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NR566 Week 8 Final Exam

An adult patient has had trouble falling asleep for the past 2 weeks. Non-drug strategies, such as sleep hygiene, have been ineffective. Which approach is MOST appropriate for managing this patient’s insomnia?

1. 🟩 <span style=”color:green”>Initiate short-term hypnotic therapy at the lowest effective dose while monitoring for tolerance and dependency.</span>
2. Advise intermittent use of hypnotics only on nights when the patient feels particularly tired.
3. Prescribe a high-dose hypnotic to ensure immediate and complete relief of insomnia symptoms.
4. Recommend continuous hypnotic therapy for several months to prevent recurrence of sleep problems.

A 14-year-old with chronic lung disease requires prophylaxis against respiratory syncytial virus (RSV). Which medication is recommended for prophylaxis in this patient?

1. Baloxavir marboxil
2. 🟩Palivizumab
3. Zanamivir
4. Oseltamivir

 

A patient is prescribed topical tazarotene for mild to moderate psoriasis. Which of the following patient education statements is MOST appropriate?

1. Apply the medication only to areas of normal skin to reduce local irritation.
2. Apply the medication under an occlusive dressing to enhance drug absorption.

🟩 C. Use sunscreen and protective clothing because this medication increases sensitivity to sunlight

1. Stop treatment immediately if mild burning or itching occurs after application.

 

A 45-year-old male with a history of migraines presents to the clinic complaining of frequent migraine attacks occurring more than 3 times a week. He reports using over-the-counter pain relievers daily for symptom relief. What complication of excessive abortive medication use should be considered in this patient?

1. Opioid dependence
2. Acetaminophen toxicity

🟩 C. Medication overuse headache

1. Serotonin syndrome

 

Which of the following statements accurately describes the recommended first-line management of uncomplicated acute otitis externa?

🟩 A. Topical antibiotic-steroid ear drops and analgesics are preferred over systemic antibiotics.

1. Corticosteroid ear drops alone are adequate because the condition is primarily inflammatory.
2. Broad-spectrum oral antibiotics should be prescribed to ensure systemic coverage.
3. Topical antifungal drops should be started until bacterial cultures confirm the pathogen.

A patient with open-angle glaucoma is prescribed latanoprost. At a follow-up visit, the NP notes the patient has developed a gradual darkening of the iris and longer, thicker eyelashes. Which is the BEST action by the NP?

🟩 A. Reassure the patient that these are expected cosmetic effects and continue therapy as prescribed.

1. Discontinue latanoprost immediately, as the pigmentation changes are a sign of toxicity.
2. Order baseline liver function tests, since systemic absorption can cause hepatic adverse effects.
3. Switch the patient to timolol to avoid further pigmentation and eyelash changes.

 

Why might levodopa be preferred over dopamine agonists in patients with Parkinson’s disease?

🟩 A.Higher efficacy

1. Lower cost
2. Lower risk of dyskinesias
3. Longer duration of action

 

A patient with acne has been prescribed a combination of topical clindamycin and benzoyl peroxide. What is the primary reason for this combination therapy?

🟩 A. To prevent emergence of resistance to clindamycin

1. To promote keratolysis
2. To enhance the anti-inflammatory effects
3. To reduce oiliness of the skin

 

What is the primary mechanism of action of tricyclic antidepressants in migraine prevention?

🟩 A. Inhibition of serotonin reuptake

1. Antagonism of N-methyl-D-aspartate (NMDA) receptors
2. Inhibition of monoamine oxidase
3. Enhancement of gamma-aminobutyric acid (GABA)-ergic neurotransmission

The NP is selecting a glucocorticoid for a patient who requires long-term suppression of inflammation with once-daily dosing. Which preparation would be MOST appropriate based on biologic half-life?

1. Cortisone, because its high mineralocorticoid activity prolongs the biologic half-life and reduces dosing frequency.
2. A short-acting glucocorticoid, because it remains in body tissues longer than long-acting preparations.
3. Hydrocortisone, because its short biologic half-life provides prolonged anti-inflammatory effects with once-daily dosing.

🟩 D. Prednisone, because its intermediate biologic half-life allows for effective once-daily administration in chronic therapy

A patient with a history of seasonal allergies presents with complaints of itchy, red, watery eyes. He has been self-medicating with an ocular decongestant for the past 3 weeks but now reports worsening redness. Which is the MOST appropriate next step in managing this patient?

1. Switch to long-term topical glucocorticoid therapy to control inflammation.
2. Reassure the patient that rebound redness will resolve without intervention.

🟩 C. Discontinue the decongestant and initiate a topical antihistamine.

1. Continue the decongestant but add saline drops to relieve dryness.

 

A patient presents with eczema involving the eyelids. They ask whether they can use the same clobetasol 0.05% cream (a super-high potency topical glucocorticoid) that was prescribed previously for their psoriasis. Which teaching point BEST demonstrates the NP’s understanding of topical glucocorticoid absorption and potency?

