Hunter College - CUNY : NURS 3310, Special Drug Treatment Considerations Quiz | Answered + Rationales 100% A+ Graded | Latest 2025/26.

Hunter College - CUNY : NURS 3310, Special Drug Treatment Considerations Quiz | Answered + Rationales 100% A+ Graded | Latest 2025/26. NURS 3310 Special Drug Treatment Considerations Q&A’s + Rationales 2025/26. Question 1. Which factor is accurate as it relates to male-dominated differences between males and females? correct 1.Decreased life expectancy 2.Decreased hearing loss 3.Decreased morbidity 4.Decreased suicide rate Rationales Option 1:Life expectancy of men is 5 years less than that of women; women outnumber men 8 to 1 at age 100 years. Option 2:Men suffer hearing loss at twice the rate of women. Option 3:Men die at higher rates from the top 10 causes of death than do women. Option 4:Men are four times more likely to commit suicide than women. Question 2. Which action should the APN take when considering routine HPV immunization for a 16-year-old female who has not been previously vaccinated? correct 1.Administer the vaccine per protocol. 2.Withhold the vaccine until the patient is sexually active. 3.As long as the patient uses condoms for birth control, immunization is not required. 4.Perform a pregnancy test before administering the vaccine. Rationales Option 1:For adolescents and adults aged 13 to 26 years who have not been previously vaccinated or who still need to complete the vaccine series, catch-up vaccination is recommended. Option 2:Routine HPV vaccination is recommended for all girls starting at age 11 to 12 years. However, it can be administered beginning at 9 years of age. Option 3:Condom use will not alone prevent acquisition of HPV. The patient should complete the vaccine series. Option 4:A pregnancy test is not required for HPV vaccination. Question 3. Which medication, if prescribed to a mother who is breastfeeding an infant, has the potential to have the most significant impact on the infant? 1.Amoxicillin 2.Acetaminophen correct 3.Atenolol 4.Cephalosporin antibiotics Rationales Option 1:Minimal. Excreted in breast milk. Infant may have diarrhea. Option 2:Minimal. Found in breast milk. No adverse reactions reported. Safer than aspirin when lactating. Option 3:Moderate to significant. Cyanosis and bradycardia have been reported in breastfed infants with maternal intake of 100 mg/d. Use with caution. Avoid in infants younger than 3 months of age. Option 4:Minimal. Excreted in small amounts in milk. Probably safe. Question 4. Which complication can occur with use of estrogen therapy as part of a gender-affirming hormone therapy (GAHT)? 1.Hypothyroidism 2.Asthma 3.Pneumonia correct 4.Hypercoagulability Rationales Option 1:The use of estrogen does not lead to development of hypothyroidism. Option 2:The use of estrogen does not lead to development of asthma. Option 3:The use of estrogen does not lead to development of pneumonia. Option 4:Potential risks of estrogen therapy include thromboembolic events, coronary artery disease, lipid panel changes, hyperprolactinemia, prolactinomas, and bone mineral density changes. Question 5. Which medication may potentially lead to increased risk of an emergency department (ED) visit for the geriatric patient? correct 1.Clopidogrel incorrect 2.Lisinopril 3.Amoxicillin 4.Chlorothiazide Rationales Option 1:Four specific classes of medications accounted for more than two-thirds of these ED visits: warfarin, insulin, oral hypoglycemic medications, and oral antiplatelet medications. Clopidogrel is an antiplatelet medication. Option 2:Lisinopril is an ACE inhibitor used to treat hypertension; typically, use will not lead to an ED visit. Option 3:Amoxicillin is an antibiotic used to treat infections; typically, use will not lead to an ED visit. Option 4:Chlorothiazide is a thiazide diuretic used to treat fluid retention; typically, use will not lead to an ED visit. Question 6. Which medication is used to inhibit testosterone levels as part of gender-affirming hormone therapy (GAHT)? 1.Furosemide 2.Lisinopril correct 3.Spironolactone 4.Vitamin D Rationales Option 1:Furosemide is a loop diuretic and has no impact on testosterone levels. Option 2:Lisinopril is an ACE inhibitor and has no impact on testosterone levels. Option 3:Androgen-suppressing agents are used in male-to-female GAHT to suppress gonadotrophic secretion and inhibit testosterone levels, thereby decreasing masculine features. Option 4:Vitamin D is a fat-soluble vitamin that can lead to increased testosterone levels. Question 7. The APN is assessing an 18-year-old female patient who complains of bloating, breast tenderness, and headache before menstrual flow. Which clinical diagnosis should the APN suspect? 