Advanced Pharmacology - Modules 1-5 Questions With
Complete Solutions
A 12-year-old patient who is obese develops type 2 diabetes
mellitus. The FNP should order:
nateglinide (Starlix).
glyburide (Micronase).
colesevelam (Welchol).
metformin (Glucophage). Correct Answers metformin
(Glucophage).
Metformin is the only drug listed that is recommended for
children.
DIF: Cognitive Level: Understanding (Comprehension)
REF: 598
A 5-year-old child has atopic dermatitis that is refractory to
treatment with hydrocortisone acetone 2.5% cream. The
prescriber should prescribe:
desonide cream 0.01%.
triamcinolone acetonide.
fluocinolone cream 0.2%.
,betamethasone dipropionate ointment 0.05%. Correct Answers
triamcinolone acetonide.
An over-the-counter steroid has failed to treat this child's
dermatitis, so the NP should prescribe something in a higher
strength. Triamcinolone is a medium-strength steroid and should
be used. The other three are in groups I and II, which are high-
strength steroids and are not recommended in children.
DIF: Cognitive Level: Applying (Application)
REF: 154| 156
A 55-year-old woman has a history of myocardial infarction
(MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35
mg/dL, and triglycerides 150 mg/dL. The woman is sedentary
with a body mass index of 26. The woman asks the prescriber
about using a statin medication. The prescriber should:
recommend dietary and lifestyle changes first.
begin therapy with atorvastatin 10 mg per day.
discuss quality-of-life issues as part of the decision to begin
medication.
tell her there is no clinical evidence regarding efficacy of statin
medication in her case. Correct Answers begin therapy with
atorvastatin 10 mg per day.
This woman would be using a statin medication for secondary
prevention because she already has a history of MI, so a statin
,should be prescribed. Dietary and lifestyle changes should be a
part of therapy, but not the only therapy. She is relatively young,
and quality-of-life issues are not a concern. There is no clinical
evidence to support use of statins as primary prevention in
women.
DIF: Cognitive Level: Applying (Application)
REF: 296
A 7-year-old patient who has severe asthma takes oral
prednisone daily. At a well-child examination, the family nurse
practitioner (FNP) notes a decrease in the child's linear growth
rate. The FNP should consult the child's asthma specialist about:
gradually tapering the child off the prednisone.
a referral for possible growth hormone therapy.
giving a double dose of prednisone every other day.
dividing the prednisone dose into twice-daily dosing. Correct
Answers giving a double dose of prednisone every other day.
Administration of a double dose of a glucocorticoid every other
morning has been found to cause less suppression of the HPA
axis and less growth suppression in children. Because the child
has severe asthma, an oral steroid is necessary. Growth hormone
therapy is not indicated. Twice-daily dosing would not change
the HPA axis suppression.
DIF: Cognitive Level: Applying (Application)
REF: 576
, A 70-year-old patient asks an NP about using diphenhydramine
(Benadryl) to control intermittent allergic symptoms that include
runny nose and sneezing. The NP should counsel this patient to:
take the lowest recommended dose initially.
monitor for hypertension while taking the drug.
take the antihistamine with a decongestant for best effect.
watch for symptoms of paradoxical excitation with this
medication. Correct Answers take the lowest recommended
dose initially.
Antihistamines are more likely to cause excessive sedation,
syncope, dizziness, confusion, and hypotension in elderly
patients; a decrease in dose is usually necessary. Hypotension is
likely; there is no need to monitor for hypertension. This patient
does not have symptoms of congestion. Paradoxical excitation
occurs in some young children but is not an identified risk in
elderly patients.
DIF: Cognitive Level: Applying (Application)
REF: 191
A 70-year-old patient with COPD who is new to the clinic
reports taking 10 mg of prednisone daily for several years. The
prescriber should:
tell the patient to take the drug every other day before 9:00 AM.
order a serum glucose, potassium level, and bone density testing.
Complete Solutions
A 12-year-old patient who is obese develops type 2 diabetes
mellitus. The FNP should order:
nateglinide (Starlix).
glyburide (Micronase).
colesevelam (Welchol).
metformin (Glucophage). Correct Answers metformin
(Glucophage).
Metformin is the only drug listed that is recommended for
children.
DIF: Cognitive Level: Understanding (Comprehension)
REF: 598
A 5-year-old child has atopic dermatitis that is refractory to
treatment with hydrocortisone acetone 2.5% cream. The
prescriber should prescribe:
desonide cream 0.01%.
triamcinolone acetonide.
fluocinolone cream 0.2%.
,betamethasone dipropionate ointment 0.05%. Correct Answers
triamcinolone acetonide.
An over-the-counter steroid has failed to treat this child's
dermatitis, so the NP should prescribe something in a higher
strength. Triamcinolone is a medium-strength steroid and should
be used. The other three are in groups I and II, which are high-
strength steroids and are not recommended in children.
DIF: Cognitive Level: Applying (Application)
REF: 154| 156
A 55-year-old woman has a history of myocardial infarction
(MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35
mg/dL, and triglycerides 150 mg/dL. The woman is sedentary
with a body mass index of 26. The woman asks the prescriber
about using a statin medication. The prescriber should:
recommend dietary and lifestyle changes first.
begin therapy with atorvastatin 10 mg per day.
discuss quality-of-life issues as part of the decision to begin
medication.
tell her there is no clinical evidence regarding efficacy of statin
medication in her case. Correct Answers begin therapy with
atorvastatin 10 mg per day.
This woman would be using a statin medication for secondary
prevention because she already has a history of MI, so a statin
,should be prescribed. Dietary and lifestyle changes should be a
part of therapy, but not the only therapy. She is relatively young,
and quality-of-life issues are not a concern. There is no clinical
evidence to support use of statins as primary prevention in
women.
DIF: Cognitive Level: Applying (Application)
REF: 296
A 7-year-old patient who has severe asthma takes oral
prednisone daily. At a well-child examination, the family nurse
practitioner (FNP) notes a decrease in the child's linear growth
rate. The FNP should consult the child's asthma specialist about:
gradually tapering the child off the prednisone.
a referral for possible growth hormone therapy.
giving a double dose of prednisone every other day.
dividing the prednisone dose into twice-daily dosing. Correct
Answers giving a double dose of prednisone every other day.
Administration of a double dose of a glucocorticoid every other
morning has been found to cause less suppression of the HPA
axis and less growth suppression in children. Because the child
has severe asthma, an oral steroid is necessary. Growth hormone
therapy is not indicated. Twice-daily dosing would not change
the HPA axis suppression.
DIF: Cognitive Level: Applying (Application)
REF: 576
, A 70-year-old patient asks an NP about using diphenhydramine
(Benadryl) to control intermittent allergic symptoms that include
runny nose and sneezing. The NP should counsel this patient to:
take the lowest recommended dose initially.
monitor for hypertension while taking the drug.
take the antihistamine with a decongestant for best effect.
watch for symptoms of paradoxical excitation with this
medication. Correct Answers take the lowest recommended
dose initially.
Antihistamines are more likely to cause excessive sedation,
syncope, dizziness, confusion, and hypotension in elderly
patients; a decrease in dose is usually necessary. Hypotension is
likely; there is no need to monitor for hypertension. This patient
does not have symptoms of congestion. Paradoxical excitation
occurs in some young children but is not an identified risk in
elderly patients.
DIF: Cognitive Level: Applying (Application)
REF: 191
A 70-year-old patient with COPD who is new to the clinic
reports taking 10 mg of prednisone daily for several years. The
prescriber should:
tell the patient to take the drug every other day before 9:00 AM.
order a serum glucose, potassium level, and bone density testing.
