Pharmacotherapeutics for Advanced Practice Nurse Practitioners Exam Questions, Exams of Nursing

Download Pharmacotherapeutics for Advanced Practice Nurse Practitioners Exam Questions and more Exams Nursing in PDF only on Docsity! Chapter 23 & 24 Woo & Robinson Pharmacotherapeutics for Advanced Practice Nurse Practitioners Chapter 23 & 24 Woo & Robinson Exam Questions (50 terms) with Verified Solutions 2024. Question 1. The 43-year-old patient comes into the clinic with flu-like symptoms. The patient's onset of symptoms is less than 48 hours. The APN will prescribe oseltamivir and understands that the half-life is which of the following? 1. 20 to 24 hours 2. 6 to 10 hours 3. 2.5 to 5 hours Chapter 23 & 24 Woo & Robinson 4. 12 to 16 hours - Answer: 2. 6 to 10 hours Option 2: The half-life for oseltamivir is 6 to 10 hours. Rationales Option 1: The half-life for peramivir is 20 hours. Option 3: The half-life for zanamivir is 2.5 to 5.1 hours. An APN is prescribing oseltamivir for the onset of flu-like symptoms to a 44-year- old patient. Which dosage is appropriate for this patient? 1. 75 mg PO bid for 5 days and start within 48 hours of symptoms 2. 75 mg PO bid for 4 days and start within 48 hours of symptoms 3. 75 mg PO bid for 3 days and start within 48 hours of symptoms 4. 75 mg PO bid for 2 days and start within 48 hours of symptoms - Answer: 1. 75 mg PO bid for 5 days and start within 48 hours of symptoms Option 1: Chapter 23 & 24 Woo & Robinson 3. Pregnancy potential 4. Cardiovascular disease - Answer: 1. HLA B*5701 testing Option 1: HLA B *5701 must be completed prior to starting abacavir because if the patient has a positive test, an anaphylaxis can occur if the patient takes abacavir. Rationales Option 2: The patient must complete pretreatment CD4+ T cell count if considering nevirapine. Option 3: Knowledge of pregnancy potential is not specific to abacavir. Option 4: Knowledge of comorbid conditions (e.g., cardiovascular disease, chemical dependency, liver disease, psychiatric disease, pregnancy, renal diseases, or tuberculosis) is not specific to abacavir. A 66-year-old patient with diabetes and chronic heart disease has been diagnosed with atypical pneumonia. Which antibiotic would be most appropriate for this patient? 1. Zithromax Chapter 23 & 24 Woo & Robinson 2. Levaquin 3. Macrobid 4. Keflex - Answer: 2. Levaquin Option 1: Presence of comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressant conditions or use of immunosuppressant drugs; use of antimicrobials within the previous 3 months; or other risk for drug-resistant Streptococcus pneumoniae (DRSP) infection requires a respiratory fluoroquinolone. A pregnant 29-year-old patient has developed community-acquired pneumonia. The APN understands that a fluoroquinolone cannot be prescribed due to the risk of malformation of the fetus. Which regimen would be most appropriate? 1. A beta-lactam plus a carbapenem 2. A beta-lactam plus a macrolide 3. A beta-lactam plus a tetracycline 4. Chapter 23 & 24 Woo & Robinson A beta-lactam plus a cephalosporin - Answer: 2. A beta-lactam plus a macrolide Option 2: Fluoroquinolones are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Women with comorbid conditions or recent antibiotics should be treated with a beta-lactam plus a macrolide. Rationales Option 1: Carbapenems are used to treat serious infections in the hospital. Option 3: Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates. Option 4: A beta-lactam plus a cephalosporin is not the most appropriate regimen for this patient. The pregnant female should receive which vaccination during pregnancy? 1. Measles, mumps, and rubella (MMR) 2. Influenza 3. Varicella 4. Chapter 23 & 24 Woo & Robinson Mycoplasma pneumoniae - Answer: 1. Streptococcus pneumoniae Option 1: S. pneumoniae is the most common cause of bacterial pneumonia in children of all ages (Bradley et al, 2011). The pneumococcal vaccine has demonstrated a decreased overall incidence and prevalence of invasive pneumococcal disease and pneumococcal pneumonia. Rationales Option 2: Klebsiella pneumonia is not the most common cause of pneumonia in children. Option 3: H. influenza is a common cause of pneumonia but is not the most common. Option 4: Mycoplasma pneumoniae, a pathogen difficult to detect on Gram stain or culture, is a common cause of pneumonia, but it is not the most common. An infant is diagnosed with chlamydial pneumonia. Which medication regimen adheres to the standard of treatment for this patient? 