Pharm Units 5-8
Which cephalosporin may be used to treat meningitis? Cefotaxime Cefaclor Cefoxitin Cefazolin
Cefotaxime Cefotaxime has increased ability to reach the cerebrospinal fluid (CSF) and treat meningitis
Which vitamin has the highest risk for toxicity? Vitamin B1 Vitamin B2 Vitamin C Vitamin A
Vitamin A Vitamins A, D, E, and K are fat soluble and are stored in the body. Excess intake may lead to toxicity.
A healthcare professional is teaching a group of nursing students about cyclooxygenase (COX) inhibitors. A student asks the professional about characteristics of COX-1 inhibitors. Which statement about COX-1 inhibitors is true? "COX-1 inhibitors protect against myocardial infarction and stroke." "COX-1 inhibitors reduce fever." "COX-1 inhibitors suppress inflammation." "COX-1 inhibitors protect against colorectal cancer."
"COX-1 inhibitors protect against myocardial infarction and stroke." COX-1 inhibitors have the beneficial effect of reducing platelet aggregation, thus reducing the risk of myocardial infarction and stroke.
Which statement by a patient about to begin taking orlistat for weight loss therapy indicates an understanding of this drug's actions? "If I take the drug four times daily instead of twice daily, I will lose weight faster." "I can eat as much as I want and still lose weight." "I should avoid fat-soluble vitamin supplements while taking this drug." "If I take a bulk-forming laxative, I can reduce the incidence of fecal incontinence."
"If I take a bulk-forming laxative, I can reduce the incidence of fecal incontinence." Because orlistat reduces fat absorption, stools often are fatty or oily, and fecal incontinence can occur. Bulk-forming laxatives can help with this side effect.
Which statement by the student indicates a need for further teaching? "Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet aggregation." "Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions." "Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase (COX)."
"Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions." Nonaspirin first-generation NSAIDs carry a risk of hypersensitivity reactions similar to the risk posed by aspirin (ASA).
A patient tells her provider that she is thinking about getting pregnant and asks about nutritional supplements. What should the provider recommend? A multivitamin with iron A balanced diet high in green vegetables and grains 400 to 800 mcg of folic acid per day Vitamin B12 supplements
400 to 800 mcg of folic acid per day The current recommendation is that all women of childbearing age take folic acid supplementation to prevent the development of neural tube defects that can occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron supplements are given when pregnancy occurs and are not necessary before becoming pregnant. Vitamin B12 supplements are not recommended.
After an exhaustive battery of tests, you suspect a four-year-old boy has neurocysticercosis. Which anthelmintic is appropriate for this patient? Albendazole Ketoconazole Mebendazole Niclosamide
Albendazole Albendazole crosses the blood-brain barrier (BBB).
A patient has been taking levothyroxine for several years and reports that for the past two weeks, the drug does not seem to work as well as before. What should the provider do? Suggest that the patient begin taking calcium supplements Expect the patient to have an elevated temperature and tachycardia Tell the patient to try taking the medication with food Ask the patient when the prescription was last refilled
Ask the patient when the prescription was last refilled Not all levothyroxine preparations have the same drug bioavailability; therefore, if a patient is experiencing differing effects, the pharmacist may have switched brands. Asking a patient about a recent refill may help explain why the drug has different effects.
A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. What should the provider suspect in this patient? Folic acid deficiency Vitamin B12 deficiency Celiac disease Iron deficiency anemia
Vitamin B12 deficiency When patients present with megaloblastic anemia, it is essential to distinguish between a folic acid deficiency and a vitamin B12 deficiency. If neurologic deficits are observed, a vitamin B12 deficiency is more likely to be the cause. This patient does not have signs of celiac disease. Iron deficiency anemia would be indicated by low hemoglobin and hematocrit.
A healthcare professional is teaching a patient who will begin taking methimazole for Graves' disease about the medication. Which statement by the patient indicates understanding of the teaching? "I will need a complete blood count every few months." "I should report a sore throat or fever to my provider if either occurs." "It is safe to get pregnant while taking this medication." "Because of the risk for liver toxicity, I will need frequent liver function tests."
"I should report a sore throat or fever to my provider if either occurs." Agranulocytosis is rare but can occur with methimazole, so patients should report signs of infection, such as a sore throat or fever.
A provider provides teaching to a patient who has had a hysterectomy and who is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates an understanding of the teaching? "I can take estrogen to reduce my risk of cardiovascular disease." "I should take the lowest effective dose for the shortest time needed." "Because I am not at risk for uterine cancer, I can take hormones indefinitely."
"I should take the lowest effective dose for the shortest time needed." For patients who have undergone a hysterectomy, progestin is unnecessary; estrogen-only preparations still carry an increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but there is an increased risk of stroke and breast cancer with estrogen.
A postmenopausal patient is at high risk for developing osteoporosis. The patient's provider orders raloxifene, and the nurse provides teaching about this drug. Which statement by the patient indicates an understanding of the teaching? "I may experience breast tenderness while taking this drug." "I may experience fewer hot flashes while taking this drug." "I should discontinue this drug several weeks before any surgery." "I should walk as much as possible during long airline flights."
"I should walk as much as possible during long airline flights." Like estrogen, raloxifene increases the risk of deep vein thrombosis. Patients taking this drug should be cautioned to take walks on long flights or whenever they must sit for long periods.
A patient who has been diagnosed with rheumatoid arthritis (RA) for one month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate. The patient asks why methotrexate is necessary since pain and swelling have been well controlled with the other medications. What should the provider tell the patient? "Starting methotrexate early can help delay joint degeneration." "Starting methotrexate now will help increase life expectancy." "A methotrexate regimen can reduce the overall costs and side effects of treatment." "With methotrexate, doses of NSAIDs can be reduced to less toxic levels."
"Starting methotrexate early can help delay joint degeneration." Current guidelines for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) early—within three months of diagnosis for most patients—to delay joint degeneration. Methotrexate may take up to three to six weeks to be at therapeutic levels, so NSAIDs and glucocorticoids should be continued until this occurs.
A patient is using a high concentration keratolytic agent containing 20 percent salicylic acid to remove warts. What should the provider teach this patient? "Systemic effects may occur with this medication." "Tinnitus is a common side effect of little concern." "Tissue injury is unlikely at this dose." "Peeling and drying are desired effects of this drug."
"Systemic effects may occur with this medication." Salicylic acid is readily absorbed through the skin, and systemic toxicity can result.
