MN553 final Exam Part 2 Completed for 2022/2023

MN553 final Exam Part 2 MN553-final-Part2 An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: Histamine2 receptor antagonists for 4 to 8 weeks Proton pump inhibitor bid for 12 ...

MN553 final Exam Part 2 MN553-final-Part2 An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: 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 While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are: 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% When determining drug treatment the NP prescriber should: 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 Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? 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 An Investigational New Drug is filed with the U.S. Food and Drug Administration: 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 When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: Not to take their regularly prescribed medications while on these antibioticsRegarding 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 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: 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. Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes: 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. 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? 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. Developmental variation in renal function has what impact on prescribing for infants and children? 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. Preventative therapy for cluster headaches includes: Massage or relaxation therapy Ergotamine nightly before bed Intranasal lidocaine four times a day during “clusters” of headaches Propranolol (Inderal) daily 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?Diuretics ARBs Beta blockers Nitrates To improve actual effectiveness of oral contraceptives women should be educated regarding: 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 Absolute contraindications that clinicians must consider when initiating estrogen therapy include: Undiagnosed dysfunctional uterine bleeding Deep vein or arterial thromboemboli within the prior year Endometriosis Both a. and b. All of the above Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include: 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 Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: Increasing heart rate to improve cardiac output Reducing vascular smooth muscle tone Increasing aldosterone-mediated volume activity Reducing aqueous humor production There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: 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.Drugs that have a significant first-pass effect: 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 Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? Betamethasone, an inhaled corticosteroid Salmeterol, an inhaled long-acting beta-agonist Albuterol, a short-acting beta-agonist Montelukast, a leukotriene modifier Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include: Amoxicillin Diphenhydramine Pseudoephedrine Nasal saline spray Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment 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 Which diuretic agents typically do not need potassium supplementation? The loop diuretics The thiazide diuretics The aldosterone inhibitors They all need supplementation The dosage of Vitamin B12 to initially treat pernicious anemia is: 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 dailyPharmacoeconomics is: 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 economy The analysis of the costs and consequences of any health-care-related treatment or service The analysis of the clinical efficacy of the drug 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)? 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. Alterations in drug metabolism among Asians may lead to: 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 Conjunctivitis in a child that is accompanied by acute otitis media is treated with: Sulfacetamide 10% ophthalmic solution (Bleph-10) Bacitracin/polymyxin B (Polysporin) ophthalmic drops Ciprofloxacin (Ciloxan) ophthalmic drops High-dose oral amoxicillin Medications are typically started for angina patients when: 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 A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response? 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.Class I recommendations for stage A heart failure include: 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 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: 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 Patient education for a patient who is prescribed antibiotics for sinusitis includes: Use of nasal saline washes Use of inhaled corticosteroids Avoiding the use of ibuprofen while ill Use of laxatives to treat constipation 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? 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. The drug of choice for type 2 diabetics is metformin. Metformin: Decreases glycogenolysis by the liver Increases the release of insulin from beta cells Increases intestinal uptake of glucose Prevents weight gain associated with hyperglycemia All of the following statements about the Beer’s List are true except: 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. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be: OTC topical azole (clotrimazole, miconazole) Oral terbinafine Oral griseofulvin microsize Nystatin cream or ointment The action of “gliptins” is different from other antidiabetic agents because they: 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 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? 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. 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? 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. 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: Urinary retention Cardiac output Peripheral edema Skin rashWhen 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: Immediate protection against pregnancy the first week of using the pill 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 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. 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. Ginseng, which is taken to assist with memory, may potentiate: Aricept Insulin Digoxin Propranolol 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: 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 Clinical judgment in prescribing includes: 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 The drug of choice for treatment of early latent or tertiary syphilis is: Ceftriaxone IM Benzathine penicillin G IM Oral azithromycinOral ciprofloxacin Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true? 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. Nurse practitioner prescriptive authority is regulated by: 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 Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for: High vitamin D levels Hyperkalemia Hypercalcemia Hyperuricemia IV forms of bisphosphonates are used for all the following except: Severe gastric irritation with oral forms Known cancer mets into the bone Persons with advancing renal dysfunction Progression of bone loss on oral formulations