A woman tells a primary care NP that she is considering getting pregnant. During a health history, the NP learns that the patient has seasonal allergies, asthma, and epilepsy, all of which are well controlled with a second-generation antihistamine daily, an inhaled steroid daily with albuterol as needed, and an antiepileptic medication daily. The NP should counsel this patient to:

• a. take her asthma medications only when she is having an acute exacerbition
• b. avoid using antihistamine medications during her first trimester of pregnancy.
• c. discontinue her seizure medications at least 6 months before becoming pregnant.
• d. use only oral corticosteroids and not inhaled steroids while pregnant for improved asthma control.

Answer: b. avoid using antihistamine medications during her first trimester of pregnancy.

1. Answer: a. prescribe folic acid supplements.
   • a. prescribe folic acid supplements.
   • b. change her antiepileptic drug to lamotrigine (Lamictal).
   • c. order prophylactic vitamin K to be given in the second trimester.
   • d. recommend that she discontinue taking the valproic sodium by 12 weeks.
2. Answer: b. give her information about diet and exercise.
   • a. prescribe an oral antidiabetic agent.
   • b. give her information about diet and exercise.
   • c. begin treating her with daily insulin injections.
   • d. reassure her that her glucose levels will return to normal after pregnancy.
3. Answer: a. consider replacing her angiotensin converting enzyme inhibitor with methyldopa.
   • 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.
4. Answer: b. continue taking the antidepressant.
   • a. stop taking the sertraline now.
   • b. continue taking the antidepressant.
   • c. change to a monoamine oxidase inhibitor (MAOI).
   • d. discontinue the sertraline a week before delivery.
5. Answer: b. provide smoking cessation information.
   • a. administer rubella vaccine.
   • b. provide smoking cessation information.
   • c. counsel her to avoid caffeine while pregnant.
   • d. reassure her that her habits are not likely to cause harm.
6. Answer: b. most over-the-counter medications are safe for the breastfed infant.
   • a. most medications enter breast milk and are not safe.
   • b. most over-the-counter medications are safe for the breastfed infant.
   • c. she may need to interrupt breastfeeding when taking headache medications.
   • d. she should consider weaning her infant to formula if her headaches are frequent.

Chapter 07: Over-the-Counter Medications

1. Answer: b. suggest using single-ingredient products to treat each symptom separately.
   • a. recommend a cough preparation that also contains acetaminophen.
   • b. suggest using single-ingredient products to treat each symptom separately.
   • c. recommend a product containing antitussive, antipyretic, and decongestant ingredients.
   • d. tell the patient that over-the-counter medications are usually not effective in manufacturer-recommended doses.
2. Answer: a. generally safe when label information is understood and followed.
   • a. generally safe when label information is understood and followed.
   • b. safer because over-the-counter doses are lower than prescription doses of the same drug.
   • c. less safe because they are not well regulated by the Food and Drug Administration (FDA).
   • d. not extensively tested, so claims made by manufacturers cannot be substantiated.
3. Answer: b. ask the parent to identify all of the ingredients listed on the medication label.
   • a. order a prescription antitussive medication for the child.
   • b. ask the parent to identify all of the ingredients listed on the medication label.
   • c. calculate the dose for the active ingredient in the over-the-counter preparation.
   • d. tell the parent to approximate the dose at about one third to one half the adult dose.
4. Answer: a. to take the dose recommended by the manufacturer.
   • a. to take the dose recommended by the manufacturer.
   • b. not to worry about taking this drug with any other medications.
   • c. to avoid taking other drugs that cause sedation while taking this drug.
   • d. that over-the-counter acid reflux medications are generally safe to take with other medications.
5. Answer: a. ask the patient to bring all vitamin bottles to the clinic appointment.
   • a. ask the patient to bring all vitamin bottles to the clinic appointment.
   • b. recommend natural vitamin products over synthetic vitamin products.
   • c. reassure the patient that vitamins that are high in folic acid are safe to take.
   • d. tell the patient that some vitamins, such as vitamin C, are safe in large doses.
6. Answer: a. review healthy dietary practices with this patient.
   • a. review healthy dietary practices with this patient.
   • b. make sure that the supplements contain large doses of vitamin A.
   • c. tell the patient that antioxidants are especially important for patients who smoke.
   • d. tell the patient that evidence shows antioxidants to be effective in preventing cancer.
7. Answer: a. antipyretics.
   • a. antipyretics.
   • b. calcium supplements.
   • c. acid reflux medications.
   • d. antioxidant supplements.