A patient has severe acne that has been refractory to treatment. The patient is taking tetracycline and using topical tretinoin and has been applying benzoyl peroxide twice daily. The provider teaches this patient about isotretinoin, which the patient will begin taking in a few weeks. Which statement should be included when teaching this patient about isotretinoin?
"Two pregnancy tests are required before each monthly refill of your prescription." "Skin rash, headache, and hair loss are common with this drug." "Tetracycline must be discontinued before beginning the isotretinoin." "Alcohol may be consumed in moderation when taking this drug." "Tetracycline must be discontinued before beginning the isotretinoin." Adverse effects of isotretinoin can be increased by tetracycline, so tetracycline must be discontinued before therapy is started.
A 45-year-old woman with a family history of osteoporosis is requesting to begin a vitamin D supplement. Her current vitamin D level is 20 ng/mL.Which dosage of vitamin D is appropriate for this patient? 600 IU/day 500 IU/day 300 IU/day 400 IU/day
600 IU/day
The provider orders 20 mg of hydrocortisone orally once each day. At what time should the drug be administered? 4:00 PM 9:00 PM 8:00 AM 12:00 PM
8:00 AM To allow the adrenals to recover, the daily hydrocortisone dose should be administered before 9:00 AM.
A 95-year-old patient is being discharged to home after being on a skilled nursing unit for a fractured hip. During the stay, the patient had several medication changes. The patient lives alone and has trouble opening medication bottles due to arthritis. Which measure will promote adherence to medication administration? Larger pill bottles Home health nurse Home health aide Pill bubble packs
A home health nurse can help set up a medication box which will take away the problem with trying to open up the medication bottles.
What is polypharmacy? A person takes different dosage forms (e.g., oral and injectable medications). A person takes five or more medications. A person takes a combination of prescription and over-the-counter medications. A person takes multiple medications.
A person takes multiple medications. In its simplest form, polypharmacy can be broken down into its roots: poly (multiple) and pharmacy (medications).
Which progestin is used in the progestin implant? Etonogestrel Medroxyprogesterone acetate Desogestrel Norethindrone
Etonogestrel The progestin implant contains 68 mg of etonogestrel.
A young female patient is seen in a clinic after complaining of abdominal pain. The patient is wearing dirty clothing and is barefoot. The provider orders a complete blood count, which shows that the patient is anemic. Which infestation may the provider suspect that this patient has? Ascariasis (giant roundworm) Ancylostomiasis (hookworm) Enterobiasis (pinworm) Trichuriasis (whipworm)
Ancylostomiasis (hookworm) Ancylostomiasis is most common when the patient's hygiene is poor and the patient habitually goes barefoot. Symptomatic anemia may occur in menstruating women or in undernourished individuals.
A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. What will be important for minimizing the risk of osteoporosis? Baseline vitamin D level Skeletal x-rays before treatment Estrogen therapy Calcium and vitamin D supplements
Calcium and vitamin D supplements Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis
A 50-year-old female is brought to the emergency department in an unconscious state after having been in a motor vehicle accident. A coworker has accompanied the patient but does not know anything about her medications, just which pharmacy the patient goes to. What is the most appropriate step to take in the medication reconciliation process at this point? Hold off on medication reconciliation until the patient is discharged Call the patient's prescriber to find out what medications she is on W
Call the pharmacy to obtain a medication list This is where you will find the most comprehensive and updated list of medications for reconciliation.
A patient with severe psoriasis will begin taking acitretin. The provider obtains a health history and learns that the patient takes a combination oral contraceptive (OCP). What should the provider do? Counsel the patient to use another form of birth control along with the OCP Tell the patient that acitretin is safe to take during pregnancy Tell the patient she may stop using contraception when the medication is withdrawn
Counsel the patient to use another form of birth control along with the OCP Acitretin is contraindicated during pregnancy and can reduce the effectiveness of progestin-only oral contraceptives. Patients should be counseled to use two reliable forms of birth control when taking this drug.
A 43-year-old male is on 50 mg losartan qd, 1000 mg metformin bid, atorvastatin 20 mg, and escitalopram 10 mg. The patient has previously tried liraglutide but only lost 6.5 lbs. "His vital signs are as follows:BP: 134/88HR: 80SpO2: 98%T: 98.7Height: 6'Weight: 325 lbs.In addition to discussing therapeutic lifestyle modifications such as diet and exercise, the team dietitian and therapist are helping with behavioral changes.Which treatment plan addition is appropriate for this patient?
Discuss bariatric surgery
A 16-year-old female presents to a clinic to discuss contraception. She would like to start an oral contraceptive and has no contraindications for estrogen. She also asks an advanced practice registered nurse (APRN) if there is anything she can take to help with her acne.Which FDA-approved medication will specifically manage both issues? Levonorgestrel Norethindrone Drospirenone Desogestrel
Drospirenone This is a fourth-generation combined oral contraceptive and is indicated for treatment of acne.
A patient is beginning therapy with oral methotrexate for rheumatoid arthritis. What should the provider teach this patient about the importance of? Having routine renal and hepatic function tests Taking the medication daily Reporting alopecia and rash Limiting folic acid consumption
Having routine renal and hepatic function tests Periodic tests of renal and liver function are mandatory for patients taking methotrexate.
A 50-year-old male patient is taking theophylline for the management of chronic obstructive pulmonary disease (COPD). The patient reports symptoms of sneezing, itching, and a runny nose. An advanced practice registered nurse wishes to prescribe a medication to control allergies but is concerned about drug interactions. Which medication should be considered? Zafirlukast Montelukast Cimetidine Zileuton
Montelukast This is used to help reduce the effects of an asthma attack.
A patient with severe community-acquired pneumonia has been prescribed telithromycin. Which aspect of the patient's medical history would be of concern? Renal disease Anemia Streptococcus pneumoniae infection Myasthenia gravis (MG)
Myasthenia gravis (MG) Telithromycin is a macrolide antibiotic used only for community-acquired pneumonia (CAP). Patients with myasthenia gravis may experience rapid muscle weakness after taking the drug, and some have died from respiratory failure, so patients with MG should not take this drug.
An adult who has been self-medicating using nutritional therapy for an elevated cholesterol level complains of repeated episodes of flushing. What should the provider suspect that the patient has been taking? Niacin Riboflavin Thiamine Pyridoxine
Niacin Niacin is used to reduce cholesterol levels. When taken in large doses, nicotinic acid can cause vasodilation with resultant flushing, dizziness, and nausea. Flushing is not a side effect of thiamine, riboflavin, or pyridoxine because they do not cause vasodilation.
