Exam three fnp july

1. The Centers for Disease Control recommends all newborn infants receive prophylactic administration of __________ within one hour of birth.
1 Gentamicin ophthalmic ointment
2 Ciprofloxacin ophthalmic drops
3 Erythromycin oral suspension
4 Erythromycin ophthalmic ointment
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3. A young adult patient comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be:
1 None, wait for the culture results to determine the course of treatment
2 Ciprofloxacin (Ciloxan) ophthalmic drops
3 Intramuscular (IM) ceftriaxone
4 High-dose oral amoxicillin
4. Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes:
1 Throw away eye makeup and purchase new.
2 Redness and intense burning is normal with ophthalmic antibiotics.
3 When applying eye ointment, set the tip of the tube on the lower lid and squeeze in 1/4 inch.
4 Use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac.
5. A patient was prescribed betaxolol ophthalmic drops by their ophthalmologist to treat glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because:
1 There may be an antagonistic reaction between the two.
2 The additive effects may include bradycardia.
3 They may potentiate each other and cause respiratory depression.
4 The additive effects may cause metabolic acidosis.
6. An adult patient presents to the clinic with symptoms of allergic conjunctivitis and is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding cromolyn eye drops includes:
1 They should not wear soft contacts while using the cromolyn eye drops.
2 Cromolyn drops are instilled once a day to prevent allergy symptoms.
3 Long-term use may cause glaucoma.
4 They may experience bradycardia as an adverse effect.
9. Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops includes:
1 Fill the canal with the drops with each dose.
2 Some redness and itching around the ear canal is normal.
3 Warm the bottle of ear drops in his or her hand before administering.
4 Cipro HC otic may cause ototoxicity.
10. A patient presents to the clinic with hard earwax in both ear canals. Instructions regarding home removal of hard cerumen include:
1 Moisten a cotton swab (Q-tip) and swab the ear canal twice daily.
2 Instill tap water in both ears while bathing.
3 Squirt hydrogen peroxide into ears with each bath.
4 Instill carbamide peroxide (Debrox) twice daily until canals are clear.
1. A patient who has been taking 10 mg per day of prednisone for the past six months should be assessed for: 1 Gout 2 Iron deficiency anemia 3 Osteoporosis 4 Renal dysfunction3 PTS: 12. Patients whose total dose of prednisone exceeds 1 g will most likely need a second prescription for: 1 Metformin, a biguanide to prevent diabetes 2 Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease 3 Naproxen, a nonsteroidal anti-inflammatory drug (NSAID) to treat joint pain 4 Furosemide, a diuretic to treat fluid retention2 PTS: 13. A patient has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued? 1 Patients with asthma are transitioned directly off the prednisone onto inhaled corticosteroids. 2 Prednisone can be abruptly discontinued with no adverse effects. 3 A tapering schedule should be developed to slowly wean them off the prednisone. 4 Prednisone should be substituted with another anti-inflammatory such as ibuprofen.3 PTS: 14. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need cotreatment with which medication to prevent adverse effects? 1 A bisphosphonate 2 Calcium supplementation 3 Vitamin D 4 All of the above4 PTS: 15. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of: 1 Serum glucose 2 Stool cultures 3 Folate levels 4 Vitamin B121 PTS: 16. Patients who are on chronic long-term corticosteroid therapy need education regarding: 1 Receiving all vaccinations, especially the live flu vaccine 2 Reporting black tarry stools or abdominal pain 3 Eating a high carbohydrate diet with plenty of fluids 4 Small amounts of alcohol are generally tolerated.2 PTS: 17. All NSAIDs have a U.S. Food and Drug Administration (FDA) black box warning regarding: 1 Potential for causing life-threatening gastrointestinal (GI) bleeds 2 Increased risk of developing systemic arthritis with prolonged use 3 Risk of life-threatening rashes, including Stevens-Johnson syndrome 4 Potential for transient changes in serum glucose1 PTS: 18. A patient has fractured their ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes: 1 It is okay to double the dose of Vicodin if the pain is severe. 2 Vicodin is not habit forming. 3 They should not take any other acetaminophen-containing medications. 4 Vicodin may cause diarrhea; increase fluid intake.3 PTS: 19. When prescribing NSAIDs, a complete drug history should be conducted as NSAIDs interact with these drugs: 1 Omeprazole, a proton pump inhibitor 2 Combined oral contraceptives 3 Diphenhydramine, an antihistamine 4 Warfarin, an anticoagulant4 PTS: 110. A 2-year-old child is diagnosed with acute otitis media and an upper respiratory infection. Along with an antibiotic they receive a recommendation to treat the ear pain with ibuprofen. What education would their parent need regarding ibuprofen? 1 They can cut an adult ibuprofen tablet in half to give the child. 2 The ibuprofen dose can be doubled for severe pain. 3 The child needs to be well hydrated while taking ibuprofen. 4 Ibuprofen is completely safe in children with no known adverse effects.3 PTS: 111. An 82-year-old takes two aspirin every morning to treat the arthritis pain in his back. The patient states the aspirin helps him to "get going" each day. Lately the patient has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for him? 1 Add an H2 blocker such as ranitidine to his therapy. 2 Discontinue the aspirin and switch him to Vicodin for the pain. 3 Decrease the aspirin dose to one tablet daily. 4 Instruct the patient to take an antacid 15 minutes before taking the aspirin each day.1 PTS: 112. The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is: 1 48 hours 2 4 to 6 days 3 Four weeks 4 Two months2 PTS: 113. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is: 1 Black tarry stools 2 Vomiting 3 Tremors 4 Tinnitus4 PTS: 114. Monitoring a patient on a high-dose aspirin includes: 1 Salicylate level 2 Complete blood count 3 Urine pH 4 All of the above4 PTS: 115. Patients who are on long-term aspirin therapy should have ______ annually. 