NR508 Test Banking Chapter 16-20

Chapter 16: Asthma and Chronic Obstructive Pulmonary Disease Medications Test Bank

MULTIPLE CHOICE

 1.           A primary care nurse practitioner (NP) is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms. The patient’s forced expiratory volume in 1 second (FEV1) is 80% of the predicted value. The patient’s current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The NP should prescribe:

a.            montelukast (Singulair) po daily.

b.            ipratropium bromide bid with albuterol.

c.             a low-dose inhaled corticosteroid (ICS), 2 puffs bid.

d.            a long-acting ?-adrenergic agonist (LABA), 1 puff bid.

2.            A primary care NP sees an adolescent patient for a hospitalization follow-up after an asthma exacerbation. The patient reports having daily symptoms with nighttime awakening 4 or 5 nights per week and misses school several days each month. The patient currently uses a salmeterol/fluticasone LABA twice daily and albuterol as needed. The patient requires a refill of the albuterol prescription once a month. The patient does not have any known allergies. The NP should:

a.            order a high-dose ICS plus a LABA twice daily.

b.            consider adding theophylline to this patient’s regimen.

c.             continue the current regimen and add omalizumab daily.

d.            order a combination product with ipratropium and albuterol.

3.            A 50-year-old patient who recently quit smoking reports a frequent morning cough productive of yellow sputum. A chest x-ray is clear, and the patient’s FEV1 is 80% of predicted. Pulse oximetry reveals an oxygen saturation of 97%. The primary care NP auscultates clear breath sounds. The NP should:

a.            reassure the patient that these symptoms will subside.

b.            prescribe a moderate-dose ICS twice daily.

c.             order a long-acting anticholinergic with albuterol twice daily.

d.            prescribe an albuterol metered-dose- inhaler, 2 puffs every 4 hours as needed.

4.            A primary care NP is evaluating a patient who has COPD. The patient uses a LABA twice daily. The patient reports having increased exertional dyspnea, a frequent cough, and poor sleep. The patient also uses a short-acting ?-adrenergic agonist (SABA) five or six times each day. Pulse oximetry reveals an oxygen saturation of 92%. The patient’s FEV1/forced vital capacity is 65, and FEV1 is 55% of predicted. The NP should prescribe a(n):

a.            oral corticosteroid.

b.            long-acting anticholinergic.

c.             long-acting oral theophylline.

d.            combination ICS/LABA inhaler.

5.            A primary care NP sees a child with asthma to evaluate the child’s response to the

a.            combination ICS/LABA inhaler twice daily.

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

c.             combination ipratropium/albuterol inhaler twice daily.

d.            SABA as needed plus a leukotriene modifier once daily.

6.            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.            a combination LABA/ICS twice daily.

b.            influenza and pneumococcal vaccines.

c.             ipratropium bromide (Atrovent) twice daily.

d.            home oxygen therapy as needed for dyspnea.

7.            A 70-year-old patient who has COPD takes theophylline daily and uses a SABA for exacerbation of symptoms. The patient reports using the SABA three or four times each week when short of breath. The patient reports feeling jittery and nauseated and having trouble sleeping. The primary care NP should:

a.            obtain a serum theophylline level.

b.            order a creatinine clearance level.

c.             prescribe a leukotriene modifier instead of theophylline.

d.            discontinue the SABA and change to ipratropium bromide.

8.            A 75-year-old patient requires frequent use of corticosteroids to control COPD exacerbations. To monitor adverse drug effects in this patient, the primary care NP should:

a.            order a bone density study.

b.            monitor the patient’s renal function at every visit.

c.             order an electrocardiogram to assess for arrhythmias.

d.            order routine chest radiographs to watch for pneumonia.

9.            A patient with asthma is given an asthma action plan and returns to the clinic in 2 weeks to follow up on symptoms. Which statement by the patient indicates a need for further teaching?

a.            “I use the ICS as needed when I am wheezing.”

b.            “A side effect of albuterol may be shortness of breath.”

c.             “I should rinse my mouth thoroughly after using an ICS.”

 d.           “I put the albuterol metered-dose inhaler in my mouth with my lips sealed around it.”

