1. A patient is diagnosed with a condition that causes chronic pain. The primary care NP
prescribes an opioid analgesic and should instruct the patient to: (Points : 2)
wait until the pain is at a moderate level before taking the medication.
take the medication at regular intervals and not just when pain is present.
start the medication at higher doses initially and taper down gradually.
take the minimum amount needed even when pain is severe to avoid dependency.
Chronic pain requires routine administration of drugs, and patients should take
analgesicsroutinely without waiting for increased pain
Question 2.2. A patient who is taking methotrexate for RA sees the primary care NP for an
annual physical examination. The patient’s alanine aminotransferase (ALT) and AGT are
elevated. The NP should: (Points : 2)
decrease the dose of methotrexate.
recheck ALT and AGT levels in 2 weeks.
contact the patient’s rheumatologist to discuss discontinuing the drug.
counsel the patient not to take acetaminophen while taking methotrexate.
Liver enzyme elevations are frequent, are usually transient and asymptomatic, and do
notappear predictive of subsequent hepatic disease. A decrease in dose or discontinuation of
thedrug is not indicated. Coadministration with acetaminophen is not contraindicated.
Question 3.3. A patient who has migraine headaches tells the primary care NP that drinking
coffee and taking nonsteroidalantiinflammatory drugs (NSAIDs) seems to help with
discomfort. The NP should tell the patient that: (Points : 2)
this combination can lead to longer lasting headache pain.
these substances are not indicated for migraine headaches.
doing this can increase the risk of more chronic migraines.
an opioid analgesic would be a better choice for migraine pain.
Overuse of pain or migraine medications can cause a transformed migraine,which is a long-
lasting headache. Following a migraine episode, the patienthas rebound headache daily or
nearly daily. NSAIDs, caffeine, opiates, andtriptans can cause these rebound headaches.
NSAIDs and caffeine are oftenused to treat migraines. Narcotics and barbiturates increase the
risk fordevelopment of chronic migraine headaches and should not be first-linedrugs
Question 4.4. The primary care NP sees an adolescent who reports moderate to severe
dysmenorrhea. The NP recommends an NSAID and counsels the patient about its use. Which
statement by the patient indicates a need for further teaching? (Points : 2)
“I should not take this if I think I might be pregnant.”
“I should take this medication on a schedule for 2 to 3 days.”
“I will begin taking this 1 to 3 days before my period begins.”
, “I will take this medicine every 4 to 6 hours as needed for pain.”
When treating primary dysmenorrhea, NSAIDs should be started 24 to 72 hours before
thepatient starts menstrual bleeding. The medication should be taken on a routine basis for 2
to 3days. It should not be taken during pregnancy
Question 5.5. A 60-year-old woman has a central dual-energy x-ray absorptiometry with a T-
score of 1.9. A health history reveals no risk factors for osteoporosis. The primary care NP
should: (Points : 2)
prescribe alendronate sodium (Fosamax).
counsel her to increase her physical activity.
prescribe calcitonin (Miacalcin nasal spray).
prescribe supplemental calcium and vitamin D.
This woman’s T-score is less than 2.5 and indicates osteoporosis. She should begin
treatmentwith a bisphosphonate. Increasing physical activity and taking supplemental calcium
andvitamin D are indicated as well but only as part of a medication regimen. Calcitonin is not
afirst-line medication.
Question 6.6. A 50-year-old white woman who is experiencing menopause asks the primary
care NP what she can do to prevent osteoporosis. She has a negative family history and no
risk factors. The NP should counsel her to: (Points : 2)
consider bisphosphonate therapy in 5 years.
undergo bone density testing every 2 years.
avoid high-impact sports that can lead to fractures.
take supplemental calcium and vitamin D every day.
Question 7.7. A patient has been taking an opioid analgesic for 2 weeks after a minor
outpatient procedure. At a follow-up clinic visit, the patient tells the primary care NP that he
took extra doses for the past 2 days because of increased pain and wants an early refill of the
medication. The NP should suspect: (Points : 2)
dependence.
drug addiction.
possible misuse.
increasing pain.
Unsanctioned dose increases are a sign of possible drug misuse. Dependence refers to
anabstinence or withdrawal syndrome. Drug addiction is an obsession with obtaining and
usingthe drug for nonmedical purposes. The patient should not have increased pain at 2
weeks.
