Pharmacology Review Questions
Terms in this set (110)
An 18-year-old female has a positive throat C&S for Strep pyogenes (Group A beta strepto-
cocci). The patient reports a history of an allergic reaction to penicillin with "swollen lips" accompanied by urticaria. Which of the following is the most appropriate treatment?
A) Clarithromycin (Biaxin) 250 mg PO BID × 10 days
B) Gargle with salt water 3 times a day
C) Cephalexin (Keflex) 250 mg PO QID × 10 days
D) Doxycycline 100 mg PO BID × 10 days
A) Clarithromycin (Biaxin) 250 mg PO BID × 10 days
A good alternative antibiotic for PCN-allergic patients with gram-positive bacterial infections are
macrolides such as azithromycin × 5 days (Z-Pack) or clarithromycin (Biaxin) PO BID.
A 16-year-old high school athlete is returning for follow-up for a severe sore throat. The test result reveals a positive throat culture for Group A beta hemolytic strep and a posi- tive Monospot test (heterophile antibody test). What is the best initial clinical manage- ment of this patient?
A) Initiate a prescription of amoxicillin 500 mg PO TID × 10 days.
B) Initiate a prescription of penicillin VK 250 mg PO QID × 10 days.
C) Order an Epstein-Barr virus (EBV) titer to determine whether the patient has an acute or a reactivated mononucleosis infection.
D) Write a prescription for an abdominal ultrasound to determine the size of the patient's liver and spleen.
B) Initiate a prescription of penicillin VK 250 mg PO QID × 10 days.
(avoid using amoxicillin due to high risk of a "drug rash" that is not due to an allergy).
About 70% to 90% of patients with mono taking amoxicillin may break out with a "nonallergic" generalized maculopapular rash (mechanism is not well understood). If a patient has both mono and strep throat, avoid using amoxicillin or ampicillin. Instead, use penicillin (if not allergic) or a macrolide to treat
A 25-year-old healthy adult is diagnosed with atypical pneumonia by the NP. The patient reports a history of nausea, upset stomach, and vomiting with erythromycin. The patient is complaining of a sore throat. The vital signs are temperature of 99°F, pulse of 80/minute, and respiratory rate of 12 breaths/minute. What is the most appropriate treatment plan for this patient?
A) Initiate a prescription of azithromycin (Z-Pack) PO × 5 days.
B) Initiate a prescription of trimethoprim-sulfamethazole (Bactrim) 1 tab PO
BID × 10 days.
C) Order a chest x-ray with the anterior-posterior and lateral views.
D) Order a sputum for culture and sensitivity.
A) Initiate a prescription of azithromycin (Z-Pack) PO × 5 days.
Bactrim is not effective against Mycoplasma or Chlamydia bacterial infections
A 65-year-old male presents with a history of a chronic cough that is productive of large amounts of off-white to light-yellow colored sputum. The patient reports a history of cigarette smoking. The chest x-ray reveals hyperinflation with flattened diaphragms and several small bullae. Which of the following drug classes is the initial treatment of choice for this condition?
A) Short-acting B2 agonists.
C) Pneumococcal polysaccharide vaccine (Pneumovax).
D) Oxygen by nasal cannula.
The initial treatment of choice for chronic bronchitis/COPD is ipratropium bromide or Atrovent (an anticholinergic).
What is a rare but serious complication of quinolone therapy?
Achilles tendon rupture
Why do you avoid quinolone therapy in children?
adverse effects on growing cartilage
1. A 72-year-old woman has been on hydrochlorothiazide 12.5 mg for many years to control her Stage II hypertension. Her blood pressure (BP) at this visit is 168/96. She is currently complaining of pain on her right hip and on both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times day (TID) to 800 mg TID. She is still in pain and would like something stronger. Which of the following statements is the best explanation of the effects of ibuprofen (Motrin) on her disease?
A) It increases the chances of adverse effects to her health
B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the
C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics
D) None of the statements are true
1. B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic NSAIDs and ASA inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to ischemia. NSAIDs and diuretics can cause acute prerenal failure by decreasing renal blood flow.
10. Which of the following antihypertensive medications should the nurse practitioner avoid when treating patients with emphysema?
A) Calcium channel blockers
B) Angiotensin-converting enzyme (ACE) inhibitors
10. C) Beta-blockers Beta-blockers should be avoided in patients with a history of emphysema. Studies have shown evidence of a reduction in forced expiratory vol- ume in 1 second (FEV1), increased airway hyperresponsiveness, and inhibition of bronchodilator response to beta agonists in patients receiving non-selective beta- blockers and high doses of cardioselective beta-blockers.
19. Which of the following antihypertensive medications has beneficial effects for an elderly White female with osteoporosis?
A) Calcium channel blocker
B) Angiotensin-converting enzyme (ACE) inhibitor
19. A) Calcium channel blocker Calcium channel blockers act by blocking the cal- cium channels in the heart muscle and the blood vessels, thereby keeping more calcium in the bones.
55. Erythromycin 200 mg with sulfisoxazole 600 mg suspension (Pediazole) is contrain- dicated in which of the following conditions?
C) Beta thalassemia minor
55. A) G6PD deficiency anemia Glucose-6-phosphate dehydrogenase (G6PD) defi- ciency is a hereditary condition that occurs when the red blood cells break down, causing hemolysis, due to a missing or lack of a sufficient enzyme that is needed to help the red blood cells work efficiently. Certain foods and medications may trigger this reaction and hemolysis will occur. Some of these medications include antimalarial drugs, aspirin, nitrofurantoin, NSAIDs, quinidine, quinine, and sulfa medications.
68. A67-year-oldretiredclerkpresentswithcomplaintsofshortnessofbreathandweight gain over a 2-week period. A nonproductive cough accompanies her symptoms. The lung exam is positive for fine crackles in the lower lobes with no wheezing. The exam is positive for egophony. Which of the following conditions is most likely?
A) Acute exacerbation of asthma
D) Chronic obstructive pulmonary disease
69. Which of the following drugs is most likely to relieve the patient's symptoms?
B) Trimethoprim/sulfamethoxazole (Bactrim DS)
D) Hydrocodone/guaifenesin syrup (Hycotuss)
68. B) Left-heart failure Signs and symptoms of left-heart failure include tachyp- nea, labored breathing, and rales or crackles in the lower bases of the lungs, which can develop into pulmonary edema.
69. C) Furosemide (Lasix) Lasix would be used to help remove the extra fluid load.
70. A patient has recently been diagnosed with migraine headache with aura. She wants advice on what she should eliminate from her diet to reduce her risk of headaches. The best response is to advise this patient to avoid:
A) Foods with aspartame (Equal) because they can trigger migraines
B) Foods with monosodium glutamate because they promote diuresis
C) Foods with garlic because they promote hypertension
D) Foods with nitrates because they do not induce flushing
70. A) Foods with aspartame (Equal) because they can trigger migraines Dietary triggers for migraine headaches include foods that contain aspartame, tyramine, nitrites, MSG, and/or red wine. These foods are thought to cause a change in the blood vessels and increased blood flow to the brain.
78. An elderly woman has been on digoxin (Lanoxin) for 10 years. Her electrocardio- graph (EKG) is showing a new onset of atrial fibrillation. Her pulse is 64/min. She denies syncope and dizziness. Which of the following interventions is most appropriate?
A) Order an electrolyte panel and a digoxin level
B) Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an elec-
C) Order a serum digoxin level and decrease her digoxin dose by half while wait-
ing for results
D) Discontinue the digoxin and order another 12-lead EKG
78. B) Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an electrolyte panel Obtaining baseline blood work to evaluate for causes of new- onset atrial fibrillation is recommended prior to decreasing or stopping medica- tions. Thyroid disease is a common cause of new-onset atrial fibrillation.
