Chapter 23 & 24 Woo & Robinson questions and answers.docx

  Question 1. The 43-year-old patient comes into the clinic with flu-like symptoms. The patient's onset of symptoms is less than 48 hours. The APN will prescribe oseltamivir and understands that the half-life is which of the following? 1. 20 to 24 hours 2. 6 to 10 hours 3. 2.5 to 5 hours 4. 12 to 16 hours - Correct Answers: 2. 6 to 10 hours Option 2: The half-life for oseltamivir is 6 to 10 hours. Rationales Option 1: The half-life for peramivir is 20 hours. Option 3: The half-life for zanamivir is 2.5 to 5.1 hours. An APN is prescribing oseltamivir for the onset of flu-like symptoms to a 44-year-old patient. Which dosage is appropriate for this patient? 1. 75 mg PO bid for 5 days and start within 48 hours of symptoms 2. 75 mg PO bid for 4 days and start within 48 hours of symptoms 3. 75 mg PO bid for 3 days and start within 48 hours of symptoms 4. 75 mg PO bid for 2 days and start within 48 hours of symptoms - Correct Answers: 1. 75 mg PO bid for 5 days and start within 48 hours of symptoms Option 1: 75 mg PO bid for 5 days and start within 48 hours of symptoms is the correct dosage and time frame. The APN diagnosed a 54-year-old patient with onychomycosis. Which medication regimen is most appropriate for this patient? 1. Itraconazole 100 mg PO once daily with meal for 12 consecutive weeks 2. Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks 3. Terbinafine 200 mg PO once daily with meal for 12 consecutive weeks 4. Terbinafine 100 mg PO once daily with meal for 12 consecutive weeks - Correct Answers: 2. Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks Option 2: Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks is the appropriate medication and dosage. Rationales Option 1: Itraconazole 100 mg PO once daily is too low a dosage for this patient. Option 3: Terbinafine 250 mg PO once daily for 6 weeks may be prescribed for onychomycosis. Option 4: Terbinafine 250 mg PO once daily for 6 weeks may be prescribed for onychomycosis. When does the World Health Organization (WHO) endorse starting antiretroviral therapy (ART) in a newly-diagnosed patient with HIV? 1. Within 7 days to the same day of newly-diagnosed HIV patient 2. Within 20 days of newly-diagnosed HIV patient 3. After the viral load numbers 4. Within 6 months of newly-diagnosed HIV patient - Correct Answers: 1. Within 7 days to the same day of newly-diagnosed HIV patient Option 1: The WHO endorsed starting ART within 7 days of new diagnosis (WHO, 2017), including same day, citing improved viral suppression. Which characteristics of the patient with HIV must be known prior to starting abacavir specifically? 1. HLA B*5701 testing 2. Pretreatment CD4+ T cell count 3. Pregnancy potential 4. Cardiovascular disease - Correct Answers: 1. HLA B*5701 testing Option 1: HLA B *5701 must be completed prior to starting abacavir because if the patient has a positive test, an anaphylaxis can occur if the patient takes abacavir. Rationales Option 2: The patient must complete pretreatment CD4+ T cell count if considering nevirapine. Option 3: Knowledge of pregnancy potential is not specific to abacavir. Option 4: Knowledge of comorbid conditions (e.g., cardiovascular disease, chemical dependency, liver disease, psychiatric disease, pregnancy, renal diseases, or tuberculosis) is not specific to abacavir. A 66-year-old patient with diabetes and chronic heart disease has been diagnosed with atypical pneumonia. Which antibiotic would be most appropriate for this patient? 1. Zithromax 2. Levaquin 3. Macrobid 4. Keflex - Correct Answers: 2. Levaquin Option 1: Presence of comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressant conditions or use of immunosuppressant drugs; use of antimicrobials within the previous 3 months; or other risk for drug-resistant Streptococcus pneumoniae (DRSP) infection requires a respiratory fluoroquinolone. A pregnant 29-year-old patient has developed community-acquired pneumonia. The APN understands that a fluoroquinolone cannot be prescribed due to the risk of malformation of the fetus. Which regimen would be most appropriate? 