Advanced Pharmacology - Modules 1-5
A 12-year-old patient who is obese develops type 2 diabetes mellitus. The FNP should order:
nateglinide (Starlix).
glyburide (Micronase).
colesevelam (Welchol).
metformin (Glucophage). - ANS -metformin (Glucophage).
Metformin is the only drug listed that is recommended for children.
DIF: Cognitive Level: Understanding (Comprehension)
REF: 598
\A 5-year-old child has atopic dermatitis that is refractory to treatment with hydrocortisone acetone 2.5% cream. The
prescriber should prescribe:
desonide cream 0.01%.
triamcinolone acetonide.
fluocinolone cream 0.2%.
betamethasone dipropionate ointment 0.05%. - ANS -triamcinolone acetonide.
,An over-the-counter steroid has failed to treat this child's dermatitis, so the NP should prescribe something in a higher
strength. Triamcinolone is a medium-strength steroid and should be used. The other three are in groups I and II, which are
high-strength steroids and are not recommended in children.
DIF: Cognitive Level: Applying (Application)
REF: 154| 156
\A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35
mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass index of 26. The woman asks the
prescriber about using a statin medication. The prescriber should:
recommend dietary and lifestyle changes first.
begin therapy with atorvastatin 10 mg per day.
discuss quality-of-life issues as part of the decision to begin medication.
tell her there is no clinical evidence regarding efficacy of statin medication in her case. - ANS -begin therapy with
atorvastatin 10 mg per day.
This woman would be using a statin medication for secondary prevention because she already has a history of MI, so a
statin should be prescribed. Dietary and lifestyle changes should be a part of therapy, but not the only therapy. She is
relatively young, and quality-of-life issues are not a concern. There is no clinical evidence to support use of statins as
primary prevention in women.
DIF: Cognitive Level: Applying (Application)
REF: 296
\A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the family nurse
practitioner (FNP) notes a decrease in the child's linear growth rate. The FNP should consult the child's asthma specialist
about:
,gradually tapering the child off the prednisone.
a referral for possible growth hormone therapy.
giving a double dose of prednisone every other day.
dividing the prednisone dose into twice-daily dosing. - ANS -giving a double dose of prednisone every other day.
Administration of a double dose of a glucocorticoid every other morning has been found to cause less suppression of the
HPA axis and less growth suppression in children. Because the child has severe asthma, an oral steroid is necessary.
Growth hormone therapy is not indicated. Twice-daily dosing would not change the HPA axis suppression.
DIF: Cognitive Level: Applying (Application)
REF: 576
\A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that
include runny nose and sneezing. The NP should counsel this patient to:
take the lowest recommended dose initially.
monitor for hypertension while taking the drug.
take the antihistamine with a decongestant for best effect.
watch for symptoms of paradoxical excitation with this medication. - ANS -take the lowest recommended dose initially.
Antihistamines are more likely to cause excessive sedation, syncope, dizziness, confusion, and hypotension in elderly
patients; a decrease in dose is usually necessary. Hypotension is likely; there is no need to monitor for hypertension. This
patient does not have symptoms of congestion. Paradoxical excitation occurs in some young children but is not an
identified risk in elderly patients.
DIF: Cognitive Level: Applying (Application)
, REF: 191
\A 70-year-old patient with COPD who is new to the clinic reports taking 10 mg of prednisone daily for several years. The
prescriber should:
tell the patient to take the drug every other day before 9:00 AM.
order a serum glucose, potassium level, and bone density testing.
perform pulmonary function tests to see if the medication is still needed.
begin a gradual taper of the prednisone to wean the patient off the medication. - ANS -order a serum glucose, potassium
level, and bone density testing.
Serum glucose and potassium levels are part of monitoring for side effects of steroids. Because elderly patients are more
prone to certain potential catabolic adverse effects of steroid therapy, caution is required. Osteoporosis is often seen with
elderly patients, so bone density testing should be performed. The medication dosing regimen should not be changed
unless there is an indication of adverse effects.
DIF: Cognitive Level: Applying (Application)
REF: 577
\A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The advance
practice registered nurse orders thyroid function tests. The tests show TSH is decreased and FT4 is increased. The
APRN should consult with an endocrinologist and order:
thyrotropin.
methimazole.
levothyroxine.
