Assignment: Discuss Prescription of Phentermine
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.
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 therapy with a statin medication.
starting a thiazide diuretic to treat hypertension.
Question 372 pts
A patient has heart failure. A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling. The patient takes low-dose furosemide and an ACE inhibitor. The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg. The NP should:
order serum electrolytes.
obtain renal function tests.
consider prescribing a ?-blocker.
call the patient’s cardiologist to discuss adding digoxin to the patient’s regimen.
Question 382 pts
A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS. The patient comes to the clinic and reports having dry mouth, difficulty urinating, and more frequent constipation. The primary care NP notes a heart rate of 92 beats per minute. The NP should:
prescribe a TCA.
discontinue the antidiarrheal medication.
encourage the patient to increase water intake.
lower the dose of the antispasmodic medication.
Question 392 pts
A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are:
not curative and may prolong the illness.
useful in cases of acute infection with elevated temperature.
most beneficial when symptoms persist longer than 2 weeks.
useful when other symptoms, such as hematochezia, develop.
Question 402 pts
A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits. The patient reports lightheadedness associated with standing up. The NP should consult with the patient’s cardiologist about changing the medication to:
verapamil HCl (Calan).
short-acting nifedipine (Procardia).
Question 412 pts
A patient who has been taking digoxin 0.25 mg daily for 6 months reports that it is not working as well as it did initially. The primary care NP should:
recommend a reduced potassium intake.
increase the dose of digoxin to 0.5 mg daily.
hold the next dose of digoxin and obtain a serum digoxin level.
contact the patient’s pharmacy to ask if generic digoxin was dispensed.
Question 422 pts
A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet. The primary care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg. The NP should:
obtain a serum drug level.
order an electrocardiogram (ECG) and serum electrolytes.
change the medication to a thiazide diuretic.
question the patient about potassium intake.
Question 432 pts
The primary care nurse practitioner (NP) sees a patient in the clinic who has a blood pressure of 130/85 mm Hg. The patient’s laboratory tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120 mg/dL; and fasting plasma glucose, 100 mg/dL. The NP calculates a body mass index of 29. The patient has a positive family history for cardiovascular disease. The NP should:
prescribe a thiazide diuretic.
consider treatment with an angiotensin-converting enzyme inhibitor.
reassure the patient that these findings are normal.
counsel the patient about dietary and lifestyle changes.
Question 442 pts
A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor) continues to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP increases the dose from 10 mg daily to 20 mg daily. The patient reports headache and dizziness a few weeks after the dose increase. The NP should:
change the atorvastatin dose to 15 mg twice daily.
change the patient’s medication to cholestyramine (Questran).
add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily.
recommend supplements of omega-3 along with the atorvastatin.
Question 452 pts
The primary care NP is seeing a patient for a hospital follow-up after the patient has had a first myocardial infarction. The patient has a list of the prescribed medications and tells the NP that “no one explained anything about them.” The NP’s initial response should be to:
ask the patient to describe the medication regimen.
ask the patient to make a list of questions about the medications.
determine what the patient understands about coronary artery disease.
give the patient information about drug effects and any adverse reactions.
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