Test#3 Pharmacology Test Banks

Which question is most important for the nurse to ask the client who has been diagnosed with osteoporosis?

"Does someone in your household smoke?"

A patient with asthma is given an asthma action plan and returns to the clinic in 2 weeks to follow up on symptoms. Which statement by the patient indicates a need for further teaching?

"I use the ICS as needed when I am wheezing."

The patient has been placed on tadalafil (Cialis) for treatment of erectile dysfunction. The patient should be instructed that the maximum number of doses that may be administered during the course of one day is:

1

Select the maximum length of time that skeletal muscle relaxants should be used.

1 week

Susan is a 52-year-old perimenopausal woman who is lactose intolerant. What is her recommended calcium and vitamin D requirement?

1,300 mg calcium and 400 IU Vitamin D

Cassie is a 15-year-old female who presents to clinic for a sports physical. Her diet history indicates she drinks less than one glass of milk per day and avoids dairy products to lose weight. What is the recommended daily calcium intake for Cassie?

1,500 mg

Recurrent episode genital herpes

1-5 days

Nicotine inhaler use

1. Blow your nose to make sure it is clear 2. Tilt your head back slightly and insert bottle tip in nostril as far as it is comfortable. 3. Breathe in through your mouth and hold your breath. 4. Press the bottom of the bottle with your thumb to release one spray, breathe out through your mouth. Do not sniff or inhale through your nose and do not swallow while spraying. If your nose runs after releasing the spray, gently sniff to keep the spray in your nose. Wait 2-3 mins before blowing your nose. 5. Repeat steps 1-4 for the next nostril. 6 Wipe bottle tips and replace cap

First 3 steps for treating COPD

1. First line treatment is SABA 2. Second line treatment; inhaled beta2-agonists and anticholinergics 3. Third line treatment; LABA and anticholinergic, and SABA prn 4. Fourth line treatment; LABA and anticholinergic, SABA PRN.and inhaled corticosteroids

First 3 steps for treating asthma

1. First line treatment: SABA prn 2. Second line treatment: Low dose inhaled corticosteroids or Cromolyn, nedocromil, theophylline, or leukotriene modifier 3. Third line treatment; low dose inhaled corticosteroids and LABA or medium-dosed inhaled corticosteroids. Alternatives that can be added include a leukotriene modifier, theophylline or zileuton to medium-dose inhaled corticosteroids (Theophylline - side effects -severe vomiting, rapid uneven heart rate, seizures, confusion, tremors or shaking, severe headache, rapid heart rate)

Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened for gonorrhea and Chlamydia in:

3 to 6 months

Lisa is a healthy non-pregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be:

"100% cranberry juice or cranberry juice extract may decrease UTIs in some patients."

Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in:

48-72 hours

The optimal maximum time frame for hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is:

5 years

Dosage changes of conjugated equine estrogen (Premarin) are made at ____ intervals.

6 to 8 week

Montelukast (Singulair) may be prescribed for:

A 2 year old with moderate persistent asthma

Use back up OC when on

ABX

sinusitis

ABX (augmentin) fold cold only after 8-10 days return to office if not better after 2-3 days of abx - complete full course, teach s/s of reaction, lifestyle changes (smoking cessation)

Which DMARDS are safe to use in pregnancy?

ANS-Sulfasalazine, Hydroxychloroquine, Azathioprine. DO NOT USE METHOTREXATE OR LEFLUNOMIDE

The nurse should instruct a client with osteoarthritis to engage in low-impact exercise and take:

Acetaminophen

Which of the following conditions would an expectorant drug such as guaifenesin treat effectively?

Acute bronchitis

Infants with neonatal herpes should be treated with

Acyclovir 30 to 60 mg/kg/d for 10 to 21 days.

Along with prescribing antibiotics, adults with pneumonia should be instructed on lifestyle modifications to improve outcomes, including:

Adequate fluid intake

When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed:

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

Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education regarding:

Alcohol should not be consumed during and for 1 day after metronidazole is taken

The drug recommended as primary prevention of osteoporosis in men over age 70 years is:

Alendronate (Fosamax)

The drug recommended as primary prevention of osteoporosis in women over age 70 years is:

Alendronate (Fosamax)

Antibiotics in COPD

Aminopenicillin is sufficient. In patients with complicated chronic bronchitis, then: 2nd or 3rd generation cephalosporin Macrolide Fluoroquinolone Treat for 10-14 days Should feel better in 2-3 days Immunizations

Juanita is a 28-year-old pregnant woman at 38 weeks gestation who is diagnosed with a lower urinary tract infection. She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be:

Amoxicillin

SAME patient cough is worse, not feeling better. What is next treatment?

Amoxicillin for 10 days

Women who have migraine with aura should not be prescribed estrogen due to:

An increased risk of stroke occurring with estrogen use

The ongoing monitoring for patients over age 65 years taking alendronate (Fosamax) or any other bisphosphonate is:

Annual renal function evaluation

Which of the following drug classes is considered to be the drug class of choice for management of overactive bladder (OAB)?

Antimuscarinics

A patient reports having urinary frequency and discomfort associated with urination. After a careful physical examination and history to determine the cause, the NP should prescribe a medication from which drug class?

