Exam 2

Question 1

When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?

a. both have major issues with a dry, irritating cough.
b. both contribute to some retention of potassium.
c. ARBs have a stronger impact on hypertension control than ACE inhibitors.
d. ARBs have stronger diabetes mellitus renal protection properties than ACE medications.

Answer 1

b. both contribute to some retention of potassium

Question 2

Blood pressure checks in children:
1.
Should occur with their annual physical examinations after 6 years of age
2.
Require a blood pressure cuff that is one-third the diameter of the child’s arm
3.
Should be done during every health-care visit after 3 years of age
4.
Require additional laboratory tests such as serum creatinine

Answer 2

3.
Should be done during every health-care visit after 3 years of age

Question 3

Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?
1.
Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently.
2.
Reduced formation of cross-bridges so that contractile force decreases.
3.
Activation of the sympathetic nervous system that increases heart rate and preload.
4.
Decreased renal blood flow that decreases oxygen supply to the kidneys.

Answer 3

3.
Activation of the sympathetic nervous system that increases heart rate and preload.

Question 4

Taking which drug with food maximizes its bioavailability?
1. Donepezil
2. Galantamine
3. Rivastigmine
4. Memantine

Answer 4

3. Rivastigmine

Question 5

Lifestyle modifications for patients with prehypertension or hypertension include:
1.
Diet and increase exercise to achieve a BMI greater than 25.
2.
Drink 4 ounces of red wine at least once per week.
3.
Adopt the dietary approaches to stop hypertension (DASH) diet.
4.
Increase potassium intake.

Answer 5

3.
Adopt the dietary approaches to stop hypertension (DASH) diet.

Question 6

Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:

a. started at about half the usual dosage.
b. not increased over the usual dosage for an adult.
c. given once daily because of memory issues in the older adult.
d. withheld if she experiences gastroesophageal reflux.

Answer 6

a. started at about half the usual dosage.

Question 7

Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:

1. Vasodilate the peripheral vasculature
2. Decrease cardiac output
3. Increase renal vascular resistance
4. Reduce atherosclerosis secondary to elevated serum lipoproteins

Answer 7

1. Vasodilate the peripheral vasculature

Question 8

Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true?
1.
Hypertension is a chronic disease where patients may be taking drugs for a long time.
2.
Most patients will require more than one drug to treat the hypertension.
3.
The cost includes the price of any routine or special laboratory tests that a specific drug may require.
4.
Few antihypertensive drugs come in generic formulations.

Answer 8

4.
Few antihypertensive drugs come in generic formulations.

Question 9

Which of the following classes of drugs is contraindicated in heart failure?
1.
Nitrates
2.
Long-acting dihydropyridines
3.
Calcium channel blockers
4.
Alpha-beta blockers

Answer 9

3.
Calcium channel blockers

Question 10

Which diuretic agents typically do not need potassium supplementation?
1.
The loop diuretics
2.
The thiazide diuretics
3.
The aldosterone inhibitors
4.
They all need supplementation

Answer 10

3.
The aldosterone inhibitors

Question 11

Laboratory monitoring for patients on angiotensin-converting enzyme ACE inhibitors or angiotensin II receptor blockers ARBs should include:

a. white blood cell counts with the drug dosage increased for elevations above 10,000.

b. liver function tests with the drug dosage stopped for alanine aminotransferase values twice that of normal

c. serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL.

d. serum glucose levels with the drug dosage increased for levels greater than 120 mg/dL.

Answer 11

c. serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL.

Question 12

Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?

1. These drugs are useful for immediate symptom relief when the patient is certain it is angina.
2. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away.
3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911.
4. All of the above

Answer 12

3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911.

Question 13

First-line therapy for hyperlipidemia is:

a. statins.
b. niacin.
c. lifestyle changes.
d. bile acid-binding resins.

Answer 13

c. lifestyle changes.

Question 14

Which hypertension medication is recommended as a first-line treatment in African Americans and older adult patients?
a. Beta blockers
b. Calcium channel blockers
c. ACE inhibitors
d. ACE II inhibitors

Answer 14

b. Calcium channel blockers

Question 15

Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be:

a. a statin.
b. niacin.
c. a fibric acid derivative.
d. determined by her risk factors.

Answer 15

d. determined by her risk factors.

Question 16

Which of the following adverse effects are less likely in a beta 1-selective blocker?

