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NR 508 ADVANCED PHARM FINAL EXAM
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS AGRADE
RATED
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: - ANSWER- perform a thorough evaluation of cognitive and motor abilities.
The body system most significantly affected by increased receptor sensitivity in elderly patients is the central nervous system, making this population sensitive to numerous drugs. It is important to evaluate motor and cognitive function before beginning drugs that affect the central nervous system to minimize the risk of falls. Assessment of sleeping patterns is important, but not in relation to patient safety. It is not necessary to evaluate stool patterns or renal function.
A patient has been taking intramuscular (IM) meperidine 75 mg every 6 hours for 3 days after surgery. When the patient is discharged from the hospital, the primary care NP should expect the patient to receive a prescription for _____ mg orally every _____ hours. - ANSWER-hydrocodone 30; 6 1 / 4
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When patients are switched from one opiate to another, an equianalgesic table should be used to convert the dosage of the current drug to the equivalent dosage of the new drug. An oral dose of 30 mg of hydrocodone is equivalent to an IM dose of 75 mg of meperidine.
When patients are switched from one opiate to another, an equianalgesic table should be used to convert the dosage of the current drug to the equivalent dosage of the new drug. An oral dose of 30 mg of hydrocodone is equivalent to an IM dose of 75 mg of meperidine. - ANSWER-prescribe febuxostat.
Colchicine is a first-line drug for preventing acute attacks. Because this patient has three risk factors, a preventive medication should be used. Febuxostat is a second-line preventive medication. The patient should not be treated on an as-needed basis.
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: - ANSWER-admit him to the hospital for detoxification.
He is showing signs of alcohol withdrawal and possible delirium tremens and so should be admitted to the hospital. Asking him about drinking and suggesting outpatient counseling would be useful for a less emergent condition. The NP should not prescribe a medication to treat delirium tremens on an outpatient basis.
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3 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: - ANSWER-ciprofloxacin.
Fluoroquinolones are effective in treatment of UTIs that are resistant to other antibiotics.Because this patient recently completed a course of TMP/SMX, the NP can assume that the bacterium causing the infection is resistant to TMP/SMX. Gemifloxacin is not indicated for UTI, but ciprofloxacin is. Azithromycin is not a fluoroquinolone.
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:
Correct! - ANSWER-order an electroencephalogram (EEG).
Discontinuation of AEDs may be considered in patients who have been seizure-free for longer than 2 years. An EEG should be obtained before the medication is withdrawn.The drug should be tapered to prevent status epilepticus, but only after a normal EEG is obtained. AED therapy is not lifelong in all patients. Patients should not stop AED medications abruptly, and these drugs are not used on an as-needed basis.
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 3 / 4
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4 at this time. The NP should: - ANSWER-ask her to write down any factors that triggered her relapses.
Each attempt to quit smoking should not be seen as a failure but as a trial for the next attempt. Asking a patient who is motivated to quit to write down things that may have contributed to the relapse will help the patient learn from the previous attempts. The patient already knows about the effects of smoking on fetal development because that is her motivation for quitting. Offering medication may be necessary, but only if the patient desires it.
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: - ANSWER- to take each dose of the NSAID with a full glass of water.
To avoid GI distress associated with NSAIDs, a full glass of water is recommended.Patients may take NSAIDs with antacids. Patients should avoid alcohol while taking NSAIDs. Patients should report GI symptoms to their provider.
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: - ANSWER-hydroxychloroquine.
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