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:
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:
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.
recommend black cohosh to alleviate symptoms.
reassure her that these symptoms will diminish over time.