Exam (elaborations)
NR-508 Midterm With complete solution | Updated 2024/25
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NR-508 Midterm With complete solution | Updated 2024/25
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NR-508 Midterm With complete solution |Updated 2024/25
nonhormonal drugs for osteoporosis - Osteopenia is diagnosed in a 55-year-old woman ii ii ii ii ii ii ii ii ii ii ii ii ii
who has not had a period in 15 months. She has a positive family history of breast cancer.
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The primary care NP should recommend
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testosterone therapy.
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estrogen-only therapy.
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nonhormonal drugs for osteoporosis.
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estrogen-progesterone therapy for 1 to 2 years. ii ii ii ii ii ii
Ondansetron (Zofran) - A woman is in her first trimester of pregnancy. She tells the
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primary care nurse practitioner (NP) that she continues to have severe morning sickness
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on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks
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prior. The NP should consult an obstetrician and prescribe:
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aprepitant (Emend).
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ondansetron (Zofran).
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scopolamine transdermal.
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prochlorperazine (Compazine). ii
Methimazole - A 75-year-old patient who has cardiovascular disease reports insomnia
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and vomiting for several weeks. The primary care NP orders thyroid function tests. The
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tests show TSH is decreased and T4 is increased. The NP should consult with an
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endocrinologist and order:
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thyrotropin.
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methimazole.
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levothyroxine.
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propylthiouracil.
perform a careful cardiovascular physical assessment. - A 55-year-old patient with no
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prior history of hypertension has a blood pressure greater than 140/90 on three separate
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occasions. The patient does not smoke, has a body mass index of 24, and exercises
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regularly. The patient has no known risk factors for cardiovascular disease. The primary
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care NP should:
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prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.
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perform a careful cardiovascular physical assessment.
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counsel the patient about dietary and lifestyle changes.
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order a urinalysis and creatinine clearance and begin therapy with a β-blocker.
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, levothyroxine - A patient reports fatigue, weight loss, and dry skin. The primary care nurse
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practitioner (NP) orders thyroid function tests. The patient's thyroid stimulating hormone
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(TSH) is 40 microunits/mL, and T4 is 0.1 ng/mL. The NP should refer the patient to an
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endocrinologist and prescribe:
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methimazole.
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liothyronine.
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levothyroxine.
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propylthiouracil.
about the frequency of clinic visits necessary for the number of refills authorized. - When
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prescribing a medication for a chronic condition, the primary care NP should tell the
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patient:
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to contact the pharmacy whenever refills are needed.
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that it is necessary to return to the clinic for each monthly refill of the medication.
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about the frequency of clinic visits necessary for the number of refills authorized.
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to ask the pharmacist to supply several months' worth of the medication at a time.
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stopping the medication and checking TSH and T4 in 4 weeks. - A child who has
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congenital hypothyroidism takes levothyroxine 75 mcg/day. The child weighs 15 kg. The
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primary care NP sees the child for a 3-year-old check-up. The NP should consult with a
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pediatric endocrinologist to discuss:
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increasing the dose to 90 mcg/day.
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decreasing the dose to 30 mcg/day.
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stopping the medication and checking TSH and T4 in 4 weeks.
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discussing the need for lifetime replacement therapy with the child's parents. ii ii ii ii ii ii ii ii ii ii
25 g of fiber each day - A patient who has IBS experiences diarrhea, bloating, and pain but
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does not want to take medication. The primary care NP should recommend:
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25 g of fiber each day.
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avoiding gluten and lactose in the diet.
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increasing water intake to eight to ten glasses per day.
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beginning aerobic exercise, such as running, every day. ii ii ii ii ii ii ii
use condoms for the next 7 days. - A woman who uses a transdermal contraceptive calls
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the primary care NP to report that while dressing that morning she discovered that the
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patch had come off and she was unable to find the patch. The NP should tell her to apply a
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new patch and:
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take one cycle of COCPs.
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take a home pregnancy test.
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use condoms for the next 7 days.
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contact the clinic if she misses a period. ii ii ii ii ii ii ii
, Dicyclomine (Bentyl) - A patient has been diagnosed with IBS and tells the primary care
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NP that symptoms of diarrhea and cramping are worsening. The patient asks about
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possible drug therapy to treat the symptoms. The NP should prescribe:
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mesalamine (Asacol).
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dicyclomine (Bentyl).
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simethicone (Phazyme).
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metoclopramide (Reglan). ii
may vary in the amount of drug that reaches the site of action in the body. - A patient wants
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to know why a cheaper version of a drug cannot be used when the primary care NP writes a
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prescription for a specific brand name of the drug and writes, "Dispense as Written." The
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NP should explain that a different brand of this drug:
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may cause different adverse effects.
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does not necessarily have the same therapeutic effect.
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is likely to be less safe than the brand specified in the prescription.
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may vary in the amount of drug that reaches the site of action in the body.
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send the patient to an emergency department for evaluation and treatment. - A patient
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comes to the clinic with a history of syncope and weakness for 2 to 3 days. The primary
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care NP notes thready, rapid pulses and 3-second capillary refill. An ECG reveals a heart
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rate of 198 beats per minute with a regular rhythm. The NP should: (PSVT)
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administer intravenous fluids and obtain serum electrolytes.
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administer amiodarone in the clinic and observe closely for response.
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order digoxin and verapamil and ask the patient to return for a follow-up examination in 1
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week.
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send the patient to an emergency department for evaluation and treatment.
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may have irregular bleeding, especially in the first month or so. - An adolescent girl has
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chosen Depo-Provera as a contraceptive method and tells the primary care NP that she
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likes the fact that she won't have to deal with pills or periods. The primary care NP should
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tell her that she:
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should consider another form of contraception after 1 year.
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may have irregular bleeding, especially in the first month or so.
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will need to take calcium and vitamin D every day while using this method.
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will have to take oral contraceptive pills in addition to Depo-Provera when she takes
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antibiotics.
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changing to amlodipine - A patient who is taking nifedipine develops mild edema of both
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feet. The primary care NP should contact the patient's cardiologist to discuss:
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changing to amlodipine.
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ordering renal function tests.
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