Exam 2-M4-6

Question 1

Nicotine replacement: indications, contra’s, and adverse effects

Answer 1

Ind: Gum: smokers 25+/day 4mg/hr; lozenge: if smoke within 30 min of waking; patch: cannot smoke while on patch; E-cigs not recommended;

Contra: pregnancy (C), post MI/CVA

AE: behavioral changes, agitation, depression, SI; patch-toxicity

Question 2

4. Clonidine has several off-label uses, including:
   a. Alcohol and nicotine withdrawal
   b. Post-herpetic neuralgia
   c. Both 1 and 2
   d. Neither 1 nor 2,

Answer 2

3 Both 1 and 2

Alpha2 adrengeripc agonist

Question 3

26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the
    following is NOT an effect of nicotine?
27. Vasodilation and decreased heart rate
28. Increased secretion of gastric acid and motility of the GI smooth muscle
29. Release of dopamine at the pleasure center
30. Stimulation of the locus coeruleus

Answer 3

1. Vasodilation and decreased heart rate

Question 4

27. Nicotine gum products are:
28. Chewed to release the nicotine and then swallowed for a systemic effect
29. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine
    release
30. Bound to exchange resins so the nicotine is only released during chewing
31. Approximately the same in nicotine content as smoking two cigarettes

Answer 4

3. Bound to exchange resins so the nicotine is only released during chewing

Question 5

Nicotine replacement therapy (NRT):
1. Is widely distributed in the body only when the gum products are used
2. Does not cross the placenta and so is safe for pregnant women
3. Delays healing of esophagitis and peptic ulcers
4. Has no drug interactions when a transdermal patch is used

Answer 5

3. Delays healing of esophagitis and peptic ulcers

Question 6

Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include:
1. The maximum time varenicline can be used is 12 weeks.
2. Nausea is a sign of varenicline toxicity and should be reported to the provider.
3. The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date.
4. Neuropsychiatric symptoms may occur.

Answer 6

4. Neuropsychiatric symptoms may occur.

Question 7

If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include:
1. Bupropion (Zyban) is started 1 to 2 weeks before the quit date.
2. Nicotine replacement products should not be used with bupropion.
3. If they smoke when taking bupropion they may have increased anxiety and insomnia.
4. Because they are not using bupropion as an antidepressant, they do not need to worry about increased suicide ideation when starting therapy.

Answer 7

1. Bupropion (Zyban) is started 1 to 2 weeks before the quit date.

Question 8

When a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include:
1. Inhale deeply with each dose to ensure deposition in the lungs.
2. The dose is one to two sprays in each nostril per hour, not to exceed 40 sprays per day.
3. If they have a sensation of “head rush” this indicates the medication is working
well.
4. Nicotine spray may be used for up to 12 continuous months.

Answer 8

2. The dose is one to two sprays in each nostril per hour, not to exceed 40 sprays per day.

Question 9

Transdermal nicotine replacement (the patch) is an effective choice in tobacco cessation because:
1.The patch provides a steady level of nicotine without reinforcing oral aspects of smoking.
2.There is the ability to “fine tune” the amount of nicotine that is delivered to the
patient at any one time.
3. There is less of a problem with nicotine toxicity than with other forms of nicotine replacement.
4. Transdermal nicotine is safer in pregnancy.

Answer 9

1.The patch provides a steady level of nicotine without reinforcing oral aspects of smoking.

Question 10

Instructions for the use of nicotine gum include:
1.Chew the gum quickly to get a peak effect.
2.The gum should be “parked” in the buccal space between chewing.
3.Acidic drinks such as coffee help with the absorption of the nicotine.
4.The highest abstinence rates occur if the patient chews the gum when he or she is having cravings.

Answer 10

2.The gum should be “parked” in the buccal space between chewing.

Question 11

Nicotine replacement therapy should not be used in which patients?
1.Pregnant women
2.Patients with worsening angina pectoris
3.Patients who have just suffered an acute myocardial infarction
4.All of the above

Answer 11

4.All of the above

Question 12

The most appropriate smoking cessation prescription for pregnant women is:
1. A nicotine replacement patch at the lowest dose available
2. Bupropion (Zyban)
3. Varenicline (Chantix)
4. Nonpharmacologic measures

Answer 12

4. Nonpharmacologic measures

Question 13

Drug resistant tuberculosis (TB) is defined as TB that is resistant to:
1.Fluoroquinolones
2.Rifampin and isoniazid
3.Amoxicillin
4.Ceftriaxone

Answer 13

2.Rifampin and isoniazid

Question 14

Goals when treating tuberculosis include:
1.Completion of recommended therapy
2.Negative purified protein derivative at the end of therapy
3.Completely normal chest x-ray
4.All of the above

Answer 14

1.Completion of recommended therapy

Question 15

The principles of drug therapy for the treatment of tuberculosis include:
1.Patients are treated with a drug to which M. tuberculosis is sensitive.
2.Drugs need to be taken on a regular basis for a sufficient amount of time.
3.Treatment continues until the patient’s purified protein derivative is negative.
4.All of the above

Answer 15

2.Drugs need to be taken on a regular basis for a sufficient amount of time.