A patient will begin taking iron supplements to treat anemia. Which food should the provider recommend that the patient take the iron with to facilitate absorption? Dairy products Orange juice Red meats Cereal
Orange juice Orange juice is a good source of vitamin C, and vitamin C facilitates the absorption of iron. Cereals are often fortified with iron but do not facilitate its absorption. Calcium interferes with the absorption of iron. Red meats are a natural source of iron.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105°F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits per mL. What should the provider caring for this patient order? Propylthiouracil (PTU) Methimazole Iodine-131 (131I) Intravenous levothyroxine
Propylthiouracil (PTU) Propylthiouracil is used for patients experiencing thyroid storm, and this patient is showing signs of this condition.
Which vitamin B deficiency is associated with cheilosis, glossitis, vascularization of the cornea, and itchy dermatitis of the scrotum and vulva? Niacin (nicotinic acid) Pyridoxine (vitamin B6) Thiamine (vitamin B1) Riboflavin (vitamin B2)
Riboflavin (vitamin B2) Riboflavin deficiency produces the symptoms described and can be treated with riboflavin supplements. The signs listed do not indicate deficiencies of niacin, pyridoxine, or thiamine.
A patient who takes daily doses of aspirin is scheduled for surgery next week. What should the patient be advised to do? Stop using aspirin three days before surgery Continue to use aspirin as scheduled Reduce the aspirin dosage by half until after surgery Stop using aspirin immediately
Stop using aspirin immediately Aspirin must be withdrawn at least one week before surgery.
What is the main intended benefit of medication reconciliation? To increase nurse practitioner involvement in patient care and medication management To prevent patients from experiencing side effects from their medications To reduce negative outcomes resulting from medication errors and discrepancies To make sure the most cost-effective treatment is used
To reduce negative outcomes resulting from medication errors and discrepancies Reducing negative outcomes resulting from medication errors and discrepancies is the crux of what a medication reconciliation is.
Taking a multivitamin-mineral (MVM) supplement increases overall nutrient intake and helps some people get the recommended amounts of vitamins and minerals when they cannot or do not get them from food alone. True False
True Taking an MVM increases their overall nutrient intake.
A patient who is about to begin therapy with etanercept has a positive tuberculin skin test. A chest radiograph is negative. What should this patient be expected to do? Undergo tuberculosis treatment prior to beginning etanercept treatment Have regular monitoring of symptoms to detect active tuberculosis Have periodic chest radiographs during treatment with etanercept Begin taking antituberculosis drugs at the beginning of treatment with etanercept
Undergo tuberculosis treatment prior to beginning etanercept treatment Since tuberculosis (TB) in a patient taking etanercept is often extrapulmonary and disseminated, it is important to test all patients for TB. Those who test positive for latent TB should be treated for TB before etanercept treatment is begun.
A patient has had three gouty flare-ups in the past year. Which drug class should the provider be expected to order for this patient? Colchicine Nonsteroidal anti-inflammatory drugs Glucocorticoids Urate-lowering drugs
Urate-lowering drugs The provider will order a urate-lowering drug for this patient. The medication should be diluted and administered with 20 mL of sterile sodium chloride and administered over five minutes or longer.
A provider is teaching a male adult patient about the use of testosterone gel. Which statement by the patient indicates an understanding of the teaching? "I should apply this to my forearms and neck after showering." "I should not let my child touch the gel to prevent behavioral problems." "I should keep treated areas exposed to the air so they can dry." "I should not swim or bathe after applying the gel for three to four hours."
should not let my child touch the gel to prevent behavioral problems Testosterone administered via gels can be transferred to others by skin-to-skin contact. In children, virilization can occur as well as aggressive behaviors. The gel should be applied to clean, dry skin on the upper arms, shoulders, or abdomen and should be covered with clothing. Swimming and bathing are allowed five to six hours after application.
An advanced practice registered nurse (APRN) is treating a 37-year-old female who is requesting birth control. The APRN prescribes a combination oral contraceptive.Which item is an absolute contraindication for the classification of medication the APRN is prescribing? Hypertension Gallbladder disease Epilepsy Smoking
Smoking Smoking when using birth control is a contraindication due to the possibility of the patient developing thrombosis.
A provider is teaching a patient who is about to begin drug therapy with orlistat. The patient, whose BMI is 28, has hypertension and type 2 diabetes mellitus. Which statement by the patient indicates understanding of the teaching? "I will need to take a multivitamin containing fat-soluble vitamins every day." "I should stop taking this drug if I have fatty or oily stools or fecal incontinence." "I should stop taking this drug once my blood pressure and serum glucose have stabilized."
"I will need to take a multivitamin containing fat-soluble vitamins every day." Because orlistat works by reducing fat absorption, fat-soluble vitamins are not absorbed as well. Patients taking orlistat should also take a multivitamin containing vitamins A, D, E, and K.
A patient who has received a prescription for orlistat for weight loss asks the provider how the drug works. What should the provider tell the patient about orlistat? "It works by altering how the body stores energy." "It works by suppressing your appetite." "It works by reducing the body's absorption of fats." "It works by increasing the body's metabolic rate
"It works by reducing the body's absorption of fats." Orlistat works by altering the absorption of fats.
A patient who has traveler's diarrhea asks the provider about using loperamide to stop the symptoms. What should the provider tell the patient about this drug? "Loperamide is useful as a prophylaxis to prevent symptoms." "Loperamide is only effective to treat certain infectious agents." "Loperamide use may prolong symptoms by slowing peristalsis." "Loperamide is used for moderate to severe symptoms only."
"Loperamide use may prolong symptoms by slowing peristalsis." Loperamide is a nonspecific antidiarrheal that slows peristalsis, which may delay transit of the causative organism and prolong the infection
An adult male patient will begin androgen therapy for testicular failure. Which statement by the patient indicates understanding of the treatment regimen? "Taking this drug may lead to the development of prostate cancer." "This will restore fertility, so I can have a child." "I will need to have X-rays of my hands and feet every six months." "My libido may improve while I am taking this medication."
"My libido may improve while I am taking this medication." Treatment with androgen replacement therapy in patients with testicular failure helps restore libido. A side effect of androgens is premature epiphyseal closure; this is not a concern in adults, so radiographs to evaluate this are not indicated. Androgens can promote the growth of prostate cancer when it occurs, but they do not cause it. Androgens do not restore fertility.
