NSG6005 Midterm questions and answers complete 100% solved solution University of Texas

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01) What is the first line and most effectiveness drug of a healthy patient with the following symptoms: severe runny nose, red watery eyes, pale and boggy turbinates: A. Cromolyn sodium (Nasalcrom)... nasal spray B. Saline Nasal Spray (Simply) C. Ipratropium bromide (Atrovent) Nasal Spray D. Oxymetazoline (Afrin) Nasal Spray E. Fluticasone Propionate(Flonase) Nasal Spray This pt has allergic rhinitis 02) What is the most likely diagnostic and treatment plan for Liz adolescent female patient: A. Bacterial Conjunctivitis and should be treated with antibiotic ocular drops B. Blepharitis and should be treated with warm compress and antibiotic ocular drops/ointment C. Allergic Conjunctivitis and should be treated with antihistamines D. Stye and should be treated with antibiotic 03) Cromolyn’s mechanism of action is as: A. An anti-immunoglobin E antibody B. A mast cell stabilizer C. A vasoconstrictor D. A leukotriene modifier Mast cell stabilizer prevent the release of histamine. 04) Which ones of the following conditions can be treated with an alpha-adrenergic antagonist? A. Functional Incontinence B. Renal Insufficiency C. Overflow incontinence D. Urge/Stress incontinence 05) Which alternative herbal is used by patients for the treatment for hot flashes related to menopause? Ginseng 06) Which of the following is the most appropriate antimicrobial for treatment of communityacquired pneumonia (CAP) in a 42-year-old man with no comorbidity, no reported drug allergy, and no recent antimicrobial use? A) Clarithromycin B. Levofloxacin C. Ceftriaxone D. Amoxicillin 07) Which ones of the following medications should you avoid? Please select all that apply? A. Sulfa contains drugs B. Azithromycin C. Aspirin D. Amoxicillin 08) You see a 70 year old women in a walk-in center with a chief complaint of increased urinary frequency and dysuria. Urinalysis reveals pyuria and positive nitrites. She mentions she has a “bit of kidney trouble, not too bad.” Recent evaluation of renal status is unavailable. In considering antimicrobial therapy for this patient, you prescribe: A. Doxycycline B. Ciprofloxacin C. Nitrofurantoin (Macrodantoin) D. Fosfomycin 09) An example of a first line therapeutic agent for treatment of pyelonephritis is: A. Trimethoprim-sulfamethoxazole/Ciprofloxacin B. Nitrofurantoin/Trimethoprim-sulfamethoxazole C. Clindamycin/Fosmomycin D. Amoxicillin with clavulanate/Macrolides 10) Megan, your adult female patient presents in the clinic with a dry, hacking, nonproductive cough that is interfering with her sleep. The family nurse practitioner would encourage the patient to purchase an OTC preparation that contains: A. Guaifenesin (expectorant) B. Pseudoephedrine (vasoconstrictor) C. Diphenhydramine (antihistamine/allergy) D. Dextromethorphan (cough suppressant) 11) Montelukast (Singular) may be prescribed for A. A two-year-old with moderate persistent asthma. B. A six-year-old with exercise-induced asthma C. None of the above. Montelukast is not approved for use in children D. An eighteen-month-old with seasonal allergic rhinitis 12) Lucy, an adult patient presents to the family nurse practitioner’s office with the following complaints for the past 10 days: fever and complaints of right facial pain, copious yellow nasal discharge, and acute pain and headache primarily when bending over. The physical exam is significant for maxillary sinus tenderness upon palpation. With allergy to PNC, the first line of treatment should be: A. Doxycycline (Vibramycin) B. Clindamycin (Dalacin) C. Azithromycin (Zithromax) D. Amoxicillin-clavulanate (Augmentin) * Pt has Acute Sinusitis and this is alternative treatment due to the PCN allergy. If allergy was not present answer would be D. Amoxicillin-clavulanate. 13) They are the drug of choice for dog bite: A. Amoxicillin B. Doxycycline C. Azithromycin D. Augmentin 14) A stepwise approach to the pharmacologic management of asthma: Begins with determining the severity of the asthma and assessing asthma control 15) Risk factors for pneumonia caused by Pseudomonas Aeruginosa include all of the following except: A. Community residence B. Chronic tracheostomy C. Mechanical ventilation D. Cystic Fibrosis 16) You instruct your patient to stop taking Aspirin before surgery because of the following? A. The life span of thrombocyte in 5 days B. Aspirin binds irreversibly with thrombocytes C. Aspirin binds reversibly with thrombocytes D. The half life of the thrombocytes is 7 days 17) When prescribing montelukast (Singular) for asthma, patients or parents of patients should be instructed as follows: A. Lethargy and hypersomnia may occur when taking montelukast B. Patients may experience weight gain on montelukast C. Montelukast twice a day is started when there is an asthma exacerbation D. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast 18) With Fluoroquinolone use, length of antimicrobial therapy during uncomplicated pyelonephritis is typically: A. 3 weeks B. 1 week C. 2 weeks D. 5 days 19) As a well-informed FNP, you are aware that to increase outflow in men with BPH you should prescribe the following class: A. A calcium channel blocker B. An alpha blocker C. An alpha agonist D. A Adrenergic agonist 20). What is the treatment plan for this patient? Picture of a lip showing herpes simplex I A. Prescribe Zanamivir (Relenza) B. Prescribe Valacyclovir (Valtrex) C. Prescribe Peramivir (Rapivab) D. Reassure the patient that no treatment is needed 21) DJ, your 80-year-old patient with COPD called your office complaining of urinary retention which medication produce is most likely to produce these effects: A. Ventolin (Albuterol) B. Flovent (Intra-Nasal Corticosteroid) C. Atrovent (Ipratropium bromide) D. Salmeterol (Serevent) 22) What is the most effectiveness with the least side effects treatment? Of a health patient with the following symptoms: severe runny nose, red watery eyes, pale and boggy turbinates: A. Oxymetazoline (Afrin) Nasal Spray B. Saline Nasal Spray (Simply) C. Cromolyn sodium (Nasalcrom) Nasal Spray D. Fluticasone Propionate (Flonase) Nasal Spray E. Ipratropium bromide (Atronvent) Nasal Spray 23) YoYo, an adult patient presents to the family nurse practitioner for evaluation of a “red”, right eye for 24 hours. The patients states that it started in both eyes with whitish discharge with light sensitivity. The patient denies trauma to the eye, eye pain, and changes in vision. During the exam, it is noted that the pupils are equal and reactive, there is mild conjunctival hyperemia bilaterally, and a significant amount of water discharge. The family nurse practitioner treats this patient with: A. Amoxicillin ophthalmic drops (Amoxicillin drops do not exist) B. Voltaren (Diclofenac) ophthalmic drops C. Polymyxin B ophthalmic drops D. Artificial tears drops like visine 24) Detrol LA (Tolterodine Tartrate) used to treat overactive bladder with symptoms of urinary frequency, urgency, and incontinence in females has the following mechanism of actions: Adrenergic receptor agonist. 25) As a well-informed FNP drug refill is considered as: Tertiary 26) Your patient on Warfarin should avoid the following medication? Erythromycin 27) Which of the following medications afford the best relief of acute nasal itch? Oral antihistamine 28) As an FNP you are well aware that Asians have high tolerance of pain medication: Due to high metabolism 29) According to the American Thoracic Society/ Infectious Diseases Society of America (ATS/IDSA) Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for the treatment of community-acquired pneumonia (CAP) for the following patient. Maria, a 78-year old woman with a history of COPD, hypertension, and dyslipidemia who is taking lovastatin and a dihydropyridine calcium channel blocker? Amoxicillin/Clavulanate (Treatment for CAP w/ patients with comorbidities= Respiratory Fluroquinolone or Beta lactam plus a macrolide.) 30) Drugs that use CYP3A4 is isoenzymes for metabolism may: Induce the metabolism of another drug Inhibit the metabolism of another drug 31) A reliable historian mother call the office and inform you that her child has the following: Cough times 10 days with low grade fever, moderate appetite, and fatigue. What is the next plan of action? Give in the first available appointment in the clinic in 3 days. 32) Herbs and supplements are tested for safety by the FDA. False 33) The family nurse practitioner has diagnosed an adult patient with community acquired pneumonia (CAP). In this healthy patient with no comorbidities, and no previous antibiotic use within the past 3 months, known allergy to macrolides therefore the family nurse practitioner should prescribe: Doxycycline 100 mg PO twice daily for 10 days. (If allergy to Macrolide and Doxy, then give them Fluoroquinolone) Beta Lactam with macrolide would be another alternative if pt doesn’t have allergy to Macrolide). Beta Lactam alone for adults is not given. For kids it is. 34) The family nurse practitioner is teaching a patient about the role of medications in the treatment of asthma. Which statement by the patient would require further teaching? “I do not need to use a spacer with my MDI” 35) According to the American Academy of Otolaryngology- Head and Neck Surgery (AAOHNS) treatment guidelines, which of the following medications gives the best relief of acute nasal congestion? Oral decongestant 36) A geriatric patient is diagnosed with chronic open-angle glaucoma. She has a past history of bradycardia and first-degree atrioventricular block. In consideration of her treatment, what medication is to be avoided? Timolol (Timoptic) (Topical beta blockers, such as timolol, lower intraocular pressure but can be absorbed systemically. The major side effects are similar to those associated with systemic beta-blocker therapy, which can include a worsening of heart failure, bradycardia, and heart block. Topical beta blockers are contraindicated in some patients with cardiac or pulmonary disease) 37) The most appropriate cost effective, short course of treatment course for a young healthy non pregnant woman is as follow: Bactrim 38) A black box warning is added to the long acting beta-2 agonists such as salmeterol can cause death, because: Delayed effect of the drug 39) Patients with asthma need to be instructed to: Take 1 to 2 puffs of b2-agonist as needed using MDI 40) 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: Has a tolerability profile with less of the adverse effects that are considered "irritating," such as nausea and dizziness. 