Pharmacology MSN 571 PHARM Midterm Exam 1 Questions and Answers- United States University

Pharmacology MSN 571 PHARM Midterm Exam 1 Questions and Answers- United States University 1. Why are most statins recommended to be taken in the evening?  Can cause insomnia  Decreases stomach upset  Cholesterol synthesis increases during the night  Cholesterol synthesis decreases during the night 2. What is the mechanism of action of ezetimibe?  It inhibits the absorption of bile, thus causing the liver to produce bile from cholesterol.*  It decreases the adhesion of cholesterol on the arterial walls.  It inhibits absorption of dietary and biliary cholesterol in the small intestine.  (option cutoff) 3. Which of the following is not an expected adverse effect of Niacin?  Arthralgias  Hyperglycemia  Itching  Flushing 4. Which adverse effects would you monitor for a patient receiving a statin to manage cholesterol levels. Select all that apply.  Gallstone development  Increased serum transaminase levels  Unexplained muscle pain or tenderness *  Nonalcoholic fatty liver disease *  Elevated creatinine kinase (CK) level with muscle pain * 5. Which of the following drug classes should be avoided in peptic ulcer disease?  Avoid diuretics  Avoid NSAIDS  Avoid proton pump inhibitors  Avoid antibiotics 6. Which of the following groups of antibiotics is notable for side effects such as nephrotoxicity and ototoxicity?  Cephalosporins  Beta-lactams  Aminoglycoside  Tetracyclines 7. Which of the following is most likely an intervention for otitis media?  Corticosteroids  Aspirin  Immunoglobulins  Amoxicillin 8. Which of the following medications is a fluoroquinolone antibiotic?  Penicillin  Azithromycin  Amikacin  Ciprofloxacin 9. Which of the following best classifieds aminoglycosides, macrolides, and clindamycin?  mycolic acid synthesis inhibitors  protein synthesis inhibitors  cell wall inhibitors  folic acid synthesis inhibitors 10. Which of the following groups of antibiotics binds to the 50S subunit of the bacterial ribosome and includes drugs such as erythromycin and azithromycin?  macrolides  fluoroquinolones  aminoglycosides  tetracyclines 11. Which of the following groups of people are at risk for early hypertension?  African American  Adolescents or young adults  Mexican American Culture  Old females 12. Which of the following drug treatment strategies is associated with peptic ulcer disease?  Opioids  Two antibiotics  Corticosteroids  Hormonal therapy 13. Which of the following medications or drug classes is commonly indicated for managing gestational hypertension?  Spironolactone (Aldactone)  Loop diuretics  Calcium channel blockers  Dobutamine  Calcium gluconate 14. Which antibiotic class disrupts folate metabolism in bacteria and is often combined with trimethoprim?  cephalosporins  fluoroquinolones  Aminoglycosides  Sulfonamides  macrolides 15. Convert 15 lbs 8 oz to kilograms. Round to the nearest 100th.  7.00  34.10  33.00  7.03 16. A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms that the dosing is correct. Which possible cause of the situation will the provider explore?  Whether patient is taking a medication that binds to serum albumin  Whether a loading dose was administered  If the ordered dose frequency is longer than the gentamicin half-life  If the drug was completely dissolved in the IV solution 17. The therapeutic index is a measure of drug:  Absorption rate  Safety profile  Bioavailability status  Effectiveness 18. Which science provides primary healthcare providers the opportunity to individualize drug therapy based on a patient's genetic makeup?  Pharmacogenetics  Pharmacogenomics *  Pharmacodynamics  Pharmacokinetics 19. Which of the following is the most appropriate choice to describe age associated changes that can affect pharmacokinetics in older patients?  Increase in total body water  Decrease in creatinine clearance  (option cutoff)  (option cutoff) 20. Drugs that use CYP 3A4 enzymes for metabolism may:  None of the answers are correct  Induce the metabolism of another drug  Inhibit the metabolism of another drug *  Both induce and inhibit the metabolism of another drug. 21. An example of a first-dose reaction that may occur includes:  Orthostatic hypotension that does not occur with repeated doses  Hemolytic anemia from Ceftriaxone use  Contact dermatitis from neomycin use *  Purple glove syndrome with phenytoin use 22. Your patient is diagnosed with Psoriasis. You can prescribe all except:  Methotrexate  Vitamin E Analogs  Tars *  Glucocorticoids 23. Isotretinoin (Accutane) is a drug employed in the treatment of severe recalcitrant cystic acne. Which one of the following is not an adverse effect associated with its use?  