nsg6005 Week 10 Assignment 2 final exam latest 2017

Week 10 Assignment 2
Final Exam

1. Question
:

The drug recommended as primary prevention of osteoporosis
in men over seventy years is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 2. Question
:

Alterations in drug metabolism among Asians may lead to:

Slower metabolism of antidepressants,
requiring lower doses

Faster metabolism of neuroleptics, requiring
higher doses

Altered metabolism of omeprazole, requiring
higher doses

Slower metabolism of alcohol, requiring higher
doses

Question 3. Question
:

Some research supports that testosterone replacement therapy
may be indicated in which of the following diagnoses in men?

Age-related decrease in cognitive functioning

Metabolic syndrome

Decreased muscle mass in aging men

All of the above

Question 4. Question
:

The chemicals that promote the spread of pain locally
include _________.

serotonin

norepinephrine

enkephalin

neurokinin A

Question 5. Question
:

The DEA:

ters manufacturers and prescribes
controlled substances

Regulates NP prescribing at the state level

Sanctions providers who prescribe drugs
off-label

Provides prescribers with a number they can
use for insurance billing

Question 6. Question
:

The trial period to determine effective anti-inflammatory
activity when starting a patient on aspirin for RA is _____.

forty-eight hours

four to six days

four weeks

two months

Question 7. Question
:

The route of excretion of a volatile drug will likely be:

The kidneys

The lungs

The bile and feces

The skin

Question 8. Question
:

Compelling indications for an ACE inhibitor as treatment for
hypertension based on clinical trials include:

Pregnancy

Renal parenchymal disease

Stable angina

Dyslipidemia

Question 9. Question
:

The American Diabetic Association has recommended which of
the following tests for ongoing management of diabetes?

Fasting blood glucose

Hemoglobin A1c

Thyroid function tests

Electrocardiograms

Question 10. Question
:

The angiotensin converting enzyme (ACE) inhibitor lisinopril
is a known teratogen. Teratogens cause Type ____ ADR.

A

B

C

D

Question 11. Question
:

The goals of therapy when prescribing HRT include reducing:

Cardiovascular risk

Risk of stroke or other thromboembolic event

Breast cancer risk

Vasomotor symptoms

Question 12. Question
:

Patients who have angina, regardless of class, who are also
diabetic should be on:

Nitrates

Beta blockers

ACE inhibitors

Calcium channel blockers

Question 13. Question
:

The New York Heart Association and 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 I

Class II

Class III

Class IV

Question 14. Question
:

Patients with allergic rhinitis may benefit from a
prescription of:

Fluticasone (Flonase)

Cetirizine (Zyrtec)

OTC cromolyn nasal spray (Nasalcrom)

Any of the above

Question 15. Question
:

Kyle has Crohn’s disease and has a documented folate
deficiency. Drug therapy for folate deficiency anemia is:

Oral folic acid 1 to 2 mg/day

Oral folic acid 1 gm/day

IM folate weekly for at least six months

Oral folic acid 400 mcg daily

Question 16. Question
:

The treatment for vitamin B12 deficiency is:

1,000 mcg daily of oral cobalamin

2 gm/day of oral cobalamin

100 mcg/day vitamin B12 IM

500 mcg/dose nasal cyanocobalamin two sprays
once a week

Question 17. Question
:

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:

Has a short half-life so that missing one dose
has limited effect

Requires several dosage titrations so that
missed doses can be replaced with lower doses to keep costs down

Has a tolerability profile with less of the
adverse effects that are considered “irritating,” such as nausea and dizziness

Must be taken no more than twice a day

Question 18. Question
:

Type II diabetes is a complex disorder involving:

Absence of insulin production by the beta
cells

A suboptimal response of insulin-sensitive
tissues in the liver

Increased levels of GLP in the postprandial
period

Too much fat uptake in the intestine

Question 19. Question
:

Metformin is a primary choice of drug to treat hyperglycemia
in type II diabetes because it:

