Pharmacotherapeutics for Advanced Practice Nursing Prescribers 4th Edition by Teri Moser Woo, Marylou V. Robinson
Chapter 1. The Role of the Nurse Practitioner
1. Nurse practitioner prescriptive authority is regulated by:
2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include:
3. Clinical judgment in prescribing includes:
4. Criteria for choosing an effective drug for a disorder include:
5. Nurse practitioner practice may thrive under health-care reform because of:
Chapter 2. Review of Basic Principles of Pharmacology
1. A patient’s nutritional intake & laboratory results reflect hypoalbuminemia. This is critical to prescribing because:
2. Drugs that have a significant first-pass effect:
3. The route of excretion of a volatile drug will likely be the:
4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs:
5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
6. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:
7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:
8. Phenytoin requires that a trough level be drawn. Peak & trough levels are done:
9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the:
10. Drugs that are receptor agonists may demonstrate what property?
11. Drugs that are receptor antagonists, such as beta blockers, may cause:
12. Factors that affect gastric drug absorption include:
13. Drugs administered via IV:
14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:
15. Which of the following statements about bioavailability is true?
16. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?
17. Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to:
18. Once they have been metabolized by the liver, the metabolites may be:
19. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by:
20. Steady state is:
21. Two different pain medications are given together for pain relief. The drug—drug interaction is:
22. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:
23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?
24. The time required for the amount of drug in the body to decrease by 50% is called:
25. An agonist activates a receptor & stimulates a response. When given frequently over time, the body may:
26. Drug antagonism is best defined as an effect of a drug that:
27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements?
28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in:
29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach?
30. Which of the following variables is a factor in drug absorption?
31. An advantage of prescribing a sublingual medication is that the medication is:
32. Drugs that use CYP 3A4 isoenzymes for metabolism may:
33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
34. Upregulation or hypersensitization may lead to:
Chapter 3. Rational Drug Selection
1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because:
2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it:
3. A client asks the NP about the differences in drug effects between men & women. What is known about the differences between the pharmacokinetics of men & women?
4. The first step in the prescribing process according to the World Health Organization is:
5. Treatment goals in prescribing should:
6. The therapeutic goals when prescribing include(s):
7. When determining drug treatment the NP prescriber should:
8. Patient education regarding prescribed medication includes:
9. Passive monitoring of drug effectiveness includes:
10. Pharmacokinetic factors that affect prescribing include:
11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine:
12. Under new U.S. Food & Drug Administration labeling, Pregnancy Categories will be:
Chapter 4. Legal & Professional Issues in Prescribing
1. The U.S. Food & Drug Administration regulates:
2. The U.S. Food & Drug Administration approval is required for:
3. An Investigational New Drug is filed with the U.S. Food & Drug Administration:
4. Phase IV clinical trials in the United States are also known as:
5. Off-label prescribing is:
6. The U.S. Drug Enforcement Administration:
7. Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration:
8. Precautions that should be taken when prescribing controlled substances include:
9. Strategies prescribers can use to prevent misuse of controlled prescription drugs include:
10. Behaviors predictive of addiction to controlled substances include:
11. Medication agreements or “Pain Medication Contracts” are recommended to be used:
12. A prescription needs to be written for:
Chapter 6. Factors That Foster Positive Outcomes
1. A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment?
2. Elena Vasquez’s primary language is Spanish, & she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed?
3. Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug?
4. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen?
5. The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier?
6. Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent?
7. Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:
8. Factors in chronic conditions that contribute to nonadherence include:
9. While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when:
10. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% & 60%. To improve adherence in this population, prescribe drugs:
11. Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence?
12. Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:
13. Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who:
14. Monitoring adherence can take several forms, including:
15. Factors that explain & predict medication adherence include:
Chapter 7. Cultural & Ethnic Influences in Pharmacotherapeutics
1. Cultural factors that must be taken into account when prescribing include(s):
2. Ethnic differences have been found in drug:
3. The National Standards of Culturally & Linguistically Appropriate Services are required to be implemented in all:
4. According to the National Standards of Culturally & Linguistically Appropriate Services, an interpreter for health care:
5. According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:
6. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:
7. Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
8. Alterations in drug metabolism among Asians may lead to:
9. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:
10. Hispanic native healers (cur&eras):
Chapter 8. An Introduction to Pharmacogenomics
1. Genetic polymorphisms account for differences in metabolism, including:
2. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
3. Rifampin is a nonspecific CYP450 inducer that may:
4. Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
5. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
6. Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.
7. Pharmacogenetic testing is required by the U.S. Food & Drug Administration prior to prescribing:
8. Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:
9. A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:
10. Patients who have a poor metabolism phenotype will have:
11. Ultra-rapid metabolizers of drugs may have:
12. A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
Chapter 10. Herbal Therapy & Nutritional Supplements
1. A good history of herb & supplement use is critical before prescribing because approximately % of patients in the United States are using herbal products.
2. A potential harmful effect on patients who take some herbal medication is:
3. A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains:
4. Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing & treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe:
5. According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will:
6. In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s:
7. Herbs & supplements are regulated by the U.S. Food & Drug Administration.
8. When melatonin is used to induce sleep, the recommendation is that the patient:
9. Valerian tea causes relaxation & can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to:
10. The standard dosage of St John’s wort for the treatment of mild depression is:
11. Patients need to be instructed regarding the drug interactions with St John’s wort, including:
12. Ginseng, which is taken to assist with memory, may potentiate:
13. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:
14. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:
15. The role of the NP in the use of herbal medication is to:
Chapter 11. Information Technology & Pharmacotherapeutics
1. Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:
2. You are going to prescribe a drug & the electronic health record (EHR) alerts you that there is a potential drug–drug interaction. The alert is generated by:
3. Which of the following is a primary benefit of the use of computerized provider order entry for patient medications?
4. A number of barriers & concerns exist before the goals of a safe & efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption & use of IT in prescribing drugs?
6. Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include:
7. Decision support systems often provide medication alerts that tell the prescriber:
8. Prescribers have been shown to override a medication alert about a patient’s allergies when:
9. The use of information technology for quality improvement in pharmacotherapeutics includes:
10. The advantage of using information technology for patient education includes:
11. One barrier to use of the Internet for both prescribing & for patient teaching is:
12. Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to:
13. Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review:
14. Information technology (IT) can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true?
15. Discharge summaries using information technology have several advantages. They can:
16. Information technology can also be used for patient teaching during the encounter & after it. The provider can help patients & their families become savvy consumers of health-care information by:
17. Incorporating information technology (IT) into a patient encounter takes skill & tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by:
Chapter 12. Pharmacoeconomics
1. Pharmacoeconomics is:
2. The direct costs of drug therapy include:
3. Indirect costs associated with drug therapy include:
4. The intangible costs of drug therapy include:
5. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy & compares the costs of each it is referred to as:
6. Cost-effectiveness analysis compares two or more treatments or programs that are:
7. When the costs of a specific treatment or intervention are calculated & then compared with the dollar value of the benefit received it is referred to as:
8. Mary has a two-tiered prescription benefit plan, which means:
9. Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists:
10. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be:
11. The “donut hole” in Medicare Part D:
12. Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in coverage they:
Chapter 13. Over-the-Counter Medications
1. Michael asks you about why some drugs are over-the-counter & some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must:
2. In the United States, over-the-counter drugs are regulated by:
3. As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to:
4. New over-the-counter drug ingredients must undergo the U.S. Food & Drug Administration New Drug Application process, just as prescription drugs do.
