Nurs 6521 Advanced Pharmacology Final Exam (245 Questions with 100% SOLUTIONS) 2024 GUARA, Exams of Nursing

Download Nurs 6521 Advanced Pharmacology Final Exam (245 Questions with 100% SOLUTIONS) 2024 GUARA and more Exams Nursing in PDF only on Docsity! Nurs 6521 Advanced Pharmacology Final Exam (245 Questions with 100% SOLUTIONS) 2024 GUARANTEE SUCCESS GRADED A+ Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: 1. Increases peripheral vasoconstriction 2. Decreases detrusor muscle contractility 3. Lowers supine blood pressure more than standing pressure 4. Relaxes smooth muscle in the bladder neck - SOLUTION 4. Relaxes smooth muscle in the bladder neck To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT: 1. Take the dose at bedtime 2. Sit up slowly and dangle their feet before standing 3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 4. Weigh daily and report weight gain of greater than 2 pounds in one day - SOLUTION 3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should: 1. Not miss a dose or stop taking the drug because of potential rebound hypertension 2. Increase fiber in the diet to treat any diarrhea that may occur 3. Reduce fluid intake to less than 2 liters per day to prevent fluid retention 4. Avoid sitting for long periods, as this can lead to deep vein thrombosis - SOLUTION 1. Not miss a dose or stop taking the drug because of potential rebound hypertension Clonidine has several off-label uses, including: 1. Alcohol and nicotine withdrawal 2. Post-herpetic neuralgia 3. Both 1 and 2 4. Neither 1 nor 2 - SOLUTION 3. Both 1 and 2 Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: 1. Increasing heart rate to improve cardiac output 2. Reducing vascular smooth muscle tone 3. Increasing aldosterone-mediated volume activity 4. Reducing aqueous humor production - SOLUTION 2. Reducing vascular smooth muscle tone Which of the following adverse effects are less likely in a beta 1-selective blocker? 1. Dysrhythmias 2. Impaired insulin release 3. Reflex orthostatic changes 4. Decreased triglycerides and cholesterol - SOLUTION 2. Impaired insulin release Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol? 1. Extend the dosage interval. 2. Decrease the dose by 75%. 3. Take no action because this value is expected in the older adult. 4. Schedule a serum creatinine level to validate the CrCl value. - SOLUTION 1. Extend the dosage interval. Beta blockers are the drugs of choice for exertional angina because they: 1. Improve myocardial oxygen supply by vasodilating the coronary arteries 2. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance 3. Both 1 and 2 4. Neither 1 nor 2 - SOLUTION 2. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance Adherence to beta blocker therapy may be affected by their: 1. Short half-lives requiring twice daily dosing 2. Tendency to elevate lipid levels 3. Effects on the male genitalia, which may produce impotence Anticholinesterase inhibitors are used to treat: 1. Peptic ulcer disease 2. Myasthenia gravis 3. Both 1 and 2 4. Neither 1 nor 2 - SOLUTION 2. Myasthenia gravis Which of the following drugs used to treat Alzheimer's disease is not an anticholinergic? 1. Donepezil 2. Memantine 3. Rivastigmine 4. Galantamine - SOLUTION 2. Memantine Taking which drug with food maximizes its bioavailability? 1. Donepezil 2. Galantamine 3. Rivastigmine 4. Memantine - SOLUTION 3. Rivastigmine Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women? 1. Memantine 2. Pyridostigmine 3. Galantamine 4. Rivastigmine - SOLUTION 2. Pyridostigmine There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include: 1. Dizziness and headache 2. Nausea 3. Decreased salivation 4. Fasciculations of voluntary muscles - SOLUTION 4. Fasciculations of voluntary muscles Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? 1. Tacrine 2. Donepezil 3. Memantine 4. Pyridostigmine - SOLUTION 2. Donepezil Cholinergic blockers are used to: 1. Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines 2. Control tremors and relax smooth muscle in Parkinson's disease 3. Inhibit the muscarinic action of ACh on bladder muscle 4. All of the above - SOLUTION 4. All of the above Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? 1. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. 2. Additive antimuscarinic effects may occur with antihistamines. 3. Cholinergic blockers may decrease the sedative effects of hypnotics. 4. Cholinergic blockers are contraindicated with antipsychotics. - SOLUTION 1. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to: 1. Apply the transdermal disk at least 4 hours before the antiemetic effect is desired. 