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NSG6005 MIDTERM EXAM (VERSION-2)

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NSG6005 MIDTERM EXAM (VERSION-2)

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NSG 6005 MIDTERM I I



I I I I I I I I I I I I I I
1. The first-line treatment for cough related to a upper respiratory infection in a five-year-old is:
I I I I
A. Fluids and symptomatic care
I I I I I I I I
B. Dextromethorphan and guaifenesin syrup (Robitussin DM for kids)
I I I I I I
C. Guaifenesin and codeine syrup (Tussin AC)
I I I I I I I
D. Chlorpheniramine and dextromethorphan syrup (NyQuil for kids)
I I I I I I I I I I
2. Pregnant patients with asthma may safely use ____ throughout their pregnancies.
I I
A. oral terbutaline
I
B. prednisone
I I I
C. inhaled corticosteroids (budesonide)
I I
D. montelukast (Singulair)
I I I I I I I I
3. A stepwise approach to the pharmacologic management of asthma:
I I I I I I I I I I I I
A. Begins with determining the severity of the asthma and assessing asthma control
I I I I I I I I I I I
B. Is used when the asthma is severe and requires daily steroids
I I I I I I I I I I I I I I I I I
C. Allows for each provider to determine his or her personal approach to the care of asthmatic patients
I I I I I I I I I I I I I I I I I
D. Provides a framework for the management of severe asthmatics but is not as helpful when patients have
I I
intermittent asthma
I I I I I I
4. Infants with reflux are initially treated with:
I I I I I
A. Histamine 2 receptor antagonist (ranitidine)
I I I
B. A PPI (omeprazole)
I I I I I I I I
C. Antireflux maneuvers (elevate the head of the bed)
I I
D. Prokinetic (metoclopramide)
I I I I I I I I I I I I I
5. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium
I I I I I I I I I I I
carbonate antacids without discussing with their providers or a pharmacist first?
I I I I
A. Patients with kidney stones
I I
B. Pregnant patients
I I I
C. Patients with heartburn
I I
D. Postmenopausal women
I I I I I I I I I I
6. Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies
I I
because they:
I I I I I I
A. Are more effective than first-generation antihistamines
I I I I I I
B. Are less sedating than first-generation antihistamines
I I I I I I I I I
C. Are prescription products and, therefore, are covered by insurance
I I I I I I I I I
D. Can be taken with CNS sedatives, such as alcohol
I I I I
7. Decongestants such as pseudoephedrine (Sudafed):
I I I I I I I
A. Are Schedule III drugs in all states
I I I I I I I I I I I I I
B. Should not be prescribed or recommended for children under four years of age
I I I I I I I I I I I I
C. Are effective in treating the congestion children experience with the common cold
I I I I I I I I
D. May cause drowsiness in patients of all ages
I I I I I I I I I I I I I I
8. Patients with pheochromocytoma should avoid which of the following classes of drugs due to the
I I I I I
possibility of developing hypertensive crisis?
I
A. Expectorants
I I I
B. Beta 2 agonists
I
C. Antitussives
I
D. Antihistamines
I I I I I I I I I I I
9. Education of patients with COPD who use inhaled corticosteroids includes the following:
I I I I I I I I I I I I I I
A. They should double the dose at the first sign of a upper respiratory infection.
I I I I I I I I I I I
B. They should use the inhaled corticosteroid first and then the bronchodilator.