Antispasmodics

Progesterone-only pills are recommended for women who:

Are breastfeeding Have a history of migraine Have a medical history that contradicts the use of estrogen

Acute prostatitis

At least 4-6 weeks of Cipro and Bactrim

In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur:

At nighttime three to four times a month

Pediatrics with COPD

Avoid tetracyclines due to the potential of discoloration of teeth

Giselle is a 14 year old who presents to clinic with symptoms consistent with mycoplasma pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent?

Azithromycin

Samantha is 34 weeks pregnant and has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe?

Azithromycin

The first-line drug choice for a previously healthy adult patient diagnosed with community acquired pneumonia would be:

Azithromycin

When treating suspected gonorrhea in a non-pregnant patient, the patient should be concurrently treated for Chlamydia with:

Azithromycin 1 gram PO x 1

Chlamydia-

Azithromycin 1gm orally as a single dose best option

uncomplicated UTI

Bactrin x 3 days

Christy has exercise and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:

Beclomethasone needs to be used every day to treat her asthma

A stepwise approach to the pharmacologic management of asthma:

Begins with determining the severity of asthma and assessing asthma control

The drug of choice for treatment of early latent or tertiary syphilis is:

Benzathine penicillin G IM

The drug of choice for treatment of primary or secondary syphilis is

Benzathine penicillin G IM

Which of the following medications are considered to be antitussives?

Benzonatate Codeine Diphenhydramine Dextromethorphan

Patients with COPD require monitoring of:

Beta-2-agonist use

CAM in menopause

Black cohosh for hot flashes; St. John's wort for mood swings

Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk?

Black women are at risk of developing osteoporosis due to their lower calcium intake as a group

if prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include:

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

Sallie has been diagnosed with osteoporosis and is asking about the "once a month" pill to treat her condition. How do bisphosphonates treat osteoporosis?

By reducing bone resorption and inhibiting osteoclastic activity

Always be sure flu/PNA vaccines up to date with

COPD pt

Drugs that increase the risk of osteoporosis developing include:

Carbamazepine

An NP prescribes azelastine for a patient who has allergic rhinitis. The NP will teach the patient that this drug:

Cause bitter aftertaste

Nicole is a 4-year-old female with a febrile urinary tract infection. She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be:

Ceftriaxone

Wing-Sing is a 4 year old who has a suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia?

Ceftriaxone

Gonorrhea

Ceftriaxone 250 mg IM in a single dose

Treatment for suspected gonorrhea is:

Ceftriaxone 250 mg IM x 1

Smoking cessation

Chantix, zyvan, Wellbutrin

Jamie is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be:

Ciprofloxacin

A patient who has an upper respiratory infection accompanied by severe cough has been given an antitussive medication with codeine. The patient asks why codeine is part of the prescribed drug. Which is the most appropriate response of the health care provider?

Codeine suppresses cough because it has a depressant effect on the cough center in the medulla.

Obese women may have increased risk of failure with which contraceptive method?

Combined topical patch

Candida infections

Commonly referred to as yeast infections

S. Pneumonia cause of

Community acquired (walking) pneumonia

When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include:

Consuming alcohol in any form may cause a severe reaction

A 22-year-old women receives a prescription for oral contraceptives. Education for this patient includes:

Counseling regarding decreasing or not smoking while taking oral contraceptives

Nicotine Patch

DO NOT USE if you have severe eczema or psoriasis

Which of the following drugs are considered to be second-generation antimuscarinic drugs? Select all that apply.

Darifenacin Solifenacin Trospium

URI treatment

Decongestant for only 3 days. If more, may develop rebd, tenderness

Medroxyprogesterone (Depo Provera) injection has an FDA Black Box warning due to:

Decreased bone density while on Depo

Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for:

Depression

When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include the adverse drug effects of:

Depression and weight gain

Choose the only benzodiazepine indicated for muscle relaxation.

Diazepam

Kristine would like to start hormone replacement therapy (HRT) to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering hormone replacement would include:

Discussing the advantages and risks of HRT

Stress incontinence

Ditroban dry mouth + glaucoma

4-year-old child-using saline for several days, no relief what is recommended

Do not recommend anything from 0- 4 years, use Vicks or natural remedies

A 4-year-old give natural remedy

Do not recommend anything from 0- 4 years, use Vicks or natural remedies

2nd line tx for prostatitis

Doxycycline, azithromycin and clarithromycin for 4-6 weeks. If infection not resolved with 4-6 wks of Tx, continue Tx for 12 weeks.

A patient has been instructed to take an antitussive medication to control cough. Which of the following adverse effects is most frequently associated with this group of drugs?

Drowsiness

A patient has been started on a treatment regimen that includes cyclobenzaprine (Flexeril). What is the most frequently encountered side effect of this medication?