2. Swallow the tablet 1 hour before traveling where motion sickness is possible. 3. Place the tablet under the tongue and allow it to dissolve. 4. Change the transdermal disk daily for maximal effect. - SOLUTION 2. Swallow the tablet 1 hour before traveling where motion sickness is possible. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is: 1. Continue the tamsulosin because the side effect will resolve with continued treatment. 2. Discontinue the tamsulosin and start doxazosin. 3. Have him double his fluid intake and stand more slowly. 4. Prescribe meclizine as needed for the dizziness. - SOLUTION 2. Discontinue the tamsulosin and start doxazosin. Activation of central alpha2 receptors results in inhibition of cardio acceleration and ______________ centers in the brain. 1. Vasodilation 2. Vasoconstriction 3. Cardiovascular 4. Respiratory - SOLUTION 2. Vasoconstriction You are treating a patient with a diagnosis of Alzheimer's disease. The patient's wife mentions difficulty with transportation to the clinic. Which medication is the best choice? 1. Donepezil 2. Tacrine 3. Doxazosin 4. Verapamil - SOLUTION 1. Donepezil A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause? 1. Acetaminophen 2. Estradiol 3. Donepezil 4. Bethanechol - SOLUTION 4. Bethanechol Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications? 1. Carvedilol 2. Donepezil 3. Bethanechol 4. Tacrine - SOLUTION 1. Carvedilol Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include: 1. Understanding that obesity is a contraindication to prescribing phentermine 2. Anorexiants may cause tolerance and should only be prescribed for 6 months 3. Patients should be monitored for postural hypotension 2. Consult with a neurologist, as this is not a common adverse effect of topiramate. 3. Decrease her dose of topiramate. 4. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight. - SOLUTION 4. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight. Monitoring of a patient on gabapentin to treat seizures includes: 1. Routine therapeutic drug levels every 3 to 4 months 2. Assessing for dermatologic reactions, including Steven's Johnson 3. Routine serum electrolytes, especially in hot weather 4. Recording seizure frequency, duration, and severity - SOLUTION 4. Recording seizure frequency, duration, and severity Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: 1. He should not play sports due to the risk of increased seizures 2. He should monitor his temperature and ability to sweat in the heat while playing 3. Reminding him that he may need higher dosages of topiramate when exercising 4. Encouraging him to use sunscreen due to photosensitivity from topiramate - SOLUTION 2. He should monitor his temperature and ability to sweat in the heat while playing Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: 1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures 2. To wear sunscreen due to photosensitivity from levetiracetam 3. To get an annual eye exam while on levetiracetam 4. To report weight loss if it occurs - SOLUTION 1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures Levetiracetam has known drug interactions with: 1. Combined oral contraceptives 2. Carbamazepine 3. Warfarin 4. Few, if any, drugs - SOLUTION 4. Few, if any, drugs Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: 1. Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days 2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure 3. Rapid strep test and symptomatic care if strep test is negative 4. Observation only, with further assessment if she worsens - SOLUTION 2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause: 1. Contraceptive failure 2. Excessive weight gain 3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine 4. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed - SOLUTION 3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine The tricyclic antidepressants should be prescribed cautiously in patients with: 1. Eczema 2. Asthma 3. Diabetes 4. Heart disease - SOLUTION 4. Heart disease A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): 1. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) 2. MAOIs interact with many common foods, including yogurt, sour cream, and soysauce 3. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment 4. All of the above - SOLUTION 4. All of the above Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is: 1. Fluoxetine 2. Fluvoxamine 3. Sertraline 4. Escitalopram - SOLUTION 1. Fluoxetine Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes: 1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects. 2. Red-green color blindness may occur and should be reported. 