1. Clarithromycin 50 mg/kg daily for 14 days 2. Erythromycin 50 mg/kg daily for 14 days 3. Azithromycin 50 mg/kg daily for 14 days Chapter 23 & 24 Woo & Robinson 4. Clindamycin 20 mg/kg daily for 14 days - Answer: 2. Erythromycin 50 mg/kg daily for 14 days Option 2: The standard treatment for infants with confirmed chlamydial pneumonia is erythromycin (EryPed) 50 mg/kg daily for 14 days or oral azithromycin (Zithromax) 20 mg/kg/d for 3 days. Rationales Option 1: Clarithromycin is not the recommended medication for this patient. Option 3: Azithromycin can be used with infants; however, the standard treatment for infants with confirmed chlamydial pneumonia is oral azithromycin 20 mg/kg/d for 3 days. Option 4: Clindamycin is not the recommended medication for this patient. Which medications are included in the 6-month regimen to effectively treat tuberculosis? 1. Isoniazid, rifampin, pyrazinamide, and ethambutol 2. Isoniazid, rifampin, cycloserine, and ethionamide 3. Chapter 23 & 24 Woo & Robinson Levofloxacin, moxifloxacin, pyrazinamide, and ethambutol 4. Levofloxacin, moxifloxacin, cycloserine, and ethionamide - Answer: 1. Isoniazid, rifampin, pyrazinamide, and ethambutol Option 1: A 6-month regimen is recommended for patients who adhere to treatment and have fully susceptible organisms. The preferred regimen for patients with newly diagnosed pulmonary tuberculosis consists of 2 months of four-drug therapy administered daily: isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB), followed by 4 months of INH and RIF daily. Rationales Option 2: Isoniazid and rifampin are included in the regimen, but cycloserine and ethionamide are second-line drugs for treating tuberculosis. Option 3: Pyrazinamide and ethambutol are included in the regimen, but levofloxacin and moxifloxacin are second-line drugs for treating tuberculosis. Option 4: Levofloxacin, moxifloxacin, cycloserine, and ethionamide are all second-line drugs for treating tuberculosis. Which serious complication is caused by tuberculosis (TB) in children younger than 5 years of age and usually occurs within 6 months of primary infection? 1. Chapter 23 & 24 Woo & Robinson Wearing a mask 2. Wearing gloves 3. Annual vaccination 4. Good hygiene - Answer: 3. Annual vaccination Option 3: The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months have an influenza annual vaccination. Rationales Option 1: Wearing a mask may help prevent influenza in some cases, but this is not the most important factor in preventing influenza. Option 2: Wearing gloves may help prevent influenza in some cases, but this is not the most important factor in preventing influenza. Option 4: Good hygiene may help prevent influenza in some cases, but this is not the single most important factor in preventing influenza. Chapter 23 & 24 Woo & Robinson A patient with HIV was prescribed an antibiotic, and 7 days later the patient developed an erythema multiforme rash. Which antibiotic is most consistent with this side effect? 1. Trimpex 2. Macrobid 3. Zithromax 4. Biaxin - Answer: 1. Trimpex Option 1: Rashes and generalized skin eruptions are common adverse reactions for sulfonamides and trimethoprim (Trimpex). The incidence may be dose-related and is more prevalent in HIV-infected patients. Skin eruptions may include erythema multiforme, exfoliative dermatitis, toxic epidermal necrolysis, and Stevens- Johnson syndrome. Rationales Option 2: Nitrofurantoin monohydrate macrocrystals (Macrobid) should be used with caution in those predisposed to its adverse effects: older patients and patients with anemia, renal impairment, electrolyte imbalance, diabetes, vitamin B deficiency, and debilitating diseases. It does not commonly cause rash. Chapter 23 & 24 Woo & Robinson Option 3: Rashes and generalized skin eruptions are not commonly noted with azithromycin (Zithromax), a macrolide. Option 4: Rashes and generalized skin eruptions are not commonly noted with clarithromycin (Biaxin), a macrolide. A 63-year-old healthy patient was diagnosed with community-acquired pneumonia. Which antibiotic would be most appropriate for this patient? 