NR508 Test Banking Chapter 41-50

Chapter 42: Medications for Dementia Test Bank

MULTIPLE CHOICE

1.            A patient is identified as having stage 2 Alzheimer’s disease and elects to take donepezil (Aricept). The patient asks the primary care nurse practitioner (NP) how long the medication will be needed. The NP should tell the patient that donepezil must be taken:

a.            until symptoms improve.

b.            indefinitely because it is not curative.

c.             for 24 weeks, which is when cognitive function improves in most patients.

d.            until symptoms worsen, when a switch to memantine (Namenda) will be needed.

2.            A patient who has Alzheimer’s disease has been taking donepezil for 1 year. The patient’s spouse reports a worsening of symptoms. The primary care NP should consider:

a.            switching to ginkgo biloba.

b.            adding an antidepressant medication.

c.             changing to galantamine (Razadyne).

d.            adding memantine hydrochloride (Namenda).

3.            Early-stage Alzheimer’s disease is diagnosed in a patient, and the primary care NP recommends therapy with a ChE inhibitor. The patient asks why drug treatment is necessary because most functioning is intact. The NP should explain that medication may:

a.            delay progression of symptoms.

b.            produce temporary disease remission.

c.             prevent depressive effects of the disease.

d.            reduce the need for adjunct medications later on.

4.            A patient has a diagnosis of depression and Alzheimer’s disease with mild, intermittent symptoms. The primary care NP should prescribe a(n):

a.            antidepressant.

b.            ChE inhibitor.

c.             antidepressant and ginkgo biloba.

d.            antidepressant and a ChE inhibitor.

5.            A patient who has Alzheimer’s disease begins taking donepezil (Aricept). After 3 months of treatment, the patient does not show improvement of symptoms. The primary care NP should:

a.            switch to rivastigmine (Exelon).

b.            switch to galantamine (Razadyne).

c.             switch to memantine (Namenda).

d.            continue donepezil and reevaluate in 3 months.

6.            A patient is newly diagnosed with Alzheimer’s disease stage 6 on the Global Deterioration Scale. The primary care NP should prescribe:

a.            donepezil (Aricept).

b.            rivastigmine (Exelon).

c.             memantine (Namenda).

d.            galantamine (Razadyne).

7.            A patient has been taking donepezil (Aricept) for several months after being diagnosed with Alzheimer’s disease. The patient’s spouse brings the patient to the clinic and reports that the patient seems to be having visual hallucinations. The primary care NP should:

a.            increase the dose.

b.            decrease the dose.

c.             switch to memantine (Namenda).

d.            switch to galantamine (Razadyne).

8.            A patient who has Alzheimer’s disease is taking 10 mg of donepezil daily and reports difficulty sleeping. The primary care NP should recommend:

a.            decreasing the dose to 5 mg.

b.            increasing the dose to 15 mg.

c.             taking the drug in the morning.

d.            taking the drug in the evening.

9.            A patient who is diagnosed with Alzheimer’s disease experiences visual hallucinations. The primary care NP should initially prescribe:

a.            donepezil (Aricept).

 b.           rivastigmine (Exelon).

c.             memantine (Namenda).

d.            galantamine (Razadyne).

MULTIPLE CHOICE

1.            A patient who has partial seizures has been taking phenytoin (Dilantin). The patient has recently developed thrombocytopenia. The primary care nurse practitioner (NP) should contact the patient’s neurologist to discuss changing the patient’s medication to:

a.            topiramate (Topamax).

b.            levetiracetam (Keppra).

c.             zonisamide (Zonegran).

d.            carbamazepine (Tegretol).

2.            A patient is newly diagnosed with generalized epilepsy. The primary care NP will refer this patient to a neurologist and should expect this patient to begin taking:

a.            phenytoin (Dilantin).

b.            topiramate (Topamax).

c.             lamotrigine (Lamictal).

d.            levetiracetam (Keppra).

3.            A patient who takes carbamazepine (Tegretol) has been seizure-free for 2 years and asks the primary care NP about stopping the medication. The NP should:

a.            order an electroencephalogram (EEG).

b.            prescribe a tapering regimen of the drug.

c.             inform the patient that antiepileptic drug (AED) therapy is lifelong.

d.            tell the patient to stop the drug and use only as needed.

4.            A 12-month-old child with severe developmental delays was recently treated in an emergency department for a febrile seizure and is seen by the primary care NP for a follow-up visit. The child’s parent asks if it is necessary to continue giving the child phenobarbital. The NP should tell the parent that:

a.            the phenobarbital may be used on an as- needed basis.

b.            the phenobarbital may be stopped when an EEG is normal.

c.             once the febrile illness is past, the phenobarbital may be stopped.

d.            their child is at increased risk for seizures and should continue the phenobarbital.

5.            A patient who is taking phenytoin (Dilantin) for a newly diagnosed seizure disorder calls the primary care NP to report a rash. The NP should:

 a.           order a phenytoin level.

b.            reassure the patient that this is a self- limiting adverse effect.

c.             recommend that the patient take diphenhydramine to treat this side effect.

d.            tell the patient to stop taking the phenytoin and contact the neurologist immediately.

