NR 508 Final Exam

NR 508 Final Exam

Question 1

2 / 2 pts

A patient who has diabetes reports intense discomfort when
needing to void. A urinalysis is normal. To treat this, the primary care NP
should consider prescribing:

flavoxate (Urispas).

bethanechol (Urecholine).

phenazopyridine (Pyridium).

oxybutynin chloride (Ditropan XL).

Question 2

2 / 2 pts

A patient reports difficulty returning to sleep after
getting up to go to the bathroom every night. A physical examination and a
sleep hygiene history are noncontributory. The primary care NP should
prescribe:

zaleplon.

ZolpiMist.

ramelteon.

chloral hydrate.

Question 3

2 / 2 pts

A 5-year-old child who has no previous history of otitis
media is seen in clinic with a temperature of 100° F. The primary care NP
visualizes bilateral erythematous, nonbulging, intact tympanic membranes. The
child is taking fluids well and is playing with toys in the examination room.
The NP should:

prescribe azithromycin once daily for 5 days.

prescribe amoxicillin twice daily for 10 days.

prescribe amoxicillin-clavulanate twice daily for 10 days.

initiate antibiotic therapy if the child’s condition
worsens.

Question 4

2 / 2 pts

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:

recommend acetaminophen.

recommend high-dose acetaminophen.

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

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

Question 5

2 / 2 pts

A patient who takes levodopa and carbidopa for Parkinson’s
disease reports experiencing freezing episodes between doses. The primary care
NP should consider using:

selegiline.

amantadine.

apomorphine.

modified-release levodopa.

Question 6

2 / 2 pts

A patient is being tapered from long-term therapy with
prednisolone and reports weight loss and fatigue. The primary care NP should
counsel this patient to:

consume foods high in vitamin D and calcium.

begin taking dexamethasone because it has longer effects.

expect these side effects to occur as the medication is
tapered.

increase the dose of prednisolone to the most recent amount
taken.

Question 7

2 / 2 pts

The primary care nurse practitioner (NP) sees a 50-year-old
woman who reports frequent leakage of urine. The NP learns that this occurs
when she laughs or sneezes. She also reports having an increased urge to void
even when her bladder is not full. She is not taking any medications. The NP
should:

perform a dipstick urinalysis.

prescribe desmopressin (DDAVP).

prescribe oxybutynin chloride (Ditropan XL).

teach exercises to strengthen the pelvic muscles.

Question 8

2 / 2 pts

A 7-year-old patient who has severe asthma takes oral
prednisone daily. At a well-child examination, the primary care NP notes a
decrease in the child’s linear growth rate. The NP should consult the child’s
asthma specialist about:

gradually tapering the child off the prednisone.

a referral for possible growth hormone therapy.

giving a double dose of prednisone every other day.

dividing the prednisone dose into twice-daily dosing.

Question 9

2 / 2 pts

A patient who is taking isoniazid and rifampin for latent TB
is seen by the primary care NP for a routine follow-up visit. The patient
reports having nausea, vomiting, and a decreased appetite. The NP should:

ask about alcohol intake.

suggest taking the medications with food.

reassure the patient that these side effects are common.

order liver and renal function tests and serum glucose.

Question 10

2 / 2 pts

A primary care NP sees a child with asthma to evaluate the
child’s response to the prescribed therapy. The child uses an ICS twice daily
and an albuterol metered-dose inhaler as needed. The child’s symptoms are well
controlled. The NP notes slowing of the child’s linear growth on a standardized
growth chart. The NP should change this child’s medication regimen to a:

combination ICS/LABA inhaler twice daily.

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

combination ipratropium/albuterol inhaler twice daily.

SABA as needed plus a leukotriene modifier once daily.

Question 11

2 / 2 pts

A patient is newly diagnosed with Alzheimer’s disease stage
6 on the Global Deterioration Scale. The primary care NP should prescribe:

donepezil (Aricept).

rivastigmine (Exelon).

memantine (Namenda).

galantamine (Razadyne).

Question 12

2 / 2 pts

The primary care NP sees a 12-month-old infant who needs the
MMR, Varivax, influenza, and hepatitis A vaccines. The child’s mother tells the
NP that she is pregnant. The NP should:

administer all of these vaccines today.

give the hepatitis A and influenza vaccines.

give the Varivax, hepatitis A, and influenza vaccines.

withhold all of these vaccines until after the baby is born.

Question 13

2 / 2 pts

A parent brings a 5-year-old child to a clinic for a
hospital follow-up appointment. The child is taking a medication at a dose
equal to an adult dose. The parent reports that the medication is not producing
the desired effects. The NP should:

order renal function tests.

prescribe another medication to treat this child’s symptoms.

discontinue the drug and observe the child for toxic side
effects.

obtain a serum drug level and consider increasing the drug
dose.

Question 14

2 / 2 pts

An NP orders an inhaled corticosteroid 2 puffs twice daily
and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough
or wheezing for a 65-year-old patient with recent onset of reactive airways
disease who reports symptoms occurring every 1 or 2 weeks. At a follow-up
appointment several months later, the patient reports no change in frequency of
symptoms. The NP’s initial action should be to:

order spirometry to evaluate pulmonary function.

prescribe a systemic corticosteroid to help with symptoms.

ask the patient to describe how the medications are taken
each day.

give the patient detailed information about the use of
metered-dose inhalers.

