Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew-Test Bank
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Sample
Test
Chapter 03: General Pharmacokinetic and Pharmacodynamic
Principles
Test Bank
MULTIPLE CHOICE
1. A
primary care nurse practitioner (NP) prescribes a drug to an 80-year-old
African-American woman. When selecting a drug and determining the correct dose,
the NP should understand that the knowledge of how age, race, and gender may
affect drug excretion is based on an understanding of:
|
a. |
bioavailability. |
|
b. |
pharmacokinetics. |
|
c. |
pharmacodynamics. |
|
d. |
anatomy and physiology. |
ANS: B
Pharmacokinetics is the study of the action of drugs in the body
and may be thought of as what the body does to the drug. Factors such as age,
race, and gender may change the way the body acts to metabolize and excrete a
drug. Bioavailability refers to the amount of drug available at the site of
action. Pharmacodynamics is the study of the effects of drugs on the body.
Anatomy and physiology is a basic understanding of how the body functions.
DIF: Cognitive Level: Understanding
(Comprehension)
REF: 21
2. A
patient asks the primary care NP which medication to use for mild to moderate
pain. The NP should recommend:
|
a. |
APAP. |
|
b. |
Tylenol. |
|
c. |
acetaminophen. |
|
d. |
any over-the-counter pain
product. |
ANS: C
Providers should use generic drug names when prescribing drugs
or recommending them to patients, unless a particular brand is essential for
some reason. Because acetaminophen can have many trade names, it is important
for patients to understand that the drug is the same for all to avoid
overdosing on acetaminophen. APAP is a commonly used abbreviation but should
not be used when recommending the drug to patients.
DIF: Cognitive Level: Applying
(Application)
REF: 21
3. 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:
|
a. |
may cause different adverse
effects. |
|
b. |
does not necessarily have
the same therapeutic effect. |
|
c. |
is likely to be less safe
than the brand specified in the prescription. |
|
d. |
may vary in the amount of
drug that reaches the site of action in the body. |
ANS: D
Different formulations of the same drug may have varying degrees
of bioavailability, and it may be important to stick to a particular brand for
drugs with narrow therapeutic ranges. All drugs with similar active ingredients
should have the same therapeutic actions and side effects and should be equally
safe.
DIF: Cognitive Level: Applying
(Application)
REF: 22
4. A
primary care NP wishes to order a drug that will be effective immediately after
administration of the drug. Which route should the NP choose?
|
a. |
Rectal |
|
b. |
Topical |
|
c. |
Sublingual |
|
d. |
Intramuscular |
ANS: C
The sublingual route is preferred for quick action because the
drug is directly absorbed into the bloodstream and avoids the pass through of
the liver, where much of an oral drug is metabolized. Rectal routes have
unpredictable absorption rates. Topical routes are the slowest. Intramuscular
routes are slow.
DIF: Cognitive Level: Remembering
(Knowledge)
REF: 22
5. A
patient receives an inhaled corticosteroid to treat asthma. The patient asks
the primary care NP why the drug is given by this route instead of orally. The
NP should explain that the inhaled form:
|
a. |
is absorbed less quickly. |
|
b. |
has reduced
bioavailability. |
|
c. |
has fewer systemic side
effects. |
|
d. |
provides dosing that is
easier to regulate. |
ANS: C
An inhaled corticosteroid goes directly to the site of action
and does not have to pass through gastrointestinal tract absorption or the
liver to get to the lungs. It is generally well absorbed at this site, although
dosing is not necessarily easier to regulate because it is not always clear how
much of an inhaled drug gets into the lungs.
DIF: Cognitive Level: Applying
(Application)
REF: 21
6. A
patient takes an oral medication that causes gastrointestinal upset. The
patient asks the primary care NP why the drug information insert cautions
against using antacids while taking the drug. The NP should explain that the
antacid may:
|
a. |
alter drug absorption. |
|
b. |
alter drug distribution. |
|
c. |
lead to drug toxicity. |
|
d. |
increase stomach upset. |
ANS: A
Changing the pH of the gastric mucosa can alter the absorption
of the drug. Drug distribution is not affected. It may indirectly cause drug
toxicity if a significant amount more of the drug is absorbed. It would
decrease stomach upset.
