Fin Misc Final Exam

FIN MISC FINAL EXAM QUESTION 1 Though all stimulants appear equally effective, which of the following drugs is used as the first line pharmacologic choice in the treatment of AD/HD Mondafinil methlyprendate Atomxetine Amphetamine salt 1.55 points QUESTION 2 A patient who is identified as having stage 2 Alzheimers Disease is prescribed donepezil (Aricept). The patient's caregiver asks the primary care nurse practitioner (NP) how long the medication will be needed. The NP should tell the patient that donepezil must be taken: Until symptoms subside For 28 weeks which is when cognitive function improves for most patients Until symptoms worsen then another drug will be added Indefinitely as the drug is not curative 1.55 points QUESTION 3 Systemic antidiarrheals, such as loperamide (Imodium), decrease the number and liquidity of stool by which of the following mechanisms? Decreasing intestinal motility Absorbing toxins Binding with fecal material to increase bulk Blocking the CTZ zone 1.55 points QUESTION 4 Ms. Smith has HTN, A-fib, diabetes, arthritis, and lewy body Dementia. She was started on Rivastigmine 3 months ago and is complaining of abdominal pain, has lost weight, and has had a loss in appetite. These signs and symptoms suggest Possible renal dysfucntion Possible hepatic dysfunction Cardiac toxicity GERD 1.55 points QUESTION 5 A 55 year old patient develops Parkinson's disease characterized by unilateral tremors only. The primary care NP will refer the patient to a neurologist and should expect initial treatment to be Dopamine precursor Monoamine Oxidase B inhibitor Anticholinergic agents Dopamine Agonist 1.55 points QUESTION 6 The following drugs exert their theraputic effects by blocking reuptake of norepinephrine and serotonin at the presynaptic neuron: tricyclic antidepressants selective serotonin reuptake inhibitors Monoamine oxidase inhibition Serotonin/Norepinephrine reuptake inhibitors 1.55 points QUESTION 7 The most commonly prescribed antidepressants are Tricyclic antidepressants (TCAs) Norepinephrine and dopamine reuptake blockers monamine Oxidase Inhibitors Selective sertonin reuptake inhibitors (SSRIs) 1.55 points QUESTION 8 John has ben prescribed phenelzine an MAOI inhibitor. He must be educated by his provider regarding his diet. A hypertensive crisis can occur within several hours after ingestion of a substance that contains Potassium Magnesium salts MSG Tyramine 1.55 points QUESTION 9 A patient reports feelings of sadness and hopelessness along with difficulty sleeping and weight loss. The primary care NP learns that the patient’s mother died 6 months earlier. The NP should Start patient on a TCA Tell the patient that the symptoms will go away in a few months Determine whether medications are causing these symptoms. Refer the patient to bereavement counseling 1.55 points QUESTION 10 Pamela has recently been prescribed a SSRI for her depression. She takes NSAID regularly for her arthritic knee NSAIDs can Increase the action of SSRIs Increase the risk for serotonin syndrome Decrease the action of SSRIs Cause hypotension 1.55 points QUESTION 11 A client has been started on Bupropion a Norepinephrine/dopamine reuptake inhibitor. Which of the following is a serious adverse effect of Bupropion? Increase liver enzymes SIADH Hypertensive crisis Arrhythmias 1.55 points QUESTION 12 ? Zolpidem is a GABA –BZ receptor agonist Benzodiazepine Tricyclic antidepressant Melatonion receptor agonist 1.55 points QUESTION 13 Avery is 79 year old male living in a skilled nursing facility. His provider has chosen to start him on a benzodiazepine. What would be the best drug in this class to start him on? Triazolam Flurazepam? Lorazepam Ativan 1.55 points QUESTION 14 Anna has insomnia, however she has a problem with both sleep onset and maintenance (FALLING ASLEEP AND STAYING ASLEEP). What drug would the NP prescribe for Anna’s insomnia? Edluar SR Zolpidem Zaleplon Ramelton ? 1.55 points QUESTION 15 Sam has GERD with erosive esophagitis has been taking a PPI for 4 weeks and reports a decrease in symptoms. Sam asks his NP if the medication may be discontinued. The NP should respond by saying; It is ok to stop taking the PPI now Your condition is cured but therapy will continue for year The dose may be decreased with long term therapy Only take the PPI if symptoms start again. 1.55 points QUESTION 16 The primary care NP performs a physical examination on an 89-year-old patient who is about to enter a skilled nursing facility. The patient reports having had chickenpox as a child. The NP should: obtain a varicella titer. administer the Varivax vaccine. give the patient the Zostavax vaccine. plan to prescribe Zovirax if the patient is exposed to shingles. 