Question

Question 1

2 / 2 pts

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:

flavoxate (Urispas)

bethanechol (Urecholine)

phenazopyridine (Pyridium)

oxybutynin chloride (Ditropan XL)

Question 2

2 / 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

chloral hydrate

Question 3

2 / 2 pts

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 roomThe 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 antibiotic therapy if the child’s condition worsens

Question 4

2 / 2 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 385° C The NP should:

recommend acetaminophen

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

Question 5

2 / 2 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

Question 6

2 / 2 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

expect these side effects to occur as the medication is tapered

increase the dose of prednisolone to the most recent amount taken

Question 7

2 / 2 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 a dipstick urinalysis

prescribe desmopressin (DDAVP)

prescribe oxybutynin chloride (Ditropan XL)

teach exercises to strengthen the pelvic muscles

Question 8

2 / 2 pts

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:

gradually tapering the child off the prednisone

a referral for possible growth hormone therapy

giving a double dose of prednisone every other day

dividing the prednisone dose into twice-daily dosing

Question 9

2 / 2 pts

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:

ask about alcohol intake

suggest taking the medications with food

reassure the patient that these side effects are common

order liver and renal function tests and serum glucose

Question 10

2 / 2 pts

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:

combination ICS/LABA inhaler twice daily

short-acting 2-agonist (SABA) with oral corticosteroids when symptomatic

combination ipratropium/albuterol inhaler twice daily

SABA as needed plus a leukotriene modifier once daily

Question 11

2 / 2 pts

A patient is newly diagnosed with Alzheimer’s disease stage 6 on the Global Deterioration Scale The primary care NP should prescribe:

donepezil (Aricept)

rivastigmine (Exelon)

memantine (Namenda)

galantamine (Razadyne)

Question 12

2 / 2 pts

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:

administer all of these vaccines today

give the hepatitis A and influenza vaccines

give the Varivax, hepatitis A, and influenza vaccines

withhold all of these vaccines until after the baby is born

Question 13

2 / 2 pts

A parent brings a 5-year-old child to a clinic for a hospital follow-up appointment The child is taking a medication at a dose equal to an adult doseThe parent reports that the medication is not producing the desired effects The NP should:

order renal function tests

prescribe another medication to treat this child’s symptoms

discontinue the drug and observe the child for toxic side effects

obtain a serum drug level and consider increasing the drug dose

Question 14

2 / 2 pts

An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65-year-old patient with recent onset of reactive airways disease who reports symptoms occurring every 1 or 2 weeks At a follow-up appointment several months later, the patient reports no change in frequency of symptoms The NP’s initial action should be to:

order spirometry to evaluate pulmonary function

prescribe a systemic corticosteroid to help with symptoms

ask the patient to describe how the medications are taken each day

give the patient detailed information about the use of metered-dose inhalers

Question 15

2 / 2 pts

A patient is diagnosed with a condition that causes chronic pain The primary care NP prescribes an opioid analgesic and should instruct the patient to:

wait until the pain is at a moderate level before taking the medication

take the medication at regular intervals and not just when pain is present

start the medication at higher doses initially and taper down gradually

take the minimum amount needed even when pain is severe to avoid dependency

Question 16

2 / 2 pts

A patient tells the primary care NP that he has difficulty getting and maintaining an erection The NP’s initial response should be to:

prescribe sildenafil (Viagra)

perform a medication history

evaluate his cardiovascular status

order a papaverine injection test to screen for erectile dysfunction

Question 17

2 / 2 pts

A 55-year-old patient develops Parkinson’s disease characterized by unilateral tremors only The primary care NP will refer the patient to a neurologist and should expect initial treatment to be:

levodopa

carbidopa

pramipexole

carbidopa/levodopa

Question 18

2 / 2 pts

A patient who has migraine headaches without an aura reports difficulty treating the migraines in time because they come on so suddenly The patient has been using over-the-counter NSAIDs The primary care NP should prescribe:

frovatriptan (Frova)

sumatriptan (Imitrex)

cyproheptadine (Periactin)

dihydroergotamine (DHE 45)

