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Terms in this set (81)

Patient with diagnosis of depression and Alzheimer's, has mild intermittent symptoms. What would we prescribe to begin treatment?
Aricept (Donepezil HCL) - cholinesterase inhibitor
Patient has Stage 2 Alzheimer's disease on Aricept, asks NP how long medication will be needed. NP tells patient
Medication needs to be taken indefinitely because Alzheimer's is not curable
Patient has early stage Alzheimer's, NP recommended a cholinesterase inhibitor, why is medication needed if almost everything is intact?
Medication will slow progression of symptoms
Patient has been taking Aricept for several months after diagnosis, spouse states patient is having visual hallucinations. NP should
Decrease the dose
Patient is diagnosed with a condition that causes chronic pain, NP prescribes an opioid analgesic. NP should advise the patient to
Take medication at regular intervals and not just when pain is present
Patient has migraine headaches, no aura, difficulty treating in time because it comes on suddenly, takes NSAIDs. NP should prescribe
Imitrex (sumatriptan)
20kg child taking Depakote for seizures, has had regular dose increases with 250mg/kg BID, continues to have 2 seizures weekly and drowsy influencing schoolwork, NP should contact neurologist to discuss
Addition of Lamictal (lamotrigine)
Patient has Parkinson's on Levodopa and Carbidopa, asks NP why 2 drugs are necessary, NP should explain
that it is to decrease peripheral side effects. (Carbidopa decreases side effects of levodopa)
65 year old with diagnosis of Parkinson's has emphysema and narrow angle glaucoma, NP should consider starting treatment with
Selegiline
Patient diagnosed with Parkinsons' on levodopa/carbidopa, which dietary interventions will be helpful with symptoms?
Increase fiber and water intake, and minimize intake of high protein
80 year old with CHF and respiratory infection, fever of 101.5, NP should prescribe
low dose APAP
Patient develops a fever with rash after taking APAP, NP should advise
patient to avoid products with APAP
Patient with persistent mild to moderate pain in bilateral knees with standing, stiffness for 15 to 20 minutes each morning, APAP and heating pads no longer provides relief, ESR normal. NP should prescribe
NSAID
70 year old patient with moderate to severe pain associated with OA in fingers, thumbs, knees, on high dose APAP, strong family history of CVD and has been diagnosed with HTN. To alleviate pain, NP should prescribe
Naproxen and a low dose ASA
Patient with mild to moderate OA pain on APAP, prescribed an NSAID. At follow up, patient complains of mild GI side effects. NP should
Add Misoprostol - synthetic prostaglandin analog, also used for preventing gastric and duodenal ulcers
Patient on 81 mg of ASA for MI prevention and APAP for mild OA pain. For flare ups of OA pain, NP should prescribe
Naproxen (diagnosis of OA). For general joint pain ibuprofen is used.
80 year old patient taking Naproxen for OA for 6 months, adequate pain relief but feels really tired, NP should order which lab
CBC due to risk of occult GI bleeding
Patient with OA scheduled to have knee surgery, takes ASA for MI risk reduction and Naproxen for pain and inflammation, which statement indicates further teaching
Both of these medications interfere with platelet production and may cause blood clots
Patient with RA on methotrexate, asks why medication does not relieve pain, APN should tell patient
Methotrexate is used to slow disease progression and preserve joint function
Patient with RA experiencing minimal pain/symptoms, consult with rheumatologist and will probably recommend
Ibuprofen for mild symptoms, methotrexate for advanced disease
Patient with HTN on Thiazide, serum uric acid level of 8, APN should order
24 hour urine
Patient comes to clinic and reports sudden pain and swelling of one knee joint, gout is suspected, most important initial test is
Synovial fluid aspiration for gram stain culture
Patient diagnosed with gout, tests show under-excretion of uric acid, APN should prescribe
Probenecid (Benemid)