DIF: Cognitive Level: Applying
(Application)
REF: 22
7. A
patient will begin taking two drugs that are both protein-bound. The primary
care NP should:
|
a. |
prescribe increased doses
of both drugs. |
|
b. |
monitor drug levels,
actions, and side effects. |
|
c. |
teach the patient to
increase intake of protein. |
|
d. |
stagger the doses of drugs
to be given 1 hour apart. |
ANS: B
Protein-bound drugs bind to albumin, and serum albumin levels
may affect how drugs are distributed. The provider should monitor drug levels,
actions, and side effects and change dosing accordingly. Increasing the dose of
both drugs is not recommended unless monitoring indicates. Increasing dietary
protein does not affect this. Staggering the drugs will not affect this.
DIF: Cognitive Level: Applying
(Application)
REF: 25
8. 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:
|
a. |
inhibitor. |
|
b. |
substrate. |
|
c. |
inducer. |
|
d. |
metabolizer. |
ANS: A
If drug A is a CYP450 enzyme inhibitor, it decreases the
capacity of the enzyme to metabolize drug B, causing more of drug B to be
available. A substrate is a drug acted on by the enzyme. If drug B is an enzyme
inducer, it would cause increased metabolism of drug A.
DIF: Cognitive Level: Applying
(Application)
REF: 26 – 27
9. The
primary care NP should understand that a drug is at a therapeutic level when it
is:
|
a. |
at peak plasma level. |
|
b. |
past 4 or 5 half-lives. |
|
c. |
at its steady plasma state. |
|
d. |
between minimal effective
concentration and toxic levels. |
ANS: D
The therapeutic range of a drug is the area between the minimal
effective concentration and the toxic concentration. Peak plasma level is the
highest level the drug reaches and may be well into the toxic range. Steady
state occurs when there is a stable concentration of the drug and generally
occurs after 4 or 5 half-lives.
DIF: Cognitive Level: Applying
(Application)
REF: 31
10. A
primary care NP is preparing to prescribe a drug and notes that the drug has
nonlinear kinetics. The NP should:
|
a. |
monitor frequently for
desired and adverse effects. |
|
b. |
administer a much higher
initial dose as a loading dose. |
|
c. |
monitor creatinine
clearance at baseline and periodically. |
|
d. |
administer the drug via a
route that avoids the first-pass effect. |
ANS: A
Drugs with nonlinear kinetics are not eliminated based on dose
or concentration of the drug, and these drugs have a narrow therapeutic window
and must be monitored closely for desired effects and toxicity.
DIF: Cognitive Level: Applying
(Application)
REF: 32
11. A
primary care NP is prescribing a drug for a patient who does not take any other
medications. The NP should realize that:
|
a. |
CYP450 enzyme reactions
will not interfere with this drug’s metabolism. |
|
b. |
substrates such as alcohol
cannot interfere with the drug when the patient is abstaining. |
|
c. |
food-drug interactions are
limited to those where food enhances or inhibits drug absorption. |
|
d. |
a thorough history of diet,
alcohol use, smoking, and over-the-counter and herbal products is required. |
ANS: D
Drugs are not the only substances that interfere with drug
kinetics and dynamics. The primary care NP should conduct a thorough history of
food and alcohol intake, smoking, and over-the-counter and herbal supplements
to identify things that might interfere with a drug. All of these may interfere
with CYP enzymes. Alcohol intake can influence this even when the patient is
abstaining because of long-term effects on the liver.
