NR508 Test Banking Chapter 31-35

Chapter 31: Medications for Irritable Bowel Syndrome and Other Gastrointestinal Problems

Test Bank

MULTIPLE CHOICE

1.            A patient in the clinic reports frequent episodes of bloating, abdominal pain, and loose stools to the primary care nurse practitioner (NP). An important question the NP should ask about the abdominal pain is:

a.            the relation of the pain to stools.

b.            what time of day the pain occurs.

c.             whether the pain is sharp or diffuse.

d.            the age of the patient when the pain began.

2.            A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe:

a.            mesalamine (Asacol).

b.            dicyclomine (Bentyl).

c.             simethicone (Phazyme).

d.            metoclopramide (Reglan).

3.            A woman with IBS has been taking antispasmodic medications and reports some relief, but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain. The NP should consider prescribing:

a.            alosetron (Lotronex).

b.            misoprostol (Cytotec).

c.             simethicone (Phazyme).

d.            tricyclic antidepressants (TCAs).

4.            A patient who has IBS experiences diarrhea, bloating, and pain but does not want to take medication. The primary care NP should recommend:

a.            25 g of fiber each day.

b.            avoiding gluten and lactose in the diet.

c.             increasing water intake to eight to ten glasses per day.

d.            beginning aerobic exercise, such as running, every day.

5.            A patient who has IBS has been taking dicyclomine and reports decreased pain and diarrhea but is now having occasional constipation. The primary care NP should recommend:

a.            beginning treatment with an SSRI.

b.            beginning therapy with a TCA.

c.             over-the-counter (OTC) laxatives as needed when constipated.

d.            increasing the amounts of raw fruits and vegetables in the diet.

6.            A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS. The patient comes to the clinic and reports having dry mouth, difficulty urinating, and more frequent constipation. The primary care NP notes a heart rate of 92 beats per minute. The NP should:

a.            prescribe a TCA.

b.            discontinue the antidiarrheal medication.

c.             encourage the patient to increase water intake.

d.            lower the dose of the antispasmodic medication.

7.            A woman has severe IBS and takes hyoscyamine sulfate (Levsin), simethicone (Phazyme), and a TCA. She reports having continued severe diarrhea. The primary care NP should:

a.            order diphenoxylate (Lomotil).

b.            prescribe alosetron after ruling out pregnancy.

c.             refer her to a gastroenterologist for endoscopy.

d.            increase the fiber in her diet to 30 g per day.

8.            A patient who has diabetic gastroparesis sees a gastroenterology specialist who orders metoclopramide (Reglan). Within 24 hours, the patient describes having extrapyramidal symptoms (EPS) to the primary care NP. The NP will contact the gastroenterologist and should expect to prescribe:

a.            benztropine (Cogentin).

b.            cimetidine.

c.             an SSRI antidepressant.

d.            a TCA.

 

Chapter 32: Diuretics Test Bank

MULTIPLE CHOICE

1.            A patient develops hypertension. The primary care nurse practitioner (NP) plans to begin diuretic therapy for this patient. The NP notes clear breath sounds, no organomegaly, and no peripheral edema. The patient’s serum electrolytes are normal. The NP should prescribe:

 a.           furosemide (Lasix).

b.            triamterene (Dyrenium).

c.             acetazolamide (Diamox).

d.            hydrochlorothiazide (HydroDIURIL).

2.            A patient takes hydrochlorothiazide to treat hypertension and asks the primary care NP why it is necessary to reduce sodium intake while taking this medication. The NP should explain that decreasing sodium is necessary to:

a.            prevent renal insufficiency.

b.            minimize the risk of hypokalemia.

c.             prevent postdiuretic sodium retention.

d.            increase the likelihood that the drug may be discontinued.

3.            A patient with congestive heart failure will begin therapy with a diuretic medication. The primary care NP orders laboratory tests, which reveal a glomerular filtration rate (GFR) of 25 mL/minute. The initial drug the NP should prescribe is:

a.            metolazone.

b.            furosemide (Lasix).

c.             spironolactone (Aldactone).

d.            hydrochlorothiazide (HydroDIURIL).

4.            A patient who has congestive heart failure and arthritis has been taking chlorthalidone (Zaroxolyn) 25 mg daily for 6 months. The primary care NP notes a persistent blood pressure of 145/90 mm Hg. The NP should:

a.            ask the patient which medications are used for pain.

b.            add furosemide (Lasix) to the patient’s drug regimen.

c.             increase the dose of chlorthalidone to 100 mg daily.

d.            recommend that the patient use salt substitutes to season foods.

5.            The primary care NP is preparing to prescribe a diuretic for a patient who has heart failure. The patient reports having had an allergic reaction to sulfamethoxazole- trimethoprim (Bactrim) previously. The NP should prescribe:

a.            ethacrynic acid.

b.            furosemide (Lasix).

c.             acetazolamide (Diamox).

d.            hydrochlorothiazide (HydroDIURIL).

6.            The primary care NP sees a patient several months after a myocardial infarction (MI). The patient has been taking furosemide to treat heart failure. The NP notes that the patient has edema of the hands, feet, and ankles. The NP should add which drug to this patient’s regimen?

 a.           Ethacrynic acid

b.            Chlorothiazide (Lozol)

c.             Triamterene (Dyrenium)

d.            Spironolactone (Aldactone)

7.            The primary care NP sees a patient who has a history of hypertension and alcoholism. The patient is not taking any medications. The NP auscultates crackles in both lungs and palpates the liver 2 cm below the costal margin. Laboratory tests show an elevated creatinine level. The NP will refer this patient to a cardiologist and should prescribe:

a.            albuterol metered-dose inhaler.

b.            furosemide (Lasix).

c.             spironolactone (Aldactone).

d.            chlorthalidone (Zaroxolyn).

