patho test 3

Question 1

Mr. Gray, a 65 year-old male with a past medical history of CHF presents to your clinic today complaining of flu-like symptoms, including shortness of breath, fever and general malaise. Chest x-rays show consolidation in the right middle and lower lobes of the lungs, positive for rhonchi in those lobes and a sputum sample testing positive for H. influenzae. One of your partners recommends a prescription of azithromycin for Mr. Gray. Which of these tests would you consider to be the least important to conduct prior to prescription of azithromycin?

A. EKG

B CMP

C Urinalysis

D Ultrasound of the abdomen

Answer 1

D. Ultrasound is not an indicated testing procedure for the prescription of macrolides like azithromycin.

It is important to take an EKG prior to prescription, as macrolides are known to cause QTc prolongation and increased risk for torsades (A) (Woo & Riley, 2024, p. 716). It is important to assess for electrolyte, hepatic and renal issues as macrolides can cause further problems in those areas.

Question 2

Bethany is a 66 year-old female who is presenting with left knee and great toe pain with swelling that is getting progressively worse over the last 3 weeks. She has a past medical history of osteoarthritis, and has taken the recommended dosage of acetaminophen to alleviate symptoms however it has not been effective, and has been attending physical therapy as well. Of note, her urinalysis indicated higher levels of uric acid. Which of these medications would be most beneficial to recommend and prescribe Bethany to help with her pain?

A. Naproxen (Aleve)

B. Ketorolac (Tramadol)

C. Celecoxib (Celebrex)

D. Ibuprofen (Advil)

Answer 2

A.
After treatment attempts with acetaminophen and physical therapy, NSAIDs are effective at helping to control discomfort/pain with OA. Bethany’s presentation of possible gout from her great toe and elevated uric acid levels indicate Naproxen as the most appropriate medication recommendation, as it is indicated to help alleviate pain from both OA and gout (Woo & Wright, 2024, p. 798). Ketorolac is not a recommended NSAID treatment for OA (B). While Celecoxib and Ibuprofen are indicated for OA, they would not be the most effective recommendation for Bethany to help alleviate her pain associated with gout presentation (C & D).

Question 3

While working with a nursing student, they ask why a patient would receive an antihistamine like benadryl for motion sickness compared to another antiemetic like ondansetron (zofran). Which of the following responses would be the best reasoning?

A. Antihistamines are more effective at targeting specific areas related to motion sickness

B. Patients first require an antihistamine before qualifying for a phenothiazine for nausea

C. Antihistamines have a shorter effect, thus allowing for the patient to have more control over their symptoms

D. Either one works effectively for motion sickness, so you can prescribe them practically the same

Answer 3

A. Antihistamines act on the vestibular system, and motion sickness tends to be caused by alterations in said system. Therefore, they are typically the preferred medication to prescribe/recommend for nausea related to motion sickness (Woo & Wright, 2024, p. 480).

Question 4

A patient with a history of atrial fibrillation on warfarin therapy comes to your clinic complaining of dysphagia and weight loss. Upon further review of systems, you find this patient has previously been to her primary provider for similar complaints around 3 months ago, and has found little relief of symptoms from lifestyle changes. In addition to referral to a gastroenterologist, which medication would be most appropriate to prescribe for this patient as part of therapy? (491)

A. Omeprazole (Prilosec)

B. Lansoprazole (Prevacid)

C. Polyethylene glycol (Colyte)

D. Dimenhydrinate (Dramamine)

Answer 4

B. This patient would likely benefit from initiation of a proton-pump inhibitor to help relieve her unpleasant GI symptoms. Between the two options, Lansoprazole (B) would likely be the best option, as there is no clinically significant data that suggest it interferes with medications that are metabolized by the CYP450 system, and her current regiment with warfarin make option B the best choice (Woo & Wright, 2024, p. 491). Omeprazole may affect the effectiveness of warfarin, and should be avoided (A). Colyte and Dramamine would not currently be appropriate prescriptions for the patient’s current condition, as there are no reports of either constipation or nausea (C & D).

Question 5

You are precepting Anne, a nursing student, at your outpatient diabetes management clinic. While reviewing metformin (Glucophage) for her upcoming test on type II diabetic management, which statement by Anne would promote further education for better understanding of the medication?

A. It is typically a first-line pharmacologic treatment for type II diabetes

B. While commonly prescribed for pre-diabetes management, this is not an FDA-approved indication

C. Hypoglycemia is a common adverse reaction for metformin, and should be monitored cautiously

D. Lifestyle modifications should be recommended/implemented before pharmacologic intervention

Answer 5

C. While it is essential for glucose monitoring for all patients with any sort of insular issue, metformin has not shown to cause issues with hypoglycemia. Metformin’s primary action is to decrease hepatic glucose production and help reduce fasting-glucose levels as well as increase insulin sensitivity, but does not directly stimulate the higher production of insulin from the pancreas (Woo & Wright, 2024, p. 518). Metformin directly acts on the pathologic issue of type II diabetes and can be tolerated by most patients over the age of 10, so it is a first-line therapy (A). It is correct that it is not an FDA-approved indication for prescription due to prediabetes, however it’s beneficial effects on decreasing fasting-plasma glucose, lowering of triglyceride levels and increase in high-density lipoproteins have made it a common choice for prescribers (B). Lifestyle modification is always the first-line treatment prior to prescription of oral antidiabetic agents, and continued if pharmacologic management is required (D).

Question 6

Which of these patients would not be appropriate for the immediate prescription of pancrelipase?

A. A 20 year-old patient diagnosed with cystic fibrosis at age 11 not currently in exacerbation

B. A 38 year-old patient post gastrectomy with mild hepatic impairment

C. A 50 year-old patient with a history of common bile duct obstruction

DA 65 year-old patient with chronic pancreatitis currently experiencing an acute exacerbation

Answer 6

The correct answer is D. While all these patients fall under the correct conditions for prescription of pancrelipase, it is not recommended for patients that are experiencing acute pancreatitis exacerbations, as they should be NPO and therefore have no need for digestive enzymes supplemented by pancrelipase (Woo & Wright, 2024, p. 556). Patients with cystic fibrosis are recommended to be on pancrelipase, as the CFTR protein is crucial for transport of enzymes necessary for digestive breakdown that come from the pancreas (A). Patients that receive a gastrectomy are recommended to have supplemental enzyme support, and while liver functioning should be monitored, it is not necessary to withhold medication from mild impairment, however dosage should be adjusted (B). Bile duct obstruction can also lead to issues with digestion due to the importance of pancreatic enzymes traveling through this system, so pancrelipase is also recommended for these patients (C ).