3. If she experiences dry mouth or heart rates greater than 80, she should stop taking the drug immediately. 4. She should eat lots of food high in fiber to prevent constipation. - SOLUTION 1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be: 1. Fluoxetine (Prozac) 2. Paroxetine (Paxil) 3. Amitriptyline (Elavil) 4. Duloxetine (Cymbalta) - SOLUTION 4. Duloxetine (Cymbalta) Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: 1. For excessive weight loss 2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS) 3. Monthly for tolerance to the haloperidol 4. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients - SOLUTION 2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS) Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: 1. Reduce the chance of tardive dyskinesia Kirk sprained his ankle and is asking for pain medication for his mild-to- moderate pain. The appropriate first-line medication would be: 1. Ibuprofen (Advil) 2. Acetaminophen with hydrocodone (Vicodin) 3. Oxycodone (Oxycontin) 4. Oral morphine (Roxanol) - SOLUTION 1. Ibuprofen (Advil) Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be: 1. Ibuprofen (Advil) 2. Acetaminophen with hydrocodone (Vicodin) 3. Oxycodone (Oxycontin) 4. Oral morphine (Roxanol) - SOLUTION 2. Acetaminophen with hydrocodone (Vicodin) Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: 1. Slurred speech and insomnia 2. Bradycardia and confusion 3. Dizziness and orthostatic hypotension 4. Insomnia and decreased appetite - SOLUTION 4. Insomnia and decreased appetite Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes: 1. ADHD symptoms 2. Routine height and weight checks 3. Amount of methylphenidate being used 4. All of the above - SOLUTION 4. All of the above When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: 1. Blood pressure 2. Blood glucose levels 3. Urine ketone levels 4. Liver function - SOLUTION 1. Blood pressure Common mistakes practitioners make in treating anxiety disorders include 1. Switching medications after an 8- to 12-week trial 2. Maximizing dosing of anti-anxiety medications 3. Encouraging exercise and relaxation therapy before starting medication 4. Thinking a partial response to medication is acceptable - SOLUTION 4. Thinking a partial response to medication is acceptable An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be 1. Alprazolam (Xanax) 2. Diazepam (Valium) 3. Buspirone/Buspar 4. Amitriptyline (Elavil) - SOLUTION 3. Buspirone/Buspar An appropriate drug to initially treat panic disorder is: 1. Alprazolam (Xanax) 2. Diazepam/Valium 3. Buspirone (Buspar) 4. Amitriptyline (Elavil) - SOLUTION 2. Diazepam/Valium Prior to starting antidepressants, patients should have laboratory testing to rule out: 1. Hypothyroidism 2. Anemia 3. Diabetes mellitus 4. Low estrogen levels - SOLUTION 1. Hypothyroidism David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression.David's education regarding his medication would include: 1.Paroxetine may cause intermittent diarrhea 2. He may experience sexual dysfunction beginning a month after he starts therapy. 3. He may have constipation and he should increase fluids and fiber. 4. Paroxetine has a long half-life so he may occasionally skip a dose. - SOLUTION 1.Paroxetine may cause intermittent diarrhea 2. He may experience sexual dysfunction beginning a month after he starts therapy. Jamison has been prescribed citalopram (Celexa) to treat his depression. Educationregarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: 1. Appetite and concentration improve in the first 1 to 2 weeks. 2. Sleep should improve almost immediately upon starting citalopram. 3. Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose. 4. His dysphoric mood will improve in 1 to 2 weeks. - SOLUTION 1. Appetite and concentration improve in the first 1 to 2 weeks. An appropriate drug for the treatment of depression with anxiety would be 1. Alprazolam (Xanax) 2. Escitalopram (Lexapro) 3. Buspirone (Buspar) 4. Amitriptyline (Elavil) - SOLUTION 2. Escitalopram (Lexapro) An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: 1. Venlafaxine (Effexor) 2. Escitalopram (Lexapro) 3. Buspirone (Buspar) 4. Amitriptyline (Elavil) - SOLUTION 1. Venlafaxine (Effexor) The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is: - SOLUTION -There is no laboratory monitoring required Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants? 1. Change dose to every other day dosing for a week 2. Reduce dose by 50% for 3 to 4 days 3. Reduce dose by 50% every other day 4. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life - SOLUTION 2. Reduce dose by 50% for 3 to 4 days The longer-term Xanax patient comes in and states they need a higher dose of themedication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason? 1. They have become tolerant of the medication, which is characterized by the need for higher and higher doses. 2. They are a drug seeker. 3. They are suicidal. ethosuximide (Zarontin) for seizures should be monitored for: 1. Increased seizure activity, as this drug may auto-induce seizures 2. Altered renal function, including renal failure 3. Blood dyscrasias, which are uncommon but possible 4. Central nervous system excitement, leading to insomnia - SOLUTION 3. Blood dyscrasias, which are uncommon but possible How is lamotrigine (Lamictal) affected when taking oral contraceptives concurrently? 1. Contraceptive failure 2. Excessive weight gain 3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine 4. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed - SOLUTION 3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigineNOT The tricyclic antidepressants should be prescribed cautiously in patients with 1. Eczema 2. Asthma 3. Diabetes 4. Heart disease - SOLUTION 4. Heart disease Patient teaching for phenelzine and other monoamine oxidase inhibitors (MAOIs): 1. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) 2. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce 3. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment 4. All of the above - SOLUTION 4. All of the above A 19-year-old male was started on risperidone. Monitoring for risperidone include observing for common side effects, including: 1. Bradykinesia (slow mvmt), akathisia (restlessness), and agitation 2. Excessive weight gain 3. Hypertension 4. Potentially fatal agranulocytosis - SOLUTION 1. Bradykinesia (slow mvmt), akathisia (restlessness), and agitation In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepine with the greatest likelihood of rapidly developing dependence is: 1. Chlordiazepoxide (Librium) 2. Clonazepam (Klonopin) 3. Alprazolam (Xanax) 4. Oxazepam (Serax) - SOLUTION 3. Alprazolam (Xanax) When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol#3), instructions to the patient should include: 1. The medication may cause sedation and they should not drive. 2. Constipation is a common side effect and they should increase fluids and fiber. 3. Patients should not take any other acetaminophen-containing medications at the same time. 4. All of the above - SOLUTION 4. All of the above Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry? 1. High-dose colchicine 2. Low-dose colchicine 3. High-dose aspirin 4. Acetaminophen with codeine - SOLUTION 2. low-dose colchine Patient education when prescribing colchicine includes: 1. Colchicine may be constipating. 2. Colchicine always causes some degree of diarrhea. 3. Mild muscle weakness is normal. 4. Moderate amounts of alcohol are safe with colchicine. - SOLUTION Colchicine always causes some degree of diarrhea Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: 1. Complete blood count 2. Blood glucose 3. C-reactive protein 4. BUN, creatinine, and creatinine clearance - SOLUTION 4. BUN, creatinine, and CCr chould be monitored when taking allopurinol Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes: 1. Gout may worsen with therapy. 2. Febuxostat may cause severe diarrhea. 3. He should consume a high-calcium diet. 4. He will need frequent CBC monitoring. - SOLUTION 1. Gout may worsen with therapy. Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for: 1. Gout 2. Iron deficiency anemia 3. Osteoporosis 4. Renal dysfunction - SOLUTION 3. Osteoporosis Patients whose total dose of prednisone will exceed 1 gram 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, an NSAID to treat joint pain 4. Furosemide, a diuretic to treat fluid retention - SOLUTION Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease Daniel 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. Develop a tapering schedule to slowly wean Daniel off the prednisone. 4. Substitute the prednisone with another anti-inflammatory such as ibuprofen. - SOLUTION 3. Develop a tapering schedule to slowly wean Daniel off the prednisone. -Must be tapered due to possible adrenal insufficiency crisis. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will needco-treatment with which medications to prevent further adverse effects? 