Woo & Robinson- Pharm Ch. 14 & 17 Respiratory and GI

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A 25-year-old female patient is about to embark on a 2-week cruise for her honeymoon, and she is worried because she experiences seasickness. She asks about using a scopolamine patch. Which advice would the APN provide the patient about this medication? 1. "Apply the patch behind your ear 4 hours before getting on the ship." 2. "Change the patch every morning while on the ship." 3. "When you change the patch, put it behind the same ear." 4. "Only apply the patch to your arm if you experience seasickness."

"Apply the patch behind your ear 4 hours before getting on the ship." Rationales Option 1: The patch should be applied behind the ear 4 hours before traveling. Option 2: The patch can be left in place for up to 3 days. Option 3: If therapy is still needed after 3 days, the new patch should be placed behind the other ear. Option 4: The patch should be applied behind the ear 4 hours before traveling.

A 55-year-old female patient who takes Spiriva for her chronic obstructive pulmonary disease complains of throat irritation since starting this medication. Which response by the APN is most appropriate? 1. "That's normal. Take Robitussin once a day with Spiriva use." 2. "Increase your water intake during the day." 3. "Are you rinsing your mouth after each use?" 4. "How much caffeine are you drinking a day?"

"Are you rinsing your mouth after each use?" Rationales Option 1: A cough may develop with inhaled anticholinergics such as Spiriva or Combivent, and less common complaints of throat irritation, hoarseness, or dry mouth may occur. Daily Robitussin is not the recommended method of decreasing these adverse effects. Option 2: A cough may develop with inhaled anticholinergics such as Spiriva or Combivent, and less common complaints of throat irritation, hoarseness, or dry mouth may occur. Using a spacer device and rinsing the mouth with water after administration will decrease the incidence of these adverse effects. Option 3: A cough may develop with inhaled anticholinergics such as Spiriva or Combivent, and less common complaints of throat irritation, hoarseness, or dry mouth may occur. Using a spacer device and rinsing the mouth with water after administration will decrease the incidence of these adverse effects. Option 4: Caffeine intake is not relevant to this patient's symptom. A cough may develop with inhaled anticholinergics such as Spiriva or Combivent, and less common complaints of throat irritation, hoarseness, or dry mouth may occur. Using a spacer device and rinsing the mouth with water after administration will decrease the incidence of these adverse effects. [Page reference: 356]

An APN is teaching a group of nursing students about asthma medications and asthma management. One of the students asks the APN to explain how the severity of asthma is evaluated. Which response by the APN is most appropriate? 1. "Asthma severity is evaluated iteratively based on trial and error of how many medications are needed to achieve control." 2. "Asthma severity is evaluated retrospectively based on the level of treatment required to achieve symptom control." 3. "Asthma severity is evaluated based on age and weight." 4. "Asthma severity is evaluated based on age and family history."

"Asthma severity is evaluated retrospectively based on the level of treatment required to achieve symptom control." Rationales Option 1: Asthma severity is not evaluated iteratively. Option 2: According to the Global Initiative for Asthma (GINA, 2018), asthma severity is evaluated retrospectively based on the level of treatment required to achieve symptom control. Typically, asthma severity is determined when the patient has been on asthma-control medication for several months and treatment step-down has been achieved. Option 3: Asthma severity is not evaluated based on age and weight. Option 4: Asthma severity is not evaluated based on age and family history.

A patient with a body mass index (BMI) of 28 has recently been diagnosed with gastroesophageal reflux disease (GERD), and omeprazole has been prescribed. Which advice would the APN give this patient regarding lifestyle changes? 1."You should eat meals high in carbohydrates." 2."Small amounts of alcohol are OK." 3."Attaining a healthy weight will help reduce symptoms of GERD." 4."Drinking peppermint tea before bed will help."

"Attaining a healthy weight will help reduce symptoms of GERD." Rationales Option 1: High-carbohydrate meals will worsen GERD. Option 2: Alcohol decreases lower esophageal sphincter tone and will make GERD worse. Option 3: Obesity increases abdominal pressure and will worsen GERD. Option 4: Peppermint decreases lower esophageal sphincter tone and will make GERD worse.

The APN is reviewing a patient's current medications, including over-the-counter (OTC) medications, with him. The patient suffers from dyspepsia and takes Tums (calcium carbonate). Which statement by the patient indicates that the patient understands how best to take this medication? 1."I take it when I have my spinach salad for lunch." 2."I take it with a glass of orange juice." 3. "I take it just before I eat my breakfast cereal." 4."I take it along with my regular medications in the morning."c

"I take it with a glass of orange juice." Rationales Option 1: Spinach contains large amounts of oxalic acid, which decreases absorption of calcium. Option 2: Acidic fruit juice may improve absorption of calcium-based antacids. Option 3: Cereals and bran contain phytic acid, which decreases absorption of calcium-based antacids. Option 4: Antacids bind with many other drugs, decreasing their absorption.

The APN is reviewing a patient's current medications, including over-the-counter (OTC) medications, with him. The patient suffers from dyspepsia and takes Tums (calcium carbonate). Which statement by the patient indicates that the patient understands how best to take this medication? 1. "I take it when I have my spinach salad for lunch." 2. "I take it with a glass of orange juice." 3. "I take it just before I eat my breakfast cereal." 4. "I take it along with my regular medications in the morning."

Which statement made by the patient indicates understanding of proper use of the prescribed inhaled corticosteroid? 1. "When I have an asthma attack, I should double my dose of inhaled corticosteroid." 2. "My inhaled corticosteroid should not be used for relief of acute bronchospasm." 3. "As long as I don't have a fever, I can double my dose of inhaled corticosteroid if I am having coughing and bronchospasm." 4. "I can decrease the number of puffs I take of my inhaled corticosteroid for status asthmaticus."

"My inhaled corticosteroid should not be used for relief of acute bronchospasm." Rationales Option 1: All of the inhaled corticosteroid preparations are contraindicated in acute status asthmaticus or when intensive, acute therapy is warranted. Option 2: All of the inhaled corticosteroid preparations are contraindicated in acute status asthmaticus or when intensive, acute therapy is warranted. They should not be used for relief of acutebronchospasm. Option 3: All of the inhaled corticosteroid preparations are contraindicated in acute status asthmaticus or when intensive, acute therapy is warranted. Option 4: All of the inhaled corticosteroid preparations are contraindicated in acute status asthmaticus or when intensive, acute therapy is warranted. [Page reference: 361]

A student APN is giving a presentation to her classmates about gastroesophageal reflux disease (GERD). Which piece of information should be included? 1. "GERD is uncomfortable for the patient but will not cause lasting damage." 2. "Most patients complain of retrosternal pain radiating downwards to the abdomen." 3. "Older adults may have few symptoms, despite having significant disease." 4."Dysphagia with GERD indicates that the patient has esophageal cancer."

"Older adults may have few symptoms, despite having significant disease." Rationales Option 1: GERD can lead to basal cell hyperplasia and cancer. Option 2: The pain is substernal and radiates upward. Option 3: Decreased gastric acid secretion and decreased pain perception occur in older adults. Option 4: Dysphagia warrants more investigation but is not necessarily due to cancer.

A patient presents for a 3-week follow-up visit after starting an albuterol inhaler. He reports to the APN that he feels like he has "tremors" when he uses it. Which response by the APN is most appropriate? 1."Stop the medication immediately. This side effect is abnormal." 2."This is a normal side effect when you initially begin the medication, but this should get better if you use it correctly." 3."Take a Tylenol prior to using your inhaler to help counteract the symptoms." 4. "Rest for 30 minutes prior to taking the medication, and you shouldn't experience these symptoms."

"This is a normal side effect when you initially begin the medication, but this should get better if you use it correctly." Option 1: Some stimulant-like effects are normal with the first use of this medication. Option 2: Patients should understand that they may have some stimulant-like effects (e.g., increased heart rate, tremors) when they initially begin the medication, but these effects should lessen if they use it correctly. Option 3: Tylenol would not counteract symptoms of tremor. Option 4: These effects will not be improved with rest prior to taking the medication. [Page reference: 350]

The patient reports that he takes oxymetazoline for allergic rhinitis and has been using it more often than prescribed. He informs the APN that he feels like it works for a while then all of a sudden stops working. Which response by the APN is most appropriate? 1. "You are describing a condition called rhinitis medicamentosa, and this happens with chronic or prolonged use of topical decongestants." 2. "You will need to add this medication to your list as an allergy. This is an allergic reaction." 3. "Rinse your nasal passages with saline and take an extra dose. This is a normal reaction and will improve with concurrent use of normal saline rinses." 4. "Immediately take a Benadryl for this reaction."

"You are describing a condition called rhinitis medicamentosa, and this happens with chronic or prolonged use of topical decongestants." Rationales Option 1: The most significant adverse reaction with topical decongestants is rebound congestion (rhinitis medicamentosa) with prolonged or chronic use. This does not occur with short-term (3- to 5-day) use. Option 2: This is not an allergic reaction. Option 3: Normal saline rinses will not improve this condition. Option 4: This is not an allergic reaction, so Benadryl would not be effective. [Page reference: 382]

The APN is performing a follow-up visit on a patient who has recently been prescribed an inhaled anticholinergic. The patient is complaining of throat irritation, hoarseness, and dry mouth since starting the medication. To decrease the incidence of adverse effects, the APN should include which information in patient education? 1. "You should use a spacer device and rinse the mouth with water after administration." 2. "Eat a meal before you administer the medication." 3. "Drink cola before and after administration of the medication." 4. "Use a humidifier next to your bed at night."