Question 7

Which of the following is an incorrect statement about the Oxazolidinone-Linezolid?

A. Linezolid is a synthetic antibiotic
B. Linezolid was originally developed as an antidepressant
C. Linezolid is slowly and not completely absorbed following oral administration
D. Linezolid is avoided in blood infections because concentration is found mostly in tissues

Answer 7

C. Linezolid is absorbed rapidly and completely absorbed after oral administration. Food does not affect the total amount of drug absorption. (Woo & Wright, 2024, p. 722)

Question 8

Christopher is a nurse practitioner at a primary care clinic. He is about to meet with a patient who has an extensive ulcerative colitis history, on currently on a short term Betamethasone 1.4 mg daily therapy for an acute flare up. Which of the following statements would require Christopher to provide education?

A. Since I am a type 2 diabetic, I have been frequently checking my blood sugar while on this medication
B. I don’t take my daily protonix anymore because I haven’t been having heartburn
C. I walk at the gym now because the sidewalk in my neighborhood is extremely deteriorated and uneven
D. NONE of the above

Answer 8

B. Corticosteroids can cause stomach irritation and gastrointestinal bleeds due to an increase in gastric acid secretion. It is important that this patient continues to take per proton pump inhibitor to avoid high levels of acid in her stomach and prevent breakdown of her stomach lining. (Woo & Wright, 2024, p. 784)

Question 9

Daniel is a nurse practitioner student who is providing a patient with heart burn education on antacids. Which statement is false?

A. Antacids help to increase the pH of the stomach, inhibit proteolytic activity of pepsin and increase lower esophageal sphincter tone
B. You should take an antacid whenever you feel a new onset of abdominal pain
C. All antacids can alter basic medications’ absorption and effectives
D. Separating administration of antacids and interaction medications by 2 hours and prevent interactions

Answer 9

B. All antacids are contraindicated in the presence of severe abdominal pain of an unknown cause. (Woo & Wright, 2024, p. 461)

Question 10

The antiemetic drug class phenothiazines, including prochlorperazine, perphenazine and promethazine, it is important to monitor for, except:

A. Agitation
B. Sedation
C. Abnormal body movements
D. Signs of infection

Answer 10

A. Phenothiazines are known to cause drowsiness. (Woo & Wright, 2024, p. 474)

Question 11

Kennedy is a nurse practitioner who is caring for a 62-year-old female who has type two diabetes, who is on Metformin for management. Which of the follow blood work value is abnormal and likely be caused by Metformin (ADR)?

A. Vitamin B12: 195 pg/ml
B. Hemoglobin: 7.2 g/dl
C. Estimated glomerular filtration rate: 105 ml/min.1.73 m2
D. Thyroid stimulating hormone: 4.5 mlU/l

Answer 11

B. Metformin has been seen to deplete B12 levels. B12 is crucial for production of red blood cells and synthesis of hemoglobin. (Woo & Wright, 2024, p. 525)

Question 12

Which of the following patient descriptions would indicate that they need their thyroid levels check and may need their dose of Synthroid DECREASED?

A. A 31-year-old pregnant female presenting with fatigue and constipation
B. A 45-year-old female presenting with heart palpations and unexplained weight loss
C. A 68-year-old male presenting with bradycardia and cold intolerance
D. A 54-year-old female presenting with declining memory and depression

Answer 12

B. Synthroid is prescribed to patient to manage hypothyroidism. With too high of a does, it can cause too much T4 hormone, causing hyperthyroidism. Signs that the dose is too high (causing hyperthyroidism) include increase metabolism, tachycardia, heat intolerance, excessive sweating, weight loss, anxiety/nervousness, etc. (Woo & Wright, 2024, p. 562)

Question 13

1: Which of the following antiviral drugs requires renal dosage adjustment due to its primary elimination through glomerular filtration and tubular secretion?

A. Acyclovir
B. Oseltamivir
C. Ribavirin
D. Zanamivir

Answer 13

A is correct because Acyclovir is eliminated 90% unchanged through the kidneys. If a patient has a renal condition or impairment, this significantly prolongs its half-life, so we will need to adjust the dosage to avoid accumulation and toxicity.

Question 14

A 55-year-old patient has a history of latent tuberculosis, and he is prescribed prednisone for severe rheumatoid arthritis. What should the provider consider before initiating corticosteroid therapy?

A. Corticosteroids should be avoided as they can reactivate latent tuberculosis.
B. Corticosteroids can be started immediately.
C. The patient should be monitored for hypoglycemia as corticosteroids lower blood sugar levels.
D. The patient should increase dietary sodium intake to prevent adrenal insufficiency.

Answer 14

A because corticosteroids can reactivate latent tuberculosis, so the provider should screen the patient and give prophylactic treatment before initiation.

Question 15

A patient is taking omeprazole (PPI) for GERD and reports that his nighttime reflux symptoms are worsening at nighttime. What is the best recommendation?

A. An H2RA should be added at bedtime to help control nocturnal reflux symptoms.
B. Increase the PPI dose to twice daily without any other changes.
C. Discontinue the PPI and advise pt to drink tea
D. Recommend on-demand H2RA use during the day instead of at night.

Answer 15

A because it is advised to add an H2RA at betimes for patients who are experiencing nighttime reflux while on a PPI to help them manage GERD at nighttime.

Question 16

What is the primary reason for exercising caution when prescribing metoclopramide to a breastfeeding mother?

A. It reduces milk production and should be avoided.
B. The drug accumulates in breast milk and can cause toxicity in the infant.
C. It passes into breast milk, but the amount the infant receives is less than the recommended therapeutic dose for infants. Correct.
D. Infants metabolize metoclopramide more slowly, leading to prolonged drug effects.