Question 16

Kaleb has extensively resistant tuberculosis (TB). Treatment for extensively resistant TB wouldinclude:
1.INH, rifampin, pyrazinamide, and ethambutol for at least 12 months
2.INH, ethambutol, kanamycin, and rifampin
3.Treatment with at least two drugs to which the TB is susceptible
4.Levofloxacin

Answer 16

3.Treatment with at least two drugs to which the TB is susceptible

Question 17

Isabella has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month regimen consists of:
1.Two months of four-drug therapy (INH, rifampin, pyrazinamide, and ethambutol) followed by Four months of INH and rifampin
2.Six months of INH with daily pyridoxine throughout therapy
3.Six months of INH, rifampin, pyrazinamide, and ethambutol
4.Any of the above

Answer 17

1.Two months of four-drug therapy (INH, rifampin, pyrazinamide, and ethambutol) followed by Four months of INH and rifampin

Question 18

Lila is 24 weeks pregnant and has been diagnosed with tuberculosis (TB). Treatment regimens for a pregnant patient with TB would include:
1.Streptomycin
2.Levofloxacin
3.Kanamycin
4.Pyridoxine

Answer 18

4.Pyridoxine

Question 19

Bilal is a 5-year-old patient who has been diagnosed with tuberculosis. His treatment would include:
1.Pyridoxine
2.Ethambutol
3.Levofloxacin
4. Rifabutin

Answer 19

1.Pyridoxine

Question 20

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:
1. 6 months of Isoniazid (INH) and rifampin
2. 2 months of INH, rifampin, pyrazinamide, and ethambutol, followed by 4 months of INH
3. 9 months of INH
4. 12 months of INH

Answer 20

3. 9 months of INH

Question 21

Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes:
1. Monthly sputum cultures
2. Monthly chest x-ray
3. Bronchoscopy every 3 months
4. All of the above

Answer 21

1. Monthly sputum cultures

Question 22

Caleb is an adult with an upper respiratory infection (URI). Treatment for his URI would include:
1.Amoxicillin
2.Diphenhydramine
3.Phenylpropanolamine
4.Topical oxymetazoline

Answer 22

4.Topical oxymetazoline

Question 23

Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include:
1.Amoxicillin
2.Diphenhydramine
3.Pseudoephedrine
4.Nasal saline spray

Answer 23

4.Nasal saline spray

Question 24

Patients who should be cautious about using decongestants for an upper respiratory infection (URI)include:
1.School-age children
2.Patients with asthma
3.Patients with cardiac disease
4.Patients with allergies

Answer 24

3.Patients with cardiac disease

Question 25

Jaheem is a 10-year-old low-risk patient with sinusitis. Treatment for a child with sinusitis is:
1.Amoxicillin
2.Azithromycin
3.Cephalexin
4.Levofloxacin

Answer 25

1.Amoxicillin

Question 26

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:
1.Azithromycin 500 mg q day for 5 days
2.Amoxicillin-clavulanate 500 mg bid for 7 days
3.Ciprofloxacin 500 mg bid for 5 days
4.Cephalexin 500 mg qid for 5 days

Answer 26

2.Amoxicillin-clavulanate 500 mg bid for 7 days

Question 27

The length of treatment for sinusitis in a low-risk patient should be:
1.5–7 days
2.7–10 days
3.14–21 days
4.7 days beyond when symptoms cease

Answer 27

1.5–7 days

Question 28

Patient education for a patient who is prescribed antibiotics for sinusitis includes:
1.Use of nasal saline washes
2.Use of inhaled corticosteroids
3.Avoiding the use of ibuprofen while ill
4.Use of laxatives to treat constipation

Answer 28

1.Use of nasal saline washes

Question 29

Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include:
1. Azithromycin
2. Amoxicillin
3. Ceftriaxone
4. Trimethoprim/sulfamethoxazole

Answer 29

2. Amoxicillin

Question 30

Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for her?
1. Continue the amoxicillin for the full 10 days.
2. Change the antibiotic to azithromycin.
3. Change the antibiotic to amoxicillin/clavulanate.
4. Change the antibiotic to trimethoprim/sulfamethoxazole.

Answer 30

3. Change the antibiotic to amoxicillin/clavulanate.

Question 31

A child that may warrant “watchful waiting” instead of prescribing an antibiotic for acute otitis media includes patients who:
1. Are low risk with temperature of less than 39 or 102.2
2. Have reliable parents with transportation
3. Are older than age 2 years
4. All of the above

Answer 31

4. All of the above

Question 32

Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about:
1. Using decongestants to provide faster symptom relief
2. Providing adequate pain relief for at least the first 24 hours
3. Using complementary treatments for acute otitis media, such as garlic oil
4. Administering an antihistamine/decongestant combination (Dimetapp) so the child can sleep better

Answer 32

2. Providing adequate pain relief for at least the first 24 hours

Question 33

First-line therapy for a patient with acute otitis externa (swimmer’s ear) and an intact tympanic membrane includes:
1. Swim-Ear drops
2. Ciprofloxacin and hydrocortisone drops
3. Amoxicillin
4. Gentamicin ophthalmic drops

Answer 33

2. Ciprofloxacin and hydrocortisone drops

Question 34

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

Answer 34

3.Increased risk of asthma-related deaths when LTBAs are used

Question 35

Digoxin levels need to be monitored closely when the following medication is started:
1.Loratadine
2.Diphenhydramine
3.Ipratropium
4.Albuterol

Answer 35

4.Albuterol

Question 36

Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:
1. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day
2. Beclomethasone needs to be used every day to treat her asthma
3. Report any systemic side effects she is experiencing, such as weight gain
4. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation

Answer 36

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

Question 37

The bronchodilator of choice for patients taking propranolol is:
1.Albuterol
2.Pirbuterol
3.Formoterol
4.Ipratropium