1. A bisphosphonate B. naproxen (Aleve) C. ergotamine (Ergostat) D. Tylenol with codeine (Tylenol #3) - SOLUTION B. naproxen (Aleve) Which of the following statements is true about age and pain? A. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children. B. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs. C. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain. D. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. - SOLUTION D. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. Which of the following is the goal of treatment of acute pain? A. Pain at a tolerable level where patient may return to activities of daily living B. Reduction of pain with a minimum of drug adverse effects C. Reduction or elimination of pain with minimum adverse reactions D. Adequate pain relief without constipation or nausea from the drugs - SOLUTION C. Reduction or elimination of pain with minimum adverse reactions Age is a factor in different responses to pain. Which of the following age- related statements about pain is NOT true? A. Preterm and newborn infants do not yet have functional pain pathways. B. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child. C. Increases in pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness. D. Decreases in pain tolerance are evident in older adults. - SOLUTION A. Preterm and newborn infants do not yet have functional pain pathways. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to determine which of the following options? A. If the diagnosis of source of pain is correct B. If the current regimen is adequate or different combinations of drugs and nondrug therapy are required C. If the patient is willing and able to be an active participant in his or her pain management D. All the given options - SOLUTION D. All the given options Chronic pain is a complex problem. Some specific strategies to deal with it include ________. A. telling the patient to "let pain be your guide" to using treatment therapies B. prescribing pain medication on a pro re nata (PRN) basis to keep down the amount used C. scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment D. All the given options - SOLUTION C. scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence ______. A. the sensory aspects of pain B. the discriminative aspects of pain C. the motivational aspects of pain D. the cognitive aspects of pain - SOLUTION C. the motivational aspects of pain One of the main drug classes used to treat acute pain is NSAIDs. They are used because: 1. They have less risk for liver damage than acetaminophen. 2. Inflammation is a common cause of acute pain. 3. They have minimal GI irritation. 4. Regulation of blood flow to the kidney is not affected by these drugs. - SOLUTION 2. Inflammation is a common cause of acute pain. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? 1. All opiates are scheduled drugs which require a DEA license to prescribe. 2. Opiates stimulate only mu receptors for the control of pain. 3. Most of the adverse effects of opiates are related to mu receptor stimulation. 4. Naloxone is an antagonist to opiates. - SOLUTION 2. Opiates stimulate only mu receptors for the control of pain. If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? 1. NSAIDs, opiates, corticosteroids 2. Low-dose opiates, salicylates, increased dose of opiates 3. Opiates, non-opiates, increased dose of non-opiate 4. Non-opiate, increased dose of non-opiate, opiate - SOLUTION 4. Non- opiate, increased dose of non-opiate, opiate Pathological similarities and differences between acute pain and chronic pain include: 1. Both have decreased levels of endorphins. 2. Chronic pain has a predominance of C-neuron stimulation. 3. Acute pain is most commonly associated with irritation of peripheral nerves. 4. Acute pain is diffuse and hard to localize. - SOLUTION 2. Chronic pain has a predominance of C-neuron stimulation. A treatment plan for management of chronic pain should include: 1. Negotiation with the patient to set personal goals for pain management 2. Discussion of ways to improve sleep and stress 3. An exercise program to improve function and fitness 4. All of the above - SOLUTION 4. All of the above Chronic pain is a complex problem. Some specific strategies to deal with it include: 1. Telling the patient to "let pain be your guide" to using treatment therapies 2. Prescribing pain medication on a "PRN" basis to keep down the amount used 3. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment 4. All of the above - SOLUTION 3. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment 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 levels - SOLUTION 4. Mask the signs and symptoms of altered glucose levels 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 neutral protamine Hagedorn insulin. 4. It has no pronounced peak. - SOLUTION 2. Duration of action is increased when the dose is increased. The decision may be made to switch from twice daily neutral protamine Hagedorn (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. - SOLUTION 1. The initial dose of glargine is reduced by 20% to avoid hypoglycemia. 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 neutral protamine Hagedorn insulin added at bedtime. - SOLUTION 3. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. 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 utilization - SOLUTION 2. Decreases glycogenolysis by the liver 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 interactions - SOLUTION 1. Draw a serum creatinine to assess renal function 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 production - SOLUTION 4. Act on the incretin system to indirectly increase insulin production 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 2 - SOLUTION 3. Both 1 and 2 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 daily - SOLUTION 1. Directly bind to a receptor in the pancreatic beta cell Avoid concurrent administration of exenatide with which of the following drugs? 1. Digoxin 2. Warfarin 3. Lovastatin 4. All of the above - SOLUTION 4. All of the above Administration of exenatide is by subcutaneous injection: 1. 30 minutes prior to the morning meal 2. 60 minutes prior to the morning and evening meal 3. 15 minutes after the evening meal 4. 60 minutes before each meal daily - SOLUTION 2. 60 minutes prior to the morning and evening meal 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 swallowing - SOLUTION 2. Fever and sore throat Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: 1. Excessive sedation 2. Tachycardia and angina 3. Weight gain 4. Cold intolerance - SOLUTION 2. Tachycardia and angina 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 have plateaued 3. Complaints of mild bone pain 4. Achievement of anticipated height goals - SOLUTION 3. Complaints of mild bone pain Besides osteoporosis, IV bisphosphonates are also indicated for: 1. Paget's Disease 2. Early osteopenia All diabetic patients with hyperlipidemia should be treated with: 1. HMG-CoA reductase inhibitors 2. Fibric acid derivatives 3. Nicotinic acid 4. Colestipol - SOLUTION 1. HMG-CoA reductase inhibitors 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 2 - SOLUTION 3. Both 1 and 2 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. Electrocardiograms - SOLUTION 2. HbA1C Before starting therapy with a statin, the following baseline laboratory values should be evaluated: 1. Complete blood count 2. Liver function (ALT/AST) and creatine kinase 3. C-reactive protein 4. All of the above - SOLUTION 2. Liver function (ALT/AST) and creatine kinase 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 months - SOLUTION 4. 6 to 12 months 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 blocker - SOLUTION 2. A beta blocker 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, treatment is best delayed until after her pregnancy ends - SOLUTION 2. Propylthiouracil (PTU) After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every: 1. 1 to 2 weeks 2. 3 to 4 weeks 3. 2 to 3 months 4. 6 to 9 months - SOLUTION 2. 3 to 4 weeks 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 above - SOLUTION 4. All of the above When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: 1. 2 weeks 2. 4 weeks 3. 2 months 4. 6 months - SOLUTION 2. 4 weeks Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every: 1. 2 weeks 2. 4 weeks 3. 2 months 4. 6 months - SOLUTION 4. 6 months Treatment of a patient with hypothyroidism and cardiovascular disease consists of: 1. Levothyroxine 2. Liothyronine 3. Liotrix 4. Methimazole - SOLUTION 1. Levothyroxine Infants with congenital hypothyroidism are treated with: 1. Levothyroxine 2. Liothyronine 3. Liotrix 4. Methimazole - SOLUTION 1. Levothyroxine 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. - SOLUTION 3. The average woman needs more medication during pregnancy. Intimate partner violence is a serious public health problem. It should be screened for: 1. At every encounter within the health-care system 2. When a women is being seen for symptoms of depression 3. Throughout pregnancy 4. If a sexually transmitted