Answer 16

C is the correct option because Metoclopramide passes into breast milk, but the amount the infant receives is less than the recommended therapeutic dose for infants, so it should be prescribed with caution when prescribing it to a breastfeeding mother.

Question 17

For which of the following patients would IV glucose and insulin therapy be most appropriate?

A. A hospitalized patient with severe hyperkalemia at risk for cardiac arrhythmias
B. A patient with mild hypokalemia managed with oral potassium supplements
C. A patient with well-controlled type 2 diabetes on metformin
D. A patient experiencing dehydration due to vomiting and diarrhea

Answer 17

A. because IV glucose and insulin therapy are primarily administered to patients with severe hyperkalemia to drive potassium into cells and reduce its concentration in the bloodstream.

Question 18

A patient is prescribed levothyroxine for hypothyroidism. Which factor is most likely to enhance the absorption of this medication?

A. Taking the medication with a high-fiber meal
B. Administering the medication on an empty stomach. Correct answer
C. Consuming calcium supplements with the medication
D. Having a history of malabsorption syndrome

Answer 18

correct answer is B because levothyroxine is better absorbed on an empty stomach. Its absorption varies between 48% and 79% when the patient is fasting, so this ensures better bioavailability.

Question 19

A 68-year-old patient who was treated with antibiotic therapy for community-acquired pneumonia a week ago presents to your office complaining of difficulty walking with painful and swollen tendons. Which of the following antibiotics is most likely responsible for these symptoms?
a. Doxycycline

b. Ceftriaxone

c. Levofloxacin

d. Cephalexin

Answer 19

c. Levofloxacin. Respiratory fluoroquinolones, such as levofloxacin and moxifloxacin, are commonly used to treat community-acquired pneumonia. However, fluoroquinolones are associated with tendinitis, which begins with inflammatory edema and manifests as painful, swollen tendons. This condition is bilateral in approximately 50% of cases, and failure to rest the affected tendons can result in rupture. The onset of tendinitis can occur as early as one week after starting the medication or even months later. Older adults are at an increased risk of tendon rupture, leading to a boxed warning on fluoroquinolones regarding this serious adverse effect (Woo & Wright, 2024, p. 710).

Question 20

A 77-year-old male patient with a history of osteoarthritis presents to your office with right shoulder pain. He states that over-the-counter naproxen provides little relief. His medical history includes heart failure (HF), stage 1 hypertension, and atrial fibrillation. Which of the following medications is the most appropriate?
a. Ibuprofen PO 600 mg TID

b. Ketorolac PO initially, followed by 10 mg every 4–6 hours

c. Acetaminophen PO 500 mg every 6 hours

d. Diclofenac PO 100 mg daily

Answer 20

c. Acetaminophen. Ibuprofen, ketorolac, and diclofenac are all NSAIDs, which pose increased risks for adverse reactions in older adults (Woo & Wright, 2024, p. 793).

Question 21

A patient diagnosed with diabetic gastroparesis is prescribed metoclopramide 10 mg QID. Which of the following are appropriate patient education points?

a. “Do not use metoclopramide (Reglan) while driving, as it can cause drowsiness.”

b. “If you experience involuntary movements of the eyes, face, or arms/legs (tardive dyskinesia), notify me immediately, as this may be a sign of an adverse effect.”

c. “If you feel more depressed or notice any mood changes, please call the office.”

d. All of the above.

Answer 21

d. All of the above.

Question 22

A 32-year-old female patient with a history of rheumatoid arthritis is being considered for misoprostol to prevent duodenal ulcers caused by long-term NSAID use. Which of the following patient education points is essential?

a. Women of childbearing age should be informed that misoprostol can cause spontaneous abortion.

b. Use cautiously in patients with a history of depression.

c. Misoprostol reduces the effectiveness of clopidogrel.

d. Use with caution in patients with seizure disorders.

Answer 22

a. Women of childbearing age should be informed that misoprostol can cause spontaneous abortion due to its ability to induce uterine contractions, which may endanger pregnancy. To minimize risks, misoprostol should be started on day 2 or 3 of the menstrual cycle to ensure the patient is not pregnant.

Question 23

Which of the following education points is appropriate for a patient prescribed 5 mg of Glipizide?

a. “This medication should be taken 30 minutes before a meal to ensure proper absorption.”

b. “If you experience symptoms of hypoglycemia, such as tremors, palpitations, sweating, hunger, weakness, or drowsiness, consume a quick source of sugar like juice or hard candy.”

c. “Notify your provider if you notice swelling of the ankles, unusual weight gain, or shortness of breath.”

d. “You may experience weight gain after starting this medication.”

e. All of the above

Answer 23

e. All of the above.

Question 24

You are considering prescribing Pioglitazone (Actos) 15 mg daily for a patient with an A1C of 8.2% after monotherapy with Metformin. Which of the following patient conditions is most concerning?
a. Patient taking oral contraceptives

b. Patient with a history of hypoglycemia

c. Patient with a history of anxiety

d. Patient with heart failure

e. a and d

Answer 24

The correct answer is e.

Question 25

Which population is appropriate to receive doxycycline following a tick bite and noted bullseye rash? a. 4 year old male b. 29 year old pregnant female c. 10 year old female d. 38 year old male e. Both C & D

Answer 25

E- both c & d.

Question 26

Which dosing is appropriate for the treatment of trichomoniasis? a. Metronidazole (Flagyl) 500mg BID x 7 days, pregnant female 2nd trimester b. Metronidazole (Flagyl) 2000mg once, pregnant female, 3rd trimester c. Metronidazole (Flagyl) 500mg BID x 7 days, breastfeeding female d. Metronidazole (Flagyl) 500mg BID x 7 days, pregnant female 1st trimester

Answer 26

A – Metronidazole can be safely administered in pregnant women in their 2nd and 3rd trimesters, but not in one time dosing (Woo & Wright, 2024, p. 775).

Question 27

Your 32 year old patient who is 10 weeks pregnant states she is experiencing constipation regularly. As her primary care provider you know all of the following laxatives are safe during pregnancy EXCEPT: A. Bisacodyl B. Colace C. Castor oil D. Magnesium Hydroxide (Milk of Magnesia)

Answer 27

C – Castor Oil “is contraindicated in pregnancy because it has been associated with induction of uterine contractions” (Woo & Wright, 2024, p. 495)

Question 28

Which adverse drug reaction would be the most concerning? A. Patient reports black stools after taking two doses of Pepto Bismol. B. Patient reports muscle twitching after taking 7 doses of promethazine (Phenergan). C. Patient reports diarrhea after two doses of metoproclamide (Reglan). D. Patient reports dark tarry stools after taking famotidine (Pepcid) for 10 days.

Answer 28

D- Patient report dark tarry stools after taking Pepcid for 10 days, this would be a cause for concern for a bleeding ulcer. Pepcid is often used to reduce acid secretion in those with a duodenal ulcer. Signs of a bleeding ulcer would include dark tarry stools. Further evaluation would be needed.

Question 29

Which of the following medications used for treatment of Type II Diabetes Mellitus can increase weight gain? A. Sulfonylurea B. GLP-1 C. Metformin D. Premixed insulin

Answer 29

A. sulfonylurea can cause weight gain after starting the medication. Thiazolidinediones can also have a similar effect (Woo & Wright, 2024, pp. 530-531).

Question 30

A diabetic patient who is taking metoprolol post myocardial infarction should be taught to check blood glucose level for hypoglycemia when experiencing? A. Dizziness B. Tachycardia C. Diaphoresis D. Nausea/vomiting

Answer 30

C. Diaphoresis- beta blockers can “increase insulin resistance, producing hyperglycemia” and can easily mask early adrenergic response to hypoglycemia. Normal hypoglycemia response and symptoms include lightheaded, dizziness, and tachycardia, however beta blockers do not block the hypoglycemic symptoms of diaphoresis. Patients who are taking beta blockers should be taught to monitor for diaphoresis, and check blood glucose when noted for potential hypoglycemia (Woo & Wright, 2024, p. 514; Dungan et al., 2019)

Question 31

Since their discovery in 1928, drug resistance to antibiotics has been an increasing problem. What are some of the most significant reasons drug resistance is a problem today? A. Individuals not taking them until they are completely gone B. The wrong antibiotics being prescribed C. Bacterial mutations that add obstacles to prevent D. antibiotics from working. All the above

Answer 31

Answer: D All the answers are correct!

Question 32

A patient enters the office and has had sneezing, coughing, sinus pressure, and yellow phlegm for 10 days. What antibiotic would you prescribe this patient? A. Doxycycline B. Macrobid (Nitrofurantoin) C. Cephalexin D. Amoxicillin

Answer 32

Answer: D Amoxicillin is the preferred antibiotic to treat upper respiratory and sinus infections.

Question 33

A patient tested positive for C.difficile and has been on vancomycin for 7 days with little to no improvement of symptoms. What would be the next intervention by the clinician? A. Tell the patient to take the medication as prescribed until gone, symptoms will resolve over the next 2 weeks. B. Tell the patient to take Imodium and increase fiber in diet. C. Have the patient switch to Dificid D. Prescribe both Penicillin G with Vancomycin and probiotic.

Answer 33

Answer: C Dificid is the preferred treatment for c.dif infections.

Question 34

Patient calls the office and states that she started to have a cold-sore about 2 days ago. She has had them before and is looking for a refill on her medication but cannot remember the name. What is the medication she is looking for? A. Valacyclovir B. Neurontin C. Abacavir D. Doxycycline

Answer 34

A

Question 35

An 82-year-old male with history of new onset AFIB <2 weeks ago, hypertension, hyperlipidemia, and hyperglycemia tests positive for Covid-19 with mild symptoms. You prescribe Paxlovid. What would be something you would educate this patient on? A. The patient should stop any statin therapy as this may interact with Paxlovid. B. The patient should treat conservatively. C. The patient should hold his Xarelto for the entire course of Paxlovid and restart after stopping. D. The patient should be made aware of rebound covid-19 and loss-of-taste with this medication which would be considered normal.

Answer 35

Answer: B Rationale: Patient has mild symptoms of covid-19 and the risk outweighs the benefits of being on Paxlovid. Provider would have to stop both his statin and Xarelto which may increase his risk of stroke.

Question 36

A patient is going to be having a total left hip replacement in two weeks. When reviewing their medication, you realize they are on prednisone 20mg PO QD long-term for her asthma. What recommendation would you put in your preoperative assessment to the anesthesiologist? A. Patient should receive a speed dose (threshold dose) of Prednisone prior B. Patient should stop prednisone 48 hours prior to surgery and resume after C. Patient can continue same dose of steroids without any changes. D. Patient is not cleared for surgery, and should be re-evaluated in 3 months for tapering.

Answer 36

Answer: A Rationale: Patient may have adrenal insufficiency and will require a threshold dose for steroid coverage during surgery.

Question 37

A 20 year old female patient presents to the clinic with complaints of painful bumps on her labia. Upon assessment and testing it is determined that this patient has HSV2 infection or genital herpes. What is the most appropriate course of treatment for this patient? A. Ciprofloxacin 500mg PO BID for 3 days B. Acyclovir 400 mg PO TID for 10 days C. Metronidazol 500mg PO BID for 5 days D. All are appropriate courses

Answer 37

Acyclovir 400 mg PO TID for 10 days is the correct answer. Acyclovir is a antiviral, nucleoside analogue. This dose is recommended for an initial outbreak then further treatment is based on frequency of outbreaks (Woo & Wright , 2024, pp 751). These medications work by interfering with dna synthesis during viral replication.

Question 38

All of the following approved indication for the use of salicylates? A. Fever B. Rheumatoid Arthritis C. Hepatic Impairment D. Transient Ischemic Attack Prophylaxis

Answer 38

The correct answer is C. Hepatic Impairment. Hepatic function needs to be monitored in patients taking salicylates. This medication is not indicated for hepatic impairment. Salicylates like aspirin is the choice drug in reducing fever in adults (Woo & Wright, 2024, pp. 803). The advantages of using salicylates in rheumatoid arthritis are pain management and inflammation reduction. For patients with a history of stroke and TIA the AHA/ASA recommends aspirin for the prevention of stroke and TIA (Woo & Wright, 2024, pp. 805).

Question 39

A 25 year old female comes to the clinic for a 34 week prenatal visit. She is G1 P1 T0. This is her first pregnancy and she has some questions for you regarding her constipation. She asks you, “I have been very constipated with this pregnancy. I saw on social media that some women use castor oil to help them with constipation. Should I try that?”. It is safe to advise her that taking castor oil is indicated for her. True or False? A. True B. False

Answer 39

the correct answer is False. Castor oil is a stimulant used to stimulate peristalsis and increase the secretion of electrolytes in the intestines. Castor oil is specifically contraindicated in pregnancy because of its association with inducing uterine contractions (Woo & Wright, 2024, pp.495). Bisacodyl can be used in pregnancy in moderation.

Question 40

Proton pump inhibitors like omeprazole are prescribed often for conditions like gastric reflux. The clinician knows that the possible adverse drug reactions to these medications include all but? A. Iron deficiency B. Osteoporosis C. Peptic Ulcer Disease D. Risk of renal disease

Answer 40

The correct answer is Peptic Ulcer Disease. PPIs are a common treatment of PUD. Iron deficiency is seen in the use of PPIs due to the need for an acidic environment for iron absorption. Osteoporosis is an adverse reaction due to the decreased calcium absorption with the use of PPIs. A VA study showed that patients on long term PPIs showed an increase risk of AKI and CKD (Woo & Wright, 2024, pp. 490).

Question 41

Which type of antidiabetic medication does not affect the body's use or production of insulin? A. Metformin B. Glipizide C. Dapahliflosin D. Ozempic

Answer 41

The correct answer is C. Dapagliflozin. Dapagliflozin is a SGLT-2 that has no effect on the body's use or production of insulin. It works by decreasing the amount of glucose reabsorbed by the kidneys. Ozempic is a GLP-1 receptor agonist. It works by multiple mechanisms including increasing insulin secretion and decreasing glucagon release. Metformin is a biguanide medication that increases the body's insulin sensitivity and decreases hepatic glucose production. Glipizide is a sulfonylurea that works by increasing insulin release from pancreatic beta cells and requires some endogenous insulin production to work (Woo & Wright, 2024, pp. 518-544).

Question 42

Which patient would not be appropriate to prescribe Metformin for the management of their hyperglycemia? A. 50 year old male with Hx of DM 2 on SQ humalog sliding scale at meal times and a sulfonylurea B. 18 year old female with DM type 1 managed on an insulin pump C. 80 year old male with DM type 2 currently managed on SQ humalog sliding scale at meal times D. 30 year old female with DM type 2 with history of Hepatitis C

Answer 42

The correct answer is B. 18 year old female with DM type 1 managed on an insulin pump. This patient would not be appropriate for this patient because it is not used in type 1 diabetics. Metformin is also not metabolized in the liver (Woo & Wright, 2024, pp. 518).

Question 43

Due to the widespread and global emergence of microbial resistance to antibiotics, multidisciplinary antimicrobial stewardship programs have been developed. Which of the following statements regarding antibiotic stewardship programs is the most accurate? A. Effective antibiotics are selected to treat infections in a manner that minimizes the development of resistance. B. Reducing healthcare costs and antibiotic resistance by limiting the use of antibiotics. C. Promoting alternative therapies to reduce the need for antibiotics. D. Treat an infection with a stronger antibiotic treatment option to reduce the risk of reinfection.

Answer 43

A. Antibiotic stewardship programs are employed in hospitals, nursing homes, and outpatient settings, utilizing a multidisciplinary team that optimizes the use of antimicrobials by selecting the most effective route, dose, and duration for each patient’s specific situation (Woo & Wright, 2024, p. 690). These programs collaborate with the CDC Core Elements of Antibiotic Stewardship team to develop comprehensive plans for antimicrobial prescription usage, along with education and framework support.

Question 44

Chronic hepatitis C virus (HCV) is a disease that primarily affects an individual’s liver and is most likely to be transmitted through the use of sharing needles with an infected person. However, over the past decade, significant advancements have been made in the treatment of this disease. Which of the following statements regarding the pharmacological treatment of hepatitis C is the most accurate? A. HCV antivirals are considered safe for administration during pregnancy. B. All of the HCV antivirals can cause hepatitis B virus reactivation. C. All HCV antivirals must be administered via IV infusion. D. Most HCV antivirals are administered as a single dose.

Answer 44

B. Over the past decade, numerous pharmacological advancements have been made in the treatment of HCV, with treatment strategies tailored to the stage and genotype of the disease, and consultation with an HCV specialist is recommended (Woo & Wright, 2024, p. 755). However, all of the HCV treatment options run the risk of reactivation of the hepatitis B virus, which can lead to hepatic failure and death if the patient is not also concurrently treated for their hepatitis B infection (Woo & Wright, 2024, p. 756).

Question 45

A 68-year-old female patient visits her primary care provider at the clinic. She has a history of rheumatoid arthritis and states that the pain and stiffness in her hands have been worsening lately. The provider recognizes that this is an autoimmune disease; therefore, treatment for the patient’s inflammation is warranted, and the provider will order a corticosteroid. Which of the following principles are false when prescribing corticosteroids? A. The provider needs to establish a time frame for the drug’s therapeutic response and discontinue the drug if the desired result does not occur. B. Corticosteroids should be tapered when discontinued if the patient has been on them for an extended period. C. To best match the body’s natural body rhythm, daily doses of corticosteroids are best given in the evening. D. Many conditions that require chronic corticosteroids can be treated with an alternate-day dosing schedule, achieving the same therapeutic effect.

Answer 45

C. Corticosteroids play a crucial role in managing disease processes and can be used as replacement therapy for adrenal cortex insufficiency, as well as for short-term treatment of acute rheumatic exacerbations or episodes (Woo & Wright, 2024, p. 755). When administering corticosteroids, it is best to take them before 9 a.m. to align with the natural body rhythm and activity of the adrenal cortex (Woo & Wright, 2024, p. 788).

