NUR 566 Midterm & Final Exam Questions and Answers Graded A+
How would you explain the mechanism of action of β-adrenergic blocking agents to a patient
with glaucoma? - Answers The β-adrenergic blockers lower IOP by decreasing production of
aqueous humor. Reductions in IOP occur with "nonselective" β blockers (drugs that block β1
and β2 receptors) as well as with "cardioselective" β blockers (drugs that block β1 receptors
only).
β blockers are used primarily for open-angle glaucoma. They are suitable for initial therapy as
well as maintenance therapy. β blockers in combination with other drugs are also employed for
emergency management of acute angle-closure glaucoma.
How would you manage a patient on warfarin therapy who has been prescribed itraconazole to
prevent potential drug interactions? - Answers itraconazole inhibits CYP3A4 and can increase
levels of other drugs
prothrombin time should be monitored
In a patient diagnosed with invasive aspergillosis, what factors would influence your decision to
prescribe caspofungin over other antifungal agents? - Answers when it is unresponsive to or
intolerant to amphotericin B or itraconazole
If a child with tinea capitis is not responding to griseofulvin, what alternative treatments would
you consider and why? - Answers oral terbinafine
When treating a patient with intestinal worms, how would you explain the importance of taking
mebendazole consistently for the full course of treatment? - Answers mebendazole works by
preventing glucose uptake of worms starving them to death. This can take 3 days to kill them so
they full course of treatment needs to be completed as they die slowly.
In a pediatric patient with pinworm infestation, how would you decide which anthelmintic to
prescribe, considering the patient's overall health and medication tolerance?
meds are contraindicated in which patients? - Answers mebendazole is drug of choice second is
albendazole and pyrantel pamoate
patients with liver, kidney, anemia, or bleeding disorders should not take albendazole or
mebendazole
In a patient newly diagnosed with HIV, what considerations would lead you to prescribe an INSTI
as part of their antiretroviral therapy? - Answers INSTI terminate the integration of HIV into DNA
and stop HIV replication. can be used first line with other meds, can lead to HIV resistance, ok in
mild liver fx
,what is onychomycosis?
If a patient with onychomycosis has not responded to topical treatments, how would you
assess their suitability for oral terbinafine therapy? - Answers fungal nails
assess ability to comply with tx as it lasts 3-6 months. educate that even after tx only 50%
chance of efficacy. Inform pt that tx is optional
How would you alter the treatment plan for a patient with recurrent herpes simplex virus
infections who is suspected of having acyclovir-resistant strains? - Answers can use foscarnet if
indicated for acyclovir resistant strains, high risk for renal injury so hydrate prior to admin.
Admin only IV.
How would you counsel a pregnant patient who is concerned about receiving the inactivated
influenza vaccine? - Answers influenza is a serious infection that can have harsh consequences.
Inactivated vaccines have been proven safe in pregnancy although all medications are
considered high risk in pg, if the pt contracts the flu it will be hard to tx and vaccine risks
outweigh benefits.
If a patient presents in January and has not yet received the flu vaccine, how would you address
their concerns about getting vaccinated later in the season?
when is flu season? - Answers ok to administer at this time although ideal admin is oct-nov
begins november and extends to march or april
How would you manage flu vaccination in a patient with a history of severe egg allergy who is
concerned about potential reactions? - Answers the report shows that it is ok to admin flu
vaccine to these patients, educate pt on s/sx of anaphylaxis to monitor for.
How would you decide whether to prescribe oseltamivir or zanamivir for a patient presenting
with early symptoms of influenza? - Answers oseltamivir is first line tx even in pg women
zanamivir is contraindicated in COPD or underlying airway disease
If a patient with COPD requires antiviral therapy for influenza, how would you manage their
treatment to avoid the risks associated with zanamivir? - Answers I would avoid zanamivir use
,and instead use oseltamivir
educate pt on s/sx of bronchospasm and to seek tx immediately if they experience SOB etc
what is palivizumab for?
How would you determine the appropriateness of palivizumab prophylaxis in a premature infant
with a history of respiratory complications? - Answers RSV prophy in premature infants
risk vs benefit? how much oversight is there? pt hospitalized?
How would you monitor a patient on NRTIs for early signs of lactic acidosis, and what would be
your approach to managing this complication? - Answers nausea, malaise, fatigue, and
hyperventilation
dx by lactic acid measurement in arterial blood
stop NRTI and treat acidosis sx, fluids (sodium bicarb acts as a buffer and regulates blood pH
levels in severe cases), hypocapnia mgmt
What factors would you consider when selecting a protease inhibitor for a patient with HIV who
has experienced treatment failure with other antiretroviral drugs? - Answers protease inhibitors
are active against both HIV 1 and 2 and are the most effective antiretroviral available. Used in
combo with NRTI they reduce viral load to undetectable. should be used with always with one
RTI and preferably 2
How would you adjust the antifungal therapy for an older adult patient with a fungal infection
and a history of altered gastric pH? - Answers Accordingly, these agents (PPI or H2) should be
administered at least 1 hour before itraconazole or 2 hours after. NEED stomach acid for
absorption
How would you determine the appropriate use of acyclovir in a patient presenting with shingles?