Substitutes for insulin usually secreted by
the pancreas

Decreases glycogenolysis by the liver

Increases the release of insulin from beta
cells

Decreases peripheral glucose utilization

Question 20. Question
:

Gender differences between men and women in pharmacokinetics
include:

More rapid gastric emptying so that drugs
absorbed in the stomach have less exposure to absorption sites

Higher proportion of body fat so that
lipophilic drugs have relatively greater volumes of distribution

Increased levels of bile acids so that drugs
metabolized in the intestine have higher concentrations

Slower organ blood flow rates so that drugs
tend to take longer to be excreted

Question 21. Question
:

If not chosen as the first drug in hypertension treatment,
which drug class should be added as the second step because it will enhance the
effects of most other agents?

ACE inhibitors

Beta blockers

Calcium channel blockers

Diuretics

Question 22. Question
:

A nineteen-year-old male was started on risperidone.
Monitoring for risperidone includes observing for common side effects,
including:

Bradykinesia, akathisia, and agitation

Excessive weight gain

Hypertension

Potentially fatal agranulocytosis

Question 23. Question
:

Levetiracetam has known drug interactions with:

Oral contraceptives

Carbamazepine

Warfarin

Few, if any, drugs

Question 24. Question
:

When the total daily insulin dose is split and given twice
daily, which of the following rules may be followed?

Give two-thirds of the total dose in the
morning and one-third in the evening.

Give 0.3 units/kg of premixed 70/30 insulin,
with one-third in the morning and two-thirds in the evening.

Give 50% of an insulin glargine dose in the
morning and 50% in the evening.

Give long-acting insulin in the morning and
short-acting insulin at bedtime.

Question 25. Question
:

Which of the following factors may adversely affect a
patient’s adherence to a therapeutic drug regimen?

Complexity of the drug regimen

Patient’s perception of the potential adverse
effects of the drugs

Both A and B

Neither A nor B

Question 26. Question
:

The time required for the amount of drug in the body to
decrease by 50% is called:

Steady state

Half-life

Phase II metabolism

Reduced bioavailability time

Question 27. Question
:

Drugs that are absolutely contraindicated in lactating women
include:

Selective serotonin reuptake inhibitors

Antiepileptic drugs such as carbamazepine

Antineoplastic drugs such as methotrexate

All of the above

Question 28. Question
:

Tobie presents to clinic with moderate acne. He has been
using OTC benzoyl peroxide at home with minimal improvement. A topical
antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are
prescribed. Education of Tobie would include which one of the following
instructions?

He should see an improvement in his acne
within the first two weeks of treatment.

If there is no response in a week, he should
double the daily application of adapalene (Differin).

He may see an initial worsening of his acne
that will improve in six to eight weeks.

Adapalene may cause bleaching of clothing.

Question 29. Question
:

Martin is a sixty-year-old with hypertension. The first-line
decongestant to be prescribed would be:

Oral pseudoephedrine

Oral phenylephrine

Nasal oxymetazoline

Nasal azelastine

Question 30. Question
:

A woman who is pregnant and has hyperthyroidism is best
managed by a specialty team that will most likely treat her with:

Methimazole.

Propylthiouracil.

Radioactive iodine.

Nothing; treatment is best delayed until after
her pregnancy ends.

Question 31. Question
:

A twenty-four-year-old male received multiple fractures in a
motor vehicle accident that required significant amounts of opioid medication
to treat his pain. He is at risk for Type __ ADR when he no longer requires the
opioids.

A

C

E

G

Question 32. Question
:

Second-generation antihistamines such as loratadine
(Claritin) are prescribed for seasonal allergies because they:

Are more effective than first-generation
antihistamines

Are less sedating than first-generation
antihistamines

Are prescription products and, therefore, are
covered by insurance

Can be taken with CNS sedatives, such as
alcohol

Question 33. Question
:

Steady state is:

The point on the drug concentration curve when
absorption exceeds excretion

When the amount of drug in the body remains
constant

When the amount of drug in the body stays
below the minimum toxic concentration (MTC)

All of the above

Question 34. Question
:

Jayla is a nine-year-old who has been diagnosed with
migraines for almost two 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?

