NR 508 Final Exam Questions With Verified Answers Latest, Exams of Nursing

Download NR 508 Final Exam Questions With Verified Answers Latest and more Exams Nursing in PDF only on Docsity! 1Question 21Question 21 NR 508 Final Exam Questions With Verified Answers Latest. A patient who has diabetes reports intense discomfort when needing to void. A urinalysis is normal. To treat this, the primary care NP should consider prescribing: flavoxate (Urispas). bethanechol (Urecholine). phenazopyridine (Pyridium). oxybutynin chloride (Ditropan XL). This patient is describing urge incontinence, or overactive bladder, which occurs when the detrusor muscle is hyperactive, causing an intense urge to void before the bladder is full. Urge incontinence is associated with many conditions, including diabetes. Oxybutynin chloride, which is an anticholinergic, acts to decrease detrusor overactivity and is indicated for treatment of urge incontinence. Flavoxate is used to treat dysuria associated with UTI. Bethanechol is indicated for urinary retention. Phenazopyridine is used to treat dysuria. A patient reports difficulty returning to sleep after getting up to go to the bathroom every night. A physical examination and a sleep hygiene history are noncontributory. The primary care NP should prescribe: zaleplon. Question 1 2 / 2 pts Question 2 2 / 2 pts 2Question 21Question 21 ZolpiMist. ramelteon. 5Question 21Question 21 expect these side effects to occur as the medication is tapered. increase the dose of prednisolone to the most recent amount taken. Sudden discontinuation or rapid tapering of glucocorticoids in patients who have developed adrenal suppression can precipitate symptoms of adrenal insufficiency, including nausea, weakness, depression, anorexia, myalgia, hypotension, and hypoglycemia. When patients experience these symptoms during a drug taper, the dose should be increased to the last dose. Vitamin D deficiency is common while taking glucocorticoids, but these are not symptoms of vitamin D deficiency. Changing to another glucocorticoid is not recommended. Patients should be taught to report the side effects so that action can be taken and should not be told that they are to be expected. The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should: perform a dipstick urinalysis. prescribe desmopressin (DDAVP). prescribe oxybutynin chloride (Ditropan XL). teach exercises to strengthen the pelvic muscles. A focused history with a careful physical examination is essential for determining the cause of incontinence. Urinalysis can rule out urinary tract infection (UTI), which can cause incontinence. Medications are prescribed after determining the cause, if any, and treating underlying conditions. Exercises to strengthen the pelvic muscles are part of treatment. Question 7 2 / 2 pts Question 8 2 / 2 pts 6Question 21Question 21 A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the primary care NP notes a decrease in the child’s linear growth rate. The NP should consult the child’s asthma specialist about: gradually tapering the child off the prednisone. a referral for possible growth hormone therapy. giving a double dose of prednisone every other day. dividing the prednisone dose into twice-daily dosing. Administration of a double dose of a glucocorticoid every other morning has been found to cause less suppression of the HPA axis and less growth suppression in children. Because the child has severe asthma, an oral steroid is necessary. Growth hormone therapy is not indicated. Twice-daily dosing would not change the HPA axis suppression. A patient who is taking isoniazid and rifampin for latent TB is seen by the primary care NP for a routine follow-up visit. The patient reports having nausea, vomiting, and a decreased appetite. The NP should: ask about alcohol intake. suggest taking the medications with food. reassure the patient that these side effects are common. order liver and renal function tests and serum glucose. Concomitant use of alcohol with isoniazid increases the risk of hepatitis. This patient shows signs of hepatitis, so the NP should ask about alcohol consumption. Isoniazid should be taken on an empty stomach. Question 9 2 / 2 pts 7Question 21Question 21 A primary care NP sees a child with asthma to evaluate the child’s response to the prescribed therapy. The child uses an ICS twice daily and an albuterol metered-dose inhaler as needed. The child’s symptoms are well controlled. The NP notes slowing of the child’s linear growth on a standardized growth chart. The NP should change this child’s medication regimen