NR 508 Week 4 Midterm Exam Version 2|
Chamberlain University| Actual Exam
Questions and Answers
Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months and has
a positive family history of breast cancer. The primary care NP should recommend:
A) Estrogen-progestin hormone therapy
B) Calcium and vitamin D supplements
C) Raloxifene
D) Alendronate alone
Correct Answer: B) Calcium and vitamin D supplements
Explanation: For a postmenopausal woman with osteopenia and a family history of breast
cancer, calcium and vitamin D supplements are first-line to support bone health without
increasing breast cancer risk, unlike hormone therapy or raloxifene. Alendronate may be
considered later if osteoporosis develops.
A woman in her first trimester of pregnancy reports severe daily morning sickness with a 1-
pound weight loss in 2 weeks. The NP should consult an obstetrician and prescribe:
A) Ondansetron after obstetric consultation
B) Metoclopramide immediately
C) Dimenhydrinate without consultation
D) No medication, only dietary changes
Correct Answer: A) Ondansetron after obstetric consultation
Explanation: Severe morning sickness with weight loss may indicate hyperemesis gravidarum.
Ondansetron is effective but requires obstetric consultation due to pregnancy-related risks and to
ensure appropriate management.
A 75-year-old patient with cardiovascular disease reports insomnia and vomiting for several
weeks. Thyroid function tests show decreased TSH and increased T4. The NP should consult an
endocrinologist and order:
A) Methimazole
B) Levothyroxine
C) Propranolol
D) No medication, repeat thyroid tests
,Correct Answer: C) Propranolol
Explanation: Decreased TSH and increased T4 indicate hyperthyroidism, which can cause
insomnia and vomiting, particularly risky in a patient with cardiovascular disease. Propranolol
controls symptoms (e.g., tachycardia) while awaiting endocrinology consultation for definitive
treatment (e.g., methimazole).
A 55-year-old patient with no prior hypertension has a BP >140/90 on three occasions, does not
smoke, has a BMI of 24, exercises regularly, and has no cardiovascular risk factors. The NP
should:
A) Monitor BP without treatment
B) Start hydrochlorothiazide
C) Prescribe losartan
D) Recommend lifestyle changes only
Correct Answer: B) Start hydrochlorothiazide
Explanation: For confirmed stage 1 hypertension (BP >140/90), initiating a thiazide diuretic like
hydrochlorothiazide is appropriate, especially with no contraindications, per JNC 8 guidelines.
A patient reports fatigue, weight loss, and dry skin. Thyroid function tests show TSH 40
microunits/mL and T4 0.1 ng/mL. The NP should refer to an endocrinologist and prescribe:
A) Levothyroxine 25–50 mcg daily
B) Methimazole
C) Liothyronine
D) No medication, await consultation
Correct Answer: A) Levothyroxine 25–50 mcg daily
Explanation: High TSH (40 microunits/mL) and low T4 (0.1 ng/mL) indicate primary
hypothyroidism. Starting levothyroxine at a low dose (25–50 mcg) is appropriate while referring
to an endocrinologist for long-term management.
When prescribing a medication for a chronic condition, the NP should tell the patient:
A) To stop the medication if symptoms improve
B) To take the medication as prescribed and report side effects
C) To adjust the dose based on how they feel
D) To skip doses if feeling well
Correct Answer: B) To take the medication as prescribed and report side effects
Explanation: For chronic conditions, adherence to the prescribed regimen is critical. Patients
should be instructed to take the medication as directed and report side effects to ensure safety
and efficacy.
, A child with congenital hypothyroidism takes levothyroxine 75 mcg/day and weighs 15 kg. At a
3-year-old check-up, the NP should consult a pediatric endocrinologist to discuss:
A) Increasing the levothyroxine dose
B) Adjusting the dose based on growth and TSH levels
C) Switching to liothyronine
D) Discontinuing levothyroxine
Correct Answer: B) Adjusting the dose based on growth and TSH levels
Explanation: Congenital hypothyroidism requires lifelong levothyroxine, with doses adjusted
based on weight, growth, and TSH levels. At 15 kg, 75 mcg (5 mcg/kg/day) is appropriate, but
regular monitoring and endocrinology consultation ensure optimal dosing.
A patient with IBS experiencing diarrhea, bloating, and pain prefers non-pharmacologic
treatment. The NP should recommend:
A) A low-fiber diet
B) A low-FODMAP diet
C) Daily laxatives
D) No dietary changes
Correct Answer: B) A low-FODMAP diet
Explanation: A low-FODMAP diet reduces fermentable carbohydrates, alleviating IBS
symptoms like diarrhea, bloating, and pain, and is a first-line non-pharmacologic approach.
A woman using a transdermal contraceptive patch discovers it came off and can’t be found. The
NP should tell her to:
A) Apply a new patch and use backup contraception for 7 days
B) Wait until her next cycle to resume
C) Apply two patches immediately
D) Switch to an oral contraceptive
Correct Answer: A) Apply a new patch and use backup contraception for 7 days
Explanation: A lost patch requires applying a new one immediately and using backup
contraception (e.g., condoms) for 7 days to ensure contraceptive efficacy.
