MN 552 - Final Exam; Latest 2019/2020 complete solutions, Attempt score 364 Out of 400 points.

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MN 552 FINAL EXAM In what year did was the Durham-Humphrey Amendment enacted which stated that a physician must prescribe drugs and a pharmacist must dispense them? Question options: 1932 1938... 1952 1958 Question 2 5 / 5 points All of the following are schedule II medications except? Question options: Ecstasy Meperidine Cocaine Pentobarbital Question 3 5 / 5 points Which pregnancy category do medications fall under if animal studies have shown an adverse effect on the fetus, no adequate human studies, and that benefits may outweigh risks? Question options: Cat. X Cat. A Cat. B Cat. C Question 4 5 / 5 points True or False: To be found negligent and responsible for harm resulting from your professional activities, courts generally require the presence of 4 conditions, to include duty, derelict, directly and damage? Question options: True False Question 5 5 / 5 points True or False: Pharmacodynamics is the study of the body’s impact on the drug to include absorption, distribution, metabolism and excretion? Question options: True False All of the following are variables that affect drug actions except? Question options: Height Weight Age Placebo response Question 2 5 / 5 points Which medication route has a 100% bioavailability? Question options: PO IM IV SQ Question 3 5 / 5 points What must be present before a drug exerts its pharmacologic action on body cells? Question options: A specified amount of time since administration The minimum effective concentration Metabolism has been completed The medication has been excreted by the kidneys Question 4 5 / 5 points True or False: Pharmacodynamics involves drug actions on target cells and the resulting alterations in cellular biochemical reactions? Question options: True False Question 5 5 / 5 points True or False: In older adults increased total body water and lean body mass-fat soluble meds stay with the patient longer? Question options: True False True or False: Zollinger-Ellison Syndrome is the excessive secretion of gastric acid and a high incidence of ulcers. It is caused by gastrin-secreting tumors in pancreas, stomach or duodenum? Question options: True False Question 2 5 / 5 points All of the following may cause Gastroesophageal Reflux Disease except? Question options: Alcohol Chocolate Beta adrenergic blockers Anticonvulsants Question 3 5 / 5 points True or False: The treatment for Helicobacter Pylori requires a combination of two antimicrobials and a PPI or an H2RA? Question options: True False Question 4 5 / 5 points All of the following are antiemetic herbal remedies except? Question options: Peppermint Saw palmetto Cayenne Meadowsweet Question 5 5 / 5 points All of the following are causes of diarrhea except: Question options: Laxative abuse Inflammatory bowel disease Gastroesophageal reflux disease Drug therapy Question options: Patients with kidney stones Pregnant patients Patients with heartburn Postmenopausal women Question 2 1 / 1 point Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: Question options: Can be given to patients of all ages, including infants and children, for viral gastroenteritis Slows gastric motility and reduces fluid and electrolyte loss from diarrhea Is the treatment of choice for the diarrhea associated with E. coli 0157 May be used in pregnancy and by lactating women Question 3 1 / 1 point Josie is a 5-year-old patient who 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 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? Question options: Prochlorperazine (Compazine) Meclizine (Antivert) Promethazine (Phenergan) Ondansetron (Zofran) I Question 4 1 / 1 point Gastroesophageal reflux disease may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: Question options: Calcium carbonate Estrogen Furosemide Metoclopramide Question 5 0 / 1 point Metoclopramide improves gastroesophageal reflux disease symptoms by: Question options: Reducing acid secretion Increasing gastric pH Increasing lower esophageal tone correct WRONG Decreasing lower esophageal tone Question 6 1 / 1 point Antacids treat gastroesophageal reflux disease by: Question options: Increasing lower esophageal tone Increasing gastric pH Inhibiting gastric acid secretion Increasing serum calcium level Question 7 1 / 1 point Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive-treatment. Which medication would be the best choice for treatment? Question options: Mupirocin (Bactroban) Bacitracin and polymixin B (generic double antibiotic ointment) Retapamulin (Altabax) Oral cephalexin (Keflex) Question 8 1 / 1 point Juakeem is a nasal methicillin resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes: Question options: Take the oral medication exactly as prescribed. Insert one-half of the dose in each nostril twice a day. Alternate treating one nare in the morning and the other in the evening. Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients. Question 9 1 / 1 point When Sam used clotrimazole (Lotrimin AF) for athlete’s foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete’s foot again. What would be a good choice of antifungal for Sam? Question options: Miconazole (Micatin) powder Ketoconazole (Nizoral) cream Terbinafine (Lamisil) cream Griseofulvin (Grifulvin V) suspension Question 10 1 / 1 point Long-term treatment of moderate atopic dermatitis includes: Question options: Topical corticosteroids and emollients Topical corticosteroids alone Topical antipruritics Oral corticosteroids for exacerbations of atopic dermatitis Question 11 1 / 1 point Josie has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be: Question options: Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane). Order Accutane after educating her on the adverse effects. Recommend she try oral antibiotics (minocycline). Refer her to a dermatologist for treatment. Question 12 1 / 1 point Appropriate initial treatment for psoriasis would be: Question options: An immunomodulator (Protopic or Elidel) Wet soaks with Burrow’s or Domeboro solution Intermittent therapy with intermediate potency topical corticosteroids Anthralin (Drithocreme) Question 13 1 / 1 point Twenty-year-old Annie 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: Question options: None, wait for the culture results to determine the course of treatment Ciprofloxacin (Ciloxan) ophthalmic drops IM ceftriaxone High-dose oral amoxicillin Question 14 1 / 1 point Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because: Question options: There may be an antagonistic reaction between the two. The additive effects may include bradycardia. They may potentiate each other and cause respiratory depression. The additive effects may cause metabolic acidosis. Question 15 1 / 1 point David presents to the clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding using cromolyn eye drops includes: Question options: He should not wear his soft contacts while using the cromolyn eye drops. Cromolyn drops are instilled once a day to prevent allergy symptoms. Long-term use may cause glaucoma. He may experience bradycardia as an adverse effect. Jim presents with complaints of “heartburn” that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be: Question options: Omeprazole (Prilosec) twice a day Ranitidine (Zantac) twice a day Famotidine (Pepcid) once a day Metoclopramide (Reglan) four times a day Question 2 2 / 2 points An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: Question options: Electrolytes, including potassium and chloride Bone mineral density for osteoporosis Magnesium level Liver function Question 3 2 / 2 points The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving is: Question options: Add a prokinetic (metoclopramide) Referral for endoscopy Switch to another proton pump inhibitor Add a cytoprotective drug Question 4 2 / 2 points If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is: Question options: Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days Test H. pylori for resistance to common treatment regimens Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days Proton pump inhibitor and levofloxacin for 14 days Question 5 2 / 2 points Erika has been prescribed isotretinoin (Accutane) by her dermatologist and is presenting to her primary care provider with symptoms of sadness and depression. A Beck’s Depression Scale indicates she has mild to moderate depression. What would be the best care for her at this point? Question options: Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant Refer her to a mental health therapist Contact her dermatologist about discontinuing the isotretinoin Reassure her that mood swings are normal and schedule follow up in a week Question 6 2 / 2 points Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes instructing them: Question options: That tazarotene is applied in a thin film to the psoriasis plaque