A patient has been taking fluoxetine 20 mg every morning for 5 days and calls the primary care NP to report decreased appetite, nausea, and insomnia. The NP should:

Question 30

2 / 2 pts

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:

methotrexate.

corticosteroids.

opioid analgesics.

hydroxychloroquine.

Question 31

2 / 2 pts

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:

dependence.

drug addiction.

possible misuse.

increasing pain.

Question 32

2 / 2 pts

An elderly patient with dementia exhibits hostility and uncooperativeness. The primary care NP prescribes clozapine (Clozaril) and should counsel the family about:

a decreased risk of extrapyramidal symptoms.

improved cognitive function.

the need for long-term use of the medication.

a possible increased risk of heart disease and stroke.

Question 33

2 / 2 pts

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:

are more likely to be toxic.

cause serious adverse effects.

carry more risk for serious allergic reactions.

must be given intramuscularly or intravenously.

Question 34

2 / 2 pts

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:

stop taking the sertraline now.

continue taking the antidepressant.

change to a monoamine oxidase inhibitor (MAOI).

discontinue the sertraline a week before delivery.

Question 35

2 / 2 pts

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:

adding zidovudine.

changing to Truvada.

changing to tenofovir.

ordering Combivir and tenofovir.

Question 36

2 / 2 pts

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:

suggest ice and rest.

order physical therapy.

prescribe diazepam (Valium).

add an opioid analgesic medication.

Question 37

2 / 2 pts

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:

order cefaclor (Ceclor).

prescribe cefixime (Suprax).

administer intramuscular ceftriaxone (Rocephin).

wait for culture results before ordering an antibiotic.

Question 38

2 / 2 pts

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:

prescribe TMP-SMX.

prescribe topical mupirocin four times daily.

suggest that the patient apply warm soaks three times daily.

refer the patient to the surgeon for further evaluation.

Question 39

2 / 2 pts

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:

prevent the virus from developing resistance.

cause episodes to be shorter and less frequent.

actually eradicate the virus and cure the disease.

reduce the chance of transmitting the virus to others.

Question 40

2 / 2 pts

A patient is taking isoniazid, pyrazinamide, rifampin, and streptomycin to treat TB. The primary care NP should routinely perform:

serum glucose and liver function tests (LFTs).

bone marrow density and ophthalmologic tests.

ophthalmologic, hearing, and serum glucose tests.

color vision, serum glucose, and LFTs.

Question 41

2 / 2 pts

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:

a serial audiometric test.

a serum blood urea nitrogen (BUN) and creatinine.

a urinalysis and complete blood count.

serum calcium, magnesium, and sodium.

Question 42

2 / 2 pts

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:

decrease dietary fat.

limit her caffeine intake.

consume a high-protein diet.

drink diet instead of sugary sodas.

Question 43

2 / 2 pts

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:

penicillin drug allergy.

a viral cause for the patient’s symptoms.

a serum sickness reaction to the penicillin.

scarlatiniform rash from the streptococcal infection.

Question 44

2 / 2 pts

A patient is taking sulfisoxazole. The patient calls the primary care NP to report abdominal pain, nausea, and insomnia. The NP should:

change to TMP/SMX.

tell the patient to stop taking the drug immediately.

reassure the patient that these are minor adverse effects of this drug.

order a CBC with differential, platelets, and a stool culture.

Question 45

2 / 2 pts

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 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?

Alprazolam

Buspirone

Melatonin

Zolpidem

Question 46

2 / 2 pts

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:

that the drug is safe if she were to become pregnant.

that she may consume alcohol while taking this medication.

to use a backup contraceptive method for the next 2 months.

that she may need a lower dose of fluconazole because she takes oral contraceptive pills.

Question 47

2 / 2 pts

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:

expect the patient to sustain permanent liver damage.

reassure the patient that these symptoms are reversible.

tell the patient that acetylcysteine cannot be given this late.

administer activated charcoal to remove acetaminophen from the body.

Question 48

2 / 2 pts

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:

discontinue the medication.

order serum drug levels to evaluate toxicity.

report the prescribing provider to the Food and Drug Administration (FDA).

ask the parent about the drug’s use and side effects.

Question 49

2 / 2 pts

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:

benztropine.

amantadine.

apomorphine.

modified-release levodopa.

Question 50

2 / 2 pts

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:

administer the 6-month immunizations at this visit today.

schedule an appointment in 2 weeks for 6-month immunizations.

administer DTaP, Hib, IPV, hepatitis B, and PCV13 today and RV in 2 weeks.

withhold all immunizations until the infant’s temperature returns to normal and the cough is gone.

Question 51

2 / 2 pts

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:

monitor renal function for several months.

reassure the patient that complete recovery should occur.

refer the patient to a nephrologist for follow-up evaluation.

monitor serum electrolytes and serum creatinine and BUN.

Question 52

2 / 2 pts

A patient has begun treatment for HIV. The primary care NP should monitor the patient’s complete blood count (CBC) at least every _____ months.

1 to 3

3 to 6

6 to 9

9 to 12

Question 53

2 / 2 pts

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 combination LABA/ICS twice daily.

influenza and pneumococcal vaccines.

ipratropium bromide (Atrovent) twice daily.

home oxygen therapy as needed for dyspnea.