A 12-year-old patient who is obese develops type 2 diabetes mellitus. The FNP should order:
nateglinide (Starlix).
glyburide (Micronase).
colesevelam (Welchol).
metformin (Glucophage). - ANS -metformin (Glucophage).
Metformin is the only drug listed that is recommended for children.
DIF: Cognitive Level: Understanding (Comprehension)
REF: 598
\A 5-year-old child has atopic dermatitis that is refractory to treatment with hydrocortisone acetone 2.5% cream. The
prescriber should prescribe:
desonide cream 0.01%.
triamcinolone acetonide.
fluocinolone cream 0.2%.
betamethasone dipropionate ointment 0.05%. - ANS -triamcinolone acetonide.
,An over-the-counter steroid has failed to treat this child's dermatitis, so the NP should prescribe something in a higher
strength. Triamcinolone is a medium-strength steroid and should be used. The other three are in groups I and II, which are
high-strength steroids and are not recommended in children.
DIF: Cognitive Level: Applying (Application)
REF: 154| 156
\A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35
mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass index of 26. The woman asks the
prescriber about using a statin medication. The prescriber should:
recommend dietary and lifestyle changes first.
begin therapy with atorvastatin 10 mg per day.
discuss quality-of-life issues as part of the decision to begin medication.
tell her there is no clinical evidence regarding efficacy of statin medication in her case. - ANS -begin therapy with
atorvastatin 10 mg per day.
This woman would be using a statin medication for secondary prevention because she already has a history of MI, so a
statin should be prescribed. Dietary and lifestyle changes should be a part of therapy, but not the only therapy. She is
relatively young, and quality-of-life issues are not a concern. There is no clinical evidence to support use of statins as
primary prevention in women.
DIF: Cognitive Level: Applying (Application)
REF: 296
\A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the family nurse
practitioner (FNP) notes a decrease in the child's linear growth rate. The FNP should consult the child's asthma specialist
about:
,gradually tapering the child off the prednisone.
a referral for possible growth hormone therapy.
giving a double dose of prednisone every other day.
dividing the prednisone dose into twice-daily dosing. - ANS -giving a double dose of prednisone every other day.
Administration of a double dose of a glucocorticoid every other morning has been found to cause less suppression of the
HPA axis and less growth suppression in children. Because the child has severe asthma, an oral steroid is necessary.
Growth hormone therapy is not indicated. Twice-daily dosing would not change the HPA axis suppression.
DIF: Cognitive Level: Applying (Application)
REF: 576
\A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that
include runny nose and sneezing. The NP should counsel this patient to:
take the lowest recommended dose initially.
monitor for hypertension while taking the drug.
take the antihistamine with a decongestant for best effect.
watch for symptoms of paradoxical excitation with this medication. - ANS -take the lowest recommended dose initially.
Antihistamines are more likely to cause excessive sedation, syncope, dizziness, confusion, and hypotension in elderly
patients; a decrease in dose is usually necessary. Hypotension is likely; there is no need to monitor for hypertension. This
patient does not have symptoms of congestion. Paradoxical excitation occurs in some young children but is not an
identified risk in elderly patients.
DIF: Cognitive Level: Applying (Application)
, REF: 191
\A 70-year-old patient with COPD who is new to the clinic reports taking 10 mg of prednisone daily for several years. The
prescriber should:
tell the patient to take the drug every other day before 9:00 AM.
order a serum glucose, potassium level, and bone density testing.
perform pulmonary function tests to see if the medication is still needed.
begin a gradual taper of the prednisone to wean the patient off the medication. - ANS -order a serum glucose, potassium
level, and bone density testing.
Serum glucose and potassium levels are part of monitoring for side effects of steroids. Because elderly patients are more
prone to certain potential catabolic adverse effects of steroid therapy, caution is required. Osteoporosis is often seen with
elderly patients, so bone density testing should be performed. The medication dosing regimen should not be changed
unless there is an indication of adverse effects.
DIF: Cognitive Level: Applying (Application)
REF: 577
\A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The advance
practice registered nurse orders thyroid function tests. The tests show TSH is decreased and FT4 is increased. The
APRN should consult with an endocrinologist and order:
thyrotropin.
methimazole.
levothyroxine.