DIF: Cognitive Level: Understanding
(Comprehension)
REF: 38-39
Chapter 04: Special Populations: Geriatrics
Test Bank
MULTIPLE CHOICE
1. A
nurse practitioner (NP) is considering a possible drug regimen for an
80-year-old patient who reports being forgetful. To promote adherence to the
regimen, the NP should:
|
a. |
select drugs that can be
given once or twice daily. |
|
b. |
provide detailed written
instructions for each medication. |
|
c. |
order medications that can
be given on an empty stomach. |
|
d. |
instruct the patient to
take a lower dose if side effects occur. |
ANS: A
To promote adherence in elderly patients, selecting the smallest
number of medications with the simplest dose regimens is recommended, with
once-daily dosing preferred. Instructions should be simplified. Drug dosing
should be timed with mealtimes to help patients remember to take them. Lower
dosing may be necessary with some drugs, but patients should not do this
without consulting their provider.
DIF: Cognitive Level: Applying
(Application)
REF: 57 – 58
2. A
75-year-old patient who lives alone will begin taking a narcotic analgesic for
pain. To help ensure patient safety, the NP prescribing this medication should:
|
a. |
assess this patient’s usual
sleeping patterns. |
|
b. |
ask the patient about
problems with constipation. |
|
c. |
obtain a baseline
creatinine clearance test before the first dose. |
|
d. |
perform a thorough evaluation
of cognitive and motor abilities. |
ANS: D
The body system most significantly affected by increased
receptor sensitivity in elderly patients is the central nervous system, making
this population sensitive to numerous drugs. It is important to evaluate motor
and cognitive function before beginning drugs that affect the central nervous
system to minimize the risk of falls. Assessment of sleeping patterns is
important, but not in relation to patient safety. It is not necessary to
evaluate stool patterns or renal function.
DIF: Cognitive Level: Applying
(Application)
REF: 50| 55
3. A
thin 90-year-old patient who will begin taking warfarin has experienced a
recent weight loss of 15 pounds. The NP caring for this patient should:
|
a. |
obtain a baseline liver
function test (LFT) before starting the drug. |
|
b. |
write the initial
prescription at the lowest possible dose. |
|
c. |
encourage the patient to
consume a diet high in fat and protein. |
|
d. |
counsel the patient to take
the drug with food to enhance absorption. |
ANS: B
A common age change that affects the distribution of drugs in
older adults is a decrease in serum albumin. Significant changes that may
affect drug therapy may be seen in malnourished elderly patients. Warfarin has
a high binding affinity with albumin. Significant decreases in albumin may
result in a greater free concentration of highly protein-bound drugs. It is
important to order the lowest possible dose and titrate upward as needed. A
baseline LFT is not indicated. A diet high in fat and protein is not indicated.
DIF: Cognitive Level: Applying
(Application)
REF: 50 – 51
4. An
86-year-old patient is seen in clinic for a scheduled follow-up after starting
a new oral medication 1 month prior. The patient reports no change in symptoms,
and a laboratory test reveals a subtherapeutic serum drug level. The NP caring
for this patient should:
|
a. |
consider ordering more
frequent dosing of the drug. |
|
b. |
titrate the patient’s dose
upward and recheck in 1 month. |
|
c. |
ask the patient about any
increased frequency of bowel movements. |
|
d. |
determine the number of
pills left in the patient’s prescription bottle. |
ANS: D
Because of cost concerns, poor understanding of a drug’s
actions, or confusion about how to take a medication, many elderly patients do
not comply with drug regimens and may not take drugs as prescribed. Before
increasing the frequency or amount of a drug, it is important to assess first
whether or not the patient has been taking the drug as ordered. Counting the
number of pills in the bottle will help the provider assess whether the patient
is taking the drug as ordered. Changes in gastric motility do not generally
have major effects on the effectiveness or serum drug levels of medications.
DIF: Cognitive Level: Applying
(Application)
REF: 57 – 58
5. An NP
learns that a 90-year-old patient is chronically constipated and has frequent
problems with acid reflux. The NP notes a weight loss of 20 pounds in this
patient in the previous 6 months. Which of the following drugs that this
patient is taking is cause for concern?
|
a. |
Quinidine |
|
b. |
Naproxen |
|
c. |
Calcium citrate |
|
d. |
Calcium channel blocker |
ANS: B
Naproxen has a high binding affinity for protein, and these
drugs can become toxic in patients who may have low serum albumin because of
the amount of free drug in serum. Constipation and acid reflux may cause
problems with absorption for some drugs, but not the drugs listed.
