HESI Question bank pharm

HESI Question bank pharm EXIT EXAM WITH QUESTIONS AND ANSWERS 2022 1. Which instructions should be included in the plan of care for a patient who is prescribed ferrous sulfate? a. Iron compounds are not taken orally b. Iron does not absorb c. Iron should only be taken at night d. Antacidsshould not be taken with iron 2. Which is the most common type of anemia? a. Iron deficiency b. Sickle cell anemia c. Folic acid deficiency d. B12 deficiency 3. Which antibiotic class disrupts folate metabolism in bacteria and is often combined with trimethoprim? a. Fluroquinolones b. Cephalosporins c. Aminoglycosides d. Sulfonamides 4. Which of the following terms least describes the mechanism of action of metoprolol? a. Alpha-1-antagonist effects b. Beta-1 selective c. Nonselective beta with alpha blocking d. Nonselective alpha-blockers 5. Which of the following drug treatment strategies is associated with peptic ulcer disease? a. Antibiotics (amoxicillin and clarithromycin) b. Hormonal therapy c. Corticosteroids d. Opioids 6. Which of the following groups of antibiotics has a beta-lactam ring in the molecular structure? a. Macrolides b. Sulfonamides c. Tetracyclines d. Cephalosporins e. Fluroquinolones 7. Which of the following diseases or disorders are more likely related to ACE inhibitors? a. Hyperthyroidism b. Pulmonary hypertension c. Cushing’s syndrome d. Angina e. Chronic kidney disease (with or without diabetes) 8. Which of the following drug classes is/are used in initial hypertension management? a. Clonidine primary b. Beta blockers primary c. Thiazide or calcium channel blocker primary d. ACE-I primary e. ARB primary 9. Which of the following medications is a fluroquinolone antibiotic? a. Penicillin b. Azithromycin c. Amikacin d. Ciprofloxacin 10. Which of the following is most likely an intervention for otitis media? a. Immunoglobulins b. Aspirin c. Corticosteroids d. Amoxicillin 11. Which antibiotic binds to 50S subunit of the bacteria ribosome and could most likely result in the development of pseudomembranous colitis? a. Tetracycline b. Vancomycin c. Clindamycin d. Amoxicillin 12. Which of the following drug classes should be avoided in c disease? a. Avoid diuretics b. Avoid antibiotics c. Avoid proton pump inhibitors d. Avoid NSAIDs 13. Prescriptive authority is regulated by the State Board of Nursing, Board of Medicine, or Board of Pharmacy, depending on the state. a. True b. False 14. Which of the following is most true of nurse practitioner prescribers? a. Prescriptive authority is under the full control of the Board of Nursing in allstates b. All states allow nurse practitioners to prescribe controlled substances c. Alstates allow some level of prescription writing by nurse practitioners d. None of the choices are correct 15. Which of the following is a non-neurotoxin treatment for head lice? a. Malathoin (Ovide) b. Benzoyl alcohol (Ulesfia) c. Permethrin 1% (Nix) d. Lindane shampoo 16. Nystatin is used for a variety of conditions. Which condition is not treated with Nystatin? a. Onychomycosis b. Vaginal candidiasis c. Intestinal candidiasis d. Oral candidiasis 17. All of the following are true regarding the treatment ofscabies except? a. Lindane does not carry risk for toxicity and can be used in children more than 2 years of age b. Treatment of scabiesinclude crotaminton, malathion, and lindane c. Lindane, though usually effective, carries a risk for toxicity and should not be used in children d. Permethrin 5% cream (Elimite) is the drug of choice for the treatment of scabies in infants greater than 2 months, and approved to use in pregnant women 18. A pediatric patient prescribed ampicillin for streptococcal pharyngitis reports new onset of pruritic, dull red, maculopapular rash on the chest and neck. Which action is most important for the provider to take to minimize this patient’s risk for injury? a. Prescribe an antihistamine for the itching b. Flag all medical records with an “Allergy to Penicillin” notice c. Prescribe azithromycin to replace ampicillin d. Discontinue the ampicillin 19. The 4 th to the 10th week of gestation is the period of time when there is the greatest concern about drug-induced: a. Fetal hemorrhage b. Labor c. Fetal malformations d. Fetal cardiac arrest 20. Match the correct drug teratogenic effect during pregnancy? a. Angiotensin-converting enzyme inhibitors – cough b. Isotretinoin – multiple defects of CNS, craniofacial, and cardiovascular c. Warfarin – Downs syndrome d. HMG CoA reductase inhibitors – decrease LDL-C e. NSAIDs – microcephaly 21. The Beers Criteria is utilized with which population of patients? a. Mental health b. OB/GYN c. Geriatrics d. Pediatrics 22. The drug manualstatesthat older adult patients are at increased risk for hepatotoxicity. Which action is most important when prescribing this medication to an 80-year-old patient? a. Ensuring that the drug is taken in the correct dose at the correct time b. Discontinuing the order, the drug is contraindicated for this patient c. Obtaining baseline liver function studies d. Giving the medication intravenously to avoid first pass metabolism 23. A patient diagnosed with otitis externa and taking a fluroquinolone/glucocorticoid combination medication asks the NP what the benefit is to taking the medications together. You reply? a. The glucocorticoid decreasesthe adverse effects of fluroquinolone b. The glucocorticoid decreasesthe likelihood of antibiotic resistance developing to the fluroquinolone c. The glucocorticoid reducesthe swelling caused by the inflammation and decreases pain, while the fluroquinolone treats the infection d. The two medications are contraindicated for use together 24. Amoxicillin is prescribed for a 12-month-old child who developed a second middle ear infection since age 8 months. Three days later, the parent calls to report that the child continues to have a temperature of 39.5° C and is unable to sleep well because of the pain. What action will the provider take to provide effective care to this child? a. Advise continuing the amoxicillin as ordered and provide a schedule of PRN dosing of ibuprofen for pain b. Discuss with the parent the child’s need for probably surgery for tympanostomy tubes placement to reduce infections c. Prescribe a medication that promotes sleep d. Discuss prescribing amoxicillin/clavulanate with the child’s parents 25. The patient is diagnosed with otitis media with perforated eardrum. You want to prescribe an otic preparation. Which of the following is not appropriate? a. Acetic acid otic b. Ciprofloxacin/dexamethasone c. Ciprofloxacin/hydrocortisone otic d. Olfloxacin otic 26. During a recent office visit, your patient is found to have atrial fibrillation. He is being treated for Graves’ disease. Which new medication will you add to his current treatment regimen? a. Atenolol (Tenormin) b. Furosemide (Lasix) c. Warfarin (Coumadin) d. Cholestyramine (Prevalite) 27. A patient who has been taking warfarin is admitted with coffee-ground emesis. How will you manage this patient? a. Administer vitamin K b. Administer vitamin E c. Administer calcium gluconate d. Administer protamine sulfate 28. A bleeding patient receiving warfarin has an INR of 6. What is the best course of action? a. Administer protamine sulfate b. Wait for INR to decrease c. Administer phytonadione d. Stop the IV drip 29. Patches are sometimes prescribed to patients. Understanding how often patches are applied, when to remove them, correct location of patch placement, frequency of dosing, and correct way to dispose are important counseling points when discussing with your patients. Match the following medication with the correct frequency of dosing: a. Rivastigmine (Exelon) once weekly b. Duragesic once daily c. Transderm Scop 48 hours d. Catapres-TTS once weekly 30. Which is the best description of the action of Clonidine? a. It selectively activates alpha-2 receptors in the central nervous system b. It causes peripheral activation of alpha-1 and alpha-2 receptors c. It depletes sympathetic neurons from norepinephrine d. It directly blocks alpha and beta receptors in the periphery 31. A patient you are treating for hypertension comes to your clinic complaining of red, painful swelling of his great left toe. Gout is diagnosed and you are treating this condition. What will you do next for this patient? a. Encourage him to lose weight b. Assess for possible alcohol abuse c. Order HbA1c d. Change histhiazide antihypertensive medication 32. Which of the following is no one of the principal indications for vasodilators? a. Heart failure b. Essential hypertension c. Hypertensive crisis d. Peripheral edema 33. The renin-angiotensin-aldosterone system plats an important role in maintaining blood pressure. Which compound in this system is most powerful at raising blood pressure? a. Angiotensin II b. Angiotensin III c. Renin d. Angiotensin I 34. The provider is discussing the management of prescribed, controlled substances with a patient. Which statement by the patient indicates understanding of the information provided? a. To reduce the probability of abuse of a drug that is Schedule II, the prescriber should call the prescription to the pharmacy b. Prescriptions for drugs in Schedule III and IV may be written to include up to 5 refills c. Schedule I drugs may only be given to hospitalized patients d. If there is a difference between state and federal laws governing a scheduled drug, the federal law takes precedence 35. In a case of an opioid overdose, naloxone can be given in repeated doses because of which property of naloxone? a. May have a shorter half-life than the opioid antagonist b. Is needed to stimulate the respiratory center c. Is effective only at high cumulative doses d. Is safe only in extremely small doses 36. 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? a. Opiates, non-opioids, increased dose of non-opiate b. NSAIDs, opiates, corticosteroids c. Low-dose opiates,salicylates, increased dose of opiates d. Non-opiates, increased dose of non-opiates, opioids 37. Which of the following opioids is so lipophilic that it is marketed in a skin patch used to treat chronic pain? a. Methadone b. Naltrexone c. Scopolamine d. Fentanyl 38. Tetracyclinesshould not be prescribed to children younger than 8 years due to: a. Risk of developing cartilage problems b. Risk of kernicterus c. Development ofsignificant diarrhea d. Adverse effects on bone growth 39. A 70-year-old patient with penicillin sensitivity isreceiving digoxin and warfarin therapy. A macrolide antibiotic is required to treat a streptococcal infection. Which of the following medications would be best for this patient? a. Azithromycin b. Telithromycin c. Clarithromycin d. Erythromycin 40. There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: a. There is not an issue with cross-resistance between the penicillins and cephalosporins b. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase producing organisms c. Renal excretion is similar in both classes of drugs d. When these drug classes are metabolized in the liver they both produce resistant enzymes 41. All of the antibiotic options listed are used to treat MRSA infections except: a. Vancomycin b. Clindamycin c. Daptomycin d. Polymyxins e. Trimethoprim/sulfamethoxazole 42. A 25-year-old woman comes into the office with complaints of profuse malodorous discharge. You diagnose bacterial vaginosis and then would: a. Initiate treatment with doxycycline (Vbramycin) 100 mg PO bid X 7 days b. Advise the patient to notify her sexual contacts regarding the diagnosis c. Treat the problem with metronidazole (Flagyl) 500 mg PO bid X 7 days d. Determine the presence of pregnancy before initiating the course of treatment 43. You are taking care of a patient that has an allergy to Bactrim. Which of the following medications would not potentially cause a cross hypersensitivity reaction? a. Furosemide b. Verapamil c. Hydrochlorothiazide d. Glyburide 44. Which cephalosporin may the prescriber order to treat meningitis? a. Cefazolin b. Cefoxitin c. Cefaclor d. Cefotaxime 45. Which assessment finding in a patient taking hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor will the NP act on immediately? a. Elevated liver function tests b. Elevated high-density lipoprotein (HDL) cholesterol c. Elevated low-density lipoprotein (LDL) cholesterol d. Decreased hemoglobin 46. Monitoring for a patient taking iron to treat iron deficiency anemia is: a. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment isstarted b. Complete blood count every 4 weeks throughout treatment c. Reticulocyte count in 4 weeks d. Annual complete blood count 47. A patient is being assessed for muscle weakness, cramping, and leg discomfort. This patient has been taking hydrochlorothiazide. What else would you do for this patient? a. Give a lower dose of the medication b. Administer calcium supplements c. Assess the serum potassium level d. Reduce salt in the patient’s diet 48. When prescribing acyclovir, patientsshould be educated regarding the: a. Risk for life-threatening rash such as stevens Johnson b. Eccentric dosing schedule c. Need to drink lots of fluid during treatment d. High risk of developing diarrhea 49. Which is true about tetanus toxoid? a. Tetanustoxoid is a bacterial toxin that has been changed to a nontoxic form b. Tetanustoxoid providesimmunity from Corynebacterium diphtheriae c. The recommended dose of tetanus toxoid for adults is 1 mL given intramuscularly d. DTaP and DT are sage to give to all adults 50. A patient is diagnosed with Bell’s palsy and prescribed high-dose steroids for 10 days, with minimal improvement. During a follow-up visit, you suspect the patient has HSV-1. Which medication will you prescribe? a. Trimethoprim-sulfamethoxazole (Bactrim DS) b. Penicillin c. Ciprofloxacin d. Acyclovir 51. Instructions for applying a topical antibiotic or antiviral ointment include: a. None of the answers are correct b. If the rash worsens, apply a thicker layer of medication to settle down the infection c. Apply thickly to the infected area, spreading the medication past the borders of the infection d. Wash hands before and after topical antimicrobials 52. Which drug would most likely be used to treat oral candidiasis? a. Terconazole b. Nystatin c. Tioconazole d. Amphotericin B 53. Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is: a. Ceftriaxone b. Cefixime c. Ciprofloxacin d. Azithromycin e. Doxycycline 54. A 19-year-old female is diagnosed with bacterial vaginosis. What is a common treatment prescribed? a. Metronidazole b. Ciprofloxacin c. Azithromycin d. Amoxicillin 55. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: a. Malabsorption b. Disintegration c. Toxicity d. Deterioration 56. Drug X produces maximal contraction of cardiac muscle in a manner similar to epinephrine. Drug X is considered to be a(n): a. Competitive antagonist b. Agonist c. Irreversible antagonist d. Partial agonist 57. Blood concentrations of drugs are variable and are influenced by the: a. Drug classification b. EC50 c. Therapeutic index d. Drug metabolism 58. The therapeutic index is a measure of drug: a. Effectiveness b. Bioavailability status c. Safety profile d. Absorption rate 59. Which of the following statements about bioavailability is true? a. Drugs that are administered more than once a day have a greater bioavailability than drugs given once a day b. All brands of drugs have the same bioavailability c. Combining an active drug with an inert substance does not affect bioavailability d. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms 60. Which statement made by a client suggests the need for further education regarding a newly prescribed medication? a. I’m paying for this prescription, so I’d like it written for the generic form b. I prefer a trade named version of the medication since they are generally more effective c. There seems to be several brand names for this medication, it’s confusing d. I’m glad I don’t have to use the medication’s chemical name when refilling the prescription 61. Antagonists are drugs that decrease or oppose the actions of another drug or endogenous ligand. a. True b. False 62. You are treating a patient with a history of hypercholesterolemia and an MI. the patient is a 45- year-old female and she is on the maximum dose of rosuvastatin which she is tolerating well. Her LDL-C is 167 mg/dL. What would be the best drug to add to her rosuvastatin therapy? a. Colesevelam b. Mipomersen c. Nicotinic acid d. Ezetimibe e. Fenofibrate 63. A patient is receiving a statin to manage his cholesterol levels. For which adverse effects will you monitor in this patient? a. Increased serum transaminase levels b. Unexplained muscle pain or tenderness c. Elevated creatinine kinase (CK) levels with muscle pain d. All answers are correct 64. Match the correct drug teratogenic effect during pregnancy? a. Angiotensin-converting enzyme inhibitors – cough b. HMG CoA reductase inhibitors – neural tube defects c. Isotretinoin – severe nausea d. Warfarin – craniofacial defects e. NSAIDs – microcephaly 65. Stimulation of lipoprotein lipase by a fenofibrate results in lowered serum levels of which substance? a. Apolipoprotein B b. Triglycerides c. HDL-cholesterol d. LDL-cholesterol 1. Criteria for choosing an effective drug for a disorder include: a. Consulting nationally recognized guidelines for disease management b. Following U.S. Drug Enforcement Administration guidelinesfor prescribing c. Asking the patient what drug they think would work best for them d. Prescribing medicationsthat are available assamples before writing a prescription 2. Prescriptive authority regulations are determined by? a. None of these choices b. Controlled by the federal government c. NPs have full prescriptive authority in allstates d. State law under the jurisdiction of a health professional board 3. Therapeutic effects of verapamil (Calan SR) are: a. Increased BP b. Decreased ventricular premature beats c. Increased HR d. Decreased systemic vascularresistance 4. You are treating a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient’s hypertension? a. Hydrochlorothiazide b. Methyldopa c. Propranolol d. Enalapril 5. Which of the following calcium-channel blocker that is used for atrial tachycardia that slows conduction at the sinoatrial and atrioventricular nodes? a. Amlodipine b. Clevidipine c. Felodipine d. Diltiazem e. Nifedipine 6. The drug classification that may reduce insulin sensitivity when treating type 2 diabetic patient for HTN are: a. Alpha blockers and ACE inhibitors b. Diuretics and beta blockers c. Calcium channel blockers and ACE inhibitors d. Diuretics and calcium channel blockers 7. Which effect is caused by both atenolol and diltiazem? a. Increased cGMP levels b. Decreased heart rate c. Relaxation of arterialsmooth muscle d. Decreased cAMP levels 8. A patient is diagnosed with otitis externa. Comorbidities include diabetes mellitus, hypertension, and advanced multiple sclerosis. Which type of education regarding medication administration would you provide? a. The oral administration of a prescription for hydrocortisone/neomycin/polymyxin B combination solution b. The administration of topical medicationsfor a prescription of alcohol plus acetic acid solution c. The oral administration of a prescription for fluoroquinolone d. The administration of topical combination medications for a prescription of flora quinolone/glucocorticoid combination solution 9. A 2 year old child presentsto the clinic with otalgia and fever. The left tympanic membrane (TM) is erythematous and bulging.; the right (TM) is perforated and draining. The child’s parents states. “This is the fifth ear infection this ear. What can we do?”