NR 508 MIDTERM EXAM STUDY GUIDE
Question 1
A patient has three consecutive blood pressure readings of 140/95 mm Hg. The
patient’s body mass index is 24. A fasting plasma glucose is 100 mg/dL. Creatinine
clearance and cholesterol tests are normal. The primary care NP should order:
a β-blocker.
an angiotensin-converting enzyme inhibitor.
a thiazide diuretic.
dietary and lifestyle changes.
The patient has stage I hypertension. Because there are no compelling indications
for other treatment, a thiazide diuretic should be used initially to treat the
hypertension. Dietary and lifestyle changes should also be recommended but are
not sufficient for patients with stage I hypertension. Other drugs may be added
later if thiazide diuretic therapy fails.
Question 2
An African-American patient is taking captopril (Capoten) 25 mg twice daily.
When performing a physical examination, the primary care nurse practitioner (NP)
,learns that the patient continues to have blood pressure readings of 135/90 mm Hg.
The NP should:
increase the captopril dose to 50 mg twice daily.
add a thiazide diuretic to this patient’s regimen.
change the drug to losartan (Cozaar) 50 mg once daily.
recommend a low-sodium diet in addition to the medication.
Some African-American patients do not appear to respond as well as whites in
terms of blood pressure reduction. The addition of a low-dose thiazide diuretic
often allows for efficacy in blood pressure lowering that is comparable with that
seen in white patients. Increasing the captopril dose is not indicated. Losartan is an
angiotensin receptor blocker (ARB) and is not indicated in this case.
Question 3
A 50-year-old woman reports severe, frequent hot flashes and vaginal dryness. She
is having irregular periods. She has no family history of CHD or breast cancer and
has no personal risk factors. The primary care NP should recommend:
estrogen-only HT.
,low-dose oral contraceptive therapy.
selective serotonin reuptake inhibitor therapy until menopause begins.
estrogen-progesterone HT.
Oral contraceptive pills are not approved by the U.S. Food and Drug
Administration for management of perimenopausal symptoms except to treat
irregular menstrual bleeding. This patient has a low risk for CHD and breast
cancer, so oral contraceptive pills are relatively safe. She is also at risk for
pregnancy, so oral contraceptive pills can help to prevent that.
Question 4
The primary care NP is prescribing a medication for an off-label use. To help
prevent a medication error, the NP should:
write “off-label use” on the prescription and provide a rationale.
call the pharmacist to explain why the instructions deviate from common use.
write the alternative drug regimen on the prescription and send it to the pharmacy.
, tell the patient to ignore the label directions and follow the verbal instructions
given in the clinic.
When prescribing a drug for an off-label use, the provider should specify this on
the written prescription and should provide a rationale so that the pharmacist
understands why the prescription is different from the normal use. Calling the
pharmacist would not provide written documentation. Merely writing the different
instructions can lead to errors if the pharmacist changes the label to conform to
usual standards. The patient may forget verbal instructions and follow the usual
regimen instead.
Question 5
The primary care nurse practitioner (NP) sees a patient in the clinic who has a
blood pressure of 130/85 mm Hg. The patient’s laboratory tests reveal high-density
lipoprotein, 35 mg/dL; triglycerides, 120 mg/dL; and fasting plasma glucose, 100
mg/dL. The NP calculates a body mass index of 29. The patient has a positive
family history for cardiovascular disease. The NP should:
prescribe a thiazide diuretic.
consider treatment with an angiotensin-converting enzyme inhibitor.
reassure the patient that these findings are normal.
counsel the patient about dietary and lifestyle changes.
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