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Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
A 14-year-old, male patient has some general concerns about eczema, as his twin brother was recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a personal history of allergic rhinitis, and a history of: (a) asthma (b) bee allergy (c) otitis media (d) psoriasis - ans(a) asthma A 15-year-old patient with type 1 diabetes mellitus reports elevated blood glucose levels in the morning. An adult-gerontology acute care nurse practitioner determines that the patient's hyperglycemia is due to the dawn phenomenon and: (a) increases the insulin dosage at bed time. (b) reduces the insulin dosage at bed time. (c) tests the blood glucose level at 3:00 AM every morning. (d) tests the blood glucose level in the evening. - ans(a) increases the insulin dosage at bed time. A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is: (a) amoxicillin (Amoxil). (b) doxycycline (Vibramycin). (c) erythromycin (E-Mycin). (d) trimethoprim-sulfamethoxazole (Bactrim). - ans(c) erythromycin (E-Mycin). A 19-year-old male patient arrives at the emergency department exhibiting symptoms of lower abdominal pain that radiates to the groin, and that the patient rates as an 8 on a scale of 1 to 10. That patient states that the pain came on suddenly, while he was playing football with friends. The patient's physical examination reveals positive bowel sounds in all quadrants; a soft, non-tender abdomen; no rebounding and no guarding; and no palpable mass in the abdomen or groin. Examination of the patient's genitalia reveals a unilateral cremasteric reflex. What is the adult-gerontology acute care nurse practitioner's leading differential diagnosis, based on the patient's presentation? (a) Appendicitis
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(b) Epididymitis (c) Inguinal hernia (d) Testicular torsion - ans(d) Testicular torsion A 21-year-old patient is admitted to the intensive care unit with a severe closed head injury. The patient's family is becoming louder and more insistent about seeing the patient. To establish a therapeutic relationship with the family, an acute care nurse practitioner's initial action is to: (a) acknowledge the family's anxiety. (b) arrange for a meeting with a social worker. (c) escort the family to a conference room. (d) gently direct the family to maintain composure. - ans(a) acknowledge the family's anxiety. A 24-year-old male patient with a closed head injury has been intubated for 12 days. The patient's parents have repeatedly refused consent for a tracheostomy and long- term care placement. On multiple occasions, the surgeon has discussed the risks and benefits of the surgery with them. Addressing the parents, the acute care nurse practitioner states: (a) "I understand you have reservations about the placement of a tracheostomy." (b) "Please know that not many patients die while undergoing a tracheostomy." (c) "Without a tracheostomy, we can't transfer your son to another facility." (d) "You know, your son will die if a tracheostomy is not placed." - ans(a) "I understand you have reservations about the placement of a tracheostomy." A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight, abdominal pain, and a long-term history of multiple sexual partners. The patient's physical examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test confirms active hepatitis B? (a) Antibody. (b) Enzyme-linked immunosorbent assay. (c) Immune globulin G. (d) Surface antigen. - ans(d) Surface antigen.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(a) benzodiazepine (Alprazolam). (b) cocaine. (c) morphine (MS Contin). (d) oxycodone (OxyContin). - ans(b) cocaine. A 45-year-old patient who is an opera singer reports progressive hoarseness for the last four weeks. The hoarseness began after a three-hour opera performance. The patient does not smoke and reports no weight loss, upper respiratory infection, dysphagia, or shortness of breath. The family nurse practitioner manages this patient by: (a) ordering a computed tomography scan of the head. (b) ordering an immediate lateral neck x-ray. (c) prescribing systemic antibiotics and cool mist inhalations. (d) requesting a referral for evaluation of the larynx. - ans(d) requesting a referral for evaluation of the larynx. A 45-year-old patient with diabetes comes to the clinic for an annual appointment. The patient declines a parenteral influenza vaccination because a friend "came down with the flu after receiving the vaccination." The adult nurse practitioner explains that the vaccination is: (a) a polysaccharide, so it may cause a mild case of influenza. (b) activated, so it may cause a mild case of influenza. (c) inactivated, and this is unable to cause influenza. (d) live attenuated, so it may cause a mild case of influenza. - ans(c) inactivated, and this is unable to cause influenza. A 55-year-old male patient who is Chinese has a follow-up appointment after cardiac bypass surgery. The patient brings his father with him into the examination room. The family nurse practitioner provides culturally sensitive care by: (a) asking the patient's father if he has any questions regarding his son's care. (b) asking the patient's father to leave the room due to confidentiality issues. (c) performing the examination without commenting to the patient's father. (d) performing the examination, then telling the patient's father the examination findings.