1.Endometriosis correct 2.Premenstrual syndrome (PMS) 3.Pregnancy 4.Premenstrual dysphoric disorder (PMDD) Rationales Option 1:The clinical diagnosis of endometriosis requires examination of the uterine lining. It cannot be diagnosed by presence of clinical symptoms alone. Option 2:Premenstrual syndrome (PMS) is characterized by both physical and behavioral (including affective) symptoms that are recurrent during the end of the luteal phase of the menstrual cycle, with a symptom-free period shortly after menses begins. Symptoms must also affect the woman's quality of life. Core symptoms of PMS include affective symptoms, such as depression, irritability, and anxiety, and somatic symptoms, such as breast pain, bloating and swelling, and headache. Option 3:The clinical diagnosis of pregnancy needs to be confirmed by a pregnancy test, either urine or blood. Option 4:Premenstrual dysphoric disorder (PMDD) is a severe form of PMS with prominent psychological symptoms such as anger, irritability, or anxiety. Question 8. Which of these statements defines the concept of pediatric exclusivity? correct 1.It provides a specific time frame related to patents. 2.It ensures that pediatric drugs contain safe ingredients. 3.It states medications are beneficial for children 16 years of age and younger. 4.It provides for evaluation of drug use in children and adults. Rationales Option 1:Pediatric exclusivity, which grants a 6-month extension on the patent if drugs are studied in children, has been successful in ensuring most new drugs are at least evaluated for use in children. Option 2:Pediatric exclusivity does not ensure that ingredients are safe but rather focuses on the process of clinical research of drugs (6-month extension) to be used for the pediatric population. Option 3:Pediatric exclusivity looks at drug use for populations 12 years and younger focusing on the process of clinical research of drugs (6-month extension). Option 4:Pediatric exclusivity ensures that new drugs are at least evaluated for use in children. It does not include adult use. Question 9. Which information should the APN provide to parents of a school-age child (first grade) who has been prescribed antibiotic therapy for treatment of a strep infection? correct 1.Provide both written and oral instructions. 2.Administer the medication when the child returns from school. 3.Provide the medication in an oral form. 4.Have the parents use a text message to remind the child to take the medication. Rationales Option 1:Giving written instructions along with the oral instructions will improve compliance. Option 2:There is no information provided relative to dosing of the antibiotic; therefore, this may not be a realistic option. Option 3:There is no information provided that an oral form of the medication is indicated. Most school-age children can swallow pills. Option 4:While this may be appropriate for adolescents, using a text message reminder for a child in first grade is not realistic. Question 10. Which route is preferred for use of testosterone as part of genderaffirming hormone therapy (GAHT)? 1.Topical patch correct 2.Subcutaneous 3.Oral 4.Inhaled Rationales Option 1:Less common forms of testosterone administration include topical patches, oral tablets, and implanted pellets. Option 2:Testosterone is labeled for IM injection; however, many providers of transgender medicine prescribe subcutaneous (SC) testosterone injections for their patients. Subcutaneous injections are significantly less painful and are less likely to result in long-term effects (scarring, fibrosis) than intramuscular injections over the course of a lifetime of injecting testosterone Option 3:Less common forms of testosterone administration include topical patches, oral tablets, and implanted pellets. Option 4:Testosterone is not available as an inhalation. Question 11. The APN is assessing an 82-year-old female patient for hearing loss. Which factor should the APN consider as being most likely to cause this potential problem? correct 1.Cerumen accumulation 2.Otitis media (OM) 3.Sepsis 4.Dehydration Rationales Option 1:Cerumen impaction, seen in more than one-third of older adults, further impairs hearing. Older adults have drier cerumen and are more likely to use hearing aids, which contribute to impaction. Option 2:It is unlikely that the elderly patient is prone to middle ear infections. Option 3:It is unlikely that sepsis would account for hearing loss. In the elderly patient, it is more likely to be associated with cognitive changes. There is no provided clinical data to support infection. Option 4:There is no clinical data presented to support dehydration. It is unlikely that dehydration would be associated with hearing loss in the elderly patient. Question 12. Which observation if noted by the APN requires additional instruction for a patient being treated for a candida infection? correct 1.Patient states she performs douching once a week. 2.Patient wears cotton underwear. 3.Patient states that she empties her bladder before and after sexual relations. 4.Patient states she wipes from front to back after elimination. Rationales Option 1:Douching is no longer recommended because of the potential for pelvic infection and its destruction of the normal Lactobacillus flora. Option 2:She maintains hygiene by wearing nonabsorbent types of fabric for underwear. Option 3:She maintains hygiene by emptying the bladder before and after intercourse. Option 4:She maintains hygiene by wiping correctly. Question 13. Which term describes a 23-year-old female who identifies with the female gender since birth? correct 1.Cisgender 2.Transfeminine 3.Nonbinary 4.Gender affirmation Rationales Option 1:A term used in the transgender community to denote individuals whose gender identity is congruent with their sex assigned at birth. Option 2:This is a term for a female-identified person who was assigned male at birth. In medical literature, transgender women may also be referred to as MTF (male to female), natal males, or biological males. Option 3:This refers to the extent to which a person's gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex. These persons may or may not identify completely as male or female and may change their genders often (also referred to as fluid). Option 4:A variety of surgical procedures are used for medical gender transition, including but not limited to top surgery (chest reconstruction), hysterectomy, phalloplasty, metoidioplasty, breast augmentation, orchiectomy, and vaginoplasty. Question 14. Which supplement should the APN prescribe for an 80-year-old male patient with suspected atrophic gastritis? 1.Vitamin C correct 2.Vitamin B12 3.Vitamin B1 4.Folic acid Rationales Option 1:Vitamin C is not indicated for treatment of atrophic gastritis. Option 2:Atrophic gastritis results in decreased iron and vitamin B12 absorption. Option 3:Vitamin B1 is not indicated for treatment of atrophic gastritis. Option 4:Folic acid is not indicated for treatment of atrophic gastritis and is typically given as a supplement during pregnancy to prevent neural tube defects. Question 15. Which treatment plan should the APN provide to the partner of a 23- year-old female who has recurrent vulvovaginitis? correct 1.No treatment is needed for the partner 2.Oral azole therapy 3.Refraining from sexual activity during acute infection for 14 days 4.Antibiotic therapy Rationales Option 1:Currently, there is no evidence supporting partner treatment for vulvovaginitis. Option 2:Currently, there is no evidence supporting partner treatment for vulvovaginitis. Option 3:There is no evidence to support this length of time for sexual abstinence. Option 4:Currently, there is no evidence supporting partner treatment for vulvovaginitis. In addition, vulvovaginitis is caused by a fungal infection, which is not treated with antibiotics. Question 16. Which clinical diagnosis is associated with primary hypogonadism? correct 1.Hemochromatosis 2.HIV/AIDS 3.Obesity 4.Opioid users Rationales Option 1:Excess iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production. This is associated with primary hypogonadism. Option 2:This virus can cause low levels of testosterone by affecting the hypothalamus, pituitary, and testes. This is associated with secondary hypogonadism. Option 3:Being significantly overweight at any age may be linked to hypogonadism. This is associated with secondary hypogonadism. Option 4:Commonly prescribed opioids in sustained-action dosage forms usually produce subnormal sex hormone levels, which may contribute to a diminished quality of life for many patients with painful chronic illness. This is associated with secondary hypogonadism. Question 17. Which of these screening tests is being discussed for recommended use for the men having sex with men (MSM) population for detection of anal cancer? correct 1.Anal PAP test 2.Prostate-specific antigen (PSA) 3.Viral load test 4.Digital rectal exam (DRE) Rationales Option 1:In view of this increased incidence, there has been considerable discussion about whether