DIF: Cognitive Level: Analyzing
(Analysis)
REF: 50 – 52
6. An NP
is caring for a 70-year-old patient who reports having seasonal allergies with
severe rhinorrhea. Using the Beers criteria, which of the following medications
should the NP recommend for this patient?
|
a. |
Loratadine (Claritin) |
|
b. |
Hydroxyzine (Vistaril) |
|
c. |
Diphenhydramine (Benadryl) |
|
d. |
Chlorpheniramine maleate
(Chlorphen 12) |
ANS: A
Loratadine is the only nonsedating antihistamine on this list. Older
patients are especially susceptible to sedation side effects and should not use
these medications if possible.
DIF: Cognitive Level: Applying
(Application)
REF: 57
7. An NP
orders an inhaled corticosteroid 2 puffs twice daily and an albuterol
metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for
a 65-year-old patient with recent onset of reactive airways disease who reports
symptoms occurring every 1 or 2 weeks. At a follow-up appointment several
months later, the patient reports no change in frequency of symptoms. The NP’s
initial action should be to:
|
a. |
order spirometry to
evaluate pulmonary function. |
|
b. |
prescribe a systemic
corticosteroid to help with symptoms. |
|
c. |
ask the patient to describe
how the medications are taken each day. |
|
d. |
give the patient detailed
information about the use of metered-dose inhalers. |
ANS: C
It is essential to explore with the older patient what he or she
is actually doing with regard to daily medication use and compare this against
the “prescribed” medication regimen before ordering further tests, prescribing
any increase in medications, or providing further education.
DIF: Cognitive Level: Applying
(Application)
REF: 57 – 58
Chapter 39: Osteoporosis Treatment
Test Bank
MULTIPLE CHOICE
1. A
55-year-old woman who experienced menopause at age 50 years undergoes central
dual-energy x-ray absorptiometry and has a T-score greater than 2.5. The
patient weighs 130 lb and has a body mass index of 22. She sits at a computer
all day at work. The primary care nurse practitioner (NP) caring for this
patient should:
|
a. |
prescribe a bisphosphonate. |
|
b. |
prescribe hormone
replacement therapy. |
|
c. |
counsel the patient about diet
and exercise. |
|
d. |
prescribe a selective
estrogen receptor modulator. |
ANS: C
The NP should counsel the patient about diet and exercise. Women
who are at least 5 years postmenopausal or who have several risk factors should
have bone density testing. Osteoporosis is defined as a T-score of less than
2.5, and treatment is indicated for women with T-scores that are 2 or more
standard deviations below the normal premenopausal level. It is not necessary
to initiate treatment at this time.
DIF: Cognitive Level: Applying
(Application)
REF: 435
2. A
50-year-old white woman who is experiencing menopause asks the primary care NP
what she can do to prevent osteoporosis. She has a negative family history and
no risk factors. The NP should counsel her to:
|
a. |
consider bisphosphonate
therapy in 5 years. |
|
b. |
undergo bone density
testing every 2 years. |
|
c. |
avoid high-impact sports
that can lead to fractures. |
|
d. |
take supplemental calcium
and vitamin D every day. |
ANS: D
Postmenopausal women should consume 1200 mg of calcium and at
least 1000 U of vitamin D each day. Bisphosphonate therapy should be considered
for persons with known risk factors. Bone density testing is indicated for
women with risk factors and then routinely after age 65. Patients should be
encouraged to engage in high-impact sports if possible to improve bone density.