 

Chapter 17: Hypertension and Miscellaneous Antihypertensive Medications Test Bank

MULTIPLE CHOICE

1.            The primary care nurse practitioner (NP) sees a patient in the clinic who has a blood pressure of 130/85 mm Hg. The patient’s laboratory tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120 mg/dL; and fasting plasma glucose, 100 mg/dL. The NP calculates a body mass index of 29. The patient has a positive family history for cardiovascular disease. The NP should:

a.            prescribe a thiazide diuretic.

b.            consider treatment with an angiotensin- converting enzyme inhibitor.

c.             reassure the patient that these findings are normal.

d.            counsel the patient about dietary and lifestyle changes.

2.            A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body mass index of 24, and exercises regularly. The patient has no known risk factors for cardiovascular disease. The primary care NP should:

a.            prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.

 b.           perform a careful cardiovascular physical assessment.

c.             counsel the patient about dietary and lifestyle changes.

d.            order a urinalysis and creatinine clearance and begin therapy with a ?-blocker.

3.            The primary care NP sees a new patient who has diabetes and hypertension and has been taking a thiazide diuretic for 6 months. The patient’s blood pressure at the beginning of treatment was 150/95 mm Hg. The blood pressure today is 138/85 mm Hg. The NP should:

a.            order a ?-blocker.

b.            add an angiotensin-converting enzyme inhibitor.

c.             continue the current drug regimen.

d.            change to an aldosterone antagonist medication.

4.            A patient who has had a previous myocardial infarction has a blood pressure of 135/82 mm Hg. The patient’s body mass index is 28, and the patient has a fasting plasma glucose of 105 mg/dL. The primary care NP should prescribe:

a.            an angiotensin-converting enzyme inhibitor.

b.            a thiazide diuretic.

 c.            lifestyle modifications.

d.            a calcium-channel blocker.

5.            A patient has three consecutive blood pressure readings of 140/95 mm Hg. The patient’s body mass index is 24. A fasting plasma glucose is 100 mg/dL. Creatinine clearance and cholesterol tests are normal. The primary care NP should order:

a.            a ?-blocker.

b.            an angiotensin-converting enzyme inhibitor.

c.             a thiazide diuretic.

d.            dietary and lifestyle changes.

6.            The primary care NP sees a new African-American patient who has blood pressure readings of 140/90 mm Hg, 130/85 mm Hg, and 142/80 mm Hg on three separate occasions. The NP learns that the patient has a family history of hypertension. The NP should:

a.            initiate monotherapy with a thiazide diuretic.

b.            prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.

c.             discuss dietary and lifestyle modifications with the patient.

d.            begin combination therapy with an ARB and a calcium-channel blocker.

7.            An 80-year-old male patient will begin taking an ?-antiadrenergic medication. The primary care NP should teach this patient to:

a.            ask for assistance while bathing.

b.            restrict fluids to aid with diuresis.

c.             take the medication in the morning with food.

d.            be aware that priapism is a common side effect.

 

Chapter 18: Coronary Artery Disease and Antianginal Medications Test Bank

MULTIPLE CHOICE

1.            A patient who has a history of angina has sublingual nitroglycerin tablets to use as needed. The primary care nurse practitioner (NP) reviews this medication with the patient at the patient’s annual physical examination. Which statement by the patient indicates understanding of the medication?

a.            “I should call 9-1-1 if chest pain persists 5 minutes after the first dose.”

b.            “I should take 3 nitroglycerin tablets 5 minutes apart and then call 9-1-1.”

c.             “I should take aspirin along with the nitroglycerin when I have chest pain.”

d.            “I should take nitroglycerin and then rest for 15 minutes before taking the next dose.”

2.            A patient who will begin using nitroglycerin for angina asks the primary care NP how the medication works to relieve pain. The NP should tell the patient that nitroglycerin acts to:

a.            dissolve atheromatous lesions.

b.            relax vascular smooth muscle.

c.             prevent catecholamine release.

d.            reduce C-reactive protein levels.

