NSG 6005 Midterm Exam 1 2023 update 487questions & answers 100% correct

NSG 6005 Midterm Exam 1 2023 update 487questions & answers 100% correct   NSG 6005 Midterm Exam 1 2023 update 1. The first-line treatment for cough related to a upper respiratory infection in a five-year-old is: A. Fluids and symptomatic care B. Dextromethorphan and guaifenesin syrup (Robitussin DM for kids) C. Guaifenesin and codeine syrup (Tussin AC) D. Chlorpheniramine and dextromethorphan syrup (NyQuil for kids) 2. Pregnant patients with asthma may safely use throughout their pregnancies. A. oral terbutaline B. prednisone C. inhaled corticosteroids (budesonide) D. montelukast (Singulair) 3. A stepwise approach to the pharmacologic management of asthma: A. Begins with determining the severity of the asthma and assessing asthma control B. Is used when the asthma is severe and requires daily steroids C. Allows for each provider to determine his or her personal approach to the care of asthmatic patients D. Provides a framework for the management of severe asthmatics but is not as helpful when patients have intermittent asthma 4. Infants with reflux are initially treated with: A. Histamine 2 receptor antagonist (ranitidine) B. A PPI (omeprazole) C. Antireflux maneuvers (elevate the head of the bed) D. Prokinetic (metoclopramide) 5. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with their providers or a pharmacist first? A. Patients with kidney stones B. Pregnant patients C. Patients with heartburn D. Postmenopausal women 6. Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they: A. Are more effective than first-generation antihistamines B. Are less sedating than first-generation antihistamines C. Are prescription products and, therefore, are covered by insurance D. Can be taken with CNS sedatives, such as alcohol 7. Decongestants such as pseudoephedrine (Sudafed): A. Are Schedule III drugs in all states B. Should not be prescribed or recommended for children under four years of age C. Are effective in treating the congestion children experience with the common cold D. May cause drowsiness in patients of all ages 8. Patients with pheochromocytoma should avoid which of the following classes of drugs due to the possibility of developing hypertensive crisis? A. Expectorants B. Beta 2 agonists C. Antitussives D. Antihistamines 9. Education of patients with COPD who use inhaled corticosteroids includes the following: A. They should double the dose at the first sign of a upper respiratory infection. B. They should use the inhaled corticosteroid first and then the bronchodilator. C. They should rinse their mouths after use. D. They should not smoke for at least thirty minutes after use. 10. Monitoring a patient with persistent asthma includes: A. Monitoring how frequently the patient has a upper respiratory infection during treatment B. Monthly in-office spirometry testing C. Determining whether the patient has increased use of his or her long-acting beta 2 agonists due to exacerbations D. Evaluating the patient every one to six months to determine whether the patient needs to step up or down in his or her therapy 11. Harold, a forty-two-year-old African American, has moderate persistent asthma. Which of the following asthma medications should he use cautiously, if at all? A. Betamethasone, an inhaled corticosteroid B. Salmeterol, an inhaled long-acting beta-agonist C. Albuterol, a short-acting beta-agonist D. Montelukast, a leukotriene modifier 12. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed as follows: A. Montelukast twice a day is started when there is an asthma exacerbation. B. Patients may experience weight gain on montelukast. C. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. D. Lethargy and hypersomnia may occur when taking montelukast. 13. Lifestyle changes are the first step in the treatment of GERD. Foods that may aggravate GERD include: A. Eggs B. White bread C. Chocolate D. Chicken 14. Christy has exercise and mild persistent asthma and is prescribed two puffs of albuterol fifteen minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (Qvar) is also prescribed. Teaching regarding her inhalers includes which one of the following? A. She should use one to two puffs of albuterol per day to prevent an attack, with no more than eight puffs per day. B. Beclomethasone needs to be used every day to treat her asthma. C. She should report any systemic side effects she is experiencing, such as weight gain. D. She should use the albuterol MDI immediately after her corticosteroid MDI to facilitate bronchodilation. 15. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is: A. Use albuterol daily to control symptoms B. Minimize exacerbations to once a month C. Keep nighttime symptoms at a maximum of twice a week D. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms 16. Treatment failure in patients with PUD associated with H. pylori may be due to: A. Antimicrobial resistance B. Ineffective antacid C. Overuse of PPIs D. All of the above 17. When using the "step-up" approach in caring for a patient with GERD, the "step up" from OTC antacid use is: A. Prokinetic (metoclopramide) for four to eight weeks B. A PPI (omeprazole) for twelve weeks C. Histamine 2 receptor antagonist (ranitidine) for four to eight weeks D. Cytoprotective drug (misoprostol) for two weeks 18. Long-term use of PPIs may lead to: A. Hip fractures in at-risk persons B. Vitamin B6 deficiency C. Liver cancer D. All of the above 19. Art is a fifty five year old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be: A. "This is a parasympathetic response to the vasodilating effects of the drug." B. "Headaches are common side effects with these drugs. How severe are they?" C. "This is associated with your smoking. Let's work on having you stop smoking." D. "This is not related to your medication. Are you under a lot of stress?" 