NR 508 MIDTERM EXAM Q & A
1. 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.
2. 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:
,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.
3. 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.
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.
4. 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.
1. 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.
2. 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:
,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.
3. 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.
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.
4. 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.