lesions To apply it liberally to all psoriatic lesions To apply tazarotene to nonaffected areas to prevent breakout That tazarotene may cause hypercalcemia if it is overused Question 7 2 / 2 points Nicolas is a football player who presents to the clinic with athlete’s foot. Patients with tinea pedis may be treated with: Question options: OTC miconazole cream for 4 weeks Oral ketoconazole for 6 weeks Mupirocin ointment for 2 weeks Nystatin cream for 2 weeks Question 8 2 / 2 points Vanessa has been diagnosed with scabies. Her education would include: Question options: She should apply the scabies treatment cream for an hour and wash it off. Scabies may need to be retreated in a week after initial treatment. All members of the household and close personal contacts should be treated. Malathion is flammable and she should take care until the solution dries. Question 9 2 / 2 points Ciprofloxacin otic drops are contraindicated in: Question options: Children Patients with acute otitis externa Patients with a perforated tympanic membrane Swimmer’s ear Question 10 2 / 2 points Janie presents to the clinic with hard ear wax in both ear canals. Instructions regarding home removal of hard cerumen include: Question options: Moisten a cotton swab (Q-tip) and swab the ear canal twice daily. Instill tap water in both ears while bathing. Squirt hydrogen peroxide into ears with each bath. Instill carbamide peroxide (Debrox) twice daily until canals are clear. Digoxin levels need to be monitored closely when the following medication is started: Question options: Loratadine Diphenhydramine Ipratropium Albuterol Question 2 1 / 1 point When educating patients who are starting on inhaled corticosteroids, the provider should tell them that: Question options: They need to get any live vaccines before starting the medication. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids. Question 3 1 / 1 point Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are: Question options: More effective than first-generation antihistamines Less sedating than the first-generation antihistamines Prescription products, therefore are covered by insurance Able to be taken with central nervous system (CNS) sedatives, such as alcohol Question 4 1 / 1 point 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? Question options: High-dose colchicine Low-dose colchicine High-dose aspirin Acetaminophen with codeine Question 5 1 / 1 point Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for: Question options: Metformin, a biguanide to prevent diabetes Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease Naproxen, an NSAID to treat joint pain Furosemide, a diuretic to treat fluid retention Question 6 1 / 1 point Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is: Question options: Black tarry stools Vomiting Tremors Tinnitus Question 7 1 / 1 point Prior to developing a plan for the treatment of asthma, the patient’s asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur: Question options: Daily Daily and limit physical activity Less than twice a week More than twice a week and less than once a day Question 8 1 / 1 point Patients with a COPD exacerbation may require: Question options: Doubling of inhaled corticosteroid dose Systemic corticosteroid burst Continuous inhaled beta-2-agonists Leukotriene therapy Question 9 1 / 1 point Asthma exacerbations at home are managed by the patient by: Question options: Increasing frequency of beta-2-agonists and contacting their provider Doubling inhaled corticosteroid doses Increasing frequency of beta-2-agonists Starting montelukast (Singulair) Question 10 1 / 1 point The most common bacterial pathogen in community-acquired pneumonia is: Question options: Haemophilus influenzae Staphylococcus aureus Mycoplasma pneumoniae Streptococcus pneumonia Question 11 1 / 1 point The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia and can be treated as an outpatient would be: Question options: Levofloxacin Amoxicillin Ciprofloxacin Cephalexin Question 12 1 / 1 point Wing-Sing is a 4-year-old patient who has suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia? Question options: Ceftriaxone Azithromycin Cephalexin Levofloxacin Question 13 1 / 1 point Instructions for a patient who is starting nicotine replacement therapy include: Question options: Smoke less than 10 cigarettes a day when starting nicotine replacement. Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco. Nicotine replacement can be used indefinitely. Nicotine replacement therapy is generally safe for all patients. Question 14 1 / 1 point If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include: Question options: Bupropion (Zyban) is started 1 to 2 weeks before the quit date. Nicotine replacement products should not be used with bupropion. If they smoke when taking bupropion they may have increased anxiety and insomnia. Because they are not using bupropion as an antidepressant, they do not need to worry about increased suicide ideation when starting therapy. Question 15 0 / 1 point The most appropriate smoking cessation prescription for pregnant women is: Question options: A nicotine replacement patch at the lowest dose available Bupropion (Zyban)incorrect Varenicline (Chantix) Nonpharmacologic measures correct Question 16 1 / 1 point Drug resistant tuberculosis (TB) is defined as TB that is resistant to: Question options: Fluoroquinolones Rifampin and isoniazid Amoxicillin Ceftriaxone Question 17 1 / 1 point Kaleb has extensively resistant tuberculosis (TB). Treatment for extensively resistant TB would include: Question options: INH, rifampin, pyrazinamide, and ethambutol for at least 12 months INH, ethambutol, kanamycin, and rifampin Treatment with at least two drugs to which the TB is susceptible Levofloxacin Question 18 1 / 1 point Ezekiel is a 9-year-old patient who lives in a household with a family member newly diagnosed with tuberculosis (TB). To prevent Ezekiel from developing TB he should be treated with: Question options: 6 months of Isoniazid (INH) and rifampin 2 months of INH, rifampin, pyrazinamide, and ethambutol, followed by 4 months of INH 9 months of INH 12 months of INH Question 19 1 / 1 point Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include: Question options: Azithromycin Amoxicillin Ceftriaxone Trimethoprim/sulfamethoxazole Question 20 1 / 1 point Jacob has been diagnosed with sinusitis. He is the parent of a child in daycare. Treatment for sinusitis in an adult who has a child in daycare is: Question options: Azithromycin 500 mg q day for 5 days Amoxicillin-clavulanate 500 mg bid for 7 days Ciprofloxacin 500 mg bid for 5 days Cephalexin 500 mg qid for 5 days ________________________________________ Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: Question options: Excessive sedation Tachycardia and angina Weight gain Cold intolerance Question 2 1 / 1 point Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: Question options: Tinnitus and decreased salivation Fever and sore throat Hypocalcemia and osteoporosis Laryngeal edema and difficulty swallowing Question 3 1 / 1 point Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: Question options: Substitutes for insulin usually secreted by the pancreas Decreases glycogenolysis by the liver Increases the release of insulin from beta cells Decreases peripheral glucose utilization Question 4 1 / 1 point Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: Question options: “Fruity” breath odor and rapid respiration Diarrhea, abdominal pain, weight loss, and hypertension Dizziness, confusion, diaphoresis, and tachycardia Easy bruising, palpitations, cardiac dysrhythmias, and coma Question 5 1 / 1 point 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: Question options: Increase endogenous insulin secretion Have a significant risk for hypoglycemia Address the insulin resistance found in type 2 diabetics Improve insulin binding to receptors Question 6 1 / 1 point Treatment with insulin for type 1 diabetics: Question options: Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight Divides the total doses into three injections based on meal size Uses a total daily dose of insulin glargine given once daily with no other insulin required Is based on the level of blood glucose Question 7 1 / 1 point The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: Question options: Glycemic targets between 7% and 7.5% Use of insulin in type 2 diabetics Control of hypertension and hyperlipidemia Stopping smoking Question 8 1 / 1 point Drugs used to treat diabetic peripheral neuropathy include: Question options: Metoclopramide Cholinergic agonists Cardioselective beta blockers Gabapentin Question 9 1 / 1 point The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: Question options: Cardiovascular risk Risk of stroke or other thromboembolic event Breast cancer Vasomotor symptoms Question 10 1 / 1 point Inadequate vitamin D intake can contribute to the development of