NR 508 MIDTERM EXAM STUDY GUIDE
A primary care NP prescribes levothyroxine for a patient to treat thyroid
deficiency. When teaching this patient about the medication, the NP should:
tell the patient that changing brands of the medication should be avoided.
Patients should be told not to change brands of the medication; there is potential
variability in the bioequivalence between manufacturers. The medication should be
taken at approximately the same time each day before breakfast or on an empty
stomAach. Patients should be instructed to contact the provider if signs of
thyrotoxicosis are present. Thyroid replacement medications are usually given for
life.
An African-American patient is taking captopril (Capoten) 25 mg twice daily.
When performing a physical examination, the primary care nurse practitioner (NP)
learns that the patient continues to have blood pressure readings of 135/90 mm Hg.
The NP should:
add a thiazide diuretic to this patient's regimen
Some African-American patients do not appear to respond as well as whites in
terms of blood pressure reduction. The addition of a low-dose thiazide diuretic
often allows for efficacy in blood pressure lowering that is comparable with that
seen in white patients. Increasing the captopril dose is not indicated. Losartan is an
angiotensin receptor blocker (ARB) and is not indicated in this case.
A primary care NP sees a patient who is about to take a cruise and reports having
had motion sickness with nausea on a previous cruise. The NP prescribes the
scopolamine transdermal patch and should instruct the patient to apply the patch:
every 3 days.
,The transdermal system allows steady-state plasma levels of scopolamine to be
reached rapidly and maintained for 3 days. The onset of action is approximately 4
hours. The patch should be changed every 3 days and left on at all times, not as
needed
A 12-year-old patient who is obese develops type 2 diabetes mellitus. The primary
care NP should order
metformin (Glucophage).
Metformin is the only drug listed that is recommended for children
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:
not curative and may prolong the illness
Treatment of patients with acute diarrhea with antidiarrheals can prolong infection
and should be avoided if possible. Antidiarrheals are best used in patients with
mild to moderate diarrhea and are used for comfort and not cure. They should not
be used for patients with bloody diarrhea or high fever because they can worsen
the disease. Prolonged diarrhea can indicate a more serious cause, and
antidiarrheals should not be used in those cases.
In every state, prescriptive authority for NPs includes the ability to write
prescriptions
for specified classifications of medications.
All states now have some degree of prescriptive authority granted to NPs, but not
all states allow authority to prescribe controlled substances. Many states still
require some degree of physician involvement with certain types of drugs.
, A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile
reveals LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The
woman is sedentary with a body mass index of 26. The woman asks the primary
care NP about using a statin medication. The NP should:
begin therapy with atorvastatin 10 mg per day
This woman would be using a statin medication for secondary prevention because
she already has a history of MI, so a statin should be prescribed. Dietary and
lifestyle changes should be a part of therapy, but not the only therapy. She is
relatively young, and quality-of-life issues are not a concern. There is no clinical
evidence to support use of statins as primary prevention in women.
A patient develops hypertension. The primary care nurse practitioner (NP) plans to
begin diuretic therapy for this patient. The NP notes clear breath sounds, no
organomegaly, and no peripheral edema. The patient's serum electrolytes are
normal. The NP should prescribe:
hydrochlorothiazide (HydroDIURIL)
Thiazide diuretics are first-line drugs for treating hypertension. The other three
drugs are not thiazide diuretics
The primary care nurse practitioner (NP) is using critical thinking skills when
analyzing current research and synthesizing new approaches to patient care.
Practitioners use critical thinking skills by reviewing and analyzing current
knowledge and synthesizing approaches to apply to unique patient situations.
Using standardized protocols, adhering to scientific principles, and following
practices of seasoned mentors may be useful, but these do not encompass the
concept of critical thinking, which requires the practitioner to use what is known in
new situations.
A primary care NP prescribes levothyroxine for a patient to treat thyroid
deficiency. When teaching this patient about the medication, the NP should:
tell the patient that changing brands of the medication should be avoided.
Patients should be told not to change brands of the medication; there is potential
variability in the bioequivalence between manufacturers. The medication should be
taken at approximately the same time each day before breakfast or on an empty
stomAach. Patients should be instructed to contact the provider if signs of
thyrotoxicosis are present. Thyroid replacement medications are usually given for
life.
An African-American patient is taking captopril (Capoten) 25 mg twice daily.
When performing a physical examination, the primary care nurse practitioner (NP)
learns that the patient continues to have blood pressure readings of 135/90 mm Hg.
The NP should:
add a thiazide diuretic to this patient's regimen
Some African-American patients do not appear to respond as well as whites in
terms of blood pressure reduction. The addition of a low-dose thiazide diuretic
often allows for efficacy in blood pressure lowering that is comparable with that
seen in white patients. Increasing the captopril dose is not indicated. Losartan is an
angiotensin receptor blocker (ARB) and is not indicated in this case.
A primary care NP sees a patient who is about to take a cruise and reports having
had motion sickness with nausea on a previous cruise. The NP prescribes the
scopolamine transdermal patch and should instruct the patient to apply the patch:
every 3 days.
,The transdermal system allows steady-state plasma levels of scopolamine to be
reached rapidly and maintained for 3 days. The onset of action is approximately 4
hours. The patch should be changed every 3 days and left on at all times, not as
needed
A 12-year-old patient who is obese develops type 2 diabetes mellitus. The primary
care NP should order
metformin (Glucophage).
Metformin is the only drug listed that is recommended for children
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:
not curative and may prolong the illness
Treatment of patients with acute diarrhea with antidiarrheals can prolong infection
and should be avoided if possible. Antidiarrheals are best used in patients with
mild to moderate diarrhea and are used for comfort and not cure. They should not
be used for patients with bloody diarrhea or high fever because they can worsen
the disease. Prolonged diarrhea can indicate a more serious cause, and
antidiarrheals should not be used in those cases.
In every state, prescriptive authority for NPs includes the ability to write
prescriptions
for specified classifications of medications.
All states now have some degree of prescriptive authority granted to NPs, but not
all states allow authority to prescribe controlled substances. Many states still
require some degree of physician involvement with certain types of drugs.
, A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile
reveals LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The
woman is sedentary with a body mass index of 26. The woman asks the primary
care NP about using a statin medication. The NP should:
begin therapy with atorvastatin 10 mg per day
This woman would be using a statin medication for secondary prevention because
she already has a history of MI, so a statin should be prescribed. Dietary and
lifestyle changes should be a part of therapy, but not the only therapy. She is
relatively young, and quality-of-life issues are not a concern. There is no clinical
evidence to support use of statins as primary prevention in women.
A patient develops hypertension. The primary care nurse practitioner (NP) plans to
begin diuretic therapy for this patient. The NP notes clear breath sounds, no
organomegaly, and no peripheral edema. The patient's serum electrolytes are
normal. The NP should prescribe:
hydrochlorothiazide (HydroDIURIL)
Thiazide diuretics are first-line drugs for treating hypertension. The other three
drugs are not thiazide diuretics
The primary care nurse practitioner (NP) is using critical thinking skills when
analyzing current research and synthesizing new approaches to patient care.
Practitioners use critical thinking skills by reviewing and analyzing current
knowledge and synthesizing approaches to apply to unique patient situations.
Using standardized protocols, adhering to scientific principles, and following
practices of seasoned mentors may be useful, but these do not encompass the
concept of critical thinking, which requires the practitioner to use what is known in
new situations.
