1
,2
,tell the patient a fever less than 40° C does not need to be treated.
Patients with congestive heart failure may have tachycardia from fever that aggravates
their symptoms, so fever should be treated. High doses should be given with caution in
elderly patients because of possible decreased hepatic function. Antibiotics should not be
given without evidence of bacterial infection.
Question 5
A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing
freezing episodes between doses. The primary care NP should consider using:
selegiline.
amantadine.
Correct!
apomorphine.
modified-release levodopa.
Apomorphine injection is used for acute treatment of immobility known as “freezing.”
Question 6
A patient is being tapered from long-term therapy with prednisolone and reports weight
loss and fatigue. The primary care NP should counsel this patient to:
consume foods high in vitamin D and calcium.
begin taking dexamethasone because it has longer effects.
expect these side effects to occur as the medication is tapered.
Correct!
increase the dose of prednisolone to the most recent amount taken.
, Sudden discontinuation or rapid tapering of glucocorticoids in patients who have
developed adrenal suppression can precipitate symptoms of adrenal insufficiency,
including nausea, weakness, depression, anorexia, myalgia, hypotension, and
hypoglycemia. When patients experience these symptoms during a drug taper, the dose
should be increased to the last dose. Vitamin D deficiency is common while taking
glucocorticoids, but these are not symptoms of vitamin D deficiency. Changing to
another glucocorticoid is not recommended. Patients should be taught to report the side
effects so that action can be taken and should not be told that they are to be expected.
Question 7
The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent
leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also
reports having an increased urge to void even when her bladder is not full. She is not
taking any medications. The NP should:
Correct!
perform a dipstick urinalysis.
prescribe desmopressin (DDAVP).
prescribe oxybutynin chloride (Ditropan XL).
teach exercises to strengthen the pelvic muscles.
A focused history with a careful physical examination is essential for determining the
cause of incontinence. Urinalysis can rule out urinary tract infection (UTI), which can
cause incontinence. Medications are prescribed after determining the cause, if any, and
treating underlying conditions. Exercises to strengthen the pelvic muscles are part of
treatment.
Question 8
A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child
examination, the primary care NP notes a decrease in the child’s linear growth rate. The
NP should consult the child’s asthma specialist about:
gradually tapering the child off the prednisone.
a referral for possible growth hormone therapy.
,2
,tell the patient a fever less than 40° C does not need to be treated.
Patients with congestive heart failure may have tachycardia from fever that aggravates
their symptoms, so fever should be treated. High doses should be given with caution in
elderly patients because of possible decreased hepatic function. Antibiotics should not be
given without evidence of bacterial infection.
Question 5
A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing
freezing episodes between doses. The primary care NP should consider using:
selegiline.
amantadine.
Correct!
apomorphine.
modified-release levodopa.
Apomorphine injection is used for acute treatment of immobility known as “freezing.”
Question 6
A patient is being tapered from long-term therapy with prednisolone and reports weight
loss and fatigue. The primary care NP should counsel this patient to:
consume foods high in vitamin D and calcium.
begin taking dexamethasone because it has longer effects.
expect these side effects to occur as the medication is tapered.
Correct!
increase the dose of prednisolone to the most recent amount taken.
, Sudden discontinuation or rapid tapering of glucocorticoids in patients who have
developed adrenal suppression can precipitate symptoms of adrenal insufficiency,
including nausea, weakness, depression, anorexia, myalgia, hypotension, and
hypoglycemia. When patients experience these symptoms during a drug taper, the dose
should be increased to the last dose. Vitamin D deficiency is common while taking
glucocorticoids, but these are not symptoms of vitamin D deficiency. Changing to
another glucocorticoid is not recommended. Patients should be taught to report the side
effects so that action can be taken and should not be told that they are to be expected.
Question 7
The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent
leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also
reports having an increased urge to void even when her bladder is not full. She is not
taking any medications. The NP should:
Correct!
perform a dipstick urinalysis.
prescribe desmopressin (DDAVP).
prescribe oxybutynin chloride (Ditropan XL).
teach exercises to strengthen the pelvic muscles.
A focused history with a careful physical examination is essential for determining the
cause of incontinence. Urinalysis can rule out urinary tract infection (UTI), which can
cause incontinence. Medications are prescribed after determining the cause, if any, and
treating underlying conditions. Exercises to strengthen the pelvic muscles are part of
treatment.
Question 8
A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child
examination, the primary care NP notes a decrease in the child’s linear growth rate. The
NP should consult the child’s asthma specialist about:
gradually tapering the child off the prednisone.
a referral for possible growth hormone therapy.