A patient who will begin combination estrogen-progestin therapy (EPT) for menopause asks the nurse why she cannot take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. What response from the provider about progestin is correct? "Progestin increases bone resorption to prevent fractures." "Progestin decreases your risk of endometrial cancer."
"Progestin decreases your risk of endometrial cancer." In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease the risk of MI or DVT.
A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the provider why the more expensive antibiotic is being used. Which response by the provider is correct?
"Sulfonamides are bacteriostatic and depend on host immunity to work." Sulfonamides are usually bacteriostatic and require intact host defenses for the complete elimination of infection.
A patient will begin taking phentermine and topiramate to help with weight loss and asks the provider why the second ingredient is necessary. Which is the correct response by the provider? "Topiramate helps reduce the risk of seizures that can occur with phentermine." "Topiramate helps produce feelings of satiety to augment the drug effects." "Topiramate increases the appetite suppression caused by phentermine." "Topiramate increases the rate of weight loss by acting as a stimulant."
"Topiramate helps produce feelings of satiety to augment the drug effects." Topiramate is an antiseizure medication that acts to induce a sense of satiety in patients taking the combination product.
A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the provider. The patient is concerned about the adverse effects of ET. What should the provider tell the patient? "An intravaginal preparation may be best for her." "Side effects of ET are uncommon among women her age." "An estrogen-progesterone product will reduce side effects." "Transdermal preparations have fewer side effects."
"Transdermal preparations have fewer side effects." Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than oral preparations do. Progesterone is contraindicated in women who have undergone a hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiencies such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient's age as for other women using ET.
A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene. Which statement should the provider include when teaching this patient about the medication? "Use of this drug increases the risk of endometrial carcinoma." "Vasomotor symptoms are a common side effect of this drug." "This drug is associated with an increased risk of breast cancer." "Raloxifene reduces the risk of thromboembolism."
"Vasomotor symptoms are a common side effect of this drug." Raloxifene can induce hot flashes in patients taking this drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer.
A patient has a free T4 level of 0.6 ng/dL and a free T3 level of 220 pg/dL. The patient asks the provider what these laboratory values mean. How should the provider respond? "These laboratory values indicate that you may have Graves' disease." "These results suggest you may have hyperthyroidism." "We will need to obtain a total T4 and total T3 to tell for sure." "We will need to obtain a TSH level to better evaluate your diagnosis."
"We will need to obtain a TSH level to better evaluate your diagnosis." free T4 level of less than 0.9 ng/dL and a free T3 level of less than 230 pg/dL are consistent with hypothyroidism, but measurement of the thyroid-stimulating hormone (TSH) level is necessary to distinguish primary hypothyroidism from secondary hypothyroidism.
A 30-year-old male patient reports having two to four urinary tract infections a year. What should the provider expect to teach this patient? "You will need to take a low dose of medication for six months to prevent infections." "We will treat each infection as a separate infection and treat with short-course therapy." "Make sure you void after intercourse and drink extra fluids to stay well hydrated." "You will need to take antibiotics for four to six weeks each time you have an infection."
"You will need to take a low dose of medication for six months to prevent infections." This patient has reinfection of his urinary tract at a rate of more than three per year, which is an indication for long-term prophylaxis.
A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The provider teaching the child's parents about how to treat this infection should include which statement? "You will use an antifungal shampoo to treat this infection." "Your child will need to take this oral medication for six to eight weeks." "Adverse effects of the medication include itching, burning, and erythema." "Apply the topical medication daily until at least one week after the rash is gone."
"Your child will need to take this oral medication for six to eight weeks." Oral griseofulvin taken for six to eight weeks is standard therapy for tinea capitis.
What is a care transition? An effective self-management education program for people with chronic health problems. It teaches skills useful for managing a variety of chronic diseases. A free program offered by Part D plans to certain members to help improve their medication use so they can better manage their chronic conditions (e.g., diabetes, hypertension, asthma) and improve their overall health. The oversight and education activities conducted by healthcare professionals to help patients wi
A set of actions designed to ensure care coordination and continuity as patients transfer between different locations or different levels of care within the same location.
A patient is diagnosed with peptic ulcer disease (PUD). The patient is otherwise healthy. The provider learns that the patient does not smoke and that he drinks one or two glasses of wine with meals once a week. Which drugs should the provider prescribe? Amoxicillin, metronidazole, and cimetidine Amoxicillin, clarithromycin, and omeprazole Tetracycline, cimetidine, and lansoprazole Clarithromycin, metronidazole, and omeprazole
Amoxicillin, clarithromycin, and omeprazole The regimen recommended for the treatment of PUD includes two antibiotics and an antisecretory agent. Amoxicillin, clarithromycin, and omeprazole would meet this recommendation.
A child with an ear infection is not responding to treatment with amoxicillin. What should the provider order? Penicillin G Ampicillin Amoxicillin-clavulanic acid Nafcillin
Amoxicillin-clavulanic acid Beta-lactamase inhibitors are drugs that inhibit bacterial beta-lactamases. These drugs are always given in combination with a penicillinase-sensitive penicillin. Augmentin contains amoxicillin and clavulanic acid and is often used when patients fail to respond to amoxicillin alone.
An adult patient is seen in an emergency room with a cough, fever, dyspnea, and pleuritic chest pain. Auscultation reveals crackles over the left lower lobe of the lung, and a chest X-ray reveals patchy infiltrates. The patient's white blood cell count is greater than 15,000 per microliter of blood, and a sputum culture is positive for gram-negative bacilli. Which medication should an advanced practice registered nurse (APRN) anticipate will be initiated for this patient? Antihistamine Antibiot
Antibiotic Antibiotic therapy is indicated for pneumonia. Starting antibiotics promptly is the standard of care as delays can result in increased morbidity and mortality.
A provider is taking a history on a clinic patient who reports being constipated. Upon further questioning, the provider learns that the patient's last stool was four days ago; that it was of normal, soft consistency; and that the patient defecated without straining. The patient's abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every one to two days. What should the provider do?
Ask about recent food and fluid intake Constipation cannot only be defined by the frequency of bowel movements because this varies from one individual to another. Constipation is defined in terms of a variety of symptoms, including hard stools, infrequent stools, excessive straining, prolonged effort, and unsuccessful or incomplete defecation. A common cause of constipation is diet, especially fluid and fiber intake; therefore, when changes in stool patterns occur, patients should be questioned about food and fluid intake.