Prescribe amitriptyline (Elavil) daily, start
at a low dose and increase the dose slowly every two weeks until effective in
eliminating migraines.

Encourage her mother to give her Excedrin
Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache
to abort the headache.

Prescribe propranolol (Inderal) to be taken
daily for at least three months.

Explain that it is rare for a nine-year-old to
get migraines and that she needs an MRI to rule out a brain tumor.

Question 35. Question
:

Josie is a five-year-old who presents to the clinic with a
forty-eight-hour history of nausea, vomiting, and some diarrhea. She is unable
to keep fluids down, and her weight is 4 pounds less than her last recorded
weight. Besides intravenous (IV) fluids, her exam warrants the use of an
antinausea medication. Which of the following would be the appropriate drug to
order for Josie?

Prochlorperazine (Compazine)

Meclizine (Antivert)

Promethazine (Phenergan)

Ondansetron (Zofran)

Question 36. Question
:

Long-term use of PPIs may lead to:

Hip fractures in at-risk persons

Vitamin B6 deficiency

Liver cancer

All of the above

Question 37. Question
:

Many patients self-medicate with antacids. Which patients
should be counseled to not take calcium carbonate antacids without discussing
with their providers or a pharmacist first?

Patients with kidney stones

Pregnant patients

Patients with heartburn

IN Postmenopausal women

0
of 2.5

Question 38. Question
:

Beta blockers treat hypertension because they:

Reduce peripheral resistance.

Vasoconstrict coronary arteries.

Reduce norepinephrine.

Reduce angiotensin II production.

Question 39. Question
:

Precautions that should be taken when prescribing controlled
substances include:

Faxing the prescription for a Schedule II drug
directly to the pharmacy

Using tamper-proof papers for all
prescriptions written for controlled drugs

Keeping any presigned prescription pads in a
locked drawer in the clinic

Using only numbers to indicate the amount of
drug to be prescribed

Question 40. Question
:

The tricyclic antidepressants should be prescribed
cautiously in patients with:

Eczema

Asthma

Diabetes

Heart disease

Question 41. Question
:

An ACE inhibitor and what other class of drug may reduce proteinuria
in patients with diabetes better than either drug alone?

Beta blockers

Diuretics

Nondihydropyridine calcium channel blockers

Angiotensin II receptor blockers

Question 42. Question
:

Metoclopramide improves GERD symptoms by:

Reducing acid secretion

Increasing gastric pH

Increasing lower esophageal tone

Decreasing lower esophageal tone

Question 43. Question
:

Patient education regarding prescribed medication includes:

Instructions written at the high school
reading level

Discussion of expected ADRs

How to store leftover medication such as
antibiotics

Verbal instructions always in English

Question 44. Question
:

If a patient with H. pylori positive PUD fails first-line
therapy, the second-line treatment is:

A PPI BID plus metronidazole plus tetracycline
plus bismuth subsalicylate for fourteen days

Testing H. pylori for resistance to common
treatment regimens

A PPI plus clarithromycin plus amoxicillin for
fourteen days

A PPI and levofloxacin for fourteen days

Question 45. Question
:

A patient with a COPD exacerbation may require:

Doubling of inhaled corticosteroid dose

Systemic corticosteroid burst

Continuous inhaled beta 2 agonists

Leukotriene therapy

Question 46. Question
:

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?

She is ; black women do not have much risk of
developing osteoporosis due to their dark skin.

Black women are at risk of developing
osteoporosis due to their lower calcium intake as a group.

If she doesn’t drink alcohol, her risk of
developing osteoporosis is low.