Conjunctivitis  Fetal abnormalities  Hyponatremia *  Hypertriglyceridemia 24. A 14-year-old patient has moderate acne that has not responded to topical Which treatment choice will the NP discuss with the patient and parents?  Doxycycline (vibramycin) *  Combination oral contraceptive medication  Spironolactone  Isotretinoin (Accutane) 25. The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising blood pressure?  Angiotensin III  Angiotensin II *  Angiotensin I  Renin 26. A patient who developed hypertension at 28 weeks gestation age. What medication do you anticipate giving?  Any one of these medications listed here may be prescribed to a pregnant *  Methyldopa  Nifedipine  Labetalol 27. A patient has been prescribing furosemide for pulmonary edema secondary to congestive heart failure. What should be included in patient teaching instructions?  Rise Slowly from sitting or reclining positions.  Report any irregular heartbeat, muscle weakness, or cramping.  Report any tenderness or swelling of the joints to your healthcare provider.  All are true * 28. Which calcium channel blocker would be ideally used to treat a dysrhythmia?  Nifedipine  Verapamil *  Amlodipine  Nicardipine 29. A patient has been taking hydrochlorothiazide and lisinopril (Prinzide, Zestoretic) for moderate hypertension. On the following the following signs and symptoms would be most concerned related to this condition?  Fatigue, weakness, dyspnea when supine  Anorexia, mild fever, dark urine  Fatigue, unexplained weight loss, polydipsia  Dull abdominal pain, anorexia, weight loss * 30. The Nurse Practitioner is teaching the NP student about acetaminophen. Which of the following would be included when teaching the student?  All of the answers are correct *  The antidote to acetaminophen overdose is acetylcysteine  Patients need to watch over-the-counter medications for acetaminophen in the product to prevent overdose  Patients with normal kidney and liver function should not take more than 4000mg per day. 31. _________ is an example of an agonist-antagonist opioid.  Morphine  Buprenorphine  Naloxone *  Diprenorphine 32. A 76-year-old female with renal insufficiency presents to the clinic with severe pain secondary to a compression fracture in the lumbar spine. She reports that the pain has been uncontrolled with tramadol, and it is decided to start treatment with an opioid. Which of the following is the best opioid for this patient?  Fentanyl transdermal patch  Hydrocodone *  Meperidine  Morphine 33. A patient with opioid use disorder has undergone detoxification with buprenorphine.  (option cutoff)  (option cutoff)  “The combination drug contains more buprenorphine”  “Buprenorphine causes more respiratory depression” 34. What are the most important characteristics that any drug can have?  Selectivity  All the answers are correct *  Effectiveness  Safety 35. Which of the following is not consistent with the rules for geriatric prescribing:  Steady state is reached more quickly in the older adult  Adverse drug responses present atypically in the older adult  Reduce the number of drugs in the patient's regimen whenever possible *  Half-life will be longer in older adults 36. The 4th to the 10th week of gestation is the period of time when there is the greatest concern about drug-induced:  Fetal hemorrhage  Fetal cardiac arrest  Fetal malformations *  Labor 37. A pediatric client is prescribed amoxicillin 25mg/kg/day divided in two daily doses. The medication is available as 125mg/5ml. The client weighs 25 pounds. What is the total daily dose for the client? Round answer to the nearest tenth __________mg.  205 mg  280 mg *  190 mg  300 mg 38. What changes in drug distribution with aging would influence prescribing a medication in a 90-year old patient?  Decreased plasma proteins *  Increased volume of distribution  Increased muscle-to-fat-ratio  Decreased lipid solubility 39. A patient is diagnosed with otitis externa. Comorbidities include diabetes mellitus, hypertension, and advanced multiple sclerosis. Which type of education regarding medication administration would you provide?  