MVU Pharm test bank questions

A stepwise approach to the pharmacologic management of asthma: 1. Begins with determining the severity of asthma and assessing asthma control 2. Is used when asthma is severe and requires daily steroids 3. Allows for each provider to determine their personal approach to the care of asthmatic patients 4. Provides a framework for the management of severe asthmatics, but is not as helpful when patients have intermittent asthma

1

An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: 1. Electrolytes, including potassium and chloride 2. Bone mineral density for osteoporosis 3. Magnesium level 4. Liver function

1

Asthma exacerbations at home are managed by the patient by: 1. Increasing frequency of beta-2-agonists and contacting their provider 2. Doubling inhaled corticosteroid doses 3. Increasing frequency of beta-2-agonists 4. Starting montelukast (Singulair)

1

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: 1. Urinary retention 2. Cardiac output 3. Peripheral edema 4. Skin rash

1

If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is: 1. Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days 2. Test H. pylori for resistance to common treatment regimens 3. Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days 4. Proton pump inhibitor and levofloxacin for 14 days

1

Long-term use of proton pump inhibitors may lead to: 1. Hip fractures in at-risk persons 2. Vitamin B6 deficiency 3. Liver cancer 4. All of the above

1

Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first? 1. Patients with kidney stones 2. Pregnant patients 3. Patients with heartburn 4. Postmenopausal women

1

Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: 1. Iron deficiency anemia, vitamin B12 and calcium deficiency 2. Folate and magnesium deficiency 3. Elevated uric acid levels leading to gout 4. Hypokalemia and hypocalcemia

1

Patients with COPD require monitoring of: 1. Beta-2-agonist use 2. Serum electrolytes 3. Blood pressure 4. Neuropsychiatric effects of montelukast

1

Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: 1. Megaloblastic anemia 2. Osteoporosis 3. Hypertension 4. Strokes

1

The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year-old child is: 1. Fluids and symptomatic care 2. Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids) 3. Guaifenesin and codeine syrup (Tussin AC) 4. Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids)

1

Tiotropium bromide (Spiriva) is an inhaled anticholinergic: 1. Used for the treatment of chronic obstructive pulmonary disease (COPD) 2. Used in the treatment of asthma 3. Combined with albuterol for treatment of asthma exacerbations 4. Combined with fluticasone for the treatment of persistent asthma

1

Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of: 1. Antimicrobial resistance 2. An ineffective antacid 3. Overuse of proton pump inhibitors 4. All of the above

1

Antacids treat gastroesophageal reflux disease by: 1. Increasing lower esophageal tone 2. Increasing gastric pH 3. Inhibiting gastric acid secretion 4. Increasing serum calcium level

2

Christy has exercise-induced 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: 1. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day 2. Beclomethasone needs to be used every day to treat her asthma 3. Report any systemic side effects she is experiencing, such as weight gain 4. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation

2

Decongestants such as pseudoephedrine (Sudafed): 1. Are Schedule III drugs in all states 2. Should not be prescribed or recommended for children under 4 years of age 3. Are effective in treating the congestion children experience with the common cold 4. May cause drowsiness in patients of all ages

2

Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes: 1. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists. 2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid. 3. Increase fluid intake to 3 liters per day. 4. Avoid use of aspirin or ibuprofen while using inhaled medications.

2

First-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are: 1. More effective than first-generation antihistamines 2. Less sedating than the first-generation antihistamines 3. Prescription products, therefore are covered by insurance 4. Able to be taken with central nervous system (CNS) sedatives, such as alcohol

2

Gastroesophageal reflux disease may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: 1. Calcium carbonate 2. Estrogen 3. Furosemide 4. Metoclopramide

2

Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes following normal food and water precautions as well as taking: 1. Loperamide four times a day throughout the trip 2. Bismuth subsalicylate with each meal and at bedtime 3. A prescription for diphenoxylate with atropine to use if she gets diarrhea 4. None of the above

2

Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? 1. Betamethasone, an inhaled corticosteroid 2. Salmeterol, an inhaled long-acting beta-agonist 3. Albuterol, a short-acting beta-agonist 4. Montelukast, a leukotriene modifier

2

If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is not improving, the plan of care would be: 1. Prokinetic (metoclopramide) for 8 to 12 weeks 2. Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks 3. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks 4. Cytoprotective drug (misoprostol) for 4 to 8 weeks

2

If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be: 1. Prokinetic (metoclopramide) for 4 to 8 weeks 2. Proton pump inhibitor (omeprazole) for 12 weeks 3. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks 4. Cytoprotective drug (misoprostol) for 2 weeks

2

In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur: 1. At nighttime one to two times a month 2. At nighttime three to four times a month 3. Less than twice a week 4. Daily

2

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: 1. Congratulate him on making a positive change in his life. 2. Recommend he try stopping smoking instead of the Atkin's diet. 3. Schedule him for regular testing of serum theophylline levels during his diet due to increased excretion of theophylline. 4. Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels.