. What action will the provider take to address the child’s ear problems? a. Discuss beginning prophylactic antibiotic therapy with trimethoprim/sulfamethoxazole b. Prescribe both ceftriaxone (Rocephin) IM with benzocaine ear dropsfor pain c. Prescribe amoxicillin/clavulanate and refer the child to an otolaryngologist d. Prescribe both high-dose amoxicillin and the influenza vaccine 10. Amoxicillin is prescribed for a 12-month-old child who developed a second middle ear infection since age 8 months. Three days later, the parent calls to report that the child continues to have a temperature of 39.5° C and is unable to sleep well because of the pain. What action will the provider take to provide effective care to this child? a. Advise continuing the amoxicillin as ordered and provide a schedule of PRN dosing of ibuprofen for pain b. Discuss with the parent the child’s need for probably surgery for tympanostomy tubes placement to reduce infections c. Prescribe a medication that promotes sleep d. Discuss prescribing amoxicillin/clavulanate with the child’s parents 11. When a patient takes a hepatic enzyme inducer, the dose of warfarin is usually modified in which way? a. It is increased b. It is very unpredictable c. It is decreased d. No change in dosage 12. When two drugs interact what are the possible outcomes? a. All the answers are correct b. The combination of drugs may produce a new response not seen with either drug alone c. One drug may reduce the effects of the other d. One drug may intensify the effects of the other 13. A generic medication is considered equal, or bioequivalent to its parent brand-name medication, and must undergo stringent safety and equivalency testing and comply with specific criteria established by the U.S. Food and Drug Administration (FDA). a. True b. False 14. Which enzyme is responsible for metabolizing drugs in the liver? a. Ptyalin b. CYP450 enzymes c. Gastric lipase d. Pancreatic lipase 15. Which of the following statements about bioavailability is true? a. Drugs that are administered more than once a day have a greater bioavailability than drugs given once a day b. All brands of drugs have the same bioavailability c. Combining an active drug with an inert substance does not affect bioavailability d. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms 16. Pharmacokineticsinvolvesthe study of which factor? a. Physiologic interactions of drugs b. Adverse reactions to medications c. Distribution rates among various body components d. Interactions among various drugs 17. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: a. After the second dose b. One hour after IV administration c. After four to five half-lives d. When the patient feels the full effect of the drug 18. How doessimvastatin exert its action? a. By activating the lipoprotein lipase enzyme b. By inhibiting the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase c. By preventing the reabsorption of bile acids d. By inhibiting lipolysis in the adipose tissue 19. Which one of the following is the most common side effect of antihyperlipidemic drug therapy? a. Elevated blood pressure b. Heart palpitations c. Gastrointestinal disturbances d. Neurologic problems 20. Which of the following is not an expected adverse effect of Niacin? a. Itching b. Flushing c. Arthralgias d. Hyperglycemia 21. A patient with cardiovascular disease is taking rosuvastatin. Which finding would indicate a potential adverse effect of this drug? a. Blood pressure of 140/90 mm Hg b. Muscle pain and tenderness c. Platelet count 100 x103 /mm3 d. Wheezing and shortness of breath 22. A provider is concerned about renal function in an 84-year-old patient who is taking several medications. What laboratory result will the provider order? a. Creatinine clearance b. Serum creatinine c. Potassium levels d. Sodium levels 23. A patient with heart failure who takes an angiotensin-converting enzyme (ACE) inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the provider will focus on which evaluation? a. Maximal exercise capacity b. Serum electrolyte levels c. Ejection fraction d. Complete blood count 24. Monitoring for a patient taking iron to treat iron deficiency anemia is: a. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment isstarted b. Complete blood count every 4 weeks throughout treatment c. Reticulocyte count in 4 weeks d. Annual complete blood count 25. An infant is prescribed a medication that has a narrow therapeutic range and is excreted by the kidneys. The provider will monitor closely for which effect? a. Tachyphylaxis b. Evidence of drug toxicity c. Decreased drug effectiveness d. Unusual CNS effects 26. Which statement by a patient about the use of aspirin during pregnancy indicates a need for further learning? a. Aspirin is most harmful when used late in pregnancy b. Aspirin can cause antepartum hemorrhage c. Aspirin can affect hemostasisin the newborn d. Aspirin can be used to relieve pain during pregnancy 27. The brain of the teate may accumulate toxic levels of drugs due to: a. Subcutaneous perfusion is nonfunctional b. The blood-brain barrier is not fully developed c. The P-glycoprotein transporter is overdeveloped d. CYP450 enzymes are nonfunctional e. Gastric motility and peristalsis are delayed 28. All of the following statements about Beer’s List are true except: a. It is derived from the expert opinion of one geriatrician and is not evidence-based b. These criteria are directed as the general population of patients over 65 years of age and do not take disease states into consideration c. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities d. It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they post unnecessary high risk for older person and a safer alternative is available 29. An older adult patient with a history of forgetfulness will need to take multiple drugs after discharge from the hospital. What provider action will most successfully promote medication adherence in a forgetful patient? a. Ask the patient to share the medication teaching with a neighbor or friend soon after discharge d. There is an increase in the volume of distribution e. There is an increase in free drug levels in the plasma b. Make sure the patient understands the actions and side effects of each drug c. Schedule medication to be taken at the same times as much as possible d. Give the patient detailed written information about each drug 30. A patient on heparin therapy has an activated partial thromboplastin time (aPTT) of 98 seconds. How will you interpret this finding? a. The levels cannot be interpreted without knowing the prothrombin time and the international normalized ratio (INR) b. The level is outside the expected target therapeutic level of anticoagulation; it is too high c. The level is within the expected target therapeutic level of anticoagulation d. The level is outside the expected target therapeutic level of anticoagulation; it is too low 31. An orally administered drug that directly inhibits thrombin: a. Eptifibatide b. Enoxaparin c. Rivaroxaban d. Prasugrel e. Dabigatran 32. A patient who has been prescribed a nonsteroidal anti-inflammatory drug (NSAID), the patient is also taking warfarin. How does taking these drugs in combination affect their distribution to the tissues? Select all that apply. a. There is a decrease