NR601 Final Exam Review Study Guide (Latest 2021/2022): Advanced Pharmacology for Care of the Family - Chamberlain

NR601 Final Exam Review Study Guide (Latest 2021/2022): Advanced Pharmacology for Care of the Family - Chamberlain Document Content and Description Below NR601 Final Exam Review Study Guide (Latest 2021/2022): Advanced Pharmacology for Care of the Family - Chamberlain 6mo ago an elderly pt was dx'd with subclinical hypothyroidism. Today the pt returns and has a TSH of 11 and c/o fatigue. He has taken Synthroid 25mcg daily as prescribed. What is the best course of action for you? - Double the dose of Synthroid 48yo female presents for annual exam. A1C is 6.2%. You interpret this result as: a. Prediabetes b. T2DM c. T1DM d. Normal - A 52yo Caucasian woman comes in for annual exam. She has mitral valve prolapse, no symptoms. PE reveals clear/equal breath sounds, midsystolic click. You know her stage of HF is: a. A b. B c. D d. C - B (Stage B) 55yo Caucasian man follows up w/you after referral to cardio. He reports that he thinks the med is causing a cough and sometimes he has dyspnea. Which of the following meds was most likely prescribed? a. Metolazone b. Enalapril c. Amlodipine d. Irbesartan - B 55yo Caucasian man w/T2DM presents as new pt. Take metformin 500mg BID. Labs reveal albuminuria and A1C was 7%. He's current on eye/foot exams. BP today is 136/84. According to 2017 ACC Guidelines, the most appropriate med for his current status is: a. Furosemide b. Amlodipine c. Lisinopril d. Clonidine - C 55yo post-menopausal woman with h/o HTN c/o jaw pain on heavy exertion. There were no c/o CP. Her EKG indicates NSR w/out ST segment abnormalities. Your plan may include: - Exercise stress test 55yo woman presents with somatic complaints. You suspect anxiety. You know that somatic symptoms of anxiety include: a. All answers are appropriate b. Palpitations, CP, tachycardia c. Fatigue, insomnia, diaphoresis d. Diarrhea, nausea, vomiting - A 55yo woman w/BMI of 28, has 20yr h/o primary HTN, has been on HCTZ 25mg for years w/excellent response. During this follow up visit, she reports that for the last 6mo she has felt thirsty all of the time even though she drinks at least 10 glasses of water/day. Previous fasting BGL was 136. No further testing was done at that time. You check random BGL now, is 210. What is the next appropriate step? a. Order 3hr OGTT b. Order another random BGL in 2wks c. Order A1C d. Prescribe metformin XR 500mg PO - D 59yo female c/o pain when she urinates. She has been seen three times for this in the last 3mo. Each time, dx'd with UTI, given abx. She carefully followed instructions, but has no relief of symptoms. Last UA: WBC: 2-3 RBC: 0-2 Epithelial cells: few Nitrite: neg Leuk: neg Which should be done next? a. Perform pelvic exam b. Reassure the pt that she has asymptomatic bacteriuria and does not need abx c. Obtain clean catch urin for UA and C&S d. Order pelvic ultrasound - A 59yo woman presents w/following: h/o MI, new onset SOB, especially w/exertion, an occasional rapid fluttering heartbeat and swollen feet. You know this pt's stage of HF is: a. Stage A b. Stage B c. Stage D d. Stage C - D (stage C) 60yo obese male has T2DM and lipid panel of TC 250, HDL 32, LDL 165. You teach the pt about his modifiable cardiac risk factors, which include? - DM, obesity, hyperlipidemia 60yo woman w/30-pack year hx presents for eval of persistent, daily cough w/increased sputum production, worse in the AM, occurring over past 3mo. She says, "I have the same thing year after year." Which of the following choices would you consider strongly in your critical thinking process? a. Acute bronchitis b. Chronic bronchitis c. Seasonal allergies d. Bronchial asthma - B 62yo female c/o fatigue and lack of energy. Constipation has increased and the pt has gained 10lbs in the past 3mo. Depression is denied although she reports lack of interest in usual hobbies. VS are WNL and her skin is dry and cool. Which of the following must be included in the DD? - Hypothyroidism 62yo male has chronic kidney dz that has been relatively stable. He has h/o hyperlipidemia, OA, HTN. He is compliant w/meds, BP has been well-controlled on a CCB. Last lipids showed TC 201, HDL 40, TG 180, LDL 98. He currently takes Crestor 20mg daily. Today his BP is 188/90 and urine dip shows significant proteinuria. He denies any changes in dietary habits or med regimen. What would be the best med change for him at this point? - Change CCB to ACEI 65yo Caucasian