to a: combination ICS/LABA inhaler twice daily. short-acting β2-agonist (SABA) with oral corticosteroids when symptomatic. combination ipratropium/albuterol inhaler twice daily. SABA as needed plus a leukotriene modifier once daily. A leukotriene modifier may be used as an alternative to ICS for children who experience systemic side effects of the ICS. This child’s symptoms are well controlled, so there is no need to step up therapy to include a LABA. Oral corticosteroids should be used only for severe exacerbations. Ipratropium and albuterol are used for severe exacerbations. A patient is newly diagnosed with Alzheimer’s disease stage 6 on the Global Deterioration Scale. The primary care NP should prescribe: donepezil (Aricept). rivastigmine (Exelon). memantine (Namenda). galantamine (Razadyne). Question 11 2 / 2 pts Question 10 2 / 2 pts 10Question 21Question 21 and then consider increasing the dose to achieve the desired effect. Renal function tests are not indicated. Unless the child is experiencing toxic effects, the drug does not need to be discontinued. An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65-year-old patient with recent onset of reactive airways disease who reports symptoms occurring every 1 or 2 weeks. At a follow-up appointment several months later, the patient reports no change in frequency of symptoms. The NP’s initial action should be to: order spirometry to evaluate pulmonary function. prescribe a systemic corticosteroid to help with symptoms. ask the patient to describe how the medications are taken each day. give the patient detailed information about the use of metered-dose inhalers. It is essential to explore with the older patient what he or she is actually doing with regard to daily medication use and compare this against the “prescribed” medication regimen before ordering further tests, prescribing any increase in medications, or providing further education. A patient is diagnosed with a condition that causes chronic pain. The primary care NP prescribes an opioid analgesic and should instruct the patient to: wait until the pain is at a moderate level before taking the medication. take the medication at regular intervals and not just when pain is present. start the medication at higher doses initially and taper Question 14 2 / 2 pts Question 15 2 / 2 pts 11Question 21Question 21 down gradually. take the minimum amount needed even when pain is severe to avoid dependency. 12Question 21Question 21 Chronic pain requires routine administration of drugs, and patients should take analgesics routinely without waiting for increased pain. A patient tells the primary care NP that he has difficulty getting and maintaining an erection. The NP’s initial response should be to: prescribe sildenafil (Viagra). perform a medication history. evaluate his cardiovascular status. order a papaverine injection test to screen for erectile dysfunction. Because the use of multiple medications is associated with a higher prevalence of erectile dysfunction, a medication history should be performed first to see if any medications have sexual side effects. A cardiovascular evaluation may be assessed next. Papaverine injection tests are useful screening tools after a thorough history has been performed. Medications are prescribed only after a diagnosis is determined and other causes have been ruled out. A 55-year-old patient develops Parkinson’s disease characterized by unilateral tremors only. The primary care NP will refer the patient to a neurologist and should expect initial treatment to be: levodopa. carbidopa. pramipexole. Question 16 2 / 2 pts Question 17 2 / 2 pts 15Question 21Question 21 2 / 2 pts A patient is taking dicloxacillin (Dynapen) 500 mg every 6 hours to treat a severe penicillinase-resistant infection. At a 1-week follow-up appointment, the patient reports nausea, vomiting, and epigastric discomfort. The primary care NP should: change the medication to a cephalosporin. decrease the dose to 250 mg every 6 hours. reassure the patient that these are normal adverse effects of this drug. order blood cultures, a white blood cell (WBC) count with differential, and liver function tests (LFTs). When giving penicillinase-resistant penicillins, it is important to monitor therapy with blood cultures, WBC with differential cell counts, and LFTs before treatment and weekly during treatment. This patient may have typical gastrointestinal side effects, but the symptoms may also indicate hepatic damage. Changing the medication is not indicated, unless serious side effects are present. Decreasing the dose is not indicated. A 75-year-old patient who lives alone will begin taking a narcotic analgesic for pain. To help ensure patient safety, the NP prescribing this medication should: assess this patient’s usual sleeping patterns. ask the patient about problems with constipation. obtain a baseline creatinine clearance test before the first dose. perform a thorough evaluation of cognitive and motor abilities. The body system most significantly affected by increased receptor sensitivity in elderly patients is the central nervous system, making this population sensitive to numerous drugs. It is important to evaluate motor and cognitive function before Question 22 2 / 2 pts 16Question 21Question 21 beginning drugs that affect the central nervous system to minimize the risk of falls. Assessment of sleeping patterns is important, but not in relation to patient safety. It is not necessary to evaluate stool patterns or renal function. A patient has been taking intramuscular (IM) meperidine 75 mg every 6 hours for 3 days after surgery. When the patient is discharged from the hospital, the primary care NP should expect the patient to receive a prescription for mg orally every hours. hydrocodone 30; 6 hydrocodone 75; 6 meperidine 300;12 meperidine 75; 6 When patients are switched from one opiate to another, an equianalgesic table should be used to convert the dosage of the current drug to the equivalent dosage of the new drug. An oral dose of 30 mg of hydrocodone is equivalent to an IM dose of 75 mg of meperidine. A patient who is obese and has hypertension is taking a thiazide diuretic and develops gouty arthritis, which is treated with probenecid. At a follow-up visit, the patient’s serum uric acid level is 7 mg/dL, and the patient denies any current symptoms. The primary care NP should discontinue the probenecid and: prescribe colchicine. prescribe febuxostat. tell the patient to use an NSAID if symptoms recur. Question 23 2 / 2 pts Question 24 2 / 2 pts 17Question 21Question 21 counsel the patient to report recurrence of symptoms. Colchicine is a first-line drug for preventing acute attacks. Because this patient has three risk factors, a preventive medication should be used. Febuxostat is a second-line preventive medication. The patient should not be treated on an as- needed basis. A mother brings her a college-age son to the primary care NP and asks the NP to talk to him about alcohol use. He reports binge drinking on occasion and drinking only beer on weekends. The NP notes diaphoresis, tachycardia, and an easy startle reflex. The NP should: admit him to the hospital for detoxification. ask him how much he had to drink last night. prescribe lorazepam (Ativan) to help with symptoms. suggest that he talk to a counselor about alcohol abuse. He is showing signs of alcohol withdrawal and possible delirium tremens and so should be admitted to the hospital. Asking him about drinking and suggesting outpatient counseling would be useful for a less emergent condition. The NP should not prescribe a medication to treat delirium tremens on an outpatient basis. A primary care NP sees a patient who has fever, flank pain, and dysuria. The patient has a history of recurrent urinary tract infections (UTIs) and completed a course of trimethoprim-sulfamethoxazole (TMP/SMX) the week before. A urine test is positive for leukocyte esterase. The NP sends the urine for culture and should treat this patient empirically with: gemifloxacin. Question 25 2 / 2 pts Question 26 2 / 2 pts 20Question 21Question 21 quit using nicotine replacement therapy and is feeling discouraged. She does not want to take medication at this time. The NP should: discuss the effects of smoking on fetal development. ask her to write down any factors that triggered her relapses. give her information about the long-term effects of smoking. convince her that taking medication will be essential in her case. Each attempt to quit smoking should not be seen as a failure but as a trial for the next attempt. Asking a patient who is motivated to quit to write down things that may have contributed to the relapse will help the patient learn from the previous attempts. The patient already knows about the effects of smoking on fetal development because that is her motivation for quitting. Offering medication may be necessary, but only if the patient desires it. A primary care NP prescribes a nonselective NSAID for a patient who has osteoarthritis. The patient expresses concerns about possible side effects of this medication. When counseling the patient about the medication, the NP should tell this patient: to avoid taking antacids while taking the NSAID. to take each dose of the NSAID with a full glass of water. that a few glasses of wine each day are allowed while taking the NSAID. to decrease the dose of the NSAID if GI symptoms occur. To avoid GI distress associated with NSAIDs, a full glass of water is recommended. Patients may take NSAIDs with antacids. Patients Question 29 2 / 2 pts 21Question 21Question 21 should avoid alcohol while taking NSAIDs. Patients should report GI symptoms to their provider. 