Test #4 Pharmacology Bank Questions

Test #4 Pharmacology Bank Questions The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes? - HbA1C A patient who has migraine headaches takes sumatriptan as abortive therapy. The patient tells the primary care nurse practitioner (NP) that the sumatriptan is effective for stopping symptoms but that the episodes are occurring three to four times per month. The NP should consider the addition of: - topiramate. A patient comes to the clinic concerned about possible migraine headaches. The primary care NP conducts a history and physical examination, and the patient describes vise-like pressure in the back of the head that occurs almost daily during the work week. The NP should recommend: - acetaminophen. A patient comes to the clinic and reports recurrent headaches. The patient has a headache diary, which reveals irritability and food cravings followed the next day by visual disturbances and unilateral right-sided headache, nausea, and photophobia lasting 2 to 3 days. The NP should recognize these symptoms as? - classic migraine. patient who has migraine headaches tells the primary care NP that drinking coffee and taking nonsteroidal antiinflammatory drugs (NSAIDs) seems to help with discomfort. The NP should tell the patient that: - this combination can lead to longer lasting headache pain. A patient takes rizatriptan (Maxalt) to abort migraine headaches but tells the primary care NP that the headaches have become more frequent since a promotion at work. The NP's initial response should be to: - stress the importance of establishing new routines. A primary care NP prescribes sumatriptan for abortive treatment of migraine headaches. The patient returns to the clinic 1 month later to report increased frequency of the headaches. The NP should: - ask the patient how often the sumatriptan is used each week. A patient who has migraine headaches without an aura reports difficulty treating the migraines in time because they come on so suddenly. The patient has been using over-the-counter NSAIDs. The primary care NP should prescribe: - sumatriptan (Imitrex). A patient who has mild to moderate migraine headaches has severe nausea and vomiting with each episode. For the best treatment of this patient, the primary care NP should prescribe: - triptan nasal spray. A patient who has migraine headaches usually has two to three severe migraines each month. The patient has been using a triptan nasal spray but reports little relief and is concerned about missing so many days of work. The primary care NP should consider: - an injectable triptan plus an oral corticosteroid. A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four times each month. The NP - prescribe an anticonvulsant such as topiramate. A patient who is diagnosed with migraine headaches has a history of cardiovascular disease and hypertension. The NP should prescribe: - cyproheptadine (Periactin). A patient reports frequent headaches to the primary NP. The patient describes the headaches as unilateral and moderate in intensity, accompanied by nausea, vomiting, and photophobia. There is no aura, and the headaches generally last 24 to 48 hours. The NP should: - recognize these as classic migraines and order sumatriptan (Imitrex). Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes: - The goal of treatment is to reduce migraine occurrence by 50% A first-line drug for abortive therapy in simple migraine is: - Naproxen (Aleve) Vicky, age 56 years, comes to clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraine and states one dose usually works to abort her migraine. What is the best care for her? - Assess how often she is using Fiorinal and refill medication When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include: - They may need premedication with an antinausea medication Migraines in pregnancy may be safely treated with: - Acetaminophen with codeine (Tylenol #3) Xi, a 54-year-old female, has a history of migraine that does not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: - Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose Kelly is a 14 year old who presents to clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: - Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers Jayla is a 9 year old who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate? - Prescribe propranolol (Inderal) to be taken daily for at least 3 months Amber is a 24 year old who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber's naratriptan education would include:-  Naratriptan will interact with antidepressants, including SSRIs and St John's Wort, and she should inform any providers she sees that she has migraines  Continue to monitor her headaches, if the migraine is consistently happening around her menses there is preventive therapy available  Pregnancy is contraindicated when taking a triptan When prescribing for migraine, patient education includes: - Stress reduction and regular sleep are integral to migraine treatment Juanita presents to clinic with a complaint of headaches off and on for months. She reports they feel like someone is "squeezing" her head. She occasionally takes Tylenol for the pain, but usually just "toughs it out." Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for: - Naproxen (Aleve) Nonpharmacologic therapy for tension headaches includes: -  Biofeedback  Stress management  Massage therapy James has been diagnosed with cluster headaches. Appropriate acute therapy would be: - Oxygen 100% for 15 to 30 minutes Preventative therapy for cluster headaches includes: - Ergotamine nightly before bed When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. The clinical characteristics of medication-overuse headaches include: - Headaches recur when medication wears off Antonia is a 3 year old who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for____ to be used for an episode of status epilepticus. - Rectal diazepam (Diastat) Rabi is being prescribed phenytoin for seizures. Monitoring includes: - Assessing for phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: - Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance Carbamazepine has a Black Box warning due to life-threatening: - Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis Long-term monitoring of patients who are taking carbamazepine includes: - Complete blood count every 3 to 4 months Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: - Blood dyscrasias, which are uncommon but possible Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: - Reassure her that this is a normal side effect of topiramate and continue to monitor her weight Monitoring of a patient on gabapentin to treat seizures includes: - Recording seizure frequency, duration, and severity Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: - He should monitor his temperature and ability to sweat in the heat while playing Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: - To not abruptly discontinue levetiracetam due to risk for withdrawal seizures Levetiracetam has known drug interactions with: - Few, if any, drugs Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: - Ruling out a hypersensitivity reaction that may lead to multi-organ failure Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for oral contraceptives. Combined oral contraceptives (OCs) interact with lamotrigine and may cause: - Reduced lamotrigine levels, requiring doubling the dose of lamotrigine Which of the following is the mechanism by which the selective serotonin reuptake inhibitor (SSRI) antidepressant drugs appear to work? - Blocking reuptake of serotonin and norepinephrine The health care provider teaches a patient beginning tricyclic antidepressant drug therapy about measures to minimize the most serious common adverse drug effects. Which of the following adverse reactions is considered the most serious? - Orthostatic hypotension A patient receiving a tricyclic antidepressant complains of constipation. What is the health care provider's interpretation of the patient's complaint? - It is a common side effect of the drug. A patient has begun taking fluoxetine (Prozac) for depression. When will the effects of the drug first be felt? - 1-4 weeks Phenelzine (Nardil) has been discontinued as a drug order for a patient. How much time must be observed before the patient can start a new drug? - 2 weeks The patient has been started on a treatment regimen which includes the use of lithium. As part of the teaching plan regarding lithium, the patient should be instructed that he should avoid: - Becoming dehydrated The patient has been started on a treatment regimen for acute mania. As part of the teaching plan for the patient and the family regarding use of the medication, they should be taught to immediately report which of the following symptoms to the primary care provider? - Deterioration of sleep pattern An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: - Venlafaxine (Effexor) The laboratory monitoring required when a patient is on an SSRI is: - There is no laboratory monitoring required Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the SSRI. What is the initial dosage adjustment when starting a taper off antidepressants? - Reduce dose by 50% for 3 to 4 days Common mistakes practitioners make in treating anxiety disorders include - Thinking a partial response to medication is acceptable An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: - Buspirone (Buspar) An appropriate drug to initially treat panic disorder is: - Diazepam (Valium) Prior to starting antidepressants, patients should have laboratory testing to rule out: - Hypothyroidism David is a 34 year old who is starting on paroxetine (Paxil) for depression. David's education regarding his medication would include: - He may experience sexual dysfunction beginning a month after he starts therapy Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly SSRI antidepressants work would be: - Appetite and concentration improve in the first 1 to 2 weeks An appropriate drug for the treatment of depression with anxiety would be: - Escitalopram (Lexapro) A patient has a drug order for zolpidem (Ambien) written in the medical record. Which of the following conditions would the health care provider expect to see in the progress notes? - Insomnia Which of the following is a common adverse effect of benzodiazepines (BZDs)? - Daytime sedation The patient has been placed on oxazepam (Serax). Which adverse reaction may be expected to occur with this drug? - Daytime sedation Which of the following medications is the only drug available to treat sleep disorders during pregnancy? - Diphenhydramine The patient is experiencing a reduction in her dosage of a benzodiazepine after 10 years of heavy use. Select the adverse effect which the health care provider expects will result from such a reduction. - Tachycardia A patient is receiving dextroamphetamine (Dexedrine). Review the following symptoms, and select the one for which the health care provider assesses the patient. - Irritability Which symptom would the health care provider expect to see in a patient receiving methamphetamine (Desoxyn)? - Suppressed appetite A patient is receiving methylphenidate (Ritalin) for the treatment of narcolepsy. What long-term effects should the health care provider expect to monitor in this patient? - Drug tolerance When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: - Blood pressure Monitoring for a child on methylphenidate for ADHD includes: -  ADHD symptoms  Routine height and weight checks  Amount of methylphenidate being used Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: - Insomnia and decreased appetite An adult patient reports feeling unfocused all the time, loses things, and has difficulty completing tasks and says that this is interfering with family relations and work. The symptoms have been present as long as the patient can remember, although there is no previous documentation of attention-deficit/hyperactivity disorder (AD/HD) in this patient's medical history. The primary care nurse practitioner (NP) should: - conduct a thorough evaluation to document behaviors associated with AD/HD and begin treatment if indicated. child is taking methylphenidate (Ritalin) for AD/HD. The child's parent calls the primary care NP to report increased behavior problems and delusional thinking. The NP should: - discontinue the medication. A primary care NP sees a child for an annual well-child check-up. The child has been taking methylphenidate for AD/HD for 3 months. The NP should discontinue the medication if which symptom is present? - Motor tics A child is diagnosed with AD/HD after being expelled from school for disruptive behaviors. The child's parents are reluctant to start medication because of the stigma attached. The primary care NP should suggest: - Concerta. A child has been taking methylphenidate 5 mg at 8 AM, 12 PM, and 4 PM for 30 days after a new diagnosis of AD/HD and comes to the clinic for evaluation. The child's mother reports that the child exhibits some nervousness and insomnia but is doing much better in school. The primary care NP should suggest: - discontinuing the 4 PM dose A patient who has recently begun working at night reports having difficulty staying awake at work. The primary care NP should consider prescribing: - modafinil (Provigil). The parent of a 4-year-old child is concerned that the child may have AD/HD and wants to know if medications can be given. The primary care NP should tell the parent that: - most drugs for AD/HD are not approved for children younger than 6 years. The parent of an 8-year-old child recently diagnosed with AD/HD verbalizes concerns about giving the child stimulants. The primary care NP should recommend: - atomoxetine (Strattera). Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as SSRIs and St John's Wort due to: - The risk of serotonin syndrome Rabi is being prescribed phenytoin for seizures. Monitoring includes: - Assessing for phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: - Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance Carbamazepine has a Black Box warning due to life-threatening: - Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis Long-term monitoring of patients who are taking carbamazepine includes: - Complete blood count every 3 to 4 months Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: - Central nervous system excitement, leading to insomnia Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be: - Assess for suicidal ideation Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: - Reassure her that this is a normal side effect of topiramate and continue to monitor her weight Monitoring of a patient on gabapentin to treat seizures includes: - Recording seizure frequency, duration, and severity Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: - He should monitor his temperature and ability to sweat in the heat while playing Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: - To not abruptly discontinue levetiracetam due to risk for withdrawal seizures Levetiracetam has known drug interactions with: - Few, if any, drugs Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: - Ruling out a hypersensitivity reaction that may lead to multi-organ failure Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for oral contraceptives. Combined oral contraceptives (OCs) interact with lamotrigine and may cause: - Reduced lamotrigine levels, requiring doubling the dose of lamotrigine The tricyclic antidepressants should be prescribed cautiously in patients with: - Heart Disease A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other MAOIs: - He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment Taylor is a 10 year old diagnosed with major depression. The appropriate first line antidepressant for children is: - Fluoxetine Suzanne is started on paroxetine (Paxil), an SSRI, for depression. Education regarding her antidepressant includes: - SSRIs may take 2 to 6 weeks before she will have maximum drug effects Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be: - Duloxetine (Cymbalta) Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: - With the Abnormal Involuntary Movement Scale (AIMS) for EPS symptoms Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: - Reduce the chance of tardive dyskinesia Patients who are prescribed olanzapine (Zyprexa) should be monitored for: - Weight gain A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: - Bradykinesia, akathisia, and agitation In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: - Alprazolam (Xanax) A patient with anxiety and depression may respond to: - Duloxetine (Cymbalta) When prescribing temazepam (Restoril) for insomnia, patient education includes: - Temazepam should not be used more than three times a week for less than 3 months Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: - Zolpidem should be taken just before going to bed One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: - Drowsiness and nausea Tom is taking lithium for bipolar disorder. He should be taught to: - Eat a diet with consistent levels of salt (sodium) Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? - Valproate is a known teratogen, but may be taken after the first trimester if necessary. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: - The medication may cause sedation and they should not drive Constipation is a common side effect and they should increase fluids and fiber Patients should not take any other acetaminophen-containing medications at the same time Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first line medication would be: - Ibuprofen (Advil) Kasey fractured his ankle in two places and is asking for pain medication for his pain. The appropriate first line medication would be: - Acetaminophen with hydrocodone (Vicodin) Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: - Insomnia and decreased appetite Which of the following drugs used to treat Alzheimer's disease is not an anticholinergic? - Memantine (NMDA receptor antagonist) Taking which drug with food maximizes it bioavailability? - Rivastigmine Because of their longer life expectancy, women are more likely than men to experience a disabling condition. Common conditions in older women that can produce disability include: - Depression Panic Disorders Dementia A patient is identified as having stage 2 Alzheimer's disease and elects to take donepezil (Aricept). The patient asks the primary care nurse practitioner (NP) how long the medication will be needed. The NP should tell the patient that donepezil must be taken: - indefinitely because it is not curative. A patient who has Alzheimer's disease has been taking donepezil for 1 year. The patient's spouse reports a worsening of symptoms. The primary care NP should consider: - adding memantine hydrochloride (Namenda) Early-stage Alzheimer's disease is diagnosed in a patient, and the primary care NP recommends therapy with a ChE inhibitor. The patient asks why drug treatment is necessary because most functioning is intact. The NP should explain that medication may: - delay progression of symptoms. patient has a diagnosis of depression and Alzheimer's disease with mild, intermittent symptoms. The primary care NP should prescribe a(n): - ChE inhibitor. A patient who has Alzheimer's disease begins taking donepezil (Aricept). After 3 months of treatment, the patient does not show improvement of symptoms. The primary care NP should: - continue donepezil and reevaluate in 3 months. A patient is newly