MN 552 QUIZ, MIDTERM EXAM AND FINAL EXAM – PACKAGE

MN 552 QUIZ, MIDTERM EXAM AND FINAL EXAM – PACKAGE In what year did was the Durham-Humphrey Amendment enacted which stated that a physician must prescribe drugs and a pharmacist must dispense them? Question options: 1932 1938 1952 1958 Question 2 5 / 5 points All of the following are schedule II medications except? Question options: Ecstasy Meperidine Cocaine Pentobarbital Question 3 5 / 5 points Which pregnancy category do medications fall under if animal studies have shown an adverse effect on the fetus, no adequate human studies, and that benefits may outweigh risks? Question options: Cat. X Cat. A Cat. B Cat. C Question 4 5 / 5 points True or False: To be found negligent and responsible for harm resulting from your professional activities, courts generally require the presence of 4 conditions, to include duty, derelict, directly and damage? Question options: True False Question 5 5 / 5 points True or False: Pharmacodynamics is the study of the body’s impact on the drug to include absorption, distribution, metabolism and excretion? Question options: True False All of the following are variables that affect drug actions except? Question options: Height Weight Age Placebo response Question 2 5 / 5 points Which medication route has a 100% bioavailability? Question options: PO IM IV SQ Question 3 5 / 5 points What must be present before a drug exerts its pharmacologic action on body cells? Question options: A specified amount of time since administration The minimum effective concentration Metabolism has been completed The medication has been excreted by the kidneys Question 4 5 / 5 points True or False: Pharmacodynamics involves drug actions on target cells and the resulting alterations in cellular biochemical reactions? Question options: True False Question 5 5 / 5 points True or False: In older adults increased total body water and lean body mass-fat soluble meds stay with the patient longer? Question options: True False True or False: Zollinger-Ellison Syndrome is the excessive secretion of gastric acid and a high incidence of ulcers. It is caused by gastrin-secreting tumors in pancreas, stomach or duodenum? Question options: True False Question 2 5 / 5 points All of the following may cause Gastroesophageal Reflux Disease except? Question options: Alcohol Chocolate Beta adrenergic blockers Anticonvulsants Question 3 5 / 5 points True or False: The treatment for Helicobacter Pylori requires a combination of two antimicrobials and a PPI or an H2RA? Question options: True False Question 4 5 / 5 points All of the following are antiemetic herbal remedies except? Question options: Peppermint Saw palmetto Cayenne Meadowsweet Question 5 5 / 5 points All of the following are causes of diarrhea except: Question options: Laxative abuse Inflammatory bowel disease Gastroesophageal reflux disease Drug therapy Question options: Patients with kidney stones Pregnant patients Patients with heartburn Postmenopausal women Question 2 1 / 1 point Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: Question options: Can be given to patients of all ages, including infants and children, for viral gastroenteritis Slows gastric motility and reduces fluid and electrolyte loss from diarrhea Is the treatment of choice for the diarrhea associated with E. coli 0157 May be used in pregnancy and by lactating women Question 3 1 / 1 point Josie 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 Josie? Question options: Prochlorperazine (Compazine) Meclizine (Antivert) Promethazine (Phenergan) Ondansetron (Zofran) I Question 4 1 / 1 point Gastroesophageal reflux disease may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: Question options: Calcium carbonate Estrogen Furosemide Metoclopramide Question 5 0 / 1 point Metoclopramide improves gastroesophageal reflux disease symptoms by: Question options: Reducing acid secretion Increasing gastric pH Increasing lower esophageal tone correct WRONG Decreasing lower esophageal tone Question 6 1 / 1 point Antacids treat gastroesophageal reflux disease by: Question options: Increasing lower esophageal tone Increasing gastric pH Inhibiting gastric acid secretion Increasing serum calcium level Question 7 1 / 1 point Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive-treatment. Which medication would be the best choice for treatment? Question options: Mupirocin (Bactroban) Bacitracin and polymixin B (generic double antibiotic ointment) Retapamulin (Altabax) Oral cephalexin (Keflex) Question 8 1 / 1 point Juakeem is a nasal methicillin resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes: Question options: Take the oral medication exactly as prescribed. Insert one-half of the dose in each nostril twice a day. Alternate treating one nare in the morning and the other in the evening. Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients. Question 9 1 / 1 point When Sam used clotrimazole (Lotrimin AF) for athlete’s foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete’s foot again. What would be a good choice of antifungal for Sam? Question options: Miconazole (Micatin) powder Ketoconazole (Nizoral) cream Terbinafine (Lamisil) cream Griseofulvin (Grifulvin V) suspension Question 10 1 / 1 point Long-term treatment of moderate atopic dermatitis includes: Question options: Topical corticosteroids and emollients Topical corticosteroids alone Topical antipruritics Oral corticosteroids for exacerbations of atopic dermatitis Question 11 1 / 1 point Josie has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be: Question options: Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane). Order Accutane after educating her on the adverse effects. Recommend she try oral antibiotics (minocycline). Refer her to a dermatologist for treatment. Question 12 1 / 1 point Appropriate initial treatment for psoriasis would be: Question options: An immunomodulator (Protopic or Elidel) Wet soaks with Burrow’s