"You should use a spacer device and rinse the mouth with water after administration." Rationales Option 1: The patient should be advised that a cough may develop with either inhaled anticholinergic and that less common complaints of throat irritation, hoarseness, or dry mouth may occur. Using a spacer device and rinsing the mouth with water after administration will decrease the incidence of these adverse effects. Option 2: The adverse effects that the patient is experiencing are not noted to be decreased or eliminated by consumption of a meal. Option 3: Drinking cola is not noted to impact these adverse effects. Option 4: The addition of humidification is not noted to decrease these adverse effects. [Page reference: 356]

The mother of a 10-year-old male patient with asthma tells the APN that she is concerned that her son may not be getting all of the inhaled medicine when he uses his inhaler. Which response from the APN is most appropriate? 1."As long as he gets most of the medication, he will be fine." 2."Have him hold his breath for 3 seconds when he inhales the medication." 3."Your son would benefit from using a spacer device with the metered-dose inhaler (MDI) to increase deposition of medication into the lungs, rather than just in the mouth." 4."Your son should take an extra inhalation of the medication if you are concerned he did not get all of the medication that was dispensed."

"Your son would benefit from using a spacer device with the metered-dose inhaler (MDI) to increase deposition of medication into the lungs, rather than just in the mouth." Rationales Option 1: This response by the APN is not most appropriate because it does not ensure the patient gets all of his inhaled medicine. Option 2: Holding his breath will not assure that he inhales all of the medication. Option 3: It is recommended that a spacer device be used with MDIs (AeroChamber, InspirEase) to increase deposition of medication into the lungs, rather than just in the mouth. Option 4: It would not be recommended to take extra doses of the medication that were not prescribed because this can contribute to adverse effects.

A 65-year-old female patient in generally good health requests information regarding the amount of calcium she should take daily as a supplement to prevent osteoporosis. Which amount would the APN recommend? 1. 500 mg/day 2. 1,000 mg/day 3. 1,500 mg/day 4. 2,500 mg/day

1,500 mg/day Rationales Option 1: The patient is 65 years old and will be postmenopausal. The dose is too low. Option 2: This dose is adequate for premenopausal women and for men but not for postmenopausal women. Option 3: This is the correct daily dose for a postmenopausal woman. Option 4: Doses higher than 2,000 mg/day are not recommended because of an increased risk of adverse effects. [Page reference: 482]

Most infants experience gastroesophageal reflux to some degree. The APN would start to be concerned if the child had not outgrown reflux by which age? 1. 3 months 2. 6 months 3. 9 months 4. 12 months

12 months Rationales Option 1: Gastroesophageal reflux is not usually a cause for concern at this age. Option 2: Gastroesophageal reflux is not usually a cause for concern at this age. Option 3: Gastroesophageal reflux is not usually a cause for concern at this age. Option 4: Most children outgrow gastroesophageal reflux by 12 to 18 months of age. [Page reference: 1058]

The capacity of an antacid to neutralize hydrochloric acid (HCl) varies between products. To be effective, antacids must neutralize at least how much HCl per dose? 1. 1 mEq HCl per dose 2. 2 mEq HCl per dose 3. 5 mEq HCl per dose 4. 10 mEq HCl per dose

5 mEq HCl per dose Rationales Option 1: To be effective, antacids must neutralize more HCl than this per dose. Option 2: To be effective, antacids must neutralize more HCl than this per dose. Option 3: Antacids must neutralize at least 5 mEq HCl per dose. Option 4: Antacids can neutralize less HCl than this per dose and be considered effective.

Codeine should be used with caution in which patient? 1. A 56-year-old patient who has just had major foot surgery 2. A 25-year-old patient with a history of substance abuse 3. A 45-year-old patient who refuses to take allergy medication 4. A 65-year-old patient who has not had a flu vaccination this season

A 25-year-old patient with a history of substance abuse Rationales Option 1: Major foot surgery would validate a possible need for codeine for pain. Option 2: Codeine may cause dependence and should be used with caution in a patient with a history of substance abuse. Option 3: Refusal to take allergy medication does not affect codeine usage. Option 4: Flu vaccination status does not affect codeine usage. [Page reference: 385]

Which patient could safely be prescribed bupropion? 1. A 56-year-old with chronic obstructive pulmonary disease 2. A 23-year-old with anorexia nervosa 3. A 35-year-old with bulimia 4. A 67-year-old who is currently taking monoamine oxidase inhibitors (MAOIs)

A 56-year-old with chronic obstructive pulmonary disease Rationales Option 1: Bupropion is contraindicated in patients with seizure disorders, bulimia, and anorexia nervosa and within 14 days of the use of monoamine oxidase inhibitors (MAOIs). Option 2: Bupropion is contraindicated in patients with anorexia nervosa. Option 3: Bupropion is contraindicated in patients with bulimia. Option 4: Bupropion is contraindicated within 14 days of the use of MAOIs.

For which patient is docusate contraindicated? 1. A female patient with an 8-week-old baby who is breastfeeding 2. A female patient who is 16 weeks pregnant 3. A male patient who has just undergone a thoracotomy 4. A male patient complaining of nausea and abdominal pain

A male patient complaining of nausea and abdominal pain Rationales Option 1: Surfactants are safe for pregnant and breastfeeding women. Option 2: Surfactants are safe for pregnant and breastfeeding women. Option 3: Surfactants are often prescribed postoperatively to prevent straining. Option 4: Laxatives should not be taken in the presence of nausea, vomiting, or abdominal pain. The patient needs further investigation to rule out a bowel obstruction. [Page reference: 517]

In adult patient woke up with fever of 102.6°F (39.2°C) and reports nasal congestion with purulent nasal discharge and facial pain that worsens when bending over. The patient has had runny nose and some nasal congestion for the past 3 days. Which medication will the nurse practitioner prescribe for this patient? 1. Acetaminophen 2. Amoxicillin 3. Amoxicillin-clavulanate 4. Doxycycline

Acetaminophen Rationales Option 1: The patient is experiencing signs and symptoms of acute sinusitis. The American Academy of Pediatrics (AAP) and the American Academy of Ophthalmology (AAO) recommend observing the patient for 3 days before starting antibiotics. However, the patient will require symptomatic treatment, such as for fever, nasal congestion, and facial pain. Option 2: American Academy of Ophthalmology (AAO) guidelines recommend amoxicillin as a first-line therapy for sinusitis, but the guidelines also provide an option for observing the patient for 3 days before starting antibiotics. Option 3: American Academy of Ophthalmology (AAO) guidelines recommend amoxicillin-clavulanate as a first-line therapy for sinusitis in patients at high-risk for resistance, but the guidelines also provide an option for observing the patient for 3 days before starting antibiotics. Option 4: Doxycycline or levofloxacin are treatment options for patients who are allergic to penicillins. However, American Academy of Ophthalmology (AAO) guidelines provide an option for observing the patient for 3 days before starting antibiotics. [Page reference: 1323]

A patient who has been diagnosed with asthma presents today for follow-up. She states that she has been using a short-acting beta2 agonist (SABA) four times a week. Which action taken by the APN is most appropriate? 1.Continue the current plan of care. 2.Add a high-dose inhaled corticosteroid and a long-acting beta agonist (LABA). 3.instruct the patient to use the SABA more frequently during the week. 4.Add a low-dose inhaled corticosteroid.

Add a low-dose inhaled corticosteroid. Rationales Option 1: Using SABAs more than twice a week may indicate a need to step up to step 2 therapy or to initiate long-term control therapy. Option 2: Using SABAs more than twice a week may indicate a need to step up to step 2 therapy or to initiate long-term control therapy. The health-care provider would add a LABA at step 3. Option 3: Using SABAs more than twice a week may indicate a need to step up to step 2 therapy or to initiate long-term control therapy. Simply increasing the frequency does not establish control of the symptoms. Option 4: Using SABAs more than twice a week may indicate a need to step up to step 2 therapy or to initiate long-term control therapy. The most appropriate step is to institute a low-dose inhaled corticosteroid, which is indicated as the preferred treatment for step 3 therapy. [Page reference: 943]

A patient has been diagnosed with asthma. The APN would inform the patient that which medication should be used for an acute asthma attack? 1. Arformoterol (Brovana) 2. Theophylline (Theo 24) 3. Albuterol (ProAir HFA) 4. Montelukast (Singulair)

Albuterol (ProAir HFA) Rationales Option 1: Arformoterol (Brovana) is administered via nebulizer and dosed at 15 mcg by inhalation twice a day. Arformoterol is not approved for use in children and should not be used for acute asthma exacerbation. Option 2: Theophylline can be used in the treatment for asthma; however, it is not recommended for acute asthma attacks. Option 3: The bronchodilators are used primarily in the treatment of bronchospasm associated with asthma, bronchitis (acute or chronic), and chronic obstructive pulmonary disease (COPD). Albuterol is a common medication used for acute asthma attacks (short-term relief). Option 4: The leukotriene modifiers are not to be used for primary treatment of an acute asthma attack.

A 43-year-old female patient who has asthma and diabetes presents today with complaints of increased wheezing and coughing. She reports having to use her albuterol inhaler more often than usual. The APN recognizes which statement below to be true regarding diabetes and albuterol use? 1. Albuterol is a long-acting beta agonist (LABA) and can potentially cause hypoglycemia. 2. Albuterol is a long-acting beta agonist (LABA) and can potentially cause hyperglycemia. 3. Albuterol is a short-acting beta2 agonist and can potentially cause hyperglycemia. 4. Albuterol is a short-acting beta2 agonist and can potentially cause hypoglycemia.