Question 54

2 / 2 pts

A patient who takes 150 mg of clozapine (Clozaril) twice daily calls the primary care NP at 10:00 AM one day to report forgetting to take the 8:00 AM dose. The NP should counsel the patient to:

take the missed dose now.

take 75 mg of clozapine now.

wait and take the evening dose at the usual time.

take the evening dose 2 hours earlier than usual.

Question 55

2 / 2 pts

A patient has been taking fluoxetine 20 mg every morning for 5 days and calls the primary care NP to report decreased appetite, nausea, and insomnia. The NP should:

suggest taking a sedative at bedtime.

change the medication to bupropion.

add trazodone to the patient’s regimen.

reassure the patient that these effects will subside.

Question 56

2 / 2 pts

A female patient presents with grayish, odorous vaginal discharge. The primary care NP performs a gynecologic examination and notes vulvar and vaginal erythema. Testing of the discharge reveals a pH of 5.2 and a fishy odor when mixed with a solution of 10% potassium hydroxide. The NP should:

order topical fluconazole.

order metronidazole 500 mg twice daily for 7 days.

withhold treatment until culture results are available.

prescribe a clotrimazole vaginal suppository for 7 days.

Question 57

2 / 2 pts

An 80-year-old patient has a diagnosis of glaucoma, and the ophthalmologist has prescribed timolol (Timoptic) and pilocarpine eye drops. The primary care NP should counsel this patient:

that systemic side effects of these medications may be severe.

that the combination of these two drugs may cause drowsiness.

to begin an exercise program to improve cardiovascular health.

that a higher dose of one or both of these medications may be needed.

Question 58

2 / 2 pts

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:

lindane.

malathion.

ivermectin.

permethrin 5%.

Question 59

2 / 2 pts

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:

determine the patient’s height and weight.

ask the patient how high the temperature has been.

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

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

Question 60

2 / 2 pts

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:

an immunomodulator may be needed to control pain.

a higher dose of methotrexate may be needed to achieve pain control.

if methotrexate does not control pain, an opioid analgesic may be necessary.

methotrexate is used to slow disease progression and preserve joint function.

Question 61

2 / 2 pts

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:

ibuprofen as needed.

bethanechol (Urecholine).

phenazopyridine (Pyridium).

increased oral fluid intake to dilute urine.

Question 62

2 / 2 pts

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:

modafinil (Provigil).

guanfacine (Intuniv).

bupropion (Wellbutrin).

atomoxetine (Strattera).

Question 63

2 / 2 pts

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:

use naproxen (Naprosyn) instead of ibuprofen.

increase the dose of digoxin while taking the ibuprofen.

use an increased dose of ibuprofen while taking the digoxin.

take potassium supplements to minimize the effects of the ibuprofen.

Question 64

2 / 2 pts

A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order:

coagulation studies.

a complete blood count.

an EEG.

a creatinine clearance test.

Question 65

2 / 2 pts

A patient who has Alzheimer’s disease is taking 10 mg of donepezil daily and reports difficulty sleeping. The primary care NP should recommend:

decreasing the dose to 5 mg.

increasing the dose to 15 mg.

taking the drug in the morning.

taking the drug in the evening.

Question 66

2 / 2 pts

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:

discontinuing the 4 PM dose.

increasing the dose to 10 mg each time.

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

changing the dosing to 15 mg twice daily.

Question 67

2 / 2 pts

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:

take a 1- to 2-year drug holiday.

change to 70 mg of alendronate weekly.

decrease the alendronate dose to 5 mg daily.

change to ibandronate (Boniva) 3 mg IV every 3 months.

Question 68

2 / 2 pts

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:

diazepam (Valium).

metaxalone (Skelaxin).

methocarbamol (Robaxin).

cyclobenzaprine (Flexeril).

Question 69

2 / 2 pts

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:

bupropion (Wellbutrin).

nicotine replacement gum or nasal spray.

a high-dose 24-hour nicotine patch.

intensive smoking cessation counseling.

Question 70

2 / 2 pts

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:

Clostridium difficile–associated disease (CDAD).

viral gastroenteritis.

serum sickness reaction.

recurrence of the UTI.

Question 71

2 / 2 pts

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:

oral ketoconazole.

griseofulvin for 4 weeks.

another dose of fluconazole.

topical miconazole (Monistat).

Question 72

2 / 2 pts

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:

suggest the patient try diphenhydramine first.

perform a thorough history and physical examination.

teach about avoiding caffeine and good sleep hygiene.

suggest melatonin and consider prescribing Ambien if this is not effective.

Question 73

2 / 2 pts

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:

ziprasidone (Geodon).

olanzapine (Zyprexa).

risperidone (Risperdal).

chlorpromazine (Thorazine).

Question 74

2 / 2 pts

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?

Liver toxicity

Excessive drowsiness

Rebound congestion

Tremor, restlessness, and insomnia

Question 75

2 / 2 pts

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:

change to a tricyclic antidepressant medication.

begin to taper the paroxetine and instruct the patient to call if symptoms increase.

tell the patient to stop taking the medication and to call if symptoms get worse.

continue the medication for several months and consider adding bupropion (Wellbutrin