An advanced practice registered nurse (APRN) is evaluating a patient with stage 3 chronic kidney disease and type 2 diabetes. The patient has a blood pressure of 172/90, pulse of 82, respiratory rate of 14, and a temperature of 98.0°F. The patient is currently taking aspirin 81 mg daily and metformin 1 g daily. The patient's baseline blood urea nitrogen (BUN) is 15 and creatinine is 1.5. The patient does not have renal stenosis. The APRN discusses starting a medication to decrease the blood pre
Captopril 25 mg twice daily ACE inhibitors have been shown to slow progression of kidney disease in patients with diabetes
An adolescent patient with mild cervicitis is diagnosed with gonorrhea. Which drug(s) should the provider be expected to order? Azithromycin, 1 g PO once, and doxycycline, 100 mg PO twice daily for seven days Ceftriaxone, 250 mg IM once, and azithromycin, 1 g PO once Ceftriaxone, 125 mg IM once
Ceftriaxone, 250 mg IM once, and azithromycin, 1 g PO once The only options for treating cervical infection with gonorrhea are cefixime and ceftriaxone. Ceftriaxone is recommended over cefixime because of antibiotic resistance to cefixime. Because a high percentage of patients with gonorrhea also have chlamydial infections, they should be treated with either doxycycline or azithromycin until a chlamydial infection has been ruled out.
A patient comes to a clinic for tuberculosis medications two weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. What should the provider be expected to do at this point? Obtain a chest radiograph and consider adding another drug to the regimen Continue the four-drug regimen and recheck the sputum in two weeks Question the patient about adherence to the drug regimen
Continue the four-drug regimen and recheck the sputum in two weeks In patients with positive pretreatment sputum test results, sputum should be evaluated every two to four weeks until cultures are negative and then should be evaluated monthly thereafter. In the absence of drug resistance, treatment with the same regimen should continue. Sputum cultures should become negative in over 90 percent of patients in three or more months. The induction phase should last two months, so this patient should remain on a four-drug regimen.
A patient in her twenties has frequent urinary tract infections (UTIs), and her prescriber suggests drinking cranberry juice. She asks how drinking this can help. Which response from the provider is correct? Cranberry juice prevents bacteria from adhering to the urinary tract wall. Cranberry juice helps treat established infections. Cranberry juice reduces the odor of the urine. Cranberry juice acidifies the urine to slow the growth of the bacteria.
Cranberry juice prevents bacteria from adhering to the urinary tract wall. Cranberry juice helps prevent UTIs by preventing bacteria from adhering to the urinary tract wall. It does not acidify the urine or treat established infections. It can reduce odor, but this action does not contribute to decreased infections.
A provider is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the provider will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement? Coenzyme Q-10 Ma huang (ephedra) St. John's wort Ginkgo biloba
Ginkgo biloba Ginkgo biloba can suppress platelet aggregation and will increase the risk of bleeding in patients taking antiplatelet medications and anticoagulants. Coenzyme Q-10, ma huang, and St. John's wort do not have antiplatelet actions
An advanced practice registered nurse (APRN) diagnosed a patient with Helicobacter pylori (H. pylori) and is reviewing medications to treat this condition. The APRN decides to use tetracycline as one of the antibiotics to treat this condition.Why should this medication be avoided in pregnant women and children? Causes distortion of taste Causes black coloration of tongue Results in disulfiram-like reaction Stains developing teeth
Stains developing teeth Tetracycline could stain developing teeth and would therefore not be used for children.
An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills. The nurse should recommend discussing which contraceptive method with the provider? An intrauterine device with a spermicide Tubal ligation and condoms DMPA (Depo-Provera) and condoms Progestin-only oral contraceptives
DMPA (Depo-Provera) and condoms This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her. Patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and is not recommended to be used by young women because it is irreversible. Progestin-only oral contraceptives must be taken every day.
Kava's mechanism of action most similarly resembles that of which drug? Diazepam Amitriptyline Fluoxetine Hydroxyzine pamoate
Diazepam Kava has targeted actions on the GABA pathway. Diazepam is the prototype drug that directly affects GABA receptors.
A patient in her twenties with Graves' disease who takes methimazole tells her provider that she is trying to conceive and asks about disease management during pregnancy. How should the provider respond? Tell her that methimazole is safe to take throughout pregnancy Discuss changing to propylthiouracil from now until her second trimester Discuss therapy with iodine-131 instead of medications Tell her that propylthiouracil should be taken throughout her pregnancy
Discuss changing to propylthiouracil from now until her second trimester Methimazole is not safe during the first trimester of pregnancy because it is associated with neonatal hypothyroidism, goiter, and cretinism; however, it is safe in the second and third trimesters.
A patient will begin taking immunosuppressant drugs for rheumatoid arthritis (RA). Which dietary supplement should this patient avoid? Echinacea Glucosamine Feverfew Black cohosh
Echinacea Echinacea stimulates the immune system, so it should not be used in patients with autoimmune diseases such as RA; it also compromises the effectiveness of immunosuppressive drugs. Black cohosh, feverfew, and glucosamine are not contraindicated in patients with RA.
Medication reconciliation must be performed using a protocol approved by The Joint Commission. True False
False The Joint Commission has recognized medication reconciliation as a National Patient Safety Goal, and they have developed elements of performance for medication reconciliation. These make for great guidelines. But using these measures is not required to perform medication reconciliation.
True or False Raloxifene is a selective estrogen receptor modifier. Its use in osteoporosis has some benefit, but not without risks. According to a black box warning in its package insert, its use should be limited in patients with estrogen receptor-positive breast cancer.
False Raloxifene has a black box warning for venous thromboembolism and stroke.
A long-term patient of yours recently had stents placed in her left anterior descending artery (LAD). Her cardiologist put her on clopidogrel. She has been taking omeprazole for years for acid indigestion, and her cardiologist told her it has a drug interaction with her new medication. She agrees to change drugs for her heartburn. What drug should the provider prescribe? Sucralfate 500 mg BID Calcium carbonate 500 mg Famotidine 2 mg QD Pantoprazole 20 mg QD
Famotidine 2 mg QD Famotidine suppresses acid production by blocking the H2A pathway.
