1 . Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months . She has a positive family history of breast cancer . The primary care NP should recommend:
testosterone therapy .
estrogen-only therapy .
nonhormonal drugs for osteoporosis .
estrogen-progesterone therapy for 1 to 2 years .
Question 2 . A patient takes a cardiac medication that has a very narrow therapeutic range . The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan . The NP knows that the bioavailability of the drug varies from brand to brand . The NP should:
contact the insurance provider to explain why this particular formulation is necessary .
change the patient’s medication to a different drug class that doesn’t have these bioavailability variations .
accept the situation and monitor the patient closely for drug effects with each prescription refill .
ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense .
Question 3 . A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it . The NP notes that the information is from an internet site called “Prism . com . ” The NP should tell this patient that:
this information is probably from a drug advertisement website .
this is factual, evidence-based material with accurate information .
the information is from a nonprofit group that will not profit from drug sales .
internet information is unreliable because anyone can post information there .
Question 4 . A primary care NP is reviewing written information about a newly prescribed medication with a patient . To evaluate this patient’s understanding of the information, the NP should ask the patient to:
read the information aloud .
describe how the medication will be taken .
write down questions about the medication .
tell the NP if the information is unclear .
Question 5 . A patient is diagnosed with lupus and reports occasional use of herbal supplements . The primary care NP should caution this patient to avoid:
ginkgo biloba .
St . John’s wort .
Question 6 . A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic to ask for a refill of the medication . The primary care NP notes that the medication refill is not due for 2 weeks . The patient tells the NP that the refill is needed because he is going out of town . The NP should:
fill the prescription and document the patient’s explanation of the reason .
review the patient’s chart to see if this is a one-time or repeat occurrence .
call the patient’s pharmacist and report suspicion of drug-seeking behaviors .
confront the patient about misuse of narcotics and refuse to fill the prescription .
Question 7 . 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 . ”
Question 8 . The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is “off-formulary . ” The NP should:
inform the patient that an out-of-pocket expense will be necessary .
write the prescription for a generic drug if it meets the patient’s needs .
call the patient’s insurance provider to advocate for this particular drug .
contact the pharmaceutical company to see if medication samples are available .
Question 9 . A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms . She has no family history or risk factors for coronary heart disease (CHD) or breast cancer but is concerned about these side effects of hormone therapy (HT) . The NP should:
tell her that starting HT now may reduce her risk of breast cancer .
advise a short course of HT now that may decrease her risk for CHD .
tell her that HT will not help control her symptoms during postmenopause .
recommend herbal supplements for her symptoms to avoid HT side effects .
Question 10 . A primary care NP recommends an over-the-counter medication for a patient who has acid reflux . When teaching the patient about this drug, the NP should tell the patient:
to take the dose recommended by the manufacturer .
not to worry about taking this drug with any other medications .
to avoid taking other drugs that cause sedation while taking this drug .
that over-the-counter acid reflux medications are generally safe to take with other medications .
Question 11 . A patient will begin taking two drugs that are both protein-bound . The primary care NP should:
prescribe increased doses of both drugs .
monitor drug levels, actions, and side effects .
teach the patient to increase intake of protein .
stagger the doses of drugs to be given 1 hour apart .
Question 12 . 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 .
Question 13 . A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital . The NP should:
use an existing guideline from a leading research hospital .
follow the guideline provided by a third-party payer to help ensure reimbursement .
review expert opinion and experimental, anecdotal, correlational study data .
write the guideline to adhere to long-standing practice protocols already in use .
Question 14 . The primary care nurse practitioner (NP) writes a prescription for an antibiotic using an electronic drug prescription system . The pharmacist will fill this prescription when:
the electronic prescription is received .
the patient brings a written copy of the prescription .
a copy of the written prescription is faxed to the pharmacy .
the pharmacist accesses the patient’s electronic record to verify .
Question 15 . A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics . The NP should:
monitor frequently for desired and adverse effects .
administer a much higher initial dose as a loading dose .
monitor creatinine clearance at baseline and periodically .
administer the drug via a route that avoids the first-pass effect .
Question 16 . An important difference between physician assistants (PAs) and NPs is PAs:
always work under physician supervision .
are not required to follow drug treatment protocols .
may write for all drug categories with physician co-signatures .
have both inpatient and outpatient independent prescriptive authority .
Question 17 . A primary care NP writes a prescription for an off-label use for a drug . To help ensure compliance, the NP should:
include information about the off-label use on the E-script .
provide the patient with written instructions about how to use the medication .
tell the patient to let the pharmacist know that the drug is being used for an off-label use .
follow up by phone in several days to see if the patient is using the drug appropriately .
Question 18 . A patient reports taking antioxidant supplements to help prevent cancer . The primary care NP should:
review healthy dietary practices with this patient .
make sure that the supplements contain large doses of vitamin A .
tell the patient that antioxidants are especially important for patients who smoke .
tell the patient that evidence shows antioxidants to be effective in preventing cancer .
Question 19 . A woman comes to the clinic to talk about weight reduction . The primary care nurse practitioner (NP) calculates a body mass index (BMI) of 28 . The woman’s waist measures 34 inches . The woman tells the NP that she would like to lose 20 lb for her daughter’s wedding in 6 months . The NP should:
suggest she try over-the-counter (OTC) orlistat .
consider prescribing phentermine short-term .
discuss her short-term and long-term weight loss goals .
give her information about physical activity and diet modification .
Question 20 . A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year . When deciding whether or not to prescribe this formulation, the NP should:
tell the patient that when postmarketing data is available, it will be considered .
review the pharmaceutical company promotional materials about the new medication .
prescribe the medication if it is less expensive than the current drug formulation .
prescribe the medication if the new drug is available in an extended-release form .
Question 21 . 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 .
Question 22 . A patient receives an inhaled corticosteroid to treat asthma . The patient asks the primary care NP why the drug is given by this route instead of orally . The NP should explain that the inhaled form:
is absorbed less quickly .
has reduced bioavailability .
has fewer systemic side effects .
provides dosing that is easier to regulate .
Question 23 . A patient who has breast cancer has been taking toremifene for 2 weeks . She tells her primary care NP that she thinks her tumor has grown larger . The NP should:
schedule her for a breast ultrasound .
reassure her that this is common and will subside .
tell her she may need an increased dose of this medication .
contact her oncologist to discuss adding another medication .
Question 24 . The primary care NP is prescribing a medication for an off-label use . To help prevent a medication error, the NP should:
write “off-label use” on the prescription and provide a rationale .
call the pharmacist to explain why the instructions deviate from common use .
write the alternative drug regimen on the prescription and send it to the pharmacy .
tell the patient to ignore the label directions and follow the verbal instructions given in the clinic .
Question 25 . The primary care NP sees a woman who has been taking HT for menopausal symptoms for 3 years . The NP decreases the dosage, and several weeks later, the woman calls to report having several hot flashes each day . The NP should:
increase the HT dose .
discontinue HT .
recommend black cohosh to alleviate symptoms .
reassure her that these symptoms will diminish over time .
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