female presents with h/o mitral valve stenosis, PE unremarkable. You know the stage of HF is: a. D b. A c. B d. C - C (stage B) 65yo female presents to the clinic for the first time and c/o urinary incontinence and dyspareunia. She went through menopause 10yrs ago w/out any hormone replacement therapy and had hysterectomy for a fibroid. Her mom had hip fx at 82. Pt's most recent mammo was 5yrs ago, no known fam h/o breast ca. She is not taking any meds. Exam is unremarkable except for findings consistent w/atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which of the following evals would be necessary prior to initiating HRT? - Mammo 65yo man presents for eval of CP and L-sided shoulder pain, begins after strenuous activity, including walking. Characterized by dull, aching, 8/10 during activity, otherwise 0/10. Began few months ago, intermittent, aggravated by exercise, relieved by rest. Occasional nausea. Pain is retrosternal, radiating to L shoulder, affects QOL by limiting activity. Pain is worse today, did not go away with rest. BP 120/80, HR 72 regular. Normal heart sounds, S1/2, no murmurs. Which of the following diff dx would be most likely? a. Afib b. Coronary artery dz w/angina pectoris c. Esophagitis d. Musculoskeletal chest wall syndrome w/radiation - B 65yo woman w/BMI 29, 15yr h/o HTN, on HCTZ 25mg for years w/excellent response. Follow up visit: reports that for last 1-2mo, she has been thirsty, increased urination. Last fasting BGL was 118. What action should you take next? a. Plan to recheck BGL as scheduled at yearly physical b. Check POC glucose now, since she has just eaten breakfast c. Educate that the diuretic is causing the increased thirst d. Order fasting BGL - D 66yo dx'd with acute prostatitis, afebrile w/out severe pain, deemed appropriate to be managed outpt. An appropriate initial treatment option for mild case is: a. Septra x6wks b. Cipro x10-14 days c. Bactrim x14 days d. Levaquin x3wks - B 68yo male, retired Air Force pilot, has been dx'd w/prostate ca in the past wk. He's never had surgery and seeks clarification on availability of tx's for prostate ca. He asks you to tell him the SE of radical prostatectomy. Which of the following is NOT a potential SE of this procedure? - Selected low back pain 68yo man presents for physical, has had T2DM x5yrs, diet controlled. BMI 32. H/o HTN, smoker 10cigs/day x20yrs. Fam h/o CAD, CABG x4 for father, now deceased; CHF, T2DM, HTN for mother. He is asymptomatic today, exam is normal, EKG NSR. According to AHA/ACC guidelines, he is at risk for what stage of HF? a. Stage C b. Stage D c. Stage B d. Stage A - D (stage A) 72yo female has been dx'd w/gout. She also has a long h/o chronic HF. The most likely contributing factor to development of gout in this pt is: - Thiazide diuretics 72yo woman and husband are on cross-country driving vacation. After long day of driving, they stop for dinner. Midway through meal, she gets very SOB, w/CP and a feeling of panic. Which of the following problems is most likely? - Pulm embolism 76yo man seen for c/o UI. You should explore which of these causes of UI in men? a. UTI b. Sildenafil c. Urethral polyps d. All of the above - A 77yo Caucasian female has h/o breast ca. She's been in remission for 6yrs. As her PCP, you are seeing her for follow up of her recent c/o intermittent abd pain x3mo and general malaise. Given the hx above, what will you direct your assessment at during the exam? - Thorough abd and gyn exam to rule out masses and ID any tenderness 78yo female presents w/sz that occurred over the weekend. In selecting the most important diagnostics for this presentation, it is important to know that the least common site of sz's in the elderly is: - Temporal lobe 78yo man w/PD is being care for in a nursing home. The nurses observe that he coughs at mealtime; he has the ability to feed himself w/adaptive equipment. He has had no aspirations. Oral exam is normal, except during swallow eval you note there is slight delayed elicitation. You assess that he has only mild dysphagia. You recommend which of the following as the next step in his care? - Provide trial of foods differing in consistency 79yo man is being eval'd for frequent urinary dribbling w/out burning. Physical exam reveals smooth but slightly enlarged prostate. His PSA is 3.3. He undergoes formal urodynamic studies and findings are as follows: decreased bladder capacity of 370mL, few involuntary detrusor contractions at a low bladder volume of 246mL, increased postvoid