2

Jim presents with complaints of "heartburn" that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be: 1. Omeprazole (Prilosec) twice a day 2. Ranitidine (Zantac) twice a day 3. Famotidine (Pepcid) once a day 4. Metoclopramide (Reglan) four times a day

2

Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: 1. Can be given to patients of all ages, including infants and children, for viral gastroenteritis 2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea 3. Is the treatment of choice for the diarrhea associated with E. coli 0157 4. May be used in pregnancy and by lactating women

2

Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Food or drink that may aggravate GERD include: 1. Eggs 2. Caffeine 3. Chocolate 4. Soda pop

2

Montelukast (Singulair) may be prescribed for: 1. A 6-year-old child with exercise-induced asthma 2. A 2-year-old child with moderate persistent asthma 3. An 18-month-old child with seasonal allergic rhinitis 4. None of the above; montelukast is not approved for use in children

2

One goal of asthma management in children is: 1. They independently manage their asthma 2. Participation in school and sports activities 3. No exacerbations 4. Minimal use of inhaled corticosteroids

2

Patients who are at risk of a fatal asthma attack include patients: 1. With moderate persistent asthma 2. With a history of requiring intubation or ICU admission for asthma 3. Who are on daily inhaled corticosteroid therapy 4. Who are pregnant

2

Patients with a COPD exacerbation may require: 1. Doubling of inhaled corticosteroid dose 2. Systemic corticosteroid burst 3. Continuous inhaled beta-2-agonists 4. Leukotriene therapy

2

Patients with pheochromocytoma should avoid which of the following classes of drugs because of the possibility of developing hypertensive crisis? 1. Expectorants 2. Beta-2-agonists 3. Antitussives 4. Antihistamines

2

Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be: 1. PEG 3350 (Miralax) 2. Bisacodyl (Dulcolax) suppository 3. Docusate (Colace) suppository 4. Polyethylene glycol electrolyte solution

2

The choice of diuretic to use in treating hypertension is based on: 1. Presence of diabetes with loop diuretics being used for these patients 2. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range 3. Ethnicity with aldosterone antagonists best for African Americans and older adults 4. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL

2

The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving is: 1. Add a prokinetic (metoclopramide) 2. Referral for endoscopy 3. Switch to another proton pump inhibitor 4. Add a cytoprotective drug

2

Treatment for mild intermittent asthma is: 1. Daily inhaled medium-dose corticosteroids 2. Short-acting beta-2-agonists (albuterol) as needed 3. Long-acting beta-2-agonists every morning as a preventative 4. Montelukast (Singulair) daily

2

After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: 1. Testing for H. pylori eradication with a serum ELISA test 2. Endoscopy by a specialist 3. A proton pump inhibitor for 8 to 12 weeks until healing is complete 4. All of the above

3

An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: 1. Histamine2 receptor antagonists for 4 to 8 weeks 2. Proton pump inhibitor bid for 12 weeks until healing is complete 3. Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days 4. Proton pump inhibitor bid and levofloxacin for 14 days

3

Education of patients with COPD who use inhaled corticosteroids includes: 1. Doubling the dose at the first sign of a URI 2. Using their inhaled corticosteroid first and then their bronchodilator 3. Rinsing their mouth after use 4. Abstaining from smoking for at least 30 minutes after using

3

Infants with reflux are initially treated with: 1. Histamine2 receptor antagonist (ranitidine) 2. Proton pump inhibitor (omeprazole) 3. Anti-reflux maneuvers (elevate head of bed) 4. Prokinetic (metoclopramide)

3

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: 1. Reassure him this is probably a viral infection and should be better soon 2. Have him seen the same day for an assessment and theophylline level 3. Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better 4. Order a theophylline level at the laboratory for him