86. Which of the following medications is indicated for the treatment of obsessive-com- pulsive disorder?
A) Paroxetine (Paxil CR)
86. A) Paroxetine (Paxil CR) Antidepressants are the most common medications used for OCD. Those antidepressants that are approved for OCD by the Food and Drug Administration (FDA) include clomipramine (Anafranil), fluvox- amine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).
118. All of the following agents are used to control the inflammatory changes seen in the lungs of asthmatics except:
A) Albuterol inhaler (Proventil)
D) Cromolyn sodium inhaler (Intal)
118. A) Albuterol inhaler (Proventil) Proventil inhaler is a short-acting bronchodila- tor and is used for immediate relief of shortness of breath. It acts quickly to dilate the tubes in the lungs. Medications that have steroids and leukotrienes help the inflamed channels to remain open and clear but take longer to get into the system to work.
133. Which of the following is recommended treatment for erythema migrans or early Lyme disease?
A) Doxycycline (Vibramycin) 100 mg PO BID x 21 days
B) Ciprofloxacin (Cipro) 250 mg PO BID x 14 days
C) Erythromycin (E-mycin) 333 mg PO TID x 10 days
D) Dicloxacillin 500 mg PO BID x 10 days
133. A) Doxycycline (Vibramycin) 100 mg PO BID x 21 days The CDC-recom- mended treatment for erythema migrans or Lyme disease is doxycycline 100 mg PO BID x 21 days.
139. A common side effect of metformin (Glucophage) therapy is:
C) Hypoglycemicepisodes D) Gastrointestinalproblems
139. D) Gastrointestinal problems Common side effects of metformin include diar- rhea/gastrointestinal problems.
148. All of the following drugs can interact with theophylline (Theo-24) except:
C) Phenytoin sodium (Dilantin)
148. B) Montelukast (Singulair) Medications that are contraindicated with theophyl- line include erythromycin, phenytoin sodium, and cimetidine.
155. A 56-year-old man complains of episodes of lancinating pain that shoots up to his right cheek when he eats or drinks. He has stopped drinking cold drinks because of the pain. Which of the following is most likely?
A) Trigeminalneuralgia B) Clusterheadache
155. A) Trigeminal neuralgia Pain shooting up the right cheek with food or drink is seen with trigeminal neuralgia.
157. All of the following are considered selective serotonin reuptake inhibitors (SSRIs) except:
D) Paroxetine (Paxil CR)
157. A) Imipramine (Elavil) Prozac, Zoloft, and Paxil CR are selective serotonin reuptake inhibitors. Elavil is a tricyclic antidepressant.
162. A patient who is on warfarin sodium (Coumadin) is advised to avoid eating large amounts of leafy green vegetables because:
A) The high Vitamin K levels will increase bleeding time
B) They have too much ascorbic acid, which can interact with the medicine
C) The high fiber content will decrease the absorption of the Coumadin
D) The vitamins in the vegetables will bind and inactivate Coumadin
162. A) The high Vitamin K levels will increase bleeding time Foods containing Vitamin K may enhance the anticoagulation effect of Coumadin, thus increasing bleeding time.
163. You are following up a 65-year-old male who has been on a new prescription of flu- vastatin (Lescol) for 6 weeks. During a follow-up visit, he reports feeling extremely fatigued and having dark-colored urine. He denies any generalized muscle sore- ness. Which of the following is the most appropriate treatment plan?
A) Order a CBC with differential
B) Order a liver function profile
C) Recommend an increase in fluid intake and rest
D) Order a urine for C&S test
164. Which of the following diagnoses is most likely in this patient?
B) Acute drug-induced hepatitis
D) A major depressive episode
165. What would you advise him regarding his fluvastatin (Lescol) prescription?
A) Continue taking the medicine until the lab results are available
B) Take half the usual daily dose until the lab results are available
C) Take the medicine every other day instead of daily until the lab results are
D) Stop taking the medicine until the lab results are available
163. B) Order a liver function profile Statin medications, such as Lescol, can affect liver function and increase liver enzymes, as well as cause the patient to feel weak, fatigued, and have muscle aches. Therefore, checking the liver function profile is recommended.
164. B) Acute drug-induced hepatitis Liver enzymes, such as ALT and AST, can be elevated with the use of medications, such as statin medications. High liver enzymes can cause an acute drug-induced hepatitis.
165. D) Stop taking the medicine until the lab results are available When liver enzymes are affected by medications, such as statin medications, the patient is advised to stop taking the medicine until the lab results are available.
169. Which of the following is recommended by JNC 7 as first-line treatment for hyper- tension in patients with microalbuminuria?
A) Angiotensin-converting enzyme (ACE) inhibitors
C) Calcium channel blockers
169. A) Angiotensin-converting enzyme (ACE) inhibitors First line of treatment for hypertension in patients with microalbuminuria is ACE inhibitors. ACE inhibitors are renal protective.
187. Which of the following is indicated for the prophylactic treatment of migraine headache?
B) Naproxen sodium (Anaprox)
187. C) Propranolol (Inderal) Medications used to prophylactically prevent migraine headaches include beta-blockers (propranolol) and tricyclic antidepressants (ami- triptyline). Motrin, Anaprox, and Imitrex are all medications used to treat migraine headache.
188. A 40-year-old male complains to the nurse practitioner of severe stabbing pains behind his left eye for the past 2 days. It is accompanied by some nasal congestion and rhinorrhea, which is clear in color. The patient denies pharyngitis and fever. Which of the following conditions is most likely?
A) Migraine headache with aura
188. B) Cluster headache Signs/symptoms of cluster headaches include severe stab- bing pain behind the eyes, with nasal congestion and rhinorrhea. Migraine head- aches with aura include visual changes, such as blind spots or flashing lights that appear before the onset of the headache. Trigeminal neuralgia (tic douloureux) is a unilateral headache from compression or inflammation of the trigeminal nerve (cranial nerve 5).
189. Ken has type 2 diabetes mellitus and a "sensitive stomach." Which medication is least likely to cause him gastrointestinal distress?
A) Naproxen sodium (Anaprox)
B) Aspirin (Bayer's aspirin)
189. D) Sucralfate (Carafate) Naproxen sodium, aspirin, and erythromycin all have gastrointestinal side effects. Sucralfate is used to protect the stomach lining by building a protective layer over the stomach lining; it allows healing to occur.
209. Which of the following drugs is effective therapy for treating pain in patients who are having an acute exacerbation of gout?
209. C) Indomethacin (Indocin) Common medications used for acute flare-ups of gout include two NSAIDs, such as indomethacin and naproxen sodium, BID prn. Colchicine may be added to the NSAIDs if relief is not obtained. Maintenance therapy consists of allopurinol and/or probenecid.
214. A lipid profile done on a newly diagnosed hypertensive patient shows a triglycer- ide level of 650 mg/dL, total cholesterol 240 mg/dL, LDL 145 mg/dL, and an HDL of 35 mg/dL. What is the best intervention for this patient?
A) Educate the patient about lifestyle changes that will help lower cholesterol levels
B) Initiate a prescription of pravastatin (Pravachol)
C) Recommend that the patient exercise at least every other day and avoid eating
fatty or fried foods
D) Initiate a prescription of nicotinic acid (Niacin, Niaspan)
214. D) Initiate a prescription of nicotinic acid (Niacin, Niaspan) Niacin is recom- mended for treatment of high triglyceride and cholesterol levels. Exercise and healthy eating lifestyle is also recommended, but with the high level of triglycer- ides at 650 mg/dL and total cholesterol 240 mg/dL, niacin is recommended.
240. A hypertensive middle-aged man who is Native American has recently been diag- nosed with mild renal insufficiency. He has been on lisinopril (Accupril) for many years. Which of the following laboratory values should be carefully monitored?