Question 8.8. A patient reports having an acute onset of low back pain associated with lifting
a heavy object the day before. Besides advising the patient to rest and apply ice, the primary
care NP should prescribe: (Points : 2)
prescribes an opioid analgesic and should instruct the patient to: (Points : 2)
wait until the pain is at a moderate level before taking the medication.
take the medication at regular intervals and not just when pain is present.
start the medication at higher doses initially and taper down gradually.
take the minimum amount needed even when pain is severe to avoid dependency.
Chronic pain requires routine administration of drugs, and patients should take
analgesicsroutinely without waiting for increased pain
Question 2.2. A patient who is taking methotrexate for RA sees the primary care NP for an
annual physical examination. The patient’s alanine aminotransferase (ALT) and AGT are
elevated. The NP should: (Points : 2)
decrease the dose of methotrexate.
recheck ALT and AGT levels in 2 weeks.
contact the patient’s rheumatologist to discuss discontinuing the drug.
counsel the patient not to take acetaminophen while taking methotrexate.
Liver enzyme elevations are frequent, are usually transient and asymptomatic, and do
notappear predictive of subsequent hepatic disease. A decrease in dose or discontinuation of
thedrug is not indicated. Coadministration with acetaminophen is not contraindicated.
Question 3.3. A patient who has migraine headaches tells the primary care NP that drinking
coffee and taking nonsteroidalantiinflammatory drugs (NSAIDs) seems to help with
discomfort. The NP should tell the patient that: (Points : 2)
this combination can lead to longer lasting headache pain.
these substances are not indicated for migraine headaches.
doing this can increase the risk of more chronic migraines.
an opioid analgesic would be a better choice for migraine pain.
Overuse of pain or migraine medications can cause a transformed migraine,which is a long-
lasting headache. Following a migraine episode, the patienthas rebound headache daily or
nearly daily. NSAIDs, caffeine, opiates, andtriptans can cause these rebound headaches.
NSAIDs and caffeine are oftenused to treat migraines. Narcotics and barbiturates increase the
risk fordevelopment of chronic migraine headaches and should not be first-linedrugs
Question 4.4. The primary care NP sees an adolescent who reports moderate to severe
dysmenorrhea. The NP recommends an NSAID and counsels the patient about its use. Which
statement by the patient indicates a need for further teaching? (Points : 2)
“I should not take this if I think I might be pregnant.”
“I should take this medication on a schedule for 2 to 3 days.”
“I will begin taking this 1 to 3 days before my period begins.”
, “I will take this medicine every 4 to 6 hours as needed for pain.”
When treating primary dysmenorrhea, NSAIDs should be started 24 to 72 hours before
thepatient starts menstrual bleeding. The medication should be taken on a routine basis for 2
to 3days. It should not be taken during pregnancy
Question 5.5. A 60-year-old woman has a central dual-energy x-ray absorptiometry with a T-
score of 1.9. A health history reveals no risk factors for osteoporosis. The primary care NP
should: (Points : 2)
prescribe alendronate sodium (Fosamax).
counsel her to increase her physical activity.
prescribe calcitonin (Miacalcin nasal spray).
prescribe supplemental calcium and vitamin D.
This woman’s T-score is less than 2.5 and indicates osteoporosis. She should begin
treatmentwith a bisphosphonate. Increasing physical activity and taking supplemental calcium
andvitamin D are indicated as well but only as part of a medication regimen. Calcitonin is not
afirst-line medication.
Question 6.6. A 50-year-old white woman who is experiencing menopause asks the primary
care NP what she can do to prevent osteoporosis. She has a negative family history and no
risk factors. The NP should counsel her to: (Points : 2)
consider bisphosphonate therapy in 5 years.
undergo bone density testing every 2 years.
avoid high-impact sports that can lead to fractures.
take supplemental calcium and vitamin D every day.
Question 7.7. A patient has been taking an opioid analgesic for 2 weeks after a minor
outpatient procedure. At a follow-up clinic visit, the patient tells the primary care NP that he
took extra doses for the past 2 days because of increased pain and wants an early refill of the
medication. The NP should suspect: (Points : 2)
dependence.
drug addiction.
possible misuse.
increasing pain.
Unsanctioned dose increases are a sign of possible drug misuse. Dependence refers to
anabstinence or withdrawal syndrome. Drug addiction is an obsession with obtaining and
usingthe drug for nonmedical purposes. The patient should not have increased pain at 2
weeks.
Question 8.8. A patient reports having an acute onset of low back pain associated with lifting
a heavy object the day before. Besides advising the patient to rest and apply ice, the primary
care NP should prescribe: (Points : 2)