residual urine volume of 225mL, and slightly decreased urinary flow rate. Which of the following is not consistent with normal age-associated change? - Increased postvoid residual urine volume 87yo female has been taking 100mcg of Synthroid x10yrs. She comes to your office for routine follow-up, feeling well. Her HR is 90. Your first response is to: - Order TSH 2017 HTN guidelines categorize a healthy 54yo African American woman with a BMI of 23 and consistent BP readings of 120-128/76-78 as: a. Normal BP b. HTN stage 1 c. Elevated BP d. HTN stage 2 - C A - You are reviewing a pt chart before the exam. You note that the pt is using topical capsaicin. You know that topical capsaicin is often used for tx of: a. Diabetic neuropathy b. Stress reduction c. All answers are appropriate d. Depression A drug that can be used to treat two very common symptoms in a dying pt (pain and dyspnea) is: - Morphine A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you teach the pt regarding taking this med? - Its effectiveness is decreased by antacids, iron, or caffeine A form of syncope that is more common in elderly than younger adults is: - Orthostatic hypotension A key symptoms of ischemic heart dz is CP. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: - A & B only (women w/ischemic heart dz many times do not present w/CP, Some pt's may have no symptoms or atypical symptoms so dx may only be made at the time of the actual MI) A pelvic mass in a post-menopausal woman: - Is highly suspicious for ovarian ca Acanthosis Nigricans is associated with all of the following except: a. Colon cancer b. Tinea versicolor c. Obesity d. DM - B ACC 2017 Guidelines for High BP in adults discusses screening/management of other CVD risk factors for hypertensive pts. According to the guideline, basic testing for primary HTN includes fasting BGL, CBC, lipids, BMP, TSH, UA, EKG w/optional echo, uric acid, and urinary albumin-to-creatinine ratio. a. True b. False - A ACC 2017 guidelines for high BP in adults, adults w/stage 1 HTN and high ASCVD risk should be managed w/both nonpharm and antihypertensive drug therapy. You know the pt should return for a follow up appointment which includes BP check in: a. 3wks b. 1wk c. 1mo d. 2wks - C According to 2017 ACC HTN guidelines, normal BP is: a. 130/90 b. 120/80 c. 140/80 d. 140/90 - B According to 2017 ACC HTN guidelines, the recommended BP goal for 65yo African American woman w/a h/o HTN and DM and no h/o chronic kidney dz is: a. 130/80 b. 120/80 c. 140/80 d. 140/90 - A According to 2017 Guidelines for HTN in adults, recommended BP goal for 68yo Asian American woman w/no h/o DM and a h/o CKD is: a. 150/90 b. 120/80 c. 140/80 d. 130/80 - D According to ADA guidelines, which of the following are appropriate screening tests for T2DM? a. Fasting plasma glucose b. 2-hour OGTT c. HgbA1C d. All of the above - D According to the GU presentation, #1 risk factor for urinary incontinence is: a. Uncontrolled DM b. Obesity c. Aging d. Smoking and caffeine intake - C Age-related changes in the bladder, urethra, and ureters include all of the following in older women except: - Increased estrogen production's influence on the bladder and ureter Aging process causes what normal physiological changes in the heart? a. Dilation of R ventricle occurs w/sclerosis of pulmonic and tricuspid valves b. Hypertrophy of R ventricle c. Heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis d. Cardiology occurs along w/prolapse of mitral valve and regurgitation - C Ali is 72yo man who recently came to US from Nigeria. He reports having BCG (bacille Calmette-Guerin) vaccinations as a child. Which of the following is correct regarding TB skin test? - Vax hx is irrelevant; read as usual All of the following antimicrobials may be indicated in chronic bacterial prostatitis except: - Azithromycin All of the following are considered as contributors to dysphagia except: - Smooth muscle relaxants All of the following are true about lab values in older adults except: a. Normal ranges may not be applicable for older adults. b. Abnormal findings are often due to physiological aging c. Reference ranges are preferable d. Reference values are not necessarily acceptable values - B All of the following may be reasons associated w/an elevated PSA besides prostate ca except: - UTI All of the following pts have a risk of adverse reaction from Metformin except: a. Pts w/alcoholic disorder b. Pts w/BMI 30 c. Pts w/hypoxia d. Pts w/renal dz - B All of the following statements