The primary care NP follows a patient who is being treated for RA with methotrexat

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 5.2 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 years.Her last bone density test yielded a T-score of 2.0. 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 day.The 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.