If she has not lost more than 10% of her
weight lately, her risk is low.

Question 47. Question
:

The role of the nurse practitioner in the use of herbal
medication is to:

Maintain competence in the prescribing of
common herbal remedies.

Recommend common OTC herbs to patients.

Educate patients and guide them to appropriate
sources of care.

Encourage patients to not use herbal therapy
due to the documented dangers.

Question 48. Question
:

Ray has been diagnosed with hypertension, and an ACE
inhibitor is determined to be needed. Prior to prescribing this drug, the nurse
practitioner should assess for:

Hypokalemia

Impotence

Decreased renal function

Inability to concentrate

Question 49. Question
:

Long-acting beta-agonists received a black box warning from
the US Food and Drug Administration due to the:

Risk of life-threatening dermatological
reactions

Increased incidence of cardiac events when
long-acting beta-agonists are used

Increased risk of asthma-related deaths when
long-acting beta-agonists are used

Risk for life-threatening alterations in
electrolytes

Question 50. Question
:

Off-Label prescribing is:

Regulated by the FDA

Illegal by NPs in all states (provinces)

Legal if there is scientific evidence for the
use

Regulated by the DEA

Question 51. Question
:

Adam has type I diabetes and plays tennis for his
university. He exhibits knowledge deficit about his insulin and his diagnosis.
He should be taught that:

He should increase his increase his
carbohydrate intake during times of exercise intake during times of exercise.

Each brand of insulin is equal in
bioavailability, so buy the least expensive.

Alcohol produces hypoglycemia and can help
control his diabetes when taken in small amounts.

If he does not want to learn to give himself
injections, he may substitute an oral hypoglycemic to control his diabetes.

Question 52. Question
:

Prior to starting antidepressants, patients should have
laboratory testing to rule out:

IN Hypothyroidism

Anemia

Diabetes mellitus

Low estrogen levels

0
of 2.5

Question 53. Question
:

What impact does developmental variation in renal function
has on prescribing for infants and children?

Lower doses of renally excreted drugs may be
prescribed to infants younger than six months

Higher doses of water-soluble drugs may need
to be prescribed due to increased renal excretion

Renal excretion rates have no impact on
prescribing

Parents need to be instructed on whether drugs
are renally excreted or not

Question 54. Question
:

All diabetic patients with hyperlipidemia should be treated
with:

3-hydroxy-3-methylglutaryl coenzyme A
(HMG-CoA) reductase inhibitors

Fibric acid derivatives

Nicotinic acid

Colestipol

Question 55. Question
:

Treatment failure in patients with PUD associated with H.
pylori may be due to:

Antimicrobial resistance

Ineffective antacid

Overuse of PPIs

All of the above

Question 56. Question
:

To improve positive outcomes when prescribing for the
elderly, the NP should:

Assess cognitive functioning in the elder

Encourage the patient to take a weekly “drug
holiday” to keep drug costs down

Encourage the patient to cut drugs in half
with a knife to lower costs

All of the above options are

Question 57. Question
:

Erik presents with a golden-crusted lesion at the site of an
insect bite consistent with impetigo. His parents have limited finances and
request the least expensive treatment. Which medication would be the best
choice for treatment?

Mupirocin (Bactroban)

Bacitracin and polymixin B (generic double
antibiotic ointment)

Retapamulin (Altabax)

Oral cephalexin (Keflex)

Question 58. Question
:

Nonselective beta blockers and alcohol create serious drug
interactions with insulin because they:

Increase blood glucose levels.

Produce unexplained diaphoresis.

Interfere with the ability of the body to
metabolize glucose.

Mask the signs and symptoms of altered glucose
levels.