6.            A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order:

a.            coagulation studies.

b.            a complete blood count.

c.             an EEG.

d.            a creatinine clearance test.

7.            A 20-kg child takes valproic acid (Depakote) for seizures and has had regular dose increases with a current dose of 250 mg twice daily. The child continues to have one to two seizures each week along with significant drowsiness that interferes with school participation. The primary care NP should contact the child’s neurologist to discuss:

a.            obtaining a serum valproic acid level.

b.            changing the medication to gabapentin (Neurontin).

c.             increasing the valproic acid by 5 mg per kg of weight.

d.            adding lamotrigine (Lamictal) to this child’s drug regimen.

 8.           A patient who takes carbamazepine (Tegretol) for a seizure disorder is seen by a primary care NP for a routine physical examination. A complete blood count (CBC) reveals a low white blood cell (WBC) count. The NP should:

a.            order a WBC differential.

b.            discontinue the carbamazepine.

c.             reassure the patient that this effect is temporary.

d.            decrease the carbamazepine dose and recheck the CBC in 2 weeks.

 

 

 

Chapter 43: Analgesia and Pain Management Test Bank

MULTIPLE CHOICE

1.            A patient has been taking an opioid analgesic for chronic pain and tells the primary care nurse practitioner (NP) that the medication doesn’t work as well anymore. The NP should suspect drug:

a.            addiction.

b.            tolerance.

c.             modulation.

d.            dependence.

2.            A patient has pain caused by a chronic condition. The patient is reluctant to take opioids because of a fear of addiction. The primary care NP should tell the patient that opioids:

a.            carry a high risk of psychological dependence when used long-term.

b.            will help to improve the patient’s functional outcomes and quality of life.

c.             will eventually become ineffective fortreating pain when used over a long period.

d.            may require switching from one type of opioid to another to prevent tolerance over time.

3.            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:

a.            wait until the pain is at a moderate level before taking the medication.

b.            take the medication at regular intervals and not just when pain is present.

c.             start the medication at higher doses initially and taper down gradually.

d.            take the minimum amount needed even when pain is severe to avoid dependency.

4.            A patient who is a recovering alcoholic is preparing for surgery and expresses fears about using opioid analgesics postoperatively for pain. The primary care NP should tell the patient:

a.            that opioids should not be used.

b.            to take a very low dose of the opioid.

c.             that nonsteroidal antiinflammatory drugs will be the only safe option.

d.            that opioids are safe when taken as directed.

5.            A patient has been taking intramuscular (IM) meperidine 75 mg every 6 hours for 3 days after surgery. When the patient is discharged from the hospital, the primary care NP should expect the patient to receive a prescription for         mg orally every         hours.

a.            hydrocodone 30; 6

b.            hydrocodone 75; 6

c.             meperidine 300;12

d.            meperidine 75; 6

6.            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:

a.            dependence.

b.            drug addiction.

c.             possible misuse.

d.            increasing pain.

7.            A patient who is taking an antibiotic to treat bronchitis reports moderate rib pain associated with frequent coughing. The primary care NP should consider prescribing:

a.            morphine.

b.            hydrocodone.

c.             hydromorphone.

 d.           oxycodone CR.

 

 

Chapter 44: Migraine Medications Test Bank

MULTIPLE CHOICE

1.            A patient who has migraine headaches takes sumatriptan as abortive therapy. The patient tells the primary care nurse practitioner (NP) that the sumatriptan is effective for stopping symptoms but that the episodes are occurring three to four times per month. The NP should consider the addition of:

a.            aspirin.

b.            topiramate.

c.             ergotamine.

d.            opioid analgesics.

2.            A patient comes to the clinic concerned about possible migraine headaches. The primary care NP conducts a history and physical examination, and the patient describes vise-like pressure in the back of the head that occurs almost daily during the work week. The NP should recommend:

a.            acetaminophen.

b.            topiramate.

c.             sumatriptan.

d.            ergotamine.

3.            A patient comes to the clinic and reports recurrent headaches. The patient has a headache

 diary, which reveals irritability and food cravings followed the next day by visual disturbances and unilateral right-sided headache, nausea, and photophobia lasting 2 to 3 days. The NP should recognize these symptoms as     migraine.

a.            classic

b.            hemiplegic

c.             basilar-type

d.            ophthalmoplegic

4.            A patient who has migraine headaches tells the primary care NP that drinking coffee and taking nonsteroidal antiinflammatory drugs (NSAIDs) seems to help with discomfort. The NP should tell the patient that:

a.            this combination can lead to longer lasting headache pain.

b.            these substances are not indicated for migraine headaches.

c.             doing this can increase the risk of more chronic migraines.

d.            an opioid analgesic would be a better choice for migraine pain.