Chapter 08: Complementary and Alternative Therapies

1. Answer: d. most studies that show benefits of alternative therapies are based on observation.
   • a. biofield therapy has been shown to be more effective than acupuncture.
   • b. creatine has been shown to be an effective herbal choice to treat back pain.
   • c. there is no valid research documenting the efficacy of this treatment for pain.
   • d. most studies that show benefits of alternative therapies are based on observation.
2. Answer: a. learning about the actions, uses, doses, and toxicities of these agents.
   • a. learning about the actions, uses, doses, and toxicities of these agents.
   • b. prescribing these agents when possible to ensure safe dosing.
   • c. counseling patients to stop using herbal products to avoid toxic side effects.
   • d. teaching patients that these products are unregulated and unsafe to use.
3. Answer: b. inform the patient of the risks of toxic side effects with this supplement.
   • a. tell the patient to stop taking the supplement immediately.
   • b. inform the patient of the risks of toxic side effects with this supplement.
   • c. refer the patient to a CAM provider who can manage this patient’s therapy.
   • d. prescribe another herbal drug that has fewer adverse effects than the one the patient is taking.
4. Answer: b. not marketed as products that can treat or cure disease.
   • a. natural, plant-based products and not man-made.
   • b. not marketed as products that can treat or cure disease.
   • c. regulated by the Dietary Supplement Health and Education Act.
   • d. covered by the Hatch-Richardson Bill of 1992, which allows them to make health claims without FDA approval.
5. Answer: b. echinacea.
   • a. ginseng.
   • b. echinacea.
   • c. ginkgo biloba.
   • d. St. John’s wort.
6. Answer: d. ginkgo biloba.
   • a. feverfew.
   • b. echinacea.
   • c. green tea.
   • d. ginkgo biloba.
7. Answer: a. milk thistle.
   • a. milk thistle.
   • b. chondroitin.
   • c. coenzyme Q.
   • d. glucosamine.

Chapter 09: Establishing the Therapeutic Relationship

1. Answer: a. encourage the patient to participate in the choice of the medication.
   • a. encourage the patient to participate in the choice of the medication.
   • b. provide education about the medication actions and adverse effects.
   • c. stress the importance of taking the medication exactly as it is prescribed.
   • d. give the patient copies of medication package inserts describing the drug use.
2. Answer: d. ask her about her lifestyle, her schedule, and her understanding of her condition.
   • a. give her shortened regimens of the drug to facilitate compliance.
   • b. provide written information about her condition and the medication.
   • c. administer the medication in the clinic to ensure that she takes the drug.
   • d. ask her about her lifestyle, her schedule, and her understanding of her condition.
3. Answer: a. give the patient basic written instructions about medications, follow-up visits, and symptoms.
   • a. give the patient basic written instructions about medications, follow-up visits, and symptoms.
   • b. ask the patient to describe the disease process and the medications to evaluate understanding.
   • c. explain to the patient that without mutual cooperation, the treatment regimen will not be effective.
   • d. ask the patient to explore feelings and fears about having a chronic disease and taking medications.
4. Answer: a. perform a careful history of the child’s symptoms and the medications that are given.
   • a. perform a careful history of the child’s symptoms and the medications that are given.
   • b. provide a written asthma action plan and encourage the parent to call when symptoms are worse.
   • c. review what other providers have prescribed in the past and explain these interventions to the parent.
   • d. explain the different purposes of maintenance and rescue medications and give the parent a schedule for medication administration.
5. Answer: c. initiate a dialogue with the parents about the implications of the child’s laboratory values.
   • a. suggest that they give the child diet soda and low-fat frozen yogurt.
   • b. understand and respect the parents’ beliefs about their child’s self-image.
   • c. initiate a dialogue with the parents about the implications of the child’s laboratory values.
   • d. suggest family counseling to explore ways to improve parenting skills and limits.