1. Dysrhythmias
2. Impaired insulin release
3. Reflex orthostatic changes
4. Decreased triglycerides and cholesterol

Answer 16

2. Impaired insulin release

Question 17

Because of their site of action, bile acid sequestering resins:
1.
Should be administered separately from other drugs by at least 4 hours
2.
May increase the risk for bleeding
3.
Both 1 and 2
4.
Neither 1 nor 2

Answer 17

1.
Should be administered separately from other drugs by at least 4 hours

Question 18

40. Which of these hypertension drugs has also been approved for the treatment of attention deficit hyperactivity disorder (ADHD)?
    1.
    Guanabenz
    2.
    Clonidine
    3.
    lisinopril
    4.
    Doxazosin

Answer 18

2.
Clonidine

Question 19

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:
1.
Symptoms markedly worsen or the patient becomes hypotensive and has syncope
2.
There is evidence of progressive renal insufficiency or failure
3.
The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic
4.
Any of the above

Answer 19

4.
Any of the above

Question 20

Digoxin is used as the classic medication to demonstrate loading dose methods to get a patient to therapeutic doses of a medication. When should a loading dose approach NOT be used for this medication?
1. When the patient is frail and elderly

2. When the HF symptoms are rapidly accelerating
3. When the renal status is stable
4. When the patient has never been on digoxin before

Answer 20

1. When the patient is frail and elderly

Question 21

A patient taking carbamazepine needs to be started on a direct factor Xa inhibitor for antithrombotic therapy. Which of the direct factor Xa inhibitors should be avoided due to drug interactions?

Answer 21

apixiban

Question 22

For patients taking warfarin, international normalized ratios (INRs) are best drawn:

Answer 22

In the morning if the patient takes their warfarin at night

Question 23

The dosage of vitamin B12 to initially treat pernicious anemia is

Answer 23

Vitamin B12 1,000mcg IM daily for one week then 1,000 mg IM weekly for a month

Question 24

When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:

A. 6 weeks if they are a cancer patient

B. 1 week if they have chronic renal failure

C. 2 weeks if they are taking it for allogenic transfusion

D Each week throughout therapy

Answer 24

A. 6 weeks if they are a cancer patient

Question 25

Patients who are beginning therapy with Vitamin B12 need to be monitored for: A. Hypertensive crisis that may occur in the first 36 hours B. Hypokalemia that occurs in the first 48 hours C. Leukopenia that occurs at 1 to 3 weeks of therapy D. Thrombocytopenia that may occur at any time in therapy

Answer 25

B. Hypokalemia that occurs in the first 48 hours

Question 26

Patients with pernicious anemia require treatment with: A. Iron B. Folic acid C. Epogen alpha D. Vitamin B12

Answer 26

D. Vitamin B12

Question 27

Patient education when prescribing clopidogrel includes: A. Do not take any herbal products without discussing with the provider B. Monitor urine output closely and contact the provider if it decreases C. Clopidogrel can be constipating, use a stool softener if needed D. The patient will need regular anticoagulant studies while on clopidogrel

Answer 27

A. Do not take any herbal products without discussing with the provider

Question 28

Patients who are being treated for folate deficiency require monitoring of

Answer 28

2.Hematocrit and hemoglobin at 1 week and then at 8 weeks

Question 29

Breastfed infants should receive iron supplementation of:

Answer 29

1mg/kg a day

Question 30

Patient education regarding taking iron replacements includes: a. doubling the dose if they miss a dose to maintain therapeutic levels. b. taking the iron with milk or crackers if it upsets their stomach. c. iron is best taken on an empty stomach with juice. d. antacids such as Tums may help the upset stomach caused by iron therapy.

Answer 30

c. iron is best taken on an empty stomach with juice.