Dry mouth

CAM for sinusitis

Echinachea

The treatment goals when treating urinary tract infection (UTI) include:

Eradication of infecting organism Relief of symptoms Prevention of recurrence of UTI

John is a 4-week-old infant who has been diagnosed with chlamydial pneumonia. The appropriate treatment for his pneumonia would be

Erythromycin

Absolute contraindications to estrogen therapy include:

Estrogen alone

Patient's disease is well controlled on NSAIDS and Methotrexate for some time, symptoms begin to worsen and radiologic studies shows progressive destruction of several joints in her finger what tumor necrosis factor agent parentally is appropriate to give

Etanercept

Monitoring a patient with persistent asthma includes:

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

Recommended treatment for osteoporosis first line treatment

FOSAMAX bisphosphonate

Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be warned about the risk for:

Fatal hypotension if combined with nitrates

The patient is scheduled to begin treatment with the alpha1-proteinase inhibitor Prolastin. The health care provider should expect to see what type of changes in the patient's vital signs approximately 12 hours after drug administration?

Fever

Which of the following medications, if crushed, may have teratogenic effects in a male fetus if the patient's female sex partner is exposed to it?

Finasteride

BPH

Finasteride 5 mg po qd 6-12 months for effect

What meds are given for rheumatoid arthritis? Are DMARDS the first line for RA?

First treat the pain, then refer out to specialist. First line treatment is DMARDS

Candida infection

Fluconazole 150mg tablets take about 2-3 days to start working

the first-line treatment for cough related to a URI in a 5 year old is:

Fluids and symptomatic care

1st line tx for Prostatitis

Fluoroquinolone for 4-6 weeks TMP-SMZ for 4-6 weeks

What is the second line treatment in a female for UTI

Fluoroquinolones

Second line tx for UTI

Fluoroquinolones and fosfomycin for empiric therapy of recurrent cystitis, use for 3 days. If symptoms don't resolve by 3 days, then complete a 7 day treatment

If a patient is exhibiting signs of nicotine toxicity when using transdermal nicotine, they should remove the patch and:

Flush the area with clear water

Patients with allergic rhinitis may benefit from a prescription of:

Flutocasone (flonase) Cetirizine (zyrtec) OTC cromolyn nasal spray (Nasalcrom)

Monitoring for a child who has had a urinary tract infection is:

Follow-up urine culture at completion of therapy

Monitoring for a pregnant woman who has had a urinary tract infection is:

Follow-up urine culture every 2 weeks until delivery

A patient tells a nurse practitioner (NP) that several coworkers have upper respiratory infections and asks about the best way to avoid getting sick. The NP should recommend which of the following?

Frequent hand washing

A patient who has just received a new prescription for guaifenesin has been taught about adverse drug effects. The patient should identify which adverse effect as commonly associated with this drug?

GI distress

Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to:

Have him seen the same day for an assessment and theophylline level

Which of the following is indicated in avoiding Celebrex in the treatment of arthritis

Hx of Myocardial Infarction

A contraindication to the use of combined contraceptives is:

Hx of clotting disorder

A client with a calcium imbalance has an elevated calcitonin level. The nurse recognizes that the secretion of calcitonin is increased when the client experiences:

Hypercalcemia.

Demione is a 24 year old who is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be:

IM benzathine penicillin G

If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:

IV or IM ceftriaxone

In the 1950s, researchers began searching for safer medications to treat rheumatoid arthritis (RA). Prior to this time, RA was treated with aspirin and corticosteroids. Which drug was identified by the researchers to be safer in the treatment of inflammation and pain for RA clients?

Ibuprofen

Second line agent for sinusitis

If not feeling better in 8-10 days, a bacterial cause is suspected and ABX therapy is ordered.

UTI in pregnancy

In pregnancy may use Amoxicillin all trimesters

A parent asks an NP which over-the-counter medication would be best to give to a 5-year-old child who has a viral respiratory illness with nasal congestion and a cough. The NP should recommend which of the following?

Increased fluids with a teaspoon of honey

Women with an intact uterus should be treated with both estrogen and progestin due to:

Increased risk for endometrial cancer if estrogen alone is used

Long-acting beta-agonists (LTBAs) received a Black Box warning from the U.S. Food and Drug Administration due to the:

Increased risk of asthma-related deaths when LTBAs are used

Inadequate Vitamin D intake can contribute to the development of osteoporosis by:

Increasing calcium absorption from the intestine

Asthma exacerbations at home are managed by the patient by:

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

A younger patient with cystic fibrosis has a new drug order for dornase alpha (Pulmozyme). The health care provider should choose which route of administration for this medication?

Inhalation via nebulizer

Medications used in the management of patients with COPD include:

Inhaled beta-2-agonists Inhaled anticholinergics (ipratropium) Inhaled corticosteroids

Pregnant patients with asthma may safely use ____ throughout their pregnancy.

Inhaled corticosteroids (budesonide)

The bronchodilator of choice for patients taking propranolol is:

Ipratropium

Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?

Irregular vaginal bleeding for the first few months

An advantage of using the NuvaRing vaginal ring for contraception is:

It does not require fitting and is easy to insert

Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection?

Jamie, a 24-year-old female

First generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are:

Less sedating than the first generation antihistamines

The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia and can be treated as an outpatient would be:

Levofloxacin

ongoing monitoring for women on estrogen replacement therapy (ERT) includes:

Lipid levels, repeated annually if abnormal Annual health history and review of risk profile Annual mammogram

What are labs that should be checked for patients on DMARDS?