41) Ambroise 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: Relaxes smooth muscle in the bladder neck (Answer can be rephrased as: Vasodilation of the peripheral) GTK: Flomax can increase the BP 42) Which of the following services is not covered by Medicare? Dental Procedure 43) During a first-time office visit, the family nurse practitioner sees Ana, an adult female with a history of asthma. She has been using her MDI inhaler 1 to 7 times per week. The family nurse practitioner diagnoses mild persistent asthma and starts her on “Step 2” therapy which includes: Fluticasone (Flovent) 44 mcg, two inhalation daily. (According to GINA, “Step 2” therapy should start with a low-dose-inhaled-corticosteroid (ICS). 44) The following patient must obtain a consent form from parents in order to be treated by you: A 15-year-old wanted to obtain IM contraception injection from your clinic. This is a procedure, therefore requires parent consent. 45) The most common pathogen found in UTI is as follow: E. Coli 46) A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is: A cytotoxic hypersensitivity reaction (In immune system disorder: Type II hypersensitivity. Allergic reactions of this type, also known as cytotoxic reactions, occur when cells within the body are destroyed by antibodies, with or without activation of the entire complement system) 47) Picture of a patient with Shingles to the Left side of the abdominal area asking, what is the next step in treatment for this patient? None of the above (Shingles is a unilateral rash, not connected or bilateral) 48) Patients with allergic rhinitis may benefit from a prescription of: A. Fluticasone (Flonase) - corticosteroid B. cetirizine (Zyrtec) -antihistamine C. OTC cromolyn nasal spray (Nasalcrom) – corticosteroid D. Any of the above 49) Infants and young children are higher risk of ADRs due to: Lack of safety and efficacy studies in the pediatric population. 50) Asthma exacerbations at home are managed by the patient by: Increasing frequency of beta-2-agonists and contacting their provider 51) The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5- year-old child is: Fluids and symptomatic care 52) Which of the following organisms is most likely to cause acute otitis media? Streptococcus pneumoniae. 53) Liz, An adult patient presents to the family nurse practitioner for evaluation of a "red", right eye for 24 hours. The patient states that when she awoke, the eye was matted shut, the patient denies trauma to the eye, eye pain, and any changes in vision. During the exam, it is noted that the pupils are equal and reactive, there is mild conjunctival hyperemia bilaterally, and significant amount of yellowish discharge. The family nurse practitioner treats this patient with: Polymyxin B ophthalmic drops (this is a bacterial infection, requiring antibiotic) 54) Which ones of the following drug is appropriate to relieve bronchospasm? Levalbuteol (Xopenex HFA) (used a lot in kids because it lessens the jitterness. It’s also expensive) 55) Step 3 Asthma for a 23 year old is treated as follow: Medium-dose ICS 56) Patients with a COPD exacerbation may require. Systemic corticosteroid burst 57) While seeing a 62-year old who is hospitalized with CAP, the NP considers that: Influenza and antipneumococcal vaccines should be given today. 58) After a week of treatment of Augmentin for sinusitis, Brenda comes back to your office and you find the following. (Pic of pt with Left swollen eye) What is the next step in the treatment process? Send to ER for IV antibioic 59) Noisy Fils, your patient who is a sheet metal worker, reports an eye injury while at work. Her right eye that began shortly after working this morning. In order to evaluate her eye for a potential abrasion you would most likely be able to: Examine the eye using fluorescein 60) An adult patient presents to the family nurse practitioner’s office with the following complaints for the past 10 days: fever and complaints of right facial pain, copious yellow nasal discharge, and acute pain and headache primarily when bending over. The physical exam is significant of right maxillary sinus tenderness upon palpation. With NKA, the first line of treatment should be: Amoxicillin- clavulanate (Augmentin). 61) The first-line therapy for mild-persistent asthma is: Low-dose inhaled corticosteroids 62) The most common pathogen found in CAP (community acquired pneumonia is as follow? Streptococcus pneumoniae 63) Which ones of the following patients Iron replacement therapy would be appropriate? Microcytic-hypochromic anemia 64) Step 4 Asthma for a 13 year old is treated as follow: Medium-dose ICS + Either LABA or Montelukast 65) Tiotropium bromide (Spiriva) is an inhaled anticholinergic: Used for the treatment of COPD 66) Decongestants such as pseudoephedrine (Sudafed): Should not be prescribed or recommended for children under 4 years of age 67) The family nurse practitioner has diagnosed an adult patient with community acquired pneumonia (CAP). In this healthy patient with no comorbidities, and no previous antibiotic use within the past 3 months, the family nurse practitioner should prescribe: Azithromycin (Zithromax) 500 mg PO once a day and then 250mg daily for 4 days. 68) The best appropriate course of treatment for a UTI for a pregnant woman in her third trimester would be the following? Macrobid (Nitrofurantoin) 69) Your asthmatic patient is experiencing acute exacerbation with wheezing. Which of the following medication should be given to relieve the symptoms? SABA (Short-acting bronchodilator) (same answer = Beta receptor agonist or Beta Adrenergic agonist) 70) Prior to developing a plan for the treatment of asthma, the patient’s asthma should be classified according to the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel 3 guidelines. In adults, mild persistent asthma is classified as asthma symptoms that occur: More than twice a week and less than once a day. 71) As a well-informed FNP you are aware that the first line of drug for bronchospasm is as follow: Ventolin (Albuterol) 72) Education of patients with COPD who use inhaled corticosteroids includes the following: Rinsing their mouth after use 73 A patient with a COPD might experience blurred vision due to the fact this following class of drug has anticholinergic property: Diphenhydramine (Benadryl) Claritin is less drowsy than Benadryl. Zyrtec is in the middle between Benadryl and Claritin. 74) A stepwise approach to the pharmacologic management of asthma: Begins with determining the severity of the asthma and assessing asthma control 75) Common OTC pain relievers such as acetaminophen or ibuprofen: Maintain competence in the prescribing of common herbal remedies DC 76. Which of the following is the most appropriate antimicrobial for treatment of communityacquired pneumonia (CAP) in Jessica, a 46-year-old healthy woman with a history of a bilateral tuba ligation who has a known type I allergic reaction to macrolide? Doxycycline 77. What is the best course of action for your patient with acute pharyngitis? Supportive Care (Acute Pharyngitis is viral so abx is not required because it’s not a bacterial infection) 78) Monitoring a patient with a persistent asthma includes: Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy 79) Decongestants such as pseudoephedrine (Sudafed): Should not be prescribed or recommended for children under four years of age 80) Long-acting beta agonists (LTBAs) received a Black Box warning from the U.S. Food and Drug Administration d/t the: Increased risk of asthma-related deaths when LTBAs are used 81) The FNP has selected nitrofurantoin (Macrodantin) for treatment of chronic UTI in a female geriatric patient. which parameter should the nurse evaluate prior to administration of this medication Creatinine clearance (>50 ml/min) 82) Your patient on Medicare is inquiring about her benefits for another state as she plans to travel. What is the most appropriate answer? The same Medicare is funded by the Federal. Medicaid is funded by the State therefore benefits change) 83) HCA eligibility is as follow: Children even married until 26 years are eligible 84) According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for treatment of communityacquired pneumonia (CAP): A 47-year-old woman who was recently treated within the past two months with a beta-lactam for acute bacterial sinusitis? Moxifloxacin Moxifloxacin is a Fluoroquinolone Clarithromycin would be first choice if pt hadn’t taken an antibiotic in the past 2 months. 85) Genetic polymorphisms account for differences in metabolism, Including: 1. Poor metabolizers, who lack a working enzyme 2. Intermediate metabolizers, who have one working, wild-type allele and one mutant allele 3. Extensive metabolizers, with two normally functioning alleles 4. All of the above 86) Your patient accidentally overloaded himself with Iron, due to overuse of OTC Iron. Please select all that apply: A. Desferal (Deferoxamine) causes low blood pressure B. Patient needs Iron-chelating drugs C. Desferal (Deferoxamine) may be used to reduce iron binding to the heme D. Hearing loss is not part of the side effects of Desferal (Deferoxamine) 87) According to the ATS/IDSA guidelines, what is the usual length of antimicrobial therapy for the treatment of CAP for outpatients? 