1. A beta-lactam plus a carbapenem 2. A beta-lactam plus a macrolide 3. A beta-lactam plus a tetracycline 4. A beta-lactam plus a cephalosporin - Correct Answers: 2. A beta-lactam plus a macrolide Option 2: Fluoroquinolones are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Women with comorbid conditions or recent antibiotics should be treated with a beta-lactam plus a macrolide. Rationales Option 1: Carbapenems are used to treat serious infections in the hospital. Option 3: Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates. Option 4: A beta-lactam plus a cephalosporin is not the most appropriate regimen for this patient. The pregnant female should receive which vaccination during pregnancy? 1. Measles, mumps, and rubella (MMR) 2. Influenza 3. Varicella 4. Pneumococcal - Correct Answers: 2. Influenza Option 2: The pregnant or postpartum patient should receive an influenza vaccine in the fall. Rationales Option 1: The MMR vaccine cannot be given during pregnancy. Option 3: The patient who has not previously had varicella should receive the varicella vaccine prior to planning a pregnancy. Option 4: Any patient with a chronic medical condition should receive a pneumococcal vaccine. If a patient has not clinically improved within 72 hours of starting an antibiotic, then the APRN must consider which possibility? 1. The pathogen is not being treated appropriately. 2. The antibiotic should be discontinued. 3. Another antibiotic needs to be added. 4. A probiotic needs to be added. - Correct Answers: 1. The pathogen is not being treated appropriately. Option 1: If no improvement in clinical status occurs within 72 hours, the practitioner needs to consider that the pathogen is not being treated appropriately. Two possibilities exist. One is that the antibiotic chosen is not treating the pathogen. Another consideration is that the pathogen is resistant to the antibiotic chosen. Rationales Option 2: Discontinuing the antibiotic without using another may increase resistance. Option 3: Adding an antibiotic without discontinuing the current one may increase resistance. Option 4: Adding a probiotic would not help treatment. Which pathogen is the most common cause of bacterial pneumonia in children of all ages? 1. Streptococcus pneumoniae 2. Klebsiella pneumoniae 3. Haemophilus influenza 4. Mycoplasma pneumoniae - Correct Answers: 1. Streptococcus pneumoniae Option 1: S. pneumoniae is the most common cause of bacterial pneumonia in children of all ages (Bradley et al, 2011). The pneumococcal vaccine has demonstrated a decreased overall incidence and prevalence of invasive pneumococcal disease and pneumococcal pneumonia. Rationales Option 2: Klebsiella pneumonia is not the most common cause of pneumonia in children. Option 3: H. influenza is a common cause of pneumonia but is not the most common. Option 4: Mycoplasma pneumoniae, a pathogen difficult to detect on Gram stain or culture, is a common cause of pneumonia, but it is not the most common. An infant is diagnosed with chlamydial pneumonia. Which medication regimen adheres to the standard of treatment for this patient? 1. Clarithromycin 50 mg/kg daily for 14 days 2. Erythromycin 50 mg/kg daily for 14 days 3. Azithromycin 50 mg/kg daily for 14 days 4. Clindamycin 20 mg/kg daily for 14 days - Correct Answers: 2. Erythromycin 50 mg/kg daily for 14 days Option 2: The standard treatment for infants with confirmed chlamydial pneumonia is erythromycin (EryPed) 50 mg/kg daily for 14 days or oral azithromycin (Zithromax) 20 mg/kg/d for 3 days. Rationales Option 1: Clarithromycin is not the recommended medication for this patient. Option 3: Azithromycin can be used with infants; however, the standard treatment for infants with confirmed chlamydial pneumonia is oral azithromycin 20 mg/kg/d for 3 days. Option 4: Clindamycin is not the recommended medication for this patient. Which medications are included in the 6-month regimen to effectively treat tuberculosis? 1. Isoniazid, rifampin, pyrazinamide, and ethambutol 2. Isoniazid, rifampin, cycloserine, and ethionamide 3. Levofloxacin, moxifloxacin, pyrazinamide, and ethambutol 4. Levofloxacin, moxifloxacin, cycloserine, and ethionamide - Correct Answers: 1. Isoniazid, rifampin, pyrazinamide, and ethambutol Option 1: A 6-month regimen is recommended for patients who adhere to treatment and have fully susceptible organisms. The preferred regimen for patients with newly diagnosed pulmonary tuberculosis consists of 2 months of four-drug therapy administered daily: isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB), followed by 4 months of INH and RIF daily. Rationales Option 2: Isoniazid and rifampin are included in the regimen, but cycloserine and ethionamide are second-line drugs for treating tuberculosis. Option 3: Pyrazinamide and ethambutol are included in the regimen, but levofloxacin and moxifloxacin are second-line drugs for treating tuberculosis. Option 4: Levofloxacin, moxifloxacin, cycloserine, and ethionamide are all second-line drugs for treating tuberculosis. Which serious complication is caused by tuberculosis (TB) in children younger than 5 years of age and usually occurs within 6 months of primary infection? 