diagnosed with Alzheimer's disease stage 6 on the Global Deterioration Scale. The primary care NP should prescribe: - memantine (Namenda) A patient has been taking donepezil (Aricept) for several months after being diagnosed with Alzheimer's disease. The patient's spouse brings the patient to the clinic and reports that the patient seems to be having visual hallucinations. The primary care NP should: - decrease the dose. A patient who has Alzheimer's disease is taking 10 mg of donepezil daily and reports difficulty sleeping. The primary care NP should recommend: - taking the drug in the morning. A patient who is diagnosed with Alzheimer's disease experiences visual hallucinations. The primary care NP should initially prescribe: - rivastigmine (Exelon). Which neurologic disorder is characterized by cortical nerve cell processes that have become twisted and dilated? - Alzheimer disease Dementia is characterized by: - loss of recent and remote memory. A seizure that starts in the fingers and progressively spreads up the arm and extends to the leg is known as a(n) _____ seizure. - simple partial The most critical aspect in diagnosing a seizure disorder and establishing its cause is: - skull x-ray films Status epilepticus is considered a medical emergency because of the: - development of cerebral hypoxia. Which description is consistent with a complex partial seizure? - Consciousness is impaired as well as the ability to respond to exogenous stimuli A sudden, explosive, disorderly discharge of cerebral neurons is termed: - seizure The tonic phase is characterized - by muscle contractions with increased muscle tone. During a generalized seizure the clonic phase begins as - inhibitory neurons in the cortex, anterior thalamus, and basal ganglia to reduce the cortical excitation. In two thirds (66%) of cases, the etiology of the epilepsy - is not identified Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90 percent of Type 1 diabetics have: - Autoantibodies to two tyrosine phosphatases Type 2 diabetes is a complex disorder involving: - A suboptimal response of insulin-sensitive tissues in the liver Diagnostic criteria for diabetes include: - Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl Routine screening of asymptomatic adults for diabetes is appropriate for: - Native Americans, African Americans, and Hispanics Screening criteria for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter: - BMI above the 85th percentile for age and sex Family history of diabetes in first- or second-degree relative Hypertension based on criteria for children Insulin is used to treat both types of diabetes. It acts by: - Increasing peripheral glucose uptake by skeletal muscle and fat Adam has Type 1 diabetes and plays tennis for his university. He exhibits a Knowledge deficit about his insulin and his diagnosis. He should be taught that: - He should increase his CHO intake during times of exercise Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous inject. Which of the following insulin preparations has the shortest onset and duration of action? - Insulin glulisine The drug of choice for Type 2 diabetics is metformin. Metformin: - Decreases glycogenolysis by the liver Before prescribing metformin, the provider should: - Draw a serum creatinine level to assess renal function Try the patient on insulin Prescribe a thyroid preparation if the patient needs to lose weight Sulfonylureas may be added to a treatment regimen for Type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they: - Have a significant risk for hypoglycemia Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: - Low risk for hypoglycemia Control targets for patients with diabetes include: - Blood pressure less than 130/80 mm Hg Treatment with insulin for Type 1 diabetics: - Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight Establishing glycemic targets is the first step in treatment of both types of diabetes. For Type 1 diabetes: - Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl When the total daily insulin dose is split and given twice daily, which of the following rules may be followed? - Give two-thirds of the total dose in the morning and one-third in the evening. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include: - Those with no significant cardiovascular disease Prevention of conversion from pre-diabetes to diabetes in young children must take highest priority and should focus on: - Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are: - Metformin and insulin Unlike most Type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: - Involuntary loss of 10% of body weight in less than 6 months The drugs recommended for older adults with Type 2 diabetes include: - Third generation sulfonylureas Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: - Have a high incidence of obesity, elevated triglycerides, and hypertension Do best with drugs that foster weight loss, such as metformin The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: - Glycemic targets between 7% and 7.5% All diabetic patients with known cardiovascular disease should be treated with: - ACE inhibitors and aspirin to reduce risk of cardiovascular events All diabetic patients with hyperlipidemia should be treated with: - HMG-CoA reductase inhibitors Both ACE inhibitors and some Angiotensin-II receptor blockers have been approved in treating: - Hypertension in diabetic patients Diabetic nephropathy Protein restriction helps slow the progression of albuminuria, GFR decline, and ESRD is some patients with diabetes. It is useful for patients who: - Show progression of diabetic nephropathy despite optimal glucose and blood pressure control Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include: - Resting tachycardia, exercise intolerance, and orthostatic hypotension Drugs used to treat diabetic peripheral neuropathy include: - Gabapentin Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90 percent of Type 1 diabetics have: - Autoantibodies to two tyrosine phosphatases Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous inject. Which of the following insulin preparations has the shortest onset and duration of action? - Insulin glulisine Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: - Low risk for hypoglycemia When methimazole is started for hyperthyroidism it may take ____ to see total reversal of hyperthyroid symptoms. - 6 to 12 months In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: - A beta blocker After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every: - 3 to 4 weeks A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with: - Propylthiouracil (PTU) Goals of treatment when treating hypothyroidism with thyroid replacement include: - Normal TSH and free T4 levels Resolution of fatigue Weight loss to baseline When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: - 4 weeks Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every: - 6 months Treatment of a patient with hypothyroidism and cardiovascular disease consists of: - Levothyroxine Infants with congenital hypothyroidism are treated with: - Levothyroxine When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: - It may take 4 to 8 weeks to get to euthyroid symptomatically and by lab testing Which of the following drugs inhibits the synthesis of thyroid hormones and reduces peripheral conversion of T4 to the more potent T3? - Propylthiouracil (PTU) Which serious adverse effects of propylthiouracil (PTU) would have to be reported to the health care provider immediately? - Sore throat and fever Which effect is associated with thyroid replacement hormones such as levothyroxine (Levothroid)? - Increase in the metabolic rate of body tissues Which group of symptoms may be indicative of overdosage in a patient taking a thyroid replacement hormone? - Tachycardia, insomnia, and nervousness A patient is undergoing thyroid replacement therapy with levothyroxine (Levothroid). At what time should the health care provider instruct the patient to take this drug? - Before breakfast on an empty stomach A home care patient taking levothyroxine (Synthroid) measures the pulse, finds it to be 110 beats per minute, and notifies his health care provider. Which action would be the most appropriate response of the health care provider? - Withhold the dose, and notify the prescriber of the drug. Individuals with panic disorder are effectively treated with cognitive behavioral therapy (CBT). - true Schizophrenia is believed to develop as a result of neurodevelopmental defects occurring during fetal life. - true People with schizophrenia commonly experience incoherent speech, delusions, and hallucinations during a psychotic episode. - true The dopamine hypothesis suggests that a depletion of dopaminergic transmission contributes to the onset of schizophrenia. - False Mania is the most common mood disorder. - False. Major (unipolar) depression is the most common mood disorder and the leading cause of disability in the United States and throughout the world. Exposure to a terrifying event may result in an onset of generalized anxiety disorder (GAD). - False Loci on chromosomes 18 and 22 have been linked to bipolar disorder and schizophrenia. - True In schizophrenia, the lateral and third ventricles of the brain are smaller than normal. - False People with posttraumatic stress disorder (PTSD) who have been exposed to trauma-related stimuli generally exhibit increased activation of the amygdala and diminished activity in some prefrontal cortical areas. - True Which is a positive symptom of schizophrenia? - Auditory hallucinations Prenatal and perinatal factors that result in the onset of schizophrenia include: - viral infection. Which neurotransmitter is reduced in people with schizophrenia? - Gamma-aminobutyric acid (GABA) Alterations in which part of the brain are linked to hallucinations, delusions, and thought disorders associated with schizophrenia? - Temporal lobe Which neurotransmitter receptors are blocked by antipsychotic drugs? - Dopamine What data confer the link between bipolar disorders and schizophrenia? - Bipolar individuals who exhibit psychotic behaviors have deficits in reelin expression linked to genetic loci located on chromosome 22. Hypothalamic-pituitary-adrenal (HPA) system abnormalities exist in a large percentage of individuals with: - major depression. The common property among the three types of medications used to treat depression is that they: - increase neurotransmitter levels within the synapse. What is the link between major depression and cortisol secretion? - Individuals with depression continue to exhibit elevated plasma cortisol levels throughout the evening and early morning. From 20% to 30% of individuals with depression have dysregulated: - thyroid function. A decrease in receptor binding for which neurotransmitter is found in depressed individuals? - Serotonin What is thought to be the alteration produced by electroconvulsive therapy (ECT) when treating individuals with depression? - It produces an alteration in the monoamine systems. Which electrolyte imbalance contributes to lithium toxicity? - Hyponatremia Which neurotransmitter is inhibited in panic disorders? - Gamma-aminobutyric acid (GABA) Which neurotransmitter is inhibited in generalized anxiety disorder (GAD)? - Gamma-aminobutyric acid (GABA) Generalized anxiety disorder (GAD) is diagnosed when a person spends _____ months worrying excessively. - 6 What are the most common side effects of selective serotonin reuptake inhibitors (SSRIs)? - Sleep disturbances and nausea Individuals who eat cheese, sour cream, liver, and avocado when taking monoamine oxidase inhibitors (MAOIs) may experience: - hypertensive crisis. Electroconvulsive therapy (ECT) is used to treat depression: - in pregnant women. What is a notable complication in panic disorder? - Agarophobia Persistent symptoms of posttraumatic stress disorder include: - difficulty sleeping. Hallucinations, delusions, thought disorder, and bizarre behavior occur with alterations in the: - temporal lobe. Perceptions are experienced without external stimulation of the sense organs - Hallucination Persistent beliefs are contrary to educational and cultural background - Delusions Fluent speech that is difficult to comprehend - Formal thought disorder Absence of spontaneous speech - Alogia Inability to have emotional experiences - Anhedonia Characterized by a deficit in spontaneous or goal-directed activities - Avolition Characterized by elevated levels of euphoria - Mania Involves psychotic episodes - Schizophrenia Repetitive, intrusive thoughts - Obsessive-compulsive disorder Unremitting feeling of sadness and despair - Depression Intensive autonomic arousal including lightheadedness, dyspnea, generalized sweating, and racing heart - Panic disorder Which of the following antiemetic drugs would most benefit a patient who experiences nausea and vomiting associated with motion sickness? - Dimenhydrinate (Dramamine) patient is receiving hydroxyzine (Vistaril) for complaints of nausea and