in protein binding of the drugs b. There is a decrease in gastric emptying time c. There is a change of the drugs to passive metabolites 33. Beta lactamase inhibitors are often indicated in which of the following? a. Delayed absorption of oral drugs b. Often combined with penicillin antibiotics c. First dose effects d. May decrease absorption of medications 34. Which of the following drug classes should be avoided in peptic ulcer disease? a. Avoid diuretics b. Avoid antibiotics c. Avoid proton pump inhibitors d. Avoid NSAIDs 35. Which of the following terms least describes the mechanism of action of metoprolol? a. Alpha-1-antagonist effects b. Beta-1 selective c. Nonselective beta with alpha blocking d. Nonselective alpha-blockers 36. Fluroquinolone antibiotics are most likely indicated in which of the following conditions? a. Asthma b. GERD c. Genital infections d. Follicular conjunctivitis 37. Which of the following diseases or disorders are more likely related to ACE inhibitors? a. Hyperthyroidism b. Pulmonary hypertension c. Cushing’ssyndrome d. Angina e. Chronic kidney disease (with or without diabetes) 38. Which of the following is most likely an intervention for otitis media? a. Corticosteroids b. Immunoglobulins c. Amoxicillin d. Aspirin 39. Which of the following medications is a fluroquinolone antibiotic? a. Penicillin b. Azithromycin c. Amikacin d. Ciprofloxacin 40. Which of the following best classifies aminoglycosides, macrolides, and clindamycin? a. Folic acid synthesisinhibitors b. Cell wall inhibitors c. Protein synthesisinhibitors d. Mycolic acid synthesis inhibitors 41. Which of the following groups of antibiotics has a beta-lactam ring in the molecular structure? a. Macrolides b. Sulfonamides c. Tetracyclines d. Cephalosporins e. Fluroquinolones 42. Which of the following best classifies penicillins, cephalosporins, and carbapenems? a. RNA synthesis inhibitors b. Mycolic acid synthesisinhibitors c. Cell wall inhibitors d. Protein synthesis inhibitors 43. A patient with genital herpes simplex becomes pregnant. What statement made by the patient concerning her prescribed acyclovir would indicate that teaching was effective? a. I may continue to use acyclovir throughout the course of my pregnancy b. I should only take this medication during an active outbreak of my herpes c. I need to switch to the topical formulation of this medication now that I am pregnant d. It is best to discontinue use of this medication until I deliver the baby 44. Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is: a. Ceftriaxone b. Cefixime c. Ciprofloxacin d. Azithromycin e. Doxycycline 45. A female patient who is beign treated for chronic hepatitis B develops nephrotoxicity while on treatment. Which is the most likely medication she is taking for s treatment? a. Entecavir b. Adefovir c. Lamivudine d. Telbivudine 46. You administer morphine to treat the pain of a patient with cancer. What process occursfor a therapeutic effect? a. Mu receptors are blocked b. Kappa receptors are stimulated c. Mu and kappa receptors are blocked d. Mu and kappa receptors are stimulated 47. Which agent is often found as an adulterant in heroin and has led to an increase in overdose deaths? a. Cathinones b. Fentanyl c. Spice d. Marijuana 48. Codeine has a greater oral bioavailability compared with morphine because of which reason? a. Morphine directly passesinto systemic circulation b. Morphine is conjugated more quickly c. Codeine undergoeslessfirst-pass metabolism d. Codeine is metabolized more by hepatic enzymes 49. A patient who has a long-term addiction to opioids is believed to have taken an overdose of barbiturates. The provider will anticipate which likely outcome? a. Pinpoint pupils, respiratory depression, and possibly coma b. Minimal respiratory depression because the patient has developed tolerance to opioids c. Paradoxical excitation resulting from drug-drug interaction d. Severe abstinence syndrome when the effects of the barbiturates are recersed 50. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be: a. A high-potency corticosteroid cream (Diprolene AF) b. A combination of corticosteroid and an antifungal (Lotrisone) c. Intermediate potency corticosteroid ointment (Kenalog) d. A low-potency corticosteroid cream applied sparingly (Hydrocortisone 1%) 51. Mupirocin ointment is used topically to treat: a. All types of eye infections b. Hemorrhoids c. Conjunctivitis d. Impetigo 52. What is the major concern for a prolonged use of prednisone? a. Hypertension b. Precipitation of a stroke c. Hepatic necrosis d. Renal insufficiency e. Osteoporosis 53. All of the antibiotic options listed are used to treat MRSA infections except: a. Vancomycin b. Clindamycin c. Daptomycin d. Polymyxins e. Trimethoprim/sulfamethoxazole 54. Which of the following are the mechanisms of resistance that can occur with antimicrobial therapy? a. Enzymatic inactivation of the drugs b. All of the answers are correct c. Drug efflux d. Altered drug targets 55. Which of the following antibiotics is not considered bactericidal? a. Minocycline b. Penicillin c. Cephalexin d. Vancomycin 56. Which antibiotic is in the macrolide class? a. Clarithromycin (Biaxin) b. Trimethoprim c. Nitrofurantoin (Macrobid) d. Minocycline (Minocin) 57. People at higher risk for methicillin-resistantstaph aureus(MRSA) include: a. All the answers are correct b. Children c. Military recruits d. Athletes e. Prison inmates 58. Which of the following is recommended treatment for erythema migrans or early Lyme disease? a. Erythromycin 333mg po for 10 days b. Dicloxacillin 500mg po for 10 days c. Doxycycline 100mg po for 21 days d. Ciprofloxacin 250mg po for 14 days 59. Which is considered the most widely used group of antibiotics because of their bactericidal nature, resistance to beta-lactamases, and activity against a broad spectrum of pathogens? a. Tetracyclines b. Penicillins c. Cephalosporins d. Aminoglycosides 60. Which is the most common type of anemia? a. Iron deficiency b. Sickle cell anemia c. Folic acid deficiency d. B12 deficiency 61. Which of the following is a common cause of iron deficiency in patients? a. Rapid growth during adolescence b. Decreased intestinal uptake of iron c. Vegetarian eating patterns d. Chronic blood lossthrough the gastrointestinal tract 62. Which medication is indicated for the treatment of either HIV or hepatitis B? a. Tenofovir b. Etravirine c. Abacavir d. Ritonavir 63. Which is true about tetanus toxoid? a. Tetanustoxoid is a bacterial toxin that has been changed to a nontoxic form b. Tetanustoxoid providesimmunity from Corynebacterium diphtheriae c. The recommended dose of tetanustoxoid for adults is 1 mL given intramuscularly d. DTaP and DT are sage to give to all adults 64. The pregnant woman