1. TB meningitis 2. Extrapulmonary TB 3. Hepatitis 4. Peripheral neuropathy - Correct Answers: 1. TB meningitis Option 1: TB meningitis is the most serious complication of TB. It usually occurs in young children (younger than 5 years) within 6 months of primary infection. The disease has three stages: prodromal (lasts 1 week), neurological involvement, and then increasing neurological involvement resulting from increasing intracranial pressure. Rationales Option 2: Extrapulmonary TB is not commonly seen in pediatric patients. Option 3: Isoniazid has a Black Box Warning regarding the development of severe and sometimes fatal hepatitis, even after many months of treatment. The risk is age-related, with the highest incidence in persons ages 50 to 64 years. Option 4: Adult patients treated for TB are at risk for peripheral neuropathy associated with isoniazid therapy. Which of these is the first step of viral replication? 1. Adsorption to and penetration into susceptible cells 2. Uncoating of viral nucleic acid 3. Synthesis of early, regulatory proteins 4. Synthesis of RNA or DNA - Correct Answers: 1. Adsorption to and penetration into susceptible cells Option 1: Adsorption to and penetration into susceptible cells is the first step of viral replication. Rationales Option 2: Uncoating of viral nucleic acid is the second step of viral replication. Option 3: Synthesis of early, regulatory proteins is the third step of viral replication. Option 4: Synthesis of RNA or DNA is the fourth step of viral replication. Which factor is most important in preventing influenza? 1. Wearing a mask 2. Wearing gloves 3. Annual vaccination 4. Good hygiene - Correct Answers: 3. Annual vaccination Option 3: The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months have an influenza annual vaccination. Rationales Option 1: Wearing a mask may help prevent influenza in some cases, but this is not the most important factor in preventing influenza. Option 2: Wearing gloves may help prevent influenza in some cases, but this is not the most important factor in preventing influenza. Option 4: Good hygiene may help prevent influenza in some cases, but this is not the single most important factor in preventing influenza. A patient with HIV was prescribed an antibiotic, and 7 days later the patient developed an erythema multiforme rash. Which antibiotic is most consistent with this side effect? 1. Trimpex 2. Macrobid 3. Zithromax 4. Biaxin - Correct Answers: 1. Trimpex Option 1: Rashes and generalized skin eruptions are common adverse reactions for sulfonamides and trimethoprim (Trimpex). The incidence may be dose-related and is more prevalent in HIV-infected patients. Skin eruptions may include erythema multiforme, exfoliative dermatitis, toxic epidermal necrolysis, and Stevens-Johnson syndrome. Rationales Option 2: Nitrofurantoin monohydrate macrocrystals (Macrobid) should be used with caution in those predisposed to its adverse effects: older patients and patients with anemia, renal impairment, electrolyte imbalance, diabetes, vitamin B deficiency, and debilitating diseases. It does not commonly cause rash. Option 3: Rashes and generalized skin eruptions are not commonly noted with azithromycin (Zithromax), a macrolide. Option 4: Rashes and generalized skin eruptions are not commonly noted with clarithromycin (Biaxin), a macrolide. A 63-year-old healthy patient was diagnosed with community-acquired pneumonia. Which antibiotic would be most appropriate for this patient? 1. Levaquin 2. Penicillin 3. Macrobid 4. Keflex - Correct Answers: 1. Levaquin Option 1: Levaquin is the most commonly used antibiotic for community-acquired pneumonia. Rationales Option 2: Although penicillin is commonly used for standard pneumonia, it is not the most common for treatment of community-acquired pneumonia. Option 3: Macrobid is not used to treat community-acquired pneumonia. Option 4: Keflex is not used to treat community-acquired pneumonia. Which condition is a major side effect of oral ketoconazole? 