Patient is obese, HTN, on thiazide, develops gouty arthritis treated with probenecid, at follow up serum uric acid is 7, denies current symptoms, APN should
Discontinue probenecid and start colchicine
55 year old woman who experienced menopause at age 50 undergoes Dexa scan and has a T-score of > 2.5, BMI 22, sits at computer all day at work, APN should
counsel patient about diet and exercise
60 year old undergoes Dexa scan with a T-score of -1.9; no risk factors for osteoporosis, APN should prescribe
Fosamax
60 year old woman for annual well-woman exam, patient has been on Fosamax for 4 years, her bone density T-score + 2.0, walks daily, fracture risk low, APN should recommend
1 to 2 year drug holiday
Reports chronic LBP, difficulty sleeping despite ibuprofen at bedtime each night, APN should prescribe
Flexeril
Patient reports acute onset LBP associated with lifting something heavy the day before, APN should recommend
NSAID
Patient with MVA and has been treated for back spasms for 1 week, CT scan is normal, APN should suggest
Physical Therapy
Patient feels unfocused, losing things, difficulty completing tasks at work and home, symptoms present for a long time. No previous documentation of ADHD, NP should
Conduct a thorough evaluation to examine behaviors
During an annual well child check up, child taking Methylphenidate for ADHD, NP should discontinue this medication if which symptom is present
Motor Tics
Child diagnosed with ADHD after being expelled form school, parents reluctant to start medication due to stigma, NP should suggest
Concerta (Methylphenidate)
Primary APN sees patient 3 days after an outpatient surgical procedure, patient reports using Zofran for nausea, 88/56 BP, APN suspects
Signs of toxicity for Zofran
Lightheadedness, room spinning, APN refers patient to specialist, which after diagnostic testing, prescribes
Meclizine
Patient complaining of nausea and vomiting, lasted for 2 to 3 days, dry oral mucous membranes, 80/56 BP, 96 HR, 38.8 C, cap refill > 3 seconds. APN should
send patient to ED for IV hydration
Patient about to have chemotherapy, has concerns about GI side effects, APN to reassure patient
Pre-medication with Zofran
Three year old vomiting for several days, fewer episodes of vomiting in the last day, and is now able to have sips of fluid without vomiting, dry oral membranes 88/46, 100, 37.2 C. APN should recommend
Oral rehydration therapy
Patient with episodes of bloating, abdominal pain, loose stools. An important question about the abdominal pain is
relation of the pain to the stools
Patient with IBS with diarrhea and cramping worsening, asking about medications to treat symptoms. APN should recommend
Bentyl (Dicyclomine)
Woman with IBS taking antispasmodic medications with some relief but disease is interfering with ability to work due to increased pain. APN should consider
Tricyclic antidepressant
Patient with IBS experiences diarrhea, bloating, pain. Does not want medications. APN should recommend
Increase fiber to 25 grams of fiber daily
Woman with severe IBS takes hyoscamine (Levsin), Phazyme, and a tricyclic antidepressant. Has continued severe diarrhea. Full medical regimen still with severe problems. NP should
Refer patient to a gastroenterologist
Patient with HTN about to start diuretics, clear breath sounds, no organomegaly/edema, labs normal including lytes. Which medication should NP start with
Thiazide (first line agent)
Patient on HCTZ for HTN, asks why it is necessary to reduce sodium. APN should explain that it is to
prevent post-diuretic sodium retention
Patient with history of HTN and ETOH, not on any medications. Crackles are auscultated bilaterally, liver 2 cm below costal margin, elevated creatinine, NP should refer this patient to cardiologist and make sure that
loop diuretics are prescribed
Patient who had an MI 6 months ago, on ACEI, nitro, furosemide, and HCTZ. NP auscultates crackles to bilateral lungs, pitting edema to both feet. APN should start
Spironolactone
Patient on spironolactone complains of weakness, tingling in the hands and feet, HR 62, 100/58 BP. APN should order
ECG and serum electrolytes
Patient with BPH taking tamsulosin (Flomax) and dutasteride (Avodart). Why are both medication necessary?
