Question 31   BONUS Howard W. is a 55 year-old male with insulin dependent diabetes who weighs 170 pounds. He presents for his 3-month diabetes follow up appointment. A review of his blood glucose log reveals the following: Breakfast     Lunch     Dinner     Bedtime    3am     260 108 120 118 240 120 124 122 164 230 105 134 128 180 262 124 128 132 He reports that he awoke at 3 a.m. 2 nights in a row to use the bathroom, so he checked his blood sugars at that time also. His current regimen is 24 units long acting insulin lantus before bed, and regular insulin 8 units before breakfast, lunch and dinner. An appropriate first course of action to take in this patient would be to: Select one:

Patients on oral bisphosphonate therapy for osteoporosis should be instructed to:

BONUS QUESTION (OPTIONAL) Nancy, age 73 has developed a Urinary Tract Infection (UTI) and you elect to treat her with Ciprofloxacin (Fluoroquinolone) 250mg twice daily for 5 days. You note that she is also on medications for peptic ulcer disease including Famotidine (H2 receptor antagonist) and sucralfate (cytoprotective agent) daily. Best advice to the patient on administering these medications is: 

Sheila B. age 30 presents to the clinic with complaint of classic migraine headache, which she describes as moderately severe. She first developed migraines in her teen years and they have worsened as she has gotten older. She has been using ibuprofen, aspirin, acetaminophen and aspirin plus caffeine 2 to 3 times per week for the treatment of her headaches, but continues to experience them despite increasing therapy. The best course-of-action from the list below to manage Sheila’s headaches is:

Question 6:  Sadie W., 32 year old female, presents with symptoms of a runny nose, itchy eyes, and nasal congestion that occurs every spring. She is a school bus driver so tells you she wants something to relieve her symptoms but not make her drowsy. The nurse practitioner determines that Sadie has seasonal  allergic rhinitis. The nurse practitioner determines that the first-line therapy best to treat seasonal allergic rhinitis for this patient is:

Question 29 Chemical dependency assessment is integral to the continued prescription of opioid medications to treat chronic pain. Of the following, the item that raises a “red flag” about potential chemical dependency is:

For a patient who presents with herpes, it is important to prescribe an antiviral like valacyclovir as early as possible to effect a cure. 

Question7: Eddie R, age 32 is a 12 pack year smoker and is interested in quitting smoking. He has a history of a seizure disorder and schizoaffective disorder with tendency toward hallucinations and disturbing dreams. GIven your knowledge of treatment options for smoking cessation, the best option for this patient would be:

Louis P. age 45 presents to the clinic with thick psoriatic plaques on his elbows and knees. You elect to treat him with a moderately potent topical corticosteroid. The vehicle that would be most effective in treating this patient’s lesions is:

Triptans with an NSAID are more effective than using either drug alone