about tremor are true except: - The most common tremor is the Parkinson tremor All of the following statements are false about drug absorption except: a. Antacids increase bioavailability of digitalis b. Gastric acidity decreases w/age c. Anticholinergics increase colonic motility d. Underlying chronic dz has little impact on drug absorption - D All of the following statements are true about drug absorption in the elderly except: a. Drugs distributed in water have lower concentration b. Drugs distributed in fat have less intense, more prolonged effect c. Drugs highly protein bound have greater potential to cause an adverse drug reaction d. The fastest way to deliver a drug to the action site is by inhalation - A All of the following statements are true about interventions in working w/the bereaved except: - There is strong evidence behind recommended interventions All of the following statements are true regarding anxiety except: a. Common in older adults b. Often co-occurs w/depression c. Is a normal part of aging d. More common in females - C An effective exercise therapy for RA is: a. Yoga and/or Pilates b. Walking 20min daily c. Bicycle riding d. Water exercise programs - D An elderly nursing home pt is maintained on phenytoin tx for h/o sz. In addition to periodic serum drug concentrations, which of the following are needed for annual eval? - CBC, LFT, platelet count An elderly pt has had a CVA in the anterior cerebral circulatory system (frontal lobe). What symptoms are most likely expressed? - Disorders of behavior and cognition An elderly pt presents w/a new onset of feeling heart race and fatigue. EKG reveals afib w/rate 100. Pt also has a newfound tremor in both hands. Which of the following would you suspect? - Hyperthyroidism An example of secondary prevention you could recommend/order for elderly would be to: a. Provide foot care for DM pt b. Check for fecal occult blood c. Administer tetanus shot d. Wear seat belts - B An example of secondary prevention you could recommend/order for older adults would be to: - Check for fecal occult blood An older adult female pt had a stroke. What symptoms are not usually expressed by pt's who have had a vertebrobasilar stroke? - Monocular blindness An older adult w/a h/o sz disorder comes into the clinic for routine checkup. Although sz-free, the pt continues on long-term phenytoin tx. You would assess for which of the following long-term effects? - Gingival hyperplasia and nystagmus An older male pt is experiencing acute onset of R-sided weakness, slurred speech, and confusion. What should you do promptly? - Eval for stroke and arrange for transport to the hospital right away Anal wink reflex is used to test: - Sensation and pudental nerve function Aortic regurgitation requires medical tx for early s/s of HF with: a. Surgery b. BB c. ACEI d. Hospitalization - C Atypical presentation of acute coronary syndrome is: - More common in females Atypical presentation of dz in elderly is reflected by all of the following except: a. Infection w/out fever b. Depression w/out dysphoric mood c. MI w/CP and diaphoresis d. Cardiac manifestations of thyroid dz - C Beers criteria are appropriate for use in evaluating use of certain meds in pts: a. 70yo b. 50yo c. 65yo d. 60yo - C Best method of verifying a dx of gout in a joint is: - Joint aspiration and polarized-light microscopy Best recommendation for pt who state they have no equipment to exercise would be: - Improvise w/recommended objects at home that can be used. Best way to diagnose structural heart dz non-invasively is: a. CXR b. Heart cath c. Echo d. EKG - C Biochemical individuality is best described as: - Each individual's variation is often much smaller than that of a larger group. Bordetella pertussis is best characterized by: - Sub-acute cough lasting 2wks CC, 62yo male, new to your practice. Previously dx'd w/Stage B HF. According to week 2 HF lecture, you'll look for the following med classes to ensure appropriate tx of HF: a. ACE/ARB, statin, BB b. ACE/ARB c. BB - A Chronic fatigue syndrome is best described as: - Fatigue lasting longer than 6mo not relieved by rest Chronic pain can have major impact on pt's ability to function and have profound impact on overall QOL. Ongoing pain may be linked to: a. Depression b. Sleep disturbance c. Decreased socialization d. All of the above - D Common auscultatory finding in CHF is: - S3 gallop Consistent finding in delirium, regardless of cause, is: - Reduction in regional cerebral perfusion