Question 4.(2pts): A 55-year-old patient with no prior history of hypertension has a blood
pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body
mass index of 24, and exercises regularly. The patient has no known risk factors for
cardiovascular disease. The primary care NP should:
a. prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.
b. perform a careful cardiovascular physical assessment.
c. counsel the patient about dietary and lifestyle changes.
d. order a urinalysis and creatinine clearance and begin therapy with a b-blocker.
Question 5. (2 pts): A patient reports fatigue, weight loss, and dry skin. The primary care nurse
practitioner (NP) orders thyroid function tests. The patient’s thyroid stimulating hormone (TSH)
is 40 microunits/mL, and T4 is 0.1 ng/mL. The NP should refer the patient to an endocrinologist
and prescribe:
a. methimazole.
b. liothyronine.
c. levothyroxine.
d. propylthiouracil.
Question 6. (2 pts): When prescribing a medication for a chronic condition, the primary care NP
should tell the patient:
a. to contact the pharmacy whenever refills are needed.
b. that it is necessary to return to the clinic for each monthly refill of the medication.
, c. about the frequency of clinic visits necessary for the number of refills authorized.
d. to ask the pharmacist to supply several months' worth of the medication at a time.
Question 7. (2 pts): A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day.
The child weighs 15 kg. The primary care NP sees the child for a 3-year-old check-up. The NP
should consult with a pediatric endocrinologist to discuss:
a. increasing the dose to 90 mcg/day.
b. decreasing the dose to 30 mcg/day.
c. stopping the medication and checking TSH and T4 in 4 weeks.
d. discussing the need for lifetime replacement therapy with the child's parents.
Question 8. (2 pts): A patient who has IBS experiences diarrhea, bloating, and pain but does not
want to take medication. The primary care NP should recommend:
a. 25 g of fiber each day.
b. avoiding gluten and lactose in the diet.
c. increasing water intake to eight to ten glasses per day.
d. beginning aerobic exercise, such as running, every day.
Question 9. (2 pts): A woman who uses a transdermal contraceptive calls the primary care NP to
report that while dressing that morning she discovered that the patch had come off and she was
unable to find the patch. The NP should tell her to apply a new patch and:
a. take one cycle of COCPs.
b. take a home pregnancy test.
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