Question 15

2 / 2 pts

A patient is diagnosed with a condition that causes chronic
pain. The primary care NP prescribes an opioid analgesic and should instruct
the patient to:

wait until the pain is at a moderate level before taking the
medication.

take the medication at regular intervals and not just when
pain is present.

start the medication at higher doses initially and taper
down gradually.

take the minimum amount needed even when pain is severe to
avoid dependency.

Question 16

2 / 2 pts

A patient tells the primary care NP that he has difficulty
getting and maintaining an erection. The NP’s initial response should be to:

prescribe sildenafil (Viagra).

perform a medication history.

evaluate his cardiovascular status.

order a papaverine injection test to screen for erectile
dysfunction.

Question 17

2 / 2 pts

A 55-year-old patient develops Parkinson’s disease
characterized by unilateral tremors only. The primary care NP will refer the
patient to a neurologist and should expect initial treatment to be:

levodopa.

carbidopa.

pramipexole.

carbidopa/levodopa.

Question 18

2 / 2 pts

A patient who has migraine headaches without an aura reports
difficulty treating the migraines in time because they come on so suddenly. The
patient has been using over-the-counter NSAIDs. The primary care NP should
prescribe:

frovatriptan (Frova).

sumatriptan (Imitrex).

cyproheptadine (Periactin).

dihydroergotamine (D.H.E. 45).

Question 19

2 / 2 pts

A woman tells a primary care NP that she is considering
getting pregnant. During a health history, the NP learns that the patient has
seasonal allergies, asthma, and epilepsy, all of which are well controlled with
a second-generation antihistamine daily, an inhaled steroid daily with
albuterol as needed, and an antiepileptic medication daily. The NP should
counsel this patient to:

take her asthma medications only when she is having an acute
exacerbation.

avoid using antihistamine medications during her first
trimester of pregnancy.

discontinue her seizure medications at least 6 months before
becoming pregnant.

use only oral corticosteroids and not inhaled steroids while
pregnant for improved asthma control.

Question 20

2 / 2 pts

A patient who has partial seizures has been taking phenytoin
(Dilantin). The patient has recently developed thrombocytopenia. The primary
care nurse practitioner (NP) should contact the patient’s neurologist to
discuss changing the patient’s medication to:

topiramate (Topamax).

levetiracetam (Keppra).

zonisamide (Zonegran).

carbamazepine (Tegretol).

Question 21

2 / 2 pts

A patient is taking dicloxacillin (Dynapen) 500 mg every 6
hours to treat a severe penicillinase-resistant infection. At a 1-week
follow-up appointment, the patient reports nausea, vomiting, and epigastric
discomfort. The primary care NP should:

change the medication to a cephalosporin.

decrease the dose to 250 mg every 6 hours.

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

order blood cultures, a white blood cell (WBC) count with
differential, and liver function tests (LFTs).

Question 22

2 / 2 pts

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:

assess this patient’s usual sleeping patterns.

ask the patient about problems with constipation.

obtain a baseline creatinine clearance test before the first
dose.

perform a thorough evaluation of cognitive and motor
abilities.

Question 23

2 / 2 pts

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.

hydrocodone 30; 6

hydrocodone 75; 6

meperidine 300;12

meperidine 75; 6

Question 24

2 / 2 pts

A patient who is obese and has hypertension is taking a
thiazide diuretic and develops gouty arthritis, which is treated with
probenecid. At a follow-up visit, the patient’s serum uric acid level is 7
mg/dL, and the patient denies any current symptoms. The primary care NP should
discontinue the probenecid and:

prescribe colchicine.

prescribe febuxostat.

tell the patient to use an NSAID if symptoms recur.

counsel the patient to report recurrence of symptoms.

Question 25

2 / 2 pts

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:

admit him to the hospital for detoxification.

ask him how much he had to drink last night.

prescribe lorazepam (Ativan) to help with symptoms.

suggest that he talk to a counselor about alcohol abuse.

Question 26

2 / 2 pts

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:

gemifloxacin.

ciprofloxacin.

azithromycin.

TMP/SMX.

Question 27

2 / 2 pts

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:

order an electroencephalogram (EEG).

prescribe a tapering regimen of the drug.

inform the patient that antiepileptic drug (AED) therapy is
lifelong.

tell the patient to stop the drug and use only as needed.

Question 28

2 / 2 pts

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 at this time. The NP should:

discuss the effects of smoking on fetal development.

ask her to write down any factors that triggered her
relapses.

give her information about the long-term effects of smoking.

convince her that taking medication will be essential in her
case.

Question 29

2 / 2 pts

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:

to avoid taking antacids while taking the NSAID.

to take each dose of the NSAID with a full glass of water.

that a few glasses of wine each day are allowed while taking
the NSAID.

to decrease the dose of the NSAID if GI symptoms occur.

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

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