DIF: Cognitive Level: Applying
(Application)
REF: 433
3. A
60-year-old woman has a central dual-energy x-ray absorptiometry with a T-score
of 1.9. A health history reveals no risk factors for osteoporosis. The primary
care NP should:
|
a. |
prescribe alendronate
sodium (Fosamax). |
|
b. |
counsel her to increase her
physical activity. |
|
c. |
prescribe calcitonin
(Miacalcin nasal spray). |
|
d. |
prescribe supplemental
calcium and vitamin D. |
ANS: A
This woman’s T-score is less than 2.5 and indicates
osteoporosis. She should begin treatment with a bisphosphonate. Increasing
physical activity and taking supplemental calcium and vitamin D are indicated
as well but only as part of a medication regimen. Calcitonin is not a
first-line medication.
DIF: Cognitive Level: Applying
(Application)
REF: 433
4. A
70-year-old patient who has a high fracture risk has been taking alendronate
(Fosamax) and calcium for 6 months. The primary care NP orders a urine NTx
level, which is 42. The NP should discontinue the alendronate and prescribe:
|
a. |
raloxifene (Evista). |
|
b. |
teriparatide (Forteo). |
|
c. |
calcitonin (Miacalcin nasal
spray). |
|
d. |
ibandronate sodium
(Boniva). |
ANS: B
Teriparatide is used in patients with a high fracture risk or in
whom bisphosphonate therapy has failed. Raloxifene and ibandronate are
second-line treatments for patients with usual fracture risks. Calcitonin is a
last-line treatment.
DIF: Cognitive Level: Applying
(Application)
REF: 436
5. A
60-year-old female patient has begun taking a daily bisphosphonate to prevent
osteoporosis and complains of gastrointestinal (GI) upset and dyspepsia. The
primary care NP’s initial response should be to:
|
a. |
prescribe a proton pump
inhibitor (PPI). |
|
b. |
order intravenous (IV)
bisphosphonates. |
|
c. |
suggest that she take the
drug with food. |
|
d. |
review the instructions for
taking the drug with the patient. |
ANS: D
Oral bisphosphonates must be taken on an empty stomach, and the
patient must remain upright and not eat or drink anything for 30 to 60 minutes.
GI upset and dyspepsia are frequent and can be minimized with correct
administration. A PPI is not indicated. IV bisphosphonates may be indicated if
the patient is unable to tolerate the oral drug after correct administration is
confirmed. Bisphosphonates should not be taken with food.
DIF: Cognitive Level: Applying
(Application)
REF: 436
6. A
50-year-old woman with osteopenia will begin taking raloxifene (Evista). When
counseling this patient about this drug regimen, the primary care NP should
tell her to:
|
a. |
go for walks daily. |
|
b. |
take the medication 1 hour
before meals. |
|
c. |
sit upright for 30 minutes
after taking the drug. |
|
d. |
avoid using diuretics while
taking this medication. |
ANS: A
Raloxifene is a selective estrogen receptor modulator, and it carries
a risk of venous thromboembolism. Patients should be encouraged to avoid
immobilization. The other instructions are part of medication teaching about
bisphosphonates.
DIF: Cognitive Level: Applying
(Application)
REF: 436
7. A
60-year-old woman is in the clinic for an annual well-woman examination. She
has been taking alendronate (Fosamax) 10 mg daily for 4 years. Her last bone
density test yielded a T-score of 2.0. Her urine NTx level today is 22. She
walks daily. Her fracture risk is low. The primary care NP should recommend
that she:
|
a. |
take a 1- to 2-year drug
holiday. |
|
b. |
change to 70 mg of
alendronate weekly. |
|
c. |
decrease the alendronate
dose to 5 mg daily. |
|
d. |
change to ibandronate
(Boniva) 3 mg IV every 3 months. |
ANS: A
The American Association of Clinical Endocrinologists recommends
patients have a “drug holiday” after 4 to 5 years of bisphosphonate treatment
if osteoporosis is mild and the fracture risk is low. The other options are all
viable treatment regimens but are not appropriate in this case.
