NR 508 Week 4 Midterm Exam Version 1|
Chamberlain University| Actual Exam
Questions and Answers
A primary care NP is developing a clinical practice guideline for managing a patient population
in a midsized suburban hospital. The NP should:
A) Follow hospital protocols without evidence review
B) Use evidence-based guidelines from national organizations
C) Develop guidelines based solely on local physician input
D) Create guidelines without stakeholder involvement
Correct Answer: B) Use evidence-based guidelines from national organizations
Explanation: Clinical practice guidelines should be based on evidence-based recommendations
from reputable sources (e.g., AHA, ADA) to ensure standardized, effective care, with
adaptations for local needs and stakeholder input.
A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour, for a patient with
chronic stable angina. The NP should teach the patient to:
A) Apply the patch in the morning and remove it at night
B) Keep the patch on for 24 hours continuously
C) Change the patch every 48 hours
D) Apply the patch only during chest pain episodes
Correct Answer: A) Apply the patch in the morning and remove it at night
Explanation: Nitroglycerin patches are applied daily (e.g., morning) and removed after 12–14
hours to provide a nitrate-free interval, preventing tolerance while managing angina symptoms.
A patient diagnosed with asthma is prescribed an inhaled corticosteroid and bronchodilator. At a
2-week follow-up, pulmonary function tests are worse. The NP should:
A) Increase the corticosteroid dose
B) Review and demonstrate proper inhaler technique
C) Switch to an oral corticosteroid
D) Add a leukotriene modifier
Correct Answer: B) Review and demonstrate proper inhaler technique
Explanation: Worsening pulmonary function tests suggest improper inhaler use, a common
,issue in asthma management. Reviewing and demonstrating technique ensures effective
medication delivery before adjusting therapy.
A patient undergoing surgery for a biosynthetic heart valve implant asks about postoperative
medications. The NP should tell the patient it will be necessary to take:
A) Warfarin lifelong
B) Antiplatelet therapy, such as aspirin, for a limited period
C) No anticoagulation or antiplatelet therapy
D) Heparin for 6 months
Correct Answer: B) Antiplatelet therapy, such as aspirin, for a limited period
Explanation: Biosynthetic (bioprosthetic) heart valves typically require short-term antiplatelet
therapy (e.g., aspirin for 3–6 months) to prevent thromboembolism, unlike mechanical valves,
which require lifelong warfarin.
A patient with a BMI of 35, fasting plasma glucose of 120 mg/dL, elevated triglycerides, and a
history of myocardial infarction should be prescribed:
A) Metformin and a statin
B) Insulin alone
C) Orlistat for weight loss
D) Lifestyle counseling alone
Correct Answer: A) Metformin and a statin
Explanation: The patient has prediabetes (glucose 120 mg/dL), obesity, and high cardiovascular
risk (post-MI). Metformin addresses prediabetes, and a statin reduces lipid levels and
cardiovascular risk, per ADA and ACC/AHA guidelines.
A patient with severe arthritis taking NSAIDs daily develops a duodenal ulcer and finds
cyclooxygenase-2 selective NSAIDs less effective. The NP should:
A) Continue the current NSAID with a PPI
B) Switch to acetaminophen and add a PPI
C) Increase the NSAID dose
D) Restart the COX-2 selective NSAID
Correct Answer: B) Switch to acetaminophen and add a PPI
Explanation: NSAIDs are contraindicated with active ulcers. Acetaminophen is safer for pain,
and a PPI (e.g., omeprazole) promotes ulcer healing by reducing acid production.
, A patient reports dizziness, fatigue, nausea, and vomiting. The NP suspects anemia but finds
elevated hemoglobin. The NP has made an error in:
A) Diagnostic reasoning
B) Ordering unnecessary tests
C) Patient history collection
D) Interpreting the CBC
Correct Answer: A) Diagnostic reasoning
Explanation: Elevated hemoglobin rules out anemia. The NP’s assumption that symptoms were
due to anemia was incorrect, indicating a diagnostic reasoning error, as other causes (e.g.,
dehydration, vertigo) should be explored.
A patient with diabetes on metformin 1000 mg daily reports abdominal pain and nausea with a
heart rate of 92 bpm. The NP should:
A) Continue metformin and prescribe an antiemetic
B) Check for lactic acidosis and hold metformin
C) Increase metformin to 1000 mg twice daily
D) Switch to a sulfonylurea
Correct Answer: B) Check for lactic acidosis and hold metformin
Explanation: Abdominal pain, nausea, and tachycardia may indicate metformin-associated lactic
acidosis, a rare but serious side effect. Holding metformin and evaluating for lactic acidosis (e.g.,
lactate levels, renal function) is critical.
An 80-year-old patient asks about OTC antacids for occasional heartburn. With normal CBC,
electrolytes, and slight creatinine elevation, the NP should recommend:
A) Calcium carbonate (Tums) as needed
B) Ranitidine daily
C) Omeprazole daily
D) Avoid all antacids
Correct Answer: A) Calcium carbonate (Tums) as needed
Explanation: Calcium carbonate is safe for occasional heartburn in patients with mild renal
impairment, provided it’s used sparingly to avoid hypercalcemia.