20. . In teaching about the use of sublingual nitroglycerine, the patient should be instructed: A. To swallow the tablet with a full glass of water B. To place one tablet under the tongue if chest pain occurs and allow it to dissolve C. To take one tablet every five minutes until the chest pain goes away D. That it should "burn" when placed under the tongue or it is no longer effective 21. A potentially life-threatening adverse response to ACE inhibitors is angioedema. Which of the following statements is true about this adverse response? A. Swelling of the tongue and hoarseness are the most common symptoms. B. It appears to be related to a decrease in aldosterone production. C. The presence of a dry, hacky cough indicates a high risk for this adverse response. D. Because it takes time to build up a blood level, it occurs after being on the drug for about one week. 22. Patients who are being treated for folate deficiency require monitoring of: A. Complete blood count every four weeks B. Hematocrit and hemoglobin at one week and then at eight weeks C. Reticulocyte count at one week D. Folate levels every four weeks until the hemoglobin stabilizes 23. Treatments for heart failure, including drug therapy, are based on the stages developed by the American Heart Association and the American College of Cardiology. Stage A patients are: A. Treated with drugs for hypertension and hyperlipidemia, if they exist B. Taught lifestyle management, including diet, exercise, and smoking cessation only C. Treated with ACE inhibitors to directly affect the heart failure only D. Not given any drugs in this early stage 24. Furosemide is added to a treatment regimen for heart failure, which includes digoxin. Monitoring for this combination includes: A. Hemoglobin B. Serum potassium C. Blood urea nitrogen D. Serum glucose 25. Isosorbide dinitrate is a long-acting nitrate given twice daily (BID). The schedule for administration is 7 a.m. and 2 p.m. because: A. Long-acting forms have a higher risk for toxicity. B. Orthostatic hypotension is a common adverse effect. C. It must be taken with milk or food. D. Nitrate tolerance can develop. 26. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is: A. Class I B. Class II C. Class III D. Class IV 27. Kyle has Crohn's disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is: A. Oral folic acid 1 to 2 mg/day B. Oral folic acid 1 gm/day C. IM folate weekly for at least six months D. Oral folic acid 400 mcg daily 28. The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as: A. Stage A B. Stage B C. Stage C D. Stage D 29. Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: A. Heart failure B. Angina C. MI D. Dyslipidemia 30. Which of the following classes of drugs is contraindicated in heart failure? A. Nitrates B. Long-acting dihydropyridines C. Calcium channel blockers D. Alpha-beta blockers 31. Which of the following is true about procainamide and its dosing schedule? A. It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen. B. GI adverse effects are common, so the drug should be taken with food. C. Adherence can be improved by using a sustained-release formulation that can be given once daily. D. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level. 32. At which stage/classification of hypertension should drug therapy be instituted according to the JNC-7 Report? A. Prehypertension B. Stage 1 C. Stage 2 D. Any stage where the blood pressure is greater than 120/80 mm Hg 33. Jose is a twelve-year-old overweight child with a total cholesterol level of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include with a reevaluation in six months. A. statins B. niacin C. sterols D. bile acid-binding resins 34. Patients who have angina, regardless of class, who are also diabetic should be on: A. Nitrates B. Beta blockers C. ACE inhibitors D. Calcium channel blockers 35. If not chosen as the first drug in hypertension treatment, which drug class should be added as the second step because it will enhance the effects of most other agents? A. ACE inhibitors B. Beta blockers C. Calcium channel blockers D. Diuretics 36. Donald has been diagnosed with hyperlipidemia. On the basis of his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: A. Become a vegetarian since this disorder is associated with eating red meat B. Stop taking the drug if abdominal cramps and diarrhea develop C. Report muscle weakness or tenderness and dark urine to his provider immediately D. Expect "hot flash" sensations during the first two weeks of therapy 37. 1.2ND LINE TX FOR GERD: quadruple therapy - 2nd line therapy for those who fail treatment initially is the PPI twice a day plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days 38. 2.39. How will you choose a diuretic in the treatment of hypertension?: - Check kidney function, thiazide diuretic need to have a GFR higher than the mid 40 mL/min range... so you would want to check a BUN and creatinine in these patients 39. 3.After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is:: 1. Testing for H. pylori eradication with a serum ELISA test 2. Endoscopy by a specialist 3. A proton pump inhibitor for 8 to 12 weeks until healing is complete *All of the above* 40. .Angela is a 5-year-old patient 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 Angela?: 41. 5.Antacid's - S/E: constipation and diarrhea 42. 6.Decongestants such as pseudoephedrine (Sudafed):: 43. .Flovent: 44. .How are upper respiratory infections treated?: - 45. Phenylephrine can be useful for patients with symptomatic relief in adults without - HTN 46. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is:: subsalicylate for 14 days(P-M-T+BSx14) 47. .If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be:: - Proton pump inhibitor (omeprazole) for 12 weeks 48. 12.Jaide 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 following normal food and water precautions as well as taking:: 49. 13.Mech of action for muscarinic antagonist: antimuscarinic or anticholinergic agent acts mainly on the M3 muscarinic receptors located on smooth muscle cells and submucosal glands this leads to a reduction in smooth muscle contraction and mucus secretion and thus produces a bronchodilatory effect 50. 14.Metoclopramide improves gastroesophageal reflux disease symptoms by:: 51. 15.Michelle is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for:: - Megaloblastic anemia 52. 16.Misoprostol should not be given to: 53. 17.Patients on digioxin and albuterol should have what checked?: - Potassium level 54. 18.Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:: 55. 19.Reglan (metoclopramide): - LOWERS esophageal tone- The antiemetic action of metoclopramide is due to its antagonist activity at the D2 receptors and the chemoreceptor trigger zone in the CNS. this action prevents nausea and vomiting triggered by most stimuli at higher doses the 5HT3 antagonists activity may also contribute to the antiemetic effect- Remember that the D2 receptor is a dopamine receptor and at the higher the dose the 5HT3 which is the serotonin receptor antagonist activity so it works both on dopamine receptors and serotonin receptors but more so on the dopamine receptors 56. 20.Richard is a 10-year-old patient who presents with uncomfortable 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 child would be:: 57. 22.Stan, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all?: - Salmeterol, an inhaled long-acting beta-agonist 58. 23.Tiotropium bromide (Spiriva) is an inhaled anticholinergic:: 59. 24.Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of:: 60. 26.What are the disadvantages of using stimulant laxatives for prolonged periods of time?: - - Long term use of stimulant laxatives can lead to dependence 61. 