Question 59. Question
:

Infants and young children are at higher risk of ADRs due
to:

Immature renal function in school-age children

Lack of safety and efficacy studies in the
pediatric population

Children’s skin being thicker than adults,
requiring higher dosages of topical medication

Infant boys having a higher proportion of
muscle mass, leading to a higher volume of distribution

Question 60. Question
:

Warfarin resistance may be seen in patients with VCORC1
mutation, leading to:

Toxic levels of warfarin building up

Decreased response to warfarin

Increased risk for significant drug
interactions with warfarin

Less risk of drug interactions with warfarin

Question 61. Question
:

Jose is a twelve-year-old overweight child with a total cholesterol
level of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and
recommending increased physical activity, a treatment plan for Jose would
include ____ with a reevaluation in six months.

statins

niacin

sterols

bile acid-binding resins

Question 62. Question
:

A potentially life-threatening adverse response to ACE
inhibitors is angioedema. Which of the following statements is true about this
adverse response?

Swelling of the tongue and hoarseness are the
most common symptoms.

It appears to be related to a decrease in
aldosterone production.

The presence of a dry, hacky cough indicates a
high risk for this adverse response.

Because it takes time to build up a blood
level, it occurs after being on the drug for about one week.

Question 63. Question
:

Amber is a twenty-four-year-old who has had migraines for
ten 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 which of the following?

Naratriptan will interact with
antidepressants, including selective serotonin reuptake inhibitors and St
John’s Wort, and she should inform any providers she sees that she has
migraines.

Continue to monitor her headaches; if the
migraine is consistently happening around her menses, then there is preventive
therapy available.

Pregnancy is contraindicated when taking a
triptan.

All the given options are .

Question 64. Question
:

One of the main drug classes used to treat acute pain is
NSAIDs. They are used due to which of the following reasons?

They have less risk for liver damage than
acetaminophen.

Inflammation is a common cause of acute pain.

They have minimal GI irritation.

Regulation of blood flow to the kidney is not
affected by these drugs.

Question 65. Question
:

A patient has been prescribed silver sulfadiazine
(Silvadene) cream to treat burns on his or her leg. Normal adverse effects of
silver sulfadiazine cream include:

Transient leukopenia on days two to four that
should resolve

Worsening of burn symptoms briefly before
resolution

A red, scaly rash that will resolve with
continued use

Hypercalcemia

Question 66. Question
:

Sulfonylureas may be added to a treatment regimen for type
II diabetics when lifestyle modifications and metformin are insufficient to
achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy
because they:

Increase endogenous insulin secretion.

Have a significant risk for hypoglycemia.

Address the insulin resistance found in type
II diabetics.

Improve insulin binding to receptors.

Question 67. Question
:

Narcotics are exogenous opiates. They act by ______.

inhibiting pain transmission in the spinal
cord

attaching to receptors in the afferent neuron
to inhibit the release of substance P

blocking neurotransmitters in the midbrain

increasing beta-lipoprotein excretion from the
pituitary

Question 68. Question
:

Patients who are on or who will be starting chronic
corticosteroid therapy need monitoring of __________.

serum glucose

stool culture

folate levels

vitamin B12

Question 69. Question
:

Henry presents to clinic with a significantly swollen,
painful great toe and is diagnosed with gout. Of the following, which would be
the best treatment for Henry?

High-dose colchicines

Low-dose colchicines

High-dose aspirin

Acetaminophen with codeine

Question 70. Question
:

Jaycee has been on escitalopram (Lexapro) for a year and is
willing to try tapering off of the selective-serotonin reuptake inhibitors.
What is the initial dosage adjustment when starting a taper off
antidepressants?

Change the dose to every other day dosing for
a week.

Reduce the dose by 50% for three to four days.

Reduce the dose by 50% every other day.

Escitalopram (Lexapro) can be stopped abruptly
due to its long half-life.

Question 71. Question
:

Christy has exercise and mild persistent asthma and is
prescribed two puffs of albuterol fifteen minutes before exercise and as needed
for wheezing. One puff per day of beclomethasone (Qvar) is also prescribed.
Teaching regarding her inhalers includes which one of the following?