Question 46

A 5-year-old female pediatric patient is brought in by her parents to see her primary care provider. Her parents report that the patient has been having diarrhea for the past three days and are inquiring about treatment options. Considering the patient scenario, which of the following statements regarding antidiarrheals is false? A. Drug-induced diarrhea should be treated by addressing the symptoms while continuing the medication. B. Diarrhea in children is a more significant concern than in adults due to children becoming dehydrated quickly. C. Most episodes of acute diarrhea are self-limiting with few serious consequences. D. Chronic diarrhea, defined as diarrhea lasting more than four weeks, can lead to nutritional deficits, unintentional weight loss, and dehydration.

Answer 46

A. Diarrhea is commonly treated with over-the-counter medications and is typically self-resolving with self-limiting (Woo & Wright, 2024, p. 465). For drug-induced diarrhea, the medication causing it should be discontinued, which will likely resolve the symptoms.

Question 47

A 78-year-old male patient presents to his primary care provider, reporting issues with constipation. The patient reports being relatively healthy, not on any prescription medications, but also reports that they currently have a low-fiber diet. The provider is considering ordering a laxative to relieve the symptoms. Due to the patient’s age and dietary history, which of the following laxative classes would be the safest to prescribe? A. Bulk-producing laxatives. B. Lubricant laxatives. C. Hyperosmolar laxatives. D. Osmotic laxatives.

Answer 47

A. Constipation is a common ailment that can have a multitude of causes and is especially bothersome for older adults due to medical comorbidities and medication side effects (Woo & Wright, 2024, p. 494). Laxatives are often the treatment option of choice for treating constipation, with the type of laxative needing to match the likely reason for the constipation. Bulk-producing laxatives are the safest and easiest option, especially for patients who follow a low-fiber diet, as they are less likely to become habit-forming and allow for proper nutrient absorption (Woo & Wright, 2024, p. 494).

Question 48

Glucagon is a hormone secreted by the pancreas and is an essential medication for the treatment of type 1 and type 2 diabetes mellitus. It can also be utilized during emergent hypoglycemic episodes. Which of the following statements regarding glucagon is true? A. Glucagon promotes liver glucogenolysis to raise blood glucose in hypoglycemic events. B. Glucagon works well even in patients suffering from starvation and chronic hypoglycemia. C. Glucagon’s primary clinical use is for the preventive treatment of hypoglycemia. D. Glucagon is produced by the liver and is metabolized by the kidneys.

Answer 48

A. Glucagon is a hormone produced by the pancreas to stimulate liver glycogenolysis, which breaks down glycogen in the liver, thereby creating glucose for the body to utilize (Woo & Wright, 2024, p. 547). This creates more blood glucose, and glucagon also works to break down stored fat into fatty acids, which are then used by the body’s cells.

Question 49

Glucagon-like peptide-1 receptor agonists (GLP-1 agonists) are a newer class of medication that has gained popularity for several reasons. Providers must understand the mechanism of action and the clinical benefits of this drug. Which of the following best describes the clinical benefits and mechanisms of action for this drug class? A. They delay gastric emptying, lower plasma glucose, and inhibit glucagon release in the setting of elevated glucose levels B. They work by promoting renal glucose reabsorption. C. They work by decreasing the amount of insulin secreted by the pancreas as well as inhibiting gastric emptying. D. They promote hepatic glycogen breakdown and work regardless of blood glucose levels

Answer 49

A. GLP-1 agonists work by delaying gastric emptying, which can lead to weight loss, as well as inhibiting glucagon release when blood glucose levels are elevated (Woo & Wright, 2024, p. 544). This has led to an increase in the popularity of their use due to the weight loss and better glycemic control that this medication allows.

Question 50

When a provider prescribes thyroid agents, several precautions and contraindications must be considered, as incorrect dosing and prescription can cause harm to patients. Which of the following statements regarding precautions and contradictions when using thyroid agents is false? A. The use of antacids can increase the absorption of orally administered thyroid agents. B. Thyroid agents are contraindicated for patients who have recently suffered from myocardial infarction. C. Long-term use of thyroid agents has been associated with a decrease in bone density. D. Hyperthyroidism is the primary potential adverse reaction, with other adverse reactions being rare.

Answer 50

A. Thyroid agents, although essential for treating thyroid levels, must be used with caution in individuals with osteoporosis, with hyperthyroidism being the primary adverse reaction (Woo & Wright, 2024, p. 561). Use of these agents is contraindicated in patients with a recent myocardial infarction, as they can put additional stress on the cardiovascular system. Antacids, bile-acid sequestrants, and iron salts all work to decrease, not increase, the absorption of orally administered thyroid preparations (Woo & Wright, 2024, p. 561).

Question 51

Aromatase inhibitors are a drug class that is used for the treatment of breast cancer. As breast cancer is still one of the most prevalent forms of cancer, providers need to be educated on the usage of this drug class. Which of the following statements regarding aromatase inhibitors is false? A. Aromatase inhibitors are contraindicated for use in men. B. Aromatase inhibitors have a significant impact on estrogen-sensitive tissues, including those found in the breast, placenta, gonads, adrenal glands, and uterus. C. They work to inhibit one particular enzyme, which is part of the P450 cytochrome system. D. This class of drug, taken orally once a day, is used as adjuvant therapy in the treatment of postmenopausal breast cancer patients.

Answer 51

A. Aromatase is a single enzyme that is part of the P450 cytochrome system; aromatase inhibitors work to inhibit this enzyme (Woo & Wright, 2024, p. 570). It has a substantial impact on estrogen-sensitive tissues and can play a role in gender determination during pregnancy. However, aromatase inhibitors can be prescribed to men if they have estrogen-sensitive breast cancer (Woo & Wright, 2024, p. 570).

