LEIK FNP FINAL EXAM TESTBANK WITH REAL
QUESTIONS AND A+ GRADE SOLUTIONS BY
EXPERT/A+GRADED
Why is Rhogam given? - ANSWER: Rho(D) immune globulin (RhoGAM) is used to
prevent the immunological condition known as rhesus disease or hemolytic disease
of the newborn. RhoGAM is a solution of IgG anti-D (anti-RhD) antibodies that
suppresses the mother's immune system from attacking Rh-positive blood cells that
have entered the maternal bloodstream from fetal circulation. In an Rh-negative
mother, RhoGAM can prevent temporary sensitization of the maternal immune
system to RhD antigens, which can cause Rh disease in the current or subsequent
pregnancies.
Pt with GERD abrupt stop of PPI, with Barrett's esophagus - ANSWER: This patient is
having severe rebound symptoms caused by abrupt cessation of the proton-pump
inhibitor (PPI). In addition, he has Barrett's esophagus, which increases the risk of
esophageal cancer. Neither an antacid nor an H2 blocker is likely to be effective in
controlling his symptoms. This question is a good example of the ethical concept of
beneficence
Depo-Provera side effect after 5 years - ANSWER: Depo-Provera (contraceptive
injection) is a progesterone hormone that causes cessation of periods. One common
side effect seen in women who have been taking Depo-Provera for more than 5
years is amenorrhea. As women continue using Depo-Provera, fewer experience
irregular bleeding and more experience amenorrhea. By month 12, amenorrhea was
reported by 55% of women, and by month 24, amenorrhea was reported by 68% of
women.
NSAIDs affect which systems: - ANSWER: Chronic use of nonsteroidal anti-
inflammatory drugs (NSAIDs) is associated with increased risk of ulcers, perforation,
and bleeding of the gastrointestinal tract, heart attacks, cardiovascular damage,
strokes, acute interstitial nephritis and kidney injury, and liver damage. It does not
affect the lungs or the pulmonary system.
Watery diarrhea after hospitalization and Clindamycin therapy - ANSWER: Important
risk factors for CDAD and C. difficile colitis are antibiotic therapy and hospitalization.
Almost any antibiotic can cause the condition, but the most common are
clindamycin, cephalosporins, and fluoroquinolones. Diarrhea can occur during as
well as after therapy (5-10 days; up to 10 weeks). Pseudomembranous colitis is a
complication of C. difficile colitis.
Drug interaction with Levothyroxine - ANSWER: Levothyroxine does not interact with
penicillins. But it does have numerous drugs it interacts with such as anticoagulants,
tricyclic antidepressants, antacids and calcium, iron, multivitamins, proton-pump
inhibitors, estrogens, statins, metformin, and others. Certain foods interfere with
absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid
,taking them together, and should space these foods and drugs several hours apart.
Levothyroxine (Synthroid) is a synthetic form of T4.
First line therapy for pain in acute exacerbation of gout - ANSWER: Nonsteroidal anti-
inflammatory drugs (NSAIDs), such as indomethacin (Indocin), have been used for
the treatment of acute gout. Colchicine may be added to the NSAIDs if relief is not
obtained. Maintenance therapy consists of allopurinol and/or probenecid.
Allopurinol is used to prevent gout attacks, not to treat them once they occur. It may
take several months or longer before the full benefit of allopurinol is felt. Allopurinol
may increase the number of gout attacks during the first few months that it is taken,
although it will eventually prevent attacks. Systemic steroids are reserved as a
second-line option for patients who cannot take NSAIDs.
Atypical Antipsychotic adverse effects - ANSWER: Orthostatic hypotension and
sedation are common side effects of atypical antipsychotics such as olanzapine
(Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal). It is also a common
side effect of the older antipsychotics like haloperidol (Haldol). Antipsychotics do not
cause severe anxiety and decreased appetite. They lower anxiety and cause
sedation, sleepiness, anorexia, and hypotension, and increase the risk of sudden
death in frail elders.
Which medication is contraindicated for bone loss? - ANSWER: Long-term use (>3
years) of medroxyprogesterone (Depo-Provera) increases risk of bone loss. Avoid
with osteopenia, osteoporosis, long-term amenorrhea, or in underweight women
with anorexia. First-line treatment of osteoporosis is the biphosphanates. Lifestyle
measures are weight-bearing exercises and adequate calcium and vitamin D intake.