disease is diagnosed - SOLUTION 1. At every encounter within the health-care system Gender differences between men and women in pharmacokinetics include: A) Slower organ blood flow rates so drugs tend to take longer to be excreted B) Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution C) More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites D) Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations - SOLUTION B) Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution 2. Taking them 2-3 times a day during the first 2 days 3. Taking them every 2-3 hours 4. They have not been found to be helpful at all - SOLUTION 1. Taking them for 2-3 days prior to the start of bleeding Which of the following is true concerning lesbian health concerns?1. They cannot contract an STI from another woman. 2. Pap smears are not required to screen for cervical cancer. 3. Lesbian women have a tendency to be frequent clinic visitors. 4. The health risks associated with smoking, alcohol, and depression are higher than in the heterosexual population. - SOLUTION 4. The health risks associated with smoking, alcohol, and depression are higher than in the heterosexual population. The factor that has the greatest effect on males developing male sexual characteristics is: 1. Cultural beliefs 2. Effective male role models 3. Adequate intake of testosterone in the diet 4. Androgen production - SOLUTION 4. Androgen production When assessing a male for hypogonadism prior to prescribing testosterone replacement, serum testosterone levels are drawn: 1. Without regard to time of day 2. First thing in the morning 3. Late afternoon 4. In the evening - SOLUTION 2. First thing in the morning The goal of testosterone replacement therapy is: 1. Absence of all hypogonadism symptoms 2. Testosterone levels in the mid-normal range 1 week after an injection 3. Testosterone levels in the mid-normal range just prior to the next injection 4. Avoidance of high serum testosterone levels during therapy - SOLUTION 2. Testosterone levels in the mid-normal range 1 week after an injection While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are: 1. Hemoglobin 14 g/dl or hematocrit 39% 2. Hemoglobin 11.5 g/dl or hematocrit 31% 3. Hemoglobin 13 g/dl or hematocrit 38% 4. Hemoglobin 17.5 g/dl or hematocrit 54% - SOLUTION 4. Hemoglobin 17.5 g/dl or hematocrit 54% Monitoring of an older male patient on testosterone replacement includes: 1. Oxygen saturation levels at every visit 2. Serum cholesterol and lipid profile every 3 to 6 months 3. Digital rectal prostate screening exam at 3 and 6 months after starting therapy 4. Bone mineral density at 3 months and 6 months after starting therapy - SOLUTION 3. Digital rectal prostate screening exam at 3 and 6 months after starting therapy When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of: 1. Statins 2. Nitrates 3. Insulin 4. Opioids - SOLUTION 2. Nitrates Men who are prescribed phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction should be educated regarding the adverse effects of the drug which include: 1. Hearing loss 2. Hypotension 3. Delayed ejaculation 4. Dizziness - SOLUTION 1. Hearing loss Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include: 1. Diabetics 2. Those who have had an acute myocardial infarction in the past 6 months 3. Patients who are deaf 4. Patients under age 60 years of age - SOLUTION 2. Those who have had an acute myocardial infarction in the past 6 months Monitoring of male patients who are using phosphodiesterase type 5 (PDE- 5) inhibitors includes: 1. Serum fasting glucose levels 2. Cholesterol and lipid levels 3. Blood pressure 4. Complete blood count - SOLUTION 3. Blood pressure If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to: A. Loop diuretics B. Sulfonylureas C. Thiazide diuretics D. All of the above - SOLUTION D. All of the above FOR TESTING PURPOSES - THIAZIDE DIURETICS May increase the incidence of thrombocytopenia with purpura Attenuated vaccines are also known as - SOLUTION Inactivated vaccines Live attenuated influenza vaccine (FluMist) may be administered to - SOLUTION All patients over 6 months of age The MMR vaccine is not recommended for pregnant women because - SOLUTION There is a risk of the fetus developing congenital rubella syndrome Pregnant women should receive the Tdap vaccine: - SOLUTION In the third trimester of every pregnancy A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so she can protect her unborn child. Which vaccine(s) may be administered to this patient? a. Gardasil vaccine b. Trivalent influenza vaccine c. MMR vaccine d. Varivax vaccine - SOLUTION b. Trivalent influenza vaccine -The influenza vaccine is recommended for pregnant women and should be given. Gardasil is given to young women who are not yet sexually active. The MMR is contraindicated because rubella can cause serious teratogenic effects. Varivax is contraindicated during pregnancy. 