Question 31

Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: A. May lead to toxicity if taken with aspirin B. Is contraindicated in children with flu-like illness C. Has antimicrobial effects against bacterial and viral entomopathogens D. All of the above

Answer 31

D. All of the above Toxicity with ASPRIN Not for kids with FLU-LIKE symptoms HAS ANTIMICROBIAL EFFECTS

Question 32

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 and water precautions as well as taking: Loperamide four times a day throughout the trip Bismuth subsalicylate with each meal and at bedtime A prescription for diphenoxylate with atropine to use if she gets diarrhea None of the above

Answer 32

Bismuth subsalicylate with each meal and at bedtime

Question 33

Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: Iron deficiency anemia, vitamin B12 and calcium deficiency Folate and magnesium deficiency Elevated uric acid levels leading to gout Hypokalemia and hypocalcemia

Answer 33

Iron deficiency anemia, vitamin B12 and calcium deficiency

Question 34

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: Megaloblastic anemia Osteoporosis Hypertension Strokes

Answer 34

Megaloblastic anemia

Question 35

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? Patients with kidney stones Pregnant patients Patients with heartburn Postmenopausal women

Answer 35

Patients with kidney stones

Question 36

What is the pharm approach to moderate GERD

Answer 36

Start with H2 inhibitors in addition with antacids for breakthrough GERD symptoms If symptoms are not controlled after 4 weeks and max dose of H2 inhibitors switch to a Proton Pump Inhibitor (PPI)

Question 37

What is the pharm approach to frequent GERD

Answer 37

Start with PPI should administer 30-60min prior to meal; may increase to BID dosing if needed

Question 38

Patients taking antacids should be educated regarding these drugs, including letting them know that: 1. They may cause constipation or diarrhea. 2. Many are high in sodium. 3. They should separate antacids from other medications by one hour. 4. All of the above

Answer 38

4. All of the above

Question 39

An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: 1. Electrolytes, including potassium and chloride 2. Bone mineral density for osteoporosis 3. Magnesium level 4. Liver function

Answer 39

1. Electrolytes, including potassium and chloride

Question 40

Which of the following medications places a patient at increased risk of developing chronic kidney disease? 1. Ranitidine 2. Omeprazole 3. Loperamide 4. Ondansetron

Answer 40

2. Omeprazole

Question 41

Jim presents with complaints of "heartburn" that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be:

Answer 41

Ranitidine (Zantac) twice a day

Question 42

If a patient with symptoms of GERD states they self-medicate with OTC Ranitidine daily the appropriate treatment would be

Answer 42

PPI omeprazole for 12 weeks

Question 43

Infants with reflux are initially treated with: Histamine2 receptor antagonist (ranitidine) Proton pump inhibitor (omeprazole) Anti-reflux maneuvers (elevate head of bed) Prokinetic (metoclopramide)

Answer 43

Anti-reflux maneuvers (elevate head of bed)

Question 44

Long-term use of proton pump inhibitors may lead to: Hip fractures in at-risk persons Vitamin B6 deficiency Liver cancer All of the above

Answer 44

Hip fractures in at-risk persons

Question 45

An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: Histamine2 receptor antagonists for 4 to 8 weeks Proton pump inhibitor bid for 12 weeks until healing is complete Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days Proton pump inhibitor bid and levofloxacin for 14 days

Answer 45

Proton pump inhibitor BID plus clarithromycin plus amoxicillin for 14 days

Question 46

If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is: Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days Test H. pylori for resistance to common treatment regimens Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days Proton pump inhibitor and levofloxacin for 14 days

Answer 46

Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days

Question 47

Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of: Antimicrobial resistance An ineffective antacid Overuse of proton pump inhibitors All of the above

Answer 47

Antimicrobial resistance

Question 48

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: Azithromycin 500 mg q day for 5 days Amoxicillin-clavulanate 500 mg bid for 7 days Ciprofloxacin 500 mg bid for 5 days Cephalexin 500 mg qid for 5 days

Answer 48

Amoxicillin-clavulanate 500 mg bid for 7 days

Question 49

Montelukast (Singulair) may be prescribed for: A 6-year-old child with exercise-induced asthma A 2-year-old child with moderate persistent asthma An 18-month-old child with seasonal allergic rhinitis None of the above; montelukast is not approved for use in children

Answer 49

A 2-year-old child with moderate persistent asthma

Question 50

When educating patients who are starting on inhaled corticosteroids, the provider should tell them that: They need to get any live vaccines before starting the medication. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids.

Answer 50

Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.