regular anal screening using an anal PAP test should be implemented in the MSM population and specifically in the HIV-infected MSM population. Option 2:PSA is used to determine/evaluate prostate cancer. Option 3:Viral load test is indicated for determination/evaluation of HIV/AIDS. Option 4:DRE does not specifically identify anal cancer but can be used to assess for abnormalities leading to further screening. Question 18. Which aspect of body composition affects distribution of medication in infants? correct 1.Decreased plasma proteins incorrect 2.Increased total body water 3.Decrease in ratio of fat to lean muscle 4.Larger body surface area Rationales Option 1:Infants younger than 6 months have decreased plasma proteins available for drug binding, which will cause elevated levels of unbound medication. Option 2:Newborns have total body water (TBW) of 80%, which drops over the first few months to 60% at 6 months. Option 3:Decrease in ratio of fat to lean muscle occurs throughout childhood resulting in gender differences between males and females. Option 4:A larger body surface area in neonates affects absorption of topical medication, not distribution. Question 19. Which metabolic change occurs in protein metabolism for the geriatric patient? incorrect 1.Immunosuppression correct 2.Cellular damage 3.Increased ability for cellular replication 4.Increased cellular communication Rationales Option 1:Stem cell exhaustion in the hematopoietic system leads to anemias and myelodysplasias. Option 2:Accumulated DNA damage and repair may accelerate aging or cause age-related disease; impaired stability and functioning of proteins lead to accumulated cell damage associated with aging. Option 3:Cellular senescence occurs, in which cells exhaust their ability to replicate over time. Option 4:Altered neurohormonal signaling affects intercellular communication and inflammatory processes in multiple physiological systems. Question 20. Which of these is associated with testosterone therapy? correct 1.Higher low-density lipid (LDL) levels 2.Higher high-density lipid (HDL) levels 3.Lower low-density lipid (LDL) levels 4.Lower total cholesterol levels Rationales Option 1:Testosterone is linked to elevations of LDLs and declines in high-density lipids (HDLs). Option 2:Testosterone is linked to declines in HDLs. Option 3:Testosterone is linked to elevations of LDLs. Option 4:Testosterone is linked to different effects on levels of low-density lipids (LDLs) and high-density lipids (HDLs). Question 1. Which recommendation is made by the American College of Obstetricians and Gynecologists (ACOG) regarding contraception counseling to pediatric patient populations? correct 1.Discuss contraception starting at age 13 regardless of sexual activity. 2.Discuss contraception when the patient asks for information. 3.Offer emergency contraception only in an emergent situation. 4.Provide information about condoms only. Rationales Option 1:ACOG recommends that providers discuss contraception options with patients between ages 13 and 15, regardless of previous sexual activity, providing an overview of the most effective methods and offering information on emergency contraception. Option 2:ACOG recommends contraception counseling to be proactive, not reactive. Options should be discussed starting at age 13, regardless of prior sexual activity. Option 3:ACOG recommends offering information on emergency contraception as part of counseling. Option 4:ACOG recommends providing an overview of the most effective methods, not just condoms. Question 2. Which metabolic change occurs in protein metabolism for the geriatric patient? incorrect 1.Immunosuppression correct 2.Cellular damage 3.Increased ability for cellular replication 4.Increased cellular communication Rationales Option 1:Stem cell exhaustion in the hematopoietic system leads to anemias and myelodysplasias. Option 2:Accumulated DNA damage and repair may accelerate aging or cause age-related disease; impaired stability and functioning of proteins lead to accumulated cell damage associated with aging. Option 3:Cellular senescence occurs, in which cells exhaust their ability to replicate over time. Option 4:Altered neurohormonal signaling affects intercellular communication and inflammatory processes in multiple physiological systems. Question 3. Which statement describes the effects of spironolactone as it is used to treat hirsutism? correct 1.It reduces the effects of aldosterone and suppresses testosterone synthesis. 2.It changes male-pattern body hair growth. 3.It offers a permanent solution for hair removal. 