Exam 5 Review Flashcards
1
Q
The ultimate goals of treatment for rheumatoid arthritis include all of the following except:
A. delay disease progression
B. maintain joint function
C. relieve symptoms
D. reverse disease progression
A
D. reverse disease progression
Ch. 59 video
2
Q
What is the best course of action when treating RA at diagnosis?
A. Start an NSAID and after pt has some relief start a DMARD
B. Start an NSAID or glucocorticoid for quick relief and start a DMARD at the same time
C. Start with an NSAID or glucocorticoid alone to determine effectiveness
D. Start with non-pharmacologic measures, such as heat or cold therapy and PT before starting any medication
A
B. Start an NSAID or glucocorticoid for quick relief and start a DMARD at the same time
Ch. 59 video
3
Q
Which of the following is a targeted DMARD?
A. Humira
B. Methotrexate
C. Xeljanz
D. Arava
A
C. Xeljanz
Ch. 59 video
4
Q
Which of the following are true about methotrexate? Select all that apply:
A. Folate antagonist
B. Folate agonist
C. May be used in pregnancy during 3rd trimester
D. Should never be used in pregnancy
A
A. Folate antagonist
D. Should never be used in pregnancy
Ch. 59 video
5
Q
Which of the following is true regarding hydroxychloroquine? Select all that apply:
A. originally developed as an antimalarial drug
B. half life is about 40 days
C. can cause retinal damage
D. works quicker than other DMARDs
A
A. originally developed as an antimalarial drug
B. half life is about 40 days
C. can cause retinal damage
Ch. 59 video
6
Q
With biologic DMARDs, which of the following are necessary teaching and monitoring parameters? Select all that apply:
A. potential for infection
B. monitor rbc’s
C. take inactivated vaccines (not live vaccines)
D. high risk for retinal damage
A
A. potential for infection
C. take inactivated vaccines (not live vaccines)
Ch. 59 video
7
Q
Which of the following is true regarding arava?
A. safer than methotrexate
B. has a half life of about 40 days
C. higher risk of liver damage than methotrexate
D. used more frequently than methotrexate
A
C. higher risk of liver damage than methotrexate
Ch. 59 video
8
Q
Which of the following are janus kinase (JAK) inhibitors? A. targeted DMARDs B. biologic DMARDs C. conventional DMARDs C. traditional DMARDs
A
A. targeted DMARDs
Ch. 59 video
9
Q
Which of the following are true? Select all that apply:
A. if pain localized to specific joints, consider prescribing intraarticular steroids to give some relief locally
B. If you are treating generalized symptoms in an RA patient, consider prescribing a systemic med
C. Start DMARD at time of diagnosis
D. DMARDs give quick relief
A
A. if pain localized to specific joints, consider prescribing intraarticular steroids to give some relief locally
B. If you are treating generalized symptoms in an RA patient, consider prescribing a systemic med
C. Start DMARD at time of diagnosis
Ch. 59 video
10
Q
Which of the following is true regarding methotrexate and folate?
A. folic acid competes with receptors at the cellular level for methotrexate
B. folic acid moves into the cells on a more passive level so it doesn’t compete
C. folic acid supplementation is not always necessary when taking methotrexate
D. folic acid supplementation is necessary in patients on methotrexate
A
B. folic acid moves into the cells on a more passive level so it doesn’t compete
D. folic acid supplementation is necessary in patients on methotrexate
Ch. 59 video
11
Q
Question: Which of the following is the only human insulin analog with effects lasting up to 42 hours? A) insulin degludec (Triseba) B) insulin glargine (U-300) C) insulin detemir (levemir) D) insulin glargine (U-100)
A
Answer: A -insulin degludec (Triseba)
Reasoning p 404 insulin glargine (U-300): analog insulin lasting over 24 hours insulin detemir (levemir): analog insulin lasting 12-24 hours (depending on dose) insulin glargine (U-100): analog insulin lasting up to 24 hours
12
Q
Question: Which of the following is a short duration: short acting insulin
A) Insulin glulisine (Aprida)
B) Regular insulin (Humalin R, Novolin R)
C) Insulin lispro (Humalog)
D) insulin gluisine (Apidra)
A
Answer: B-Regular insulin (Humalin R, Novolin R)
Reasoning: the rest are short duration: rapid acting p402-403
13
Q
Question: It is very important to teach a patient with diabetes about hypoglycemia. Which one of the following is NOT a cause of hypoglycemia?
A) excessive alcohol intake
B) vomiting or diarrhea
C) unusually intense exercise
D) increase in fluid intake
A
Answer: D-increase in fluid intake
Reasoning: increase in fluid intake is not a cause of hypoglycemia p. 406
14
Q
Question: It is important to educate patients with diabetes to tell their family members or friends about hypoglycemia in case they are not able to recognize or treat it themselves. Which of the following are signs that you would have your patient tell their loved ones to watch out for? (select all that apply)
A) sweating
B) nervousness
C) confusion
D) drowsiness
A
Answer: A, B, C, D
Reasoning. P. 406
15
Q
Question: Some drugs increase blood sugar and should be used with caution in patients with diabetes. Which of the following drugs increase blood sugar (select all that apply)
A) alcohol
B) glucocorticoids
C) thiazide diuretics
D) B-blockers
A
Answer: B- glucocorticoids
and C - thiazide diuretics
Reasoning Alcohol causes hypoglycemia and B-blockers mask symptoms of hypoglycemia
16
Q
When do patients start seeing effects of Insulin lispro (Humalog) and how long do these effects last?
A) 1-2 minutes; 1-2 hours
B) 15-30 minutes; 3-6 hours
C) 10-20 minutes; 3-5 hours
D) 10-15 minutes; 3-5 hours
A
Answer: B- 15-30 minutes; 3-6 hours
Reasoning: p. 402
17
Q
Question When do patients start seeing effects of Insulin aspart (Novolog) and how long do these effects last? A) 1-2 minutes; 1-2 hours B) 15-30 minutes; 3-6 hours C) 10-20 minutes; 3-5 hours D) 10-15 minutes; 3-5 hours
A
Answer: C 10-20 minutes; 3-5 hours
Reasoning p402
18
Q
Question: When do patients start seeing effects of Regular insulin (Humulin R, Novolin R) and how long do these effects last?
A) 30-60 min; up to 10 hours
B) 15-30 minutes; 3-6 hours
C) 10-20 minutes; 3-5 hours
D) 4-6 hours; 24 hours
A
Answer: A - 30-60 min; up to 10 hours
Reasoning p. 403
19
Q
Question: How often should an A1c be monitored?
A) every year
B) every 3 months
C) every 2 weeks
D) monthly
A
Answer: B - every 3 months
Reasoning: p 400
20
Q
Question: What is the first step to treating diabetes?
A) lifestyle changes
B) insulin
C) metformin + thiazolidinedione
D) metformin + lifestyle changes
A
Answer: D - metformin + lifestyle changes
Reasoning p 400
21
Q
Maternal hypothyroidism can result in permanent neuropsychological deficits in the child in the
A. First Trimester
B. Second Trimester
C. Third Trimester
D. Fourth Trimester
A
Answer: A. First Trimester
Reasoning: Module audio clips ch 49
22
Q
When women taking thyroid supplements become pregnant, dosage requirements usually
A. Decrease
B. Don’t change
C. Increase
D. Thyroid supplements are stopped during pregnancy
A
C. Increase
ch. 49
23
Q
In all children born with hypothyroidism treatment is
A. Started 3-4 weeks after birth and continued for 3 years
B. Best if started within a few days after birth and continued for 3 years
C. Initiated at birth and continued for 5 years
D. Never started
A
Answer: B Best if started within a few days after birth and continued for 3 years
Reasoning: Hypothyroidism in newborns can be transient or permanent. If treatment is initiated within a few days mental development will be normal. If treatment is delayed beyond 3-4 weeks some permanent disability may be evident. Treatment lasts for 3 years, then stopped for 4 weeks. If TSH rises this indicates thyroid hormone levels are low=permanent. If TSH and T4 normalize =transient
ch 49
24
Q
Hypothyroidism occurs
A. Only in adults and due to genetic factors
B. In all ages and due to genetic factors
C. In all ages and can be due to certain medications, autoimmune disease, insufficient iodine,
D. In all ages and due to surgical removal of thyroid, destruction of thyroid by radioactive iodine
E. C & D
A
Answer: E - C & D
Reasoning: Module Audio Clips Dr. Bruce states Amiodarone is known to cause hypothyroidism
ch 49
25
5. What patient education is imperative to teach regarding levothyroxine
A. It has a narrow therapeutic range and TSH should be drawn 6-8 weeks after starting treatment
B. It is recommended to stay on the same brand of medication
C. It can cause an overdose (hyperthyroidism) and patients should report heat intolerance, racing heartbeat, tremors, chest pain
D. It should be taken on an empty stomach and it also increases dosage requirements for digoxin and insulin
E. All of the above
Answer: E-All of the above
Reasoning: Module Audio clips: If Synthroid cannot be taken on an empty stomach it should still be taken and the provider may have to adjust dose and account for meal consumption.
ch 49
26
Select the drug that does not reduce levothyroxine absorption
A. Tums
B. Cimetidine
C. Dilantin
D. Questran
Answer: C-Dilantin
Reasoning: Dilantin accelerates levothyroxine metabolism
ch 49
27
Methimazole is a first line drug for hyperthyroidism. Select what does not apply to Methimazole
A. Pregnant, breastfeeding and patients in thyrotoxic crisis should not take Methimazole
B. Therapeutic effects result from destruction of thyroid hormone
C. It can be given as adjunct to radiation therapy until radiation effects manifest
D. It can be given to suppress thyroid hormone prior to subtotal thyroidectomy
E. Patient dosing consist of 1-3/day compared to PTU’s dosing at 3-4/day
Answer: B- Therapeutic effects result from destruction of thyroid hormone
Reasoning: Module Audio Clips: Therapeutic effects result from blocking synthesis of thyroid hormone not from destroying it.
ch 49
28
Methimazole should be completely stopped if
A. The patient has Graves disease
B. Mild Hypothyroidism occurs
C. Euthyroid state is not achieved in 3 weeks
D. Agranulocytosis occurs
Answer: D - Agranulocytosis occurs
Reasoning: Methimazole is given to patients with Graves disease. Dosages are reduced for hypothyroidism. Euthyroid states are reached in 3-12 weeks because Methimazole does not destroy existing thyroid hormones. Sore throat and fever may be the first signs of agranulocytosis
ch 49
29
```
Iodine -131 is used for
A. Only Pediatric patients
B. Only for female patients
C. Mainly for adults
D. Only for male patients
```
C. Mainly for adults
Reasoning: Module Audio Clips
ch 49
30
What is Not an effect of radioactive iodine (Iodine-131)
A. Treatment effect is delayed up to several months for maximal effect.
B. No tissue other than thyroid tissue is injured
C. Hyperthyroidism results from excess dosing
D. It has a relatively low cost
Answer: C -Hyperthyroidism results from excess dosing
Reasoning: Module Audio Clips: Iodine-131 causes hypothyroidism in 90% of patients within the first year of treatment from excessive dosage.
ch 49
31
```
What type of opioid receptors are activated from a pharmacologic perspective? Select all that apply.
