Final Pharm NR 508 exam with correct answers

Final Pharm NR 508 exam with correct |\ |\ |\ |\ |\ |\ |\




answers

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: - CORRECT ANSWERS ✔✔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: - CORRECT ANSWERS ✔✔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: - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\



ANSWERS ✔✔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:
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\



- CORRECT ANSWERS ✔✔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: - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\



✔✔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: - CORRECT ANSWERS ✔✔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: - CORRECT ANSWERS ✔✔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: - CORRECT ANSWERS ✔✔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: - CORRECT ANSWERS ✔✔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: - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\



ANSWERS ✔✔ask about alcohol intake. |\ |\ |\ |\