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NR 508 Week 4 Midterm (Version 2), NR 508: ADVANCED PHARMACOLOGY, Chamberlain College of Nursing
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NR 508 Week 4 Midterm (Version 2), NR 508: ADVANCED PHARMACOLOGY, Chamberlain College of Nursing
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NR 508 Week 4 Midterm ExamNR 508: ADVANCED PHARMACOLOGY
,NR 508 Week 4 Midterm Exam, Chamberlain
college of Nursing
Question 1
pts
A patient is given a diagnosis of peptic ulcer disease. A laboratory test confirms the
presence of Helicobacter pylori. The primary care NP orders a proton pump inhibitor
(PPI) before meals twice daily, clarithromycin, and amoxicillin. After 14 days of
treatment, H. pylori is still present. The NP should order:
continuation of the PPI for 4 to 8 weeks.
Correct!
a PPI, amoxicillin, and metronidazole for 14 days.
a PPI, clarithromycin, and amoxicillin for 14 more days.
a PPI, bismuth subsalicylate, tetracycline, and metronidazole.
A PPI, along with amoxicillin and metronidazole, is used as first-line treatment in
macrolide-allergic patients and for re-treatment for 14 days if first-line treatment of
choice failed because of occasional resistance to clarithromycin.
Question 2
pts
A patient is newly diagnosed with type 2 diabetes mellitus. The primary care NP reviews
this patient’s laboratory tests and notes normal renal function, increased triglycerides,
and deceased HDL levels. The NP should prescribe:
nateglinide (Starlix).
glyburide (Micronase).
,colesevelam (Welchol).
Correct!
metformin (Glucophage).
Metformin is recommended as initial pharmacologic treatment for type 2 diabetes. It has
been shown to decrease triglycerides and LDLs.
Question 3
pts
The primary care NP is considering prescribing captopril (Capoten) for a patient. The
NP learns that the patient has decreased renal function and has renal artery stenosis in
the right kidney. The NP should:
Correct!
initiate ACE inhibitor therapy at a low dose.
consider a different drug class to treat this patient’s symptoms.
give the captopril with a thiazide diuretic to improve renal function.
orderlisinopril (Zestril) instead of captopril to avoid increased nephropathy.
Patients with impaired renal function should use low-dose ACE inhibitors. It is not
necessary to avoid ACE inhibitors with unilateral renal stenosis.
Question 4
pts
A woman who has been taking a COCP for 2 months tells the primary care NP that she
has had several headaches, breakthrough bleeding, and nausea. The NP should
counsel the woman:
to change to a progestin-only pill.
, to stop taking the COCP immediately.
to use a backup form of contraception.
Correct!
that these effects will likely decrease in another month.
Breakthrough bleeding, nausea, and headaches are common during the first 3 months
of therapy and should improve without intervention. Progestin-only pills are used for
lactating women only. Prolonged bleeding and severe headache would warrant
discontinuation of the COCP. Backup contraception is not indicated.
Question 5
pts
A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6
months. The patient’s initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL,
and triglycerides of 160 mg/dL. The primary care NP orders a lipid profile today that
shows LDL of 105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient
reports muscle pain and weakness. The NP should:
order liver function tests (LFTs).
Correct!
order a creatine kinase-MM (CK-MM) level.
change atorvastatin to twice-daily dosing.
add gemfibrozil (Lopid) to the patient’s medication regimen.
Hepatotoxicity and muscle toxicity are the two primary adverse effects of greatest
concern with statin use. Patients who report muscle discomfort or weakness should
have a CK-MM level drawn. LFTs are indicated with signs of hepatotoxicity. It is not
correct to change the dosing schedule. Gemfibrozil is not indicated.
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