One gives faster symptom relief (flomax), the other shrinks the size of the prostate (avodart)
Patient complaining of difficulty getting and maintaining an erection. APN should
perform a medication history
NP preparing to prescribe Viagra for a patient with erectile dysfunction. NP should make sure that
patient does not take nitroglycerine
Patient with CVD on nitro, develops erectile dysfunction, APN should recommend
Use of a vacuum constriction device
Patient wants erectile dysfunction medication to use PRN. NP should recommend
Stendra (avanafil)
50 year old woman who reports frequent leakage of urine, occurs when patient laughs or sneezes, urge to void even when bladder is not full. APN should
Perform a urine dipstick
Patient with urinary frequency, discomfort associated with urination, after a thorough exam, APN should prescribe
antispasmodic
Patient with UTI will begin antibiotics, patient reports moderate to severe suprapubic pain, NP should prescribe
Pyridium (phenazopyridine)
Oxybutynin Cl prescribed to 80 year old patient to treat urinary incontinence, when teaching, APN should tell patient
Increase fluids and fiber
Patient with viral respiratory infection asks about APAP for fever and muscles aches. Don't want them to get toxic so NP should
ask about any other over the counter medications
2 year old with a temp of 37.5 C, mom asks about APAP. NP should explain
APAP is not usually necessary for temps less that 37.7 C or 99.5 F
Patient with GERD has an endoscopy that shows a hiatal hernia, mildly obese, asks about treatment options
Combination of lifestyle changes, medications, and surgery may be necessary
Patient has endoscopy and gets diagnosis of erosive esophagitis, no health insurance. Wants to know about over the counter antacids like TUMS. NP should tell patient
TUMS can help reduce symptoms in conjunction with PPIs
Patient has GERD with erosive esophagitis, taking PPI for 4 weeks with a decrease of symptoms, asks patient if it can be discontinued. APN should explain
dose is going to be continued for long-term therapy.
Patient reporting heartburn 30 minute after meals, constant sour taste, frequency belching, normal weight, high stress job. APN should prescribe
PPI - first line treatment for GERD with moderate symptoms
Patient taking low dose PPI for long-term GERD management and takes an occassional Alca-Seltzer. APN should
recommend TUMS (calcium bicarbonate) is a better agent
80 year old male asks about OTC antacids for occasional heartburn, normal CBC, electrolytes, slight elevation in creatinine. APN should recommend
TUMS
Patient with peptic ulcer disease asks about nonpharmacologic management. APN should instruct
diet high in fiber.
Patient with severe arthritis takes an NSAID and develops a duodenal ulcer. Tried a different NSAID in the past which was not as effective. NP should recommend
PPI
Patient with peptic ulcer disease. Lab tests confirms H. Pylori. APN orders clarithrymycin, PPI, and amoxicillin. After two weeks, H. Pylori is still present. NP should
Prescribe PPI, Amoxicillin and Flagyl for 14 days
Patient with erosive esophagitis takes Prevacid and is also on Digoxin. APN should
Check Digoxin level
Patient concerned about constipation, patient has 3 to 4 BMs per week with occasional hard stools but not straining with defecation. NP should recommend
Increase intake of fluids and fiber
Five year old with chronic constipation, PCP plans to recommend laxative for long-term management. In addition to pharmacological management, APN should recommend fiber at what amount
5 grams of fiber + 1 gram per year of age
Patient has history of chronic constipation, uses bulk laxative for preventing acute constipation, now complaining of increase in episodes of constipation. APN should prescribe
Colace
Patient taking Digoxin reports taking Metamucil 3-4 times a month for constipation. APN should counsel patient
take the Digoxin about two hours before the metamucil
Woman 4 months pregnant, acute diarrhea and nausea, husband has same symptoms, HR 92 baseline is 70, temp 101, BP 100/60. APN should
refer patient to ED for IV fluids
Patient has been on antibiotics for recurrent PNA, is having diarrhea for 5 days with 6 to 7 liquid stool each day. APN should
check for C-Diff
Patient with 4-5 liquid stools each day asks about medications that stop the diarrhea. APN should explain
antidiarrheal medications are not curative and may prolong the illness
Patient with 5-7 liquid stools a day, no vomiting, been drinking Gatorade, stool sample ordered. NP should recommend
Pepto-Bismol (kills bacteria without inhibiting fecal evacuation).
Two year old with chronic toddler's diarrhea, unknown benign etiology, asks about treating child's symptoms. APN should recommend
Pedialyte
Twelve year old with acute diarrhea, URI, family members with similar symptoms that have resolved. APN should recommend
Pedialyte
Woman in first trimester, continues to have morning sickness, weight loss of 1 pound since previous visit two weeks ago. NP should consult with an OB for which antiemetic.
Zofran
Patient about to take a cruise, has motion sickness and nausea. Asks how often to apply patch
Apply patch every 3 days
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