DIF: Cognitive Level: Applying
(Application)
REF: 436
8. A
patient who has several risk factors for osteoporosis has a bone density test
that indicates osteopenia. The primary care NP plans to prescribe a
bisphosphonate. Before initiating treatment, the NP should:
|
a. |
order an upper GI x-ray. |
|
b. |
initiate PPI therapy. |
|
c. |
order serum calcium and
vitamin D levels. |
|
d. |
prescribe a calcium and
vitamin D supplement. |
ANS: C
Patients must have adequate nutrition, calcium, and vitamin D.
Hypocalcemia and vitamin D deficiency must be corrected before therapy is
initiated. An upper GI x-ray is indicated only if the patient is symptomatic.
Patients at risk for fracture should not take PPIs. Calcium and vitamin D
supplements should be given with bisphosphonate therapy; however, the first
action is to evaluate current serum levels.
DIF: Cognitive Level: Applying
(Application)
REF: 438
Chapter 73: Vitamins and Minerals
Test Bank
MULTIPLE CHOICE
1. An
80-year-old woman has chronically low hemoglobin despite a diet high in iron.
The primary care nurse practitioner (NP) will perform laboratory tests to
confirm a diagnosis and should suspect the patient will need:
|
a. |
omega-3 supplements. |
|
b. |
a folic acid supplement. |
|
c. |
a daily multivitamin with
iron. |
|
d. |
a diet high in green, leafy
vegetables. |
ANS: B
Women and elderly adults are often at risk for folic acid
deficiency leading to anemia because folic acid is necessary for synthesis of
hemoglobin. Folic acid supplements are indicated. Omega-3 supplements are not
indicated for anemia. If anemia is caused by iron deficiency alone, iron
supplements must be used, which have more iron than a multivitamin with iron.
Folic acid supplements are more effective than dietary folic acid.
DIF: Cognitive Level: Applying
(Application)
REF: 809
2. The
parent of a 3-year-old is concerned that the child’s legs are not straight. The
primary care NP notes marked bowing of the child’s lower extremities.
Radiologic studies show decreased ossification of the child’s bones. The NP
should:
|
a. |
prescribe vitamin D
supplements. |
|
b. |
recommend calcium
supplements. |
|
c. |
counsel the parent to
increase the child’s milk intake. |
|
d. |
ensure that the parent is
buying vitamin D–fortified milk. |
ANS: A
Children who do not get enough vitamin D can have abnormalities
in bone ossification leading to rickets, which is characterized by bowing of
the legs. The NP should prescribe vitamin D. Calcium supplements or increased
milk intake would not be helpful. Without vitamin D, the body cannot use
calcium for bone ossification. The amount of vitamin D in fortified milk is not
sufficient to overcome vitamin D deficiency.
DIF: Cognitive Level: Applying
(Application)
REF: 803
3. An
adolescent girl reports having heavy menstrual periods. Her hemoglobin is
consistently on the low end of the normal range. The primary care NP should
prescribe:
|
a. |
iron supplements. |
|
b. |
a folic acid supplement. |
|
c. |
oral contraceptive pills. |
|
d. |
increased red meats in her
diet. |
ANS: C
Women are at risk for iron-deficiency anemia from menstrual
blood loss. Taking oral contraceptives reduces this risk by moderating periods.
Iron would be indicated if anemia actually occurs, but this patient is just at
risk. Folic acid supplements are not indicated to prevent iron-deficiency
anemia. Dietary iron usually is not sufficient for replacing iron losses.
DIF: Cognitive Level: Applying
(Application)
REF: 803
4. The
parents of a 3-year-old child tell the primary care NP that their child is a
very picky eater and they are worried about the child’s nutrition. The NP
should recommend:
|
a. |
giving the child a daily
multivitamin containing iron. |
|
b. |
providing small portions of
a variety of foods at each meal. |
|
c. |
disciplining the child at
mealtimes to ensure proper nutrition. |
|
d. |
making sure the child’s
cereals are fortified with vitamins and minerals. |
ANS: B
Children often develop strong food preferences as they start to
eat solid foods. Parents should be taught that balance over time is important
and should provide small portions of a variety of foods at every meal. Not
every meal has to include every nutrient. Vitamin supplementation may be
necessary for children who refuse to eat a variety of foods.