Prophylactic treatment for migraine headaches - ANSWER: Propranolol (Inderal) is a
beta-blocker. Sufficient evidence and consensus exist to recommend propranolol,
timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line
agents for migraine prevention. The goal of preventive therapy is to improve
patients' quality of life by reducing migraine frequency, severity, and duration, and
by increasing the responsiveness of acute migraines to treatment. A full therapeutic
trial may take 2 to 6 months. Ibuprofen (Motrin), naproxen sodium (Anaprox), and
sumatriptan (Imitrex) are all medications used to treat symptoms of migraine
headache
Which medication does not cause insomnia? 1. Zoloft 2. Sudafed 3. Theophylline 4.
Xanax - ANSWER: Alprazolam (Xanax) and other benzodiazepines cause sedation and
promote sleep. But selective serotonin reuptake inhibitors (SSRIs), such as sertraline
(Zoloft), can cause insomnia in some patients. Other drug classes with stimulating
effects are decongestants, such as pseudoephedrine (Sudafed), and methylxanthines
such as theophylline (Theo-Dur) and caffeine.
Contraindication for Wellbutrin (bupropion) - ANSWER: Bupropion increases the risk
of seizures. Contraindications are seizures, anorexia nervosa, and bulimia. Avoid with
any condition that increases seizures, such as after abrupt withdrawal of alcohol or
,sedatives and with certain head injuries. For peripheral neuropathy, treatment
options are an SNRI (duloxetine/Cymbalta), tricyclic antidepressants,
anticonvulsants, topical capsaicin cream, and others.
Recommended treatment for erythema migrans or early Lyme disease - ANSWER:
Erythema migrans is the rash characteristic of Lyme disease and it usually appears 7
to 10 days after a tick bite. Lyme disease is caused by Borrelia burgdorferi, a
spirochete. The rash appears either as a single expanding red patch or a central spot
surrounded by clear skin that is in turn ringed by an expanded red rash (bull's eye).
The choice of antibiotic depends on bacterial sensitivity. Doxycycline 100 mg BID for
14 to 21 days is the recommended treatment of adults.
Digoxin - ANSWER: - treats SVT and HF d/t left ventricular systolic dysfunction
- narrow therapeutic index (.5-2 n/ml)
- not first line for hR control with AFIB
- Overdose: starts with GI symptoms. Arrhythmias, confusion, yellow-green tinged
vision, scotomas
-lab tests to order - digoxin level, electrolytes (K, Mg, Ca), Crt, serial EKGs
- Tx: IgG antidigoxin antibodies that bind free digoxin in blood (Digibind, Digifab)
Warfarin (Coumadin) - ANSWER: - Vitamin K antagonist
- Indication: prophylaxis and tx for thromboembolic events assoc. with Afib or heart
valve replacement (PE, DVT, stroke, thromboembolism)
- Duration of action - 2-5 days
- For atrial fibrillation, target INR is 2.0 to 3.0 (ideal INR 2.5)
Initial dose (outpatients): Starting dose 2 to 5 mg orally once a day (maintenance
dose 2 to 10 mg per day based on INR value); may start lower doses if elderly
patient, liver disease, etc; do not forget to check baseline PT, aPTT, creatinine, LFTs,
and INROn day 3 (outpatient): Periodically check INR (dose changes are based on INR
value); consult with clinic's or hospital's warfarin-dosing protocols.
