A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?
a) order herpes simplex virus (HSV) antibody testing
b) Order a blood urea nitrogen (BUN) and creatinine STAT
c) Prescribe lidocaine 5%
d) Prescribe hydromorphone (dilaudid) 2mg
The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?
a) Increase the dose of lamotrigine (Lamictal) to 25mg twice daily
b) Ask if the pt has been taking the medication as prescribed
c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient
d) Order a CBC to assess for an infection
An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do?
a) order an X-ray because it is possible that she dislocated her hip
b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon
c) Order naproxen because she may havarthritis and chronic pain is not uncommon
d) Order morphine and physical therapy
The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP?
a) Orders liver function tests
b) Educate the patient on avoiding grapefruits when taking this medication
c) Encourage this patient to keep fluids to 1500ml/day until the swelling subside
d) Order BUN/Creatinine test
The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?
a) Prescribe estrin FE 24 birth control
b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain
c) Prescribe desvenlafaxine (Pristiq) 50mg daily
d) Prescribe Risperdal 2mg TID
A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?
a) “the SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”
b) “the SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”
c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex”
d) “the SNRI can increase neurotransmission to descending neurons”
A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?
a) Venlafaxine (Effexor)
b) Duloxetine (Cymbalta)
c) Clozapine (Clozaril)
d) Phenytoin (Dilantin)
The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?
a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels
b) It will induce synaptic changes, including sprouting
c) It will act on the presynaptic neuron to trigger sodium influx
d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain
Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition?
a) Venlafaxine (Effexor)
b) Armodafinil (Nuvigil)
c) Bupropion (Wellbutrin)
d) All of the above