Answer 37

4.Ipratropium

Question 38

Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all?
1.Betamethasone, an inhaled corticosteroid
2.Salmeterol, an inhaled long-acting beta-agonist
3.Albuterol, a short-acting beta-agonist
4.Montelukast, a leukotriene modifier

Answer 38

2.Salmeterol, an inhaled long-acting beta-agonist

Question 39

Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
1. Used for the treatment of chronic obstructive pulmonary disease (COPD)
2. Used in the treatment of asthma
3. Combined with albuterol for treatment of asthma exacerbations
4. Combined with fluticasone for the treatment of persistent asthma

Answer 39

1. Used for the treatment of chronic obstructive pulmonary disease (COPD)

Question 40

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

Answer 40

2. A 2-year-old child with moderate persistent asthma

Question 41

When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed:
1. Montelukast twice a day is started when there is an asthma exacerbation.
2. Patients may experience weight gain on montelukast.
3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
4. Lethargy and hypersomnia may occur when taking montelukast.

Answer 41

3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.

Question 42

The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include:
1. Albuterol
2. MMR vaccine
3. Insulin
4. None of the above

Answer 42

4. None of the above

Question 43

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

Answer 43

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

Question 44

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:
1. Urinary retention
2. Cardiac output
3. Peripheral edema
4. Skin rash

Answer 44

1. Urinary retention

Question 45

When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to:
1. Take the dimenhydrinate after they get nauseated
2. Drink lots of water while taking the dimenhydrinate
3. Take the dimenhydrinate 15 minutes before it is needed
4. Double the dose if one tablet is not effective

Answer 45

3. Take the dimenhydrinate 15 minutes before it is needed

Question 46

Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population:
1. Older adults
2. Hypertensive patients
3. Infants
4. All of the above

Answer 46

4. All of the above

Question 47

Decongestants such as pseudoephedrine (Sudafed):
1. Are Schedule III drugs in all states
2. Should not be prescribed or recommended for children under 4 years of age
3. Are effective in treating the congestion children experience with the common cold
4. May cause drowsiness in patients of all ages

Answer 47

2. Should not be prescribed or recommended for children under 4 years of age

Question 48

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:
1.Daily
2.Daily and limit physical activity
3.Less than twice a week
4.More than twice a week and less than once a day

Answer 48

4.More than twice a week and less than once a day

Question 49

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

Answer 49

3. Nasal oxymetazoline

Question 50

In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur:
1.At nighttime one to two times a month
2.At nighttime three to four times a month
3.Less than twice a week
4.Daily

Answer 50

2.At nighttime three to four times a month

Question 51

In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur:
1.At nighttime one to two times a month
2.At nighttime three to four times a month
3.Less than twice a week
4.Daily

Answer 51

2.At nighttime three to four times a month

Question 52

A stepwise approach to the pharmacologic management of asthma:
1.Begins with determining the severity of asthma and assessing asthma control
2.Is used when asthma is severe and requires daily steroids
3.Allows for each provider to determine their personal approach to the care of asthmatic patients
4.Provides a framework for the management of severe asthmatics, but is not as helpful when patients have intermittent asthma

Answer 52

1.Begins with determining the severity of asthma and assessing asthma control

Question 53

Treatment for mild intermittent asthma is:
1.Daily inhaled medium-dose corticosteroids
2.Short-acting beta-2-agonists (albuterol) as needed
3.Long-acting beta-2-agonists every morning as a preventative
4.Montelukast (Singulair) daily

Answer 53

2.Short-acting beta-2-agonists (albuterol) as needed

Question 54

The first-line therapy for mild-persistent asthma is:
1.High-dose montelukast
2.Theophylline
3.Low-dose inhaled corticosteroids
4.Long-acting beta-2-agonists

Answer 54

3.Low-dose inhaled corticosteroids

Question 55

Monitoring a patient with persistent asthma includes:
1.Monitoring how frequently the patient has an upper respiratory infection (URI) during treatment
2. Monthly in-office spirometry testing
3. Determining if the patient has increased use of his or her long-acting beta-2-agonist due to exacerbations
4. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

Answer 55

4. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

Question 56

Asthma exacerbations at home are managed by the patient by:
1. Increasing frequency of beta-2-agonists and contacting their provider
2. Doubling inhaled corticosteroid doses
3. Increasing frequency of beta-2-agonists
4. Starting montelukast (Singulair)

Answer 56

1. Increasing frequency of beta-2-agonists and contacting their provider

Question 57

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

Answer 57

2. With a history of requiring intubation or ICU admission for asthma

Question 58

Pregnant patients with asthma may safely use _______throughout their pregnancy.
1. Oral terbutaline
2. Prednisone
3. Inhaled corticosteroids (budesonide)
4. Montelukast (Singulair)

Answer 58

3. Inhaled corticosteroids (budesonide)

Question 59

Medications used in the management of patients with chronic obstructive pulmonary disease (COPD) include:
1. Inhaled beta-2-agonists
2. Inhaled anticholinergics (ipratropium)
3. Inhaled corticosteroids
4. All of the above

Answer 59

4. All of the above

Question 60

Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes:
1. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.
2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.
3. Increase fluid intake to 3 liters per day.
4. Avoid use of aspirin or ibuprofen while using inhaled medications

Answer 60

2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.

Question 61

The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be:
1.Ciprofloxacin
2.Azithromycin
3.Amoxicillin
4.Doxycyclin

Answer 61

2.Azithromycin

??

Question 62

The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia and can be treated as an outpatient would be:
1.Levofloxacin
2.Amoxicillin
3.Ciprofloxacin
4.Cephalexin

Answer 62

1.Levofloxacin
??

