A patient comes to the clinic with a 2-day history of cough and ...

[Bernana]

A patient comes to the clinic with a 2-day history of cough and wheezing. The patient has no previous history of asthma. The patient reports having heartburn for several months, which has worsened considerably.
 
  The primary care NP makes a diagnosis of asthma and orders oral steroids and inhaled albuterol. The patient's condition worsens, and a chest radiograph obtained 2 days later shows bilateral infiltrates. The NP has failed to: a. confirm the diagnosis.
  b. determine the aggressiveness of therapy.
  c. prescribe an adequate dose of medications.
  d. allow the drugs an adequate amount of time to work.

Question 2

A patient who has migraine headaches has begun taking timolol and 2 months after beginning this therapy reports no change in frequency of migraines. The patient's current dose is 30 mg once daily. The primary care NP should:
 
  a. change the medication to propranolol.
  b. increase the dose to 40 mg once daily.
  c. obtain serum drug levels to see if the dose is therapeutic.
  d. tell the patient to continue taking the timolol and return in 1 month.

[macagnavarro]

Answer to Question 1

A
This patient had symptoms that could occur with both asthma and aspiration pneumonia. The NP failed to confirm the diagnosis and prescribed the wrong treatment, leading to worsening of symptoms.

Answer to Question 2

D
When giving timolol for migraine prophylaxis, the provider should inform the patient that it may take several weeks for therapy to be effective. The dose should be titrated and maintained for a minimum of 3 months before the treatment is deemed a failure. It may be necessary to change to propranolol if the therapy is not effective in 1 month. The maximum dose of timolol for migraine prophylaxis is 30 mg. Drug effectiveness is determined by patient response, not serum drug levels.

[Bernana]

TYSM

[kjohnson]

Excellent