1 Complete blood count 2 Salicylate level 3 Amylase 4 Urine analysis1 PTS: 1 Chapter 18. Drugs Affecting the Endocrine System: Antidiabetic Drugs MULTIPLE CHOICE1. When given subcutaneously, how long until neutral protamine Hagedorn (NPH) insulin begins to take effect (onset of action) after administration? 1 Fifteen to thirty minutes 2 Sixty to ninety minutes 3 Three to four hours 4 Six to eight hours2 PTS: 12. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: 1 "Fruity" breath odor and rapid respiration 2 Diarrhea, abdominal pain, weight loss, and hypertension 3 Dizziness, confusion, diaphoresis, and tachycardia 4 Easy bruising, palpitations, cardiac dysrhythmias, and coma3 PTS: 13. Nonselective beta blockers and alcohol create serious drug interactions with insulin because they: 1 Increase blood glucose levels 2 Produce unexplained diaphoresis 3 Interfere with the ability of the body to metabolize glucose 4 Mask the signs and symptoms of altered glucose levels4 PTS: 14. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true? 1 Optimal time of preprandial injection is 15 minutes. 2 Duration of action is increased when the dose is increased. 3 It is compatible with NPH insulin. 4 It has no pronounced peak.2 PTS: 15. The decision may be made to switch from twice daily NPH insulin to insulin glargine to improve glycemia control throughout the day. If this is done: 1 The initial dose of glargine is reduced by 20% to avoid hypoglycemia. 2 The initial dose of glargine is 2 to 10 units per day. 3 Patients who have been on high doses of NPH will need tests for insulin antibodies. 4 Obese patients may require more than 100 units per day.1 PTS: 16. When blood glucose levels are difficult to control in type 2 diabetes, some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research? 1 Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia. 2 Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. 3 Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. 4 Patients who are not controlled on oral agents and have postprandial hyperglycemia can have NPH insulin added at bedtime.3 PTS: 17. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: 1 Substitutes for insulin usually secreted by the pancreas 2 Decreases glycogenolysis by the liver 3 Increases the release of insulin from beta cells 4 Decreases peripheral glucose utilization2 PTS: 18. Prior to prescribing metformin, the provider should: 1 Draw a serum creatinine to assess renal function 2 Try the patient on insulin 3 Tell the patient to increase iodine intake 4 Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions1 PTS: 19. The action of gliptins is different from other antidiabetic agents because they: 1 Have a low risk for hypoglycemia 2 Are not associated with weight gain 3 Close ATP-dependent potassium channels in the beta cell 4 Act on the incretin system to indirectly increase insulin production4 PTS: 110. Sitagliptin has been approved for: 1 Monotherapy in once-daily doses 2 Combination therapy with metformin 3 Both 1 and 2 4 Neither 1 nor 23 PTS: 111. GLP-1 agonists: 1 Directly bind to a receptor in the pancreatic beta cell 2 Have been approved for monotherapy 3 Speed gastric emptying to decrease appetite 4 Can be given orally once daily1 PTS: 112. Avoid concurrent administration of exenatide with which of the following drugs? 1 Digoxin 2 Warfarin 3 Lovastatin 4 All of the above4 PTS: 113. Administration of exenatide is by subcutaneous injection: 1 Thirty minutes prior to the morning meal 2 Sixty minutes prior to the morning and evening meal 3 Fifteen minutes after the evening meal 4 Sixty minutes before each meal daily2 PTS: 114. When is metformin typically initiated for glucose metabolism issues? 1 Only after the HgA1C is greater than 8.0 2 When the patient is diagnosed with prediabetes 3 When metabolic syndrome ensues 4 When true diabetes mellitus (DM_ is diagnosed2 PTS: 115. Which characteristic of metformin makes it a popular selection for diabetes care? 1 No gastrointestinal (GI) side effects 2 Only rarely causes hypoglycemia 3 Pain-free injections due to the micro needle 4 Once-weekly dosing2 PTS: 116. All of the following are options for insulin injections when each dose is close to 100 units except: 1 Split dosing 2 Move to insulin pen use 3 Change to U500 insulin 4 Stop injectable insulin and change to oral methods only4 PTS: 117. Long-term injection site skin changes are called: 1 Lipodystrophy 2 Tuberous sclerosis 3 Telangiectasia 4 Medication caveronosa1 PTS: 118. Angiotensin-converting enzyme (ACE) inhibitors are considered renal-protective in DM; however, they must be reduced and/or discontinued when: 1 The patient reaches stage 3 chronic kidney disease (CKD) 2 Creatinine levels reach 1.1 3 Potassium levels are consistently found to be below four 4 The patient first starts spilling protein in their urine1 PTS: 1 Chapter 19. Drugs Affecting the Endocrine System MULTIPLE CHOICE1. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is prescribed in units of: 1 Lipase 2 Protease 3 Amylase 4 Pancreatin1 PTS: 12. Different brands of pancreatic enzyme replacement drugs are: 1 Bioequivalent 2 About the same in cost per unit of lipase across brands 3 Able to be interchanged between generic and brand-name products to reduce cost 4 None of the above2 PTS: 13. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: 1 Tinnitus and decreased salivation 2 Fever and sore throat 3 Hypocalcemia and osteoporosis 4 Laryngeal edema and difficulty swallowing2 PTS: 14. Elderly patients who are on levothyroxine for thyroid replacement should be monitored for: 1 Excessive sedation 2 Tachycardia and angina 3 Weight gain 4 Cold intolerance2 PTS: 15. Which of the following is not an indication that growth hormone supplements should be discontinued? 1 Imaging indication of epiphyseal closure 2 Growth curve increases that have plateaued 3 Complaints of mild bone pain 4 Achievement of anticipated height goals3 PTS: 16. Which of the following statements about pancreatic enzymes is true? 1 Dosing may be titrated according to the decrease of steatorrhea. 