1. A patient who has been taking digoxin 0.25 mg daily for 6 months reports that it is not
working as well as it did initially. The primary care NP should: (Points : 2)
recommend a reduced potassium intake.
increase the dose of digoxin to 0.5 mg daily.
hold the next dose of digoxin and obtain a serum digoxin level.
contact the patient’s pharmacy to ask if generic digoxin was dispensed.
Question 2.2. A patient with a history of coronary heart disease develops atrial fibrillation. The
primary care NP refers the patient to a cardiologist who performs direct current cardioversion.
The NP should expect the patient to begin taking which -blocker medication? (Points : 2)
Nadolol (Corgard)
Sotalol (Betapace)
Timolol (Blocadren)
Propranolol (Inderal)
Question 3.3. A patient comes to the clinic with a complaint of gradual onset of left-sided
weakness. The primary care NP notes slurring of the patient’s speech. A family member
accompanying the patient tells the NP that these symptoms began 4 or 5 hours ago. The NP
will activate the emergency medical system and expect to administer: (Points : 2)
325 mg of chewable aspirin.
LMWH.
intravenous alteplase and aspirin.
warfarin (Coumadin) and aspirin.
Question 4.4. The primary care NP sees a new patient for a routine physical examination.
When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional
extra beats followed by a pause. History reveals no past cardiovascular disease, but the
patient reports occasional syncope and shortness of breath. The NP should: (Points : 2)
order an ECG and refer to a cardiologist.
schedule a cardiac stress test and a graded exercise test.
order a complete blood count (CBC) and electrolytes and consider a trial of
procainamide.
prescribe a -blocker and anticoagulant and order 24-hour Holter monitoring.
Question 5.5. The primary care NP refers a patient to a cardiologist who diagnoses long QT
syndrome. The cardiologist has prescribed propranolol (Inderal). The patient exercises
regularly and is not obese. The patient asks the NP what else can be done to minimize risk of
sudden cardiac arrest. The NP should counsel the patient to: (Points : 2)
drink extra fluids when exercising.
reduce stress with yoga and hot baths.
, ask the cardiologist about an implantable defibrillator.
ask the cardiologist about adding procainamide to the drug regimen.
Question 6.6. A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The
primary care NP should counsel the patient to: (Points : 2)
report wheezing and shortness of breath, which may occur with these drugs.
take care when getting out of bed or a chair after the first dose of the ACE inhibitor.
discuss taking an increased dose of the thiazide diuretic with the cardiologist.
minimize fluid intake for several days when beginning therapy with the ACE inhibitor.
Question 7.7. A female patient who is underweight tells the primary care NP that she has
been using bisacodyl (Dulcolax) daily for several years. The NP should: (Points : 2)
prescribe docusate sodium (Colace) and decrease bisacodyl gradually.
suggest she use polyethylene glycol (MiraLAX) on a daily basis instead.
tell her that long-term use of suppositories is safer than long-term laxative use.
counsel the patient to discontinue the laxative and increase fluid and fiber intake.
Question 8.8. A woman who is 4 months pregnant comes to the clinic with acute diarrhea and
nausea. Her husband is experiencing similar symptoms. The primary care nurse practitioner
(NP) notes a temperature of 38.5° C, a heart rate of 92 beats per minute, and a blood
pressure of 100/60 mm Hg. The NP should: (Points : 2)
prescribe attapulgite to treat her diarrhea.
obtain a stool culture and start antibiotic therapy.
instruct her to replace lost fluids by drinking Pedialyte.
refer her to an emergency department for intravenous (IV) fluids.
Question 9.9. 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: (Points : 2)
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.
Question 10.10. An 80-year-old patient asks a primary care NP about OTC antacids for
occasional heartburn. The NP notes that the patient has a normal complete blood count and
normal electrolytes and a slight elevation in creatinine levels. The NP should recommend:
(Points : 2)
working as well as it did initially. The primary care NP should: (Points : 2)
recommend a reduced potassium intake.
increase the dose of digoxin to 0.5 mg daily.
hold the next dose of digoxin and obtain a serum digoxin level.
contact the patient’s pharmacy to ask if generic digoxin was dispensed.
Question 2.2. A patient with a history of coronary heart disease develops atrial fibrillation. The
primary care NP refers the patient to a cardiologist who performs direct current cardioversion.
The NP should expect the patient to begin taking which -blocker medication? (Points : 2)
Nadolol (Corgard)
Sotalol (Betapace)
Timolol (Blocadren)
Propranolol (Inderal)
Question 3.3. A patient comes to the clinic with a complaint of gradual onset of left-sided
weakness. The primary care NP notes slurring of the patient’s speech. A family member
accompanying the patient tells the NP that these symptoms began 4 or 5 hours ago. The NP
will activate the emergency medical system and expect to administer: (Points : 2)
325 mg of chewable aspirin.
LMWH.
intravenous alteplase and aspirin.
warfarin (Coumadin) and aspirin.
Question 4.4. The primary care NP sees a new patient for a routine physical examination.
When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional
extra beats followed by a pause. History reveals no past cardiovascular disease, but the
patient reports occasional syncope and shortness of breath. The NP should: (Points : 2)
order an ECG and refer to a cardiologist.
schedule a cardiac stress test and a graded exercise test.
order a complete blood count (CBC) and electrolytes and consider a trial of
procainamide.
prescribe a -blocker and anticoagulant and order 24-hour Holter monitoring.
Question 5.5. The primary care NP refers a patient to a cardiologist who diagnoses long QT
syndrome. The cardiologist has prescribed propranolol (Inderal). The patient exercises
regularly and is not obese. The patient asks the NP what else can be done to minimize risk of
sudden cardiac arrest. The NP should counsel the patient to: (Points : 2)
drink extra fluids when exercising.
reduce stress with yoga and hot baths.
, ask the cardiologist about an implantable defibrillator.
ask the cardiologist about adding procainamide to the drug regimen.
Question 6.6. A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The
primary care NP should counsel the patient to: (Points : 2)
report wheezing and shortness of breath, which may occur with these drugs.
take care when getting out of bed or a chair after the first dose of the ACE inhibitor.
discuss taking an increased dose of the thiazide diuretic with the cardiologist.
minimize fluid intake for several days when beginning therapy with the ACE inhibitor.
Question 7.7. A female patient who is underweight tells the primary care NP that she has
been using bisacodyl (Dulcolax) daily for several years. The NP should: (Points : 2)
prescribe docusate sodium (Colace) and decrease bisacodyl gradually.
suggest she use polyethylene glycol (MiraLAX) on a daily basis instead.
tell her that long-term use of suppositories is safer than long-term laxative use.
counsel the patient to discontinue the laxative and increase fluid and fiber intake.
Question 8.8. A woman who is 4 months pregnant comes to the clinic with acute diarrhea and
nausea. Her husband is experiencing similar symptoms. The primary care nurse practitioner
(NP) notes a temperature of 38.5° C, a heart rate of 92 beats per minute, and a blood
pressure of 100/60 mm Hg. The NP should: (Points : 2)
prescribe attapulgite to treat her diarrhea.
obtain a stool culture and start antibiotic therapy.
instruct her to replace lost fluids by drinking Pedialyte.
refer her to an emergency department for intravenous (IV) fluids.
Question 9.9. 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: (Points : 2)
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.
Question 10.10. An 80-year-old patient asks a primary care NP about OTC antacids for
occasional heartburn. The NP notes that the patient has a normal complete blood count and
normal electrolytes and a slight elevation in creatinine levels. The NP should recommend:
(Points : 2)