A patient with worsening IBS symptoms of diarrhea and cramping should be prescribed:
A) Loperamide as needed
B) Dicyclomine for symptom relief
Chamberlain University| Actual Exam
Questions and Answers
Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months and has
a positive family history of breast cancer. The primary care NP should recommend:
A) Estrogen-progestin hormone therapy
B) Calcium and vitamin D supplements
C) Raloxifene
D) Alendronate alone
Correct Answer: B) Calcium and vitamin D supplements
Explanation: For a postmenopausal woman with osteopenia and a family history of breast
cancer, calcium and vitamin D supplements are first-line to support bone health without
increasing breast cancer risk, unlike hormone therapy or raloxifene. Alendronate may be
considered later if osteoporosis develops.
A woman in her first trimester of pregnancy reports severe daily morning sickness with a 1-
pound weight loss in 2 weeks. The NP should consult an obstetrician and prescribe:
A) Ondansetron after obstetric consultation
B) Metoclopramide immediately
C) Dimenhydrinate without consultation
D) No medication, only dietary changes
Correct Answer: A) Ondansetron after obstetric consultation
Explanation: Severe morning sickness with weight loss may indicate hyperemesis gravidarum.
Ondansetron is effective but requires obstetric consultation due to pregnancy-related risks and to
ensure appropriate management.
A 75-year-old patient with cardiovascular disease reports insomnia and vomiting for several
weeks. Thyroid function tests show decreased TSH and increased T4. The NP should consult an
endocrinologist and order:
A) Methimazole
B) Levothyroxine
C) Propranolol
D) No medication, repeat thyroid tests
,Correct Answer: C) Propranolol
Explanation: Decreased TSH and increased T4 indicate hyperthyroidism, which can cause
insomnia and vomiting, particularly risky in a patient with cardiovascular disease. Propranolol
controls symptoms (e.g., tachycardia) while awaiting endocrinology consultation for definitive
treatment (e.g., methimazole).
A 55-year-old patient with no prior hypertension has a BP >140/90 on three occasions, does not
smoke, has a BMI of 24, exercises regularly, and has no cardiovascular risk factors. The NP
should:
A) Monitor BP without treatment
B) Start hydrochlorothiazide
C) Prescribe losartan
D) Recommend lifestyle changes only
Correct Answer: B) Start hydrochlorothiazide
Explanation: For confirmed stage 1 hypertension (BP >140/90), initiating a thiazide diuretic like
hydrochlorothiazide is appropriate, especially with no contraindications, per JNC 8 guidelines.
A patient reports fatigue, weight loss, and dry skin. Thyroid function tests show TSH 40
microunits/mL and T4 0.1 ng/mL. The NP should refer to an endocrinologist and prescribe:
A) Levothyroxine 25–50 mcg daily
B) Methimazole
C) Liothyronine
D) No medication, await consultation
Correct Answer: A) Levothyroxine 25–50 mcg daily
Explanation: High TSH (40 microunits/mL) and low T4 (0.1 ng/mL) indicate primary
hypothyroidism. Starting levothyroxine at a low dose (25–50 mcg) is appropriate while referring
to an endocrinologist for long-term management.
When prescribing a medication for a chronic condition, the NP should tell the patient:
A) To stop the medication if symptoms improve
B) To take the medication as prescribed and report side effects
C) To adjust the dose based on how they feel
D) To skip doses if feeling well
Correct Answer: B) To take the medication as prescribed and report side effects
Explanation: For chronic conditions, adherence to the prescribed regimen is critical. Patients
should be instructed to take the medication as directed and report side effects to ensure safety
and efficacy.
, A child with congenital hypothyroidism takes levothyroxine 75 mcg/day and weighs 15 kg. At a
3-year-old check-up, the NP should consult a pediatric endocrinologist to discuss:
A) Increasing the levothyroxine dose
B) Adjusting the dose based on growth and TSH levels
C) Switching to liothyronine
D) Discontinuing levothyroxine
Correct Answer: B) Adjusting the dose based on growth and TSH levels
Explanation: Congenital hypothyroidism requires lifelong levothyroxine, with doses adjusted
based on weight, growth, and TSH levels. At 15 kg, 75 mcg (5 mcg/kg/day) is appropriate, but
regular monitoring and endocrinology consultation ensure optimal dosing.
A patient with IBS experiencing diarrhea, bloating, and pain prefers non-pharmacologic
treatment. The NP should recommend:
A) A low-fiber diet
B) A low-FODMAP diet
C) Daily laxatives
D) No dietary changes
Correct Answer: B) A low-FODMAP diet
Explanation: A low-FODMAP diet reduces fermentable carbohydrates, alleviating IBS
symptoms like diarrhea, bloating, and pain, and is a first-line non-pharmacologic approach.
A woman using a transdermal contraceptive patch discovers it came off and can’t be found. The
NP should tell her to:
A) Apply a new patch and use backup contraception for 7 days
B) Wait until her next cycle to resume
C) Apply two patches immediately
D) Switch to an oral contraceptive
Correct Answer: A) Apply a new patch and use backup contraception for 7 days
Explanation: A lost patch requires applying a new one immediately and using backup
contraception (e.g., condoms) for 7 days to ensure contraceptive efficacy.
A patient with worsening IBS symptoms of diarrhea and cramping should be prescribed:
A) Loperamide as needed
B) Dicyclomine for symptom relief
