Question 1 . Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months . She has a positive family history of breast cancer . The primary care NP should recommend: testosterone therapy . estrogen-only therapy . nonhormonal drugs for osteoporosis . estrogen-progesterone therapy for 1 to 2 years . Question 2 . A patient takes a cardiac medication that has a very narrow therapeutic range . The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan . The NP knows that the bioavailability of the drug varies from brand to brand . The NP should: contact the insurance provider to explain why this particular formulation is necessary . change the patient’s medication to a different drug class that doesn’t have these bioavailability variations . accept the situation and monitor the patient closely for drug effects with each prescription refill . ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense . Question 3 . A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it . The NP notes that the information is from an internet site called “Prism . com . ” The NP should tell this patient that: this information is probably from a drug advertisement website . this is factual, evidence-based material with accurate information . the information is from a nonprofit group that will not profit from drug sales . internet information is unreliable because anyone can post information there . Question 4 . A primary care NP is reviewing written information about a newly prescribed medication with a patient . To evaluate this patient’s understanding of the information, the NP should ask the patient to: read the information aloud . describe how the medication will be taken . write down questions about the medication . tell the NP if the information is unclear . Question 5 . A patient is diagnosed with lupus and reports occasional use of herbal supplements . The primary care NP should caution this patient to avoid: ginseng . echinacea . ginkgo biloba . St . John’s wort . Question 6 . A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic to ask for a refill of the medication . The primary care NP notes that the medication refill is not due for 2 weeks . The patient tells the NP that the refill is needed because he is going out of town . The NP should: fill the prescription and document the patient’s explanation of the reason . review the patient’s chart to see if this is a one-time or repeat occurrence . call the patient’s pharmacist and report suspicion of drug-seeking behaviors . confront the patient about misuse of narcotics and refuse to fill the prescription . Question 7 . The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners . Which statement by the patient indicates she understands the  regimen? “I have to take a pill only every 3 months . ” “I should expect to have only four periods each year . ” “I will need to use condoms for only 7 more days . ” “This type of pill has fewer side effects than other types . ” Question 8 . The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is “off-formulary . ” The NP should: inform the patient that an out-of-pocket expense will be necessary . write the prescription for a generic drug if it meets the patient’s needs . call the patient’s insurance provider to advocate for this particular drug . contact the pharmaceutical company to see if medication samples are available . Question 9 . A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms…

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