2 The amount of carbohydrates in a meal drives the amount of enzyme used. 3 The amount of medication used increases with a cystic fibrosis pulmonary flare. 4 The U.S. Food and Drug Administration (FDA) and internet-available formulations are bioequivalent.1 PTS: 17. Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes? 1 Paget's disease 2 Pulmonary cancers 3 Gallbladder surgery 4 Some bariatric surgeries4 PTS: 18. A precaution when sprinkling pancreatic enzymes on food is: 1 Wash off any "dust" that gets on the hands to decrease potential dermatology issues. 2 Keep it on top of food instead of mixing it in. 3 Do not drink fluids during the meal. 4 Keep the powder primarily on the carbohydrate-rich foods.1 PTS: 19. A postsurgical patient may experience water balance issues for a while due to alteration in which hypothalamic, pituitary, adrenal hormone: 1 Prolactin 2 Thyroid-stimulating hormone (TSH) 3 Antidiuretic hormone (ADH) 4 Oxytocin3 PTS: 110. Patients with Addison's disease frequently carry an emergency supply of which medication in case of sudden onset crisis: 1 Adrenaline 2 Aldosterone 3 Florinef 4 Benadryl3 PTS: 111. Why must steroids be tapered after long-term use? 1 Chronic use intensifies adrenal response. 2 So that the resolution of longer-term adrenal suppression is not rapid. 3 Tapering reduces the sequela of "moon facies" and lipomas. 4 Abrupt cessation causes tachyphylaxis.2 PTS: 112. A woman who is not pregnant and not breastfeeding has unexplained "milk production" from her left breast. Which endocrine abnormality is the most likely cause? 1 Adrenal tumor 2 Pancreatic cancer 3 Cushing's syndrome 4 Pituitary tumor4 PTS: 1 Chapter 17. Drugs Affecting the Gastrointestinal System MULTIPLE CHOICE1. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first? 1 Patients with kidney stones 2 Pregnant patients 3 Patients with heartburn 4 Postmenopausal women1 PTS: 12. Patients taking antacids should be educated regarding these drugs, including letting them know that: 1 They may cause constipation or diarrhea. 2 Many are high in sodium. 3 They should separate antacids from other medications by one hour. 4 All of the above4 PTS: 13. A patient has diarrhea and is wondering if they can take loperamide (Imodium). Loperamide: 1 Can be given to patients of all ages, including infants and children, for viral gastroenteritis 2 Slows gastric motility and reduces fluid and electrolyte loss from diarrhea 3 Is the treatment of choice for the diarrhea associated with E. coli 0157 4 May be used in pregnancy and by lactating women2 PTS: 14. Bismuth subsalicylate (Pepto-Bismol) is a common over-the-counter (OTC) remedy for gastrointestinal complaints. Bismuth subsalicylate: 1 May lead to toxicity if taken with ibuprofen 2 Is contraindicated in children with flu-like illness 3 Has no antimicrobial effects against bacterial and viral enteropathogens 4 May cause stools to turn reddish color4 PTS: 15. A young adult will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes following normal food and water precautions as well as taking: 1 Loperamide four times a day throughout the trip 2 Bismuth subsalicylate before each meal and at bedtime 3 Prescription diphenoxylate with atropine if she gets diarrhea 4 Calcium carbonate (Tums) four times a day for stomach upset2 PTS: 16. A 15-year-old patient presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is four pounds less than her last recorded weight. Besides intravenous (IV) fluids, the exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order? 1 Prochlorperazine (Compazine) 2 Meclizine (Antivert) 3 Promethazine (Phenergan) 4 Ondansetron (Zofran)4 PTS: 17. A patient presents with complaints of heartburn that is minimally relieved with Tums (calcium carbonate) and is diagnosed as gastroesophageal reflux disease (GERD). An appropriate on-demand therapy would be: 1 Omeprazole (Prilosec) twice a day 2 Ranitidine (Zantac) twice a day 3 Famotidine (Pepcid) once a day 4 Metoclopramide (Reglan) four times a day2 PTS: 18. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: 1 Iron deficiency anemia, vitamin B12 and calcium deficiency 2 Folate and magnesium deficiency 3 Elevated uric acid levels leading to gout 4 Hypokalemia and hypocalcemia1 PTS: 19. A 72-year-old patient takes omeprazole for their chronic GERD. Chronic long-term omeprazole use places them at increased risk for: 1 Megaloblastic anemia 2 Osteoporosis 3 Hypertension 4 Strokes1 PTS: 110. A 10-year-old patient 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: 1 PEG 3350 (Miralax) 2 Bisacodyl (Dulcolax) suppository 3 Docusate (Colace) suppository 4 Methylnaltrexone2 PTS: 111. Methylnaltrexone is used to treat constipation in: 1 Patients with functional constipation 2 Patients with irritable bowel syndrome-associated constipation 3 Children with encopresis 4 Patients with opioid-associated constipation4 PTS: 112. An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: 1 Electrolytes, including potassium and chloride 2 Bone mineral density for osteoporosis 3 Magnesium level 4 Liver function1 PTS: 113. Which of the following medications places a patient at increased risk of developing chronic kidney disease? 1 Ranitidine 2 Omeprazole 3 Loperamide 4 Ondansetron2 PTS: 1 Chapter 43. Hyperthyroidism and Hypothyroidism MULTIPLE CHOICE1. When methimazole is started for hyperthyroidism it may take ________ to see a total reversal of hyperthyroid symptoms. 1 2 to 4 weeks 2 1 to 2 months 3 3 to 4 months 4 6 to 12 months4 PTS: 12. In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: 1 A calcium channel blocker 2 A beta blocker 3 Liothyronine 4 An alpha blocker2 PTS: 13. After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes thyroid-stimulating hormone (TSH) and free thyroxine (T4) every: 1 1 to 2 weeks 2 3 to 4 weeks 3 2 to 3 months 4 6 to 9 months2 PTS: 14. A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with: 1 Methimazole 2 Propylthiouracil (PTU) 3 Radioactive iodine 4 Nothing, because treatment is best delayed until after her pregnancy ends.2 PTS: 15. Goals when treating hypothyroidism with thyroid replacement include: 1 Normal TSH and free T4 levels 2 Resolution of fatigue 3 Weight loss to baseline 4 All of the above4 PTS: 16. When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: 1 Two weeks 2 Four weeks 3 Two months 4 Six months2 PTS: 17. Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored for TSH and free T4 levels every: 1 Two weeks 2 Four weeks 3 Two months 4 Six months4 PTS: 18. Treatment of a patient with hypothyroidism and cardiovascular disease consists of: 1 Levothyroxine 2 Liothyronine 3 Liotrix 4 Methimazole1 PTS: 19. Infants with congenital hypothyroidism are treated with: 1 Levothyroxine 2 Liothyronine 3 Liotrix 4 Methimazole1 PTS: 110. When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: 1 They should feel symptomatic improvement in 1 to 2 weeks. 2 Drug adverse effects such as lethargy and dry skin may occur. 3 It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing. 4 Because of its short half-life, levothyroxine doses should not be missed.3 PTS: 111. In hyperthyroid states, what, other than the cardiovascular (CV), must be evaluated to establish potential adverse issues? 1 The liver 2 The nails and skin 3 The eyes 4 The ears3 PTS: 112. Why are "natural" thyroid products not readily prescribed for most patients? 1 There is no reliability for the amount of hormone per dose. 2 There is higher incidence of allergic reactions. 3 There is a more reliable dose of triiodothyronine (T3) to T4 per batch lot of preparation. 4 All of the above4 PTS: 113. What is the desired ratio of T3 to T4 drug levels in newly diagnosed endocrine patients? 1 Ninety-nine percent of T3 and the rest is T4 to get rapid resolution. 2 Most needs to be T4 to mimic natural ratios of hormone. 3 The ratio is unimportant. 4 The mix needs to be 50-50 at first.2 PTS: 114. Laboratory values are different for TSH when screening for thyroid issues and when used for medication management. Which of the following holds true? 1 Screening TSH has a wider range of normal values (0.02 to 5.0); therapeutic levels need to remain above 5.0. 2 Screening values are much narrow than the acceptable range used to keep a person stable on hormone replacement. 3 Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. 4 Screening values are between 5 and 10, and therapeutic values are greater than 10.3 PTS: 115. What happens to the typical hormone replacement dose when a woman becomes pregnant? 1 Most women need less medication. 2 Most women do not require a dose change. 3 The average woman needs more medication during pregnancy. 4 The average woman needs more medication only if carrying multiples.3 PTS: 116. Hyperthyroid patients require which specialty consultation even when asymptomatic for that organ system? 1 Hepatology 2 Pulmonary 3 Ophthalmology 4 Rheumatology3 PTS: 117. Treatment with radioactive iodine requires which precaution in the first few days of therapy? 1 Keeping 100 ft. distance from all others 2 Not bathing 3 Not sharing dishes, cups, and utensils 4 Wearing a neck brace3 PTS: 118. Why are some patients unable to achieve stability on generic forms of Synthroid? 1 The U.S. Food and Drug Administration (FDA)-allowed tolerance of 20% variance per tablet is of potential issue even with very small dosage changes in this drug family. 2 Thyroid patients are sensitive to the food coloration used in the tablets. 3 It is a psychosomatic belief that emphasizes the true power of the hypothalamic pituitary adrenal (HPA) axis. 4 This only occurs during pregnancy.1 PTS: 119. Which body system is most impacted if congenital hypothyroid is not rapidly recognized after birth? 1 Central nervous system 2 CV system 3 Gastrointestinal (GI) system 4 Immune system1 PTS: 120. After decades of thyroid supplementation in a patient with TSH at the low end of the range, the patient has increased risk for what? 1 Cataracts 2 Osteoporosis 3 Cancer 4 Dementia2 PTS: 1 Chapter 41. Hyperlipidemia MULTIPLE CHOICE1. The overall goal of treating hyperlipidemia is: 1 Maintain a low-density lipoprotein (LDL) level of less than 160 mg/dL 2 To reduce atherogenesis 3 Lowering apo-B, one of the apolipoproteins 4 All of the above2 PTS: 12. When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? 1 Total LDL 2 Fasting high-density lipoprotein (HDL) 3 Coronary artery disease risk level 4 Fasting total cholesterol3 PTS: 13. First-line therapy for hyperlipidemia is: 1 Statins 2 Niacin 3 Lifestyle changes 4 Bile acid-binding resins3 PTS: 14. James is a 45-year-old patient with a very high cardiovascular (CV) risk profile, an LDL level of 120, and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and: 1 A statin 2 Niacin 3 Sterols 4 A fibric acid derivative1 PTS: 15. Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increasing fiber and plant sterols) to lower her LDL but after six months her LDL is slightly higher. The next step in her treatment would be: 1 A statin 2 Niacin 3 Sterols 4 A fibric acid derivative1 PTS: 16. Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past three months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: 1 A statin 2 Niacin 3 A fibric acid derivative 4 Determined by her risk factors4 PTS: 17. Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for three months to treat his high LDL level. His LDL is still higher than his goal and his triglycerides are elevated. A reasonable change in therapy would be to: 1 Discontinue the statin and change to a fibric acid derivative. 2 Discontinue the statin and change to ezetimibe. 3 Continue the statin and add in ezetimibe. 4 Refer him to a specialist in managing patients with recalcitrant hyperlipidemia.3 PTS: 18. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? 1 A statin 2 Niacin 3 Fibric acid derivative 4 Bile acid-binding resins4 PTS: 19. Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a: 1 Sterol 2 Niacin 3 Fibric acid derivative 4 Bile acid-binding resin3 PTS: 110. Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include ____________ with a re-evaluation in six months. 