NR 508 Final Exam Practice Q&As with Rationale
1. A patient who has diabetesreports intense discomfort when needing to void.A urinalysis
is normal. To treat this, the primary care NP should consider prescribing: oxybut
...
NR 508 Final Exam Practice Q&As with Rationale
1. A patient who has diabetesreports intense discomfort when needing to void.A urinalysis
is normal. To treat this, the primary care NP should consider prescribing: 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, actsto 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.
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: 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.
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: 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.
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: recommend acetaminophen.
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
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