Devry nr508 week 1 quiz 2016


1 .  Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months .  She has a positive family history of breast cancer .  The primary care NP should recommend:

testosterone therapy .

estrogen-only therapy .

nonhormonal drugs for osteoporosis .

estrogen-progesterone therapy for 1 to 2 years .

Question 2 .  A patient takes a cardiac medication that has a very narrow therapeutic range .  The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan .  The NP knows that the bioavailability of the drug varies from brand to brand .  The NP should:

contact the insurance provider to explain why this particular formulation is necessary .

change the patient’s medication to a different drug class that doesn’t have these bioavailability variations .

accept the situation and monitor the patient closely for drug effects with each prescription refill .

ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense .

Question 3 .  A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it .  The NP notes that the information is from an internet site called “Prism . com . ” The NP should tell this patient that:

this information is probably from a drug advertisement website .

this is factual, evidence-based material with accurate information .

the information is from a nonprofit group that will not profit from drug sales .

internet information is unreliable because anyone can post information there .

Question 4 .  A primary care NP is reviewing written information about a newly prescribed medication with a patient .  To evaluate this patient’s understanding of the information, the NP should ask the patient to:

read the information aloud .

describe how the medication will be taken .

write down questions about the medication .

tell the NP if the information is unclear .

Question 5 .  A patient is diagnosed with lupus and reports occasional use of herbal supplements .  The primary care NP should caution this patient to avoid:

ginseng .

echinacea .

ginkgo biloba .

St .  John’s wort .

Question 6 .  A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic to ask for a refill of the medication .  The primary care NP notes that the medication refill is not due for 2 weeks .  The patient tells the NP that the refill is needed because he is going out of town .  The NP should:

fill the prescription and document the patient’s explanation of the reason .

review the patient’s chart to see if this is a one-time or repeat occurrence .

call the patient’s pharmacist and report suspicion of drug-seeking behaviors .

confront the patient about misuse of narcotics and refuse to fill the prescription .

Question 7 .  The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners . Which statement by the patient indicates she understands the  regimen?

“I have to take a pill only every 3 months . ”

“I should expect to have only four periods each year . ”

“I will need to use condoms for only 7 more days . ”

“This type of pill has fewer side effects than other types . ”

Question 8 .  The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is “off-formulary . ” The NP should:

inform the patient that an out-of-pocket expense will be necessary .

write the prescription for a generic drug if it meets the patient’s needs .

call the patient’s insurance provider to advocate for this particular drug .

contact the pharmaceutical company to see if medication samples are available .

Question 9 .  A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms .  She has no family history or risk factors for coronary heart disease (CHD) or breast cancer but is concerned about these side effects of hormone therapy (HT) .  The NP should:

tell her that starting HT now may reduce her risk of breast cancer .

advise a short course of HT now that may decrease her risk for CHD .

tell her that HT will not help control her symptoms during postmenopause .

recommend herbal supplements for her symptoms to avoid HT side effects .

Question 10 .  A primary care NP recommends an over-the-counter medication for a patient who has acid reflux .  When teaching the patient about this drug, the NP should tell the patient:

to take the dose recommended by the manufacturer .

not to worry about taking this drug with any other medications .

to avoid taking other drugs that cause sedation while taking this drug .

that over-the-counter acid reflux medications are generally safe to take with other medications .

Question 11 .  A patient will begin taking two drugs that are both protein-bound .  The primary care NP should:

prescribe increased doses of both drugs .

monitor drug levels, actions, and side effects .

teach the patient to increase intake of protein .

stagger the doses of drugs to be given 1 hour apart .

Question 12 .  The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement .  The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration .  The child’s parents do not want the procedure .  The NP should:

compromise with the parents and order a nasogastric tube for feedings .

initiate a discussion with the parents about the potential outcomes of each possible action .

refer the family to a case manager who can help guide the parents to the best decision .

understand that the child’s parents have a right to make choices that override those of the medical team .