- ans(a) asking the patient's father if he has any questions regarding his son's care.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
A 55-year-old man who has no history of diabetes mellitus, heart disease, hypertension, or thrombotic events is diagnosed with paroxysmal atrial fibrillation. Based on national stroke prevention guidelines, the recommended antithrombotic management for this patient is: (a) aspirin (Bayer). (b) aspirin with dipyridamole (Aggrenox). (c) clopidogrel (Plavix). (d) warfarin (Coumadin). - ans(a) aspirin (Bayer). A 57-year-old male patient arrives at the emergency department with substernal chest pain. An electrocardiogram reveals ST segment depression in leads V3 and V4. Before administering nitrates, an acute care nurse practitioner assesses the patient's use of: (a) angiotensin-converting enzyme inhibitors. (b) aspirin. (c) beta-blockers. (d) phosphodiesterase inhibitors. - ans(d) phosphodiesterase inhibitors. A 60-year-old patient with diabetes has a blood pressure reading of 150/96 mmHg. After three months of increased exercise and decreased calories, the patient has lost 10 lb (4.54 kg). The patient's follow-up blood pressure is 142/94 mmHg. Which medication does the family nurse practitioner prescribe? (a) Enalapril (Vasotec). (b) Furosemide (Lasix). (c) Hydrochlorothiazide (HydroDIURIL). (d) Propranolol (Inderal). - ans(a) Enalapril (Vasotec). A 65-year-old female patient has a confirmed diagnosis of terminal liver disease. The patient's advance directive designates comfort measures, only. An adult-gerontology acute care nurse practitioner's action is to: (a) discuss the patient's decision with the patient's family members. (b) persuade the patient to participate in a hepatitis clinical trial.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(a) a local, topical antifungal cream. (b) a topical hormonal cream. (c) a water-soluble lubricating jelly. (d) daily douching. - ans(b) a topical hormonal cream. A 70-year-old patient reports fatigue and a nonproductive cough with pain on inspiration and expiration. The patient denies a sore throat, fever, nasal congestion, or postnasal drip. Examination reveals a well-developed patient in no acute distress who is afebrile and has respirations of 32 breaths/min. The patient's lungs have diminished breath sounds. The heart rate is 70 beats/min, regular with no murmur. There is no edema of the extremities. An adult nurse practitioner orders: (a) a chest x-ray. (b) a lung perfusion scan. (c) over-the-counter treatments for symptomatic relief. (d) pulmonary function tests. - ans(a) a chest x-ray. A 70-year-old patient with acute systolic heart failure denies any functional limitations, is able to walk five blocks before tiring, and is euvolemic. Which medication is the first-line therapy for this patient? (a) Amlodipine (Norvasc) (b) Digoxin (Lanoxin) (c) Furosemide (Lasix) (d) Lisinopril (Zestril) - ans(d) Lisinopril (Zestril) [Note: ACE-I's are first line therapy for asymptomatic and symptomatic heart failure, unless presenting with dyspnea at rest, in which case a diuretic would be first line.] A 70-year-old, female patient is having her yearly evaluation. The adult-gerontology primary care nurse practitioner gives which physical examination finding the highest priority for immediate treatment? (a) Atrophy of vaginal rugae. (b) Cystocele present. (c) Palpable ovary. (d) Pessary in place. - ans(c) Palpable ovary.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
A 78-year-old male patient comes to the ambulatory care clinic and reports an inability to void. The adult nurse practitioner has difficulty inserting a urinary catheter due to an obstruction. The nurse practitioner's action is to: (a) obtain consent from the patient to perform prostatic massage. (b) perform a suprapubic aspiration to relieve bladder distention. (c) prescribe an oral loop diuretic. (d) refer the patient to a urologist for further treatment. - ans(d) refer the patient to a urologist for further treatment. A difficult aspect of determining occupational exposure to disease is the: (a) confidentiality of the information within company records. (b) inaccuracy of occupational disease reporting. (c) long latency period between exposure and disease development. (d) reliance on workers' memories. - ans(c) long latency period between exposure and disease development. A female patient is receiving adjuvant chemotherapy for breast cancer and has been given information about her treatment regimen, expected side effects, and symptom management. Which symptom, if occurring two weeks after treatment, warrants a prompt call to the acute care nurse practitioner? (a) Alopecia (b) Fatigue (c) Fever (d) Nausea - ans(c) Fever A hospital requires adult-gerontology acute care nurse practitioners to submit credentialing applications for the purpose of: (a) authorizing clinical roles and responsibilities. (b) delineating therapeutic and diagnostic services. (c) monitoring the nurse practitioner's clinical activities. (d) verifying education, licensure, and experience. - ans(d) verifying education, licensure, and experience.