5 to 7 days 88) They are the drugs of choice for prophylaxis and treatment for Pertussis? Macrolides 89) Your adult patient is seen in the clinic complaining of increased difficulty breathing and an intermittent productive cough that worsens in the evening. The history reveals that the patient has a 20-pack-year-history of smoking. Mild wheezing breath sounds to auscultation, there is no evidence of fever, and chest radiography is within normal limits. The FNP instructs the patient concerning the importance of smoking cessation and fluid therapy and prescribes: Albuterol 180 mcg (2 puffs) inhaled q 4-6hr prn. 90) Albuterol (Proventil, Proventil HFA and Ventolin HFA), Levalbuterol (Xopenex, Xopenex HFA), and pirbuterol (Maxair) can all be used as rescue inhalers because their onset of action is? Rapid onset (aka short acting) 91) In patients with infectious mononucleosis, which medication should be avoided because of a risk of rash development which one of the following drug classes? PNC (Mono does not require antibiotic because it is a viral infection. However, some pts can have Strep AND mono requiring antibiotic. However, you should ALWAYS avoid PCN and its family if you suspect Mono. PCN can cause a rash called morbilliform that can kill the patient if they have Mono. Always ask pt about GI issues to help with differential diagnosis and spotting Mono. Usually provider will prescribe a Macrolide) 92) Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they: Are less sedating than first-generation antihistamines 93) Treatment of viral conjunctivitis include the use of: Cold Compresses 94) As you are reviewing your patient chart, Paulette a 35-year-old with Asthma and headache migraines as part of her medical history. You realize she is taking the following: Albuterol (Ventolin HFA) Propranolol (Inderal) What is the most appropriate course of action? Stop the propranolol knowing that it will cancel out the Albuterol  Otitis Media: First Line Treatment=Oral antibiotic  Otitis Externa: First Line Treatment= Drops such as Cortisporin Drops Quiz 3: HTN 1) During her first pregnancy visit, Jessica your pregnant woman disclose with you that she is taking a statin drug. What is the next appropriate next step? Stop the medication ASAP and do a sonogram to check of the fetus. (Statin drug is a category X drug) 2) Your patient of African American origin with hypertension should be treated as first choice based on the JNC 8 Guidelines: Initiate Thiazides or CCB alone or combo 3) A 45 years-old patient with total cholesterol of 270mg/dl non fasting. What is the next step in managing this patient? Order a fasting Lipid panel (Can be 8-12 hrs. of fasting) 4) A 45-year-old African-American male patient with essential hypertension is treated by the family nurse practitioner with sodium restriction and hydrochlorothiazide (Diuril) 25mg PO daily. After 3 months of therapy, the patient’s blood pressure is measured at 160/110 mm Hg. At this point, the family nurse practitioner would: Add 5mg of amlodipine (Norvasc) daily. (The best add on is a CCB) 5) A patient with a history of high cholesterol and high blood pressure who is being treated with Erythromycin for pneumonia called the office and complains about muscle cramping. The logical explanation is that: Macrolides are CYP450 inhibitors causing the statins drug to rise at a toxic level. 6) Crystal, as a well-informed NP, you are well aware that the drug class can potentially produce hypotension, bradycardia and worsening HF is which one of the following class of drugs? Beta adrenergic blockers 7) The main difference between Cycloexegenase-1 (COX-1) and Cyclooxegenase-2 (COX2) is their contribution: Of the maintenance of gastric protective mucosal layer COX-1 COX-2 Protects: Does not protect: 1)GI 1)GI 2)Kidney 2)Kidney 3)Liver 3)Liver 4)Uterus 4)Uterus Blood Clots Blood Thinner 8) All diabetic patients with hyperlipidemia should be treated with: 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors 9) Deena has the following fasting labs results: 1-Total cholesterol: 250 2- Triglyceride:510 3- HDL: 40 4- LDL:150 What is the next plan of action? Lipitor (atorvastatin) (Our main concern here is treating the LDL. Atorvastatin and Rovastatin are the two aggressive statins. Don’t let the high triglyceride level distract you. ) 10) The use of which of the following medications is associated with the least risk of postural hypotension in the older adult? Lisinopril (ACE protects the kidneys as well therefore also beneficial for older adults) 11) Which of the following anti-hypertensive medication causes galactorrhea? Potassium Sparing diuretics, Spironolactone(aldactone) (Spironolactone is also useful for the skin and to treat acne. 12) Erika, your patient with a history of unstable angina is seen in the cardiac clinic for a checkup. The assessment reveals increased weight of 10 lb, distended jugular neck veins, and an S3. What changes in the pharmacologic treatment should be initiated? Discontinue B-blockers and calcium channel blockers. (Remember S3 is a problem of volume. You don’t want the pt to end up with Bradycardia) 13) Your Caucasian patient who is been diagnosed with Osteoporosis is also hypertensive. What is the best diuretic for her? Thiazides (This is the least likely to cause a loss of calcium) 14) When compared with Caucasians, African Americans tend to have a reduced effect with monotherapy with all of the following blood pressure medications except: Calcium channel blockers 15) What is a serious side effect of ibuprofen in the older adult patient? Impairment of Renal Function 16) The family nurse practitioner initiates antihypertensive therapy for a patient. One week later, the patient returns for a follow-up visit and complains of being experiencing fatigue since initiating the medications. This is most likely a side effect of: Beta Blocker 17) What is the best of drugs for your 45-year-old patient complaining of dysuria, pelvic pain and burning with urination? TMP-SMZ Trimethoprim-Sulfamethoxazole times 10-14 days 18) Rock 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: Relaxes smooth muscles in the bladder neck 19)Juanita, your patient has been prescribed lisinopril (Prinivil) 5mg PO qd for hypertension. She has developed an intractable cough that is unrelated to heart failure. Which of the following medications can be substituted for this medication? Angiotensin II receptor blocker (ARB) 20) Common side effect with Niacin is to cause which side effect: High Blood Glucose (Hyperglycemia and flushing are the two most common SE of Niacin) 21) You examine Nikola you 78-year-old female patient with longstanding, poorly controlled hypertension. When evaluating her for hypertensive target organ damage, you look for evidence of: Left ventricular hypertrophy 22) Erectile dysfunction (ED) medications warn about mixing them with nitrates. Why? Profound Hypotension 23) Which drug is most likely to increase lipoprotein levels? Spironolactone 24) Marilynn, your pregnant woman with high cholesterol needs to be medicated for her high cholesterol. Which one of the following medications would you prescribe? Bile Acid Sequestrants 25) Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? White 26) The family nurse practitioner initiates antihypertensive therapy for a middle-aged nonsmoking male. One week later, the patient returns for a follow-up visit and complains of a recurrent dry cough since initiating the medications. This is most likely a side effect of: Ace Inhibitor 27) Your hypertensive male patient is complaining of BPH. What is the best choice for him? Doxazosin (Cardura) 28) One of your patients, Marie has a dual diagnosis of Gout and Hypertension. The medication of choice to manage her blood pressure is: Losartan 29) Ericka, your patient with liver failure has to be a cholesterol lowering drug. Which ones of the following is safe? Colesevelam (Welchol) (Welchol bypasses the liver) 30) Magalie is a 54-year old patient with type 2 diabetes has been diagnosed with hypertension. Which anti-hypertensive drug is the recommended choice to treat hypertension in patients with diabetes? ACE Inhibitors 31) All NSAIDs have this following this following FDA black box warning: Potential for causing life threatening GI bleeds 32) The family nurse practitioner is evaluating a patient in the office who is complaining of chest pain. The patient’s BP is 86/52mm Hg and ECG results show some signs of ischemia. The patient is to be transferred to the emergency department. What drug might the family nurse practitioner give the patient while awaiting transfer? Aspirin 81mg PO (Aspirin prescribed for blood clots is not very effective but during chest pain, still critical) 33) When prescribing antihypertensive drug therapy for older adult patients, the family nurse practitioner recognizes that which class of antihypertensive agents should be avoided in the older adult? Beta Blocker (Avoid in older adults because it causes fatigue and Bradycardia) 34) The family nurse practitioner initiates antihypertensive therapy for a nonsmoking female. One week later, the patient returns for a follow-up visit and complains of edema in bilateral hands since initiating the medications. This is most likely a side effect of: Calcium Channel Blocker 35) Non-dihydropyridine calcium channel blocker is contraindicated in patients with: Severe Left Ventricular dysfunction 36)Jessica, a geriatric patient is diagnosed with chronic open-angle glaucoma. She has a past history of first-degree atrioventricular block. In consideration of the treatment what medication is to be avoided? Timolol 37) An older adult white male with a long history of COPD has recently developed hypertension. Which class of antihypertensive agents should the family nurse practitioner avoid for this patient? B-Blocker 38) As you examine Marlene your 38-year old female patient who has presented for an initial examination and Papanicolaou test. She has no complaints. Her blood pressure (BP) is 