Albuterol is a short-acting beta2 agonist and can potentially cause hyperglycemia. Rationales Option 1: Albuterol is not a LABA and does not cause hypoglycemia. Option 2: Albuterol is not a LABA. Option 3: Albuterol is a short-acting beta2 agonist. For patients with diabetes mellitus, there is a potential drug-induced hyperglycemia that may result in loss of diabetic control when using any of the beta2 agonists. Because of this, insulin dosage may need to be increased. Option 4: Albuterol is a short-acting beta2 agonist but does not cause hypoglycemia. [Page reference: 339]

Which is a clinical use for cromolyn? 1. Status asthmaticus 2. Allergic rhinitis 3. Acute bronchospasm 4. Leukocytosis

Allergic rhinitis Rationales Option 1: Cromolyn is not a bronchodilator, and it is contraindicated in the treatment of status asthmaticus. Option 2: Approved clinical uses for cromolyn include allergic rhinitis, asthma, inflammatory bowel disease, bronchospasm prophylaxis, and mastocytosis. Option 3: Cromolyn is not a bronchodilator, and it is contraindicated in the treatment of acute bronchospasm. Option 4: Leukocytosis is not a clinical use for cromolyn. [Page reference: 367]

A patient with chronic renal failure is on dialysis three times a week. He frequently complains of dyspepsia and has been receiving aluminum hydroxide orally several times a day for the past 2 years. Why would this be of grave concern to the APN? 1. Aluminum hydroxide can worsen renal failure. 2. Aluminum hydroxide frequently causes diarrhea. 3. Prolonged use of aluminum hydroxide can cause metabolic acidosis. 4. Aluminum hydroxide can cause dialysis osteomalacia.

Aluminum hydroxide can cause dialysis osteomalacia. Rationales Option 1: The patient is already on dialysis, so it would be irrelevant. Option 2: The medication causes constipation, not diarrhea. Option 3: The medication can sometimes cause alkalosis. Option 4: Prolonged use can cause or worsen the osteomalacia commonly seen in dialysis patients.

The parents have brought in a 30-month-old who has a 102.6°F (39.2°C) temperature, is pulling on his left ear, and has not eaten anything since that morning. The nurse practitioner observes that the patient's left ear is erythematous with mild bulging of the tympanic membrane. The patient regularly attends daycare and has not had an illness in the past 3 months. What is an appropriate treatment for the patient? 1. Clarithromycin 2. Amoxicillin/clavulanate 3. Amoxicillin 4. Ibuprofen

Amoxicillin Rationales Option 1: Clarithromycin has 35.2% resistance to common pathogens causing acute otitis media and should not be used as treatment for the condition. Option 2: The patient has signs and symptoms of severe acute otitis media. Amoxicillin/clavulanate is to be prescribed to patients who have had amoxicillin in the past 30 days, those with concurrent conjunctivitis, or those who warrant coverage for beta-lactamase-positive H. influenzae and M. catarrhalis. Option 3: The patient has signs and symptoms of severe acute otitis media. Amoxicillin is the first-choice antibiotic in spite of resistance for most children if they have not received amoxicillin in the past 30 days. Option 4: The patient has signs and symptoms of severe acute otitis media and is not a candidate for watchful waiting with adequate pain management.

The APN has diagnosed a patient with group A streptococcal (GAS) pharyngitis who does not have any known drug allergies. Which drug is considered the first-line therapy? 1. Clindamycin (Cleocin) 2. Doxycycline (Doryx) 3. Amoxicillin (Amoxil) 4. Azithromycin (Zithromax)

Amoxicillin (Amoxil) Rationales Option 1: Clindamycin is not considered first-line therapy for GAS. Option 2: Doxycycline is not considered first-line therapy for GAS. Option 3: First-line therapy for GAS is penicillin V or amoxicillin in a patient who is not allergic to penicillin. Option 4: Azithromycin is not considered first-line therapy for GAS. [Page reference: 1326]

A patient was given a prescription for codeine after being discharged home after carpal tunnel surgery. She tells the APN that she has a little cough at times and takes benzonatate (Tessalon) for this, which she has at home. How would the APN respond? 1."You should not take any cough suppressants while you are taking codeine." 2."You can take the Tessalon along with the codeine as long as you are not a smoker." 3."You can take the Tessalon along with the codeine as long as you don't take more than the prescribed dose of each medication." 4."You may require an increased dose of Tessalon while taking codeine."

Answer: "You should not take any cough suppressants while you are taking codeine." Rationales Option 1: Use of antitussives with any central nervous system (CNS) depressant may cause increased CNS depression. Option 2: Use of antitussives with codeine should be addressed, regardless of smoking status. Option 3: Use of antitussives with codeine should be addressed, regardless of dose. Option 4: An increased dose of Tessalon is not indicated.

Answer: 1,500 mg/day Rationales Option 1: The patient is 65 years old and will be postmenopausal. The dose is too low. Option 2: This dose is adequate for premenopausal women and for men but not for postmenopausal women. Option 3: This is the correct daily dose for a postmenopausal woman. Option 4: Doses higher than 2,000 mg/day are not recommended because of an increased risk of adverse effects.

Traveler's diarrhea is common in people who journey to high-risk areas such as Central and South America. Which medications are specifically indicated for traveler's diarrhea? 1. Bismuth subsalicylate and alosetron 2. Loperamide and kaolin-pectin 3. Crofelemer and bismuth subsalicylate 4. Bismuth subsalicylate and loperamide

Answer: Bismuth subsalicylate and loperamide Rationales Option 1: Alosetron is for severe irritable bowel syndrome (IBS) with diarrhea in women. Option 2: Kaolin-pectin is not indicated for traveler's diarrhea. Option 3: Crofelemer is for diarrhea associated with antiretroviral therapy. Option 4: These are the only drugs indicated for traveler's diarrhea.

A patient in the emergency room (ER) has been prescribed ondansetron for nausea. The APN understands that this medication works by which mechanism? 1. Blocking dopamine receptors in the chemoreceptor trigger zone 2. Blocking histamine1 receptors in the gastrointestinal (GI) tract 3. Blocking serotonin on vagal nerve terminals 4. Stimulating gastric emptying and peristalsis

Answer: Blocking serotonin on vagal nerve terminals Rationales Option 1: This mechanism describes the actions of a phenothiazine. Option 2: Antihistamines medications work through this mechanism. Option 3: The 5-hydroxytryptamine-3 receptor (5-HT3) receptor antagonists block serotonin. Option 4: This mechanism is used by a prokinetic agent, such as metoclopramide.

If any of the beta agonists are prescribed with digitalis glycosides, caution and careful monitoring of which test is recommended? 1. Electrocardiogram (ECG) 2. Sodium 3. Thyroid-stimulating hormone (TSH) 4. Radiograph of the chest

Answer: Electrocardiogram (ECG) Rationales Option 1: If any of the beta agonists are prescribed with digitalis glycosides, caution and careful monitoring of the patient's ECG is necessary because there is an increased risk of cardiac arrhythmia. Option 2: Sodium is not recommended to be monitored. Option 3: There is not a clear indication that TSH is recommended to be monitored. Option 4: Radiograph of the chest is not recommended.

Many patients, particularly older adults, take over-the-counter (OTC) laxatives regularly. Which statement about laxative use is accurate? 1. Patients cannot become dependent on laxatives. 2. Fluid and electrolyte imbalances can occur. 3. Persons with Crohn's disease often abuse laxatives and take too many. 4. Castor oil is good choice of laxative for a pregnant woman.

Answer: Fluid and electrolyte imbalances can occur. Rationales Option 1: This is untrue. Many patients become dependent on laxatives for a bowel movement, particularly with the overuse of stimulant laxatives. Option 2: This is especially true of older adults using bulk-forming laxatives or hyperosmolar agents. Option 3: Laxative abuse is commonly seen in those with personality disorders and women with depression or anorexia nervosa. Option 4: Castor oil induces uterine contractions and should not be used. [Page reference: 516]

Beta-adrenergic agonists should be avoided in patients with pheochromocytoma because of which adverse effect? 1. Apnea 2. Coronary insufficiency 3. Bradycardia 4.Hypertension

Answer: Hypertension Rationales: Option 1: Apnea is not a side effect related to the use of beta-adrenergic agonists. Option 2: Because of these drugs' effects on the cardiovascular system, patients with coronary insufficiency should be monitored closely for adverse effects during administration of any of the sympathomimetic bronchodilators. However, it is not a reason to avoid their use in patients with pheochromocytoma. Option 3: Bradycardia is not a side effect related to the use of beta-adrenergic agonists. Option 4: Patients with diagnosed or suspected pheochromocytoma should avoid the beta-adrenergic agonists because severe hypertension may occur.

The patient with which condition can be safely prescribed an antihistamine? 1.Lower-respiratory tract symptoms 2.Stenosing peptic ulcer 3.Narrow-angle glaucoma 4.Otitis media with cerumen impaction

Answer: Otitis media with cerumen impaction Rationale: Antihistamines are not contraindicated in patients with otitis media with cerumen impaction. 1. Antihistamines are contraindicated in patients with lower-respiratory tract symptoms (they thicken secretions and impair expectoration). 2. Antihistamines are contraindicated in patients with stenosing peptic ulcer. 3. Antihistamines are contraindicated in patients with narrow-angle glaucoma.