5. The ailment that generates the greatest over-the-counter annual drug sales is:
6. Common over-the-counter pain relievers such as acetaminophen or ibuprofen:
7. When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of:
8. The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:
9. When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:
Chapter 14. Drugs Affecting the Autonomic Nervous System
1. Charlie is a 65-year-old male who has been diagnosed with hypertension & benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
2. To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT:
3. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:
4. Clonidine has several off-label uses, including:
5. Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:
6. Which of the following adverse effects are less likely in a beta1-selective blocker?
7. Richard is 70 years old & has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work & find a CrCl of 25 ml/min. What action should you take related to his nadolol?
8. Beta blockers are the drugs of choice for exertional angina because they:
9. Adherence to beta blocker therapy may be affected by their:
10. Beta blockers have favorable effects on survival & disease progression in heart failure. Treatment should be initiated when the:
11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:
12. To prevent life-threatening events from rapid withdrawal of a beta blocker:
13. Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia & block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs & so can be used to warn diabetics of possible decreased blood glucose?
14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:
15. Carvedilol is heavily metabolized by CYP2D6 & 2C9, resulting in drug interactions with which of the following drug classes?
16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?
18. Clinical dosing of Bethanechol:
19. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?
20. Anticholinesterase inhibitors are used to treat:
21. Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
22. Taking which drug with food maximizes it bioavailability?
23. Which of the following drugs should be used only when clearly needed in pregnant & breastfeeding women?
24. There is a narrow margin between first appearance of adverse reaction to AChE inhibitors & serious toxic effects. Adverse reactions that require immediate action include:
25. Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily?
26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine?
27. Nicotine gum products are:
28. Nicotine replacement therapy (NRT):
29. Success rates for smoking cessation using NRT:
30. Cholinergic blockers are used to:
31. Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?
32. Scopolamine can be used to prevent the nausea & vomiting associated with motion sickness. The patient is taught to:
33. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when st&ing abruptly. The best option for this patient is:
34. You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?
35. A patient presents with a complaint of dark stools & epigastric pain described as gnawing & burning. Which of the medications is the most likely cause?
36. Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications?
37. Activation of central alpha2 receptors results in inhibition of cardioacceleration & __ centers in the brain.
Chapter 15. Drugs Affecting the Central Nervous System
1. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:
2. Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) & St John’s wort due to:
3. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_ to be used for an episode of status epilepticus.
4. Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:
5. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you & you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:
6. Carbamazepine has a Black Box Warning due to life-threatening:
7. Long-term monitoring of patients who are taking carbamazepine includes:
8. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:
9. Sook has been prescribed gabapentin to treat neuropathic pain & is complaining of feeling depressed & having “strange” thoughts. The appropriate initial action would be:
10. Selma, who is overweight, recently started taking topiramate for seizures & at her follow-up visit you note she has lost 3 kg. The appropriate action would be:
11. Monitoring of a patient on gabapentin to treat seizures includes:
12. Scott’s seizures are well controlled on topiramate & he wants to start playing baseball. Education for Scott regarding his topiramate includes:
13. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:
14. Levetiracetam has known drug interactions with:
15. Zainab is taking lamotrigine (Lamictal) & presents to the clinic with fever & lymphadenopathy. Initial evaluation & treatment includes:
16. Samantha is taking lamotrigine (Lamictal) for her seizures & requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine & may cause:
17. The tricyclic antidepressants should be prescribed cautiously in patients with:
18. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine & other monoamine oxidase inhibitors (MAOIs):
19. Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:
20. Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes:
21. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, & lack of motivation. An appropriate initial antidepressant for her would be:
22. Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:
23. Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:
24. Patients who are prescribed olanzapine (Zyprexa) should be monitored for:
25. A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:
26. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is:
27. A patient with anxiety & depression may respond to:
28. When prescribing temazepam (Restoril) for insomnia, patient education includes:
29. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:
30. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:
31. Tom is taking lithium for bipolar disorder. He should be taught to:
32. Cynthia is taking valproate (Depakote) for seizures & would like to get pregnant. What advice would you give her?
33. When prescribing an opioid analgesic such as acetaminophen & codeine (Tylenol #3), instructions to the patient should include:
34. Kirk sprained his ankle & is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:
35. Kasey fractured his ankle in two places & is asking for medication for his pain. The appropriate first-line medication would be:
36. Jack, age 8, has attention deficit disorder (ADD) & is prescribed methylphenidate (Ritalin). He & his parents should be educated about the side effects of methylphenidate, which are:
37. Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes:
38. When prescribing Adderall (amphetamine & dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor:
Chapter 16. Drugs Affecting the Cardiovascular & Renal Systems
1. Ray has been diagnosed with hypertension & an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for:
2. Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic patients because they:
3. A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response?
4. Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder & the reason for its use?
5. Despite good blood pressure control, an NP might change a patient’s drug from an angiotensin-converting enzyme (ACE) inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:
6. While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because:
7. Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include:
8. Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it:
9. Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker?
10. Patient teaching related to amlodipine includes:
11. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:
12. Larry has heart failure, which is being treated with digoxin because it exhibits:
13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes:
14. Which of the following create a higher risk for digoxin toxicity? Both the cause & the reason for it must be correct.
15. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur:
16. Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, & peripheral edema because they may indicate:
17. Which of the following is true about procainamide & its dosing schedule?
18. Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT:
19. The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease & wants to know why the test is ordered. Which is a correct response?
20. Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. & 2 p.m. because:
21. Art is a 55-year-old smoker who has been diagnosed with angina & placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:
22. In teaching about the use of sublingual nitroglycerine, the patient should be instructed:
23. Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:
24. Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?
25. Because of the pattern of cholesterol synthesis, reductase inhibitors are given:
26. Janice has elevated LDL, VLDL, & triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism & excretion, which of the following laboratory results should be monitored?
27. Niaspan is less likely to cause which side effect that is common to niacin?
28. Dulcea has type 2 diabetes & a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug?
29. Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug & the reason must both be correct for the answer to be correct.
30. Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug:
31. Because of their site of action, bile acid sequestering resins:
32. Colestipol comes in a powdered form. The patient is taught to:
33. The choice of diuretic to use in treating hypertension is based on:
34. Direct renin inhibitors have the following properties. They:
35. When comparing angiotensin-converting enzyme (ACE) & angiotensin II receptor blocker (ARB) medications, which of the following holds true?
36. What does the provider understand about the issue of “Diabetic Renal Protection” with angiotensin-converting enzyme (ACE) medications? Diabetes mellitus patients:
37. What dermatological issue is linked to Amiodarone use?
38. Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?
Chapter 17. Drugs Affecting the Respiratory System
1. Digoxin levels need to be monitored closely when the following medication is started:
2. Patients with pheochromocytoma should avoid which of the following classes of drugs because of the possibility of developing hypertensive crisis?
3. Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all?
4. Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food & Drug Administration due to the:
5. The bronchodilator of choice for patients taking propranolol is:
6. James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin’s diet for weight loss. The appropriate response would be:
7. Li takes theophylline for his persistent asthma & calls the office with a complaint of nausea, vomiting, & headache. The best advice for him would be to:
8. Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
9. Christy has exercise-induced & mild persistent asthma & is prescribed two puffs of albuterol 15 minutes before exercise & as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:
10. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed:
11. Montelukast (Singulair) may be prescribed for:
12. The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include:
13. When educating patients who are starting on inhaled corticosteroids, the provider should tell them that:
14. Patients with allergic rhinitis may benefit from a prescription of:
15. Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for:
16. First-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are:
17. When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to:
18. Decongestants such as pseudoephedrine (Sudafed):
19. Cough & cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population:
20. Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be:
21. The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year-old child is:
Chapter 18. Drugs Affecting the Hematopoietic System
1. Kenneth is taking warfarin & is asking about what he can take for minor aches & pains. The best recommendation is:
2. Juanita had a deep vein thrombosis (DVT) & was on heparin in the hospital & was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:
3. The safest drug to use to treat pregnant women who require anticoagulant therapy is:
4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?
5. Cecil & his wife are traveling to Southeast Asia on vacation & he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting “a shot” to prevent blood clots like his friend Ralph did before international travel. The correct respond would be:
6. Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended?
7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated?
8. Patient education when prescribing clopidogrel includes:
9. For patients taking warfarin, INRs are best drawn:
10. Patients receiving heparin therapy require monitoring of:
11. The routine monitoring recommended for low molecular weight heparin is:
12. When writing a prescription for warfarin it is common to write _ on the prescription.
13. Education of patients who are taking warfarin includes discussing their diet. Instructions include:
14. Patients who are being treated with epoetin alfa need to be monitored for the development of:
15. The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that:
16. When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:
17. Jim is having a hip replacement surgery & would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed:
18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes:
19. Patient education regarding taking iron replacements includes:
20. Patients with pernicious anemia require treatment with:
21. The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:
22. Patients who are beginning therapy with vitamin B12 need to be monitored for:
Chapter 19. Drugs Affecting the Immune System
1. Attenuated vaccines are also known as:
2. Live attenuated influenza vaccine (FluMist) may be administered to:
3. The reason that two MMR vaccines at least a month apart are recommended is:
4. The MMR vaccine is not recommended for pregnant women because:
5. If the measles, mumps, rubella, & varicella (MMRV) combined vaccine is ordered to be given as the first MMR & varicella dose to a child the CDC recommends:
6. The rotavirus vaccine (RotaTeq, Rotarix):
7. Varicella vaccine is recommended to be given to patients who are:
8. Zoster vaccine (Zostavax) is:
9. True contraindications to diphtheria, tetanus, & acellular pertussis (DTaP or Tdap) vaccine include:
10. Hepatitis B vaccine is contraindicated in patients who:
11. Human papillomavirus (HPV) vaccine (Gardasil, Cervarix):
12. Influenza vaccine may be administered annually to:
13. Immune globulin serums:
14. Hepatitis B immune globulin is administered to provide passive immunity to:
15. Rho(D) immune globulin (RhoGAM) is given to:
16. Tuberculin purified protein derivative:
17. Diane may benefit from cyclosporine (S&immune). Cyclosporin may be prescribed to:
18. Azathioprine has significant adverse drug effects, including:
19. Pregnant women should receive the Tdap vaccine:
20. Children who should receive meningococcal conjugate vaccine (Hib-MenCY, MenHibrix) include:
Chapter 20. Drugs Affecting the Gastrointestinal System
1. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first?
2. Patients taking antacids should be educated regarding these drugs, including letting them know that:
3. Kelly has diarrhea & is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide:
4. Bismuth subsalicylate (PeptoBismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate:
5. Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food & water precautions as well as taking:
6. Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, & some diarrhea. She is unable to keep fluids down & her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie?
7. Jim presents with complaints of “heartburn” that is minimally relieved with Tums (calcium carbonate) & is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be:
8. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:
9. Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for:
10. Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be:
11. Methylnaltrexone is used to treat constipation in:
12. An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include:
Chapter 21. Drugs Affecting the Endocrine System
1. Both men & women experience bone loss with aging. The bones most likely to demonstrate significant loss are:
2. Bisphosphonates treat or prevent osteoporosis by:
3. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?
4. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, & amylase components, but the drug is prescribed in units of:
5. Brands of pancreatic enzyme replacement drugs are:
6. When given subcutaneously, how long until neutral protamine Hagedorninsulin begins to take effect (onset of action) after administration?
7. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs & symptoms of hypoglycemia include:
8. Nonselective beta blockers & alcohol create serious drug interactions with insulin because they:
9. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?
10. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
11. When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose & limit complication risks. Which of the following statements is accurate based on research?
12. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:
13. Prior to prescribing metformin, the provider should:
14. The action of “gliptins” is different from other antidiabetic agents because they:
15. Sitagliptin has been approved for:
16. GLP-1 agonists:
17. Avoid concurrent administration of exenatide with which of the following drugs?
18. Administration of exenatide is by subcutaneous injection:
19. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report:
20. Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for:
21. Which of the following is not an indication that growth hormone supplements should be discontinued?
22. Besides osteoporosis, IV bisphosphonates are also indicated for:
23. What is the role of calcium supplements when patients take bisphosphonates?
24. Which of the following statements about pancreatic enzymes is true?
25. Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes?