Question 19

2 / 2 pts

A woman tells a primary care NP that she is considering getting pregnant During a health history, the NP learns that the patient has seasonal allergies, asthma, and epilepsy, all of which are well controlled with a second-generation antihistamine daily, an inhaled steroid daily with albuterol as needed, and an antiepileptic medication daily The NP should counsel this patient to:

take her asthma medications only when she is having an acute exacerbation

avoid using antihistamine medications during her first trimester of pregnancy

discontinue her seizure medications at least 6 months before becoming pregnant

use only oral corticosteroids and not inhaled steroids while pregnant for improved asthma control

Question 20

2 / 2 pts

A patient who has partial seizures has been taking phenytoin (Dilantin) The patient has recently developed thrombocytopenia The primary care nurse practitioner (NP) should contact the patient’s neurologist to discuss changing the patient’s medication to:

topiramate (Topamax)

levetiracetam (Keppra)

zonisamide (Zonegran)

carbamazepine (Tegretol)

Question 21

2 / 2 pts

A patient is taking dicloxacillin (Dynapen) 500 mg every 6 hours to treat a severe penicillinase-resistant infection At a 1-week follow-up appointment, the patient reports nausea, vomiting, and epigastric discomfort The primary care NP should:

change the medication to a cephalosporin

decrease the dose to 250 mg every 6 hours

reassure the patient that these are normal adverse effects of this drug

order blood cultures, a white blood cell (WBC) count with differential, and liver function tests (LFTs)

Question 22

2 / 2 pts

A 75-year-old patient who lives alone will begin taking a narcotic analgesic for pain To help ensure patient safety, the NP prescribing this medication should:

assess this patient’s usual sleeping patterns

ask the patient about problems with constipation

obtain a baseline creatinine clearance test before the first dose

perform a thorough evaluation of cognitive and motor abilities

Question 23

2 / 2 pts

A patient has been taking intramuscular (IM) meperidine 75 mg every 6 hours for 3 days after surgery When the patient is discharged from the hospital, the primary care NP should expect the patient to receive a prescription for _____ mg orally every _____ hours

hydrocodone 30; 6

hydrocodone 75; 6

meperidine 300;12

meperidine 75; 6

Question 24

2 / 2 pts

A patient who is obese and has hypertension is taking a thiazide diuretic and develops gouty arthritis, which is treated with probenecid At a follow-up visit, the patient’s serum uric acid level is 7 mg/dL, and the patient denies any current symptoms The primary care NP should discontinue the probenecid and:

prescribe colchicine

prescribe febuxostat

tell the patient to use an NSAID if symptoms recur

counsel the patient to report recurrence of symptoms

Question 25

2 / 2 pts

A mother brings her a college-age son to the primary care NP and asks the NP to talk to him about alcohol use He reports binge drinking on occasion and drinking only beer on weekends The NP notes diaphoresis, tachycardia, and an easy startle reflex The NP should:

admit him to the hospital for detoxification

ask him how much he had to drink last night

prescribe lorazepam (Ativan) to help with symptoms

suggest that he talk to a counselor about alcohol abuse

Question 26

2 / 2 pts

A primary care NP sees a patient who has fever, flank pain, and dysuria The patient has a history of recurrent urinary tract infections (UTIs) and completed a course of trimethoprim-sulfamethoxazole (TMP/SMX) the week before A urine test is positive for leukocyte esterase The NP sends the urine for culture and should treat this patient empirically with:

gemifloxacin

ciprofloxacin

azithromycin

TMP/SMX

Question 27

2 / 2 pts

A patient who takes carbamazepine (Tegretol) has been seizure-free for 2 years and asks the primary care NP about stopping the medication The NP should:

order an electroencephalogram (EEG)

prescribe a tapering regimen of the drug

inform the patient that antiepileptic drug (AED) therapy is lifelong

tell the patient to stop the drug and use only as needed

Question 28

2 / 2 pts

A primary care NP has been working with a young woman who wants to quit smoking before she begins having children She has made several attempts to quit using nicotine replacement therapy and is feeling discouraged She does not want to take medication at this time The NP should:

discuss the effects of smoking on fetal development

ask her to write down any factors that triggered her relapses

give her information about the long-term effects of smoking

convince her that taking medication will be essential in her case

Question 29

2 / 2 pts

A primary care NP prescribes a nonselective NSAID for a patient who has osteoarthritis The patient expresses concerns about possible side effects of this medication When counseling the patient about the medication, the NP should tell this patient:

to avoid taking antacids while taking the NSAID

to take each dose of the NSAID with a full glass of water

that a few glasses of wine each day are allowed while taking the NSAID

to decrease the dose of the NSAID if GI symptoms occur

Question 30

2 / 2 pts

A patient has been taking a COX-2 selective NSAID to treat pain associated with a recent onset of RA The patient tells the primary care NP that the pain and joint swelling are becoming worse The patient does not have synovitis or extraarticular manifestations of the disease The NP will refer the patient to a rheumatologist and should expect the specialist to prescribe:

methotrexate

corticosteroids

opioid analgesics

hydroxychloroquine

Question 31

2 / 2 pts

A patient has been taking an opioid analgesic for 2 weeks after a minor outpatient procedure At a follow-up clinic visit, the patient tells the primary care NP that he took extra doses for the past 2 days because of increased pain and wants an early refill of the medication The NP should suspect:

dependence

drug addiction

possible misuse

increasing pain

Question 32

2 / 2 pts

An elderly patient with dementia exhibits hostility and uncooperativeness The primary care NP prescribes clozapine (Clozaril) and should counsel the family about:

a decreased risk of extrapyramidal symptoms

improved cognitive function

the need for long-term use of the medication

a possible increased risk of heart disease and stroke

Question 33

2 / 2 pts

A patient who was hospitalized for an infection was treated with an aminoglycoside antibiotic The patient asks the primary care nurse practitioner (NP) why outpatient treatment wasn’t an option The NP should tell the patient that aminoglycoside antibiotics:

are more likely to be toxic

cause serious adverse effects

carry more risk for serious allergic reactions

must be given intramuscularly or intravenously

Question 34

2 / 2 pts

A woman who is pregnant tells an NP that she has been taking sertraline for depression for several years but is worried about the effects of this drug on her fetus The NP will consult with this patient’s psychiatrist and will recommend that she:

stop taking the sertraline now

continue taking the antidepressant

change to a monoamine oxidase inhibitor (MAOI)

discontinue the sertraline a week before delivery

Question 35

2 / 2 pts

A patient who has HIV is being treated with Emtriva The patient develops hepatitis B The primary care NP should contact the patient’s infectious disease specialist to discuss:

adding zidovudine

changing to Truvada

changing to tenofovir

ordering Combivir and tenofovir

Question 36

2 / 2 pts

A patient who was in a motor vehicle accident has been treated for lower back muscle spasms with metaxalone (Skelaxin) for 1 week and reports decreased but persistent pain A computed tomography scan is normal The primary care NP should:

suggest ice and rest

order physical therapy

prescribe diazepam (Valium)

add an opioid analgesic medication

Question 37

2 / 2 pts

A primary care NP sees a patient who has dysuria, fever, and urinary frequency The NP orders a urine dipstick, which is positive for nitrates and leukocyte esterase, and sends the urine to the laboratory for a culture The patient is allergic to sulfa drugs The NP should:

order cefaclor (Ceclor)

prescribe cefixime (Suprax)

administer intramuscular ceftriaxone (Rocephin)

wait for culture results before ordering an antibiotic

Question 38

2 / 2 pts

A patient comes to the clinic several days after an outpatient surgical procedure complaining of swelling and pain at the surgical site The primary care NP notes a small area of erythema but no abscess or induration The NP should:

prescribe TMP-SMX

prescribe topical mupirocin four times daily

suggest that the patient apply warm soaks three times daily

refer the patient to the surgeon for further evaluation

Question 39

2 / 2 pts

A patient who has genital herpes has frequent outbreaks The patient asks the primary care NP why it is necessary to take oral acyclovir all the time and not just for acute outbreaks The NP should explain that oral acyclovir may:

prevent the virus from developing resistance

cause episodes to be shorter and less frequent

actually eradicate the virus and cure the disease

reduce the chance of transmitting the virus to others

Question 40

2 / 2 pts

A patient is taking isoniazid, pyrazinamide, rifampin, and streptomycin to treat TB The primary care NP should routinely perform:

serum glucose and liver function tests (LFTs)

bone marrow density and ophthalmologic tests

ophthalmologic, hearing, and serum glucose tests

color vision, serum glucose, and LFTs

Question 41

2 / 2 pts

A primary care NP sees a patient who was recently hospitalized for infection and treated with gentamicin for 10 days The patient tells the NP that the drug was discontinued early because “my blood level was too high” The NP should order:

a serial audiometric test

a serum blood urea nitrogen (BUN) and creatinine

a urinalysis and complete blood count

serum calcium, magnesium, and sodium

Question 42

2 / 2 pts

A 40-year-old woman asks the primary care NP what she can do to minimize her risk of osteoporosis She takes 800 mg of calcium and drinks 2 cups of skim milk each day The NP should recommend that she:

decrease dietary fat

limit her caffeine intake

consume a high-protein diet

drink diet instead of sugary sodas

Question 43

2 / 2 pts

A patient has a sore throat with fever The primary care NP observes erythematous 4+ tonsils with white exudate A rapid antigen strep test is negative, and a culture is pending The NP orders amoxicillin as empiric treatment The patient calls the next day to report a rash The NP should suspect:

penicillin drug allergy

a viral cause for the patient’s symptoms

a serum sickness reaction to the penicillin

scarlatiniform rash from the streptococcal infection

Question 44

2 / 2 pts

A patient is taking sulfisoxazole The patient calls the primary care NP to report abdominal pain, nausea, and insomnia The NP should:

change to TMP/SMX

tell the patient to stop taking the drug immediately

reassure the patient that these are minor adverse effects of this drug

order a CBC with differential, platelets, and a stool culture

Question 45

2 / 2 pts

A patient is in the clinic with acute symptoms of anxiety The patient is restless and has not slept in 3 days The primary care NP observes that the patient is irritable and has moderate muscle tension The patient’s spouse reports that similar symptoms have occurred before in varying degrees for several years The NP should refer the patient to a psychologist and should prescribe which drug for short-term use?

Alprazolam

Buspirone

Melatonin

Zolpidem

Question 46

2 / 2 pts

A woman who takes oral contraceptive pills develops vaginal candidiasis The primary care NP prescribes a single dose of fluconazole When counseling the patient about this drug, the NP should tell her:

that the drug is safe if she were to become pregnant

that she may consume alcohol while taking this medication

to use a backup contraceptive method for the next 2 months

that she may need a lower dose of fluconazole because she takes oral contraceptive pills

Question 47

2 / 2 pts

A patient in the clinic reports taking a handful of acetaminophen extra-strength tablets about 12 hours prior The patient has nausea, vomiting, malaise, and drowsiness The patient’s aspartate aminotransferase and alanine aminotransferase are mildly elevated The primary care NP should:

expect the patient to sustain permanent liver damage

reassure the patient that these symptoms are reversible

tell the patient that acetylcysteine cannot be given this late

administer activated charcoal to remove acetaminophen from the body

Question 48

2 / 2 pts

An NP sees a preschooler in clinic for the first time When obtaining a medication history, the NP notes that the child is taking a medication for which safety and effectiveness in children has not been established in drug information literature The NP should:

discontinue the medication

order serum drug levels to evaluate toxicity

report the prescribing provider to the Food and Drug Administration (FDA)

ask the parent about the drug’s use and side effects

Question 49

2 / 2 pts

A patient who has Parkinson’s disease who takes levodopa and carbidopa reports having drooling episodes that are increasing in frequency The primary care NP should order:

benztropine

amantadine

apomorphine

modified-release levodopa

Question 50

2 / 2 pts

The primary care NP sees a 6-month-old infant for a routine physical examination and notes that the infant has a runny nose and a cough The parents report a 2-day history of a temperature of 99° F to 100° F and two to three loose stools per day Other family members have similar symptoms The infant has had two sets of immunizations at 2 and 4 months of age The NP should:

administer the 6-month immunizations at this visit today

schedule an appointment in 2 weeks for 6-month immunizations

administer DTaP, Hib, IPV, hepatitis B, and PCV13 today and RV in 2 weeks

withhold all immunizations until the infant’s temperature returns to normal and the cough is gone

Question 51

2 / 2 pts

A patient who was recently hospitalized and treated with gentamicin tells the primary care NP, “My kidney function test was abnormal and they stopped the medication” The patient is worried about long-term effects The NP should:

monitor renal function for several months

reassure the patient that complete recovery should occur

refer the patient to a nephrologist for follow-up evaluation

monitor serum electrolytes and serum creatinine and BUN

Question 52

2 / 2 pts

A patient has begun treatment for HIV The primary care NP should monitor the patient’s complete blood count (CBC) at least every _____ months