1. “Potency depends only on the drug’s concentration, so using a smaller amount of clobetasol would be safe for your eyelids.”
2. “You can safely apply clobetasol to the eyelids because absorption is the same across all skin areas.”
3. “Using an occlusive dressing over your eyelids would reduce absorption and minimize systemic effects.”

🟩 D. Super-high potency glucocorticoids should be avoided on thin skin like the eyelids because absorption is greater and increases risk for adverse effects.

 

A 3-year-old child is brought to the clinic with acute otitis media (AOM). The child is otherwise healthy, has mild ear pain, and a temperature of 99 degrees F. The parents are concerned and request antibiotics immediately. According to the American Academy of Pediatrics (AAP) guidelines (2013), what is the MOST appropriate management?

🟩 A. Recommend symptomatic treatment with analgesics and observe for 48–72 hours, starting antibiotics only if symptoms persist or worsen.

1. Prescribe antibiotics immediately because all children with AOM benefit from early treatment.
2. Withhold all medications, including pain relief, because most AOM cases resolve without intervention.
3. Prescribe antibiotics immediately to prevent mastoiditis, since delaying therapy greatly increases this risk.

A young adult patient with a history of major convulsive seizures is starting carbamazepine therapy. The nurse practitioner wants to achieve rapid seizure control and minimize the risk of toxicity. Which approach BEST reflects evidence-based practice for monitoring and adjusting the patient’s antiseizure therapy?

1. Rely solely on observing seizure frequency over several weeks to determine whether the initial dose is effective.
2. Avoid measuring plasma drug levels, because they are only relevant for absence seizures, which occur frequently.

🟩 C. Use plasma drug level measurements to guide dosage adjustments while monitoring clinical response and assessing adherence and toxicity risk.

1. Adjust the dose based on patient-reported side effects without considering plasma drug levels or seizure frequency.

 

A 6-month-old infant requires treatment with a central nervous system (CNS) drug. Which pharmacologic consideration is MOST important when selecting a medication for this patient?

🟩 A. The infant’s underdeveloped blood-brain barrier may allow higher CNS drug penetration, increasing sensitivity.

1. Protein-bound drugs readily cross the infant’s blood-brain barrier, so lower doses are typically ineffective.
2. The blood-brain barrier in infants blocks most lipid-soluble drugs, requiring higher doses for therapeutic effect.
3. Highly ionized drugs easily cross the infant’s blood-brain barrier, reducing the risk of CNS side effects.

An older adult patient with advanced Parkinson’s disease (PD) presents with worsening bradykinesia and tremor despite initial therapy. The nurse practitioner considers pharmacologic options to restore dopamine-acetylcholine balance in the striatum. Which management approach BEST aligns with current evidence-based guidelines?

1. Start an N-methyl-D-aspartate (NMDA) receptor antagonist exclusively, because these agents are safer and equally effective as dopaminergic drugs in all stages of PD.

🟩 B. Initiate a dopaminergic agent, such as levodopa/carbidopa, while considering adjunctive therapies to optimize dopamine activity and reduce “off” periods

1. Prescribe an anticholinergic agent alone, as these drugs are first-line therapy and sufficiently restore dopamine-acetylcholine balance.
2. Recommend only nonpharmacologic therapies, deferring all dopaminergic or anticholinergic drugs until symptoms become disabling.

 

A young adult patient with bipolar disorder presents with severe insomnia, anxiety, and agitation during an acute manic episode. Which management strategy would be MOST appropriate for this patient?

1. Start a benzodiazepine alone to manage agitation and insomnia without adding an antipsychotic.

🟩 B. Use an antipsychotic such as olanzapine or risperidone, adding a benzodiazepine if insomnia, anxiety, or agitation is present.

1. Prescribe a long-term antidepressant to manage mood symptoms during the acute manic episode.
2. Initiate ziprasidone monotherapy without addressing insomnia or agitation.

 

A patient with Parkinson’s disease has been experiencing “off” times and drug-induced dyskinesias despite long-term treatment with levodopa. Which medication would be MOST appropriate to reduce the “off” times in this patient?

1. Levodopa/carbidopa

🟩 B. Entacapone

1. Rasagiline
2. Pramipexole

 

The NP should monitor for which adverse effect when taking phentermine/topiramate?

1. Bradycardia

🟩 B. Acidosis

1. Hypertension
2. Hypoglycemia

 

A patient on chronic lithium therapy develops polyuria and excessive thirst. Which drug can be used to reduce lithium-induced polyuria?

🟩 A. Amiloride

1. Anticholinergic drugs
2. Non-steroidal anti-inflammatory drugs (NSAIDs)
3. Thiazide diuretics

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