MN553 Unit 10 Final Exam / MN 553 Unit 10 Final Exam (Version 1,Newest ): Pharmacology: Kaplan University(ANSWERS VERIFIED ALL CORRECT)

MN 553 Final Exam / MN553 Final Exam (Latest): Pharmacology: Kaplan University MN553 Unit 10 Final Exam / MN 553 Unit 10 Final Exam (Latest): Pharmacology: Kaplan University Subsection Question 1 Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: Question options: Increasing heart rate to improve cardiac output Reducing vascular smooth muscle tone Increasing aldosterone-mediated volume activity Reducing aqueous humor production Question 2 4 / 4 points Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? Question options: All opiates are scheduled drugs which require a DEA license to prescribe. Opiates stimulate only mu receptors for the control of pain. Most of the adverse effects of opiates are related to mu receptor stimulation. Naloxone is an antagonist to opiates. Question 3 4 / 4 points When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? Question options: Total LDL Fasting HDL Coronary artery disease risk level Fasting total cholesterol Question 4 4 / 4 points Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to: Question options: Search for information using the most common search engines Serve as content experts in developing, implementing, and evaluating information Systems Write programs to assure the integrity of health information Use information technology to prescribe drugs Question 5 4 / 4 points The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class: Question options: I II III IV Question 6 4 / 4 points An Investigational New Drug is filed with the U.S. Food and Drug Administration: Question options: When the manufacturer has completed phase III trials When a new drug is discovered Prior to animal testing of any new drug entity Prior to human testing of any new drug entity Question 7 4 / 4 points True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include: Question options: Fever up to 104oF (40.5oC) after previous DTaP vaccine Family history of seizures after DTaP vaccine Adolescent pregnancy Anaphylactic reaction with a previous dose Question 8 4 / 4 points A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to: Question options: Ensure the patient will not have increased adverse drug reactions to the tamoxifen Identify potential drug-drug interactions that may occur with tamoxifen Reduce the likelihood of therapeutic failure with tamoxifen treatment Identify poor metabolizers of tamoxifen Question 9 4 / 4 points Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? Question options: Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. Additive antimuscarinic effects may occur with antihistamines. Cholinergic blockers may decrease the sedative effects of hypnotics. Cholinergic blockers are contraindicated with antipsychotics. Question 10 4 / 4 points Absolute contraindications that clinicians must consider when initiating estrogen therapy include: Question options: Undiagnosed dysfunctional uterine bleeding Deep vein or arterial thromboemboli within the prior year Endometriosis Both a. and b. All of the above Question 11 4 / 4 points First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be: Question options: OTC topical azole (clotrimazole, miconazole) Oral terbinafine Oral griseofulvin microsize Nystatin cream or ointment Question 12 4 / 4 points Preventative therapy for cluster headaches includes: Question options: Massage or relaxation therapy Ergotamine nightly before bed Intranasal lidocaine four times a day during “clusters” of headaches Propranolol (Inderal) daily Question 13 4 / 4 points Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)? Question options: It has a shorter half-life and withdrawal syndrome has a faster onset without taper. It has the longest half-life and the withdrawal syndrome has a faster onset. It is quasi-addictive in the dopaminergic reward system. It is the most activating of SSRI medications and will cause the person to have sudden deep sadness. Question 14 4 / 4 points 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: Question options: Increase her dose Assess for suicidal ideation Discontinue the medication immediately Decrease her dose to half then slowly titrate up the dose Question 15 4 / 4 points The drug of choice for type 2 diabetics is metformin. Metformin: Question options: Decreases glycogenolysis by the liver Increases the release of insulin from beta cells Increases intestinal uptake of glucose Prevents weight gain associated with hyperglycemia Question 16 4 / 4 points Gender differences between men and women in pharmacokinetics include: Question options: More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations Slower organ blood flow rates so drugs tend to take longer to be excreted Question 17 4 / 4 points Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be: Question options: Sixteen ounces per day of cranberry juice cocktail will prevent UTIs. 100% cranberry juice or cranberry juice extract may decrease UTIs in some patients. There is no evidence that cranberry juice helps prevent UTIs. Cranberry juice only works to prevent UTIs in children. Question 18 4 / 4 points ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy? Question options: Diuretics ARBs Beta blockers Nitrates Question 19 4 / 4 points Which of the following holds true for the pharmacokinetics of women? Question options: Gastric emptying is faster than that of men. Organ blood flow is the same as that of men. Evidence is strong concerning renal differences in elimination. Medications that involve binding globulins are impacted by estrogen levels. Question 20 4 / 4 points Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: Question options: Complete blood count Blood glucose C-reactive protein BUN, creatinine, and creatinine clearance Question 21 4 / 4 points The most cost-effective treatment for two or three impetigo lesions on the face is: Question options: Mupirocin ointment Retapamulin (Altabax) ointment Topical clindamycin solution Oral amoxicillin/clavulanate (Augmentin) Question 22 4 / 4 points Which of the following statements is true about acute pain? Question options: Somatic pain comes from body surfaces and is only sharp and well-localized. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area. Question 23 4 / 4 points A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: Question options: Concentration will produce therapeutic effects Concentration will produce an adverse response Time between doses must be shortened Duration of action of the drug is too long Question 24 4 / 4 points While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are: Question options: Hemoglobin 14 g/dl or hematocrit 39% Hemoglobin 11.5 g/dl or hematocrit 31% Hemoglobin 13 g/dl or hematocrit 38% Hemoglobin 17.5 g/dl or hematocrit 54% Question 25 0 / 4 points A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with: Question options: Methimazole Propylthiouracil (PTU) Radioactive iodine Nothing, treatment is best delayed until after her pregnancy ends Question 26 4 / 4 points Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes: Question options: Monthly sputum cultures Monthly chest x-ray Bronchoscopy every 3 months All of the above Question 27 4 / 4 points Precautions that should be taken when prescribing controlled substances include: Question options: Faxing the prescription for a Schedule II drug directly to the pharmacy Using tamper-proof paper for all prescriptions written for controlled drugs Keeping any pre-signed prescription pads in a locked drawer in the clinic Using only numbers to indicate the amount of drug to be prescribed Question 28 4 / 4 points Patients who are prescribed exogenous androgens need to be warned that decreased libido: Question options: Is an unusual side effect of androgens and should be reported to the provider Is treated with increased doses of androgens, so the patient should let the provider know if he is having problems May be a sign of early prostate cancer and he should make an appointment for a prostate screening exam May occur with androgen therapy Question 29 4 / 4 points Which the following persons should not have a statin medication ordered? Question options: Someone with 3 first- or second-degree family members with history of muscle issues when started on statins Someone with high lipids, but low BMI Premenopausal woman with recent history of hysterectomy Prediabetic male with known metabolic syndrome Question 30 4 / 4 points When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as: Question options: Cost-minimization analysis Cost-of-illness analysis Cost-effectiveness analysis Cost-benefit analysis Question 31 4 / 4 points Ginseng, which is taken to assist with memory, may potentiate: Question options: Aricept Insulin Digoxin Propranolol Question 32 4 / 4 points Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include: Question options: Diabetics Those who have had an acute myocardial infarction in the past 6 months Patients who are deaf Patients under age 60 years of age Question 33 4 / 4 points Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: Question options: Appetite and concentration improve in the first 1 to 2 weeks. Sleep should improve almost immediately upon starting citalopram. Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose. His dysphoric mood will improve in 1 to 2 weeks. Question 34 4 / 4 points Patrick is a 10-year-old patient who presents with uncomfortable 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 child would be: Question options: PEG 3350 (Miralax) Bisacodyl (Dulcolax) suppository Docusate (Colace) suppository Polyethylene glycol electrolyte solution Question 35 4 / 4 points Which diuretic agents typically do not need potassium supplementation? Question options: The loop diuretics The thiazide diuretics The aldosterone inhibitors They all need supplementation Question 36 4 / 4 points According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: Question options: The belief among African Americans that prayer is more powerful than drugs Poor compliance on the part of the African American patient The genetic predisposition for illness found among African Americans Discrimination, cultural barriers, and lack of access to health care Question 37 4 / 4 points Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? Question options: Add an H2 blocker such as ranitidine to his therapy. Discontinue the aspirin and switch him to Vicodin for the pain. Decrease the aspirin dose to one tablet daily. Have Henry take an antacid 15 minutes before taking the aspirin each day. Question 38 4 / 4 points The Best Pharmaceuticals for Children Act: Question options: Includes a pediatric exclusivity rule which extends the patent on drugs studied in children Establishes a committee that writes guidelines for pediatric prescribing Provides funding for new drug development aimed at children Encourages manufacturers specifically to develop pediatric formulations Question 39 4 / 4 points Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? Question options: Juanita, a 28-year-old pregnant woman Sally, a 16-year-old healthy adolescent Jamie, a 24-year-old female Suzie, a 26-year-old diabetic Question 40 4 / 4 points Class I recommendations for stage A heart failure include: Question options: Aerobic exercise within tolerance levels to prevent the development of heart failure Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention Beta blockers for all patients regardless of cardiac history Treatment of thyroid disorders, especially if they are associated with Tachyarrhythmias Question 41 4 / 4 points All of the following statements about the Beer’s List are true except: Question options: It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available. It is derived from the expert opinion of one geriatrician and is not evidence-based. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities. These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration. Question 42 4 / 4 points Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include: Question options: The maximum time varenicline can be used is 12 weeks. Nausea is a sign of varenicline toxicity and should be reported to the provider. The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date. Neuropsychiatric symptoms may occur. Question 43 4 / 4 points If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be: Question options: Prokinetic (metoclopramide) for 4 to 8 weeks Proton pump inhibitor (omeprazole) for 12 weeks Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks Cytoprotective drug (misoprostol) for 2 weeks Question 44 4 / 4 points Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true? Question options: Screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0. Screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. Screening values are between 5 and 10, and therapeutic values are greater than 10. Question 45 4 / 4 points Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? Question options: Betamethasone, an inhaled corticosteroid Salmeterol, an inhaled long-acting beta-agonist Albuterol, a short-acting beta-agonist Montelukast, a leukotriene modifier Question 46 0 / 4 points The dosage of Vitamin B12 to initially treat pernicious anemia is: Question options: Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month Vitamin B12 IM monthly Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month Oral cobalamin 1,000 mcg daily Question 47 4 / 4 points If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be: Question options: IV or IM gentamicin IV or IM ceftriaxone IV amoxicillin IV ciprofloxacin Question 48 0 / 4 points Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: Question options: For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment For pedal edema throughout therapy Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm For vision changes, such as red-green blindness, at least annually Question 49 4 / 4 points Patients who have a poor metabolism phenotype will have: Question options: Slowed metabolism of a prodrug into an active drug, leading to accumulation of Prodrug Accumulation of inactive metabolites of drugs A need for increased dosages of medications Increased elimination of an active drug Question 50 4 / 4 points Developmental variation in renal function has what impact on prescribing for infants and children? Question options: Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months. Higher doses of water soluble drugs may need to be prescribed because of increased renal excretion. Renal excretion rates have no impact on prescribing. Parents need to be instructed on whether drugs are renally excreted or not. Question 51 4 / 4 points There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: Question options: Renal excretion is similar in both classes of drugs. When these drug classes are metabolized in the liver they both produce resistant enzymes. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms. There is not an issue with cross-resistance between the penicillins and cephalosporins. Question 52 4 / 4 points Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: Question options: Heart failure Angina Myocardial infarction Dyslipidemia Question 53 4 / 4 points Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated? Question options: Tinnitus Diarrhea Hearing loss Photosensitivity Question 54 4 / 4 points Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes: Question options: Use the inhaled corticosteroid first, followed by the inhaled beta-agonists. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid. Increase fluid intake to 3 liters per day. Avoid use of aspirin or ibuprofen while using inhaled medications. Question 55 4 / 4 points Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: Question options: Iron deficiency anemia, vitamin B12 and calcium deficiency Folate and magnesium deficiency Elevated uric acid levels leading to gout Hypokalemia and hypocalcemia Question 56 4 / 4 points Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because: Question options: It is a long-acting drug with potential for toxicity. Nitrate tolerance can develop. Orthostatic hypotension is a common adverse effect. It must be taken with milk or food. Question 57 4 / 4 points Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? Question options: Use correct medical terminology because Spanish has a Latin base. Use a family member who speaks more English to act as an interpreter. Use a professional interpreter or a reliable staff member who can act as an interpreter. Use careful, detailed explanations. Question 58 4 / 4 points Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that: Question options: Has a short half-life so that missing one dose has limited effect Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea and dizziness Must be taken no more than twice a day Question 59 4 / 4 points IV forms of bisphosphonates are used for all the following except: Question options: Severe gastric irritation with oral forms Known cancer mets into the bone Persons with advancing renal dysfunction Progression of bone loss on oral formulations Question 60 4 / 4 points The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: Question options: Requires all providers to screen their patients for methamphetamine use Restricts the prescribing of amphetamines to U.S. citizens Requires a prescription be written for all methamphetamine precursors in all states Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales Question 61 4 / 4 points To improve actual effectiveness of oral contraceptives women should be educated regarding: Question options: Use of a back-up method if they have vomiting or diarrhea during a pill packet Doubling pills if they have diarrhea during the middle of a pill pack The fact that they will have a normal menstrual cycle if they miss two pills The fact that mid-cycle spotting is not normal and the provider should be contacted immediately Question 62 4 / 4 points The action of “gliptins” is different from other antidiabetic agents because they: Question options: Have a low risk for hypoglycemia Are not associated with weight gain Close ATP-dependent potassium channels in the beta cell Act on the incretin system to indirectly increase insulin production Question 63 4 / 4 points What is the role of calcium supplements when patients take bisphosphonates? Question options: They must be restricted to allow the medication to work. They must be taken in sufficient amounts to provide foundational elements for bone growth. They must be taken at the same time as the bisphosphonates. They only work with bisphosphonates if daily intake is restricted. Question 64 4 / 4 points Medications are typically started for angina patients when: Question options: The first permanent EKG changes occur The start of class I or II symptoms The events trigger a trip to the emergency department When troponin levels become altered Question 65 4 / 4 points An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: Question options: Histamine2 receptor antagonists for 4 to 8 weeks Proton pump inhibitor bid for 12 weeks until healing is complete Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days Proton pump inhibitor bid and levofloxacin for 14 days Question 66 4 / 4 points Alterations in drug metabolism among Asians may lead to: Question options: Slower metabolism of antidepressants, requiring lower doses Faster metabolism of neuroleptics, requiring higher doses Altered metabolism of omeprazole, requiring higher doses Slower metabolism of alcohol, requiring higher doses Question 67 4 / 4 points The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: Question options: Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care. APRNs are less likely to prescribe narcotics and other controlled substances. APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice. Question 68 4 / 4 points Pharmacoeconomics is: Question options: The study of the part of the U.S. economy devoted to drug use The study of the impact of prescription drug costs on the overall economy The analysis of the costs and consequences of any health-care-related treatment or service The analysis of the clinical efficacy of the drug Question 69 4 / 4 points Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include: Question options: Metronidazole 2 grams PO x 1 dose Topical intravaginal metronidazole daily x 7 days Intravaginal clindamycin daily x 7 days Azithromycin 2 grams PO x 1 dose Question 70 4 / 4 points When determining drug treatment the NP prescriber should: Question options: Always use evidence-based guidelines Individualize the drug choice for the specific patient Rely on his or her experience when prescribing for complex patients Use the newest drug on the market for the condition being treated Question 71 4 / 4 points A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women? Question options: Body temperature varies between men and women. Muscle mass is greater in women. Percentage of fat differs between genders. Proven subjective factors exist between the genders. Question 72 4 / 4 points Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: Question options: Platelet count BUN and creatinine White blood cell count AST, ALT, alkaline phosphatase, and bilirubin Question 73 4 / 4 points Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: Question options: Urinary retention Cardiac output Peripheral edema Skin rash Question 74 4 / 4 points Which of the following is a primary benefit of the use of computerized provider order entry for patient medications? Question options: Reduces time that prescribing drugs takes Eliminates the need to chart drugs prescribed Decreases prescribing and transcription errors Helps keep the number of drugs prescribed to a minimum Question 75 4 / 4 points The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: Question options: 2 years 5 years 10 years 15 years Question 76 0 / 4 points Patient education regarding taking iron replacements includes: Question options: Doubling the dose if they miss a dose to maintain therapeutic levels Taking the iron with milk or crackers if it upsets their stomach Iron is best taken on an empty stomach with juice Antacids such as Tums may help the upset stomach caused by iron therapy Question 77 4 / 4 points When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: Question options: Not to take their regularly prescribed medications while on these antibiotics Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption Not to take antacids while on these medications, as the antacid decreases absorption That there are no drug interactions with these antibiotics Question 78 4 / 4 points Clinical judgment in prescribing includes: Question options: Factoring in the cost to the patient of the medication prescribed Always prescribing the newest medication available for the disease process Handing out drug samples to poor patients Prescribing all generic medications to cut costs Question 79 0 / 4 points Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: Question options: Topical antipruritics Oral corticosteroids for 2 to 3 weeks Thickly applied topical intermediate-dose corticosteroids Isolation of the patient to prevent spread of the dermatitis Question 80 4 / 4 points Instructions for the use of nicotine gum include: Question options: Chew the gum quickly to get a peak effect. The gum should be “parked” in the buccal space between chewing. Acidic drinks such as coffee help with the absorption of the nicotine. The highest abstinence rates occur if the patient chews the gum when he or she is having cravings. Question 81 0 / 4 points Vicky, age 56 years, comes to the 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 migraines and states one dose usually works to abort her migraine. What is the best care for her? Question options: Switch her to sumatriptan (Imitrex) to treat her migraines. Assess how often she is using Fiorinal and refill her medication. Switch her to a beta blocker such as propranolol to prevent her migraine. Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines. Question 82 4 / 4 points Nurse practitioner prescriptive authority is regulated by: Question options: The National Council of State Boards of Nursing The U.S. Drug Enforcement Administration The State Board of Nursing for each state The State Board of Pharmacy Question 83 4 / 4 points The drug of choice for treatment of early latent or tertiary syphilis is: Question options: Ceftriaxone IM Benzathine penicillin G IM Oral azithromycin Oral ciprofloxacin Question 84 0 / 4 points When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is: Question options: Immediate protection against pregnancy the first week of using the pill No back-up method is needed when starting Menses occur during the week They can start the pill on the Sunday after the office visit Question 85 4 / 4 points Drugs that have a significant first-pass effect: Question options: Must be given by the enteral (oral) route only Bypass the hepatic circulation Are rapidly metabolized by the liver and may have little if any desired action Are converted by the liver to more active and fat-soluble forms Question 86 4 / 4 points Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie? Question options: Increased volume of distribution Decreased lipid solubility Decreased plasma proteins Increased muscle-to-fat ratio Question 87 4 / 4 points Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for: Question options: High vitamin D levels Hyperkalemia Hypercalcemia Hyperuricemia Question 88 4 / 4 points A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response? Question options: Swelling of the tongue or hoarseness are the most common symptoms. It appears to be related to the decrease in aldosterone production. Presence of a dry, hacky cough indicates a high risk for this adverse response. Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week. Question 89 0 / 4 points The first-line therapy for mild-persistent asthma is: Question options: High-dose montelukast Theophylline Low-dose inhaled corticosteroids Long-acting beta-2-agonists Question 90 4 / 4 points Conjunctivitis in a child that is accompanied by acute otitis media is treated with: Question options: Sulfacetamide 10% ophthalmic solution (Bleph-10) Bacitracin/polymyxin B (Polysporin) ophthalmic drops Ciprofloxacin (Ciloxan) ophthalmic drops High-dose oral amoxicillin Question 91 4 / 4 points Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include: Question options: Amoxicillin Diphenhydramine Pseudoephedrine Nasal saline spray Question 92 4 / 4 points Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: Question options: Rapidly achieves drug levels in the therapeutic range Requires four- to five-half-lives to attain Is influenced by renal function Is directly related to the drug circulating to the target tissues Question 93 4 / 4 points Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be: Question options: 18 mg/day of iron supplementation 6 mg/kg per day of elemental iron 325 mg ferrous sulfate per day 325 mg ferrous sulfate tid Question 94 4 / 4 points Patient education for a patient who is prescribed antibiotics for sinusitis includes: Question options: Use of nasal saline washes Use of inhaled corticosteroids Avoiding the use of ibuprofen while ill Use of laxatives to treat constipation Question 95 4 / 4 points The role of the NP in the use of herbal medication is to: Question options: Maintain competence in the prescribing of common herbal remedies Recommend common over-the-counter herbs to patients Educate patients and guide them to appropriate sources of care Encourage patients to not use herbal therapy due to the documented dangers Question 96 4 / 4 points The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be: Question options: Ciprofloxacin Azithromycin Amoxicillin Doxycycline Question 97 4 / 4 points Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine? Question options: Delay eating the midday meal until after the swimming class. Increase the morning dose of NPH insulin on days of the swimming class. Adjust the morning insulin injection so that the peak occurs while swimming. Check glucose level before, during, and after swimming. Question 98 0 / 4 points Goals when treating tuberculosis include: Question options: Completion of recommended therapy Negative purified protein derivative at the end of therapy Completely normal chest x-ray All of the above Question 99 4 / 4 points Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes: Question options: Throwing away eye makeup and purchasing new Redness and intense burning is normal with ophthalmic antibiotics When applying eye ointment, set the tip of the tube on the lower lid and squeeze in inch Use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac Question 100 4 / 4 points The reason that two MMR vaccines at least a month apart are recommended is: Question options: The second dose of MMR “boosts” the immunity built from the first dose. Two vaccines 1 month apart is the standard dosing for all live virus vaccines. If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR. ________________________________________