3.            A patient who has angina uses 0.4 mg of sublingual nitroglycerin for angina episodes. The patient brings a log of angina episodes to an annual physical examination. The primary care NP notes that the patient has experienced an increase in frequency of episodes in the past month but no increase in duration or severity of pain. The NP should:

a.            increase the nitroglycerin dose to 0.6 mg per dose.

b.            change from a sublingual to a transdermal patch nitroglycerin.

c.             discontinue the nitroglycerin and order ranolazine (Ranexa ER).

d.            contact the patient’s cardiologist to discuss admission to the hospital.

4.            A patient who has stable angina and uses sublingual nitroglycerin tablets is in the clinic and begins having chest pain. The primary care NP administers a nitroglycerin tablet and instructs the patient to lie down. The NP’s next action should be to:

a.            obtain an electrocardiogram.

b.            administer oxygen at 2 L/minute.

c.             give 325 mg of chewable aspirin.

d.            call EMS.

5.            A 45-year-old patient who has a positive family history but no personal history of coronary artery disease is seen by the primary care NP for a physical examination. The patient has a body mass index of 27 and a blood pressure of 130/78 mm Hg. Laboratory tests reveal low-density lipoprotein, 110 mg/dL; high-density lipoprotein, 70 mg/dL; and triglycerides, 120 mg/dL. The patient does not smoke but has a sedentary lifestyle. The NP should recommend:

a.            30 minutes of aerobic exercise daily.

b.            taking 81 to 325 mg of aspirin daily.

c.             beginning therapy with a statin medication.

d.            starting a thiazide diuretic to treat hypertension.

6.            The primary care NP is preparing to prescribe isosorbide dinitrate sustained release (Dilatrate SR) for a patient who has chronic, stable angina. The NP should recommend initial dosing of:

a.            60 mg four times daily at 6-hour intervals.

b.            40 mg twice daily 30 minutes before meals.

c.             60 mg on awakening and 40 mg 7 hours later.

d.            80 mg three times daily at 8:00 AM, 1:00

PM, and 6:00 PM.

7.            A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. The NP should teach the patient to:

a.            change the patch four times daily.

b.            use the patch as needed for angina pain.

c.             use two patches daily and change them every 12 hours.

d.            apply one patch daily in the morning and remove in 12 hours.

 

Chapter 19: Heart Failure and Digoxin Test Bank

MULTIPLE CHOICE

1.            A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The primary care nurse practitioner (NP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles. The NP should consult a cardiologist to discuss prescribing a(n):

a.            ?-blocker.

b.            loop diuretic.

c.             angiotensin-converting enzyme (ACE) inhibitor.

d.            angiotensin receptor blocker (ARB).

2.            A patient who has heart failure has been treated with furosemide and an ACE inhibitor. The patient’s cardiologist has added digoxin to the patient’s medication regimen. The primary care NP who cares for this patient should expect to monitor:

a.            serum electrolytes.

b.            blood glucose levels.

c.             serum thyroid levels.

d.            complete blood counts (CBCs).

3.            A patient who takes spironolactone for heart failure has begun taking digoxin (Lanoxin) for atrial fibrillation. The primary care NP provides teaching for this patient and asks the patient to repeat back what has been learned. Which statement by the patient indicates understanding of the teaching?

a.            “I should avoid high-sodium foods.”

b.            “I should eat foods high in potassium.”

c.             “I need to take a calcium supplement every day.”

d.            “I should use a salt substitute while taking these medications.”

4.            A patient has heart failure. A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling. The patient takes low-dose furosemide and an ACE inhibitor. The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg. The NP should:

a.            order serum electrolytes.

b.            obtain renal function tests.

c.             consider prescribing a ?-blocker.

d.            call the patient’s cardiologist to discuss adding digoxin to the patient’s regimen.

5.            A primary care NP is preparing to order digoxin for an 80-year-old patient who has systolic heart failure. The NP obtains renal function tests, which are normal. The NP should:

a.            prescribe a digoxin 0.125 mg tablet once daily.

b.            give an initial dose of 0.5 mg digoxin tablet and then 0.125 mg every 6 hours ? 4.

c.             administer a digoxin 0.6 mg capsule once and then 0.3 mg every 8 hours ? 3.

d.            administer a loading dose of intravenous digoxin in the clinic and then give 0.125 mg once daily.

