The primary care NP is preparing to prescribe isosorbide ...

[Haya94]

The primary care NP is preparing to prescribe isosorbide dinitrate sustained release (Dilatrate SR) for a patient who has chronic, stable angina. The NP should recommend initial dosing of:
 
  a. 60 mg four times daily at 6-hour intervals.
  b. 40 mg twice daily 30 minutes before meals.
  c. 60 mg on awakening and 40 mg 7 hours later.
  d. 80 mg three times daily at 8:00 AM, 1:00 PM, and 6:00 PM.

Question 2

A primary care NP sees a 5-year-old child who is morbidly obese. The child has an elevated hemoglobin A1c and increased lipid levels.
 
  Both of the child's parents are overweight but not obese, and they tell the NP that they see nothing wrong with their child. They both state that it is difficult to refuse their child's requests for soda or ice cream. The NP should: a. suggest that they give the child diet soda and low-fat frozen yogurt.
  b. understand and respect the parents' beliefs about their child's self-image.
  c. initiate a dialogue with the parents about the implications of the child's laboratory values.
  d. suggest family counseling to explore ways to improve parenting skills and limits.

[stano32]

Answer to Question 1

B
Long-acting nitrates should be considered to treat chronic, stable angina. The main limitation is tolerance, which can be limited by providing a nitrate-free period of 6 to 10 hours each day. The medication should be taken on an empty stomach, 30 to 60 minutes before a meal. An appropriate initial dose of isosorbide dinitrate is 40 mg every 12 hours. This dose can be increased as needed. Isosorbide mononitrate is given on awakening and again 7 hours later. The medication is not given four times daily. Dosing may be increased to 80 mg tid, and the dosing schedule of 8:00 AM, 1:00 PM, and 6:00 PM. would be appropriate at that point.

Answer to Question 2

C
In this case, the child is at risk if the parents do not intervene. The NP should help the parents to see the potential adverse effects so that they can understand the need for treatment. The other answers are examples of the NP creating solutions. Unless the parents see the problem, they are not likely to engage in the treatment regimen.

[Haya94]

Both answers were spot on, thank you once again

[stano32]

Great! Please up vote