Liver function test and kidney function tests with Diff, Sed Rate Immune functions before and during the treatments, EKGs are not indicated

Asthma Stepwise Mod persis

Low ICS + LABA OR Medium ICS OR Low ICS +theophylline -should see a specialist at this level

Asthma Stepwise Mild Persist

Low ICS OR cromolyn, nedocromyl (these are alt for children as steroids affect growth), or Theophylline (bronchodilation, increase strength of diaphragm, easy to get mucous out), or Leukotriene modifiers (singulair, AE are inc LFT and infection)

The first-line therapy for mild-persistent asthma is:

Low-dose inhaled corticosteroids

What medication for UTI is contraindicated in patients older than 65?

Macrobid

Oral emergency contraception (Plan B) is contraindicated in women who:

May be pregnant

When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:

Menses occur during the week

Sophie presents to clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include:

Metronidazole 2 grams PO x 1 dose

Helima presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in a non-pregnant symptomatic women would be:

Metronidazole 500 mg PO BID x 7 days

trichomonas

Metronidazole 500mg po q12h x 7 days or 2G as a single dose

Prior to developing a plan for the treatment of asthma, the patient's asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur:

More than twice a week and less than once a day

Martin is a 60 year old with hypertension. The first-line decongestant to prescribe would be:

Nasal oxymetazoline

Side effects of Chantix

Nausea, constipation, insomnia, difficulty concentrating, abnormal vivid or strange dreams, mood changes, suicidal and homicidal thoughts

In addition to antimicrobial therapy, patients treated for Trichomonas infection should be educated regarding:

Necessity of treating sexual partner simultaneously Abstaining from intercourse until both partners are treated Need for retesting in 3 months due to high reinfection rate

Nicotine withdrawal symptoms include:

Nervousness Increased appetite Difficulty concentrating

Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include:

Neuropsychiatric symptoms may occur

Instructions for a patient who is starting nicotine replacement therapy include:

Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco

The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include:

None

The most appropriate smoking cessation prescription for pregnant women

Nonpharmacologic measures

Sydney presents to clinic with vulvovaginal candidiasis. Appropriate treatment for her would be

OTC intravaginal clotrimazole OTC intravaginal miconazole Oral fluconazole one-time dose

A patient comes to the clinic with a 3-day history of fever and a severe cough that interferes with sleep. The patient asks the NP about using a cough suppressant to help with sleep. The NP should:

Obtain hx

Treatment for chancroid in a non-pregnant patient would be:

Oral azithromycin IM ceftriaxone Oral ciprofloxacin

Oxybutinin

Over reactive bladder

One goal of asthma management in children is:

Participation in school and sports activities

When educating patients who are starting on inhaled corticosteroids, the provider should include:

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

The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should:

Perform a dipstick urinalysis.

Zoe presents with genital warts present on her labia. Patient-applied topical therapy for warts includes:

Podofilox 0.5% gel

for visible warts

Podofilox and podophyllin resin- apply weekly, wash in 1-4 hours.

Nicotine inhaler and nasal sprays are

Pregnancy Category D

A test of cure is recommended after treating Chlamydia in which patient population?

Pregnant patients

Nicotine replacement therapy should not be used in which patients?

Pregnant women Patient with worsening angina pectoris Immediately after an acute myocardial infarction

Ashley comes to clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:

Prescribe oral contraceptives and have her start them the same day with a back-up method used for the first 7 days

The mechanism of action of oral combined contraceptives which prevents pregnancy is:

Progestins thicken cervical mucous and slow tubal motility

Preventing osteoporosis Selective estrogen receptor modulators

Raloxifene (Evista) 60mg po qd plus Calcium and Vitamin D

Shana received her first medroxyprogesterone (Depo Provera) injection 6 weeks ago and calls the clinic with a concern that she has been having a light "period" off and on since receiving her Depo shot. What would be the management of Shana?

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

The nurse is establishing outcomes for a client with rheumatoid arthritis. What would be an appropriate outcome following three days of immunosuppressant therapy?

Reduced joint inflammation

A client is prescribed a disease-modifying antirheumatic agent. What will the nurse explain as the mechanism of action for this medication?

Reduces damage and delays disease progression

The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is:

Relief of symptoms without increasing cardiovascular risk

A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil). The nurse should caution the client to:

Report blurred vision or decreased reading ability immediately.

One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is:

Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms

the nurse demonstrates understanding of the appropriate use of immunosuppressant therapy by anticipating its use in the client with which disorder?

Rheumatoid arthritis

Education of patients with COPD who use inhaled corticosteroids includes:

Rinsing mouth after use

Asthma stepwise intermittent

SABA PRN (albuterol inhaler (ProAir) 30 min before exercise

A primary care NP sees a child with asthma to evaluate the child's response to the prescribed therapy. The child uses an ICS twice daily and an albuterol metered-dose inhaler as needed. The child's symptoms are well controlled. The NP notes slowing of the child's linear growth on a standardized growth chart. The NP should change this child's medication regimen to a:

SABA as needed plus a leukotriene modifier once daily.

Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all?

Salmeterol, an inhaled long-acting beta-agonist

James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin's diet for weight loss. The appropriate response would be:

Schedule him for regular serum theophylline levels during his diet due to increased excretion of theophylline

Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:

Selectively acting on the estrogen receptors in the bone

Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of

Serum potassium

A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications?

She should use a back-up method of birth control such as condoms for the rest of the current pill pack

Treatment for mild intermittent asthma is:

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

Decongestants such as pseudoephedrine (Sudafed):

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

The most common adverse effect of the transdermal nicotine replacement patch is:

Skin irritation under the patch site

Men who use transdermal testosterone gel (AndroGel) should be advised to avoid:

Skin-to-skin contact with pregnant women while using the gel

f a patient wants to quit smoking, nicotine replacement therapy is recommended if the patient:

Smokes within 30 minutes of awakening in the morning

The topical patch combined contraceptive (Ortho Evra) is

Started on the first day of the menstrual cycle

Cromolyn and Nedocromil

Step-2 alternative for children. May be used as preventive Tx before exercise or exposure to allergens.

The most common bacterial pathogen in community acquired pneumonia is:

Streptococcus pneumoniae

A patient has been instructed to take benzonatate (Tessalon Perles) for nonproductive cough due to bronchial irritation. Which patient instruction should the health care provider give to this patient?

Swallow the capsule whole

Monitoring for a healthy, non-pregnant adult patient being treated for a urinary tract infection is:

Symptom resolution in 48 hours

The patient has been placed on a treatment regimen that includes bethanechol chloride (Urecholine). Which symptom should the patient be instructed to report because of its potential to be life-threatening?

Syncope

Jamie was treated for chancroid. Follow-up testing after treatment of chancroid would be:

Syphilis and HIV testing at 3-month intervals

Patient with a COPD exacerbation may required

Systemic corticosteroid burst

First line tx for UTI

TMP-SMZ BID x 3 days Nitrofurantoin BID x 7 days Do NOT use a fluoroquinolone as a 1st line Tx

third line tx genital herpes

Take antiviral once or twice a day every day, depending on the agent

When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to:

Take the dimenhydrinate 15 minutes before it is needed

Inhaled Corticosteroids for ashtma

Takes 2 wks of continuous therapy to achieve maximum effectiveness

Which of the following drugs is used for benign prostatic hypertrophy (BPH) and has the greatest potential for causing orthostatic hypotension?

Tamsulosin

Which of the following medications is considered to be a nonselective alpha blocker?

Tamsulosin

Instructions for the use of nicotine gum include:

The gum should be "parked" in the buccal space between chewing

Transdermal nicotine replacement (patch) is an effective choice in tobacco cessation because:

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

Smoking interferes with

Theophyline

Which bronchodilator used for asthma that causes insomnia and seizures?

Theophylline

Why shouldn't quinolones be used in men having sex with men or men who have recently travelled?

To minimize gonococcal drug resistance

First line agent for sinusitis

Topical decongestant for the first 3 days Antipyretics- acetaminophen NSAIDs- for body aches

The goals of treatment when prescribing for sexually transmitted infections include:

Treatment of infection Prevention of disease spread Prevention of long-term sequelae from the infection

A patient asks an NP about using an oral over-the-counter decongestant medication for nasal congestion associated with a viral upper respiratory illness. The NP learns that this patient uses loratadine (Claritin), a β-adrenergic blocker, and an intranasal corticosteroid. The NP would be concerned about which adverse effects?

Tremor, restlessness, and insomnia

Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be:

Trimethoprim/sulfamethoxazole

Which of the following is an analgesic, antipyretic drug which lacks the anti-inflammatory property?

Tylenol

William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for ____ before prescribing sildenafil.

Unstable coronary artery disease

Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for:

Urinary retention

Which condition would be a contraindication for use of an antimuscarinic agent in a patient?

Urinary retention

Patricia has been prescribed doxycycline for a Chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Patricia's education would include:

Use a back-up method of birth control (condom) until her next menses

To improve actual effectiveness of oral contraceptives women should be educated regarding:

Use of a back-up method if they have vomiting or diarrhea during a pill packet

Patients who choose the nicotine lozenge to assist in quitting tobacco should be instructed:

Use one lozenge every 1 to 2 hours (at least nine per day with a maximum of twenty per day)

Plan B one step

Used to prevent pregnancy up to 5 days after unprotected intercourse. It may prevent 87% of pregnancies.

56-year-old women is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed:

Vaginal estradiol ring

The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing:

Vasomotor symptoms

Along with an antibiotic prescription, lifestyle education for a non-pregnant adult female who has had a urinary tract infection includes:

Voiding 10 to 15 minutes after intercourse

Topical Anti-inflammatory by prescription

Voltaren, Capsaicin is OTC

Antitussives (tessalon pearls) with DRY cough,

WET Expectorant

If a woman presents with recurrent vulvovaginal candidiasis she may be treated with:

Weekly fluconazole 150 mg PO x 6 months

Patients who are at risk of a fatal asthma attack include patients:

With a history of requiring intubation or ICU admission for asthma

Intranasal calcitonin is used in the treatment of osteoporosis. Calcitonin therapy is appropriate for which patient?