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(d) "Quitting smoking is the most important thing you can do for your health." - ans(a) "Do you have any ideas about how you would like to quit smoking?" A patient is brought to the emergency department after being found unresponsive in a car. The patient's spouse arrives at the hospital to find the patient comatose, on mechanical ventilation, and brain death has been established. The spouse informs the staff that the patient has an advance directive and did not want to be kept alive, artificially. The spouse struggles with the decision to remove the patient from life support. The adult-gerontology acute care nurse practitioner: (a) consults the ethics committee to help with the decision-making process. (b) discusses with the spouse that removing the patient is the right thing to do. (c) encourages the spouse to have a family meeting to make the decision as a group. (d) reviews the patients advance directive with the spouse. - ans(d) reviews the patients advance directive with the spouse. A patient is scheduled for elective orthopedic surgery. During the preadmission physical examination, the acute care nurse practitioner detects an asymptomatic pulsatile mass in the middle upper abdomen. The nurse practitioner's most appropriate action is to: (a) obtain a kidney-urethra-bladder x-ray. (b) obtain a renal arteriogram. (c) obtain an abdominal ultrasound. (d) proceed with the patient's elective surgery. - ans(c) obtain an abdominal ultrasound. A patient who had a total gastrectomy one year ago complains of a sore mouth, indigestion, and tingling in the lower extremities. Which test is ordered by the family nurse practitioner? (a) Blood urea nitrogen level. (b) Complete blood count. (c) Liver function study. (d) Thyroid function study. - ans(b) Complete blood count. A patient who sustained a myocardial infarction comes to the clinic for a refill of atorvastatin (Lipitor). The family nurse practitioner explains that the medication is prescribed for: (a) cancer prevention. (b) primary prevention.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(c) secondary prevention. (d) tertiary prevention. - ans(d) tertiary prevention. A patient, who is allergic to penicillin, requires antibiotic treatment for community- acquired pneumonia. The patient has a limited income, lacks health insurance, and is about to be discharged from the hospital. An acute care nurse practitioner's intervention is to: (a) consult social services for assistance. (b) order an aerosol antibiotic. (c) transfer the patient to an extended care facility. (d) write a prescription for an antibiotic. - ans(a) consult social services for assistance. A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: (a) asks the child to provide a copy of the patient's advance directive document. (b) assures the child that the nurse practitioner can disclose requested information. (c) informs the child that he or she must come to the clinic to discuss the parent's case. (d) tells the child that the nurse practitioner can discuss the information only with the patient. - ans(d) tells the child that the nurse practitioner can discuss the information only with the patient. After determining that a patient has a lead level of 16 mcg/dL, the family nurse practitioner: (a) advises the parent to avoid giving the patient bottles of whole milk. (b) consults with a physical therapist for muscle strengthening. (c) observes for signs of diminished reflexes on the physical exam. (d) orders an increase of iron supplements to 6 mg/kg per day divided in two doses. - ans(c) observes for signs of diminished reflexes on the physical exam. After undergoing a successful autologous bone marrow transplant for multiple myeloma, a 55-year-old male patient comes to the clinic for his followup appointment. The patient reports that a skin lesion has changed in appearance. The acute care nurse practitioner responds by:
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
