A 45-year-old female presents to the clinic with a history of recurrent migraines. She reports experiencing throbbing headaches associated with nausea, photophobia, and phonophobia, occurring approximately twice a month and lasting for 24-48 hours. Despite trying over-the-counter medications, she finds little relief from her symptoms. Given her history, the nurse practitioner decides to initiate prophylactic therapy for migraine prevention. Which of the following medications might not be the best choice (i.e., relative contraindication) in this patient due to comorbid reactive airway disease (i.e., severe asthma)? 

Which of the following medicatons has been associated with a high risk of developing a clostridium difficile (C. diff) infection?

A 71-year-old woman comes into the ED complaining of exertional chest pain. She currently takes atenolol (Tenormin*) 50 mg PO daily, amlodipine (Norvasc*) 5 mg PO daily, ramipril (Altace*) 10 mg PO daily, aspirin (Bayer Baby Aspirin*) 81 mg PO daily, and rosuvastatin (Creastor*) 10 mg PO daily. Which monitoring parameters are needed for you to make a recommendation to relieve her angina symptoms? 

JP is a 17-year-old male who complains of redness, tenderness and warmth of his left lower leg which has been spreading for the past 3 days.  From your questioning, you discover JP has a recent spider bite in the same area but it never seemed to heal.  You suspect that JP has an uncomplicated cellulitis since the infection appears to be localized and JP does not have signs/symptoms of systemic infection.  JP has a history of hypothyroidism and obesity.  He currently takes levothyroxine (Synthroid) 50 mcg po daily.  He has no medication allergies. UPDATES: Upon further questioning of JP’s mother, you find out that he is a football player and she noticed his leg infection began shortly after football camp.  She seemed to think the spider bite was small and healing until he went to camp. You suspect he may have a CA-MRSA cellulitis. Which of the following medications would be the best choice to treat this mild CA-MRSA cellulitis?

A 55-year-old male presents to the clinic with complaints of sudden onset severe pain, erythema, and swelling in his right big toe joint. Based on the presenting symptoms, the nurse practitioner suspects an acute gout attack. Which of the following statements regarding the diagnosis of gout is true?

NJ is receiving 40 mg po morphine/day.  You wish to convert him to po oxycodone (Oxy IR).  Which of the following regimens is the best recommendation for this patient?   Assume a 25% reduction for incomplete cross tolerance.  The following conversions are provided for you:   Drug IV (mg) Oral (mg) Morphine 10 30 Oxycodone N/A 20

Anthony is a 70yo male who presents with complaints of substernal chest pain (he ranked as a 5 out of 10) that occurred while doing yard work.  His pain resolved after he rested.  He feels frustrated because this problem is limiting him from getting exercise.  His PMH includes hypertension for which he takes metoprolol (Lopressor) 12.5 mg BID.  He takes no other medications and does not smoke. Vitals:  BP 140/70, HR 72, RR 20, and EKG is normal sinus rhythm (NSR).  Now with the diagnosis of angina, which is (are) the most appropriate recommendation(s) for Anthony at this time?

KP is a 64-year-old African American woman with a history of ischemic stroke several months ago. She was previously prescribed ASA 325 mg daily but developed an allergy to ASA and stopped taking it 2 weeks ago. Which one of the following is the most appropriate recommendation at this time?

An orthopedic surgeon writes an order for a 85 y/o elderly male patient who is post-op hip replacement. He has acute pain from his procedure (7 on scale 0-10) and no history of chronic pain.  The surgeon asks for your opinion on his order. He writes: Hydrocodone 5mg/Acetaminophen 500mg (Vicodin, Norco) per tablet. Dosage: i-ii (One or Two) tablets Q3H (Every Three Hours) as needed for pain. What is the best response to this order?

JP, a 17-year-old male, presents with a three-day history of redness, tenderness, and warmth in his left lower leg, where he also reports a spider bite that has not healed properly. Given that the infection is non-purulent and localized, with no systemic signs or symptoms, you suspect an uncomplicated case of cellulitis. Considering JP’s medical background of hypothyroidism, for which he takes levothyroxine, and his obesity, which pathogens are most likely responsible for his cellulitis?