A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban

Question 1: A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

a. use an existing guideline from a leading research hospital.

b. follow the guideline provided by a third-party payer to help ensure reimbursement.

c. review expert opinion and experimental, anecdotal, correlational study data.

d. write the guideline to adhere to long-standing practice protocols already in use

Question 2: A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. The NP should teach the patient to:

a. change the patch four times daily.
b. use the patch as needed for angina pain.
c. use two patches daily and change them every 12 hours.
d. apply one patch daily in the morning and remove in 12 hours.

Question 3: A patient is diagnosed with asthma. The primary care nurse practitioner (NP) prescribes an inhaled corticosteroid and an inhaled bronchodilator medication and provides education about how to use inhalers. At a follow-up visit 2 weeks later, the patient’s pulmonary function tests are worse. The NP should:

a. provide a detailed written asthma action plan for the patient.
b. ask the patient to describe how the medications have been used.
c. review the symptoms of an acute asthma exacerbation with the patient.
d. teach the patient to use the albuterol more often and order an oral steroid.

Question 4: A patient who will undergo surgery in implant a biosynthetic heart valve asks the primary care NP whether any medications will be necessary postoperatively. The NP should tell the patient that it will be necessary to take:

a. daily low-dose aspirin for 1 year.
b. heparin injections as needed based on activated partial thromboplastin time levels.
c. lifelong warfarin combined with enoxaparin as needed.
d. warfarin for 3 months postoperatively plus long-term aspirin.

Question 5: A patient has a BMI of 35, a fasting plasma glucose of 120 mg/dL, elevated triglycerides, and a history of myocardial infarction. The primary care NP plans to initiate dietary and lifestyle counseling and should consider prescribing:

a. ephedra.
b. orlistat (Xenical).
c. phentermine (Adipex-P).
d. phentermine and topiramate (Onexa).