osteoporosis by: Question options: Increasing calcitonin production Increasing calcium absorption from the intestine Altering calcium metabolism Stimulating bone formation Question 11 1 / 1 point The drug recommended as primary prevention of osteoporosis in men over age 70 years is: Question options: Alendronate (Fosamax) Ibandronate (Boniva) Calcium carbonate Raloxifene (Evista) Question 12 1 / 1 point In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: Question options: A calcium channel blocker A beta blocker Liothyronine An alpha blocker Question 13 1 / 1 point When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: Question options: 2 weeks 4 weeks 2 months 6 months Question 14 1 / 1 point Treatment of a patient with hypothyroidism and cardiovascular disease consists of: Question options: Levothyroxine Liothyronine Liotrix Methimazole Question 15 1 / 1 point Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: Question options: Washing their hands after applying the gel Wearing occlusive clothing while using the gel Exposure to estrogens while using the gel Skin-to-skin contact with pregnant women while using the gel Question 16 1 / 1 point A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes: Question options: Counseling regarding decreasing or not smoking while taking oral contraceptives Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive Advising that she may miss two pills in a row and not be concerned about pregnancy Recommending that her next follow-up visit is in 1 year for a refill and annual exam Question 17 1 / 1 point A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed: Question options: Low-dose oral estrogen A low-dose estrogen/progesterone combination A vaginal estradiol ring Vaginal progesterone cream Question 18 1 / 1 point 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: Question options: Recommend she return to the clinic at the start of her next menses to get a Depo Provera shot. 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 7 days. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days. Discuss the advantages of using the topical birth control patch and recommend she consider using the patch. Question 19 1 / 1 point Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? Question options: Increased migraine headaches Increased risk of developing blood clots Irregular vaginal bleeding for the first few months Increased risk for hypercalcemia Question 20 1 / 1 point Oral emergency contraception (Plan B) is contraindicated in women who: Question options: Had intercourse within the past 72 hours May be pregnant Are taking combined oral contraceptives Are using a diaphragm ________________________________________ 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? Question options: Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime. Question 2 2 / 2 points Prior to prescribing metformin, the provider should: Question options: Draw a serum creatinine to assess renal function Try the patient on insulin Tell the patient to increase iodine intake Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions Question 3 2 / 2 points Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action? Question options: Levemir Glulisine Glargine Detemir Question 4 2 / 2 points The drugs recommended for older adults with type 2 diabetes include: Question options: Second-generation sulfonylureas Metformin Pioglitazone Third-generation sulfonylureas Question 5 2 / 2 points Women with an intact uterus should be treated with both estrogen and progestin due to: Question options: Increased risk for endometrial cancer if estrogen alone is used Combination therapy provides the best relief of menopausal vasomotor symptoms Reduced risk for colon cancer with combined therapy Lower risk of developing blood clots with combined therapy Question 6 2 / 2 points Bisphosphonate administration education includes: Question options: Taking it on a full stomach Requiring sitting erect for at least 30 minutes afterward Drinking it with orange juice Taking it with H2 blockers or proton pump inhibitors (PPI) to protect the stomach Question 7 2 / 2 points Long-term use of androgens requires specific laboratory monitoring of: Question options: Glucose, calcium, testosterone, and thyroid function Calcium, testosterone, PSA, and liver function Calcium, testosterone, PSA, liver function, glucose, and lipids CBC, testosterone, PSA, and thyroid level Question 8 2 / 2 points Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: Question options: Nausea Breakthrough bleeding Breast tenderness Pregnancy Question 9 2 / 2 points The mechanism of action of oral combined contraceptives that prevents pregnancy is: Question options: Estrogen prevents the luteinizing hormone surge necessary for ovulation. Progestins thicken cervical mucus and slow tubal motility. Estrogen thins the endometrium making implantation difficult. Progestin suppresses follicle stimulating hormone release. Question 10 2 / 2 points When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: Question options: They should feel symptomatic improvement in 1 to 2 weeks. Drug adverse effects such as lethargy and dry skin may occur. It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing. Because of its short half-life, levothyroxine doses should not be missed. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be: Question options: Penicillin VK, because his rash does not sound like a serious rash Amoxicillin Cefadroxil (Duricef) Azithromycin Question 2 1 / 1 point Nicholas has been diagnosed with type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include: Question options: Starting oseltamivir within the first 48 hours of influenza symptoms Advising the patient he can stop the oseltamivir when his symptoms resolve Educating the patient that oseltamivir will cure influenza Prophylactic treatment of all family members Question 3 1 / 1 point The drug of choice for treatment of primary or secondary syphilis is: Question options: Ceftriaxone IM Benzathine penicillin G IM Oral azithromycin Oral ciprofloxacin Question 4 1 / 1 point When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with: Question options: Azithromycin 1 gram PO x 1 Amoxicillin 500 mg PO x 1 Ciprofloxacin 500 mg PO x 1 Penicillin G 2.4 million units IM x 1 Question 5 1 / 1 point Lila is 24 weeks pregnant and has been diagnosed with tuberculosis (TB). Treatment regimens for a pregnant patient with TB would include: Question options: Streptomycin Levofloxacin Kanamycin Pyridoxine Question 6 1 / 1 point The principles of drug therapy for the treatment of tuberculosis include: Question options: Patients are treated with a drug to which M. tuberculosis is sensitive. Drugs need to be taken on a regular basis for a sufficient amount of time. Treatment continues until the patient’s purified protein derivative is negative. All of the above Question 7 1 / 1 point Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is: Question options: Amoxicillin Azithromycin Cephalexin Levofloxacin Question 8 1 / 1 point Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for her? Question options: Continue the amoxicillin for the full 10 days. Change the antibiotic to azithromycin. Change the antibiotic to amoxicillin/clavulanate. Change the antibiotic to trimethoprim/sulfamethoxazole. Question 9 1 / 1 point Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be: Question options: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Levofloxacin Question 10 1 / 1 point Jamie is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be: Question options: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Ciprofloxacin Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to: Question options: Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily. Change the antibiotic to one that is less of a gastrointestinal irritant. Order stool cultures for suspected viral pathogens not treated by the amoxicillin. Recommend increased fluids and fiber in his diet. Question 2 2 / 2 points To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of: Question options: Urinary tract infections in young women Upper respiratory infections in adults Skin and soft tissue infections in adults Community-acquired pneumonia in patients with comorbidities Question 3 2 / 2 points Treatment for suspected gonorrhea is: Question options: Ceftriaxone 250 mg IM x 1 Ceftriaxone 2 grams IM x 1 Ciprofloxacin 500 mg PO x 1 Doxycycline 100 mg bid x 7 days Question 4 2 / 2 points If a woman presents with recurrent vulvovaginal candidiasis she may be treated with: Question options: Weekly intravaginal butoconazole for 3 months Fluconazole 150 mg PO daily x 7 doses then monthly for 6 months Weekly fluconazole 150 mg PO x 6 months Intravaginal tioconazole x 14 days Question 5 2 / 2 points Bilal is a 5-year-old patient who has been diagnosed with tuberculosis. His treatment would include: Question options: Pyridoxine Ethambutol Levofloxacin