8.            The primary care NP sees a patient who has heart failure following an MI 6 months before this visit. The patient has been taking an ACE inhibitor, nitroglycerin, furosemide, and hydrochlorothiazide. The NP auscultates crackles in both lungs and notes pitting edema of both feet. The NP should prescribe:

a.            mannitol.

b.            metolazone.

c.             acetazolamide (Diamox).

d.            spironolactone (Aldactone).

9.            A patient has been taking furosemide 80 mg once daily for 4 weeks and returns for a follow-up visit. The primary care NP notes a blood pressure of 100/60 mm Hg. The patient’s lungs are clear, and there is no peripheral edema. The patient’s serum potassium is 3.4 mEq/L. The NP should:

a.            continue furosemide at the current dose.

b.            decrease furosemide to 60 mg once daily.

c.             increase furosemide to 80 mg twice daily.

d.            change furosemide dose the 40 mg twice daily.

10.          A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet. The primary care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg. The NP should:

a.            obtain a serum drug level.

b.            order an electrocardiogram (ECG) and serum electrolytes.

c.             change the medication to a thiazide diuretic.

d.            question the patient about potassium intake.

MULTIPLE CHOICE

1.            An adult patient reports feeling unfocused all the time, loses things, and has difficulty completing tasks and says that this is interfering with family relations and work. The symptoms have been present as long as the patient can remember, although there is no previous documentation of attention-deficit/hyperactivity disorder (AD/HD) in this patient’s medical history. The primary care nurse practitioner (NP) should:

a.            tell the patient that a diagnosis of AD/HD as a child is a prerequisite for diagnosing this in adults.

b.            conduct a thorough evaluation to document behaviors associated with AD/HD and begin treatment if indicated.

c.             suggest that the patient may have a major depressive disorder and refer the patient for psychiatric evaluation and treatment.

d.            prescribe a methylphenidate trial, ask the patient to keep a diary of behaviors and feelings, and reevaluate in 1 to 2 months.

2.            A child is taking methylphenidate (Ritalin) for AD/HD. The child’s parent calls the primary care NP to report increased behavior problems and delusional thinking. The NP should:

a.            increase the drug dose.

b.            discontinue the medication.

c.             change to dextroamphetamine.

d.            order methylphenidate SR.

3.            A primary care NP sees a child for an annual well-child check-up. The child has been taking methylphenidate for AD/HD for 3 months. The NP should discontinue the medication if which symptom is present?

a.            Motor tics

b.            Decreased appetite

c.             Occasional headaches

d.            Decreased blood pressure

4.            A child is diagnosed with AD/HD after being expelled from school for disruptive behaviors. The child’s parents are reluctant to start medication because of the stigma attached. The primary care NP should suggest:

a.            Ritalin.

b.            Concerta.

c.             Adderall.

d.            Dexedrine.

5.            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:

a.            discontinuing the 4 PM dose.

b.            increasing the dose to 10 mg each time.

c.             giving 10 mg at 8 AM and 5 mg at noon.

d.            changing the dosing to 15 mg twice daily.

6.            A patient who has recently begun working at night reports having difficulty staying awake at work. The primary care NP should consider prescribing:

a.            caffeine.

b.            modafinil (Provigil).

c.             methylphenidate (Ritalin).

d.            dextroamphetamine (Dexedrine).

7.            The parent of a 4-year-old child is concerned that the child may have AD/HD and wants to know if medications can be given. The primary care NP should tell the parent that:

a.            children cannot be diagnosed with AD/HD at this age.

b.            alternative therapies to treat AD/HD are used at this age.

c.             symptoms at this age are more likely due to environmental factors.

d.            most drugs for AD/HD are not approved for children younger than 6 years.

8.            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:

a.            modafinil (Provigil).

b.            guanfacine (Intuniv).

c.             bupropion (Wellbutrin).

d.            atomoxetine (Strattera).

 

Chapter 35: Acetaminophen Test Bank

MULTIPLE CHOICE

1.            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:

a.            determine the patient’s height and weight.

b.            ask the patient how high the temperature has been.

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

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

2.            A parent asks a primary care NP how much acetaminophen to give a 2-year-old child who has a temperature of 37.5° C. The NP should tell the parent that:

a.            acetaminophen is not safe in children younger than 6 years.

b.            acetaminophen may mask a fever and prevent treatment of other symptoms.

c.             antipyretics are usually not necessary for temperatures less than 37.7° C.

d.            antipyretics should be given to prevent seizures, but nonsteroidal antiinflammatory drugs are a better choice.

3.            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:

a.            recommend acetaminophen.

b.            recommend high-dose acetaminophen.

c.             tell the patient that antibiotics are needed with a fever that high.

d.            tell the patient a fever less than 40° C does not need to be treated.

4.            A patient comes to the clinic and reports breaking out in an urticarial rash 1 hour after taking acetaminophen for osteoarthritis symptoms. The primary care NP should:

a.            order a complete blood count with differential.

b.            order liver and renal function tests.

c.             suspect Reye’s syndrome and arrange for hospitalization.

d.            tell the patient not to take products containing acetaminophen again.

5.            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:

a.            expect the patient to sustain permanent liver damage.

b.            reassure the patient that these symptoms are reversible.

c.             tell the patient that acetylcysteine cannot be given this late.

d.            administer activated charcoal to remove acetaminophen from the body.