NR566 Final exam

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NR566 Final exam

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

 

Which of the following statements should the nurse practitioner include when educating a patient about infectious conjunctivitis?

A. Bacterial conjunctivitis remains contagious until treated for at least 24 to 48 hours with antibiotics.

1. Warm compresses alone are sufficient to prevent transmission of the infection.
2. Viral conjunctivitis is not contagious once redness and discharge begin to improve.
3. Contact lenses may be worn as long as antibiotic drops are instilled twice daily.

 

When counseling a patient about the potential risks of tacrolimus ointment, which statement is MOST accurate?

1. Routine blood testing is required because systemic absorption frequently causes immunosuppression.
2. Use high-dose systemic corticosteroids concurrently to minimize the risk of skin malignancy.
3. Apply the medication only under occlusive dressings to prevent UV-related absorption.

 D. Protect treated areas from sunlight and avoid tanning beds to reduce possible cancer risk.

Before initiating ustekinumab for a patient with moderate to severe psoriasis, which of the following actions should the nurse practitioner take?

 A. Screen for latent tuberculosis infection before starting therapy.

1. Avoid all vaccinations during therapy and for one year afterward.
2. Begin therapy without delay because infection risk is minimal.
3. Initiate prophylactic antibiotic therapy to prevent local infections.

Before initiating ustekinumab for a patient with moderate to severe psoriasis, which of the following actions should the nurse practitioner take?

1. Screen for latent tuberculosis infection before starting therapy
2. Avoid all vaccinations during therapy and for one year afterward
3. Begin therapy without delay because infection risk is minimal
4. Initiate prophylactic antibiotic therapy to prevent local infections

When counseling a patient about the potential risks of tacrolimus ointment, which statement is MOST accurate?

1. Routine blood testing is required because systemic absorption frequently causes immunosuppression
2. Use high-dose systemic corticosteroids concurrently to minimize the risk of skin malignancy
3. Apply the medication only under occlusive dressings to prevent UV-related absorption

D. Protect treated areas from sunlight and avoid tanning beds to reduce possible cancer risk

 

Which anti-seizure drug acts on voltage-gated potassium channels to facilitate potassium efflux, thereby slowing repetitive neuronal firing?

1. Vigabatrin

B. Ezogabine

1. Gabapentin
2. Tiagabine

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