NR 508 FINAL EXAM | A patient who has diabetes reports intense discomfort when needing to void.

1. 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: ________. 2. 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: ________. 3. 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: ________. 4. 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: ________. 5. A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing freezing episodes between doses. The primary care NP should consider using: ________. 6. 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: ________. 7. 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: ________. 8. 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: ________. 9. 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: ________ 10. 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: ________. 11. A patient is newly diagnosed with Alzheimer’s disease stage 6 on the Global Deterioration Scale. The primary care NP should prescribe: ________. 12. 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: ________. 13. 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 dose. The parent reports that the medication is not producing the desired effects. The NP should: ________. 14. 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 15. 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: ________. 16. 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: ________. 17. A patient tells the primary care NP that he has difficulty getting and maintaining an erection. The NP’s initial response should be to: ________. 18. 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: ________. 19. 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: ________. 20. 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: ________. 21. 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: ________. 22. 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: ________. 23. 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: ________. 24. A patient has been taking intramuscular (IM) meperidine 75 mg every 6 hours for 3 days after hospital, the primary care NP should expect the patient to receive a prescription for _____ mg orally every _____ hours: ________. 25. 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: ________. 26. 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: ________. 27. 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: ________. 28. 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: ________. 29. 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: ________. 30. 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: ________. 31. 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: ________. 32. 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: ________. 33. An elderly patient with dementia exhibits hostility and uncooperativeness. The primary care NP prescribes clozapine (Clozaril) and should counsel the family about: ________. 34. 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: ________. 35. 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: ________. 36. 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: ________. 37. 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: ________. 38. 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: ________. 39. 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: ________. 40. 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: ________. 41. A patient is taking isoniazid, pyrazinamide, rifampin, and streptomycin to treat TB. The 42. primary care NP should routinely perform: ________. 43. 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: ________. 44. 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: ________. 45. 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: ________. 46. A patient is taking sulfisoxazole. The patient calls the primary care NP to report abdominal pain, nausea, and insomnia. The NP should: ________. 47. 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 48. 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? ________. 49. 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: ________. 50. 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: ________. 51. 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: ________. 52. 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: ________. 53. 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: ________. 54. 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: ________. 55. A patient has begun treatment for HIV. The primary care NP should monitor the patient’s complete blood count (CBC) at least every _____ months. ________. 56. 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 57. 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: ________. 58. 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: ________. 59. 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: ________. 60. 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: ________. 61. 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: ________. 62. 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: ________. 63. A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order: ________. 64. A patient who has Alzheimer’s disease is taking 10 mg of donepezil daily and reports difficulty sleeping. The primary care NP should recommend: ________. 65. 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: ________. 66. 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: ________. 67. 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: ________. 68. 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: ________. 69. 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: ________. 70. 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: ________. 71. 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: ________. 72. 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: ________. 73. 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? ________. 74. 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: ________.