1. Hepatotoxicity 2. Dry mouth and metallic taste 3. Renal dysfunction 4. Heart failure - Correct Answers: 1. Hepatotoxicity Option 1: Ketoconazole oral tablets may cause hepatotoxicity leading to death or need for liver transplant and should only be used when no other effective antifungal therapy is available (U.S. Food and Drug Administration [FDA], 2013). Rationales Option 2: Dry mouth and a metallic taste may also develop with metronidazole. Option 3: Oral and intravenous acyclovir therapy has been associated with renal dysfunction. Option 4: Itraconazole, not ketoconazole, has been rarely associated with development of heart failure and should be used cautiously in patients with preexisting heart failure or ventricular dysfunction. Which medication is approved for C. parvum in children 11 years old or younger? 1. Tinidazole 2. Nitazoxanide 3. Ivermectin 4. Metronidazole - Correct Answers: 2. Nitazoxanide Option 2: Nitazoxanide is the only drug approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger. Its safety and efficacy have not been established for older children or adults, but doses are provided in the literature for these age groups. Rationales Option 1: Tinidazole is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger, although it is in the same group as a drug that is. Option 3: Ivermectin is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger. Option 4: Metronidazole is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger, although it is in the same group as a drug that is. A 33-year-old female has been diagnosed with genital herpes, and this is her first outbreak. Which recommended dose of antiviral will the APN prescribe to this patient? 1. Acyclovir 200 mg 5 times per day for 10 days 2. Acyclovir 500 mg 5 times per day for 10 days 3. Acyclovir 200 mg 3 times per day for 10 days 4. Acyclovir 500 mg 3 times per day for 10 days - Correct Answers: 1. Acyclovir 200 mg 5 times per day for 10 days Option 1: Acyclovir 200 mg every 4 hours while awake, 5 times per day for 10 days is the recommended dose for treatment of the initial episode of genital herpes. Rationales Option 2: The initial recommended dose of acyclovir is fewer than 200 mg. Option 3: An accepted off-label dose of acyclovir is 400 mg, not 200 mg, 3 times per day for 10 days. Option 4: An accepted off-label dose of acyclovir is 400 mg, not 500 mg, 3 times per day for 10 days. A 33-year-old female patient is diagnosed with vaginal candidiasis. Which medication and dosage are most appropriate for the APN to prescribe? 1. Itraconazole 100 mg as single PO dose 2. Fluconazole 150 mg as single PO dose 3. Fluconazole 100 mg as single PO dose 4. Itraconazole 150 mg as single PO dose - Correct Answers: 2. Fluconazole 150 mg as single PO dose Option 2: Fluconazole 150 mg as single PO dose is the correct medication and dosage. Rationales Option 1: Itraconazole 100 mg as single PO dose is appropriate treatment for esophageal candidiasis but not vaginal candidiasis. Option 3: This dose of fluconazole is too low. Option 4: Itraconazole 150 mg as single PO dose is appropriate treatment for esophageal candidiasis but not vaginal candidiasis. A 36-year-old patient is diagnosed with oral candidiasis. Which regimen of fluconazole is most appropriate for this patient? 1. Fluconazole 300 mg PO on first day, followed by 50 mg once daily for 2 weeks 2. Fluconazole 300 mg PO on first day, followed by 100 mg once daily for 2 weeks 3. Fluconazole 200 mg PO on first day, followed by 50 mg once daily for 2 weeks 4. Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks - Correct Answers: 4. Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks Option 4: Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks is the proper medication and dosage to be prescribed with a patient with oral candidiasis. Rationales Option 1: Fluconazole 300 mg PO on first day is too high for an initial dose. Fluconazole 50 mg once daily for 2 weeks is too low of a continuing dose. Option 2: Fluconazole 300 mg PO on first day is too high for an initial dose. Option 3: Fluconazole 50 mg once daily for 2 weeks is too low of a continuing dose. Protease inhibitors are used to treat HIV and which other viral infection? 