4.The potassium-sparing effect stops hair growth. Rationales Option 1:Spironolactone aids in breast development, slightly reduces male-pattern hair growth, and stops male-pattern hair loss. Option 2:Spironolactone does not change male-pattern body hair growth. Option 3:Spironolactone may reduce hair growth, but the effect on texture and distribution is reversible and ceases with drug discontinuation. Option 4:Spironolactone may reduce hair growth, but the effect on texture and distribution is reversible and ceases with drug discontinuation. Question 4. Which is a basic activity of daily living (ADL)? 1.Grocery shopping 2.Paying bills and investing money correct 3.Shaving and showering 4.Keeping up with house repairs Rationales Option 1:Grocery shopping is an instrumental ADL. Option 2:Money management is an instrumental ADL. Option 3:Shaving and showering are basic ADLs. Option 4:Home maintenance is an instrumental ADL. Question 5. The Pediatric Research Equity Act (PREA) requires that any new drug considered for approval include which of these? correct 1.Safety statement for use in children 2.Topical preparation for use in children 3.List of products safe to mix with the drug to make it taste better 4.Handout on how to calculate the correct dose for a child using the adult preparation Rationales Option 1:The PREA requires that all applications for new active ingredients, indications, dosage forms, dosing regimens, and routes of administration contain a pediatric assessment. Option 2:The PREA does not require a topical preparation for all drugs. Option 3:The PREA does not require a list of safe products for improving drug taste. Option 4:The PREA does not require a handout on dose calculation. Question 6. The APN is caring for a transgender man who has menstrual bleeding despite longstanding testosterone therapy. Which option for reducing menstrual bleeding is most appropriate for this patient? 1.Levonorgestrel (LNg) intrauterine device (IUD) correct 2.Depot medroxyprogesterone acetate (DMPA) 3.Etonogestrel implant 4.Danazol Rationales Option 1:The LNg IUD (Mirena, Skyla) is effective both for reducing or stopping menstrual bleeding and for contraception. However, the invasive procedure required for insertion may be distressing. Option 2:DMPA (Depo-Provera) is effective for reducing or stopping menstrual bleeding and for contraception. Its administration is noninvasive, and it has few significant side effects. Option 3:The etonogestrel implant (Nexplanon) is the least effective progesterone-based method for reducing menstrual bleeding. Option 4:Danazol is generally quite effective at stopping menses. However, it has a few significant side effects that make it less desirable for this patient. Question 7. Normal age-related changes alter the absorption of medications from the gastrointestinal (GI) tract. Which of these is caused by age-related changes? correct 1.Decreased acid production 2.Decreased gastric pH 3.Increased gastric emptying time 4.Increased esophageal peristalsis Rationales Option 1:With aging, the GI tract produces less acid as fewer parietal cells are generated. Option 2:Achlorhydria, caused by atrophic gastritis, results in increased gastric pH and leads to altered availability of pH-sensitive drugs. This is typically small but clinically important if the patient is on proton pump inhibitors (PPIs). Option 3:With aging, gastric peristalsis decreases. Option 4:With aging esophageal peristalsis decreases. Question 8. Which population should the APN consider to be at most risk for diagnosis of advanced anal cancer? correct 1.Adults 50 to 60 years 2.Adults 30 to 40 years 3.Adults 18 to 25 years 4.Adults 40 to 50 years Rationales Option 1:In addition to the overall rising incidence, the number of cases of anal cancer diagnosed at a later stage when the cancer had already spread to nearby or distant parts of the body has increased. The rising rate of advanced-stage disease is likely responsible for the increase in deaths, particularly in older adults. Option 2:The rising rate of advanced-stage disease is likely responsible for the increase in deaths, particularly in older adults. Option 3:The rising rate of advanced-stage disease is likely responsible for the increase in deaths, particularly in older adults. Option 4:The rising rate of advanced-stage disease is likely responsible for the increase in deaths, particularly in older adults. Question 9. A mother asks the APN about using an over-the-counter (OTC) medication for her child because the label says, "Consult your provider for use instructions as safety and effectiveness have not been established." Which response by the APN is most appropriate? 