Beta-Blockers - ANSWER: Indication: Hypertension, postmyocardial infarction (MI),
angina, arrhythmias, and migraine prophylaxis
Contraindication:
Asthma (causes bronchoconstriction)
Chronic obstructive pulmonary disease (COPD; causes bronchoconstriction)
Chronic bronchitis (causes bronchoconstriction)
Emphysema (causes bronchoconstriction)
Bradycardia and atrioventricular (AV) block (second- to third-degree block)
First line treatment for gonorrhea - ANSWER: Rocephin 250 mg IM
First line therapy MRSA skin infection - ANSWER: Bactrim DS,
doxycycline/minocyclin, or clindamycin
- x5-10 days
-DO NOT use cephalosporin
, First line treatment for COPD with mild dyspnea - ANSWER: - SABA (albuterol,
levalbuterol) or
- Short acting anticholinergic (ipatropium bromide) or BOTH
- if not effective, next step: LABA or long acting anticholinergic or BOTH
Alternative tx for strep A with PCN allergy - ANSWER: Macrolide:
Z-pack x 5 days or clarithromycin 250mg BID
Initial treatment for uncomplicated mononucleosis: - ANSWER: - Peniciliin V 250 mg
PO TID x 10 days
- DO NOT use amoxicillin for mononucleosis - risk of drug rash (not allergy)
Rhinitis medicamentosa - ANSWER: due to chronic use of nasal decongestant (>3
days)
Max days Toradol can be used - ANSWER: 5 days
Do not give aspirin for children under 12 yo - ANSWER: Reye's Syndrome
Low-potency steroid body areas - ANSWER: face, intertriginous areas, genitals
5 rights - ANSWER: 1. right patient
2. right drug
3. right dose
4. right time
5. right route
First line treatment for poly myalgia rheumatic: - ANSWER: Patients with polymyalgia
rheumatica (PMR) are treated with oral corticosteroids such as prednisone. One of
the hallmarks of the disorder is the dramatic improvement of symptoms after
starting treatment with oral prednisone. Usually, the symptoms can be controlled
with long-term (2-3 years) low-dose oral prednisone, which can be tapered when
symptoms are under control. For most patients, PMR is a self-limiting illness (from a
few months to 3 years).
Triple therapy for H. Pylori: - ANSWER: Clarithromycin BID, Amoxicillin BID,
Omeprazole QD x 14 days
Hives and swollen lips with Bactrim - ANSWER: The patient can take sulfonylureas.
The sulfonamide component in the typical sulfa antibiotics is of a slightly different
molecular structure than that in sulfonylureas. Although cross-reactivity is
technically possible, current literature does not consider this likely, and sulfonylureas
are typically well tolerated in patients with a sulfa allergy.
HTN medication associated with largest amount of research studies: - ANSWER:
Thiazide diuretics.
QUESTIONS AND A+ GRADE SOLUTIONS BY
EXPERT/A+GRADED
Why is Rhogam given? - ANSWER: Rho(D) immune globulin (RhoGAM) is used to
prevent the immunological condition known as rhesus disease or hemolytic disease
of the newborn. RhoGAM is a solution of IgG anti-D (anti-RhD) antibodies that
suppresses the mother's immune system from attacking Rh-positive blood cells that
have entered the maternal bloodstream from fetal circulation. In an Rh-negative
mother, RhoGAM can prevent temporary sensitization of the maternal immune
system to RhD antigens, which can cause Rh disease in the current or subsequent
pregnancies.
Pt with GERD abrupt stop of PPI, with Barrett's esophagus - ANSWER: This patient is
having severe rebound symptoms caused by abrupt cessation of the proton-pump
inhibitor (PPI). In addition, he has Barrett's esophagus, which increases the risk of
esophageal cancer. Neither an antacid nor an H2 blocker is likely to be effective in
controlling his symptoms. This question is a good example of the ethical concept of
beneficence
Depo-Provera side effect after 5 years - ANSWER: Depo-Provera (contraceptive
injection) is a progesterone hormone that causes cessation of periods. One common
side effect seen in women who have been taking Depo-Provera for more than 5
years is amenorrhea. As women continue using Depo-Provera, fewer experience
irregular bleeding and more experience amenorrhea. By month 12, amenorrhea was
reported by 55% of women, and by month 24, amenorrhea was reported by 68% of
women.
NSAIDs affect which systems: - ANSWER: Chronic use of nonsteroidal anti-
inflammatory drugs (NSAIDs) is associated with increased risk of ulcers, perforation,
and bleeding of the gastrointestinal tract, heart attacks, cardiovascular damage,
strokes, acute interstitial nephritis and kidney injury, and liver damage. It does not
affect the lungs or the pulmonary system.
Watery diarrhea after hospitalization and Clindamycin therapy - ANSWER: Important
risk factors for CDAD and C. difficile colitis are antibiotic therapy and hospitalization.