or Domeboro solution Intermittent therapy with intermediate potency topical corticosteroids Anthralin (Drithocreme) Question 13 1 / 1 point Twenty-year-old Annie comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be: Question options: None, wait for the culture results to determine the course of treatment Ciprofloxacin (Ciloxan) ophthalmic drops IM ceftriaxone High-dose oral amoxicillin Question 14 1 / 1 point Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because: Question options: There may be an antagonistic reaction between the two. The additive effects may include bradycardia. They may potentiate each other and cause respiratory depression. The additive effects may cause metabolic acidosis. Question 15 1 / 1 point David presents to the clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding using cromolyn eye drops includes: Question options: He should not wear his soft contacts while using the cromolyn eye drops. Cromolyn drops are instilled once a day to prevent allergy symptoms. Long-term use may cause glaucoma. He may experience bradycardia as an adverse effect. Jim 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: Question options: Omeprazole (Prilosec) twice a day Ranitidine (Zantac) twice a day Famotidine (Pepcid) once a day Metoclopramide (Reglan) four times a day Question 2 2 / 2 points An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: Question options: Electrolytes, including potassium and chloride Bone mineral density for osteoporosis Magnesium level Liver function Question 3 2 / 2 points The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving is: Question options: Add a prokinetic (metoclopramide) Referral for endoscopy Switch to another proton pump inhibitor Add a cytoprotective drug Question 4 2 / 2 points If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is: Question options: Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days Test H. pylori for resistance to common treatment regimens Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days Proton pump inhibitor and levofloxacin for 14 days Question 5 2 / 2 points Erika has been prescribed isotretinoin (Accutane) by her dermatologist and is presenting to her primary care provider with symptoms of sadness and depression. A Beck’s Depression Scale indicates she has mild to moderate depression. What would be the best care for her at this point? Question options: Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant Refer her to a mental health therapist Contact her dermatologist about discontinuing the isotretinoin Reassure her that mood swings are normal and schedule follow up in a week Question 6 2 / 2 points Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes instructing them: Question options: That tazarotene is applied in a thin film to the psoriasis plaque lesions To apply it liberally to all psoriatic lesions To apply tazarotene to nonaffected areas to prevent breakout That tazarotene may cause hypercalcemia if it is overused Question 7 2 / 2 points Nicolas is a football player who presents to the clinic with athlete’s foot. Patients with tinea pedis may be treated with: Question options: OTC miconazole cream for 4 weeks Oral ketoconazole for 6 weeks Mupirocin ointment for 2 weeks Nystatin cream for 2 weeks Question 8 2 / 2 points Vanessa has been diagnosed with scabies. Her education would include: Question options: She should apply the scabies treatment cream for an hour and wash it off. Scabies may need to be retreated in a week after initial treatment. All members of the household and close personal contacts should be treated. Malathion is flammable and she should take care until the solution dries. Question 9 2 / 2 points Ciprofloxacin otic drops are contraindicated in: Question options: Children Patients with acute otitis externa Patients with a perforated tympanic membrane Swimmer’s ear Question 10 2 / 2 points Janie presents to the clinic with hard ear wax in both ear canals. Instructions regarding home removal of hard cerumen include: Question options: Moisten a cotton swab (Q-tip) and swab the ear canal twice daily. Instill tap water in both ears while bathing. Squirt hydrogen peroxide into ears with each bath. Instill carbamide peroxide (Debrox) twice daily until canals are clear. Digoxin levels need to be monitored closely when the following medication is started: Question options: Loratadine Diphenhydramine Ipratropium Albuterol Question 2 1 / 1 point When educating patients who are starting on inhaled corticosteroids, the provider should tell them that: Question options: They need to get any live vaccines before starting the medication. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids. Question 3 1 / 1 point Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are: Question options: More effective than first-generation antihistamines Less sedating than the first-generation antihistamines Prescription products, therefore are covered by insurance Able to be taken with central nervous system (CNS) sedatives, such as alcohol Question 4 1 / 1 point Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry? Question options: High-dose colchicine Low-dose colchicine High-dose aspirin Acetaminophen with codeine Question 5 1 / 1 point Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for: Question options: Metformin, a biguanide to prevent diabetes Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease Naproxen, an NSAID to treat joint pain Furosemide, a diuretic to treat fluid retention Question 6 1 / 1 point Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is: Question options: Black tarry stools Vomiting Tremors Tinnitus Question 7 1 / 1 point 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: Question options: Daily Daily and limit physical activity Less than twice a week More than twice a week and less than once a day Question 8 1 / 1 point Patients with a COPD exacerbation may require: Question options: Doubling of