Graduate Nursing 615, Maryville University of St. Louis, Latest 2019/20 Test 4- Review Questions. Graded a Straight A - $9.49   Add to cart

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Graduate Nursing 615, Maryville University of St. Louis, Latest 2019/20 Test 4- Review Questions. Graded a Straight A

Test 4- Review Questions Graduate Nursing 615 | Maryville University of St. Louis 1. Henry presents to clinic with a significantly swollen painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry? A.High-dose colchicine B.Low-dose colchicine C.High-dose aspirin D.Acetaminophen with codeine 2. Patient education when prescribing colchicine includes: A.Colchicine may be constipating B.Colchicine always causes some degree of diarrhea C.Mild muscle weakness is normal D.Moderate amounts of alcohol are safe with colchicine 3. Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: A.Complete blood count B.Blood glucose C.C-reactive protein D.BUN, creatinine, and creatinine clearance 4. Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes: A.Gout may worsen with therapy B.Febuxostat may cause severe diarrhea C.He should consume a high-calcium diet D.He will need frequent CBC monitoring 5. Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for: A.Gout B.Iron deficiency anemia C.Osteoporosis D.Renal dysfunction 6. Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for: A.Metformin, a biguanide to prevent diabetes B.Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease C.Naproxen, an NSAID to treat joint pain D.Furosemide, a diuretic to treat fluid retention 7. Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued? A.Patients with asthma are transitioned directly off the prednisone onto inhaled corticosteroids B.Prednisone can be abruptly discontinued with no adverse effects C.Develop a tapering schedule to slowly wean Daniel off the prednisone D.Substitute the prednisone with another anti-inflammatory such as ibuprofen 8. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects? A.A bisphosphonate B.Calcium supplementation C.Vitamin D D.All of the above 9. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of: A. Serum glucose B. Stool culture C. Folate levels D. Vitamin B12 10. Patients who are on chronic long-term corticosteroid therapy need education regarding: A. Receiving all vaccinations, especially the live flu vaccine B. Reporting black tarry stools or abdominal pain C. Eating a high carbohydrate diet with plenty of fluids D. Small amounts of alcohol are generally tolerated 11. All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box warning regarding: A.Potential for causing life-threatening GI bleeds B.Increased risk of developing systemic arthritis with prolonged use C.Risk of life-threatening rashes, including Stevens-Johnson D.Potential for transient changes in serum glucose 12. Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes: A.It is OK to double the dose of Vicodin if the pain is severe B.Vicodin is not habit forming C.He should not take any other acetaminophen-containing medications D.Vicodin may cause diarrhea; increase his fluid intake 13. When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs: A.Omeprazole, a proton pump inhibitor B.Combined oral contraceptive C.Diphenhydramine, an antihistamine D.Warfarin, an anticoagulant 14. Josefina is a 2 year old with acute otitis media and upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen? A.They can cut an adult ibuprofen tablet in half to give Josefina B.Ibuprofen dose can be doubled for severe pain C.Josefina needs to be well hydrated while taking ibuprofen D.Ibuprofen is completely safe in children with no known adverse effects 15. Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? A. Add an H2 blocker such as ranitidine to his therapy B.Discontinue the aspirin and switch him to Vicodin for the pain C.Decrease the aspirin dose to one tablet daily D.Have Henry take an antacid 15 minutes before taking the aspirin each day The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is: A.48 hours B.4 to 6 days C.4 weeks D.2 months 16. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is: A. Black tarry stools B. Vomiting C. Tremors D. Tinnitus Monitoring a patient on a high dose aspirin level includes: A. Salicylate level B. Complete blood count C. Urine pH D. All of the above 17. Patients who are on long-term aspirin therapy should have ____ annually. A. Complete blood count B. Salicylate level C. Amylase D. Urine analysis 18. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include: A. Understanding that obesity is a contraindication to prescribing phentermine B. Anorexiants may cause tolerance and should only be prescribed for 6 months C. Patients should be monitored for postural hypotension D. Renal function should be monitored closely while on anorexiants Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as SSRIs and St John’s Wort due to: A. Additive respiratory depression risk B. Additive effects affecting liver function C. The risk of serotonin syndrome D. The risk of altered cognitive functioning 19. Antonia is a 3 year old who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for____ to be used for an episode of status epilepticus. A. IV phenobarbital B. Rectal diazepam (Diastat) C. IV phenytoin (Dilantin) D. Oral carbamazepine (Tegretol) 20. Rabi is being prescribed phenytoin for seizures. Monitoring includes: A. Assessing for phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment B. Assessing for pedal edema throughout therapy C. Assessing heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm D. Assessing for vision changes, such as red-green blindness, at least annually 21. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: A. Dwayne hasn’t been taking his carbamazepine because it causes insomnia B. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance C. Dwayne was not originally prescribed the correct amount of carbamazepine D. 22. Carbamazepine is probably not the right antiseizure medication for Dwayne Carbamazepine has a Black Box warning due to life-threatening: A. Renal toxicity, leading to renal failure B. Hepatotoxicity, leading to liver failure C. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis D. Cardiac effects, including supraventricular tachycardia 23. Long-term monitoring of patients who are taking carbamazepine includes: A. Routine troponin levels to assess for cardiac damage B. Annual eye examinations to assess for cataract development C.Monthly pregnancy tests for all women of childbearing age D.Complete blood count every 3 to 4 months 24. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: A. Increased seizure activity, as this drug may auto-induce seizures B. Altered renal function, including renal failure C. Blood dyscrasias, which are uncommon but possible D. Central nervous system excitement, leading to insomnia 25. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be: A.Increase her dose B.Assess for suicidal ideation C.Discontinue the medication immediately D.Decrease her dose to half then slowly titrate up the dose 26. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: A.Tell her to increase her caloric intake to counter the effects of the topiramate B.Consult with a neurologist, as this is not a common adverse effect of topiramate C.Decrease her dose of topiramate D.Reassure her that this is a normal side effect of topiramate and continue to monitor her weight 27. Monitoring of a patient on gabapentin to treat seizures includes: A. Routine therapeutic drug levels every 3 to 4 months B. Assessing for dermatologic reactions, including Steven’s Johnson C. Routine serum electrolytes, especially in hot weather D. Recording seizure frequency, duration, and severity 28. Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: A. He should not play sports due to the risk of increased seizures B. He should monitor his temperature and ability to sweat in the heat while playing C. Reminding him that he may need higher dosages of topiramate when exercising D. Encouraging him to use sunscreen due to photosensitivity from topiramate 29. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: A. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures B. To wear sunscreen due to photosensitivity from levetiracetam C. To get an annual eye exam while on levetiracetam D. To report weight loss if it occurs 30. Levetiracetam has known drug interactions with: A. Oral contraceptives B. Carbamazepine C. Warfarin D. Few, if any, drugs 31. Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: A. Reassuring her she has a viral infection and to call if she isn’t better in 4 or 5 days B. Ruling out a hypersensitivity reaction that may lead to multi-organ failure C. Rapid strep test and symptomatic care if strep test is negative D. Observation only, with further assessment if she worsens 32. Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for oral contraceptives. Combined oral contraceptives (OCs) interact with lamotrigine and may cause: A. Contraceptive failure B. Excessive weight gain C. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine D. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed 33. The tricyclic antidepressants should be prescribed cautiously in patients with: A. Eczema B. Asthma C. Diabetes D. Heart disease 34. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other MAOIs: A. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) B. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce C. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment D. All of the above 35. Taylor is a 10 year old diagnosed with major depression. The appropriate first line antidepressant for children is: A. Fluoxetine B. Fluvoxamine C. Sertraline D. Escitalopram 36. Suzanne is started on paroxetine (Paxil), an SSRI, for depression. Education regarding her antidepressant includes: A. SSRIs may take 2 to 6 weeks before she will have maximum drug effects B. Red-green color blindness may occur and should be reported C. If she experiences dry mouth or heart rates greater than 80, stop taking the drug immediately D. She should eat lots of food high in fiber to prevent constipation 37. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be: A. Fluoxetine (Prozac) B. Paroxetine (Paxil) C. Amitriptyline (Elavil) D. Duloxetine (Cymbalta) 38. Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: A. For excessive weight loss B. With the Abnormal Involuntary Movement Scale (AIMS) for EPS symptoms C. Monthly for tolerance to the haloperidol D. 39. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: A. Reduce the chance of tardive dyskinesia B. Potentiate the effects of the drug C. Reduce the tolerance which tends to occur D. Increase CNS depression 40. Patients who are prescribed olanzapine (Zyprexa) should be monitored for: A. Insomnia B. Weight gain C. Hypertension D. Galactorrhea 41. A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: A. Bradykinesia, akathisia, and agitation B. Excessive weight gain C. Hypertension D. Potentially fatal agranulocytosis 42. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: A. Chlordiazepoxide (Librium) B. Clonazepam (Klonopin) C. Alprazolam (Xanax) D. Oxazepam (Serax) 43. A patient with anxiety and depression may respond to: A. Duloxetine (Cymbalta) B. Fluoxetine (Prozac) C. Oxazepam (Serax) D. Buspirone (Buspar) and a SSRI combined 44. When prescribing temazepam (Restoril) for insomnia, patient education includes: A. Take temazepam nightly approximately 15 minutes before bedtime B. Temazepam should not be used more than three times a week for less than 3 months C. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better D. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam 45. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: A. Zolpidem should be taken just before going to bed B. Zolpidem may cause dry mouth and constipation C. Patients may need to double the dose for effectiveness D. They should stop drinking alcohol at least 30 minutes before taking zolpidem 46. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: A. Orthostatic hypotension B. Agitation and irritability C. Drowsiness and nausea D. Painful urination and abdominal distention 47. Tom is taking lithium for bipolar disorder. He should be taught to: A. Take his lithium with food B. Eat a diet with consistent levels of salt (sodium) C. Drink at least 2 quarts of water if he is in a hot environment D. Monitor blood glucose levels 48. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? A. Valproate is safe during all trimesters of pregnancy. B. She can get pregnant while taking valproate, but she should take adequate folic acid. C. Valproate is not safe at any time during pregnancy. D. Valproate is a known teratogen, but may be taken after the first trimester if necessary. 49. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: A. The medication may cause sedation and they should not drive B. Constipation is a common side effect and they should increase fluids and fiber C. Patients should not take any other acetaminophen-containing medications at the same time D. All of the above 50. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first line medication would be: A. Ibuprofen (Advil) B. Acetaminophen with hydrocodone (Vicodin) C. Oxycodone (Oxycontin) D. Oral morphine (Roxanol) 51. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: A. Slurred speech and insomnia B. Bradycardia and confusion C. Dizziness and orthostatic hypotension D. Insomnia and decreased appetite 52. Monitoring for a child on methylphenidate for ADHD includes: A. ADHD symptoms B. Routine height and weight checks C. Amount of methylphenidate being used D. All of the above 53. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: A. Blood pressure B. Blood glucose levels C. Urine ketone levels D. Liver function 54. Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that effects lower esophageal sphincter (LES) tone: A. Calcium carbonate B. Estrogen C. Furosemide D. Metoclopramide 55. Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Foods that may aggravate GERD include: A. Eggs B. White bread C. Chocolate D. Chicken 56. Metoclopramide improves GERD symptoms by: A. Reducing acid secretion B. Increasing gastric pH C. Increasing lower esophageal tone D. Decreasing lower esophageal tone 57. Antacids treat GERD by: A. Increasing lower esophageal tone B. Increasing gastric pH C. Inhibiting gastric acid secretion D. Increasing serum calcium level 58. When treating patients using the “Step-Down” approach the patient with GERD is started on ____ first. A. Antacids B. Histamine2 receptor antagonists C. Prokinetics D. Proton pump inhibitors Proton pump inhibitors 59. When using the “Step-Up” approach in caring for patients with GERD, the “step up” from OTC antacid use is: A. Prokinetic (metoclopramide) for 4 to 8 weeks B. Proton pump inhibitor (omeprazole) for 12 weeks C. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks D. Cytoprotective drug (misoprostol) for 2 weeks C. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks 60. When using the “Step-Up” approach in caring for patients with GERD, the “step up” from once daily proton pump inhibitor use is: A. Prokinetic (metoclopramide) for 8 to 12 weeks B. Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks C. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks D. Cytoprotective drug (misoprostol) for 4 to 8 weeks 61. When using “Step-Up” therapy for GERD, the next “step up” in treatment when a patient has been on proton pump inhibitors for 12 weeks is: A. Add a prokinetic (metoclopramide) B. Referral for endoscopy C. Switch to another proton pump inhibitor D. Add a cytoprotective drug 62. Infants with reflux are initially treated with: A. Histamine2 receptor antagonist (ranitidine) B. Proton pump inhibitor (omeprazole) C. Anti-reflux maneuvers (elevate head of bed) D. Prokinetic (metoclopramide) 63. Long-term use of proton pump inhibitors may lead to: A. Hip fractures in at-risk persons B. Vitamin B6 deficiency C. Liver cancer D. All of the above 64. An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: A. Histamine2 receptor antagonists for 4 to 8 weeks B. Proton pump inhibitor BID for 12 weeks until healing is complete C. Proton pump inhibitor BID plus clarithromycin plus amoxicillin for 14 days D. Proton pump inhibitor BID and levofloxacin for 14 days 65. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be due to: A. Antimicrobial resistance B. Ineffective antacid C. Overuse of proton pump inhibitors D. All of the above 66. If a patient with H. pylori positive peptic ulcer disease fails first-line therapy the second-line treatment is: Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with their provider or a pharmacist first? A. Patients with kidney stones B. Pregnant patients C. Patients with heartburn D. Post-menopausal women 67. Patients taking antacids should be educated regarding these drugs, including: A. They may cause constipation or diarrhea B. Many are high in sodium C. Separate antacids from other medications by 1 hour D. All of the above 68. Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: A. Can be given to all age patients, including infants and children, for viral gastroenteritis B. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea C. Is the treatment of choice for the diarrhea associated with E. coli 0157 D. May be used in pregnancy and by lactating women 69. Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: A. May lead to toxicity if taken with aspirin B. Is contraindicated in children with flu-like illness C. Has antimicrobial effects against bacterial and viral enteropathogens D. All of the above 70. Hannah will be traveling to Mexico with her church group over Spring Break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes normal food and water precautions as well as:Select one:a. Loperamide four times a day throughout the tripb. Bismuth subsalicylate with each meal and bedtime c. A prescription for diphenoxylate with atropine to use if she gets diarrhead. None of the above 71. Josie is a 5 year old who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? A. Prochlorperazine (Compazine) B. Meclizine (Antivert) C. Promethazine (Phenergan) D. Ondansetron (Zofran) Jim presents with complaints of “heart burn” that is minimally relieved with Tums (calcium carbonate) and is diagnosed with GERD. An appropriate first step therapy would be: A. Omeprazole (Prilosec) twice a day B. Ranitidine (Zantac) twice a day C. Famotidine (Pepcid) once a day D. Metoclopramide (Reglan) four times a day • Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: A. Iron deficiency anemia, vitamin B12 and calcium deficiency B. Folate and magnesium deficiency C. Elevated uric acid levels leading to gout D. Hypokalemia and hypocalcemia • Sadie is a 72 year old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: A. Megaloblastic anemia B. Osteoporosis C. Hypertension D. Strokes • Patrick is a 10 year old who presents with constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10 year old would be: A. PEG 3350 (Miralax) B. Bisacodyl (Dulcolax) suppository C. Docusate (Colace) suppository D. Polyethylene glycol electrolyte solution

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