1 Statins 2 Niacin 3 Sterols 4 Bile acid-binding resins3 PTS: 111. Monitoring of a patient who is on a lipid-lowering drug includes: 1 Fasting total cholesterol every six months 2 Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in six weeks 3 Complete blood count, C-reactive protein, and erythrocyte sedimentation rate after six weeks of therapy 4 All of the above2 PTS: 112. Before starting therapy with a statin, the following baseline laboratory values should be evaluated: 1 Complete blood count 2 Liver function [alanine aminotransferase/aspartate aminotransferase (ALT/AST)] and creatine kinase 3 C-reactive protein 4 All of the above2 PTS: 113. When starting a patient on a statin, education would include: 1 If they stop the medication their lipid levels will return to pretreatment levels. 2 Medication is a supplement to diet therapy and exercise. 3 If they have any muscle aches or pain, they should contact their provider. 4 All of the above4 PTS: 114. Omega-3 fatty acids are best used to help treat: 1 High HDL 2 Low LDL 3 High triglycerides 4 Any high lipid value3 PTS: 115. When are statins traditionally ordered to be taken? 1 At bedtime 2 At noon 3 At breakfast 4 With the evening meal4 PTS: 116. Which of the following patients should not have a statin medication ordered? 1 Someone with three first- or second-degree family members with history of muscle issues when started on statins 2 Someone with high lipids but low body mass index (BMI) 3 Premenopausal woman who have had a recent hysterectomy 4 A prediabetic male with known metabolic syndrome1 PTS: 117. Fiber supplements are great options for elderly patients who have the concurrent problem of: 1 End-stage renal failure on fluid restriction 2 Recurrent episodes of diarrhea several times a day 3 Long-term issues of constipation 4 Needing to take multiple medications around the clock every two hours3 PTS: 118. What is considered the order of statin strength from lowest effect to highest? 1 Lovastatin, Simvastatin, Rosuvastatin 2 Rosuvastatin, Lovastatin, Atorvastatin 3 Atorvastatin, Rosuvastatin, Simvastatin 4 Simvastatin, Atorvastatin, Lovastatin1 PTS: 119. The most recent treatment guidelines strongly recommend dosing primarily based on: 1 Family history 2 Personal CV risk 3 Specific lipid levels 4 Twenty-year risk of CV event2 PTS: 120. Which statins are most associated with soft plaque regression? 1 Lovastatin and simvastatin 2 Rosuvastatin and atorvastatin 3 Atorvastatin and pravastatin 4 Lovastatin and rosuvastatin2 PTS: 121. The first step in responding to a patient who complains of muscular pain with statins is: 1 Review the history and characteristics of the pain. 2 Stop the medication and draw liver function tests. 3 Switch them to another statin. 4 Draw a lipid level to determine if dosing is still indicated.1 PTS: 122. Omega-3 supplements can come from animal or plant sources. Which of the following is correct? 1 Both sources have equal efficacy. 2 Plant sources have more rapid impact on LDL levels than fish sources. 3 Fish sources have potential contamination with mercury. 4 Marine creature-derived supplements are safe for patients with shellfish allergies.3 PTS: 123. Why has nonfasting lipid testing become popular? 1 Results are close enough to fasting results and help in observing trends of the therapeutic response. 2 Screening helps identify larger numbers of patients who should be treated. 3 More patients tend to keep lab appointments when fasting is not required. 4 All of the above4 PTS: 1 Chapter 40. Hormone Replacement Therapy MULTIPLE CHOICE1. The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: 1 Cardiovascular risk 2 Risk of stroke or other thromboembolic event 3 Risk of breast cancer 4 Vasomotor symptoms4 PTS: 12. The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: 1 Two years 2 Five years 3 10 years 4 15 years2 PTS: 13. Dosage changes of conjugated equine estrogen (Premarin) are made at _________ intervals. 1 1 to 2 week 2 2 to 4 week 3 6 to 8 week 4 12 week3 PTS: 14. The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is: 1 Ability to deliver higher doses of estrogen in a nonoral form 2 The vaginal cream formula provides moisture to the vaginal area. 3 Relief of symptoms without increasing cardiovascular risk 4 All of the above3 PTS: 15. Women with an intact uterus should be treated with HRT with both estrogen and progestin due to: 1 Increased risk for endometrial cancer if estrogen alone is used 2 Combination therapy providing the best relief of menopausal vasomotor symptoms 3 Reduced risk for colon cancer with combined therapy 4 Lower risk of developing blood clots with combined therapy1 PTS: 16. Ongoing monitoring for women on ERT includes: 1 Lipid levels, repeated annually if abnormal 2 Annual health history and review of risk profile 3 Annual mammogram 4 All of the above4 PTS: 17. Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering HRT includes: 1 Explaining that HRT is totally safe if used short term 2 Telling her to ignore media hype regarding HRT 3 Discussing the advantages and risks of HRT 4 Encouraging her to use phytoestrogens with HRT3 PTS: 18. What is the duration of selective estrogen receptor modifier (SERM) use for menopausal issues? 1 It matches the five year duration for estrogen products. 2 The bone health impact allows long-term use. 3 The increased risk of breast cancer encourages tapering as soon as possible. 4 The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur.2 PTS: 19. Why are SERMs generally not ordered for women early into menopause? 1 The rapid onset of severe hot flashes can be unbearable. 2 The bone remodeling effect results in osteoporosis. 3 They tend to induce intermittent spotting. 4 The increased risk of breast cancer isn't worth the benefits of a SERM.1 PTS: 110. Which of the following is not an indication for starting HRT? 1 Symptomatic hot flashes 2 Treatment or prevention of vaginal atrophy 3 Prevention of osteoporosis 4 Early surgical menopause3 PTS: 111. "Menopause" is diagnosed when: 1 The patient has no menses for 12 months. 2 The patient has onset of vasomotor symptoms with irregular menses. 3 The patient has no bleeding cycle for six months. 4 Precise laboratory values are documented.1 PTS: 112. All of the following are risks of exogenous hormones except: 1 Breast cancer 2 Uterine cancer 3 Increased cardiovascular problems 4 Vaginal atrophy4 PTS: 113. Herbals that have proven efficacy for improving vasomotor symptoms include: 1 Black cohosh 2 Red clover 3 Evening primrose 4 None of the above4 PTS: 114. Re-evaluation of the Women's Health Study has resulted in what changes in HRT implementation? 