DIF: Cognitive Level: Applying
(Application)
REF: 803
5. A
patient exhibits keratin deposits around hair follicles and has hardened
pigmented “goose bump” lesions on all extremities. The primary care NP should
consider prescribing:
|
a. |
thiamine. |
|
b. |
vitamin A. |
|
c. |
beta carotene. |
|
d. |
ascorbic acid. |
ANS: C
The patient is exhibiting signs of early vitamin A deficiency.
Beta carotene is recommended to avoid vitamin A toxicity because beta carotene
is converted to vitamin A as needed and there is no need to monitor intake
levels as with vitamin A. Thiamine and ascorbic acid are not indicated.
DIF: Cognitive Level: Applying
(Application)
REF: 804 – 805
6. The
primary care NP sees a patient for an annual physical examination. The patient
reports chronic alcohol abuse. The NP should refer the patient for treatment
and should prescribe:
|
a. |
niacin. |
|
b. |
thiamine. |
|
c. |
folic acid. |
|
d. |
vitamin B6. |
ANS: B
Patients who are alcohol abusers are prone to thiamine
deficiency.
DIF: Cognitive Level: Applying (Application)
REF: 807
7. As
patients age, it becomes particularly important to increase their intake of:
|
a. |
iron. |
|
b. |
omega 3. |
|
c. |
vitamin C. |
|
d. |
B vitamins. |
ANS: D
Elderly patients are especially prone to deficiencies of B
vitamins, generally because of poor dietary intake.
DIF: Cognitive Level: Understanding
(Comprehension)
REF: 803
8. A
40-year-old woman asks the primary care NP what she can do to minimize her risk
of osteoporosis. She takes 800 mg of calcium and drinks 2 cups of skim milk
each day. The NP should recommend that she:
|
a. |
decrease dietary fat. |
|
b. |
limit her caffeine intake. |
|
c. |
consume a high-protein
diet. |
|
d. |
drink diet instead of
sugary sodas. |
ANS: B
Large amounts of caffeine decrease calcium absorption. Calcium
absorption is improved with fat and decreased with high protein intake. All
sodas contain phosphorus, which decreases calcium levels.
DIF: Cognitive Level: Applying
(Application)
REF: 811
9. A
13-month-old child drinks 40 to 48 ounces of milk every day. The parents report
that the toddler eats a variety of baby fruits and vegetables but refuses meats
and cereals. The primary care NP should order a:
|
a. |
complete blood count (CBC). |
|
b. |
ferritin level. |
|
c. |
vitamin D level. |
|
d. |
serum calcium level. |
ANS: A
This child is consuming a diet low in iron. The NP should order
a CBC to check this child’s hemoglobin.
DIF: Cognitive Level: Applying (Application)
REF: 813
10. A
patient reports fatigue and increased frequency of stools over the past week
and reports having just begun a regimen of dietary changes to prevent
hypertension. The primary care NP notes a rapid, irregular heart rate and a
blood pressure of 92/58 mm Hg. The NP should question the patient about:
|
a. |
caffeine intake. |
|
b. |
B vitamin intake. |
|
c. |
fat-soluble vitamins. |
|
d. |
use of salt substitutes. |
ANS: D
The patient exhibits signs of potassium toxicity. Patients who
use salt substitutes often consume excessive potassium.
DIF: Cognitive Level: Applying
(Application)
REF: 815
11. An
adolescent girl has decided to become a vegetarian. The primary care NP should
counsel her about iron intake and considering a vitamin containing:
|
a. |
zinc. |
|
b. |
vitamin A. |
|
c. |
vitamin C. |
|
d. |
potassium. |
ANS: A
Patients who are vegetarians often do not consume adequate
amounts of zinc.
DIF: Cognitive Level: Understanding
(Comprehension)
REF: 816
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