Question 1
pts
A patient who has angina uses 0.4 mg of sublingual nitroglycerin for angina episodes.
The patient brings a log of angina episodes to an annual physical examination. The
primary care NP notes that the patient has experienced an increase in frequency of
episodes in the past month but no increase in duration or severity of pain. The NP
should:
increase the nitroglycerin dose to 0.6 mg per dose.
Correct Answer
contact the patient’s cardiologist to discuss admission to the hospital.
discontinue the nitroglycerin and order ranolazine (Ranexa ER).
You Answered
change from a sublingual to a transdermal patch nitroglycerin.
Unstable angina is a change in pattern or pain, such as an increase in frequency,
severity, or duration of pain and fewer precipitating factors. Patients with unstable
angina should be admitted to a coronary care unit. The primary care NP should not
change any medications without consultation with the patient’s cardiologist.
Question 2
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:
You Answered
order liver function tests (LFTs).
add gemfibrozil (Lopid) to the patient’s medication regimen.
Correct Answer
order a creatine kinase-MM (CK-MM) level.
change atorvastatin to twice-daily dosing.
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.
Question 3
pts
A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals
LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The woman is
sedentary with a body mass index of 26. The woman asks the primary care NP about
using a statin medication. The NP should:
tell her there is no clinical evidence of efficacy of statin medication in her case.
Correct Answer
begin therapy with atorvastatin 10 mg per day.
discuss quality-of-life issues as part of the decision to begin medication.
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