Chapter 22. Drugs Affecting the Reproductive System
1. Men who use transdermal testosterone gel (&roGel) should be advised to avoid:
2. Education when prescribing &rogens to male patients includes advising that:
3. Patients who are prescribed exogenous &rogens need to be warned that decreased libido:
4. The U.S. Food & Drug Administration warns that &rogens may cause:
5. Monitoring for a patient who is using &rogens includes evaluation of:
6. Male patients require __ before & during &rogen therapy.
7. Absolute contraindications to estrogen therapy include:
8. Postmenopausal women with an intact uterus should not be prescribed:
9. Women who have migraines with an aura should not be prescribed estrogen because of:
10. A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes:
11. A 19-year-old female is a nasal Staph aureus carrier & is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications?
12. A 56-year-old woman is complaining of vaginal dryness & dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed:
13. Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for:
14. When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects:
15. The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to:
16. Shana received her first medroxyprogesterone (Depo Provera) injection 6 weeks ago & calls the clinic with a concern that she has been having a light “period” off & on since receiving her Depo shot. What would be the management of Shana?
17. William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for before prescribing sildenafil.
18. Men who are prescribed sildenafil (Viagra) need ongoing monitoring for:
19. Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be warned about the risk for:
20. &rogens are indicated for:
21. Long-term use of &rogens requires specific laboratory monitoring of:
22. Effects of estrogen include:
23. Absolute contraindications that clinicians must consider when initiating estrogen therapy include:
24. Patients taking hormonal contraceptives & hormone replacement therapy need to take the drug daily at the same time to prevent:
Chapter 23. Drugs Affecting the Integumentary System
1. Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances & request the least expensive-treatment. Which medication would be the best choice for treatment?
2. Juakeem is a nasal methicillin resistant staphylococcus aureus(MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes:
3. Instructions for applying a topical antibiotic or antiviral ointment include:
4. When Sam used clotrimazole (Lotrimin AF) for athlete’s foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete’s foot again. What would be a good choice of antifungal for Sam?
5. When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to:
6. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:
7. When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include:
8. Erika has been prescribed isotretinoin (Accutane) by her dermatologist & is presenting to her primary care provider with symptoms of sadness & depression. A Beck’s Depression Scale indicates she has mild to moderate depression. What would be the best care for her at this point?
9. Drew is a 17-year-old competitive runner who presents with complaint of pain in his hip that occurred after he fell while running. His only medical problem is severe acne for which he takes isotretinoin (Accutane). With this history what would you be concerned for?
10. Catherine calls the clinic with concerns that her acne is worse 1 week after starting topical tretinoin. What would be the appropriate care for her?
11. Li is a 6-month-old infant with severe eczema. She would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include:
12. Jose has had eczema for many years & reports that he thinks his corticosteroid cream is not working as well as it was previously. He may be experiencing tolerance to the corticosteroid. Treatment options include:
13. When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that:
14. Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:
15. Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes instructing them:
16. Instructions for the use of selenium sulfide shampoo (Selsun) to treat scalp seborrhea include:
17. Topical diphenhydramine (Benadryl) is available OTC to treat itching. Patients or parents should be instructed regarding the use of topical diphenhydramine that:
18. A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his leg. Normal adverse effects of silver sulfadiazine cream include:
19. Instructions for the use of malathion (Ovide) for head lice include:
20. When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include:
Chapter 24. Drugs Used in Treating Infectious Diseases
1. Factors that place a patient at risk of developing an antimicrobial-resistant organism include:
2. Infants & young children are at higher risk of developing antibiotic-resistant infections due to:
3. Providers should use an antibiogram when prescribing. An antibiogram is:
4. There is often cross-sensitivity & cross-resistance between penicillins & cephalosporins because:
5. Jonathan has been diagnosed with strep throat & needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be:
6. Sarah is a 25-year-old female who is 8 weeks pregnant & has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?
7. Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic & say he has developed diarrhea. The appropriate action would be to:
8. Lauren is a 13-year-old child who comes to clinic with a 4-day history of cough, low-grade fever, & rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The appropriate antibiotic to prescribe would be:
9. Joanna had a small ventricle septal defect (VSD) repaired when she was 3 years old & has no residual cardiac problems. She is now 28 & is requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology & American Heart Association guidelines is:
10. To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of:
11. Fluoroquinolones have a Black Box Warning regarding even months after treatment.
12. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?
13. Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction?
14. Jamie has glucose-6-phosphate dehydrogenase deficiency (G6PD) & requires an antibiotic. Which class of antibiotics should be avoided in this patient?
15. If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to:
16. Tetracyclines such as minocycline are safe to use in:
17. Tetracyclines should not be prescribed to children younger than 8 years due to:
18. Nicole is a 16-year-old female who is taking minocycline for acne. She comes to the clinic complaining of a headache. What would be the plan of care?
19. Patricia has been prescribed doxycycline for a chlamydia infection. She is healthy & her only medication is an oral combined contraceptive. Patricia’s education would include:
20. To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed:
21. Sadie is an 82-year-old patient who has herpes zoster (shingles) & would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir she will need an assessment of:
22. When prescribing acyclovir, patients should be educated regarding the:
23. Nicholas has been diagnosed with type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include:
24. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes:
25. When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include:
26. Every antibiotic drug class has resistant organisms that influence prescribing decisions.
Chapter 25. Drugs Used in Treating Inflammatory Processes
1. Henry presents to clinic with a significantly swollen, painful great toe & is diagnosed with gout. Of the following, which would be the best treatment for Henry?
2. Patient education when prescribing colchicine includes:
3. Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:
4. Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:
5. Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:
6. Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:
7. Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?
8. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?
9. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:
10. Patients who are on chronic long-term corticosteroid therapy need education regarding:
11. All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:
12. Jamie has fractured his ankle & has received a prescription for acetaminophen & hydrocodone (Vicodin). Education when prescribing Vicodin includes:
13. When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs:
14. Josefina is a 2-year-old child with acute otitis media & an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen?
15. Henry is 82 years old & takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?
16. The trial period to determine effective anti-inflammatory activity aspirin for rheumatoid arthritis is:
17. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is:
18. Monitoring a patient on a high-dose aspirin level includes:
19. Patients who are on long-term aspirin therapy should have __ annually.
Chapter 26. Drugs Used in Treating Eye & Ear Disorders
1. The Centers for Disease Control recommends all newborn infants receive prophylactic administration of __ within 1 hour of birth.
2. Conjunctivitis in a child that is accompanied by acute otitis media is treated with:
3. Twenty-year-old Annie comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be:
4. Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes:
5. Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because:
6. David presents to the clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding using cromolyn eye drops includes:
7. Ciprofloxacin otic drops are contraindicated in:
8. __ is / are prescribed to prevent swimmer’s ear.
9. Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops includes:
10. Janie presents to the clinic with hard ear wax in both ear canals. Instructions regarding home removal of hard cerumen include:
Chapter 27. Anemia
1. Pernicious anemia is treated with:
2. Premature infants require iron supplementation with:
3. Breastfed infants should receive iron supplementation of:
4. Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 & her ferritin is 15 ng/mL. Initial treatment for her anemia would be:
5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be:
6. Monitoring for a patient taking iron to treat iron deficiency anemia is:
7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include:
8. Allie has just had her pregnancy confirmed & is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy?
9. Kyle has Crohn’s disease & has a documented folate deficiency. Drug therapy for folate deficiency anemia is:
10. Patients who are being treated for folate deficiency require monitoring of:
11. The treatment of vitamin B12 deficiency is:
12. The dosage of Vitamin B12 to initially treat pernicious anemia is:
13. Before beginning IM vitamin B12 therapy, which laboratory values should be obtained?
14. should be monitored when vitamin B12 therapy is started.
15. Anemia due to chronic renal failure is treated with:
Chapter 28. Chronic Stable Angina & Low-Risk Unstable Angina
1. Angina is produced by an imbalance between myocardial oxygen supply (MOS) & dem& (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?
2. Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:
3. The New York Heart Association & the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:
4. Patients at high risk for developing significant coronary heart disease are those with:
5. To reduce mortality, all patients with angina, regardless of class, should be on:
6. Patients who have angina, regardless of class, who are also diabetic, should be on:
7. Management of all types & grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification & the reason for it must be true for the answer to be correct.
8. Nitrates are especially helpful for patients with angina who also have:
9. Beta blockers are especially helpful for patients with exertional angina who also have:
10. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?
11. Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7 a.m. & 2 p.m. because:
12. Combinations of a long-acting nitrate & a beta blocker are especially effective in treating angina because:
13. Drug choices to treat angina in older adults differ from those of younger adults only in:
14. Which of the following drugs has been associated with increased risk for myocardial infarction in women?
15. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:
16. Situations that suggest referral to a specialist is appropriate include:
17. The rationale for prescribing calcium blockers for angina can be based on the need for:
18. Medications are typically started for angina patients when:
19. The most common cause of angina is:
20. Ranolazine is used in angina patients to:
21. When is aspirin (ASA) used in angina patients?
Chapter 29. Anxiety & Depression
1. Common mistakes practitioners make in treating anxiety disorders include:
2. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:
3. An appropriate drug to initially treat panic disorder is:
4. Prior to starting antidepressants, patients should have laboratory testing to rule out:
5. David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include:
6. Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:
7. An appropriate drug for the treatment of depression with anxiety would be:
8. An appropriate first-line drug for the treatment of depression with fatigue & low energy would be:
9. The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is:
10. Jaycee has been on escitalopram (Lexapro) for a year & is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants?
11. The longer-term Xanax patient comes in & states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason?
12. What “onset of action” symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor?
13. Which of the following should not be taken with a selective serotonin reuptake inhibitor?
14. Why is the consistency of taking paroxetine (Paxil) & never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)?
15. The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response?
Chapter 30. Asthma & Chronic Obstructive Pulmonary Disease
1. Prior to developing a plan for the treatment of asthma, the patient’s asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur:
2. In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur:
3. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is:
4. A stepwise approach to the pharmacologic management of asthma:
5. Treatment for mild intermittent asthma is:
6. The first-line therapy for mild-persistent asthma is:
7. Monitoring a patient with persistent asthma includes:
8. Asthma exacerbations at home are managed by the patient by:
9. Patients who are at risk of a fatal asthma attack include patients:
10. Pregnant patients with asthma may safely use throughout their pregnancy.
11. One goal of asthma management in children is:
12. Medications used in the management of patients with chronic obstructive pulmonary disease(COPD) include:
13. Patients with a COPD exacerbation may require:
14. Patients with COPD require monitoring of:
15. Education of patients with COPD who use inhaled corticosteroids includes:
16. Education for patients who use an inhaled beta-agonist & an inhaled corticosteroid includes:
Chapter 31. Contraception
1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of:
2. The mechanism of action of oral combined contraceptives that prevents pregnancy is:
3. To improve actual effectiveness of oral contraceptives women should be educated regarding:
4. A contraindication to the use of combined contraceptives is:
5. Obese women may have increased risk of failure with which contraceptive method?
6. Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before & has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse & has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:
7. When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:
8. The topical patch combined contraceptive (Ortho Evra) is:
9. Progesterone-only pills are recommended for women who:
10. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?
11. An advantage of using the NuvaRing vaginal ring for contraception is:
12. Oral emergency contraception (Plan B) is contraindicated in women who:
Chapter 32. Dermatologic Conditions
1. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be:
2. Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for:
3. Long-term treatment of moderate atopic dermatitis includes:
4. Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:
5. When a patient has contact dermatitis, wet dressings with Domeboro solution are used for:
6. Appropriate initial treatment for psoriasis would be:
7. Patient education when prescribing the vitamin D3 derivative calcipotriene for psoriasis includes:
8. Mild acne may be initially treated with:
9. Tobie presents to the clinic with moderate acne. He has been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) & a topical retinoid adapalene (Differin) are prescribed. Education of Tobie would include:
10. Josie has severe cystic acne & is requesting treatment with Accutane. The appropriate treatment for her would be:
11. The most cost-effective treatment for two or three impetigo lesions on the face is:
12. Dwayne has classic tinea capitis. Treatment for tinea on the scalp is:
13. Nicolas is a football player who presents to the clinic with athlete’s foot. Patients with tinea pedis may be treated with:
14. Jim presents with fungal infection of two of his toenails (onychomycosis). Treatment for fungal infections of the nail includes:
15. Scabies treatment for a 4-year-old child includes a prescription for:
16. Vanessa has been diagnosed with scabies. Her education would include:
17. Catherine has head lice & her mother is asking about what products are available that are not neurotoxic. The only non-neurotoxin head lice treatment is:
18. Rick has male pattern baldness on the vertex of his head & has been using Rogaine for 2 months. He asks how effective minoxidil (Rogaine) is. Minoxidil:
Chapter 33. Diabetes Mellitus
1. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1 diabetics have:
2. Type 2 diabetes is a complex disorder involving:
3. Diagnostic criteria for diabetes include:
4. Routine screening of asymptomatic adults for diabetes is appropriate for:
5. Screening for children who meet the following criteria should begin at age 10 & occur every 3 years thereafter:
6. Insulin is used to treat both types of diabetes. It acts by:
7. Adam has type 1 diabetes & plays tennis for his university. He exhibits a knowledge deficit about his insulin & his diagnosis. He should be taught that:
8. Insulin preparations are divided into categories based on onset, duration, & intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset & duration of action?