Rifabutin Question 6 2 / 2 points Isabella has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month regimen consists of: Question options: Two months of four-drug therapy (INH, rifampin, pyrazinamide, and ethambutol) followed by Four months of INH and rifampin Six months of INH with daily pyridoxine throughout therapy Six months of INH, rifampin, pyrazinamide, and ethambutol Any of the above Question 7 2 / 2 points First-line therapy for a patient with acute otitis externa (swimmer’s ear) and an intact tympanic membrane includes: Question options: Swim-Ear drops Ciprofloxacin and hydrocortisone drops Amoxicillin Gentamicin ophthalmic drops Question 8 2 / 2 points The length of treatment for sinusitis in a low-risk patient should be: Question options: 5–7 days 7–10 days 14–21 days 7 days beyond when symptoms cease Question 9 2 / 2 points Nicole is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: Question options: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Ciprofloxacin Question 10 2 / 2 points Juanita is a 28-year-old pregnant woman at 38 weeks’ gestation who is diagnosed with a lower urinary tract infection (UTI). She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be: Question options: Azithromycin Trimethoprim/sulfamethoxazole Amoxicillin Ciprofloxacin Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for: Question options: Hypokalemia Impotence Decreased renal function Inability to concentrate Question 2 1 / 1 point Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct. Question options: Older adults because of reduced renal function Administration of aldosterone antagonist diuretics because of decreased potassium levels Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin Doses between 0.25 and 0.5 mg/day Question 3 1 / 1 point Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to: Question options: Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times. Question 4 1 / 1 point Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended? Question options: He has arthritis and this will help with the inflammation and pain. Aspirin has anti-platelet activity and prevents clots that cause heart attacks. Aspirin acidifies the urine and he needs this for prostrate health. He has a history of GI bleed, and one aspirin a day is a safe dosage. Question 5 1 / 1 point Education of patients who are taking warfarin includes discussing their diet. Instructions include: Question options: Avoiding all vitamin K-containing foods Avoiding high-vitamin K-containing foods Increasing intake of iron-containing foods Making sure they eat 35 grams of fiber daily Question 6 1 / 1 point Pernicious anemia is treated with: Question options: Folic acid supplements Thiamine supplements Vitamin B12 Iron Question 7 1 / 1 point Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be: Question options: 18 mg/day of iron supplementation 6 mg/kg per day of iron supplementation 325 mg ferrous sulfate per day 325 mg ferrous sulfate tid Question 8 1 / 1 point Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is: Question options: Oral folic acid 1 to 2 mg per day Oral folic acid 1 gram per day IM folate weekly for at least 6 months Oral folic acid 400 mcg daily Question 9 1 / 1 point Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS? Question options: Calcium channel blockers Beta blockers Angiotensin-converting-enzyme (ACE) inhibitors Aspirin Question 10 0 / 1 point The rationale for prescribing calcium blockers for angina can be based on the need for: Question options: Increased inotropic effect in the heart wrong it decreases Increasing peripheral perfusion Keeping heart rates high enough to ensure perfusion of coronary arteries Help with rate control correct Question 11 1 / 1 point Which of the following drugs has been associated with increased risk for myocardial infarction in women? Question options: Aspirin Beta blockers Estrogen replacement *** Lipid-lowering agents Question 12 1 / 1 point Increased life expectancy for patients with heart failure has been associated with the use of: Question options: ACE inhibitors, especially when started early in the disease process All beta blockers regardless of selectivity Thiazide and loop diuretics Cardiac glycosides Question 13 1 / 1 point Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with: Question options: Ejection fractions above 40% An audible S3 Mitral stenosis as a primary cause for heart failure Renal insufficiency Question 14 1 / 1 point Which of the following classes of drugs is contraindicated in heart failure? Question options: Nitrates Long-acting dihydropyridines Calcium channel blockers Alpha-beta blockers Question 15 1 / 1 point What is considered the order of statin strength from lowest effect to highest? Question options: Lovastatin, Simvastatin, Rosuvastatin Rosuvastatin, Lovastatin, Atorvastatin Atorvastatin, Rosuvastatin, Simvastatin Simvastatin, Atorvastatin, Lovastatin Question 16 1 / 1 point First-line therapy for hyperlipidemia is: Question options: Statins Niacin Lifestyle changes *** Bile acid-binding resins Question 17 1 / 1 point 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: Question options: Sterol Niacin Fibric acid derivative Bile acid-binding resin Question 18 1 / 1 point Hypertensive African Americans are typically listed as not being as responsive to which drug groups? Question options: ACE inhibitors Calcium channel blockers Diuretics Bidil (hydralazine family of medications) Question 19 1 / 1 point Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive the following supplement: Question options: Potassium Calcium Magnesium Phosphates Question 20 1 / 1 point An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? Question options: Beta blockers Diuretics Nondihydropyridine calcium channel blockers Angiotensin II receptor blockers 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: Question options: Increases peripheral vasoconstriction Decreases detrusor muscle contractility Lowers supine blood pressure more than standing pressure Relaxes smooth muscle in the bladder neck Question 2 1 / 1 point Which of the following adverse effects are less likely in a beta1-selective blocker? Question options: Dysrhythmias Impaired insulin release Reflex orthostatic changes Decreased triglycerides and cholesterol Question 3 1 / 1 point Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: Question options: Symptoms are severe Patient has not responded to other therapies Patient has concurrent hypertension Left ventricular dysfunction is diagnosed Question 4 1 / 1 point 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? Question options: Donepezil Tacrine Doxazosin Verapamil Question 5 1 / 1 point Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus. Question options: IV phenobarbital Rectal diazepam (Diastat) IV phenytoin (Dilantin) Oral carbamazepine (Tegretol) Question 6 1 / 1 point Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: Question options: Dwayne hasn’t been taking his carbamazepine because it causes insomnia. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance. Dwayne was not originally prescribed the correct amount of carbamazepine. Carbamazepine is probably not the right antiseizure medication for Dwayne. Question 7 1 / 1 point Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be: Question options: Ibuprofen (Advil) Acetaminophen with hydrocodone (Vicodin) Oxycodone (Oxycontin) Oral morphine (Roxanol) Question 8 1 / 1 point 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: Question options: Slurred speech and insomnia Bradycardia and confusion Dizziness and orthostatic hypotension Insomnia and decreased appetite Question 9 1 / 1 point An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: Question options: Alprazolam (Xanax) Diazepam (Valium) Buspirone (Buspar) Amitriptyline (Elavil) Question 10 1 / 1 point David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include: Question options: Paroxetine may cause intermittent diarrhea. He may experience sexual dysfunction beginning a month after he starts therapy. He may have constipation and he should increase fluids and fiber. Paroxetine has a long half-life so he may occasionally skip a dose. Question 11 1 / 1 point An appropriate drug for the treatment of depression with anxiety would be: Question options: Alprazolam (Xanax) Escitalopram (Lexapro) Buspirone (Buspar) Amitriptyline (Elavil) Question 12 1 / 1 point The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason? Question options: They have become tolerant of the medication, which is characterized by the need for higher and higher doses. They are a drug seeker. They are suicidal. They only need additional counseling on lifestyle modification. Question 13 1 / 1 point A first-line drug for abortive therapy in simple migraine is: Question options: Sumatriptan (Imitrex) Naproxen (Aleve) Butorphanol nasal spray (Stadol NS) Butalbital and acetaminophen (Fioricet) Question 14 1 / 1 point Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: Question options: Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use. Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose. Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital). Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan. Question 15 1 / 1 point Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: Question options: Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic. Question 16 1 / 1 point James has been diagnosed with cluster headaches. Appropriate acute therapy would be: Question options: Butalbital and aspirin (Fiorinal) Meperidine IM (Demerol) Oxygen 100% for 15 to 30 minutes Indomethacin (Indocin) Question 17 1 / 1 point 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? Question options: NSAIDs, opiates, corticosteroids Low-dose opiates, salicylates, increased dose of opiates Opiates, non-opiates, increased dose of non-opiate Non-opiate, increased dose of non-opiate, opiate Question 18 1 / 1 point Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency? Question options: Use of more than one drug to treat the pain Multiple times when prescriptions are lost with requests to refill Preferences for treatments that include alternative medicines Presence of a family member who has abused drugs Question 19 1 / 1 point The Pain Management Contract is appropriate for: Question options: Patients with cancer who are taking morphine Patients with chronic pain who will require long-term use of opiates Patients who have a complex drug regimen Patients who see multiple providers for pain control Question 20 1 / 1 point Which of the following statements is true about age and pain? Question options: Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: Question options: A need to monitor drugs metabolized by 2D6 for toxicity Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors Decreased conversion of codeine to morphine by CYP 2D6 The need for lowered dosages of drugs, such as beta blockers Question 2 1 / 1 point Rifampin is a nonspecific CYP450 inducer that may: Question options: Lead to toxic levels of rifampin and must be monitored closely Cause toxic levels of drugs, such as oral contraceptives, when coadministered Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure Cause nonspecific changes in drug metabolism Question 3 1 / 1 point Inhibition of P-glycoprotein by a drug such as quinidine may lead to: Question options: Decreased therapeutic levels of quinidine Increased therapeutic levels of quinidine Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination Question 4 1 / 1 point Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: Question options: Toxic levels of warfarin building up Decreased response to warfarin Increased risk for significant drug interactions with warfarin Less risk of drug interactions with warfarin Question 5 1 / 1 point Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing: Question options: Erythromycin Digoxin Cetuximab Rifampin Question 6 1 / 1 point Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to: Question options: Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 Allele Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine Question 7 1 / 1 point A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to: Question options: Decreased effectiveness of irinotecan in the treatment of cancer Increased adverse drug reactions, such as neutropenia Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 Increased concerns for irinotecan being carcinogenic Question 8 1 / 1 point A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products. Question options: 10 5 38 70 Question 9 1 / 1 point A potential harmful effect on patients who take some herbal medication is: Question options: Constipation Lead poisoning Diarrhea Life-threatening rash Question 10 1 / 1 point A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains: Question options: Coumadin, which may lead to bleeding problems Coumarin, which can cause liver and kidney damage Cinnamic aldehyde, which is toxic to the kidney Cinnamate eugenol, which is toxic to the liver Question 11 1 / 1 point Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe: Question options: Herbs which are yang in nature Herbs that are yin in nature Ginger Golden seal Question 12 1 / 1 point According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will: Question options: Get worse Get better Not be adequately treated Need additional herbs to treat the yang Question 13 1 / 1 point In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s: Question options: Vata Pitta Kapha Prakriti Question 14 1 / 1 point When melatonin is used to induce sleep, the recommendation is that the patient: Question options: Take 10 mg 30 minutes before bed nightly Take 1 to 5 mg 30 minutes before bed nightly Not take melatonin more than three nights a week Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep Question 15 1 / 1 point In the United States, over-the-counter drugs are regulated by: Question options: No one. There is no oversight for over-the-counter medications. The U.S. Food and Drug Administration Center for Drug Evaluation and Research The U.S. Drug Enforcement Administration MedWatch Question 16 1 / 1 point As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to: Question options: Get a new patent for the over-the-counter form of the drug Lower the costs because most prescription benefit plans do not cover generics Market the drug to a whole new population, as they are able to market to patients instead of just providers Continue to make large profits from their blockbuster brand-name drug Question 17 1 / 1 point The ailment that generates the greatest over-the-counter annual drug sales is: Question options: Constipation Cough and colds Heartburn Acute and chronic pain Question 18 1 / 1 point Common over-the-counter pain relievers such as acetaminophen or ibuprofen: Question options: Are always safer for the patient than prescription pain medication Are harmful if taken in higher than recommended amounts Have minimal interaction with prescription medications Should never be given to children unless recommended by their provider Question 19 1 / 1 point When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of: Question options: His appropriately only telling you about his regularly prescribed medications His hiding information regarding his inappropriate use of aspirin from you A common misconception that intermittently taken over-the counter medications are not an important part of his drug history A common misuse of over-the-counter aspirin Question 20 1 / 1 point Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must: Question options: Be safe and labeled for appropriate use Have a low potential for abuse or misuse Be taken for a condition the patient can reliably self-diagnose All of the above There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: Question options: Renal excretion is similar in both classes of drugs. When these drug classes are metabolized in the liver they both produce resistant enzymes. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms. There is not an issue with cross-resistance between the penicillins and cephalosporins. Question 2 4 / 4 points The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class: Question options: I II III IV Question 3 4 / 4 points Class I recommendations for stage A heart failure include: Question options: Aerobic exercise within tolerance levels to prevent the development of heart failure Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention Beta blockers for all patients regardless of cardiac history Treatment of thyroid disorders, especially if they are associated with Tachyarrhythmias Question 4 4 / 4 points Patient education regarding taking iron replacements includes: Question options: Doubling the dose if they miss a dose to maintain therapeutic levels Taking the iron with milk or crackers if it upsets their stomach Iron is best taken on an empty stomach with juice Antacids such as Tums may help the upset stomach caused by iron therapy Question 5 0 / 4 points Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? Question options: Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. Additive antimuscarinic effects may occur with antihistamines.WRONG Cholinergic blockers may decrease the sedative effects of hypnotics. Cholinergic blockers are contraindicated with antipsychotics. Question 6 4 / 4 points What is the role of calcium supplements when patients take bisphosphonates? Question options: They must be restricted to allow the medication to work. They must be taken in sufficient amounts to provide foundational elements for bone growth. They must be taken at the same time as the bisphosphonates. They only work with bisphosphonates if daily intake is restricted. Question 7 4 / 4 points Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true? Question options: Screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0. Screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. Screening values are between 5 and 10, and therapeutic values are greater than 10. Question 8 4 / 4 points Preventative therapy for cluster headaches includes: Question options: Massage or relaxation therapy Ergotamine nightly before bed Intranasal lidocaine four times a day during “clusters” of headaches Propranolol (Inderal) daily Question 9 4 / 4 points Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: Question options: Rapidly achieves drug levels in the therapeutic range Requires four- to five-half-lives to attain Is influenced by renal function Is directly related to the drug circulating to the target tissues Question 10 4 / 4 points The dosage of Vitamin B12 to initially treat pernicious anemia is: Question options: Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month Vitamin B12 IM monthly Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month Oral cobalamin 1,000 mcg daily Question 11 4 / 4 points The reason that two MMR vaccines at least a month apart are recommended is: Question options: The second dose of MMR “boosts” the immunity built from the first dose. Two vaccines 1 month apart is the standard dosing for all live virus vaccines. If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR. Question 12 0 / 4 points Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: Question options: For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatmentWRONG For pedal edema throughout therapy Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm For vision changes, such as red-green blindness, at least annually Question 13 4 / 4 points Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because: Question options: It is a long-acting drug with potential for toxicity. Nitrate tolerance can develop. Orthostatic hypotension is a common adverse effect. It must be taken with milk or food. Question 14 4 / 4 points Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes: Question options: Monthly sputum cultures Monthly chest x-ray Bronchoscopy every 3 months All of the above Question 15 4 / 4 points 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? Question options: Delay eating the midday meal until after the swimming class. Increase the morning dose of NPH insulin on days of the swimming class. Adjust the morning insulin injection so that the peak occurs while swimming. Check glucose level before, during, and after swimming. Question 16 4 / 4 points First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be: Question options: OTC topical azole (clotrimazole, miconazole) Oral terbinafine Oral griseofulvin microsize Nystatin cream or ointment Question 17 4 / 4 points Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include: Question options: Amoxicillin Diphenhydramine Pseudoephedrine Nasal saline spray Question 18 4 / 4 points Conjunctivitis in a child that is accompanied by acute otitis media is treated with: Question options: Sulfacetamide 10% ophthalmic solution (Bleph-10) Bacitracin/polymyxin B (Polysporin) ophthalmic drops Ciprofloxacin (Ciloxan) ophthalmic drops High-dose oral amoxicillin Question 19 4 / 4 points The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be: Question options: Ciprofloxacin Azithromycin Amoxicillin Doxycycline Question 20 4 / 4 points Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? Question options: Use correct medical terminology because Spanish has a Latin base. Use a family member who speaks more English to act as an interpreter. Use a professional interpreter or a reliable staff member who can act as an interpreter. Use careful, detailed explanations. Question 21 4 / 4 points Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include: Question options: Diabetics Those who have had an acute myocardial infarction in the past 6 months Patients who are deaf Patients under age 60 years of age Question 22 4 / 4 points Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes: Question options: Throwing away eye makeup and purchasing new Redness and intense burning is normal with ophthalmic antibiotics When applying eye ointment, set the tip of the tube on the lower lid and squeeze in inch Use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac Question 23 4 / 4 points Clinical judgment in prescribing includes: Question options: Factoring in the cost to the patient of the medication prescribed Always prescribing the newest medication available for the disease process Handing out drug samples to poor patients Prescribing all generic medications to cut costs Question 24 4 / 4 points Goals when treating tuberculosis include: Question options: Completion of recommended therapy Negative purified protein derivative at the end of therapy Completely normal chest x-ray All of the above Question 25 4 / 4 points When determining drug treatment the NP prescriber should: Question options: Always use evidence-based guidelines Individualize the drug choice for the specific patient Rely on his or her experience when prescribing for complex patients Use the newest drug on the market for the condition being treated Question 26 4 / 4 points Which diuretic agents typically do not need potassium supplementation? Question options: The loop diuretics The thiazide diuretics The aldosterone inhibitors They all need supplementation Question 27 4 / 4 points Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: Question options: Urinary retention Cardiac output Peripheral edema Skin rash Question 28 4 / 4 points Which of the following holds true for the pharmacokinetics of women? Question options: Gastric emptying is faster than that of men. Organ blood flow is the same as that of men. Evidence is strong concerning renal differences in elimination. Medications that involve binding globulins are impacted by estrogen levels. Question 29 4 / 4 points Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: Question options: Topical antipruritics Oral corticosteroids for 2 to 3 weeks Thickly applied topical intermediate-dose corticosteroids Isolation of the patient to prevent spread of the dermatitis Question 30 4 / 4 points To improve actual effectiveness of oral contraceptives women should be educated regarding: Question options: Use of a back-up method if they have vomiting or diarrhea during a pill packet Doubling pills if they have diarrhea during the middle of a pill pack The fact that they will have a normal menstrual cycle if they miss two pills The fact that mid-cycle spotting is not normal and the provider should be contacted immediately Question 31 4 / 4 points Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? Question options: Juanita, a 28-year-old pregnant woman Sally, a 16-year-old healthy adolescent Jamie, a 24-year-old female Suzie, a 26-year-old diabetic Question 32 4 / 4 points A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: Question options: Concentration will produce therapeutic effects Concentration will produce an adverse response Time between doses must be shortened Duration of action of the drug is too long Question 33 4 / 4 points The action of “gliptins” is different from other antidiabetic agents because they: Question options: Have a low risk for hypoglycemia Are not associated with weight gain Close ATP-dependent potassium channels in the beta cell Act on the incretin system to indirectly increase insulin production Question 34 4 / 4 points The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: Question options: Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care. APRNs are less likely to prescribe narcotics and other controlled substances. APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice. Question 35 4 / 4 points Which of the following is a primary benefit of the use of computerized provider order entry for patient medications? Question options: Reduces time that prescribing drugs takes Eliminates the need to chart drugs prescribed Decreases prescribing and transcription errors Helps keep the number of drugs prescribed to a minimum Question 36 4 / 4 points Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be: Question options: 18 mg/day of iron supplementation 6 mg/kg per day of elemental iron 325 mg ferrous sulfate per day 325 mg ferrous sulfate tid Question 37 4 / 4 points Medications are typically started for angina patients when: Question options: The first permanent EKG changes occur The start of class I or II symptoms The events trigger a trip to the emergency department When troponin levels become altered Question 38 4 / 4 points When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as: Question options: Cost-minimization analysis Cost-of-illness analysis Cost-effectiveness analysis Cost-benefit analysis Question 39 4 / 4 points Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated? Question options: Tinnitus Diarrhea Hearing loss Photosensitivity Question 40 4 / 4 points Gender differences between men and women in