27.What conditions should cause a patient to avoid the use of antihistamines?: 62. .What do H2 blockers do?: stomach this decreases the production of aci 63. What do PPI's do?: or the ATPA or more commonly the gastric proton pump of the gastric parietal cells 64. 30.What ethnic background should not be prescribed long-acting beta agonists?: 65. 31.What is the first line therapy for peptic ulcer disease with a positive H. pylori?: - twice daily for 7-14 days 66. 32.What is the mechanism of action of codeine in the suppression of cough?: Works on the cough center of the brain in themedulla oblongata 67. 33.What is the mechanism of action of docusate sodium?: - feces ...it typically comes in the form a sodium, calcium or potassium salt 68. 34.What is the mechanism of action of ondansetron?: - - Highly specific selective serotonin receptor antagonist, with a low affinity for dopamine receptors - may stimulate vagal afferents via the serotonin receptors to initiate the vomiting reflex 69. 35.What is the mechanism of action of the phenothiazine antiemetics?: receptors in various pathways to the CNS...the D2 or dopamine blockade results in antipsychotic and antiemetic and other effects 70. 36.What is the Step Down Approach with GERD?: - PPI daily for 8 weeks, if the symptoms have not resolved then the dose of the PPI is doubled for another 4-8 weeks ....after 4 weeks a lower dose of PPI is tried ...if no relief after 8 weeks of twice daily PPI then referral to a GI doctor is warranted 71. 37.What is the Step Up Approach with GERD?: - - If symptoms are refractory after 4-8 weeks of treatment or if endoscopy shows evidence of erosive disease then PPI's become central management ...first once daily and if symptoms continue then twice daily 72. Asthma exacerbations at home are managed by the patient by: CORRECT Increasing the frequency of beta 2 agonists and contacting his or her provider Doubling inhaled corticosteroid dose Increasing the frequency of beta 2 agonists Starting montelukast (Singulair) 73. Howard is a seventy-two-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: CORRECT Urinary retention Cardiac output Peripheral edema Skin for rash 74. A patient with a COPD exacerbation may require ... Doubling of inhaled corticosteroid dose CORRECT Systemic corticosteroid burst Continuous inhaled beta 2 agonists Leukotriene therapy 75. Decongestants such as pseudoephedrine (Sudafed): Are Schedule III drugs in all states CORRECT Should not be prescribed or recommended for children under four years of age Are effective in treating the congestion children experience with the common cold May cause drowsiness in patients of all ages 76. An acceptable first-line treatment for PUD disease with positive H. pylori test is: Histamine 2 receptor antagonists for four to eight weeks A PPI twice daily (BID) for twelve weeks until healing is complete CORRECT A PPI BID plus clarithromycin plus amoxicillin for fourteen days A PPI BID and levofloxacin for fourteen days 77. In five- to eleven-year-old children, mild-persistent asthma is diagnosed when asthma symptoms occur: At nighttime one to two times a month CORRECT At nighttime three to four times a month Less than twice a week Daily 78. When treating a patient using the "step-down" approach, the patient with GERD is started on first antacids histamine 2 receptor antagonists prokinetics CORRECT PPIs 79. Monitoring a patient with persistent asthma includes: Monitoring how frequently the patient has a upper respiratory infection during treatment Monthly in-office spirometry testing Determining whether the patient has increased use of his or her long-acting beta 2 agonists due to exacerbations CORRECT Evaluating the patient every one to six months to determine whether the patient needs to step up or down in his or her therapy 80. Patients with pheochromocytoma should avoid which of the following classes of drugs due to the possibility of developing hypertensive crisis? Expectorants CORRECT Beta 2 agonists Antitussives Antihistamines 81. Metoclopramide improves GERD symptoms by: Reducing acid secretion Increasing gastric pH CORRECT Increasing lower esophageal tone Decreasing lower esophageal tone 82. Patients who are on chronic long-term PPI therapy require monitoring for: CORRECT Iron deficiency anemia, vitamin B12, and calcium deficiency Folate and magnesium deficiency Elevated uric acid levels leading to gout Hypokalemia and hypocalcemia 83. Digoxin levels need to be monitored closely when the following medication is started: 84. Patients with pheochromocytoma should avoid which of the following classes of drugs because of the possibility of developing hypertensive crisis? 85. Stan, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? 86. Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug Administration due to the: 87. The bronchodilator of choice for patients taking propranolol is: 88. Mathew is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin's diet for weight loss. The appropriate response would be: 89. Marty takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to: 90. Tiotropium bromide (Spiriva) is an inhaled anticholinergic: 91. Angela has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes: 92. When educating patients who are starting on inhaled corticosteroids, the provider should tell them that: 93. Patients with allergic rhinitis may benefit from a prescription of: - Fluticasone (Flonase) Cetirizine (Zyrtec) OTC cromolyn nasal spray (Nasalcrom) * Any of the above * 94. William is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: 95. When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to: 96. Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population: Older adults Hypertensive patients Infants * All of the above * 97. George is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be: 98. Prior to developing a plan for the treatment of asthma, the patient's asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults, mild-persistent asthma is classified as asthma symptoms that occur: 99. In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur: 100. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is: - Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms 101. Treatment for mild intermittent asthma is: 102. The first-line therapy for mild-persistent asthma is: 103. Monitoring a patient with persistent asthma includes: in their therapy 104. Asthma exacerbations at home are managed by the patient by: 105. Patients who are at risk of a One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include: A. Myocardial ischemia and injury secondary to myocardial infarction B. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction C. Increased demands of the heart beyond its ability to adapt secondary to anemia D. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension 106. One goal of asthma management in children is: 107. Medications used in the management of patients with chronic obstructive pulmonary disease (COPD) include: - Inhaled beta-2-agonists Inhaled anticholinergics (ipratropium) Inhaled corticosteroids * All of the above * 108. Patients with a COPD exacerbation may require: 109. Patients with COPD require monitoring of: 110. Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes: - Use the inhaled beta-agonist first, followed by the inhaled corticosteroid. 111. The most common bacterial pathogen in community-acquired pneumonia is 112. The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be: 113. The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia and can be treated as an outpatient would be 114. If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be: 115. Jennifer is 34 weeks pregnant and has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe? 116. Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in: 117. Along with prescribing antibiotics, adults with pneumonia should be instructed on lifestyle modifications to improve outcomes, including: 118. Liam is a 4-week-old infant who has been diagnosed with chlamydial pneumonia. An appropriate treatment for his pneumonia would be: 119. Charlie is a 4-year-old patient who has suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia? 120. Bailey is a 14-year-old patient who presents to the clinic with symptoms consistent with mycoplasma pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent? 121. Drug resistant tuberculosis (TB) is defined as TB that is resistant to: 122. Goals when treating tuberculosis include: 123. The principles of drug therapy for the treatment of tuberculosis include: 124. Lilliana has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month regimen consists of: Four months of INH and rifampin 125. Jordan has extensively resistant tuberculosis (TB). Treatment for extensively resistant TB would include: - Treatment with at least two drugs to which the TB is susceptible 126. Sunny is 24 weeks pregnant and has been diagnosed with tuberculosis (TB). Treatment regimens for a pregnant patient with TB would include: 127. Lola is a 5-year-old patient who has been diagnosed with tuberculosis. His treatment would include: 128. Frankie is a 9-year-old patient who lives in a household with a family member newly diagnosed with tuberculosis (TB). To prevent Ezekiel from developing TB he should be treated with: 129. Cidney is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes: 130. Compliance with directly observed therapy can be increased by: - Convenient clinic times Incentives such as food, clothing, and transportation costs Offering gifts for compliance *All of the above* 131. Patients taking antacids should be educated regarding these drugs, including letting them know that: - They may cause constipation or diarrhea Many are high in sodium They should separate antacids from other medications by 1 hour *All of the above* 132. Charlotte has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: 133. Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: - May lead to toxicity if taken with aspirin Is contraindicated in children with flu-like illness Has antimicrobial effects against bacterial and viral enteropathogens *All of the above* 134. Joe presents with complaints of "heartburn" that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be: 135. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: 136. Michelle is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: 137. Richard is a 10-year-old patient who presents with uncomfortable 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 child would be: 138. Methylnaltrexone is used to treat constipation in: 139. An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: 140. Gastroesophageal reflux disease may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: 141. Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Food or drink that may aggravate GERD include: 142. Metoclopramide improves gastroesophageal reflux disease symptoms by: 143. Antacids treat gastroesophageal reflux disease by: 144. When treating patients using the "Step-Down" approach the patient with gastroesophageal reflux disease is started on first. 145. If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be: 146. If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is not improving, the plan of care would be: 147. The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving is: 148. Long-term use of proton pump inhibitors may lead to: 149. An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: - Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days 150. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of: 151. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is: 14 days 152. After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: 153. The treatment goals when treating urinary tract infection (UTI) include: - Eradication of infecting organism Relief of symptoms Prevention of recurrence of the UTI *All of the above* 154. Janis is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be: 155. Laurel is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be: 156. Karina is a 28-year-old pregnant woman at 38 weeks' gestation who is diagnosed with a lower urinary tract infection (UTI). She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be: 157. Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? 158. Carmin is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: 159. Monitoring for a healthy, non-pregnant adult patient being treated for a urinary tract infection is: - Symptom resolution in 48 hours 160. Monitoring for a child who has had a urinary tract infection is: 161. Monitoring for a pregnant woman who has had a urinary tract infection is: 162. Along with an antibiotic prescription, lifestyle education for a non-pregnant adult female who has had a urinary tract infection includes: 163. Cheryl a is a healthy non-pregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be: 164. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes: 165. What assessments should be made before prescribing any antihypertensive agent? BP, RF, and head to toe assessment. Assess diet, sodium intake, electrolytes, and potassium levels. Prior to prescribing any antihypertensives, creatinine and BUN levels should be evaluated. Confirmation of elevated BP at 3 different times. Children over 3 years old should be assessed at least once at every visit-preferred method for children is by auscultation, the correct measurement requires using a cuff that is appropriate to the child's upper arm. 12 lead EKG. UA, albumin, albumin/creatinine ratio. Diabetics or those with renal disease should have the albumin/creatinine ratio annually. The presence of albuminuria, micro albuminuria even in the setting of normal GFR is associated with increased cardiovascular risk. Blood sugar, hct, serum calcium, and lipid profile. 