstrated that osteosarcoma is associated with

TP53.

myc.

TSC2.

src.

Question 13

2 / 2 pts

The pain experienced in Legg-Calvé-Perthes disease is referred to as involving

elbows and upper and lower arms and is described as a continuous ache and relieved by anti-inflammatory drugs.

knees, inner thighs, and groin and is described as a continuous ache and relieved by anti-inflammatory drugs.

knees, inner thighs, and groin that is aggravated by activity and relieved by rest.

elbows and upper and lower arms that is aggravated by activity and relieved by rest.

Question 14

2 / 2 pts

Facioscapulohumeral muscular dystrophy is likely inherited from one’s

father.

mother.

affected parent.

maternal lineage.

Question 15

2 / 2 pts

The total mass of muscle in the body can be estimated from which serum laboratory test value?

Creatine

Blood urea nitrogen

Albumin

Creatinine

Question 16

2 / 2 pts

Cutaneous vasculitis develops from the deposit of _____ in small blood vessels as a toxic response allergen.

T lymphocytes

immune complexes

complement

IgE

Question 17

2 / 2 pts

Which cells of the dermis secrete connective tissue matrix?

Fibroblasts

Macrophages

Histiocytes

Mast cells

Question 18

2 / 2 pts

Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck?

Squamous cell carcinoma

Kaposi sarcoma

Malignant melanoma

Basal cell carcinoma

Question 19

2 / 2 pts

Keloids are sharply elevated, irregularly shaped, progressively enlarging scars caused by excessive amounts of _____ in the corneum during connective tissue repair.

reticular fibers

collagen

elastin

stroma

Question 20

2 / 2 pts

_____ of the epidermis initiate immune responses and provide defense against environmental antigens.

Melanocytes

Keratinocytes

Merkel cells

Langerhans cells

Question 21

2 / 2 pts

Thrush is a superficial infection that commonly occurs in children and is caused by

Candida albicans.

Streptococcus.

Staphylococcus.

herpesvirus.

Question 22

2 / 2 pts

Which vascular anomaly is a congenital malformation of dermal capillaries that does not fade with age?

Cavernous hemangioma

Port-wine (nevus flammeus) stain

Strawberry hemangioma

Cutaneous hemangioma

Question 23

0 / 2 pts

Which of the following viral diseases has an incubation period of 14 to 21 days and a duration of 1 to 4 days?

Varicella

Rubeola

Roseola

Rubella

Question 24

2 / 2 pts

Which clinical manifestation is considered the hallmark of atopic dermatitis?

High fever

Itching

Papular rash

Vesicles that burst and form crusts

Question 25

2 / 2 pts

Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or wheal with hemorrhagic puncture site?

Rubeola

Scabies

Pediculosis

Tinea capitis

Conduct an evidence-based literature search to identify the most recent standards of care/treatment modalities from peer-reviewed articles and professional association guidelines (www.guideline.gov).

Cite a minimum of three resources.

Answer the following questions:

1. What is the transmission and pathophysiology of TB?
2. What are the clinical manifestations?
3. After considering this scenario, what are the primary identified medical concerns for this patient?
4. What are the primary psychosocial concerns?
5. What are the implications of the treatment regimen, as far as likelihood of compliance and outcomes? Search the Internet to research rates of patient compliance in treatment of TB, as well as drug resistant TB.
6. Identify the role of the community clinic in assisting patients, particularly undocumented patients, in covering the cost of TB treatment. What resources exist for TB treatment in community health centers around the United States? Compare the cost for treatment between, subsidized as it would be for a community health center, and unsubsidized.
7. What are the implications of TB for critical care and advanced practice nurses?

 

Your paper should be 4 pages, (excluding cover page and reference page).

Your resources must include research articles as well as reference to non-research evidence-based guidelines.

Use APA format to style your paper and to cite your sources.