Which of these will increase the rate of excretion of theophylline? 1. Smoking 2.Exercise 3. High-carbohydrate diets 4. Alcohol use

Answer: Smoking Rationales Option 1: Smoking and high-protein diets can increase the theophylline excretion rate, and high-carbohydrate diets can decrease it. Option 2: Exercise does not affect the rate of excretion of theophylline. Option 3: High-carbohydrate diets can decrease the rate of excretion of theophylline. Option 4: Alcohol use is not noted to affect the rate of excretion of theophylline.

A 50-year-old male patient is complaining of recurrent heartburn. He has been taking over-the-counter (OTC) famotidine as per the directions on the box but has had little relief. Which situation could influence the efficacy of the medication? 1. The patient sleeps on four pillows. 2. The patient takes the medication with meals. 3. The patient feels sleepy after taking famotidine. 4.The patient smokes 5 to 10 cigarettes per day.

Answer: The patient smokes 5 to 10 cigarettes per day. Rationales: Option 1: Sleeping in a more upright position can help alleviate dyspepsia. Option 2: Histamine2 receptor antagonists are best taken with meals or at bedtime. Option 3: Drowsiness is a known adverse effect of histamine2 receptor antagonists. Option 4: Smoking interferes with absorption of histamine2 receptor antagonists and also stimulates gastric acid secretion. [Page reference: 484]

A patient with known liver disease should avoid which medication below? 1. Albuterol 2. Combivent 3. Prednisone 4.Zafirlukast

Answer: Zafirlukast Rationales: Option 1: Albuterol has no specific indications for patients with hepatic dysfunction. Option 2: Combivent has no specific indications for patients with hepatic dysfunction. Option 3: Prednisone has no indications for patients with liver disease. Option 4: Zafirlukast should be used with caution in patients with hepatic dysfunction because it is extensively metabolized by the liver.

When prescribing varenicline (Chantix) to a patient for tobacco cessation therapy, which action should the nurse practitioner take? 1. Ask the patient about a desired quit date. 2. Prescribe varenicline for 8 weeks. 3. Teach patient that having a depressed mood is an expected side effect of the drug. 4. Titrate varenicline dose to 1 mg twice a day on day 4 of treatment.

Ask the patient about a desired quit date. Rationales Option 1: When beginning tobacco cessation therapy using varenicline (Chantix), the patient should choose a quit date, and the prescriber will prescribe medication that will need to be started 1 week before the scheduled quit date. Option 2: Varenicline (Chantix) treatment for tobacco cessation should continue for 12 weeks. Option 3: The most concerning adverse effects of varenicline (Chantix) are related to serious neuropsychiatric events (e.g., agitation, changes in behavior, depressed mood, suicidal ideation). Patients should be counseled to stop taking varenicline if they develop any mood, thought, or behavioral side effects. Option 4: The manufacturer of varenicline (Chantix) suggests the following titration schedule for the medication: 0.5 mg once a day for the first 3 days, then 0.5 mg twice a day on days 4 to 7, and will be increased to 1 mg twice a day on day 8 throughout the rest of the treatment.

Which medication is used to treat seasonal allergic rhinitis and vasomotor rhinitis? 1. Atrovent 2. Afrin 3. Astelin 4. Mucinex nasal

Astelin Rationales Option 1: Ipratropium is indicated for rhinorrhea. Option 2: Afrin is a decongestant; however, it causes rebound congestion. Option 3: Azelastine (Astelin, Astepro) and olopatadine (Patanase) are the intranasal histamine (H1) blockers currently available in the United States. They are used for the treatment of seasonal allergic rhinitis andvasomotor rhinitis. Option 4: Mucinex is a decongestant. It is not used for treatment of seasonal allergic rhinitis and vasomotor rhinitis.

A patient with advanced chronic obstructive pulmonary disease (COPD) has had at least two recurring exacerbations of bronchitis. The nurse practitioner should prescribe which antibiotic to prevent severe exacerbations? 1. Amoxicillin clavulanate 2. Doxycycline 3. Levofloxacin 4. Azithromycin

Azithromycin Rationales Option 1: Amoxicillin clavulanate is a first-line therapy for bronchial infections but has not been shown to prevent severe exacerbations of bronchial infections. Option 2: Doxycycline (a tetracycline) is a first-line therapy for bronchial infections but has not been shown to prevent severe exacerbations of bronchial infections. Option 3: Patients with moderate exacerbation who may require hospitalization or who do not respond to first-line therapy are to be treated with respiratory fluoroquinolones, such as levofloxacin. Option 4: Macrolide antibiotics have an immunomodulatory effect that has been effective for patients with moderate to severe COPD to prevent severe exacerbations. Patients who received azithromycin 250 mg three times a week showed a significant reduction in exacerbations compared to usual therapy and placebo. [Page reference: 963]

Which medication is contraindicated for patients allergic to tetracaine? 1. Dextromethorphan 2. Benzonatate 3. Guaifenesin 4. Codeine

Benzonatate Rationales Option 1: Dextromethorphan is not contraindicated for patients allergic to tetracaine. Option 2: Benzonatate is contraindicated for patients allergic to tetracaine, procaine, or related compounds. Option 3: Guaifenesin is not contraindicated for patients allergic to tetracaine. Option 4: Codeine is not contraindicated for patients allergic to tetracaine.

Which medication is contraindicated for patients allergic to tetracaine? 1.Dextromethorphan 2.Benzonatate 3.Guaifenesin 4.Codeine

A patient in the emergency room (ER) has been prescribed prochlorperazine for nausea. By which mechanism of action does this medication work? 1. Blocking dopamine receptors in the chemoreceptor trigger zone (CTZ) 2. Blocking histamine1 receptors in the gastrointestinal (GI) tract 3. Blocking serotonin on vagal nerve terminals 4. Stimulating gastric emptying and peristalsis

Blocking dopamine receptors in the chemoreceptor trigger zone (CTZ) Rationales Option 1: The medication is a phenothiazine and therefore works by blocking dopamine receptors. Option 2: Antihistamines medications work using this mechanism. Option 3: The 5-hydroxytryptamine-3 receptor (5-HT3) receptor antagonists block serotonin. Option 4: This mechanism describes a prokinetic agent, such as metoclopramide. [Page reference: 494]

The APN is caring for a patient who is being treated for an ileus. Which medication listed below would be of concern for this patient? 1. Codeine 2. Acetaminophen (Tylenol) 3. Albuterol 4. Fluticasone (Flonase)

Codeine Rationales Option 1: Codeine causes decreased gastric motility and therefore should be used cautiously by patients with gastrointestinal (GI) obstruction, ileus, or preexisting constipation. Option 2: Acetaminophen (Tylenol) would not be of concern for this patient. Option 3: Albuterol would not be of concern for this patient. Option 4: Fluticasone (Flonase) would not be of concern for this patient. [Page reference: 386]

Which medication gives short-term relief of dyspepsia by directly increasing the pH of the gastric contents? 1. Pantoprazole 2. Sucralfate 3. Calcium carbonate 4. Diphenoxylate with atropine

Calcium carbonate Rationales Option 1: Pantoprazole is a proton pump inhibitor and works by preventing secretion of hydrochloric acid from the parietal cells. Option 2: Sucralfate is a cytoprotective agent used to form a protective layer over peptic ulcers. Option 3: Calcium carbonate is an antacid and directly neutralizes acid in the stomach. Option 4: Diphenoxylate with atropine is an antidiarrheal medication and has no bearing on gastric acidity. [Page reference: 480]

The APN must be sure to educate the patient about ways to avoid constipation when they are taking which drug? 1. Psyllium 2. Magnesium hydroxide 3. Calcium carbonate 4. Metoclopramide

Calcium carbonate Rationales Option 1: Psyllium is a bulk-forming laxative and will treat constipation, not cause it. Proton pump inhibitors (PPIs) typically cause diarrhea, if anything. Option 2: Magnesium-based antacids cause diarrhea. Option 3: Calcium-based antacids can cause constipation. Option 4: Metoclopramide is a prokinetic agent used to increase peristalsis. [Page reference: 482]

Considering eradication rates, adverse effects, antimicrobial resistance, and patient compliance, which regimen is most appropriate for treatment of H. pylori-induced peptic ulcer disease (PUD)? 1. Clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) 2. Tetracycline, metronidazole, and a proton pump inhibitor (PPI) 3. Clarithromycin, tetracycline, and a histamine-2 (H2) blocker 4. Metronidazole, amoxicillin, and a histamine-2 (H2) blocker

Clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) Rationales Option 1: This regimen has fewer adverse effects, less antibiotic resistance, and good-to-excellent eradication rates. Option 2: Metronidazole has numerous adverse effects. Option 3: Proton pump inhibitors (PPIs) are the standard for treating H. pylori-induced PUD. Option 4: Proton pump inhibitors (PPIs) are the standard for treating H. pylori-induced PUD. Metronidazole has numerous adverse effects.