Almost any antibiotic can cause the condition, but the most common are
clindamycin, cephalosporins, and fluoroquinolones. Diarrhea can occur during as
well as after therapy (5-10 days; up to 10 weeks). Pseudomembranous colitis is a
complication of C. difficile colitis.
Drug interaction with Levothyroxine - ANSWER: Levothyroxine does not interact with
penicillins. But it does have numerous drugs it interacts with such as anticoagulants,
tricyclic antidepressants, antacids and calcium, iron, multivitamins, proton-pump
inhibitors, estrogens, statins, metformin, and others. Certain foods interfere with
absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid
,taking them together, and should space these foods and drugs several hours apart.
Levothyroxine (Synthroid) is a synthetic form of T4.
First line therapy for pain in acute exacerbation of gout - ANSWER: Nonsteroidal anti-
inflammatory drugs (NSAIDs), such as indomethacin (Indocin), have been used for
the treatment of acute gout. Colchicine may be added to the NSAIDs if relief is not
obtained. Maintenance therapy consists of allopurinol and/or probenecid.
Allopurinol is used to prevent gout attacks, not to treat them once they occur. It may
take several months or longer before the full benefit of allopurinol is felt. Allopurinol
may increase the number of gout attacks during the first few months that it is taken,
although it will eventually prevent attacks. Systemic steroids are reserved as a
second-line option for patients who cannot take NSAIDs.
Atypical Antipsychotic adverse effects - ANSWER: Orthostatic hypotension and
sedation are common side effects of atypical antipsychotics such as olanzapine
(Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal). It is also a common
side effect of the older antipsychotics like haloperidol (Haldol). Antipsychotics do not
cause severe anxiety and decreased appetite. They lower anxiety and cause
sedation, sleepiness, anorexia, and hypotension, and increase the risk of sudden
death in frail elders.
Which medication is contraindicated for bone loss? - ANSWER: Long-term use (>3
years) of medroxyprogesterone (Depo-Provera) increases risk of bone loss. Avoid
with osteopenia, osteoporosis, long-term amenorrhea, or in underweight women
with anorexia. First-line treatment of osteoporosis is the biphosphanates. Lifestyle
measures are weight-bearing exercises and adequate calcium and vitamin D intake.
Prophylactic treatment for migraine headaches - ANSWER: Propranolol (Inderal) is a
beta-blocker. Sufficient evidence and consensus exist to recommend propranolol,
timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line
agents for migraine prevention. The goal of preventive therapy is to improve
patients' quality of life by reducing migraine frequency, severity, and duration, and
by increasing the responsiveness of acute migraines to treatment. A full therapeutic
trial may take 2 to 6 months. Ibuprofen (Motrin), naproxen sodium (Anaprox), and
sumatriptan (Imitrex) are all medications used to treat symptoms of migraine
headache
Which medication does not cause insomnia? 1. Zoloft 2. Sudafed 3. Theophylline 4.
Xanax - ANSWER: Alprazolam (Xanax) and other benzodiazepines cause sedation and
promote sleep. But selective serotonin reuptake inhibitors (SSRIs), such as sertraline
(Zoloft), can cause insomnia in some patients. Other drug classes with stimulating
effects are decongestants, such as pseudoephedrine (Sudafed), and methylxanthines
such as theophylline (Theo-Dur) and caffeine.
Contraindication for Wellbutrin (bupropion) - ANSWER: Bupropion increases the risk
of seizures. Contraindications are seizures, anorexia nervosa, and bulimia. Avoid with
any condition that increases seizures, such as after abrupt withdrawal of alcohol or
,sedatives and with certain head injuries. For peripheral neuropathy, treatment
options are an SNRI (duloxetine/Cymbalta), tricyclic antidepressants,
anticonvulsants, topical capsaicin cream, and others.
Recommended treatment for erythema migrans or early Lyme disease - ANSWER:
Erythema migrans is the rash characteristic of Lyme disease and it usually appears 7
to 10 days after a tick bite. Lyme disease is caused by Borrelia burgdorferi, a
spirochete. The rash appears either as a single expanding red patch or a central spot
surrounded by clear skin that is in turn ringed by an expanded red rash (bull's eye).