1 to 3

3 to 6

6 to 9

9 to 12

Question 53

2 / 2 pts

A patient who was recently diagnosed with COPD comes to the clinic for a follow-up evaluation after beginning therapy with a SABA as needed for dyspnea The patient reports occasional mild exertional dyspnea but is able to sleep well The patient’s FEV1 in the clinic is 85% of predicted, and oxygen saturation is 96% The primary care NP should recommend:

a combination LABA/ICS twice daily

influenza and pneumococcal vaccines

ipratropium bromide (Atrovent) twice daily

home oxygen therapy as needed for dyspnea

Question 54

2 / 2 pts

A patient who takes 150 mg of clozapine (Clozaril) twice daily calls the primary care NP at 10:00 AM one day to report forgetting to take the 8:00 AM dose The NP should counsel the patient to:

take the missed dose now

take 75 mg of clozapine now

wait and take the evening dose at the usual time

take the evening dose 2 hours earlier than usual

Question 55

2 / 2 pts

A patient has been taking fluoxetine 20 mg every morning for 5 days and calls the primary care NP to report decreased appetite, nausea, and insomnia The NP should:

suggest taking a sedative at bedtime

change the medication to bupropion

add trazodone to the patient’s regimen

reassure the patient that these effects will subside

Question 56

2 / 2 pts

A female patient presents with grayish, odorous vaginal discharge The primary care NP performs a gynecologic examination and notes vulvar and vaginal erythema Testing of the discharge reveals a pH of 52 and a fishy odor when mixed with a solution of 10% potassium hydroxide The NP should:

order topical fluconazole

order metronidazole 500 mg twice daily for 7 days

withhold treatment until culture results are available

prescribe a clotrimazole vaginal suppository for 7 days

Question 57

2 / 2 pts

An 80-year-old patient has a diagnosis of glaucoma, and the ophthalmologist has prescribed timolol (Timoptic) and pilocarpine eye drops The primary care NP should counsel this patient:

that systemic side effects of these medications may be severe

that the combination of these two drugs may cause drowsiness

to begin an exercise program to improve cardiovascular health

that a higher dose of one or both of these medications may be needed

Question 58

2 / 2 pts

An 18-month-old child who attends day care has head lice and has been treated with permethrin 1% (Nix) The parent brings the child to the clinic 1 week later, and the primary care NP notes live bugs on the child’s scalp The NP should order:

lindane

malathion

ivermectin

permethrin 5%

Question 59

2 / 2 pts

An adult patient who has a viral upper respiratory infection asks the primary care nurse practitioner (NP) about taking acetaminophen for fever and muscle aches To help ensure against possible drug toxicity, the NP should first:

determine the patient’s height and weight

ask the patient how high the temperature has been

tell the patient to take 325 mg initially and increase as needed

ask the patient about any other over-the-counter (OTC) cold medications being used

Question 60

2 / 2 pts

The primary care NP follows a patient who is being treated for RA with methotrexate The patient asks the NP why the medication does not seem to alleviate pain The NP tells the patient that:

an immunomodulator may be needed to control pain

a higher dose of methotrexate may be needed to achieve pain control

if methotrexate does not control pain, an opioid analgesic may be necessary

methotrexate is used to slow disease progression and preserve joint function

Question 61

2 / 2 pts

A patient has a UTI and will begin treatment with an antibiotic The patient reports moderate to severe suprapubic pain The primary care NP should prescribe:

ibuprofen as needed

bethanechol (Urecholine)

phenazopyridine (Pyridium)

increased oral fluid intake to dilute urine

Question 62

2 / 2 pts

The parent of an 8-year-old child recently diagnosed with AD/HD verbalizes concerns about giving the child stimulants The primary care NP should recommend:

modafinil (Provigil)

guanfacine (Intuniv)

bupropion (Wellbutrin)

atomoxetine (Strattera)