Question 63

The most common bacterial pathogen in community-acquired pneumonia is:
1.Haemophilus influenzae
2.Staphylococcus aureus
3.Mycoplasma pneumoniae
4.Streptococcus pneumoniae

Answer 63

4.Streptococcus pneumoniae

Question 64

If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:
1.IV or IM gentamicin
2.IV or IM ceftriaxone
3.IV amoxicillin
4.IV ciprofloxacin

Answer 64

2.IV or IM ceftriaxone

Question 65

Samantha is 34 weeks pregnant and has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe?
1.Levofloxacin
2.Azithromycin
3.Amoxicillin
4.Doxycycline

Answer 65

2.Azithromycin

Question 66

Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in:
1.12 to 24 hours
2.24 to 36 hours
3.48 to 72 hours
4.4 or 5 days

Answer 66

3.48 to 72 hours

Question 67

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%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia?
1. Ceftriaxone
2. Azithromycin
3. Cephalexin
4. Levofloxacin

Answer 67

1. Ceftriaxone

Question 68

Mycobacterium pneumonia: tx in children 5-adolesence. common in this age group

Answer 68

Azith: 10mg/kg Day1; and 5mg/kg days 2-5
Clarithromycin: 15mg/kg per day with bid dosing
Erythromycin: 40-50mg/kg/day

Question 69

When to admit a PNA pt?

Answer 69

CURB-65
Confusion
Uremia BUN>19
Respiratory rate >30
BP <90
65+ years

or PSI: gives more factors and is more complex.

BOTH tools have sites to calculate

Question 70

CAP: healthy adults, no risk factors

Answer 70

1. Macrolide (level 1 evidence): azimuth, clarithromycin, erythromycin;
   Doxycycline if allergic

Tx: min of 5 days

Question 71

CAP: adults w/ comorbids or risk of drug resistent S. Pneumonia

Answer 71

Fluoroquinolone: Moxiflox, gemiflox, or levoflox.

B-Lactam + macrolide (amoxicillin, augmenting, cefpodoxime, cefuroxime or IV ceftiaxone

Doxycycle can be used instead of macrolide

5-7 days

Question 72

Strep pneumoniae:
COMPS

Answer 72

Conjunctivitis
Otitis media
meningitis
pneumonia
sinusitis

Question 73

Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitoris determined to be needed. Prior to prescribing this drug, the NP should assess for:
1.Hypokalemia
2.Impotence
3.Decreased renal function
4.Inability to concentrate

Answer 73

3.Decreased renal function

Question 74

Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic patients because they:
1.Improve insulin sensitivity
2.Improve renal hemodynamics
3.Reduce the production of angiotensin II
4.All of the above

Answer 74

4.All of the above

Question 75

A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitorsis angioedema. Which of the following statements is true about this adverse response?
1.Swelling of the tongue or hoarseness are the most common symptoms.
2.It appears to be related to the decrease in aldosterone production.
3.Presence of a dry, hacky cough indicates a high risk for this adverse response.
4.Because it takes time to build up a blood level, it occurs after being on the drug forabout 1 week.

Answer 75

1.Swelling of the tongue or hoarseness are the most common symptoms.

Question 76

Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitoris determined to be needed. Prior to prescribing this drug, the NP should assess for:
1.Hypokalemia
2.Impotence
3.Decreased renal function
4.Inability to concentrate

Answer 76

3.Decreased renal function

Question 77

Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of thefollowing statements are true about both its usefulness in the disorder and the reason for its use?
1.Stable angina because it decreases the thickening of vascular walls due todecreased modified release.
2.Heart failure because it reduces remodeling of injured myocardial tissues.
3.Both 1 and 2 are true and the reasons are correct.
4.Both 1 and 2 are true but the reasons are wrong.
5.Neither 1 nor 2 are true.

Answer 77

4.Both 1 and 2 are true but the reasons are wrong.

Question 78

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:
1.Is stronger than the ACE inhibitor
2.Does not produce a dry, hacky cough
3.Has no effect on the renal system
4.Reduces sodium and water retention

Answer 78

2.Does not produce a dry, hacky cough

Question 79

The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response?
1. Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.
2. Amiodarone damages the thyroid gland and can result in inflammation of that
gland, causing hyperthyroidism.
3. Amiodarone is a broad-spectrum drug with many adverse effects. Many different tests need to be done before it is given.
4. Amiodarone can cause corneal deposits in up to 25% of patients.

Answer 79

1. Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.

Question 80

Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT:
1. Notify your healthcare provider immediately if you have a visual change.
2. Monitor your own blood pressure and pulse daily.
3. Take a hot shower or bath if you feel dizzy.
4. Use a sunscreen on exposed body surfaces.

Answer 80

3. Take a hot shower or bath if you feel dizzy.

Question 81

What dermatological issue is linked to Amiodarone use?
1. Increased risk of basal cell carcinoma
2. Flare up of any prior psoriasis problems
3. Development of plantar warts
4. Progressive change of skin tone toward a blue spectrum

Answer 81

4. Progressive change of skin tone toward a blue spectrum

Question 82

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:
1. Become a vegetarian because this disorder is associated with eating red meat.
2. Stop taking the drug if abdominal cramps and diarrhea develop.
3. Report muscle weakness or tenderness and dark urine to his provider immediately.
4. Expect “hot flash” sensations during the first 2 weeks of therapy.