1. Herpes simplex 2. Hepatitis C 3. Herpes zoster 4. Cytomegalovirus - Correct Answers: 2. Hepatitis C Option 2: Protease inhibitors are a class of medications used to treat or prevent viral infection such as HIV and hepatitis C. Rationales Option 1: Protease inhibitors are not used to treat herpes simplex. Option 3: Protease inhibitors are not used to treat herpes zoster. Option 4: Protease inhibitors are not used to treat cytomegalovirus. Which medication is U.S. Federal Drug Administration (FDA)-approved for pre-exposure prophylaxis (PrEP) in patients who are at high risk for contracting HIV? 1. Truvada 2. Atripla 3. Emtriva 4. Stribild - Correct Answers: 1. Truvada Option 1: Truvada is a combination of tenofovir disoproxil fumarate and emtricitabine for PrEP in patients who have high-risk behavior. Rationales Option 2: Tenofovir disoproxil fumarate (Atripla) is one of the drugs included in PrEP. Option 3: Emtricitabine (Emtriva) is one of the drugs included in PrEP. Option 4: Stribild is not FDA-approved for PrEP in patients who are at high risk for contracting HIV. Which pathogen is most common in nursing home-acquired pneumonia? 1. Staphylococcus aureus 2. Streptococcus pneumoniae 3. Klebsiella pneumoniae 4. Haemophilus influenzae - Correct Answers: 2. Streptococcus pneumoniae Option 2: S. pneumoniae is the most common pathogen in nursing home-acquired pneumonia, accounting for up to 48% of cases. Rationales Option 1: S. aureus accounts for up to 33% of cases of nursing home-acquired pneumonia, but it is not the most common pathogen. Option 3: K. pneumonia is not the most common pathogen in nursing home-acquired pneumonia. Option 4: H. influenzae accounts for up to 22% of cases of nursing home-acquired pneumonia, but it is not the most common pathogen. The APN has diagnosed S. pneumoniae in an adolescent. Which antibiotic is most appropriate for the APN to prescribe? 1. High-dose amoxicillin (90 mg/kg daily, divided in two doses) 2. Low-dose amoxicillin (45 mg/kg daily, divided in two doses) 3. High-dose azithromycin (90 mg/kg daily, divided in two doses) 4. Low-dose azithromycin (45 mg/kg daily, divided in two doses - Correct Answers: 1. High-dose amoxicillin (90 mg/kg daily, divided in two doses) Option 1: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children, high-dose amoxicillin (90 mg/kg daily, divided in two doses) is the drug of choice for 7 to 10 days of outpatient treatment. Rationales Option 2: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children should be given a higher dose of amoxicillin. Option 3: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children, azithromycin is not the drug of choice. The APN understands that a pregnant female who has tuberculosis can be treated with which medication regimen? 1. Isoniazid, rifampin, pyrazinamide, and ethambutol 2. Isoniazid, rifampin, cycloserine, and ethionamide 3. Levofloxacin, moxifloxacin, pyrazinamide, and ethambutol 4. Levofloxacin, moxifloxacin, cycloserine, and ethionamide - Correct Answers: 1. Isoniazid, rifampin, pyrazinamide, and ethambutol Option 1: The initial treatment regimen for pregnant women is isoniazid, rifampin, and ethambutol. Pyrazinamide is used worldwide in pregnant women. Rationales Option 2: Isoniazid and rifampin are included in the regimen, but cycloserine and ethionamide are not. Option 3: Pyrazinamide and ethambutol are included in the regimen, but levofloxacin and moxifloxacin are fluoroquinolones that are contraindicated in pregnancy. Option 4: Levofloxacin, moxifloxacin, cycloserine, and ethionamide are not the treatment regimen for pregnant women with tuberculosis. A 46-year-old patient is newly diagnosed with hepatitis C. The APN understands that hepatitis B serum will need to be drawn prior to starting any hepatitis C virus (HCV) medications for which reason? 1. Risk of hepatitis C reactivation 2. Risk of hepatitis A reactivation 3. Risk of hepatitis B reactivation 4. Risk of hepatitis D reactivation - Correct Answers: Option 3: There is a risk of reactivation of hepatitis B, and this would need to be covered. In which time frame would an APN expect to see signs of allergic reactions after an antibiotic is initiated? 1. From 20 minutes to 3 weeks 2. From 3 weeks to 6 months 3. From 6 months to 1 year 4. From 1 year to 18 months - Correct Answers: 1. From 20 minutes to 3 weeks Option 1: Signs of allergic reactions may occur from minutes to weeks after the antibiotic is initiated and even after the course of therapy is completed. Although immediate hypersensitivity reactions are more likely to be life threatening, delayed reactions can also be serious. Fluoroquinolones are considered to be which type of agent? 