1. Levaquin 2. Penicillin 3. Macrobid 4. Keflex - Answer: 1. Levaquin Option 1: Levaquin is the most commonly used antibiotic for community-acquired pneumonia. Rationales Option 2: Chapter 23 & 24 Woo & Robinson Option 1: Tinidazole is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger, although it is in the same group as a drug that is. Option 3: Ivermectin is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger. Option 4: Metronidazole is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger, although it is in the same group as a drug that is. A 33-year-old female has been diagnosed with genital herpes, and this is her first outbreak. Which recommended dose of antiviral will the APN prescribe to this patient? 1. Acyclovir 200 mg 5 times per day for 10 days 2. Acyclovir 500 mg 5 times per day for 10 days 3. Acyclovir 200 mg 3 times per day for 10 days 4. Acyclovir 500 mg 3 times per day for 10 days - Answer: 1. Acyclovir 200 mg 5 times per day for 10 days Option 1: Chapter 23 & 24 Woo & Robinson Acyclovir 200 mg every 4 hours while awake, 5 times per day for 10 days is the recommended dose for treatment of the initial episode of genital herpes. Rationales Option 2: The initial recommended dose of acyclovir is fewer than 200 mg. Option 3: An accepted off-label dose of acyclovir is 400 mg, not 200 mg, 3 times per day for 10 days. Option 4: An accepted off-label dose of acyclovir is 400 mg, not 500 mg, 3 times per day for 10 days. A 33-year-old female patient is diagnosed with vaginal candidiasis. Which medication and dosage are most appropriate for the APN to prescribe? 1. Itraconazole 100 mg as single PO dose 2. Fluconazole 150 mg as single PO dose 3. Fluconazole 100 mg as single PO dose 4. Itraconazole 150 mg as single PO dose - Answer: 2. Fluconazole 150 mg as single PO dose Option 2: Chapter 23 & 24 Woo & Robinson Fluconazole 150 mg as single PO dose is the correct medication and dosage. Rationales Option 1: Itraconazole 100 mg as single PO dose is appropriate treatment for esophageal candidiasis but not vaginal candidiasis. Option 3: This dose of fluconazole is too low. Option 4: Itraconazole 150 mg as single PO dose is appropriate treatment for esophageal candidiasis but not vaginal candidiasis. A 36-year-old patient is diagnosed with oral candidiasis. Which regimen of fluconazole is most appropriate for this patient? 1. Fluconazole 300 mg PO on first day, followed by 50 mg once daily for 2 weeks 2. Fluconazole 300 mg PO on first day, followed by 100 mg once daily for 2 weeks 3. Fluconazole 200 mg PO on first day, followed by 50 mg once daily for 2 weeks 4. Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks - Answer: 4. Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks Option 4: Chapter 23 & 24 Woo & Robinson Rationales Option 2: Tenofovir disoproxil fumarate (Atripla) is one of the drugs included in PrEP. Option 3: Emtricitabine (Emtriva) is one of the drugs included in PrEP. Option 4: Stribild is not FDA-approved for PrEP in patients who are at high risk for contracting HIV. Which pathogen is most common in nursing home-acquired pneumonia? 1. Staphylococcus aureus 2. Streptococcus pneumoniae 3. Klebsiella pneumoniae 4. Haemophilus influenzae - Answer: 2. Streptococcus pneumoniae Option 2: S. pneumoniae is the most common pathogen in nursing home-acquired pneumonia, accounting for up to 48% of cases. Rationales Chapter 23 & 24 Woo & Robinson Option 1: S. aureus accounts for up to 33% of cases of nursing home-acquired pneumonia, but it is not the most common pathogen. Option 3: K. pneumonia is not the most common pathogen in nursing home-acquired pneumonia. Option 4: H. influenzae accounts for up to 22% of cases of nursing home-acquired pneumonia, but it is not the most common pathogen. The APN has diagnosed S. pneumoniae in an adolescent. Which antibiotic is most appropriate for the APN to prescribe? 1. High-dose amoxicillin (90 mg/kg daily, divided in two doses) 2. Low-dose amoxicillin (45 mg/kg daily, divided in two doses) 3. High-dose azithromycin (90 mg/kg daily, divided in two doses) 4. Low-dose azithromycin (45 mg/kg daily, divided in two doses - Answer: 1. High-dose amoxicillin (90 mg/kg daily, divided in two doses) Option 1: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and Chapter 23 & 24 Woo & Robinson adolescent children, high-dose amoxicillin (90 mg/kg daily, divided in two doses) is the drug of choice for 7 to 10 days of outpatient treatment. Rationales Option 2: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children should be given a higher dose of amoxicillin. Option 3: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children, azithromycin is not the drug of choice. The APN understands that a pregnant female who has tuberculosis can be treated with which medication regimen? 