A. U (Mu) receptors
B. K (kappa) receptors
C. Delta receptors
D. All of the above
```
Answer is A & b PAGE 183
A. U (Mu) receptors
B. K (kappa) receptors
32
What type of response do Kappa receptors activate? Select all that apply
```
A. Analgesia
B. Resp depression
C. Sedation
D. Euphoria
E. Physical dependence
F. Decreased gi motility
```
Answer is A, C, & F the kappa receptors produce analgesia, sedation and decrease G.I motility page 184 table 24.1
33
What medications should be avoided with opioids?
A. CNS Depressants
B. Agonist antagonist opioids
C. MAOI
D. All of the above
Page 184 table 24.3
CNS depressants (alcohol, barbiturates, benzodiazepines) further cause resp depression and there are multiple black box warnings among many of the opioids
Agonist antagonist opioids PRECIPITATE A WITHDRAWL OF REACTION
MAOS hyperpyrexic coma
34
What are the most common side effects of strong opioids? Select all that apply
```
A. Sedation
B. Euphoria
C. Constipation
D. Urinary retention
E. Cough suppression
F. Hypotension
G. Miosis
```
All of the above page 186
35
What medication would you give a patient with opioid induced constipation after already trying to give the typical a standard laxative therapy?
A. Naloxone
B. Methylnaltrexone (Relistor)
C. Naltrexone
D. Pentazocine
Answer is B Methylnaltrexone (Relistor)
pg. 184 and 186
Also note that methylnaltrexone can Not cross the blood brain barrier hence would not be able to reverse CNS depression
36
True or false?
| Methadone has a black box warning for prolong QT interval and may pose the risk for a fatal dysthymia.
True page 187
37
Which of the following oral medication undergoes conversion to morphine by 10 %?
A. Tramadol
B. Oxycodone
C. Codeine
D. Tapentadol
The answer is B codeine undergoes conversion by 10% there is a black box warning to NOT TO BREASTFEED CHILD! the enzyme responsible for this is conversion is CYP2D6 isoenzyme. In addition, codeine has led to deaths in some children. Page 188
38
It is safe to combine agonist antagonist opioids with opioids? True or false?
False the book mentions multiple times NOT to administer agonist antagonist to a patient who is physically dependent on a pure opioid agonist, drugs like pentazocine can precipitate a withdrawal.pg 189
39
What is some drug-drug interactions with tramadol? select all that apply
A. Avoid CNS depressants
B. SSNI/SSRI
C. MAOI
D. They are all safe to use together
A,B,& C pg 191
A. Avoid CNS depressants
B. SSNI/SSRI
C. MAOI
40
When starting opioid therapy which option is safer to use Immediate release or extended release ?
Immediate release page 192
41
A nurse is teaching a lifeguard about safe sunning. Which statement indicates understanding?
a) Sunscreens should be applied 30 minutes before going outside.
b) I do not need to wear sunscreen if it is cloudy.
c) I should reapply sunscreen after swimming.
d) UV radiation cannot penetrate through water.
Answer: C; Sunscreen should be reapplied after swimming and profuse sweating. Most sunscreens should be applied 30 minutes before going outside but some require application two hours before sun exposure. UV radiation goes through clouds and several inches of water.
42
To provide benefit against the full range of UV radiation, an organic sunscreen must contain which component?
a) Avobenzone
b) Para-aminobenzoic acid (PABA)
c) Titanium Dioxide
d) Zinc Oxide
Answer: A; only A protects against the full range of UV radiation. C & D are not organic.
43
A female pt with baldness asks the nurse about the safety and efficacy of minoxidil (Rogaine). What will the nurse tell the pt?
a) Hair regrowth is most effective when baldness developed recently.
b) Minoxidil cannot be used by females.
c) Once hair growth has been restored, Minoxidil can be discontinued and hair loss will not reoccur.
d) Systemic side effects such as headache and flushing are common.
Answer: A; more effective in recent hair loss. Can be used in women. Hair loss may still occur even during minoxidil treatment. Systemic effects are not common.
44
A child with eczema has been treated unsuccessfully with a topical glucocorticoid for a year and has skin atrophy and hypopigmentation. The nurse will suggest discussing which drugs with the provider?
a) Higher potency topical glucocorticoids
b) Topical keratolytic agents
c) Topical immunosuppressants
d) Topical NSAIDs
Answer: C; Topical immunosuppressants
if topical glucocorticoids are unsuccessful in treating, topical immunosuppressants are indicated. a would make the problem worse. B is not indicated.
45
A 50-year-old patient receives botulinum toxin type A (botox) injections for the first time on her forehead ad around her eyes. One week later, she calls the clinic to report she is experiencing droopy eyelids. The nurse will tell the patient that this effect:
a) Is normal and will resolve in a few days
b) May persist 3-6 mo but will resolve
c) May progress to cause drooling and aphasia
d) Represents an adverse effect that may be permanent
Answer: B; May persist 3-6 mo but will resolve
Botox is a neurotoxin that acts on cholinergic neurons to block release of ACTH. Injection into the wrong site or diffusion into surrounding tissues at the correct site can cause unintended muscle weakness. The pts droopy eyelids are an example of an unintended effect. Weakening will last 3-6 mo but will resolve. Drooling and aphasia are only a risk when injected around mouth.
46
A patient asks the nurse what an SPF 15 indicates?
a) A 93% block of UVB radiation.
b) Half the protection of a sunscreen with SPF 30.
c) Low protection
d) It takes 15 minutes for the sun to produce a burn on the skin
Answer: A; A 93% block of UVB radiation.
SPF 15= 93% UVB protection. As the SPF increases, the increment in protection gets slightly smaller so it is not half the protection of SPF 30. Low protection is SPF 2-14. SPF is calculated by time required for the development of erythema in the protected region divided by the time required for erythema in the unprotected region.
47
An 18-month-old child is seen in the clinic with a temperature of 40 degrees Celsius. The child’s parents tell the nurse that the child developed a fever the previous evening and was inconsolable during the night. The provider examines the child and notes a bulging, erythematous tympanic membrane. The nurse will expect to:
a) Ask the parent to return t the clinic in 2 days to see if an antibiotic need to be started
b) Discuss a referral to an ENT for follow up
c) Teach the parent to give analgesics for 3 days while observing for worsening symptoms
d) Tell the parent to administer amoxicillin 45mg/kg/dose twice daily
Answer: D; Tell the parent to administer amoxicillin 45mg/kg/dose twice daily
patients with severe symptoms of AOM should begin antibiotics upon diagnosis. For children 6 mo to 2 years, treatment should begin when diagnosis is certain as evidenced by erythema on tympanic membrane and distinct discomfort. ENT referral would only be recommended if AOM was reoccurring.
48
A provider has told a parent that a 3-year-old child has a minor ear infection, and an antibiotic will be prescribed in a couple of days if the child’s symptoms worsen. The parent asks the nurse why they cannot get an antibiotic today. Which response is correct?
a) If the eardrum ruptures, we can culture the fluid and decide which antibiotic is best.
b) Most ear infections are caused by viruses and antibiotics are not effective.
c) Most ear infections will resolve on their own without antibiotics.
d) Your child will develop a tolerance to antibiotics if they are prescribed too often.
Answer: C; Most ear infections will resolve on their own without antibiotics.
the majority of AOM infections resolve on their own without treatment. Therefore, unless a child is ill, observation is the initial choice. Rupture can occur but provider do not wait for this for treatment. Antibiotic overuse can cause resistant organisms but pts do not develop tolerance to antibiotic effects.
49
A 6-year-old child has otitis media and is being treated with amoxicillin and Motrin. The child’s parent calls the nurse to report that the child’s pain is not relieved by the ibuprofen. The child is afebrile and there is no drainage from either ear. The nurse will discuss which additional treatment?
a) Adding Tylenol to pain regimen
b) Adding antipyrine and benzocaine (Aurodex) solution to the ear canals
c) Changing the antibiotic to Augmentin
d) Performing a tympanostomy to the middle ear to relive pressure
Answer: B; Adding antipyrine and benzocaine (Aurodex) solution to the ear canals
for children over 5 years, the AAP guidelines recommend topical anesthetic ear drops for pain relief. This is contraindicated if the TM is ruptured. This child does not have drainage indicating intact eardrums. Adding another oral analgesic will not be as effective as a topical one. The child is afebrile, there is no concern the antibiotic is not working. Tympanostomy not indicated.
50
A 2-year-old child is seen in the clinic in the clinic in July with otalgia, erythematous, bulging tympanic membranes, a ruptured R TM and a fever of 39.4 C. The child’s parent tells the nurse, “This is the fifth ear infection this year, what can we do?” The provider will:
a) Administer IM Rocephin and give a flu vaccine
b) Begin prophylactic antibiotic therapy with trimethoprim/ sulfamethoxazole (Septra)
c) Prescribe Augmentin and refer to an otolaryngologist
d) Prescribe high dose Augmentin and give flu vaccine
Answer: C; Prescribe Augmentin and refer to an otolaryngologist
recurrent AOM is defined as AOM 3 or more times in 6 months or 4 or more times a year. Giving an antibiotic is appropriate for each episode but a referral is needed to an ENT. IM Rocephin might be appropriate, but a flu vaccine is not.
51
Which medication should not be used in a Diabetic patient on insulin?
a. Flagyl
b. Metoprolol
c. Lisinopril
d. Amlodipine
Answer: B-Metoprolol
| pg. 406
52
Patients who are using insulin should be aware of what signs/symptoms of
hypoglycemia?
a. Slow heart rate, rapid breathing, sweating
b. Tachycardia, slow breathing, decreased perspiration
c. Tachycardia, palpitations, sweating and nervousness
d. Diarrhea, tachycardia, thirst
Answer: C-Tachycardia, palpitations, sweating and nervousness
, pg. 406
53
What quality does Metformin have from other oral treatments for diabetes that sets it
apart?
a. Risk for hypoglycemia
b. No risk for hypoglycemia
c. Causes constipation
d. Must be given with meals
B - No risk for hypoglycemia
pg. 408
54
Which side effect is the most causative reason for patients stopping Metformin?
a. Insomnia
b. Diarrhea
c. Lethargy
d. Hunger
Answer B - diarrhea
pg. 408
The most common side effects are decreased appetite, nausea and diarrhea. These generally subside over time. However in 3%-5% of patients, GI side effects lead to discontinuation of treatment
55
What is an absolute contraindication to use of sulfonylureas?
a. Pregnancy and breastfeeding
b. Type 2 Diabetes
c. Obesity
d. Renal disease
Answer: A - Pregnancy and breastfeeding
| pg. 409
56
What should be monitored for frequently with a patient taking Pioglitazone (Meglitinide)?
a. Decreased renal function leading to ESRD
b. Increased fluid retention leading to HF
c. Decreased ovulation leading to infertility
d. Increased sodium leading to edema
Answer: B - Increased fluid retention leading to HF
Pg. 411
57
Patients being prescribed Dipeptidyl Peptidase-4 Inhibitors (Gliptins) should be educated
on the signs and symptoms of:
a. Liver disease
b. Pancreatitis
c. Meningitis
d. Renal dysfunction
Answer: B - Pancreatitis
pg. 413
58
Sodium-Glucose Cotransporter 2 Inhibitors can lead to increased UTI and yeast
infections because:
a. They can lead to increased buildup of bacteria in the urine
b. They cause the patient to have urinary retention
c. They block the reabsorption of filtered glucose, leading to glucosuria
d. They cause increased reabsorption of glucose from the urine.