1."The drug meets OTC label requirements, but studies in children have not been conducted." correct 2."Pediatric studies have shown this drug to be either unsafe or ineffective in children." 3."This drug is safe in adults, so usually we should use half the recommended dose for children." 4."This medication is perfectly safe to use. Let me calculate the dose for your child." Rationales Option 1:The statement means that the drug is either not safe or not effective in children as determined by pediatric studies. Option 2:The statement means that the drug is either not safe or not effective in children as determined by pediatric studies. Option 3:The statement does not mean children should receive half the recommended dose for adults. Option 4:The statement does not mean that the medication is safe for use with children. Question 10. Which of these would the APN include in teaching for the transmasculine patient starting testosterone replacement therapy? 1.The patient's voice should deepen quickly, within the first month of therapy. 2.The patient can expect acne to get better and even go away. correct 3.The patient's periods should stop within 6 months. 4.The patient should be able to grow a beard within 3 to 6 months. Rationales Option 1:Deepening of the voice typically begins within the first 3 months but will continue to change gradually, with most changes typically achieved within the first 12 months on testosterone. Option 2:Skin often becomes oilier and more prone to acne. Option 3:Menses typically cease within 6 months. Option 4:Growth of facial hair is typically one of the most gradual changes, sometimes taking 4 or more years of testosterone administration to reach maximum growth. Question 11. Which statement regarding topical absorption of medications is accurate? 1.It is increased in adults due to larger body surface area in relation to their size. correct 2.It is increased in children due to larger body surface in relation to size. 3.It is decreased in adults due to their thin stratum corneum. 4.It is decreased in children due to their thin stratum corneum. Rationales Option 1:Absorption is decreased in adults due to smaller surface area in relation to size. Option 2:Absorption is increased in children due to larger surface area in relation to size. Option 3:Absorption is decreased in adults due to their thicker stratum corneum. Option 4:Absorption is increased in children due to their thin stratum corneum. Question 12. Which aspect of body composition affects distribution of medication in infants? correct 1.Decreased plasma proteins incorrect 2.Increased total body water 3.Decrease in ratio of fat to lean muscle 4.Larger body surface area Rationales Option 1:Infants younger than 6 months have decreased plasma proteins available for drug binding, which will cause elevated levels of unbound medication. Option 2:Newborns have total body water (TBW) of 80%, which drops over the first few months to 60% at 6 months. Option 3:Decrease in ratio of fat to lean muscle occurs throughout childhood resulting in gender differences between males and females. Option 4:A larger body surface area in neonates affects absorption of topical medication, not distribution. Question 13. Which clinical diagnosis should the APN suspect in a female patient who has blood-tinged purulent vaginal discharge, complaints of itching, and dysuria? correct 1.Trichomoniasis 2.Bacterial vaginosis (BV) 3.Candidiasis 4.Atrophic Rationales Option 1:Trichomoniasis exhibits blood-tinged purulent vaginal discharge, itching, dysuria, and a foul odor. Option 2:BV exhibits thin, white vaginal discharge, fishy odor, and presence of clue cells. Option 3:Candidiasis exhibits white, curdy vaginal discharge with burning and itching. Option 4:Atrophic changes lead to scant white or yellow vaginal discharge, burning, and sore cracks. Question 14. Normal aging is associated with a decrease in serum albumin levels. How does this affect drug distribution? correct 1.Fewer protein molecules are available for drug binding, leading to higher levels of free, unbound drug and an increased risk for drug toxicity. 2.Protein molecules are more concentrated, leading to full binding with the drug. 3.The decrease in serum albumin levels has a neutral impact on drug distribution because older people also have more protein-binding sites to compensate for the lower albumin level. 