4. Urine protein and potassium levels - SOLUTION 2. Lipid levels and liver function tests Absolute contraindications to estrogen therapy include: 1. History of any type of cancer 2. Clotting disorders 3. History of tension headaches 4. Orthostatic hypotension - SOLUTION 2. Clotting disorders A contraindication to the use of combined contraceptives is: A. Adolescence (not approved for this age) B. A history of clotting disorder C. Recent pregnancy D. Overweight - SOLUTION B. A history of clotting disorder A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes: 1. Counseling regarding decreasing or not smoking while taking oral contraceptives 2. Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive 3. Advising that she may miss two pills in a row and not be concerned about pregnancy 4. Recommending that her next follow-up visit is in 1 year for a refill and annual exam - SOLUTION 1. Counseling regarding decreasing or not smoking while taking oral contraceptives A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications? 1. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour. 2. Both medications are best tolerated if taken on an empty stomach. 3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack. 4. If she gets nauseated with the medications she should call the office for an antiemetic prescription. - SOLUTION 3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack. Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for: 1. Depression 2. Hypertension 3. Weight loss 4. Cataracts - SOLUTION 1. Depression When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects: 1. Hypertension and dysuria 2. Depression and weight gain 3. Abdominal pain and constipation 4. Orthostatic hypotension and dermatitis - SOLUTION 2. Depression and weight gain The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to: 1. The potential development of significant hypertension 2. Increased risk of strokes 3. Decreased bone density 4. The risk of a life-threatening rash such as Stevens-Johnson - SOLUTION 3. Decreased bone density Shana received her first medroxyprogesterone (Depo Provera) injection 6 weeks ago and calls the clinic with a concern that she has been having a light "period" off and on since receiving her Depo shot. What would be the management of Shana? 1. Reassurance that some spotting is normal the first few months of Depo and it should improve. 2. Schedule an appointment for an exam as this is not normal. 3. Prescribe 4 weeks of estrogen to treat the abnormal vaginal bleeding. 4. Order a pregnancy test and suggest she use a back-up method of contraception until she has her next shot. - SOLUTION 1. Reassurance that some spotting is normal the first few months of Depo and it should improve. The trial period to determine effective anti-inflammatory activity when starting a pt on aspirin for RA is: - SOLUTION 4-6 days Pt's rx aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of toxicity is: - SOLUTION Tinnitus Pt's with cystic fibrosis are often rx enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is rx in units of: - SOLUTION lipase Brands of pancreatic enzyme replacement drugs are: - SOLUTION about the same in cost per unit of lipase across brands Which of the following statements about pancreatic enzymes is true? - SOLUTION Dosing may be titrated according to the decrease of steatorrhea Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes? - SOLUTION Some bariatric surgeries Postmenopausal women with an intact uterus should not be rx: - SOLUTION estrogen alone William is a 62 year old male who is requesting a rx for sildenafil (Viagra). He should be screened for - SOLUTION unstable coronary artery disease before rx it. Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: - SOLUTION breakthrough bleeding The optimal max time frame for HRT or estrogen replacement therapy (ERT) is: - SOLUTION 5 years The advantage of vaginal estrogen preparations in the tx of vulvovaginal atrophy and dryness is: - SOLUTION relief of symptoms without increasing cardiovascular risk Women with an intact uterus should be tx with both estrogen and progestin due to: - SOLUTION increased risk for endometrial cancer if estrogen alone is used