An 87-year-old patient, who has multiple, fluid-filled and unilateral lesions on an erythematous base that follows a dermatome, reports severe pain and burning at the site. The patient asks how long the pain will last. The gerontological nurse practitioner responds that the pain: (a) might never completely disappear. (b) will disappear in four to six weeks. (c) will disappear in six months to one year. (d) will disappear once the lesions are gone. - ans(a) might never completely disappear. An acute care nurse practitioner is deciding whether to recommend a long-term medication regimen that will help a patient manage disease symptoms but may also introduce problematic side effects. This decision reflects which ethical principle? (a) Autonomy (b) Beneficence (c) Fidelity (d) Justice - ans(b) Beneficence An acute care nurse practitioner is evaluating a 78-year-old patient for an aortic valve replacement. Laboratory results indicate a low serum albumin level. The nurse practitioner prescribes a high-protein diet and evaluates the patient's response by: (a) assessing the total serum protein level. (b) calculating the body fat percentage. (c) obtaining a complete blood count. (d) obtaining a serum prealbumin level. - ans(d) obtaining a serum prealbumin level. An acute care nurse practitioner performs a cardiac assessment on a patient with a confirmed mitral valve prolapse. During which activity does the nurse practitioner expect the patient's murmur to diminish? (a) Inhaling (b) Sitting (c) Squatting (d) Standing - ans(c) Squatting An adult nurse practitioner evaluates a new patient, an African American with hypertension who has been taking lisinopril (Prinivil). To optimize the patient's response, a more effective pharmacological treatment is:
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(a) a beta-blocker. (b) a direct-acting vasodilator. (c) a thiazide diuretic. (d) an angiotensin-converting enzyme inhibitor. - ans(c) a thiazide diuretic. An adult nurse practitioner evaluates a patient who has been a victim of domestic violence. After the office visit, law enforcement authorities contact the nurse practitioner, requesting information regarding any visible injuries observed during the visit. The nurse practitioner's response is to: (a) call the patient to obtain consent. (b) provide the written record, as requested. (c) refer the request to the office manager. (d) require a court order for release. - ans(b) provide the written record, as requested. An adult nurse practitioner is designing a research study to investigate the efficacy of a patient education tool for adults with low literacy levels. Which action reflects the nurse's inclusion of ethical principles in the research plan? (a) Ensuring that the participants understand their right to withdraw from the study at any time, without incurring penalties (b) Explaining the study in scientific, medical, and nursing terms so as not to patronize the participants (c) Testing the study's informed consent form on nursing doctoral candidates at a local university to validate its clarity (d) Using large print in the content of the study's informed consent form - ans(a) Ensuring that the participants understand their right to withdraw from the study at any time, without incurring penalties An adult nurse practitioner is educating a female patient about her newly diagnosed phobia. The nurse practitioner explains that phobias differ from other anxiety disorders in that phobias: (a) are innate and can be prevented. (b) are related to specific trigger experiences.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(a) asks the nurse to step into the room. (b) asks the spouse to step out of the room. (c) speaks with the patient and spouse together. (d) speaks with the spouse privately. - ans(b) asks the spouse to step out of the room. An adult-gerontology acute care nurse practitioner who specializes in cardiology is asked to give a presentation on lipid-lowering drugs. A major drug company that markets a lipid-lowering medication plans to pay the presenter an honorarium, but asks the nurse practitioner to limit his or her remarks to its drug. This situation presents a: (a) breach of contract. (b) conflict of interest. (c) personal choice. (d) reasonable request. - ans(b) conflict of interest. An exception to the practice of maintaining patient confidentiality is when: (a) a family member of the patient gives consent. (b) a family member of the patient is paying for the treatment. (c) the patient is unresponsive. (d) the patient plans to hurt someone. - ans(d) the patient plans to hurt someone. An institutional review board rejects an adult nurse practitioner's research proposal on the grounds that the: (a) chosen statistics were not optimal to meet research objectives. (b) literature review was insufficient to develop the research question. (c) proposed budget did not cover the cost of the study. (d) subject's rights were not clearly protected. - ans(d) subject's rights were not clearly protected. An older adult patient complains of recent lapses in memory and decreased alertness. The patient's laboratory test results indicate a mild, macrocytic anemia. Which additional test does the adult-gerontology acute care nurse practitioner order to confirm a diagnosis?