4.Exogenous sources of protein are required to keep drug levels normal. Rationales Option 1:The consequence of lower serum albumin levels is fewer protein molecules available for binding to the drug and higher levels of free, unbound drug. Option 2:Albumin does not become more concentrated or more active in a concentrated state. There are finite molecules available for drug binding. Option 3:The number of binding sites is related to the amount of albumin and is not compensated for in older people. Option 4:Exogenous sources of protein are not required to keep drug levels normal. Question 15. Which medication has been shown to be safe in children between the ages of 2 and 12 years? 1.Elocon lotion correct 2.Mometasone ointment 3.Betamethasone dipropionate cream 4.Diprolene ointment Rationales Option 1:Mometasone (Elocon) lotion is not recommended, although Elocon cream and ointment may be used in children as young as 2 years. Option 2:Mometasone ointment is approved for use in children as young as 2 years. Option 3:Betamethasone dipropionate cream is not indicated for use in people under age 17 years. Option 4:Diprolene (Diprosone) cream, ointment, and lotion are not recommended for use in children younger than 12 years due to hypothalamic–pituitary–adrenal (HPA) axis suppression. Question 16. Which medication should the APN not prescribe if a patient is taking testosterone therapy? 1.Acetaminophen 2.Atorvastatin 3.Low-dose salicylate correct 4.Warfarin Rationales Option 1:There is no contraindication to taking acetaminophen with testosterone. Option 2:There is no contraindication to taking a statin with testosterone. Option 3:There is no contraindication to taking low-dose salicylate with testosterone. Option 4:Major interactions with testosterone may occur with anisindione, berotralstat, carfilzomib, dicumarol, leflunomide, levoketoconazole, lomitapide, mipomersen, morphine, paopanib, pexidartinib, teriflunomide, and warfarin. Using testosterone with any of these medicines is usually not recommended but may be required in some cases. Question 17. Which instruction should the APN provide to the patient prescribed sildenafil? correct 1.Administer daily as needed, 1 to 4 hours before sexual activity. 2.Take 15 minutes before sexual activity. 3.Initial dose is 10 mg. 4.Starting dose is 100 mg. Rationales Option 1:The medication can be taken once a day as needed before sexual activity. Option 2:This instruction is for the medication avanafil. Option 3:Sildenafil is available in 20 mg tablets, and 2 to 5 tablets as needed can be taken 1 to 4 hours before sexual activity on a daily basis. Option 4:This instruction is for the medication avanafil. Question 18. Which factor leads to increased renal excretion of drugs in women? correct 1.Decreased glomerular filtration rate (GFR) incorrect 2.Decreased body mass index (BMI) 3.Increased body fat 4.Decreased gastric emptying Rationales Option 1:Sex-related differences influence the renal excretion of drugs. For example, renal blood flow, glomerular filtration rate (GFR), tubular secretion, and tubular reabsorption are lower in women than men. Option 2:Decreased BMI leads to altered drug distribution, not increased renal excretion. Option 3:Increased body fat leads to altered drug distribution, not increased renal excretion. Option 4:Decreased gastric emptying leads to decreased absorption, not increased renal excretion. Question 19. Which of these is a pharmacokinetic concept used to describe the time it takes for a drug to reach target levels in tissues and organ systems? correct 1.Volume of distribution (VD) 2.Metabolism incorrect 3.Absorption 4.Elimination Rationales Option 1:VD is the pharmacokinetic concept used to describe the tissues and organ systems penetrated by specific drugs and the time required to reach targeted levels. Option 2:Metabolism is the biotransformation of drugs in the body so that they can be more easily eliminated. Option 3:Absorption is the movement of the drug from the site of administration to the bloodstream. Option 4:Elimination is the process by which a drug is eliminated, that is, either cleared or excreted. Question 20. Which mechanism leads to decreased fertility in hypogonadism? 1.Gynecomastia 2.Hot flashes correct 3.Decreased sperm production 4.Alopecia Rationales Option 1:Gynecomastia refers to enlargement of the male breast; it is not associated with infertility. Option 2:Hot flashes can occur in hypogonadism due to hormone fluctuations, but it does not lead to decreased fertility. Option 3:Hypogonadism affects a man's fertility because the lack of testosterone makes it difficult to properly produce sperm. Option 4:Alopecia refers to loss of hair, which does not lead to decreased fertility.