1. A 72-year-old woman has been on hydrochlorothiazide 12.5 mg for many
years to control her Stage II hypertension. Her blood pressure (BP) at this visit
is 168/96. She is currently complaining of pain on her right hip and on both
knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times
day (TID) to 800 mg TID. She is still in pain and would like something stronger.
Which of the following statements is the best explanation of the effects of
ibuprofen (Motrin) on her disease?
A) It increases the chances of adverse effects to her health
B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of
the diuretic
C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuret-
ics
D) None of the statements are true
Answer> It inhibits the effect of renal prostaglandins and blunts the effectiveness of
the diuretic.
NSAIDs and ASA inhibit the vasodilatory effects of prostaglandins, which predispos-
es the kidney to ischemia. NSAIDs and diuretics can cause acute prerenal failure
by decreasing renal blood flow.
2. A 28-year-old student is seen in the school health clinic with complaints
of a hacking cough that is productive of small amounts of sputum and a
runny nose. He does not take any medications, denies any allergies, and
has no significant medical history. Physical examination reveals a low-grade
temperature of 99.9 degrees Fahrenheit, respirations of 16/min, a pulse of
90 beats per minute, and diffuse fine crackles in the base of the lungs. A
chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe of the right
lung. The total white blood cell count is 10,500/uL. What is the most likely
,D) Legionnaires disease
Answer> Mycoplasma pneumonia
Mycoplasma pneumonia is the organism most com- monly seen in children and
young adults. It is easily spread from droplets, from sneezing and coughing, in close
proximity. Diagnosis is based on symptoms and x-ray results of infiltrates in lower
lobes.
,3. Which of the following antihypertensive medications should the nurse prac-
titioner avoid when treating patients with emphysema?
A) Calcium channel blockers
B) Angiotensin-converting enzyme (ACE) inhibitors
C) Beta-blockers
D) Diuretics
Answer> Beta-blockers
Beta-blockers should be avoided in patients with a history of emphysema. Studies
have shown evidence of a reduction in forced expiratory volume in 1 second (FEV1),
increased airway hyperresponsiveness, and inhibition of bronchodilator response to
beta agonists in patients receiving non-selective beta- blockers and high doses of
cardioselective beta-blockers.
4. A 30-year-old chef complains of pruritic hives over her chest and arms
but denies difficulty swallowing or breathing. She reports a family history
of allergic rhinitis and asthma. Which of the following interventions is most
appropriate?
A) Perform a complete and thorough history
B) Prescribe an oral antihistamine such as diphenhydramine 25 mg PO QID
C) Give an injection of epinephrine 1:1000 intramuscularly stat
D) Call 911
Answer> Perform a complete and thorough history
Prior to prescribing medications, a complete and thorough history must be per-
formed to determine possible causes of hives. The patient denied difficulty with
swallowing and breathing, so there was no medical emergency to require calling
911.
, C) A vegan diet
D) Tingling and numbness of both feet
Answer> Tingling and numbness of both feet
Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symp-
toms of B12 deficiency anemia may include tingling or numbness in fingers and
toes, difficulty walking, mood changes or depression, memory loss, disorientation,
and dementia.
years to control her Stage II hypertension. Her blood pressure (BP) at this visit
is 168/96. She is currently complaining of pain on her right hip and on both
knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times
day (TID) to 800 mg TID. She is still in pain and would like something stronger.
Which of the following statements is the best explanation of the effects of
ibuprofen (Motrin) on her disease?
A) It increases the chances of adverse effects to her health
B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of
the diuretic
C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuret-
ics
D) None of the statements are true
Answer> It inhibits the effect of renal prostaglandins and blunts the effectiveness of
the diuretic.
NSAIDs and ASA inhibit the vasodilatory effects of prostaglandins, which predispos-
es the kidney to ischemia. NSAIDs and diuretics can cause acute prerenal failure
by decreasing renal blood flow.
2. A 28-year-old student is seen in the school health clinic with complaints
of a hacking cough that is productive of small amounts of sputum and a
runny nose. He does not take any medications, denies any allergies, and
has no significant medical history. Physical examination reveals a low-grade
temperature of 99.9 degrees Fahrenheit, respirations of 16/min, a pulse of
90 beats per minute, and diffuse fine crackles in the base of the lungs. A
chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe of the right
lung. The total white blood cell count is 10,500/uL. What is the most likely
,D) Legionnaires disease
Answer> Mycoplasma pneumonia
Mycoplasma pneumonia is the organism most com- monly seen in children and
young adults. It is easily spread from droplets, from sneezing and coughing, in close
proximity. Diagnosis is based on symptoms and x-ray results of infiltrates in lower
lobes.
,3. Which of the following antihypertensive medications should the nurse prac-
titioner avoid when treating patients with emphysema?
A) Calcium channel blockers
B) Angiotensin-converting enzyme (ACE) inhibitors
C) Beta-blockers
D) Diuretics
Answer> Beta-blockers
Beta-blockers should be avoided in patients with a history of emphysema. Studies
have shown evidence of a reduction in forced expiratory volume in 1 second (FEV1),
increased airway hyperresponsiveness, and inhibition of bronchodilator response to
beta agonists in patients receiving non-selective beta- blockers and high doses of
cardioselective beta-blockers.
4. A 30-year-old chef complains of pruritic hives over her chest and arms
but denies difficulty swallowing or breathing. She reports a family history
of allergic rhinitis and asthma. Which of the following interventions is most
appropriate?
A) Perform a complete and thorough history
B) Prescribe an oral antihistamine such as diphenhydramine 25 mg PO QID
C) Give an injection of epinephrine 1:1000 intramuscularly stat
D) Call 911
Answer> Perform a complete and thorough history
Prior to prescribing medications, a complete and thorough history must be per-
formed to determine possible causes of hives. The patient denied difficulty with
swallowing and breathing, so there was no medical emergency to require calling
911.
, C) A vegan diet
D) Tingling and numbness of both feet
Answer> Tingling and numbness of both feet
Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symp-
toms of B12 deficiency anemia may include tingling or numbness in fingers and
toes, difficulty walking, mood changes or depression, memory loss, disorientation,
and dementia.