1. Bacteriostatic 2. Bactericidal 3. Cytotoxic 4. Enteric - Correct Answers: 2. Bactericidal Option 2: Fluoroquinolones are bactericidal through interference with enzymes required for the synthesis and repair of bacterial DNA. Rationales Option 1, 3, 4: Fluoroquinolones are not considered bacteriostatic, cytotoxic, or enteric agents First-generation cephalosporins are active against which organisms? 1. Methicillin-resistant Staphylococcus Aureus 2. Gram-negative organisms 3. Methicillin-sensitive Staphylococcus Aureus 4. Enterococcus organisms - Correct Answers: 3. Methicillin-sensitive Staphylococcus Aureus Option 3: First-generation cephalosporins are active against gram-positive cocci, including S. aureus and S. epidermidis (excluding methicillin-resistant strains), and most streptococci. Option 1: First-generation cephalosporins are active against gram-positive cocci, including S. aureus and S. epidermidis (excluding methicillin-resistant strains), and most streptococci. Option 2: First-generation cephalosporins are not active against gram-negative organisms. Option 4: First-generation cephalosporins are resistant to enterococcus species. A 19-year-old patient was diagnosed with bacterial conjunctivitis. Which antibiotic would be most appropriate for this patient? 1. Cipro tablets 2. Ocuflox solution 3. Levaquin tablets 4. Cleocin solution - Correct Answers: Option 2: Ocuflox solution would be the eye drop antibiotic prescribed in this case. A 23-year-old patient was diagnosed with Trichomonas vaginal infection. Which medication is most appropriate for this patient? 1. A single dose of 2 g metronidazole 2. A single dose of 1 g metronidazole 3. A single dose of 5 g tinidazole 4. A single dose of 500 mg tinidazole - Correct Answers: 1. A single dose of 2 g metronidazole Option 1: One-day treatment with metronidazole is 2 g as a single dose or tinidazole 2 g orally in a single dose; 7-day treatment is 500 mg twice a day. Rationales Option 2: One-day treatment with metronidazole is more than 1 g as a single dose. Option 3: One-day treatment with tinidazole is less than 5 g orally in a single dose. Option 4: One-day treatment with tinidazole is more than 500 mg orally in a single dose. A 76-year-old patient was diagnosed with a first episode of herpes zoster. Which medication regimen is most appropriate for the APN to prescribe? 1. Acyclovir 800 mg 5 times per day for 7 to 10 days 2. Acyclovir 800 mg 5 times per day for 10 to 12 days 3. Acyclovir 800 mg 3 times per day for 7 to 10 days 4. Acyclovir 800 mg 3 times per day for 10 to 12 days - Correct Answers: 1. Acyclovir 800 mg 5 times per day for 7 to 10 days Option 1: Oral acyclovir 800 mg taken every 4 hours while awake, 5 times per day for 7 to 10 days, is the recommended dose for initial episode of herpes zoster. Rationales Option 2: Acyclovir does not need to be taken for 10 to 12 days to treat herpes zoster. Option 3: Acyclovir needs to be taken more frequently than 3 times per day to treat herpes zoster. Option 4: Acyclovir needs to be taken more frequently than 3 times per day but for less than 10 to 12 days to treat herpes zoster. Voriconazole is used in the treatment of which condition? 1. Invasive aspergillosis 2. Oropharyngeal candidiasis 3. Onychomycosis 4. Tinea capitis - Correct Answers: 1. Invasive aspergillosis Option 1: Voriconazole is used in the treatment for invasive aspergillosis. Rationales Option 2: Posaconazole is used in the treatment of oropharyngeal candidiasis. Option 3: Terbinafine and itraconazole are used in treatment of onychomycosis. Option 4: Terbinafine is used in the treatment of tinea capitis. A health-care provider was exposed to HIV by a needle stick. The APN understands that post-exposure prophylaxis (PEP) is effective only if the exposure occurred within which time frame? 1. 72 hours 2. 48 hours 3. 24 hours 4. 12 hours - Correct Answers: Option 1: PEP is effective only if the exposure occurred within 72 hours (or 3 days). The APN has diagnosed the patient with atypical pneumonia and prescribes the patient empirical antibiotics. The patient asks how long it will take to feel better. Which response by the APN is most appropriate? 1. "You should feel better within 48 to 72 hours." 2. "You should feel better within 12 to 24 hours." 3. "You should feel better within 24 to 48 hours." 