5.            A patient takes rizatriptan (Maxalt) to abort migraine headaches but tells the primary care NP that the headaches have become more frequent since a promotion at work. The NP’s initial response should be to:

a.            prescribe topiramate (Topamax).

b.            stress the importance of establishing new routines.

c.             help the patient identify stressors associated with the new role.

d.            add a combination NSAID, aspirin, and caffeine product to the regimen.

6.            A primary care NP prescribes sumatriptan for abortive treatment of migraine headaches. The patient returns to the clinic 1 month later to report increased frequency of the headaches. The NP should:

a.            add an opioid analgesic.

b.            consider changing to dihydroergotamine (D.H.E. 45).

c.             suggest that the patient take sumatriptan with a NSAID.

d.            ask the patient how often the sumatriptan is used each week.

7.            A patient who has migraine headaches without an aura reports difficulty treating the migraines in time because they come on so suddenly. The patient has been using over- the-counter NSAIDs. The primary care NP should prescribe:

a.            frovatriptan (Frova).

b.            sumatriptan (Imitrex).

c.             cyproheptadine (Periactin).

d.            dihydroergotamine (D.H.E. 45).

8.            A patient who has mild to moderate migraine headaches has severe nausea and vomiting with each episode. For the best treatment of this patient, the primary care NP should prescribe:

a.            triptan nasal spray.

b.            metoclopramide and aspirin.

c.             an NSAID and prochlorperazine.

d.            sumatriptan and metoclopramide.

9.            A patient who has migraine headaches usually has two to three severe migraines each month. The patient has been using a triptan nasal spray but reports little relief and is concerned about missing so many days of work. The primary care NP should consider:

a.            an oral triptan plus an opioid analgesic.

b.            an injectable triptan plus an oral corticosteroid.

c.             an intramuscular steroid plus an opioid analgesic.

d.            dihydroergotamine hydrochloride plus an opioid analgesic.

10.          A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four times each month. The NP should:

 a.           add a selective serotonin reuptake inhibitor (SSRI) antidepressant.

b.            change to dihydroergotamine hydrochloride.

c.             prescribe a ?-blocker such as propranolol.

d.            prescribe an anticonvulsant such as topiramate.

11.          A patient who is diagnosed with migraine headaches has a history of cardiovascular disease and hypertension. The NP should prescribe:

a.            triptan nasal spray.

b.            rizatriptan (Maxalt).

c.             cyproheptadine (Periactin).

d.            dihydroergotamine (D.H.E. 45).

12.          A patient reports frequent headaches to the primary NP. The patient describes the headaches as unilateral and moderate in intensity, accompanied by nausea, vomiting, and photophobia. There is no aura, and the headaches generally last 24 to 48 hours. The NP should:

a.            prescribe dihydroergotamine (D.H.E. 45).

b.            prescribe topiramate (Topamax) as migraine prophylaxis.

c.             recognize these as classic migraines and order sumatriptan (Imitrex).

d.            suggest treatment with acetaminophen because these are probably tension headaches.

 

 

Chapter 46: Antiparkinson Agents Test Bank

MULTIPLE CHOICE

1.            A patient who has Parkinson’s disease takes levodopa and carbidopa. The patient asks the primary care nurse practitioner (NP) why two drugs are necessary. The NP should explain that both drugs are needed to:

a.            prolong effects of the levodopa.

b.            delay progression of the disease.

c.             decrease adverse peripheral side effects.

d.            enhance passage of both drugs across the blood-brain barrier.

2.            A patient who has Parkinson’s disease and who takes levodopa reports that the drug effects wear off more quickly than before. The primary care NP should:

a.            add carbidopa.

b.            add amantadine.

c.             increase the dose of levodopa.

d.            add a monoamine oxidase B inhibitor (MAO-B).

3.            A patient who has Parkinson’s disease takes levodopa and carbidopa. The patient reports experiencing tremors between doses. The primary care NP should:

a.            add entacapone.

b.            add amantadine.

c.             discontinue the carbidopa.

d.            increase the dose of levodopa.

4.            A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing freezing episodes between doses. The primary care NP should consider using:

a.            selegiline.

b.            amantadine.

c.             apomorphine.

d.            modified-release levodopa.

5.            A patient who has Parkinson’s disease who takes levodopa and carbidopa reports having drooling episodes that are increasing in frequency. The primary care NP should order:

a.            benztropine.

b.            amantadine.

c.             apomorphine.

d.            modified-release levodopa.

6.            A patient who is diagnosed with Parkinson’s disease will begin taking levodopa and carbidopa. The patient asks the primary care NP what dietary interventions may be helpful in improving symptoms. The NP should recommend:

a.            consuming a high-calorie diet.

b.            consuming a low-carbohydrate diet.

c.             avoiding extra fluids during meal times.

d.            minimizing intake of high-protein foods during the day.

7.            A 55-year-old patient develops Parkinson’s disease characterized by unilateral tremors only. The primary care NP will refer the patient to a neurologist and should expect initial treatment to be:

a.            levodopa.

b.            carbidopa.

c.             pramipexole.

d.            carbidopa/levodopa.

8.            A 65-year-old patient is diagnosed with Parkinson’s disease.