A primary care NP examines a patient who complains of chronic, ...

[Bernana]

A primary care NP examines a patient who complains of chronic, intermittent watery eyes and runny nose. The NP notes cobblestone-like papillae inside the upper eyelid with nonerythematous conjunctivae. The NP should:
 
  a. prescribe intranasal corticosteroids.
  b. refer the patient to an ophthalmologist.
  c. prescribe trifluridine ophthalmic eye drops.
  d. apply fluorescein dye to examine the cornea.

Question 2

A patient who has been taking quinidine for several years reports lightheadedness, fatigue, and weakness. The primary care NP notes a heart rate of 110 beats per minute. The serum quinidine level is 6 g/mL. The NP should:
 
  a. discontinue the medication immediately.
  b. reassure the patient that this is a therapeutic drug level.
  c. order an ECG, CBC, liver function tests (LFTs), and renal function tests.
  d. admit the patient to the hospital and obtain a cardiology consultation.

[Kedrick2014]

Answer to Question 1

A
This patient has symptoms characteristic of allergic conjunctivitis. Any allergic rhinitis should be treated first. Intranasal corticosteroids are often effective. It is not necessary to refer to an ophthalmologist. Trifluridine is an antiviral solution used to treat documented herpetic keratitis. Fluorescein dye is used to assess for corneal abrasions or tears.

Answer to Question 2

C
The therapeutic level for quinidine is 2 to 5 g/mL. Some patients have therapeutic responses at up to 6 g/mL. The NP should order ECG, CBC, LFT, and renal function tests.

[Bernana]

Thanks for the timely response, appreciate it

[kthug]

TYSM