NSG 6320 AGNP Board Exam – Orthopedics
Prescribing
1. Question:
Which medication is NOT a brand name for acetaminophen?
Mapap
Cetafen
Aleve Correct
Feverall
Explanation:
Brand names for acetaminophen include Mapap, Cetafen, FeverAll and
Tylenol. Aleve is the brand name for naproxen sodium.
2. Question:
To treat low back pain in a patient for whom nonsteroidal anti-inflammatory
drugs (NSAIDs) are contraindicated, the recommended therapy is:
acetaminophen (Tylenol). Correct
ibuprofen (Motrin).
cyclobenzaprine (Amrix).
tramadol (Ultram).
Explanation:
To treat low back pain in a patient for whom nonsteroidal anti-inflammatory
drugs (NSAIDs) are contraindicated, the recommended therapy is
acetaminophen (Tylenol). A nonsteroidal anti-inflammatory drug (ibuprofen)
is recommended as initial therapy for the treatment of back pain. The trial
should be short-term, usually 2 to 4 weeks. Acetaminophen is a reasonable
option for initial therapy in patients with contraindications to NSAIDs.
3. Question:
The patient at highest risk for side effects from cyclobenzaprine (Amrix) is a:
20-year-old man with spasticity and a history of seizures.
40-year-old woman diagnosed with diabetes mellitus.
50-year-old woman with a history of asthma.
70-year-old man diagnosed with benign prostatic hypertrophy. Correct
Explanation:
Cyclobenzaprine (Amrix) is identified in the Beers Criteria as a potentially
inappropriate medication and should be to be avoided in patients 65 years
and older (independent of diagnosis or condition). This is because most
muscle relaxants are poorly tolerated in older adults due to anticholinergic
effects. Amrix may also increase sedation and fracture risk. Cyclobenzaprine
(Amrix) has strong anticholinergic properties. In addition, efficacy is
,questionable at doses tolerated by geriatric patients. Although
cyclobenzaprine may lower the seizure threshold, it is not a contraindication.
The provider should weigh the risks versus the benefits.
4. Question:
When assessing a patient with suspected acetaminophen (Tylenol) overdose,
the time of ingestion can be confirmed by checking:
acetaminophen levels now and in 4 hours. Correct
baseline acetaminophen levels.
liver function studies now and in 4 hours.
acetylcysteine levels.
Explanation:
When assessing a patient with suspected acetaminophen (Tylenol) overdose,
the time of ingestion can be confirmed by checking serum acetaminophen
levels at the time of presentation and again in 4 hours. This is especially
important if the time of acetaminophen ingestion is unknown.
5. Question:
A patient with severe osteoarthritis is complaining of a pain exacerbation
due to weather change. Ketorolac should be avoided in this patient due to a
drug-drug interaction with:
diclofenac (Zorvolex). Correct
lisinopril (Zestril).
omega-3 fatty acids.
spironolactone (Aldactone).
Explanation:
The concomitant use of ketorolac (Toradol) and other nonsteroidal anti-
inflammatory drugs (NSAIDs), such as diclofenac (Zorvolex), is absolutely
contraindicated due to enhancement of the adverse/toxic effect of NSAIDs.
Therapy should be monitored in the presence of ACE inhibitors, omega-3
fatty acids and potassium-sparing diuretics, but it is not contraindicated.
6. Question:
The half-life elimination of colchicine (Colcrys), used in the treatment of gout,
is approximately:
8 hours.
15 hours.
30 hours. Correct
48 hours.
Explanation:
,The half-life elimination of colchicine (Colcrys) in an otherwise healthy
person is about 27-31 hours. Colchicine is an alkaloid indicated for the
treatment of acute gout and for the prophylactic treatment of gout. It is
approved for use in patients aged 16 and older for gout prophylaxis.
7. Question:
Dantrolene (Dantrium) reduces skeletal muscle spasticity by:
interfering with the release of potassium from the sarcoplasmic reticulum.
interfering with the release of calcium from the sarcoplasmic
reticulum. Correct
centrally blocking action potentials.
blocking the actin-myosin binding site in striated muscle.
Explanation:
Dantrolene (Dantrium) reduces skeletal muscle spasticity by acting directly
on skeletal muscle and interfering with release of calcium ion from the
sarcoplasmic reticulum. It is classified as a peripherally-acting muscle
relaxant. It is not a centrally-acting muscle relaxant.
8. Question:
Which formulation of naproxen would result in fewer GI side effects?
Naprosyn
Naprosyn suspension
Anaprox DS
EC-Naprosyn Correct
Explanation:
EC-Naprosyn dissolves in the small intestine rather than in the stomach.