6.            A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop diuretic, and an ACE inhibitor. The patient reports having nausea. The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg. The NP should:

a.            decrease the dose of the diuretic to prevent further dehydration.

b.            obtain a serum potassium level to assess for hyperkalemia.

c.             hold the ACE inhibitor until the patient’s blood pressure stabilizes.

d.            obtain a digoxin level before the patient takes the next dose of digoxin.

7.            A patient who has been taking digoxin 0.25 mg daily for 6 months reports that it is not working as well as it did initially. The primary care NP should:

a.            recommend a reduced potassium intake.

b.            increase the dose of digoxin to 0.5 mg daily.

c.             hold the next dose of digoxin and obtain a serum digoxin level.

d.            contact the patient’s pharmacy to ask if generic digoxin was dispensed.

 

Chapter 20: Beta-Blockers Test Bank

MULTIPLE CHOICE

 1.           An 80-year-old patient with chronic stable angina has begun taking nadolol (Corgard) 20 mg once daily in addition to taking nitroglycerin as needed. After 1 week, the patient reports no change in frequency of nitroglycerin use. The primary care nurse practitioner (NP) should change the dose of nadolol to            mg          daily.

a.            40; once

b.            80; once

c.             20; twice

d.            40; twice

2.            A patient is in the clinic for a follow-up examination after a myocardial infarction (MI). The patient has a history of left ventricular systolic dysfunction. The primary care NP should expect this patient to be taking:

a.            nadolol (Corgard).

b.            carvedilol (Coreg).

c.             timolol (Blocadren).

d.            propranolol (Inderal).

3.            An 80-year-old patient has begun taking propranolol (Inderal) and reports feeling tired all of the time. The primary care NP should:

a.            tell the patient to stop taking the medication immediately.

b.            recommend that the patient take the medication at bedtime.

c.             tell the patient that tolerance to this side effect will occur over time.

 d.           contact the patient’s cardiologist to discuss decreasing the dose of propranolol.

4.            A patient with a history of coronary heart disease develops atrial fibrillation. The primary care NP refers the patient to a cardiologist who performs direct current cardioversion. The NP should expect the patient to begin taking which ?-blocker medication?

a.            Nadolol (Corgard)

b.            Sotalol (Betapace)

c.             Timolol (Blocadren)

d.            Propranolol (Inderal)

5.            A patient who has migraine headaches has begun taking timolol and 2 months after beginning this therapy reports no change in frequency of migraines. The patient’s current dose is 30 mg once daily. The primary care NP should:

a.            change the medication to propranolol.

b.            increase the dose to 40 mg once daily.

c.             obtain serum drug levels to see if the dose is therapeutic.

d.            tell the patient to continue taking the timolol and return in 1 month.

6.            A patient who has been taking propranolol for 6 months reports having nocturnal cough and shortness of breath. The primary care NP should:

a.            tell the patient to stop taking the medication.

b.            obtain serum drug levels to monitor for toxicity of this medication.

c.             instruct the patient to increase activity and exercise to counter these side effects.

d.            contact the patient’s cardiologist to discuss changing to a selective ?-blocker.

7.            A patient is in the clinic for an annual physical examination. The primary care NP obtains a medication history and learns that the patient is taking a ?-blocker and nitroglycerin. The NP orders laboratory tests, performs a physical examination, and performs a review of systems. Which finding may warrant discontinuation of the ?-blocker in this patient?

a.            Increased triglycerides

b.            Decreased exercise tolerance

c.             Wheezing, dyspnea, and cough

d.            Nausea, vomiting, and anorexia

8.            A primary care NP provides teaching for a patient who will begin taking propranolol (Inderal). Which statement by the patient indicates understanding of the teaching?

a.            “I should take this medication on an empty stomach.”

b.            “I should use caution while driving while taking this medication.”

 c.            “I should not take the medication if my pulse is less than 60 beats per minute.”

d.            “If I have shortness of breath, I should discontinue the medication immediately.”