Which condition is the most common adverse drug reaction reported with ipratropium (Atrovent)? 1. Double vision 2. Diarrhea 3. Rhinitis 4. Cough

Cough Rationales Option 1: Double vision is not an adverse reaction to be considered with this drug. Accidental exposure to the eye can result in symptoms specific to the eye; however, this is not what the question is asking. Option 2: Although patients can report nausea, vomiting, and dyspepsia, diarrhea is not listed as an adverse effect. Option 3: Rhinitis is not a common adverse reaction. Option 4: The most common adverse drug reaction reported with ipratropium is cough. Also reported are the related symptoms of hoarseness, throat irritation, and dysgeusia (altered taste sensation). Nausea, vomiting, and dyspepsia are thought to be related to the local anticholinergic effects that ipratropium has on the gastrointestinal (GI) system. Xerostomia (dry mouth) is also reported in a small portion of patients. [Page reference: 354]

The APN recognizes which of these as the principal symptom of cough variant asthma? 1. Coughing when around pine trees 2. Coughing at night 3. Coughing at midday 4. Coughing with exercise

Coughing at night Rationales Option 1: Coughing when around pine trees is not the principal symptom of cough variant asthma. Option 2: Cough variant asthma is seen especially in young children. It is diagnosed when coughing, usually at night, is the principal symptom. Option 3: Coughing at midday is not the principal symptom of cough variant asthma. Option 4: Coughing with exercise is not the principal symptom of cough variant asthma. [Page reference: 952]

The APN is assessing a patient who is complaining of frequent and debilitating diarrhea. The APN notes that the patient was diagnosed HIV-positive 6 months ago and is taking a combination of antiretroviral medications. Which medication would be most appropriate for the APN to prescribe? 1. Loperamide 2. Kaolin-pectin 3. Crofelemer 4. Bismuth subsalicylate

Crofelemer Rationales Option 1: Loperamide is an opiate antidiarrheal and will not give adequate relief to this patient. Option 2: Kaolin-pectin is used for simple diarrhea. Option 3: Crofelemer is approved for patients taking antiretroviral therapy. Option 4: Bismuth subsalicylate is not effective in this type of patient.

The APN understands that loperamide works by which mechanism? 1. Supplying missing bacteria to the gastrointestinal (GI) tract 2. Decreasing gastric and bowel motility 3. Coating the walls of the gastrointestinal (GI) tract and binding to toxins 4. Stimulating peristalsis and gastric motility

Decreasing gastric and bowel motility Rationales Option 1: This describes the mechanism of a probiotic. Option 2: Loperamide binds to the opiate receptors of the intestine, leading to a decrease in gastric and intestinal motility. Option 3: This describes the mechanism of an adsorbent. Option 4: This describes the mechanism of a stimulant laxative or prokinetic agent. [Page reference: 485]

A patient underwent sternotomy and coronary artery bypass surgery yesterday. It is important to avoid straining for a bowel movement postoperatively. Which laxative would be the best choice for this type of patient? 1. Psyllium 2. Lubiprostone 3. Methylnaltrexone 4. Docusate

Docusate Rationales Option 1: Bulk-forming laxatives are used for simple, chronic constipation. Option 2: Lubiprostone is used for women who have irritable bowel syndrome (IBS) with constipation. Option 3: Methylnaltrexone is used for treating constipation from chronic opioid use. Option 4: Surfactants, or "stool softeners," are commonly prescribed postoperatively to prevent straining and the resultant pressure on the surgical incision.

A patient comes to the clinic complaining of a 2-day history of diarrhea. He receives two tablets of diphenoxylate HCl with atropine sulfate to take orally as needed for each loose stool. The APN should inform him that he may experience which symptom(s)? 1. A slower heart rate than normal 2. The need to urinate frequently 3. An increase in appetite 4. Drowsiness and dizziness

Drowsiness and dizziness Rationales Option 1: This medication occasionally causes tachycardia. Option 2: The anticholinergic effects of the medication may cause urinary retention. Option 3: Enhanced appetite is not caused by this medication. Option 4: Diphenoxylate with atropine may cause sedation and possibly dizziness. [Page reference: 485]

When treating a patient with a duodenal ulcer, the APN should consider which action to be the priority? 1. Advise the patient to stop smoking. 2. Eradicate infection of H. pylori. 3. Advise the patient to avoid spicy foods. 4. Evaluate the patient for infection with methicillin-resistant S. aureus (MRSA).

Eradicate infection of H. pylori. Rationales Option 1: While this is important, it is not the priority. Option 2: Most duodenal ulcers are caused by H. pylori, so the priority is to eradicate the infection. Option 3: There is little concrete evidence that dietary modifications influence peptic ulcer disease (PUD). Option 4: Most duodenal ulcers are caused by H. pylori, not MRSA.

Which condition is a potential side effect of dextromethorphan, codeine, and benzonatate? 1. Obstructive sleep apnea 2. Gastrointestinal (GI) upset 3. Dependence 4. Central nervous system (CNS) excitability

Gastrointestinal (GI) upset Rationales Option 1: Codeine is not recommended for use in adolescents with obstructive sleep apnea, but it is not a potential side effect of these drugs. Option 2: Dextromethorphan, codeine, and benzonatate can cause drowsiness, dizziness, nausea, and GI upset. Option 3: Codeine may cause dependence and should be used with caution in a patient with a history of substance abuse. Benzonatate is not noted to cause dependence. Option 4: CNS excitability is not a potential side effect of these medications. [Page reference: 385]

Which condition is a potential side effect of dextromethorphan, codeine, and benzonatate? 1.Obstructive sleep apnea 2.Gastrointestinal (GI) upset 3.Dependence 4.Central nervous system (CNS) excitability

The APN could safely prescribe an oral decongestant to the patient with which condition? 1. Severe hypertension 2. Concurrent monoamine oxidase inhibitor (MAOI) therapy 3. Glaucoma 4. Coronary artery disease

Glaucoma Rationales Option 1: Oral decongestants are contraindicated for patients with severe hypertension. Option 2: The oral decongestants are absolutely contraindicated for patients on concurrent MAOI therapy. Concurrent use of these medications may result in severe headache, hypertension, hyperpyrexia, and possibly hypertensive crisis. Option 3: Topical naphazoline is contraindicated for patients with glaucoma, but the oral decongestants are not. Option 4: Oral decongestants are contraindicated for patients with coronary artery disease.

When comparing the histamine2 antagonists with each other, the APN recognizes that cimetidine is more likely to cause which adverse effect in male patients? 1. Drowsiness 2. Dizziness 3. Tardive dyskinesia 4. Gynecomastia

Gynecomastia Rationales Option 1: The risk of drowsiness is the same for male and female patients. Option 2: The risk of dizziness is the same for male and female patients. Option 3: Tardive dyskinesia is not an adverse effect of cimetidine. Option 4: Gynecomastia and impotence are adverse effects of cimetidine in men.

Which symptom may indicate theophylline toxicity? 1. Cough 2. Chest tightness 3. Headache 4. Double vision

Headache Rationales Option 1: Cough is the most commonly reported adverse drug reaction with ipratropium, not theophylline. Option 2: Chest tightness is a symptom of oxygen toxicity, not theophylline toxicity. Option 3: Patients who are having signs of toxicity may mistakenly think that they have a viral illness. Instead, patients with any unusual symptoms should contact their health-care provider. The symptoms to report include nausea, vomiting, insomnia, jitteriness, headache, rash, severe gastrointestinal (GI) pain, restlessness, convulsions, or irregular heartbeat. Option 4: Double vision is not a sign or symptom of theophylline toxicity. [Page reference: 352]

The nurse practitioner has prescribed zafirlukast (Accolate) to a 12-year-old for asthma control. Which is a common adverse effect of this medication? 1. Respiratory infections 2. Headaches 3. Dyspepsia 4. Nausea

Headaches Rationales Option 1: Respiratory infections have been reported in patients older than 55 years old who are taking zafirlukast. Option 2: The most common adverse effect of zafirlukast is headache. Option 3: Patients taking zileuton have reported significant increase in dyspepsia. Option 4: Nausea is not a common adverse effect of zafirlukast therapy. [Page reference: 358]

Beta-adrenergic agonists should be avoided in patients with pheochromocytoma because of which adverse effect? 1.Apnea 2.Coronary insufficiency 3.Bradycardia 4.Hypertension

Hypertension Rationales Option 1: Apnea is not a side effect related to the use of beta-adrenergic agonists. Option 2: Because of these drugs' effects on the cardiovascular system, patients with coronary insufficiency should be monitored closely for adverse effects during administration of any of the sympathomimetic bronchodilators. However, it is not a reason to avoid their use in patients with pheochromocytoma. Option 3: Bradycardia is not a side effect related to the use of beta-adrenergic agonists. Option 4: Patients with diagnosed or suspected pheochromocytoma should avoid the beta-adrenergic agonists because severe hypertension may occur. [Page reference: 339]

In 2009, the U.S. Food and Drug Administration (FDA) established a recommendation that patients be informed of the potential for neuropsychiatric events associated with which drug? 1. Leukotriene modifiers 2.Bronchodilators 3.Antihistamines 4.Oxygen

Leukotriene modifiers Rationales Option 1: Neuropsychiatric events have been reported in postmarketing surveillance of adult, adolescent, and pediatric patients taking leukotriene modifiers. The reported neuropsychiatric events include agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor (FDA, 2009). The FDA (2009) recommends that patients be informed of the potential for neuropsychiatric events with these medications and should consider discontinuing leukotriene modifiers if they develop neuropsychiatric problems.The FDA (2009) recommends that patients be informed of the potential for neuropsychiatric events with leukotriene modifiers and consider discontinuing if they develop neuropsychiatric problems. Option 2: Bronchodilators are not noted to have a potential for neuropsychiatric events. Option 3: Antihistamines are not noted to have a potential for neuropsychiatric events. Option 4: Oxygen is not noted to have a potential for neuropsychiatric events. [Page reference: 358]

A 54-year-old male patient is on Zyrtec daily for his chronic allergic rhinitis. He calls the APN's office to report that he missed a daily dose of this medication. Which statement is accurate regarding missed doses of this medication? 1. Long-acting second-generation antihistamines should not be taken closer together than prescribed, so missed doses need to be held until the time of the next dose (every 12 or 24 hours). 2. Long-acting first-generation antihistamines should not be taken closer together than prescribed, so missed doses need to be held until the time of the next dose (every 12 or 24 hours). 3. The dose can be doubled for missed doses because it is a second-generation antihistamine and not a first-generation antihistamine. 4. The dose can be doubled for missed doses because it is a first-generation antihistamine and not a second-generation antihistamine.