you are caring for has declined to receive the influenza vaccine during her pregnancy. You inform her that: a. It is important for her to receive the vaccination while she is pregnant, as the influenza vaccine cannot be administered to breastfeeding mothers b. The nasal spray influenza vaccine is a simple and effective means of preventing “the flu” in pregnant women c. Pregnant women are five times more likely to develop serious disease in a pregnant woman when compared to a non-pregnant woman d. There are potential risks of receiving the influenza vaccine during pregnancy, however the benefits outweigh the risks 65. In which of the following the human papillomavirus (HPV) is not recommended. a. Men who have sex with men b. Only young men through the age of 21 c. A 25-year-old who did not finish the vaccine series as a teen d. Men with compromised immune systems (including HIV) through age 30, if they did not get HPV vaccine as teenagers 1. A patient has been prescribed doxycycline For a chlamydia infection. She is healthy and her only oral medication Is combined contraceptive. Her education would include: a. Doxycycline is used for one dose. Treatment of STI's, take the whole prescription at once b. Use a back-up method for birth control (condom) until next menses c. Doxycycline may cause tendonitis and she should report any joint pain d. Her partner will need treatment for infection, doesn't clear with the doxycycline 2. Which Organism is a common sexually transmitted bacterial infection? a. Helicobacter pylori b. Staphylococcus aureus c. Clostridium perfringens d. Treponema pallidum 3. a 19-year-old female, is diagnosed with bacterial vaginosis. What is a considered treatment prescribed? a. Azithromycin b. Metronidazole c. Ciprofloxacin d. Amoxicillin 4. which patient condition would be a contraindication for the administration of Clindamycin? a. Skin infection b. Ulcerative colitis c. Arthritis d. diabetes mellitus 5. which of the following statements is (are) True of metronidazole (flagyl)? a. It is used as an anti-protozoal to treat trichomoniasis. b. It is used to treat Clostridium difficile c. All of the answers are correct d. It has a disulfiram like activity. 6. Therapiesfor acute uncomplicated urinary tract infection. Include all of the following except: a. Levofloxacin b. Trimethoprim/sulfamethoxazole c. Azithromycin d. Nitrofurantoin 7. the mechanism(s) Of transmission of community acquired methicillin-resistant Staphylococcus aureua include(s): a. Skin contact b. all the answers are correct c. Droplets d. Exposure to contaminated objects 8. The laboratory analysis conducted on a patient with acute onset fever MLAsreveals an elevated neutrophil count. This finding suggests that the problem is most likely a: a. Viral infection. b. Parasitic infection c. Sinusinfection d. bacterial infection 9. The NP is teaching an NP student about sulfasalazine. Which of the following patient situation should the NP student alert the NP? a. A patient with a sulfa allergy b. A patient with rheumatoid arthritis c. A patient with inflammatory bowel disease d. A patient with latex allergy 10. A patient presentsto your clinic with symptoms of a potentially serious gram-negative infection. You decide to give a Cephalosporin antibiotic. Now, while awaiting laboratory results. You choose: a. None of the answers are correct b. Second generation Cephalosporin c. First generation cephalosporin d. 3rd generation Cephalosporin 11. a patient is seen daily in a community clinic for treatment of a narcotic addiction. Which medication included in the patient's prescription willsupport the patient'srecovery Efforts? a. Flumazenil b. Buprenorphine c. Methadone d. Naloxone 12. The partial agonism of Buprenorphine at mu opioid receptors is associate with lower abuse a. True b. False 13. A 64-year-old male presents with mild to moderate musculoskeletal back pain after playing golf. He states he has tried acetaminophen and that it did not help. His past medical history includes diabetes, hypertension, hyperlipidemia, gastric ulcer resolved and coronary artery disease. Which of the following is the most appropriate NSAID regimen to treat his pain? a. Naproxen, and omeprazole b. Celecoxib c. Indomethacin and omeprazole d. Naproxen 14. a schedule three drug, is ordered for a patient. The patient asks you what the schedule designation means. How will you reply? a. Scheduled drugs are assigned a number based on their potential for abuse b. Schedule three drugs have a high risk for toxicity c. A Schedule 3 means that more pain relief is provided than a scheduled two drug can provide d. This means that the drug has a low number of adverse effects 15. Which order for furosemide is written appropriately by the prescriber? a. Furosemide (Lasix) 20 mg PO QD b. Furosemide (Lasix) 20 mg daily c. Furosemide (Lasix) 20 mg PO daily d. Furosemide (Lasix) 20 mg PO qd 16. Which of these medication orders are complete? Select all that apply a. Promethazine 50 mg IV q3-6h PRN for nausea b. Aspirin 81 mg PO daily c. Vitamin D 2000 units PO d. Multivitamin e. Ciprofloxacin hydrochloride (cipro) 500 mg PO q12h x 7 days 17. The brain of the neonate may accumulate toxic levels of drugs due to: a. The blood brain barrier is not fully developed b. Gastric motility in peristalsisis delayed c. The P glycoprotein transporter is overdeveloped d. Cy P450 enzymes are nonfunctional e. Subcutaneous perfusion is nonfunctional 18. The NP student is concerned that in older adult patients, adverse drug reactions are due to reduced renal excretion. Which laboratory result should be closely monitored? a. Blood urea nitrogen BUN b. Creatinine clearance c. serum albumin levels d. Serum creatinine levels 19. The beers criteria is utilized with which population of patients? a. Mental health b. OBGYN c. Geriatrics d. Pediatrics 20. Which of the following is true? a. Enzyme inducers can enhance clinical responses to pro drugs b. The bio availability of lipid soluble drugs is increased in the elderly c. Drug doses may need to be increased in pregnancy d. All of the above 21. Match the correct adverse drug reactions unique to the pediatric population: a. Sulfonamides- Staining of developing teeth b. Glucocorticoids - Weight loss c. Chloramphenicol - Red syndrome d. Tetracyclines – Kernicterus e. Fluoroquinolones - Muscle hypertrophy f. Aspirin - Reyes syndrome 22. A patient with hypercholesterolemia who is taking 20 milligrams of simvastatin as prescribed. After a few days, the patients your analysis reports indicated the presence of myoglobin. How would you manage this patient? a. Instruct the patient to take the simvastatin before meals b. Instruct the patient to discontinue the simvastatin c. Instruct the patient to drink 250 milliliters of