NR566 WEEK 8 FINAL EXAM

1. A patient with obesity has a BMI of 29 and hypertension despite ongoing diet and exercise efforts. Which management strategy is most appropriate?

A. Discontinue lifestyle modification and use medication therapy alone because lifestyle changes are ineffective at this BMI
B. Continue lifestyle modification and consider adding pharmacologic therapy since the patient has a BMI ≥27 with an obesity-related comorbidity
C. Refer immediately for bariatric surgery because surgery is indicated for all patients with BMI >30 who fail lifestyle therapy
D. Continue lifestyle modification only because weight-loss medications are reserved for patients with BMI ≥35

Correct Answer: B. Continue lifestyle modification and consider adding pharmacologic therapy since the patient has a BMI ≥27 with an obesity-related comorbidity

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2. A patient with recurrent migraine headaches is prescribed sumatriptan for acute symptom relief. Which statement best reflects evidence-based administration of this medication?

A. Sumatriptan should be avoided for acute migraines because headache recurrence within 24 hours is unavoidable
B. Route selection should depend on the desired speed of relief, with subcutaneous administration producing the fastest onset and highest bioavailability compared with oral or intranasal formulations
C. Transdermal sumatriptan is preferred first-line because it provides the greatest bioavailability and longest duration of action
D. Oral sumatriptan is recommended exclusively because all dosage forms have similar onset and efficacy

Correct Answer: B. Route selection should depend on the desired speed of relief, with subcutaneous administration producing the fastest onset and highest bioavailability compared with oral or intranasal formulations

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3. A 22-year-old woman is preparing to begin isotretinoin therapy for severe cystic acne unresponsive to standard treatment. What must the nurse practitioner verify before prescribing the medication?

A. Pregnancy testing is only required before starting therapy and after treatment completion
B. The patient understands the need to avoid alcohol and vitamin A supplements
C. Baseline CBC and urinalysis are the only required laboratory studies
D. The patient is enrolled in the iPLEDGE program and has documentation of two effective forms of contraception

Correct Answer: D. The patient is enrolled in the iPLEDGE program and has documentation of two effective forms of contraception

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4. An older adult with partial seizures continues to experience breakthrough seizure activity despite gradual increases in gabapentin dosage over several weeks. Which explanation best accounts for this response?

A. Saturation of the intestinal transport system limits gabapentin absorption at higher doses
B. The patient has developed complete pharmacologic tolerance to gabapentin
C. Chronic therapy has caused downregulation of GABA receptors
D. Accelerated hepatic metabolism is reducing serum gabapentin levels

Correct Answer: A. Saturation of the intestinal transport system limits gabapentin absorption at higher doses

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5. An adult patient reports a lifelong history of absence seizures without tonic-clonic or focal seizure activity. Which medication is considered the most appropriate first-line treatment?

A. Carbamazepine
B. Topiramate
C. Ethosuximide
D. Phenytoin

Correct Answer: C. Ethosuximide

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6. A patient interested in naltrexone/bupropion for weight reduction asks about the medication’s boxed warning. Which response by the nurse practitioner is most appropriate?

A. The medication carries a significant risk for hepatotoxicity
B. The primary boxed warning involves severe allergic reactions
C. The medication has been associated with an increased risk of suicidal thoughts and behaviors
D. The medication significantly increases the risk of gastrointestinal bleeding

Correct Answer: C. The medication has been associated with an increased risk of suicidal thoughts and behaviors