, I I I I I I I
C. They should rinse their mouths after use.
I I I I I I I I I I I
D. They should not smoke for at least thirty minutes after use.
I I I I I I
10. Monitoring a patient with persistent asthma includes:
I I I I I I I I I I I I
A. Monitoring how frequently the patient has a upper respiratory infection during treatment
I I I I
B. Monthly in-office spirometry testing
I I I I I I I I I I I I I I I I I
C. Determining whether the patient has increased use of his or her long-acting beta 2 agonists due to
I
exacerbations
I I I I I I I I I I I I I I I I I
D. Evaluating the patient every one to six months to determine whether the patient needs to step up
I I I I I I I
or down in his or her therapy
I I I I I I I I I I I I
11. Harold, a forty-two-year-old African American, has moderate persistent asthma. Which of the following
I I I I I I I I I
asthma medications should he use cautiously, if at all?
I I I I
A. Betamethasone, an inhaled corticosteroid
I I I I I
B. Salmeterol, an inhaled long-acting beta-agonist
I I I I
C. Albuterol, a short-acting beta-agonist
I I I I
D. Montelukast, a leukotriene modifier
I I I I I I I I I I I I I
12. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed
I I
as follows:
I I I I I I I I I I I I
A. Montelukast twice a day is started when there is an asthma exacerbation.
I I I I I I I
B. Patients may experience weight gain on montelukast.
I I I I I I I I I I I
C. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
I I I I I I I I
D. Lethargy and hypersomnia may occur when taking montelukast.
I I I I I I I I I I I I I I I I
13. Lifestyle changes are the first step in the treatment of GERD. Foods that may aggravate GERD include:
I
A. Eggs
I I
B. White bread
I
C. Chocolate
I
D. Chicken
I I I I I I I I I I I I I I I
14. Christy has exercise and mild persistent asthma and is prescribed two puffs of albuterol fifteen minutes
I I I I I I I I I I I I I I I I
before exercise and as needed for wheezing. One puff per day of beclomethasone (Qvar) is also
I I I I I I I I I I I
prescribed. Teaching regarding her inhalers includes which one of the following?
I I I I I I I I I I I I I I I I I I I I I
A. She should use one to two puffs of albuterol per day to prevent an attack, with no more than eight puffs
I I
per day.
I I I I I I I I I I I
B. Beclomethasone needs to be used every day to treat her asthma.
I I I I I I I I I I I I I I
C. She should report any systemic side effects she is experiencing, such as weight gain.
I I I I I I I I I I I I I
D. She should use the albuterol MDI immediately after her corticosteroid MDI to facilitate
I
bronchodilation.
I I I I I I I I I I I I I
15. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is:
I I I I I I
A. Use albuterol daily to control symptoms
I I I I I I
B. Minimize exacerbations to once a month
I I I I I I I I I I
C. Keep nighttime symptoms at a maximum of twice a week
I I I I I I I I I I I I
D. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms
I I I I I I I I I I I I I
16. Treatment failure in patients with PUD associated with H. pylori may be due to:
I I
A. Antimicrobial resistance
I I
B. Ineffective antacid
I I I
C. Overuse of PPIs
I I I I
D. All of the above
I I I I I I I I I I I I I I I I I I
17. When using the "step-up" approach in caring for a patient with GERD, the "step up" from OTC antacid use
I
is:
I I I I I I I
A. Prokinetic (metoclopramide) for four to eight weeks
I I I I I I
B. A PPI (omeprazole) for twelve weeks

, I I I I I I I I I I
C. Histamine 2 receptor antagonist (ranitidine) for four to eight weeks
I I I I I I
D. Cytoprotective drug (misoprostol) for two weeks
I I I I I I
18. Long-term use of PPIs may lead to:
I I I I I
A. Hip fractures in at-risk persons
I I I
B. Vitamin B6 deficiency
I I
C. Liver cancer
I I I I I
D. All of the above
I I I I I I I I I I I I I I I I I I
19. Art is a fifty five year old smoker who has been diagnosed with angina and placed on nitrates. He
I I I I I I I I I I I I
complains of headaches after using his nitrate. An appropriate reply might be:
I I I I I I I I I I I
A. "This is a parasympathetic response to the vasodilating effects of the drug."
I I I I I I I I I I I I
B. "Headaches are common side effects with these drugs. How severe are they?"
I I I I I I I I I I I I I
C. "This is associated with your smoking. Let's work on having you stop smoking."
I I I I I I I I I I I I I I
D. "This is not related to your medication. Are you under a lot of stress?"
I I I I I I I I I I I I I
20. . In teaching about the use of sublingual nitroglycerine, the patient should be instructed:
I I I I I I I I I I
A. To swallow the tablet with a full glass of water
I I I I I I I I I I I I I I I I
B. To place one tablet under the tongue if chest pain occurs and allow it to dissolve
I I I I I I I I I I I I I
C. To take one tablet every five minutes until the chest pain goes away
I I I I I I I I I I I I I I I
D. That it should "burn" when placed under the tongue or it is no longer effective
I I I I I I I I I I I I I
21. A potentially life-threatening adverse response to ACE inhibitors is angioedema. Which of the following
I I I I I I I
statements is true about this adverse response?
I I I I I I I I I I I
A. Swelling of the tongue and hoarseness are the most common symptoms.
I I I I I I I I I I I
B. It appears to be related to a decrease in aldosterone production.
I I I I I I I I I I I I I I I
C. The presence of a dry, hacky cough indicates a high risk for this adverse response.
I I I I I I I I I I I I I I I I I I I I I
D. Because it takes time to build up a blood level, it occurs after being on the drug for about one week.
I I I I I I I I I I
22. Patients who are being treated for folate deficiency require monitoring of:
I I I I I I
A. Complete blood count every four weeks
I I I I I I I I I I I
B. Hematocrit and hemoglobin at one week and then at eight weeks
I I I I I
C. Reticulocyte count at one week
I I I I I I I I I
D. Folate levels every four weeks until the hemoglobin stabilizes
I I I I I I I I I I I I I I I
23. Treatments for heart failure, including drug therapy, are based on the stages developed by the American
I I I I I I I I I I I I
Heart Association and the American College of Cardiology. Stage A patients are:
I I I I I I I I I I
A. Treated with drugs for hypertension and hyperlipidemia, if they exist
I I I I I I I I I I
B. Taught lifestyle management, including diet, exercise, and smoking cessation only
I I I I I I I I I I I
C. Treated with ACE inhibitors to directly affect the heart failure only
I I I I I I I I
D. Not given any drugs in this early stage
I I I I I I I I I I I I I I I
24. Furosemide is added to a treatment regimen for heart failure, which includes digoxin. Monitoring for this
I I
combination includes:
I
A. Hemoglobin
I I
B. Serum potassium
I I I
C. Blood urea nitrogen
I I
D. Serum glucose
I I I I I I I I I I I I I I I
25. Isosorbide dinitrate is a long-acting nitrate given twice daily (BID). The schedule for administration is 7
I I I I I
a.m. and 2 p.m. because:
I I I I I I I I
A. Long-acting forms have a higher risk for toxicity.
I I I I I I I
B. Orthostatic hypotension is a common adverse effect.
I I I I I I I I
C. It must be taken with milk or food.
I I I I
D. Nitrate tolerance can develop.
I I I I I I I I I I I I I
26. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria
I I I I I I I I I I I I I I I I I
for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair
I I I
after meals is:

, I I
A. Class I
I I
B. Class II
I I
C. Class III
I I
D. Class IV
I I I I I I I I I I I I I I
27. Kyle has Crohn's disease and has a documented folate deficiency. Drug therapy for folate deficiency
I I
anemia is:
I I I I I I I
A. Oral folic acid 1 to 2 mg/day
I I I I I
B. Oral folic acid 1 gm/day
I I I I I I I I
C. IM folate weekly for at least six months
I I I I I I
D. Oral folic acid 400 mcg daily
I I I I I I I I I I I I I
28. The American Heart Association and the American College of Cardiology have devised a classification
I I I I I I I I I I I I I I I I
system for heart failure that can be used to direct treatment. Patients with symptoms and underlying
I I I I
disease are classified as:
I I
A. Stage A
I I
B. Stage B
I I
C. Stage C
I I
D. Stage D
I I I I I I I I I I I I I I I I I
29. Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of
I I I
beta blockers include:
I I
A. Heart failure
I
B. Angina
I
C. MI
I
D. Dyslipidemia
I I I I I I I I I I I
30. Which of the following classes of drugs is contraindicated in heart failure?
I
A. Nitrates
I I
B. Long-acting dihydropyridines
I I I
C. Calcium channel blockers
I I
D. Alpha-beta blockers
I I I I I I I I I I I
31. Which of the following is true about procainamide and its dosing schedule?
I I I I I I I I I I I I I I I I
A. It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower
I I I I
heart rate might worsen.
I I I I I I I I I I I I I
B. GI adverse effects are common, so the drug should be taken with food.
I I I I I I I I I I I I I I I
C. Adherence can be improved by using a sustained-release formulation that can be given once daily.
I I I I I I I I I I I I I I I I I I
D. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.
I I I I I I I I I I I I I
32. At which stage/classification of hypertension should drug therapy be instituted according to the JNC-7
I
Report?
I
A. Prehypertension
I I
B. Stage 1
I I
C. Stage 2
I I I I I I I I I I I I
D. Any stage where the blood pressure is greater than 120/80 mm Hg
I I I I I I I I I I I I I I I I I
33. Jose is a twelve-year-old overweight child with a total cholesterol level of 180 mg/dL and LDL of 125
I I I I I I I I I I I I I I I
mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose
I I I I I I I I I
would include ____ with a reevaluation in six months.
I
A. statins
I
B. niacin
I
C. sterols
I I I
D. bile acid-binding resins
I I I I I I I I I I I I I
34. Patients who have angina, regardless of class, who are also diabetic should be on:

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