NSG 6320 AGNP Board Exam – Gastroenterology Prescription

NSG 6320 AGNP Board Exam – Gastroenterology Prescription 1. Question: A 45-year-old woman has been taking oral omeprazole (Prilosec) 40 mg twice daily for the treatment of gastroesophageal reflux. To discontinue the medication the nurse practitioner would: advise the patient to stop the medication. reduce the dose by 50% every other day. reduce the dose by 50% weekly. Correct reduce dose by 50% every month. Explanation: For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec) 40 mg daily or twice daily), reduce the dose by 50% every week until the patient is on the lowest dose of the medication. For patients on twice daily dosing, the initial reduction can be accomplished by decreasing the dosing to once in the morning before breakfast. Once the patient has completed a week at the lowest dose, the medication can be discontinued. 2. Question: Patients receiving long-term proton pump inhibitors (PPIs) are at increased risk for fractures and: lower extremity edema. extraesophageal symptoms. myocardial infarction. Correct muscle spasms. Explanation: Analysis of patients taking PPIs for long periods of time showed an increased risk of myocardial infarctions. This is thought to be related to reduced nitric oxide in the blood vessel walls. The FDA suggests that providers consider periodically obtaining magnesium levels in patients while they are on a PPI. Increased risk of myocardial infarction has not been associated with histamine receptor blockers. 3. Question: Ondansetron (Zofran) dosage should be adjusted in patients: with renal insufficiency. who are pregnant. who are 65 years old. with hepatic impairment. Correct Explanation: Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment of nausea and vomiting. Dose limitations are recommended for patients with severe hepatic impairment (Child-Pugh class C); use with caution in mild-moderate hepatic impairment; clearance is decreased and half-life increased in hepatic impairment. No dosage adjustment is recommended with renal insufficiency, pregnancy or in advanced age. 4. Question: The antiemetic that does NOT have potential to cause QT prolongation is: promethazine (Phenergan). Correct chlorpromazine (Thorazine). ondansetron (Zofran). prochlorperazine (Compazine). Explanation: Antihistamines such as promethazine and diphenhydramine do not cause QT prolongation. Dopamine and serotonin antagonists are both associated with QT prolongation. Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are dopamine antagonists. Ondansetron (Zofran) is a serotonin antagonist. If a patient has suspected QT interval prolongation or is taking other medications with which the QT interval prolongation could be additive, a 12-lead EKG is recommended before treatment is initiated. 5. Question: Promethazine (Phenergan), a 1st generation antihistamine, is contraindicated in the presence of: motion sickness. sedation. asthma. Correct seasonal allergic rhinitis. Explanation: Promethazine (Phenergan) is contraindicated in patients with hypersensitivity reaction to promethazine, other phenothiazines, or any component of the formulation; coma; lower respiratory tract symptoms, including asthma; children younger than 2 years of age; intra-arterial or subcutaneous administration. 6. Question: Oral metoclopramide is contraindicated in the patient diagnosed with: migraines. epilepsy. Correct diabetes. renal impairment. Explanation: Metoclopramide (Reglan) is contraindicated in situations when gastrointestinal (GI) motility may be dangerous, including mechanical GI obstruction, perforation, or hemorrhage; pheochromocytoma; history of seizure disorder (e.g., epilepsy); and concomitant use with other agents likely to increase extrapyramidal reactions. Caution is advised in patients with renal impairment; dosage adjustment may be needed. 7. Question: Hyperosmotic agents and saline laxatives should be avoided or used with caution in patients who have: chronic constipation. liver disease. heart failure. Correct hypothyroidism. Explanation: Hyperosmotic agents and saline laxatives may seriously alter fluid and electrolyte balance. This increases the risk for dehydration and electrolyte disturbances, especially hypokalemia. Therefore, the risks versus the benefits should be considered prior to use in patients with heart failure. 8. Question: Corticosteroids, used in the treatment of ulcerative colitis, usually do NOT: increase the rate of infection. reduce the effectiveness of vaccines. increase the effectiveness of antibiotics. Correct increase the risk of developing osteoporosis. Explanation: Corticoster