A primary care NP sees an adolescent patient for a ...

[skymedlock]

A primary care NP sees an adolescent patient for a hospitalization follow-up after an asthma exacerbation. The patient reports having daily symptoms with nighttime awakening 4 or 5 nights per week and misses school several days each month.
 
  The patient currently uses a salmeterol/fluticasone LABA twice daily and albuterol as needed. The patient requires a refill of the albuterol prescription once a month. The patient does not have any known allergies. The NP should: a. order a high-dose ICS plus a LABA twice daily.
  b. consider adding theophylline to this patient's regimen.
  c. continue the current regimen and add omalizumab daily.
  d. order a combination product with ipratropium and albuterol.

Question 2

A woman is 4 weeks pregnant. The primary care NP sees her for her first prenatal visit and obtains a rubella titer, which is negative. The woman tells the NP that she drinks 2 cups of coffee and smokes 3 to 5 cigarettes each day.
 
  She denies alcohol use. The NP should: a. administer rubella vaccine.
  b. provide smoking cessation information.
  c. counsel her to avoid caffeine while pregnant.
  d. reassure her that her habits are not likely to cause harm.

[Sammyo]

Answer to Question 1

A
The patient has moderate persistent asthma not well controlled with the current regimen. The next step is to prescribe a high-dose ICS to be taken along with the LABA and to refer to an asthma specialist. Theophylline is recommended in the 5- to 11-year age group. Omalizumab is indicated if the patient has allergies. Ipratropium is used during acute exacerbations.

Answer to Question 2

B
Each cigarette smoked decreases maternal blood pressure for up to 15 minutes and decreases uteroplacental perfusion. The NP should encourage the woman to quit smoking. Rubella vaccine should be given after the baby is delivered because rubella vaccine is a live virus, with severe teratogenic effects. There is no conclusive evidence that women who are pregnant should avoid caffeine completely. Her habits, although not severe, are not harmless.

[skymedlock]

Thanks

[Sammyo]

Welcome