154/98 mm Hg bilaterally and her body mass index (BMI) is 31kg/m2. The rest of her physical examination is unremarkable. Your next best action is to: Arrange for at least two additional BP measurements during the next 2 weeks 39)Juanita, your patient presents to day to the office for the following labs: Total Cholesterol: 225, HDL 40, LDL 150 TRG: 500. The next step is to prescribe: Fibrates (Fibrates is the first line for treating Triglycerides) 40) Michelle, your patient has been prescribed lisinopril (Prinivil) 5mg PO qd for hypertension. She has developed an intractable cough that is unrelated to heart failure. Which of the following medication can be substituted for this medication? Angiotensin II receptor blocker (ARB) 41) You see a 68-year old who is transferring care into your practice. She has a 10-year history of hypertension, diabetes mellitus, and hyperlipidemia. Current medications include hydrochlorothiazide (HCTZ), glipizide, metformin, simvastatin, and daily lowdose aspirin. Todays BP reading is 158/92 mm Hg, and rest of her history and examination are unremarkable. Documentation from her former healthcare provider indicates that her BP has been in range for the past 12 months. Your next best action is to: Prescribe an angiotensin-converting enzyme inhibitor (ACEI) 42) According to JNC-8 guidelines, all of the following medication are the first line agents for use in a middle –aged white man without diabetes mellitus except: Metoprolol 43) As you are reviewing Marie’s medication list, your patient with Metabolic Syndrome which medication would you removed as its not recommended: Beta Blockers (BBs have nothing to do with Metabolic Syndrome) 44) What is the best of drugs for your 30-old male patient complaining of dysuria, pelvic pain and burning with urination? Cephalosporin with Macrolide (Treatment for Chlamydia and Gonorrhea. When a male complains of symptoms of UTI think-STI/STD) 45) Carolyn, you start your patient with hypertension who is already receiving an ACEI on spironolactone. You advise the patient to return in 4 weeks to check which of the following laboratory parameters? Potassium 46) The use of NSAIDs during pregnancy can potentially increase the risk for: Premature closure of ductus art 47) Angiotensin-converting enzyme (ACE) inhibitors are recommended for slowing the progression of chronic renal disease, but are contraindicated in the following disorder: Renal Artery stenosis 48) Esther is a 54-year old patient with type 2 diabetes has been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes? ACE Inhibitor 49) Furosemide is added to a treatment for heart failure that includes digoxin. Monitoring for this combination includes: Serum Potassium 50) As a well known FNP you are aware that 5-alpha reductase inhibitors drug is use in men base on the following mechanisms of action? Reduce the prostate size (Ex: Finasteride is a 5-alpha reductase inhibitor. This medication was discovered for hair growth and later used off-label for the prostrate. Now it is used primarily for the prostate.) 51) Use of a beta-blocker during pregnancy can cause all of the following except: Eclampsia CARDIO-VASCULAR/STD’s 1) Which of the drugs used in thyroid disorders can lead to leukopenia? A. Atenolol B. Levothyroxine C. Propranolol D. Propylthiouracil (PTU) 2) Reportable STD’s are the following with the exception of: A. Chlamydia B. Trichomoniasis C. Syphilis D. Gonorrhea 3) Which of the following type of Insulin is least likely to produce hypoglycemia in DM patients? A. Long Acting B. Regular C. NPH D. Immediate Acting 4) The blood exam came back for your diabetic patient as follows: Hb A1C of 12.5 and you decide to add which of the following drug? A. Aspart B. Glulisin C. Lantus D. Humalog 5) KiKi, presented to the clinic with the following signs and symptoms. Feeling itchy or tingly around the genitals, followed by painful, small blisters that pop and leave sores that ooze or bleed. Patient reports that is the first time she experiencing the current symptoms. She also complains of fever, headache, or other flu-like symptoms. What is the appropriate treatment: A. Tenofovir (TDF) B. Famciclovir (Famvir) C. Zanamivir (Relenza) D. Peramivir (Rapivab) 6) Your patient, Marie is asking you how many days after can she return to sexual activities after being diagnosed with Chlamydia? A. She should abstain from sexual activity for 2 weeks days after single dose antibiotics or until completion of a 7-day course of antibiotics B. There are no clear guidelines regarding treatment completion and sexual activities C. She should abstain from sexual activity for 1 month after single dose antibiotics or until completion of a 7-day course of antibiotics D. She should abstain from sexual activity for 7 days after a single -dose antibiotics or until completion of a 7-day course of antibiotics 7) Nonselective beta blockers and alcohol create serious drug interactions with insulin because they: A. Mask the signs and symptoms of altered glucose level. B. Produce unexplained diaphoresis C. Increase Blood glucose levels D. Interfere with the ability of the body to metabolize glucose 8) Pleas Match the following: T-Score – 1 1. Osteoporosis -4 T-Score – 4 2. Normal bone Density +2 WBCs 150,000 3. Osteopenia -1 T-Score +2 4. Osteomyelitis WBC 150,000 9) The photo of the Woman’s Genitals. What is the next step in your treatment plan? A. Prescribe Penicillin B. Prescribe Azithromycin C. Prescribe Metronidazole D. Prescribe Fluconazole 10) Hyperthyroidism may affect the blood pressure: A. When the heart rate is increased B. By producing a decrease in diastolic blood pressure C. With unpredictable results D. By producing an increase in systolic and diastolic readings 11) Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patient should be taught to report: Fever and Sore Throat 12) The guidelines are against of using the selective estrogen-receptor modulator drugs for the sole purpose of osteoporosis because of: Their potential of causing endometrial cancer 13) Biphosphonates treat or prevent osteoporosis by: Inhibiting Osteoclastic activity. 14) A patient has been diagnosed with Grave’s disease. He is likely to have: An elevated T3 or T4 15) As you are seeing your Osteoporosis patient who is improving on the current treatment after about 1 year of the initial diagnosis. What is the best course of action? Please select all that apply: A. Her T- score to be increased to -2 B. Continue with Bisphosphonate 16) The Lab for your patient with hypothyroidism came back with as follows: TSH: 3.5(mIU/L). You interpret it as: Euthyroidism 17) Warts are caused by: Human Papillomavirus (HPV) 18) Which ones of the following statement is true regarding HPV. Please select all that apply: A. There are treatments available for the symptoms it can cause B. There is no treatment for HPV infection in men when no symptoms are present. 19) Dr D, your female patient presents with recurrent vulvovaginal candidiasis she may be treated with: Fluconazole 150mg PO daily x 7 doses then monthly for 6 months. 20) A 50 year old housewife complains of progressive weight gain of 20 pounds in 1year, fatigue, loss of memory, deepening of her voice, dry skin, constipation, and cold intolerance. She has been placed on Levothyroxine for about 2 weeks, today she calls and reports that the symptoms are not getting any better. what would be the next step on your management? Explain to the patient that the medication takes 4 to 6 weeks to observe meaningful changes 21) Long term use of levothyroxine sodium replacement is been associated with the following: Osteoporosis 22) Gesie, presents with a complaint of vaginal discharge that when tested meets the criteria for chlamydia. She has known allergy to Macrolides. Her treatment plan would be as follow: Doxycycline 23) The first line drug of treatment for your DM II patient is : Glucophages. 24) Which one of the following side effects is associated with the usage of Thiazolidinediones? Fluid retention 25) For the treatment with insulin for type I DM, the NP should: Start with a total daily dose of 0.2 to 0.4 units per kg of body weight. 26) What is the first line of treatment for osteoporosis? Bisphosphonates 27) Insulin is used to treat both types of diabetes. It acts by: Increasing peripheral glucose update by skeletal muscle or fat. 28) Please match the following: Podophyllin Condylomata Accumination Cryosurgery Molluscum contagiosum PNC-G Condylomata lata 29) Prior to prescribing metformin, the provider should: Draw a serum creatinine to assess renal function. 30) Undiagnosed diabetes may present as: Recurrent vaginal candidiasis 31) A patient newly diagnosed with hyperthyroidism. What would be the first line drug therapy in the treatment? Methimazole 32) Which one of the following smoking cessation drug cannot be combined with any of the NRT drugs (Nicotine Replacement Therapy)? Varenicline (Chantix) 33) Patients who are started on Levothyroxine for thyroid replacement should be monitored for: Tachycardia and angina 34) Which one of the following drug can be used with any other diabetes mellitus drug classes, because it is not known clinically to cause hypoglycemia? Metformin (Glucophage) 35) Yaya, your female patient presents with genital warts present on her labia. Patient-applied topical therapy for warts includes: A. Trichloroacetic acid B. Podophyllin 10% resin C. Podofilox 0.5% gel D. Any of the above 36) As a well informed FNP you know that a test-of-cure for Chlamydia, is performed three to four weeks after treatment Three to four weeks after treatment 37) Which one of the following statements needs correction from your patient with osteoporosis? I swim almost every day. 38) A patient has 2 non-fasting glucose values of 101 mg/dL and 114 mg/dL that were measured on 2 separate days in the same week. This patient: Has normal blood glucose values. 39) How should levothyroxine be taken? Early in the morning on an empty stomach. 