Answer 82

3. Report muscle weakness or tenderness and dark urine to his provider immediately.

Question 83

Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?
1. Elevated serum transaminase
2. Increased serum creatinine
3. Elevated creatinine kinase
4. Increased white blood cell counts

Answer 83

4. Increased white blood cell counts

Question 84

Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following laboratory results should be monitored?
1. Serum alanine aminotransferase
2. Serum amylase
3. Serum creatinine
4. Phenylketonuria

Answer 84

3. Serum creatinine

Question 85

Dulcea has type 2 diabetes and 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?
1. Reactive airway disease/asthma
2. Inflammatory bowel disease
3. Allergy to aspirin
4. Gallbladder disease

Answer 85

4. Gallbladder disease`

Question 86

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 and the reason must both be correct for the answer to be correct.
1. Reductase inhibitors, due to an increased risk for rhabdomyolysis
2. Bile-acid sequestering resins, due to interference with folic acid absorption
3. Grapefruit juice, due to interference with metabolism
4. Niacin, due to decreased gemfibrozil activity

Answer 86

1. Reductase inhibitors, due to an increased risk for rhabdomyolysis

Question 87

Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug:
1. Blocks synthesis of cholesterol in the liver
2. Exchanges chloride ions for negatively charged acids in the bowel
3. Increases HDL levels the most among the classes
4. Blocks the lipoprotein lipase pathway

Answer 87

2. Exchanges chloride ions for negatively charged acids in the bowel

Question 88

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 88

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

Question 89

The choice of diuretic to use in treating hypertension is based on:
1. Presence of diabetes with loop diuretics being used for these patients
2. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range
3. Ethnicity with aldosterone antagonists best for African Americans and older adults
4. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL

Answer 89

2. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range

Question 90

Direct renin inhibitors have the following properties. They:
1. Are primarily generic drugs
2. Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during pregnancy
3. Can be used with an angiotensin-converting enzyme and angiotensin II receptor blocker medications for stronger impact
4. “Shut down” the entire RAAS cycle

Answer 90

4. “Shut down” the entire RAAS cycle

Question 91

When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?
1. Both have major issues with a dry, irritating cough
2. Both contribute to some retention of potassium
3. ARBs have a stronger impact on hypertension control than ACE medications
4. ARBs have stronger diabetes mellitus renal protection properties than ACE medications

Answer 91

2. Both contribute to some retention of potassium

Question 92

Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand(MOD) in the myocardium. Which of the following drugs help to correct this imbalance byincreasing MOS?
1.Calcium channel blockers
2.Beta blockers
3.Angiotensin-converting-enzyme (ACE) inhibitors
4.Aspirin

Answer 92

3.Angiotensin-converting-enzyme (ACE) inhibitors

Question 93

To reduce mortality, all patients with angina, regardless of class, should be on:
1.Aspirin 81 to 325 mg/d
2.Nitroglycerin sublingually for chest pain
3.ACE inhibitors or angiotensin receptor blockers
4.Digoxin

Answer 93

1.Aspirin 81 to 325 mg/d

Question 94

Beta blockers are especially helpful for patients with exertional angina who also have:
1. Arrhythmias
2. Hypothyroidism
3. Hyperlipidemia
4. Atherosclerosis

Answer 94

1. Arrhythmias

Question 95

Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:
1. Nitrates increase MOS and beta blockers increase MOD.
2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out.
3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease.
4. All of the above

Answer 95

2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out.

??

Question 96

Ranolazine is used in angina patients to:
1. Dilate plaque-filled arteries
2. Inhibit platelet aggregation
3. Restrict late sodium flow in the myocytes
4. Induce vasoconstriction in the periphery to open coronary vessels

Answer 96

3. Restrict late sodium flow in the myocytes

Question 97

When is aspirin (ASA) used in angina patients?
1. All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons.
2. ASA should only be used in men.
3. ASA has no role in angina, but is useful in MI prevention.
4. The impact of ASA is best at the time of an angina attack.

Answer 97

1. All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons.

Question 98

Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failurebecause they have more than one action to address the pathological changes in this disorder. Whichof 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, anduses 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 98

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

Question 99

Treatments for heart failure, including drug therapy, are based on the stages developed by theACC/AHA. Stage A patients are treated with:
1.Drugs for hypertension and hyperlipidemia, if they exist
2.Lifestyle management including diet, exercise, and smoking cessation only
3.Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart failureonly
4.No drugs are used in this early stage

Answer 99

1.Drugs for hypertension and hyperlipidemia, if they exist

Question 100

Class I recommendations for stage A heart failure include:
1.Aerobic exercise within tolerance levels to prevent the development of heart
failure
2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention
3. Beta blockers for all patients regardless of cardiac history
4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias

Answer 100

4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias

Question 101

Stage B patients should have beta blockers added to their heart failure treatment regimen when:
1. They have an ejection fraction less than 40%
2. They have had a recent MI
3. Both 1 and 2
4. Neither 1 nor 2

Answer 101

3. Both 1 and 2

Question 102

Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?
1. Diuretics reduce preload associated with fluid retention.
2. Diuretics can be used earlier than stage C when the goal is control of hypertension.
3. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism.
4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB).

Answer 102

4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB).

