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A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping blood glucose within normal limits and has had multiple episodes of both hypoglycemia and hyperglycemia

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Quiz 5 Pharm

 

 1.

Question :

A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping blood glucose within normal limits and has had multiple episodes of both hypoglycemia and hyperglycemia. As adjunct therapy to manage this problem, the primary care NP should prescribe:

 

   

pramlintide (Symlin).

 

   

repaglinide (Prandin).

 

   

glyburide (Micronase).

 

   

metformin (Glucophage).

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 2.

Question :

A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary care NP should recommend:

 

   

adding docusate sodium (Colace).

 

   

polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax).

 

   

lactulose (Chronulac) and polyethylene glycol (MiraLAX).

 

   

adding nonpharmacologic measures such as biofeedback.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 3.

Question :

A patient who has type 2 diabetes mellitus takes metformin (Glucophage). The patient tells the primary care NP that he will have surgery in a few weeks. The NP should recommend:

 

   

taking the metformin dose as usual the morning of surgery.

 

   

using insulin during the perioperative and postoperative periods.

 

   

that the patient stop taking metformin several days before surgery.

 

   

adding a sulfonylurea medication until recovery from surgery is complete.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 4.

Question :

A patient has NSAID-induced ulcer and has started taking ranitidine (Zantac). At a follow-up appointment 3 days later, the patient reports no alleviation of symptoms. The primary care NP should:

 

   

order cimetidine (Tagamet).

 

   

add metronidazole to the drug regimen.

 

   

change from ranitidine to omeprazole (Prilosec).

 

   

reassure the patient that drug effects take several weeks.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 5.

Question :

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:

 

   

prescribe a TCA.

 

   

discontinue the antidiarrheal medication.

 

   

encourage the patient to increase water intake.

 

   

lower the dose of the antispasmodic medication.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 6.

Question :

An 80-year-old patient has a history of renal disease and develops a duodenal ulcer. The primary care NP should order a:

 

   

normal dose of a histamine-2 blocker.

 

   

decreased dose of a histamine-2 blocker.

 

   

normal dose of a PPI.

 

   

decreased dose of a PPI.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 7.

Question :

A 40-year-old patient is in the clinic for a routine physical examination. The patient has a body mass index (BMI) of 26. The patient is active and walks a dog daily. A lipid profile reveals low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30 mg/dL, and triglycerides of 250 mg/dL. The primary care nurse practitioner (NP) should:

 

   

order a fasting plasma glucose level.

 

   

consider prescribing metformin (Glucophage).

 

   

suggest dietary changes and increased exercise.

 

   

obtain serum insulin and hemoglobin A1c levels.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 8.

Question :

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

 

   

25 g of fiber each day.

 

   

avoiding gluten and lactose in the diet.

 

   

increasing water intake to eight to ten glasses per day.

 

   

beginning aerobic exercise, such as running, every day.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 9.

Question :

A patient with Graves’ disease is taking methimazole. After 6 months of therapy, the primary care NP notes normal T3 and T4 and elevated TSH. The NP should:

 

   

order a complete blood count (CBC) with differential.

 

   

order aspartate aminotransferase, AGT, and LDH tests.

 

   

decrease the dose of the medication.

 

   

add levothyroxine to the patient’s regimen.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 10.

Question :

A 30-year-old white woman has a BMI of 26 and weighs 150 lb. At an annual physical examination, the patient’s fasting plasma glucose is 130 mg/dL. The patient walks 1 mile three or four times weekly. She has had two children who weighed 7 lb and 8 lb at birth. Her personal and family histories are noncontributory. The primary care NP should:

 

   

order metformin (Glucophage).

 

   

order a lipid profile, complete blood count, and liver function tests (LFTs).

 

   

order an oral glucose tolerance test.

 

   

set a weight loss goal of 10 to 15 lb.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 11.

Question :

An 80-year-old female patient with a history of angina has increased TSH and decreased T4. The primary care NP should prescribe _____ mcg of _____.

 

   

25; liothyronine

 

   

75; liothyronine

 

   

25; levothyroxine

 

   

75; levothyroxine

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 12.

Question :

A patient who has GERD with erosive esophagitis has been taking a PPI for 4 weeks and reports a decrease in symptoms. The patient asks the primary care NP if the medication may be discontinued. The NP should tell the patient that:

 

   

the dose may be decreased for long-term therapy.

 

   

antireflux surgery must be done before the PPI can be discontinued.

 

   

the condition may eventually be cured, but therapy must continue for years.

 

   

once the symptoms have cleared completely, the medication may be discontinued.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 13.

Question :

A patient who has gastroesophageal reflux disease (GERD) undergoes an endoscopy, which shows a hiatal hernia. The patient is mildly obese. The patient asks the primary care nurse practitioner (NP) about treatment options. The NP should tell this patient that:

 

   

a fundoplication will be necessary to correct the cause of GERD.