Question 51

Patients with allergic rhinitis may benefit from a prescription of: Fluticasone (Flonase) Cetirizine (Zyrtec) OTC cromolyn nasal spray (Nasalcrom) Any of the above

Answer 51

Any of the above

Question 52

Education of patients with COPD who use inhaled corticosteroids includes: Doubling the dose at the first sign of a URI Using their inhaled corticosteroid first and then their bronchodilator Rinsing their mouth after use Abstaining from smoking for at least 30 minutes after using

Answer 52

Rinsing their mouth after use

Question 53

Patients who are at risk of a fatal asthma attack include patients: With moderate persistent asthma With a history of requiring intubation or ICU admission for asthma Who are on daily inhaled corticosteroid therapy Who are pregnant

Answer 53

With a history of requiring intubation or ICU admission for asthma

Question 54

Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to: Reassure him this is probably a viral infection and should be better soon Have him seen the same day for an assessment and theophylline level Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better Order a theophylline level at the laboratory for him

Answer 54

Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better

Question 55

Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be: Oral pseudoephedrine Oral phenylephrine Nasal oxymetazoline Nasal azelastine

Answer 55

Nasal oxymetazoline

Question 56

Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug Administration due to the: Risk of life-threatening dermatological reactions Increased incidence of cardiac events when LTBAs are used Increased risk of asthma-related deaths when LTBAs are used Risk for life-threatening alterations in electrolytes

Answer 56

Increased risk of asthma-related deaths when LTBAs are used

Question 57

One goal of asthma management in children is: They independently manage their asthma Participation in school and sports activities No exacerbations Minimal use of inhaled corticosteroids

Answer 57

Participation in school and sports activities

Question 58

Androgens are indicated for: 1. Symptomatic treatment for male deficiency 2. Female libido, endometriosis, and postmenopausal symptoms treatment 3. Increased muscle mass in frail women 4. Symptomatic treatment in both sexes for cancer and human immunodeficiency virus (HIV)

Answer 58

1. Symptomatic treatment for male deficiency

Question 59

Obese women may have increased risk of failure with which contraceptive method? Combined oral contraceptives Progestin-only oral contraceptive pill Injectable progestin Combined topical patch

Answer 59

Combined topical patch

Question 60

"Menopause" is diagnosed when A. the patient has no menses for 12 months B. the patient has onset of vasomotor symptoms with irregular menses C. the patient has no bleeding cycle for 6 months D. precise laboratory values are documented

Answer 60

A. the patient has no menses for 12 months

Question 61

A 19-year-old female is a nasal Staph aureus carrier and is placed on five days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications? 1. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour. 2. Both medications are best tolerated if taken on an empty stomach. 3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack to avoid the low possibility of birth control pill (BCP) ineffectiveness. 4. If she gets nauseated with the medications she should call the office for an antiemetic prescription.

Answer 61

3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack to avoid the low possibility of birth control pill (BCP) ineffectiveness.

Question 62

Male patients require ______________________ before and during androgen therapy. 1. A digital prostate exam 2. A Doppler exam of testicular blood flow 3. Urine analysis for proteinuria 4. Serial orthostatic blood pressures

Answer 62

1. A digital prostate exam

Question 63

"Fertility drugs" linked with female infertility treatments can also be used for: 1. Male spermatogenesis issues 2. Lactation suppression 3. Pituitary tumor suppression 4. An abortifacient

Answer 63

1. Male spermatogenesis issues

Question 64

The medroxyprogesterone (Depo-Provera) injection has a black box warning due to: 1. The potential development of significant hypertension 2. Increased risk of strokes 3. Decreased bone density 4. The risk of a life-threatening rash such as Stevens-Johnson syndrome

Answer 64

3. Decreased bone density

Question 65

Shana received her first medroxyprogesterone (Depo-Provera) injection six weeks ago and calls the clinic, concerned that she has been having a light period off and on since receiving her Depo shot. What should the provider do? 1. Reassure her that some spotting is normal the first few months of Depo and it should improve. 2. Schedule an appointment for an exam as this is not normal. 3. Prescribe four weeks of estrogen to treat the abnormal vaginal bleeding. 4. Order a pregnancy test and suggest she use a back-up method of contraception

Answer 65

1. Reassure her that some spotting is normal the first few months of Depo and it should improve.

Question 66

The U.S. Food and Drug Administration warns that androgens may cause: 1. Peliosis hepatis 2. Orthostatic hypotension 3. Menstrual irregularities 4. Acne 1. Peliosis hepatis

Answer 66

1. Peliosis hepatis

Question 67

Monitoring for a patient who is using androgens includes evaluation of: 1. Complete blood count and C-reactive protein levels 2. Lipid levels and liver function tests 3. Serum potassium and magnesium levels 4. Urine protein and potassium levels

Answer 67

2. Lipid levels and liver function tests