A patient is to undergo orthopedic surgery, and the provider is going to order a cephalosporin to be given preoperatively as a prophylaxis against infection. Which cephalosporin should the provider order? Third-generation cephalosporin Second-generation cephalosporin Fourth-generation cephalosporin First-generation cephalosporin
First-generation cephalosporin First-generation cephalosporins are widely used for prophylaxis against infection in surgical patients because they are as effective and less expensive and have a narrower antimicrobial spectrum than second-, third-, and fourth-generation cephalosporins do.
A patient is highly interested in pursuing the use of supplements in addition to more traditional medical treatments for a variety of problems. The advanced practice registered nurse (APRN) has a concern about only one of the items that was mentioned by the patient due to its low efficacy.Which item is of concern to the APRN? Peppermint for management of IBS symptoms Ginger for treatment of nausea and vomiting Ginkgo biloba for prevention of dementia
Ginkgo biloba for prevention of dementia Ginkgo biloba has failed to prevent dementia in trials, so the APRN would be concerned due to its low efficacy.
One method to improve transition of care is to create a standardized discharge process. As a primary care provider, how can you integrate standardization into your practice? Use a generic standardization process as a template Have a standardized process you go through for every patient who has engaged a new aspect of the healthcare system Use electronic health records (EHRs) Gather information from the hospital discharge liaison
Have a standardized process you go through for every patient who has engaged a new aspect of the healthcare system As part of your care, standardization has been shown to be an important part of a process of continuous quality improvement
A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for two days calls the clinic to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. Which type of drug should the nurse suggest that the patient discuss with the provider? Ocular decongestants Glucocorticoid drops An ophthalmic demulcent Histamine receptor antagonists
Histamine receptor antagonists Histamine receptor antagonists can be used to provide immediate symptom relief. So, until the cromolyn has provided relief, they may be useful for treating symptoms.
A provider is educating a patient about tetracycline. Which statement by the patient best demonstrates understanding of the administration of this medication? "I should take an antacid if I experience gastrointestinal distress." "I should not worry if I experience an acne-like rash with this medication." "I should not take this medication with milk or other dairy products." "I should take this antibiotic with a calcium supplement to improve absorption."
I should not take this medication with milk or other dairy products." The patient should avoid taking tetracycline with dairy products to help prevent chelation.
A patient with a vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. Which of the following therapies should the provider order? PO cyanocobalamin and folic acid IM cyanocobalamin and folic acid PO cyanocobalamin and blood transfusions IM cyanocobalamin and antibiotics
IM cyanocobalamin and folic acid This patient is showing signs of more severe vitamin B12 deficiency with neurologic symptoms; therefore, cyanocobalamin should be given parenterally along with folic acid. Antibiotics are indicated only when signs of infection are present. Oral cyanocobalamin is not recommended.
Which finding would indicate that terazosin has been effective for a patient with benign prostatic hyperplasia (BPH)? Decreased prostate size Improved urinary hesitation Decreased serum prostate-specific antigen levels Increased urinary frequency
Improved urinary hesitation Terazosin is an alpha1-adrenergic antagonist. These medications relax the smooth muscles of the bladder neck to improve urinary symptoms experienced with BPH. They do not decrease the size of the prostate. Increased urinary frequency is a sign of worsening BPH, not improvement.
A patient who is known to be a heavy drinker is brought to the emergency department with ataxia and confusion. The patient cannot remember the events of the previous day. The examination reveals nystagmus, and the patient reports having double vision. Which vitamin should the provider order for this patient? Intravenous thiamine (vitamin B1) Nicotinic acid (niacin) PO Ascorbic acid (vitamin C) IV Intramuscular pyridoxine (vitamin B6)
Intravenous thiamine (vitamin B1) Alcoholics who are malnourished have a form of thiamine deficiency called Wernicke-Korsakoff syndrome, which is characterized by nystagmus, diplopia, ataxia, confusion, and short-term memory loss. Parenteral thiamine is indicated for treatment. Ascorbic acid is given to treat a vitamin C deficiency, which leads to scurvy. Pyridoxine is given for vitamin B6 deficiency, also common in alcoholics, but this patient does not have the symptoms of seborrheic dermatitis and peripheral neuropathy. Nicotinic acid is used for niacin deficiency, which is characterized by severe dry, rough skin.
The provider is obtaining a history from a patient who discloses daily use of St. John's wort in addition to prescription drugs. Which effect of this dietary supplement should most concern the provider? It increases the risk of bleeding. It enhances the effects of digoxin. It counteracts the effects of CNS depressants. It accelerates the metabolism of some drugs.
It accelerates the metabolism of some drugs. St. John's wort has the potential to interact with many drugs through three different mechanisms. One mechanism, induction of P450, accelerates the metabolism of many drugs, causing loss of therapeutic effects. St. John's wort reduces the effects of digoxin because P-glycoprotein transports drugs out of tubular cells of the kidney and into the urine, greatly reducing digoxin levels. St. John's wort does not counteract the beneficial effects of CNS depressants; it can intensify the effects of serotonin. St. John's wort is not known to increase the risk of bleeding.
Why is it important to collect medication histories as part of the medication reconciliation process? It ensures a patient's medications remain accurate during transitions of care. It increases documentation, which protects against liability. It helps ensure a patient's drug therapy meets current treatment guidelines. It helps focus clinicians on the most critical prescription medications a patient is taking
It ensures a patient's medications remain accurate during transitions of care. Transitions of care can be managed more effectively with a thorough patient history and medication reconciliation.
A patient has a positive test for influenza type A and tells the provider that symptoms began five days before being tested. The provider has ordered oseltamivir. What should the provider tell the patient about oseltamivir? It may decrease symptom duration by two or three days. It may not be effective because of the delay in starting treatment. It will alleviate symptoms within 24 hours of the start of therapy. It may reduce the severity, but not the duration of symptoms.
It may not be effective because of the delay in starting treatment. Oseltamivir is most effective when begun within two days after symptom onset. When started within 12 hours of symptom onset, it may decrease duration of symptoms by two to three days.
The Joint Commission identified which of the following breakdowns as a contributor to ineffective transitions of care? Lack of accountability Medication reconciliation by interdisciplinary teams Contact with the next provider of care to exchange health information about mutual patients Discharge instructions to patient and caregivers
Lack of accountability The Joint Commission has outlined the root cause of ineffective transition of care to be lack of accountability.
A patient presents to a clinic with a history of chronic liver disease and hepatic encephalopathy. An advanced practice registered nurse (APRN) has noticed that the patient has an elevated ammonia level. Which laxative should the APRN prescribe to enhance intestinal excretion of this substance? Bisacodyl Lubiprostone Polyethylene glycol Lactulose
Lactulose This does enhance the intestinal excretion of ammonia.