A) Hemoglobin, hematocrit, and the MCV (mean corpuscular volume)
B) Serum creatinine and potassium levels
C) Aspartate aminotransferase and alanine aminotransferase
D) Serum sodium, potassium, and magnesium
240. B) Serum creatinine and potassium levels Native Americans have a much higher rate of kidney disease and renal failure when compared to other races. Native Americans have a 1 in 3 incidence of hypertension. Hypertension is the second leading cause of kidney failure. BUN, creatinine, estimated GFR, and uri- nalysis are performed to assess the function of the kidneys.
245. A 10-year-old male who was recently accepted into his school's soccer team has a history of exercise-induced asthma. The child wants to know when he should take his albuterol inhaler. The nurse practitioner would advise the patient:
A) Premedicate himself 20 minutes prior to starting exercise
B) Wait until he starts to exercise before using the inhaler
C) Premedicate 60 minutes before starting exercise
D) Wait until he finishes his exercise before using his inhaler
245. A) Premedicate himself 20 minutes prior to starting exercise Exercise-induced asthma is best controlled by using the Proventil inhaler (bronchodilator) approxi- mately 20 minutes prior to exercise, to prevent vasospasm of the bronchioles and shortness of breath with exercise. These bronchodilators usually last approxi- mately 4 hours. They also work quickly to open up the bronchioles if an acute attack/shortness of breath occurs.
252. A 12-year-old male's peak expiratory flow results indicate 60 to 80% of the pre- dicted range. How would you classify his asthma?
A) Mild intermittent asthma
B) Mild persistent asthma
C) Moderate persistent asthma
252. C) Moderate persistent asthma Asthma classifications: Intermittent: normal FEV between exacerbations, FEV > 80%; mild persistent, FEV > 80%; moderate persistent, FEV 60-80%; severe persistent, FEV < 60%.
264. The most current recommendation from the Joint National Commission on the Evaluation and Treatment of High Blood Pressure in Adults (JNC 7) for the blood pressure goal in diabetics is:
A) <140/90 B) <130/85 C) <130/80 D) <125/75
264. C) < 130/80 JNC 7 bp goals include < 130/80 in patients with diabetes.
265. All of the following pharmacologic agents are used to treat inflammation in the lungs of asthmatics except:
A) Nedocromil sodium (Tilade) two sprays QID
B) Cromolyn sodium inhaler (Intal) two puffs QID
C) A long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours
D) Fluticasone inhaler (Flovent) two puffs BID
265. C) A long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours Theo- phylline is used to control inflammation of the lungs. Tilade, Intal, and Flovent help to treat inflammation.
280. A 65-year-old woman's bone density result shows severe demineralization of cor- tical bone. All of the following pharmacologic agents are useful in treating this condition except:
D) Calcium with Vitamin D
280. C) Medroxyprogesterone (Depo-Provera) Common treatments for osteoporosis include calcium and Vitamin D, Evista, Miacalcin, and bisphosphonates. Depo- Provera is a type of contraception.
285. Some pharmacologic agents may cause confusion in the elderly. Which of the follow- ing pharmacologic agents is most likely to cause confusion in this population?
A) Cimetidine (Tagamet), digoxin (Lanoxin), diphenhydramine (Benadryl)
B) Acetaminophen (Tylenol), aspirin (Bayer), indomethacin (Indocin)
C) Sucralfate (Carafate), docusate sodium (Surfak), psyllium (Metamucil)
D) Cephalexin (Keflex), amoxicillin (Amoxil), clarithromycin (Biaxin)
285. A) Cimetidine (Tagamet), digoxin (Lanoxin), diphenhydramine (Benadryl)
Medications that commonly cause confusion in the elderly include cimetidine, lanoxin, and diphenhydramine.
286. A 55-year-old female with a history of migraine headaches has recently been diag- nosed with Stage II hypertension. Her EKG strips reveal second-degree heart block. The chest x-ray is normal. Which of the following drugs should this patient avoid?
B) Angiotensin receptor blockers
D) Calcium channel blockers
286. D) Calcium channel blockers Common side effects of calcium channel blockers include headaches, edema of the lower extremities, and heart block or bradycardia. Contraindications for calcium channel blockers include second- or third-degree AV block, bradycardia, and congestive heart failure.
306. Which of the following drugs is recommended by the Centers for Disease Control and Prevention (CDC) as first-line treatment for treating infections by the organ- ism Bacillus anthracis (anthrax)?
A) Clindamycin(Cleocin) B) Fluconazole(Diflucan) C) Penicillin G injection D) Ciprofloxacin(Cipro)
306. D) Ciprofloxacin (Cipro) The CDC's first-line treatment recommendation for anthrax is Cipro.
316. According to the guidelines outlined in JNC 7, the normal blood pressure should be:
A) <140/90 B) <130/85 C) <120/80 D) <110/75
316. C) <120/80 The JNC VII Guidelines recommended that bp be less than 120/80.
323. Laura, who is 18 years old, is being followed up for acne by the nurse practitio- ner. The facial exam reveals that papules and pustules are present mostly on the forehead and the chin areas. The patient has been using prescription topicals and OTC medicated soap daily for 6 months without much improvement. Which of the following would you recommend next?
C) Clindamycin topical solution (Cleocin T)
323. B) Tetracycline (Sumycin) First-line treatment for acne vulgaris includes OTC medicated soap and water with topical antibiotic gels. The next step of treatment would be the initiation of oral tetracycline.
326. A possible side effect from the use of nifedipine (Procardia XL) is:
A) Hyperuricemia and hypoglycemia
B) Hyperkalemia and angioedema
C) Edema of the ankles and headache
D) Dry hacking cough
326. C) Edema of the ankles and headache Common side effects of calcium channel blockers, such as Procardia, include edema of the ankles, dizziness, headaches, flushing, and weakness. ACE inhibitors tend to have the side effects of angioedema and a dry hacking cough. Diuretics can cause hyperkalemia and hyperuricemia.
329. What is the first-line class of antibiotics recommended by the American Thoracic Society (ATS) for patients younger than 60 years of age who are diagnosed with community-acquired pneumonia with no comorbidity?
329. C) Macrolides The American Thoracic Society recommends macrolides as the first line of therapy for community-acquired pneumonia without comorbidity.
332. Which of the following would be appropriate initial management of a second- degree burn?
A) Irrigate with hydrogen peroxide and apply Silvadene cream BID
B) Irrigate with normal saline and apply Silvadene cream BID
C) Irrigate with tap water and apply Neosporin ointment BID
D) Unroof all intact blisters and apply antibiotic ointment BID
332. B) Irrigate with normal saline and apply Silvadene cream BID Burns should be cleansed with saline solution and Silvadene cream applied BID to the site. Hydrogen peroxide is no longer recommended. Intact blisters should not be unroofed.
337. All of the following factors have been found to increase the risk of atrial fibrillation in predisposed individuals except:
B) Excessive alcohol intake in susceptible individuals
C) Theophylline (Theodur) and pseudoephedrine (Sudafed)
337. D) Acute esophagitis Factors that influence the risk of atrial fibrillation include hypertension, excessive alcohol consumption, and medications such as Theodur and Sudafed.
342. All of the following patients have an increased risk of developing adverse effects from Metformin (Glucophage) except:
A) Patients with renal disease
B) Patients with hypoxia
D) Patients who are alcoholics
342. C) Obese patients Metformin is used as a hyperglycemic agent for NIDDM. However, increased mortality has been associated with drug-induced lactic aci- dosis. Contraindications for the use of metformin include patients with significant renal and hepatic disease, alcoholism, and conditions associated with hypoxia (cardiac/pulmonary problems), sepsis, dehydration, high doses, and advanced age. Metformin is used in obese patients and education regarding the lactic acido- sis risk should be discussed with the patient and family.
344. Lifestyle modifications are an important aspect in the treatment of hypertension. Which of the following statements is incorrect?