Long-acting second-generation antihistamines should not be taken closer together than prescribed, so missed doses need to be held until the time of the next dose (every 12 or 24 hours). Rationales Option 1: Zyrtec is a second-generation antihistamine. Doses shouldn't be taken closer together than prescribed. Missed doses need to be held until the time of the next dose (every 12 or 24 hours). Option 2: Zyrtec is a second-generation antihistamine, not a first-generation antihistamine. Option 3: Zyrtec is a second-generation antihistamine, and doses shouldn't be taken closer together than prescribed. Option 4: Zyrtec is a second-generation antihistamine, not a first-generation antihistamine. [Page reference: 380]

A patient consults the APN because of concerns about experiencing repeated bouts of vertigo and nausea. The patient asks whether anything can be prescribed to help. Which medication would be most appropriate for this patient? 1. Prochlorperazine 10 mg oral tablet 2. Aprepitant 40 mg capsule 3. Meclizine 25 mg oral tablet 4. Dolasetron 100 mg tablet

Meclizine 25 mg oral tablet Rationales Option 1: Prochlorperazine is not usually effective for treating vertigo. Option 2: Aprepitant is used for nausea and vomiting in patients receiving chemotherapy. Option 3: Antihistamines act on the vestibular system and chemoreceptor trigger zone (CTZ) and thus are good for vertigo and its associated nausea. Option 4: Dolasetron is used for preventing nausea and vomiting after surgery or chemotherapy. [Page reference: 494]

Older adults taking ranitidine should be monitored carefully for which of these? 1. Mental status changes 2. Asymptomatic ventricular tachycardia 3. Community-acquired pneumonia (CAP) 4. Bone fractures

Mental status changes Rationales Option 1: Confusion often occurs in older adults taking ranitidine. Option 2: Asymptomatic ventricular tachycardia tends to happen with nizatidine, not ranitidine. Option 3: Older patients taking proton pump inhibitors (PPIs) are more at risk for CAP, but ranitidine is a histamine2 receptor antagonist (H2RA). Option 4: Older patients taking PPIs are more at risk for bone fractures if they are immobile, but ranitidine is a histamine2 receptor antagonist (H2RA). [Page reference: 1059]

Many patients are prescribed opioid analgesics for the amelioration of chronic pain. Chronic constipation often results from taking these medications long term. Which medication is the best choice for the APN to prescribe to help with the constipation? 1. Lubiprostone 2. Methylnaltrexone 3. Docusate 4. Psyllium

Methylnaltrexone Rationales Option 1: Lubiprostone is a chloride channel activator and is commonly prescribed for women who have irritable bowel syndrome (IBS) with constipation. Option 2: Methylnaltrexone is an antagonist to the mu-receptor in the gastrointestinal (GI) tract. It is used for treating constipation from chronic opioid use. Option 3: Surfactants, or "stool softeners," are commonly prescribed postoperatively to prevent straining and the resultant pressure on the surgical incision. Option 4: Bulk-forming laxatives are used for simple, chronic constipation. [Page reference: 517]

A 56-year-old male patient with diabetes has been taking a proton pump inhibitor (PPI) daily as prescribed for gastroesophageal reflux disease (GERD) but still experiences significant acid reflux. Which medication could be prescribed to increase gastric emptying and help improve his symptoms? 1. Metoclopramide 2. Famotidine 3. Prochlorperazine 4. Sucralfate

Metoclopramide Rationales Option 1: Metoclopramide is a prokinetic agent and can be used as adjunctive therapy in patients who do not respond to PPIs alone. Option 2: Famotidine is a histamine2 receptor antagonist (H2RA) and is used to decrease gastric acid secretion. Option 3: Prochlorperazine is a phenothiazine and blocks dopamine receptors in the chemoreceptor trigger zone to control nausea. Option 4: Sucralfate decreases exposure of the gastric mucosa to acid. It is not a prokinetic agent. [Page reference: 494]

Use of dextromethorphan should be avoided within 14 days of which type of medication? 1. Selective serotonin reuptake inhibitors (SSRIs) 2. Central nervous system (CNS) depressants 3. Monoamine oxidase inhibitors (MAOIs) 4. Drugs that inhibit cytochrome P450 2D6 (CYP 2D6)

Monoamine oxidase inhibitors (MAOIs) Rationales Option 1: SSRIs interfere with dextromethorphan metabolism, leading to toxicity. Lower doses of dextromethorphan should be used. Option 2: Concurrent use with CNS depressants can exacerbate CNS depression. Caution should be used. Option 3: Dextromethorphan can block neuronal uptake of serotonin and can increase concentrations of serotonin if combined with MAOIs; hypertensive or hyperpyretic crisis is possible. Use should be avoided within 14 days. Option 4: Drugs such as amiodarone and quinidine that inhibit DYP 2D6 can lead to dextromethorphan toxicity. Toxicity should be monitored for in concurrent use. [Page reference: 386]

Oral decongestants are absolutely contraindicated for patients who are concurrently on which type of medication? 1.Monoamine oxidase inhibitors (MAOIs) 2.Inhaled corticosteroids 3.Antihistamines 4.Antitussives

Monoamine oxidase inhibitors (MAOIs) Rationales Option 1: The oral decongestants are absolutely contraindicated for patients on concurrent MAOI therapy. Concurrent use of these medications may result in severe headache, hypertension, hyperpyrexia, and possibly hypertensive crisis. Option 2: Oral decongestants are not absolutely contraindicated for patients on inhaled corticosteroids. Option 3: Oral decongestants are not absolutely contraindicated for patients on antihistamines. Option 4: Oral decongestants are not absolutely contraindicated for patients on antitussives.

First-generation antihistamines are contraindicated in patients with which condition? 1. Maxillary sinus congestion 2. Urinary retention 3. Nausea 4. Narrow-angle glaucoma

Narrow-angle glaucoma Rationales Option 1: Antihistamines would actually benefit patients with maxillary sinus congestion. Option 2: Urinary retention is an adverse drug reaction seen with first-generation antihistamines, not a contraindication for them. Option 3: Nausea is not a contraindication for first-generation antihistamines. Option 4: First-generation antihistamines are contraindicated in patients with narrow-angle glaucoma, lower-respiratory tract symptoms (they thicken secretions and impair expectoration), stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction, pyloroduodenal obstruction, and monoamine oxidase inhibitor (MAOI) use.

To prevent exercise-induced bronchospasm, which dose of salmeterol (Serevent DiSKUS) is recommended? 1. Two puffs (50 mcg) inhalation 30 minutes before exercise 2. Two puffs (50 mcg) inhalation 30 minutes after exercise 3. One puff (50 mcg) inhalation 30 minutes before exercise 4. One puff (50 mcg) inhalation 30 minutes after exercise

One puff (50 mcg) inhalation 30 minutes before exercise Rationales Option 1: Two puffs before exercise is higher than the recommended dose. Option 2: Two puffs after exercise is higher than the recommended dose. Option 3: To prevent exercise-induced bronchospasm, the dose of one actuation/puff (50 mcg) is inhaled 30 minutes before exercise. Option 4: One puff after exercise is not the correct timing for the recommended dose. [Page reference: 345]

The APN is assessing a 6-year-old boy who has Down syndrome. His mother states that he is starting to get over a severe bout of flu but now has diarrhea. She asks what can be prescribed to stop the diarrhea. Which regimen would the APN order? 1. Oral rehydration therapy (ORT) 2. Loperamide orally after each loose stool 3. Diphenoxylate with atropine orally once daily 4. Bismuth subsalicylate orally after each loose stool

Oral rehydration therapy (ORT) Rationales Option 1: Antidiarrheals are contraindicated in most children. ORT is the standard of care. Option 2: Antidiarrheals are contraindicated in most children. Standard of care is oral rehydration therapy (ORT). Option 3: Diphenoxylate and atropine are contraindicated for children under 12 and those with Down syndrome. Option 4: Bismuth subsalicylate is contraindicated for children or teenagers recovering from flulike illness or chickenpox or for children under age 12. [Page reference: 488]

To decrease the risk for hypothalamic-pituitary-adrenal (HPA) suppression in patients prescribed inhaled corticosteroids, the APN should avoid concurrently prescribing which type of drug? 1. Anticholinergics 2. Beta2-receptor agonists 3. Decongestants 4. Oral steroids

Oral steroids Rationales Option 1: Concurrent use of inhaled corticosteroids with anticholinergics is not indicated to increase the risk of HPA suppression. Option 2: Concurrent use of inhaled corticosteroids with beta2-receptor agonists is not indicated to increase the risk of HPA suppression. Option 3: Concurrent use of inhaled corticosteroids with decongestants is not indicated to increase the risk of HPA suppression. Option 4: The risk for HPA suppression is low with inhaled corticosteroids, but the risk increases when inhaled corticosteroids are administered while the patient is taking oral steroids. The health-care provider should avoid concurrent use of inhaled corticosteroids with oral steroids. [Page reference: 361]

The patient has been started on azelastine for allergic rhinitis. Patient education concerning azelastine use should include which information? 1. Patients should use an extra dose when flares occur. 2. Patients should not use alcohol or other central nervous system (CNS) depressants while using azelastine. 3. Patients should not use this medication if they are currently smoking. 4. Patients may share the single device with household family members.