Question 103

Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with:
1. Ejection fractions above 40%
2. An audible S3
3. Mitral stenosis as a primary cause for heart failure
4. Renal insufficiency

Answer 103

2. An audible S3

Question 104

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 104

3. Calcium channel blockers

Question 105

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?
1. Diuretics
2. ARBs
3. Beta blockers
4. Nitrates

Answer 105

3. Beta blockers

Question 106

ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely?
1. Elderly patients with reduced renal clearance
2. Pregnant women
3. Women under age 30
4. 1 and 2

Answer 106

4. 1 and 2

Question 107

HF patients frequently take more than one drug. When are anticoagulants typically used?
1. When the patient enters stage III
2. Only in cases of diastolic failure
3. When there is concurrent A Fib
4. In all cases

Answer 107

3. When there is concurrent A Fib

Question 108

When considering which cholesterol-lowering drug to prescribe, which factor determines thetype and intensity of treatment?
1.Total LDL
2.Fasting HDL
3.Coronary artery disease risk level
4.Fasting total cholesterol

Answer 108

3.Coronary artery disease risk level

Question 109

First-line therapy for hyperlipidemia is:
1.Statins
2.Niacin
3.Lifestyle changes
4.Bile acid-binding resins

Answer 109

3.Lifestyle changes

Question 110

James is a 45-year-old patient with an LDL level of 120 and normal triglycerides.Appropriate first-line therapy for James may include diet counseling, increased physicalactivity, and:
1.A statin
2.Niacin
3.Sterols
4.A fibric acid derivative

Answer 110

3.Sterols

Question 111

Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL, and after 6 months, her LDL is slightly higher. The next step in her treatment would be:
1.A statin
2.Niacin
3.Sterols
4.A fibric acid derivative

Answer 111

1.A statin

Question 112

Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterolmargarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for herwould be:
1.A statin
2.Niacin
3.A fibric acid derivative
4.Determined by her risk factors

Answer 112

4.Determined by her risk factors

Question 113

Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for 3months to treat his high LDL level. His LDL is 135 mg/dL and his triglycerides are elevated. A
reasonable change in therapy would be to:
1. Discontinue the statin and change to a fibric acid derivative.
2. Discontinue the statin and change to ezetimibe.
3. Continue the statin and add in ezetimibe.
4. Refer him to a specialist in managing patients with recalcitrant hyperlipidemia.

Answer 113

3. Continue the statin and add in ezetimibe.

Question 114

Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman?
1. A statin
2. Niacin
3. Fibric acid derivative
4. Bile acid-binding resins

Answer 114

4. Bile acid-binding resins

Question 115

Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a:
1. Sterol
2. Niacin
3. Fibric acid derivative
4. Bile acid-binding resin

Answer 115

3. Fibric acid derivative

Question 116

Jose is a 12-year-old overweight child with a total cholesterol 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 6 months.
1. Statins
2. Niacin
3. Sterols
4. Bile acid-binding resins

Answer 116

3. Sterols

Question 117

Monitoring of a patient who is on a lipid-lowering drug includes:
1. Fasting total cholesterol every 6 months
2. Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in 6 weeks
3. Complete blood count, C-reactive protein, and erythrocyte sedimentation rate after 6 weeks of therapy
4. All of the above

Answer 117

2. Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in 6 weeks

Question 118

Before starting therapy with a statin, the following baseline laboratory values should be evaluated:
1. Complete blood count
2. Liver function (ALT/AST) and creatine kinase
3. C-reactive protein
4. All of the above

Answer 118

2. Liver function (ALT/AST) and creatine kinase

Question 119

When starting a patient on a statin, education would include:
1. If they stop the medication their lipid levels will return to pretreatment levels.
2. Medication is a supplement to diet therapy and exercise.
3. If they have any muscle aches or pain, they should contact their provider.
4. All of the above

Answer 119

4. All of the above

Question 120

Omega 3 fatty acids are best used to help treat:
1. High HDL
2. Low LDL
3. High triglycerides
4. Any high lipid value

Answer 120

3. High triglycerides

Question 121

Which the following persons should not have a statin medication ordered?
1. Someone with 3 first- or second-degree family members with history of muscle issues when started on statins
2. Someone with high lipids, but low BMI
3. Premenopausal woman with recent history of hysterectomy
4. Prediabetic male with known metabolic syndrome

Answer 121

1. Someone with 3 first- or second-degree family members with history of muscle issues when started on statins

Question 122

What is considered the order of statin strength from lowest effect to highest?
1. Lovastatin, Simvastatin, Rosuvastatin
2. Rosuvastatin, Lovastatin, Atorvastatin
3. Atorvastatin, Rosuvastatin, Simvastatin
4. Simvastatin, Atorvastatin, Lovastatin

Answer 122

1. Lovastatin, Simvastatin, Rosuvastatin

Question 123

Because primary hypertension has no identifiable cause, treatment is based on interfering with thephysiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension becausethey:
1.Increase renin secretion
2.Decrease the production of aldosterone
3.Deplete body sodium and reduce fluid volume
4.Decrease blood viscosity

Answer 123

3.Deplete body sodium and reduce fluid volume

Question 124

Because of its action on various body systems, the patient taking a thiazide or loop diuretic may alsoneed to receive the following supplement:
1.Potassium
2.Calcium
3.Magnesium
4.Phosphates

Answer 124

1.Potassium

Question 125

All patients with hypertension benefit from diuretic therapy, but those who benefit the most are:
1.Those with orthostatic hypertension
2.African Americans
3.Those with stable angina
4.Diabetics

Answer 125

2.African Americans

Question 126

Beta blockers treat hypertension because they:
1.Reduce peripheral resistance
2.Vasoconstrict coronary arteries
3.Reduce norepinephrine
4.Reduce angiotensin II production

Answer 126

1.Reduce peripheral resistance

Question 127

Which of the following disease processes could be made worse by taking a nonselectivebeta blocker?
1.Asthma
2.Diabetes
3.Both might worsen
4.Beta blockade does not affect these disorders

Answer 127

3.Both might worsen

Question 128

Disease states in addition to hypertension in which beta blockade is a compelling indication forthe use of beta blockers include:
1.Heart failure
2.Angina
3.Myocardial infarction
4.Dyslipidemia

Answer 128

3.Myocardial infarction

Question 129

Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they:
1.Reduce sodium and water retention
2.Decrease vasoconstriction
3. Increase vasodilation
4. All of the above

Answer 129

4. All of the above

Question 130

An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?
1. Beta blockers
2. Diuretics
3. nondihydropyridine calcium channel blockers
4. Angiotensin II receptor blockers

Answer 130

3. nondihydropyridine calcium channel blockers

Question 131

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?
1. ACE inhibitors
2. Beta blockers
3. Calcium channel blockers
4. Diuretics

Answer 131

4. Diuretics

Question 132

Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include:
1. Lifestyle changes are difficult to achieve and maintain.
2. Adverse drug reactions are common and often fall into the categories more
associated with nonadherence.
3. Costs of drugs and monitoring with laboratory tests can be expensive.
4. All of the above

Answer 132

4. All of the above

Question 133

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 133

3. The aldosterone inhibitors

Question 134

Aldactone family medications are frequently used when the hypertensive patient also has:
1. Hyperkalemia
2. Advancing liver dysfunction
3. The need for birth control
4. Rheumatoid arthritis

Answer 134

2. Advancing liver dysfunction

Question 135

Antihypertensive Agents to Avoid or Use Cautiously in Gout

Answer 135

Diuretics: thiazides and loops

Question 136

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?
1. Tinnitus
2. Diarrhea
3. Hearing loss
4. Photosensitivity

Answer 136

1. Tinnitus

Question 137

The safest drug to use to treat pregnant women who require anticoagulant therapy is:
1.Low-molecular-weight heparin
2.Warfarin
3.Aspirin
4.Heparin

Answer 137

1 low molecular wt heparin
Cat c
Per text book

Question 138

The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should beconsidered in which patients?
1.Pregnant women
2.Elderly men
3.Overweight or obese patients
4.Patients with multiple comorbidities

Answer 138

3.Overweight or obese patients

Question 139

Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic toreview 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:
1.Administer one dose of low-molecular weight heparin 24 hours before travel.
2.Prescribe one dose of warfarin to be taken the day of travel.
3.Consult with a hematologist regarding a treatment plan for Cecil.
4.Explain that Cecil is not at high risk of a blood clot and provide education abouthow to prevent blood clots while traveling.

Answer 139

4.Explain that Cecil is not at high risk of a blood clot and provide education abouthow to prevent blood clots while traveling.

Question 140

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

Answer 140

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

Question 141

Patients receiving heparin therapy require monitoring of:
1. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
2. Electrolytes for elevated potassium levels in the first 24 hours of therapy
3. INR throughout therapy to stay within the range of 2.0
4. Blood pressure for hypertension that may occur in the first 2 days of treatment

Answer 141

1. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy

Question 142

The routine monitoring recommended for low molecular weight heparin is:
1. INR every 2 days until stable, then weekly
2. aPTT every week while on therapy
3. Factor Xa levels if the patient is pregnant
4. White blood cell count every 2 weeks

Answer 142

3. Factor Xa levels if the patient is pregnant

Question 143

Patients who are being treated with epoetin alfa need to be monitored for the development of:
1. Thrombocytopenia
2. Neutropenia
3. Hypertension
4. Gout

Answer 143

1. Thrombocytopenia

Question 144

Monitoring for a patient being prescribed iron for iron deficiency anemia includes:
1. Reticulocyte count 1 week after therapy is started
2. Complete blood count every 2 weeks throughout therapy
3. Hemoglobin level at 1 week of therapy
4. INR weekly throughout therapy

Answer 144

1. Reticulocyte count 1 week after therapy is started

Question 145

Patient education regarding taking iron replacements includes:
1. Doubling the dose if they miss a dose to maintain therapeutic levels
2. Taking the iron with milk or crackers if it upsets their stomach
3. Iron is best taken on an empty stomach with juice
4. Antacids such as Tums may help the upset stomach caused by iron therapy

Answer 145

3. Iron is best taken on an empty stomach with juice

Question 146

The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:
1. Hematocrit levels start to rise
2. Hemoglobin levels return to normal
3. Reticulocyte count begins to rise
4. Vitamin B12 levels return to normal

Answer 146

2. Hemoglobin levels return to normal

Question 147

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

Answer 147

3. Leukopenia that occurs at 1 to 3 weeks of therapy

Question 148

Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL.Initial treatment for her anemia would be:
1.18 mg/day of iron supplementation
2.6 mg/kg per day of iron supplementation
3.325 mg ferrous sulfate per day
4.325 mg ferrous sulfate tid

Answer 148

4
325 mg ferrous sulfate tid

Question 149

Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemiawould be:
1.18 mg/day of iron supplementation
2.6 mg/kg per day of elemental iron
3.325 mg ferrous sulfate per day
4.325 mg ferrous sulfate tid

Answer 149

2.
6 mg/kg per day of elemental iron

Question 150

Monitoring for a patient taking iron to treat iron deficiency anemia is:
1.Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started
2.Complete blood count every 4 weeks throughout treatment
3.Annual complete blood count
4.Reticulocyte count in 4 weeks

Answer 150

1.Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started

Question 151

Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency
anemia is:
1. Oral folic acid 1 to 2 mg per day
2. Oral folic acid 1 gram per day
3. IM folate weekly for at least 6 months
4. Oral folic acid 400 mcg daily