She should use one to two puffs of albuterol
per day to prevent an attack, with no more than eight puffs per day.

Beclomethasone needs to be used every day to
treat her asthma.

She should report any systemic side effects
she is experiencing, such as weight gain.

She should use the albuterol MDI immediately
after her corticosteroid MDI to facilitate bronchodilation.

Question 72. Question
:

Asthma exacerbations at home are managed by the patient by:

Increasing the frequency of beta 2 agonists
and contacting his or her provider

Doubling inhaled corticosteroid dose

Increasing the frequency of beta 2 agonists

Starting montelukast (Singulair)

Question 73. Question
:

A woman with an intact uterus should not be prescribed:

Estrogen/progesterone combination

Intramuscular (IM) medroxyprogesterone (Depo
Provera)

Estrogen alone

Androgens

Question 74. Question
:

The drug recommended as primary prevention of osteoporosis
in women over seventy years old is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 75. Question
:

Patient education when prescribing the vitamin D3 derivative
calcipotriene for psoriasis includes:

Applying calcipotriene thickly to affected
psoriatic areas two to three times a day

Applying a maximum of 100 grams of
calcipotriene per week

Not using calcipotriene in combination with
its topical corticosteroids

Augmenting calcipotriene with the use of
coal-tar products

Question 76. Question
:

Both ACE inhibitors and some angiotensin-II receptor
blockers have been approved in treating:

Hypertension in diabetic patients

Diabetic nephropathy

Both A and B

Neither A nor B

Question 77. Question
:

Scott is presenting for follow-up on his lipid panel. He had
elevated total cholesterol, elevated triglycerides, and an LDL of 122 mg/dL. He
has already implemented diet changes and increased physical activity. He has
mildly elevated liver studies. An appropriate next step for therapy would be:

Atorvastatin (Lipitor)

Niacin (Niaspan)

Simvastatin and ezetimibe (Vytorin)

Gemfibrozil (Lopid)

Question 78. Question
:

Hypoglycemia can result from the action of either insulin or
an oral hypoglycemic. Signs and symptoms of hypoglycemia include:

“Fruity” breath odor and rapid respiration

Diarrhea, abdominal pain, weight loss, and
hypertension

Dizziness, confusion, diaphoresis, and
tachycardia

Easy bruising, palpitations, cardiac
dysrhythmias, and coma

Question 79. Question
:

Incorporating IT into a patient encounter takes skill and
tact. During the encounter, the provider can make the patient more comfortable
with the IT the provider is using by:

Turning the screen around so the patient can
see material being recorded

Not placing the computer screen between the
provider and the patient

Both A and B

Neither A nor B

Question 80. Question
:

Which one of the below-given instructions can be followed
for applying a topical antibiotic or antiviral ointment?

Apply thickly to the infected area, spreading
the medication well past the borders of the infection

If the rash worsens, apply a thicker layer of
medication to settle down the infection

Wash hands before and after application of
topical antimicrobials

None of the above

Question 81. Question
:

Sadie is a ninety-year-old patient who requires a new
prescription. What changes in drug distribution with aging would influence prescribing
for Sadie?

Increased volume of distribution

Decreased lipid solubility

Decreased plasma proteins

Increased muscle-to-fat ratio

Question 82. Question
:

First-line therapy for treating topical fungal infections
such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

OTC topical azole (clotrimazole, miconazole)

Oral terbinafine

Oral griseofulvin microsize

Nystatin cream or ointment

Question 83. Question
:

Which of the following is true about procainamide and its
dosing schedule?

It produces bradycardia and should be used
cautiously in patients with cardiac conditions that a slower heart rate might
worsen.

GI adverse effects are common, so the drug
should be taken with food.

Adherence can be improved by using a
sustained-release formulation that can be given once daily.

Doses of this drug should be taken evenly
spaced around the clock to keep an even blood level.

Question 84. Question
:

A nurse practitioner would prescribe the liquid form o

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