inhaled corticosteroid dose Systemic corticosteroid burst Continuous inhaled beta-2-agonists Leukotriene therapy Question 9 1 / 1 point Asthma exacerbations at home are managed by the patient by: Question options: Increasing frequency of beta-2-agonists and contacting their provider Doubling inhaled corticosteroid doses Increasing frequency of beta-2-agonists Starting montelukast (Singulair) Question 10 1 / 1 point The most common bacterial pathogen in community-acquired pneumonia is: Question options: Haemophilus influenzae Staphylococcus aureus Mycoplasma pneumoniae Streptococcus pneumonia Question 11 1 / 1 point 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: Question options: Levofloxacin Amoxicillin Ciprofloxacin Cephalexin Question 12 1 / 1 point Wing-Sing 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? Question options: Ceftriaxone Azithromycin Cephalexin Levofloxacin Question 13 1 / 1 point Instructions for a patient who is starting nicotine replacement therapy include: Question options: Smoke less than 10 cigarettes a day when starting nicotine replacement. Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco. Nicotine replacement can be used indefinitely. Nicotine replacement therapy is generally safe for all patients. Question 14 1 / 1 point If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include: Question options: Bupropion (Zyban) is started 1 to 2 weeks before the quit date. Nicotine replacement products should not be used with bupropion. If they smoke when taking bupropion they may have increased anxiety and insomnia. Because they are not using bupropion as an antidepressant, they do not need to worry about increased suicide ideation when starting therapy. Question 15 0 / 1 point The most appropriate smoking cessation prescription for pregnant women is: Question options: A nicotine replacement patch at the lowest dose available Bupropion (Zyban)incorrect Varenicline (Chantix) Nonpharmacologic measures correct Question 16 1 / 1 point Drug resistant tuberculosis (TB) is defined as TB that is resistant to: Question options: Fluoroquinolones Rifampin and isoniazid Amoxicillin Ceftriaxone Question 17 1 / 1 point Kaleb has extensively resistant tuberculosis (TB). Treatment for extensively resistant TB would include: Question options: INH, rifampin, pyrazinamide, and ethambutol for at least 12 months INH, ethambutol, kanamycin, and rifampin Treatment with at least two drugs to which the TB is susceptible Levofloxacin Question 18 1 / 1 point Ezekiel 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: Question options: 6 months of Isoniazid (INH) and rifampin 2 months of INH, rifampin, pyrazinamide, and ethambutol, followed by 4 months of INH 9 months of INH 12 months of INH Question 19 1 / 1 point Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include: Question options: Azithromycin Amoxicillin Ceftriaxone Trimethoprim/sulfamethoxazole Question 20 1 / 1 point Jacob has been diagnosed with sinusitis. He is the parent of a child in daycare. Treatment for sinusitis in an adult who has a child in daycare is: Question options: Azithromycin 500 mg q day for 5 days Amoxicillin-clavulanate 500 mg bid for 7 days Ciprofloxacin 500 mg bid for 5 days Cephalexin 500 mg qid for 5 days Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: Question options: Excessive sedation Tachycardia and angina Weight gain Cold intolerance Question 2 1 / 1 point Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: Question options: Tinnitus and decreased salivation Fever and sore throat Hypocalcemia and osteoporosis Laryngeal edema and difficulty swallowing Question 3 1 / 1 point Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: Question options: Substitutes for insulin usually secreted by the pancreas Decreases glycogenolysis by the liver Increases the release of insulin from beta cells Decreases peripheral glucose utilization Question 4 1 / 1 point Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: Question options: “Fruity” breath odor and rapid respiration Diarrhea, abdominal pain, weight loss, and hypertension Dizziness, confusion, diaphoresis, and tachycardia Easy bruising, palpitations, cardiac dysrhythmias, and coma Question 5 1 / 1 point Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they: Question options: Increase endogenous insulin secretion Have a significant risk for hypoglycemia Address the insulin resistance found in type 2 diabetics Improve insulin binding to receptors Question 6 1 / 1 point Treatment with insulin for type 1 diabetics: Question options: Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight Divides the total doses into three injections based on meal size Uses a total daily dose of insulin glargine given once daily with no other insulin required Is based on the level of blood glucose Question 7 1 / 1 point The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: Question options: Glycemic targets between 7% and 7.5% Use of insulin in type 2 diabetics Control of hypertension and hyperlipidemia Stopping smoking Question 8 1 / 1 point Drugs used to treat diabetic peripheral neuropathy include: Question options: Metoclopramide Cholinergic agonists Cardioselective beta blockers Gabapentin Question 9 1 / 1 point The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: Question options: Cardiovascular risk Risk of stroke or other thromboembolic event Breast cancer Vasomotor symptoms Question 10 1 / 1 point Inadequate vitamin D intake can contribute to the development of osteoporosis by: Question options: Increasing calcitonin production Increasing calcium absorption from the intestine Altering calcium metabolism Stimulating bone formation Question 11 1 / 1 point The drug recommended as primary prevention of osteoporosis in men over age 70 years is: Question options: Alendronate (Fosamax) Ibandronate (Boniva) Calcium carbonate Raloxifene (Evista) Question 12 1 / 1 point In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: Question options: A calcium channel blocker A beta blocker Liothyronine An alpha blocker Question 13 1 / 1 point When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: Question options: 2 weeks 4 weeks 2 months 6 months Question 14 1 / 1 point Treatment of a patient with hypothyroidism and cardiovascular disease consists of: Question options: Levothyroxine Liothyronine Liotrix Methimazole Question 15 1 / 1 point Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: Question options: Washing their hands after applying the gel Wearing occlusive clothing while using the gel Exposure to estrogens while using the gel Skin-to-skin contact with pregnant women while using the gel Question 16 1 / 1 point A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes: Question options: Counseling regarding decreasing or not smoking while taking oral contraceptives Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive Advising that she may miss two pills in a row and not be concerned about pregnancy Recommending that her next follow-up visit is in 1 year for a refill and annual exam Question 17 1 / 1 point A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed: Question options: Low-dose oral estrogen A low-dose estrogen/progesterone combination A vaginal estradiol ring Vaginal progesterone cream Question 18 1 / 1 point Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: Question options: Recommend she return to the clinic at the start of her next menses to get a Depo Provera shot. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first 7 days. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days. Discuss the advantages of using the topical birth control patch and recommend she consider using the patch. Question 19 1 / 1 point Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? Question options: Increased migraine headaches Increased risk of developing blood clots Irregular vaginal bleeding for the first few months Increased risk for hypercalcemia Question 20 1 / 1 point Oral emergency contraception (Plan B) is contraindicated in women who: Question options: Had intercourse within the past 72 hours May be pregnant Are taking combined oral contraceptives Are using a diaphragm When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research? Question options: Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime. Question 2 2 / 2 points Prior to prescribing metformin, the provider should: Question options: Draw a serum creatinine to assess renal function Try the patient on insulin Tell the patient to increase iodine intake Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions Question 3 2 / 2 points Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action? Question options: Levemir Glulisine Glargine Detemir Question 4 2 / 2 points The drugs recommended for older adults with type 2 diabetes include: Question options: Second-generation sulfonylureas Metformin Pioglitazone Third-generation sulfonylureas Question 5 2 / 2 points Women with an intact uterus should be treated with both estrogen and progestin due to: Question options: Increased risk for endometrial cancer if estrogen alone is used Combination therapy provides the best relief of menopausal vasomotor symptoms Reduced risk for colon cancer with combined therapy Lower risk of developing blood clots with combined therapy Question 6 2 / 2 points Bisphosphonate administration education includes: Question options: Taking it on a full stomach Requiring sitting erect for at least 30 minutes afterward Drinking it with orange juice Taking it with H2 blockers or proton pump inhibitors (PPI) to protect the stomach Question 7 2 / 2 points Long-term use of androgens requires specific laboratory monitoring of: Question options: Glucose, calcium, testosterone, and thyroid function Calcium, testosterone, PSA, and liver function Calcium, testosterone, PSA, liver function, glucose, and lipids CBC, testosterone, PSA, and thyroid level Question 8 2 / 2 points Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: Question options: Nausea Breakthrough bleeding Breast tenderness Pregnancy Question 9 2 / 2 points The mechanism of action of oral combined contraceptives that prevents pregnancy is: Question options: Estrogen prevents the luteinizing hormone surge necessary for ovulation. Progestins thicken cervical mucus and slow tubal motility. Estrogen thins the endometrium making implantation difficult. Progestin suppresses follicle stimulating hormone release. Question 10 2 / 2 points When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: Question options: They should feel symptomatic improvement in 1 to 2 weeks. Drug adverse effects such as lethargy and dry skin may occur. It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing. Because of its short half-life, levothyroxine doses should not be missed. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be: Question options: Penicillin VK, because his rash does not sound like a serious rash Amoxicillin Cefadroxil (Duricef) Azithromycin Question 2 1 / 1 point Nicholas has been diagnosed with type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include: Question options: Starting oseltamivir within the first 48 hours of influenza symptoms Advising the patient he can stop the oseltamivir when his symptoms resolve Educating the patient that oseltamivir will cure influenza Prophylactic treatment of all family members Question 3 1 / 1 point The drug of choice for treatment of primary or secondary syphilis is: Question options: Ceftriaxone IM Benzathine penicillin G IM Oral azithromycin Oral ciprofloxacin Question 4 1 / 1 point When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with: Question options: Azithromycin 1 gram PO x 1 Amoxicillin 500 mg PO x 1 Ciprofloxacin 500 mg PO x 1 Penicillin G 2.4 million units IM x 1 Question 5 1 / 1 point Lila is 24 weeks pregnant and has been diagnosed with tuberculosis (TB). Treatment regimens for a pregnant patient with TB would include: Question options: Streptomycin Levofloxacin Kanamycin Pyridoxine Question 6 1 / 1 point The principles of drug therapy for the treatment of tuberculosis include: Question options: Patients are treated with a drug to which M. tuberculosis is sensitive. Drugs need to be taken on a regular basis for a sufficient amount of time. Treatment continues until the patient’s purified protein derivative is negative. All of the above Question 7 1 / 1 point Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is: Question options: Amoxicillin Azithromycin Cephalexin Levofloxacin Question 8 1 / 1 point Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for her? Question options: Continue the amoxicillin for the full 10 days. Change the antibiotic to azithromycin. Change the antibiotic to amoxicillin/clavulanate. Change the antibiotic to trimethoprim/sulfamethoxazole. Question 9 1 / 1 point Sally 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: Question options: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Levofloxacin Question 10 1 / 1 point Jamie 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: Question options: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Ciprofloxacin Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to: Question options: Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily. Change the antibiotic to one that is less of a gastrointestinal irritant. Order stool cultures for suspected viral pathogens not treated by the amoxicillin. Recommend increased fluids and fiber in his diet. Question 2 2 / 2 points To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of: Question options: Urinary tract infections in young women Upper respiratory infections in adults Skin and soft tissue infections in adults Community-acquired pneumonia in patients with comorbidities Question 3 2 / 2 points Treatment for suspected gonorrhea is: Question options: Ceftriaxone 250 mg IM x 1 Ceftriaxone 2 grams IM x 1 Ciprofloxacin 500 mg PO x 1 Doxycycline 100 mg bid x 7 days Question 4 2 / 2 points If a woman presents with recurrent vulvovaginal candidiasis she may be treated with: Question options: Weekly intravaginal butoconazole for 3 months Fluconazole 150 mg PO daily x 7 doses then monthly for 6 months Weekly fluconazole 150 mg PO x 6 months Intravaginal tioconazole x 14 days Question 5 2 / 2 points Bilal is a 5-year-old patient who has been diagnosed with tuberculosis. His treatment would include: Question options: Pyridoxine Ethambutol Levofloxacin Rifabutin Question 6 2 / 2 points Isabella has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month regimen consists of: Question options: Two months of four-drug therapy (INH, rifampin, pyrazinamide, and ethambutol) followed by Four months of INH and rifampin Six months of INH with daily pyridoxine throughout therapy Six months of INH, rifampin, pyrazinamide, and ethambutol Any of the above Question 7 2 / 2 points First-line therapy for a patient with acute otitis externa (swimmer’s ear) and an intact tympanic membrane includes: Question options: Swim-Ear drops Ciprofloxacin and hydrocortisone drops Amoxicillin Gentamicin ophthalmic drops Question 8 2 / 2 points The length of treatment for sinusitis in a low-risk patient should be: Question options: 5–7 days 7–10 days 14–21 days 7 days beyond when symptoms cease Question 9 2 / 2 points Nicole 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: Question options: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Ciprofloxacin Question 10 2 / 2 points Juanita 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: Question options: Azithromycin Trimethoprim/sulfamethoxazole Amoxicillin Ciprofloxacin Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for: Question options: Hypokalemia Impotence Decreased renal function Inability to concentrate Question 2 1 / 1 point Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct. Question options: Older adults because of reduced renal function Administration of aldosterone antagonist diuretics because of decreased potassium levels Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin Doses between 0.25 and 0.5 mg/day Question 3 1 / 1 point Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to: Question options: Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times. Question 4 1 / 1 point Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended? Question options: He has arthritis and this will help with the inflammation and pain. Aspirin has anti-platelet activity and prevents clots that cause heart attacks. Aspirin acidifies the urine and he needs this for prostrate health. He has a history of GI bleed, and one aspirin a day is a safe dosage. Question 5 1 / 1 point Education of patients who are taking warfarin includes discussing their diet. Instructions include: Question options: Avoiding all vitamin K-containing foods Avoiding high-vitamin K-containing foods Increasing intake of iron-containing foods Making sure they eat 35 grams of fiber daily Question 6 1 / 1 point Pernicious anemia is treated with: Question options: Folic acid supplements Thiamine supplements Vitamin B12 Iron Question 7 1 / 1 point Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be: Question options: 18 mg/day of iron supplementation 6 mg/kg per day of iron supplementation 325 mg ferrous sulfate per day 325 mg ferrous sulfate tid Question 8 1 / 1 point Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is: Question options: Oral folic acid 1 to 2 mg per day Oral folic acid 1 gram per day IM folate weekly for at least 6 months Oral folic acid 400 mcg daily Question 9 1 / 1 point Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS? Question options: Calcium channel blockers Beta blockers Angiotensin-converting-enzyme (ACE) inhibitors Aspirin Question 10 0 / 1 point The rationale for prescribing calcium blockers for angina can be based on the need for: Question options: Increased inotropic effect in the