Question 52

You are teaching a patient who was prescribed levofloxacin 500 mg Q24 hrs for 7 days for a urinary tract infection. Which of the following statements should be included in the education? A. Avoid direct sunlight and tanning beds while on this medication and for a while afterwards. B. If your UTI symptoms clear up, you can stop taking the medication. C. If you experience swelling or tenderness, stop taking the medication and call the office. D. Both A & C

Answer 52

D Fluoroquinolones can cause photosensitivity or phototoxicity, therefore Option A is correct and the patient should avoid those things and wear sunscreen and proper clothing if exposed to sunlight (Woo & Wright, 2024, p. 712). Option C is also correct, as fluoroquinolones have a Black Box warning for causing tendonitis and tendon rupture, and you should include signs and what to do in the education

Question 53

You are caring for a patient who has a Clostridium difficile infection (CDI) following a course of ceftriaxone. What antibiotic would be the best option to prescribe for the CDI? A. Ciprofloxacin B. Amoxicillin C. Bactrim D. Vancomycin

Answer 53

D Oral vancomycin is a first-line medication to treat CDI (Woo & Wright, 2024, p. 736). The other options are not indicated.

Question 54

You are caring for a 59 year old patient who has a peptic ulcer. He has a history of a MI, an allergy to penicillins, and depression. Which of the following would be most important to know prior to the prescription of omeprazole? A. If the patient is taking clopidogrel B. The reaction to the penicillin allergy C. If the patient has any food or environmental allergies D. If he takes any antidepressants

Answer 54

A There is a Black Box warning between PPIs such as omeprazole and Clopidogrel (Plavix), that PPIs can reduce effectiveness of the clopidogrel and risk of increased clot formation. Therefore, Option A is correct. You may still be able to prescribe a PPI if necessary, however pantoprazole might be a better choice and monitoring is important. There is no known drug interactions between PPIs and penicillins and antidepressants, therefore although these would be good to know for overall patient care, they are not the MOST important. Same with Option C, food or environmental allergies. (Woo & Wright, 2024, p. 498).

Question 55

Which of the following statements best describes the relationship between metoclopramide and tardive dyskinesia? A. Metoclopramide promotes dopamine, reducing tardive dyskinesia B. Tardive dyskinesia may occur with initialization of the drug, however will go away once the body acclimates C. Metoclopramide only causes tardive dyskinesia in patients with a history of Parkinson’s or Tourette’s D. Metoclopramide may cause tardive dyskinesia with long term use, and it should be discontinued if that occurs

Answer 55

D Metoclopramide is a dopamine receptor antagonist and is recommended for short term use (less than 12 weeks) to stimulate GI tract in GERD or diabetic gastroparesis. Option A is incorrect because it is a dopamine ANTAGONIST and does not reduce, but rather causes tardive dyskinesia. Option B is incorrect because it does not occur right away and goes away, rather there is a higher risk with longer use of treatment. Option C is incorrect, it may cause it even if patient with no history. Therefore, Option D is correct. It may cause tardive dyskinesia with long term use and should be stopped. (Woo & Wright, 2024, p. 485).

Question 56

You are teaching a nurse practitioner student about semaglutide. They ask you about the pharmacodynamics of the drug. Which of the following best describes the mechanism of action of GLP-1 agonists? A. It moderates glucose and glucagon secretion, aids in insulin release, slows gastric emptying, and reduces appetite B. Blocks reabsorption of glucose in the kidneys, resulting in increased urinary glucose excretion C. Treats hypoglycemia by stimulating glucagon secretion by the alpha cells of the pancreas D. Increase peripheral glucose uptake, insulin sensitivity, decreases glucose production and absorption

Answer 56

A GLP-1 agonists, including semaglutide, binds with the GLP-1 receptor on the pancreatic beta cell to augment glucose-mediated insulin release, enhances antidiabetic actions, such as moderating glucagon secretion and lowering glucagon concentrations during periods of hyperglycemia. This effect leads to decreased hepatic glucose output and decreased insulin demand. Also improve glycemic control by reducing fasting and postprandial glucose concentrations, slowing gastric emptying and reducing appetite. (Woo & Wright, 2024, p. 545).

Question 57

You are caring for a young adult patient with a history of Type 1 diabetes mellitus. The patient has a new diagnosis of hypothyroidism. Which of the following most accurately describes the relationship between hypothyroidism and insulin requirements? A. Hypothyroidism does not effect insulin requirements B. Hypothyroidism increases renal clearance, increasing insulin requirements C. Hypothyroidism delays insulin breakdown, resulting in decreased insulin requirements D. Hypothyroidism increases insulin sensitivity, resulting in increased insulin requirements

Answer 57

C Hypothyroidism delays insulin breakdown, resulting in less insulin needed, therefore option C is correct.

Question 58

Which macrocyclic antibiotic that is currently classified as an 18-ring macrolide is used in the treatment of Clostridium species bacteria? A. Erythromycin B. Fidaxomicin (Dificid) C. Azithromycin (Zithromax) D. Clarithromycin (Biaxin)

Answer 58

B. Fidaxomicin (Dificid) is used to treat Clostridium species, particularly C. difficile.

Question 59

A 45-year-old male presents to the clinic with a six-month history of thickened, discolored toenails. A diagnosis of onychomycosis is made, and you consider prescribing oral terbinafine. What is the most important laboratory test to monitor during therapy with this medication? A. Complete blood count (CBC) B. Liver function tests (LFTs) C. Renal function tests (BUN/Creatinine) D. Serum potassium levels

Answer 59

B. Liver function tests (LFTs): Terbinafine is an antifungal medication commonly used to treat onychomycosis and other dermatophyte infections. It is metabolized by the liver and has been associated with hepatotoxicity, including rare cases of liver failure. Therefore, liver function tests (LFTs) should be monitored before initiating therapy and periodically during treatment.

Question 60

A 58-year-old male with a history of gastroesophageal reflux disease (GERD) is prescribed ranitidine, a histamine 2 receptor antagonist (H2RA). What is the primary mechanism of action of this class of medications? A. Neutralizing stomach acid B. Inhibiting the proton pump in parietal cells C. Blocking histamine at H2 receptors in the stomach D. Coating the gastric mucosa to prevent acid damage

Answer 60

C . Blocking histamine at H2 receptors in the stomach: Histamine 2 receptor antagonists (H2RAs), such as ranitidine, famotidine, and cimetidine, work by selectively blocking histamine at H2 receptors located on gastric parietal cells. This inhibition decreases the secretion of gastric acid, helping to manage conditions like GERD, peptic ulcer disease, and Zollinger-Ellison syndrome.