1. Isoniazid, rifampin, pyrazinamide, and ethambutol 2. Isoniazid, rifampin, cycloserine, and ethionamide 3. Levofloxacin, moxifloxacin, pyrazinamide, and ethambutol 4. Levofloxacin, moxifloxacin, cycloserine, and ethionamide - Answer: 1. Isoniazid, rifampin, pyrazinamide, and ethambutol Option 1: Chapter 23 & 24 Woo & Robinson Cytotoxic 4. Enteric - Answer: 2. Bactericidal Option 2: Fluoroquinolones are bactericidal through interference with enzymes required for the synthesis and repair of bacterial DNA. Rationales Option 1, 3, 4: Fluoroquinolones are not considered bacteriostatic, cytotoxic, or enteric agents First-generation cephalosporins are active against which organisms? 1. Methicillin-resistant Staphylococcus Aureus 2. Gram-negative organisms 3. Methicillin-sensitive Staphylococcus Aureus 4. Enterococcus organisms - Answer: 3. Methicillin-sensitive Staphylococcus Aureus Option 3: Chapter 23 & 24 Woo & Robinson First-generation cephalosporins are active against gram-positive cocci, including S. aureus and S. epidermidis (excluding methicillin-resistant strains), and most streptococci. Option 1: First-generation cephalosporins are active against gram-positive cocci, including S. aureus and S. epidermidis (excluding methicillin-resistant strains), and most streptococci. Option 2: First-generation cephalosporins are not active against gram-negative organisms. Option 4: First-generation cephalosporins are resistant to enterococcus species. A 19-year-old patient was diagnosed with bacterial conjunctivitis. Which antibiotic would be most appropriate for this patient? 1. Cipro tablets 2. Ocuflox solution 3. Levaquin tablets 4. Cleocin solution - Answer: Option 2: Ocuflox solution would be the eye drop antibiotic prescribed in this case. Chapter 23 & 24 Woo & Robinson A 23-year-old patient was diagnosed with Trichomonas vaginal infection. Which medication is most appropriate for this patient? 1. A single dose of 2 g metronidazole 2. A single dose of 1 g metronidazole 3. A single dose of 5 g tinidazole 4. A single dose of 500 mg tinidazole - Answer: 1. A single dose of 2 g metronidazole Option 1: One-day treatment with metronidazole is 2 g as a single dose or tinidazole 2 g orally in a single dose; 7-day treatment is 500 mg twice a day. Rationales Option 2: One-day treatment with metronidazole is more than 1 g as a single dose. Option 3: One-day treatment with tinidazole is less than 5 g orally in a single dose. Option 4: One-day treatment with tinidazole is more than 500 mg orally in a single dose. A 76-year-old patient was diagnosed with a first episode of herpes zoster. Which medication regimen is most appropriate for the APN to prescribe? Chapter 23 & 24 Woo & Robinson 48 hours 3. 24 hours 4. 12 hours - Answer: Option 1: PEP is effective only if the exposure occurred within 72 hours (or 3 days). The APN has diagnosed the patient with atypical pneumonia and prescribes the patient empirical antibiotics. The patient asks how long it will take to feel better. Which response by the APN is most appropriate? 1. "You should feel better within 48 to 72 hours." 2. "You should feel better within 12 to 24 hours." 3. "You should feel better within 24 to 48 hours." 4. "You should feel better within 6 to 12 hours." - Answer: Option 1: Initially, patients who are responding to empirical antibiotic therapy should show improved clinical condition in 48 to 72 hours. A 33-year-old pregnant female patient has developed community-acquired pneumonia (CAP). Which antibiotic is most appropriate for this patient? 1. Levaquin Chapter 23 & 24 Woo & Robinson 2. Avelox 3. Noroxin 4. Zithromax - Answer: 4. Zithromax Option 4: Antibiotic therapy for the pregnant patient is similar to treatment of other adults with CAP: the macrolides erythromycin, azithromycin (Zithromax), and clarithromycin are safe during pregnancy, although erythromycin or azithromycin is the first choice because each is Pregnancy Category B, whereas clarithromycin is Pregnancy Category C. Quinolones are contraindicated in pregnancy due to the inhibition of fetal growth. Rationales Option 1: Fluoroquinolones such as levofloxacin (Levaquin) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Option 2: Fluoroquinolones such as moxifloxacin (Avelox) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Option 3: Fluoroquinolones such as norfloxacin (Noroxin) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Chapter 23 & 24 Woo & Robinson Doxycycline is not used during pregnancy because it may cause which effect in neonates? 