NR 508 MIDTERM EXAM QUIZ
I. A 40-year-old woman tells the primary care nurse practitioner (NP) that she does not want
more children and would
like a contraceptive. She does not smoke and has no personal or family history of cardiovascular
disease. She has frequent tension headaches. For this patient, the NP should prescribe:
condoms.
tubal ligation.
monophasic combined oral contraceptive pill (COCP).
low-estrogen COCP.
Low-estrogen COCPs are recommended for women older than 40 with or without cardiovascular
risk. Monophasic COCPs are recommended for women with migraine headaches. Condoms are
more useful for preventing sexually transmitted diseases and not as reliable as contraception.
Tubal ligation has surgical risks.
II. A woman who has been taking a COCP tells the primary care NP that, because of frequent
changes in her work
schedule, she has difficulty remembering to take her pills. The woman and the NP decide to
change to a vaginal ring. The NP will instruct her to insert the ring:
, NR 508 MIDTERM EXAM QUIZ
within 7 days after her last active pill.
and use a backup contraceptive for 7 days.
and continue the COCP for one more cycle.
on the same day she stops taking her COCP.
Patients should be switched from a COCP to a vaginal ring by insertion within 7 days after the
last active pill. No backup method is needed. Patients do not need to continue one more cycle of
COCPs. Women taking progestin-only pills insert the ring on the last day of the pill pack.
III. A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs
(NSAIDs) daily develops a
duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states
that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should:
prescribe cimetidine (Tagamet).
prescribe omeprazole (Prilosec).
teach the patient about a bland diet.
, NR 508 MIDTERM EXAM QUIZ
change the NSAID to a corticosteroid.
Patients with NSAID-induced ulcer should discontinue the NSAID if possible and use an acid
suppressant. This patient has severe arthritis and so cannot discontinue the NSAID. In a
situation such as this, a PPI is indicated. Cimetidine is a histamine-2 blocker, which would be a
second-line choice, but cimetidine has many serious side effects. Bland diets are not effective in
treating ulcers. Corticosteroids are not indicated.
IV. A patient in the clinic develops sudden shortness of breath and tachycardia. The primary
care NP notes thready
pulses, poor peripheral perfusion, and a decreased level of consciousness. The NP activates the
emergency medical system and should anticipate that this patient will receive:
intravenous alteplase.
low-dose aspirin and warfarin.
low-molecular-weight heparin (LMWH).
Correct Answer
unfractionated heparin (UFH) and warfarin.
This patient has unstable pulmonary embolism (PE) and should receive thrombolytic therapy.
Intravenous alteplase is the preferred agent. UFH and warfarin are recommended for stable PE.
, NR 508 MIDTERM EXAM QUIZ
LMWH is beneficial in submassive PE and deep vein thrombosis (DVT) but is controversial for
treatment of massive PE.
V. A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor) continues
to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP
increases the dose from 10 mg daily to 20 mg daily. The patient reports headache and
dizziness a few weeks after the dose increase. The NP should:
change the atorvastatin dose to 15 mg twice daily.
change the patient’s medication to cholestyramine (Questran).
add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily.
recommend supplements of omega-3 along with the atorvastatin.
When used in combination with a low-dose statin, ezetimibe has been noted to produce an
additional 18% reduction in LDL. Because this patient continues to have elevated LDL along
with side effects of the statin, the NP should resume the lower dose of the statin and add
ezetimibe. Atorvastatin is given once daily. Cholestyramine and omega- 3 supplements are not
indicated.
Question 2
pts
A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6 months.
The patient’s
I. A 40-year-old woman tells the primary care nurse practitioner (NP) that she does not want
more children and would
like a contraceptive. She does not smoke and has no personal or family history of cardiovascular
disease. She has frequent tension headaches. For this patient, the NP should prescribe:
condoms.
tubal ligation.
monophasic combined oral contraceptive pill (COCP).
low-estrogen COCP.
Low-estrogen COCPs are recommended for women older than 40 with or without cardiovascular
risk. Monophasic COCPs are recommended for women with migraine headaches. Condoms are
more useful for preventing sexually transmitted diseases and not as reliable as contraception.
Tubal ligation has surgical risks.
II. A woman who has been taking a COCP tells the primary care NP that, because of frequent
changes in her work
schedule, she has difficulty remembering to take her pills. The woman and the NP decide to
change to a vaginal ring. The NP will instruct her to insert the ring:
, NR 508 MIDTERM EXAM QUIZ
within 7 days after her last active pill.
and use a backup contraceptive for 7 days.
and continue the COCP for one more cycle.
on the same day she stops taking her COCP.
Patients should be switched from a COCP to a vaginal ring by insertion within 7 days after the
last active pill. No backup method is needed. Patients do not need to continue one more cycle of
COCPs. Women taking progestin-only pills insert the ring on the last day of the pill pack.
III. A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs
(NSAIDs) daily develops a
duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states
that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should:
prescribe cimetidine (Tagamet).
prescribe omeprazole (Prilosec).
teach the patient about a bland diet.
, NR 508 MIDTERM EXAM QUIZ
change the NSAID to a corticosteroid.
Patients with NSAID-induced ulcer should discontinue the NSAID if possible and use an acid
suppressant. This patient has severe arthritis and so cannot discontinue the NSAID. In a
situation such as this, a PPI is indicated. Cimetidine is a histamine-2 blocker, which would be a
second-line choice, but cimetidine has many serious side effects. Bland diets are not effective in
treating ulcers. Corticosteroids are not indicated.
IV. A patient in the clinic develops sudden shortness of breath and tachycardia. The primary
care NP notes thready
pulses, poor peripheral perfusion, and a decreased level of consciousness. The NP activates the
emergency medical system and should anticipate that this patient will receive:
intravenous alteplase.
low-dose aspirin and warfarin.
low-molecular-weight heparin (LMWH).
Correct Answer
unfractionated heparin (UFH) and warfarin.
This patient has unstable pulmonary embolism (PE) and should receive thrombolytic therapy.
Intravenous alteplase is the preferred agent. UFH and warfarin are recommended for stable PE.
, NR 508 MIDTERM EXAM QUIZ
LMWH is beneficial in submassive PE and deep vein thrombosis (DVT) but is controversial for
treatment of massive PE.
V. A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor) continues
to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP
increases the dose from 10 mg daily to 20 mg daily. The patient reports headache and
dizziness a few weeks after the dose increase. The NP should:
change the atorvastatin dose to 15 mg twice daily.
change the patient’s medication to cholestyramine (Questran).
add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily.
recommend supplements of omega-3 along with the atorvastatin.
When used in combination with a low-dose statin, ezetimibe has been noted to produce an
additional 18% reduction in LDL. Because this patient continues to have elevated LDL along
with side effects of the statin, the NP should resume the lower dose of the statin and add
ezetimibe. Atorvastatin is given once daily. Cholestyramine and omega- 3 supplements are not
indicated.
Question 2
pts
A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6 months.
The patient’s
