Question

1. A patient is newly diagnosed with Alzheimer's disease stage 6 on the Global Deterioration Scale. The primary care NP should prescribe:

1. donepezil (Aricept).
2. rivastigmine (Exelon).
3. memantine (Namenda).
4. galantamine (Razadyne).

2. A patient who takes carbamazepine (Tegretol) has been seizure-free for 2 years and asks the primary care NP about stopping the medication. The NP should:

a. order an electroencephalogram (EEG).

b. prescribe a tapering regimen of the drug.

                            c. inform the patient that antiepileptic drug (AED) therapy is lifelong.

                            d. tell the patient to stop the drug and use only as needed.

3. A patient who takes valproic acid for a seizure disorder is preparing to have surgery. The primary care NP should order:

                         a. coagulation studies.

                         b. a complete blood count.

                         c. an EEG.

                         d.   a creatinine clearance test.

4. A 65-year-old patient is diagnosed with Parkinson's disease. The patient has emphysema and narrow-angle glaucoma. Given the patient’s medical history ,the primary care NP should consider beginning therapy with:

a. selegiline.

b. benztropine

c. carbidopa/levodopa.

d. ropinirole hydrochloride.

5. The primary care NP sees a 14-year-old patient who reports feeling hopeless and sad. The child's parent reports increased aggression and a decline in school performance. The NP should consider prescribing:

a. fluoxetine (Prozac).

b. nortriptyline (Pamelor)

c. tranylcypromine (Parnate)

                         d. venlafaxine hydrochloride (Effexor)

6. A patient is in the clinic with acute symptoms of anxiety. The patient is restless and has not slept in 3 days. The primary care NP observes that the patient is irritable and has moderate muscle tension. The patient's spouse reports that similar symptoms have occurred before in varying degrees for several years. The NP should refer the patient to a psychologist and should prescribe which drug for short-term use?

            a. Alprazolam

            b. Buspirone

            c. Melatonin

            d. Zolpidem

7. A patient who is overweight is diagnosed with schizophrenia. Which of these medications is the best choice for this overweight patient:

                          a. olanzapine (Zyprexa).

                          b. ziprasidone (Geodon).

c.quetiapine (Seroquel).

                          d. aripiprazole (Abilify).

8. The patient with rheumatoid arthritis is scheduled to begin treatment with sulfasalazine. He should be instructed that he should notify his primary health care provider immediately if he notices:

a.	vision changes.
b.	hair loss.
c.	dizziness.
d.	bruising and bleeding.

9. The patient is scheduled to begin osteoporosis treatment. She has a family history of breast cancer. Given her family history, the correct medication for the primary health care provider to prescribe would be:

a.	alendronate.(Fosamax)
b.	ibandronate.(Boniva)
c.	risedronate (Actonel)
d.	raloxifene.   (Evista)

10. A patient comes to the clinic for a physical examination 2 weeks after a last dose of clozapine (Clozaril). The primary care NP should:

1. order a CBC with differential
2. order serum LFTs and lipids
3. order a serum clozapine level
4. assess the patient for orthostatic hypotension

Answer 1

1.

(a) Donepezil(arecept)

As it is used in all stages of alzehmiers disease.

2.

(b.) prescribe a tapering regimen of the drug

3.

(a.) coagulation studies

Because valproic acid use causes perioperative bleeding chances.

4.

(b.) benztropine

5.

(a.) Flouxetine

6.

(a.) Alprazolam

Because alprazolam is used for insomnia and also it reduces anxiety and stress.

7.

(b.) Ziprasidone

Because research shows its causes the least weight gain on longterm use.

8.

(D.) bruising and bleeding

Because these are the side effects to develop.

9.

(d.) raloxifeme

Because it reduces the risk of breast cancer by 50%

10.

(d.) Assess the patient for orthostatic hypotension

Because hypotension is a common problem occurring on use of clozapine.