166. Why are ACE inhibitors the drug of choice in diabetic patients with hypertension? - ACE-Is will improve insulin sensitivity, as well as reduce the effects of DM on the kidneys. Protect the kidneys, watch for renal function, any creatinine >2.5 requires dose reduction. Prevents diabetic nephropathy or slow its progression. Reduce albuminuria and BP. ACEIs and ARBs should be used to treat the HTN. Renal protection, reduces the conversion of AT II and improve the insulin sensitivity. 167. What is the drug of choice to improve symptoms for patients taking propranolol? 168. What is the most common adverse effect of an ACE inhibitor? cough. Reduce dose with either of these if Cr >2.5. Most are associated with hypotension, dizziness, HA, fatigue, orthostatic hypotension, tachyphylaxis. 169. What is the action of an ACE inhibitor? heart. Blocks the RAAS system leads to rennin acts on angiotensinogen to angiotensin I to angiotensin II through ACE. Angiotensin II stimulates aldosterone causing sodium and water while losing potassium via the kidney. ACE is also involved in the inactivation of bradykinin a vasodilator. Bradykin is what causes the cough (irritating the lungs). 170. What is the action of an Angiotensin Receptor Blocker? smooth muscle contraction. One of the greatest advantages: doesn't produce the dry, hacking cough that ACE-Is do. Similar to ACE-I except to bradykinin activity (no cough), lowers BP, decreases vascular resistance, decreases pulmonary cap wedge pressure, decreases HR, increases cardiac index. 171. What ethnic background should not be prescribed long-acting beta-agonists? 172. What is tiotropium used to treat? 173. What is the action of a Calcium Channel Blocker? inhibits transmembrane influx of extracellular calcium ions across myocardial and vascular smooth muscle cell membranes without changing serum calcium concentrations. This results in inhibition of cardiac and vascular smooth muscle contraction, thereby dilating main coronary and systemic arteries. Vasodilatation with decreased peripheral resistance and increased heart rate. Nondihydropyridine CCB: inhibits extracellular calcium ion influx across membranes of myocardial cells and vascular smooth muscle cells. Resulting in inhibition of cardiac and vascular smooth muscle contraction and thereby dilating main coronary and systemic arteries. No effect on serum calcium contractions. Substantial inhibitory effects on cardiac conduction system, acting principally at AV node, with some effects at sinus node. 174. What are the adverse effects of a dihydropyridine-type calcium channel blocker? (dihydropyridine=vessel loving) = peripheral edema. Type 1 (non-dihydropyridine=heart loving)=bradycardia, dizziness, hypotension. 175. A 70-year-old patient is admitted with peripheral edema. He is taking a calcium channel blocker and metformin. What is the cause of his peripheral edema? report swelling of the hands, feet, ankles, and decreased urine output. 176. What special populations should not be prescribed pseudoephedrine? symptomatic management. Schedule III- addictive personalities, HTN, CAD. Children under 4= Infants cause sudden death, not recommended for children under 4. Anytime thinking of cough and cold medications you should always think of the elderly, very young and HTN. 177. How is amlodipine metabolized? juice, it will increase amlodipine level. Has a half life of 30-50 hours (56hr in hepatic impairment), eliminated via urine. 178. A patient is prescribed amlodipine. She develops reflex tachycardia. What is the reason for the development of bradycardia? causes such a dramatic drop in BP that baroreceptor reflex is triggered. The baroreceptors are in the aortic arch. The baroreceptor causes sympathetic stimulation of the heart. It increases pulse, it increases contractile force. Peripheral or facial edema can result. Hypotension is a common adverse effect of CCB. A beta blocker can be administered to prevent the reflex tachycardia. When prescribing CCB you always start low and progress slow. Older patients should be started at half the regular dose. Decrease in SA and AV node conduction velocity occurs. 179. What drug should be prescribed for a patient with nasal congestion with hypertension? by inhalation can be used safely for nasal congestion by patients with HTN. 180. What patient teaching will you provide when prescribing amiodarone? hypotension. Avoid taking hot showers or baths, they will cause hypotension. COPD patients. For doses taken more than once daily, evenly space the doses. An abrupt withdrawal may result in life threatening arrhythmia, HTN or myocardial ischemia. Keep enough medication on vacations, holidays, and weekends. If a dose is missed at its usual time, take the next day. 181. What are the drug interactions with digoxin? levels and lead to toxicity. Drugs that cause bradycardia will increase the risk of bradycardia. Albuterol and digoxin will decrease digoxin levels. Levels go down especially with increased albuterol use. Phenobarbital, phenytoin, rifampin = decrease effect of digoxin. Thiazide and loop diuretics, mezlocillin, piperacillin, ticarcillin, amphotericin B, glucocorticoids=may cause hypokalemia, increase risk of digoxin toxicity. Calcium preparations = facilitates toxicity by accelerating overloading of intracellular calcium stores. Spironolactone=increases digoxin half life. Beta adrenergic blockers, quinidine, disopyramide + additive bradycardia. Antacids, colestipol, kaolinpectin, cholestyramine=decreases absorption of CG if given concurrently. Thyroid hormones=may decrease therapeutic effects and cause arrhythmias. Reductase inhibitors=increase digoxin levels. Albuterol=decreases digoxin levels. 182. What is the purpose of a thyroid panel with amiodarone what is nitrate tolerance? hyperthyroidism. It is also a known cause of hypothyroidism, interferes with thyroid hormone (TH). Can cause hypothyroidism in normal thyroid patients. 183. What are the adverse effects of statins. HA, urine will get dark, CPK checks for muscle breakdown. Monitor liver function and initially and then every 1-3 months. S/s unusual or increased muscle weakness, dark urine. 184. What is nitrate tolerance? (helps prevent intolerance). This is due attenuation of the vascular effects of nitrates. If the doses are too close together then the patient will develop nitrate tolerance. In regards to adverse effects, assess the severity of the HA (is expected). Patient teaching for sublingual use: if swallowed there will be decrease in effect, under tongue to dissolve. Tachyphylaxis: once start using nitrates and you continue using the medication you are going to get to a level where increasing the dose isn't going to necessarily help. It's a ceiling effect. Only after nitrates have been absent from the body for 10-12 hours does the effectiveness return. 