Answer 151

1. Oral folic acid 1 to 2 mg per day

Question 152

Patients who are being treated for folate deficiency require monitoring of:
1. Complete blood count every 4 weeks
2. Hematocrit and hemoglobin at 1 week and then at 8 weeks
3. Reticulocyte count at 1 week
4. Folate levels every 4 weeks until hemoglobin stabilizes

Answer 152

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

Question 153

The treatment of vitamin B12 deficiency is:
1. 1,000 mcg daily of oral cobalamin
2. 2 gm per day of oral cobalamin
3. Vitamin B12 100 mcg/day IM
4. 500 mcg/dose nasal cyanocobalamin 2 sprays once a week

Answer 153

1. 1,000 mcg daily of oral cobalamin

Question 154

The dosage of Vitamin B12 to initially treat pernicious anemia is:
1. Nasal cyanocobalamin 1-gram spray in each nostril daily x 1 week then weekly x 1 month
2. Vitamin B12 IM monthly
3. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month
4. Oral cobalamin 1,000 mcg daily

Answer 154

3. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month

Question 155

Before beginning IM vitamin B12 therapy, which laboratory values should be obtained?
1. Reticulocyte count, hemoglobin, and hematocrit
2. Iron
3. Vitamin B12
4. All of the above

Answer 155

4. All of the above

Question 156

Anemia due to chronic renal failure is treated with:
1. Epoetin alfa (Epogen)
2. Ferrous sulfate
3. Vitamin B12
4. Hydroxyurea

Answer 156

1. Epoetin alfa (Epogen)

Question 157

Gerd-1st line treatment?

Answer 157

H2RA receptor antagonists or PPI’s
plus lifestyle mods, limit caffeine

Question 158

Proton-Pump Inhibitors (PPI)

Answer 158

Indications: PUD, GERD, Zollinger-Ellison syndrome

Agents: Omeprazole, (Prilosec) lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium), dexlansoprazole (Dexilant)

MOA: Reduce H+ secretion by inhibition of the H+/K+/adenosine triphosphatase (ATPase) enzyme system at the secretory surface of the parietal cell
Decrease in acid secretion lasts for up to 72 hours after each dose (inhibits gastric secretion)

Adverse Effects: Headache, diarrhea, constipation, abdominal pain, nausea, thrombocytopenia (1-5%), interstitial nephritis leading to CKD
Pregnancy category B or C
Children: omprazole, lansoprazole ok @ 1 year old, protonix not until 5+

Comments: Superior to H2RA for healing PUD/GERD

Slow onset; long duration of action

Administer 30 minutes prior to meal

No adjustment needed for renal dysfunction

Potential increased risk of Clostridium difficile

Several drug-drug interactions

**May increase risk for osteoporosis and hip fractures, kidney disease, increased risk of PNA

Blackbox: interactions with Plavix
Clinical dosing: Duodenal and gastric ulcers

PPIs are combined with antibiotics to treat H. pylori.

GERD Used for 8 weeks, then patient weaned off

May need to double dose for 4 weeks and then decrease dose for another 4 weeks

May mask the symptoms of gastric cancers

Weaning: Decrease from twice/day to once/day, then every other day, with an H2RA used for symptoms, then patient weaned off.
Monitor for neutrapenia, prolonged PT, Thrombocytopenia

Question 159

dyspepsia or mild GERD-Which drug first?

Answer 159

H2 receptor antagonist

Question 160

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

Answer 160

1. Iron deficiency anemia, vitamin B12 and calcium deficiency

Question 161

Gastroesophageal reflux disease may be aggravated by the following medication that affects loweresophageal sphincter (LES) tone:
1.Calcium carbonate
2.Estrogen
3.Furosemide
4.Metoclopramide

Answer 161

2.Estrogen

Question 162

Metoclopramide improves gastroesophageal reflux disease symptoms by:
1.Reducing acid secretion
2.Increasing gastric pH
3.Increasing lower esophageal tone
4.Decreasing lower esophageal tone

Answer 162

3.Increasing lower esophageal tone

Question 163

Antacids treat gastroesophageal reflux disease by:
1.Increasing lower esophageal tone
2.Increasing gastric pH
3.Inhibiting gastric acid secretion
4.Increasing serum calcium level

Answer 163

2.Increasing gastric pH

Question 164

When treating patients using the “Step-Down” approach the patient with gastroesophageal reflux disease is started on_______ first.
1.Antacids
2.Histamine2 receptor antagonists
3.Prokinetics
4.Proton pump inhibitors

Answer 164

4.Proton pump inhibitors

Question 165

If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treatingat home with OTC ranitidine daily, the appropriate treatment would be:
1.Prokinetic (metoclopramide) for 4 to 8 weeks
2.Proton pump inhibitor (omeprazole) for 12 weeks
3.Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks
4.Cytoprotective drug (misoprostol) for 2 weeks

Answer 165

2.Proton pump inhibitor (omeprazole) for 12 weeks

Question 166

If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is notimproving, the plan of care would be:
1.Prokinetic (metoclopramide) for 8 to 12 weeks
2. Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks
3. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks
4. Cytoprotective drug (misoprostol) for 4 to 8 weeks

Answer 166

2. Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks

Question 167

The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving is:
1. Add a prokinetic (metoclopramide)
2. Referral for endoscopy
3. Switch to another proton pump inhibitor
4. Add a cytoprotective drug

Answer 167

2. Referral for endoscopy