40) 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? Glusine 41) After receiving a Darkfield microscopy and serologic testing positive for your patient. You’ve decided to initiate the following treatment: Penicillin G 42) Which of the following populations is at highest risk of low calcium intake? Native Americans 43) Gonorrhea can lead to the following: Severe joint pain in men. 44) Treating Cat your patient suspected with gonorrhea in a non-pregnant patient, she should be concurrently with: Doxycycline 100mg PO bid x 7 days. 45) Ongoing monitoring is essential for your patient Juanita, after treating for gonorrhea. The patient should be rescreened for gonorrhea and chlamydia in: 3 to 6 months 46) The following drug class although is the most widely used for diabetes miletus but is no longer the first class of choice: Sulfonylureas 47) Which one of the following statements indicates a need for further patient teaching? I take my iron pill with a glass of milk, so it won’t upset my stomach. 48) Gesie has been diagnosed with scabies. Her education would include: All members of the household and close personal contacts should be treated. 49) The most appropriate time to begin screening for renal nephropathy in a patient with Type 2 diabetes is: at the time of diagnosis 50) Which of the following is a risk for Osteoporosis? Asian descent women 51) Which of the following drugs are the only ones approved by FDA for smoking cessation and do not contain nicotine? Please select all that apply. A. Chantix (varenicline tartrate) B. Zyban (bupropion hydrochloride) 52) A 30 year-old female patient who complains of fatigue has a screening TSH performed. Her TSH value is 8 mU/L. What should be done next? 53) Yaya, presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be: Metronidazole 500mg PO bid x 7 days 54) Cat, your patient presented with the following signs and symptoms vaginal pus-like yellow discharge; frequent and painful urination; spotting between periods or after sex with rectal pain. Azithromycin. 55) Please arrange in order regarding Smoking Cessation approach for the patient: Nicotine Replacement Therapy (NRT) 2 Chantix (varenicline) 3 12 Steps Smoking Cessation Meetings 1 Bupropion (Wellbutrin) 4 56) Please match the Hemaglobin HbA1c: Reduce the Metformin 4.5 Start patient on Insulin 9.9 Increase the dose of current meds/add another oral hypoglycemic drug. 8.5 Patient is at goal-Maintain same treatment. 6.5 57) A 35 year old nurse complained of nervouseness, weakness, and palpitations with exertion for the past 6 months. Recently, she noticed excessive sweating and wanted to sleep with fewer blankets than her husband. She had maintained a normal weight of 120 pounds but was eating twice as much as she did 1 year ago. Menstrual periods have been regular but there was less bleeding. What are the medications you would prescribe her? Please select all that apply. A. Propanolol (Inderal) B. Methimazole (Tapazole) 58) Please Match the following: Haemophilus ducreyi Painful tender soft chancre (groin) Granuloma inguinale Painful nodule with itching. Ulcers on penis or labia Primary syphilis Hard chancre, eroded, painless, firm, and indurated ulcer (groin) Bacterial vaginosis Presence of “clue” cells on wet mount 59) Yoyo, your female patient just diagnosed with Syphilis reports anaphylactic reaction to Amoxicillin. What is the best course of action: Give Tetracycline 60) Which smoking medication can you take and still be smoking? Chantix and Wellbutrin 61) Physiologically when the serum free T4 concentration falls: The TSH rises 62) As your female presented to the office with fishy-like vaginal discharge. Patient has known allergy to Metronidazole. You have decided to treat her with the following: Clindamycin cream 2% applicator intravaginally once a day/7days. 63) Insulin is used to treat both types of diabetes. It acts by: Increasing peripheral glucose uptake by skeletal muscle and fat. 64) Your hypertensive diabetic patient who is taking ketonazole for a fungal infection is complaining of more than usual signs and symptoms of hypoglycemia. Patient is taking repaglinde (prandin), nifedipine (Procardia) As an NP you suspect that: Ketonazole is well known to inhibit the metabolism of the oral glycemic drug and causing the hypoglycemia. 65) Your patient with a BMI of 37 has the following current medical history: morbidly obese, BP: 140/90 and fasting glucose: 127. He/she is mostly at risk for the following: Insulin Resistance (Metabolic Syndrome) 66) GLP-1 agonists mechanism: Directly bind to receptor in the pancreatic beta cell. DC 67) A normotensive patient with DM type 1, which one of the following medications to order: Lisinopril 68) In order to determine how much T4 replacement a patient needs to re-establish a euthyroid state, the nurse practitioner considers: The patient’s body weight 69) The proper treatment for Popp a non-pregnant female patient diagnosed with chlamydia is as follow: Levofloxacin 500 mg orally once daily for 7 days. 70) A patient has been prescribed pioglitazone. The nurse practitioner must remember to: Order liver function studies in about 2-3 months. 71) Kiki, you patient presents to the clinic for suspected gonorrhea is Ceftriazone 250mg IM x 1 72) Patient has a history of long-term use of the Synthroid medication: what information would you teach him/her: Risk of osteoporosis 73) The blood exam came back for your diabetic patient as follows: Hb A1C of 9.5 and you decide to add which of the following drug? Lantus? (Question is similar to number 4) Quiz 6: 1. Education about Syphilis should include the following: It is mostly highly contagious: In Stage 1 2. The main difference between Cycloexegenase-1 (COX-1) and Cyclooxegenase-2 (COX2) is their contribution: Of the maintenance of gastric protective mucosal layer 3. Ericka, your patient with liver failure has to be a cholesterol lowering drug. Which ones of the following is safe? Colesevelam (Welchol) (Welchol bypasses the liver) 4. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? White 5. Magalie is a 54-year old patient with type 2 diabetes has been diagnosed with hypertension. Which anti-hypertensive drug is the recommended choice to treat hypertension in patients with diabetes? ACE Inhibitors 6. Hyperthyroidism may affect the blood pressure: E. When the heart rate is increased F. By producing a decrease in diastolic blood pressure G. With unpredictable results H. By producing an increase in systolic and diastolic readings 7. Juanita, your patient has been prescribed lisinopril (Prinivil) 5mg PO qd for hypertension. She has developed an intractable cough that is unrelated to heart failure. Which of the following medications can be substituted for this medication? Angiotensin II receptor blocker (ARB) 8. During her first pregnancy visit, Jessica your pregnant woman disclose with you that she is taking a statin drug. What is the next appropriate next step? Stop the medication ASAP and do a sonogram to check of the fetus. (Statin drug is a category X drug) 9. All NSAIDs have this following this following FDA black box warning: Potential for causing life threatening GI bleeds 10. Your patient just diagnosed with Syphilis reports anaphylactic reaction to Amoxicillin. What is the best course of action: Give Tetracycline 11. Patient has a history of long-term use of the Synthroid medication: what information would you teach him/her: Risk of osteoporosis 12. A patient has been taking doxazosin (Cardura) 2mg PO daily for 3 weeks for treatment of BPH. He returns to the clinic and is complaining of feeling dizzy when he stands up. Which action would the family nurse practitioner take? Determine blood pressure (BP) with patient lying down, standing, and sitting. (Cardura is also prescribed as an antihypertensive so pt may be experiencing orthostatic hypotension. Other options are directed towards evaluating his BPH which has already been diagnosed) 13. What is the correct drug therapy for an adult with an acute episode of gout? For Dr. B, answer is Indomethacin 25 to 50mg four times daily. In book, answer is Colchicine 0.6 mg 2 tablets PO x 1, then repeat every 1 hour until symptoms subsidized. 14. The primary lesions for syphilis can be described as the following: Painless papule that rapidly becomes eroded and indurated, with a surrounding red areola. 15. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: Fever and Sore Throat 16. Which one of the following drugs can potentially worsen a Gout exacerbation: Allopurinol 17. Michelle, your patient has been prescribed lisinopril (Prinivil) 5mg PO qd for hypertension. She has developed an intractable cough that is unrelated to heart failure. Which of the following medication can be substituted for this medication? Angiotensin II receptor blocker (ARB) 18. Your Caucasian patient who is been diagnosed with Osteoporosis is also hypertensive. What is the best diuretic for her? Thiazides (This is the least likely to cause a loss of calcium) 19. If a 24-hour urine test indicates that a patient is secreting too much uric acid (>900 mg/day), the family nurse practitioner would prescribe: Allopurinol (Zyloprim) 100mg PO dq x 1 week, then increase daily dose by 100mg to a maximum of 300mg/day. 20. Juanita, your patient presents to day to the office for the following labs: Total Cholesterol: 225, HDL 40, LDL 150 TRG: 500. The next step is to prescribe: Fibrates (Fibrates is the first line for treating Triglycerides) 21. Crystal, as a well-informed NP, you are well aware that the drug class can potentially produce hypotension, bradycardia and worsening HF is which one of the following class of drugs? Beta adrenergic blockers 22. Esther is a 54-year old patient with type 2 diabetes has been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes? ACE Inhibitor 23. What type of immunity does a person develop after contracting a contagious disease? Active natural Immunity 24. Your hypothyroidism patient has the following lab results during a follow-up TSH: 7 What is the best course of action? Increase the Synthroid dosage. 