Patients should not use alcohol or other central nervous system (CNS) depressants while using azelastine. Rationales Option 1: The medication should only be taken as prescribed. Option 2: Some patients using intranasal azelastine may experience somnolence and should be cautioned not to drive or operate heavy equipment while using it. Patients should not use alcohol or other CNS depressants while using azelastine. Option 3: Concurrent use with smokers is not a contraindication. Option 4: Patients should never share medications. [Page reference: 370]

The patient has been started on azelastine for allergic rhinitis. Patient education concerning azelastine use should include which information? 1. Patients should use an extra dose when flares occur. 2. Patients should not use alcohol or other central nervous system (CNS) depressants while using azelastine. 3. Patients should not use this medication if they are currently smoking. 4.Patients may share the single device with household family members.

Education for patients using decongestants should include which information? 1. The medications may have serious interactions with macrolide antibiotics. 2. Patients should refrain from smoking when congested. 3. Alcohol-containing products may cause tachycardia if ingested with decongestants. 4. Increased doses may be taken depending on the severity of symptoms.

Patients should refrain from smoking when congested. Rationales Option 1: The antihistamine loratadine is noted to have a serious interaction with macrolide antibiotics and the oral azole antifungals. Option 2: Patients taking decongestants should be instructed to refrain from smoking when they are congested. Option 3: Caffeine-containing products can cause tachycardia when taken with decongestants. Option 4: Patients are always advised to take the prescribed dose. [Page reference: 388]

Use of antitussives is contraindicated in the patient with which condition? 1. Constipation 2. Persistent or chronic cough caused by asthma 3. Hepatic function impairment 4. History of substance abuse

Persistent or chronic cough caused by asthma Rationales Option 1: Constipation is a possible adverse drug effect of dextromethorphan, not a contraindication for use of antitussives. Option 2: Antitussives are not to be used for persistent or chronic cough caused by smoking, asthma, or emphysema. A cough should not be suppressed if it is protecting the airway. Option 3: Patients with hepatic function impairment should be monitored if dextromethorphan is prescribed because metabolism of the drug may be impaired. Option 4: Codeine may cause dependence and should be used with caution in a patient with a history of substance abuse. [Page reference: 385]

Use of antitussives is contraindicated in the patient with which condition? 1.Constipation 2.Persistent or chronic cough caused by asthma 3.Hepatic function impairment 4.History of substance abuse

The APN is writing orders for a patient who is scheduled to have a colonoscopy 3 days from now. Which medication should be prescribed to cleanse the entire gastrointestinal (GI) tract prior to this procedure? 1. Polyethylene glycol 2. Methylcellulose 3. Lactulose 4. Docusate calcium

Polyethylene glycol Rationales Option 1: Polyethylene glycol is commonly used as bowel prep before a colonoscopy. Option 2: Methylcellulose is a bulk-forming laxative used to treat simple, chronic constipation. Option 3: Lactulose is most commonly used to treat hepatic encephalopathy. Option 4: Docusate is a surfactant, or "stool softener," and would not cleanse the colon sufficiently. [Page reference: 502]

Which is the standard first-line therapy for the treatment of gastroesophageal reflux disease (GERD)? 1. Histamine2 receptor antagonists (H2RAs) 2. Antacids 3. Histamine1 receptor antagonists (H1RAs) 4. Proton pump inhibitors (PPIs)

Proton pump inhibitors (PPIs) Rationales Option 1: H2RAs are not first-line therapy for GERD. H2RAs decrease acid secretion but not by as much as the first-line therapy. Option 2: Antacids increase gastric pH for short-term relief. Option 3: H1RAs are for the treatment of allergies. Option 4: PPIs are the standard first-line therapy for GERD. [Page reference: 1055]

A patient with stable angina and hypertension is being checked for flu-like symptoms. The nurse practitioner should instruct the patient to avoid which medications due to the worsening of cardiac problems? 1. Pseudoephedrine 2. Guaifenesin 3. Cetirizine 4. Dextromethorphan

Pseudoephedrine Rationales Option 1: Pseudoephedrine is a sympathomimetic oral decongestant that causes vasoconstriction. Patients with a history of hypertension and coronary artery disease will experience a worsening of cardiac problems if this medication is taken. Option 2: Guaifenesin, an expectorant, does not have any significant drug interactions. Option 3: Cetirizine, a second-generation antihistamine, and dextromethorphan, an antitussive, have central nervous system (CNS) depressant drug interactions. Option 4: Cetirizine, a second-generation antihistamine, and dextromethorphan, an antitussive, have central nervous system (CNS) depressant drug interactions. [Page reference: 381]

A 21-year-old patient newly diagnosed with mild persistent asthma reports to the family nurse practitioner that she has used her albuterol inhaler at least four times in the past week due to dyspnea. She started using inhaled corticosteroids 2 months ago. Her current peak flow spirometry results are 75% of personal best. Prior to making any changes in treatment, the nurse practitioner should conduct which assessment? 1. Review and observe the patient's use of the inhaled corticosteroid inhaler. 2. Check the patient's pharmacy filling records for inhaled corticosteroids. 3. Ask the patient about her adherence to medication. 4. Explore the patient's stress levels.

Review and observe the patient's use of the inhaled corticosteroid inhaler. Rationales Option 1: Because the patient is newly using inhaled corticosteroids for asthma, it may be possible that the patient is not using the inhaler properly. It is important to check patient use of the inhaler first. Option 2: Because the patient is newly using inhaled corticosteroids for asthma, it may be possible that the patient is not using the inhaler properly. It is important to check patient use of the inhaler first before checking for medication adherence. Option 3: Because the patient is newly using inhaled corticosteroids for asthma, it may be possible that the patient is not using the inhaler properly. It is important to check patient use of the inhaler first before checking for medication adherence. Option 4: Assessment of stress levels does not address the problem of the patient's asthma not being well controlled.

The APN recognizes that second-generation antihistamines have which varying characteristic in comparison with first-generation antihistamines? 1. Second-generation antihistamines are selective for peripheral H1 receptors and therefore, as a group, are less sedating. 2. Second-generation antihistamines are selective for peripheral H1 receptors and therefore, as a group, are more sedating. 3. Second-generation antihistamines are selective for peripheral H2 receptors and therefore, as a group, are more sedating. 4. Second-generation antihistamines are selective for peripheral H2 receptors and therefore, as a group, are less sedating.

Second-generation antihistamines are selective for peripheral H1 receptors and therefore, as a group, are less sedating. Rationales Option 1: Second-generation antihistamines are selective for peripheral H1 receptors and therefore, as a group, are less sedating. They do not cross the blood-brain barrier in appreciable amounts; consequently, very little of the second-generation antihistamines gets into the brain. Option 2: Second-generation antihistamines are not more sedating. They do not cross the blood-brain barrier in appreciable amounts; consequently, very little of the second-generation antihistamines gets into the brain. Option 3: Second-generation antihistamines are selective for peripheral H1 receptors, not H2, and therefore, as a group, are less, not more, sedating. Option 4: Second-generation antihistamines are selective for peripheral H1 receptors, not H2 receptors. [Page reference: 373]

Which statement regarding long-acting beta agonists (LABAs) is most accurate? 1. Single-ingredient LABAs should not be used alone. 2. Concurrent use of LABAs and inhaled corticosteroids is contraindicated. 3. LABAs should be prescribed long term for treatment of chronic asthma. 4. The use of LABAs is contradicted without the use of digitalis glycosides.

Single-ingredient LABAs should not be used alone. Rationales Option 1: Single-ingredient LABAs should be used only in combination with an asthma controller medication; they should not be used alone. Option 2: The use of LABAs is contraindicated without the use of an asthma controller medication, such as an inhaled corticosteroid. Option 3: LABAs should be used for the shortest duration of time required to achieve control of asthma symptoms and discontinued, if possible, once asthma control is achieved. Option 4: If any of the beta agonists are prescribed with digitalis glycosides, caution and careful monitoring of the patient's electrocardiogram (ECG) is necessary because there is an increased risk of cardiac arrhythmia. [Page reference: 341]

Which medication works by binding to the base of ulcers and gastric erosions, thus forming a protective barrier? 1. Metoclopramide 2. Sucralfate 3. Aluminum carbonate 4. Bismuth subsalicylate

Sucralfate Rationales Option 1: Metoclopramide is a prokinetic agent. It does not have the described mechanism of action. Option 2: Sucralfate is a cytoprotective agent and binds to the base of ulcers and erosions. Option 3: Aluminum carbonate is an antacid. It does not have the described mechanism of action. Option 4: Bismuth subsalicylate has numerous uses, including the treatment of diarrhea. It does not have the described mechanism of action.

Patients with uncomplicated peptic ulcer disease or mild gastroesophageal reflux disease (GERD) may benefit from taking antacids daily. Which instruction should the APN give the patient regarding an antacid suspension? 1. Take the antacid suspension 1 to 3 hours after meals and at bedtime. 2. Take the suspension immediately before eating. 3. Take the antacid once a day just before going to bed. 4. Take the antacid suspension along with morning medications.

Take the antacid suspension 1 to 3 hours after meals and at bedtime. Rationales Option 1: Taking the antacid 1 to 3 hours after eating will prolong the antacid effect. Option 2: Antacids will be effective for only approximately 40 minutes if taken before eating. Option 3: The medication needs to be taken after food when the stomach is most acidic. Option 4: Antacids can alter the absorption and bioavailability of medications when taken at the same time. [Page reference: 1055]

A patient is to start taking esomeprazole for the treatment of gastroesophageal reflux disease (GERD). Which instruction must the APN give the patient regarding this medication? 1. Take this medication with every meal. 2. Take the medication at least 1 hour before a meal. 3. Take the medication 1 to 3 hours after meals. 4. Take the medication every time you experience heartburn.