1 A combination of estrogen and progestin is no longer required in patients with an intact uterus. 2 Women with breast cancer survivorship over 10 years are no longer considered "at risk." 3 HRT can be used in the first five years of menopause without major risk increase. 4 Low-dose estrogen can be used again in women over 65.3 PTS: 1 Chapter 36. Gastroesophageal Reflux and Peptic Ulcer Disease MULTIPLE CHOICE1. Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: 1 Calcium carbonate 2 Estrogen 3 Furosemide 4 Metoclopramide2 PTS: 12. Lifestyle changes are the first step in treatment of GERD. Food or drink that may aggravate GERD include: 1 Eggs 2 Caffeine 3 Chocolate 4 Soda pop2 PTS: 13. Metoclopramide improves GERD symptoms by: 1 Reducing acid secretion 2 Increasing gastric pH 3 Increasing lower esophageal tone 4 Decreasing lower esophageal tone3 PTS: 14. Antacids treat GERD by: 1 Increasing lower esophageal tone 2 Increasing gastric pH 3 Inhibiting gastric acid secretion 4 Increasing serum calcium level2 PTS: 15. A patient with mild GERD is started on _______ first. 1 Antacids 2 Histamine-2 receptor antagonists 3 Prokinetics 4 Proton pump inhibitors (PPIs)2 PTS: 16. If a patient with symptoms of GERD states that he has been self-treating at home with over-the-counter (OTC) ranitidine daily, the appropriate treatment would be: 1 Prokinetic (metoclopramide) for 4 to 8 weeks 2 PPI (omeprazole) for 12 weeks 3 Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks 4 Cytoprotective drug (misoprostol) for two weeks2 PTS: 17. If a patient with GERD who is taking a PPI daily is not improving, the plan of care would be: 1 Prokinetic (metoclopramide) for 8 to 12 weeks 2 PPI (omeprazole) twice a day for 4 to 8 weeks 3 Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks 4 Cytoprotective drug (misoprostol) for 4 to 8 weeks2 PTS: 18. The next step in treatment when a patient has been on PPIs twice daily for 12 weeks and not improving is: 1 Add a prokinetic (metoclopramide). 2 Refer the patient for endoscopy. 3 Switch to another PPI. 4 Add a cytoprotective drug.2 PTS: 19. Infants with reflux are initially treated with: 1 Histamine-2 receptor antagonist (ranitidine) 2 PPI (omeprazole) 3 Antireflux maneuvers (such as elevating the head of the bed) 4 Prokinetic (metoclopramide)3 PTS: 110. Long-term use of PPIs may lead to: 1 Hip fractures in at-risk persons 2 Vitamin B6 deficiency 3 Liver cancer 4 All of the above1 PTS: 111. An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori (H. pylori) test is: 1 Histamine-2 receptor antagonists for 4 to 8 weeks 2 PPI bid for 12 weeks until healing is complete 3 PPI bid plus clarithromycin plus amoxicillin for 14 days 4 PPI bid and levofloxacin for 14 days3 PTS: 112. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of: 1 Antimicrobial resistance 2 An ineffective antacid 3 Overuse of PPIs 4 All of the above1 PTS: 113. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the next step would be: 1 A PPI b.i.d. plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days 2 To test H. pylori for resistance to common treatment regimens 3 A PPI plus clarithromycin plus amoxicillin for 14 days 4 A PPI and levofloxacin for 14 days1 PTS: 114. After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: 1 Testing for H. pylori eradication with a serum enzyme-linked immunosorbent assay (ELISA) test 2 Endoscopy by a specialist 3 A PPI for 8 to 12 weeks until healing is complete 4 All of the above3 PTS: 115. What would be the appropriate treatment for H. pylori in a patient who recently took azithromycin for "bronchitis"? 1 PPI b.i.d. plus clarithromycin plus amoxicillin for 14 days 2 Quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole for 10 to 14 days 3 PPI and levofloxacin for 14 days 4 Triple therapy with PPI, bismuth, and levofloxacin2 PTS: 1 Chapter 35. Diabetes Mellitus MULTIPLE CHOICE1. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to ninety percent of type 1 diabetics have: 1 Autoantibodies to two tyrosine phosphatases 2 Mutation of the hepatic transcription factor on chromosome 12 3 A defective glucokinase molecule due to a defective gene on chromosome 7p 4 Mutation of the insulin promoter factor1 PTS: 12. Type 2 diabetes is a complex disorder involving: 1 Absence of insulin production by the beta cells 2 A suboptimal response of insulin-sensitive tissues in the liver 3 Increased levels of glucagon-like peptide in the postprandial period 4 Too much fat uptake in the intestine2 PTS: 13. Diagnostic criteria for diabetes include: 1 Fasting blood glucose greater than 140 mg/dL on two occasions 2 Postprandial blood glucose greater than 140 mg/dL 3 Fasting blood glucose 100 to 125 mg/dL on two occasions 4 Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dL4 PTS: 14. Routine screening of asymptomatic adults for diabetes is appropriate for: 1 Individuals who are older than 45 and have a body mass index (BMI) of less than 25 kg/m2 2 Native Americans, African Americans, and Hispanics 3 Persons with high-density lipoprotein (HDL) cholesterol greater than 100 mg/dL 4 Persons with prediabetes confirmed on at least two occasions2 PTS: 15. Diabetes screening for children who meet the following criteria should begin at age 10 and occur every three years thereafter: 1 BMI above the 85th percentile for age and sex 2 Family history of diabetes in first- or second-degree relative 3 Hypertension based on criteria for children 4 Any of the above4 PTS: 16. Insulin is used to treat both types of diabetes. It acts by: 1 Increasing beta cell response to low blood-glucose levels 2 Stimulating hepatic glucose production 3 Increasing peripheral glucose uptake by skeletal muscle and fat 4 Improving the circulation of free fatty acids3 PTS: 17. Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that: 1 He should increase his carbohydrate intake during times of exercise. 2 Each brand of insulin is equal in bioavailability, so he can buy the least expensive. 3 Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts. 4 If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes.1 PTS: 18. Insulin preparations are divided into categories based on onset time, duration of action, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action? 1 Lispro 2 Glulisine 3 Glargine 4 Detemir2 PTS: 19. The drug of choice for type 2 diabetics is metformin. Metformin: 1 Decreases glycogenolysis by the liver 2 Increases the release of insulin from beta cells 3 Increases intestinal uptake of glucose 4 Prevents weight gain associated with hyperglycemia1 PTS: 110. Before prescribing metformin, the provider should: 1 Draw a serum creatinine level to assess renal function. 2 Try the patient on insulin. 3 Prescribe a thyroid preparation if the patient needs to lose weight. 4 All of the above1 PTS: 111. Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to step 2 therapy because they: 1 Increase endogenous insulin secretion 2 Increase the risk for hypoglycemia 3 Address the insulin resistance found in type 2 diabetics 4 Improve insulin binding to receptors2 PTS: 112. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: 1 Better reduction in glucose levels than other classes 2 Less weight gain than with sulfonylurea use 3 Low risk for hypoglycemia 4 Can be given twice daily3 PTS: 1 13. Control targets for patients with diabetes include: 1 HbA1C between seven and eight 2 Fasting blood glucose levels between 100 and 120 mg/dL 3 Blood pressure less than 130/80 mm Hg 4 Low-density lipoproteins (LDL) lipids less than 130 mg/dL ANS: 3 PTS: 114. Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes: 1 Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily. 2 Tight control is acceptable for older adults if they are without complications. 3 Plasma glucose levels are the same for children as adults. 4 Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dL.4 PTS: 115. Treatment with insulin for type 1 diabetics: 1 Starts with a total daily dose of 0.2 to 0.4 units per kilogram of body weight 2 Divides the total doses into three injections based on meal size 3 Uses a total daily dose of insulin glargine given once daily with no other insulin required 4 Is based on the level of blood glucose1 PTS: 116. When the total daily insulin dose is split and given twice daily, which of the following rules may be followed? 1 Give two-thirds of the total dose in the morning and one-third in the evening. 2 Give 0.3 units per kilogram of premixed 70/30 insulin with one-third in the morning and two-thirds in the evening. 3 Give 50% of an insulin glargine dose in the morning and 50% in the evening. 4 Give long-acting insulin in the morning and short-acting insulin at bedtime.1 PTS: 117. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include: 1 Those with long-standing diabetes 2 Older adults 3 Those with no significant cardiovascular disease 4 Young children who are early in their disease3 PTS: 118. Prevention of conversion from prediabetes to diabetes in young children must take highest priority and should focus on: 1 Aggressive dietary manipulation to prevent obesity 2 Fostering LDL levels less than 100 mg/dL and total cholesterol less than 170 mg/dL to prevent cardiovascular disease 3 Maintaining a blood pressure that is less than 80% based on weight and height to prevent hypertension 4 All of the above2 PTS: 119. The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are: 1 Metformin and insulin 2 Sulfonylureas and insulin glargine 3 Split-mixed dose insulin and glucagon-like peptide-1 (GLP-1) agonists 4 Biguanides and insulin lispro1 PTS: 120. Unlike most type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: 1 Weight loss in previously overweight persons 2 Involuntary loss of 10% of body weight in less than six months 3 Decline in lean body mass over a 12 month period 4 Increase in central versus peripheral body adiposity2 PTS: 121. The drugs recommended for older adults with type 2 diabetes include: 1 Second-generation sulfonylureas 2 Metformin 3 Pioglitazone 4 Third-generation sulfonylureas4 PTS: 122. Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: 1 Have a high incidence of obesity, elevated triglycerides, and hypertension 2 Do best with drugs that foster weight loss, such as metformin 3 Both 1 and 2 4 Neither 1 nor 23 PTS: 123. The American Heart Association states that people with diabetes have a two- to four-fold increase in risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: 1 Glycemic targets between 7% and 7.5% 2 Use of insulin in type 2 diabetics 3 Control of hypertension and hyperlipidemia 4 Stopping smoking1 PTS: 124. All diabetic patients with known cardiovascular disease should be treated with: 1 Beta blockers to prevent myocardial infarctions (MIs) 2 Angiotensin-converting enzyme inhibitors and aspirin to reduce risk of cardiovascular events 3 Sulfonylureas to decrease cardiovascular mortality 4 Pioglitazone to decrease atherosclerotic plaque buildup2 PTS: 125. All diabetic patients with hyperlipidemia should be treated with: 1 HMG-CoA reductase inhibitors 2 Fibric acid derivatives 3 Nicotinic acid 4 Colestipol1 PTS: 126. Both angiotensin-converting enzyme inhibitors and some angiotensin II receptor blockers have been approved in treating: 1 Hypertension in diabetic patients 2 Diabetic nephropathy 3 Both 1 and 2 4 Neither 1 nor 23 PTS: 127. Protein restriction helps slow the progression of albuminuria, glomerular filtration rate, decline, and end stage renal disease in some patients with diabetes. It is useful for patients who: 1 Cannot tolerate angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 2 Have uncontrolled hypertension 3 Have HbA1C levels above 7% 4 Show progression of diabetic nephropathy despite optimal glucose and blood pressure control4 PTS: 128. Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include: 1 Resting tachycardia, exercise intolerance, and orthostatic hypotension 2 Gastroparesis, cold intolerance, and moist skin 3 Hyperglycemia, erectile dysfunction, and deficiency of free fatty acids 4 Pain, loss of sensation, and muscle weakness1 PTS: 129. Drugs used to treat diabetic peripheral neuropathy include: 1 Metoclopramide 2 Cholinergic agonists 3 Cardioselective beta blockers 4 Gabapentin4 PTS: 130. The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes? 1 Fasting blood glucose 2 HbA1C 3 Thyroid function tests 4 Electrocardiograms2 PTS: 131. 