A patient with a history of diabetes, diabetic nephropathy, and hypertension complains of numbness and loss of sensation in the lower extremities. An advanced practice registered nurse prescribes captopril 25 mg two times a day. What is the pharmacological effect of this medication? Binds with renin and inhibits the cleavage of angiotensinogen to angiotensin I Decreases the release of aldosterone and increases renal excretion of sodium and water Produces selective blockades of aldosterone recep
Lowers the glomerular filtration pressure Captopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers glomerular filtration pressure and thereby slows development of renal injury.
What is the relationship between medication reconciliation and hospital readmissions? Medication reconciliation alone has been proven to universally reduce hospital readmissions in all settings. Hospital readmissions are not impacted by medication reconciliation. Medication reconciliation in combination with other services may positively impact hospital readmissions in some institutions. Hospital readmissions negatively impact the success of medication reconciliation.
Medication reconciliation in combination with other services may positively impact hospital readmissions in some institutions. Hospital readmissions are decreased when transitions of care are performed at a high level.
A 48-year-old patient is diagnosed with type 2 diabetes. The patient's initial HbA1c level is 7.5, and the serum creatinine level is 1.0 mg/dL. Which first-line medication is indicated for this patient? Metformin Glipizide Canagliflozin Sitagliptin
Metformin This is the first-line treatment for type 2 diabetes with normal renal function.
A long-time patient of yours was hospitalized from an exacerbation of congestive heart failure (CHF). This patient shows up at your office today for the first follow-up visit. During the hospital stay, your patient was placed on new medications. Your patient was previously on metoprolol 50 mg QD, furosemide 40 mg QD, potassium 20 mEq QD, amlodipine 10 mg QD, omeprazole 20 mg QD, and loratadine 10 mg QD. The new medications on discharge are carvedilol 12.5 mg BID, metolazone 5 mg QD, and losartan
Metoprolol and carvedilol Metoprolol and carvedilol are in the same drug class and concomitant therapy could lead to heart block.
An advanced practice registered nurse (APRN) is preparing to discharge a 76-year-old male patient from a hospital to his home. The APRN is concerned that the patient's hospitalization was due to medication nonadherence. The APRN discusses these findings with an interdisciplinary team and then sets up a meeting with the patient and unit educator to provide education verbally and in writing regarding the medication nonadherence. Which topic should the APRN include in the discharge education? Fo
Missing a dose and forgetting to take the medication This is the key topic due to the reason for hospitalization and should be the main focus.
The provider is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the provider notes that the patient has newly elevated plasma triglycerides and cholesterol. What should the provider be expected to manage these levels with? Simvastatin Modified diet, exercise, and lipid-lowering agents Pancrease Lovastatin
Modified diet, exercise, and lipid-lowering agents All PIs can elevate plasma levels of cholesterol and triglycerides. Potential interventions for hyperlipidemia include modified diet, exercise, and lipid-lowering agents.
A patient with erectile dysfunction is prescribed tadalafil 2.5 mg daily. Which medication history finding would indicate the need to discontinue this prescription? Carvedilol 6.25 mg twice daily Labetalol 25 mg twice daily Nitro-tab 0.4 mg sublingual as needed Nitrofurantoin 100 mg daily
Nitro-tab 0.4 mg sublingual as needed Use of PDE5 inhibitors is contraindicated in patients receiving nitrate preparations due to the risk of profound hypotension. Labetalol is administered for hypertension. Carvedilol is administered for chronic heart failure. Tadalafil should be used with caution in these patients but may still be administered. Nitrofurantoin is an antimicrobial that does not affect tadalafil administration.
An 18-year-old patient who is newly diagnosed with diabetes comes to a primary clinic for a follow-up transitional care visit and expresses concern about the ability to comply with taking multiple doses of medications each day. An interprofessional team determines that the patient is at risk for noncompliance. Which action should be taken to overcome this issue? Use only generic medications for this patient Conduct an internal review of each medication and explain the importance of taking them
Simplify the regimen so that the number of drugs and doses per day are as small as possible The patient could benefit from a simplified and more easily understood regimen.
A 94-year-old patient is admitted to a hospital through an emergency department from a nursing home one week after being discharged to the nursing home due to documented altered mental status. Medications ordered at the time of discharge included warfarin, potassium, a multivitamin, hydrochlorothiazide, and PRN pain medication. The current medication list differs from the list documented one week ago. Which member of the interprofessional care team should be consulted to obtain accurate medicati
Nursing home discharge planner The nursing home discharge planner would have the most up-to-date medication list from the nursing home as this activity is within the function of this role.
Insulin glargine is prescribed for a hospitalized patient who has diabetes. When should this drug be administered? After meals and at bedtime Once daily at bedtime In the morning and at 4:00 PM Approximately 15 to 30 minutes before each meal
Once daily at bedtime Insulin glargine is indicated for once-daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime.
Which drug could you prescribe for weight loss without a DEA registration? One containing bupropion and naltrexone One containing phentermine and topiramate Lorcaserin Phentermine
One containing bupropion and naltrexone Bupropion and naltrexone are not controlled substances.
A patient appears malnourished. The patient's folic acid levels are low, and vitamin B12 levels are normal. What should this patient's treatment include? Intramuscular folic acid Oral folic acid supplements Oral folic acid and vitamin B12 A diet high in folic acid
Oral folic acid supplements If a folic acid deficiency is caused by a poor diet, it should be corrected with dietary measures, not supplements. Intramuscular or oral supplements of folic acid are not indicated. Vitamin B12 is not recommended.
A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks the provider what can be done to prevent ulcers. Which medication should the provider discuss with the patient? Antibiotics Proton pump inhibitors Histamine-2 receptor antagonists Mucosal protectants
Proton pump inhibitors Patients taking NSAIDs should use proton pump inhibitors for ulcer prophylaxis.
A patient has an infection caused by Streptococcus pyogenes. The prescriber is considering prescribing dicloxacillin PO. What should the provider do? Prescribe vancomycin to treat this infection Question the need for a penicillinase-resistant penicillin Prescribe the medication Consider giving the drug IV
Question the need for a penicillinase-resistant penicillin The provider should consider prescribing another drug. Penicillinase-resistant penicillins have been developed for use against penicillinase-producing strains of staphylococci. These drugs have a very narrow antimicrobial spectrum and should be used only for such infections. S. pyogenes can be treated with penicillin G.
