Discussion: Testosterone therapy

Discussion: Testosterone therapy

Discussion: Testosterone therapy

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Question

Question 12 pts

Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months. She has a positive family history of breast cancer. The primary care NP should recommend:

testosterone therapy.

estrogen-only therapy.

nonhormonal drugs for osteoporosis.

estrogen-progesterone therapy for 1 to 2 years.

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Question 22 pts

A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe:

aprepitant (Emend).

ondansetron (Zofran).

scopolamine transdermal.

prochlorperazine (Compazine).

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Question 32 pts

A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased. The NP should consult with an endocrinologist and order:

thyrotropin.

methimazole.

levothyroxine.

propylthiouracil.

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Question 42 pts

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:

prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.

perform a careful cardiovascular physical assessment.

counsel the patient about dietary and lifestyle changes.

order a urinalysis and creatinine clearance and begin therapy with a ?-blocker.

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Question 52 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:

methimazole.

liothyronine.

levothyroxine.

propylthiouracil.

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Question 62 pts

When prescribing a medication for a chronic condition, the primary care NP should tell the patient:

to contact the pharmacy whenever refills are needed.

that it is necessary to return to the clinic for each monthly refill of the medication.

about the frequency of clinic visits necessary for the number of refills authorized.

to ask the pharmacist to supply several months’ worth of the medication at a time.

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Question 72 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:

increasing the dose to 90 mcg/day.

decreasing the dose to 30 mcg/day.

stopping the medication and checking TSH and T4 in 4 weeks.

discussing the need for lifetime replacement therapy with the child’s parents.

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Question 82 pts

A patient who has IBS experiences diarrhea, bloating, and pain but does not want to take medication. The primary care NP should recommend:

25 g of fiber each day.

avoiding gluten and lactose in the diet.

increasing water intake to eight to ten glasses per day.

beginning aerobic exercise, such as running, every day.

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Question 92 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:

take one cycle of COCPs.

take a home pregnancy test.

use condoms for the next 7 days.

contact the clinic if she misses a period.

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Question 102 pts

A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe:

mesalamine (Asacol).

dicyclomine (Bentyl).

simethicone (Phazyme).

metoclopramide (Reglan).

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Question 112 pts

A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug:

may cause different adverse effects.

does not necessarily have the same therapeutic effect.

is likely to be less safe than the brand specified in the prescription.

may vary in the amount of drug that reaches the site of action in the body.

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Question 122 pts

A patient comes to the clinic with a history of syncope and weakness for 2 to 3 days. The primary care NP notes thready, rapid pulses and 3-second capillary refill. An ECG reveals a heart rate of 198 beats per minute with a regular rhythm. The NP should:(PSVT)

administer intravenous fluids and obtain serum electrolytes.

administer amiodarone in the clinic and observe closely for response.

order digoxin and verapamil and ask the patient to return for a follow-up examination in 1 week.

send the patient to an emergency department for evaluation and treatment.

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Question 132 pts

An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won’t have to deal with pills or periods. The primary care NP should tell her that she:

should consider another form of contraception after 1 year.

may have irregular bleeding, especially in the first month or so.

will need to take calcium and vitamin D every day while using this method.

will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics.

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Question 142 pts

A patient who is taking nifedipine develops mild edema of both feet. The primary care NP should contact the patient’s cardiologist to discuss:

changing to amlodipine.

ordering renal function tests.

increasing the dose of nifedipine.

evaluation of left ventricular function.

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Question 152 pts

A patient who is taking trimethoprim-sulfamethoxazole for prophylaxis of urinary tract infections tells the primary care NP that a sibling recently died from a sudden cardiac arrest, determined to be from long QT syndrome. The NP should:

schedule a treadmill stress test.

order genetic testing for this patient.

discontinue the trimethoprim-sulfamethoxazole.

refer the patient to a cardiologist for further evaluation.

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Question 162 pts

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 ?-blocker.

an angiotensin-converting enzyme inhibitor.

a thiazide diuretic.

dietary and lifestyle changes.

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Question 172 pts

A male patient tells the primary care NP he is experiencing decreased libido, lack of energy, and poor concentration. The NP performs an examination and notes increased body fat and gynecomastia. A serum testosterone level is 225 ng/dL. The NP’s next action should be to:

order LH and FSH levels.

order a serum prolactin level.

prescribe testosterone replacement.

obtain a morning serum testosterone level.

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Question 182 pts

A woman has severe IBS and takes hyoscyamine sulfate (Levsin), simethicone (Phazyme), and a TCA. She reports having continued severe diarrhea. The primary care NP should:

order diphenoxylate (Lomotil).

prescribe alosetron after ruling out pregnancy.

refer her to a gastroenterologist for endoscopy.

increase the fiber in her diet to 30 g per day.

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Question 192 pts

A patient is given a diagnosis of peptic ulcer disease. A laboratory test confirms the presence of Helicobacter pylori. The primary care NP orders a proton pump inhibitor (PPI) before meals twice daily, clarithromycin, and amoxicillin. After 14 days of treatment, H. pyloriis still present. The NP should order:

continuation of the PPI for 4 to 8 weeks.

a PPI, amoxicillin, and metronidazole for 14 days.

a PPI, clarithromycin, and amoxicillin for 14 more days.

a PPI, bismuth subsalicylate, tetracycline, and metronidazole.

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Question 202 pts

A patient is taking drug A and drug B. The primary care NP notes increased effects of drug B. The NP should suspect that in this case drug A is a cytochrome P450 (CYP450) enzyme:

inhibitor.

substrate.

inducer.

metabolizer.