4. "You should feel better within 6 to 12 hours." - Correct Answers: Option 1: Initially, patients who are responding to empirical antibiotic therapy should show improved clinical condition in 48 to 72 hours. A 33-year-old pregnant female patient has developed community-acquired pneumonia (CAP). Which antibiotic is most appropriate for this patient? 1. Levaquin 2. Avelox 3. Noroxin 4. Zithromax - Correct Answers: 4. Zithromax Option 4: Antibiotic therapy for the pregnant patient is similar to treatment of other adults with CAP: the macrolides erythromycin, azithromycin (Zithromax), and clarithromycin are safe during pregnancy, although erythromycin or azithromycin is the first choice because each is Pregnancy Category B, whereas clarithromycin is Pregnancy Category C. Quinolones are contraindicated in pregnancy due to the inhibition of fetal growth. Rationales Option 1: Fluoroquinolones such as levofloxacin (Levaquin) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Option 2: Fluoroquinolones such as moxifloxacin (Avelox) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Option 3: Fluoroquinolones such as norfloxacin (Noroxin) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Doxycycline is not used during pregnancy because it may cause which effect in neonates? 1. Growth stunt 2. Discoloration of deciduous teeth 3. Cardiac malformation 4. Decrease in lung surfactant - Correct Answers: 2. Discoloration of deciduous teeth Option 2: Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates. Rationales Option 1: Doxycycline is not noted to cause growth stunt, cardiac malformations, or decreased lung surfactant in neonates. Which pathogen is associated with asthma exacerbation? 1. M. pneumoniae 2. S. aureus 3. H. influenzae 4. P. aeruginosa - Correct Answers: 1. M. pneumoniae Option 1: M. pneumoniae may be associated with asthma exacerbation. The patient may have been treated with amoxicillin for "bronchitis" without improvement. A chest x-ray reveals bronchovascular markings with areas of atelectasis. Rationales S. aureus, H. influenzae, P. aeruginosa are not associated with asthma exacerbation. Which basic principle must the APN apply when treating tuberculosis (TB)? 1. Treatment regimens must contain multiple drugs. 2. Failing treatment regimens must be bolstered with the addition of a single drug at a time. 3. Treatment for tuberculosis must include three phases: bactericidal, intensive, and sterilizing. 4. Treatment must be ceased at 6 months to avoid severe adverse drug reactions. - Correct Answers: 1. Treatment regimens must contain multiple drugs. Option 1: There are three basic principles that must be applied when treating tuberculosis: (1) treatment regimens must contain multiple drugs to which the organisms are susceptible; (2) the drugs must be taken regularly; and (3) drug therapy must continue for a sufficient period of time. Rationales Option 2: A fundamental principle of managing TB patients is never to add a single drug to a failing treatment regimen. Option 3: Treatment for TB has two phases: (1) the first phase or initiation phase (bactericidal or intensive phase), which lasts for 2 months; and (2) the continuation phase (sterilizing phase), which lasts for 4 to 7 months. Option 4: There is no basic principle that treatment must be ceased at 6 months. The APN understands that the patient prescribed ethambutol must be followed up with by specialists in which department? 1. Ophthalmology 2. Cardiology 3. Gynecology 4. Urology - Correct Answers: 1. Ophthalmology Option 1: Ethambutol is an effective drug, but its main limitation is ocular toxicity, which causes optic neuritis leading to blurred vision, color blindness, and visual field constriction. Rationales Ethambutol is not indicated to have increased risk of cardiological, gynecological, or urological problems. Oral ribavirin, combined with interferon, is used to treat infection of which virus? 1. Influenza A 2. HIV-1 3. Respiratory syncytial virus (RSV) 4. Hepatitis C virus (HCV) - Correct Answers: 4. Hepatitis C virus (HCV) Rationales Option 4: Oral ribavirin plays a key role when combined with interferon for the treatment of HCV. Option 1: Ribavirin is active against influenza A, but its oral form combined with interferon is not used to treat it. Option 2: Ribavirin is active against H1V-1, but its oral form combined with interferon is not used to treat it. Option 3: Ribavirin is active against RSV, but its oral form combined with interferon is not used to treat it. A 42-year-old pregnant female patient comes to the clinic with an outbreak of herpes simplex to the lips. Which medication would be most appropriate for the patient? 