A) Reduce intake of sodium, potassium, and calcium
B) Reduce intake of sodium and saturated fats
C) Exercise at least three to four times per week
D) Maintain an adequate intake of potassium, magnesium, and calcium
344. A) Reduce intake of sodium, potassium, and calcium Lifestyle modifications for hypertension include exercise 3-4 times a week, diet modifications of reduced intake of sodium and saturated fats, and adequate dietary intake of potassium, magnesium, and calcium.
345. Which of the following classes of antihypertensive drugs should a patient be weaned off slowly to avoid the risk of severe rebound hypertension?
D) Calcium channel blockers
345. B) Beta-blockers Reverse rebound hypertension can occur if beta-blockers are abruptly stopped. Recommendations include weaning off the beta-blockers when changing medications.
346. A 70-year-old male with open-angle glaucoma is prescribed Betimol (timolol) oph- thalmic drops. All of the following are contraindications to Betimol ophthalmic drops except:
A) Overt heart failure or sinus bradycardia
C) Second- or third-degree AV block
D) Migraine headaches
346. D) Migraine headaches Contraindications with Betimol (timolol) include heart fail- ure or sinus bradycardia, asthmatic patients, and second- or third-degree AV block.
357. Terazosin(Hytrin),analpha-blocker,is used to treat which of the following conditions?
A) Benign prostatic hypertrophy and hypertension
B) Chronic prostatitis and atrial fibrillation
C) Urinary tract infections and arrhythmias
D) Benign prostatic hypertrophy and chronic prostatitis
357. A) Benign prostatic hypertrophy and hypertension Hytrin is used to treat benign prostatic hypertrophy and hypertension.
360. Which of the following classes of drugs is implicated with blunting the signs and symptoms of hypoglycemia in diabetics?
A) Calcium channel blockers
D) ARBs (angiotensin receptor blockers)
360. C) Beta-blockers Beta-blockers are known to blunt the signs/symptoms of hypoglycemia in patient with diabetes.
362. The bacterium responsible for the highest mortality in patients with community- acquired pneumonia is:
A) Streptococcus pneumoniae
B) Mycoplasma pneumoniae
C) Moraxella catarrhalis
D) Haemophilus influenzae
362. A) Streptococcus pneumoniae Steptococcus pneumoniae is known for being respon- sible for the highest mortality in patients with community-acquired pneumonia.
363. Mr. R. J. is a 40-year-old asthmatic male with hypertension. For the past 6 months, he has been following a low-fat, low-sodium diet and walking 3 times a week. His BP readings from the past 2 visits were 160/95 and 170/ 100. On this visit, it is 160/90. What is the most appropriate action for the nurse practitioner to follow at this visit?
A) Continue the lifestyle modifications and recheck his blood pressure again in 4 weeks
B) Initiate a prescription of hydrochlorothiazide 12.5 mg PO daily
C) Initiate a prescription of atenolol (Tenormin) 25 mg PO daily
D) Refer the patient to a cardiologist for a stress EKG
363. B) Initiate a prescription of hydrochlorathiazide 12.5 mg PO daily The patient would be started on HCTZ 12.5 mg PO daily for his high BP. He has been trying lifestyle modifications for 6 months with diet changes and exercise.
364. When initially treating an adult for acute bronchitis, which of the following should the nurse practitioner be least likely to order?
364. B) Antibiotics Acute bronchititis is normally a viral infection, so expectorants, bronchodilators, and antitussives would be prescribed for the cough. Antibiotics are not effective against viral infections.
367. Mrs. Nottam, who has a BMI of 29, has a 20-year history of primary hypertension. She has been on hydrochlorothiazide 25 mg PO daily with excellent results. On this visit, she is complaining of feeling thirsty all the time even though she drinks more than 10 glasses of water per day. She reports to the nurse practitioner that she has been having this problem for about 6 months. Upon reading the chart, the nurse practitioner notes that the last two fasting blood glucose levels have been140 mg/dL and 168 mg/dL. A random blood glucose is at 210 mg/dL. Which of the following is the best treatment plan to follow at this visit?
A) Order another random blood sugar test in 2 weeks
B) Initiate a prescription of metformin (Glucophage) 500 mg PO BID
C) Order a 3-hour glucose tolerance test
D) Order a HgbA1c level
367. B) Initiate a prescription of metformin (Glucophage) 500 mg PO BID Initiating metformin is recommended because she has met the criteria for diagnosis of dia- betes. Criteria for diagnosing type 2 diabetes: fasting blood glucose 126 mg/dL or higher on 2 separate occasions, 2-hour blood glucose 200 mg/dL or higher during OCT with 75 g glucose load, symptoms of diabetes (polyuria, polydipsia, polyphagia) plus random blood glucose greater than 200 mg/dL.
368. A newly diagnosed middle-aged type 2 diabetic wants to start an exercise pro- gram. All of the following statements are true except:
A) If the patient is unable to eat due to illness, antidiabetic agents can be contin- ued with frequent glucose monitoring
B) Strenuous exercise is contraindicated for type 2 diabetics because of a higher risk of hypoglycemic episodes
C) Exercise increases the body's ability to metabolize glucose
D) Patients who exercise vigorously in the afternoon may have hypoglycemic epi-
sodes in the evening or at night if they do not eat
368. B) Strenuous exercise is contraindicated for type 2 diabetics because of a higher risk of hypoglycemic episodes Exercise is recommended because exercise helps to use the glucose stores and reduce blood sugar. Blood sugar should be moni- tored closely, especially if on insulin, when exercising to avoid hypoglycemia.
369. What is the least common pathogen found in community-acquired atypical pneumonia?
A) Moxarella catarrhalis
B) Streptococcus pneumoniae
C) Pseudomonas aeruginosa
D) Mycoplasma pneumonia
369. C) Pseudomonas aeruginosa Pseudomonas aeruginosa is an uncommon cause of CAP but is a particularly difficult bacterial infection to treat.
372. Which of the following is indicated for initial treatment of an uncomplicated case of Helicobacter pylori negative peptic ulcer disease?
A) Omeprazole(Prilosec) B) Misoprostol(Cytotec) C) Ranitidine(Zantac) D) Pepto-Bismoltablets
372. B) Misoprostol (Cytotec) Misoprostol is recommended for short-term, uncom- plicated PUD; it acts by decreasing gastric acid production and enhancing mucosal resistance to injury.
373. Erythromycin inhibits the cytochrome P-450 system. The following drugs should be avoided because of a potential for a drug interaction except:
373. D) Furosemide (Lasix) There are many medications that are contraindicated with the cytochrome P-450 system. Lasix is one medication that can be used.
375. All of the following are considered Category X drugs except:
375. D) Meperidine (Demerol) Demerol is in drug Category C and and treated by the FDA as a controlled drug Schedule II.
388. Metronidazole (Flagyl) produces the disulfiram (Antabuse) effect when combined with alcoholic drinks or medicine. You would educate the patient to avoid:
A) Alcoholic drinks during the time she takes the medicine
B) Alcoholic drinks 1 day before, during therapy, and a few days after therapy
C) Alcoholic drinks after she takes the medicine
D) There is no need to avoid any food or drink.
388. B) Alcoholic drinks 1 day before, during, therapy and a few days after ther-
apy Alcohol is contraindicated during the use and up until 3 days following the administration of Flagyl. Severe side effects may occur, such as tachycardia, flush- ing, tingling sensations, nausea, and vomiting.
386. A 25-year-old woman complains of dysuria, severe vaginal pruritis, and a malodorous vaginal discharge. Pelvic examination reveals a strawberry-colored cervix and frothy yellow discharge. Microscopic exam of the discharge reveals mobile organisms that have flagella. The correct pharmacologic therapy for the condition is:
B) Ceftriaxone sodium (Rocephin)
C) Doxycycline hyclate (Vibramycin)
386. A) Metronidazole (Flagyl) Trichomoniasis symptoms include dysuria, severe vaginal pruritis, and malodorous vaginal discharge. Wet prep will show trichomonads that are pear-shaped and have several flagella (whiplike tails) at one end. CDC recommendation for treatment is metronidazole.
392. Prophylaxis for Pneumocystis carinii pneumonia includes all of the following drugs except:
D) Aerosolized albuterol sulfate (Ventolin)
392. D) Aerosolized albuterol sulfate (Ventolin) Prophylaxis for Pneumocystis carinii pneumonia includes the use of Bactrim, dapsone, and aerosolized pentamidine. Aerosolized pentamidine is a antimicrobial treatment for prevention, along with Bactrim and dapsone, which are antibacterial medications.
395. A kindergarten teacher is diagnosed with acute pharyngitis. On exam, the throat is a bright red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The result of her urinalysis shows a large amount of white blood cells and is positive for nitrites. The patient has a sulfa allergy and thinks she is also allergic to penicillins. Which of the following is the best treatment choice?
A) Amoxicillin/clavulanic acid (Augmentin) 500 mg PO BID
B) Levoquinolone (Levaquin) 250 mg PO daily
C) Trimethoprim sulfamethoxazole (Bactrim DS) 1 tablet PO BID
D) Clarithromycin (Biaxin) 500 mg PO BID
395. B) Levoquinolone (Levaquin) Pharyngitis and urinary tract infection are both covered by using Levaquin, which is a quinolone. Augmentin and Bactrim could not be used due to her allergies.
396. All of the following drugs interfere with the metabolism of oral contraceptives except:
C) Phenytoin(Dilantin) D) Ciprofloxacin(Cipro)
396. D) Ciprofloxacin (Cipro) Cipro is the only medication listed that will not inter- fere with the metabolism and absorption of OCPs.
397. When starting an elderly patient on a new prescription of levothyroxine (Synthroid), the nurse practitioner should keep in mind that the rationale for starting an elderly patient on a lower dose is which of the following?
A) Due to its central nervous system effects
B) Due to its cardiac effects
C) Due to its renal effects
D) Due to its hepatic effects
397. B) Due to its cardiac effects Levothyroxine (Synthroid) should be started on the lowest dose in elderly patients due to the severe side effects that can occur. Side effects include palpitations, tachycardia, anxiety, irritability, elevated BP, flushing, and insomnia.
400. Which of the following is a CDC-recommended treatment for a case of uncompli- cated gonorrheal and chlamydial infection?
A) Metronidazole (Flagyl) 250 mg PO TID x 7 days
B) Valacyclovir (Valtrex) 500 mg PO BID x 10 days
C) Azithromycin 1 g orally OR doxycycline 100 mg orally twice a day for 7 days
D) 1 dose of oral fluconazole (Diflucan) 150 mg
400. C) Azithromycin 1 g orally OR doxycycline 100 mg orally twice a day for 7 days Drug therapy is based on the 2010 CDC STD guidelines for treatment.
402. A nurse practitioner is taking part in a community outreach program for a local hospital. Most of her audience has a diagnosis of hypertension. They are all inter- ested in learning more about a proper diet. When discussing potential sources of potassium and magnesium, which of the following is the best advice?
A) Most fruits and vegetables
B) Whole grains and sausages
C) Processed corned beef and yogurt
D) Mushrooms and sauerkraut
402. A) Most fruits and vegetables Fruits and vegetables are higher in potassium and magnesium.
404. Julia, a 16-year-old patient, is being treated for her first urinary tract infection. Julia had an allergic reaction with hives after taking sulfa as a child. Which of the following antibiotics would be contraindicated?
D) Nitrofurantoin crystals (Macrobid)
404. C) Trimethoprim-sulfamethoxazole (Bactrim) With the allergic history to sulfa drugs, it would be safest to avoid Bactrim.
420. The first-line treatment consideration for managing acute alcohol withdrawal delirium includes:
C) Avoidance of physical restraints to decrease agitation
420. B) Benzodiazepines Acute alcohol withdrawal delirium is managed with benzodiazepines.
424. A 28-year-old male nurse tells the employee health nurse practitioner that he was treated for a UTI twice the previous year. The patient denies fever, flank pain, or urethral discharge during the visit. Which of the following is the best follow-up for this patient?
A) Refer the patient to a urologist
B) Prescribe the patient ofloxacin (Floxin) for 2 weeks instead of 1 week
C) Advise the patient that he needs to void every 2 hours when awake
D) Refer the patient to the local ED, because he has a very high risk of sepsis
424. A) Refer the patient to a urologist It is recommended that frequent UTIs in males be referred to a urologist for evaluation and treatment.
433. A patient diagnosed with bacterial vaginosis should be advised that her sexual partner be treated with:
A) Ceftriaxone (Rocephin) 250 mg IM with doxycycline 100 mg BID for 14 days
B) Metronidazole (Flagyl) 500 mg PO BID for 7 days and 1 dose of azithromycin
C) Her partner does not need treatment
D) Clotrimazole cream (Lotrimin) on his penis BID for 1 to 2 weeks
433. C) Her partner does not need treatment Bacterial vaginosis is a bacterial infec- tion, but is not considered an STD for which the partner needs treatment. Studies show that men rarely carry this infection.
442. The following are treatment plans related to migraine headaches. Which one of the following would not be considered effective therapy?
B) Cold packs to the forehead
D) Moderate sodium restriction
442. D) Moderate sodium restriction Effective treatments for migraine headaches include propranolol, trimethobenzamide, cold packs to the forehead/neck, and hydration.
448. Peakexpiratoryflow(PEF)metersareusedtomonitorasthmabyusingpersonalbest measurements. All of the following factors are used to determine the PEF except:
B) Gender C) Height D) Weight
448. D) Weight Peak expiratory flow volume is determined by using height, gender, and age. Weight is not used in the formula.
455. Which of the following drugs can increase the risk of bleeding in patients who are on anticoagulation therapy with warfarin sodium (Coumadin)?
A) Trimethoprim/sulfamethoxazole (Bactrim DS)
455. A) Trimethoprim/sulfamethoxazole (Bactrim DS) Coumadin interacts with Bactrim and will increase the risk of bleeding; therefore. it is contraindicated.
459. You have diagnosed Tom J., a 30-year-old male, with contact dermatitis on the left side of the face secondary to poison ivy. You would recommend:
A) Washing with antibacterial soap BID to reduce risk of secondary bacterial infection until it is healed
B) Hydrocortisone cream 1% BID until it is healed
C) Clotrimazole (Lotrimin) cream BID for 2 weeks
D) Halcinonide (Halog) 1% ointment BID for 2 weeks
459. B) Hydrocortisone cream 1% BID until it is healed Treatment for contact der- matitis includes using a steroid cream BID until healed.
464. What cholesterol level is classified as borderline?
A) 180 to 199 mg/dL
B) 200 to 239 mg/dL
C) > 240 mg/dL
D) > 300 mg/dL
464. B) 200 to 239 mg/dL Total cholesterol levels should be < 200. The levels 200-239 would be the best answer.
473. Your newly diagnosed diabetic patient reports to you that she had severe hives and swollen lips when she took Bactrim for a bladder infection 2 months ago. Which of the following statements is correct?
A) She cannot take any pills in the sulfonylurea class
B) She can take some of the pills in the sulfonylurea class
C) She can take any of the pills in the sulfonylurea class
D) None of the above
473. A) She cannot take any pills in the sulfonylurea class If an allergic reaction occurs with Bactrim, the patient must not take any medications in the sulfonylurea class.
480. A 13-year-old boy wants to be treated for his acne. He has a large number of closed and open comedones on his face. The patient has been treating himself with OTC benzoyl peroxide and salicylic acid topical products. Which of the following would be recommended next?
A) Retinoic acid (Accutane)
C) Retin A 0.25% gel
D) Wash face carefully with medicated soap at bedtime
480. C) Retin A 0.25% gel Topical agents are the first-line treatment for acne vulgaris. Retin A 0.25% gel would be the next step. Oral preparations would then be offered for the next step (tetracycline), and Accutane would be the final step of therapy.
490. You would advise a patient who is on a MAOI (monoamine oxidase inhibitor) pre- scription to avoid taking one of the following drugs because of increased potential for a serious reaction. Which of the following is this drug?
C) Erythromycin(E-mycin) D) Amoxicillin(Amoxil)
490. B) Fluoxetine (Prozac) Patients taking MAOIs should not also take SSRIs (Prozac), due to the possibility of developing serotonin syndrome. This causes excessive serotonin release in the brain, which will cause symptoms of severe anx- iety, restlessness, confusion, and muscle twitching. If not stopped, the patient may develop muscle contractions, renal failure, respiratory failure, coma, and even death.
496. Which of the following drug classes is recommended for the treatment of post- herpetic neuralgia?
A) TCAs (tricyclic antidepressants)
B) SSRIs (selective serotonin reuptake inhibitors)
496. A) TCAs (tricyclic antidepressants) Tricyclic antidepressants and anticonvul- sants are recommended for post-herpetic neuralgia. These medications may help with the neuropathic pain.
501. Which of the following is recommended as first-line treatment for essential tremor?
A) Propranolol(Inderal) B) Phenytoin(Dilantin) C) Amitriptyline(Elavil) D) Fluoxetine(Prozac)
501. A) Propranolol (Inderal) Propranolol (Inderal) is approved for "treatment" of essential tremor. It helps control the symptoms. Essential tremors are perma- nent and cannot be cured. Before prescribing, order an EKG. Do not use beta- blockers if a patient has second- or third-degree heart block or chronic lung disease.
514. A patient with chronic obstructive pulmonary disease (COPD) is referred for pul- monary function testing. Which of the following pulmonary function tests are abnormal in patients with COPD?
A) Reduction of the TLC (total lung capacity) and the RV (residual volume)
B) Complaints of mild to severe dyspnea with hypoxemia
C) Normal forced vital capacity (FVC) with no changes in the FEV1 (forced expi- ratory volume in 1 second)
D) Reduction of the FEV1 (forced expiratory volume in 1 second) with increase in the TLC (total lung capacity) and RV (residual volume)
514. D) Reduction of the FEV1 (forced expiratory volume in 1 second) with increase in the TLC (total lung capacity) and RV (residual volume) COPD findings dur- ing pulmonary function testing are the reduction of the FEV1 (forced expiratory volume in 1 second) and reduction of the FVC (forced vital capacity). There is an increase in the TLC (total lung capacity) and RV (residual volume). The lungs of patients with emphysema have lost their recoil (decreases FEV1). The lungs are always full of air that is hard to "squeeze out" of the lungs (increases residual vol- ume and total lung capacity). To summarize, COPD=reduction in FEV1 and FVC with increased RV and TLC.
515. The nurse practitioner is evaluating a middle-aged female who is complaining of gradual weight gain, lack of energy, dry hair, and an irregular period over an 8-month period. The routine annual laboratory testing showed a TSH result of 10 mU/L. The nurse practitioner decides to order a thyroid profile. The TSH is 8.50 mU/L and the serum free T4 is decreased. During the physical exam, the patient's BMI is 28. The heart and lung exams are both normal. Which of the fol- lowing is best treatment plan?
A) Advise the patient that because the TSH level has decreased, she does not have a thyroid problem anymore
B) Start the patient on levothyroxine (Synthroid) 0.25 mcg PO daily
C) Start the patient on Armour thyroid
D) Refer the patient to an endocrinologist
515. B)Startthepatientonlevothyroxine(Synthroid)0.25mcgPOdaily Thepatient is symptomatic (weight gain, lack of energy, and irregular periods) with low free T4. Even though the TSH went down slightly, the free T4 remains low. An elevated TSH and low free T4 are indicative of hypothyroidism. The next step is to start the patient on levothyroxine (Synthroid) 0.25 mcg daily and recheck the TSH in 6 weeks. The goal is to normalize the TSH (between 1.0 and 3.5) and to ameliorate the patient's symptoms (increased energy, feels better, etc.). Armour thyroid (desic- cated thyroid) is a natural supplement composed of dried (desiccated) pork thyroid glands. It is used in alternative medicine as an alternative to synthetic levothyrox- ine/T4 (Synthroid).
521. The atypical antipsychotic drugs have many adverse effects. Which of the follow- ing side effects is most likely to be seen with this drug class?
A) Orthostatic hypotension and sedation
B) Malignant hypertension and headache
C) Skin hyperpigmentation and alopecia
D) Severe anxiety and increased appetite
521. A) Orthostatic hypotension and sedation 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 hyperphagia (increased appetite). They lower anxiety and cause sedation, sleepiness, anorexia, and hypotension and increase the risk of sud- den death in frail elders.
522. A55-year-oldwomanwhoisonaprescriptionofclindamycinforadentalinfec- tion presents to the nurse practitioner with complaints of watery diarrhea for the past 4 days. She complains of abdominal cramping and bloating with diar- rheal stools up to 10 times a day. She denies seeing blood or pus in her stool. There is no history of recent travel. The patient has been taking over-the-counter medicine with no relief. The nurse practitioner suspects that the patient has a mild case of Clostridium difficile colitis. Which of the following antibiotics is indi- cated for this infection?
A) Ciprofloxacin (Cipro) 400 mg PO BID x 7 days
B) Metronidazole (Flagyl) 500 mg PO TID x 10 days
C) Levofloxacin (Levaquin) 750 mg PO daily x 7 days
D) Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet PO BID x 10 days
522. B) Metronidazole (Flagyl) 500 mg PO TID x 10 days First-line treatment for a mild case of Clostridium difficile colitis is metronidazole (Flagyl) 500 mg PO TID x 10 days. Discontinuation of the offending antibiotic (if possible) or switching to another antibiotic class is recommended. The role of probiotic supplementation is controversial. Complications are pseudomembranous colitis, toxic megacolon, and fulminant colitis.
523. A 13-year-old patient has a throat culture that is positive for strep throat. She reports that her younger brother was recently diagnosed with strep throat and treated. The patient has a severe allergy to penicillin and reports that erythromycin makes her very nauseated. Which of the following antibiotics is the best choice?
C) Cefuroxime axetil (Ceftin)
523. A) Azithromycin (Zithromax) If the patient has a severe penicillin allergy, there is a 10% chance of cross-reactivity to cephalosporins (especially first generation). Because the patient is a child, the levofloxacin is contraindicated. Nausea is a com- mon adverse reaction to erythromycin (it is not an allergic reaction). The best option is to use azithromycin because of its minimal GI adverse effects. Azithromycin has fewer drug interactions compared with other macrolides.
528. All of the following conditions are contraindications for bupropion (Wellbutrin, Zyban) except:
A) Anorexia nervosa and bulimia
D) Within 14 days after discontinuation of a monoamine oxidase inhibitor
528. C) Peripheral neuropathy 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 certain head injuries. For peripheral neuropathy, atypical antide- pressants such as duloxetine (Cymbalta) and TCAs such as amitriptyline (Elavil) are used.
532. All of the following drug classes are approved for treating hypertension. Which of the following antihypertensive drug classes is associated with the largest number of research studies?
B) Angiotensive receptor blockers (ARBs)
D) Calcium channel blockers (CCBs)
532. C) Thiazide diuretics Thiazide diuretics have been used to treat hypertension for many decades and numerous placebo-controlled studies have documented their effectiveness as an antihypertensive drug class.
534. Thiazide diuretics have been shown to have a beneficial effect on the bones. Hypertensive women with osteopenia or osteoporosis benefit from thiazide diuret- ics. What is the mechanism of action for its effect on the bones?
A) Thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoclast production
B) Thiazide diuretics increase both calcium and magnesium retention by the kidneys
C) Thiazide diuretics increase bone mineral density (BMD)
D) Thiazide diuretics influence electrolyte excretion by the kidneys
534. A) Thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoclast production This positive side effect of thiazides results in a decrease in calcium bone loss and an increase in the bone mineral density.
536. A 30-year-old male with a history of gout is walking to the examination room and the nurse practitioner notices that he is limping. When the patient sits down, the nurse practitioner notes that the metatarsophalangeal joint of the great toe is very swollen and is bright red. The patient reports that he was attending a party the night before and drank. The patient is requesting a prescription to treat his painful toe. The nurse practitioner prescribes the patient indomethacin (Indocin) 50 mg TID PRN and colchicine. Regarding colchicine, which of the following instructions is correct?
A) Take 1 pill every hour to every 2 hours until relief is obtained or adverse gas- trointestinal effects occur, such as abdominal pain, nausea, or diarrhea
B) Take 1 pill every hour until relief is obtained up to 24 hours
C) Take 1 pill every 4 to 6 hours until the pain is relieved
D) Take 2 to 3 pills QID until relief is obtained or adverse GI effects occur, such as
abdominal pain, nausea, or diarrhea
536. A) Take 1 pill every hour to every 2 hours until relief is obtained or adverse gastrointestinal effects occur, such as abdominal pain, nausea, or diar-
rhea Colchicine acts as an anti-inflammatory and helps to suppress gouty attacks. It is usually taken as 1 tablet (0.6 mg) every 1 to 2 hours until relief is obtained (or adverse gastrointestinal effects occur, such as abdominal pain, nau- sea, or diarrhea). Prescribe the patient only 10 tablets at a time (do not refill) dur- ing a flare-up. The maximum dose is 6 mg/day. Many patients will develop GI adverse effects even before the pain is relieved. Colchicine can also be taken daily in small amounts for prophylaxis.
537. What type of testing is recommended before starting a patient on a prescription of hydroxychloroquine (Plaquenil)?
B) Serum creatinine and urine for microalbumin
C) Liver function tests
D) Comprehensive eye exam
537. D) Comprehensive eye exam A comprehensive eye exam by an ophthalmolo- gist is recommended because hydroxychloroquine can adversely affect the retina (scotomas or visual field defects, loss of central vision, loss of color vision). Higher doses and long-term use increase the risk of retinal toxicity.
539. An adult patient was recently discharged from the hospital with a prescription of clindamycin. The patient reports that he took his last dose yesterday. He presents in the primary care clinic with complaints of the recent onset of watery diarrhea from 10 to 15 times a day with abdominal cramping. He denies fever and chills. Which of the following conditions is most likely in this patient?
A) Clostridium difficile-associated diarrhea (CDAD)
D) Irritable bowel syndrome
539. A) Clostridium difficile-associated diarrhea (CDAD) An important risk factor for Clostridium difficile-associated diarrhea (CDAD) and C. difficile colitis is antibi- otic therapy and hospitalization. Almost any antibiotic can cause the condition, but the most common are clindamycin, cephalosporins, and fluoroquinolones. Diarrhea can occur during therapy as well as after therapy (5 to 10 days; up to 10 weeks). Pseudomembranous colitis is a complication of C. difficle colitis.
544. Which of the following drugs that are used to treat attention deficit hyperactivity disorder (ADHD) is not classified as an amphetamine/stimulant?
A) Dexmethylphenidate (Focalin XR)
B) Mixed salts of amphetamine (Adderall)
544. D) Atomoxetine (Strattera) Strattera is classified as a norepinephrine reuptake inhibitor. It is not a stimulant or an amphetamine. Strattera is contraindicated dur- ing/within 14 days of taking an MAOI, narrow-angle glaucoma, heart disorder where increases in BP or heart rate will worsen it, or pheochromocytoma. Children and teenagers should be monitored for suicidal thoughts/plans.
545. A 25-year-old male with schizophrenia comes in for a routine annual physical. He is a heavy smoker and has a BMI of 28. The patient has been on olanzapine (Zyprexa) for 10 years. Regarding the patient's prescription, which of the follow- ing laboratory tests is recommended for monitoring for adverse effects of atypical antipsychotics?
A) Fasting blood glucose, fasting lipid profile, and weight
B) Urinalysis, serum creatinine, 24-hour urine for protein and creatinine
C) Liver function tests only
D) CBC with differential, liver function tests, weight
545. A) Fasting blood glucose, fasting lipid profile, and weight Patients on atypical antipsychotics commonly gain weight and are at risk for obesity, hyperglycemia, and type 2 diabetes. Zyprexa will increase lipids (cholesterol, LDL, and triglycer- ides). Atypical antipsychotics also increase the risk of death among frail elders and older adults living in nursing homes.
551. A 22-year old is going on a 5-day cruise for her honeymoon. She reports a history of severe motion sickness. Which of the following medicines can be prescribed for motion sickness?
C) Ondansetron(Zofran) _
D) Scopolamine patch (Transderm Scop)
551. D) Scopolamine patch (Transderm Sco_p) Scopolamine patch (Transderm Sco_p) is a prescription medicine that is used for motion/sea sickness. It is a small, circular patch that is placed behind the ear and is effective for 3 days. Advise the patient to apply it 4 hours before the trip to be effective. Because the question is asking about a "prescribed" med, answers with OTCs such as Dramamine are incorrect. Zofran is indicated for cancer-related nausea and vomiting (chemo, radiation, surgery).
554. Which of the following benzodiazepines has the shortest half-life?
554. C) Triazolam (Halcion) Triazolam (Halcion) has an average half-life of about 2 hours. Xanax has a half-life of 12 hours. Ativan has a half-life of 15 hours. Klonopin has a half-life of 34 hours.
557. A 62-year-old male with chronic obstructive pulmonary disease (COPD) complains to the nurse practitioner that his prescription of ipratropium bromide (Atrovent) is not working. He reports that he still feels short of breath even after using it 4 times a day for 3 months. Which of the following actions is the next step for the nurse practitioner?
A) Increase the patient's dose of ipratropium bromide (Atrovent) to 3 inhalations QID
B) Continue the ipratropium bromide and start the patient on oxygen by nasal cannula
C) Continue ipratropium bromide (Atrovent) and add albuterol (Ventolin) inhaler 2 inhalations QID
D) Start the patient on oxygen by nasal cannula at bedtime and PRN during the daytime
557. C) Continue ipratropium bromide (Atrovent) and add albuterol (Ventolin) inhaler 2 inhalations QID Treatment of COPD starts with an anticholinergic (ipratropium bromide). The next step is to add a short-acting beta-2 agonist (albuterol).
569. Which of the following pharmacologic agents is the best choice for an elderly patient with insomnia?
569. B) Zolpidem (Ambien) Ambien has a quick onset of action (15 minutes) and a short half-life of 2 hours. Avoid diphenhydramine in the elderly, as there is a higher incidence of adverse effects (confusion, prolonged sedation) in this population. Avoid long-acting benzodiazepines such as diazepam (half-life 12 hours) and temazepam (half-life of 10 hours). Hypnotics can be used PRN up to 2 weeks; otherwise, benzodiazepines can cause addiction and withdrawal symptoms.
570. An elderly Hispanic male has been taking finasteride (Proscar) for several months. The nurse practitioner decides to check the prostate specific antigen (PSA). The PSA result is 10 ng/mL. The patient's baseline PSA was 30 ng/mL. Which of the following is the next step?
A) Add the baseline PSA value to the treatment PSA value
B) The treatment PSA value is the correct value
C) Multiply the treatment PSA value by 2
D) Divide the baseline PSA value by the treatment PSA value
570. C) Multiply the treatment PSA value by 2 Before starting a prescrip- tion of Proscar, obtain the baseline PSA. Recheck the PSA again within 2 to 3 months during treatment to assess the patient's response (treatment PSA). For this example, the corrected treatment PSA is 20 (multiply 10 x 2 = 20). When com- paring the corrected treatment PSA (20) with the baseline PSA (30), the value is lower (means the prostate has shrunk in size). The patient's symptoms will also improve, including less nocturia, less dribbling, and stronger urinary stream.