1.55 points QUESTION 17 The primary care NP sees a 65-year-old patient in October. The patient has a history of COPD and has not had any vaccines for more than 20 years. The NP should administer: influenza and Td vaccines. PCV 13 and influenza vaccines. PPV 23, Td, and influenza vaccines. PPV 23, influenza, and TdaP vaccines 1.55 points QUESTION 18 An 80-year-old patient with congestive heart failure has a viral upper respiratory infection. The patient asks the primary care NP about treating the fever, which is 38.5° C. The NP should: recommend acetaminophen. recommend high-dose acetaminophen. tell the patient that antibiotics are needed with a fever that high. tell the patient a fever less than 40° C does not need to be treated 1.55 points QUESTION 19 A patient comes to the clinic and reports breaking out in an urticarial rash 1 hour after taking acetaminophen for osteoarthritis symptoms. The primary care NP should: Order a complete blood count with differential. order liver and renal function tests. suspect Reye's syndrome and arrange for hospitalization. tell the patient not to take products containing acetaminophen again. 1.55 points QUESTION 20 A patient reports having persistent mild to moderate pain in both knees usually associated with standing. The patient reports knee stiffness for 15 to 20 minutes each morning. The primary care nurse practitioner (NP) learns that the patient has used heating pads and acetaminophen, which no longer relieve the pain. The NP orders an erythrocyte sedimentation rate, which is normal. The NP should consider prescribing: aspirin A cycloxygenase-2 (COX-2) inhibitor glucosamine and chondroitin. a topical nonsteroidal antiinflammatory drug (NSAID 1.55 points QUESTION 21 . A 70-year-old patient describes moderate to severe pain associated with osteoarthritis in fingers, thumbs, hips, and knees. The patient is currently taking high-dose acetaminophen. The patient has a strong family history of cardiovascular disease and has been diagnosed with hypertension. To help alleviate this patient's pain, the primary care NP should consider prescribing: a COX-2 inhibitor and low-dose aspirin. ketorolac (Toradol) and 325 mg of aspirin. naproxen (Naprosyn) and low-dose aspirin. indomethacin (Indocin) and 325 mg of aspirin. 1.55 points QUESTION 22 A client is in the clinic today and he reports heart burn 45 minutes after meals a feeling of fullness, a lot of belching. The patient’s weight is normal and reports a high stress work and home life. What should the primary NP recommend? Antacid therapy as needed Emergent referral to Gastroenterologist Work on relieving "stress" Daily treatment with a PPI 1.55 points QUESTION 23 Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with you their provider or a pharmacist first? Patients with kidney stones Pregnant patients Patients with heartburn Post-menopausal women 1.55 points QUESTION 24 A patient has been taking an opioid analgesic for chronic pain and tells the primary care nurse practitioner (NP) that the medication doesn't work as well anymore. The NP should suspect drug: addiction. tolerance. modulation. dependence. 1.55 points QUESTION 25 A patient is diagnosed with a condition that causes chronic pain. The primary care NP prescribes an opioid analgesic and should instruct the patient to: Wait until the pain is at a moderate level before taking the medication Take the medication at regular intervals and not just when pain is present Start the medication at higher doses initially and taper down gradually Take the minimum amount needed even when pain is severe to avoid dependency 1.55 points QUESTION 26 A patient has been taking an opioid analgesic for 2 weeks after a minor outpatient procedure. At a follow-up clinic visit, the patient tells the primary care NP that he took extra doses for the past 2 days because of increased pain and wants an early refill of the medication. The NP should suspect: dependence. drug addiction. possible misuse. increasing pain. 1.55 points QUESTION 27 Selegiline can cause confusion, insomnia, and an unbalanced gait. Unfortunately, these are also symptoms of Parkinson’s disease. Another side effect of Selegiline is hypertension hypotension Dry mouth paresthesia 1.55 points QUESTION 28 Xie is a 72 year old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: Megoblastic Anemia Hypertension Osteoporosis Strokes 1.55 points QUESTION 29 A 22 year old requests a prescription for an anorexiant to treat her obesity. She has been struggling with her weight for many years. A trial of phentermine is prescribed. Prescribing precautions include: Obesity is a contraindication to prescribing this drug Anorexiants may cause tolerance and should only be prescribed for 6 months Clients should be monitored for postural hypotension Renal function must be monitored closely while on anorexiants ? 