Nokea
A female patient who is 8 weeks pregnant is seen by a primary care nurse practitioner (NP) after a routine prenatal screen was positive for human immunodeficiency virus (HIV). A CD4 cell count is 750 cells/mm. The NP should:
- A. begin immediate therapy with zidovudine and lamivudine.
- B. begin therapy with zidovudine when she is in her second trimester.
- C. delay treatment with antiretroviral medications until after her pregnancy.
- D. initiate therapy with zidovudine if her CD4 cell count decreases to 500 cells/mm.
Correct Answer: B
Rationale: The correct answer is B because antiretrovirals like zidovudine are recommended in pregnancy but avoided in the first trimester if possible. Choice A is incorrect (first trimester risk). Choice C is wrong (delay risks transmission). Choice D is inaccurate (CD4 threshold not applicable).
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The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include:
- A. Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program.
- B. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care.
- C. APRNs are less likely to prescribe narcotics and other controlled substances.
- D. APRNs are able to prescribe independently in all states, whereas a physician's assistant needs to have a physician supervising their practice.
Correct Answer: B
Rationale: Choice B is correct because APRNs are trained to adopt a holistic approach, addressing physical, emotional, and social aspects of health, and often involve patients in care decisions, improving satisfaction and outcomes. Choice A is incorrect as it exaggerates pharmacology knowledge; APRNs study it extensively, but so do physicians, making superiority unproven. Choice C is wrong because APRNs' prescribing of narcotics varies by practice and isn't inherently less than others. Choice D is false since independent prescribing isn't universal—state laws differ, and some require oversight, similar to physician assistants.
Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
- A. After the second dose
- B. After four to five half-lives
- C. When the patient feels the full effect of the drug
- D. One hour after IV administration
Correct Answer: B
Rationale: Choice B is correct because steady state is reached after four to five half-lives, when absorption equals elimination, stabilizing drug levels for therapeutic monitoring. Choice A is incorrect as the second dose is too early for steady state. Choice C is wrong because patient perception doesn't define pharmacokinetics. Choice D is incorrect since IV timing varies and doesn't inherently match steady state.
When educating a client with a new prescription for nitroglycerin, which of the following instructions should the nurse include?
- A. Store the medication in a cool, dark place.
- B. Take the medication before bedtime.
- C. Take the medication with food.
- D. Take the medication at the first sign of chest pain.
Correct Answer: D
Rationale: The correct instruction for a client with a new prescription for nitroglycerin is to take the medication at the first sign of chest pain. Nitroglycerin is a vasodilator used to relieve chest pain associated with angina. Taking it at the onset of chest pain ensures prompt relief by dilating blood vessels and increasing blood flow to the heart muscle. Storing nitroglycerin in a cool, dark place helps maintain its potency, while taking it with food can alter its absorption. Timing the medication with bedtime is not necessary, but prompt administration at the first sign of chest pain is crucial for effective management of angina. Choices A, B, and C are incorrect because storing the medication in a cool, dark place, taking it before bedtime, and taking it with food are not essential instructions for nitroglycerin use. The priority is to administer it promptly when chest pain occurs to achieve optimal therapeutic effects.
In every state, prescriptive authority for NPs includes the ability to write prescriptions:
- A. for controlled substances.
- B. for specified classifications of medications.
- C. without physician-mandated involvement.
- D. with full, independent prescriptive authority.
Correct Answer: B
Rationale: The correct answer is B because all states grant NPs some prescriptive authority, but it’s often limited to specific drug classes. Choice A is incorrect as not all states allow controlled substances. Choice C is wrong since physician involvement is required in many states. Choice D is inaccurate as full independence isn’t universal.
A woman who takes an angiotensin converting enzyme inhibitor for hypertension tells her primary care NP that she is trying to get pregnant. The NP should:
- A. consider replacing her angiotensin converting enzyme inhibitor with methyldopa.
- B. lower her angiotensin converting enzyme inhibitor dose during the first trimester.
- C. counsel her to increase her antihypertensive medications during pregnancy.
- D. add an angiotensin receptor blocker (ARB) during the first trimester of her pregnancy.
Correct Answer: A
Rationale: The correct answer is A because ACE inhibitors are contraindicated in pregnancy and should be replaced with safer options like methyldopa. Choice B is incorrect (lowering dose still risky). Choice C is wrong (increasing not indicated). Choice D is inaccurate (ARBs also contraindicated).