25. The following person should not receive the shingles vaccine: A person being treated with corticosteroids. 26. Furosemide is added to a treatment for heart failure that includes digoxin. Monitoring for this combination includes: Serum Potassium 27. Which of the following patient situations requires the use of inactivated (not live) vaccines? Immunocompromised adult 28. In taking the history of a healthy 50-year-old man, the family nurse practitioner determines the patient is an avid gardener and spends much of his time enjoying outdoor activities. A health maintenance recommendation for this patient is to obtain a: Tdap/Td vaccine 29. The first line of treatment of Rheumatoid Arthritis is the following: NSAIDS (Aspirin, preferably. Methotrexate is given for severe cases that don’t respond to NSADS) 30. What is a serious side effect of ibuprofen in the older adult patient? Impairment of Renal Function 31. Rock 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: Relaxes smooth muscles in the bladder neck 32. Marilynn, your pregnant woman with high cholesterol needs to be medicated for her high cholesterol. Which one of the following medications would you prescribe? Bile Acid Sequestrants 33. Immunizations recommended for healthy young adults include: Influenza, hepatitis B, rubella, measles, and tetanus. 34. The following nurse practitioner understands that the following is considered an attenuated live-virus vaccination: Rubella and measles (but for Dr. B= Rubella and Rabies) Live Vaccinations are contraindicated for Pregnant women. 35. Primary treatment of any joint or muscle injuries involves: Rest, ice, compression, and elevation. 36. Erectile dysfunction (ED) medications warn about mixing them with nitrates. Why? Profound Hypotension 37. One of your patients, Marie has a dual diagnosis of Gout and Hypertension. The medication of choice to manage her blood pressure is: Losartan 38. Finasteride (Proscar) is prescribed for a 50-year old man who is experiencing a problem with urination secondary to an enlarged prostate. The family nurse practitioner would teach the patient that while he is taking this medication, it is important to: Take special precaution around women of childbearing age. (Exposure to Finasteride can cause fetal abnormalities) FINAL Q’s QUESTIONS 1) What is the next in the treatment plan for your patient with an acute flare up of Acute Atopic Dermatitis after Emolients use have failed. Desonide 0.5% cream (Desonate), which is a low dose topical Steroid agent. Emolients are OTC self-treatments. As far as the creams, you need to try a low dose before trying a higher dose. Betamethasone 0.05% is stronger than Desonide 0.5% cream). If creams have failed then you turn to oral corticosteroid. 2) When ordering an oral diabetes medication for Juanita your DM type II patient of 70- year-old with recent history of decreased appetite and risk of hypoglycemia, the NP should prescribe: Metformin Metformin is the first line treatment and has a very low risk for hypoglycemia. All the other options can cause hypoglycemia. 3) Which drug would you most likely avoid in a patient with BPH? Tricylic antidepressant (TCA) (You want to avoid any anticholinergic class drugs) Download the BPH table. Know the first line TX. The mechanisms and their side effect to always have handy and memorize) 4) As well informed FNP you are aware that the following information regarding high cholesterol drug regimen treatment: Lifestyle Modifications Total Cholesterol: 240mg/dl Nicotinic Acids HDL: 30mg/dl Statins LDL 190mg/dl Fibrates Triglycerides: 550mg/dl 5) Your male patient with depression is complaining of erectile dysfunction. Which of the following medication may be responsible for the ED? Paroxetine (Paxil) (SSRIs are known to possible cause ED.) Anafranil enduces prism. And Elavil is used for premature ejaculation. 6) Which of the following is true regarding BuSpar (buspirone hydrochloride)? It is a partial agonist for the serotonin 5-HT(1A) and an antagonist for the dopamine D(2) receptors. 7) Medications and psychotherapy are effective for most people with depression. The following class is preferred and considered safer and generally cause fewer bothersome side effects than other types of antidepressants. Selective serotonin reuptake inhibitors (SSRIs) 8) What class of medications can be used to treat benign prostatic hyperplasia and provide immediate by relaxing the bladder neck relief? Alpha-1 blockers 9) A 45 years-old patient with total cholesterol of 270mg/dl non fasting. What is the next step in managing this patient? Order a fasting lipid panel 10) Which two medications listed below BOTH require frequent monitoring of liver function tests: Glipizide (Glucotrol XL), Actos (Pioglitazone) 11) Your patient Magalie a 65-year-old with right lower lobe Pneumonia, with a past medical history of COPD. As an FNP you should use: A higher dose of antibiotics 12) Which one of the following female patients you will treat for Trichomoniasis? With vaginal discharge Upper abdominal pain, lesions, fever are options you will not have therefore vaginal discharge as vague as it is, it’s the answer. (The answer is vague, but as per Dr. B you will encounter questions like that and you have to know how to play the game) 13) As you prescribe a child an antiparasitic medication: Mebendazole (Vermox) who has pin worn, you educate the patients that the treatment should be repeated: 3 weeks 14) What is the next step in your plan of care for this patient complaining of Acne, He has been using OTC facial acne scrub product. Topical retinoid 15) As a well-informed FNP you know that HITECH ultimate goal is as follow: Safety 16) (Picture of patient with acne similar to this picture but is 50 y/o) What is the next step in your plan of care for this 50-year-old patient complaining of facial acne? Topical metronidazole (People that are middle age with acne typically has acne rosacea and the treatment is topical metronidazole) 17) A 50-year-old male comes to the nurse practitioner clinic for evaluation. He complains of fever 101F, chills, pelvic pain, and dysuria. He should be diagnosed with the, so that proper treatment can be initiated: Acute Bacterial Prostatitis 18) A 60-year-old patient with diabetes has a blood pressure reading of 150/96mm Hg. After three months of increased exercise and decreased calories, the patient has lost 10lb (4.54kg). The patient’s follow-up blood pressure is 142/94 mm Hg. Which medication does the family nurse practitioner prescribe? Enalapril (Vasotec). (This is an ACE, the first line tx for a pt with comorbidities.) so you start the pt on this medication because they are diabetic. Giving them a Hydrochlorothiazide withh) 19) An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: Buspirone (Buspar) 20) What is the first line of treatment of patients with newly diagnosed OA (Osteoarthritis) Acetaminophen 21) As well informed FNP you are aware that Propylthiouracil (PTU) is associated with the following: Please select all that apply: Autoimmune syndrome Drug-induced agranulocytosis Drug-induced Blood Dyscrasia Hepatotoxicity 22) Which one of the following medication classes/agents are indicated throughout the pregnancy? Please select four options: A. Cephalosporins/Erythromycin B. PNC and Iron C. Acetaminophen D. Parenteral Insulin and heparin 23)Jessica has been using Lindane (Kwell) the treatment of scabies. As a FNP you are well aware that: It is not considered as a first line of treatment. (This medication is a poison and used as a last alternative when other treatment fails) 24) Which one of the following class of antibiotics can cause hearing impairment? Aminoglycosides 25) The FNP diagnoses UTI in a 50-year-old male patient. The drug of choice is: Oral Trimethoprim-Sulfamethoxazole 26) Your patient Erika is taking a medication with the mechanism of action of inhibiting blood coagulation by selectively blocking the active factor Xa. Which one of the following is this medication? Aprixaban (Eliquis) 27) Upon Physical evaluation of your patient child you find this along with high fever and bilateral anterior adenopathy. Pertinent information includes an anaphylactic reaction previously with PNC and Macrolides. What is the next step in the management? Prescribe Clindamycin (Cleocin) *This is NOT a macrolide 28) What is the main mechanism behind the drug choice for Parkinson’s disease? Parkinson’s disease results primarily from the profound decrease of dopaminergic neurons (neurodegeneration: death) in the substantia nigra. Therefore causing an inbalance with the acetylcholine) (Treatment of Parkinson is to restore dopamine and balance dopamine and acetylcholine.) 29) Rose, a 35-year-old patient is afebrile and complains of severe right earache. On examination, the TM is gray and intact and there is a greenish discharge at the external canal. What is the next step by the FNP in managing this patient? Prescribe an oral antibiotic combined with corticosteroid. (This is Otitis Externa and it’s treatment) 30) Using a topical steroid can increase the risk of which one of the following? Bacterial Secondary Infections 31) The family nurse practitioner recognizes that which antibiotic class can interfere with the metabolism of first-generation antiepilepsy drugs, such as carbamazepine? Macrolides. 32) Which drug is most likely to increase lipoprotein levels? Spironolactone 33) What is the least appropriate prophylactic treatment medication for Deena a 22 year old woman with a medical history of Gout? Colchicine (Colcrys) (NSAID, Steroid, and Colchicine is for acute treatment/ flare-up/exacerbation. Know what to give as Prophylactic and what to give for flare-ups) 34) As you just diagnosed your patient with anxiety what is the first-line of drug recommended by the American Psychiatric Association? Fluoxetine (Think SSRI is the first line of treatment, not sure) 35) A female patient is 95-year-old with recurrent UTI, past medical history is positive for allergy to Levofloxacin. Order the following drugs according to her condition. Drug of a similar class 1. Ciprofloxacin (Cipro) Cannot be given if chronic renal disease present. 