Women over age 65 with severe osteoporosis

Third line tx for UTI

Women with recurrent UTIs, take TMP-SMZ, norfloxacin, or nitrofurantoin x 1 post-coitus to reduce recurrence of UTI.

Is acetaminophen the first choice to treat osteoarthritis

YES

Is it ok to put the patient on an alpha blocker and finasteride?

Yes but watch for hypotension

A primary care nurse practitioner (NP) is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms. The patient's forced expiratory volume in 1 second (FEV1) is 80% of the predicted value. The patient's current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The NP should prescribe:

a low-dose inhaled corticosteroid (ICS), 2 puffs bid.

Digoxin levels need to be monitored closely when the following medication is started:

albuterol

Rescue breathing

albuterol

COPD pt is coughing

albuterol inhaler, exacerbation give steroids

Fibromyalgia first line treatment

amitriptyline

First episode genital herpes

antiviral 7-10 days

Chantix-smoking cessation

assess if patient is ready for education on smoking cessation

A patient who has erectile dysfunction wants a medication to use as needed. The primary care NP should recommend:

avanafil (Stendra)

Which of the following medications has an unlabeled use as treatment for Huntington's chorea?

baclofen

Rheumatoid Arthritis

begin NSAID oral steroid ACUTE Exacerbation: Methotrexate

Patients with pheochromocytoma should avoid which of the following classes of drugs due to the possibility of developing hypertensive crisis?

beta-2-agonists

Osteroporosis treatmeent

biphosphates + weight bearing excercise

Steroids adverse effects

bone density and elevated glucose levels, cataract formation, GI Upset

Azoepyridium

cause urine to be orange + will stain clothing

Cough should not be suppressed unless

causing pain or interfering with sleep, look for cause

A primary care NP is evaluating a patient who has COPD. The patient uses a LABA twice daily. The patient reports having increased exertional dyspnea, a frequent cough, and poor sleep. The patient also uses a short-acting β-adrenergic agonist (SABA) five or six times each day. Pulse oximetry reveals an oxygen saturation of 92%. The patient's FEV1/forced vital capacity is 65, and FEV1 is 55% of predicted. The NP should prescribe a(n):

combination ICS/LABA inhaler.

Nitrofurantoin

contraindicated after age 65.

55-year-old woman who experienced menopause at age 50 years undergoes central dual-energy x-ray absorptiometry and has a T-score greater than 2.5. The patient weighs 130 lb and has a body mass index of 22. She sits at a computer all day at work. The primary care nurse practitioner (NP) caring for this patient should:

counsel the patient about diet and exercise.

Select the medication that has an unlabeled use as treatment for fibromyalgia.

cyclobenzaprine

The patient needs to have a muscle relaxant added to her treatment regimen. She also is being treated with a monoamine oxidase inhibitor. Select the muscle relaxant that should be avoided when one is prescribing for this patient.

cyclobenzaprine

Adult

decongestants

Rebound congestion with

decongestants

A parent brings an 8-year-old child to the clinic because the child continues to wet the bed despite using cognitive-behavioral measures and a bed alarm system. The NP should prescribe:

desmopressin (DDAVP)

Itching + burning sensation vaginal infection

difflucan or 7 day OTC

A man who has benign prostatic hypertrophy (BPH), in whom prostate carcinoma has been ruled out, asks the primary care nurse practitioner (NP) about beginning drug therapy to treat his symptoms. The NP notes that he consistently has blood pressure readings around 145/90 mm Hg. The NP should prescribe:

doxazosin (Cardura)

Fluoroquinolones and fosfomycin for

empiric therapy of recurrent cystitis, use for 3 days. If symptoms don't resolve by 3 days, then complete a 7 day treatment.

Bisphononates may cause

esophagitis take with 8 oz water sit upright 35-45 min Once a week for compliance

Mirena

excellent option for women with HX of dysmenorrhea, monorrhagia and anemia

Enlarged prostate

finasteride

Osteoarthritis

first line treatment acetaminophen,, topical NSAID voltaren gel

combination estrogen and progestin.

for a woman with intact uterus

Use Mast cell stabilizer or low dose corticosteroids

for asthma exacerbation in a child

WET-expectorant ABX (augmentin)

for cold only after 8-10 days, sinusitis return to office after 2-3 days of abx, complete full course

Long term use of prednisone puts patient at risk

for hyperglycemia, osteoporosis, affects growth in children

Use the IUD Morena

for patients who had heavy periods it last 5 years

tetosterone

for the treatment of severe vasomotor disturbances and decreased libido combination estrogen/methyltestosterone

Vaginosis

frothy, fishy flagyl 500 po or intravaginal

50-year-old woman with osteopenia will begin taking raloxifene (Evista). When counseling this patient about this drug regimen, the primary care NP should tell her to:

go for walks daily.

patient who has BPH is taking doxazosin and finasteride. The patient asks the primary care NP whether he has an increased risk of prostate cancer. The NP should tell him:

he has an increased risk of a certain type of cancer.