1. Famciclovir 2. Acyclovir 3. Famvir 4. Valganciclovir - Correct Answers: 2. Acyclovir Option 2: Acyclovir is Pregnancy Category B and safe to use in pregnancy. Rationales Option 1: There is inadequate human data on famciclovir to justify prescribing to a pregnant patient. Option 3: There is inadequate human data on Famvir to justify prescribing to a pregnant patient. Option 4: Valganciclovir is Pregnancy Category C and is most often used in treating cytomegalovirus disease in HIV patients. Fluoroquinolones fall under which pregnancy category? 1. Category B 2. Category X 3. Category A 4. Category C - Correct Answers: 4. Category C Option 4: Fluoroquinolones are Pregnancy Category C. Use is not recommended in pregnant women because there are no adequate, well-controlled studies in this population, and teratogenesis has been demonstrated in animals. Use during pregnancy only if there is a clear benefit that justifies the risk to the fetus. A 24-year-old patient was diagnosed with bacterial vaginosis. Which medication dosage is most appropriate for this patient? 1. Tinidazole 2 g oral dose once daily for 2 days taken with food 2. Tinidazole 1 g oral dose once daily for 2 days taken with food 3. Tinidazole 1 g oral dose once daily for 7 days taken with food 4. Tinidazole 2 g oral dose once daily for 7 days taken with food - Correct Answers: 1. Tinidazole 2 g oral dose once daily for 2 days taken with food Option 1: The recommended dose of tinidazole in nonpregnant females with bacterial vaginosis is a 2 g oral dose once daily for 2 days taken with food or a 1 g oral dose once daily for 5 days taken with food. Current treatment of HIV infection functions through which mechanism of action? 1. Reduction in transmissibility 2. Pre-exposure prophylaxis 3. Eradication of infection 4. Viral suppression - Correct Answers: 4. Viral suppression Option 4: Until there is a cure for HIV, the best treatment for HIV includes viral suppression with adherence to effective and safe antiretroviral therapy. Rationales Option 1: Reducing transmissibility of HIV is a goal of treatment but is not the mechanism of action. Option 2: Pre-exposure prophylaxis is a method for preventing HIV infection but is not the mechanism of action of treatment. Option 3: Eradication of infection is currently not possible. Treatment for a patient with pneumonia has which long-term goal? 1. To return to the previous respiratory status 2. To improved clinical condition 3. To end fever 4. Resolution of leukocytosis - Correct Answers: 1. To return to the previous respiratory status Option 1: The ultimate goal of treatment for all patients is the return to the respiratory status they had before the illness. Rationales Option 2: Improved clinical condition usually occurs within 48 to 72 hours and is a short-term goal of treatment. Option 3: Fever resolution usually occurs within 2 to 4 days and is a short-term goal of treatment. Option 4: Leukocytosis resolution usually occurs by day 4 of treatment and is a short-term goal of treatment. A 23-year-old female patient presents to the clinic with a 24-hour history of zoster outbreak. When would therapy with a nucleoside analog be initiated for greatest effect? 1. Within 3 days 2. Within 4 days 3. Within 2 days 4. Within 5 days - Correct Answers: 3. Within 2 days Option 3: Therapy is most effective if initiated within 48 hours of the outbreak of the rash. Rationales Option 1: Therapy with nucleoside analogues should be initiated within 3 days of the outbreak of the rash in herpes zoster. Option 2: Therapy would be losing effect after 4 days following outbreak of rash. The 53-year-old patient just completed a 14-day course of antibiotic and developed Clostridium difficile colitis. Which antibiotic most likely caused this patient to have Clostridium difficile colitis? 1. Zithromax 2. Biaxin 3. Cleocin 4. Prilosec - Correct Answers: 3. Cleocin Option 3: There is a high incidence of Clostridium difficile colitis associated with clindamycin (Cleocin). Rationales Option 1: An azalide such as Zithromax does not have the highest incidence of Clostridium difficile colitis. Option 2: A macrolide such as Biaxin does not have the highest incidence of Clostridium difficile colitis. Option 4: Prilosec is not an antibiotic but a proton pump inhibitor (PPI).