FNP Smoking Cessation Practice Questions

Nicotine lozenges, like nicotine gum, rely heavily on buccal absorption to deliver rapid relief for breakthrough cravings. This absorption is highly dependent on an alkaline oral environment. Consuming acidic beverages like coffee, soda, or juice lowers oral pH, which ionizes the nicotine and severely impairs its absorption across the mucosa. Therefore, option C is correct; patients must avoid eating or drinking for 15 minutes before and during use. Option A is incorrect because nicotine gum is equally susceptible to pH changes from acidic beverages. Option B is incorrect; increasing the dose does not fix the absorption block and may cause toxicity later. Option D is incorrect because lozenges are designed to dissolve slowly over 20 to 30 minutes; chewing them defeats the delivery mechanism and causes gastrointestinal distress.

This patient is in the contemplation stage, demonstrating clear ambivalence. Exploring how smoking affects her asthma helps develop discrepancy between her current behavior and her health goals. Recommending varenicline (A) or setting a firm quit date (C) jumps to the preparation or action stage prematurely, which can cause resistance. Reassurance (D) is empathetic but fails to elicit change talk or actively address her ambivalence.

Bupropion lowers the seizure threshold and is strictly contraindicated in patients undergoing abrupt alcohol withdrawal, which independently increases seizure risk. Varenicline is the safer first-line alternative in this scenario. Option A is incorrect because bupropion remains contraindicated regardless of withdrawal education. Option B is incorrect; while benzodiazepines treat alcohol withdrawal, they do not make bupropion safe to use during this acute high-risk period. Option D is incorrect because the primary contraindication for bupropion in this context is seizures, not hepatotoxicity.

In the precontemplation stage, the patient has no intent to quit. Asking permission respects autonomy and rolls with resistance, keeping the communication door open for future visits. Explaining risks (B) often creates defensiveness and damages rapport. Providing support groups (C) or prescribing nicotine replacement therapy (D) are action-oriented interventions that are clinically inappropriate for a patient in precontemplation.

An ABI of 0.91 to 0.99 is considered borderline peripheral arterial disease. In an asymptomatic patient, the primary focus should be cardiovascular risk reduction, including smoking cessation, blood pressure control, and lipid management (D) to prevent disease progression. Angiography (A) is an invasive procedure reserved for severe, limb-threatening ischemia. The patient does not have moderate PAD (B), which correlates with an ABI of 0.41 to 0.90. A toe-brachial index (C) is indicated for abnormally high ABIs (greater than 1.40), not for borderline results.

When a patient experiences intolerable adverse effects early in treatment without significant clinical benefit, the best strategy is to switch the medication class. Bupropion is an excellent choice here because it lacks serotonergic activity and has a very low risk of sexual dysfunction. Adding sildenafil increases polypharmacy and doesn't address the lack of mood improvement. Decreasing the paroxetine dose might reduce side effects but will likely result in subtherapeutic treatment. Continuing the medication is inappropriate when the patient is highly distressed and refusing the drug.

Varenicline is a highly effective smoking cessation aid, but it requires careful consideration in patients with underlying psychiatric conditions. The FDA previously mandated a boxed warning regarding neuropsychiatric adverse events, but this was removed after large trials showed the risk was lower than initially thought. Therefore, option A is correct; you can prescribe it to a patient with well-controlled depression, provided you monitor them closely for mood changes. Option B is incorrect because a psychiatric history is a precaution, not an absolute contraindication. Option C is incorrect; while NRT is safe, varenicline is not strictly unsafe and often provides superior cessation rates. Option D is unnecessary gatekeeping; APRNs can safely initiate this therapy in stable patients without requiring formal psychiatric clearance, provided appropriate follow-up is maintained.

Bupropion requires approximately one to two weeks to reach steady-state therapeutic levels in the bloodstream. Patients should begin taking the medication while they are still smoking and set a target quit date for the second week of treatment. Option A is incorrect because quitting tomorrow will cause withdrawal symptoms before the medication becomes effective. Option B is incorrect because adding a patch does not resolve the delayed onset of bupropion. Option C is incorrect because bupropion must be initiated before the quit date, not after.

Bupropion is contraindicated in patients with a history of eating disorders like bulimia nervosa due to a significantly lowered seizure threshold. Varenicline is a safe, effective oral alternative that does not carry this specific risk. Option A is incorrect because bupropion could provoke seizures in this patient, regardless of monitoring. Options C and D are incorrect; while nortriptyline and clonidine are second-line off-label options for smoking cessation, varenicline is an FDA-approved first-line agent with superior efficacy and should be prioritized over second-line therapies.

The patient's extensive history of shipyard construction combined with the incidental finding of calcified pleural plaques on chest imaging is highly specific for prior occupational asbestos exposure. Asbestosis significantly increases the patient's long-term risk of developing bronchogenic carcinoma and malignant pleural mesothelioma, making targeted assessment for these malignancies a critical ongoing priority for the nurse practitioner. Assessing for an underlying alpha-1 antitrypsin deficiency is incorrect because it causes early-onset panacinar emphysema, not pleural plaques. Assessing for a concurrent active tuberculosis infection is vital for patients with silicosis, not asbestosis, and typically presents with upper lobe cavitations. Assessing for acute hypersensitivity pneumonitis exposure is incorrect because it is an immunologic reaction to inhaled organic antigens, not inorganic asbestos fibers.