vomiting. Consider the following adverse effects of the drug, and select the one that is most significant. - Sedation A patient has been instructed to use meclizine (Bonine) to prevent motion sickness. Select the statement that demonstrates that the patient understands proper use of the drug. - Administer at least 30 minutes and preferably 1-2 hours before travel. A patient who frequently takes diphenhydramine (Benadryl) to prevent motion sickness is scheduled for skin testing to diagnose possible allergies. For what number of days should the patient refrain from taking diphenhydramine before skin testing? - 4 A patient has a drug order for prochlorperazine (Compazine) for management of nausea and vomiting. Review the following statements, and select the one that most accurately describes the action of the drug. - It blocks the effects of dopamine in the chemoreceptor trigger zone. Which of the following extrapyramidal adverse effects is associated with phenothiazine drugs? - Pseudoparkinsonism Phenothiazines most successfully treat nausea and vomiting produced by which of the following? - Radiation therapy and chemotherapy Which of the following factors are associated with psychogenic vomiting? Select all that apply. - Physical syndrome Sexual abuse Posttraumatic stress Eating disorders A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe: - ondansetron (Zofran). A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise. The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch: - every 3 days. A primary care NP sees a patient 2 days after an outpatient surgical procedure. The patient reports using ondansetron for nausea. The NP notes a blood pressure of 88/56 mm Hg, and the patient reports feeling faint. The NP should suspect: - drug toxicity. A patient reports having episodes of dizziness, nausea, and lightheadedness and describes a sensation of the room spinning when these occur. The primary care NP will refer the patient to a specialist who, after diagnostic testing, is likely to prescribe: - meclizine. A patient is in the clinic complaining of nausea and vomiting that has lasted 2 to 3 days. The patient has dry oral mucous membranes, a blood pressure of 90/56 mm Hg, a pulse of 96 beats per minute, and a temperature of 38.8° C. The primary care NP notes a capillary refill of greater than 3 seconds. The NP should: - admit to the hospital for intravenous (IV) rehydration. A patient who is about to begin chemotherapy expresses concern to the primary care NP about gastrointestinal side effects of the treatments. The NP should reassure the patient that: - taking ondansetron before chemotherapy decreases nausea and vomiting. A primary care NP sees a 3-year-old patient who has been vomiting for several days. The child has had fewer episodes of vomiting the past day and is now able to take sips of fluids without vomiting. The child has dry oral mucous membranes, 2-second capillary refill, and pale but warm skin. The child's blood pressure is 88/46 mm Hg, the heart rate is 110 beats per minute, and the temperature is 37.2° C. The NP should: - begin oral rehydration therapy. Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that effects lower esophageal sphincter (LES) tone: - Estrogen Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Foods that may aggravate GERD include: - White bread Metoclopramide improves GERD symptoms by: - Increasing lower esophageal tone Antacids treat GERD by: - Increasing gastric pH When treating patients using the "Step-Down" approach the patient with GERD is started on ____ first. - Proton pump inhibitors When using the "Step-Up" approach in caring for patients with GERD, the "step up" from OTC antacid use is: - Histamine2 receptor antagonist (ranitidine) for 4 to 8 When using the "Step-Up" approach in caring for patients with GERD, the "step up" from once daily proton pump inhibitor use is: - Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks When using "Step-Up" therapy for GERD, the next "step up" in treatment when a patient has been on proton pump inhibitors for 12 weeks is: - Referral for endoscopy Infants with reflux are initially treated with: - Anti-reflux maneuvers (elevate head of bed) Long-term use of proton pump inhibitors may lead to: - Hip fractures in at-risk persons An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: - Proton pump inhibitor BID plus clarithromycin plus amoxicillin for 14 days Treatment failure in patients with peptic ulcer disease associated with H. pylori may be due to: - Antimicrobial resistance If a patient with H. pylori positive peptic ulcer disease fails first-line therapy the second-line treatment is: - Proton pump inhibitor BID plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: - Testing for H. pylori eradication with a serum ELISA test Endoscopy by a specialist Proton pump inhibitor for 8 to 12 weeks until healing is complete A patient who has gastroesophageal reflux disease (GERD) undergoes an endoscopy, which shows a hiatal hernia. The patient is mildly obese. The patient asks the primary care nurse practitioner (NP) about treatment options. The NP should tell this patient that: - a combination of lifestyle changes, medications, and surgery may be necessary. A patient undergoes endoscopy, and a diagnosis of erosive esophagitis is made. The patient does not have health insurance and asks the primary care NP about using OTC antacids such as Tums. The NP should tell the patient that Tums: - help reduce symptoms in conjunction with PPIs. A patient who has GERD with erosive esophagitis has been taking a PPI for 4 weeks and reports a decrease in symptoms. The patient asks the primary care NP if the medication may be discontinued. The NP should tell the patient that: - the dose may be decreased for long-term therapy. A patient in the clinic reports heartburn 30 minutes after meals, a feeling of fullness, frequent belching, and a constant sour taste. The patient has a normal weight and reports having a high-stress job. The primary care NP should recommend: - daily treatment with a PPI. A patient who has GERD has been taking a PPI for 2 months and reports a slight decrease in symptoms. The next response of the primary care NP is to: - add a histamine-2-receptor agonist. A patient is taking a low-dose PPI for long-term management of GERD and reports taking sodium bicarbonate (Alka-Seltzer) to help with occasional heartburn. The primary care NP should tell the patient to: - take calcium carbonate (Tums) instead of sodium bicarbonate (Alka-Seltzer). An 