A child with chronic allergic symptoms uses an intranasal steroid for control of symptoms. At this child's annual well-child checkup, the NP should carefully review this child's:

height and weight.

Menopause

hormone replacement therapy

A serious side effect associated with desmopressin is:

hyponatremia.

Pregnancy- if allergic to penicillin, patient should be desensitized

in order to receive Penicillin G.

A patient who was recently diagnosed with COPD comes to the clinic for a follow-up evaluation after beginning therapy with a SABA as needed for dyspnea. The patient reports occasional mild exertional dyspnea but is able to sleep well. The patient's FEV1 in the clinic is 85% of predicted, and oxygen saturation is 96%. The primary care NP should recommend:

influenza and pneumococcal vaccines

Estrogen and progesterone are prescribed when the patient has an

intact uterus

Rheumatoid Arthritis

is an inflammatory disease so an anti-inflammatory medication is indicated

The primary contraceptive action of progestin in hormonal contraceptives

is suppression of the LH surge, which inhibits ovulation.

A 23 years old woman is using an albuterol inhaler for frequent acute episodes of asthma what is not an adverse effect related to the albuterol and the SABA?

it dies not have diuretic effect

Mini pill (progestin only)

lactation

In URI fever and last longer than 7 days

may be bacterial component

Select the medications that are considered to be antispasmodics.

metaxalone methocarbamol chlorzoxazone cyclobenzapri

if decreased libido

methyltestosterone

bacterial vaginosis

milky gray frothy metronidazole tabs x 7 days crem

Better choice for women unable to tolerate estrogens, smokers, over age 35, lactating

mini pill (progestin only)

Estrogen

no uterus

Can hormone Replacement therapy be used to treat Cardiovascular Disease.

no, it can cause cardiovascular disease

A 70-year-old patient who has COPD takes theophylline daily and uses a SABA for exacerbation of symptoms. The patient reports using the SABA three or four times each week when short of breath. The patient reports feeling jittery and nauseated and having trouble sleeping. The primary care NP should:

obtain a serum theophylline level.

Antibiotics for bronchitis only w/ hx

of COPD, purulent sputum, resp s/s for more than 6 days

Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population:

older adults HTN patients Infants

If the patient is asymptomatic for about 2 weeks or asthma is well controlled put the child

on a leukotriene like singulair (nonsteroidal and does not cause growth problems) then slowly stop the low dose corticosteroids

A patient who has BPH is taking tamsulosin and dutasteride and asks the primary care NP why he needs to take both medications. The NP should tell him:

one gives faster symptom relief, whereas the other shrinks the size of the prostate.

URI children under 6

only natural remedies, nasal spray or inh monitor for stunted growth

A 75-year-old patient requires frequent use of corticosteroids to control COPD exacerbations. To monitor adverse drug effects in this patient, the primary care NP should:

order a bone density study.

A primary care NP sees an adolescent patient for a hospitalization follow-up after an asthma exacerbation. The patient reports having daily symptoms with nighttime awakening 4 or 5 nights per week and misses school several days each month. The patient currently uses a salmeterol/fluticasone LABA twice daily and albuterol as needed. The patient requires a refill of the albuterol prescription once a month. The patient does not have any known allergies. The NP should:

order a high-dose ICS plus a LABA twice daily.

A patient who has several risk factors for osteoporosis has a bone density test that indicates osteopenia. The primary care NP plans to prescribe a bisphosphonate. Before initiating treatment, the NP should:

order serum calcium and vitamin D levels.

DEPO-PROVERA may cause

osteoporosis regular exercise, Calcium and vitamin D

A patient who has diabetes reports intense discomfort when needing to void. A urinalysis is normal. To treat this, the primary care NP should consider prescrib

oxybutynin chloride (Ditropan XL).

A 12-year-old with sinus congestion x 4 days, fever only the first 2 days, started coughing last night-not expectorating, patient cannot sleep and feels like he needs to "cough up something"

patient needs a decongestant

A 12-year-old with sinus congestion x 4 days, fever only the first 2 days, started coughing last night-not expectorating, patient cannot sleep and feels like he needs to "cough up something"

patient needs a descongestant

A patient tells the primary care NP that he has difficulty getting and maintaining an erection. The NP's initial response should be to:

perform a medication history.

A patient has a UTI and will begin treatment with an antibiotic. The patient reports moderate to severe suprapubic pain. The primary care NP should prescribe:

phenazopyridine (Pyridium).

treatment for syphillis even with

pregnancy

A 60-year-old woman has a central dual-energy x-ray absorptiometry with a T-score of 1.9. A health history reveals no risk factors for osteoporosis. The primary care NP should:

prescribe alendronate sodium (Fosamax).

A 50-year-old patient who recently quit smoking reports a frequent morning cough productive of yellow sputum. A chest x-ray is clear, and the patient's FEV1 is 80% of predicted. Pulse oximetry reveals an oxygen saturation of 97%. The primary care NP auscultates clear breath sounds. The NP should:

prescribe an albuterol metered-dose-inhaler, 2 puffs every 4 hours as needed.

estrogen

prevents pathological fractures

Smoker, with cough once or twice a month

recommend short acting beta agonist, recommend smoking cessation and immunization (flu and pneumonia)

A patient who has BPH is taking alfuzosin (Uroxatral) and finasteride (Proscar). The patient has had two urinary tract infections (UTIs) in the past 2 months. A urinalysis in the clinic is negative for leukocyte esterase but positive for hematuria. The primary care NP should:

refer the patient to a urologist.