Answer: C, They block the reabsorption of filtered glucose, leading to glucosuria
pg. 413
59
GLP-1 Agonists should be used with caution in which patient population?
a. Renal dysfunction
b. Liver disease
c. Epilepsy
d. Migraine headaches
Answer: A - Renal dysfunction
pg. 415
60
What should be monitored every 3 months for the 1st year of therapy when a patient is
started on Acarbose?
a. BMP
b. LFT’s
c. Pt with INR
d. CBC
Answer: B - LFTs
pg. 412
61
Which is untrue regarding treatment for acne?
A) Dietary changes are as effective as topical medications for reduction in acne
B) Moderate to severe acne is typically treated with oral medications
C) Benzoyl peroxide is the first line treatment for mild to moderate acne
D) Drying and peeling of the skin is a normal side effect of benzoyl peroxide
Answer: A- Dietary changes are as effective as topical medications for reduction in acne
Reasoning: pg 837, dietary changes have not been found to have any benefit in the reduction of acne
62
```
Dapsone cream should not be combined with which other acne topical?
A) Retinoids
B) Salicylic acid
C) Benzoyl Peroxide
D) Erythromycin
```
Answer: C - Benzoyl Peroxide
Reasoning: pg 838, Dapsone and Benzoyl peroxide should not be mixed because of the risk of dying the skin orange or yellow
63
```
Select all that apply: Which ingredients should not be applied to the same area as Treitinoin cream is applied?
A) Alcohol
B) Astringents
C) Oil based makeup
D) Mild cleansers
```
Answer: A & B: alcohol, astringents
Reasoning : Application of alcohol, astringents, lime and spices used concurrently with treitinoin cream can cause excessive burning & stinging
64
What are the requirements when prescribing Isotretinoin (Accutane) to female patients? Select all that apply
A) Before initial prescription, patient must have 2 negative pregnancy tests
B) Patient must be on an effective birth control method
C) Birth control requirements do not apply to patients with tubal ligation or their partner has had a vasectomy
D) Patient must sign Informed Consent Documentation and register with IPLEDGE (risk management program)
Answer: A & D
Reasoning: All patients on Accutane must have 2 negative pregnancy tests, and use 2 forms of birth control even patients who have had a tubal ligation or their partner has had a vasectomy. A tubal ligation or vasectomy counts as one of the two required birth control forms. All patients must be in IPLEDGE and must contact them a month before starting, every month on Accutane and a month after
65
Which of these statements by a patient requires further education?
A) “I must wear sunscreen every day on Accutane even if I am not directly exposed to the sun)
B) “I need to tell my plastic surgery office that I am on Accutane so that they will use a lower setting on my laser hair removal”
C) “I will need to have my blood taken periodically while on Accutane to check for serious side effects”
D) “I need to stop my tetracycline before I start Accutane to prevent side effects”
Answer: B
Reasoning: No laser hair removal, waxing or dermabrasion should be done while on Accutane for risk of severe scarring
66
```
A female patient with acne has continued to have symptoms even after taking oral birth control pills- what would be the next medication that the APRN would add on?
A) Accutane
B) Retinoids
C) Spironolactone
D) Erythromycin
```
Answer: C
Reasoning: Sprionolactone can be added to oral birth control to block hormonal acne.
67
Patient education for sun safety should include, select all that apply
A) Avoid sun exposure in the middle of day when the UVB radiation is the highest
B) Sunscreens are most effective when applied one hour before going outside
C) Sunscreens should be reapplied throughout the day especially after swimming or profuse sweating
D) Sunscreen should not be the only measure used to protect against the sun: sunglasses, hats, and protective clothing are also recommended
Answer: A, C, D
Reasoning: Sunscreen should be applied 30 minutes before exposure
68
```
Which of these acne topicals is also used for rosacea?
A) Retinoids
B) Salicylic Acid
C) Accutane
D) Azelaic Acid
```
Answer: D
Reasoning: Azelaic acid is commonly prescribed for rosacea which has similarities to acne
69
Clindamycin or Erythromycin can be used as topicals alone to treat acne
A) True
B) False
Answer: B
Reasoning: Use of either of these antibiotic topicals alone can lead to antibiotic resistant, they are most often combined benzoyl peroxide to prevent emergence of resistance
70
Salicylic acid toxicity can occur when large amounts are applied for prolonged amount of time. Salicylic acid toxicity presents as
A) Tinnitus, hyperpnea, vomiting, psychologic disturbances
B) Arrythmia, hypotension
C) Neurological signs such as weakness and tics
D) Diarrhea, fever, vomiting
Answer: A
Reasoning: Salicylic acid toxicity is uncommon if only applied to face but when applied to large portions of the body it can occur, symptoms include tinnitus, hyperpnea, vomiting and mental status changes.
71
Mr. Johnson, an 85 y/o male patient has a history of an AV heart block. He has
been diagnosed with acute angle glaucoma. What would be the medication of
choice to prescribe this patient?
A) Timolol
B) Latanoprost (Xalantan)
C) Ciprofloxacin
D) Metipranolol
Answer: B-Latanoprost (Xalantan)
Reasoning: pg 825. The 1 st drug of choice for this patient would be Latanoprost.
Patient with a hx of AV block or bradycardia should not be given a beta blocker
due to the systemic effects on the heart and lungs.
72
Latanoprost is usually well tolerated. Which side effect is rare, but a patient should be educated on as a side effect?
A) tearing of the eye
B) blurred vision after application of medication
C) brown pigmentation of the iris
D) increased thickness and length of eye lashes
Answer: C - brown pigmentation of the iris
Reasoning: pg 826. The most significant side effect of Latanoprost is a harmless heightened brown pigmentation of the iris, which is most noticeable in patients whose irides are green-brown, yellow-brown, blue/gray-brown. It is rarely seen in blue, green, or blue/green irides.
73
What is the therapeutic goal of drug treatment for glaucoma (select all that apply)?
A) Improve dry eyes
B) Decrease eye pain
C) Reduce elevated IOP
D) Prevent vision loss
Answer: C and D
C) Reduce elevated IOP
D) Prevent vision loss
Reasoning: pg. 829. The therapeutic goal for drugs in the treatment of glaucoma is reducing elevated intraocular pressure (IOP) and preventing vision loss.
74
Which of the follow patients is considered a high-risk population when treating acute angle glaucoma?
A) Pediatric patients
B) Patients with dementia
C) patient with a hx of Asthma
D) All of the above
Answer: D - All of the above
Reasoning: pg 826 and 829. There is a limited number of drugs available for the pediatric population due to the adverse effects. Pt with dementia is high risk due to the non-adherence of medication and the risk for permanent vision loss if the drugs are not administered. Pt with a hx of asthma is a poor candidate for beta blocker therapy.
75
When discussing eye drops administration with a patient, who wears soft contact lenses ,what is an appropriate timeframe to discuss with the patient that would be safe to administer drops and continue wearing contact lenses? The drug being administered contains Benzalkonium as a preservative.
A) administer drops 15 min prior to insertion of the contact lens.
B) administer drops 10 min prior to insertion of the contact lens
C) There is no time frame, and the drops can be administered with lenses in.
D) administer drops 30 min after insertion of contact lens.
Answer: A- administer drops 15 min prior to insertion of the contact lens.
Reasoning: pg. 829. Check label of ophthalmic drugs to see if they contain benzalkonium as a preservative. These drugs may be absorbed by soft contact lenses. Allow at least 15 min to elapse between administration and insertion of the lenses
76
A 50 y/o female has severe eye itching, redness, and edema from seasonal allergies. She has tried multiple OTC treatments drops and oral medications. She has been referred to an eye doctor. It has been determined that she does NOT have an eye infection. Which class of drugs would be most beneficial to prescribe for this patient?
A) Glucocorticoid drops
B) Ciprofloxacin drops
C) Timolol ocular drops
D) Phenylephrine drops
Answer: A - Glucocorticoid drops
Reasoning: pg 830-831. Follow the algorithm for ocular allergies RX> severe>. Glucocorticoids are highly effective to tx severe ocular allergies.
77
A 20 y/o patient complains of dry eyes in the clinic. They have been participating in remote/online learning. Their visual acuity is 20/20. Which of the following would an APRN suggestion to the patient?
A) Ophthalmic demulcents (artificial tears)
B) Naphazoline (Clear eyes)
C) no treatment is suggested at this time
D) Oxymetazoline (Visine)
Answer: B- Naphazoline (Clear eyes)
Reasoning: pg. 831. After confirmation of a normal visual acuity, initial treatment for dry eyes would be ophthalmic demulcents (artificial tears). These can be administered as often and as long as desired.
78
A 15 y/o patient presents with redness, greenish discharge, and swelling of the Right eye, and similar symptoms on the Left eye. Pt education should include which of the following for a diagnosis of a bacterial eye infection? Select all that apply.
A) You are contagious for 24-48 hours after the initiation of treatment.
B) Do not wear contacts with an eye infection or during treatment of the infection.
C) Wash your hands frequently, before and after administration of topical eye medications
D) Use antibiotic ointment or antibiotic drops as prescribed and ensure that you complete the treatment coarse.
Answer: A,B,C,D
Reasoning: Pg. 833. Topical drugs are available for treating viral and bacterial infections of the eye. Antibiotics are used to treat serious eye infections and prevent infections after eye surgery. Bacterial infections will remain contagious until they have been treated for 24-48 hours. Patients should not use contact lenses while they have an eye infection and while they are treating the infection with a topic drug.
79
Alpha2- adrenergic agonist medications are used for short term and/or long-term therapy to treat glaucoma. Which of the following is the mechanism of action of Brimonidine (Alphagan P, Alphagan)?
A) Lowers IOP by reducing the production of aqueous humor and perhaps by increasing the outflow. It may delay optic nerve degeneration and protect retinal neurons from death.
B) Lowers IOP by facilitating aqueous humor outflow, in part by relaxing the ciliary muscle.
C) Decrease production of aqueous humor.
D) Decreases IOP by increasing aqueous humor outflow through the trabecular meshwork
Answer: A
Reasoning: pg. 827. Brimonidine is used to treat patients with open-angle glaucoma and ocular hypertension. The drug lowers IOP by reducing the production of aqueous humor and perhaps by increasing outflow. In addition to lowering IOP, brimonidine may delay optic nerve degeneration and protect retinal neurons from death.
80
Carbonic Anhydrase inhibitors are primarily used for long term treatment of open-angle glaucoma. It is not a first line drug. It is given as an adjunct therapy in some patients to rapid lower IOP. Carbonic anhydrase inhibitors are NOT contraindicated in which patient.
A) a 36 y/o pregnant female
B) a 87 y/o male patient with dementia
C) a 56 y/o patient with kidney disease
D) a 60 y/o female with no significant health history
Answer: D - a 60 y/o female with no significant health history
Reasoning: pg 828. Carbonic Anhydrase inhibitors are contraindicated in pregnant patients due to teratogenic effects. Due to CNS effects, which are relatively common, this medication should be used with caution in elderly patients with dementia. Acid-base disturbances and electrolyte imbalances can be a concern and should be used with caution in patients with kidney disease.
81
```
Question: Fat-soluble vitamins can be stored extensively in the body minimizing the risk for deficiency as well as increasing the potential for toxicity if intake is excessive. Which is an example of a fat-soluble vitamin? (select all that apply)
A) A
B) D
C) C
D) E
```
Answer: A, B, E
Reasoning: Fat-soluble vitamins are K, A, D, E. Remember the pneumonic Fat KADE (pronounced Caty) to remember the fat-soluble vitamins. All the others are water-soluble.
82
There is insufficient evidence that the average American should take a daily multivitamin. Exceptions include: (choose 3)
A) The bariatric surgery patient
B) The patient who has a restrictive diet
C) The patient with a malabsorption disorder
D) The patient who exercises every day
Answer: A, B, C
Reasoning: There is little evidence to advocate for the use of a multivitamin except for the bariatric surgery patient, those with restrictive diets (vegan, vegetarian, etc.) and those with malabsorption disorders. Ch. 67, page 617.
83
Excess Vitamin A:
A) is associated with supple skin and visibly decreases fine lines and wrinkles
B) is associated with multiple congenital abnormalities
C) is recommended for pregnant women
D) may benefit adults ages 65 and older
Answer: B
Reasoning: Excess Vitamin A is associated with multiple congenital abnormalities and is NOT recommended for pregnant women. It is not associated with supple skin or helps improve wrinkles and does not benefit adults age 65 and older (Vitamin D may, however). Chapter 67, page 619, Patient-centered care across the life span.
84
Question: When teaching the patient insistent on taking multiple vitamins every day it is important: (choose all that apply)
A) To make the patient aware that a consistent, well-balanced diet is just as good as taking multiple vitamin supplements
B) Not to exceed the Recommended Daily Allowance (RDA) unless instructed by your provider
C) To drink a full glass of water with the multivitamin to help with absorption
D) To take calcium carbonate with the multivitamin to help with absorption
Answer: A, B
Reasoning: A and B are true regarding patient education. C & D are not true. Chapter 67, page 626, Patient education box
85
Question: Breastfed infants should receive:
A) Iron at 2 weeks old
B) Vitamin D rather than foregoing sunscreen
C) Calcium
D) Vitamin C to enhance immunity
Answer: B
Reasoning: Rather than foregoing sunscreen, the AAP recommends 400iu Vitamin D for breastfed infants. Iron is recommended at 4 months, breastfed infants do not need calcium or Vitamin C. Chapter 67, Page 619, Patient centered care across the lifespan.
86
Question: Which of the following is true regarding antioxidants? (choose all that appl)
A) they are present in food and reduce cellular and tissue injury
B) reduce oxidative stress by neutralizing free radicals
C) high doses of antioxidants protect against heart disease and cancer
D) certain antioxidants increase the risk for disease
Answer: A, B, D
Reasoning: All are true regarding antioxidants except for C- “Despite plausible theories and observational studies that provided support for protective effects of antioxidant supplements, more recent and rigorous trials have failed to show protection against heart disease, cancer, or any other long-term illness.” Chapter 67, page 619 under What About Protective Antioxidant Effects?
87
Question: Vitamin A has multiple functions, among which are:
A) plays a role in the eye in adaptation to dim light
B) maintains structural integrity of the skin
C) plays a role in spermatogenesis
D) plays a major role in normal fetal development
Answer: A, B, C
Reasoning: A, B, C are true. Vitamin A is extremely teratogenic and does not help the fetus develop normally. Chapter 67, Pages 620-621
88
```
Question: Vitamin D deficiency can result in
A) Osteomalacia
B) Arthritis
C) Obesity
D) Rickets in children
```
Answer: A, C, D.
Reasoning: Vitamin D plays an important role in metabolism and maintenance of bone health. A deficiency in Vitamin D will result in osteomalacia, obesity and rickets. Adequate levels of Vitamin D helps protect against arthritis. Chapter 67, Page 621
89
Question: The only established indication for Vitamin C is:
A) to boost immunity and prevent the common cold
B) to prevent scurvy
C) to prevent rickets
D) To hasten wound healing
Answer: B
Reasoning: The only established indication for Vitamin C is to prevent scurvy. The others just have claims of efficacy. Chapter 67, page 623.
90
Question: Niacin (Vitamin B3) has fallen out of favor recently for the use of lowering cholesterol. However, as a vitamin Niacin:
A) treats niacin deficiency
B) is used off-label for pellagra
C) has the lowest toxicity of all the fat soluble vitamins
D) can be administered orally or IV
Answer: A, B
Reasoning: The only indication for the vitamin Niacin is for niacin deficiency and is also used off-label for pellagra. It is a water-soluble vitamin and is only administered orally. Chapter 67, page 623.
91
A 18mo patient presents with persistent ear pulling, fever, and awakening from sleep over the last 2 days. The patient had an upper respiratory infection a week ago. Which medication would you prescribe the patient? The patient has no allergies.
a. 2% solution of acetic acid
b. Amoxicillin
c. Ceftriaxone
d. Acyclovir
Answer: b. Amoxicillin
Rationale: The patient is 18 month old with treatment within 48 hours for otitis media. The patient does not have a known penicillin allergy, therefore amoxicillin is the correct initial treatment for the patient. (Lehne’s, pg. 850)
92
Your 10 yo patient presents with acute otitis externa. Which would be the best education to provide the patient and their parent?
a. Regularly clean the ear canal with a cotton swab after bathing.
b. Remove all visible cerumen from the ear canals when possible.
c. Encourage use of ear plugs while swimming in order to prevent bacteria from entering the ear canal.
d. Recommend an OTC spray for removal of extra cerumen from the ear canal.
Answer: c. Encourage use of ear plugs while swimming in order to prevent bacteria from entering the ear canal.
Rationale: Ear plugs can be used while swimming in order to prevent pool water from entering the ear canal. Ear plugs should be avoided all other times. Cerumen should not be removed from the ear canal as it is part of the body’s natural defense against bacteria. No objects or sprays should be placed into the ear canal because it could damage the EAC lining. (Lehne’s, pg. 853 “patient education”)
93
For a 4 yo patient presenting with acute otitis externa, which treatment would be prescribed?
a. Amoxicillin plus clavunate
b. 2% solution of acetic acid
c. Amoxicillin
d. Cefdinir
Answer: b. 2% solution of acetic acid
Rationale: Best treatment for uncomplicated acute otitis externa is a topical solution such as 2% solution of acetic acid. If this does not clear the infection, a topical antibiotic could be prescribed. (Lehne’s, pg. 853)
94
In a patient with an Aspergillus infection of the external ear, what treatment is the best treatment to be initially prescribed?
a. Itraconazole PO
b. Fluconazole IV
c. 2% acetic acid drops
d. Ibuprofen or Tylenol for pain management
Answer: c. 2% acetic acid drops
Rationale: Patients with fungal otitis externa, the initial recommended treatment is application of 2% acetic acid drops 3-4x/day for 7 days. If the infection does not respond to this treatment, a topical antifungal is recommended. If it continues to fail to respond, oral antifungal therapy with fluconazole or itraconazole is recommended. (Lehne’s, pg. 855)
95
A patient presents with acute otitis media. Of report, the patient took an antibiotic two weeks ago for strep throat. What treatment would be most appropriate?
a. Amoxicillin/Clavulanate
b. Cefdinir
c. 2% acetic acid drops
d. Amoxicillin
Answer: a. amoxicillin/clavulanate
Rationale: The patient has recent antibiotic exposure, likely amoxicillin, for their strep throat infection. In order to prevent amoxicillin resistance, the patient should be prescribed Amoxicillin with Clavulanate. (Lehne’s, pg. 852)
96
A parent brings their child into clinic with concerns about the child’s language development. The parent reports that the child had 3 ear infections in the last year. What is the best education to provide the parent?
a. The child likely has another ear infection and will need to be treated with prophylactic antibiotics.
b. It is most likely a behavior problem and will be resolved with time.
c. The child will be referred to a specialist for early intervention to assess the child’s hearing.
d. It is likely a buildup of cerumen, and the language problems will likely resolve with prompt removal of the excess cerumen in the ear canal.
Answer: c. The child will be referred to a specialist for early intervention to assess the child’s hearing.
Rationale: In young children who have recurrent acute otitis media that experience language problems, a prompt referral to a specialist is recommended to assess for need of intervention. (Lehne’s, pg. 855)
97
What treatment modality is recommended in a patient with otitis media with effusion?
a. Amoxicillin PO
b. 2% acetic acid otic drops
c. Supportive care
d. Cerumen removal
Answer: c. supportive care
Rationale: If the patient has otitis media with effusion with no signs of local or systemic infection, it is likely that it is fluid remaining from an old acute otitis media infection. The patient does not need antimicrobial support at this time. Cerumen should not be removed from the ear for otitis media with effusion. (Lehne’s, pg. 849)
98
Which drug is not used the treatment of glaucoma?
a. Betaxolol
b. Pilocarpine
c. Latanoprost
d. Phenylephrine
Answer: d. Labetalol
Rationale: Topical beta blockers and prostaglandin analogs (the other 3 options) are used in the treatment of glaucoma. Phenylephrine is used as an ocular decongestant but is contraindicated in patients with glaucoma. (Lehne’s pg. 824-5)
99
In which patient is a beta blocker not contraindicated?
a. Older adult, no previous medical history
b. Pregnant patient, no previous medical history
c. Diabetic patient, no other medical history
d. A 5yo patient, no previous medical history
Answer: a. older adult, no previous medical history
Rationale: Beta blockers (even topical) are to be used with care in patients with heart failure and diabetes due to the potential worsening of symptoms. They are also to be avoided in children and pregnant women. Treatment is not contraindicated in older adults without comorbidities. (Lehne’s, pg. 826)
100
What education is most appropriate for a patient with allergic conjunctivitis being treated with cromolyn?
a. If no symptom resolution occurs within 1 week, discontinue the medication.
b. Artificial tears can be used to flush out allergens and improve symptoms.
c. Use artificial tears within five minutes after administering cromolyn drops to improve absorption.
d. Symptoms should be improved even in the setting of allergens while using cromolyn drops.
Answer: b. Artificial tears can be used to flush out allergens and improve symptoms.
Rationale: Cromolyn, a mast-cell stabilizer, can take up to 2 weeks to become maximally effective. Artificial tears or other topical drops should be administered at least five minutes apart to ensure that the medications are each being absorbed. (Lehne’s pg. 831)
101
Select the true statements regarding botanical products (herbal supplements), vitamins, and minerals classified as dietary (food) supplements. Select all that apply:
a. DSHEA exempts them from undergoing FDA scrutiny and approval before marketing.
b. They can be manufactured and marketed without giving the FDA any proof that they are safe or effective.
c. If a product eventually proves to be harmful or has made false claims, the FDA does have the authority to intervene, but only after the product has been released for marketing.
d. All supplements must be proved to be safe and effective by the FDA prior to being marketed and sold to individuals in the United States.
Answer: A, B, C
| Pg 638
102
What is the adverse reaction with conventional drugs when referring to St. Johns Wort?
a. Can suppress platelet aggregation and hence can increase the risk for bleeding in patients receiving antiplatelet drugs or anticoagulants.
b. Can elevate the blood pressure and stimulate the heart and CNS. This medication can intensify the effects of pressor agents, cardiac stimulants and CNS stimulants to counteract the beneficial effects of antihypertensive drugs and CNS depressants.
c. Can render Birth control ineffective
d. Can induce CYP3A4 (the 3A4 isoenzyme of cytochrome P450) and can, thereby accelerate the metabolism of many drugs, causing a loss of therapeutic effects.
Answer: D – Can induce CYP3A4 (the 3A4 isoenzyme of cytochrome P450) and can, thereby accelerate the metabolism of many drugs, causing a loss of therapeutic effects.
pg 640
a- Is the interaction for Ginko Biloba
b- Is the interaction for Ma huang (ephedra)
103
What dietary supplement is commonly used for treating symptoms of menopause, including hot flashes, vaginal dryness, palpitations, depression, irritability, and sleep disturbance.
a. St Johns Wort
b. Ephedra
c. Black Cohosh
d. Butterbur
Answer C – Black Cohosh pg 640
Butterbur is most commonly taken for migraine headaches, allergies, and asthma
insufficient evidence showing that this herb supports management of menopausal symptoms
104
What labs should be run before a pt takes black cohosh?
a. Liver function test
b. Cbc
c. BUN
d. H&H
Answer: A Liver Function Test – pg 640
Some women taking black cohosh have developed liver inflammation which has led to liver failure. This is rare but until more is known, it may be wise to check baseline liver function with periodic re-checks.
105
What are the benefits of Coenzyme Q-10? Select all that apply
a. Potent antioxidant
b. Vital role in cellular energy production
c. Can be effective in treating a migraine
d. Treatment of conditions associated with aging and with cellular energy production
e. Treat heart failure
f. Treat muscle injury caused by HMG-COS reductase inhibitors (statins)
g. Treat mitochondrial encephalomyopathies (muscle and nervous system injury caused by deranged mitochondrial metabolism)
A, B, D, E, F, G – pg 641
106
What are the potential interactions of Coenzyme Q-10 with conventional drugs. Select all that apply:
a. Structurally similar to vit K – may antagonize the effects of warfarin
b. May cause UTI
c. Shares a common pathway with cholesterol. Drugs such as statins, which inhibit the synthesis of cholesterol, can also inhibit the synthesis of CoQ-10 causing endogenous Co-Q10 to decline.
d. Potentiate the hypotensive effects of antihypertensive drugs as well as they hypoglycemic effects of the insulin and other drugs for diabetes.
Answer: A, C = pg 641
| D- is Black cohosh
107
Daily consumption of cranberry juice can:
a. Treat a current UTI
b. Prevent UTIs
c. Cause a UTI
d. Cause dehydration
Answer: B – Prevent UTIs Pg 642
studies show very effective
108
What is Oral Echinacea used for?
a. Stimulate immune function, suppress inflammation, and treat viral infections
b. Treat wounds, burns, eczema, psoriasis and herpes simplex infections
c. Prophylaxis of migraines
d. Constipation and dyslipidemias
Answer: A: Stimulate immune function, suppress inflammation, and treat viral infections
Pg 642-643
B – Topical Echinacea
C- Feverfew
D – Flaxseed
studies have mixed results - very small reduction for those who took echinacea compared to those taking a placebo (10-20% )
109
What population of patients should avoid Echinacea?
a. Individual with no health problems because they do not need it
b. Patients with autoimmune disease
c. Pt with psoriasis
d. Pt with Herpes simplex
Answer: Patients with autoimmune disease – pg 642.
Even though studies have shown a very small reduction in the prevention of common colds (10-20%), until the effects on the immune system are fully known, it is advised to avoid using in patients with autoimmune diseases because it could stimulate immune function
Topical Echinacea is used to treat psoriasis and Herpes simplex
110
True/False
By suppressing platelet aggregation, feverfew can increase the risk for bleeding in patients taking antiplatelet drugs or anticoagulants.
True – pg 643. Also this product should be discontinued 2 weeks before elective surgery
111
What list of symptoms best matches postfeverfew syndrome?
a. Nervousness, fatigue, insomnia, tension headache, joint pain, joint stiffness
b. Euphoria, restlessness, headache, joint pain, joint stiffness
c. Syncopal episodes, headaches, joint pain, joint stiffness, drowsiness
d. Restless leg syndrome, fatigue, insomnia, headaches, joint pain
Answer: A Nervousness, fatigue, insomnia, tension headache, joint pain, joint stiffness
pg 642
112
What dietary supplement is used for a vegetarian source of Omega-3 fatty acids?
a. Echinacea
b. Garlic
c. Flaxseed
d. Cranberry
C. Flaxseed
pg 643
113
A patient with history of high cholesterol is experiencing constipation. What dietary supplement might benefit them?
a. Flaxseed
b. Coenzyme Q-10
c. Black Cohosh
d. Butterbur
A. Flaxseed
pg. 643
Like other fiber products, flaxseed has the potential to decrease plasma levels of total cholesterol and low density lipoprotein (LDL) but does night affect HDL or triglycerides.
Flaxseed also acts like a bulk-forming laxative to relieve constipation
114
If I take my medication at noon, what time would be okay to take flaxseed?
a. 11am
b. 2pm
c. noon
d. 1pm
B. 2pm
pg 643
flaxseed may reduce the absorption of conventional medications. Therefore it should be taken 1 hour before or 2 hours after these drugs
115
Garlic is used primarily for its effects on what body system?
a. Gastrointestinal
b. endocrine
c. Cardiovascular
d. Respiratory
C. Cardiovascular
The herb is taken to reduce levels of triglycerides and LDL cholesterol and to raise levels of HDL cholesterol. Also reduces blood pressure, suppresses platelet aggregation, increases arterial elasticity and decreases the formation of atherosclerotic plaque.
Also use for antimicrobial and anticancer effects
studies show - does not appear to lower LDL cholesterol
- may lower BP modestly
- may have a role in cancer prevention but not enough adequate data
- been shown to have antibacterial and antifungal properties
116
what herbal supplement is used to treat vertigo, suppress nausea and vomiting associated with morning sickness, seasickness and general anesthesia
Also for anti-inflammatory, analgesic properties.
a. ginko biloba
b. Ginger Root
c. chondroitin
d. Cranberry
b. Ginger Root
pg 644
good evidence supporting the benefits of ginger root for the prevention and treatment of morning sickness
studies show decrease in nausea but not in vomiting
Patients with RA, ginger root appears to reduce pain, improve joint mobility, and decrease swelling and morning stiffness
117
Select the dietary supplement that does not have an increased risk of bleeding as an interaction for a conventional drug. Select all that apply
a. Ginger Root
b. Garlic
c. Ginko Biloba
d. Feverfew
e. Coenzyme Q-10
f. Green Tea
g. Cranberry
h. Echinacea
i. Saw Palmetto
j. Peppermint
k. Resveratrol
l. Valerian
h. Echinacea
j. Peppermint
l. Valerian
ch. 69
118
Select the dietary supplements that are generally used together and used to treat osteoarthritis
a. Ginko Biloba and Ginger root
b. Glucosamine and Chondroitin
c. Peppermint and Green Tea
d. Feverfew and Flaxseed
b. Glucosamine and Chondroitin
pg. 645
mixed results - some studies have showed modest improvements
119
If you are allergic to _____, you should avoid taking Glucosamine and Chondroitin?
a. Grapefruit
b. Citrus
c. Shellfish
d. gluten
c. Shellfish
| pg. 645
120
What dietary supplement is taken for weight loss, improve mental clarity and to prevent and treat cancers of the stomach, skin, bladder, and breast?
a. Green Tea
b. Ginko Biloba
c. Ginger Root
d. Feverfew
A. Green Tea
Ginko Biloba - improve memory, halt progression of dementia and decrease intermittent claudication
Ginger Root - vertigo,
nausea and vomiting associated with motion sickness, morning sickness, seasickness and general anesthesia
Feverfew - prophylaxis of migraine
p. 645
studies show that drinking green tea throughout the day can improve mental clarity and help with weight loss but this may be to caffeine
studies done have shown that green tea and EGCG may prevent or slow the growth of certain cancers
121
What dietary supplement is used to improve memory, halt progression of dementia and decrease intermittent claudication. Less common uses include treatment of erectile dysfunction and other conditions associated with decreased perfusion
a. Feverfew
b. Glucosamine
c. Ginko Biloba
d. Peppermint
C. Ginko Biloba
pg. 644
mixed results in studies, degree of improvement was small.
studies showed no improvement with any type of dementia
122
A postmenopausal woman presents to your clinic with a history of osteoporosis. Her osteoporosis has been manageable with exercise and over the counter medications. Now her osteoporosis has become unmanageable and is seeking further treatment. What medication would be most appropriate for this patient?
a. Alendronate
b. Labetalol
c. Estrogen
d. Tylenol
Ans: Alendronate (page 545)
123
A patient presents to the clinic with a history of osteoporosis and has been taking Alendronate. She states she is having pain with swallowing and a new onset of heartburn. What would be the most appropriate action by the NP?
a. Prescribe an Antacid.
b. Discontinue the Alendronate.
c. Instruct the patient to drink tea to help soothe the symptoms.
d. Teach the patient that this is a typical side effect and will resolve with time.
Ans: B (page 546) Alendronate has a high risk of causing esophagitis and should be d/c with symptoms of difficulty swallowing, heartburn, pain with swallowing.
124
A patient recently prescribed Risedronate asks you (the NP) how it works in the body to help their osteoporosis. How would you describe this medication?
a. Becomes incorporated into the bone where it persists for years.
b. Vitamin D carries it into the bone.
c. Only lasts 3-6 months in the bone, therefore the med needs to be taken indefinitely.
d. The medication needs to be taken with a full glass of water.
Ans: A (page 546)
125
A nurse is providing teaching for a patient with osteoporosis. This patient has just switched from taking Alendronate to Zoledronate. Which statement indicates is correct?
a. I will only need a dose of this med every 6 months.
b. I will need to have blood tests taken frequently when taking this drug.
c. This drug is less likely to cause osteonecrosis of the jaw.
d. This drug is only given PO.
Ans: B, this drug will be monitored frequently by periodic blood tests. Zoledronate is only given every 1 to 2 years, not every 6 months and is only offered IV, not PO. Zoledronate has an increased risk for osteonecrosis, as well as Alendronate.
126
A post-menopausal woman develops osteoporosis and has a family history of breast cancer. Which medication would be most appropriate to prescribe to this patient?
a. Pamidronate
b. Teriparatide
c. Raloxifene
d. Estrogen estradiol
Ans: C, Raloxifene can preserve bone mineral density while protecting against breast and endometrial cancers. Page 550.
127
A patient presents for a checkup in your clinic. Newly diagnosed with metastatic cancer, this patient has had several fractures throughout her body secondary to bone metastases and has started on chemo/radiation. This patient is visibly upset and crying in your clinic. What would be an appropriate drug to prescribe to this patient?
a. Zoloft
b. Denosumab
c. Calcifediol
d. Long acting NSAIDS.
Ans: B, Denosumab. Denosumab is used to treat bone loss in men and women receiving certain anticancer therapy and is used for bone metastases (Xgeva). Although this is indicated for bone metastases, bone fracture healing may be delayed and can exacerbate hypocalcemia and still cause osteonecrosis of the jaw. Page 552.
128
A patient presents to your clinic who takes Teriparatide at home. They administer the drug sub-Q with a prefilled pen that expires every 28 days. The patient is trying to be cost efficient and use all the doses in the syringe before discarding even if its past the 28 day mark. What is most important to educate to this patient?
a. It is okay to continue to use the drug past the expiration.
b. The patient should not have extra doses. Discuss the frequency of the medication with the patient.
c. The drug is not stable after the 28 day mark.
d. It is okay to use the drug up to 30 days.
Ans: C, page 551.
129
Select all that apply: which of the following are appropriate drugs for Hypercalcemia?
a. Furosemide.
b. Glucocorticoids
c. Inorganic phosphates
d. Edeate disodium
Ans: All of the above (A, B, C, D).
130
A patient presents for a follow up appointment and has been taking Risderonate IR for a few weeks and has been experiencing diarrhea and headaches. Which of the following would be an appropriate statement to the patient?
a. These symptoms indicate an overdose and you need to be transferred to the ER now.
b. These are common side effects of this drug.
c. A patient should discuss taking a extended release version of this drug.
d. This this med is taken after meals it would decrease symptoms.
Ans: B, page 547.
131
A post-menopausal woman is at high risk for developing osteoporosis. She has been prescribed Raloxifene. What is the most correct statement made my the patient when she is reflecting on education you provided about this drug?
a. I should walk around as much as possible when I travel on long airline flights.
b. I may experience breast tenderness while taking this drug.
c. I may experience fewer hot flashes.
d. I should d/c this drug weeks before planned surgeries.
Ans: A, page 550. This drug has a black box warning that it has an increased risk for DVTs and PE.
132
What dietary supplement is used to decrease nausea, management of IBS, small intestinal bacterial overgrowth (SIBO) and topically to prevent nipple cracking r/t breastfeeding. This dietary supplement has demonstrated bacteriostatic effects against 22 strains of both gram positive and gram negative bacteria and bactericidal activity against E. coli, H. Pylori and salmonella.
a. Probiotics
b. Resveratrol
c. Peppermint oil
d. Saw Palmetto
C. Peppermint Oil
p. 646
Randomized control studies have showed a beneficial effect for IBS
Also gaining recognition for SIBO
133
When should Probiotics be given in relation to antibacterial or antifungal drugs?
a. no sooner than 2 hours after dosing with antibacterial or antifungal drugs
b. give at the same as the antibacterial or antifungal drugs
c. give 30 minutes after the antibacterial or antifungal drugs
d. Do not give at the same time
a. no sooner than 2 hours after dosing with antibacterial or antifungal drugs
pg. 646
134
A nurse is teaching a group of lifeguards about safe sunning. Which statement by a lifeguard indicates understanding of the teaching?
A. “Sunscreen should be applied 30 minutes before going outside.”
B. “I do not need sunscreen when it is cloudy outside.”
C. “I should reapply sunscreen after swimming.”
D. “UV radiation does not penetrate through the clouds.”
ANSWER: C
drugs for skin study video
135
A female patient comes in with complaints of hair loss. She states, “my husband takes Minoxidil – the 5% solution and it works really well for him – can I get the same prescription? What would the provider tell the patient?
A. Only the 2% solution is approved for women
B. The 5% solution would need to be applied more frequently
C. Tell her that you will order the 5% solution
D. Prescribe an antianxiety medication
ANSWER: A - Only the 2% solution is approved for women
drugs for skin study video
136
```
What is the first line therapy regarding treating Eczema?
A. Glucocorticoids
B. Antihistamines
C. Topical Immunosuppressants
D. Moisturizers
```
ANSWER: D - Moisturizers
drugs for skin study video
137
A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend?
A. Asking the provider about oral contraceptives
B. Cleansing the face gently two to three times daily
C. Eliminating greasy foods from the diet
D. Using an abrasive agent to scrub the face
ANSWER: B Gentle cleansing two to three times a day can reduce surface oiliness and help minimize acne lesions. Oral contraceptives are not first-line treatment for acne. Eliminating greasy foods from the diet does not affect pimple formation. An abrasive agent is not indicated for mild acne
drugs for skin study video
138
As the healthcare provider, what education should be provided to the patient prior to receive a Botox injection?
A. That Botox is only effective if the patient is over the age of 65
B. Avoid alcohol and Aspirin for one week prior to receiving the injection
C. Continue drinking and taking all meds as the patient normally would
D. Bruising is normal after the procedure
ANSWER: B. Avoid alcohol and Aspirin for one week prior to receiving the injection
Botox should not be given to a patient over the age of 65. The patient is likely to bruise after the procedure, and ETOH & ASA will increase the likelihood of the bruising – therefore these should be stopped one week prior to receiving the injection.
drugs for skin study video
139
Impetigo is usually caused by?
A. C. Diff
B. H. Pylori
C. S. aureus
D. Moraxella catarrhalis
ANSWER: C - S. Aureus
drugs for skin study video
140
A female patient with baldness asks a nurse about the safety and efficacy of minoxidil [Rogaine]. What will the nurse tell the patient?
A. Hair regrowth is most effective when baldness has developed recently.
B. Minoxidil cannot be used by female patients.
C. Once hair has been restored, minoxidil may be discontinued, because hair loss will stop.
D. Systemic side effects, such as headaches and flushing, are common.
ANSWER: A - Hair regrowth is most effective when baldness has developed recently.
Minoxidil is most effective at treating recent hair loss. It may be used in female patients. Hair loss may continue even with uninterrupted treatment. Systemic side effects are not common
drugs for skin study video
141
A patient is using a high-concentration keratolytic agent containing 20% salicylic acid to remove warts. What will the nurse teach this patient?
A. Peeling and drying are desired effects of this drug.
B. Systemic effects may occur with this medication.
C. Tinnitus is a common side effect of little concern.
D. Tissue injury is unlikely at this dose.
ANSWER: B - Systemic effects may occur with this medication.
Salicylic acid is readily absorbed through the skin, and systemic toxicity can result. Peeling and drying are not desired effects of salicylic acid. Tinnitus is a symptom of systemic toxicity. Tissue injury is likely in any concentration above 6%
drugs for skin study video
142
A patient asks a nurse what a sun protection factor (SPF) of 15 indicates. The nurse will tell the patient that an SPF of 15 indicates:
A. a 93% block of UVB radiation.
B. half the protection of a sunscreen with an SPF of30.
C. low protection
D that it takes 15 minutes for the sun to burn.
ANSWER: A. A sun protection factor of 15 indicates a 93% block of UVB. As the SPF increases, the increment in protection gets progressively smaller, so an SPF of 15 is not half that of an SPF of 30. Low protection is indicated by an SPF of 2 to 14.
drugs for skin study video
143
Drug therapy for acne is based on?
A. How long the acne has been occurring
B. The symptom severity
C. Genetic Predisposition
D. Skin type
ANSWER: B - The symptom severity
drugs for skin study video
144
Which of the following calcium salt provides the highest percentage of calcium content?
A) Calcium Citrate/ Citracal
B) Calcium Acetate/ PhosLo
C) Calcium Carbonate/ Tums
D) Tricalcium Phosphate/ Posture
Answer: C - Calcium Carbonate/ Tums
pg. 540
145
A patient taking calcium supplements reports lethargy, nausea, vomiting, and feeling ‘down’. Which could be the indication for these signs and symptoms?
A) Hypercalcemia
B) Hypocalcemia
C) Vit D deficiency
D) Vit D Toxicity
Answer: A - Hypercalcemia
pg. 540
146
A patient is to begin taking calcium supplements and reports being on a tetracycline antibiotic. The patient does not require further teaching when they say-
A) “I need to complete antibiotic therapy before taking any calcium salts.”
B) “I should switch to another antibiotic.”
C) “Taking the medications at the same time will increase the absorption of the antibiotic.”
D) “I should separate the antibiotic and calcium salt by 1 hour.”
Answer: D- “I should separate the antibiotic and calcium salt by 1 hour.”
pg. 540
147
All of the following can reduce risks for bisphosphonate-associated esophagitis except-
A) Standing for at least 30 minutes after administration.
B) Taking the medication with a sip of water.
C) Sitting up for 30 minutes after administration.
D) Avoiding in patients with swallowing difficultly.
Answer: B- Taking the medication with a sip of water.
pg. 546; Bisphosphonates are contraindicated in patients with unsuccessful swallowing, who cannot sit or stand for at least 30 minute, and should be taken with a full glass of water.
148
```
Which of the following does not have adverse drug interactions with calcium salts?
A) Glucocorticoids
B) Spinach
C) Orange Juice
D) Bisphosphonates
```
Answer: C-Orange Juice
| pg. 540
149
Which of the following drugs affecting calcium levels and bone mineralization is viewed as a hormone?
A) Vitamin D
B) Calcium Gluconate
C) Zoledronic Acid/Reclast
D) Roloxifene/Evista
Answer A- Vitamin D
pg. 542
150
Prior to initiating oral bisphosphonate therapy, which baseline data should the provider not be concerned about collecting?
A) Dental exam
B) Axial DXA
C) Serum Calcium
D) Height
Answer: A- pg. 549; Dental exam is appropriate to reduce risk of ONJ in IV bisphosphonates.
151
Which bisphosphonate is recommended to take with food as opposed to other bisphosphonates?
A) Alendronate/Fosamax
B) Ibandronate/Boniva
C) Zoledronic Acid/Reclast
D) Risedronate/Altevia
Answer: D- pg. 547; Risedronate/Altevia should be taken with food to reduce stomach pain.
152
A patient being prescribed a bisphosphonate requires further education when they say-
A) “I should remain in an upright position for at least 30 minutes after administration.”
B) “I need to take this medication lifelong to prevent fractures.”
C) “I should report any vision changes or eye pain.”
D) “Taking this medication on an empty stomach allows the medication to work better.”
