Exam 5 Review COPY Flashcards
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
D. reverse disease progression
Ch. 59 video
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
B. Start an NSAID or glucocorticoid for quick relief and start a DMARD at the same time
Ch. 59 video
Which of the following is a targeted DMARD?
A. Humira
B. Methotrexate
C. Xeljanz
D. Arava
C. Xeljanz
Ch. 59 video
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. Folate antagonist
D. Should never be used in pregnancy
Ch. 59 video
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. originally developed as an antimalarial drug
B. half life is about 40 days
C. can cause retinal damage
Ch. 59 video
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. potential for infection
C. take inactivated vaccines (not live vaccines)
Ch. 59 video
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
C. higher risk of liver damage than methotrexate
Ch. 59 video
Which of the following are janus kinase (JAK) inhibitors? A. targeted DMARDs B. biologic DMARDs C. conventional DMARDs C. traditional DMARDs
A. targeted DMARDs
Ch. 59 video
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. 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
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
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
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)
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
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)
Answer: B-Regular insulin (Humalin R, Novolin R)
Reasoning: the rest are short duration: rapid acting p402-403
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
Answer: D-increase in fluid intake
Reasoning: increase in fluid intake is not a cause of hypoglycemia p. 406
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
Answer: A, B, C, D
Reasoning. P. 406
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
Answer: B- glucocorticoids
and C - thiazide diuretics
Reasoning Alcohol causes hypoglycemia and B-blockers mask symptoms of hypoglycemia
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
Answer: B- 15-30 minutes; 3-6 hours
Reasoning: p. 402
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
Answer: C 10-20 minutes; 3-5 hours
Reasoning p402
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
Answer: A - 30-60 min; up to 10 hours
Reasoning p. 403
Question: How often should an A1c be monitored?
A) every year
B) every 3 months
C) every 2 weeks
D) monthly
Answer: B - every 3 months
Reasoning: p 400
Question: What is the first step to treating diabetes?
A) lifestyle changes
B) insulin
C) metformin + thiazolidinedione
D) metformin + lifestyle changes
Answer: D - metformin + lifestyle changes
Reasoning p 400
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
Answer: A. First Trimester
Reasoning: Module audio clips ch 49
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
C. Increase
ch. 49
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
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
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
Answer: E - C & D
Reasoning: Module Audio Clips Dr. Bruce states Amiodarone is known to cause hypothyroidism
ch 49
- 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
When starting opioid therapy which option is safer to use Immediate release or extended release ?
Immediate release page 192
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