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? 1 Delay eating the midday meal until after the swimming class. 2 Increase the morning dose of NPH insulin on days of the swimming class. 3 Adjust the morning insulin injection so that the peak occurs while swimming. 4 Check glucose level before, during, and after swimming.4 PTS: 132. Allison is an 18-year-old college student with type 1 diabetes. Allison's premeal blood glucose (BG) at 11:30 a.m. is 130. She eats an apple and has a sugar-free soft drink. At 1 p.m. before swimming her BG is 80. What should she do? 1 Proceed with the swimming class. 2 Recheck her BG immediately. 3 Eat a granola bar or other snack with carbohydrates (CHO). 4 Take an additional dose of insulin.3 PTS: 133. Bart is a 67-year-old male with type 2 diabetes mellitus (T2 DM). He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly, and he hasn't checked his BG for one week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment? 1 Diabetic keto acidosis (DKA) 2 Hyperglycemic hyperosmolar syndrome (HHS) 3 Infection 4 Hypoglycemia2 PTS: 134. What would one expect to find during an assessment for HHS? 1 Low hemoglobin 2 Ketones in the urine 3 Deep, labored breathing 4 pH of 7.352 PTS: 135. A patient on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic and dizzy. She reports taking her medication that morning and having a bagel and coffee for breakfast. Blood pressure (BP) is 110/70 and random finger-stick glucose is 64. How should this patient be treated? 1 12 oz apple juice with 1 tsp sugar 2 10 oz diet soda 3 8 oz milk or 4 oz orange juice 4 4 cookies and 8 oz chocolate milk3 PTS: 136. Documented reduction in cardiovascular (CV) risk is linked with: 1 Selective sodium-dependent glucose cotransporters-2 (SGLT-2) medications 2 Metformin replacement with insulin 3 Early adoption of basal insulin 4 Sulfonylurea reduction1 PTS: 137. Thyroid medullary cancer risk has been linked with: 1 Chronic sulfonylurea use 2 Later addition of basal insulin to oral therapy 3 GLP-1 therapies 4 SGLT-2 medication3 PTS: 138. Genital yeast infections are increased with: 1 GLP-1 therapies 2 SGLT-2 therapies 3 Amylin-based treatment 4 Weekly noninsulin-based therapies2 PTS: 139. The dipeptidyl peptidase 4 (DPP-4) inhibitors have the following suffix in their names: 1 Gliptin 2 Urea 3 Exenatide 4 Flozine1 PTS: 140. Which type of insulin is used in insulin pumps? 1 Only regular insulin 2 Basal insulin 3 Rapid acting insulin 4 Any type is okay depending on rate and pattern of infusion3 PTS: 1 Chapter 33. Contraception MULTIPLE CHOICE1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of: 1 Hemoglobin 2 Serum calcium 3 White blood count 4 Serum potassium4 PTS: 12. The mechanism of action of oral combined contraceptives that prevents pregnancy is: 1 Estrogen prevents the luteinizing hormone surge necessary for ovulation. 2 Progestins thicken cervical mucus and slow tubal motility. 3 Estrogen thins the endometrium making implantation difficult. 4 Progestin suppresses follicle stimulating hormone release.2 PTS: 13. To improve actual effectiveness of oral contraceptives women should be educated regarding: 1 Use of a back-up method if they have vomiting or diarrhea during a pill packet 2 Doubling pills if they have diarrhea during the middle of a pill pack 3 The fact that they will have a normal menstrual cycle if they miss two pills 4 The fact that mid-cycle spotting is not normal and the provider should be contacted immediately1 PTS: 14. A contraindication to the use of combined contraceptives is: 1 Adolescence (not approved for this age) 2 A history of clotting disorder 3 Recent pregnancy 4 Being overweight2 PTS: 15. Obese women may have increased risk of failure with which contraceptive method? 1 Combined oral contraceptives 2 Progestin-only oral contraceptive pill 3 Injectable progestin 4 Combined topical patch4 PTS: 16. Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: 1 Recommend she return to the clinic at the start of her next menses to get a Depo- Provera shot. 2 Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first seven days. 3 Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first seven days. 4 Discuss the advantages of using the topical birth control patch and recommend she consider using it.3 PTS: 17. 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: 1 Immediate protection against pregnancy the first week of using the pill 2 No back-up method is needed when starting 3 Menses occur during the week 4 They can start the pill on the Sunday after the office visit3 PTS: 18. The topical patch combined contraceptive (Ortho Evra) is: 1 Started on the first day of the menstrual cycle 2 Recommended for women over 200 pounds 3 Not as effective as oral combined contraceptives 4 Known to have more adverse effects, such as nausea, than the oral combined contraceptives1 PTS: 19. Progesterone-only pills are recommended for women who: 1 Are breastfeeding 2 Have a history of migraine 3 Have a medical history that contradicts the use of estrogen 4 All of the above4 PTS: 110. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? 1 Increased migraine headaches 2 Increased risk of developing blood clots 3 Irregular vaginal bleeding for the first few months 4 Increased risk for hypercalcemia3 PTS: 111. An advantage of using the NuvaRing vaginal ring for contraception is: 1 It does not require fitting and is easy to insert. 2 It is inserted once a week, eliminating the need to remember to take a daily pill. 3 Patients get a level of estrogen and progestin equal to combined oral contraceptives. 4 It also provides protection against vaginal infections.1 PTS: 112. Oral emergency contraception (Plan B) is contraindicated in women who: 1 Had intercourse within the past 72 hours 2 May be pregnant 3 Are taking combined oral contraceptives 4 Are using a diaphragm2 PTS: 113. Adverse effects of depot medroxyprogesterone acetate (DMPA) (Depo-Provera) include: 1 Decrease in bone mineral density with longer-term use 2 Increase in migraines 3 Increased risk for venous thromboembolism (VTE) 4 Increased risk of cardiovascular events1 PTS: 1