Take the medication at least 1 hour before a meal. Rationales Option 1: Esomeprazole is most effective when given 1 hour prior to a meal, and it is not taken with every meal. Option 2: Esomeprazole is most effective when given 1 hour prior to a meal. Option 3: Antacids should be taken 1 to 3 hours after meals and at bedtime. Option 4: Esomeprazole should be taken daily for several weeks to treat GERD. If the patient has no relief of symptoms, he or she needs further investigation. [Page reference: 1059]

A patient asks how orally inhaled adrenocorticosteroids work in the treatment of asthma and allergic rhinitis. Which response by the APN is most appropriate? 1. The inhaled adrenocorticosteroids inhibit the immunoglobulin E (IgE). 2. The inhaled adrenocorticosteroids inhibit the immunoglobulin G (IgG). 3. The inhaled adrenocorticosteroids inhibit the immunoglobulin M (IgM). 4. The inhaled adrenocorticosteroids inhibit the immunoglobulin A (IgA).

The inhaled adrenocorticosteroids inhibit the immunoglobulin E (IgE). Rationales Option 1: In the treatment of asthma and allergic rhinitis, the primary actions of orally inhaled corticosteroids are anti-inflammatory. The inhaled adrenocorticosteroids inhibit the IgE and mast cell-mediated migration of inflammatory cells into the bronchial tissue (late-phase allergic reaction). Option 2: The inhaled adrenocorticosteroids do not inhibit the IgG. Option 3: The inhaled adrenocorticosteroids do not inhibit the IgM. Option 4: The inhaled adrenocorticosteroids do not inhibit the IgA.

Short-acting beta2 agonists are metabolized by which organ(s)? 1. The lungs 2. The kidneys 3. The liver 4. The intestines

The liver Rationales Option 1: Short-acting beta2 agonists are not metabolized by the lungs. Option 2: Short-acting beta2 agonists are not metabolized by the kidneys. They are, however, excreted primarily in the urine. Option 3: Most of the common bronchodilators are metabolized in the liver and excreted primarily in the urine. Option 4: Short-acting beta2 agonists are not metabolized by the intestines. [Page reference: 339]

A 70-year-old male patient on the medical floor tells the APN that he has frequent heartburn but that his wife has brought in Alka-Seltzer from home. Which fact about the patient would be a contraindication for this over-the-counter (OTC) medication? 1. The patient has been admitted for an exacerbation of congestive heart failure. 2. The patient was diagnosed with benign prostatic hypertrophy (BPH) 3 years ago. 3. The patient has experienced intermittent episodes of asthma over the past 20 years. 4. The patient has occasional constipation and takes bisacodyl once or twice a week.

The patient has been admitted for an exacerbation of congestive heart failure. Rationales Option 1: Alka-Seltzer (sodium bicarbonate) contains a significant amount of sodium, which will lead to fluid retention and a corresponding increase in preload, thus increasing myocardial workload and exacerbating the heart failure. Option 2: Although the increased fluid retention may increase his BPH symptoms, it is not a contraindication. Option 3: Alka-Seltzer is not contraindicated for intermittent asthma. Option 4: Many older adults experience constipation. Bisacodyl is a stimulant laxative and would not be a contraindication to Alka-Seltzer. [Page reference: 484]

A 62-year-old male patient in the clinic tells the APN that he often experiences motion sickness when traveling but that his wife has bought over-the-counter (OTC) scopolamine patches for him to use on their upcoming trip. Which fact about the patient would be a contraindication for this medication? 1. The patient has Parkinson's disease (PD). 2. The patient has a history of emphysema. 3. The patient has narrow-angle glaucoma. 4. The patient has a history of seizures.

The patient has narrow-angle glaucoma. Rationales Option 1: Phenothiazines are contraindicated for patients with PD. Scopolamine should be used cautiously in these patients, but it is not an absolute contraindication. Option 2: The phenothiazines may exacerbate respiratory disorders, such as emphysema. Option 3: Scopolamine is an anticholinergic medication and is contraindicated for patients with narrow-angle glaucoma. Option 4: Cannabinoids, such as dronabinol, should be used with caution in patients with seizures. [Page reference: 495]

Which condition is a contraindication to the use of beta2 agonists? 1. Type 2 diabetes mellitus 2. Narrow-angle glaucoma 3. Hypertension 4. Hypothyroidism

A patient with a 10-year history of smoking one pack a day has been prescribed nicotine gum (Nicorette) to assist with smoking cessation in addition to attendance at group counseling. What should the nurse practitioner emphasize during the patient education session to ensure the effectiveness of nicotine replacement therapy? 1. Chewing the gum quickly will ensure better absorption. 2. The patient should have a fixed schedule of when to chew the nicotine gum. 3. There are no food restrictions when using nicotine gum. 4. The gum should be chewed for no more than 15 minutes.

The patient should have a fixed schedule of when to chew the nicotine gum. Rationales Option 1: Chewing too quickly causes too much nicotine to be released in the bloodstream and may lead to adverse effects, such as nausea, throat irritation, and hiccups. Option 2: Abstinence rates are higher in patients who chew gum on a fixed schedule, such as every hour or every 2 hours. Option 3: Patients should be counseled that acidic foods (e.g., coffee, soft drinks, juice) can interfere with buccal absorption of the nicotine and should be avoided for 15 minutes before, during, and after chewing the gum. Option 4: Nicotine polacrilex gum takes 30 minutes to reach its peak serum concentration. Patients should intermittently chew and park the gum over a period of 30 minutes for effective buccal absorption.

The APN is considering treatment options for a patient with diabetic gastroparesis. Which clinical fact about this patient would cause the APN to prescribe half the normal dose of metoclopramide? 1. The patient's serum creatinine is 1.1. 2. The patient's creatinine clearance is 32 mL/minute. 3. The patient has diabetic neuropathy in both feet. 4. The patient experiences abdominal bloating and nausea after eating.

The patient's creatinine clearance is 32 mL/minute. Rationales Option 1: This is a normal value and has no bearing on the dose of metoclopramide. Option 2: Metoclopramide is excreted mainly by the kidney, so the patient must have a reduced dose if the creatinine clearance is less than 40 mL/minute. Option 3: This is a common finding in diabetic patients and has no bearing on the dose of metoclopramide. Option 4: These are two key signs of diabetic gastroparesis. [Page reference: 494]

A 56-year-old patient who has taken theophylline for several years presents today and reports nausea, vomiting, diarrhea, headache, insomnia, and irritability. He asks if these are symptoms of a viral illness. The APN would suspect which condition? 1. Reaction to other medications 2. Normal adverse reactions 3. A viral illness 4. Theophylline toxicity

Theophylline toxicity Rationales Option 1: In this patient, the health-care provider should suspect theophylline toxicity because these signs/symptoms can present as levels exceed above 20 mcg/mL. Option 2: Adverse drug reactions are uncommon with serum theophylline levels below 20 mcg/mL, although some patients may show toxic effects between 15 and 20 mcg/mL, especially during initiation of therapy. Option 3: Patients who are having signs of toxicity may mistakenly think they have a viral illness. Instead, patients with any unusual symptoms should contact their provider. Option 4: At serum theophylline levels above 20 mcg/mL, patients may experience nausea, vomiting, diarrhea, headache, insomnia, and irritability. At levels above 35 mcg/mL, the patient may have hyperglycemia, hypotension, cardiac arrhythmias, tachycardia, seizures, brain damage, and death. [Page reference: 352]

Which condition is a clinical indication for antihistamines? 1. Nervousness 2. Headache 3. Urticaria 4. Constipation

Urticaria Rationales Option 1: Nervousness is a possible adverse drug reaction to first-generation antihistamines, not a clinical indication for their use. Option 2: Headache is a possible adverse drug reaction to first-generation antihistamines, not a clinical indication for their use. Option 3: In urticaria, histamine is the primary mediator; therefore, the antihistamines are the drugs of choice and quite effective. Option 4: Constipation is not a clinical indication for the use of antihistamines. [Page reference: 379]

The APN is preparing to write a prescription for albuterol for a patient. Which finding would be an absolute contraindication to prescribing albuterol? 1. Hypothyroidism 2. Ventricular tachycardia 3. Bradycardia 4. Hyperlipidemia

Ventricular tachycardia Rationales Option 1: Adverse reactions are more likely to occur with the use of bronchodilators in hyperthyroidism, not hypothyroidism. Option 2: Because of the side effect of increased heart rate, cardiac arrhythmias associated with tachycardia or heart block caused by digitalis intoxication, angina, narrow-angle glaucoma, organic brain damage, and shock during general anesthesia with halogenated agents are all contraindications to beta2 agonists such as albuterol. Option 3: Bradycardia would not be a contraindication to the use of albuterol. Option 4: Hyperlipidemia would not be affected by the use of a beta2 agonist. [Page reference: 339]

A patient with gastroesophageal reflux disease (GERD) has been self-medicating with various antacids at home. The APN is reviewing the patient's prescription medications with him. Which medication decreases lower esophageal sphincter (LES) tone and could potentially exacerbate GERD? 1. Verapamil 2. Metoclopramide 3. Prochlorperazine 4. Cisapride

Verapamil Rationales Option 1: Calcium channel blockers decrease LES tone. Option 2: Metoclopramide increases LES tone and is sometimes used to treat GERD. Option 3: Prochlorperazine increases LES tone. Option 4: Cisapride is a prokinetic agent that increases LES tone. [Page reference: 482]

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