1. Growth stunt 2. Discoloration of deciduous teeth 3. Cardiac malformation 4. Decrease in lung surfactant - Answer: 2. Discoloration of deciduous teeth Option 2: Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates. Rationales Option 1: Doxycycline is not noted to cause growth stunt, cardiac malformations, or decreased lung surfactant in neonates. Which pathogen is associated with asthma exacerbation? 1. M. pneumoniae 2. Chapter 23 & 24 Woo & Robinson Cardiology 3. Gynecology 4. Urology - Answer: 1. Ophthalmology Option 1: Ethambutol is an effective drug, but its main limitation is ocular toxicity, which causes optic neuritis leading to blurred vision, color blindness, and visual field constriction. Rationales Ethambutol is not indicated to have increased risk of cardiological, gynecological, or urological problems. Oral ribavirin, combined with interferon, is used to treat infection of which virus? 1. Influenza A 2. HIV-1 3. Respiratory syncytial virus (RSV) 4. Hepatitis C virus (HCV) - Answer: 4. Hepatitis C virus (HCV) Chapter 23 & 24 Woo & Robinson Rationales Option 4: Oral ribavirin plays a key role when combined with interferon for the treatment of HCV. Option 1: Ribavirin is active against influenza A, but its oral form combined with interferon is not used to treat it. Option 2: Ribavirin is active against H1V-1, but its oral form combined with interferon is not used to treat it. Option 3: Ribavirin is active against RSV, but its oral form combined with interferon is not used to treat it. A 42-year-old pregnant female patient comes to the clinic with an outbreak of herpes simplex to the lips. Which medication would be most appropriate for the patient? 1. Famciclovir 2. Acyclovir 3. Famvir 4. Chapter 23 & 24 Woo & Robinson Valganciclovir - Answer: 2. Acyclovir Option 2: Acyclovir is Pregnancy Category B and safe to use in pregnancy. Rationales Option 1: There is inadequate human data on famciclovir to justify prescribing to a pregnant patient. Option 3: There is inadequate human data on Famvir to justify prescribing to a pregnant patient. Option 4: Valganciclovir is Pregnancy Category C and is most often used in treating cytomegalovirus disease in HIV patients. Fluoroquinolones fall under which pregnancy category? 1. Category B 2. Category X 3. Category A 4. Category C - Answer: 4. Category C Chapter 23 & 24 Woo & Robinson To improved clinical condition 3. To end fever 4. Resolution of leukocytosis - Answer: 1. To return to the previous respiratory status Option 1: The ultimate goal of treatment for all patients is the return to the respiratory status they had before the illness. Rationales Option 2: Improved clinical condition usually occurs within 48 to 72 hours and is a short- term goal of treatment. Option 3: Fever resolution usually occurs within 2 to 4 days and is a short-term goal of treatment. Option 4: Leukocytosis resolution usually occurs by day 4 of treatment and is a short-term goal of treatment. A 23-year-old female patient presents to the clinic with a 24-hour history of zoster outbreak. When would therapy with a nucleoside analog be initiated for greatest effect? 1. Chapter 23 & 24 Woo & Robinson Within 3 days 2. Within 4 days 3. Within 2 days 4. Within 5 days - Answer: 3. Within 2 days Option 3: Therapy is most effective if initiated within 48 hours of the outbreak of the rash. Rationales Option 1: Therapy with nucleoside analogues should be initiated within 3 days of the outbreak of the rash in herpes zoster. Option 2: Therapy would be losing effect after 4 days following outbreak of rash. The 53-year-old patient just completed a 14-day course of antibiotic and developed Clostridium difficile colitis. Which antibiotic most likely caused this patient to have Clostridium difficile colitis? 1. Zithromax 2. Biaxin Chapter 23 & 24 Woo & Robinson 3. Cleocin 4. Prilosec - Answer: 3. Cleocin Option 3: There is a high incidence of Clostridium difficile colitis associated with clindamycin (Cleocin). Rationales Option 1: An azalide such as Zithromax does not have the highest incidence of Clostridium difficile colitis. Option 2: A macrolide such as Biaxin does not have the highest incidence of Clostridium difficile colitis. Option 4: Prilosec is not an antibiotic but a proton pump inhibitor (PPI).