pharmacokinetics include: Question options: More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations Slower organ blood flow rates so drugs tend to take longer to be excreted Question 41 4 / 4 points Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: Question options: Platelet count BUN and creatinine White blood cell count AST, ALT, alkaline phosphatase, and bilirubin Question 42 4 / 4 points The role of the NP in the use of herbal medication is to: Question options: Maintain competence in the prescribing of common herbal remedies Recommend common over-the-counter herbs to patients Educate patients and guide them to appropriate sources of care Encourage patients to not use herbal therapy due to the documented dangers Question 43 4 / 4 points The drug of choice for type 2 diabetics is metformin. Metformin: Question options: Decreases glycogenolysis by the liver Increases the release of insulin from beta cells Increases intestinal uptake of glucose Prevents weight gain associated with hyperglycemia Question 44 4 / 4 points The drug of choice for treatment of early latent or tertiary syphilis is: Question options: Ceftriaxone IM Benzathine penicillin G IM Oral azithromycin Oral ciprofloxacin Question 45 4 / 4 points If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be: Question options: IV or IM gentamicin IV or IM ceftriaxone IV amoxicillin IV ciprofloxacin Question 46 4 / 4 points Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to: Question options: Search for information using the most common search engines Serve as content experts in developing, implementing, and evaluating information Systems Write programs to assure the integrity of health information Use information technology to prescribe drugs Question 47 4 / 4 points ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy? Question options: Diuretics ARBs Beta blockers Nitrates Question 48 4 / 4 points Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? Question options: Add an H2 blocker such as ranitidine to his therapy. Discontinue the aspirin and switch him to Vicodin for the pain. Decrease the aspirin dose to one tablet daily. Have Henry take an antacid 15 minutes before taking the aspirin each day. Question 49 4 / 4 points Developmental variation in renal function has what impact on prescribing for infants and children? Question options: Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months. Higher doses of water soluble drugs may need to be prescribed because of increased renal excretion. Renal excretion rates have no impact on prescribing. Parents need to be instructed on whether drugs are renally excreted or not. Question 50 4 / 4 points True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include: Question options: Fever up to 104oF (40.5oC) after previous DTaP vaccine Family history of seizures after DTaP vaccine Adolescent pregnancy Anaphylactic reaction with a previous dose Question 51 4 / 4 points If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be: Question options: Prokinetic (metoclopramide) for 4 to 8 weeks Proton pump inhibitor (omeprazole) for 12 weeks Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks Cytoprotective drug (misoprostol) for 2 weeks Question 52 4 / 4 points Patients who are prescribed exogenous androgens need to be warned that decreased libido: Question options: Is an unusual side effect of androgens and should be reported to the provider Is treated with increased doses of androgens, so the patient should let the provider know if he is having problems May be a sign of early prostate cancer and he should make an appointment for a prostate screening exam May occur with androgen therapy Question 53 4 / 4 points Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? Question options: All opiates are scheduled drugs which require a DEA license to prescribe. Opiates stimulate only mu receptors for the control of pain. Most of the adverse effects of opiates are related to mu receptor stimulation. Naloxone is an antagonist to opiates. Question 54 4 / 4 points Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include: Question options: Metronidazole 2 grams PO x 1 dose Topical intravaginal metronidazole daily x 7 days Intravaginal clindamycin daily x 7 days Azithromycin 2 grams PO x 1 dose Question 55 4 / 4 points Drugs that have a significant first-pass effect: Question options: Must be given by the enteral (oral) route only Bypass the hepatic circulation Are rapidly metabolized by the liver and may have little if any desired action Are converted by the liver to more active and fat-soluble forms Question 56 4 / 4 points Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie? Question options: Increased volume of distribution Decreased lipid solubility Decreased plasma proteins Increased muscle-to-fat ratio Question 57 4 / 4 points A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response? Question options: Swelling of the tongue or hoarseness are the most common symptoms. It appears to be related to the decrease in aldosterone production. Presence of a dry, hacky cough indicates a high risk for this adverse response. Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week. Question 58 4 / 4 points The first-line therapy for mild-persistent asthma is: Question options: High-dose montelukast Theophylline Low-dose inhaled corticosteroids Long-acting beta-2-agonists Question 59 4 / 4 points IV forms of bisphosphonates are used for all the following except: Question options: Severe gastric irritation with oral forms Known cancer mets into the bone Persons with advancing renal dysfunction Progression of bone loss on oral formulations Question 60 4 / 4 points When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: Question options: Not to take their regularly prescribed medications while on these antibiotics Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption Not to take antacids while on these medications, as the antacid decreases absorption That there are no drug interactions with these antibiotics Question 61 4 / 4 points While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are: Question options: Hemoglobin 14 g/dl or hematocrit 39% Hemoglobin 11.5 g/dl or hematocrit 31% Hemoglobin 13 g/dl or hematocrit 38% Hemoglobin 17.5 g/dl or hematocrit 54% Question 62 4 / 4 points Instructions for the use of nicotine gum include: Question options: Chew the gum quickly to get a peak effect. The gum should be “parked” in the buccal space between chewing. Acidic drinks such as coffee help with the absorption of the nicotine. The highest abstinence rates occur if the patient chews the gum when he or she is having cravings. Question 63 4 / 4 points Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: Question options: Iron deficiency anemia, vitamin B12 and calcium deficiency Folate and magnesium deficiency Elevated uric acid levels leading to gout Hypokalemia and hypocalcemia Question 64 4 / 4 points Precautions that should be taken when prescribing controlled substances include: Question options: Faxing the prescription for a Schedule II drug directly to the pharmacy Using tamper-proof paper for all prescriptions written for controlled drugs Keeping any pre-signed prescription pads in a locked drawer in the clinic Using only numbers to indicate the amount of drug to be prescribed Question 65 4 / 4 points Which the following persons should not have a statin medication ordered? Question options: Someone with 3 first- or second-degree family members with history of muscle issues when started on statins Someone with high lipids, but low BMI Premenopausal woman with recent history of hysterectomy Prediabetic male with known metabolic syndrome Question 66 4 / 4 points Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? Question options: Betamethasone, an inhaled corticosteroid Salmeterol, an inhaled long-acting beta-agonist Albuterol, a short-acting beta-agonist Montelukast, a leukotriene modifier Question 67 4 / 4 points Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her? Question options: Switch her to sumatriptan (Imitrex) to treat her migraines. Assess how often she is using Fiorinal and refill her medication. Switch her to a beta blocker such as propranolol to prevent her migraine. Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines. Question 68 0 / 4 points Ginseng, which is taken to assist with memory, may potentiate: Question options: Aricept Insulin DigoxinWRONG Propranolol Question 69 4 / 4 points When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? Question options: Total LDL Fasting HDL Coronary artery disease risk level Fasting total cholesterol Question 70 4 / 4 points Patrick is a 10-year-old patient who 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: Question options: PEG 3350 (Miralax) Bisacodyl (Dulcolax) suppository Docusate (Colace) suppository Polyethylene glycol electrolyte solution Question 71 0 / 4 points Absolute contraindications that clinicians must consider when initiating estrogen therapy include: Question options: Undiagnosed dysfunctional uterine bleeding Deep vein or arterial thromboemboli within the prior year Endometriosis Both a. and b. All of the aboveWRONG Question 72 0 / 4 points 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: Question options: Immediate protection against pregnancy the first week of using the pillWRONG No back-up method is needed when starting Menses occur during the week They can start the pill on the Sunday after the office visit Question 73 4 / 4 points Nurse practitioner prescriptive authority is regulated by: Question options: The National Council of State Boards of Nursing The U.S. Drug Enforcement Administration The State Board of Nursing for each state The State Board of Pharmacy Question 74 4 / 4 points The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: Question options: Requires all providers to screen their patients for methamphetamine use Restricts the prescribing of amphetamines to U.S. citizens Requires a prescription be written for all methamphetamine precursors in all states Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales Question 75 0 / 4 points Patients who have a poor metabolism phenotype will have: Question options: Slowed metabolism of a prodrug into an active drug, leading to accumulation of Prodrug Accumulation of inactive metabolites of drugsWRONG A need for increased dosages of medications Increased elimination of an active drug Question 76 4 / 4 points A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to: Question options: Ensure the patient will not have increased adverse drug reactions to the tamoxifen Identify potential drug-drug interactions that may occur with tamoxifen Reduce the likelihood of therapeutic failure with tamoxifen treatment Identify poor metabolizers of tamoxifen Question 77 4 / 4 points Patient education for a patient who is prescribed antibiotics for sinusitis includes: Question options: Use of nasal saline washes Use of inhaled corticosteroids Avoiding the use of ibuprofen while ill Use of laxatives to treat constipation Question 78 4 / 4 points Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)? Question options: It has a shorter half-life and withdrawal syndrome has a faster onset without taper. It has the longest half-life and the withdrawal syndrome has a faster onset. It is quasi-addictive in the dopaminergic reward system. It is the most activating of SSRI medications and will cause the person to have sudden deep sadness. Question 79 4 / 4 points Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: Question options: Heart failure Angina Myocardial infarction Dyslipidemia Question 80 4 / 4 points Alterations in drug metabolism among Asians may lead to: Question options: Slower metabolism of antidepressants, requiring lower doses Faster metabolism of neuroleptics, requiring higher doses Altered metabolism of omeprazole, requiring higher doses Slower metabolism of alcohol, requiring higher doses Question 81 0 / 4 points Which of the following statements is true about acute pain? Question options: Somatic pain comes from body surfaces and is only sharp and well-localized. WRONG Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area. Question 82 4 / 4 points Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: Question options: Appetite and concentration improve in the first 1 to 2 weeks. Sleep should improve almost immediately upon starting citalopram. Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose. His dysphoric mood will improve in 1 to 2 weeks. Question 83 0 / 4 points Pharmacoeconomics is: Question options: The study of the part of the U.S. economy devoted to drug use The study of the impact of prescription drug costs on the overall economyWRONG The analysis of the costs and consequences of any health-care-related treatment or service The analysis of the clinical efficacy of the drug Question 84 4 / 4 points Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: Question options: Complete blood count Blood glucose C-reactive protein BUN, creatinine, and creatinine clearance Question 85 4 / 4 points The Best Pharmaceuticals for Children Act: Question options: Includes a pediatric exclusivity rule which extends the patent on drugs studied in children Establishes a committee that writes guidelines for pediatric prescribing Provides funding for new drug development aimed at children Encourages manufacturers specifically to develop pediatric formulations Question 86 4 / 4 points All of the following statements about the Beer’s List are true except: Question options: It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available. It is derived from the expert opinion of one geriatrician and is not evidence-based. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities. These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration. Question 87 4 / 4 points Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that: Question options: Has a short half-life so that missing one dose has limited effect Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea and dizziness Must be taken no more than twice a day Question 88 4 / 4 points According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: Question options: The belief among African Americans that prayer is more powerful than drugs Poor compliance on the part of the African American patient The genetic predisposition for illness found among African Americans Discrimination, cultural barriers, and lack of access to health care Question 89 4 / 4 points Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include: Question options: The maximum time varenicline can be used is 12 weeks. Nausea is a sign of varenicline toxicity and should be reported to the provider. The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date. Neuropsychiatric symptoms may occur. Question 90 4 / 4 points Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be: Question options: Sixteen ounces per day of cranberry juice cocktail will prevent UTIs. 100% cranberry juice or cranberry juice extract may decrease UTIs in some patients. There is no evidence that cranberry juice helps prevent UTIs. Cranberry juice only works to prevent UTIs in children. Question 91 4 / 4 points Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for: Question options: High vitamin D levels Hyperkalemia Hypercalcemia Hyperuricemia Question 92 0 / 4 points A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with: Question options: Methimazole Propylthiouracil (PTU)WRONG Radioactive iodine Nothing, treatment is best delayed until after her pregnancy ends Question 93 4 / 4 points An Investigational New Drug is filed with the U.S. Food and Drug Administration: Question options: When the manufacturer has completed phase III trials When a new drug is discovered Prior to animal testing of any new drug entity Prior to human testing of any new drug entity Question 94 4 / 4 points Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: Question options: Increasing heart rate to improve cardiac output Reducing vascular smooth muscle tone Increasing aldosterone-mediated volume activity Reducing aqueous humor production Question 95 4 / 4 points The most cost-effective treatment for two or three impetigo lesions on the face is: Question options: Mupirocin ointment Retapamulin (Altabax) ointment Topical clindamycin solution Oral amoxicillin/clavulanate (Augmentin) Question 96 4 / 4 points An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: Question options: Histamine2 receptor antagonists for 4 to 8 weeks Proton pump inhibitor bid for 12 weeks until healing is complete Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days Proton pump inhibitor bid and levofloxacin for 14 days Question 97 4 / 4 points A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women? Question options: Body temperature varies between men and women. Muscle mass is greater in women. Percentage of fat differs between genders. Proven subjective factors exist between the genders. Question 98 4 / 4 points Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be: Question options: Increase her dose Assess for suicidal ideation Discontinue the medication immediately Decrease her dose to half then slowly titrate up the dose Question 99 4 / 4 points The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: Question options: 2 years 5 years 10 years 15 years Question 100 4 / 4 points Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes: Question options: Use the inhaled corticosteroid first, followed by the inhaled beta-agonists. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid. Increase fluid intake to 3 liters per day. Avoid use of aspirin or ibuprofen while using inhaled medications. ________________________________________ Attempt Score: 364 / 400 - 91 % Overall Grade (highest attempt): 364 / 400 - 91 % Done [Show More]

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