water with the simvastatin d. Instruct the patient to decrease his dose to 10 milligrams ofsimvastatin daily 23. You are caring for a patient with renal failure who is prescribed a protein bound drug. Which parameter in the patient must be assessed before administering the medication? a. Lipid profile b. Blood glucose level c. Serum albumin levels d. Hemoglobin level 24. before beginning I am vitamin B12 therapy. Which laboratory value should be obtained? a. Iron b. All the answers are correct c. reticulocyte count, Hemoglobin, and hematocrit d. Vitamin B12 25. A patient asks how nitroglycerin worksto relieve anginal pain. Your response is: a. Increases the oxygen demand in the cardiac muscle b. Promote spaso dilation, which reduces preload and oxygen demand c. Constricts coronary arteries to increase blood flow to the heart d. Increases ventricular filling to improve cardiac output 26. A patient with diabetes develops hypertension. Which type of medication will the provider prescribe to treat hypertension in this patient? a. Thiazide diuretics b. beta blockers c. Direct acting vasodilators d. angiotensin converting enzyme ACE inhibitors 27. which drug blocks A1 beta one and beta two adrenoceptors? a. Carvedilol b. Propranolol c. Metoprolol d. Dobutamine 28. You are treating a patient who has diabetes and hypertension. Which medication is most likely to prescribe to treat this patient’s hypertension? a. Enalapril b. Hydrochlorothiazide c. Propranolol d. Methyldopa 29. the drug classifications that may reduce insulin sensitivity when treating type 2 diabetic patient for hypertension are: a. Alpha blockers and ACE inhibitors. b. Diuretics and calcium channel blockers. c. Calcium channel blockers and ACE inhibitors. d. Diuretics and beta blockers. 30. A partial agonist is best described as an agent that: a. Has affinity, but lacks efficacy b. Haslow potency but high efficacy c. Cannot produce the full effect even at high doses d. Interacts with more than one receptor type 31. An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of the following routes of administration is the most desirable for administering the antidote for the drug overdose? a. Subcutaneous b. Intramuscular c. Oral d. Intravenous e. Trans dermal 32. A medication has a half life of 12 hours. How would you interpret this to guide therapy? a. The medication will be 50% illuminated in 12 hours b. The medication will not work for the first 12 hours c. The medication will be administered every six hours to maintain consistent blood levels d. The patient will require two extra doses of medication before there is an effect 33. When two drugs interact, what are the possible outcomes? a. One drug may reduce the effects of the other b. The combination of drugs may produce a new response not seen with either drug alone c. All the answers are correct d. One drug may intensify the effects of the other 34. If lipid solubility is the only factor affecting drug action, how soon will you see in effect of the drug compared to water soluble drug? a. Slowly b. Unpredictably c. Variability. d. Rapidly 35. Drug X produces maximal contraction of cardiac muscle in a manner similar to epinephrine. Drug X is considered to be a(n) a. Agonist b. competitive antagonist c. Irreversible antagonist d. partial agonist 36. The definition of pharmacokinetics is: a. The drug movement through the body and what the body does to the drug b. What the drug does to the body c. Adverse reactions to the drug d. Impact of food on drugs 37. What is a priority assessment for a patient with severe anemia? a. Integumentary assessment b. neurologic assessment c. Cardiac assessment d. gastrointestinal assessment 38. What is not a common side effect of oral iron therapy? a. Dark stools b. Staining of teeth c. Nausea, vomiting d. Paresthesia 39. The patient asks if there is any other option besides antibiotics to treat acute otitis media. How will you respond? a. Antibiotics are the only way to cure otitis media b. Pain management is only necessary when antibiotics are prescribed. c. Pain management is reserved for use when the tympanic membrane is burst. d. Pain management is also part of the treatment plan for otitis media. 40. A 6-year-old child presents with crying due to ear pain. Tympanic membranes are erythematous, bulging and immobile, bur intact. In addition to antibiotic therapy, what will the provider recommend for pain management? a. Low dose aspirin b. Lidocaine ear drops c. A tympanostomy to relieve pressure in the middle ear d. Prednisone 41. a patient is diagnosed with otitis externa caused by Aspergillus organisms. All of the therapy is appropriate except: a. Oral fluconazole b. 2% acetic acid solution ear drops c. Topical 1% Clotrimazole d. Ciprofloxacin plus hydrocortisone otic solution 42. Which agent is used to treat the majority of infections caused by herpessimplex virus, an varicella zoster virus? a. Zanamivir b. Ganciclovir c. Amantadine d. Acyclovir 43. Health maintenance recommendation for a 51-year-old patient who enjoys outdoor activities: a. Pneumococcal vaccine b. Varicella vaccine c. T DAP TD vaccine. d. Hepatitis B vaccine. 44. A patient with a history of congestive heart failure and renal impairment is diagnosed with esophageal Candidiasis. Which antifungal agent will the provider prescribe this patient? a. Itraconazole b. Fluconazole c. D Voriconazole d. Amphotericin B 45. which infections are fungal? Select all that apply a. Ringworm b. Cholera. c. Candida. d. Athlete’sfoot. e. Aspergillus. 46. Which of the following terms best describes the mechanism of action of metoprolol? a. A1 antagonist effects. b. Beta one selective c. nonselective beta with alpha blocking. d. Nonselective alpha blockers. 47. Which antibiotic class disrupts folate metabolism in bacteria and is often combined with trimethoprim? a. Aminoglycosides. b. Fluoroquinolones c. Cephalosporins d. Macrolides e. sulfonamides. 48. Which of the following best classifies penicillins, cephalosporins and carbapenems? a. Cell wall inhibitors. b. Protein synthesisinhibitors. c. Mycolic acid synthesisinhibitors. d. RNA synthesis inhibitors. 49. Which of the following groups of antibiotics bind to the 50 S subunit of the bacterial ribosome and includes drugs such as erythromycin and azithromycin? a. Macrolides b. aminoglycosides. c. Fluoroquinolones d. tetracyclines. 50. Which of the following medications is a fluoroquinolone antibiotic? a. Penicillin. b. Amoxicillin. c. Ciprofloxacin d. Azithromycin 51. which of the following is most likely an intervention for otitis media? a. Aspirin b. Corticosteroids. c. Immunoglobulins. d. Amoxicillin. 52. Beta lactamase inhibitors are often indicated in which of the following? a. First dose effect b. Delayed absorption of oral drugs. c. Often combined with penicillin antibiotics. d. May decrease absorption of medications. 