Answer: B- pg. 546; Bisphosphonates remain in the bone and prevent fractures for years and even decades after being discontinued. Use should be evaluated after 5 years.
153
. A patient with osteoporosis taking Calcium Carbonate reports experiencing nausea and bloating. Which of the following is the most appropriate for the provider implement?
A) Lower the dose and follow up in a week.
B) Prescribe an antiemetic.
C) Switch the patient to another calcium salt supplement.
D) Recommend taking with leafy green vegetables.
Answer: C- pg. 540 and video notes; Calcium Citrate is better tolerated to reduce GI upset. Patient should not switch to other calcium salts OTC on their own due to variation in calcium content.
154
what dietary supplement is found in small quantities in red wine and has been studied for its benefits in increasing cardiovascular function, bone density, motor coordination and delayed formation of cataracts. This dietary supplement has also been studied for suppression of tumor growth in cancer research.
a. Saw Palmetto
b. Resveratrol
c. Ginko Biloba
d. Garlic
B. Resveratrol
pg 646
the amount in red wine does not seem to be high enough to cause significant cardioprotectant effects
clear benefits in animal studies
155
What dietary supplement is taken to relieve urinary symptoms associated with BPH and for treatment of androgenic alopecia?
a. Resveratrol
b. Echinacea
c. Saw Palmetto
d. Resveratrol
c. Saw Palmetto
pg 647
insufficient evidence to support using saw palmetto for BPH or any other condition
156
What dietary supplement is used for prevention of breast cancer and in postmenopausal women, treatment of vasomotor symptoms (ie) hot flashes) and prevention of osteoporosis.
a. Resveratrol
b. Saw Palmetto
c. Echinacea
d. Soy
D. Soy
pg 647
studies lean towards a reduction in hot flashes
some studies may show reduction in risk for breast cancer
mixed studies on the effectiveness of increasing bone density
157
what dietary supplement is primarily used for treatment of mild to moderate depression. This herb has also been used topically to manage local infection and orally to relieve pain and inflammation
a. Soy
b. Garlic
c. Echinacea
d. St. Johns Wort
d. St Johns Wort
pg 648
appears to be superior to placebo in mild to moderate depression and equal to tricyclic antidepressants
NOT recommended for patients taking any other medications due to the number of potential interactions
158
What dietary supplement is used to promote sleep and help with anxiety-related restlessness?
a. St Johns Wort
b. Valerian
c. Echinacea
d. Resveratrol
b. Valerian
pg. 648
FDA has given valerian a Generally Recognized as Safe (GRAS) rating
159
What are the 3 harmful supplements to avoid labeled as dietary supplements.
a. . Comfrey, Kava, Ephedra
b. Ephedra, Valerian, Resveratrol
c. Echinacea, St. Johns Wort, Ephedra
d. St. Johns Wort, Ephedra, Soy
A. Comfrey, Kava, Ephedra
pg. 649
Comfrey - supposed to be removed from the market
Kava - used to relieve anxiety, promote sleep and relax muscles - caused severe liver injury - still available in the US but not safe
Ephedra - associated with stroke, MI and death - banned in the US but not in Asian medicines or herbal teas which are not marked as dietary supplements
160
Which of the following is a biologic DMARD?
A. Methotrexate
B. Sulfasalazine
C. Golimumab
D. Hydroxychloroquine
Answer: C (table 59.3)
161
Which of the following is the DMARD of first choice, typically prescribed as soon as possible upon diagnosis of RA?
A. Hydroxychloroquine
B. Celecoxib
C. Methotrexate
D. Sulfasalazine
Answer: C (pg 517)
162
What is a concern with prescribing DMARDs to older adults?
A. Fall risk
B. Orthostatic hypotension
C. Drowsiness
D. Immunosuppression
Answer: D (pg 518)
163
Select all that apply: Which of the following drug classes are used for symptomatic and short term treatment of RA only?
A. conventional DMARDs
B. glucocorticoids
C. biologic DMARDs
D. NSAIDs
Answers: B, D (RA study guide video)
164
```
Which of the following is the most serious adverse effect of hydroxychloroquine?
A. hypoglycemia
B. retinal damage
C. GI distress
D. prolonged QT interval
```
Answer: B (all are adverse effects to watch for, but retinal damage is listed as the most serious on pg 520)
165
Select all that apply. Which labs must be monitored on a patient taking biologic DMARDs?
A. LFTs
B. CBC
C. WBC
D. platelet count
Answer: all of the above (RA study guide video and pg 527)
166
```
Which of the following should a patient avoid if they are taking biologic DMARDs?
A. orange juice
B. antihypertensives
C. live flu shot
D. inactivated vaccines
```
Answer: C (pg 527)
167
Which of the following is considered a high risk patient for DMARD treatment?
A. moderate to severe RA
B. previous history of a knee replacement
C. patient with HIV
D. 45 year old man
Answer: C (pt 527)
168
Select all that apply. Which of the following is a therapeutic goal of RA treatment?
A. slow disease progression
B. symptom management
C. maintain joint function
D. minimize systemic involvement
Answer: all of the above (pg 527)
169
Which of the following is an important part of monitoring a patient taking hydroxychloroquine?
A. DEXA scan
B. ophthalmologic exam
C. renal function labs
D. chest x-ray
Answer: B (pg 527)
170
In adults, a severe deficiency of thyroid is called
a. hypothyroidism
b. Graves disease
c. myxedema
d. hyperthyroidism
Answer C pg 418
171
Thyroid medication should be taken with or without food?
WITHOUT
| Taking it with food will make it more difficult to adjust doses. Absorption decreases with food!
172
Treatment for Graves disease is directed at
a. increasing the production of thyroid hormones
b. decreasing the production of thyroid hormones
Answer: B, page 419 Graves disease is caused by EXCESSIVE thyroid hormone secretion
173
Levothyroxine is indicated for all of the following conditions EXCEPT:
a. hypothyroidism
b. myxedema coma
c. simple goiter
d. congenital hypothyroidism
e. hyperthyroidism
Answer E. pg 420
174
Which of the following drugs is known to accelerate levothyroxine absorption?
a. Heparin
b. Warfarin
c. Catecholamines
d. aspirin
Answer B, C. page 420
175
Symptoms of thyrotoxicosis include which of the following? Select all that apply
a. tachycardia
b. bradycardia
c. angina
d. tremor
e. nervousness
d. insomnia
f. cold intolerance
g. somnolence
Answer: A,C,D, E, F HEAT intolerance is also common pg 421
176
When should TSH levels be checked after initiating treatment?
a. 7-10 days
b. 6-8 weeks
c. 9-12 weeks
d. 72 hours
Answer B, pg 421
177
Therapeutic uses for Methimazole include
a. monotherapy for Graves disease
b. adjunct to radiation therapy
c. thyrotoxic crisis
d. all of the above
Answer: D, page 422
178
If a newborn is diagnosed with hypothyroidism, the plan of action should be
a. treat the infant with Synthroid for 6-8 weeks and reevaluate
b. nothing, the condition is from the mother and it will correct itself
c. treat for 3 years and then stop for 4 weeks followed by labs to determine next step
d. Treat the infant with high dose levothyroxine hoping it will correct the level faster
Answer: C, once the labs are completed after the 4 weeks without meds, it will be determined if the hypothyroidism was transient or permanent pg 423
179
True or false, methimazole is safe in pregnancy.
FALSE
| Pg 422
180
Q1. A patient is prescribed Alendronate (Fosamax). What will the APRN educate the patient on in regards to medication administration?
a. Take the medication with a full glass of water in the evening after two-hours after eating
b. Take this medication with breakfast and a glass of milk
c. Take with orange juice any time of day
d. Take the medication on an empty stomach a full glass of water and sit or stand for 30-60 minutes after taking.
Answer: D.
Take the medication on an empty stomach a full glass of water and sit or stand for 30-60 minutes after taking.
ch. 61 audio clip
181
Q2. Bisphosphonates are medications used to treat osteoporosis. Which medications are considered Bisphosphonates?
a. Alendronate, Ibandronate, Risedronate, Zoledronic Acid
b. Ibandronate, Risedronate, Zoledronic Acid
c. Ibandronate, Zoledronic Acid
d. Alendronate, Risedronate
Answer: A.
| ch. 61 audio clip
182
Q3. A patient is being educated on dietary choices when starting calcium salts. What will the APRN advise the patient to avoid?
a. Foods containing Tyramine such as wines and cheeses
b. Avoid all dairy products
c. Foods containing oxalic acid such as spinach, beets, swiss chard
d. No dietary changes are necessary when taking calcium salts
Answer: C.
ch. 61 audio clip
183
Q4. The RDA of vitamin D for adults 1-70 years old is?
a. 800 IU/day
b. 600 IU/day
c. 400 IU/day
d. Vitamin D supplementation is not recommended until after 70 years old
Answer: B
ch. 61 audio clip
184
How do Bisphosphonates work?
a. They incorporate into the bone and then inhibit bone resorption by decreasing osteoclasts
b. They incorporate into the bone and then inhibit bone resorption by increasing osteoclasts
c. They incorporate into the bone and then inhibit bone resorption by decreasing osteoblasts
d. They incorporate into the bone and then inhibit bone resorption by helping maintain the number of osteoclasts
Answer: A
ch. 61 audio clip
185
Teriparatide (Forteo) is a drug that is approved for osteoporosis. How is this drug administered?
a. Patients will receive yearly IV treatments of the medication
b. Patients can administer the medication themselves with an auto-injector pen
c. This is an oral medication that is taken once daily
d. Patients will receive twice yearly IV treatments
Answer: B
ch. 61 audio clip
186
Q7. Which of the following drugs is designed to treat and prevent breast cancer and has effects on maintain bone mineral density?
a. Teriparatide (Forteo)
b. Raloxifene (Evista)
c. Ibandronate
d. Risedronate
Answer: B
ch. 61 audio clip
187
The APRN recommends the patient with osteoporosis should start taking a calcium supplement. During teaching, the patient asks if there are any medications that can interact with the calcium supplement. Which of the following medications will the APRN tell the patient can interact by decreasing absorption of the calcium supplement?
a. Glucocorticoids
b. Beta Blockers
c. NSAIDS
d. Selective Estrogen Receptor Modulators
Answer: A
ch. 61 audio clip
188
The bisphosphonate, Zoledronic acid (Reclast) has which side effect?
a. Photophobia
b. Blurred Vision
c. New onset Atrial Fibrillation
d. Fever, Flu-like symptoms
Answer: D
ch. 61 audio clip
189
Q10. A patient is taking a calcium supplement and tetracycline. The patient asks the APRN if they can take the two medications at the same time. What does the APRN tells the patient?
a. There is no need to wait between medications
b. Wait at least one hour, ideally two hours, before taking other medication
c. Wait 5-minutes between taking another medication
d. Wait 15-minutes after taking the calcium supplement to take the antibiotic
Answer: B
ch. 61 audio clip
190
A NP is seeing a 25 year old female with complaints of a severe, throbbing headache
with nausea and vomiting. It has been ongoing for 2 days. She states that she gets them
about twice a month. She has been taking Excedrin migraine as directed on the box with
no relief. She is currently on birth control. What medication should the NP prescribe?
a. Butorphanol nasal spray
b. Acetaminophen
c. Sumatriptan (Imitrex) nasal spray
d. dihydroergotamine (D.H.E. 45, Migranal) IM
Answer C. p. 196-199: triptans, are first-line drugs for terminating a migraine attack
Opioid analgesics are reserved for severe migraine that has not responded to first-line
medications; Acetaminophen should be used only in combination with other drugs, not
alone and the patient has not responded to Excedrin migraine; dihydroergotamine
(D.H.E. 45, Migranal)—given by the intramuscular (IM)- is a second-line drug for
terminating a migraine attack
191
Which of the following statements is incorrect?
a. When determining how to prescribe an opioid, providers should start with the
lowest effective dosage for the patient
b. Most patients get enough relief with the standard doses of opioids
c. larger doses are needed for patients who have more intense pain and for those
who have developed tolerance
d. Older-adult patients metabolize opioids slowly and therefore require lower
doses than younger adults
Answer B. p. 194 “Standard” doses cannot be relied on as appropriate for all patients.
For example, if a “standard” 10-mg dose of morphine were employed for all adults, only
70% would receive adequate relief; the other 30% would be undertreated
192
The use of aspirin in conjunction to opioids is contraindicated in which patient?
a. A 7 year old boy that broke his arm
b. A 24 year old male that was recently in a car accident and has multiple injuries
c. A 35 year old female that recently had a c-section
d. A 50 year old male with a debilitating work injury that is requiring PT.
Answer A. p. 194 Patient centered care across the life span; Aspirin, as an adjuvant to
opioids, should be avoided {in children} because of risk for Reye syndrome
193
Which of the following statements are correct with regards to a patient that has been
taking high doses of opioids for more than 20 days? (select all that apply)
a. clinically significant physical dependence may have developed
b. abrupt withdrawal will precipitate an abstinence syndrome
c. The opioid should be replaced with an NSAID without tapering the opioid
d. The dosages should be tapered over 3 days or more
Answer C p. 194 To minimize symptoms of abstinence, opioids should be withdrawn
slowly, tapering the dosage over 3 days. If the degree of dependence is especially high,
as can occur in opioid addicts, dosage should be tapered over 7 to 10 days.
194
The CDC guidelines for Safe Opiate prescribing states that: (select all that apply)
a. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred
for chronic pain. Clinicians should consider opioid therapy only if expected
benefits for both pain and function are anticipated to outweigh risks to the
patient
b. When starting opioid therapy for chronic pain, clinicians should prescribe
extended-release/long-acting (ER/A) opioids
c. Clinicians should review the patient's history of controlled substance
prescriptions using state prescription drug monitoring program (PDMP) data to
determine whether the patient is receiving opioid dosages or dangerous
combinations that put him or her at high risk for overdose.
d. Clinicians should avoid prescribing opioid pain medication and benzodiazepines
concurrently whenever possible.
Answer A,C,D p. 192 Box 24.1; B is incorrect--When starting opioid therapy for chronic
pain, clinicians should prescribe immediate-release opioids instead of extended-
release/long-acting (ER/A) opioids
195
All of the following medications have been shown to help prevent migraine headaches,
EXCEPT:
a. Propranolol
b. Sumatriptan
c. Divalproex
d. Amitriptyline
Answer B. p. 196 Sumatriptan is a drug for terminating a migraine attack
196
Which of the following patient should not be prescribed sumatriptan (Imitrex) for
migraine headaches?
a. 25 year female with two children that has 1-2 migraines a month
b. 55 year old male with a history of MI and 1-2 migraines a month
c. 40 year old female with family history of diabetes and 1-2 migraines a month
d. 30 year old female with a history of asthma and 1-2 migraines a month
Answer B. p. 198 Owing to the risk for coronary vasospasm, sumatriptan is
contraindicated for patients with a history of ischemic heart disease, myocardial
infarction (MI), uncontrolled hypertension, or other heart disease.
197
An NP is seeing a patient with a migraine headache. The patient states that the last
doctor she saw prescribed sumatriptan, but she was not able to fill that prescription
because it was too expensive. What should the NP do?
a. Prescribe metoclopramide with aspirin
b. Prescribe sumatriptan again
c. Tell her to take OTC acetaminophen
d. Prescribe ergotamine
Answer A. p 196 . when combined with metoclopramide (to enhance absorption),
aspirin may work as well as sumatriptan, a highly effective antimigraine drug. Moreover,
the combination of aspirin plus metoclopramide costs less than sumatriptan and causes
fewer adverse effects; the patient cannot afford sumatriptan, therefore, this option is
not in the best interest of patient. Acetaminophen should be used only in combination
with other drugs, not alone; ergotamine is second line drug.
198
An NP is seeing a patient for migraines. The patient states that she has had migraines for
years and she takes medication for them (sumatriptan), but lately she has been having
to take it more frequently because she has been getting more headaches. What is the
most probable cause?
a. The patient needs a higher dose of sumatriptan
b. The patient should be switched to butorphanol nasal spray since her headaches
are not responding
c. The patient is experiencing medication overuse headaches from her frequent use
of sumatriptan.
d. The patients pain tolerance has declined
Answer C. p. 201 MOH is a chronic headache that develops in response to frequent use
of headache medicines. Almost all of the medicines used for abortive headache therapy
can cause MOH: analgesics (aspirin-like drugs, opioids), triptans, ergotamine (but not
dihydroergotamine), and caffeine
199
10. What are two highly effective choices for treating an ongoing cluster headache? (choose 2)
a. Sumatriptan 6 mg subQ.
b. Inhaling 100% O2 for 15-20 minutes
c. Sublingual ergotamine
d. butorphanol nasal spray
Answer A&B. p. 201 If an attack occurs despite preventive therapy, it can be aborted
with sumatriptan or oxygen. Sumatriptan (6 mg subQ) is the treatment of choice for
cluster headaches. Inhaling 100% oxygen (7 to 10 L/min for 15 to 20 minutes) is also
highly effective and has virtually no adverse effects. In the past, ergot preparations (e.g.,
intravenous dihydroergotamine, sublingual ergotamine) were commonly used.
However, their use today is limited because modern trials are small in population and
lack evidence that these drugs work any better at relieving cluster headaches than
placebo.
200
Auranofin (Ridaura) has a black box warning that gold compounds can cause gold toxicity by serious (select all that apply)
A) Blood Dyscrasias
B) Stomatitis
C) Constipation
D) Proteinuria and Hematuria
Answer: A, B, D (pg 521)
201
```
Hydroxychloroquine has a half life of
A) 40 days
B) 2 weeks
C) 6-8 hours
D) 18 days
```
Answer: A- 40 days (pg 520)
202
```
You are starting your patient on a Biologic Disease-Modifying Antirheumatic Drug for the treatment of RA, what would be the most important lab to monitor?
A) CBC w/ Diff
B) LFTs
C) CMP
D) PTI/INR
```
Answer: A (pg 521) Patients taking BDMAs are at high risk for immunosuppression
203
You are prescribing a Biologic Disease-Modifying Antirheumatic Drug, which of the following should be included in your patient education (select all that apply)
A) Avoid live vaccinations while taking the drug
B) The patient should obtain a TB test
C) They should avoid anyone with an active infection
D) They should undergo an eye exam prior to starting the medication
Answer: A, B, C (pg 521/522) An eye exam is not necessary
204
Which type of patient should be monitored with extreme caution while taking Etanercept? (Select all that apply)
A) A patient with Diabetes
B) A patient with Heart Failure
C) A patient with Hep C
D) A patient with MS
Answer: A, B, D (pg 522/523)
205
Which drugs fall in the class of Biologic Disease-Modifying Antirheumatic Drugs (DMARD)? Select all that apply
a. Enanercept (Enbrel)
b. Hydroxychloroquine (Plaquenil)
c. Infliximab (Remicade)
d. Methotrexate
e. Adalimumab (Humira)
f. Golimumab (Simponi, Simponi Aria)
g. Certolizumab Pegol (Cimzia)
h. Sulfasalazine (Azulfindine)
i. Rituximab (Rituxan)
j. Atabacept
k. Tocilizumab (Actemra)
l. Sarilumab (Kevzara)
m. Anakinra (kineret)
n. Tofacitinib (Xeljanz)
Answer: a) Enanercept (Enbrel)
c) Infliximab (Remicade)
e) Adalimumab (Humira)
f) Golimumab (Simponi, Simponi Aria)
g) Certolizumab Pegol (Cimzia)
i) Rituximab (Rituxan)
j) Atabacept
k) Tocilizumab (Actemra)
l) Sarilumab (Kevzara)
m) Anakinra (kineret)
Hydroxychloroquine (Plaquenil), Methotrexate, Sulfasalazine are all Conventional DMARDs
Tofacitinib (Xeljanz) is a Targeted Disease Modifying Antirheumatic Drug: Janus Kinase Inhibitor
Ch. 524
206
What medication would be indicated to treat adults with moderate to severe RA who have not responded to one or more TNF inhibitors used in combination with Methotrexate? This medication can also be used to treat two inflammatory disorders of the blood vessels, Wegener granulomatosis and microscopic polyangiitis, and for two types of cancer: B cell non-Hodgkin Lymphoma and B-cell chronic lymphocytic leukemia?
a. Atabacept
b. Tocilizumab (Actemra)
c. Sarilumab (Kevzara)
d. Rituximab (Rituxan)
Answer d) Rituximab (Rituxan) - pg 523-524
| This is in the only med in the B-lymphocyte-depleting agents class
207
What must patients be premedicated with prior to receiving Rituximab (Rituxan)? Select all that apply
a. Antihistamine
b. Acetaminophen
c. Motrin
d. Intravenous glucocorticoid such as e. methylprednisolone
f. Epinephrine
g. Bronchodilators
h. Oxygen
Answer: A, B, D
Antihistamine, Acetaminophen and some experts recommend also premedication with an IV glucocorticoid such as methylprednisolone - pg 524
Severe and fatal reactions occur in approximately 80% of patients during the first induction
If a severe reaction occurs, management includes giving glucocorticoids, epinephrine, bronchodilators and oxygen
This med has serious side effects and serious adverse reactions
208
For a patient who is taking a Biologic DMARD, what should be their stance when offered a vaccine?
a. These patients should not take any vaccines.
b. This patient can take only inactivated vaccines
c. This patient should always opt for the live-attenuated vaccines when given a choice
d. Either vaccine choice is acceptable
Answer: B
These patients are immune-compromised and should receive vaccinations. However, they should not receive live vaccinations
209
What combination of medications would be concerning for someone diagnosed with RA
a. Methotrexate and Rituximab (Rituxan)
b. Tofacitinib (Xeljanz) and Infliximab (Remicade)
c. Hydroxychloroquine (Plaquenil), Methotrexate, Aspirin, and Prednisone
Answer: B - Tofacitinib (Xeljanz) and Infliximab (Remicade)
Pg 526
Option c is your first line combo