SABA

rescue inhaler for wheezing

A 60-year-old female patient has begun taking a daily bisphosphonate to prevent osteoporosis and complains of gastrointestinal (GI) upset and dyspepsia. The primary care NP's initial response should be to:

review the instructions for taking the drug with the patient.

Rheumatoid Arthritis only DMARDS

safe in pregnancy Antimalarials, sulfasalazine, Azathioprine, cyclosporine

Depo=Provera

safe in women with Hx of CVD, stroke, DVT, PVD. May cause osteoporosis, recommend regular exercise, calcium and vitamin D. Administer q12w.

Children

saline drops

Children with sinusitis

saline nasal drops do not blow nose

Exercise induced asthma use

short acting beta agonist 30 minutes before the exercise

Anti-inflammatories for atrophic vaginitis

short term mild topical steroids.

Depo PRovera

shouldn't be used long term because of risk for osteoporosis and vaginal bleeding

A patient reports dribbling small amounts of urine but also has difficulty initiating a urine stream. The primary care NP should prescribe:

solifenacin (VESIcare)

Chantix treatment for smoking cessation

start w/low does for 1 wk over 12 wks watch for suicidal thoughts mood changes

Chantix use

start with the lowest dose over a one week period. More successful when used for 12 weeks. Start with 0.5mg daily for days 1 -3, then 0.5mg twice a day days 4 - 7 and then on day 8 start 1mg twice a day. The target dose is 1mg twice a day. If patient cannot tolerate 1mg bid then reduce to 1mg daily

UTI

supra pubic, low back pain, cloudy urine +nitrites for infection Bactrin 3 days 100k colonies of E.Coli to treatment

Treatment: Penicillin G 2.4 million units IM x 1 dose is the preferred Tx

syphilis

Theophylline AE

tachyarrhythmias, restless, insomnia, tremor, seizure

A 60-year-old woman is in the clinic for an annual well-woman examination. She has been taking alendronate (Fosamax) 10 mg daily for 4 years. Her last bone density test yielded a T-score of 2.0. Her urine NTx level today is 22. She walks daily. Her fracture risk is low. The primary care NP should recommend that she:

take a 1- to 2-year drug holiday.

50-year-old white woman who is experiencing menopause asks the primary care NP what she can do to prevent osteoporosis. She has a negative family history and no risk factors. The NP should counsel her to:

take supplemental calcium and vitamin D every day.

A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that include runny nose and sneezing. The NP should counsel this patient to:

take the lowest recommended dose initially.

A 70-year-old patient who has a high fracture risk has been taking alendronate (Fosamax) and calcium for 6 months. The primary care NP orders a urine NTx level, which is 42. The NP should discontinue the alendronate and prescribe:

teriparatide (Forteo)

when a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include:

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

Estrogen with or w/o progesterone prevents or reduces

the risk for pathological fractures Increases risk for strokes, CAD, DVT, bresat cancer

Side effects of Ditropan

thirst, dry mouth, constipation, do not give to patients with glaucoma

The primary care NP is preparing to prescribe sildenafil for a man who has erectile dysfunction. The NP should remember to tell this patient:

to avoid oral nitrates while taking this medication.

A primary care NP prescribes oxybutynin chloride for an 80-year-old patient to treat urinary incontinence. When teaching this patient about this medication, the NP should tell the patient:

to increase intake of fluids and fiber.

Progesterone

to protect uterus from getting cancer

DMARDS-Disease-Modifying Antirheumatic Drugs-used

to treat rheumatoid arthritis

An NP sees a patient who reports persistent seasonal symptoms of rhinorrhea, sneezing, and nasal itching every spring unrelieved with diphenhydramine (Benadryl). The NP should prescribe:

triamcinolone (Nasacort AQ).

Fluconazole is the only one recommended by the CDC for treating

uncomplicated Candida vaginitis. 2-3 days

Omalizumab

use as adjunctive therapy in steps 5 or 6 in patients with allergies and severe persistent asthma

A man who has cardiovascular disease and takes nitroglycerin for angina pain develops erectile dysfunction. The primary care NP who cares for this patient should recommend:

use of a vacuum constriction device

tiotropium bromide (Spiriva) is an inhaled anticholinergic:

used for treatment of COPD

Progestin

used to stop menstrual or eliminate period changes in the cycle

Estrogens

used topically for atrophic vaginitis

what is used to treat yeast infection-

vaginal cream for 3- 7 days, Po Diflucan

Male dysfunction

viagra

When do we recommend estrogen only

when patient had a hysterectomy

Antitussives (tessalon pearls)

with Dry cough

Chalmydia

yellow discharge Azythromycin Ig gonorrhea - centriaxone or rocephin

Trichominiasis

yellow/green discharge red macular lession Flagyl 2g single dose, treat sex partner