1.55 points QUESTION 30 The effectiveness of Levodopa can be reduced when taking: vitamin B6 amantadine opiramate colace 1.55 points QUESTION 31 . SSRIs can be used to treat depression, anxiety, obsessive compulsive disorders, and panic attacks. How long do they take to provide the full therapeutic effect? 24 Hours 32 hours 2-4 Weeks 7 Days 1.55 points QUESTION 32 Taking which of the following drugs with food maximizes its bioavailability? Rivasstigmine Memantine 1.55 points QUESTION 33 A client has absence seizures which of the following medications would be appropriate for absence seizures? Valporic Acid Gabapentin Carbamazepine All of the above 1.55 points QUESTION 34 Antiepileptics control seizure disorders by various mechanisms, which include all of the following except: Slowing the entrance of calcium and sodium back into the neuron, thus extending the time it takes for the nerve to return to its active state Suppressing neuronal firing, which decreases seizure activity and prevents propagation of seizure activity into other areas of the brain Decreasing seizure activity by enhancing the inhibitory effects of gamma butyric acid (GABA) Increasing the entrance of calcium and sodium back into the neuron, thus decreasing the time it takes for the nerve to return to its active state 1.55 points QUESTION 35 . Which of the following would necessitate the cessation of phenytoin? Acne Hypertension Poor dentition Blistered skin rash 1.55 points QUESTION 36 A client is taking phenytoin for seizure control and states she has started taking birth control pills. Which of the following would be important for the NP to discuss with the client? The drug may decrease the effectiveness of the birth control pill. This drug combination will increase the risk of developing DVTs. Oral contraceptives decreease the effectiveness of phenytoin Severe GI effects can occur when these drugs are taken together. 1.55 points QUESTION 37 Carbidopa-levodopa is preferred over plain levodopa in the treatment of Parkinson disease because it Is better absorbed from the GI tract urine specific gravity Induces fewer CNS side effects Allows more dopamine to reach the brain Can be administered once a day 1.55 points QUESTION 38 You have just prescribed lorazepam for your 49-year-old patient. Your patient states , Boy this sure is a lot of information you gave me. What is the bottom –line what should I really look out for? Which of the following is your best response? "Assess how much sedation you experience before you attempt anything that reuir3s mental alertness" "Try to take the medication on an empty stomach, there is nothing much to look out for" "Just let me know when you need your prescription refilled" "Take your medication as frequently as you feel you need it" 1.55 points QUESTION 39 . The most troublesome side effect associated with haloperidol (a typical antipsychotic) is Hypertension Asthma Extrapyramidal symptoms Myastenia Gravis 1.55 points QUESTION 40 Rivastigmine works by Stimulating cholinergic activity Blocking cholinergic activity Stimulating sympathetic activity Stimulating dopaminergic activity 1.55 points QUESTION 41 The therapeutic margin(range) for Dilantin is 10-20 mcg/ml 2-10 mcg/ml 40-100 mcg/ml 4-12mcg/ml 1.55 points QUESTION 42 Age is a factor in the different responses to pain. Which of the following age-related statements about pain is NOT true? Preterm and newborn infants do not yet have functional pain pathways Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter the neuronal organization in the infant. Increases in pain threshold in older adults may be related to peripheral neuropathies and skin changes. Decreases in pain tolerance are evident in older adults. 1.55 points QUESTION 43 . Potential side effects of Opiods include all of the following EXCEPT: Respiratory depression Mydriasis Constipation Uticaria and puritis 1.55 points QUESTION 44 The suggested maximum recommended daily dose limit for acetaminophen is: 5000mg/day 3000mg/day 2000mg/day There is no maximum daily dose limit 1.55 points QUESTION 45 The primary mechanism by which NSAIDs cause gastritis and peptic ulcers is through Blocking prostaglandins which stimulate and thicken the stomach mucus layer Direct gastric irritation Inhibition of the inflammatory response Increasing enkephalin release. 1.55 points QUESTION 46 . Which of the following statements about the COX 2 inhibitor, Celecoxib, is NOT true? There is less GI irritation than with NSAIDs It should be used with caution in persons with a history of cardiovascular disease It can cause fluid retention and worsen heart failure It is preferred over opiates in management of moderate to severe pain because of no addictive potential. 