2. Nitrofurantoin (Macrobid) An adequate first line drug option: 3. Fosfomycin (Monurol) Interaction with several drugs 4. Sulfamethoxazole-Trimethoprim (Bactrim) (Tough question because Macrobid, Cipro, and Bactrim are all first-line treatments, so you have to do process of elimination based on your knowledge of the txs and the information given for this patient.) 36) A family nurse practitioner examines a 24-year-old Hispanic-American female patient who is experiencing symptoms of a urinary tract infection. The patient reports that her mother sent her some ampicillin (Polycillin) 500 mg tablets from Mexico and that she has taken a pill a day, for the past three days, with little relief of her symptoms. What is the nurse practitioner’s response? Prescribing trimethoprim-sulfamethoxazole (Bactrim DS) twice daily for three days. 37) NOCDURNA (desmopressin acetate) side effects includes the following except. Weight Loss The side effect of this medication is hyponatremia. Ans confusion, hallucination, and seizures are the other options in the test and all are a side effect of hyponatremia. You will actually have weight gain with this medication. 38) Anemia due to chronic renal failure is treated with: Epoetin alfa (Epogen) 39) The treatment of acute Gout includes the following: Please select all that apply? NSAIDS, Colchicine, and Corticosteroids 40) What is the appropriate medication of choice for a pregnant woman with a UTI? Cefuroxime (Zinacef) or Nitrofurantoin (Macrobid) (Cipro, tetracycline cannot be given) 41) A 46-year-old female patient is being seen in the clinic by the family nurse practitioner. She was the last seen 2 weeks ago for an upper respiratory tract infection and was treated with amoxicillin (Amoxil) 250 mg PO tid x 10 days. She completed her medication last week, but now is aware of vaginal itching and has cottage cheese-like vaginal discharge. She states that she has never experienced such intense itching. She is in a mutually monogamous relationship. Her LMP was 2 weeks ago. Her partner had a vasectomy 2 years ago. Wet mount with KOH shows negative whiff test, rare clue cells, positive lactobacilli, positive hyphae and spores, few WBC’s and no trichomonads. She is leaving tomorrow for a week-long cruise. She is not taking any medications and has no known drug allergies. The family nurse practitioner knows that the best treatment for this problem is: Fluconazole (Diflucan) 150mg 1 tab PO one time 42) An elderly male patient is taking Finasteride (Proscar*) 5-alpha-reductade inhibitors, and has asked you the mechanism of action of his medication? A decrease in the size of the prostate. 43) Which of the following medication classes is considered first line therapy for patients who have heart failure (HF)? Ace Inhibitors 44) What is the primary goal of antiviral treatment for patients with shingles? Answer is both Decrease Viral shedding and Reduce the risk of post herpetic neuralgia. But if there is a choice between both chose reduce the risk of post herpatic neuralgia. 45) A hemoglobin A1C level at 7.1 in a patient with type 2 Diabetes Mellitus. The patient is currently taking a Sulfonylurea medication. Which of the following drugs should be added next to the medication treatment regimen? Metformin 46) Your patient with extensive cardiac history is taking the following drugs, Warfarin (Coumadin), Amoxicillin for an Otitis Media and Metformin for his DM type II with the following OTC medications: St. John’s wort and Niacin. Today his INR is low, what do you think can be the reason for it? St. John’s Wort induces Cytochrome P50 and causes Warfarin to fail 47) Which medications are used in the treatment of allergic rhinitis? Antihistamines, corticosteroids, and environmental control 48) Your patient accidentally overloaded himself with Iron, due to overuse of OTC Iron. Please select all that apply A. Desferal (Deferoxamine) causes low blood pressure B. Patient needs Iron-chelating drugs C. Desferal (Deferoxamine) may be used to reduce iron binding to the heme 49) The symptoms of Depression might be a side effect of which of neurotransmitter medication? Dopamine 50) The following is considered as first line treatment for chronic bacterial prostatitis: Sulfamethroxazole/trimethoprim (Bactrim DS) twice daily for 4 to 12 weeks. (For chronic prostatitis the treatment is lengthier.) Bactrim and Cipro is the treatment for Prostatitis for either acute or chronic prostatitis. The length of treatment varies if it’s chronic or acute. For acute tx can be 14 days. For chronic it can be 2-3 months) 51)Which of the following antimicrobials, when used as indicated, is preferred during pregnancy? Erythromycin 52) Pic of Acne chin: Topical Clindamycin solution DC 53) What is the first recommendation for patients with newly diagnosed with OA(Osteoarthritis) Weight Loss (Asians and frail women are at risk for Osteoporosis, not OA. Pt’s with OA usually are overweight and benefit from light weight exercise. First RECOMMENDATION= weight loss (Lifestyle modification) However, for the first-line TREATMENT the answer is Acetaminophen. 54) Pic of Bull eye rash: A) Bactrim, B) Augmentin, C) Doxycycline D) Triple Antibiotic 55) Please match the Pics with the treatment: MCV 120Fl= ___, LDL = ____, Cyclovir =____, Augmentin(Amoxicillin Clavulanate)= _____ 56) Patient educated regarding taking Iron replacement includes: Iron is best taken on an empty stomach with orange juice 57) Preventative therapy for cluster headaches includes: Ergotamine nightly before bed 58)Which of the following should not be avoided when the patient has benign prostatic hyperplasia (BPH)? Alpha-Adrenergic Blockers 59) Please name the actions of the major drugs classes usage in treating Parkinson’s. SATA: Dopaminargic agents Anticholinergic agents 60) Your patient with extensive cardiac history is taking the following drugs: Warfarin(Coumadin), Amoxicillin for an Otis Media and Metformin for his DM type II with the following OTC medications: St. Johns Wort and Niacin. Today his INR is low, what do you think can be the reason for it? St. Johns Wort induces CP50 and causes Warfarin to fail. 61) Match the following: Fatigue = Beta Blocker (Propranolol) High Cholesterolemia = Isotretinoin (Acutane) Steven-Johnson Syndrome = Sulfonamides (Bactrim) Neurological Disorders = Ciprofloxacin (Levaquin) 62) An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: A: Escitalopram (Lexapro) B: Venlafaxine (Effexor) C: Amitriptyline (Elavil) D: Buspirone (Buspar) (SSRI is the first-line treatment but always remember it takes a few weeks to work and see whether or not it benefits the pt. Some patients can be depressed and aggressive and some can be depressed and have low energy. The SSRI stabilizes the mood. But they are all not made equal. SSRI control’s the mood but some can excite, and some can calm you down. For this patient, the Effexor will excite the patient and help with the low energy.) 63) Which of the following is used as an anticoagulant is the reverse agent for Dabigatran Etexilate (Pradaxa)? A: Vitamin K B: Protamine Sulfate C: Fondaparinux (Anixtra) D: Idarucizumab (Prazbind) 64)Which of the following should not be taken with a selective serotonin reuptake inhibitor? A: Green Leafy Vegetables B: Aged blue cheese C: Alcohol D: Grapefruit (Aged cheese you avoid for TCA, MAO) 65) Prior to starting antidepressants, patients should have a diagnostic workup testing to rule out: SATA: A: Anemia B: Chronic fatigue syndrome C: Heart Failure D: Hypothyroidism E: Diabetes Mellitus F: Menopause G: Sleep Apnea 66) A young adult complaining of vaginal itching, thick yellow mucous discharge, and urinary discomfort is seen in the urgent care unit by the family nurse practitioner. She is sexually active and uses condoms with only one of her two partners. As his result came back positive for Chlamydia. What is likely appropriate treatment? A) Metronidazole (Flagyl) 2g PO single dose B) Doxycycline (Avidox) 100mg PO 12h X 5 days C) Ceftriaxone (Rocephin) 125mg IM D) Acyclovir (Zovirax) 200 mg 1 Cap PO q4h X 5 days 67) Which of the following medications can cause a false positive in the urine drug test for Marie? A) Bupropion B) Glyburide C) Lisinopril D) Metformin 68) Your patient Marline is taking digoxin for Afib but today her lab test result demonstrates an abnormal low digoxin level? What could be the reason: A) Decreased Creatinine clearance B) Weight Loss C) Increase physical activities D) Regular use of antacid (If you take antacid with digoxin. The antacid will cancel out and not allow the digoxin to metabolize.) 69) When Desmopressin is used to treat bed-wetting: A) It is usually taken once a day at bedtime B) It is usually taken once a day in the morning C) It is usually taken two to three times a day D) It is usually taken at the same time of the day regardless if it’s the morning or night time. 70) Your patient Gia is taking Warfarin for DVT and has called the clinic this morning to report that he missed his AM dose of 5mg. What should he be instructed to do? A) Take 2 warfarin 5mg now and resume the daily warfarin 5mg on the next morning. B) Take warfarin 10mg now C) Take warfarin 5mg now, Warfarin 5mg at 5pm and resume the daily warfarin 5mg on the next morning D) Wait until tomorrow and resume daily dosing of warfarin 5 mg 71)Which of the following medications should be avoided in a 65year-old male with benign prostatic hyperplasia (BPH)? A) Doxazosin B) Pseudoephedrine C) Propanolol D) Ciprofloxacin 72) Your cardiac patient with valvopathy has developed arrhythmia. The most likely plan of care to prevent further complication would include: A) Anticoagulant drugs B) Immediate referral for a pacemaker C) Beta Blocker drugs D) Valve replacement (you cannot give BB because u don’t know what type of arrythmia it is.) 73) Which of the following is recommended for pregnant women? A) Iron and Vitamin C supplement B) Folate and Vitamin C supplement C) Vitamin B12 and Folate supplement D) Folate and Vitamin C supplement Because you are pregnant it doesn’t mean you have Iron deficiency. The Anemia that pregnant women have physiological diluted anemia. They have hypervolemia causing diluted anemia. But it is not true anemia. Therefore, Iron supplement is not needed. Only time you give them Iron is if they have iron deficiency before pregnancy. 