A patient with angina on nitroglycerin and nifedipine has persistent BP of 90/60 mm Hg and
lightheadedness on standing. The NP should consult the cardiologist about changing to:
A) Amlodipine
B) Verapamil
Chamberlain University| Actual Exam
Questions and Answers
A primary care NP is developing a clinical practice guideline for managing a patient population
in a midsized suburban hospital. The NP should:
A) Follow hospital protocols without evidence review
B) Use evidence-based guidelines from national organizations
C) Develop guidelines based solely on local physician input
D) Create guidelines without stakeholder involvement
Correct Answer: B) Use evidence-based guidelines from national organizations
Explanation: Clinical practice guidelines should be based on evidence-based recommendations
from reputable sources (e.g., AHA, ADA) to ensure standardized, effective care, with
adaptations for local needs and stakeholder input.
A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour, for a patient with
chronic stable angina. The NP should teach the patient to:
A) Apply the patch in the morning and remove it at night
B) Keep the patch on for 24 hours continuously
C) Change the patch every 48 hours
D) Apply the patch only during chest pain episodes
Correct Answer: A) Apply the patch in the morning and remove it at night
Explanation: Nitroglycerin patches are applied daily (e.g., morning) and removed after 12–14
hours to provide a nitrate-free interval, preventing tolerance while managing angina symptoms.
A patient diagnosed with asthma is prescribed an inhaled corticosteroid and bronchodilator. At a
2-week follow-up, pulmonary function tests are worse. The NP should:
A) Increase the corticosteroid dose
B) Review and demonstrate proper inhaler technique
C) Switch to an oral corticosteroid
D) Add a leukotriene modifier
Correct Answer: B) Review and demonstrate proper inhaler technique
Explanation: Worsening pulmonary function tests suggest improper inhaler use, a common
,issue in asthma management. Reviewing and demonstrating technique ensures effective
medication delivery before adjusting therapy.
A patient undergoing surgery for a biosynthetic heart valve implant asks about postoperative
medications. The NP should tell the patient it will be necessary to take:
A) Warfarin lifelong
B) Antiplatelet therapy, such as aspirin, for a limited period
C) No anticoagulation or antiplatelet therapy
D) Heparin for 6 months
Correct Answer: B) Antiplatelet therapy, such as aspirin, for a limited period
Explanation: Biosynthetic (bioprosthetic) heart valves typically require short-term antiplatelet
therapy (e.g., aspirin for 3–6 months) to prevent thromboembolism, unlike mechanical valves,
which require lifelong warfarin.
A patient with a BMI of 35, fasting plasma glucose of 120 mg/dL, elevated triglycerides, and a
history of myocardial infarction should be prescribed:
A) Metformin and a statin
B) Insulin alone
C) Orlistat for weight loss
D) Lifestyle counseling alone
Correct Answer: A) Metformin and a statin
Explanation: The patient has prediabetes (glucose 120 mg/dL), obesity, and high cardiovascular
risk (post-MI). Metformin addresses prediabetes, and a statin reduces lipid levels and
cardiovascular risk, per ADA and ACC/AHA guidelines.
A patient with severe arthritis taking NSAIDs daily develops a duodenal ulcer and finds
cyclooxygenase-2 selective NSAIDs less effective. The NP should:
A) Continue the current NSAID with a PPI
B) Switch to acetaminophen and add a PPI
C) Increase the NSAID dose
D) Restart the COX-2 selective NSAID
Correct Answer: B) Switch to acetaminophen and add a PPI
Explanation: NSAIDs are contraindicated with active ulcers. Acetaminophen is safer for pain,
and a PPI (e.g., omeprazole) promotes ulcer healing by reducing acid production.
, A patient reports dizziness, fatigue, nausea, and vomiting. The NP suspects anemia but finds
elevated hemoglobin. The NP has made an error in:
A) Diagnostic reasoning
B) Ordering unnecessary tests
C) Patient history collection
D) Interpreting the CBC
Correct Answer: A) Diagnostic reasoning
Explanation: Elevated hemoglobin rules out anemia. The NP’s assumption that symptoms were
due to anemia was incorrect, indicating a diagnostic reasoning error, as other causes (e.g.,
dehydration, vertigo) should be explored.
A patient with diabetes on metformin 1000 mg daily reports abdominal pain and nausea with a
heart rate of 92 bpm. The NP should:
A) Continue metformin and prescribe an antiemetic
B) Check for lactic acidosis and hold metformin
C) Increase metformin to 1000 mg twice daily
D) Switch to a sulfonylurea
Correct Answer: B) Check for lactic acidosis and hold metformin
Explanation: Abdominal pain, nausea, and tachycardia may indicate metformin-associated lactic
acidosis, a rare but serious side effect. Holding metformin and evaluating for lactic acidosis (e.g.,
lactate levels, renal function) is critical.
An 80-year-old patient asks about OTC antacids for occasional heartburn. With normal CBC,
electrolytes, and slight creatinine elevation, the NP should recommend:
A) Calcium carbonate (Tums) as needed
B) Ranitidine daily
C) Omeprazole daily
D) Avoid all antacids
Correct Answer: A) Calcium carbonate (Tums) as needed
Explanation: Calcium carbonate is safe for occasional heartburn in patients with mild renal
impairment, provided it’s used sparingly to avoid hypercalcemia.
A patient with angina on nitroglycerin and nifedipine has persistent BP of 90/60 mm Hg and
lightheadedness on standing. The NP should consult the cardiologist about changing to:
A) Amlodipine
B) Verapamil