22Question 21Question 21 A patient has been taking a COX-2 selective NSAID to treat pain associated with a recent onset of RA. The patient tells the primary care NP that the pain and joint swelling are becoming worse. The patient does not have synovitis or extraarticular manifestations of the disease. The NP will refer the patient to a rheumatologist and should expect the specialist to prescribe: methotrexate. corticosteroids. opioid analgesics. hydroxychloroquine. In mild RA disease, patients are given NSAIDs first for 2 to 3 months, and then either hydroxychloroquine or sulfasalazine is added if the disease does not remit. Methotrexate is a first-line drug for patients with more aggressive symptoms, such as synovitis or extraarticular symptoms. Opioid analgesics are used as adjuncts for pain relief along with DMARDs. A patient has been taking an opioid analgesic for 2 weeks after a minor outpatient procedure. At a follow-up clinic visit, the patient tells the primary care NP that he took extra doses for the past 2 days because of increased pain and wants an early refill of the medication. The NP should suspect: dependence. drug addiction. possible misuse. Question 31 2 / 2 pts Question 30 2 / 2 pts 25Question 21Question 21 adding zidovudine. changing to Truvada. changing to tenofovir. ordering Combivir and tenofovir. Truvada contains the antiretroviral therapies in Emtriva plus tenofovir. Tenofovir is effective against hepatitis B and is used in combination with emtricitabine as a preferred first-line choice. A patient who was in a motor vehicle accident has been treated for lower back muscle spasms with metaxalone (Skelaxin) for 1 week and reports decreased but persistent pain. A computed tomography scan is normal. The primary care NP should: suggest ice and rest. order physical therapy. prescribe diazepam (Valium). add an opioid analgesic medication. Physical therapy may be used as an injury begins to heal. This patient is experiencing improvement of symptoms, so physical therapy may now be helpful. Ice and rest are useful in the first 24 to 48 hours after injury. Diazepam is used on a short-term basis only. Opioid analgesics are used for severe pain. Question 36 2 / 2 pts Question 37 2 / 2 pts 26Question 21Question 21 A primary care NP sees a patient who has dysuria, fever, and urinary frequency. The NP orders a urine dipstick, which is positive for nitrates and leukocyte esterase, and sends the urine to the laboratory for a culture. The patient is allergic to sulfa drugs. The NP should: order cefaclor (Ceclor). prescribe cefixime (Suprax). administer intramuscular ceftriaxone (Rocephin). wait for culture results before ordering an antibiotic. Cephalosporins are useful for empirical treatment of many of the most common infections seen in primary care. Cefixime is a third- generation cephalosporin, which has greater activity against Escherichia coliand excellent penetration into body fluids, making it a good choice for empirical treatment of urinary tract infection. A patient comes to the clinic several days after an outpatient surgical procedure complaining of swelling and pain at the surgical site. The primary care NP notes a small area of erythema but no abscess or induration. The NP should: prescribe TMP-SMX. prescribe topical mupirocin four times daily. suggest that the patient apply warm soaks three times daily. refer the patient to the surgeon for further evaluation. This patient has cellulitis, so empirical treatment with TMP-SMX is indicated. Topical mupirocin is used for superficial skin infections, not cellulitis. Warm soaks Question 38 2 / 2 pts 27Question 21Question 21 may be used as an adjunct to antimicrobial treatment. Unless the cellulitis becomes worse, it is not necessary to refer the patient to the surgeon. A patient who has genital herpes has frequent outbreaks. The patient asks the primary care NP why it is necessary to take oral acyclovir all the time and not just for acute outbreaks. The NP should explain that oral acyclovir may: prevent the virus from developing resistance. cause