80-year-old patient asks a primary care NP about OTC antacids for occasional heartburn. The NP notes that the patient has a normal complete blood count and normal electrolytes and a slight elevation in creatinine levels. The NP should recommend: - calcium carbonate (Tums). Anorexia is the lack of desire to eat despite physiologic stimuli that would normally produce hunger. - True Because patterns of bowel evacuation differ greatly among individuals, constipation must be individually defined. - True Parietal pain is diffuse because nerve endings in abdominal organs are sparse and multisegmented. - False. Parietal pain arises from the parietal peritoneum. With losses of more than 1000 ml or more, the heart rate is greater than 100 beats per minute and systolic blood pressure is less than 100 mm Hg. - True Chronic gastritis of the fundus occurs more frequently than chronic gastritis of the antrum. - False. Chronic antral gastritis generally involves the antrum only and is approximately four times more common than fundal gastritis. Chronic gastritis tends to occur in older adults and causes thinning and degeneration of the stomach wall. - True Endoscopy and biopsy may show long-standing inflammatory process and gastric atrophy indicating chronic gastritis in an individual with no history of abdominal distress. - True After a gastrectomy, individuals develop anemia from deficiencies in iron, folate, and vitamin B12. - True Obesity is defined as a body mass index (BMI) greater than 40. - False. Obesity is an energy imbalance, with energy intake exceeding energy expenditure, and is defined as a BMI greater than 30. Ammonia formation may increase hepatic encephalopathy. - True Hepatitis D virus (HDV) occurs in individuals with hepatitis B. - True Hepatitis A is transmitted through infected blood and other body fluids. - False. The usual mode of transmission is the fecal-oral route (contaminated food or water), but the virus can be spread also by the transfusion of infected blood. Approximately 45% of adults in urban areas have hepatitis A virus antibodies in their blood Hepatitis B is a sexually transmitted disease. - True Individuals with chronic hepatitis C are at increased risk for chronic liver disease. - True Primary biliary cirrhosis can be a result of gallstones. - False. Primary biliary cirrhosis is an autoimmune disease of unknown etiology leading to destruction of small intrahepatic bile ducts. The chemoreceptor trigger zone (CTZ) for vomiting is located in the: - medulla oblongata. The action of antiemetics, such as domperidone, and haloperidol is to _____ the effects of _____. - stimulate; dopamine (D2) _____ vomiting is caused by direct stimulation of the vomiting center by neurologic lesions involving the brainstem. - Projectile Normal bowel habits range from two or three evacuations per day to one per: - week More than _____ stools per day is considered abnormal. - Three The adult intestine processes approximately _____ L of luminal content per day. - 9 A person who has cholera would be expected to have which type of diarrhea? - Secretory The type of diarrhea that is a result of unhydrolyzed lactose is referred to as: - osmotic. Which statement is false about how abdominal pain is produced? - Low concentrations of anaerobes, such as streptococci, lactobacilli, staphylococci, enterobacteria, and Bacteroides, produce abdominal pain. Abdominal pain is best described as visceral pain that: - is diffused, vague, poorly localized, and dull. Gastroesophageal reflux disease (GERD) is a result of: - a zone of low pressure of the lower esophageal sphincter (LES). Frank bleeding of the rectum is called: - hematochezia. Functional dysphagia is caused by: - a neural or muscular disorder. Reflux esophagitis may be defined as a(n): - inflammatory response to gastroesophageal reflux. Intussusception causes intestinal obstruction by: - telescoping of part of the intestine into another usually causing strangulation of the blood supply The most commonly occurring small intestinal obstruction is: - adhesions An intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing the: - excessive loss of hydrogen ions normally absorbed from gastric juice. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with their provider or a pharmacist first? - Patients with kidney stones Patients taking antacids should be educated regarding these drugs, including: - They may cause constipation or diarrhea Many are high in sodium Separate antacids from other medications by 1 hour Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamid - Slows gastric motility and reduces fluid and electrolyte loss from diarrhea Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: - May lead to toxicity if taken with aspirin Is contraindicated in children with flu-like illness Has antimicrobial effects against bacterial and viral enteropathogens Hannah will be traveling to Mexico with her church group over Spring Break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes normal food and water precautions as well as: - Bismuth subsalicylate with each meal and bedtime Josie is a 5 year old who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? - Ondansetron (Zofran) Jim presents with complaints of "heart burn" that is minimally relieved with Tums (calcium carbonate) and is diagnosed with GERD. An appropriate first step therapy would be: - Ranitidine (Zantac) twice a day Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: - Iron deficiency anemia, vitamin B12 and calcium deficiency Sadie is a 72 year old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: - Osteoporosis Patrick is a 10 year old who presents with constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10 year old would be: - PEG 3350 (Miralax) Which of the following electrolyte abnormalities would be expected to be present in a patient who has a drug order for a cation-exchange resin? - Hyperkalemia Which of the following adverse effects would a health care provider expect to see in a patient receiving sodium polystyrene sulfonate resin (Kayexalate)? - Nausea and vomiting Review the following diagnoses, and select the one that would cause a health care provider to use sodium polystyrene sulfonate resin (Kayexalate) with caution. - Heart failure Which of the following substances is appropriate for mixing with a dose of oral sodium polystyrene sulfonate resin (Kayexalate)? - Sorbitol Which of the following serum laboratory studies should be evaluated by the health care provider who is determining the