Delirium is typically characterized by all of the following except: - Hyperactive level of psychomotor activity Diabetic pt presents w/the c/o R foot pain but denies recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense as well as sensation tested w/a monofilament was abnormal. Pt's foot is warm, edematous, misshapen. You suspect Charcot foot. What intervention is indicated? - Refer to podiatry Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is: - Rapid change and fluctuating course of cognitive function Drug-induced pruritis is distinguished because it: - May occur right after drug is taken or months after During routine exam of 62yo female, you ID xanthelasma around both eyes. What is significant about this? - Abnormal lipid metabolism requiring medical management Elderly are at high risk for delirium because of: - All of the above (multisensory declines, polypharmacy, multiple medical problems) ERV - Expiratory reserve volume: max volume of air that can be exhaled from end-expiratory position Evidence reflects the primary obstacle to implementing palliative care in the long-term care setting include all of the following except: - Lack of sufficient staff Evidence shows that the most important predictor of a fall is: - Prior h/o a fall Example of active strategy of health promotion for an individual to accomplish would be: - Beginning stress management program Exercise recommended for older adults should include activities that: - Strengthen muscles Feeding gastrostomy tubes at end-of-life Alzheimer's pts have been associated with: - Aspiration Pna FEV1 - Forced expiratory volume: amount of air expelled in first second of FVC; most reproducible/reliable Foot problems are a major concern for diabetics due to vascular insufficiency and neuropathy. Part of the annual exam for detection of neuropathy should include: a. Monofilament testing b. Assess for loss of temp sensation c. Physical exam of feet d. POC glucose - A Four main domains of clinical preventive services that you will provide are: - Counseling interventions, screening tests, immunizations, chemoprophylaxis FRC - Functional residual capacity: volume in lungs at end-expiratory position (at resting and expiration) Functional abilities are best assessed by: a. Family report of function b. Comprehensive head-to-toe exam c. Observed assessment of function d. Self-report of function - C FVC - Forced vital capacity: Total amount of air which can be forcibly exhaled from lungs after taking deepest breath possible GOLD 1 Class - Mild: /=80% predicted (post bronch FEV1) GOLD 2 Class - Moderate: 50-79% predicted (post bronch FEV1) GOLD 3 Class - Severe: 30-49% predicted (post bronch FEV1) GOLD 4 Class - Very severe: 30% predicted (post bronch FEV1) Hospice care differs from palliative care in that: - It supports pts and families through both the dying and bereavement process How do you manage minor or no symptoms of BPH? - Watchful waiting Behavioral techniques: -Limit fluid after dinner -Avoid meds such as anti-Parkinson, antipsychotic, antispasmodic, cold meds, diuretics How does women's anatomy make them more susceptible to UTIs? a. Their urethras are shorter b. There's a longer distance between urethra and anus c. Women tend to get UTIs when pregnant d. Asymptomatic UTIs do not resolve themselves w/out tx - A How is a relapsing UTI treated? - Usually occurs within 3wks of first infection Treated similarly to 1st infection, but 2wks of abx How is urethritis in men treated? - 7 days of doxy or 1 day of azithromycin How long are uncomplicated female UTIs treated for? - 3 days How long should first-line UI management be tried before using pharm therapy? - 3 months How often do you recheck BPH during watchful waiting? - Every 6-12mo How often do you recheck BPH if they're on meds? - Every 4-6wks IC - Inspiratory capacity: max volume of air that can be inhaled from resting expiratory level If dizziness has a predictable patter associated w/it, the clinician should first consider: - Hypoglycemia In acute prostatitis, an exam of the prostate may find it to be: - Swollen and tender In chronic bacterial prostatitis, what is the organism most commonly associated with the dz? - E. coli In considering the specificity of lab data, the most reliable diagnostic test listed below would be: - Synovial fluid analysis to differentiate between an infectious vs an inflammatory infusion In differentiating OA from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be: a. CBC b. CRP c. Synovial flui