episodes to be shorter and less frequent. actually eradicate the virus and cure the disease. reduce the chance of transmitting the virus to others. Oral acyclovir has prevented or reduced the frequency of severity of recurrences in more than 95% of patients and so should be given to patients with recurrent episodes. It does not affect resistance. The antiviral medication does not eradicate the virus; it prevents replication. The disease is transmitted even without symptoms. A patient is taking isoniazid, pyrazinamide, rifampin, and streptomycin to treat TB. The primary care NP should routinely perform: serum glucose and liver function tests (LFTs). bone marrow density and ophthalmologic tests. ophthalmologic, hearing, and serum glucose tests. color vision, serum glucose, and LFTs. Question 39 2 / 2 pts Question 40 2 / 2 pts 30Question 21Question 21 culture. 31Question 21Question 21 These side effects are considered common minor side effects of sulfonamide medications. They occur with all drugs in this class, so changing to TMP/SMX is not indicated. The patient should continue taking the medication. It is not necessary to perform laboratory tests. A patient is in the clinic with acute symptoms of anxiety. The patient is restless and has not slept in 3 days. The primary care NP observes that the patient is irritable and has moderate muscle tension. The patient’s spouse reports that similar symptoms have occurred before in varying degrees for several years. The NP should refer the patient to a psychologist and should prescribe which drug for short-term use? Alprazolam Buspirone Melatonin Zolpidem For acute anxiety, a benzodiazepine should be prescribed. SSRIs or buspirone should be used for long-term treatment. Melatonin and zolpidem are anti- insomnia agents. A woman who takes oral contraceptive pills develops vaginal candidiasis. The primary care NP prescribes a single dose of fluconazole. When counseling the patient about this drug, the NP should tell her: that the drug is safe if she were to become pregnant. that she may consume alcohol while taking this medication. to use a backup contraceptive method for the next 2 months. Question 45 2 / 2 pts Question 46 2 / 2 pts 32Question 21Question 21 that she may need a lower dose of fluconazole because she takes oral contraceptive pills. Women using oral contraception who take antifungals should be advised to use supplemental contraception during and for 2 months after antifungal therapy. Antifungals have teratogenic effects and are not safe during pregnancy. Patients should not consume alcohol while taking antifungal medications. It is not necessary to lower the antifungal dose in women taking oral contraceptive pills. A patient in the clinic reports taking a handful of acetaminophen extra- strength tablets about 12 hours prior. The patient has nausea, vomiting, malaise, and drowsiness. The patient’s aspartate aminotransferase and alanine aminotransferase are mildly elevated. The primary care NP should: expect the patient to sustain permanent liver damage. reassure the patient that these symptoms are reversible. tell the patient that acetylcysteine cannot be given this late. administer activated charcoal to remove acetaminophen from the body. After acetaminophen overdose, if liver enzymes are elevated within 24 hours, irreversible liver damage is likely. Acetylcysteine may still be given to mitigate the effects. Activated charcoal is effective only when given immediately. An NP sees a preschooler in clinic for the first time. When obtaining a medication history, the NP notes that the child is taking a medication for which safety and effectiveness in children has not been established in drug information literature. The NP should: discontinue the medication. order serum drug levels to evaluate toxicity. Question 47 2 / 2 pts Question 48 2 / 2 pts 35Question 21Question 21 3 to 6 6 to 9 9 to 12 The patient’s CBC should be monitored at least every 3 to 6 months and more frequently if values are low and bone marrow toxicity is present. A patient who was recently diagnosed with COPD comes to the clinic for a follow- up evaluation after beginning therapy with a SABA as needed for dyspnea. The patient reports occasional mild exertional dyspnea but is able to sleep well. The patient’s FEV1 in the clinic is 85% of predicted, and oxygen saturation is 96%. The primary care NP should recommend: a combination LABA/ICS twice daily. influenza and pneumococcal vaccines. ipratropium bromide (Atrovent) twice daily. home oxygen therapy as needed for dyspnea. Influenza and pneumococcal