Question 63

2 / 2 pts

The primary care NP is performing a medication reconciliation on a patient who takes digoxin for congestive heart failure and learns that the patient uses ibuprofen as needed for joint pain The NP should counsel this patient to:

use naproxen (Naprosyn) instead of ibuprofen

increase the dose of digoxin while taking the ibuprofen

use an increased dose of ibuprofen while taking the digoxin

take potassium supplements to minimize the effects of the ibuprofen

Question 64

2 / 2 pts

A patient who takes valproic acid for a seizure disorder is preparing to have surgery The primary care NP should order:

coagulation studies

a complete blood count

an EEG

a creatinine clearance test

Question 65

2 / 2 pts

A patient who has Alzheimer’s disease is taking 10 mg of donepezil daily and reports difficulty sleeping The primary care NP should recommend:

decreasing the dose to 5 mg

increasing the dose to 15 mg

taking the drug in the morning

taking the drug in the evening

Question 66

2 / 2 pts

A child has been taking methylphenidate 5 mg at 8 AM, 12 PM, and 4 PM for 30 days after a new diagnosis of AD/HD and comes to the clinic for evaluation The child’s mother reports that the child exhibits some nervousness and insomnia but is doing much better in school The primary care NP should suggest:

discontinuing the 4 PM dose

increasing the dose to 10 mg each time

giving 10 mg at 8 AM and 5 mg at noon

changing the dosing to 15 mg twice daily

Question 67

2 / 2 pts

A 60-year-old woman is in the clinic for an annual well-woman examination She has been taking alendronate (Fosamax) 10 mg daily for 4 yearsHer last bone density test yielded a T-score of 20 Her urine NTx level today is 22 She walks daily Her fracture risk is low The primary care NP should recommend that she:

take a 1- to 2-year drug holiday

change to 70 mg of alendronate weekly

decrease the alendronate dose to 5 mg daily

change to ibandronate (Boniva) 3 mg IV every 3 months

Question 68

2 / 2 pts

The primary care nurse practitioner (NP) is seeing a patient who reports chronic lower back pain The patient reports having difficulty sleeping despite taking ibuprofen at bedtime each night The NP should prescribe:

diazepam (Valium)

metaxalone (Skelaxin)

methocarbamol (Robaxin)

cyclobenzaprine (Flexeril)

Question 69

2 / 2 pts

A patient reports smoking two or more packs of cigarettes per day and expresses a desire to quit smoking The primary care NP learns that the patient smokes heavily during breaks at work and during the evening but with no established schedule The NP should recommend:

bupropion (Wellbutrin)

nicotine replacement gum or nasal spray

a high-dose 24-hour nicotine patch

intensive smoking cessation counseling

Question 70

2 / 2 pts

A patient is seen in the clinic with a 1-week history of frequent watery stools The primary care NP learns that a family member had gastroenteritis a week prior The patient was treated for a UTI with a sulfonamide antibiotic 2 months prior The NP should suspect:

Clostridium difficile–associated disease (CDAD)

viral gastroenteritis

serum sickness reaction

recurrence of the UTI

Question 71

2 / 2 pts

A female patient has vaginal candidiasis and has taken a single dose of fluconazole without resolution of the infection The primary care NP obtains a culture and should order:

oral ketoconazole

griseofulvin for 4 weeks

another dose of fluconazole

topical miconazole (Monistat)

Question 72

2 / 2 pts

A patient reports difficulty falling asleep and staying asleep every night and has difficulty staying awake during the commute to work every dayThe NP should:

suggest the patient try diphenhydramine first

perform a thorough history and physical examination

teach about avoiding caffeine and good sleep hygiene

suggest melatonin and consider prescribing Ambien if this is not effective

Question 73

2 / 2 pts

A patient who is newly diagnosed with schizophrenia is overweight and has a positive family history for type 2 diabetes mellitus The primary care NP should consider initiating antipsychotic therapy with:

ziprasidone (Geodon)

olanzapine (Zyprexa)

risperidone (Risperdal)

chlorpromazine (Thorazine)

Question 74

2 / 2 pts

A patient asks an NP about using an oral over-the-counter decongestant medication for nasal congestion associated with a viral upper respiratory illness The NP learns that this patient uses loratadine (Claritin), a ?-adrenergic blocker, and an intranasal corticosteroid The NP would be concerned about which adverse effects?

Liver toxicity

Excessive drowsiness

Rebound congestion

Tremor, restlessness, and insomnia

Question 75

2 / 2 pts

A patient has been taking paroxetine (Paxil) for major depressive symptoms for 8 months The patient tells the primary care NP that these symptoms improved after 2 months of therapy The patient is experiencing weight gain and sexual dysfunction and wants to know if the medication can be discontinued The NP should:

change to a tricyclic antidepressant medication

begin to taper the paroxetine and instruct the patient to call if symptoms increase

tell the patient to stop taking the medication and to call if symptoms get worse

continue the medication for several months and consider adding bupropion (Wellbutrin)