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(a) A reticulocyte count (b) A serum folate level (c) An erythrocyte sedimentation rate (d) Iron studies - ans(b) A serum folate level An older patient, who has chronic obstructive pulmonary disease, develops a fever and changes in sputum production. The gerontological nurse practitioner prescribes: (a) a corticosteroid. (b) an antibiotic. (c) an inhaled bronchodilator. (d) nebulizer treatments. - ans(b) an antibiotic. Assessment of which endocrine system response to sepsis-induced hypotension is essential in guiding subsequent therapy? (a) Adrenal (b) Pancreatic (c) Pituitary (d) Thyroid - ans(a) Adrenal Before initiating a new antihypertensive drug therapy, an acute care nurse practitioner uses which evidence-based practice approach? (a) Discussing the medication choices with a collaborating physician (b) Discussing the medication's side effects with a colleague (c) Reviewing the confidence intervals of related research (d) Reviewing the institutional formulary - ans(c) Reviewing the confidence intervals of related research Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which laboratory values does the adult-gerontology primary care nurse practitioner obtain? (a) Liver function studies. (b) Platelet count. (c) Renal function studies. (d) White blood cell count. - ans(a) Liver function studies. Clinical practice guidelines are designed to:
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
(a) T4 level decreased, and TSH level increased. (b) T4 level increased, and TSH level decreased. (c) T4 level increased, and TSH level is unchanged. (d) T4 level is unchanged, and TSH level decreased. - ans(a) T4 level decreased, and TSH level increased. Generally healthy patients, who are diagnosed with acute bronchitis, inappropriately ask for which category of drugs? (a) Antibiotics (b) Beta-agonists (c) Corticosteroids (d) Xanthines - ans(a) Antibiotics In addition to altered mental status, which is the best early indicator of pneumonia in an older adult? (a) Cough (b) Fever (c) Malaise (d) Tachypnea - ans(d) Tachypnea In the early stages of iron deficient anemias, blood studies show: (a) macrocytic normochromic (b) microcytic hypochromic (c) normochromic normocytic (d) pancytopenic hypocytic - ans(a) normochromic normocytic Initial measures to prevent deformity and maintain function for the knee during an acute inflammatory reaction secondary to injury include: (a) a hot daily shower followed by a short period of exercise. (b) application of a splint to the joint followed by application of heat. (c) cautious performance of active range-of-motion exercises. (d) total immobilization of the joint and performance of isometric exercises. - ans(d) total immobilization of the joint and performance of isometric exercises.
Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|
Questions and Verified Answers - Chamberlain
Many patients view illness as a distortion in the balance of some aspect of their lives, and believe that folk medicine can remedy this. When encountering such beliefs, an adult nurse practitioner's appropriate action is to: (a) discuss these remedies and include them in the management plan. (b) educate these patients about evidence-based practice that is specific to their present condition. (c) promote scientifically proven treatment measures. (d) refer the patient to a homeopathic specialist. - ans(a) discuss these remedies and include them in the management plan. One effect of using electronic health record applications, such as telemedicine and portable monitoring systems, has been to: (a) create stand-alone clinics. (b) decrease billable visits. (c) increase risks to patients. (d) open access to care. - ans(d) open access to care. Preparing to implement an incontinence reduction program at a nursing home, the adult-gerontology primary care nurse practitioner reviews several studies. Place the studies in sequential order of the strength of evidence for this population from strongest to weakest. (a) A case report of an experimental incontinence reduction program in older adults. (b) A consensus statement from the urologic association regarding the use of scheduled toileting. (c) A systematic review of nonrandomized trials concerning the use of vaginal estrogen.
- ansStrongest evidence: (c) a systematic review ...then: (b) a consensus statement Weakest evidence: (a) a case report Temporal arteritis requires immediate treatment in order to prevent: (a) blindness in the affected eye. (b) facial nerve palsy. (c) transient ischemic attack. (d) trigeminal neuralgia. - ans(a) blindness in the affected eye.
