NR 508 Final Pharm Exam
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: ANS: administer all of
these vaccines today
Although live-virus vaccines should not be administered to mothers during pregnancy, they may be
given to children whose mothers are pregnant.
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: ANS: oxybutynin chloride (Ditropan XL).
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. Bethanechol is indicated for urinary retention.
Phenazopyridine is used to treat dysuria.
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: ANS: ZolpiMist
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.
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: ANS: initiate
antibiotic therapy if the child's condition worsens.
,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.
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: ANS: recommend
acetaminophen.
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.
A patient who takes levodopa and carbidopa for Parkinson's disease reports experiencing freezing
episodes between doses. The primary care NP should consider using: ANS: apomorphine.
Apomorphine injection is used for acute treatment of immobility known as "freezing."
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: ANS: increase the dose of prednisolone to
the most recent amount taken.
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
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: ANS:
perform a dipstick urinalysis.
A focused 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.
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: ANS: giving a double dose of prednisone every other day.
Administration of a double dose of a glucocorticoid every other morning has been found to cause less
suppression of the HPA axis and less growth suppression in children. Because the child has severe
asthma, an oral steroid is necessary. Growth hormone therapy is not indicated. Twice-daily dosing would
not change the HPA axis suppression.
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:
ANS: ask about alcohol intake.
Concomitant use of alcohol with isoniazid increases the risk of hepatitis. This patient shows signs of
hepatitis, so the NP should ask about alcohol consumption. Isoniazid should be taken on an empty
stomach.
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: ANS: SABA as needed plus a leukotriene
modifier once daily.
A leukotriene modifier may be used as an alternative to ICS for children who experience systemic side
effects of the ICS. This child's symptoms are well controlled, so there is no need to step up therapy to
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: ANS: administer all of
these vaccines today
Although live-virus vaccines should not be administered to mothers during pregnancy, they may be
given to children whose mothers are pregnant.
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: ANS: oxybutynin chloride (Ditropan XL).
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. Bethanechol is indicated for urinary retention.
Phenazopyridine is used to treat dysuria.
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: ANS: ZolpiMist
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.
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: ANS: initiate
antibiotic therapy if the child's condition worsens.
,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.
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: ANS: recommend
acetaminophen.
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.
A patient who takes levodopa and carbidopa for Parkinson's disease reports experiencing freezing
episodes between doses. The primary care NP should consider using: ANS: apomorphine.
Apomorphine injection is used for acute treatment of immobility known as "freezing."
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: ANS: increase the dose of prednisolone to
the most recent amount taken.
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
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: ANS:
perform a dipstick urinalysis.
A focused 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.
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: ANS: giving a double dose of prednisone every other day.
Administration of a double dose of a glucocorticoid every other morning has been found to cause less
suppression of the HPA axis and less growth suppression in children. Because the child has severe
asthma, an oral steroid is necessary. Growth hormone therapy is not indicated. Twice-daily dosing would
not change the HPA axis suppression.
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:
ANS: ask about alcohol intake.
Concomitant use of alcohol with isoniazid increases the risk of hepatitis. This patient shows signs of
hepatitis, so the NP should ask about alcohol consumption. Isoniazid should be taken on an empty
stomach.
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: ANS: SABA as needed plus a leukotriene
modifier once daily.
A leukotriene modifier may be used as an alternative to ICS for children who experience systemic side
effects of the ICS. This child's symptoms are well controlled, so there is no need to step up therapy to