immunizations are recommended to help reduce comorbidity that will affect respiratory status. This patient is stable with the prescribed medications, so no additional medications are needed at this time. Home oxygen therapy is used for patients with severe resting hypoxemia. A patient who takes 150 mg of clozapine (Clozaril) twice daily calls the primary care NP at 10:00 AM one day to report forgetting to take Question 53 2 / 2 pts Question 54 2 / 2 pts 36Question 21Question 21 the 8:00 AM dose. The NP should counsel the patient to: 37Question 21Question 21 take the missed dose now. take 75 mg of clozapine now. wait and take the evening dose at the usual time. take the evening dose 2 hours earlier than usual. Advise patients to take missed doses only if remembered within 1 hour after the time the dose was due. A patient has been taking fluoxetine 20 mg every morning for 5 days and calls the primary care NP to report decreased appetite, nausea, and insomnia. The NP should: suggest taking a sedative at bedtime. change the medication to bupropion. add trazodone to the patient’s regimen. reassure the patient that these effects will subside. Side effects are seen with the first few doses but resolve in approximately 7 days. Patients should avoid taking sedatives while taking antidepressants. A female patient presents with grayish, odorous vaginal discharge. The primary care NP performs a gynecologic examination and notes vulvar and vaginal erythema. Testing of the discharge reveals a pH of 5.2 and a fishy odor when mixed with a solution of 10% potassium hydroxide. The NP should: Question 55 2 / 2 pts Question 56 2 / 2 pts 40Question 21Question 21 Acetaminophen is present in many other OTC products, so patients should be cautioned about taking these with acetaminophen to avoid overdose. The adult dose is not based on height and weight and is not determined by the degree of temperature elevation. The primary care NP follows a patient who is being treated for RA with methotrexate. The patient asks the NP why the medication does not seem to alleviate pain. The NP tells the patient that: an immunomodulator may be needed to control pain. a higher dose of methotrexate may be needed to achieve pain control. if methotrexate does not control pain, an opioid analgesic may be necessary. methotrexate is used to slow disease progression and preserve joint function. Disease-modifying antirheumatic drugs (DMARDs) have antiinflammatory effects that may slow disease progression and preserve joint function. Acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) are common adjuncts to therapy to treat pain. A patient has a UTI and will begin treatment with an antibiotic. The patient reports moderate to severe suprapubic pain. The primary care NP should prescribe: ibuprofen as needed. bethanechol (Urecholine). phenazopyridine (Pyridium). increased oral fluid intake to dilute urine. Question 60 2 / 2 pts Question 61 2 / 2 pts 41Question 21Question 21 Phenazopyridine is a urinary tract analgesic used to treat pain via a local analgesic effect on urinary tract mucosa in conjunction with antibiotics to treat UTI. Ibuprofen may be used but does not have direct effects on the urinary tract mucosa. Bethanechol is used to treat voiding dysfunction and not pain. Increasing fluid intake should be used as adjunct therapy. The parent of an 8-year-old child recently diagnosed with AD/HD verbalizes concerns about giving the child stimulants. The primary care NP should recommend: modafinil (Provigil). guanfacine (Intuniv). bupropion (Wellbutrin). atomoxetine (Strattera). Atomoxetine is not a stimulant medication but is thought to be as effective as stimulant medications. It is the only nonstimulant treatment approved by the U.S. Food and Drug Administration for AD/HD that has been shown to be safe, well tolerated, and efficacious in the treatment of children. The primary care NP is performing a medication reconciliation on a patient who takes digoxin for congestive heart failure and learns that the patient uses ibuprofen as needed for joint pain. The NP should counsel this patient to: use naproxen (Naprosyn) instead of ibuprofen. increase the dose of digoxin while taking the ibuprofen. use an increased dose of ibuprofen while taking the digoxin. Question 62 2 / 2 pts Question 63 2 / 2 pts 42Question 21Question 21 take potassium supplements to minimize the effects of the ibuprofen. Ibuprofen and indomethacin increase the effects of digoxin, so the NP should recommend another NSAID, such as naproxen, that does not have this effect. Increasing the dose