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Question 212 pts

The primary care NP sees a new patient who has diabetes and hypertension and has been taking a thiazide diuretic for 6 months. The patient’s blood pressure at the beginning of treatment was 150/95 mm Hg. The blood pressure today is 138/85 mm Hg. The NP should:

order a b-blocker.

add an angiotensin-converting enzyme inhibitor.

continue the current drug regimen.

change to an aldosterone antagonist medication.

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Question 222 pts

A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should:

obtain a stool specimen and order vancomycin.

order testing for Clostridium difficile and consider metronidazole therapy.

prescribe diphenoxylate (Lomotil) to provide symptomatic relief.

reassure the patient that diarrhea is a common side effect of antibiotic therapy.

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Question 232 pts

The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should:

compromise with the parents and order a nasogastric tube for feedings.

initiate a discussion with the parents about the potential outcomes of each possible action.

refer the family to a case manager who can help guide the parents to the best decision.

understand that the child’s parents have a right to make choices that override those of the medical team.

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Question 242 pts

The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners. Which statement by the patient indicates she understands the regimen?

“I have to take a pill only every 3 months.”

“I should expect to have only four periods each year.”

“I will need to use condoms for only 7 more days.”

“This type of pill has fewer side effects than other types.”

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Question 252 pts

The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma. The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes. The NP should:

provide pharmaceutical company samples of the medication for the patient.

inform the patient that the drug must be paid for out of pocket because it is not covered.

order the closest formulary-approved approximation of the drug and monitor effectiveness.

write a letter of medical necessity to the insurer to explain the need for this particular medication.

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Question 262 pts

A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor. All of the patient’s baseline LFTs were normal. At a 6-month follow-up visit, the patient reports occasional headache. A lipid profile reveals a decrease of 20% in the patient’s LDL cholesterol. The NP should:

order LFTs.

order CK-MM tests.

consider decreasing the dose of the medication.

reassure the patient that this side effect is common.

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Question 272 pts

A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to:

report wheezing and shortness of breath, which may occur with these drugs.

take care when getting out of bed or a chair after the first dose of the ACE inhibitor.

discuss taking an increased dose of the thiazide diuretic with the cardiologist.

minimize fluid intake for several days when beginning therapy with the ACE inhibitor.

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Question 282 pts

A thin 52-year-old woman who has recently had a hysterectomy tells the primary care NP she is having frequent hot flashes and vaginal dryness.A recent bone density study shows early osteopenia. The woman’s mother had CHD. She has no family history of breast cancer. The NP should prescribe:

estrogen-only HT now.

estrogen-only HT in 5 years.

estrogen-progesterone HT now.

estrogen-progesterone HT in 5 years.

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Question 292 pts

A patient who will begin using nitroglycerin for angina asks the primary care NP how the medication works to relieve pain. The NP should tell the patient that nitroglycerin acts to:

dissolve atheromatous lesions.

relax vascular smooth muscle.

prevent catecholamine release.

reduce C-reactive protein levels.

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Question 302 pts

A patient is in the clinic complaining of nausea and vomiting that has lasted 2 to 3 days. The patient has dry oral mucous membranes, a blood pressure of 90/56 mm Hg, a pulse of 96 beats per minute, and a temperature of 38.8° C. The primary care NP notes a capillary refill of greater than 3 seconds. The NP should:

obtain a complete blood count and serum electrolytes.

prescribe a rectal antiemetic medication.

admit to the hospital for intravenous (IV) rehydration.

encourage the patient to take small, frequent sips of Gatorade.

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Question 312 pts

A patient who has severe arthritis and who takes nonsteroidalantiinflammatory drugs (NSAIDs) daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should:

prescribe cimetidine (Tagamet).

prescribe omeprazole (Prilosec).

teach the patient about a bland diet.

change the NSAID to a corticosteroid.

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Question 322 pts

A patient who has stable angina and uses sublingual nitroglycerin tablets is in the clinic and begins having chest pain. The primary care NP administers a nitroglycerin tablet and instructs the patient to lie down. The NP’s next action should be to:

obtain an electrocardiogram.

administer oxygen at 2 L/minute.

give 325 mg of chewable aspirin.

call EMS.

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Question 332 pts

A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop diuretic, and an ACE inhibitor. The patient reports having nausea. The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg. The NP should:

decrease the dose of the diuretic to prevent further dehydration.

obtain a serum potassium level to assess for hyperkalemia.

hold the ACE inhibitor until the patient’s blood pressure stabilizes.

obtain a digoxin level before the patient takes the next dose of digoxin.

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Question 342 pts

A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled. The primary care NP should counsel this patient to:

avoid foods that are high in vitamin K for several days.

take a double dose of the medication the next morning.

refill the prescription and take today’s dose immediately.

skip today’s dose and resume a regular dosing schedule in the morning.

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Question 352 pts

A primary care NP has prescribed phentermine for a patient who is obese. The patient loses 10 lb in the first month but reports that the drug does not seem to be suppressing appetite as much as before. The NP should:

discontinue the phentermine.

increase the dose of phentermine.

continue the phentermine at the same dose.

change to a combination of phentermine and topiramate.

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Question 362 pts

A 45-year-old patient who has a positive family history but no personal history of coronary artery disease is seen by the primary care NP for a physical examination. The patient has a body mass index of 27 and a blood pressure of 130/78 mm Hg. Laboratory tests reveal low-density lipoprotein, 110 mg/dL; high-density lipoprotein, 70 mg/dL; and triglycerides, 120 mg/dL. The patient does not smoke but has a sedentary lifestyle. The NP should recommend:

30 minutes of aerobic exercise daily.

taking 81 to 325 mg of aspirin daily.

beginning thera

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