9. The drug of choice for type 2 diabetics is metformin. Metformin:
10. Before prescribing metformin, the provider should:
11. Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications & metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:
12. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include:
13. Control targets for patients with diabetes include:
14. Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes:
15. Treatment with insulin for type 1 diabetics:
16. When the total daily insulin dose is split & given twice daily, which of the following rules may be followed?
17. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include:
18. Prevention of conversion from prediabetes to diabetes in young children must take highest priority & should focus on:
19. The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:
20. Unlike most type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity & mortality. The most reliable indicator of poor nutritional status in older adults is:
21. The drugs recommended for older adults with type 2 diabetes include:
22. Ethnic groups differ in their risk for & presentation of diabetes. Hispanics:
23. The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments & targets that do not appear to decrease risk for micro- & macro-vascular complications include:
24. All diabetic patients with known cardiovascular disease should be treated with:
25. All diabetic patients with hyperlipidemia should be treated with:
26. Both angiotensin converting enzymeinhibitors & some angiotensin II receptor blockers have been approved in treating:
27. Protein restriction helps slow the progression of albuminuria, glomerular filtration rate, decline, & end stage renal disease in some patients with diabetes. It is useful for patients who:
28. Diabetic autonomic neuropathy (DAN) is the earliest & most common complication of diabetes. Symptoms associated with DAN include:
29. Drugs used to treat diabetic peripheral neuropathy include:
30. The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes?
31. Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily & Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine?
32. Allison is an 18-year-old college student with type 1 diabetes. Allison’s pre-meal BG at 11:30 a.m. is 130. She eats an apple & has a sugar-free soft drink. At 1 p.m. before swimming her BG is 80. What should she do?
33. Bart is a patient is a 67-year-old male with T2 DM. He is on glipizide & metformin. He presents to the clinic with confusion, sluggishness, & extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly, & hasn’t checked his BG for 1 week. A r&om glucose is drawn & it is 500. What is a likely diagnosis based on preliminary assessment?
34. What would one expected assessment finding be for hyperglycemic hyperosmolar syndrome?
35. A patient on metformin & glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic & dizzy. She reports taking her medication this morning & ate a bagel & coffee for breakfast. BP is 110/70 & r&om finger-stick glucose is 64. How should this patient be treated?
Chapter 34. Gastroesophageal Reflux & Peptic Ulcer Disease
1. Gastroesophageal reflux disease may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone:
2. Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Food or drink that may aggravate GERD include:
3. Metoclopramide improves gastroesophageal reflux disease symptoms by:
4. Antacids treat gastroesophageal reflux disease by:
5. When treating patients using the “Step-Down” approach the patient with gastroesophageal reflux disease is started on ___ first.
6. If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be:
7. If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is not improving, the plan of care would be:
8. The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks & not improving is:
9. Infants with reflux are initially treated with:
10. Long-term use of proton pump inhibitors may lead to:
11. An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is:
12. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of:
13. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is:
14. After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is:
Chapter 35. Headaches
1. Paige has a history of chronic migraines & would benefit from preventative medication. Education regarding migraine preventive medication includes:
2. A first-line drug for abortive therapy in simple migraine is:
3. Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin & butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines & states one dose usually works to abort her migraine. What is the best care for her?
4. When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include:
5. Migraines in pregnancy may be safely treated with:
6. Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:
7. Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:
8. Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?
9. Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber’s naratriptan, education would include:
10. When prescribing for migraines, patient education includes:
11. Juanita presents to the clinic with a complaint of headaches off & on for months. She reports they feel like someone is “squeezing” her head. She occasionally takes Tylenol for the pain, but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary & a prescription for:
12. Nonpharmacologic therapy for tension headaches includes:
13. James has been diagnosed with cluster headaches. Appropriate acute therapy would be:
14. Preventative therapy for cluster headaches includes:
15. When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they:
Chapter 36. Heart Failure
2. One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include:
3. The American Heart Association & the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms & underlying disease are classified as stage:
4. Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific & sensitive diagnostic test for heart failure is:
5. Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with:
6. Class I recommendations for stage A heart failure include:
7. Stage B patients should have beta blockers added to their heart failure treatment regimen when:
8. Increased life expectancy for patients with heart failure has been associated with the use of:
9. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors & beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?
10. Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with:
11. Which of the following classes of drugs is contraindicated in heart failure?
12. Heart failure is a leading cause of death & hospitalization in older adults (greater than 65 years old). The drug of choice for this population is:
13. ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy?
14. Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when:
15. ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely?
16. What assessment that can be done at home is the most reliable for making decisions to change HF medications?
17. Evidence is strong that the timing of HF interventions are best initiated when:
18. HF patients frequently take more than one drug. When are anticoagulants typically used?
19. What can chest x-rays contribute to the diagnosis & management of HF?
Chapter 38. Hormone Replacement Therapy & Osteoporosis
1. The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing:
2. The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is:
3. Dosage changes of conjugated equine estrogen (Premarin) are made at _ intervals.
4. The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy & dryness is:
5. Women with an intact uterus should be treated with both estrogen & progestin due to:
6. Ongoing monitoring for women on ERT includes:
7. Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering hormone replacement would include:
8. Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk?
9. Drugs that increase the risk of osteoporosis developing include:
10. Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:
11. Sallie has been diagnosed with osteoporosis & is asking about the “once a month” pill to treat her condition. How do bisphosphonates treat osteoporosis?
12. Inadequate vitamin D intake can contribute to the development of osteoporosis by:
13. The drug recommended as primary prevention of osteoporosis in women over age 70 years is:
14. The drug recommended as primary prevention of osteoporosis in men over age 70 years is:
15. The ongoing monitoring for patients over age 65 years taking alendronate (Fosamax) or any other bisphosphonate is:
16. Bisphosphonate administration education includes:
17. IV forms of bisphosphonates are used for all the following except:
18. What is the established frequency of repeating DEXA imaging after stating bisphosphonates?
19. What is the duration of SERM use for menopausal issues?
20. Why are SERMS generally not ordered for women early into menopause?
Chapter 39. Hyperlipidemia
1. The overall goal of treating hyperlipidemia is:
2. When considering which cholesterol-lowering drug to prescribe, which factor determines the type & intensity of treatment?
3. First-line therapy for hyperlipidemia is:
4. James is a 45-year-old patient with an LDL level of 120 & normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, &:
5. Joanne is a 60-year-old patient with an LDL of 132 & a family history of coronary artery disease. She has already tried diet changes (increased fiber & plant sterols) to lower her LDL & after 6 months her LDL is slightly higher. The next step in her treatment would be:
6. Sharlene is a 65-year-old patient who has been on a lipid-lowering diet & using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be:
7. Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for 3 months to treat his high LDL level. His LDL is 135 mg/dL & his triglycerides are elevated. A reasonable change in therapy would be to:
8. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia & elevated LDL levels. What is the appropriate treatment for a pregnant woman?