Question 61

A 50-year-old woman with a history of peptic ulcer disease is prescribed omeprazole, a proton pump inhibitor (PPI). What is the primary mechanism of action of PPIs? A. Blocking histamine at H2 receptors in the stomach B. Neutralizing stomach acid by increasing bicarbonate production C. Inhibiting the hydrogen-potassium ATPase pump in gastric parietal cells D. Increasing mucus production to protect the gastric lining

Answer 61

C. Inhibiting the hydrogen-potassium ATPase pump in gastric parietal cells: Proton pump inhibitors (PPIs), such as omeprazole, pantoprazole, and esomeprazole, work by irreversibly inhibiting the hydrogen-potassium ATPase pump (also known as the proton pump) in gastric parietal cells. This inhibition prevents the final step of gastric acid secretion, leading to a significant reduction in stomach acid production.

Question 62

A 55-year-old male with type 1 diabetes mellitus is prescribed regular insulin, a short-acting insulin, to be administered before meals. When should the patient ideally inject this insulin to optimize postprandial glucose control? A. Immediately after meals B. 30 minutes before meals C. At bedtime D. Only when blood glucose is above 250 mg/dL

Answer 62

B. 30 minutes before meals: Short-acting insulins, such as regular insulin, have an onset of action of approximately 30 minutes, peak at around 1-2 hours, and last up to 14 hours. To match the rise in blood glucose after eating, patients should administer regular insulin 30 minutes before meals.

Question 63

A 40-year-old woman is diagnosed with Hashimoto thyroiditis after presenting with fatigue, weight gain, and cold intolerance. Laboratory tests reveal elevated thyroid-stimulating hormone (TSH) and low free thyroxine (T4) levels. Which medication is the first-line treatment for this condition? A. Methimazole B. Propylthiouracil (PTU) C. Levothyroxine D. Liothyronine

Answer 63

C. Hashimoto thyroiditis is an autoimmune condition that leads to hypothyroidism due to the gradual destruction of the thyroid gland. The first-line treatment is levothyroxine (synthetic T4), which is converted into the active form (T3) in the body to normalize thyroid hormone levels. Levothyroxine provides stable and consistent hormone replacement.

Question 64

Which of the following statements is true regarding folic acid supplements? A. Folic Acid is available over the counter (OTC) and as a prescription, however it is likely that the cost of OTC folic acid will be lower. B. Folic acid is available over the counter (OTC) and as a prescription, however it is likely that the cost of prescription folic acid will be lower. C. The only contraindications to folic acid administration are when vitamins B12 and B6 are deficient. D. The only contraindication to folic acid administration is when vitamin B6 is deficient.

Answer 64

A. Folic Acid is available over the counter (OTC) and as a prescription, however it is likely that the cost of OTC folic acid will be lower.

Question 65

If a prescriber were to educate a patient on the adverse effects of iron supplementation, which of the following statements would be most appropriate? A. The most common adverse reactions to iron supplementation are gastrointestinal side effects such as constipation or diarrhea B. Iron supplementation may cause gastrointestinal bleeding; therefore, it is important to promptly report darker colored stools to the provider. C. If you experience gastrointestinal side effects from taking iron, try taking it with milk because it will coat the stomach. D. Taking iron with food will significantly decrease absorption and it must be avoided.

Answer 65

A. The most common adverse reactions to iron supplementation are gastrointestinal side effects such as constipation or diarrhea rationale GI symptoms, although usually mild, are the most common side effects of iron supplementation (Woo & Wright, p. 373, 2024).

Question 66

Administration of glucagon for reversal of hypoglycemia is unlikely to be effective in all of the following EXCEPT? A. A non-diabetic patient undergoing an endoscopy who has been NPO since midnight. B. A hypoglycemic patient with adrenal insufficiency/ C. A patient who is chronically hypoglycemic. D. A pediatric patient who is growing more slowly than expected due to severe malnutrition

Answer 66

A. A non-diabetic patient undergoing an endoscopy who has been NPO since midnight. rationale Glucagon may be administered in patients who have been NPO for hours. It can relax the gastrointestinal musculature and facilitate scoping procedures (Woo & Wright, p. 547, 2024).

Question 67

In which of the following patients receiving exocrine pancreatic enzymes would require individualized dosing? A. An adult patient with pancreatic insufficiency B. A patient with cystic fibrosis C. a pediatric patient between the ages of 1-4 years D. An infant patient younger than 1 year.

Answer 67

A. An adult patient with pancreatic insufficiency. rationale Individualized adult dosing in patients with pancreatic insufficiency is based on stool output and stool consistency (Woo & Wright, p. 557, 2024).

Question 68

Which of the following statements regarding Proton Pump Inhibitor (PPI) is true? A. The effects of drugs metabolized by the CYP$%) enzyme system may be decreased with concurrent administration of PPIs B. The use of omeprazole is contraindicated in pregnancy C. Omeprazole is the only PPI that doesn't cross the placenta and has not been identified in breast milk in animal studies. D. Pantoprazole is the preferred PPI for pediatric adminstration.

Answer 68

A. The effects of drugs metabolized by the CYP450 enzyme system may be decreased with concurrent administration of PPIs. rationale This is true. PPIs are extensively metabolized by CYP450 2C19 and CYP450 3A4 (Woo & Wright, p. 488, 2024).

Question 69

Which statement best reflects the differences in approach to treatment between simple acute diarrhea and chronic diarrhea? A. Most episodes of diarrhea are cases of simple acute diarrhea, which doesn’t necessarily require an etiological diagnosis. Although infectious etiology should be considered. B. Chronic diarrhea doesn’t require an etiological diagnosis. C. Diarrhea secondary to food poisoning always requires antimicrobial therapy. D. Diarrhea lasting longer than 72 hours is considered chronic.

Answer 69

A. Most episodes of diarrhea are cases of simple acute diarrhea, which doesn’t necessarily require an etiological diagnosis. Although infectious etiology should be considered. rationale In chronic diarrhea, the source must be identified because simply suppressing the symptoms is inadequate treatment (Woo & Wright, p. 467, 2024).