185. What are the adverse effects of antihistamines? confusion, dry mouth. In the elderly pt 1st generation antihistamines shouldn't be prescribed. The risk of urinary retention is extremely large. 186. What patient education will you provide for a client in which you have prescribed a statin Don't take if you are pregnant or planning to become pregnant. Administer the medication at night (works best at HS, the bodies cholesterol time). Best taken at night. Don't take with grapefruit juice because it is an inhibitor of P450. Call practitioner with weakness or muscle pain because it's a sign of rhabdomyolysis. Limit fats in the diet, exercise and weight control. 187. How will you choose a diuretic in the treatment of hypertension? with an (estimated GFR higher than mid 40) this is key, if less choose an alternative. Furosemide (lasix) and HTZ are not K sparing. CrCl <25, race, amount of dieresis you are going to go with things like thiazide diuretics, sironolactone. Extensive dieresis you will use furosemide. Depends on K. If renal disease usually use angiotensin receptor blockers or ACE-I along with diuretics. Look at the level of kidney function and GFR that is in the mid 40s range. Want to know that kidneys are functioning, as long as looking in direction of renal functions. You have a question you have a 57 year old HTN patient that you want to start furosemide or any diuretic. What is one of the first things you would check or monitor if you want to lean toward renal function. 188. What are the central nervous system adverse effects with montelukast (Singular)? to the inflammatory process. They include smooth muscle contractility, neutrophil aggregation, degranulation and chemotaxis which is vascular permeability. Montelukast (Singular) is rapidly absorbed following oral administration. Its peak concentration is reached in 3-4 hours. Adverse effects: agitation, aggression, anxiety, dream abnormalities, hallucinations, depression, irritability, insomnia, restlessness, suicidal thinking, and tremor. Be sure that you are assessing these pts for suicidal ideation. Instruct the patient and families about the adverse effects. Can be prescribed to pts 2 years and older, but it has to be with persistent asthma, not for sudden onset. Zafirlukast & Lukast is indicated in the treatment of pts with chronic asthma 5 years and older. The FDA recommends that patients be informed of the potential for neuropsychiatric events with these medications and discontinue if neuropsychiatric problems arise. Sleep disorders were most frequent. 189. Ray has been diagnosed with hypertension and an ACE inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for: A. Hypokalemia B. Impotence C. Decreased renal function D. Inability to concentrate 190. ACE inhibitors are the drug of choice in treating hypertension in diabetic patients because they: A. Improve insulin sensitivity B. Improve renal hemodynamics C. Reduce the production of angiotensin II D. All of the above 191. ACE inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder and the reason for its use? A. Stable angina because it decreases the thickening of vascular walls to decreased MOD. B. Heart failure because it reduces remodeling of injured myocardial tissues. C. Both A and B are true and the reasons are correct D. Both A and B are true but the reasons are wrong E. Neither A nor B are true 192. Despite good blood pressure control, a NP might change a patient's drug from an ACEI to an angiotensin II receptor blocker (ARB) because the ARB: A. Is stronger than the ACEI B. Does not produce a dry, hacky cough C. Has no effect on the renal system D. Reduces sodium and water retention 193. While taken an ARB, patients need to avoid certain over-the-counter drugs without first consulting the provider because: A. Cimetidine is metabolized by the CYP 3A4 isoenzymes B. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels C. Both A and B D. Neither A nor B 194. Laboratory monitoring for patients on ACEIs or ARBs should include: A. White blood cells counts with the drug dose increased for elevations above 10,000 B. Liver function tests with the drug dose stopped for ALT values 2 normal C. Serum creatinine levels with the drug dose reduced for values above 2.5 mg/dL D. Serum glucose levels with the drug dose increased for levels above 120 mg/dL 195. Jacob has hypertension for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it: A. Decreases the amount of calcium inside the cell B. Reduces stroke volume C. Increases the activity of the Na+/K+/ATPase pump indirectly D. Decreases heart rate 196. Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker? A. Bradycardia B. Hepatic impairment C. Increased contractility D. Edema of the hands and feet 197. Patient teaching related to amlodipine includes: A. Increase calcium intake to prevent osteoporosis from calcium blockade. B. Do not crush the tablet; it must be given in liquid form if the patient has trouble swallowing it. C. Avoid grapefruit juice as it affects the metabolism of this drug. D. Rise slowly from a supine position to reduce orthostatic hypotension. 198. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker doses for her should be: A. Started at about half the usual dose B. Not raised above the usual dose for an adult C. Given once daily due to memory issues in the older adult D. Withheld if she experiences gastroesophageal reflux 199. Larry has heart failure which is being treated with digoxin because it exhibits: A. Negative inotropism B. Positive chronotropism C. Both A and B D. Neither A nor B 200. Furosemide is added to a treatment regimen for heart failure which includes digoxin. Monitoring for this combination includes: A. Hemoglobin B. Serum potassium C. Blood urea nitrogen D. Serum glucose 201. Which of the following create higher risk for digoxin toxicity? Both the cause and the reason for it must be correct. A. Older adults due to reduced renal function B. Administration of aldosterone antagonist diuretics due to decreased potassium levels C. Taking an antacid for GERD because it increases the absorption of digoxin D. Doses between 0.25 and 0.5 mg/day 202. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: A. Within 6 hours of the last dose B. Because a reference point is needed in adjusting a dose C. After three half-lives from the starting of the drug D. When a patient has stable renal function 203. Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate: A. Widening of the area of infarction B. Onset of congestive heart failure C. An electrolyte imbalance involving potassium D. Renal dysfunction 204. Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT: A. Notify your health-care provider immediately if you have visual change B. Monitor your own blood pressure and pulse daily C. Take a hot shower or bath if you feel dizzy D. Use a sunscreen on exposed body surfaces 205. The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response? A. "Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism." B. "Amiodarone damages the thyroid gland and can result in inflammation of that gland causing hyperthyroidism." C. "Amiodarone is a broad spectrum drug with many adverse effects. Many different tests need to be done before it is given." D. "Amiodarone can cause corneal deposits in up to 25% of patients." 206. Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be: A. "This is a parasympathetic response to the vasodilating effects of the drug." B. "Headaches are common side effects with these drugs. How severe are they?" C. "This is associated with your smoking. Let's work on having you stop smoking." D. "This is not related to your medication. Are you under a lot of stress?" 207. Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor? A. Elevated serum transaminase B. Increased serum creatinine C. Elevated creatinine kinase D. Increased white blood cells counts 208. Because of the pattern of cholesterol synthesis, reductase inhibitors are given: A. In the evening in a single daily dose B. Twice daily in the morning and the evening C. With each meal and at bedtime D. In the morning before eating 209. Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following labs should be monitored? A. Serum alanine aminotransferase B. Serum amylase C. Serum creatinine D. Phenylketonuria 210. Niaspan is less likely to cause which side effect that is common to niacin? A. Gastrointestinal irritation B. Cutaneous flushing C. Dehydration D. Headaches 211. Which of the following statements is true? A. Niacin is a B-complex vitamin and taking double the dose of the over-the-counter vitamin will lower LDL and save money. B. Niacin has been shown to reduce all-cause mortality for patients with CAD if taken in prescription strength. C. Niacin should be given on an empty stomach to avoid GI irritation. D. All of the above 212. Dulcea has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? A. Reactive airway disease/asthma B. Inflammatory bowel disease C. Allergy to aspirin D. Gallbladder disease 213. Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. A. Reductase inhibitors, due to an increased risk for rhabdomyolysis B. Bile-acid sequestering resins, due to interference with folic acid absorption C. Grapefruit juice, due to interference with metabolism D. Niacin, due to decreased gemfibrozil activity 214. Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug: A. Blocks synthesis of cholesterol in the liver B. Exchanges chloride ions for negatively charged acids in the bowel C. Increases HDL levels the most among the classes D. Blocks the lipoprotein lipase pathway 215. Because of their site of action, bile acid sequestering resins: A. Should be administered separated from other drugs by at least 4 hours B. May increase the risk for bleeding C. Both A and B D. Neither A nor B 216. Colestipol comes in a powdered form. The patient is taught to: A. Take the powder dry and follow it with at least 8 ounces of water B. Take it with a meal to enhance its action on fatty food C. Mix the powder with 4 to 6 ounces of milk or fruit juice D. Take after the evening meal to coincide with cholesterol synthesis 217. The choice of diuretic to use in treating hypertension is based on: A. Presence of diabetes with loop diuretics being used for these patients B. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range C. Ethnicity with aldosterone antagonists best for African Americans and older adults D. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL 218. Digoxin levels need to be monitored closely when the following medication is started: A. Loratadine B. Diphenhydramine C. Ipratropium D. Albuterol 219. Patients with pheochromocytoma should avoid which of the following classes of drugs due to the possibility of developing hypertensive crisis? A. Expectorants B. Beta-2-agonists C. Antitussives D. Antihistamines 220. Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? A. Betamethasone, an inhaled corticosteroid B. Salmeterol, an inhaled long-acting beta-agonist C. Albuterol, a short-acting beta-agonist D. Montelukast, a leukotriene modifier 221. Long-acting beta-agonists (LTBAs) received a Black Box warning from the U.S. Food and Drug Administration due to the: A. Risk of life-threatening dermatological reactions B. Increased incidence of cardiac events when LTBAs are used C. Increased risk of asthma-related deaths when LTBAs are used D. Risk for life-threatening alterations in electrolytes 222. The bronchodilator of choice for patients taking propranolol is: A. Albuterol B. Pirbuterol C. Formoterol D. Ipratropium 223. James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin's diet for weight loss. The appropriate response would be: A. Congratulate him on making a positive change in his life B. Recommend he try stopping smoking instead of the Atkin's diet C. Schedule him for regular serum theophylline levels during his diet due to increased excretion of theophylline D. Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels 224. Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to: A. Reassure him this is probably a viral infection and should be better soon B. Have him seen the same day for an assessment and theophylline level C. Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better D. Order a theophylline level at the lab for him 225. Tiotropium bromide (Spiriva) is an inhaled anticholinergic: A. Used for the treatment of COPD B. Used in the treatment of asthma C. Combined with albuterol for treatment of asthma exacerbations D. Combined with fluticasone for the treatment of persistent asthma 226. Montelukast (Singulair) may be prescribed for: A. A 6 year old with exercise-induced asthma B. A 2 year old with moderate persistent asthma C. An 18 month old with seasonal allergic rhinitis D. None of the above; montelukast is not approved for use in children 227. the known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include: A. Albuterol B. MMR vaccine C. Insulin D. None of the above 228. When educating patients who are starting on inhaled corticosteroids, the provider should include: A. They need to get any live vaccines before starting the medication. B. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. C. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. D. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids. 229. Patients with allergic rhinitis may benefit from a prescription of: A. Fluticasone (Flonase) B. Cetirizine (Zyrtec) C. OTC cromolyn nasal spray (Nasalcrom) D. Any of the above 230. Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: A. Urinary retention B. Cardiac output C. Peripheral edema D. Skin for rash 231. Martin is a 60 year old with hypertension. The first-line decongestant to prescribe would be: A. Oral pseudoephedrine B. Oral phenylephrine C. Nasal oxymetazoline D. Nasal azelastine 232. Angina is produced by an imbalance between oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS? A. Calcium channel blockers B. Beta blockers C. ACE inhibitors D. Aspirin 233. Not all chest pain is caused by myocardial ischemia. Non-cardiac causes of chest pain include: A. Pulmonary embolism B. Pneumonia C. Gastroesophageal reflux D. All of the above 234. Patients at high risk for developing significant coronary heart disease are those with: A. LDL values between 100 and 130 B. Systolic blood pressure between 120 and 130 C. Class III angina D. Obesity 235. To reduce mortality, all patients with angina, regardless of Class, should be on: A. Aspirin 81 to 325 mg/d B. Nitroglycerin sublingually for chest pain C. ACE inhibitors or ARBs D. Digoxin 236. Patients who have angina, regardless of Class, who are also diabetic, should be on: A. Nitrates B. Beta blockers C. ACE inhibitors D. Calcium channel blockers 237. Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct. A. Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload. B. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload. C. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply. D. Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function. 238. The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as: A. Stage A B. Stage B C. Stage C D. Stage D 239. Diagnosis of heart failure cannot be made by symptoms alone since many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is: A. Chest x-rays that show cephalization and measure heart size B. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction C. Complete blood count, BUN, and serum electrolytes that facilitate staging for end-organ damage D. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction 240. treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with: A. Drugs for hypertension and hyperlipidemia, if they exist B. Lifestyle management including diet, exercise, and smoking cessation only C. ACE inhibitors to directly affect the heart failure only D. No drugs are used in this early stage 241. Class I recommendations for Stage A heart failure include: A. Aerobic exercise within tolerance levels to prevent the development of heart failure B. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention C. Beta blockers for all patients regardless of cardiac history D. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias 242. Stage B patients should have beta blockers added to their heart failure treatment regimen when: A. They have an ejection fraction less than 40% B. They have had a recent MI C. Both A and B D. Neither A nor B 243. Increased life expectancy for patients with heart failure has been associated with the use of: A. ACE inhibitors, especially when started early in the disease process B. All beta blockers regardless of selectivity C. Thiazide and Loop diuretics D. Cardiac glycosides 244. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true? A. Diuretics reduce preload associated with fluid retention. B. Diuretics can be used earlier than Stage C when the goal is control of hypertension. C. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism. D. Diuretics from the potassium-sparing class should be used when using an ARB. 245. Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with: A. Ejection fractions above 40% B. An audible S3 C. Mitral stenosis as a primary cause for heart failure D. Renal insufficiency 246. Which of the following classes of drugs is contraindicated in heart failure? A. Nitrates B. Long-acting dihydropyridines C. Calcium channel blockers D. Alpha-beta blockers 247. Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is: A. Aldosterone antagonists B. Eplerenone C. ACE inhibitors D. ARBs 248. Nitrates are especially helpful for patients with angina who also have: A. Heart failure B. Hypertension C. Both A and B D. Neither A nor B 249. Beta blockers are especially helpful for patients with exertional angina who also have: A. Arrhythmias B. Hypothyroidism C. Hyperlipidemia D. Atherosclerosis 250. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use? A. These drugs are useful for immediate symptom relief when the patient is certain it is angina. B. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away. C. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than three doses. If chest pain is still not relieved, go to the hospital. D. All of the above 251. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because: A. Nitrates increase MOS and beta blockers increase MOD B. Their additive affects permit lower doses of both drugs and their adverse reactions cancel each other out. C. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease D. All of the above 252. Although they are often described as helpful in the lay media, which of the following therapies have not been shown to be helpful based on clinical evidence? A. Vitamins C and E B. Co-enzyme Q10 C. Folic acid D. All of the above 253. Drug choices to treat angina in older adults differ from those of younger adults only in: A. Consideration of risk factors for diseases associated with and increased in aging B. The placement of drug therapy as a treatment choice before lifestyle changes are tried C. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult D. Those with higher risk for silent myocardial infarction (MI) 254. Which of the following drugs has been associated with increased risk for myocardial infarction (MI) in women? A. Aspirin B. Beta blockers C. Estrogen replacement D. Lipid-lowering agents 255. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT: A. Patients often require multiple drugs B. A large number of angina patients are older adults on fixed incomes C. Generic formulations may be cheaper but are rarely bioequivalent D. Lack of drug selectivity may result in increased adverse reactions 256. Five questions should be asked during the follow up of any angina patient. They include: A. Have there been any changes in lab data since the last visit? B. Has the level of physical activity associated with the angina changed since the last visit? C. Have new risk factors come to light in producing the angina? D. Is the patient filling prescriptions and taking the drugs as prescribed? 257. Situations that suggest referral to a specialist is appropriate include: A. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors B. When a post-MI patient develops new-onset angina C. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina D. All of the above 258. Prior to developing a plan for the treatment of asthma, the patient's asthma should be classified according to the N