9. Han is a 48-year-old diabetic with hyperlipidemia & high triglycerides. His LDL is 112 mg/dL & he has not tolerated statins. He warrants a trial of a:
10. Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL & LDL of 125 mg/dL. Along with diet education & recommending increased physical activity, a treatment plan for Jose would include with a reevaluation in 6 months.
11. Monitoring of a patient who is on a lipid-lowering drug includes:
12. Before starting therapy with a statin, the following baseline laboratory values should be evaluated:
13. When starting a patient on a statin, education would include:
14. Omega 3 fatty acids are best used to help treat:
15. When are statins traditionally ordered to be taken?
16. Which the following persons should not have a statin medication ordered?
17. Fiber supplements are great options for elderly patients who have the concurrent problem of:
18. What is considered the order of statin strength from lowest effect to highest?
Chapter 40. Hypertension
1. Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they:
2. Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive the following supplement:
3. All patients with hypertension benefit from diuretic therapy, but those who benefit the most are:
4. Beta blockers treat hypertension because they:
5. Which of the following disease processes could be made worse by taking a nonselective beta blocker?
6. Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include:
7. Angiotensin-converting enzyme(ACE) inhibitors treat hypertension because they:
8. Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials includes:
9. An ACE inhibitor & what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?
10. If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents?
11. Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true?
12. Caffeine, exercise, & smoking should be avoided for at least how many minutes before blood pressure measurement?
13. Blood pressure checks in children:
14. Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include:
15. Lifestyle modifications for patients with prehypertension or hypertension include:
16. Which diuretic agents typically do not need potassium supplementation?
17. Aldactone family medications are frequently used when the hypertensive patient also has:
18. Hypertensive African Americans are typically listed as not being as responsive to which drug groups?
19. What educational points concerning fluid intake must be covered with diuretic prescriptions?
20. What is a common side effect concern with hypertensive medications & all individuals, but especially the elderly?
Chapter 41. Hyperthyroidism & Hypothyroidism
1. When methimazole is started for hyperthyroidism it may take to see a total reversal of hyperthyroid symptoms.
2. In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for:
3. After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes TSH & free T4 every:
4. A woman who is pregnant & has hyperthyroidism is best managed by a specialty team who will most likely treat her with:
5. Goals when treating hypothyroidism with thyroid replacement include:
6. When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in:
7. Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH & free T4 levels every:
8. Treatment of a patient with hypothyroidism & cardiovascular disease consists of:
9. Infants with congenital hypothyroidism are treated with:
10. When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include:
11. In hyperthyroid states, what organ system other than CV must be evaluated to establish potential adverse issues?
12. Why are “natural” thyroid products not readily prescribed for most patients?
13. What is the desired mixed of T3 to T4 drug levels in newly diagnosed endocrine patients?
14. Laboratory values are actually different for TSH when screening for thyroid issues & when used for medication management. Which of the follow holds true?
15. What happens to the typical hormone replacement dose when a woman becomes pregnant?
Chapter 42. Pneumonia
1. The most common bacterial pathogen in community-acquired pneumonia is:
2. The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be:
3. The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia & can be treated as an outpatient would be:
4. If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:
5. Samantha is 34 weeks pregnant & has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe?
6. Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in:
7. Along with prescribing antibiotics, adults with pneumonia should be instructed on lifestyle modifications to improve outcomes, including:
8. John is a 4-week-old infant who has been diagnosed with chlamydial pneumonia. An appropriate treatment for his pneumonia would be:
9. Wing-Sing is a 4-year-old patient who has suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, & is taking fluids adequately. What would be appropriate initial treatment for his pneumonia?
10. Giselle is a 14-year-old patient who presents to the clinic with symptoms consistent with mycoplasma pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent?
Chapter 43. Smoking Cessation
1. Nicotine withdrawal symptoms include:
2. If a patient wants to quit smoking, nicotine replacement therapy is recommended if the patient:
3. Instructions for a patient who is starting nicotine replacement therapy include:
4. Nicotine replacement therapy should not be used in which patients?
5. Instructions for the use of nicotine gum include:
6. Patients who choose the nicotine lozenge to assist in quitting tobacco should be instructed:
7. Transdermal nicotine replacement (the patch) is an effective choice in tobacco cessation because:
8. The most common adverse effect of the transdermal nicotine replacement patch is:
9. If a patient is exhibiting signs of nicotine toxicity when using transdermal nicotine, they should remove the patch &:
10. When a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include:
11. If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include:
12. Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include:
13. The most appropriate smoking cessation prescription for pregnant women is:
Chapter 44. Sexually Transmitted Infections & Vaginitis
1. The goals of treatment when prescribing for sexually transmitted infections include:
2. The drug of choice for treatment of primary or secondary syphilis is:
3. The drug of choice for treatment of early latent or tertiary syphilis is:
4. Demione is a 24-year-old patient who is 32 weeks pregnant & has tested positive for syphilis. The best treatment for her would be:
5. Treatment for suspected gonorrhea is:
6. When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with:
7. Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened for gonorrhea & chlamydia in:
8. A test of cure is recommended after treating chlamydia in which patient population?
9. Treatment for chancroid in a nonpregnant patient would be:
10. Jamie was treated for chancroid. Follow-up testing after treatment of chancroid would be:
11. Helima presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be:
12. Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education regarding the fact that:
13. Sydney presents to the clinic with vulvovaginal c&idiasis. Appropriate treatment for her would be:
14. If a woman presents with recurrent vulvovaginal c&idiasis she may be treated with:
15. Zoe presents with genital warts present on her labia. Patient-applied topical therapy for warts includes:
16. Sophie presents to the clinic with a malodorous vaginal discharge & is confirmed to have Trichomonas infection. Treatment for her would include:
17. In addition to antimicrobial therapy, patients treated for Trichomonas infection should be educated regarding:
Chapter 45. Tuberculosis
1. Drug resistant tuberculosis (TB) is defined as TB that is resistant to:
2. Goals when treating tuberculosis include:
3. The principles of drug therapy for the treatment of tuberculosis include:
4. Isabella has confirmed tuberculosis & is placed on a 6-month treatment regimen. The 6-month regimen consists of:
5. Kaleb has extensively resistant tuberculosis (TB). Treatment for extensively resistant TB would include:
6. Lila is 24 weeks pregnant & has been diagnosed with tuberculosis (TB). Treatment regimens for a pregnant patient with TB would include:
7. Bilal is a 5-year-old patient who has been diagnosed with tuberculosis. His treatment would include:
8. Ezekiel is a 9-year-old patient who lives in a household with a family member newly diagnosed with tuberculosis (TB). To prevent Ezekiel from developing TB he should be treated with:
9. Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes:
10. Compliance with directly observed therapy can be increased by:
Chapter 46. Upper Respiratory Infections, Otitis Media, & Otitis Externa
1. Caleb is an adult with an upper respiratory infection (URI). Treatment for his URI would include:
2. Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include:
3. Patients who should be cautious about using decongestants for an upper respiratory infection (URI) include:
4. Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is:
5. Jacob has been diagnosed with sinusitis. He is the parent of a child in daycare. Treatment for sinusitis in an adult who has a child in daycare is:
6. The length of treatment for sinusitis in a low-risk patient should be:
7. Patient education for a patient who is prescribed antibiotics for sinusitis includes:
8. Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile & has not been treated with antibiotics recently. First-line treatment for his otitis media would include:
9. Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile & there is no change in her tympanic membrane examination. What would be the plan of care for her?