- Answers there are no contraindications for patients with shingles and little adverse effects but
can be CNS effects and pt with renal issues should be started on lower doses
What would be your considerations for dosing acyclovir in a patient with renal impairment? -
Answers start with the lowest dose and monitor renal function
In a patient presenting with flu-like symptoms, how would you decide on the appropriateness of
prescribing oseltamivir based on symptom onset and clinical presentation? - Answers based on
severity of symptoms and should be started within 48 hours ideally of symptom onset, the
, sooner the better
What factors would influence your choice of an NRTI in a treatment-naïve patient starting
antiretroviral therapy? - Answers check for hypersensitivity which starts within 6 wks of tx, can
manifest as respiratory sx.
check with dr before taking supplements and OTC
stick to med admin as ordered
report NVD immediately as can be lactic acidosis or hepatic steatosis
How would you select the appropriate route of administration for amphotericin B in a patient
with disseminated cryptococcosis? - Answers amphotericin B is only reserved for (systemic
fungal) infections that are life threatening and is administered by IV for weeks to months in
hospital closely monitored
How would you manage the administration of amphotericin B in a patient with HIV and a
systemic fungal infection to minimize potential adverse effects? - Answers to protect the
kidneys admin 1L NS when amphotericin is given, monitor renal function
How would you adjust the dosage of warfarin in a patient who has been newly prescribed
itraconazole? - Answers itraconazole inhibits P450 and warfarin needs this to metabolize. So it
does not metabolize and stays in the system and increased risk for bleeding occurs due to high
warfarin levels. Monitor INR and should likely reduce warfarin dose.
How is caspofungin administered and why?
How would you monitor liver function in a patient receiving caspofungin therapy, and what
would prompt you to alter the treatment plan? - Answers caspofungin not absorbed by GI tract
and must be given by IV
Liver function tests, significant changes to albumin, bilirubin, and INR
In a patient with severe or recurrent tinea pedis, how would you decide whether to initiate
systemic antifungal therapy? - Answers if the infection is severe and extensive and is impeding
the patient's quality of life.
How would you explain to a patient the importance of adhering to albendazole therapy for the
complete eradication of intestinal parasites? - Answers albendazoles inhibit microtubule
formation which worms need to uptake glucose. Albendazoles therefore inhibit glucose uptake
and starve the worms. this can take a few days so tx needs to be completed to ensure
eradication
How would you explain the mechanism of action of β-adrenergic blocking agents to a patient
with glaucoma? - Answers The β-adrenergic blockers lower IOP by decreasing production of
aqueous humor. Reductions in IOP occur with "nonselective" β blockers (drugs that block β1
and β2 receptors) as well as with "cardioselective" β blockers (drugs that block β1 receptors
only).
β blockers are used primarily for open-angle glaucoma. They are suitable for initial therapy as
well as maintenance therapy. β blockers in combination with other drugs are also employed for
emergency management of acute angle-closure glaucoma.
How would you manage a patient on warfarin therapy who has been prescribed itraconazole to
prevent potential drug interactions? - Answers itraconazole inhibits CYP3A4 and can increase
levels of other drugs
prothrombin time should be monitored
In a patient diagnosed with invasive aspergillosis, what factors would influence your decision to
prescribe caspofungin over other antifungal agents? - Answers when it is unresponsive to or
intolerant to amphotericin B or itraconazole
If a child with tinea capitis is not responding to griseofulvin, what alternative treatments would
you consider and why? - Answers oral terbinafine
When treating a patient with intestinal worms, how would you explain the importance of taking
mebendazole consistently for the full course of treatment? - Answers mebendazole works by
preventing glucose uptake of worms starving them to death. This can take 3 days to kill them so
they full course of treatment needs to be completed as they die slowly.
In a pediatric patient with pinworm infestation, how would you decide which anthelmintic to
prescribe, considering the patient's overall health and medication tolerance?
meds are contraindicated in which patients? - Answers mebendazole is drug of choice second is
albendazole and pyrantel pamoate
patients with liver, kidney, anemia, or bleeding disorders should not take albendazole or
mebendazole
In a patient newly diagnosed with HIV, what considerations would lead you to prescribe an INSTI
as part of their antiretroviral therapy? - Answers INSTI terminate the integration of HIV into DNA
and stop HIV replication. can be used first line with other meds, can lead to HIV resistance, ok in
mild liver fx
,what is onychomycosis?
If a patient with onychomycosis has not responded to topical treatments, how would you
assess their suitability for oral terbinafine therapy? - Answers fungal nails
assess ability to comply with tx as it lasts 3-6 months. educate that even after tx only 50%
chance of efficacy. Inform pt that tx is optional
How would you alter the treatment plan for a patient with recurrent herpes simplex virus
infections who is suspected of having acyclovir-resistant strains? - Answers can use foscarnet if
indicated for acyclovir resistant strains, high risk for renal injury so hydrate prior to admin.