Fewer GI side effects would be expected with this medication. However, this
results in delayed absorption and thus delayed relief of acute pain could also
be anticipated. The other listed forms of naproxen are absorbed in the
stomach and produce a greater risk of GI upset.
9. Question:
Salicylates, such as aspirin,:
prevent the formation of clots by affecting blood coagulation.
inhibit vitamin K epoxide reductase and prevent blood clots.
inhibit the synthesis of prostaglandin in the process of
inflammation. Correct
block the activity of clotting factor X and prevent blood clots.
Explanation:
Salicylates are nonsteroidal anti-inflammatory drugs (i.e. aspirin [Ecotrin]
and magnesium salicylate [Doan's]). Salicylates inhibit the synthesis of
, prostaglandins and other mediators in the process of inflammation and have
anti-inflammatory, antipyretic and analgesic properties.
10. Question:
When evaluating the effectiveness of baclofen (Lioresal), the LEAST
appropriate goal is to:
reduce caregiver challenges such as dressing, feeding, transport, and
bathing.
reduce the pain and frequency of muscle contractions.
improve voluntary motor functions such as reaching, releasing and
grasping.
significantly reduce muscle spasticity and contractions. Correct
Explanation:
“Reducing spasticity” per se is not an appropriate treatment goal.
Appropriate goals include increasing range of motion, easing care,
decreasing pain, improving quality of life, improving gait, or decreasing the
development of contractures. Use with caution when spasticity is utilized to
sustain upright posture and balance in locomotion, or when spasticity is
necessary to obtain increased function.
11. Question:
The concomitant use of aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs) can cause:
hypoglycemia.
abnormally high serum levels of potassium. Correct
a decrease in the development of angioedema.
reduced absorption of nonsteroidal anti-inflammatory drugs (NSAIDs).
Explanation:
The concomitant use of aspirin and NSAIDs can cause abnormally high serum
levels of potassium by inducing a hyporeninemic hypoaldosteronism state
via inhibition of prostaglandin synthesis.
12. Question:
Clindamycin (Cleocin) is NOT indicated for the treatment of serious
infections, such as septic arthritis, caused by:
Streptococcus pyogenes.
Staphylococcus aureus.
Streptococcus pneumoniae.
Escherichia coli. Correct
Explanation:
Clindamycin (Cleocin) is not effective against infections caused by
Escherichia coli. Clindamycin (Cleocin) is indicated in the treatment of
Prescribing
1. Question:
Which medication is NOT a brand name for acetaminophen?
Mapap
Cetafen
Aleve Correct
Feverall
Explanation:
Brand names for acetaminophen include Mapap, Cetafen, FeverAll and
Tylenol. Aleve is the brand name for naproxen sodium.
2. Question:
To treat low back pain in a patient for whom nonsteroidal anti-inflammatory
drugs (NSAIDs) are contraindicated, the recommended therapy is:
acetaminophen (Tylenol). Correct
ibuprofen (Motrin).
cyclobenzaprine (Amrix).
tramadol (Ultram).
Explanation:
To treat low back pain in a patient for whom nonsteroidal anti-inflammatory
drugs (NSAIDs) are contraindicated, the recommended therapy is
acetaminophen (Tylenol). A nonsteroidal anti-inflammatory drug (ibuprofen)
is recommended as initial therapy for the treatment of back pain. The trial
should be short-term, usually 2 to 4 weeks. Acetaminophen is a reasonable
option for initial therapy in patients with contraindications to NSAIDs.
3. Question:
The patient at highest risk for side effects from cyclobenzaprine (Amrix) is a:
20-year-old man with spasticity and a history of seizures.
40-year-old woman diagnosed with diabetes mellitus.
50-year-old woman with a history of asthma.
70-year-old man diagnosed with benign prostatic hypertrophy. Correct
Explanation:
Cyclobenzaprine (Amrix) is identified in the Beers Criteria as a potentially
inappropriate medication and should be to be avoided in patients 65 years
and older (independent of diagnosis or condition). This is because most
muscle relaxants are poorly tolerated in older adults due to anticholinergic
effects. Amrix may also increase sedation and fracture risk. Cyclobenzaprine
(Amrix) has strong anticholinergic properties. In addition, efficacy is
,questionable at doses tolerated by geriatric patients. Although
cyclobenzaprine may lower the seizure threshold, it is not a contraindication.
The provider should weigh the risks versus the benefits.
4. Question:
When assessing a patient with suspected acetaminophen (Tylenol) overdose,
the time of ingestion can be confirmed by checking:
acetaminophen levels now and in 4 hours. Correct
baseline acetaminophen levels.
liver function studies now and in 4 hours.
acetylcysteine levels.
Explanation:
When assessing a patient with suspected acetaminophen (Tylenol) overdose,
the time of ingestion can be confirmed by checking serum acetaminophen
levels at the time of presentation and again in 4 hours. This is especially
important if the time of acetaminophen ingestion is unknown.
5. Question:
A patient with severe osteoarthritis is complaining of a pain exacerbation
due to weather change. Ketorolac should be avoided in this patient due to a
drug-drug interaction with:
diclofenac (Zorvolex). Correct
lisinopril (Zestril).
omega-3 fatty acids.
spironolactone (Aldactone).
Explanation:
The concomitant use of ketorolac (Toradol) and other nonsteroidal anti-
inflammatory drugs (NSAIDs), such as diclofenac (Zorvolex), is absolutely
contraindicated due to enhancement of the adverse/toxic effect of NSAIDs.
Therapy should be monitored in the presence of ACE inhibitors, omega-3
fatty acids and potassium-sparing diuretics, but it is not contraindicated.
6. Question:
The half-life elimination of colchicine (Colcrys), used in the treatment of gout,
is approximately:
8 hours.
15 hours.
30 hours. Correct
48 hours.
Explanation:
,The half-life elimination of colchicine (Colcrys) in an otherwise healthy
person is about 27-31 hours. Colchicine is an alkaloid indicated for the
treatment of acute gout and for the prophylactic treatment of gout. It is
approved for use in patients aged 16 and older for gout prophylaxis.
7. Question:
Dantrolene (Dantrium) reduces skeletal muscle spasticity by:
interfering with the release of potassium from the sarcoplasmic reticulum.
interfering with the release of calcium from the sarcoplasmic
reticulum. Correct
centrally blocking action potentials.
blocking the actin-myosin binding site in striated muscle.
Explanation:
Dantrolene (Dantrium) reduces skeletal muscle spasticity by acting directly
on skeletal muscle and interfering with release of calcium ion from the
sarcoplasmic reticulum. It is classified as a peripherally-acting muscle
relaxant. It is not a centrally-acting muscle relaxant.
8. Question:
Which formulation of naproxen would result in fewer GI side effects?
Naprosyn
Naprosyn suspension
Anaprox DS
EC-Naprosyn Correct
Explanation:
EC-Naprosyn dissolves in the small intestine rather than in the stomach.
Fewer GI side effects would be expected with this medication. However, this
results in delayed absorption and thus delayed relief of acute pain could also
be anticipated. The other listed forms of naproxen are absorbed in the
stomach and produce a greater risk of GI upset.
9. Question:
Salicylates, such as aspirin,:
prevent the formation of clots by affecting blood coagulation.
inhibit vitamin K epoxide reductase and prevent blood clots.
inhibit the synthesis of prostaglandin in the process of
inflammation. Correct
block the activity of clotting factor X and prevent blood clots.
Explanation:
Salicylates are nonsteroidal anti-inflammatory drugs (i.e. aspirin [Ecotrin]
and magnesium salicylate [Doan's]). Salicylates inhibit the synthesis of
, prostaglandins and other mediators in the process of inflammation and have
anti-inflammatory, antipyretic and analgesic properties.
10. Question:
When evaluating the effectiveness of baclofen (Lioresal), the LEAST
appropriate goal is to:
reduce caregiver challenges such as dressing, feeding, transport, and
bathing.
reduce the pain and frequency of muscle contractions.
improve voluntary motor functions such as reaching, releasing and
grasping.
significantly reduce muscle spasticity and contractions. Correct
Explanation:
“Reducing spasticity” per se is not an appropriate treatment goal.
Appropriate goals include increasing range of motion, easing care,
decreasing pain, improving quality of life, improving gait, or decreasing the
development of contractures. Use with caution when spasticity is utilized to
sustain upright posture and balance in locomotion, or when spasticity is
necessary to obtain increased function.
11. Question:
The concomitant use of aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs) can cause:
hypoglycemia.
abnormally high serum levels of potassium. Correct
a decrease in the development of angioedema.
reduced absorption of nonsteroidal anti-inflammatory drugs (NSAIDs).
Explanation:
The concomitant use of aspirin and NSAIDs can cause abnormally high serum
levels of potassium by inducing a hyporeninemic hypoaldosteronism state
via inhibition of prostaglandin synthesis.
12. Question:
Clindamycin (Cleocin) is NOT indicated for the treatment of serious
infections, such as septic arthritis, caused by:
Streptococcus pyogenes.
Staphylococcus aureus.
Streptococcus pneumoniae.
Escherichia coli. Correct
Explanation:
Clindamycin (Cleocin) is not effective against infections caused by
Escherichia coli. Clindamycin (Cleocin) is indicated in the treatment of