heart wrong it decreases Increasing peripheral perfusion Keeping heart rates high enough to ensure perfusion of coronary arteries Help with rate control correct Question 11 1 / 1 point Which of the following drugs has been associated with increased risk for myocardial infarction in women? Question options: Aspirin Beta blockers Estrogen replacement *** Lipid-lowering agents Question 12 1 / 1 point Increased life expectancy for patients with heart failure has been associated with the use of: Question options: ACE inhibitors, especially when started early in the disease process All beta blockers regardless of selectivity Thiazide and loop diuretics Cardiac glycosides Question 13 1 / 1 point Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with: Question options: Ejection fractions above 40% An audible S3 Mitral stenosis as a primary cause for heart failure Renal insufficiency Question 14 1 / 1 point Which of the following classes of drugs is contraindicated in heart failure? Question options: Nitrates Long-acting dihydropyridines Calcium channel blockers Alpha-beta blockers Question 15 1 / 1 point What is considered the order of statin strength from lowest effect to highest? Question options: Lovastatin, Simvastatin, Rosuvastatin Rosuvastatin, Lovastatin, Atorvastatin Atorvastatin, Rosuvastatin, Simvastatin Simvastatin, Atorvastatin, Lovastatin Question 16 1 / 1 point First-line therapy for hyperlipidemia is: Question options: Statins Niacin Lifestyle changes *** Bile acid-binding resins Question 17 1 / 1 point Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a: Question options: Sterol Niacin Fibric acid derivative Bile acid-binding resin Question 18 1 / 1 point Hypertensive African Americans are typically listed as not being as responsive to which drug groups? Question options: ACE inhibitors Calcium channel blockers Diuretics Bidil (hydralazine family of medications) Question 19 1 / 1 point Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive the following supplement: Question options: Potassium Calcium Magnesium Phosphates Question 20 1 / 1 point An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? Question options: Beta blockers Diuretics Nondihydropyridine calcium channel blockers Angiotensin II receptor blockers Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: Question options: Increases peripheral vasoconstriction Decreases detrusor muscle contractility Lowers supine blood pressure more than standing pressure Relaxes smooth muscle in the bladder neck Question 2 1 / 1 point Which of the following adverse effects are less likely in a beta1-selective blocker? Question options: Dysrhythmias Impaired insulin release Reflex orthostatic changes Decreased triglycerides and cholesterol Question 3 1 / 1 point Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: Question options: Symptoms are severe Patient has not responded to other therapies Patient has concurrent hypertension Left ventricular dysfunction is diagnosed Question 4 1 / 1 point You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice? Question options: Donepezil Tacrine Doxazosin Verapamil Question 5 1 / 1 point Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus. Question options: IV phenobarbital Rectal diazepam (Diastat) IV phenytoin (Dilantin) Oral carbamazepine (Tegretol) Question 6 1 / 1 point Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: Question options: Dwayne hasn’t been taking his carbamazepine because it causes insomnia. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance. Dwayne was not originally prescribed the correct amount of carbamazepine. Carbamazepine is probably not the right antiseizure medication for Dwayne. Question 7 1 / 1 point Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be: Question options: Ibuprofen (Advil) Acetaminophen with hydrocodone (Vicodin) Oxycodone (Oxycontin) Oral morphine (Roxanol) Question 8 1 / 1 point Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: Question options: Slurred speech and insomnia Bradycardia and confusion Dizziness and orthostatic hypotension Insomnia and decreased appetite Question 9 1 / 1 point An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: Question options: Alprazolam (Xanax) Diazepam (Valium) Buspirone (Buspar) Amitriptyline (Elavil) Question 10 1 / 1 point David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include: Question options: Paroxetine may cause intermittent diarrhea. He may experience sexual dysfunction beginning a month after he starts therapy. He may have constipation and he should increase fluids and fiber. Paroxetine has a long half-life so he may occasionally skip a dose. Question 11 1 / 1 point An appropriate drug for the treatment of depression with anxiety would be: Question options: Alprazolam (Xanax) Escitalopram (Lexapro) Buspirone (Buspar) Amitriptyline (Elavil) Question 12 1 / 1 point The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason? Question options: They have become tolerant of the medication, which is characterized by the need for higher and higher doses. They are a drug seeker. They are suicidal. They only need additional counseling on lifestyle modification. Question 13 1 / 1 point A first-line drug for abortive therapy in simple migraine is: Question options: Sumatriptan (Imitrex) Naproxen (Aleve) Butorphanol nasal spray (Stadol NS) Butalbital and acetaminophen (Fioricet) Question 14 1 / 1 point Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: Question options: Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use. Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose. Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital). Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan. Question 15 1 / 1 point Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: Question options: Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic. Question 16 1 / 1 point James has been diagnosed with cluster headaches. Appropriate acute therapy would be: Question options: Butalbital and aspirin (Fiorinal) Meperidine IM (Demerol) Oxygen 100% for 15 to 30 minutes Indomethacin (Indocin) Question 17 1 / 1 point If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? Question options: NSAIDs, opiates, corticosteroids Low-dose opiates, salicylates, increased dose of opiates Opiates, non-opiates, increased dose of non-opiate Non-opiate, increased dose of non-opiate, opiate Question 18 1 / 1 point Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency? Question options: Use of more than one drug to treat the pain Multiple times when prescriptions are lost with requests to refill Preferences for treatments that include alternative medicines Presence of a family member who has abused drugs Question 19 1 / 1 point The Pain Management Contract is appropriate for: Question options: Patients with cancer who are taking morphine Patients with chronic pain who will require long-term use of opiates Patients who have a complex drug regimen Patients who see multiple providers for pain control Question 20 1 / 1 point Which of the following statements is true about age and pain? Question options: Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: Question options: A need to monitor drugs metabolized by 2D6 for toxicity Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors Decreased conversion of codeine to morphine by CYP 2D6 The need for lowered dosages of drugs, such as beta blockers Question 2 1 / 1 point Rifampin is a nonspecific CYP450 inducer that may: Question options: Lead to toxic levels of rifampin and must be monitored closely Cause toxic levels of drugs, such as oral contraceptives, when coadministered Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure Cause nonspecific changes in drug metabolism Question 3 1 / 1 point Inhibition of P-glycoprotein by a drug such as quinidine may lead to: Question options: Decreased therapeutic levels of quinidine Increased therapeutic levels of quinidine Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination Question 4 1 / 1 point Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: Question options: Toxic levels of warfarin building up Decreased response to warfarin Increased risk for significant drug interactions with warfarin Less risk of drug interactions with warfarin Question 5 1 / 1 point Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing: Question options: Erythromycin Digoxin Cetuximab Rifampin Question 6 1 / 1 point Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to: Question options: Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 Allele Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine Question 7 1 / 1 point A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to: Question options: Decreased effectiveness of irinotecan in the treatment of cancer Increased adverse drug reactions, such as neutropenia Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 Increased concerns for irinotecan being carcinogenic Question 8 1 / 1 point A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products. Question options: 10 5 38 70 Question 9 1 / 1 point A potential harmful effect on patients who take some herbal medication is: Question options: Constipation Lead poisoning Diarrhea Life-threatening rash Question 10 1 / 1 point A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains: Question options: Coumadin, which may lead to bleeding problems Coumarin, which can cause liver and kidney damage Cinnamic aldehyde, which is toxic to the kidney Cinnamate eugenol, which is toxic to the liver Question 11 1 / 1 point Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe: Question options: Herbs which are yang in nature Herbs that are yin in nature Ginger Golden seal Question 12 1 / 1 point According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will: Question options: Get worse Get better Not be adequately treated Need additional herbs to treat the yang Question 13 1 / 1 point In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s: Question options: Vata Pitta Kapha Prakriti Question 14 1 / 1 point When melatonin is used to induce sleep, the recommendation is that the patient: Question options: Take 10 mg 30 minutes before bed nightly Take 1 to 5 mg 30 minutes before bed nightly Not take melatonin more than three nights a week Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep Question 15 1 / 1 point In the United States, over-the-counter drugs are regulated by: Question options: No one. There is no oversight for over-the-counter medications. The U.S. Food and Drug Administration Center for Drug Evaluation and Research The U.S. Drug Enforcement Administration MedWatch Question 16 1 / 1 point As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to: Question options: Get a new patent for the over-the-counter form of the drug Lower the costs because most prescription benefit plans do not cover generics Market the drug to a whole new population, as they are able to market to patients instead of just providers Continue to make large profits from their blockbuster brand-name drug Question 17 1 / 1 point The ailment that generates the greatest over-the-counter annual drug sales is: Question options: Constipation Cough and colds Heartburn Acute and chronic pain Question 18 1 / 1 point Common over-the-counter pain relievers such as acetaminophen or ibuprofen: Question options: Are always safer for the patient than prescription pain medication Are harmful if taken in higher than recommended amounts Have minimal interaction with prescription medications Should never be given to children unless recommended by their provider Question 19 1 / 1 point When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of: Question options: His appropriately only telling you about his regularly prescribed medications His hiding information regarding his inappropriate use of aspirin from you A common misconception that intermittently taken over-the counter medications are not an important part of his drug history A common misuse of over-the-counter aspirin Question 20 1 / 1 point Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must: Question options: Be safe and labeled for appropriate use Have a low potential for abuse or misuse Be taken for a condition the patient can reliably self-diagnose All of the above There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: Question options: Renal excretion is similar in both classes of drugs. When these drug classes are metabolized in the liver they both produce resistant enzymes. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms. There is not an issue with cross-resistance between the penicillins and cephalosporins. Question 2 4 / 4 points 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 class: Question options: I II III IV Question 3 4 / 4 points Class I recommendations for stage A heart failure include: Question options: Aerobic exercise within tolerance levels to prevent the development of heart failure Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention Beta blockers for all patients regardless of cardiac history Treatment of thyroid disorders, especially if they are associated with Tachyarrhythmias Question 4 4 / 4 points Patient education regarding taking iron replacements includes: Question options: Doubling the dose if they miss a dose to maintain therapeutic levels Taking the iron with milk or crackers if it upsets their stomach Iron is best taken on an empty stomach with juice Antacids such as Tums may help the upset stomach caused by iron therapy Question 5 0 / 4 points Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? Question options: Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. Additive antimuscarinic effects may occur with antihistamines.WRONG Cholinergic blockers may decrease the sedative effects of hypnotics. Cholinergic blockers are contraindicated with antipsychotics. Question 6 4 / 4 points What is the role of calcium supplements when patients take bisphosphonates? Question options: They must be restricted to allow the medication to work. They must be taken in sufficient amounts to provide foundational elements for bone growth. They must be taken at the same time as the bisphosphonates. They only work with bisphosphonates if daily intake is restricted. Question 7 4 / 4 points Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true? Question options: Screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0. Screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. Screening values are between 5 and 10, and therapeutic values are greater than 10. Question 8 4 / 4 points Preventative therapy for cluster headaches includes: Question options: Massage or relaxation therapy Ergotamine nightly before bed Intranasal lidocaine four times a day during “clusters” of headaches Propranolol (Inderal) daily Question 9 4 / 4 points Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: Question options: Rapidly achieves drug levels in the therapeutic range Requires four- to five-half-lives to attain Is influenced by renal function Is directly related to the drug circulating to the target tissues Question 10 4 / 4 points The dosage of Vitamin B12 to initially treat pernicious anemia is: Question options: Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month Vitamin B12 IM monthly Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month Oral cobalamin 1,000 mcg daily Question 11 4 / 4 points The reason that two MMR vaccines at least a month apart are recommended is: Question options: The second dose of MMR “boosts” the immunity built from the first dose. Two vaccines 1 month apart is the standard dosing for all live virus vaccines. If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR. Question 12 0 / 4 points Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: Question options: For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatmentWRONG For pedal edema throughout therapy Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm For vision changes, such as red-green blindness, at least annually Question 13 4 / 4 points Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because: Question options: It is a long-acting drug with potential for toxicity. Nitrate tolerance can develop. Orthostatic hypotension is a common adverse effect. It must be taken with milk or food. Question 14 4 / 4 points Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes: Question options: Monthly sputum cultures Monthly chest x-ray Bronchoscopy every 3 months All of the above Question 15 4 / 4 points Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine? Question options: Delay eating the midday meal until after the swimming class. Increase the morning dose of NPH insulin on days of the swimming class. Adjust the morning insulin injection so that the peak occurs while swimming. Check glucose level before, during, and after swimming. Question 16 4 / 4 points First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be: Question options: OTC topical azole (clotrimazole, miconazole) Oral terbinafine Oral griseofulvin microsize Nystatin cream or ointment Question 17 4 / 4 points Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include: Question options: Amoxicillin Diphenhydramine Pseudoephedrine Nasal saline spray Question 18 4 / 4 points Conjunctivitis in a child that is accompanied by acute otitis media is treated with: Question options: Sulfacetamide 10% ophthalmic solution (Bleph-10) Bacitracin/polymyxin B (Polysporin) ophthalmic drops Ciprofloxacin (Ciloxan) ophthalmic drops High-dose oral amoxicillin Question 19 4 / 4 points The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be: Question options: Ciprofloxacin Azithromycin Amoxicillin Doxycycline Question 20 4 / 4 points Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? Question options: Use correct medical terminology because Spanish has a Latin base. Use a family member who speaks mor