Question 13 .  A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital .  The NP should:

use an existing guideline from a leading research hospital .

follow the guideline provided by a third-party payer to help ensure reimbursement .

review expert opinion and experimental, anecdotal, correlational study data .

write the guideline to adhere to long-standing practice protocols already in use .

Question 14 .  The primary care nurse practitioner (NP) writes a prescription for an antibiotic using an electronic drug prescription system .  The pharmacist will fill this prescription when:

the electronic prescription is received .

the patient brings a written copy of the prescription .

a copy of the written prescription is faxed to the pharmacy .

the pharmacist accesses the patient’s electronic record to verify .

Question 15 .  A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics .  The NP should:

monitor frequently for desired and adverse effects .

administer a much higher initial dose as a loading dose .

monitor creatinine clearance at baseline and periodically .

administer the drug via a route that avoids the first-pass effect .

Question 16 .  An important difference between physician assistants (PAs) and NPs is PAs:

always work under physician supervision .

are not required to follow drug treatment protocols .

may write for all drug categories with physician co-signatures .

have both inpatient and outpatient independent prescriptive authority .

Question 17 .  A primary care NP writes a prescription for an off-label use for a drug .  To help ensure compliance, the NP should:

include information about the off-label use on the E-script .

provide the patient with written instructions about how to use the medication .

tell the patient to let the pharmacist know that the drug is being used for an off-label use .

follow up by phone in several days to see if the patient is using the drug appropriately .

Question 18 .  A patient reports taking antioxidant supplements to help prevent cancer .  The primary care NP should:

review healthy dietary practices with this patient .

make sure that the supplements contain large doses of vitamin A .

tell the patient that antioxidants are especially important for patients who smoke .

tell the patient that evidence shows antioxidants to be effective in preventing cancer .

Question 19 .  A woman comes to the clinic to talk about weight reduction .  The primary care nurse practitioner (NP) calculates a body mass index (BMI) of 28 .  The woman’s waist measures 34 inches .  The woman tells the NP that she would like to lose 20 lb for her daughter’s wedding in 6 months .  The NP should:

suggest she try over-the-counter (OTC) orlistat .

consider prescribing phentermine short-term .

discuss her short-term and long-term weight loss goals .

give her information about physical activity and diet modification .

Question 20 .  A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year .  When deciding whether or not to prescribe this formulation, the NP should:

tell the patient that when postmarketing data is available, it will be considered .

review the pharmaceutical company promotional materials about the new medication .

prescribe the medication if it is less expensive than the current drug formulation .

prescribe the medication if the new drug is available in an extended-release form .

Question 21 .  An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won’t have to deal with pills or periods .  The primary care NP should tell her that she:

should consider another form of contraception after 1 year .

may have irregular bleeding, especially in the first month or so .

will need to take calcium and vitamin D every day while using this method .

will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics .

Question 22 .  A patient receives an inhaled corticosteroid to treat asthma .  The patient asks the primary care NP why the drug is given by this route instead of orally .  The NP should explain that the inhaled form:

is absorbed less quickly .

has reduced bioavailability .

has fewer systemic side effects .

provides dosing that is easier to regulate .

Question 23 .  A patient who has breast cancer has been taking toremifene for 2 weeks .  She tells her primary care NP that she thinks her tumor has grown larger .  The NP should:

schedule her for a breast ultrasound .

reassure her that this is common and will subside .

tell her she may need an increased dose of this medication .

contact her oncologist to discuss adding another medication .

Question 24 .  The primary care NP is prescribing a medication for an off-label use .  To help prevent a medication error, the NP should:

write “off-label use” on the prescription and provide a rationale .

call the pharmacist to explain why the instructions deviate from common use .

write the alternative drug regimen on the prescription and send it to the pharmacy .

tell the patient to ignore the label directions and follow the verbal instructions given in the clinic .

Question 25 .  The primary care NP sees a woman who has been taking HT for menopausal symptoms for 3 years .  The NP decreases the dosage, and several weeks later, the woman calls to report having several hot flashes each day .  The NP should:

increase the HT dose .

discontinue HT .

recommend black cohosh to alleviate symptoms .

reassure her that these symptoms will diminish over time .



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