74) Your patient Rose who has been treated with Griseofulvin (Grifulvin V) for Tinea Capitis after 3 weeks is complaining of mild improvement. What is the next step in the treatment plan? A) Add 2.5 % Selenium Sulfide shampoo BID weekly to the treatment regimen B) Initiate a short course of oral steroids to reduce inflammation and prevent scarring. C) Continue with the current treatment as it takes usually 4 to 6 weeks and even to 8 weeks to complete the treatment. D) Have the patient shave his head and notify him the new hair will not be infected 75) As you are prescribing Phenazopyridium (Pyridium) for UTI you should educate your patient about the following side effects: A) The Cost B) Occurrence of Hemolytic Anemia C) Gastritis D) Possible resistance 76) Treatment of viral conjunctivitis includes the use of : A) Cold Compress B) Tetrahydrozoline hydrochloride (Visine) drops C) lubricating eye ointment D) Steroid eyedrops 77) Match the following: Anti-anxiety drug Wellbutrin (Bupropion) Antidepressant drug Buspar (Buspirone) Raynaud Phenomenon Sular (Nisoldipine) 78) The single dose of treatment of choice for trichomoniasis is: A) Metronidazole (Flagyl) 2g PO B) Clindamycin (Cleocin) 300mg PO C) Ofloxacin (Floxin) 500mg PO D) Azithromycin (Zithromax) 1g PO 79) A patient with hypertension describes a previous allergy to a sulfa antibiotic a severe allergic reaction and hospitalization. Which medication is contraindicated in this patient? A) Metoprolol B) Hydrochlorothiazide C) Ramipril D) Verapamil 80) Your female patient with positive medical history of DMII, Hypertensive and Hyperlipidemia is complaining of galactorrhea? What is the most likely drug in cause? A) Potassium-Sparing diuretic B) Loop Diuretics C) Thiazide Diuretics D) Losartan 81) A 35-year-old female sees the family nurse practitioner with a complaint of cold intolerance, fatigue, dry skin, weight gain, and heavy menstrual periods. Physical exam shows pulse of 58 beats/min, a waxy sallow complexion, and a firm goiter. Her TSH level is 3.1mU/L. What is the best treatment choice for this patient? A) Begin levothyroxine at 0.1 mg PO qd and recheck TSH in 4 weeks. B) Normal no need to start on levothyroxine C) Begin levothyroxine at 0.1 mg PO qd and recheck TSH in 6 weeks D) Administer loading dose of PO levothyroxine and start full replacement dose The TSH level is never enough to diagnose a pt. with Hypothyroid. T3 and T4 levels are not needed to manage hypothyroidism. 82) An elderly patient is taking an effective dose of Doxepin (Sinequan) for the treatment of agitated depression with insomnia. Today the patient is still complaining of constipation although he is getting enough fiber and hydration on a daily basis. What is the next step in the treatment? A) Stop the Doxepin (Sinequan) and replace it by Trazodone (Desyrel) B) Keep the Doxepin (Sinequan) and add a daily enema C) Stop the Doxepin (Sinequan) and replace it by Fluoxetine (Prozac) D) Stop the Doxepin (Sinequan) and replace it by Wellbutrin (bupropion) (This patient is excited, and Doxepin excites. Not a good choice for this patient who is already aggressive.) 83) Tricyclic antidepressants should be avoided in the elderly patients because they have a potentially disabling side effects. Which of the following is least likely to be a side effect of TCA’s? A) Potentiation of seizures B) Dizziness C) Confusion D) Nausea and urinary retention (TCA has anticholinergic effect) 84) As you are seeing a patient with past medical history of HTN, DMII, AV block 2nd degree. Below is her list of medications that she is currently taking as it is prescribed by a previous provider. Which medication would you remove as it is contraindicated? A) ACE Inhibitor B) Beta Blocker C) Insulin D Calcium Channel Blocker 85) Prophylactic treatment for Migraines in patients with asthma should include all of the following except: A) Divalproex (Depakote) B) Topiramate (Topamax) C) Valproic Acid (Depakene) D) Propranolol (Inderal) (Propranolol will constrict their lungs further therefore should be avoided.) 86) Benazepril (Lotensin) should be discontinued immediately if: A) Pregnancy occurs B) Potassium levels decrease C) Dry cough develops D) Gout develops (You cannot give ACE to pregnant women, It is contraindicated and if pt is taking it, you hav to do a sonogram to check the status of the fetus) 87) Which drug would be most useful for the family nurse practitioner to prescribe for an adult patient’s arthritis pain to reduce the risk of ulcers? A) Misoprostol (Cytotec) B) Cimetidine (Tagamet) C) Celecoxib (Celebrex) D) Omeprazole (Prilosec) Pt does not have an ulcer. Which medication is most useful for the pt with arthritis pain? Celebrex) 88) Which is the best course of action for a patient diagnosed with lice? A) Do not close family member leaving in the same household B) Not treat the co-worker C) Treat any close family member leaving in another household D) Educate the patient to use a conditioner after using prescribed shampoo. 89) Pic of the Knees: Upon examination of your patient complaining of severe itching, swelling, and pain at his knees. What is your treatment plan for him based on your diagnostic: A) Ketoconazole shampoo daily for 6 weeks B) Oral griseofulvin 6 to 8 weeks C) Reassure the patient that the symptoms will go away for themselves D) Dexamethasone topical cream 90) Your patient on (Fluoxetine) Prozac 20mg (max dose) complains after 8 weeks that the medication is not working. What is the next step in the treatment plan? A) Tell him to be patient as the drug takes time to work B) Increase the dose to a safer level C) Change it to another drug of its class D) Refer him to the ER 91) Which medication per the American Psychiatric Association is indicated for Ester your patient with Generalized Anxiety Disorder (GAD)? A) Buproprion HCL (Wellbutrin B) Buspirone (BuSpar) C) Citalopram (Celexa) (answer on TB) D) Impramine (Tofranil) 92) A patient reports that “something is inside my eyes” after cutting Christmas trees about 6 hours ago. If indeed there was a foreign body in his eyes, the FNP would expect to find all except: A) A purulent discharge B) A positive fluorescein stain C) possible corneal abrasion D) feeling of foreign body in the eyes 93) Pierre, a 45 year-old male patient with history of migraine headaches is requesting prophylactic medication treatment. Which one of the following should be avoided: A) Metoprolol (Lopressor) B) Verapamil (Veretan) C) Amitriptyline D) Sumatriptan (Imitrex) 94) The main difference between Cyclooxegenase-1(COX-1) and Cyclooxegenase-2 (COX-2) is their contribution: A) Renal arteriole constriction B) to the inflammation response C) of the maintenance of gastric protective mucosal layer D) to the pain transmission 95) Three of the following medications warrant monitoring of potassium levels. Which one does not? A) Hydrochlorothiazide B) Fosinopril C) Amlodipine D) Candesartan 96) Your patient who is taking Zoloft, Amitriptyline and Tramadol as his daily drug regimen. What kind of major risk is he subjective to: A) Extra Pyramidal Syndrome B) Serotonin Syndrome C) Disulfiram-like Reaction D) Increased risk of suicidal ideation 97) A 27 year-old Caucasian patient has blood pressure reading of 175/95, 169/100, and 173/93. What is a reasonable plan of care for this patient today: A) Initiate a thiazide or CCB, alone or combo B) Recommends lifestyle changes C) Initiate Thiazide, ACEI, ARB, or CCB, alone or in combo D) Have the patient initiate a journal of her BP numbers (White pts can have all of them) 98) PIC of rash between the fingers: Patient is complaining of an itchy rash times 5 days worsening at night. Upon physical examination you find this. What is the next step in the treatment plan? A) Miconazole cream rubbed in well for 4 weeks B) Permethrin 1% C) Permethrin 5% D) Refer her to a dermatologist for treatment 99) The FNP has been asked by a asymptomatic 45 year-old male about the use of ASA. After determining that he is at a minimum 10 years risk assessment for a MI. The patient would like to know if he would benefit of taking ASA every AM to prevent MI. What is the best way to approach it? A) Tell him that take a daily ASA because the Literature review supports the rationale for the benefit in giving people who do not have a heart problem, One aspirin per day B) Tell him to not take a daily ASA because Literature review does not support the rationale for the benefit in giving people who do not have heart problems, one aspirin per day C) Tell him that all men after 40 year-old should take a daily ASA because the Literature review supports the rationale for the benefit in giving people who do not have heart problems, one aspirin per day. D) Tell him to take a daily aspirin because Literature review supports the rationale for the benefit in giving people who do not have heart problems one aspirin per day 100) As an informed FNP you are well aware that Antibiotics like Lincosamides class (Clindamycin) or Macrolides (Erthromycin) have been added to Benzoyl peroxide (salicylic acid) for the following reason: A) The Benzoyl peroxide has no effect on the Antibiotic B) The Benzoyl peroxide potentiate the Antibiotic action C) The Antibiotic potentiates the Benzoyl peroxide action D) The Antibiotic has no effect on the Benzoyl peroxide action [Show More]

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