effectiveness of lactulose (Cephulac)? - Ammonia Evaluate the following conditions that may be noted in older adults, and select the one that can be treated with lactulose (Cephulac). - Constipation Neomycin (Mycifradin sulfate) is ordered for the patient who is to undergo bowel surgery. Which of the following purposes would accurately explain to the patient the action of this drug and why it is being used preoperatively? - To decrease the gastrointestinal (GI) tract bacterial coun patient in the clinic reports frequent episodes of bloating, abdominal pain, and loose stools to the primary care nurse practitioner (NP). An important question the NP should ask about the abdominal pain is: - the relation of the pain to stools. A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe: - dicyclomine (Bentyl). A woman with IBS has been taking antispasmodic medications and reports some relief, but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain. The NP should consider prescribing: - tricyclic antidepressants (TCAs). A patient who has IBS experiences diarrhea, bloating, and pain but does not want to take medication. The primary care NP should recommend: - 25 g of fiber each day A patient who has IBS has been taking dicyclomine and reports decreased pain and diarrhea but is now having occasional constipation. The primary care NP should recommend: - over-the-counter (OTC) laxatives as needed when constipated. A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS. The patient comes to the clinic and reports having dry mouth, difficulty urinating, and more frequent constipation. The primary care NP notes a heart rate of 92 beats per minute. The NP should: - lower the dose of the antispasmodic medication. A woman has severe IBS and takes hyoscyamine sulfate (Levsin), simethicone (Phazyme), and a TCA. She reports having continued severe diarrhea. The primary care NP should: - refer her to a gastroenterologist for endoscopy. A patient who has diabetic gastroparesis sees a gastroenterology specialist who orders metoclopramide (Reglan). Within 24 hours, the patient describes having extrapyramidal symptoms (EPS) to the primary care NP. The NP will contact the gastroenterologist and should expect to prescribe: - benztropine (Cogentin). A woman who is 4 months pregnant comes to the clinic with acute diarrhea and nausea. Her husband is experiencing similar symptoms. The primary care nurse practitioner (NP) notes a temperature of 38.5° C, a heart rate of 92 beats per minute, and a blood pressure of 100/60 mm Hg. The NP should: - refer her to an emergency department for intravenous (IV) fluids. A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should: - order testing for Clostridium difficile and consider metronidazole therapy A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are: - not curative and may prolong the illness. A patient who has experienced five to seven liquid stools for 3 days is seen in the clinic by the primary care NP. The patient reports having had fever, mucoid stools, and nausea without vomiting. The patient has been drinking Gatorade to stay hydrated. The NP obtains a stool specimen for culture and should prescribe: - bismuth subsalicylate (Pepto-Bismol). A 2-year-old child has chronic "toddler's" diarrhea, which has an unknown but benign etiology. The child's parent asks the primary care NP if a medication can be used to treat the child's symptoms. The NP should recommend giving: - an electrolyte solution (Pedialyte). A patient comes to the clinic with a 4-day history of 10 to 12 liquid stools each day. The patient reports seeing blood and mucus in the stools. The patient has had nausea but no vomiting. The primary care NP notes a temperature of 37.9° C, a heart rate of 96 beats per minute, and a blood pressure of 90/60 mm Hg. A physical examination reveals dry oral mucous membranes and capillary refill of 4 seconds. The NP's priority should be to: - begin rehydration therapy. A 12-year-old patient has acute diarrhea and an upper respiratory infection. Other family members have had similar symptoms, which have resolved. The primary care NP should recommend: - an electrolyte solution (Pedialyte). A primary care nurse practitioner (NP) sees a patient who is concerned about constipation. The NP learns that the patient has three to four bowel movements per week with occasional hard stools but no straining with defecation. The NP should recommend: - increased intake of fluids and fiber. A patient reports having occasional acute constipation with large, hard stools and pain and asks the primary care NP about medication to treat this condition. The NP learns that the patient drinks 1500 mL of water daily; eats fruits, vegetables, and bran; and exercises regularly. The NP should recommend: - a saline laxative as needed. A 5-year-old child has chronic constipation. The primary care NP plans to prescribe a laxative for long-term management. In addition to pharmacologic therapy, the NP should also recommend _____ g of fiber per day. - 10 A patient who has cerebral palsy is wheelchair dependent and receives enteral nutrition via a gastrostomy tube. The patient has infrequent, hard bowel movements despite using a high-fiber formula and receiving 1500 mL of fluid per day. The NP should order: - polyethylene glycol (MiraLAX). A primary care NP sees a patient who reports having decreased frequency of stools over the past few months. In the clinic today, the patient has severe abdominal cramping and an abdominal radiograph shows an increased stool load in the sigmoid colon and rectum. The NP should: - order a sodium phosphate enema and psyllium (Metamucil). A female patient who is underweight tells the primary care NP that she has been using bisacodyl (Dulcolax) daily for several years. The NP should: - prescribe docusate sodium (Colace) and decrease bisacodyl gradually. A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation. The patient reports having an increased frequency of episodes. The primary care NP should recommend: - adding docusate sodium (Colace). A patient who takes digoxin reports taking psyllium (Metamucil) three or four times each month for constipation. The primary care NP should counsel this patient to: - take the digoxin 2 hours before taking the psyllium. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90 percent of Type 1 diabetics have: - Autoantibodies to two tyrosine phosphatases Type 2 diabetes is a complex disorder involving: - A suboptimal response of insulin-sensitive tissues in the liver