1
NR 508 Final Exam
Question 1
pts
Apatient 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 ichloride i(Ditropan iXL).
This patient is describing urge incontinence, or overactive bladder, which occurs
when the detrusor muscle is hyperactive, causing an intense urge to void before
the bladder is full. Urge incontinence is associated with many conditions, including
diabetes. Oxybutynin chloride, which is an anticholinergic, acts to decrease
detrusor overactivity and is indicated for treatment of urge incontinence.
Flavoxate is used to treat dysuria associated with UTI. Bethanecholis indicated for
urinary retention. Phenazopyridine is used to treat dysuria.
Question 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.
Page 1 of 41
,2
chloral hydrate.
ZolpiMist oral spray is useful for patients who have trouble returning to sleep in the
middle of the night. Zaleplon and ramelteon are used for insomnia caused by
difficulty with sleep onset. Chloral hydrate is not typically used as outpatient
therapy.
Question 3
pts
A 5-year-old child who has no previous history of otitis media is seen in clinic witha
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 iantibiotic itherapy iif ithe ichild’s icondition iworsens.
Signs and symptoms of otitis media that indicate a need for antibiotic treatment
include otalgia, fever, otorrhea, or a bulging yellow or red tympanic membrane.
This child has a low-grade fever, no history of otitis media, a nonbulging tympanic
membrane, and no otorrhea, so watchful waiting is appropriate. When an antibiotic
is started, amoxicillin is the drug of choice.
Question 4
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 iacetaminophen.
Page 2 of 41
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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.
Patients with congestive heart failure may have tachycardia from fever that
aggravates their symptoms, so fever should be treated. High doses should be
given with caution in elderly patients because of possible decreased hepatic
function.Antibiotics should not be given without evidence of bacterial infection.
Question 5
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.
Apomorphine injection is used for acute treatment of immobility known as
“freezing.”
Question 6
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.
Page 3 of 41
, 4
expect these side effects to occur as the medication is tapered.
increase ithe idose iof iprednisolone ito ithe imost irecent iamount itaken.
Sudden discontinuation or rapid tapering of glucocorticoids in patients who have
developed adrenal suppression can precipitate symptoms of adrenal insufficiency,
including nausea, weakness, depression, anorexia, myalgia, hypotension, and
hypoglycemia. When patients experience these symptoms during a drug taper, the
dose should be increased to the last dose. Vitamin D deficiency is common while
taking glucocorticoids, but these are not symptoms ofvitamin D deficiency.
Changing to another glucocorticoid is not recommended.
Patients should be taught to report the side effects so that action can be takenand
should not be told that they are to be expected.
Question 7
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 ia idipstick iurinalysis.
prescribe desmopressin (DDAVP).
prescribe oxybutynin chloride (Ditropan XL).
teach exercises to strengthen the pelvic muscles.
Afocused history with a careful physical examination is essential for determining
the cause of incontinence. Urinalysis can rule out urinary tract infection (UTI),
which can cause incontinence. Medications are prescribed after determining the
cause, if any, and treating underlying conditions. Exercises to strengthen the pelvic
muscles are part of treatment.
Question 8
pts
Page 4 of 41
NR 508 Final Exam
Question 1
pts
Apatient 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 ichloride i(Ditropan iXL).
This patient is describing urge incontinence, or overactive bladder, which occurs
when the detrusor muscle is hyperactive, causing an intense urge to void before
the bladder is full. Urge incontinence is associated with many conditions, including
diabetes. Oxybutynin chloride, which is an anticholinergic, acts to decrease
detrusor overactivity and is indicated for treatment of urge incontinence.
Flavoxate is used to treat dysuria associated with UTI. Bethanecholis indicated for
urinary retention. Phenazopyridine is used to treat dysuria.
Question 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.
Page 1 of 41
,2
chloral hydrate.
ZolpiMist oral spray is useful for patients who have trouble returning to sleep in the
middle of the night. Zaleplon and ramelteon are used for insomnia caused by
difficulty with sleep onset. Chloral hydrate is not typically used as outpatient
therapy.
Question 3
pts
A 5-year-old child who has no previous history of otitis media is seen in clinic witha
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 iantibiotic itherapy iif ithe ichild’s icondition iworsens.
Signs and symptoms of otitis media that indicate a need for antibiotic treatment
include otalgia, fever, otorrhea, or a bulging yellow or red tympanic membrane.
This child has a low-grade fever, no history of otitis media, a nonbulging tympanic
membrane, and no otorrhea, so watchful waiting is appropriate. When an antibiotic
is started, amoxicillin is the drug of choice.
Question 4
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 iacetaminophen.
Page 2 of 41
,3
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.
Patients with congestive heart failure may have tachycardia from fever that
aggravates their symptoms, so fever should be treated. High doses should be
given with caution in elderly patients because of possible decreased hepatic
function.Antibiotics should not be given without evidence of bacterial infection.
Question 5
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.
Apomorphine injection is used for acute treatment of immobility known as
“freezing.”
Question 6
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.
Page 3 of 41
, 4
expect these side effects to occur as the medication is tapered.
increase ithe idose iof iprednisolone ito ithe imost irecent iamount itaken.
Sudden discontinuation or rapid tapering of glucocorticoids in patients who have
developed adrenal suppression can precipitate symptoms of adrenal insufficiency,
including nausea, weakness, depression, anorexia, myalgia, hypotension, and
hypoglycemia. When patients experience these symptoms during a drug taper, the
dose should be increased to the last dose. Vitamin D deficiency is common while
taking glucocorticoids, but these are not symptoms ofvitamin D deficiency.
Changing to another glucocorticoid is not recommended.
Patients should be taught to report the side effects so that action can be takenand
should not be told that they are to be expected.
Question 7
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 ia idipstick iurinalysis.
prescribe desmopressin (DDAVP).
prescribe oxybutynin chloride (Ditropan XL).
teach exercises to strengthen the pelvic muscles.
Afocused history with a careful physical examination is essential for determining
the cause of incontinence. Urinalysis can rule out urinary tract infection (UTI),
which can cause incontinence. Medications are prescribed after determining the
cause, if any, and treating underlying conditions. Exercises to strengthen the pelvic
muscles are part of treatment.
Question 8
pts
Page 4 of 41
