Directions: For each of the scenarios below, answer the questions below using clinical
practice guideline where applicable. Explain the problem and explain how you would
address the problem. If prescribing a new drug, write out a complete medication order
just as you would if you were completing a prescription. Use at least 3 sources for each
scenario and cite sources using APA format.
1. Sara is a 45-year-old female presenting for her annual exam. Her blood pressure
today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her
last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking
ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal
for her blood pressure? What medication would you prescribe to treat her blood
pressure? What education would you prescribe?
2. Monty is a 52-year-old male following up on his labs that were drawn last week.
He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is
allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL
cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan
would you implement for Monty’s lipid profile? What is the goal Total Cholesterol
(TC), HDL-C, and LDL-C level for Monty? How would you monitor the
effectiveness of your treatment plan? How many risk factors for coronary artery
disease does this patient have? Identify them specifically.
3. Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age
7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days
per week over the past 2 months. Over the past week she has been using
albuterol at least once per day. She reports being awakened by a cough three
nights during the last month. She is becoming more short of breath with exercise.
She also has a fluticasone MDI, which she uses “most days of the week.” Her
current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA
two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80
mg PO BID. What treatment plan would you implement for this patient? What
medication changes would you make? How would you monitor the effectiveness
of this plan?
4. Daute is a 56-year-old man seeking evaluation for increasing shortness of
breath. He noticed difficulty catching his breath about 3 years ago. Physical
activity increases his symptoms. He avoids activity as much as possible to
prevent any SOB. His previous physician had placed him on
salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He
thinks his physician initiated the medication for the shortness of breath, but he is
not entirely sure. He did not refill the prescription and has not been taking it.
Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12
months of treatment with oral antibiotics. He has a 40-pack-year smoking history.
What treatment plan would you implement for this patient? What medication(s)
would you prescribe? How would you monitor the effectiveness of this plan?
