Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 49-year-old female patient has been taking gabapentin for 6 months. It has produced some relief for her neuropathic pain, but she still rates her average daily pain at about a 5. What would be the next most appropriate treatment?
A. Hydrocodone (Norco)
Hydrocodone is an opioid analgesic and may be considered for severe pain, but it is not first-line for chronic neuropathic pain due to risk of dependence and side effects.
B. Acetaminophen (Tylenol)
Acetaminophen is effective for mild to moderate nociceptive pain but has limited efficacy in neuropathic pain.
C. Amitriptyline (Elavil)
Amitriptyline is a tricyclic antidepressant effective for neuropathic pain and could be considered, but switching to pregabalin is often preferred for patients already partially responsive to gabapentin due to similar mechanisms but potentially better efficacy.
D. Pregabalin (Lyrica)
This choice is correct because pregabalin is a first-line agent for neuropathic pain and can be considered when gabapentin provides only partial relief. It works similarly but has different pharmacokinetics and dosing flexibility, making it an appropriate next step.
This question is an excerpt from Nurse Dive's nursing test bank - Mental Health Northern Kentucky University Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason: Hydrocodone is an opioid analgesic and may be considered for severe pain, but it is not first-line for chronic neuropathic pain due to risk of dependence and side effects.
Choice B reason: Acetaminophen is effective for mild to moderate nociceptive pain but has limited efficacy in neuropathic pain.
Choice C reason: Amitriptyline is a tricyclic antidepressant effective for neuropathic pain and could be considered, but switching to pregabalin is often preferred for patients already partially responsive to gabapentin due to similar mechanisms but potentially better efficacy.
Choice D reason: This choice is correct because pregabalin is a first-line agent for neuropathic pain and can be considered when gabapentin provides only partial relief. It works similarly but has different pharmacokinetics and dosing flexibility, making it an appropriate next step.
Similar Questions
A 22-year-old woman recently began treatment with fluoxetine (Prozac) for major depressive disorder. She now exhibits symptoms of mania. She completes the Young Mania Rating Scale (YMRS) and her score is 25. What does this indicate?
A. Moderate mania
This choice is correct because a YMRS score of 20–29 indicates moderate mania, reflecting significant mood elevation, increased activity, and behavioral disturbances that require monitoring and possibly treatment adjustment.
B. Mild mania
Mild mania corresponds to YMRS scores of 12–19, indicating less pronounced symptoms than observed in this patient.
C. Severe mania
Severe mania corresponds to YMRS scores of 30 or higher, which would reflect extreme agitation, psychosis, or risk to self/others.
D. Minimal mania
Minimal mania corresponds to YMRS scores below 12, which does not match the patient’s clinical presentation or score of 25.
Full Explanation
Choice A reason: This choice is correct because a YMRS score of 20–29 indicates moderate mania, reflecting significant mood elevation, increased activity, and behavioral disturbances that require monitoring and possibly treatment adjustment.
Choice B reason: Mild mania corresponds to YMRS scores of 12–19, indicating less pronounced symptoms than observed in this patient.
Choice C reason: Severe mania corresponds to YMRS scores of 30 or higher, which would reflect extreme agitation, psychosis, or risk to self/others.
Choice D reason: Minimal mania corresponds to YMRS scores below 12, which does not match the patient’s clinical presentation or score of 25.
The APRN asks the patient to elevate his eyebrows, close his eyes, smile, frown, and puff out his cheeks. Which cranial nerve is the NP assessing by issuing these instructions?
A. Cranial nerve VII (CN VII), facial nerve
This choice is correct because the facial nerve (CN VII) controls the muscles of facial expression, including eyebrow elevation, eye closure, smiling, frowning, and cheek puffing. Assessing these movements evaluates CN VII function.
B. Cranial nerve V (CN V), trigeminal nerve
The trigeminal nerve (CN V) primarily mediates facial sensation and mastication muscles, not facial expressions.
C. Cranial nerve III (CN III), oculomotor nerve
The oculomotor nerve (CN III) controls most extraocular eye movements and eyelid elevation, not the full range of facial expressions tested.
D. Cranial nerve VI (CN VI), abducens nerve
The abducens nerve (CN VI) controls lateral eye movement only and is not involved in facial expressions.
Full Explanation
Choice A reason: This choice is correct because the facial nerve (CN VII) controls the muscles of facial expression, including eyebrow elevation, eye closure, smiling, frowning, and cheek puffing. Assessing these movements evaluates CN VII function.
Choice B reason: The trigeminal nerve (CN V) primarily mediates facial sensation and mastication muscles, not facial expressions.
Choice C reason: The oculomotor nerve (CN III) controls most extraocular eye movements and eyelid elevation, not the full range of facial expressions tested.
Choice D reason: The abducens nerve (CN VI) controls lateral eye movement only and is not involved in facial expressions.
A 52-year-old woman with a BMI of 31 is diagnosed with osteoarthritis of the knee. The nurse practitioner (NP) instructs the woman that weight loss will help minimize both pain and functional loss. Which of the following most closely explains the NP's advice to lose weight?
A. Weight loss is encouraged for the overall health of the patient because it reduces the chance of developing diabetes and other cardiometabolic issues
While true, this choice is a general health benefit and does not directly explain the reduction in knee pain or functional loss.
B. Each pound of weight loss can decrease the load across the knee 3 to 6-fold
This choice is correct because mechanical load on the knee joint increases disproportionately with body weight. Even a small amount of weight loss significantly reduces joint stress, thereby improving pain and function in osteoarthritis.
C. Weight loss can reduce cardiovascular strain
Reducing cardiovascular strain is beneficial but does not directly impact knee joint load or osteoarthritis symptoms.
D. Weight loss can reduce the chance for a fall, which might lead to additional damage to the knee joint
Preventing falls is important but is an indirect benefit; the primary mechanism for pain reduction is decreased mechanical load on the joint.
Full Explanation
Choice A reason: While true, this choice is a general health benefit and does not directly explain the reduction in knee pain or functional loss.
Choice B reason: This choice is correct because mechanical load on the knee joint increases disproportionately with body weight. Even a small amount of weight loss significantly reduces joint stress, thereby improving pain and function in osteoarthritis.
Choice C reason: Reducing cardiovascular strain is beneficial but does not directly impact knee joint load or osteoarthritis symptoms.
Choice D reason: Preventing falls is important but is an indirect benefit; the primary mechanism for pain reduction is decreased mechanical load on the joint.