53. Which of the following best classifieds aminoglycosides, macrolides, and clindamycin? a. Folic acid synthesisinhibitors. b. Mycolic acid synthesisinhibitors. c. Cell wall inhibitors. d. Protein synthesisinhibitors. 54. Which antibiotic binds to the 50 S subunit of bacterial ribosome and could most likely result in development of pseudomembranous colitis? a. Amoxicillin. b. Vancomycin c. clindamycin d. tetracycline 55. Which of the following medications are drug classes is commonly indicated for managing gestational hypertension? a. Spironolactone. b. Loop diuretics. c. Calcium channel blockers d. Dobutamine e. calcium gluconate. 56. Mild acne may be initially treated with: a. Topicalretinoid b. Topical combined antibiotic. c. Minocycline. d. OTC benzol peroxide. 57. Isotretinoin is a drug employed in the treatment of severe recalcitrant cystic acne. Which of the following is not an adverse effect associated with its use? a. Fetal abnormalities. b. Hypertriglyceridemia c. hyponatremia. d. Conjunctivitis 58. in which of the following patients will you prescribe appropriate therapy for lice infestations? a. Malathion to a 3-year-old patient with head lice. b. Spinosad to a 6-year-old with head lice. c. Lindane to a 105-pound patient with lice d. I ever met into a 12-kilogram patient with lice. 59. What would you prescribe for a warfarin overdose? a. Calcium. b. Phytonadione c. Aspirin. d. potassium. 60. The drug heparin acts in hemostasis by which process? a. Degrading the fibrin within blood clots. b. Shortening the fibrin strands to retract the blood clot. c. Inhibiting thrombin antithrombin 3. d. Presenting the conversion of prothrombin to thrombin. 61. A bleeding patient receiving warfarin has an INR of six. What is the best course of action? a. Administer protamine sulfate. b. Administer phytonadione c. wait for INR to decrease d. Stop the IV drip. 62. In which patient would niacin be contraindicated? a. Patient with history of hypothyroidism. b. Patient with history of hypoglycemia. c. Patient with history of gout. d. Patient was history of eczema. 63. What is the first line therapy when treating hyperlipidemia? a. Niacin b. bile acid sequestrants c. statin therapy. d. Lifestyle modifications 64. which patient receiving LOR Staten should be monitored closely while receiving thistherapy. a. The patient with an elevated creatinine level. b. The patient with a potassium level of 3.4. c. The patient with a heart rate of 90 beats per minute. d. The patient with Constipation. 65. Which drug inhibits the intestinal absorption of cholesterol? a. Ezetimibe b. Colestipol c. Fenofibrate d. colesevelam MISSED QUESTIONS 1. Your first line treatment forscabiesin a 5-year-old would be all of the following except: a. Crotamiton b. Malathion c. Permethrin d. Lindane 2. A patient is prescribed amiodarone. What should be included in the patient teaching about this medication? Select all that apply a. High fiber diet. b. Gastrointestinal upset. c. Decreased fluid intake? d. Photophobia and wearing sunglasses. e. Sunscreen use. 3. Which pharmacological therapy would be inappropriate for a patient with a previous history of MI and atrial fibrillation complaining of waking up at night with a feeling of smothering and breathing difficulty? a. Beta blockers and loop diuretic b. Nitrate and alpha-1 adrenergic blockers c. Calcium channel blocker and thiazide diuretic d. ACE inhibitor and digitalis 4. Which of the following drugs are considered broad spectrum penicillins? Select all that apply a. Amoxicillin b. Nafcillin c. Ampicillin d. Oxacillin 5. select the antibiotic that may be used to treat systemic infections in a patient with a diagnosis of Cellulitis a. Doxycycline b. Cefazolin c. Levofloxacin d. Imipenem-cilastatin 6. Which of the following person should not receive the shingles vaccine? a. A person currently on Corticosteroids b. A 63-year-old patient who had chickenpox c. A 48-year-old patient who was exposed to chickenpox. d. A 60-year-old patient who received the vaccine nine years ago. 7. A provider is conducting a smoking cessation class in the community. Which effects will be included in the discussion about physiological effects of nicotine? Select all that apply a. Suppression of nausea. b. Vomiting c. decreased gastric acid. d. Increased alertness e. Suppression of appetite f. Increased blood pressure 8. What do the following medications or drug classes is commonly indicated for managing just stational hypertension? a. Spironolactone (Aldactone) b. Loop diuretics. c. Calcium channel blockers d. Dobutamine e. Calcium gluconate 9. Which action should the nurse perform to ensure the medication dose for a pediatric patient is correct? Select all that apply a. If the drug dosage prescribed varies from recommended reference range, notify the provider. b. Use a current drug reference to determine usual dosage for 24 hours c. Determine the total amount of the drug to administer per dose and per day d. Determine the dose parameters by multiplying the weight by the minimum and maximum daily dose of the drug to determine the safe range e. Use the patient’s weight in pounds 10. When prescribing medications to infants, it is important for the provider to consider with fact. Select all that apply a. Breastfeeding infants are more likely to develop toxicity when the mother is taking lipid soluble drugs. b. Infants have immature livers which slow drug metabolism. c. Immaturity of renal function in infancy causes infantsto excrete drugs less efficiently d. Infants are more sensitive to medications that act on the central nervous system 11. Which of the following is not consistent with the rules for Geriatric prescribing? a. Half-life will be longer in older adults. b. Reduce the number of drugsin the patient’s regimen whenever possible. c. Adverse drug response is present atypically in the older adult. d. Steady state is reached more quickly in the older adult. 12. Which client hasthe greatest risk for medication toxicity? a. A 52-year-old client with renal failure on hemodialysis. b. A 67-year-old client receiving. The medicationsthat are highly protein bound. c. A 74-year -old client prescribed for medications for hypertension. d. A 38-year-old client with a serum albumin level of 6.2. 13. The FDA recommendsthat individualstaking the Cox two inhibitor. Select coxib should be Take a drug holiday to decrease the risk associated with this drug. The increased risk associated with the chronic use of Cox two inhibitors may be attributed to: a. Gastrointestinal bleeding b. Increased platelet aggregation c. Renal insufficiency d. A hypersensitivity reaction e. Respiratory depression 14.14.