1
,2
,consider a different drug class to treat this patient’s symptoms.
give the captopril with a thiazide diuretic to improve renal function.
orderlisinopril (Zestril) instead of captopril to avoid increased nephropathy.
Patients with impaired renal function should use low-dose ACE inhibitors. It is not necessary to
avoid ACE inhibitors with unilateral renal stenosis.
Question 4
pts
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:
to change to a progestin-only pill.
to stop taking the COCP immediately.
to use a backup form of contraception.
Correct!
that these effects will likely decrease in another month.
, Breakthrough bleeding, nausea, and headaches are common during the first 3 months of therapy
and should improve without intervention. Progestin-only pills are used for lactating women only.
Prolonged bleeding and severe headache would warrant discontinuation of the COCP. Backup
contraception is not indicated.
Question 5
pts
A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6
months. The patient’s initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL, and
triglycerides of 160 mg/dL. The primary care NP orders a lipid profile today that shows LDL of
105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient reports muscle pain
and weakness. The NP should:
order liver function tests (LFTs).
Correct!
order a creatine kinase-MM (CK-MM) level.
change atorvastatin to twice-daily dosing.
add gemfibrozil (Lopid) to the patient’s medication regimen.
Hepatotoxicity and muscle toxicity are the two primary adverse effects of greatest concern with
statin use. Patients who report muscle discomfort or weakness should have a CK-MM level
,2
,consider a different drug class to treat this patient’s symptoms.
give the captopril with a thiazide diuretic to improve renal function.
orderlisinopril (Zestril) instead of captopril to avoid increased nephropathy.
Patients with impaired renal function should use low-dose ACE inhibitors. It is not necessary to
avoid ACE inhibitors with unilateral renal stenosis.
Question 4
pts
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:
to change to a progestin-only pill.
to stop taking the COCP immediately.
to use a backup form of contraception.
Correct!
that these effects will likely decrease in another month.
, Breakthrough bleeding, nausea, and headaches are common during the first 3 months of therapy
and should improve without intervention. Progestin-only pills are used for lactating women only.
Prolonged bleeding and severe headache would warrant discontinuation of the COCP. Backup
contraception is not indicated.
Question 5
pts
A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6
months. The patient’s initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL, and
triglycerides of 160 mg/dL. The primary care NP orders a lipid profile today that shows LDL of
105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient reports muscle pain
and weakness. The NP should:
order liver function tests (LFTs).
Correct!
order a creatine kinase-MM (CK-MM) level.
change atorvastatin to twice-daily dosing.
add gemfibrozil (Lopid) to the patient’s medication regimen.
Hepatotoxicity and muscle toxicity are the two primary adverse effects of greatest concern with
statin use. Patients who report muscle discomfort or weakness should have a CK-MM level