3

Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug Administration due to the: 1. Risk of life-threatening dermatological reactions 2. Increased incidence of cardiac events when LTBAs are used 3. Increased risk of asthma-related deaths when LTBAs are used 4. Risk for life-threatening alterations in electrolytes

3

Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be: 1. Oral pseudoephedrine 2. Oral phenylephrine 3. Nasal oxymetazoline 4. Nasal azelastine

3

Metoclopramide improves gastroesophageal reflux disease symptoms by: 1. Reducing acid secretion 2. Increasing gastric pH 3. Increasing lower esophageal tone 4. Decreasing lower esophageal tone

3

Pregnant patients with asthma may safely use ________ throughout their pregnancy. 1. Oral terbutaline 2. Prednisone 3. Inhaled corticosteroids (budesonide) 4. Montelukast (Singulair)

3

The first-line therapy for mild-persistent asthma is: 1. High-dose montelukast 2. Theophylline 3. Low-dose inhaled corticosteroids 4. Long-acting beta-2-agonists

3

When educating patients who are starting on inhaled corticosteroids, the provider should tell them that: 1. They need to get any live vaccines before starting the medication. 2. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. 3. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. 4. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids.

3

When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed: 1. Montelukast twice a day is started when there is an asthma exacerbation. 2. Patients may experience weight gain on montelukast. 3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. 4. Lethargy and hypersomnia may occur when taking montelukast.

3

When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to: 1. Take the dimenhydrinate after they get nauseated 2. Drink lots of water while taking the dimenhydrinate 3. Take the dimenhydrinate 15 minutes before it is needed 4. Double the dose if one tablet is not effective

3

Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: 1. May lead to toxicity if taken with aspirin 2. Is contraindicated in children with flu-like illness 3. Has antimicrobial effects against bacterial and viral enteropathogens 4. All of the above

4

Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population: 1. Older adults 2. Hypertensive patients 3. Infants 4. All of the above

4

Digoxin levels need to be monitored closely when the following medication is started: 1. Loratadine 2. Diphenhydramine 3. Ipratropium 4. Albuterol

4

Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? 1. Prochlorperazine (Compazine) 2. Meclizine (Antivert) 3. Promethazine (Phenergan) 4. Ondansetron (Zofran)

4

Medications used in the management of patients with chronic obstructive pulmonary disease (COPD) include: 1. Inhaled beta-2-agonists 2. Inhaled anticholinergics (ipratropium) 3. Inhaled corticosteroids 4. All of the above

4

Methylnaltrexone is used to treat constipation in: 1. Patients with functional constipation 2. Patients with irritable bowel syndrome-associated constipation 3. Children with encopresis 4. Opioid-associated constipation

4

Monitoring a patient with persistent asthma includes: 1. Monitoring how frequently the patient has an upper respiratory infection (URI) during treatment 2. Monthly in-office spirometry testing 3. Determining if the patient has increased use of his or her long-acting beta-2-agonist due to exacerbations 4. Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy

4

One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is: 1. Ability to use albuterol daily to control symptoms 2. Minimize exacerbations to once a month 3. Keep nighttime symptoms at a maximum of twice a week 4. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms

4

Patients taking antacids should be educated regarding these drugs, including letting them know that: 1. They may cause constipation or diarrhea 2. Many are high in sodium 3. They should separate antacids from other medications by 1 hour 4. All of the above

4

Patients with allergic rhinitis may benefit from a prescription of: 1. Fluticasone (Flonase) 2. Cetirizine (Zyrtec) 3. OTC cromolyn nasal spray (Nasalcrom) 4. Any of the above

4

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: 1. Daily 2. Daily and limit physical activity 3. Less than twice a week 4. More than twice a week and less than once a day

4

The bronchodilator of choice for patients taking propranolol is: 1. Albuterol 2. Pirbuterol 3. Formoterol 4. Ipratropium

4

The most common bacterial pathogen in community-acquired pneumonia is: 1. Haemophilus influenzae 2. Staphylococcus aureus 3. Mycoplasma pneumoniae 4. Streptococcus pneumoniae

4

When treating patients using the "Step-Down" approach the patient with gastroesophageal reflux disease is started on _______ first. 1. Antacids 2. Histamine2 receptor antagonists 3. Prokinetics 4. Proton pump inhibitors

4