A patient admitted to the emergency department with abdominal pain tells the provider he has been taking kava. Which action should be the provider's priority at this time? Monitor cardiovascular status Assess breath sounds and respiratory effort Review liver function studies Review complete blood count results
Review liver function studies Kava can cause severe liver injury and, in some cases, require liver transplantation. This patient has abdominal pain, which can be the result of liver damage, so liver function tests should be reviewed. Kava does not affect the respiratory system, the cardiovascular system, or the blood-forming organs.
An advanced practice registered nurse (APRN) is seeing a 36-year-old female for the first time who has a history of asthma and hypertension and is currently on an albuterol inhaler and an ACE inhibitor (captopril). At the visit, the woman has a positive pregnancy test. Which recommendation should the APRN make for this patient? Stop captopril and replace it with another antihypertensive medication Keep the medication regime as currently prescribed Continue captopril and consider a secondary ant
Stop captopril and replace it with another antihypertensive medication Angiotensin converting enzyme (ACE) inhibitors can cause serious fetal harm, especially during the second and third trimesters of pregnancy. They must not be given to pregnant women.
A patient reports taking an oral bisacodyl laxative for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this. What should the provider tell the patient to do? Stop taking the laxative immediately and expect no stool for several days Switch to a bulk-forming laxative, such as methylcellulose Stop taking the oral laxative and use a suppository until normal motility resumes
Stop taking the laxative immediately and expect no stool for several days The first step in breaking a laxative habit is abrupt cessation of laxative use. Bowel movements will be absent for several days after laxative withdrawal.
A patient is diagnosed with a moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin, 500 mcg per day. What should the nurse contact the provider to do? Discuss intramuscular dosing Request an order for folic acid Suggest an increased dose Suggest platelet transfusion therapy
Suggest an increased dose Patients with a vitamin B12 deficiency associated with B12 malabsorption need increased doses of oral cyanocobalamin of 1,000 to 10,000 mcg per day. It is not necessary to give this drug intramuscularly. Folic acid is indicated when B12 deficiency is severe. Platelets are given when B12 deficiency is severe.
When your patient leaves your office, you have a conference call with her cardiologist to give an update and ensure coordination of care. How do you bill for this service? Transitional care management services with high medical decision complexity using Current Procedural Terminology (CPT) code 99496 Medical team conference using Current Procedural Terminology (CPT) code 99367 Telephone services using Current Procedural Terminology (CPT) code 99442 Medication reconciliation using Current Proced
Telephone services using Current Procedural Terminology (CPT) code 99442 Telephone services are non-face-to-face evaluation and management (E/M) services provided to a patient using the telephone by a physician or other qualified healthcare professional, who may report evaluation and management services.
A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why should the provider be concerned? The beta-blocker can cause insulin resistance. Using the two agents together increases the risk of ketoacidosis. Propranolol increases insulin requirements because of receptor blocking. The beta-blocker can mask the symptoms of hypoglycemia.
The beta-blocker can mask the symptoms of hypoglycemia. Beta-blockers can delay awareness of and response to hypoglycemia by masking signs associated with the stimulation of the sympathetic nervous system (e.g., tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose. Beta-blockers, therefore, can worsen insulin-induced hypoglycemia.
Earlene Craig was given a home health nurse as part of her transition of care. She is on your schedule today for her first follow-up visit post discharge. Which information is critical for her transition of care? The medications she is currently taking The fill history from the pharmacy and discharge medications from the hospital The medications she was taking while in the hospital The medication list from her last visit
The fill history from the pharmacy and discharge medications from the hospital These pieces of information are paramount to see which medications she is currently taking and which medications she should be taking.
Coordination of care has been shown to decrease hospital readmission rates and decrease overall healthcare costs. True False
True The Care Coordination and Transition Management (CCTM) Model evolved to standardize the work of ambulatory care nurses. This model uses evidence from interdisciplinary literature on care coordination and transition management to decrease overall healthcare costs.
A 68-year-old patient will be transitioning from the hospital to a nursing home with a separate Medicare rehabilitation unit for two weeks of intense rehabilitation therapy and then returning home. The discharge paperwork has been completed, and the advanced practice registered nurse (APRN) is reviewing the discharge plan and medication list with the patient. The next step is to contact the nursing home to review the discharge orders. Which professional in the nursing home should the APRN contac
The nurse who works on the Medicare unit The nurse to nurse report to the correct unit will ensure the patient has the best possible outcome. This prevents wrong information from being passed on if calling the wrong unit.
Mrs. T has type 2 diabetes, cardiovascular disease, and a history positive for MI. The pharmacy calls you to inform you of a clear example of polypharmacy. What is an example of polypharmacy? The patient is on many medications, and she is not taking some of them because they are too expensive. The patient is taking too many medications that interact or interfere with one another. The patient is on many medications for her conditions, and changes should not be made. The patient is taking multipl
The patient is taking multiple medications from multiple providers and probably needs to discontinue some of them. The pharmacy and pharmacist are good resources to identify duplications in therapy and overprescribing from multiple providers.
A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in two months. What should the nurse recommend for this patient? The patient should request an OC containing less estrogen after surgery. The patient should discuss an alternative method of birth control prior to surgery. The patient should ask her provider about an OC with less progestin.
The patient should discuss an alternative method of birth control prior to surgery. Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least four weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The OC containing estrogen should be stopped four weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.
A patient refilled a long-standing levothyroxine prescription at the pharmacy. The pills are usually white, but this time they are yellow. The bottle has the correct dose and directions on it, but the generic manufacturer is different. When the patient questions the situation, the patient is told that the previous generic formulation is no longer available. The patient contacts an advanced practice registered nurse (APRN) for assistance. How should the APRN advise this patient?
The patient should take the new generic levothyroxine at the originally prescribed dose and return in six weeks for a retest of thyroid-stimulating hormone (TSH) and an adjustment of the dose as indicated.
What is referred to as the prescribing cascade? When prescribers are not aware of which drugs have been prescribed and add other prescriptions that may have unsafe interactions The practice of using two medications to treat a particular disease when one would work just as well The process whereby drug side effects are misdiagnosed as symptoms of another problem, resulting in further prescriptions When one medication is not covered by a patient's insurance, so the prescriber has to pick an alter
The process whereby drug side effects are misdiagnosed as symptoms of another problem, resulting in further prescriptions This is the definition of the prescribing cascade.
