NR 291 FINAL EXAM 2
1.The primary care NP sees an adolescent who reports moderate to severe dysmenorrhea. The NP recommends
an NSAID and counsels the patient about its use. Which statement by the patient indicates a need for further
teaching?
“I should not take this if I think I might be pregnant.”
“I should take this medication on a schedule for 2 to 3 days.”
“I will begin taking this 1 to 3 days before my period begins.”
“I will take this medicine every 4 to 6 hours as needed for pain.”
Explanation:
When treating primary dysmenorrhea, NSAIDs should be started 24 to 72 hours before the patient starts
menstrual bleeding. The medication should be taken on a routine basis for 2 to 3 days. It should not be taken
during pregnancy.
2. patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary
care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four
times each month. The NP should:
add a selective serotonin reuptake inhibitor (SSRI) antidepressant.
change to dihydroergotamine hydrochloride.
prescribe a –B blocker such as propranolol.
prescribe an anticonvulsant such as topiramate.
Explanation:
Topiramate is useful for migraine prophylaxis. SSRI antidepressants are considered second-line treatment for
prophylaxis and are less effective than tricyclic antidepressants. Ergotamines are not used as prophylaxis.
B-Blockers are commonly used but may aggravate neurologic symptoms associated with hemiplegic or basilar
migraine, which is what this patient has.
3. A patient who has osteoarthritis is scheduled to have knee surgery. The patient takes aspirin for MI
prophylaxis and naproxen (Naprosyn) for pain and inflammation. Which statement by the patient to the primary
care NP indicates a need for further teaching?
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, “I should stop taking aspirin at least 5 days before surgery.”
“I will check with the surgeon to see if I need to stop taking the naproxen.”
“I will need to stop taking both medications 1 week before I have surgery.”
“Both of these medications interfere with platelet production and may cause blood clots.”
Explanation:
Although both medications interfere with platelet formation, some NSAIDs may continue to be taken before
surgery, depending on the procedure and the surgeon preference. The patient should stop taking aspirin 5 days
before surgery.
4. A patient reports having an acute onset of low back pain associated with lifting a heavy object the day before.
Besides advising the patient to rest and apply ice, the primary care NP should prescribe:
an opioid analgesic.
metaxalone (Skelaxin).
cyclobenzaprine (Flexeril).
a nonsteroidal antiinflammatory drug (NSAID).
Explanation:
NSAIDs and acetaminophen are first-line analgesic treatments for low back pain. Opioids are used for severe
low back pain. The other two medications are not first-line treatments.
5. A patient who has hypertension is taking a thiazide diuretic. The patient has a serum uric acid level of 8
mg/dL. The primary care nurse practitioner (NP) caring for this patient should:
prescribe colchicine.
discontinue the thiazide diuretic.
order a 24-hour urine collection.
refer the patient to a rheumatologist.
Explanation:
Patients who have hypertension or who take thiazide diuretics are at increased risk for gout. An elevated uric
acid level alone is not diagnostic, and a 24-hour urine collection should be ordered. Colchicine should not be
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1.The primary care NP sees an adolescent who reports moderate to severe dysmenorrhea. The NP recommends
an NSAID and counsels the patient about its use. Which statement by the patient indicates a need for further
teaching?
“I should not take this if I think I might be pregnant.”
“I should take this medication on a schedule for 2 to 3 days.”
“I will begin taking this 1 to 3 days before my period begins.”
“I will take this medicine every 4 to 6 hours as needed for pain.”
Explanation:
When treating primary dysmenorrhea, NSAIDs should be started 24 to 72 hours before the patient starts
menstrual bleeding. The medication should be taken on a routine basis for 2 to 3 days. It should not be taken
during pregnancy.
2. patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary
care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four
times each month. The NP should:
add a selective serotonin reuptake inhibitor (SSRI) antidepressant.
change to dihydroergotamine hydrochloride.
prescribe a –B blocker such as propranolol.
prescribe an anticonvulsant such as topiramate.
Explanation:
Topiramate is useful for migraine prophylaxis. SSRI antidepressants are considered second-line treatment for
prophylaxis and are less effective than tricyclic antidepressants. Ergotamines are not used as prophylaxis.
B-Blockers are commonly used but may aggravate neurologic symptoms associated with hemiplegic or basilar
migraine, which is what this patient has.
3. A patient who has osteoarthritis is scheduled to have knee surgery. The patient takes aspirin for MI
prophylaxis and naproxen (Naprosyn) for pain and inflammation. Which statement by the patient to the primary
care NP indicates a need for further teaching?
1
, “I should stop taking aspirin at least 5 days before surgery.”
“I will check with the surgeon to see if I need to stop taking the naproxen.”
“I will need to stop taking both medications 1 week before I have surgery.”
“Both of these medications interfere with platelet production and may cause blood clots.”
Explanation:
Although both medications interfere with platelet formation, some NSAIDs may continue to be taken before
surgery, depending on the procedure and the surgeon preference. The patient should stop taking aspirin 5 days
before surgery.
4. A patient reports having an acute onset of low back pain associated with lifting a heavy object the day before.
Besides advising the patient to rest and apply ice, the primary care NP should prescribe:
an opioid analgesic.
metaxalone (Skelaxin).
cyclobenzaprine (Flexeril).
a nonsteroidal antiinflammatory drug (NSAID).
Explanation:
NSAIDs and acetaminophen are first-line analgesic treatments for low back pain. Opioids are used for severe
low back pain. The other two medications are not first-line treatments.
5. A patient who has hypertension is taking a thiazide diuretic. The patient has a serum uric acid level of 8
mg/dL. The primary care nurse practitioner (NP) caring for this patient should:
prescribe colchicine.
discontinue the thiazide diuretic.
order a 24-hour urine collection.
refer the patient to a rheumatologist.
Explanation:
Patients who have hypertension or who take thiazide diuretics are at increased risk for gout. An elevated uric
acid level alone is not diagnostic, and a 24-hour urine collection should be ordered. Colchicine should not be
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