1.55 points QUESTION 47 . Which of the following would be an example of the progression of medication in ascending order according the World Health Organization (WHO) analgesic ladder? Aspirin, Celebrex, Morphine Codeine, Morphine, Fentanyl Acetaminophen, Tramadol, Morphine Morphine, Codeine, Tramadol 1.55 points QUESTION 48 The are a number of medications that may be helpful in treating chronic neuropathic pain. Which of the following medications would be LEAST likely to be helpful in this situation? Vicodin Amitryptiline Gabapentin Duloxetine 1.55 points QUESTION 49 Fluoroquinolones have a Black Box warning regarding which of the following? renal dysfunction hepatic toxicity tendon rupture development of glaucoma 1.55 points QUESTION 50 Janie has glucose-6-phosphate dehydrogenase deficiency (G6PD) and requires an antibiotic. Which class of antibiotics should be avoided in this patient? Sulfonamides Pencillins Macrolides Cephalosporins 1.55 points QUESTION 51 If a patient if allergic to sulfonamide antibiotics, he or she will most likely have cross sensitivity to: Loop diuretics Sulfonylureas Thiazide diuretics All of the above 1.55 points QUESTION 52 . To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of: community-acquired pneumonia in patients with comorbidities skin and soft tissue infections in adults upper respiratory infections in adults urinary tract infections in young women 1.55 points QUESTION 53 Sarah is a 25 year old female who is 12 weeks pregnant and has a urinary tract infection. Which of the following antibiotics would be most appropriate for her? ciprofloxacin doxycycline trimethoprim-sulfamethoxazole nitrofuantoin 1.55 points QUESTION 54 Tetracyclines such as minocycline are safe to use in: pregnant women adolescents Children older than 4 years of age patients with liver impairment 1.55 points QUESTION 55 Which of the following is NOT considered first line treatment for an uncomplicated UTI in a young woman? Levaquin Bactrim DS Macrobid Fosfomycin 1.55 points QUESTION 56 Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: Platelet count BUN and creatinine White blood cell count Liver function tests 1.55 points QUESTION 57 Clavulanic acid is added to amoxicillin to: Increase the duration of action Prevent deactivation from penicillimase Decrease gastrointestinal side effects Decrease length of therapy necessary 1.55 points QUESTION 58 Treatment option for MSRA infection include: trimethoprim-sulfamethoxazole dicloxacillin ciprofloxacin cephalexin 1.55 points QUESTION 59 This antibiotic has decreased absorption when taken with antacids, dairy, and, vitamins: (Select All That Apply) trimethoprim-sulfamethoxazole dicloxacillin ciprofloxacin cephalexin Penicillin V 1.55 points QUESTION 60 . This drug can cause a potential disulfiram-like reaction when taken with alcohol trimethoprim-sulfamethoxazole dicloxacillin Ciprofloxacin Metronidazole 1.55 points QUESTION 61 According to the National Asthma Education and Prevention Program Expert Panel 3 guidelines, treatment for mild intermittent asthma in an adult is: Daily low dose inhaled corticosteroid Short acting beta agonist (SABA) as needed Long acting agonist (LABA) in the morning Montelukast daily 1.55 points QUESTION 62 . A primary care nurse practitioner is evaluating a 20 year old patient with asthma who reports feeling “tight” and needing to use his albuterol about once a day and awakening from sleep three or four times each week with asthma symptoms. The patient's forced expiratory volume in 1 second (FEV1) is 75% of the predicted value. The patient's current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The NP should prescribe: Montelukast (Singulair) po daily Ipratropium bromide bid with albuterol A medium dose inhaled corticosteroid (ICS), 2 puffs bid A long acting Beta adrengergic agonist (LABA) 1 puff bid 1.55 points QUESTION 63 Long acting beta agonists (LABAs) received a black box warning from the US Food and Drug Administration due to the: Risk of life threatening dermatological reactions Increased incidence of cardiac events Increased risk of asthma-related deaths risk for life-threatening alterations in electrolytes 1.55 points QUESTION 64 Second generation antihistamines such as loratadine are prescribed for seasonal allergies because they are: More effective than first generation antihistamines Less sedating than first generation antihistamines rescription products and therefore covered by insurance able to be taken with CNS sedatives such as alcohol 1.55 points QUESTION 65 Which of the following is a stimulant laxative Sodium phosphate Docusate sodium Bisacodyl Lactulose