579. An elderly Hmong, who is from Thailand, is seen by the nurse practitioner for a follow-up visit. He is accompanied by his eldest daughter. The patient presented 6 weeks ago with complaints of the recent onset of morning headaches. The patient was diagnosed with Stage 2 hypertension and prescribed hydrochlorothiazide, 125 mg tablet once a day. On this visit, Mr. Nguyen tells the nurse practitioner that the new medicine cured the headache and he stopped taking the medicine. What is the best plan to follow during this visit?
A) Educate the patient about hypertension, how the medicine works on his body, and the importance of taking his pill daily
B) Reassure the patient that he can resume his prescription medicine again the next morning
C) Tell the patient that you will lower the dose of the hydrochlorothiazide to 12.5 mg daily
D) Speak to the patient in a loud voice and confront him about his behavior
579. A) Educate the patient about hypertension, how the medicine works on his body, and the importance of taking his pill daily When Hmong (Thailand, Burma, Vietnamese) see a medical doctor for a symptom, they expect to be treated and "cured" of their illness. When the symptoms disappear, many will stop taking the medicine. When medication is to be taken on a long-term basis, it is important to educate the patient (and the patient's family) about the disease (i.e., hypertension),how the medicine works on the body, and the reason why he has to take his medi- cine daily. Hmong and Vietnamese are very polite and consider speaking in a loud voice, staring, or confrontation to be rude behavior.
580. A 68-year-old woman has recently been diagnosed with polymyalgia rheu- matica. The nurse practitioner is discussing the treatment options with the patient. Which of the following medications is the first-line treatment for this condition?
A) Etanercept(Enbrel) B) Oralprednisone
580. B) Oral prednisone Patients with PMR are treated with oral steroids (gluco- corticoids). 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).
581. Which of the following is a true statement regarding the first-pass metabolism process?
A) Drugs that are administered by intramuscular injection all go through the pro- cess of first-pass metabolism
B) After being swallowed, oral drugs are absorbed by the GI tract and metabo- lized by the bacteria in the small intestines before being released into the gen- eral circulation
C) Drugs administered through the skin (patches) are metabolized by the dermis of the skin
D) After a drug is taken by the oral route, it is absorbed in the small intestines and enters the liver through the portal circulation, where it is metabolized before being released into the general circulation
581. D) After a drug is taken by the oral route, it is absorbed in the small intes- tines and enters the liver through the portal circulation, where it is metabolized before being released into the general circulation After drugs are taken by the oral route, they are absorbed by the small intestines and enter the liver through the portal circulation, where they are metabolized before being released into the general circulation. First-pass metabolism (first-pass effect) determines how much of the active drug is available to the body (bioavailability). Depending on the drug and other factors, a drug may be poorly metabolized or extensively metabolized by the liver.
583. A college student is seen as a walk-in appointment in a college health clinic. She complains of the abrupt onset of sore throat, nasal congestion, runny nose, and malaise. Vital signs are a temperature of 99.8 degrees Fahrenheit, pulse 84, and respiratory rate 14 breaths/minute. The physical exam reveals an erythematous throat, swollen nasal turbinates, and rhinitis. The NP suspects viral URI. All of the following treatments are appropriate except:
A) Saline nasal spray (Ocean nasal spray)
D) Oral prednisone (Medrol Dose Pack)
583. D) Oral prednisone (Medrol Dose Pack) Symptomatic treatment for viral URI are saline nasal sprays (Ocean spray), decongestants (pseudoephedrine), NSAIDs (Advil), increased fluid intake, and alternative herbal remedies (echinachea, astralagus, elderberry syrup, high doses of Vitamin C).
586. A 16-year-old male with a recent history of a cat bite is brought in by his father. The bite occurred about 2 hours before the visit. The nurse practitioner evaluates the wound and notes 2 small puncture wounds. There is no redness or purulent discharge. The father reports that the teenager received a tetanus booster when he was 12 years old. Which of the following is the correct action to take?
A) Clean the wound with soap and water and apply topical antibiotic and a bandage
B) Because the wound is clean and does not appear infected, there is no need for antibiotics
C) Give the patient a tetanus booster using the Tdap form of the vaccine
D) Clean the wound with soap and water and prescribe Augmentin 500 mg PO
BID x 10 days for the patient
586. D) Clean the wound with soap and water and prescribe Augmentin 500 mg PO BID x 10 days for the patient Cat wounds are more likely to become infected compared with dog bites; in addition, this patient's bite is located on an extremity. These facts justify the prescription of Augmentin 500 mg PO BID x 10 days for the patient.
589. Anelderlyfemalepatientwhoisaretirednursehasrecentlybeendischargedfrom the hospital. A few days later, she started having random and recurrent episodes of dizziness, but denies passing out. The patient describes it as the sensation of the room spinning or moving, which is worsened by sudden head movement. During the episodes, she gets very nauseated and sometimes vomits. The patient reports that she was given IV antibiotics and one of them was tobramycin. Which of the following medications is helpful in treating her symptom of dizziness?
A) Scopolamine patch (Transderm Sco_p)
589. B) Meclizine (Antivert) The case is describing vertigo. Meclizine (Antivert) 12.5 mg to 50 mg TID to QID is used to treat vertigo. Do not forget to also treat nau- sea, which can be severe. Anti-nausea medicine like dimenhydrinate (Dramamine) or prochlorperazine (Compazine) are effective. Advise the patient that these drugs can cause drowsiness.
597. All of the following signs and symptoms are present with an anticholinergic drug overdose except:
B) Flushing and tachycardia
597. C) Hypertension Drugs with strong anticholinergic properties include diphen- hydramine, scopolamine, TCAs, antipsychotics, and others. The mnemonic is "dry as a bone, red as a beet, mad as a hatter, blind as a bat." Look for a low-grade temperature.
603. Glucosamine sulfate is a natural supplement that is used for which of the follow- ing conditions?
A) Rheumatoidarthritis B) Osteoarthritis
603. B) Osteoarthritis Glucosamine sulfate has been found to have a beneficial effect on cartilage growth and repair. It may also have an anti-inflammatory effect. Many patients with OA who take it claim that it helps to relieve joint pain. It can take from 1 to 3 months of taking the medicine to feel its effects. Glucosamine is a com- pound made up of glucose and an amino acid.
628. Which of the following drugs is most likely to cause sexual dysfunction in males?
628. A) SSRIs A common side effect of SSRIs (e.g., Prozac, Paxil, Zoloft) is sexual dys- function in males. For depressed males, atypical antidepressants such as bupro- pion (Wellbutrin) cause less sexual dysfunction.
629. Which of the following drugs is classified as a 5-alpha reductase inhibitor?
A) Terazosin(Hytrin) B) Tamsulosin(Flomax) C) Finasteride(Proscar) D) Sildenafil(Viagra)
629. C) Finasteride (Proscar) Finasteride (Proscar) belongs to the drug class called 5-alpha reductase inhibitors. It helps to lower serum testosterone, which helps
632. A new mother is planning on breastfeeding her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (APA) latest guideline during the first few days of life?
A) Vitamin D drops
B) Multi vitamin drops
C) It is not necessary to give breastfed infants vitamin supplements because breast milk contains enough vitamins and minerals that are necessary for the infant's growth and development
D) Folic acid drops
632. A) Vitamin D drops According to the APA, all infants should be given Vitamin D supplementation within the first few days of life. Mothers who plan to breast- feed their infants should be taught how to use Vitamin D drops. Infant formula is supplemented with Vitamin D (and many other vitamins, minerals, and omega-3 oil), so there is no need to give it separately.