Admin only IV.
How would you counsel a pregnant patient who is concerned about receiving the inactivated
influenza vaccine? - Answers influenza is a serious infection that can have harsh consequences.
Inactivated vaccines have been proven safe in pregnancy although all medications are
considered high risk in pg, if the pt contracts the flu it will be hard to tx and vaccine risks
outweigh benefits.
If a patient presents in January and has not yet received the flu vaccine, how would you address
their concerns about getting vaccinated later in the season?
when is flu season? - Answers ok to administer at this time although ideal admin is oct-nov
begins november and extends to march or april
How would you manage flu vaccination in a patient with a history of severe egg allergy who is
concerned about potential reactions? - Answers the report shows that it is ok to admin flu
vaccine to these patients, educate pt on s/sx of anaphylaxis to monitor for.
How would you decide whether to prescribe oseltamivir or zanamivir for a patient presenting
with early symptoms of influenza? - Answers oseltamivir is first line tx even in pg women
zanamivir is contraindicated in COPD or underlying airway disease
If a patient with COPD requires antiviral therapy for influenza, how would you manage their
treatment to avoid the risks associated with zanamivir? - Answers I would avoid zanamivir use
,and instead use oseltamivir
educate pt on s/sx of bronchospasm and to seek tx immediately if they experience SOB etc
what is palivizumab for?
How would you determine the appropriateness of palivizumab prophylaxis in a premature infant
with a history of respiratory complications? - Answers RSV prophy in premature infants
risk vs benefit? how much oversight is there? pt hospitalized?
How would you monitor a patient on NRTIs for early signs of lactic acidosis, and what would be
your approach to managing this complication? - Answers nausea, malaise, fatigue, and
hyperventilation
dx by lactic acid measurement in arterial blood
stop NRTI and treat acidosis sx, fluids (sodium bicarb acts as a buffer and regulates blood pH
levels in severe cases), hypocapnia mgmt
What factors would you consider when selecting a protease inhibitor for a patient with HIV who
has experienced treatment failure with other antiretroviral drugs? - Answers protease inhibitors
are active against both HIV 1 and 2 and are the most effective antiretroviral available. Used in
combo with NRTI they reduce viral load to undetectable. should be used with always with one
RTI and preferably 2
How would you adjust the antifungal therapy for an older adult patient with a fungal infection
and a history of altered gastric pH? - Answers Accordingly, these agents (PPI or H2) should be
administered at least 1 hour before itraconazole or 2 hours after. NEED stomach acid for
absorption
How would you determine the appropriate use of acyclovir in a patient presenting with shingles?
- Answers there are no contraindications for patients with shingles and little adverse effects but
can be CNS effects and pt with renal issues should be started on lower doses
What would be your considerations for dosing acyclovir in a patient with renal impairment? -
Answers start with the lowest dose and monitor renal function
In a patient presenting with flu-like symptoms, how would you decide on the appropriateness of
prescribing oseltamivir based on symptom onset and clinical presentation? - Answers based on
severity of symptoms and should be started within 48 hours ideally of symptom onset, the
, sooner the better
What factors would influence your choice of an NRTI in a treatment-naïve patient starting
antiretroviral therapy? - Answers check for hypersensitivity which starts within 6 wks of tx, can
manifest as respiratory sx.
check with dr before taking supplements and OTC
stick to med admin as ordered
report NVD immediately as can be lactic acidosis or hepatic steatosis
How would you select the appropriate route of administration for amphotericin B in a patient
with disseminated cryptococcosis? - Answers amphotericin B is only reserved for (systemic
fungal) infections that are life threatening and is administered by IV for weeks to months in
hospital closely monitored
How would you manage the administration of amphotericin B in a patient with HIV and a
systemic fungal infection to minimize potential adverse effects? - Answers to protect the
kidneys admin 1L NS when amphotericin is given, monitor renal function
How would you adjust the dosage of warfarin in a patient who has been newly prescribed
itraconazole? - Answers itraconazole inhibits P450 and warfarin needs this to metabolize. So it
does not metabolize and stays in the system and increased risk for bleeding occurs due to high
warfarin levels. Monitor INR and should likely reduce warfarin dose.
How is caspofungin administered and why?
How would you monitor liver function in a patient receiving caspofungin therapy, and what
would prompt you to alter the treatment plan? - Answers caspofungin not absorbed by GI tract
and must be given by IV
Liver function tests, significant changes to albumin, bilirubin, and INR
In a patient with severe or recurrent tinea pedis, how would you decide whether to initiate
systemic antifungal therapy? - Answers if the infection is severe and extensive and is impeding
the patient's quality of life.
How would you explain to a patient the importance of adhering to albendazole therapy for the
complete eradication of intestinal parasites? - Answers albendazoles inhibit microtubule
formation which worms need to uptake glucose. Albendazoles therefore inhibit glucose uptake
and starve the worms. this can take a few days so tx needs to be completed to ensure
eradication