10. A child that may warrant “watchful waiting” instead of prescribing an antibiotic for acute otitis media includes patients who:
11. Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about:
12. First-line therapy for a patient with acute otitis externa (swimmer’s ear) & an intact tympanic membrane includes:
Chapter 47. Urinary Tract Infections
1. The treatment goals when treating urinary tract infection (UTI) include:
2. Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months & no drug allergies. An appropriate first-line antibiotic choice for her would be:
3. Jamie is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, & her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be:
4. Juanita is a 28-year-old pregnant woman at 38 weeks’ gestation who is diagnosed with a lower urinary tract infection (UTI). She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be:
5. Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection?
6. Nicole is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy & has no drug allergies. Appropriate initial therapy for her UTI would be:
7. Monitoring for a healthy, nonpregnant adult patient being treated for a urinary tract infection is:
8. Monitoring for a child who has had a urinary tract infection is:
9. Monitoring for a pregnant woman who has had a urinary tract infection is:
10. Along with an antibiotic prescription, lifestyle education for a nonpregnant adult female who has had a urinary tract infection includes:
11. Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be:
Chapter 48: Women as Patients
1. Prescribing for women during their childbearing years requires constant awareness of the possibility of:
2. Intimate partner violence is a serious public health problem. It should be screened for:
3. Because of their longer life expectancy, women are more likely than men to experience a disabling condition. Common conditions in older women that can produce disability include:
4. Gender differences between men & women in pharmacokinetics include:
5. Which of the following drug classes is associated with significant differences in metabolism based on gender?
6. Since 40% of bone accrual occurs during adolescence, building bone during this time is critical. Ways to improve bone accrual in adolescents include:
7. Hot flashes are often a concern during menopause. Which of the following may help in reducing them?
8. Factors common in women that can affect adherence to a treatment regimen include all of the following EXCEPT:
9. Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is:
10. Premenstrual dysphoric disorder (PMDD) occurs in a fairly small number of patients. Theories of the pathology behind PMDD that are supported in research include:
11. Treatment of PMDD that affects all or most of the symptoms includes:
12. Women are now the fastest growing population with HIV infection & AIDS. HIV-infected women:
13. Maternal-to-child transmission of HIV infection during pregnancy may be prevented by:
14. Erroneous information about LGBTQ individuals can lead to failure to give accurate advice to them as patients. Which of the following statements is true about lesbians:
15. Which of the following holds true for the pharmacokinetics of women?
16. The metabolism of drugs in women is primarily impacted by:
17. The interpretation of DEXA scores in the rare cases of adolescent osteoporosis in teens:
18. The timing of NSAIDS for best control of severe menstrual cramps includes:
19. Which of the following is true concerning lesbian health concerns?
Chapter 49. Men as Patients
1. The factor that has the greatest effect on males developing male sexual characteristics is:
2. When assessing a male for hypogonadism prior to prescribing testosterone replacement, serum testosterone levels are drawn:
3. Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men?
4. The goal of testosterone replacement therapy is:
5. While on testosterone replacement, hemoglobin & hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are:
6. Monitoring of an older male patient on testosterone replacement includes:
7. When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of:
8. Men who are prescribed phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction should be educated regarding the adverse effects of the drug which include:
9. Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include:
10. Monitoring of male patients who are using phosphodiesterase type 5 (PDE-5) inhibitors includes:
Chapter 50. Children as Patients
1. The Pediatric Research Equity Acts requires:
2. The Best Pharmaceuticals for Children Act:
3. The developmental variation in Phase I enzymes has what impact on pediatric prescribing?
4. Developmental variation in renal function has what impact on prescribing for infants & children?
5. Topical corticosteroids are prescribed cautiously in young children because:
6. Liza is breastfeeding her 2-month-old son & has an infection that requires an antibiotic. What drug factors influence the effect of the drug on the infant?
7. Drugs that are absolutely contraindicated in lactating women include:
8. Zia is a 4-month-old patient with otitis media. Education of his parents regarding administering oral antibiotics to an infant includes:
9. To increase adherence in pediatric patients a prescription medication should:
10. Janie is a 5-month-old breastfed infant with a fever. Treatment for her fever may include:
Chapter 51. Geriatric Patients
1. Principles of prescribing for older adults include:
2. Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?
3. Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen?
4. A medication review of an elderly person’s medications involves:
5. Steps to avoid polypharmacy include:
6. Robert is a 72-year-old patient who has hypertension & angina. He is at risk for common medication practices seen in the elderly including:
7. To improve positive outcomes when prescribing for the elderly the nurse practitioner should:
8. When an elderly diabetic patient is constipated the best treatment options include:
9. Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?
10. Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:
11. The GFRs for a 91-year-old woman who weighs 93 pounds & is 5’1″ with a serum creatinine of 1.1, & for a 202-pound, 25-year-old male who is 5’9″ with the same serum creatinine according to the Cockcroft Gault formula are:
12. In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?
13. All of the following statements about the Beer’s List are true except:
14. You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. Which of the following would you find to be decreased & the most common cause of these problems in older adults?
15. Which of the following is not consistent with the rules for geriatric prescribing:
Chapter 52. Pain Management: Acute & Chronic Pain
1. Different areas of the brain are involved in specific aspects of pain. The reticular & limbic systems in the brain influence the:
2. Patients need to be questioned about all pain sites because:
3. The chemicals that promote the spread of pain locally include:
4. Narcotics are exogenous opiates. They act by:
5. Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true?
6. Which of the following statements is true about acute pain?
7. One of the main drug classes used to treat acute pain is NSAIDs. They are used because:
8. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?
9. If interventions to resolve the cause of pain (e.g., rest, ice, compression, & elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?
10. The goal of treatment of acute pain is:
11. Which of the following statements is true about age & pain?
12. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to:
13. Pathological similarities & differences between acute pain & chronic pain include:
14. A treatment plan for management of chronic pain should include:
15. Chronic pain is a complex problem. Some specific strategies to deal with it include:
16. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?
17. The Pain Management Contract is appropriate for: