NSG 6320 AGNP Board Exam – Respiratory
Prescribing
100 correct Q&A
1. Question:
Treatment of Bordetella pertussis in a patient with a hypersensitivity to
macrolides is:
doxycycline.
clindamycin (Cleocin).
metronidazole (Flagyl).
sulfamethoxazole/trimethoprim (Bactrim). Correct
Explanation:
Sulfamethoxazole/trimethoprim (Bactrim) is an alternative choice for patients
in whom a macrolide is contraindicated.
2. Question:
The mainstay of treatment in the management of mild and moderate croup
is symptomatic relief that includes:
antibiotics.
beta-2 agonists.
corticosteroids. Correct
decongestants.
Explanation:
The mainstay of treatment in the management of mild and moderate croup
is symptomatic relief, which includes corticosteroids (inhaled or oral).
Antibiotics, beta-2 agonists and decongestants have not been studied, and
their use is discouraged.
3. Question:
In adults with community-acquired pneumonia in which B-lactamase
producing Haemophilus influenzae is identified as the causative organism,
the outpatient treatment of choice is:
amoxicillin (Amoxil).
azithromycin (Zithromax).
Cefixime (Suprax). Correct
oseltamivir (Tamiflu).
Explanation:
The treatment of choice in adults with B-lactamase producing Haemophilus
influenzae community acquired pneumonia is cefixime (Suprax). Amoxicillin
is recommended in the presence of non-B-lactamase producing Haemophilus
,influenzae. Alternate antibiotics include fluoroquinolones (ie. moxifloxacin
[Avelox]), doxycycline, azithromycin and clarithromycin.
4. Question:
A patient with sinusitis is treated with amoxicillin. Caution is advised with
concomitant use of:
lisinopril (Zestril).
fexofenadine (Allegra).
warfarin (Coumadin). Correct
furosemide (Lasix).
Explanation:
Amoxicillin should be used with caution with warfarin (Coumadin). The
combination will increase the INR and thus increase the risk of bleeding,
possibly due to altered vitamin K production by gut flora. Amoxicillin can be
co- administered with lisinopril (Zestril), fexofenadine (Allegra), and
furosemide (Lasix).
5. Question:
A patient with bacterial sinusitis taking an oral penicillin should be
instructed:
to monitor capillary blood glucose readings if they have diabetes.
that additional protection against pregnancy is necessary if they are taking
an oral contraceptive. Correct
to use an anti-diarrheal if they experience diarrhea.
to avoid penicillin if they are pregnant or trying to become pregnant.
Explanation:
Penicillin is a beta-lactam antibiotic. The drug interactions of most concern
with the beta-lactam antibiotics are those with oral contraceptive products,
methotrexate and valproic acid. In the case oral contraceptives, even though
a small percentage of women may potentially experience decreased
effectiveness of these birth control products while taking beta-lactam
antibiotic, alternative birth control methods should be considered while
taking these antibiotics. Anti-diarrheal medicine should not be taken because
it may worsen or prolong diarrhea. Most penicillins are safe to use during
pregnancy. Penicillins may cause false readings with some urine glucose
tests.
6. Question:
An example of a beta2-adrenergic receptor agonist used in the treatment of
asthma is:
dobutamine.
denopamine.
xamoterol.
, albuterol. Correct
Explanation:
ß2 (beta2) adrenergic receptor agonists, also known as adrenergic ß2
receptor agonists, act on the ß2 adrenergic receptor. Like other ß adrenergic
agonists, they cause smooth muscle relaxation. ß2 adrenergic agonists'
effects on smooth muscle cause dilation of bronchial passages. They are
primarily used to treat asthma and other pulmonary disorders, such as
COPD. Examples of a beta2-adrenergic receptor agonists are albuterol,
xamoterol, and terbutaline. The others are examples of beta1-adrenergic
receptor agonists.
7. Question:
Benzonatate (Tessalon Perles), a non-narcotic antitussive,:
does not cause sedation.
is centrally acting on cough receptors.
is safe in children 6 years and older.
should be swallowed whole. Correct
Explanation:
Benzonatate (Tessalon Perles) capsules act peripherally by anesthetizing the
stretch receptors located in the respiratory passages, lungs, and pleura by
dampening their activity and thereby reducing the cough reflex. It is
approved for the relief of cough in adults and children older than 10 years.
Benzonatate capsules should be swallowed whole. Severe hypersensitivity
reactions (including bronchospasm, laryngospasm and cardiovascular
collapse) have been reported from sucking or chewing the capsule instead of
swallowing it. This is thought to be related to a local anesthetic property of
the drug. The most common side effects of benzonatate are sedation,
headache and dizziness.
8. Question:
Which of the following medications, when combined with pulmonary
rehabilitation, enhances exercise performance?
Ipratropium bromide (Atrovent).
Levalbuterol (Xopenex) inhaled.
Salmeterol (Serevent Diskus).
Tiotropium (Spiriva HandiHaler). Correct
Explanation:
Tiotropium (Spiriva HandiHaler), a long-acting antimuscarinic antagonist,
enhances the effectiveness of pulmonary rehabilitation in increasing exercise
performance.
9. Question:
, Which of the following would NOT be a potential adverse reaction of an
intramuscular corticosteroid?
anuria. Correct
angioedema.
cardiac arrhythmias.
mood swings.
Explanation:
Anuria has not been reported as a potential side effect of intramuscular
corticosteroids. Reactions that may occur include anaphylaxis, angioedema,
convulsions, depression, emotional instability, euphoria, headache, insomnia,
mood swings, neuritis, neuropathy, paresthesia, personality changes,
bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement,
circulatory collapse, congestive heart failure, and tachycardia.
10. Question:
Doxycycline (Vibramycin), for the treatment of pneumonia, is classified as a:
fluoroquinolone.
penicillin.
macrolide.
tetracycline. Correct
Explanation:
Doxycycline (Vibramycin), demeclocycline (Declomycin) and minocycline
(Minocin) are tetracycline derivatives. Doxycycline (Vibramycin) is the
preferred treatment of pneumonia caused by Mycoplasma pneumoniae.
11. Question:
The main side effect related to the use of long-acting antimuscarinic
antagonists is:
dry mouth. Correct
headache.
tachycardia.
watering eyes.
Explanation:
The main side effect is dryness of mouth. Inhaled anticholinergic drugs are
poorly absorbed, which limits the troublesome systemic effects observed
with atropine. Extensive use of this class of agents in a wide range of doses
and clinical settings has shown them to be very safe.
12. Question:
Theophylline (Theo-24) relaxes bronchial smooth muscle and:
depresses the central nervous system.
decreases renal blood flow.
Prescribing
100 correct Q&A
1. Question:
Treatment of Bordetella pertussis in a patient with a hypersensitivity to
macrolides is:
doxycycline.
clindamycin (Cleocin).
metronidazole (Flagyl).
sulfamethoxazole/trimethoprim (Bactrim). Correct
Explanation:
Sulfamethoxazole/trimethoprim (Bactrim) is an alternative choice for patients
in whom a macrolide is contraindicated.
2. Question:
The mainstay of treatment in the management of mild and moderate croup
is symptomatic relief that includes:
antibiotics.
beta-2 agonists.
corticosteroids. Correct
decongestants.
Explanation:
The mainstay of treatment in the management of mild and moderate croup
is symptomatic relief, which includes corticosteroids (inhaled or oral).
Antibiotics, beta-2 agonists and decongestants have not been studied, and
their use is discouraged.
3. Question:
In adults with community-acquired pneumonia in which B-lactamase
producing Haemophilus influenzae is identified as the causative organism,
the outpatient treatment of choice is:
amoxicillin (Amoxil).
azithromycin (Zithromax).
Cefixime (Suprax). Correct
oseltamivir (Tamiflu).
Explanation:
The treatment of choice in adults with B-lactamase producing Haemophilus
influenzae community acquired pneumonia is cefixime (Suprax). Amoxicillin
is recommended in the presence of non-B-lactamase producing Haemophilus
,influenzae. Alternate antibiotics include fluoroquinolones (ie. moxifloxacin
[Avelox]), doxycycline, azithromycin and clarithromycin.
4. Question:
A patient with sinusitis is treated with amoxicillin. Caution is advised with
concomitant use of:
lisinopril (Zestril).
fexofenadine (Allegra).
warfarin (Coumadin). Correct
furosemide (Lasix).
Explanation:
Amoxicillin should be used with caution with warfarin (Coumadin). The
combination will increase the INR and thus increase the risk of bleeding,
possibly due to altered vitamin K production by gut flora. Amoxicillin can be
co- administered with lisinopril (Zestril), fexofenadine (Allegra), and
furosemide (Lasix).
5. Question:
A patient with bacterial sinusitis taking an oral penicillin should be
instructed:
to monitor capillary blood glucose readings if they have diabetes.
that additional protection against pregnancy is necessary if they are taking
an oral contraceptive. Correct
to use an anti-diarrheal if they experience diarrhea.
to avoid penicillin if they are pregnant or trying to become pregnant.
Explanation:
Penicillin is a beta-lactam antibiotic. The drug interactions of most concern
with the beta-lactam antibiotics are those with oral contraceptive products,
methotrexate and valproic acid. In the case oral contraceptives, even though
a small percentage of women may potentially experience decreased
effectiveness of these birth control products while taking beta-lactam
antibiotic, alternative birth control methods should be considered while
taking these antibiotics. Anti-diarrheal medicine should not be taken because
it may worsen or prolong diarrhea. Most penicillins are safe to use during
pregnancy. Penicillins may cause false readings with some urine glucose
tests.
6. Question:
An example of a beta2-adrenergic receptor agonist used in the treatment of
asthma is:
dobutamine.
denopamine.
xamoterol.
, albuterol. Correct
Explanation:
ß2 (beta2) adrenergic receptor agonists, also known as adrenergic ß2
receptor agonists, act on the ß2 adrenergic receptor. Like other ß adrenergic
agonists, they cause smooth muscle relaxation. ß2 adrenergic agonists'
effects on smooth muscle cause dilation of bronchial passages. They are
primarily used to treat asthma and other pulmonary disorders, such as
COPD. Examples of a beta2-adrenergic receptor agonists are albuterol,
xamoterol, and terbutaline. The others are examples of beta1-adrenergic
receptor agonists.
7. Question:
Benzonatate (Tessalon Perles), a non-narcotic antitussive,:
does not cause sedation.
is centrally acting on cough receptors.
is safe in children 6 years and older.
should be swallowed whole. Correct
Explanation:
Benzonatate (Tessalon Perles) capsules act peripherally by anesthetizing the
stretch receptors located in the respiratory passages, lungs, and pleura by
dampening their activity and thereby reducing the cough reflex. It is
approved for the relief of cough in adults and children older than 10 years.
Benzonatate capsules should be swallowed whole. Severe hypersensitivity
reactions (including bronchospasm, laryngospasm and cardiovascular
collapse) have been reported from sucking or chewing the capsule instead of
swallowing it. This is thought to be related to a local anesthetic property of
the drug. The most common side effects of benzonatate are sedation,
headache and dizziness.
8. Question:
Which of the following medications, when combined with pulmonary
rehabilitation, enhances exercise performance?
Ipratropium bromide (Atrovent).
Levalbuterol (Xopenex) inhaled.
Salmeterol (Serevent Diskus).
Tiotropium (Spiriva HandiHaler). Correct
Explanation:
Tiotropium (Spiriva HandiHaler), a long-acting antimuscarinic antagonist,
enhances the effectiveness of pulmonary rehabilitation in increasing exercise
performance.
9. Question:
, Which of the following would NOT be a potential adverse reaction of an
intramuscular corticosteroid?
anuria. Correct
angioedema.
cardiac arrhythmias.
mood swings.
Explanation:
Anuria has not been reported as a potential side effect of intramuscular
corticosteroids. Reactions that may occur include anaphylaxis, angioedema,
convulsions, depression, emotional instability, euphoria, headache, insomnia,
mood swings, neuritis, neuropathy, paresthesia, personality changes,
bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement,
circulatory collapse, congestive heart failure, and tachycardia.
10. Question:
Doxycycline (Vibramycin), for the treatment of pneumonia, is classified as a:
fluoroquinolone.
penicillin.
macrolide.
tetracycline. Correct
Explanation:
Doxycycline (Vibramycin), demeclocycline (Declomycin) and minocycline
(Minocin) are tetracycline derivatives. Doxycycline (Vibramycin) is the
preferred treatment of pneumonia caused by Mycoplasma pneumoniae.
11. Question:
The main side effect related to the use of long-acting antimuscarinic
antagonists is:
dry mouth. Correct
headache.
tachycardia.
watering eyes.
Explanation:
The main side effect is dryness of mouth. Inhaled anticholinergic drugs are
poorly absorbed, which limits the troublesome systemic effects observed
with atropine. Extensive use of this class of agents in a wide range of doses
and clinical settings has shown them to be very safe.
12. Question:
Theophylline (Theo-24) relaxes bronchial smooth muscle and:
depresses the central nervous system.
decreases renal blood flow.