The choice of antibiotic depends on bacterial sensitivity. Doxycycline 100 mg BID for
14 to 21 days is the recommended treatment of adults.
Digoxin - ANSWER: - treats SVT and HF d/t left ventricular systolic dysfunction
- narrow therapeutic index (.5-2 n/ml)
- not first line for hR control with AFIB
- Overdose: starts with GI symptoms. Arrhythmias, confusion, yellow-green tinged
vision, scotomas
-lab tests to order - digoxin level, electrolytes (K, Mg, Ca), Crt, serial EKGs
- Tx: IgG antidigoxin antibodies that bind free digoxin in blood (Digibind, Digifab)
Warfarin (Coumadin) - ANSWER: - Vitamin K antagonist
- Indication: prophylaxis and tx for thromboembolic events assoc. with Afib or heart
valve replacement (PE, DVT, stroke, thromboembolism)
- Duration of action - 2-5 days
- For atrial fibrillation, target INR is 2.0 to 3.0 (ideal INR 2.5)
Initial dose (outpatients): Starting dose 2 to 5 mg orally once a day (maintenance
dose 2 to 10 mg per day based on INR value); may start lower doses if elderly
patient, liver disease, etc; do not forget to check baseline PT, aPTT, creatinine, LFTs,
and INROn day 3 (outpatient): Periodically check INR (dose changes are based on INR
value); consult with clinic's or hospital's warfarin-dosing protocols.
Beta-Blockers - ANSWER: Indication: Hypertension, postmyocardial infarction (MI),
angina, arrhythmias, and migraine prophylaxis
Contraindication:
Asthma (causes bronchoconstriction)
Chronic obstructive pulmonary disease (COPD; causes bronchoconstriction)
Chronic bronchitis (causes bronchoconstriction)
Emphysema (causes bronchoconstriction)
Bradycardia and atrioventricular (AV) block (second- to third-degree block)
First line treatment for gonorrhea - ANSWER: Rocephin 250 mg IM
First line therapy MRSA skin infection - ANSWER: Bactrim DS,
doxycycline/minocyclin, or clindamycin
- x5-10 days
-DO NOT use cephalosporin
, First line treatment for COPD with mild dyspnea - ANSWER: - SABA (albuterol,
levalbuterol) or
- Short acting anticholinergic (ipatropium bromide) or BOTH
- if not effective, next step: LABA or long acting anticholinergic or BOTH
Alternative tx for strep A with PCN allergy - ANSWER: Macrolide:
Z-pack x 5 days or clarithromycin 250mg BID
Initial treatment for uncomplicated mononucleosis: - ANSWER: - Peniciliin V 250 mg
PO TID x 10 days
- DO NOT use amoxicillin for mononucleosis - risk of drug rash (not allergy)
Rhinitis medicamentosa - ANSWER: due to chronic use of nasal decongestant (>3
days)
Max days Toradol can be used - ANSWER: 5 days
Do not give aspirin for children under 12 yo - ANSWER: Reye's Syndrome
Low-potency steroid body areas - ANSWER: face, intertriginous areas, genitals
5 rights - ANSWER: 1. right patient
2. right drug
3. right dose
4. right time
5. right route
First line treatment for poly myalgia rheumatic: - ANSWER: Patients with polymyalgia
rheumatica (PMR) are treated with oral corticosteroids such as prednisone. One of
the hallmarks of the disorder is the dramatic improvement of symptoms after
starting treatment with oral prednisone. Usually, the symptoms can be controlled
with long-term (2-3 years) low-dose oral prednisone, which can be tapered when
symptoms are under control. For most patients, PMR is a self-limiting illness (from a
few months to 3 years).
Triple therapy for H. Pylori: - ANSWER: Clarithromycin BID, Amoxicillin BID,
Omeprazole QD x 14 days
Hives and swollen lips with Bactrim - ANSWER: The patient can take sulfonylureas.
The sulfonamide component in the typical sulfa antibiotics is of a slightly different
molecular structure than that in sulfonylureas. Although cross-reactivity is
technically possible, current literature does not consider this likely, and sulfonylureas
are typically well tolerated in patients with a sulfa allergy.
HTN medication associated with largest amount of research studies: - ANSWER:
Thiazide diuretics.