 

   

over-the-counter (OTC) antacids can be effective and should be tried first.

 

   

elevation of the head of the bed at night can relieve most symptoms.

 

   

a combination of lifestyle changes, medications, and surgery may be necessary.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 14.

Question :

A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day. The child weighs 15 kg. The primary care NP sees the child for a 3-year-old check-up. The NP should consult with a pediatric endocrinologist to discuss:

 

   

increasing the dose to 90 mcg/day.

 

   

decreasing the dose to 30 mcg/day.

 

   

stopping the medication and checking TSH and T4 in 4 weeks.

 

   

discussing the need for lifetime replacement therapy with the child’s parents.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 15.

Question :

A patient who has experienced five to seven liquid stools for 3 days is seen in the clinic by the primary care NP. The patient reports having had fever, mucoid stools, and nausea without vomiting. The patient has been drinking Gatorade to stay hydrated. The NP obtains a stool specimen for culture and should prescribe:

 

   

diphenoxylate (Lomotil).

 

   

attapulgite (Kaopectate).

 

   

bismuth subsalicylate (Pepto-Bismol).

 

   

loperamide hydrochloride (Imodium).

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 16.

Question :

A patient with a diagnosis of peptic ulcer disease asks the primary care NP about nonpharmacologic treatment. Which statement by the NP is correct?

 

   

“You should consume a diet that is high in fiber.”

 

   

“One or two cups of coffee each day won’t hurt you.”

 

   

“Alcoholic beverages are strictly prohibited when you have an ulcer.”

 

   

“Lifestyle changes and proper diet may eliminate the need for medication.”

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 17.

Question :

A 2-year-old child has chronic “toddler’s” diarrhea, which has an unknown but benign etiology. The child’s parent asks the primary care NP if a medication can be used to treat the child’s symptoms. The NP should recommend giving:

 

   

diphenoxylate (Lomotil).

 

   

attapulgite (Kaopectate).

 

   

an electrolyte solution (Pedialyte).

 

   

bismuth subsalicylate (Pepto-Bismol).

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 18.

Question :

A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are:

 

   

not curative and may prolong the illness.

 

   

useful in cases of acute infection with elevated temperature.

 

   

most beneficial when symptoms persist longer than 2 weeks.

 

   

useful when other symptoms, such as hematochezia, develop.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 19.

Question :

A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased. The NP should consult with an endocrinologist and order:

 

   

thyrotropin.

 

   

methimazole.

 

   

levothyroxine.

 

   

propylthiouracil.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 20.

Question :

A primary care NP prescribes levothyroxine for a patient to treat thyroid deficiency. When teaching this patient about the medication, the NP should:

 

   

counsel the patient to take the medication with food.

 

   

tell the patient that changing brands of the medication should be avoided.

 

   

instruct the patient to stop taking the medication if signs of thyrotoxicosis occur.

 

   

tell the patient that the drug may be stopped when thyroid function tests stabilize.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 21.

Question :

A patient with erosive esophagitis is taking lansoprazole (Prevacid). The primary care NP performs a medication history and learns that the patient also takes digoxin. The NP should recommend:

 

   

decreasing the dose of digoxin.

 

   

obtaining a serum digoxin level.

 

   

changing the PPI to omeprazole.

 

   

increasing the dose of lansoprazole.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 22.

Question :

A patient who takes digoxin reports taking psyllium (Metamucil) three or four times each month for constipation. The primary care NP should counsel this patient to:

 

   

decrease fluid intake to avoid cardiac overload.

 

   

change the laxative to docusate sodium (Colace).

 

   

take the digoxin 2 hours before taking the psyllium.

 

   

ask the cardiologist about taking an increased dose of digoxin.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 23.

Question :

A patient who has diabetes is taking metformin 1000 mg daily. At a clinic visit, the patient reports having abdominal pain and nausea. The primary care NP notes a heart rate of 92 beats per minute. The NP should:

 

   

obtain LFTs.

 

   

decrease the dose of metformin.

 

   

change metformin to glyburide.

 

   

order electrolytes, ketones, and serum glucose.

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 24.

Question :

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:

 

   

beginning treatment with an SSRI.

 

   

beginning therapy with a TCA.

 

   

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

 

   

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

 

Instructor Explanation:

 
 

 

Points Received:

2 of 2

 

Comments:

 

 

Question 25.

Question :

A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3%. The NP should:

 

   

begin insulin therapy.

 

   

change to therapy with colesevelam (Welchol).

 

   

add a third oral antidiabetic agent to this patient’s drug regimen.

 

   

enroll the patient in a weight loss program to achieve better glycemic control.

 

Instructor Explanation:

 

 

 

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