The oral administration of a prescription for hydrocortisone/neomycin/polymyxin B combination solution  The administration of topical combination medications for a prescription of fluoroquinolones/glucocorticoid com *  The oral administration of a prescription for fluoroquinolone  The administration of topical medications for a prescription of alcohol plus acetic acid solution. 40. A 6-year-old child presents with crying due to ear pain. Tympanic membranes are erythematous, bulging, and immobile, but intact. In addition to antibiotic therapy, what will the provider recommend for pain management?  Prednisone  A tympanostomy to relieve pressure in the middle ear  Low dose aspirin  Lidocaine ear drops * 41. The patient asks if there is any other option besides antibiotics to treat acute otitis media. How will you respond?  “Pain management is only necessary when antibiotics are prescribed.”  “Pain management is also part of the treatment plan for otitis media.*  “Antibiotics are the way to cure otitis media.”  “Pain management is reserved for use when the tympanic membrane is burst.” 42. Which drug would most likely be used to treat candidiasis?  Terconazole  Amphotericin B  Tioconazole  Nystatin * 43. A 19-year-old female comes to your clinic with a greenish, malodorous discharge. Vulvar pruritus is also present. On pelvic exam, vaginal mucosa is erythematous. Wet mount of discharge shows a motile organism. The patient is started on an appropriate therapy. Later that evening, the patient develops flushing, nausea and vomiting after eating dinner with a glass of wine. The patient was most likely treated with which of the following medications?  Metronidazole *  Ceftriaxone  Fluconazole  Azithromycin 44. A patient with genital herpes simplex becomes pregnant. What statement made by the patient concerning her prescribed acyclovir would indicate that teaching was effective?  “I should only take this medication during an active outbreak of my herpes,”  “I need to switch to the topical formulation of this medication now that I am pregnant.”  It is best to discontinue the use of this medication until I deliver the baby.”  “I may continue the acyclovir throughout the course of my pregnancy.” * 45. Which of the following is a common case of iron deficiency in patients in the United States?  Chronic blood loss through the gastrointestinal tract *  Rapid growth during adolescence  Vegetarian eating patterns  Decreased intestinal uptake of iron 46. Anemia of chronic renal failure is caused by the lack of:  parathyroid hormone  adrenaline  thyroid hormone  Erythropoietin * 47. A 75-year-old woman with hypertension is being treated with a thiazide. Her blood pressure responds well and reads at 120/76mmHg. After several months on the medication, she complains of being tired and weak. An analysis of the blood indicates values for which of the following?  Potassium *  Sodium  Calcium  Glucose 48. The patient is receiving anticoagulant therapy. The INR value for the patient today is 1.5. In response to this, what will you do?  The level cannot be interpreted without knowing the prothrombin time and the international normalized ratio (INR).  The level is outside the expected target therapeutic level of anticoagulation; it is too high.  The level is within the expected target therapeutic level of anticoagulation.  The level is outside the expected target therapeutic level of anticoagulation; it is too low. * 49. A patient with hypercholesterolemia who is taking 20mg of simvastatin as prescribed. After a few days, the patient’s urinalysis reports indicated the presence of myoglobin. How would you manage this patient?  Instruct the patient to take the simvastatin before meals.  Instruct the patient to decrease his dose to 10mg of simvastatin daily.  Instruct the patient to drink 250 mL of water with the simvastatin.  Instruct the patient to discontinue the simvastatin. * 50. Which of the following may cause a detrimental potentiate drug interaction?  Propranolol and albuterol  Isoniazid and rifampin  Aspirin and warfarin *  Sulbactam and ampicillin 1. A patient is started on warfarin therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What would you tell the patient?  “Because of your valve replacement, it is especially important for you to be given anticoagulant therapy. The heparin and warfarin together are more effective than one alone”  “Your concern is valid. I will call the doctor to discontinue the heparin.”  “Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications.”  “It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic.” * 52. The patient is receiving anticoagulant therapy. The INR value for the patient today is 1.5. In response to this, what will you do?  Hold the nest dose of warfarin  Prescribe protamine sulfate  Increase the heparin drip rate  Prescribe an additional dose of warfarin. * 53. Which of the following is most true of nurse practitioner prescribers?  Prescriptive authority is under the full control of the Board of Nursing in all states. *  All states allow nurse practitioners to prescribe controlled substances  All states allow some level of prescription writing by nurse practitioners.  None of the answer choices are correct. 54. Which prescriber action will have the greatest impact on the patient’s commitment to adherence to any medication therapy?  Assuring that the medication prescription will be covered by the patient's insurance  Providing mediation education that the patient can easily understand*  Scheduling once a day administration  Prescribing the medication in oral form whenever possible 55. The selection of antibiotics for the treatment of infection is based on which understanding of selective toxicity?  The ability to avoid injuring host cells.  The ability to act against a specific microbe.  The ability to suppress bacterial resistance. *  The ability to transfer DNA coding. 56. When planning care for a patient receiving a sulfonamide antibiotic, which is the appropriate intervention?  Force fluids to at least 2000 mL/day *  Encourage liquids that produce acidic urine.  Insert a Foley catheter for accurate input and output measurement.  Encourage a diet that causes an alkaline ash. 57. A patient presents to your clinic with symptoms of a potentially serious gram-negative infection. You decide to give a cephalosporin antibiotic now while awaiting laboratory results. You choose:  None of the answers are correct. *  1st generation cephalosporin  3rd generation cephalosporin  2nd generation cephalosporin 58. Acute Bacterial Rhinosinusitis Syndrome (ABRS)  Acinetobacter, Enterococcus Faecalis, Campylobacter  Escherichia Coli, klebsiella pneumoniae, proteus Mirabilis  Legionella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae  Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus, Influenza* 59. The NP explains to the NP students about penicillin. Which is true about penicillin? Select all that apply.  They are known as beta-lactam antibiotics. *  They cause bacteria to take up excess amounts of water and sodium.  They are considered one of the safest antibiotics.  They are active only against bacteria that are growing and dividing. * 60. The patient is taking daptomycin. The NP should obtain a creatine phosphokinase (CPK) level when the patient shows which symptom?  Abdominal bloating and diarrhea  Muscle pain and weakness *  Headache and visual disturbances  Increased urination and urinary urgency 61. Risk factors for extended spectrum Beta Lactamase producing organisms include all except:  Use of corticosteroids  (option cutoff)  They are considered one of the safest antibiotics  They are active only against bacteria that are growing and dividing * 62. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding nasal MRSA includes:  Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients.*  Alternate treating one nare in the morning and the other in the evening.  Take the oral medication exactly as prescribed.  Insert one-half of the dose in each nostril twice a day. 63. A patient suspected of having influenza comes to the urgent care for treatment. Which information will the NP need before prescribing oseltamivir?  Allergies to antibiotics  Length of time since onset of symptoms *  Over-the-counter medications taken in the last 48 hours  Immunization history 64. What is the treatment option for a patient who reported small, vesicular lesions on his genitals that lasted between 10 and 20 days?  Acyclovir (Zovirax) *  Three injections of penicillin  Test of cure  One time dose of azithromycin 65. A provider is about to prescribe prednisone to a patient for tendonitis. What item in the patient’s medical history would cause the provider to reconsider that action?  Systemic fungal infection *  Seborrheic dermatitis  Allergic rhinitis  Gouty arthritis