of digoxin or the ibuprofen would increase the likelihood of digoxin toxicity further. Potassium should be monitored while taking NSAIDs long-term, but supplements should not be given unless there is a potassium deficiency. A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order: coagulation studies. a complete blood count. an EEG. a creatinine clearance test. Valproic acid may cause thrombocytopenia and inhibition of platelet aggregation. Platelet counts and coagulation studies should be done before therapy is initiated, at regular intervals, and before any surgical procedure is performed. A patient who has Alzheimer’s disease is taking 10 mg of donepezil daily and reports difficulty sleeping. The primary care NP should recommend: decreasing the dose to 5 mg. increasing the dose to 15 mg. Question 64 2 / 2 pts Question 65 2 / 2 pts 45Question 21Question 21 nicotine replacement gum or nasal spray. a high-dose 24-hour nicotine patch. intensive smoking cessation counseling. Nicotine replacement gum and nasal spray both can be used when patients have cravings and are especially useful for patients who do not smoke at particular times. The patch is useful when patients smoke consistently throughout the day. Bupropion is not indicated. Intensive counseling is often necessary for patients who have difficulty stopping and have failed several times. A patient is seen in the clinic with a 1-week history of frequent watery stools. The primary care NP learns that a family member had gastroenteritis a week prior. The patient was treated for a UTI with a sulfonamide antibiotic 2 months prior. The NP should suspect: Clostridium difficile–associated disease (CDAD). viral gastroenteritis. serum sickness reaction. recurrence of the UTI. Cases of CDAD have been reported 2 months after a course of antibiotics, and CDAD should be suspected in all patients who present with diarrhea after antibiotic use. Viral gastroenteritis is possible, but the possibility of CDAD must be investigated. Serum sickness reaction is not usually associated with diarrhea and generally occurs within weeks of drug administration. Question 70 2 / 2 pts Question 71 2 / 2 pts 46Question 21Question 21 A female patient has vaginal candidiasis and has taken a single dose of fluconazole without resolution of the infection. The primary care NP obtains a culture and should order: oral ketoconazole. griseofulvin for 4 weeks. another dose of fluconazole. topical miconazole (Monistat). Topical miconazole is still recommended as the drug of first choice and should be given when oral fluconazole has failed. Fluconazole has been approved for single-dose treatment of vulvovaginal candidiasis, although the Centers for Disease Control and Prevention continues to recommend topical therapy with an imidazole derivative because of fluconazole-resistant candidiasis. Ketoconazole and griseofulvin are not recommended first-line treatments for vulvovaginal candidiasis. Another dose of fluconazole would not be effective if resistance is present. A patient reports difficulty falling asleep and staying asleep every night and has difficulty staying awake during the commute to work every day. The NP should: suggest the patient try diphenhydramine first. perform a thorough history and physical examination. teach about avoiding caffeine and good sleep hygiene. suggest melatonin and consider prescribing Ambien if this is not effective. Question 72 2 / 2 pts 47Question 21Question 21 Before treating insomnia with drug therapy, it is important first to rule out any physiologic causes of a sleep disorder. The other interventions may be tried if no serious cause of the disorder is found. A patient who is newly diagnosed with schizophrenia is overweight and has a positive family history for type 2 diabetes mellitus. The primary care NP should consider initiating antipsychotic therapy with: ziprasidone (Geodon). olanzapine (Zyprexa). risperidone (Risperdal). chlorpromazine (Thorazine). Many antipsychotics increase the risk of metabolic syndrome in patients. Ziprasidone does not have effects on weight. The other agents all increase the risk of weight gain and metabolic syndrome. A patient asks an NP about using an oral over-the-counter decongestant medication for nasal congestion associated with a viral upper respiratory illness. The NP learns that this patient uses loratadine (Claritin), a β-adrenergic blocker, and an intranasal corticosteroid. The NP would be concerned about which adverse effects? Liver toxicity Excessive drowsiness Rebound congestion Question 73 2 / 2 pts Question 74 2 / 2 pts