Advanced pharmacology NR 508 Week 4 Mid-Term exam questions and answers

Advanced pharmacology NR 508 Week 4 Mid-Term Flag this Question Question 22 pts A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe: aprepitant (Emend). ondansetron (Zofran). scopolamine transdermal. prochlorperazine (Compazine). Flag this Question Question 32 pts A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased. The NP should consult with an endocrinologist and order: mazole. levothyroxine. propylthiouracil. Flag this Question Question 42 pts 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: prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor. perform a careful cardiovascular physical assessment. counsel the patient about dietary and lifestyle changes. order a urinalysis and creatinine clearance and begin therapy with a ­blocker.β Flag this QuestionQuestion 52 pts Flag this Question Question 62 pts When prescribing a medication for a chronic condition, the primary care NP should tell the patient: to contact the pharmacy whenever refills are needed. that it is necessary to return to the clinic for each monthly refill of the medication. about the frequency of clinic visits necessary for the number of refills authorized. to ask the pharmacist to supply several months’ worth of the medication at a time. Flag this Question Question 72 pts A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day. The child weighs 15 kg. The primary care NP sees the child for a 3-year-old check-up. The NP should consult with a pediatric endocrinologist to discuss: increasing the dose to 90 mcg/day. decreasing the dose to 30 . discussing the need for lifetime replacement therapy with the child’s parents. Flag this Question Question 82 pts Flag this Question Flag this Question stopping the medication and checking TSH and T 4 in 4 weeks day.Question 102 pts Flag this Question Question 112 pts A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug: may cause different adverse effects. does not necessarily have the same therapeutic effect. is likely to be less safe than the brand specified in the prescription. simethicone (Phazyme). metoclopramide (Reglan).may vary in the amount of drug that reaches the site of action in the body. Flag this Question Question 122 pts A patient comes to the clinic with a history of syncope and weakness for 2 to 3 days. The primary care NP notes thready, rapid pulses and 3-second capillary refill. An ECG reveals a heart rate of 198 beats per minute with a regular rhythm. The NP should: (PSVT) administer intravenous fluids and obtain serum electrolytes. administer amiodarone in the clinic and observe closely for response. order digoxin and verapamil and ask the patient to return for a follow-up examination in 1 week. send the patient to an emergency department for evaluation and treatment. Flag this Question Question 132 pts An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won’t have to deal with pills or periods. The primary care NP should tell her that she: should consider another form of contraception after 1 year. may have irregular bleeding, especially in the first month or so. will need to take calcium and vitamin D every day while using this method. will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics. Flag this Question Question 142 pts A patient who is taking nifedipine develops mild edema of both feet. The primary care NP should contact the patient’s cardiologist to discuss:changing to amlodipine. ordering renal function tests. increasing the dose of nifedipine. evaluation of left ventricular function. Flag this Question Question 152 pts 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: schedule a treadmill stress test. order genetic testing for this patient. discontinue the trimethoprim-sulfamethoxazole. refer the patient to a cardiologist for further evaluation. Flag this Question Question 162 pts a -blocker. inhibitor.Flag this Question Question 172 pts A male patient tells the primary care NP he is experiencing decreased libido, lack of energy, and poor concentration. The NP performs an examination and notes increased body fat and gynecomastia. A serum testosterone level is 225 ng/dL. The NP’s next action should be to: order LH and FSH levels. order a serum prolactin level. prescribe testosterone replacement. obtain a morning serum testosterone level. Flag this Question Question 182 pts Flag this Question Question 192 pts 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 order diphenoxylate (Lomotil).(PPI) before meals twice daily, clarithromycin, and amoxicillin. After 14 days of treatment, H. pyloriis still present. The NP should order: continuation of the PPI for 4 to 8 weeks. a PPI, amoxicillin, and metronidazole for 14 days. a PPI, clarithromycin, and amoxicillin for 14 more days. a PPI, bismuth subsalicylate, tetracycline, and metronidazole. Flag this QuestionFlag this Question Question 212 pts The primary care NP sees a new patient who has diabetes and hypertension and has been taking a thiazide diuretic for 6 months. The patient’s blood pressure at the beginning of treatment was 150/95 mm Hg. The blood pressure today is 138/85 mm Hg. The NP should: order a ­blocker.β add an angiotensin-converting enzyme inhibitor. continue the current drug regimen. change to an aldosterone antagonist medication. Flag this Question Question 222 pts A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should: obtain a stool specimen and order vancomycin. metronidazole therapy. order testing for Clostridium difficile and consider ribe diphenoxylate (Lomotil) to provide symptomatic relief. reassure the patient that diarrhea is a common side effect of antibiotic therapy. Flag this Question Question 232 pts The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should: compromise with the parents and order a nasogastric tube for feedings. initiate a discussion with the parents about the potential outcomes of each possible action. refer the family to a case manager who can help guide the parents to the best decision. understand that the child’s parents have a right to make choices that override those of the medical team. Flag this Question Question 242 pts The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners. Which statement by the patient indicates she understands the regimen? “I have to take a pill only every 3 months.” “I should expect to have only four periods each year.” “I will need to use condoms for only 7 more days.” “This type of pill has fewer side effects than other types.” Flag this QuestionQuestion 252 pts 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: provide pharmaceutical company samples of the medication for the patient. inform the patient that the drug must be paid for out of pocket because it is not covered. order the closest formulary-approved approximation of the drug and monitor effectiveness. write a letter of medical necessity to the insurer to explain the need for this particular medication. Flag this Question Question 262 pts 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: